I am Dr Darakhshanda Khurram from Pakistan Karachi.
I appeared in FRCS Glasgow and ALHAMDULILLAH passed with the grace of God. I
dedicate my success to my family for their support and prayers without which
I would not have been possible. I found this exam to be a constant battle of
nerves, you have to keep yourself calm and confident. Here is my experience
, I would like to thank Dr Ayman Elghonemy and Dr Ahmed Sallam for running a
teaching course on the FRCOphth.yahoogroups.com.
DAY ONE: WRITTEN PAPER AND MCQS
A 74 yr old man is referred by his optician with suspected glaucoma. He is a
smoker and has a history of ischaemic heart disease and peripheral vascular
disease. On examination visual acuities are good but the intraocular
pressure is 24mmHg in each eye. There is a relative papillary defect in the
left eye with a pale, cupped disc in this eye. The right disc looks healthy.
What are the possible diagnoses in this case and how would you investigate
and manage him.
A 45yr old dentist has vision of 6/6 bilaterally with a prescription of:
-16.00DS/-1.50 C90DC right and
–14.00DS/-2.50 C100DC left
she has previously worn contact lenses but now has developed an intolerance
to them and has heard about refractive surgery. The right eye previously had
successful detachment surgery 10 years earlier.
Explain all the possible treatments available for this patient and decide on
the best option, giving your reasons.
A 23 yr old man has severe bilateral pan-uveitis, with macular oedema, and
evidence of retinal vasculitis. What is the differential diagnosis what is
your management of this patient.
MCQs read all that are available from Chua website.
DAY TWO: I had my vivas the very next day which was a good
Conducted by a
British examiner and a Dr Gupta.
What are anti-inflammatory drugs? (Recited the list from Wong's book.)
How do you use anti-inflammatory drugs in eye diseases? How would you
manage a patient with scleritis? What is the treatment of anterior
non-necrotizing scleritis? Name the conditions in which you would give
intraocular injections of drugs (endophthalmitis, macular oedema….) What
is ARMD? What are the available treatments for ARMD? What is PDT? Name
the conditions causing macular oedema? How do you treat macular oedema?
How do you laser the macula? What do you know about CRVO? As I was
answering when the bell rang
Dr Gupta was the next examiner and wanted us to stay on the same topic
ie. CRVO. I told him the BRVO and types of CRVO. How do you
differentiate between non-ischaemic and ischaemic CRVO? When do you do
FFA on the patient with vein occlusion? What are the indications of
starting the treatment? What type of laser will you do in BRVO and CRVO?
What are BRVO and CRVO trials? What are the complications of retinal
vein occlusion? What is hemi-retinal vein occlusion? How will you treat
it like either like BRVO or CRVO (I said BRVO) and thank God bell
rang….cause I was sick of vein occlusion by that time.
General medicine and neuro-ophthalmology:
Two British examiners
First one, after greeting me showed me an ECG (typical saw shaped) asked
me to comment on it. I started with describing the rate and rhythm and
said it shows supraventricular trachycardia, which one he said I said
atrial fibrillation he was happy, asked me that one of my staff nurse
has reported that a patient with this ECG is on the list of cataract
operation what are you going to do. I answered that I will take this
patient off the list counsel him about his condition since it is an
elective procedure postpone it and ask him to seek medical assistance
from his cardiac physician and get a cardiac fitness.What are the ocular
complications of atrial fibrillations? (CRAO) asked about the mechanism.
Your patient is diabetic, at what level of his blood sugar will you
operate? I said around 11mmole/l asked me why not less said because of
the chances of hypoglycemia, asked why not more (said because
hyperglycemia induces stress and increases the chances of infections.
Your patient is on insulin what will you do preoperatively? (make a
sliding scale chart for my staff nurse a night before and would like to
know his FBS in the morning). Would you keep the patient after the
surgery or discharge him? (I will keep him over night).
Then bell rang….
Second examiner started with
How do you examine a patient with anisocoria ( started with telling him
that I would like to examine his pupil in light and then dark to
establish which pupil is faulty.asked how so told him the pupil which is
dilated in light is the faulty and the pupil which is miosed in dark is
Asked me to name the conditions in which there is a dilated pupil…told
him the list drugs , 3rd n, sphincter damage…interrupted me
what is the most common cause said adies. Asked what is adie what are
the ocular features and how will you confirm your diagnosis. What is the
cause of painful dilated pupil( said 3rd n, aneurysm) asked
me to differentiate between the surgical and medical lesion.
Then he moved on to ask me the effects of vitamin deficiency in
eye.(told him that vitamin A causes dry eye , and pigmentary changes in
the retina and also Bitot's spots. Vitamin B deficiency causes toxic
neuropathy and Wernicke's encephalopathy asked me about it, said it
causes said nystagmus, diplopia and ophthalmoplegia in eyes…bell rang
(my best viva)
OPHTHALMIC SURGERY AND PATHOLOGY:
British examiner and an Asian examiner
A young man presents with an exotropia how will you manage him? I
started with telling him about checking the pts visual acuity, ph,
refractive status, cover and un cover test prism measurements, extra
ocular movements and optic nerve tests, counsel the patient if he is
amblyopic that eye can deviate again if surgery is undertaken .then I
will perform medial rectus resection and lateral rectus recession. Then
he asked me about the complications of the surgery.
What are the possible causes of uniocular proptosis in a boy of 7 years
old. I gave a list including dermoid cyst ,orbital cellulitis, optic
nerve glioma, rhabdomyosarcoma etc. Asked me what is rhabdomyosarcoma
,said malignancy of the connective tissue in the eye , said what
connective tissue said the one that may differentiate into the
extraocular muscles…asked what are the pathological types and which has
the worse prognosis, (embryonal, alveolar and pleomorphic)….asked me how
will u treat it.
Then he asked me the complications of the cataract surgery …..told him
the intraocular and then post op complications ….asked me the late
complications said late endophthalmitis and PCO and Irvine gass syndrome
asked me how will you treat it.
Then the bell rang….
(Showed me lots of pictures on the laptop and asked only few questions just
kept asking what is it and how will you treat it.)
First he showed me a visual field of pituitary adenoma bitemporal loss
of visual field it was bitemporal quadrantinopia, asked me where the
lesion is and treatment
Then he showed me fundus photograph of disc edema with macular
involvement and BRVO….asked me what is it and comment on the disc
Then he showed me on laptop a sunflower cataract asked me the cause …
Then he showed me anterior segment hyphema how will u treat…
Picture of the patient with herpes zoster ophthalmicus
Picture of the patient with dacryocystitis with preseptal cellulitis
Picture of the limbal dermoid
Patient with bilateral disc edema …what is BIH and how will u treat it
And then bell rang (whao what a relief). Results were announced after an
hour and we were given a schedule for our clinical examination….mine was at
Clinicals were the smoothest both of my examiners were very good , one was
Indian and other was British. We are given 35 minutes and have to see as
many as we can , I saw 7 patients in this station.
A middle aged lady who was waiting for me by the slit-lamp. I was asked to
examine her anterior segment….she had bilateral aniridia…as I said it both
the examiners nodded and looked pleased.
A middle aged man , iwas asked to perform ocular motility test and also did
cover uncover test … findings were alternating exotropia with left eye
dominant ..British examiner asked me what would be his refractive error I
said he will probably be a myope.
An old lady, I was asked to examine her anterior segment.she had
symblepharon in both eyes asked me what can be the condition said OCP…asked
me the treatment.
A middle aged lady with iris coloboma asked to do an indirect ophthalmoscopy
on her …not much dilated ..she had bilateral chorioretinal coloboma as well.
Asked me what could be her visual acuity said 6/60.
Examine him on the slit-lamp had a polycystic bleb , patent PI, fundus with
90 D showed cupped disc and laser burn marks…asked me what could be the
reason said initially CRVO then developed neovascularization for which
laser was done .
Patient had iris new vessels; fundus had heamorrahges in all the
A middle aged lady walking with a stick…had a scar on the neck …British
examiner showed me her fingers they were stained yellow and had clubbing
asked me what could it be I said patient is a smoker and had a neck scar was
from the endarterctomy procedure.
Examiners looked happy and the time was up.
Results were posted on the website and was the happiest day of my life. I
studied from the Kanski and Wong and Wills…and surgery from Collins and
Stallard. Also Chua website is a goldmine for anyone preparing for this
exam. My email is
firstname.lastname@example.org . please contact me if you need my help for the exams.