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FRCR 2B Examiners'​ Report: Long Cases

Revise Radiology

Revise Radiology

November 23rd, 2022

This article is transcribed from a webinar hosted by Dr. Koshy Jacob. We recommend this article for radiology students preparing to sit their FRCR 2B exam.

It can be quite confusing to sit the FRCR 2B Exams because they have this reputation for being clinical Exams. This makes them different from the Part 2A Exams which are primarily knowledge-based. Often, our members are overwhelmed when they start their preparation.

In this newsletter, I have looked at the Examiners' reports after each FRCR 2B Examination. The reports have succinct explanations of candidates' mistakes in each part. I have summarised their observations and put them together as tips for the Exam. I recommend you read these before you begin your revision.

Reporting (Long Cases)

  • People who failed their long cases almost always fail their vivas. People who pass their vivas didn't usually fail their long cases. 

  • Go through the whole package of questions. Look at the ones that have the lowest number of images, seem to have the most straightforward question and have the lowest number of sequences / modalities. Do them first and move on to the easier ones.

  • Some people spend a lot of time in the first three cases. It's far easier to achieve a passing mark overall by providing adequate answers to all six questions.

Use your experience and knowledge of disease patterns to look for features that confirm or refute your proposed diagnosis.

  • So, if they've given you some clinical history and you've got some experience of patterns of disease and knowledge of disease, use that to try and confirm or disprove your diagnosis.

  • Although it's limited, the clinical information is there to help you narrow your differential diagnosis. Remember, it's a clinical exam, they’re trying to see if you can make a clinical diagnosis.

  • Ensure the diagnosis you offer is appropriate for the age of the patient. Whether the patient presents with acute or chronic symptoms should also affect your analysis of the most likely underlying cause.

  • The other thing the examiners have noted is that candidates often omit important negatives. If, for example, you have a small bowel obstruction, and you don't mention that there's no free intra-abdominal air.

The examiners actually encourage the use of bullet points, and they don't like lovely prose. They don't want long sentences.

  • When you put bullet points, you've got to put some detail. You can't just say pneumothorax. You've got to say left pneumothorax.

  • You may also find it helpful to consider having made your primary diagnosis, to mention other features to look for that might affect the patient's subsequent management.

  • Features that may affect the patient’s subsequent management should be considered where appropriate and the further management of a patient should go beyond referral to an appropriate MDT.

  • Now, a lot of people parrot out this phrase, 'I will refer to the MDT.' That is just a standard phrase that the examiners have heard now for ten years. Go beyond that. Find out what are the kind of things that they will do for different conditions. Ideally, the candidate should provide the advice that would be given to that MDT.

Written Component

  • For the written components many candidates do not make use of the full resolution capacity of the system.

  • Enlarge the screen, get maximal spatial resolution.

  • Do not enter in the keyboard once the exam is finished, stop everything. All keyboard entries are logged and any keyboard entries made after the exam will be discarded. And of course, you risk the chance of disqualification. 

General Comments

The top difficult areas for candidates are paediatrics, chest and abdomen imaging, and neuroradiology. These are the most challenging systems you need to work on.

When we read through all the reports, MRIs and plain films seem to be the modalities that give candidates the most difficulty.

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