|My name iss M. A'
Aal, it was my first attempt of FRCS examination in Tripoli
April 2006 and THANKS TO ALLAH I passed. It is possible to pass in
your first attempt but the key is to know what the examiners expect of
you. The examination was simple and the examiners are kind and ask only
the common diseases and problems we face in daily practices. Of course,
you have to have good knowledge and be fluent with commonclinical examination
techniques. This web site is very helpful, I think its better to revise
with some like-minded colleagues and attend course. Lastly I'd like to
thank Dr. A Ghonemy for his valuable course.
Clinicl case interpretation:
1. A 13-year-old girl was brought to your
clinic by her mother complaining of reduced vision. Visual acuities are
6/18 in both eyes, reading N8 unaided. Her parents have just been divorced.
How would you manage this patient and what investigations may be appropiate?
(Don'tt forget non-organic visual loss
beside organic causes in this age group and the relevant tests to differentiate
between organic and non-organic causes.)
2. A 55-year-old man who works as an engineer
has attended the eye clinic previously with latent angle closure glaucoma
and has bilateral peripheral iridttomies performed. His refraction is +7.5DS
in the right eye and +8.00DS in the left. On this occasion vision is reduced
to 6/12 in each eye because of cataract. What potential risks would you
perceive with this patient and how would you manage his cataract?
3. A 33-year-old woman has been awared
of a degree of left sided proptosis for several months.she presents to
your clinic with a one-week history of pain and redness in the left eye,reduced
vision and an apparent corneal ulcer. Explain the possible causes of this
patient's symptoms and how you woud manage her.
Two examiners (one Indian and one British)
for general medicine and neurology:
While in the ward preparing for the next day
list, you are called to attend a dibetic patient who just collapsed. What
would you do? Call for help, ABC, Test for glucose and further
examinations. Then one of them showed me a ECG with MI and heart block.
Papillaedema and its management. Field defects
of chiasmal lesion and implications of homonnymous hemianopia. Then the
A British and An Arabic examiner
for pathology and surgery
They show me a lot of photos: traumatic dislocated
lens, post-trabeculectomy flat anterior chamber, capillary hemanigioma,
Brown's syndrome, Morgagnian's cataract, molluscum contagiosum, epithelial
downgrowth, combined surgery in hypermature catarect, surgery on inferior
oblique muscle. Before more photos, the happy moment of the bell.
Optic atrophy in young, principle of OCT,
heterochromia, Fuchs' heterochromic cyclitis, MRI for posterior scleritis,
vitritis, diplopia work up, effect of herpes zoster on the eye, anisocoria
and before more questions, the sweet sound of the bell.
41 candidates from one hundred passed
and went on to the clinical examination we were divided into 6 groups I
was in group (D ). I was examined by 2 examiners: one Nigerian and
the other Arabic.
Examine the right eye of a middle-aged
lady with slit-lamp. She had a phakic IOL, 2 peripheral iridectomy in upper
section closed with 3 interrupted sutures. I was asked why phakic IOL used?
Examine the fundus with a 90D revealed a tesselated fudus, myopic
crescent. Asked why she didn't have LASIK and how to follow her up? I mentioned
IOP, endothelial count and fundal examination. What is the risk of retinal
detachment in pre- and post-operative period?
Examine a nearly 6-month old beatiful
girl with a right enucleated/eviscerated eye with granulation tissue and
a mass behind the secured muscles. I was not sure if it is eviscerated
with midpore implant for trauma or enucleated for tumour I mentioned both
Q: What tumor do you have in mind? A:
Q: What is this tissue? A: I don'tt know
Q: What do you usually do when you are
uncertain of a tissue? A: Biopsy and sent for histopathological.
Q: Ok, this is a case of recurrent
retinoblastoma, what will you do for the other eye?dilated fundus examination
with scleral indentation.Q:what will you do if there is small mass at periphery?U/S
& refer to ophthalmic oncologist if it small:laser-cryo-RX
If there is recurrent in the biopsy of
the enucleated eye..chemotherapy
Examine the right eye of a 6-year-old
boy with a slit-lamp.
There was a paracentral corneal opacity
with 2 corneal stitches and an anterior chamber IOL. The corneal incision
would was closed with interrupted 10/0 nylon with presence of peripheral
Q: What is the likely scenario? A: Trauma
to the eye resulting in globe rupture, lens injury which developed into
traumatic cataract. The patient underwent repair with cataract extraction
and primary IOL implant. (He told me that might be a secondary implant
and I agreed.)
Q: What do you expect the vision to be?
A: There is good vision potential unless there were posterior segment complications
but it was likely to be lower than the fellow eye and when compared to
his previous vision.
Q: What would be your instructions to
parents regarding the other eye? A: Occlusion. (Come to think of it, the
parents need to contact the ophthalmologist if the good eye become blurred
or red due to the risk of sympathetic ophthalmia)
Q: How often would you perform the patching?
A: Till the patient is around 8-year-old (Also asked about how many times
or hours per day and I mentioned 3 hours/day
Inspect a young male in his mid-20s.
The examiner told me the patient was deaf;
I found muscle twitches in the face and the patient squeezed his eyes during
examination. There was a jerky nystagmus and I described it with using
the mnemonic DWARF. The left eye had a band keratopathy.
Q: When do you think the band keratopathy
occur? A: Early in life when he was about 2-year-old because of the
prescence of nystagmus.
Q: What about these twitches you see?
A: (That was a difficult question for me) Myokaemia? (The examiner tried
to guide to guide me but I was clueless then he said it was hemifacial
Q: What will you do for his facial problem?
A: Refer to a neurologist. (He agreed but asked what drugs the neurologist
will give him? I thought a little bit and said carbamazepine but I wasn't
sure. Eventually it got to botox injection what was the answer he was after).
Examine the fundus of a 17-year-old boy
with an indirect ophthalmoscope.
The lens was 28 D which was not
the usual 20D that I used but there was not much difficulty. I described
my findings and said it was retinitis pigmentosa. He told me the central
vision was poor and what would I expect to find? I said there might be
macular involvement but I need to confirm this with the indirect ophthalmoscopy
using 78 or 90D lens.He asked if RP patients are more prompt to glaucoma,
I said yes and he asked me to examine the optic disc again and this time
I found the disc was cup with glaucomatous characteristics.
Examination of an old woman using indirect
It was difficult to examine as there was
a nasal shift of blood vesseles. With some problems, I found hard exudate
in the macula and mentioned diabetic retinopathy. He asked me if I would
like to examine for other signs using a direct ophthalmoscope. I mentioned
the retina thickness then promptly regreted it and quickly corrected myself
by saying that I would need special filters such as the red free on the
slit-lamp to do so. He went on to talk about clinically significant diabetic
maculopathy and the indications for laser and fluorescein angiography.
Examine an old man using an indirect ophthalmoscopy.
I focused on the anterior segment and
he was pseudophakic. There was a fibrous band along the arcades with a
hypereamic disc. The view was not great. I was asked what this was? I described
my findings and believed it was a proliferative diabetic retinopathy. He
asked about pan-photocoagulation and asked if vitrectomy was indicated?
I said no as there was no macular detachment or band crossing the macula.
In the last 5 minutes I was asked to examine
a 3-year-old child. She was esotropic with an abnormal head posture. I
placed the head in the normal position first and carried out cover /uncover
and ocular motility but she was uncoperative or tired for a smooth examination.
I was asked about the findings. I mentioned esotropia, latent nystagmus
and inferior oblique over-action in the right eye. He asked me if
there was anything else and I said I have nothing else to add as I could
not see any other signs.
I didn't know how I did and have to wait
for about 3 hours. That was the longest and the most difficult time in
my life but once again THANKS to ALLAH, I passed, my email is firstname.lastname@example.org.