My name is
Waleed Alorabi, an ophthalmologist from Syria working in National
Guard hospital Riyadh, KSA. Thanks Allah, I passed the final FRCS exam
in Glasgow (Amman 2013) from the first attempt.
First and most
important advice: think positively and think positively and think
positively….. Use the power of thinking to pass … and you will pass.
and don’t believe all the myths about how difficult to
pass this exam, you will pass….Otherwise, if you go there without
self-confidence, you will fail…
I dedicate my
success to Allah, my country (Syria) and my family, especially my
parents, wife and sons who supported me without limits.
hesitate to contact me should you need any help with your preparations
for FRCS exam, my email is:
Kanski is enough as a single reading book; however AAo is a
good and very helpful adjunct book.
is a MUST, particularly the past candidates experience.
My experience in the final Part
of FRCS in Amman 2013.
First table: Ophthalmic
medicine, one Arabian and one UK examiners. Showed a picture of VKC
with giant papillae and shield ulcer, discussion went about management
of shield ulcer and vkc in general, what other clinical findings of
vkc?? (I forgot pannus!!), what the clinical term of limbal
I don’t know sir.
Another picture of best’s
disease, hypopyonstage, was asked about staging and VA in this stage?
I was a bit confused and did not give clear answers. Then discussion
went about genetics and diagnostic exam (EOG) is the exam of choice in
Pic of pigmented round lesion at
the mid peripheral fundus, prescribe and spot diagnosis.
It was heavily pigmented and
surrounded by a halo of hypopigmentation. I said the most likely
diagnosis is RPE hypertrophy but choroidal melanoma should be ruled
out. Then asked why do you think it is not melanoma?? I said: small
size, hallo, no lipofuscin; pigment, flat ….. He looked satisfied.
A pic of markedly injected eye
with thick mucous discharge, I described the findings and he was happy
when I told him about the pseudomembranous, I gave a DD of adenoviral
conj, then asked about management I replied quickly because the bell
I was not satisfied after this
part because it supposed to be the easiest part, but I didn’t lose
Second table: surgery and
pathology one UK and one Arabian examiner.
Started with a photo and scenario
AACG…….. How well you proceed?
I said this is an emergency,
first I will confirm the diagnosis by measuring IOP and quick history
of past similar attacks ….etc. and then I will put the patient supine
and start topical and oral anti-glaucoma meds….. If IOP is more than
50 mmhg I well consider IV Diamox or mannitol…I mentioned to the
examiner that there no benefit from pilocarpin initially but he was
surprised … why??? Will it harm??? I said no … he said plz if I came
to you give me pilocarpin!!!!! I smiled … ok sir.
Was given scenario of 3 days post
phaco op onset of pain and decreased vision, I gave DD of post op
endophthalmitis….. What is the management?? Again this is an
emergency; I will admit the patient for vitreous sample culture and
intra vetreal antibiotic inj or PPv if VA is LP or less…..Then asked
what factors can affect visual outcomes in this case???? I answered:
VA at presentation.
Virulence of the causative
Delay in treatment…..etc. looks
The Arabian examiner showed me a
pic of corneal dystrophy; I said this is Avellino’s dystrophy and I
described the findings…. Discussion went about features, management,
staining and genetics….
A scenario of a young boy
assaulted to his eye with glasses on, c/o pain and decreased vision,
how will you manage?
I discussed in details the
management of a ruptured globe from a-z, special focus on suggestive
features of a ruptured globe and surgical repair in details.
A Question about the causes of decreased VA post
I gave a long but a well-organized list but I
forgot the most common cause!!!!! The refractive errors.
The last question was a pic of a large ulcerative
lesion at the lateral canthus, causes?
SCC, SGC, melanoma….. Merckl cell carcinoma…
The UK examiner said: Thank you, you did well.
Thank God, my hopes revived again.
Third table: neuro-opthalmology and
Pic of few brown iris nodules, I said it is lisch
nodules commonly seen in NF1, Question about ocular findings in
patient with NF1.
Question about the possible causes of visual
impairment in NF1…. I answered:
Optic nerve glioma.
Glaucoma….etc. then discussion went about optic
nerve glioma, what the management in 7 years old boy with good visual
acuity? I said observation if the tumor is not growing rapidly.
Other treatment options: resection, chemotherapy,
radiotherapy. Was asked about medication used in chemotherapy?! I said
vincristine, etoposide, but I was not sure. He said OK.
Fundus photo with yellow exudates extending from
the optic nerve around the macula at the upper temporal arcades. I
said it is most likely a CMV retinitis in an immunocompromised
patient. Discussion went about CMV and available treatment options (gancyclovir).
Was given a scenario of a patient with acute
chest pain, how will you proceed?
Call for the help, brief history especially type
and duration of pain HTN, DM … pain radiating to the shoulder and the
arm….. MI management …. Don’t forget blood works particularly CK and
troponin. Aspirin, morphine………
An 11 years old girl, obese, short, c/o decreased
vision? The bell rang, but I think it is a case of Bardet Biedl
The examiner was very satisfied at the end….
Thank God I did well in this difficult part.
4 rooms, 8 patients.
Ant-segment: a case of PKP, I was asked
about types of keratoplasty, when to remove the sutures?
I examined the other, it was keratoconus.
Discussion went about pathology, inheritance, modules of management,
farther about cross linking technique (the slit lamp was very old and
I asked to decrease the illumination in order not to burn out the
lamp!!!! The view was very poor so I increased the light!).
Second case: old lady with bilateral diffuse
central corneal opacity in the anterior stroma + early cataract with
pxf. I told the examiner this could be a case of central stromal
dystrophy op François, he said ok the diagnosis doesn’t matter but
tell me how will you manage this case?
I replied this depend on the visual acuity and
patient complaint, I will start with glasses if not work I will
discuss the possibility of cataract surgery with the patient, I will
do ECCE because phaco will be extremely hazardous due to poor view and
zonular weakness and poor dilation, then discussion went about how
to manage the small pupil before surgery?
First case: examine the fundus of a young lady
with the indirect ophthalmoscope. It was optic disc coloboma
accompanied by adjacent choroidal coloboma; discussion went about
etiology, systemic associations and invx.
Second case: an old man with decreased vision OD,
examination by 90 indirect lens. It was a case of wet AMD, there were
some exudates at the macula with RPE changes, I described the shown a
FFA demonstrating an occult CNVM with late leakage. I mentioned the
deference between the classic and occult CNVM, discussion then went
about treatment, a said anti VEGF is the treatment of choice, then
discussion about type of anti VEGF and the deference between them.
First case: a 29 years old lady with a history of
headache for 6 months, I was asked to examine the fundus by 90D, I
found pale optic discs in both eyes, macular pigmentery changes both
eyes. I got confused regarding the macular changes, but I told the
examiner honestly I can’t reach the diagnosis but the history is
consistent with IIH, he said ok you are right and this is a resolved
papilledema which can cause macular changes, discussion then went
about the diagnosis and management of IIH….. History of headache,
type, severity and visual symptoms…etc. enquiry about current
medication (contraceptive pills, naldexic acid, tetracycline…etc.) and
previous trauma. Then complete eye exam + brain MRI+LP….
Treatment: D/C any suspected drug, diuretics….
f/up for routine exam + visual field exam…
Second case: a young lady with recent onset of
diplopia, examine the ocular motility.
There was a limitation of upper gaze in the right
eye but no obvious squint in the primary position. I gave DD of TED,
orbital myositis, blow out fracture, Brown’s syndrome….. Discussion
went about diagnosis and management of blow out fracture, particularly
the indications for surgery.
A very kind Indian examiner asked me to examine
the eye lids of an old man. I found a cystic lesion at the lower lid,
I described it and I used my torch to illuminate it (the examiner
seemed impressed!!), I gave DD of Zeiss cyst, Moll cyst, chalazion… I
also found the patient to have mild ectropion, I showed the examiner
how to measure lid laxity and medial and lateral canthal tendon
laxity, and again he got impressed. Then discussion about treatment
options of this patient.
Second case was a young boy with bilaterally
blind eyes from congenital glaucoma with right eye ptosis, i did a
complete ptosis exam, it was a ptosis secondary to volume loss (phthisic
eye), and then discussion went about the treatment options of this
boy, in this case as the eye was cosmetically unacceptable, one may
consider removal of the eye and put an implant to correct the volume
loss and tis alone may alleviate the ptosis itself. First a said we
can insert a scleral shell but tis alone will not correct the ptosis.
Discussion then went about the type of ocular implant post
evisceration and enucleation; I talked about the advantages and
disadvantages of porous and nonporous implants, materials: PMMS,
hydroxyapatite….. Examiners were happy.
Thank God it was as fast as a short dream, I felt
comfortable and happy at the end of the exam mainly because I did it
and I’m free now………………………….
Having any question please contact me on