Centre: Tripoli, Libya
Final FRCS (Glasgow) Date: March, 2006
|My name is Tag
Eldin Mohamed from Egypt, it was my first attempt of FRCS examination
in Tripoli April 2006 and THANKS ALOT TO ALLAH I passed. I like to gift
this success to whole my family specially my parents and my wife. Special
dedication to Dr. Aman Elghonemi and Dr. Ayman salah who provided me a
lot of support. One can pass if he went to the exam to pass, and not to
go, just to be examined and if you expect that you answered badly in one
of the exams, you must not let this affect your answers in the next exam.
The examiners are kind and ask a logic questions you have to know. I think
it's very important to know the experience of passed candidates and not
to surprise with the exam in the first time.
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 appropriate?
My answer plan was:
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 iridotomies 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 this cataract?
My answer paln was:
3. A 33-vear-old
woman has been aware of a degree of left-sided proptosis for several months.
She presents to your clinic with a 1-week history of pain and redness in
the left eve. Reduced vision and an apparent corneal ulcer.
My answer plan was:
The first professor asked me about 70 years
old male patient in the word, got a surgery 2 days ago, complaining of
chest pain (How do u manage this patient?), my answer was that, I'll call
for help and check ABC then I have to exclude life threatening conditions
pulmonary embolism and myocardial infarction, by rapid history, examination
(do not forget to look for DVT at lower leg) and ECG. Then he asked me
about criteria of the pain of pulmonary embolism (pleuretic) and myocardial
infarction (retrosternal radiating to left shoulder). Then he asked what
the changes of ECG in acute myocardial infarction are? (Raised ST segment).
Can you know which part of the heart affected by the ECG? (If V1, 2, 3
anteroseptal, if V1-6 extensive inferior……) So if u diagnosed pulmonary
embolism and the physician is not available what will u do? (IV morphine
10mg, 5000 u IV bolus heparin).
The second professor: You have a
60 years old patient in your clinic complaining of diplopia so what will
u ask him to know the cause of diplopia ?(uniocular or binocular, if binocular:
horizontal or vertical, more for near or for far. At which direction it
increases) Then he gave me a Hess chart of and asked me what this is? What
is your diagnosis? (………Superior oblique palsy. What are the possible causes
of superior oblique palsy in this patient? (Mediacal causes e.g. DM, hypertension,
GCA). IF you suspect GCA how do u manage? (I answered in detail). Then
he asked how u can differentiate between congenital and acquired superior
oblique palsy?.................. If the patient is diabetic
how do u investigate for diabetes in your clinic with a simple rapid test?
(………..He wanted to hear urine analysis!).
The first professor: drew a picture of a pterygium reaching near to the papillary border and asked me about the management? (I have to individualize the patient: age, VA, BCVA, visual needs of the patient, if cosmetically annoying the patient, then I'll manage accordingly……………..) Then he asked me how u will close the bare area? (In our center we use amniotic membrane transplantation) Do you know other methods to prevent requrrences? (Bare area technique with suturing of the edges, conjunctival graft, beta radiation, laser, mitomycin). What is the dose and time of aplication of mitomycin? What is the mechanism and precaution with applications? (Answer in detail).
Then he showed me on his laptop, a color photograph of a large upper temporal tear, associated with subclinical RD and asked me how do u manage? (Should be managed prophylatically without delay as it may progress to clinical RD with involvement of the macula, so I'll send him to our vitreoretinal consultant for photocoagulation or cryotherapy)
Then he gave me a refraction (0 / + 4.0 * 60) this patient asks for refractive surgery? (LASIK) Another method? (I don't know).
If you got posterior capsule rupture while you arte doing extracapsular cataract extraction, how do u manage? (Answer in detail).
The second professor: showed me a photo of 2 months old baby with upper eye lid defect and asked what this is? (Upper eye lid coloboma). How do you manage? (Repair of the lid defect in detail).
Then showed me a photo of an eye with rejected
graft of PKP. Why this patient got a PKP surgery? (The iris picture was
suggestive of trauma so most probably leucoma). What are other indications
for PKP? (Answer in detail). The graft was closed with interrupted sutures,
he asked me why do u think the surgeon use these interrupted sutures? (Better
control of astigmatism, easier for him). When the surgeon can remove the
sutures? (9-12 months).
He showed me also a photograph of patient
with lower eyelid involutional enteropion. What is the pathogenesis
of involutional enteropion? (Answer in detail). How do you treat this patient?
(Weiss procedure). What is Weiss procedure? (Just the idea of this procedure).
The first professor: First question was a surprise to me: What are the diseases of RPE? (…………, Best disease), Tell me what do u know about Best disease? (Stages are…... EOG is subnormal during all stages but ERG is normal). How do u do EOG & ERG? What is the Arden ratio?!. What is the inheritance of Best disease? (AD).
What is retinitis Pigmentosa? (It is diffuse retinal dystrophy mainly affecting rods). What are the stages of RP? (Arteriolar attenuation, RP sin pigmento, Retinitis punctata albescens, bone specules,waxy disc)what is the pathology of bone specules?! Can RP be treatable? (Yes), how come? (As in Refsume disease: plasmapharesis and phytanic acid free diet. And in Bassen-Korenezweig: with vitamin E).Tell me about the pathology of one of systemic association of RP? (Kearn-Sayre: Red Ragged muscles).
You are in the clinic and a child came
to you complaining of arthritis without ocular complaint. What do you expect
to see in his eye? (He is most probably JIA and has anterior uveitis).
If you find flare and cells but the patient doesn't complain, are you going
to treat him? (Yes) Why? (For fear of complication e.g. glaucoma).
The second professor: showed me a photo
of a hand with to nodules, and asked me what do u think that this patient
has in his eye? (Glaucomatous uveities). What are these nodules could be?
(Sarcoidosis, when he showed me the face of the patient so I said rapidly
it is neurofibromatosis). So what could be the ocular features of this
patient? (Answer in detail……. Till said choroidal nevus) then he asked
why this disease is associated with the choroidal nevus? (Cause it is phacomatosis).
What is the mechanism of glaucoma in this disease? (Answer in detail).
The clinical exam: (two English examiners)
In this examination do what you use to
do in your practice and let the examiner feel that you are practising as
in your clinic and not just for the examination.
Thanks a lot to ALLAH that I passed from the first attempt. It will give me much pleasure to provide the hand of help to any candidate for FRCS or any ophthalmological exam. My email address is firstname.lastname@example.org