My name is Elham Eltohamy, from Egypt…I attended
the FRCS exam 3 times, and passed in the third
attempt…I wrote my experiences in the way that
can facilitate revision for you before the
exam...I wrote the written exams together...then
the viva of each section together...
I confess that answering the previous
experiences of the others before the exam helped
me very much.
My impression about the exam..is it is very easy
to pass and easier to fail..but it will be easy
if you practice to answer the exam itself and
studying in groups or at least with one honest
colleague..And too many discussions about the
exams….try practice clinical also as much as you
For problem solving (which is helpful also in
Viva) questions, Prof. Muthusamy was a great
helper by his continuous advises and correcting
problem solving answers for me and all his
students, and very supportive...His web site is
Also, Dr. Ayman Elghoneimy and Dr.Ahmed Sallam
course online and their FRCS notes at(FRCS yahoo
group) were a great help in viva and clinical
exams..,the web site contains every detail about
the exam…e.g(the book that you need to read
before the exam…the dates of the exam, how the
examiners evaluates you..b eside the scientific
notes which downloaded as power point
presentations) you can open the web site and
download all their lecture notes..
FRCophth group also by Dr.Samer Bashir was very
helpful by the files, and FAQ…
is very very important for practice the
exam...after reading all books that you should
read(Kanski,Wong,Willis eye manual, Oxford hand
book for ophthalmology) and any other
books..please try to answer questions of chua
page,it is very important and it is the exam at
Wish you all Good luck….hope my experiences are
useful (not boring ) to you..and sorry that I
forgot many of viva questions..
I didn’t pass the first exam because I did a lot
of guess in MCQ, and was hesitated in one of the
viva exam…so, please answer only what you are
sure in MCQ and ,be confident.
In the second attempt, I didn’t pass the
neurology and general medicine viva station.
In the third attempt, I passed...thanks godJ.
1- A 13-year-old girl is brought to your clinic
by her mother complaining of reduced vision.
Visual acuity was 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?
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 +7.50 DS in the right eye and +8.00 DS 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 cataracts?
3- A 33-years-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
eye. Reduced vision and an apparent corneal
Explain the possible causes of this patient's
symptoms and how you would manage her?
Problem solving2 (Tripoli 2007):
1-A 32 year old woman is 35 weeks into her
pregnancy when she come to see you complaining
of reduced vision.On examination her acuities
were 6/12 in each eye.
Describe the possible reasons for her poor
vision and how they might best be managed.
2- A 70 year old diabeteic man presented to your
clinic complaining of distortion in his right
eye for 1 month.His vision in the right eye is
6/36 compared to 6/9 in the left.
What is the DD?how would you investigate and
manage this case?
3-The parents of a 2 year old boy bring him to
see you complaining that the left eye looks
larger than the right.
What possible conditions could this child have
and describe how you would manage the case?
Q1 50 years old woman complains of a recent
onset of vertical diplopia .On examination there
is a small right hypertropia
What is the DD,and describe how would you
investigate and manage this patient?
Q2 A 47 year old man has been treated for ocular
cicatricial pemphegiod for several years and
had a right cataract extraction performed 6
months ago.He is sent to your clinic with pain
in his right eye and you diagnose right corneal
decompensation with bullous keratopathy and
vision of Counting fingers. The left eye has a
vision of 6/24 with a cataract.
State what treatment options are for this
patient and what management plan you would
Q3 A 24 year old man was assaulted one year ago
and had a left malar fracture repaired by the
Maxillo facial surgeons. He is now referred to
your clinic by his optician who has found the
vision in the left eye to be reduced to 6/18 and
has noticed a left RAPD.
What are the possible diagnosis with this
patient and how would you manage him?
General medicine and neurology
attempt (Tripoli 2006)
English and an Arabic examiner:
I lost confidence in this station so,I lost
The English examiners asked me: 60 years old
female patient come with diplopia(6 nerve
palsy)..what you will do?
I started with history of systemic illness,
then...I said:I have to start with history of
onset of her problem and if it was associated
with pain or not..He asked about the importance
of pain here? My answer : related to aneurysm or
infection( he wanted giant cell arteritis) and
he guided me to the answer by telling that she
felt pain on combing hair....and asked me if GCA
can cause 6 nerve palsy or not..I was not sure
as I always read it with AION...so this was
confusing to me a little...then ask about
investigations(ESR,C-reactive protein),what can
you do in the clinic( he wanted measuring blood
pressure)..he asked if I do this by myself, I
said yes( wrong answer, as the nurse who usually
do that)..and asked me if I would give the
steroid injection treatment by my self...I
couldn't answer..and I never think about that
before, and didn’t practice it in my life, the
correct answer is to admit the patient and start
immediate investigation and IV steroids after
steroids work up(by the way…This is a very
common viva question).
The Arabic examiners questions:
Effect of systemic blood pressure on the body?
Systemic manifestations of infective
endocarditis and how can it affect the eye?
Mythenia gravis?Tensilon test?
Eye manifestations of thyroid dysfunction?
Second attempt (Tripoli 2007):
An Arabic and an English examiner
how would you manage a recently diagnosed
Q: complications of diabetes?
Q: systemic causes of anisocoria?
Q: Hyperthyroidism? level of TSH, in
thyrotoxicosis and why??Difference between T3
and T4? When all level of thyroid hormone are
Third attempt (Glasgow 2007):
English and Indian Examiners:
Q: DD of patient with acute chest pain...Cardiac
causes, pulmonary causes…the acute chest pain in
healthy young adult with no previous systemic or
chest illness (Pneumothorax)...Management?
Q Systemic neurological diseases associated with
eye manifestations (MS,GCA,Phacomatosis..
Q Systemic diseases that affect the lens...those
that cause cataract...DM, Mytonia Dystrophica…
And those that cause lense
Q 18 years old female, recently got
diabetes…what risks that she can face, and what
you will tell her?
(DKA, hypoglycemia…and long term complications
of DM (neuropathy, nephropathy, retinopathy..
Q Diabetic patient with vitreous hemorrhage and
PDR...management…? My answer started with
counseling the patient that the laser will not
improve vision but will keep it from
deteriorating...then he stopped me saying that
,that is all what I want to hear..
Ophthalmic pathology and surgery
First Attempt (Tripoli 2006):
One Nigerian and one Arabic examiner
laptop photo of 40 years old man with right
hypotropia and mild proptosis(dd .of hypotropia
was muscular or neurological causes
how can you differentiate?(forced duction test)
investigations(thyroid function test)he said the
patient was Euthyroid, the CT Scan,,he showed
photo of his CT and there was enlargement of
EOM(thyroid ophthalmopathy(manag ement)IR
recession guided by
adjustable sutures(he liked my answer and
Laptop pic of sub retinal dark pigmented
can you differentiate?(US to check thickness and
internal reflectivity)…He agreed...bell rang.
Slit lamp photo of a child with right convergent
squint (history of onset)…he said it started
when he was 2.5 years old (accomodative
esotropia)..Management? (cyclopegic refraction
and fundus examination to exclude any organic
lesions..he said his vision was 6l6 both
eyes,refraction +4D both eyes..fundus
normal,would you give him glasses?I said yes as
hypermetropia can be overcomed by the
accomodation of the child...after correction
still residual esotropia(partially accomodative
esotropia)management?.Bilateral medial rectus
recession a vision is equal in both eyes.
Q: Refractive surgery and LASIK?If I would
advise him to do a surgery or not? then asked
about complications of LASIK and if I would
advise him to do LASIK or no(I said no,but I
think that was a wrong answer).
Q pathology of malignant melanoma (types of cell
and which has worst prognosis (,epitheliod
cells)…Best prognosis.(spindle A cells)…(this is
a very common question in pathology)bell rang
Second attempt(Tripoli 2007):
An Indian and a Nigerian examiners
laptop picture of histopathology slide..showing
different kinds of cells…no definitive tissue to
recognize..so I start to describe the slide(many
spidle shaped cells…few pigmintations..)Q:what
is the lesion? choroidal melanoma.
Q: Laptop picture of an eye with keratoplasy PKP
and sclera ring (intraoperative pic)..I said PKP
with sclera ring to prevent sclera from
Q:lap top movie of patient with frequent
blinking..( essential blepharospasm)
Q:Management?he draw the eye and asked where you
will inject the Botox?
Q:Direction of nasolacrimal duct in children?and
how to do probing in children?
Q: Treatment options for myopic patient with –
4 D myopia…glasses,CL,lasik,lasek,Intacs..but he
wanted phakic IOL also..I was objecting as it is
very invasive procedure for such degree of
myopia..( he smiled).
Third attempt(Glasgow 2007):
Q Laptop pic of Lisch
nodules..definition…clinical picture of
The examiner told me that there is a proptosis
in this patient?what do you expect?and what is
the fundus picture..( choroidal
folds,astrocytoma,glioma,optic atrophy…he was
Q Laptop pic of child face with unilateral
Q what is the most important and single question
to ask to the mother?....( family History).
Q Complications of phaco and how to manage PCR
and nucleus drop?
Q an old man with a mass in the lower
Q How to do PRP in details?spot size..how many
English and Arabic examiners
Q: diseases of RPE?how can you see RPE
detachment clinically?(dome shaped
elevation)..how can you differentiate from CSR
as there is dome shaped elevation
also(Flourescin angiography,ICG)..why sometime
dome shaped elevation in RPE detachment
sometimes look notched?( tear in this layer and
folding of tear).
1-coloboma of the iris?causes?
2-subretinal white lesion occupy half of the
retina?I didn't know but I Tell for differential
diagnosis(he liked the answer!!!!)
3- corneal dystrophy(dystrophy then said
opacity)what is the difference between dystrophy
4-FFA of non proliferative DR?which stage of DR
and which stage of flourescin? management?(good
metabolic control and follow up every 3 to 6
month) he insisted to choose between either 3
or 6 month follow up( I said 6 month as there is
no signs of ischemia).
5-dragged optic disc?(DD)..ROP?
causes?(prematurity with Oxygen
supply).concentration of Oxygen?(was not
Second attempt(Tripoli 2007)
Q: How different types of laser work?(laser
tissue interaction)?the answer is found in wong
in laser in Ophthalmology chapter and Rifaii
Egyptian book for refraction.
Q: Management of idiopathic increase ICT?
Q: GCA..managemnt? what is steroid work up?
Sorry don’t remember the all questions.
Third attempt(Glasgow 2007):
Indian and an English examiner
Laptop pic of Retinoschisis….DD.
Intravitreal injection of anti VEGF…how to do
intravitreal injection in details…
Problems of Anti VEGF…(v.expensive).
A pic of sclera
Q side effects of cidamex(diamox)?
Q a 35 years old woman with bilateral disc
swelling,visual acuity normal,DD?how to manage?
Q Causes of idiopathic increase ICT?
Q How to cofirm the diagnosis ?..lumbar
Clinical( the only attempt):
cases (3 slit lamp cases ,and one ocular
And by the way,in each case they changed the
slit lamp setting,so,I have to readjust the slit
lamp setting for each patient..so be very
careful of such tricks..
54 years old female,with sudden painless loss of
vision RE since 6 months,
Q1 Take a short history(DM,HTN,Trauma,Pain at
muscle or on combing hair-she was diabetic and
hypertensive for 8 years)…asked about the
nature of visual loss..she explained that it was
Q2 Examin the patient…Pupil(RAPD..RE)….Iris,no
rubeosis…fundus shows pale dic swelling.
Q3 Then the examiner asked me about my
Q4 Investigations?C-reactive protein,ES…
Old lady (about 80 years old)
Q:examine the anterior segment( cataract with
pseudoexfoliation)..asked me to examine the
anterior chamber???..there were pigments on the
corneal endothelium and irirs transillumination..
Q:exmine posterior Segment(ARMD-Dry type) Q How
to increase vision in this patient,and recent
management of ARMD ?(low vision aids,vitamins
Q Risk of cataract surgery in this patient?(
pupil dilatation,zonular dialysis,dropped
Old male ,asked to examine the posterior
segment.Very strange lesion to me,I couldn’t
diagnosis it from the first look,so I started
to describe the lesion(pale disc ,attenuated
vessels,the whole retina looks white.
Then asked to examine the other eye, there was a
rim of retina adjacent to the optic disc…I said
Q:what else? A:Gyrate atrophy.
Q:How could you differentiate? then said from
Q:asked me again to take short history…
onset:Since child hood, all his son have the
disease, all his daughters are carriers..his
brother also has the same illness..
Q: mode of inheritance? A: X-linked.
Middle aged lady,asked to examine her…there was
ptosis in left eye…asked to come nearer and
examine the upper lid of right eye…there was a
scar Q: what it could be? A scar of ptosis
Q: Asked to do cover and uncover test…I asked
the patient first if she has a glasses, the the
examiners told me never mind..go on…then asked
the patient to look straight ahead (the room was
small..about 3 meters distance)..and then did
the cover and uncover for distance…There was
I wanted to do it for near, but time was up.