Candidate 124

Final FRCS (passed)                          

Centre: Muscat, Oman                         

Date:    Dec. 2008 

My name is Syed Hassan Raza Jafri from Karachi, Pakistan. I am working as a Senior Registrar in Al-Ibrahim Eye Hospital (Isra Post graduate Institute Of Ophthalmology). By the grace of Almighty Allah I passed FRCS Glasgow from Muscat 2008. It was my first attempt. I owe my success to my parents, my wife, my sisters, my children and all my nears and dears who prayed for me and supported me. I would like to thank my mentors Dr. Saleh Memon, Dr. PS Mehar, Dr. Waseem |Jafri specially for inspiring me to go for it. Hats off to my seniors and teachers Dr Fazal Kamal and Dr. Azizurrehman for guiding me at their best. Last but not the least my friend Dr Fahad Feroze, who cleared it along with me, for carrying me along and sharing his knowledge. Special thanks to Dr Chua for providing with such a wonderful and helping stuff.

This exam is all about keeping yourself composed. Mounds of knowledge are not required. Basic but prompt knowledge suffices. One needs a lot of practice regarding clinical examination skills as the time for clinicals is very short. Only those with good practice succeed through their reflexes, otherwise itís very usual to miss important findings which lead to failure. Also discussion with a friend in medicine regarding emergencies is of great benefit.

I read following books
-Kanski
-Wong
-Oxford handbook of ophthalmology (very important for viva)
- Oxford handbook of clinical medicine (for emergencies)
-American academy of ophthalmology- systemic diseases section for selected topics
- Chua web page is the gold mine for this examination specially MCQs, pathology slides, investigations and viva challenge. Also past candidate experiences give a comprehensive picture of the exam level and atmosphere.

Now my experience for exam

DAY 1
First, the theory paper

Q1 a 40 years old lady is seen at your clinic with a history of intermittent pain, redness and watering in the left eye for 6 months, occurring particularly at night. During the last attack 5 days ago, the vision in the eye had become blurred and she had been aware of colored haloes. On examination acuities were 6/6 with refraction and both eyes were quiet with normal IOPs.
What are the possible differential diagnoses and how would you investigate and treat this patient?

Q2 A 25 year old female patient is myopic and has always had reduced vision in the left eye. Her best corrected is 6/6 right with -4.00 DS and 6/60 left with -7.00DS. She usually only wears a soft contact lens in her right eye. Two days before her wedding she is referred to your clinic with pain and redness in her right eye and an obvious corneal opacity.
How would you investigate and manage this case?

Q3 A 75 year old lady who is a carer for her invalid husband presents with sudden loss of vision in the right eye, with the left having been poor for many years. On examination acuities are counting fingers left and 6/60 right and she has a macular BRVO in the right eye. On left side there is a dense cataract.
What are the possible treatment options for this patient and how should she be managed?

Two hours are given, its better to formulate a plan for each question before jumping into writing the answers

MCQ paper -60 MCQs (5 stems each) in 2 hours

Try not to attempt those needing a second thought, however if in your first go, your score is below 160, go for taking chances but only in those MCQs which are somewhat familiar.

DAY 2

My viva was on first day. Following were the tables and the viva topics at them

Pathology and ophthalmic surgery

English examiner
Pathology of thyroid orbitopathy, various signs and their treatment
Nodular lesion on lid margin D/D and management, how to resect and reconstruct.

Indian examiner
Picture of hyphema, identification and management, if patient having sickle cell problem
Slide of Fuchs endothelial dystrophy, identification, presentation, treatment, brief discussion about keratoplasty.

Medical ophthalmology

Arab examiner
Photo of unilateral lid retraction, causes, management.
Photo of CRVO, identification, workup, management and treatment options if the patient is only eyed and needs early visual rehabilitation.

English examiner
Photo of corneal abscess with history of contact lens, management, complications
Photo of severe NPDR with CSME, identification, ETDRS definitions, treatment options. How to apply lasers for diabetic maculopathies.

Medicine and neurology

The most feared viva
English examiner
Metabolic causes of cataract
Management of a young patient with bilateral cataract
Investigation and criteria for Diabetes

Arab examiner
Causes of sudden loss of vision
Painless causes and detail in management of CRAO including cardiac and carotid workup
Painful causes and detail in management of GCA including steroid workup, complications of using systemic steroids and problems regarding sudden with drawl with management of Addisonian crisis.


I was through for the clinicals

Clinicals

I entered a small room with lot of patients. I was sweating and palpating despite a dose of Inderal. The examinersí smiling faces calmed me a lot. After that I didnít had time to think as the examiners were very fast and were trying to present all the patients. After 30 minutes they realized that all patients are finished so one of them went out and bring one more. But Alhamdolillah everything went smoothly. Following were the patients and the questions asked.

1st patient had penetrating ocular trauma with corneal repair with 10/0 nylon sutures which were loose along with iridodialysis. Asked about sequence of events, complications and other associated areas to look for.

2nd patient on indirect ophthalmoscope had multiple hemorrhages and hard exudates along with laser marks. Asked about possible diagnoses and treatment.

3rd patient on slit lamp had KPs on endothelium, thin cystic bleb and pale slopping cup disc. Asked about sequence of events.

4th patient had alternating exotropia. I was asked to check ocular motility. Deviation was equal in distance and near with no obliques abnormality. Asked about management, possible refractive error, visual status and chances of amblyopia

5th patient on 78 D, asked to look at the posterior pole. There was atrophic maculopathy with areas of retinal thinning. Examiner showed me his high myopic glasses and asked for a single diagnosis. Asked about other ocular associations, complications and possible visual rehabilitation.

6th patient, I was asked to observe grossly. She was a young female having a staring n frightening gaze. I also noticed lid retraction. I was asked about possible diagnosis followed by a brief discussion about thyroid eye disease as the bell rang.

Result was announced in the evening. I was entering the building with my heart pumping out of my chest when suddenly a fellow candidate greeted me that I have passed. My colleague Dr Fahad also cleared the exam. Thanks to Almighty Allah. My email address is shjafri77@hotmail.com. I will be delightful if I can be of any help to anyone going for FRCS.