Candidate 138

Final FRCS

Centre:    Muscat

   Date:    November 2009

I am Dr khattab Rabab. I appeared in FRCS Glasgow  in Muscat  in November 2009 and ALHAMDULILLAH passed with the grace of God from the first attempt. I dedicate my success to my family for their support and prayers without which I would not have been possible. I found this exam to be a constant battle of nerves, you have to keep yourself calm and confident. Here is my experience , I would like to thank Prof  Dr  Chua,  Prof Dr Muthu and members of his virtual Muthusamy university  who were very helpful  to me in preparing to enter the exam also I would like to thank Dr  Hussein Swellim  and members of Dr Ayman Elghonemy and Dr Mohamed Hantira for running a clinical course  in Muscat. I advise all my colleagues who are planning to enter this exam to be guided by the previous sites (Chua, Dr Muthu and

Day 1 Problem solving and MCQ:

Clinical case interpretation in FRCS Glasgow exam in Muscat 2009:

Case 1:

A 6-month-old baby girl is brought to you by her parents complaining that her left upper eyelid is drooping. On examination the infant appears to have bilateral ptosis, more marked on the left, and objects to having the right eye occluded. The baby seems to be otherwise well, although the mother was diagnosed with multiple sclerosis 2 years earlier. What are the possible diagnosis with this patient and how would you investigate and manage the case?


A 35-year- old lady presents to casualty with a 2-day history of severe pain in her right eye which has kept her awake at night. On examination the eye is grossly injected and there is a small corneal ulcer just at the limbus. Acuities are 6/12 right and 6/6 left. She also has history of rheumatoid arthritis. What is the differential diagnosis and how would you manage the case?

Case 3:

A 75- year-old retired accountant gives a 6-month history of recurrent severe headaches and for the last few weeks has also been aware of episodes of transient loss of vision on the right side. His acuities remain at 6/6 bilaterally and he is a lifelong smoker with mild repiratory disease. How would you further investigate and manage this patient.


Day 2 oral and viva:

Surgery  and pathology:

The first examiner showed me a case of unilateral proptosis of a young man, she asked me about the signs present and the differential diagnosis, the investigations needed, the causes of vision affection and how to manage in details.

The second examiner asked me to draw the site of incision of orbitotomy and the complications of angular vein injury and why this vein is in particular dangerous.

Then he showed me a pigmented lower lid lesion with lid margin distortion and madarosis and asked me about the differential diagnosis of the lesion, and the signs of malignancy, then he asked for the differential diagnosis if it was a benign one. He  asked me to draw the  incision for removal and the safety margin and how to close the defect.

He also asked about labeling of the specimen when sent to the pathologist.

Then he asked me how to manage a case of shallow AC 24 hours postoperative after trabeculectomy in details.


Ophthalmic medicine:

The first examiner asked me about a child of 3 years old presenting with periorbital oedema and pain for differential diagnosis and management in detail. Then he asked me about definition of secondary glaucoma, granulomatous uveitis and causes, ICE syndromes and its types. The definition of cystoids macular oedema and how the macula is examined (he means the lens used for examination).

The second examiner asked me about the optics of the 90 lens. The he asked me to draw the waves of normal ERG, from which cells they arise, the oscillatory waves. Then he asked me about Fuch’s iridocyclitis  and what is the complication that may occur during cataract surgery in such a case then he asked about  the relation between it and fuch’s endothelial dystrophy, how the patient presents, what are the investigations done, normal endothelial cell count, and if the patient is planned for cataract what are the precautions taken.

Then he asked me about a patient with large central corneal ulcer, hypopyon and history of trivial trauma, what is the differential diagnosis, and how you reach a diagnosis within few minutes.


General medicine and neurophthalmology:

The first examiner was an internist he asked how to manage a 75 years old diabetic patient with sudden loss of conscious followed by seizures few hours postoperative,

Then if signs of hemiparesis starts and what the investigation of choice now, and what favours thrombotic lesions versus hemorrhagic one and what you give until a neurologist manage the case. Then he asked me how to manage a young lady 34 years old on warfarin planned for minor surgery.

The second examiner asked me about thyrotoxicosis in details (systemic, ophthalmic and treatment given), arthritis with uveitis in a young male, uveitis in a child especially  rheumatoid arthritis and its complications. Other ophthalmic diseases affecting children then marfan syndrome in details.


Day 3 clinical cases:

Case 1:

The examiner asked me to examine the anterior segment, there was paracentral nebula, pseudophakia and PCO. The whole discussion was about the causes of PCO, how to manage, the complications and precautions taken to avoid them then he asked me what is the difference between the posterior lens capsule in  a young man and that of an old man.

Case 2:

The examiner asked me to examine the anterior and posterior segment of both eyes, the patient has bilateral conjunctival melanosis, glaucoma bleb in one eye, and primary optic atrophy in this eye. The other eye showed no abnormality except for a pannus and melanosis. The whole discussion was about the difference between a primary and a secondary optic atrophy and why I diagnosed the case as a primary optic atrophy.

Case 3:

The examiner asked me to examine a young man with unilateral ptosis and lid scar is seen, he asked me to also examine ocular motility, to do the cover uncover test (it was proposed by me before ocular motility), the he discuss with me every step in examination in details then asked how to manage and complication of ptosis surgery.

Case 4:

The examiner asked me to examine a 55 year old male with bilateral asymmetrical proptosis, I have asked to see his glasses, examined for proptosis and also I examined the ocular motility and there was diplopia when the patient looks up and laterally. He asked me to palpate the orbit.

Case 5:

the examiner asked me to examine the anterior segment of an elderly female patient, she had a pigmented iris nodules on the lid margin and the pupil was irregular due to involvement of the iris sphincter , he asked me about the differential diagnosis, how to manage, pathology of malignant melanoma and the prognosis, if cataract is planned what is the precautions to be taken,  and how pupilloplasty is done.


Thanks to GOD to help me to pass this exam, I would like to help any collegue who prepare to enter this exam, my e-mail is  


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