Candidate 144

Final FRCS

Centre:   Glasgow / Muscat

   Date:    2010

My Name is Hassan Thabet, from Alexanderia Egypt.Thank to Allah ( الحمد لله ) I cleared the third part of FRCS Muscat 2010. This done by the willing and offer of Allah, then by the warm prayers of some people I know that ALLAH likes them because they are good people احسبهم كذلك I want to thank after Allah, many many people ,I will name some of them. First, my supporting kind and wonderful wife who did everything to push me to success. My daughter (already Graduated from college of Art) and my son (still in college of engineering last year), for their unlimited support and bearing my stress and their praying every day.My friends who did pray for me and they are so many, God bless them all. FRCS and FRCOPHTH groups for their invaluable support and advises and cooperation all of them one by one. Special thanks to one of them Dr Abdlaesaid from Libyia , who met me in Glasgow and did many thing to me  that my words fall short to thank him. Dr. Hussein Swelim, I have no words to say for what he did for me and his worm pray which I felt them really, and his white hands on me, god bless him. Dr Muthu  and his wonderful virtual university who is my teacher and my  friend also who put my foots on the right way for how to pass FRCs either part 2 or part 3. The staff of ophthalmology department in the college of medicine in Alexanderia University and their unlimited support and their powerful scientific meeting held all over the year. Now Let me start by my experience in part 2 which I cleared it in November 2009 from the first attempt.  This experience I wrote it at that time and sent it to Dr Muthu and I think it is still viable. At that time we had 200 MCQs not 160 as the situation now and believe me I answered 189 MCQS completely then the residual time was one minute so I put marks on the last 11 questions without reading them because no loss marks and certainly no time.
This is what I sent to Dr Muthu:
Firstly,  my advices:
1- time is v. short and v.v.v. short for MCQs because there was 200 problems must be answered in 120 minutes which means that each question must read and answered in half a minute (30 seconds) so you must practice v. well on MCQs from all sources you found and don't forget the AAO questions at the end of each section and did this many times not once 
2- put a watch on your disk and check it every 30 minutes and must 50 MCQs be answered in these time if not try to harry up more and more
3- use the first impression method which means : after reading the problem (question head) put the answer you feel it is right by first impression and don't think bec no time for thinking
4- if one question you don't know it put a mark on any answer and not leave it empty bec no loss of marks in this type of exam if answer is wrong
5- no time for review so answer at once bec no time for revision
6- In problem solving , the question of medical emergeny is v. important and mandatory pass is needed in this question, so my advice is to start with it and try to prepare your self about the questions for any topics of these emergency
7- study the indications and side effects of the drugs commonly used in emergency like digitalis, beta-blockers,anti-coagulant,....... ect
8- distribute allowed time on the 4 questions and don't allow for any question to take more time from other questions 

now secondly: my suggestions:
1- for the emergency question , the college put a sample on the website and in the exam it was typical so my expectation about this question is:
- it is not a problem to deal with it as the other problems, no it always come with ahead problem with some questions to know that you are understanding the topic even if you will not deal with it as being ophthalmologist
2- about the other 3 problem solving,after reading the question, as you teach us sir, you will put the most probably diagnosis and my suggestion is  to follow this probable diagnosis by the plan for answering this question on the first page of answer sheet bec they want to know how you think as this example which i did in my exam:
the question was: " 75y old male patient has been referred for consideration for cataract surgery.Visual acuity measures 6/9 in each eye . on initial slit lamp examination, you note pseudoexfoliation material on the left pupilmargin. Intra-ocular pressure 28 mm in each eye.
How would you assess this patient and what management would you propose?
my answer was ( with each sentence in separate line ):
- the given data are: 75y old male
- pseudoexfoliation in one eye
- IOP is 28 both eyes
- VA is 6/9  OU
- want cataract suregry
- the most probable diagnosis is pseudoexfoliation galucoma with early cataract as VA is 6/9 OU
My plan is:
- I must first exclude ocular HTN .
- As the pseudoexfoliation is commonly unilateral in 70% and bilateral in about 30% of cases and this pateint has pseudoexfoliative material in one eye so i must  check and exclude other causes for glaucoma as POAG , other secondary causes , PACG and also sec angle closure glaucoma
- I must check the other eye
- i will check which causes for Visual affection is more apparent than the other , galucoma or cataract and deal with it firstly
- I will take care of the problems expected in this patient with pseudoexfoliation before and during surgery like:
1- raised pre-op IOP
2- poor pupil dilataion
3- weak Zonules
4- expected vitroues loss
5-post-op spikes of raised IOP
-then in the second page of answer sheet I started to answer the question as you teach us starting with history,....... ect.
- This will give the examiner an idea how you think .
- My advises for preparation for the exam :
- I recommend the following :
Firstly Chua website with every part in this amazing site
1- Kanski from the cover to the index
2- AAO part of general medicine
3- AAO part of neuro
4- AAO  some topics you will find them short or not enough in Kanski
5- any brief surgical book for the surgical procedure mentioned in Kanski as lid surgery, strabismus surgery, Cat, glaucoma  and nothing else but others as vitrectomy or RD , kanski is enough
6- no need for pathology book but what mentioned in kanski is enough
7- emergency topics of general medicine and study them from big text justy to understand them then from the group website there is a brief collecting this topics but after understanding them from a big text
8- some short notes on the common drugs used in R/ of common emergency topics as digoxin, warfarin,amiodarone, ......... ect
9- some short notes on the new procedures as CCLinking, lasik, Intacs,.Dsaek, Dalk....... only short notes no details except for yourself to understand
10- then the clinical part which need more practice and apply the procedures of examinations exactly as the college recommend (see chua pages video parts)
11- some Topics and DD collections from Moorfield book
I hope i did not forget anything

Now let us go to the first attempt in Glasgow :
Firstly I want to say that Glasgow is a v.beautiful city and I enjoyed this place v. much and I hope to go there again. The oral was in Royal college itself and the clinical was in Caldonian university as I remembered and it is a very well prepared place with all facilities and v. good equipments. There were 37 doctors and we examined oral in 2 days Monday and Tuesday, I was in first day.


There were three stations.

My first one was Medicine and Neuro ( the horrible one ) and it was my worst station:
He was a Scottish doctor started by telling me : I will tell you a scenario and you will then answer my questions , I said ok sir, his language was difficult to follow and his pronouncing is difficult to understand,he started to say that an old woman has some symptoms ( I can not hear what he say ) but I could get the word bilateral temporal hemianopia with sweating and thirst and something else, what do you think ?

A: I told him This is a chiasmal lesion , ask me where, I said may be pituitary, asked me where else , I said may be craniopharigioma, he asked in this age ? I said may be bec I has Bimodal presenataion but he is not satisified. Then asked me every thing about Atrial fibrillation and drugs used in R/ and doses and side effects in v. details. He then started to ask me many questions about this situation and I hardly could follow his language and many times I asked him to repeat what he said , and sorry I could not remember anything from what he said. Then the other Dr also was a Scottish and asked me about Epilepsy in details and nothing else  only epilepsy although he could feel that I am not so well prepared in this topic but he never shifted to another topic until time is finished (I failed this Viva completely as in the feedback)
Then in the rest time (only few minutes) I was depressed and started other situations with  depression and blocked mind and many questions they asked me some I answered good but others are not, and this is what I remembered in that time :

In  surgery and pathology Viva:

One patient came to you one month after Cataract surgery with diminution of central vision (CMO) how to manage ( doing OCT first to establish the diagnosis and also for FU then start conservative by topical NSAID and acetozolamide systemic then if not rsponde after 2 months -------- IVTA , dose , procedure …… everything about IVTA and its complications either operative (RD , Vit hage, endohthalmitis…. and Post operative as high IOP , cataract …..)
Then ask me about Graves disease and pathogenesis of TED and every point in this topic
Second Dr asked me about  Drusen of Optic nerve and how to confirm ( autoflroesecnce ,US, CT) and which is better (US) and its complications (CNV)
Then asked me about Aniridia everything about it and genetics and associated (WAGR syndrome) and FU of sporadic cases by US  for Wilms tumor (  I passed this Viva completely)

The last one was Medicine and it was my best one and I passed this one also
There was a male Dr and female Indian dr and both are v. gentle and helpful. Started by showing me a picture of anterior segment with shallow AC and moderate corlea oedema and told me this patient had  IOP 45 what is you DD and how to mange, then asked me in details about ACG and management and his last question was : any thing you can do on the Lens to treat him ? I said yes we can remove the lens specially if it is cataractous or even has mild opacity and value of the procedure and he was pleased from our discussion
Then the nice  Lady asked me about 6th N palsy , causes , how to manage either medicall and surgically and after how long you will interfere (at least 6 months), and how ( if paresis or paralysis )

Then showed me a picture of epibulbar dermoid in a baby and how to deal with it (don't forget to assurance of the parents and most  important is to refract the patient bec may have high astigmatic error in this eye which is amblyogenic )

The after 2 days was my clinical one:

I started by the Neuro and ocular motility :He was Nigarian DR and he was helpful one. There was 2 cases one is INO and asked me to do ocular motility and the other was  confrontation test for constricted field and causes of this constrictions (advanced glaucoma, RP, extensive PRP…….) I passed this one

Then post segment one: A macular scar  OU but our discussion was not good. Strange mid peripheral lesion I could not diagnose it  but give some DD but the examiner was not pleased .  I failed this one completely

Then Oculoplastic :A case of one with artificial eye , causes of enucleation , types of implants. The other eye has proptosis , causes and what is the common cause (thyroid) and how to manage , and complications of TED and what is the most serious (optic nerve compression) how do you diagnose it (decreae VA, APD , color vison) how to treat it (urgent IV steroids , then decompression) he was statisfied. Second one showed me a female patient setting and told me : without touching her she came complaining of watering ou , what are the causes ( I told him some but he not satisfied) then asked me what is the most useful clinical test you do in your clinic to diagnose her condition , I said fluorescence clearance test but he said no , and asked what ? I did not know and he wanted Syringing  !!!!!!  I forgot everything about it. So in this one I had one pass  and one failed

Then last one was anterior segment :A case of bil iris coloboma with also post pole coloboma but our discussion was bad. A case of aphakia in one eye and phakic in the other eye  also the discussion was bad bec some questions I did not understand what he want. So I got one pass and one failed in this one

So my final feedback was one complete Viva failed  (medicine and neuro) and one complete clinical failed ,and 2 parts failure in 2 different clinical situations. So the final result was Failed. But I got many benefits from this exam, I know how to study again and which parts is to stress and my weak points to strength them and the most important part is general  medicine  so I studied it from a big text (the emergency topics only but with big details) and it was Clark's and Kumar medical Text

Then come now for the successful attempt but firstly I have some advices

My advice are:
You must  study every word in Kanski and Keep a complete copy of Kanski in …. Your mind. Sometimes you said , this part is not important , but you are wrong they will ask about it so kanski ..kanski..kanski… every word …. every letter in it
Any picture of intraocular mass in adult in the exam  – it is Melanoma until proved otherwise. Any intraocular  mass in child it is a retinoblastoma until proved otherwise. There were 69 of us (and 29 passed)

My first Viva was surgery and pathology
2 Doctors one was DR Fathi Elsayad and an English Doctor and both are v. gentlemen and helpful.

Q- showed me a paper wrote on it the following : child aged 5y, with glasses +4.o and seeing 6/6  Ou with altern ET 30 PD at near and Far, how to manage ?
A – I will recheck his refraction under cycloplegic again
Q- ok it is the same then what?
A-This is non accom. ET so I will go for Surgery
Q- what surgery ?
A- Bil medial recession as Et is equal in near and dist
Q- how many mm recession ?
A- About 4.0 ( the right is  4.5 mm)
Q- what are complications of this surgery ?
A- anaethesia complications firstly
Q- skip this , what else
A- operative like bleeding, slipped muscle, sclera perforation
Q- what you will do if sclera perforation happened ?
A- I will call retinal surgeon (this is the right answer)
Q- Ok but he is busy so what you will do
A- I will dilate the pupil and examine the fundus by indirect ophthalm. And check the status of retina and if everything is ok I will complete my procedure then next day I will send him to retina consultation
Q- Ok , what this  ( a picture of non-pigmented large mass over the optic Nerve head area) I did not see like it before
A - I will give DD
Q-  OK
A- I started by : metastasis , then stopped  and non pigmented melanoma not come to my mind at all bec the strange of the mass morphology
Q- could be Melanoma?
A- oh yes Sir
Q- Ok it is melanoma so how you will manage ?
A- I will be sure first it is melanoma by US , then according to the condition of the other eye and age of patient and location and size and if there is metastasis or not and if there is extracocular extension or not
Q- ok for this picture ? no metastasis and no extraocular extension
A - as this is large tumor , I will go for enculeation
Q- patient refuse to do enculeation?
A- I will think of Brachytherapy (this is wrong as the tumor is over the area of optic nerve and this is inaccessible  to put plaques
Q-  can you reach this place to put plaque ?
A- No sir it Is difficult
Q- so what ?
A- I stopped
Q- you will not do anything in outclinic for this old man?
A Oh yes Sir , we can do TTT ……..  Bell rang

Then start the other Dr (Dr fathi Elsayad)
Q- 55y old did cat since 3 days and come to you with painful eye and decreased VA and red eye, what do you think ?
A- I will think first it is post-op endophthalimitis 
Q- what else ?
A- Retained lens matter
Q- how retained lens matter cause pain
A- by elevating IOP and causing iritis
Q- Ok, it is endophthalmitis how you manage ?
According to level of VA , if better than PL I will give intravetrial injection and if Va is PL or less I will go for vitrectomy as EVS said
Q- what AB you will give
A - I will start by vancomycin and Ceftazidime
Q-Why vancomycin and why Ceftazidime?
Vanco to cover GR+ve and ceftazid   to cover Gr –ve
Q- ok , what is  the dose
A- 1mg in 0.1ml
Q do you use systemic AB
According to the study no effect of systemic AB but new quinolones has effect
Q- how you give it?
A Ciprofloxacin 750mg twice daily for 10 days
Q- what is this ( picture of optic nerve with a large whte mass appear attached to its apex ) exactly as in Kanski
This optic N. tumor may be glioma or memenigioma
Q – he is boy aged 5y
A- Most probably Glioma
Q- What is the histopathology ?
A- (I tried to remember  but I failed ) so he shifted to another question
Q- how this  patient will presented to you ?
By proptosis and decrease VA
Q- which is first proptosis or VA
A- proptosis
Q- if proptosis is mild and VA is good what to do ….. bell rang but I said :
A - Observation

Then the deadly Viva Medicine and neuro
2 Drs One omanian and the other is Dr Basaek  (Indian one). The omanian Dr start by telling me a Scenario of:
Q-The nurse calling you for a patient aged 70 y was waiting  for cat surgery and vomiting blood with the following HR 110 and BP 90/60, Resp rate 25 how to manage
A- This is hypovolumic shock I will start by ABC
Q- What ABC stand for ?
A- A = patent airway , B = breathing  C= circulation
Q- Then what? What you will give him
A-  I will Give him Crystalloids as Saline or Ringer's lactate
Q- if you have blood available is it better to give or still you will give saline ?
( I got his point bec in this age and situation it is better to start with blood transfusion)
A- No sir I will give Blood
Q- Ok what else ?
A- He is shocked so also I will treat him as a case of shock  by giving epinephrine, antihistamincs ……
Q- when you give Bl transfusion what are you afraid from?
A- Reactions like fever Chills , rigors , and the most serious haemolytic reactions
Q- if you know the reactions of blood transfusion  as fever , Rigors and other do you give him something before  transfusion  as antipyretics or antihistamincs?
A- If this the first time he take blood I will not give him
Q- why ?
A- Bec these symptoms may indicate serious reaction and if I gave him pre-medication these signs will be not clear for me
( he smiled and said ok )
Q-  what is the causes of Atriall fibrillation?
A- May be cardiac or non cardiac , cardiac like Mitral stenosis, MI, pulmonary embolism, non cadiac as Thyrotoxicosis, ecessive cofaeine, smoking
Q- how you mange him
A- I will either do Rate control or Rhythem control
Q- till me some drugs used in AF ?
A- Amiodarone, digoxin, Virapamil, and warfarin
Q- why warfarin?
A- As prophylactic of  thrombosis formation
Q- what is side effects of warfarin?
A- Bleeding, skin photosensitivity, gray color of skin face, sometimes necrosis of skin
Q- ok what you see in this picture ? (he show me a discrete pigmented lesions at the macular area looks like of RP I never seen like  it before)
A- I started by describing  It looks like RP Sir, it is bilateral sir ?
Q- No , and it is raised lesions
A- My be ……. I stopped
Q- it is Metastatic !!!!!! so where the common place for the  primary lesion?
A- In male ---- brochus  and in female -----, breast
Q- ok tell me some drugs used in treatment of  AIDs?
Q- name some drugs
A- Ziduvodine,  …….. Bell rang (I saved by the bell bec I did not remember others bec difficult names)
Then Dr Basaek start the other situation by shocked question!!!
Q-  tell me about Post fixational blindness
A- I shocked , I don't know it at all, so I quickly told him, I don't know Sir
Q- Ok , how patient with pituitary tumor will present to you ?
A- There are systemic and ocular features
Q- I mean about his visual field ?
A- Bitemporal hemanopia
Q- he will come to you telling you he has Bitemporal hemanopia!!!! He was some angry , how he complain ?
A- He will complain from peripheral field loss
Q- this is what I asked for and this is the postfixation blindness
Q- Now tell me some systemic features of pit. Tumors
A- according to the  type of adenoma and the secreted hormones, so if  GH so will be Gigantism in infancy or acromegaly in adult, if cromophobe he will has prolactinaemia
Q- what is C/P of prolactinaemia
A- Dymsneorrhyea, infertility and gynacomastia he was not satisfied)
Q- female patient aged 23y come to you with bil dic swelling what you do for herv?
A- First I will exclude causes of pseudoDisc swelling
Q- like what?
A- Tilted disc, Mylinated N. fiber, hypermetropia
Q- what Else ?
A- Drusen of optic disc ( I was forget it but then I remembered)
Q- how you confirm it is Drusen
A- By US or CT
Q- what else ? I for get to say autofloeuscence which is the simplest answer ) so again said : non invasive method without costing ?
A- Oh sir, autoflourescence
Q- what common causes of disc swelling in this female ?
A- It may be PTC (pseudotumor cerebri)
Q- how you confirm ?
A- It is a diagnosis of exclusion so I will do first neuro-imaging to exclude space occupying lesions
Q- what type of neuro-imaging?
A- Better to do MRI bec we look for soft tissue lesions
Q- then what ?
A- Doing lumbar pucture to measure the ICP
Q- what are causes of PTC
A- It is idiopathic sir,
Q- only idiopathic !!!!??? or other causes ??  like drugs or……
A- Yes sir, drugs like Tetracycline, Vit A, nalidexic acid
Q- what else in females particularly
A- Oral contraceptives
Q- what is the first advise you tell to this patient
A- Weight loss
Q- yes, what else ?
I stopped (but I must say I will advise her to stop drugs she used!!!!! It is logic but where is my mind in these moments ??)
Q- Ok , describe this picture ( he showed me a picture of  fundus picture with upper part of  hages and necrosis of retina , I described what I see
Q- what is the Diagnosis?
A- It may be CMV or ARN or PORN
Q- he is healthy patient
A- So may be ARN
Q- how you treat him ……….. then the happiest moment came  , Bell rang  , thank God
Wow it was deadly station and I was exhausted

Then the Last station ophthalmic medicine
Was 2 gentlemen English Drs and v. helpful. He started by showing me anterior segment picture  with something like adhesions between lid and conj . it is not clear from the first moment by he guided me to the area of adhesions
Q- what could be the causes for adhesions?
A- It may be  cicatrizing conj like old trachoma, steven Joh syndrome, acne Rosecia
Q- what else?
A- Chemical burn
Q- what else ? he want OCP
A- I want to say OCP sir but I looked to the Carancle and it is ok so it is not OCp
(he was pleased and nodded ,saying  yes you are right )
Q-  he show me another ant segment picture  of a child with bil skin eczema around the eyes affection both upper and lower lids  what you see in this picture?
A- I described what I see
Q- what could be the causes?
A- May be drug eruptions
Q- what else?
A- Eczema
Q- the child is asthmatic
A- So he is atopic patient, so may be allergic  dermatitis
Q- how you treat him?
A- Emoluent like hydrocortisone oint. 1% topical
Q- do you see any other thing in the picture , look to his left eye
A- Oh yes sir he has ptosis
Q- ok what time of ptosis?
A- It is mechanical
Q- how you treat it?
A- By treating the cause
Q- what you see ? he showed me a picture of  dendritic ulcer on the temporal side of Rt cornea stained with Flourscene
A- I described what I see and told him this is Dendritic ulcer

Then the Bell rang. But the other dr continued on the same picture :
Q- what is the C/p
A- Redused corneal sensation
Q- how you test C. sensation
A- Simply by a filament of cotton or thread and touching the cornea from temporal side and the patient looking straight a head
Q- what drugs you use in R/?
A- Acyclover   
Q- what else
A- I can't remember another drugs
Q-Do you use steroids ?
A- In stromal affection after epithelial healing
Q-  do you do Culture?
A- No need sir but if I will do I will do PCR
Q- how you do PCR ?
A- ( I started to think but he shifted to another question , thanks bec I don't know)
Q-  causes of ocular pain and decreased VA in young guy?
A- Corneal ulcers or keratitis, iritis, acute attack of glaucoma
Q- and in post segment?
A- Optic neuritis (he want this answer)
Q- how optic N. cause pain
A- Bec the adhesion of MR and SR to optic N at thenorigin of these muscles
Q- how you treat him?
A- By 3 days IV prednisolone methyleacetate 250 mg 4 times followed by 11 days oral steroids 1.0 mg/KG/dayt
Q- what is the common cause in this age?
Q- how you confirm
Q- what you will see on MRI
A- Periventricaular  white plaques of demylinations
Q- what clinical test you do to confirm , clinical test (he stressed on clinical test
A- APD by swinging test
Q- Yes, ok, any thing to inject than steroids?
A- Yes interferon
Q- how it works
A- I don't remember sir
( he laughed and said you don't remember!!!!!!! , no , no you did not know, I smiled)
Q- what are percentage of people to get MS after ONeuritis
A- I said 34% (but the correct is 38% in kanski)
Q-a guy come to you with ptosis and variable diplopia, what do you think?
A- I will think of MG?
Q- what is MG (he need the definition)
A- It is autoimmune disorder affecting the  AC receptors at synaptic nerve ending causing………….
Q-  how you confirm?
A- Simply by ice test or Edrophonuim test
Q- how you differentiate between between MG and Dystrophia Myotonia?
A- DM is AD with delayed relaxation…..  bell rang
Thank to god , lastly I finished this difficult part

My clinical was 2 days later

Clinical exam

First station was posterior segment: 3 cases.
First case was mylinated  N. fiber around the optic disc and surrounding with white band at the periphery involving the whole circumference(it was a  circulage)
Q- did mylinated N. fiber affect VA or VF
A- No sir it just may cause enlarged blind spot in VF.  DR with PRP peripheral. RT ARMD with hage and exudates with severe MO and other eye was soft drusen confluent Questions are just what is the diagnosis bec time is v. short
Then the bell rang

Second station was neuro and ocular motility :3 cases.

A Man in fifty age  and asked me to do Confrontation test  I did it and it Was a case of Rt lower altitudinal defect
Q- what is DD
A- Glaucoma, Ant ischemic ON , (I forgot BRVO or BRAO). Girl with dist XT corrected with glass (he told me her glass is -1.50 OU) and asked me to do Ocular motility. I asked him if I can do Cover uncover first he said do it. I removed the glass  and did it with and without then motility and it was present  altern XT on dist only  when removing the glass.
Q-  he asked me how to treat her
A- Just glass sir as she corrected by it.  Rt brown syndrome
Q- how you treat him
A- As eyes are straighted in primary position and no head tilt so just observation and FU

Third station was  Oculoplasty and lid: 2 cases

Rt ptosis in a boy aged about 15y  asked me to do measures of ptosis by a ruler
Q- what test you must do ?
A- Coneal sensation, motility
Q- what else ?
A- Bell's phenom . Lady with Rt proptosis and  left enophthalmous and asymmetrical face. Asked me to do measures of proptosis and give me Hertel and asked me what is this I said Hertel , he said ok use it , I said no sir I don't use it But I use  a ruler.  He let me measure with the ruler and it was 21 mm. He asked me what is possible cause of left enophthlmous , I said may be Trauma and fracture bones of the face and orbit (he did not comment)

Forth station was Anterior segment:    2 cases
Man with left sutured penetrated wound  and the sutures not buried with rupture cap with cataractous lens matter in the cap
Q- what you will do for him if come to you for first time?
A- I will do first x-ray or CT to exclude IOFFB then I will do primary repair  to close the eye and keep th integrity of the eye then  next day I will examine him copmpletly and manage according
Q- if x-ray or CT is not available what you will do?
A- I will do US on closed lid ……. , (she staring at me as if warning me ) … No , no Sir it is opened wound so I will do primary repair then next day I will do everything for him. Second case was Lady with Rt Diffuse opacity looks like macular dystrophy with 2 rubbing lashes and left Clear Graft
Q- what is the is the diagnosis?
A- I described what II see then asked him to examine the other eye , he said ok then I told him it looks like Macular dystrophy bec the interval between opacities are also opaque
Q- could the rubbing lashes causing this diffuse opacity?
A- I did not think that Sir
Q- why?
A- Bec Rubbing lashes causing epithelial opacity but this opacity is deep and involving the stroma deeply
Q- if I told you that she did entropion operation in left eye (Grafted eye)
A- No answer ( but the correct answer is she must do entropion operation to keep her graft clear otherwise rubbing lashes will do opacity on it )
This was the last station in the clinical exam

I tried to write every thing with details bec I know it will be beneficial for every colleague than just mention the questions . I hope I did not forget anything. I will be happy to help any one or answering any question about the exam
My email is
Thank you v. much and best wishes for every one
Hassan Thabet



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