Candidate 146

Final FRCS

Centre:   Muscat

   Date:    Dec 2010


My name is Dr.Wessam Badawy .thanks to God I finally passed the final FRCS exame in Muscat 2010. I want to thank all my friends inside and outside magrabi eye hospital for all support they provide to me all the time. My special thanks go to my father and my family. Books which I studied during FRCS studies WONG, KANSKI, WILLS, and many thanks for Chua eye site which was the main resource for me during FRCS study. Let me share my experience of my examination:


English and Arabian female professors ,starting with the English doctor :

1-picture of cobble stones and asked me Q: What is this? A: Cobblestones Q: What are the causes of this picture ? A: Vernal KC, CL wear ,prosthesis Q: How to manage this case? A:  I will take history from the patient and according to the cause I will manage, if the cause is VKC I will start with antihistaminic , chromoglycate ,mild steroids, N acetyl cystiene if there is any mucus ,if more severe supratarsal injection of steroids. If cl wear remove cl and topical steroids if no corneal ulcer,if prosthesis remove and medical ttt until the eye is quite . Q: What are the complications of CL wear? A: Dry eye,infective keratitis,recurrent corneal erosions
Q: Management of dry eye? A:ttt of the cause ,humidity, lubricant, mild steroids,if more severe temporary plug then may be permenant plug.

2 ESOTROPIA in the primary position since one month in achild aging 5years A: accomdative esotropia,duane type 1,congenital 6th n,rarely if truma medial wall fracture Q:How to manage this case ? A: I will take ahistory from the relative of this patient ,glasses, trauma, onset ,course ,duration ,I will do cycloplegic refraction for this patient ,and I will manage according to the cause. Q: how to manage accomdative esotropia? A: history,cycloplegic refraction ,ttt of amblyopia,I will give the patient full cycloplegic refraction and I will see if fully or partially accomodative ,if fully continue on glasses, if partially I will transfere this patient to squint department for surgery.
Q:what type of surgery?
A:bilateral MR recession,and correction of IOOA and DVD if found by anteriorization. Bell rang(good session)

THE ARABIAN FEMALE PROFESSOR: (did not do well in this session) Q:what do you know about the the hypersensitivity reactions? A:types 1,2,3,4
Q:tell me the names? A:ianswered type 1 mast cell …..and then rapidly ianswerd I can’t recall. She told me you should know the names .then she asked me:
Q:tell me about an example for each type from ophthalmology ? itried to keep calm and answerd A:type 1,anaphylaxcis and VKC ,ididnt recall type 2,ocular cicatricial pemphegoid for type 3,corneal graft rejection for type 4. Q:how to manage all these situations? A:management all these situations respectively according to the cause(describe in details).
2nd question:metamorphopsia in apatient 50ys . A:macular lesions such as,macular hole,epiretinal membrane,CNVmembrane,and rarely late CSR.
Q:if the patient is myopic A:starting chorioretinal atrophy,and fuch,s spot ,CNV membrane
Q:if the cause is CNV membrane how will you manage? A:I will take history,onset,course,duration,ask about glasses ,and examination of anterior and posterior segment. I will do FFA and OCT for this patient. Q:what will you find inFFA A:ianswerd well Q:how you will ttt?: A:MACULAR PHOTOCOAGULATION STUDY (in details)
Q:she asked me about new ttt of CNV membrane?
A:if subfoveal or juxtafoveal photodynamic therapy,and the newest intravitreal injection of avastin
Q:she asked me a newest question about the comparison between the prognosis of avastin in CNVM due to age releated is better or due to myopia (isaid both of them has poor prognosis but idont know actually)iknew after this that it is more better in myopia from oxford without cause.
ifinished this session but ifelt that ididnt do well,when ifelt depressed the other English professor saved me and told you have about 2ms can iask you aquestion,irapidly said yes of course,and asked me about symptoms and signs of giant cell arteritis and I answerd well.bell rang

SURGERY AND PATHOLOGY (DID WELL IN THIS STATION) ARABIAN AND ENGLISH EXAMINERS ,starting with the Arabian one: Q:female patient 50ys with sudden eye ache,shsllow ac, and IOP =40? A:most propably acute congestive glaucoma. Q:signs of acute congestive glaucoma? A:lid edema,ciliary injection,corneal edema,flare and cells,semidilated fixed pupil,remasure IOP to confirm Q:how will you manage this case?
A:acute manangment
cidamex ,predfort,cosopt,antiemetic
after one hour:pilocarpine bilateral if not improved mannitol or glysrol(1g/kg) ,PI ater clear cornea,if persistant rise SST
2nd question:
Q:young patient 7ys has lt hypertropia 10prism ,head tilt to the rt
A:lt 4th npalsy
Q:how will you manage? A:I will take history ,truma,onset ,course, duration. Examination,cover uncover,motility,3 step test. Investigations:hess chart
treatment:superior oplique tucking ,and if there is IOOA I will do IO recession. Q:the examiner asked me if there is any way to manange instead of surgery? A:ianswerd use glasses first ,if not benefit use the prism.bell rang (good session)
the 2nd english examiner:
Q:5ms baby with epiphora
A:ianswerd congenital NLDO,congenital glaucoma,and ishould exclude conjunctivitis and blepharitis.
Q:how to manage congenital NLDO
A:massage,probing after 1st year,may I do another probing(rate of sucsses more than 90%),ballon,finally DCR
THE 2nd QUESTION:precautions of ECCE in high myopic patient(pre,intra,post op)completely from wong
Still there is enough time for 3rd question:
3rd question:isaw apicture of aswelling releated to lateral canthus
A:basal cell,squamous cell carcinoma
Q:how to manage A:excisional biopsy,frozen section,cell nest if BCC or intrdermal keratin pearl if SCC. Bell rang(completely happy)

GENERAL MEDICINE AND NEUROOPHTHALMOLOGY: English professor and Nigerian professor starting with the English professor 1st question
Q: patient with chest pain and he will be prepared for cataract surgery tomorrow and this is his ECG and he put an ECG infront of me
A:ipassed the 1st irritable moments ,and itried to find any abnormalities but ididnt find,ianswerd that ididnt find any abnormalities,the professor smiled and told me that ishould give you an abnormal ECG because it was anormalECG.the prof asked me how will you proceed? told him that I will cancel the operation and I will send this patient for investigations. Q:what kind of investigations? A:itold to him cardiac enzymes,echo(iknew also that ishould answer stress ECG) 2nd question:multiple cavitations in the lung? A:ianswerd TB,WEGNER,BROCHOGENIC CARCINOMA Q:investigations of TB? A:chest xray,tuberculin test Q:TTT of TB? A:rifampicin, ethambutol, isonizide
Q:what are the complications of these drugs? A:optic neuropathy Q:what is the specific drug of them causes optic neuropathy?
A:isaid after moments of thinking isonizid then ethambutol.(no comment from the examiner) Q:how will you manage optic neuropathy? A:isaid stop the drug Q:he asked with asmile ,what is the actual ttt?
A:ididnt recall,but he answerd me pyridoxine,isaid yes vitaminB6.he nodding his head
THE 3rd QUESTION:female with rash on the nose and the face A:isaid systemic lupus,acne rosecea. Q:if she has arthritis? A:isaid systemic lupus. Q:what are the anterior and posterior segment manifestations of systemic lupus? A:completely from wong Q:what are the investigations of systemic lupus? A:ANA,Anti sm ab,Anti DNA ab,ESR for vasculitis bell rang (did well in this session)

SECOND SESSION THE NIGERIAN PROFESSOR:picture of central retinal artery occlusion in apatient 65ys with preserved cilioretinal artery and discussion about causes and treatment of CRAO and the professor wants to say GCA 2nd question:cause of unilateral proptosis
A:thyroid eye disease
cause of bilateral proptosis
A:thyroid eye disease and discussion about investigations and ttt of thyroid eye disease and the end of this station by the most important radiological investigation
A:my answer is CT ,he asked CT or MRI.
A:CT bell rang but he asked me what you will find in CT
A:proptosis,enlarged EOM


POSTERIOR SEGMENT SESSIONS: 1st case: with 90 lens Q: What do you see in the rt eye in this young patient?
A: I see retina flat under silicon oil and I said that this patient did pars plana vitrectomy in this eye with s.oil. I asked the patient if he is diabetic or hypertensive but the answer was no. The professor asked me what you want to do in this patient? A: I want to see the other eye ,go on,ifound macular hole. The discussion about the indications of surgery in macular hole especially he is a young patient ending with(parsplana vitrectomy+gas+posture)

2nd case: young patient with indirect ophthalmoscope A:isaid isee mylinated nerve fiber,and isee luster of s.oiland retina on under s.oil.the professor told me look to the temporal side  I answerd ican see an old tear flat under silicon oil and I can see all the retina is elevated most propably due to buckle effect.iasked the professor if this child exposed to truma.he said yes,itold him this patient had retinal tear and detachment after truma,and he did ppv,s.oil,sclera nodding,bell rang .

2nd session : (did well)
1st case: motility for ayoung male
A:limitation of abduction/OD +narrowing of the fissure(DUANE TYPE1)
2nd case:motility for young female A:limitation of abduction only /OD.(6thn palsy)and discussion about the causes for this patient in this age. (we have enough time for 3rd session)
3rd case:pupillary reaction for old male
A: ifound RAPD grade 1 and discussion about the causes and pathway of light perception.bell rang

3rd session:LID AND OCULOPLASTY(did well): 1st case:congenital ptosis/OD and measurements in details.the trick in this case that the patient has moderate levator function (8mm) and he is for levator resection not brow suspension 2nd case:old female patient did tarsl fracture procedure for entropion and has dermatochalesis and discussion about the differance between dermatochalesis and blepharochalesis and also about the complications of the operation(the examiner was so cooperative in this case) . bell rang

4th session :ANTERIOR SEGMENT 1st case:corneal rupture globe with 10 nylon sutures,traumatic mydriasis,aphakia.the discussion about ttt of the cornea after removal of suture ,how to deal with the photophopia from traumatic mydriasis(colored CL)which ididnt tell,and ttt of aphakia(no ACIOL because of the cornea and traumatic mydriasis,for asenior consultant for sclera fixation).perfect answer is aniridic IOL which ididnt tell,{not happy with this session}
2nd case:middle aged male with diffuse corneal opacification as I described Q:what is your diagnosis A:can isee the other eye the other eye PKP+cataract extraction+IOL Q:what is your diagnosis A:may atype of dystrophy Q:did you see any vascularization? A:yes,superiorly Q:normally you can see vascularization with dystrophy A:no Q:what is the cause?
A:may be accompanied by conjunctivitis for any cause.he told me yes, iasked him can iexamine the eye again ,god helped me to evert the lid and ifound PTDs so ianswerd corneal opacification and vascularization due to trachomatous keratocojunctivitis,then normal discussion about the ttt thanks for you my god for success in this exame,no one can imagine my happiness when isaw my number in success god in this exame and tell to yourself that you do your best and if ididnt succed sure god will preserve for you best because you deserve this.
if anyone wants any help my email:



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