I am Dr. Mohammed
Ali Al-Shekeil, from Yemen.
Alhamdulellah I passed the final FRCS held in Amman this
May 2011, I dedicate my success to my parents, family, patients,
colleagues for their help, prayers and support.
I would like to thank Prof. Dr.
Mahfouth A. Bamashmus who
was a great brother, supporter and teacher.
Also I would like to thank Prof. Dr.
Abdulmungi Al-Said for his
help, and I would like to thank everyone in the two great groups FRCS
and FRCOphth especially Dr. Ayman
Elghonemy, Dr. Ahmed Sallam,
Dr. Samer Bashir and Prof
Chua for his nice site and
Prof Muthusamy Palanisamy
for his great help especially for my early preparations.
My reading list was as follows:
1. Kanski (Basic Knowledge).
2. Wills eye manual.
3. Ophthalmic review (A case study approach) for
Kuldev Singh and others (A great book for both part 2 and 3 FRCS) I
find it one of the main sources for the FRCS exam (My opinion).
4. Ophthalmology clinical signs and differential
diagnosis by Kanski (very nice for pictures and D/D)
5. Essential Ophthalmic Surgery (very nice for
surgery and I add some points from other sources – malignant
hyperthermia, slipped muscle management in squint surgery …) my advice
in surgery is to concentrate more in indications and complications of
6. Pathology: from Chua site is more than enough.
7. Reading all discussions and Presentations in
FRCS and FRCS groups for years, I am a silent member.
8. Medical Emergency: ‘notes in FRCS group and last
chapter from Oxford Medical book and all possible topics (Bleeding
problems, Upper GIT bleeding, cardiovascular, respiratory, endocrine
and CNS related to emergency or the eye,…..)
1. PATHOLOGY AND
SURGERY (British examiner and female examiner Maybe
There are many questions but I can’t remember all
Q: Scenario, of a patient 4 weeks post cataract
surgery with decrease vision?
A: I started with many possible causes; they want
steroid induced glaucoma, then discussion about Pathology,
Q: picture of bilateral Exophthalmous and
A: it is a typical picture of Thyroid eye disease,
Discussion about pathology all clinical picture and presentation,
cause of loss of vision, management … And also the management of
muscle restriction, when to do surgery? Why
recession not resection (fibrosis) and what are the complications of
surgery? (squint surgery complications)
Q: Picture of bilateral senile ptosis??
What you will do?
A: examination, measurements, other test (ask
patient to clause the eyes, Bells phenomena, corneal sensation, …….,
Really I can’t remember the other questions
MEDICINE (Pakistani and British examiner)
Q: Fundus picture.
A: Angiod streaks, pathology..
Q: scenario of decrease vision after
A: all possible causes, but he want CMO, how to
examine, Lens type (fundus contact lens), Features in FFA, Other tests
(OCT), what you will see? (Cystic spaces), which layer? Management?
self limiting , patient job …what medicine?..
Q: Picture of very big right skin
ulcerative lesion lateral to the lateral canthus?
A: I described what I am seeing, Most common cause
is BCC, Other causes SCC, Management? Surgical excision, chemotherapy,
radiotherapy.. Is it enough?? No, exenteration . What you will do
before all these?? (Biopsy).
Q: scenario of a child with white pupil?
A: all D/D of leukocorea, then detailed discussion
on retinoblastoma, pathology? Management? Why necrosis? Fast growing,…
Q: Drugs used in treatment of glaucoma?
A: all drugs…
Q: Picture of left eye ectropion with a
A: causes of ectropion, he want the paralytic
cause, and management (types of surgery)
Q: Picture of lateral tarsoraphy??
A: it is lateral tarsoraphy, other possible
causes?? Steven Jonson syndrome? Sicatricial pimphigoid?? Indications
3. MEDICAL EMERGENCY AND NEURO-OPHTHALMOLOGY
(British and Arabic examinars)
Q: Fundus picture with small pigments (looks like
retinitis pigmentosa but in central distribution) and he said that
there is a central elevated lesion?
A: at the end after D/D it was a metastasis from
other malignancy, from where? Lung in male, breast in female, other
Q: Fundus picture?
A: It was a CMV retinitis, detailed discussion
about treatment, ..
Q: Fundus picture?
A: it was of CRAO? In neuroophthalmology??? Okey
what you would like to do?? Patient is 65 years??
If patient have headache? Oh yes I will ask about
the history of headache, scalp tenderness, jaw claudicating, etc. what
you will do? ESR, CRP, TAB, for AAION in GCA.
Q: scenario, pregnant lady with right
central depression of VF? I can’t remember the rest of question)
A: I will do Brain CT Scan, after history and
examination (pupil…) for what? Mass occupying lesion, I will think of
junctional scotoma, he asked me to draw it, is it risky for the baby??
Yes, hormonal disturbance, also I mentioned the pituitary tumor as a
cause also I will think of other possible causes (HTN).
Q: Iris Picture?
A: Lisch nodules, then a discussion of
neurofibromatosis1 (skin and eye manifestations) , O.N. Glioma, …
Q: scenario, After a FFA injection patient
developed skin rash??and??
A: I will think of anaphylactic shock, what you
will do? Stop, call for help, ABC ……….etc
If the same patient came to you after 3 weeks
again, Are you going to do for him the FFA?
Station I (Britsh
and Pakistani examiners)
1. Oculoplastics & Lid Disorders:
A case with bilateral tearing
O/E bilateral elevated lower puncti (Punctal
elevation), and senile ptosis (examination and managmenet).
A case with right lower lid small ulcerative mass
Basal cell carcinoma, management, flap??
Station 2 (Dr.
Khalid Al-Shareef and British examiner)
2. Anterior Segment Disorders :
Young man for slit lamp examination:
Bilateral cornea plana, discussion about possibilities of refractive
surgery, K reading, AC depth…
Slit lamp examination, Man with left eye med
dilated pupil, PI and Ahmed valve, bilateral optic cupping, (pigmentary
Glue in a perforated cornea with Bandage contact
(Jordanian and British examiners)
3. Posterior Segment Disorders :
A young lady with a vititis, macular old
toxoplasmosis scar and an active peripheral lesion, discussion on
management (investigations and treatment) +90 lens used
A young man with a left CRVO and
neovascularization, discussion about the management and the
predisposing factors for ischemic type. He asked me to use indirect
ophthalmoscope and then I asked to re examine the patient with +90
Station 4 (2
4. Neuro- ophthalmic and Ocular Motility Disorders:
Around 6-7 years old uncooperative girl,
he asked me to do ocular motility test, I started with cover uncover
(Ortho), on motility test there was limitation of adduction on the
left eye, and limitation of abduction on both eyes, I told him that
she have left Duane type 3, and limitation of abduction on the right
eye. I think this case is a bilateral Duane???
An old man sitting on a chair, the examiner asked
me to do pupil test, there was a weak RAPD on the left eye, it was not
clear, than he asked me to do ocular motility, on pursuit there was a
limitation of adduction on the left eye, and the was a nystagmus on
the left eye. On saccadic movement the limitation was clear, I told
him that he has INO.
Finally, Thanks God again and best wishes for all
And best Regards
MBBS, ICO, FICO, FRCS