Candidate 149

Final FRCS

Centre:   Amman

   Date:    May 2011

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 surgeries.

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,…..)

Viva Exam:

1. PATHOLOGY AND SURGERY (British examiner and female examiner Maybe Indian??)

There are many questions but I can’t remember all of them:

 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, management..

Q: picture of bilateral Exophthalmous and lid retraction

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, ……., management)

Really I can’t remember the other questions

2. OPHTHALMIC MEDICINE (Pakistani and British examiner)

 Q: Fundus picture.

A: Angiod streaks, pathology..

Q: scenario of decrease vision after cataract surgery?

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 punctual occluder?

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 for tarsoraphy??


 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 sites?

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?


Bell ring

Clinical Exam:

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 glaucoma)

 Glue in a perforated cornea with Bandage contact lens, indications…

Station 3 (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 lens.

Station 4 (2 British examiners)

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 of you.

And best Regards

Mohammed Al-Shekeil, MBBS, ICO, FICO, FRCS

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