Candidate 162


Centre:   Amman

   Date:    May 2012

My name is Khalid Ali Almubarek from Libya, I work in ophthalmology department- Misurata Central Hospital- Misurata- Libya. I passed ICO clinical exam in June - 2010 , part ii FRCS exam in Oct. 2011 and FRCS part iii in Amman -May 2012, by the grace of god I passed theses 3 exams from the first attempt, I dedicate my success to my parents and my wife for their support and prayers, I would like to thank my boss. Dr: Abdalla Musa, our head of department Dr Mohamed Swaisis, and my brother Dr Mohamed Bensasi for their support, also I would like to thank Prof Muthusamy Palanisamy, finally Prof C.N Chua for his amazing website.

Viva 1-5-2012:

Station-1 ophthalmic surgery and pathology:

Examiner 1-
Q- photo of yellowish white mass excised from 12yr child who has coffee au lait spots ( examiner said) what it could be?
A- Optic nerve glioma, type I NF I discussed ocular and systemic association of NF in details . he asked about histopathologic features and indication for surgical intervention.
Q- pt with -16 D myopoia & grade ii nuclear sclerosis, discussion goes about complication of surgery, risk of RD and prophylactic laser, type of IOL. I answered most of the questions and the examiner satisfied.
Examiner 2-
Q- Photo of pt with unilateral congestive proptosis ? we discuss the DD of TED, orbital pseudotumor, orbital cellulitis, CCF , primary and secondary orbital tumor, he asked me how to differentiate theses diagnoses from the history, examination and invx in detail.
Q- you give peribulber injection and the pt develops retrobulbar he. How would you manage him . will you postpone surgery? When you will do surgery? Will you repeat peribulbar injection? . I answered all the questions and the examiner satisfied with my answer.

Station 2- general medicine and neurology:
Examiner 1-
Q- photo of middle aged pt with left side mild ptosis and miosis. I discussed Honer syndrome from A to Z.
Q- 30 yr old pt with painful loss of vision ? . I gave DD of optic neuritis , traumatic hyphema, corneal ulcer, acute glaucoma. Then he asked about optic neuritis and MS ,ocular and systemic features, indication of ttt and dose and regime of steroid.
Q- you exposed to needle stick injury from pt expected to have HIV what will you do?
Examiner 2-
Q- colored fundus photo showing 2 small CWS and said this is a fundus photo of young pt in ICU who has pathological fractures? I do not know .
Q- How do you differentiate scleritis from episcleritis. He asked about the systemic association of scleritis, Invx, and how it could be treated.
Q- 30yr old pt who C/O chest pain 2 days after surgery? DD?. I agave DD pneumothorax, pulmonary embolism, MI, pneumonia. Then he asked me how to diagnose pulmonary embolism from history, examination, INVX. How to treat. I answered all qs and when I start mention ttt , I told him that I will call emergency team and I explained all the ttt for PE up to thrombolysis but I forgot to mention high flow O2 , the examiner were looking for it.
Q how will you treat pneumonia?

Station 3- ophthalmic medicine:

Examiner 1-
Q- a photo of clild's eye with limbal dermoid . what is this? With which syndrome it is associated? (Goldenhar syndrome, its other features?) what other ocular association( duane syndrome). What is ocular complications ( astigmatism, amblyopia), when you consider surgery? How would you excise it ( I will refer to paediatric ophthalmologist).
Q- fudus photo with hazy media (vit hge) and NVD, I discussed diabetic retinopathy in details PRP laser setting. He asked me when you treat areas of hge will you increase or decrease laser power?
(I do not know, I will seek expert help). If persistent vit hge , how will you manage?
Q- photo of flourescein stained dendritic ulcer? He asked about the diagnosis complications, ttt, disciform keratitis and its ttt, stromal keratitis, neurotrophic ulcer.
Examiner 2-
Q- photo of giant papillae in CL wearer, how would you manage? What are the complication ( he was looking for induced astigmatism).
Q- youg pt C/0 night blindness, I gave dd of retinitis pigmentosa, post PRP, miotic agent,
He asked about the features of RP in details, VF and ERG finding?
Q- 3m child with watering? I gave DD of NLD obst, congenital glaucoma, corneal abrasion, conjunctivitis. He asked how to differentiate?, if NLD obst. How do you manage?, how do you teach the mother for massage? How frequent? When you do probing and describe how you do it?
Q- how do manage pt with acute glaucoma?

Clinical: 3-5-2012

Station I: posterior segment:

Case 1- +90 D in old lady: RE: recent vitrectomy with silicon oil, laser marks, LE advanced TRD
I was asked about classifications and ttt of DR.
Case 2- indirect ophthalmoscope: young adult : RE: circinate maculopathy reaching the macula, midperipheral RPE hyperpigmentation with overlying vitreous changes, I gave DD of vasculitis and CNV, work up for vasculitis and FA.

Station 2- ocular motility and neuroophthalmology:

Case 1- old diabetic lady with 4th N palsy.
Case 2- child with bilateral disc swelling, it was pseudopapilledema, the child was high hyperope, we discuss the DD and how to differentiate them.

Station 3- oculoplastic and lid surgery:

Case 2- lt s shaped ptosis with thickened and rubbery upper lid, I missed the diagnosis, it was plexiform neurofibroma.
Case 2- old pt with rt upper lid ptosis and lower lid entropion and keratoplasty, symblepharone

Station 4- anterior segment;
Case 1- young adult with lt pseudophakic bullous keratopathy in corneal graft, bandage CL, anterior chamber IOL.
The rt eye was normal. The examiner asked what could be the cause and indication for keratoplasty. I said trauma, keratoconus , corneal dystrophy. How will you manage? I answered regraft and repositioning the IOL in the PC with scleral fixation.
Case 2- 10 yr old child with bilateral superficial granular opacity involving the visual axis and clear zone at the limbus, I said Ries Buckler dystrophy , examiner agreed and asked how to manage.
Case 3- young child with white eye, lt early band keratopathy and flare in the AC. I said CAU associated with JIA.
I hope I did not forget anything. I will be happy to help any one or answering any question about the exam
Khalid almubarek- ICO, FRCS


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