I passed the FRCS exam in Amman , Jordan 2013
I am writing my experience hoping it might be of
use and benefit for my colleagues .
My exam was on the 15th of April 2013
M first day was for the Oral exam
My first session was for Neuro-ophthalmology and
Emergency medicine :
1st Examiner :
He first gave me a scenario of a female pt. who's
overweight with optic disc swellings and He discussed with me the
possible D.D. and management ( BIH , Papelledema ...etc ) .
Then He gave a photo of an Iris with multiple
uniform lesions - I described the lesions ( size , colour ,
distribution ... etc ) and I told him my provisional diagnosis is
Lisch nodules in NF 1 . He asked me how NF 1 affects the vision and I
mentioned Glaucoma , meningioma and glioma ( I forgot to mention the
lesions affecting the vision in anatomical order - I was supposed to
tell him : lesions affecting the lid causing ptosis , lesions
affecting the Iris , the angle , the lens ... etc ) .
Then he gave me a scenario of an old pt. waiting in
my clinic for 4 hours and he fainted , he was cold and sweating but
conscious . I gave a rapid DD including vasovagal attack ,
Hypoglycaemia and the most serious The MI and pulmonary embolism . I
told him rapidly the general steps for management of Shock .
He asked what if it's MI - I started mentioning the
management steps till the Oral aspirin then I've got a mental block
and I didn't continue as if my memory was wipped out !!!! But he said
to me " and you already called for help ... "!!!!!!
The second examiner was a Lady from Oman .
She gave me a scenario of a female child who's
underdevelopped , of short stature and with poor VAs. OU .
I didn't know the DD nor the a Diagnosis so I
started mentioning the steps of management including any maternal
problems or infections during pregnancy , birth wait - prematurity .
I told the Lady how I am going to examine the pt.
including VA., pupillary reflexes , fundus exam. to exclude optic
nerve hypoplaesia , VF. and ocular motility + referral for
Neurologist/Neuroimaging , but she looked satisfied when I mentioned
HORMONAL PROFILE .
She gave me a photo of a BRAO and I misdiagnosed it
for CMV indolent retinitis !!!!!!
Then she asked me about craniopharygioma - I
mentioned the signs , the typical VF defects and management but I
forgot to tell about Hydrocephalus and HORMONAL PROFILE in children
and she was keen to hear me saying it but again I had a mental block .
Then she asked what to do for a 12 ys. old female
patient with a small glioma of the ON in her right eye with very mild
proptosis and VA of 6/12 in the affected eye and 6/6 in the other eye
. I said just for regular f/u and I must request Neuroimaging to
exclude intracranial glioma which is devastating and fatal .
My second session was Ophthalmology Medicine :
The 1st examiner
He asked me about the manifestations of thyroid eye
disease in details and how to manage them .
Then he showed me a photo of GPC with shield ulcer
and How to manage .
Then he showed me a photo of CHRPE and what are the
The 2nd examiner
He showed me a photo of an eye with conjunctival
injection tears and he told me this is the photo of a patient who had
fever few days ago and now his eyes are like this - and I said "
Pharyngoconjunctival Fever " , he asked me about the signs of the
adenoviral keratoconj. and I mentioned the corneal subepithelial
infiltrates . He asked me what else - but again I had a mental block (
I was supposed to say " Follicular conj. " and " lymphadenopathy " ) ,
so he asked me what's the lymphatic drainage of the eye and I answered
but still I didn't say " lymphadenopathy " !!!!
Then He showed an unclear photo , I failed to see
any criteria or signs , so he said " what if I told you that this
patient had a hypermature cataract and IOP of 42 mmhg - I said it's a
case of Phacoanaphylactic glaucoma .
He showed me a photo of a fundus with Best
vitelliform dystrophy ( scrambled eggs stage ) and he asked about the
investigations , the prognosis , the stages and what I would say to
his family .
Then he showed me a photo of lattice corneal
dystrophy and asked me about my diagnosis .
My last Oral session was Surgery and Pathology :
The 1rst examiner
He asked me about management of a pt. with Acute
Angle Closure Glaucoma in details including the other eye , surgical
and LASER PI ... etc .
He Then gave a scenario of a patient who had a
severe blunt trauma causing Iridodialysis and how to manage in details
even surgically and I started by saying " I wouldn't do it by myself "
- but when he asked about the surgical management of the the Iris
dialysis I said I don't know .
He also asked me about the possible complications
to this type of trauma .
The 2nd examiner
He asked me about a pt. who underwent a successfull
phaco. with IOL in his Rt. eye who came after 2 days complaining of
pain in the affected eye with decreased VA - what are the possible
causes then he discussed with me the management of Endophtalmitis in
this patient in details .
He asked me about a patient who had been hit on his
eye by a glass bottle and how to manage .
He asked me about a case of corneoscleral wound and
how to manage . And if the wound is corneal but self sealed .
Then he showed me a photo of a large deeply
infiltrating ulcer involving the temporal region and the upper and
lower lids and I mentioned my DD starting with the BCC and SCC and I
told him that my provisional diagnosis is " SCC " and he asked me why
- I answered " due to the size , the site and the deep infiltration
and shape of the base of the ulcer " ....Then he asked me how to
manage it .
Two days later I had my clinical exam
In King Hussein Medical city in the LASIK center
My first session was RETINA :
The first examiner asked me to examine the fundud
of a female patient by the indirect , I found her to have an Optic
nerve Coloboma , He asked me about the associations and how to manage
. He wanted to hear from me about the Amblyopia in the affected eye
and management by patching .
The second examiner asked me to examine an old man
with the Volk 90 lens on the slit lamp . I examined him , He had a
large raised macular scar with drusen and exudate and I diagnosed it
as a case of ARMD .
He asked me how to manage - When I reached the OCT
and IVFA in my management He showed me the pt.'s IVFA photos and asked
me to discribe them - It was a Predominently classic CNVM . He asked
me how to manage and what are the ttt. options - When I mentioned the
Anti-VEGF he asked what are the types and why I favour one over the
other and what's the frequency of the post-injection F/Us .
My 2nd session was NEURO. and OCULAR motility
The first examiner asked me to examine the Ocular
Motility of a young female patient .
She had a defective Elevation in the RT. eye on
abduction and on adduction - I diagnosed it as case of DEP vs.
Blow-out fracture of the orbital floor . He asked me in details about
the signs , the symptoms and the management in details .
The second examiner asked me to examine a female
pt. in her 30s by the VOLK 90 lens , It was acase of longstanding
papilloedema and the cause was BIH ( IIH ) and he discussed me about
the case in details .
My 3rd session was oculoplasty
The First Examiner showed a young male patient who
had phthisis bulbi OD with sensory XT and mild Ptosis with Buphthalmos
He asked me about the management and possible
cosmetic surgeries and about the ptosis .He even asked me to perform
the measurements for the levator function , Marin/reflex distance with
a ruler - and I told him that under normal circumstances , in a case
of ptosis , I would like to test the pt. for Bell's phenomenon esp. if
it's a case of congenital ptosis .
The second examiner asked me to examine a 40-50 ys.
pt. especially that he doesn't like his own appearance .
I examined him with my pen torch , he had
Blepharochaleasis of the lower lids OU and a Cyst of Moll n the Rt. LL
Then She , the examiner , asked me " Don't you want
to examine this patient for PROPTOSIS ??? " and frankly I got confused
because I missed it !!!!
But I examined the pt. again and I discovered that
he has Rt mild proptosis !!!!
She asked me in details how to manage and what are
the tests to be done in the clinic for this patient ? She discussed it
with me in details .And when I told her about the need to measure the
amont of Exophthalmos with the Hertel's exophthalmometer or a ruler ,
She rapidly gave me a Hertel's and asked if I am familiar with it and
I said Yes and I took the measurements - I think , Thank GOD , it
saved me from failing in this session .
She asked me what else - I mentioned the Ocular
motility and she told me to perform it - I did and found the patient
having limited adduction in the proptosed eye .
My 4th session was for the Anterior Segment :
The first examiner asked me to examine , on the
slit lamp , a patient - He had bil. corneal central opacities , dense
cataract and Pseudoexfoliation .
He asked me how to manage in details .
The second examiner showed me a young female
patient on the slit lamp , she had Keratoconus in the Lt. eye and PKP
in the Rt. eye .
He discussed the case with me in details and he
even showed me her TMS photos .
And That's it ......
My personal advice is put all your Trust in GOD ,
use and study every thing on CHUA website in details especially the
photo galleries and candidate experience .
Fear and mental Block and forgetting are normal in
such exam. , try to keep yourself calm as much as you can .