Candidate 74                                                 Centre: New Dehli 
Final FRCS                                                                       Date: September, 2005
My name is Ashraf Mohammad Mobarak  From Mansoura, Egypt I have attended FRCS. (Glasgow. In New Delhi September 2005 and thanks GOD I have passed then thanks my parents for unlimited encourages and prayers .

Here are what I went through.

Essay questions (2 hours)

1. An 85-year-old man has had advanced primary open angle glaucoma for 30 years. He had a trabeculectomy performed on the left eye many years ago but the vision has been poor in this eye ever since the operation.  Visual acuity are 6/12 right eye and hand movement left eye despite being on maximum medications. His IOPs are 28mmHg right eye and 10mmHg left eye. Lt. His visual fields are grossly restricted in both eyes and he is on warfarin tablets for atrial fibrillation. Discuss this patient management and explain the risks to his vision.
2. A 30- years- old general surgical colleague presented to your clinic complaining of redness and blurring in his right eye for one week. He had had bilateral laser refractive surgery
4 weeks back and and although his vision had initially been good it is now reduced to 6/36 right eye & 6/6 left eye unaided. He is busy and just wants you to give him some drops.
Describe how you will deal with this situation and what possible investigations and treatment would you recommend.

3. A 10-year old boy is found by his optician to have reduced vision in his right eye. On examination the vision is 6/36 in this eye. There is a right relative afferent pupillary defect and fundoscopy shows disc pallor. Discuss the possible diagnosis & explain how you would manage the case. 

MCQ. 300qs. study MCQs of this website and general medicine from American Academy of Ophthalmology Series.

3 stations

Station 1: General medicine and Neurology

2 Indian examiners.
First examiner asked the following questions:

  • Starting with showing me fundus photos with haemorrhages and opacification of retina saying that this belongs to an AIDS patient. (Differential diagnosis: CMV retinitis, HIV retinopathy, PORN). 
  • FFA showing vascular staining (Differential diagnosis retinal vein occlusion, vasculitis etc.) 
  • Photograph of a 15-years-old with hearing aid and cataract with esotropia (Differential diagnosis: congenital rubella, congenital syphilis, Refsum's syndrome etc).
  • CT of orbit and brain showing opacity of ethmoidal sinus. 
  • MRI of the brain with hyperintense lesions in the paraventricular regions. Questions on multiple sclerosis, treatment and criteria for the diagnosis of MS.,
2nd examiner asked the following:
  • Patient with bilateral ptosis and ophthalmoplegia (Differential diagnosis: myasthenia gravis and chronic progressive external ophthalmoplegia). How to differentiate between the two conditions from history and investigations (family history, muscle biopsy, antibody tests etc). Treatment of myasthenia.
  • Fundus photo of a patient with polymyalgia rheumatica showing pale disc. Diagnosed giant cell arteritis. Investigations, temporal artery biopsy. complications of steroids.
  • Medical management of a patient who has epileptic fit in operating room. (ABC, position, shout for help, diazepam, air way) 

Station 2: Ophthalmic surgery and  pathology
One English and one Indian examiner

  • Lacrimal gland swellings: what are the possible diagnosis. Investigations. Should biopsy be done?.
  • Management of acute angle closure glaucoma.
  • Blow-out fracture and blow-in fracture. Investigations and management.
  • How to detect and mange zonulysis during cataract operation. If the dialysis is 2 clock hours and if it is 270 0 . Use of capsular tension ring and how to choose its diameter.
  • Retinoblastoma  in children. Possible differential diagnosis and management.

Station 3: Medical ophthalmology

  • 60-year-old patient with NIDDM for 20 years with decrease vision. How to manage the CMO. Definitions of significant macular oedema and high risk new vessels and how do you manage the patients. PRP: argon setting and possible complications.
  • How to manage a patient with IOP of 26 right eye and 27mm. with normal field and normal cup/disc ratio. Advantages of treatment versus no treatment. New technique for detecting nerve fibre layer loss. The importance of corneal thickness on IOP.
  • 40-year- old female with sudden loss of vision. Give a  DD and then move on to multiple sclerosis.
  • Types of blepharitis. How to manage marginal keratitis.
I passed the above and got into the clinical session.

Clinical examination: in total 7 cases were examined

1. Non-proliferative diabetic retinopathy with macular oedema using the indirect. Discussion about macular oedema and indications for treatment.

2. Fundal examination using 90D, the patients had C/D ratio of 0.8 right eye and 0.9 left eye. Patients already on maximum medications. Questions on treatment options. Important of target pressure.

3. Fundal examination of a patient with macular drusens and dry age-related macular degeneration.

4. Slit-lamp examination of a patient with bilateral pseudophakia. One eye was operated on with phacoemulsification and the other with ECCE.

5. Slit-lamp examination of an eye with shallow anterior chamber. The eye had peripheral iridotomy and posterior synechiae.

6. A case of bilateral upper lid retraction. Asked to examine the ocular motility.

7, A case of exotropia. Asked to perform cover test for near and distant.

I am more than happy to help other candidates. My e-mail is amobarak1@

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