Centre: New Dehli
Final FRCS (Glasgow) Date: Sept, 2006
I hesitated in sending my experience as I thought it wasn’t that beneficial, but here I am hoping that those who plan to sit for the FRCS (Glasgow) exam from my country (Egypt) will find it useful. ALHAMDULELLAH (Thanks be to GOD): I passed this exam (part B) in September 2006 (New Delhi) it was my second attempt after Tripoli April, 2006 where I failed the clinical exam.
I would like to thank my family, my friends especially Samah, A.Nassef, A. Al Ghoneimy and H. Sweilam for their support, and all those who prayed for me.I found the CHUA website to be extremely useful for preparation. In addition I studied from Kanski, Wills eye manual, secrets of ophthalmology, Manual of ocular diagnosis & therapy (Deborah): tables only, neurophthalmology: A problem oriented approach, oxford handbook of ophthalmology, essential surgery, and oxford handbook of medicine. I also answered a huge number of MCQs.My advice: to be prepared psychologically, to pray, and to take different experiences from this site and others. I found the examiners to be kind and helpful.
First I like to relate my experience of the previous examination in Tripoli
First day written exam+ MCQ:
1. A 13-year-old girl was brought to your clinic by her mother complaining of reduced vision. Visual acuities are 6/18 in both eyes, reading N8 unaided. Her parents have just been divorced. How would you manage this patient and what investigations may be appropriate?
My answer plan was:
Hysterical, but I should exclude other causes of diminution of visual acuity
in children and don’t forget to refer to psychologist.
2. A 55-year-old man who works as an engineer has attended the eye clinic previously with latent angle closure glaucoma and has bilateral peripheral iridotomies performed. His refraction is +7.5DS in the right eye and +8.00DS in the left. On this occasion vision is reduced to 6/12 in each eye because of cataract. What potential risks would you perceive with this patient and how would you manage this cataract?
answer plan was: this engineer had two problems which should be managed
simultaneously according to severity of each one, according to the patient
needs. Problems of shallow AC, dilatation, Iol calculating, anisometropia
and anisokonia especially with unilateral cataract extraction.
3. A 33-vear-old woman has been aware of a degree of left-sided proptosis for several months. She presents to your clinic with a 1-week history of pain and redness in the left eye, reduced vision, and an apparent corneal ulcer. Explain the possible causes of this patient's symptoms and how you would manage her?
My answer plan was:I
defined my problem as a corneal ulcer that may be related to the proptosis
(Exposure) I excluded serious condition of infection. I discussed thyroid
as the most logical cause of proptosis here but also excluded serious condition
of malignancy and other causes of proptosis. Remember VEIN (vascular,
endocrine, inflammatory, neoplasm).
2nd Day Viva
Ophthalmic Surgery and pathology:
The first Scottish examiner: (was very kind and smiling)
The second Egyptian examiner:
The first examiner from Libya:
The second Scottish examiner:
General medicine and neuroophthalmolgy:
The first Scottish examiner (ever so kind)
The second examiner was very angry and very nervous which made me depressed but thank GOD I passed this viva. No one can tell what will happen next. Please always be calm to not miss anything in other exams if you meet this personality from the beginning:
When I passed this I was very happy this made me more comfortable and relaxed which may affect my performance in the clinical exam. Please you must remember that this is not the end. You still need to pass tomorrow. You need a minimum score of 6 marks or even 7 marks to pass do your best.
3rd Day Clinical exam:
Before relating my Dehli experience, here were the cases and experience I encountered in my first attempt. I was the last one that entered the exam the room was dark there was many patients , two examiners with no place to move, I was very irritable I missed many signs especially that the instruments were not so good .
When I knew that I had failed the clinical I was very, very, very depressed until I passed this exam in the Delhi THANKS GOD
Now my good experience in Delhi.
First day Written exam+ MCQ:
1. 75 year old woman has been attending the clinic for some time with an indolent left corneal ulcer. There is a history of joint pains and weight loss, and she has dry eyes. She presents acutely with worsening pain in her left eye and blurring of vision .on exam u notice the ulcer has perforated with flat AC. Describe acute and long term management & what investigations are appropriate.
answer plan was: Collagen disease leading to perforated corneal ulcer.
I must admit the patient and work with rheumatologist, exclude infection
manage according to the site, size of perforation, consider the visual
acuity, and the depth of anterior chamber, may be medical or surgical.
Taking in consideration that rheumatoid make joint deformities that affect
the patient in putting the eye drops, in doing surgery (neck stiffness),
also consider the associated dry eye and scleritis, and the systemic treatment
as systemic steroid may induce cataract and glaucoma. Don't forget in old
female to check the endothelium.
2. A 3 years old boy has been seen at the clinic for 2 years with bilateral watering & has had 2 probing procedure performed. On both occasions the probe was passed easily. The Rt. Eye has settled but on the left side he is having recurrent dacryocystitis every few months requiring systemic antibiotics. His parents are angry and are demanding something is done or a second opinion is given. Explain how would u manage this situation & write a letter to the GP detailing your action
answer plan was:First I'll reassure the parents regarding that this can
occur with success rate of 70% but we may be in need reevaluate the condition.
Exclude other causes of lacrimation and examine for epiphora (remember
BLINK= blink to examine the pump, Lid examination, Imbrication, NLD examination
and kissing puncti). Don’t forget to write the letter by a formal way starting
by dear colleague and ending by thanking him. And don't forget that this
child'll take general anaesthesia for the 3rd time so refer to pediatrician.
Our plan was reprobing, intubations (Ritling tube) versus DCR.
3. A 50 year old male artist in known to have small bilateral Inferior retinoschisis. He presents to his optician having become aware of some distortion in his Rt. Eye with a change in color perception. The optician thinks the retinoschisis has enlarged on the Rt. Side and is now encroaching onto the macular area. The patient is referred for your opinion. What is your DD, and how to investigate & manage him?
answer plan was: DD should include optic neuropathy, macular disease, and
other causes of distortion and other causes of color affection (don't forget
cortical lesion and MRI)
2nd Day Viva
Ophthalmic Surgery & Pathology (was a very long exam but also a very pleasurable one. I didn't want the bell to ring)
Indian examiner Questions
Ophthalmic Medicine (was too short)
The Indian examiner Questions
The Scottish examiner Questions (was forgiving)
General Medicine and Neurology (I was very exhausted)
The Indian examiner Questions
The Jordan examiner Questions
The 3rd and last Day Clinical exam: (35minutes only)
The clinics were so nice, bright, and clean with good instruments. There was only one patient in the clinic and when I finished the other patient entered. When I entered I was wearing my usual white coat and I arranged my instruments. The examiners were happy and the Scottish examiner complimented me on that. I presented myself and asked to take the permission from each patient before examining they told me ok but there is no need really. The Indian patients were very cooperative.
The Indian examiner asked to examine the anterior segment of a young man (18 years old) sitting on the slit lamp.
The Indian examiner asked to examine a middle aged man by the indirect ophthalmoscope?OD NPDR, and OS PDR with vitreous and subhyaloid haemorrhage involving the inferior region.
The Scottish asked: systemic and ocular associations? How to manage? Laser parameters (detailed).
The Scottish examiner asked to do cover uncover test to a young manThe patient could not see for far without glasses I did the test only for near without glasses, both near and far with glasses. There was bilateral intermittent exotropia.He asked me how you do cover uncover (9 gazes). How to manage (angle, sensory exam: Bagolini glasses and follow up).
Indirect ophthalmoscope of an old woman that showed a right reddish macular reflex he told me I know it'll be difficult but try without the 90D lens.I inspected before examination that the left was with white reflex (RD) so I told macular hole how to manage by OCT to determinate the grade, grade 3, surgery vitrectomy, ILM peeling, gas especially with this single eyed patient as I expect. Ok examine the other eye it was closed funnel RD the examiner was happy and told me yes
The British examiner asked me to look at the fundus of a young girl (10years) with bilateral primary optic atrophy and no PL. DD and possible management.
A young girl 15 year-old with left complete ptosis. The Examiner asked me to perform eyelid examination. There was complete ptosis, dilated pupil and exotropia with intact intorsion. I diagnosed isolated surgical third nerve palsy. The bell rang at the same time.
The results were announced after about 3 hours during which I went shopping to relieve stress but it was followed by very happy moments with my colleagues in Delhi. I pray for all those who didn’t pass with us better luck in the coming exam.
I hope I did not forget anything, and that you did not find it boring... Praying to ALLAH to accept this work . I will be more than happy to help any colleague.