My name's DR MOHAMMAD ABU DAB'AT from Jordan, I've appeared for  the FRCS Glasgow in Muscat nov. 2009. Thanx God I've passed from the 1^st attempt.

Personal thanks goes to my family and  my lovely wife..

Many thanx to Dr Mu'taz Shawar for his great help. The Chua site cannot be thanked enough for providing free valuable input to FRCS candidates,

Professor Muthu online university http://www.mvupgo.com is a free online university that provides lecture notes as well as training for answering the problem solving paper, which also helps in the vivas and clinicals. He sends you questions that you answer them and email it to them, which they then assess and send you a detailed discussion of your answer. It helps you to understand how the examiner thinks. His advices were invaluable and it’s a completely volunteer work that’s helping people attend the exam from all over the world. Words alone fall short to thank these people. I would advice them to anyone attending the exams

My exam was as follows.

Essay

1-    1. A 6 month old baby girl is brought to u by her parents complaining that her left upper lid is drooping. On examination the infant appeared to have bilateral ptosis,more marked on the left, and objecting to having the right eye occluded. The baby seems otherwise well, although the mother was diagnosed with multiple sclerosis 2 yrs earlier. What are the possible diagnoses with this patient and how would u investigate and manage the case?

• I put the differential diagnosis of congenital ptosis, Diff. diagnosis of left amblyobia. (which may be related to ptosis or may be not )

• risk of steroid intake by the mother during pregnancy (MS treatment) and based my management on all that.

2-    2. A 35 y old lady presents to casuality with a 2 days Hx of severe pain in the right eye which has kept her awake at night. On examination the eye is grossly injected and there is a small corneal ulcer just at the limbus. VA 6/12 rt, 6\6 lt. she also has a Hx of rheumatoid arthritis. What is the DDx and how would u manage this case?

• Most straightforward case , I considered it as an infectious ulcer until proven otherwise.

• risk of perforation,

• complications of RA and its medication on the eye.

3-   3.  A 75 yr old retired accountant gives a 6 months Hx of recurrent severe headaches and for the last few weeks has also been aware of episodes of transient loss of vision on the rt side. His VA remained 6/6 bilaterally. He's life long smoker and has mild pulmonary disease. How would you further investigate and manage this patient??

•  Differentials went around GCA, lung cancer and secondary mets, aneurysm, carotid disease ….

VIVA.

1^st station was neuro ophthalmology and emergency.

• Questions about retinal emboli ,risk factors, management ,

• Visual pathway lesions and effect on visual field.

• 3^rd nerve palsy management/

• Chiasmal lesions, presentation, complication

• Scenario of a patient with chest pain in the ward, management…

• Pulmonary embolism management…if u don’t have a CT to confirm the Dx what will u do??i said V/Q scan. If u don’t have V/Q scan also?? I said D dimmer. The prof agreed .

• Managenet of MI.

• Management of cardiac arrest.

Ophthalmic medicine

It was a station of photos

• Hypopyon photo…diff dx. Then management of endophthalmitis in details.

• Ddx of endophthalmitis and how to differentiate between them?

• Endophthalmits post trab sx photo.  Most common organism?strp.

• Outer retinal necrosis photo, cause and management.

• Mylenated nerve fiber layer. Atypical, how to confirm? FA.

• Dragged disc, Ddx.   Management of ROP. Staging of ROP.

• Telangectasia.

• DR.. when to treat DR by laser?

• FA of IRMA

• Management of coats disease.  

• Gonioscopy photo with pigmentation on angle Ddx.

 Surgery and pathology

•  How u perform trab?

• Post trab flat A/C management in details?

•  If u dropped the forceps during sx?  Methods of sterilization.  

• Types of stitches used in trab? In RD sx? In ECCE? 

• Types of absorbable sutures u know? 

• Types of non-absorbable sutures u know?      

• Types of needles? Draw the spatulated one, 

• Management of rupture globe? leak post op management?

• Management of intraocular foreign body?

• Management of intralenticular foreign body?

• Magnification of 20 D indirect lens?feild? which is better to examine in miosed pupil, 20 or 30 D?

• Optics of indirect ophthalmoscope?

• Management of hyphema?

•  Iris dialysis ? management for diplopia? Needles used to repair iris? ,suture material used?

Clinical

• Fundal exam on slit lamp for a young male patient showed bilateral optic atrophy. Ddx hereditary,toxic,nutritional….

• A nice 4y old child with left congenital ptosis. Detailed discussion about approach to ptosis and management

• Indirect ophthalmoscope for DR with laser marks..i asked to check the macula on slit lamp.

• Motility test on a young guy with left alternating exotropia. Discussion about management of this case.

• Slit lamp examination of ant segment for a young adult with typical macular dystrophy.

• DDx and management discussion.

• Slit lamp exam of a young adult shoed bilateral corneal opacification,Hudson stahli line,corneal endothelial pigmentation. left eye showed PSCC,vit degeneration.sheathing of bld vsls. macular hole. Retinal scars and epiretinal membranes. Rt eye showed inferior  iridectomy, aphakia, silicon oil filling the vitreous. Sheathing of blood vessels.

Ddx of pan uveits.

Most common in this region? behcet

My e mail address is drmad79@yahoo.com  I will be happy for any help.          

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