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I am Dr khattab Rabab.
I appeared in FRCS Glasgow
in Muscat in November 2009 and ALHAMDULILLAH passed with the grace
of God from the first attempt. I dedicate my success to my family for
their support and prayers without which I would not have been
possible. I found this exam to be a constant battle of nerves, you
have to keep yourself calm and confident. Here is my experience , I
would like to thank Prof Dr Chua, Prof Dr Muthu and members of his
virtual Muthusamy university who were very helpful to me in
preparing to enter the exam also I would like to thank Dr Hussein
Swellim and members of RRCOphth.yahoogropus.com Dr Ayman Elghonemy
and Dr Mohamed Hantira for running a clinical course in Muscat. I
advise all my colleagues who are planning to enter this exam to be
guided by the previous sites (Chua, Dr Muthu and
FRCOphth.yahoogroups.com).
Day 1
Problem solving and MCQ:
Clinical case
interpretation in FRCS Glasgow exam in Muscat 2009:
Case 1:
A 6-month-old baby
girl is brought to you by her parents complaining that her left upper
eyelid is drooping. On examination the infant appears to have
bilateral ptosis, more marked on the left, and objects to having the
right eye occluded. The baby seems to be otherwise well, although the
mother was diagnosed with multiple sclerosis 2 years earlier. What are
the possible diagnosis with this patient and how would you investigate
and manage the case?
Case2:
A 35-year- old lady
presents to casualty with a 2-day history of severe pain in her 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.
Acuities are 6/12 right and 6/6 left. She also has history of
rheumatoid arthritis. What is the differential diagnosis and how would
you manage the case?
Case 3:
A 75- year-old
retired accountant gives a 6-month history of recurrent severe
headaches and for the last few weeks has also been aware of episodes
of transient loss of vision on the right side. His acuities remain at
6/6 bilaterally and he is a lifelong smoker with mild repiratory
disease. How would you further investigate and manage this patient.
Day 2 oral and viva:
Surgery and
pathology:
The first examiner
showed me a case of unilateral proptosis of a young man, she asked me
about the signs present and the differential diagnosis, the
investigations needed, the causes of vision affection and how to
manage in details.
The second examiner
asked me to draw the site of incision of orbitotomy and the
complications of angular vein injury and why this vein is in
particular dangerous.
Then he showed me a
pigmented lower lid lesion with lid margin distortion and madarosis
and asked me about the differential diagnosis of the lesion, and the
signs of malignancy, then he asked for the differential diagnosis if
it was a benign one. He asked me to draw the incision for removal
and the safety margin and how to close the defect.
He also asked about
labeling of the specimen when sent to the pathologist.
Then he asked me how
to manage a case of shallow AC 24 hours postoperative after
trabeculectomy in details.
Ophthalmic medicine:
The first examiner
asked me about a child of 3 years old presenting with periorbital
oedema and pain for differential diagnosis and management in detail.
Then he asked me about definition of secondary glaucoma, granulomatous
uveitis and causes, ICE syndromes and its types. The definition of
cystoids macular oedema and how the macula is examined (he means the
lens used for examination).
The second examiner
asked me about the optics of the 90 lens. The he asked me to draw the
waves of normal ERG, from which cells they arise, the oscillatory
waves. Then he asked me about Fuch’s iridocyclitis and what is the
complication that may occur during cataract surgery in such a case
then he asked about the relation between it and fuch’s endothelial
dystrophy, how the patient presents, what are the investigations done,
normal endothelial cell count, and if the patient is planned for
cataract what are the precautions taken.
Then he asked me
about a patient with large central corneal ulcer, hypopyon and history
of trivial trauma, what is the differential diagnosis, and how you
reach a diagnosis within few minutes.
General medicine and
neurophthalmology:
The first examiner
was an internist he asked how to manage a 75 years old diabetic
patient with sudden loss of conscious followed by seizures few hours
postoperative,
Then if signs of
hemiparesis starts and what the investigation of choice now, and what
favours thrombotic lesions versus hemorrhagic one and what you give
until a neurologist manage the case. Then he asked me how to manage a
young lady 34 years old on warfarin planned for minor surgery.
The second examiner
asked me about thyrotoxicosis in details (systemic, ophthalmic and
treatment given), arthritis with uveitis in a young male, uveitis in a
child especially rheumatoid arthritis and its complications. Other
ophthalmic diseases affecting children then marfan syndrome in
details.
Day 3 clinical cases:
Case 1:
The examiner asked
me to examine the anterior segment, there was paracentral nebula,
pseudophakia and PCO. The whole discussion was about the causes of PCO,
how to manage, the complications and precautions taken to avoid them
then he asked me what is the difference between the posterior lens
capsule in a young man and that of an old man.
Case 2:
The examiner asked
me to examine the anterior and posterior segment of both eyes, the
patient has bilateral conjunctival melanosis, glaucoma bleb in one
eye, and primary optic atrophy in this eye. The other eye showed no
abnormality except for a pannus and melanosis. The whole discussion
was about the difference between a primary and a secondary optic
atrophy and why I diagnosed the case as a primary optic atrophy.
Case 3:
The examiner asked
me to examine a young man with unilateral ptosis and lid scar is seen,
he asked me to also examine ocular motility, to do the cover uncover
test (it was proposed by me before ocular motility), the he discuss
with me every step in examination in details then asked how to manage
and complication of ptosis surgery.
Case 4:
The examiner asked
me to examine a 55 year old male with bilateral asymmetrical proptosis,
I have asked to see his glasses, examined for proptosis and also I
examined the ocular motility and there was diplopia when the patient
looks up and laterally. He asked me to palpate the orbit.
Case 5:
the examiner asked
me to examine the anterior segment of an elderly female patient, she
had a pigmented iris nodules on the lid margin and the pupil was
irregular due to involvement of the iris sphincter , he asked me about
the differential diagnosis, how to manage, pathology of malignant
melanoma and the prognosis, if cataract is planned what is the
precautions to be taken, and how pupilloplasty is done.
Thanks to GOD to
help me to pass this exam, I would like to help any collegue who
prepare to enter this exam, my e-mail is khattab.abab.mvupgo@gmail.com |