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My Name is Hassan Thabet, from Alexanderia
Egypt.Thank to Allah ( الحمد لله ) I cleared the third part of FRCS Muscat
2010. This done by the willing and offer of Allah, then by the warm
prayers of some people I know that ALLAH likes them because they are good
people احسبهم كذلك I want to thank after Allah, many many people ,I will
name some of them. First, my supporting kind and wonderful wife who did
everything to push me to success. My daughter (already Graduated from
college of Art) and my son (still in college of engineering last year),
for their unlimited support and bearing my stress and their praying every
day.My friends who did pray for me and they are so many, God bless them
all. FRCS and FRCOPHTH groups for their invaluable support and advises and
cooperation all of them one by one. Special thanks to one of them Dr
Abdlaesaid from Libyia , who met me in Glasgow and did many thing to me
that my words fall short to thank him. Dr. Hussein Swelim, I have no words
to say for what he did for me and his worm pray which I felt them really,
and his white hands on me, god bless him. Dr Muthu and his wonderful
virtual university who is my teacher and my friend also who put my foots
on the right way for how to pass FRCs either part 2 or part 3. The staff
of ophthalmology department in the college of medicine in Alexanderia
University and their unlimited support and their powerful scientific
meeting held all over the year. Now Let me start by my experience in part
2 which I cleared it in November 2009 from the first attempt. This
experience I wrote it at that time and sent it to Dr Muthu and I think it
is still viable. At that time we had 200 MCQs not 160 as the situation now
and believe me I answered 189 MCQS completely then the residual time was
one minute so I put marks on the last 11 questions without reading them
because no loss marks and certainly no time.
This is what I sent to Dr Muthu:
Firstly, my advices:
1- time is v. short and v.v.v. short for MCQs because there was 200
problems must be answered in 120 minutes which means that each question
must read and answered in half a minute (30 seconds) so you must practice
v. well on MCQs from all sources you found and don't forget the AAO
questions at the end of each section and did this many times not once
2- put a watch on your disk and check it every 30 minutes and must 50 MCQs
be answered in these time if not try to harry up more and more
3- use the first impression method which means : after reading the problem
(question head) put the answer you feel it is right by first impression
and don't think bec no time for thinking
4- if one question you don't know it put a mark on any answer and not
leave it empty bec no loss of marks in this type of exam if answer is
wrong
5- no time for review so answer at once bec no time for revision
6- In problem solving , the question of medical emergeny is v. important
and mandatory pass is needed in this question, so my advice is to start
with it and try to prepare your self about the questions for any topics of
these emergency
7- study the indications and side effects of the drugs commonly used in
emergency like digitalis, beta-blockers,anti-coagulant,....... ect
8- distribute allowed time on the 4 questions and don't allow for any
question to take more time from other questions
now secondly: my suggestions:
1- for the emergency question , the college put a sample on the website
and in the exam it was typical so my expectation about this question is:
- it is not a problem to deal with it as the other problems, no it always
come with ahead problem with some questions to know that you are
understanding the topic even if you will not deal with it as being
ophthalmologist
2- about the other 3 problem solving,after reading the question, as you
teach us sir, you will put the most probably diagnosis and my suggestion
is to follow this probable diagnosis by the plan for answering this
question on the first page of answer sheet bec they want to know how you
think as this example which i did in my exam:
the question was: " 75y old male patient has been referred for
consideration for cataract surgery.Visual acuity measures 6/9 in each eye
. on initial slit lamp examination, you note pseudoexfoliation material on
the left pupilmargin. Intra-ocular pressure 28 mm in each eye.
How would you assess this patient and what management would you propose?
my answer was ( with each sentence in separate line ):
- the given data are: 75y old male
- pseudoexfoliation in one eye
- IOP is 28 both eyes
- VA is 6/9 OU
- want cataract suregry
- the most probable diagnosis is pseudoexfoliation galucoma with early
cataract as VA is 6/9 OU
My plan is:
- I must first exclude ocular HTN .
- As the pseudoexfoliation is commonly unilateral in 70% and bilateral in
about 30% of cases and this pateint has pseudoexfoliative material in one
eye so i must check and exclude other causes for glaucoma as POAG , other
secondary causes , PACG and also sec angle closure glaucoma
- I must check the other eye
- i will check which causes for Visual affection is more apparent than the
other , galucoma or cataract and deal with it firstly
- I will take care of the problems expected in this patient with
pseudoexfoliation before and during surgery like:
1- raised pre-op IOP
2- poor pupil dilataion
3- weak Zonules
4- expected vitroues loss
5-post-op spikes of raised IOP
-then in the second page of answer sheet I started to answer the question
as you teach us starting with history,....... ect.
- This will give the examiner an idea how you think .
- My advises for preparation for the exam :
- I recommend the following :
Firstly Chua website with every part in this amazing site
1- Kanski from the cover to the index
2- AAO part of general medicine
3- AAO part of neuro
4- AAO some topics you will find them short or not enough in Kanski
5- any brief surgical book for the surgical procedure mentioned in Kanski
as lid surgery, strabismus surgery, Cat, glaucoma and nothing else but
others as vitrectomy or RD , kanski is enough
6- no need for pathology book but what mentioned in kanski is enough
7- emergency topics of general medicine and study them from big text justy
to understand them then from the group website there is a brief collecting
this topics but after understanding them from a big text
8- some short notes on the common drugs used in R/ of common emergency
topics as digoxin, warfarin,amiodarone, ......... ect
9- some short notes on the new procedures as CCLinking, lasik,
Intacs,.Dsaek, Dalk....... only short notes no details except for yourself
to understand
10- then the clinical part which need more practice and apply the
procedures of examinations exactly as the college recommend (see chua
pages video parts)
11- some Topics and DD collections from Moorfield book
I hope i did not forget anything
Now let us go to the first attempt in
Glasgow :
Firstly I want to say that Glasgow is a v.beautiful city and I enjoyed
this place v. much and I hope to go there again. The oral was in Royal
college itself and the clinical was in Caldonian university as I
remembered and it is a very well prepared place with all facilities and v.
good equipments. There were 37 doctors and we examined oral in 2 days
Monday and Tuesday, I was in first day.
There were three stations.
My first one was Medicine and Neuro (
the horrible one ) and it was my worst station:
He was a Scottish doctor started by telling me : I will tell you a
scenario and you will then answer my questions , I said ok sir, his
language was difficult to follow and his pronouncing is difficult to
understand,he started to say that an old woman has some symptoms ( I can
not hear what he say ) but I could get the word bilateral temporal
hemianopia with sweating and thirst and something else, what do you think
?
A: I told him This is a chiasmal lesion ,
ask me where, I said may be pituitary, asked me where else , I said may be
craniopharigioma, he asked in this age ? I said may be bec I has Bimodal
presenataion but he is not satisified. Then asked me every thing about
Atrial fibrillation and drugs used in R/ and doses and side effects in v.
details. He then started to ask me many questions about this situation and
I hardly could follow his language and many times I asked him to repeat
what he said , and sorry I could not remember anything from what he said.
Then the other Dr also was a Scottish and asked me about Epilepsy in
details and nothing else only epilepsy although he could feel that I am
not so well prepared in this topic but he never shifted to another topic
until time is finished (I failed this Viva completely as in the feedback)
Then in the rest time (only few minutes) I was depressed and started other
situations with depression and blocked mind and many questions they asked
me some I answered good but others are not, and this is what I remembered
in that time :
In surgery and pathology Viva:
One patient came to you one month after
Cataract surgery with diminution of central vision (CMO) how to manage (
doing OCT first to establish the diagnosis and also for FU then start
conservative by topical NSAID and acetozolamide systemic then if not
rsponde after 2 months -------- IVTA , dose , procedure …… everything
about IVTA and its complications either operative (RD , Vit hage,
endohthalmitis…. and Post operative as high IOP , cataract …..)
Then ask me about Graves disease and pathogenesis of TED and every point
in this topic
Second Dr asked me about Drusen of Optic nerve and how to confirm (
autoflroesecnce ,US, CT) and which is better (US) and its complications (CNV)
Then asked me about Aniridia everything about it and genetics and
associated (WAGR syndrome) and FU of sporadic cases by US for Wilms tumor
( I passed this Viva completely)
The last one was Medicine and it was
my best one and I passed this one also
There was a male Dr and female Indian dr and both are v. gentle and
helpful. Started by showing me a picture of anterior segment with shallow
AC and moderate corlea oedema and told me this patient had IOP 45 what is
you DD and how to mange, then asked me in details about ACG and management
and his last question was : any thing you can do on the Lens to treat him
? I said yes we can remove the lens specially if it is cataractous or even
has mild opacity and value of the procedure and he was pleased from our
discussion
Then the nice Lady asked me about 6th N palsy , causes , how to manage
either medicall and surgically and after how long you will interfere (at
least 6 months), and how ( if paresis or paralysis )
Then showed me a picture of epibulbar
dermoid in a baby and how to deal with it (don't forget to assurance of
the parents and most important is to refract the patient bec may have
high astigmatic error in this eye which is amblyogenic )
The after 2 days was my clinical one:
I started by the Neuro and ocular motility
:He was Nigarian DR and he was helpful one. There was 2 cases one is INO
and asked me to do ocular motility and the other was confrontation test
for constricted field and causes of this constrictions (advanced glaucoma,
RP, extensive PRP…….) I passed this one
Then post segment one: A macular scar OU
but our discussion was not good. Strange mid peripheral lesion I could not
diagnose it but give some DD but the examiner was not pleased . I failed
this one completely
Then Oculoplastic :A case of one with
artificial eye , causes of enucleation , types of implants. The other eye
has proptosis , causes and what is the common cause (thyroid) and how to
manage , and complications of TED and what is the most serious (optic
nerve compression) how do you diagnose it (decreae VA, APD , color vison)
how to treat it (urgent IV steroids , then decompression) he was
statisfied. Second one showed me a female patient setting and told me :
without touching her she came complaining of watering ou , what are the
causes ( I told him some but he not satisfied) then asked me what is the
most useful clinical test you do in your clinic to diagnose her condition
, I said fluorescence clearance test but he said no , and asked what ? I
did not know and he wanted Syringing !!!!!! I forgot everything about
it. So in this one I had one pass and one failed
Then last one was anterior segment :A case
of bil iris coloboma with also post pole coloboma but our discussion was
bad. A case of aphakia in one eye and phakic in the other eye also the
discussion was bad bec some questions I did not understand what he want.
So I got one pass and one failed in this one
So my final feedback was one complete Viva
failed (medicine and neuro) and one complete clinical failed ,and 2 parts
failure in 2 different clinical situations. So the final result was
Failed. But I got many benefits from this exam, I know how to study again
and which parts is to stress and my weak points to strength them and the
most important part is general medicine so I studied it from a big text
(the emergency topics only but with big details) and it was Clark's and
Kumar medical Text
Then come now for the successful attempt but
firstly I have some advices
My advice are:
You must study every word in Kanski and Keep a complete copy of Kanski in
…. Your mind. Sometimes you said , this part is not important , but you
are wrong they will ask about it so kanski ..kanski..kanski… every word
…. No..no.. every letter in it
Any picture of intraocular mass in adult in the exam – it is Melanoma
until proved otherwise. Any intraocular mass in child it is a
retinoblastoma until proved otherwise. There were 69 of us (and 29 passed)
My first Viva was surgery and pathology
2 Doctors one was DR Fathi Elsayad and an English Doctor and both are
v. gentlemen and helpful.
Q- showed me a paper wrote on it the
following : child aged 5y, with glasses +4.o and seeing 6/6 Ou with
altern ET 30 PD at near and Far, how to manage ?
A – I will recheck his refraction under cycloplegic again
Q- ok it is the same then what?
A-This is non accom. ET so I will go for Surgery
Q- what surgery ?
A- Bil medial recession as Et is equal in near and dist
Q- how many mm recession ?
A- About 4.0 ( the right is 4.5 mm)
Q- what are complications of this surgery ?
A- anaethesia complications firstly
Q- skip this , what else
A- operative like bleeding, slipped muscle, sclera perforation
Q- what you will do if sclera perforation happened ?
A- I will call retinal surgeon (this is the right answer)
Q- Ok but he is busy so what you will do
A- I will dilate the pupil and examine the fundus by indirect ophthalm.
And check the status of retina and if everything is ok I will complete my
procedure then next day I will send him to retina consultation
Q- Ok , what this ( a picture of non-pigmented large mass over the optic
Nerve head area) I did not see like it before
A - I will give DD
Q- OK
A- I started by : metastasis , then stopped and non pigmented melanoma
not come to my mind at all bec the strange of the mass morphology
Q- could be Melanoma?
A- oh yes Sir
Q- Ok it is melanoma so how you will manage ?
A- I will be sure first it is melanoma by US , then according to the
condition of the other eye and age of patient and location and size and if
there is metastasis or not and if there is extracocular extension or not
Q- ok for this picture ? no metastasis and no extraocular extension
A - as this is large tumor , I will go for enculeation
Q- patient refuse to do enculeation?
A- I will think of Brachytherapy (this is wrong as the tumor is over the
area of optic nerve and this is inaccessible to put plaques
Q- can you reach this place to put plaque ?
A- No sir it Is difficult
Q- so what ?
A- I stopped
Q- you will not do anything in outclinic for this old man?
A Oh yes Sir , we can do TTT …….. Bell rang
Then start the other Dr (Dr fathi Elsayad)
Q- 55y old did cat since 3 days and come to you with painful eye and
decreased VA and red eye, what do you think ?
A- I will think first it is post-op endophthalimitis
Q- what else ?
A- Retained lens matter
Q- how retained lens matter cause pain
A- by elevating IOP and causing iritis
Q- Ok, it is endophthalmitis how you manage ?
According to level of VA , if better than PL I will give intravetrial
injection and if Va is PL or less I will go for vitrectomy as EVS said
Q- what AB you will give
A - I will start by vancomycin and Ceftazidime
Q-Why vancomycin and why Ceftazidime?
Vanco to cover GR+ve and ceftazid to cover Gr –ve
Q- ok , what is the dose
A- 1mg in 0.1ml
Q do you use systemic AB
According to the study no effect of systemic AB but new quinolones has
effect
Q- how you give it?
A Ciprofloxacin 750mg twice daily for 10 days
Q- what is this ( picture of optic nerve with a large whte mass appear
attached to its apex ) exactly as in Kanski
This optic N. tumor may be glioma or memenigioma
Q – he is boy aged 5y
A- Most probably Glioma
Q- What is the histopathology ?
A- (I tried to remember but I failed ) so he shifted to another question
Q- how this patient will presented to you ?
By proptosis and decrease VA
Q- which is first proptosis or VA
A- proptosis
Q- if proptosis is mild and VA is good what to do ….. bell rang but I said
:
A - Observation
Then the deadly Viva Medicine and neuro
2 Drs One omanian and the other is Dr Basaek (Indian one). The omanian Dr
start by telling me a Scenario of:
Q-The nurse calling you for a patient aged 70 y was waiting for cat
surgery and vomiting blood with the following HR 110 and BP 90/60, Resp
rate 25 how to manage
A- This is hypovolumic shock I will start by ABC
Q- What ABC stand for ?
A- A = patent airway , B = breathing C= circulation
Q- Then what? What you will give him
A- I will Give him Crystalloids as Saline or Ringer's lactate
Q- if you have blood available is it better to give or still you will give
saline ?
( I got his point bec in this age and situation it is better to start with
blood transfusion)
A- No sir I will give Blood
Q- Ok what else ?
A- He is shocked so also I will treat him as a case of shock by giving
epinephrine, antihistamincs ……
Q- when you give Bl transfusion what are you afraid from?
A- Reactions like fever Chills , rigors , and the most serious haemolytic
reactions
Q- if you know the reactions of blood transfusion as fever , Rigors and
other do you give him something before transfusion as antipyretics or
antihistamincs?
A- If this the first time he take blood I will not give him
Q- why ?
A- Bec these symptoms may indicate serious reaction and if I gave him
pre-medication these signs will be not clear for me
( he smiled and said ok )
Q- what is the causes of Atriall fibrillation?
A- May be cardiac or non cardiac , cardiac like Mitral stenosis, MI,
pulmonary embolism, non cadiac as Thyrotoxicosis, ecessive cofaeine,
smoking
Q- how you mange him
A- I will either do Rate control or Rhythem control
Q- till me some drugs used in AF ?
A- Amiodarone, digoxin, Virapamil, and warfarin
Q- why warfarin?
A- As prophylactic of thrombosis formation
Q- what is side effects of warfarin?
A- Bleeding, skin photosensitivity, gray color of skin face, sometimes
necrosis of skin
Q- ok what you see in this picture ? (he show me a discrete pigmented
lesions at the macular area looks like of RP I never seen like it before)
A- I started by describing It looks like RP Sir, it is bilateral sir ?
Q- No , and it is raised lesions
A- My be ……. I stopped
Q- it is Metastatic !!!!!! so where the common place for the primary
lesion?
A- In male ---- brochus and in female -----, breast
Q- ok tell me some drugs used in treatment of AIDs?
A- By HAART
Q- name some drugs
A- Ziduvodine, …….. Bell rang (I saved by the bell bec I did not remember
others bec difficult names)
Then Dr Basaek start the other situation by shocked question!!!
Q- tell me about Post fixational blindness
A- I shocked , I don't know it at all, so I quickly told him, I don't know
Sir
Q- Ok , how patient with pituitary tumor will present to you ?
A- There are systemic and ocular features
Q- I mean about his visual field ?
A- Bitemporal hemanopia
Q- he will come to you telling you he has Bitemporal hemanopia!!!! He was
some angry , how he complain ?
A- He will complain from peripheral field loss
Q- this is what I asked for and this is the postfixation blindness
Q- Now tell me some systemic features of pit. Tumors
A- according to the type of adenoma and the secreted hormones, so if GH
so will be Gigantism in infancy or acromegaly in adult, if cromophobe he
will has prolactinaemia
Q- what is C/P of prolactinaemia
A- Dymsneorrhyea, infertility and gynacomastia he was not satisfied)
Q- female patient aged 23y come to you with bil dic swelling what you do
for herv?
A- First I will exclude causes of pseudoDisc swelling
Q- like what?
A- Tilted disc, Mylinated N. fiber, hypermetropia
Q- what Else ?
A- Drusen of optic disc ( I was forget it but then I remembered)
Q- how you confirm it is Drusen
A- By US or CT
Q- what else ? I for get to say autofloeuscence which is the simplest
answer ) so again said : non invasive method without costing ?
A- Oh sir, autoflourescence
Q- what common causes of disc swelling in this female ?
A- It may be PTC (pseudotumor cerebri)
Q- how you confirm ?
A- It is a diagnosis of exclusion so I will do first neuro-imaging to
exclude space occupying lesions
Q- what type of neuro-imaging?
A- Better to do MRI bec we look for soft tissue lesions
Q- then what ?
A- Doing lumbar pucture to measure the ICP
Q- what are causes of PTC
A- It is idiopathic sir,
Q- only idiopathic !!!!??? or other causes ?? like drugs or……
A- Yes sir, drugs like Tetracycline, Vit A, nalidexic acid
Q- what else in females particularly
A- Oral contraceptives
Q- what is the first advise you tell to this patient
A- Weight loss
Q- yes, what else ?
I stopped (but I must say I will advise her to stop drugs she used!!!!! It
is logic but where is my mind in these moments ??)
Q- Ok , describe this picture ( he showed me a picture of fundus picture
with upper part of hages and necrosis of retina , I described what I see
Q- what is the Diagnosis?
A- It may be CMV or ARN or PORN
Q- he is healthy patient
A- So may be ARN
Q- how you treat him ……….. then the happiest moment came , Bell rang ,
thank God
Wow it was deadly station and I was exhausted
Then the Last station ophthalmic medicine
Was 2 gentlemen English Drs and v. helpful. He started by showing me
anterior segment picture with something like adhesions between lid and
conj . it is not clear from the first moment by he guided me to the area
of adhesions
Q- what could be the causes for adhesions?
A- It may be cicatrizing conj like old trachoma, steven Joh syndrome,
acne Rosecia
Q- what else?
A- Chemical burn
Q- what else ? he want OCP
A- I want to say OCP sir but I looked to the Carancle and it is ok so it
is not OCp
(he was pleased and nodded ,saying yes you are right )
Q- he show me another ant segment picture of a child with bil skin
eczema around the eyes affection both upper and lower lids what you see
in this picture?
A- I described what I see
Q- what could be the causes?
A- May be drug eruptions
Q- what else?
A- Eczema
Q- the child is asthmatic
A- So he is atopic patient, so may be allergic dermatitis
Q- how you treat him?
A- Emoluent like hydrocortisone oint. 1% topical
Q- do you see any other thing in the picture , look to his left eye
A- Oh yes sir he has ptosis
Q- ok what time of ptosis?
A- It is mechanical
Q- how you treat it?
A- By treating the cause
Q- what you see ? he showed me a picture of dendritic ulcer on the
temporal side of Rt cornea stained with Flourscene
A- I described what I see and told him this is Dendritic ulcer
Then the Bell rang. But the other dr
continued on the same picture :
Q- what is the C/p
A- Redused corneal sensation
Q- how you test C. sensation
A- Simply by a filament of cotton or thread and touching the cornea from
temporal side and the patient looking straight a head
Q- what drugs you use in R/?
A- Acyclover
Q- what else
A- I can't remember another drugs
Q-Do you use steroids ?
A- In stromal affection after epithelial healing
Q- do you do Culture?
A- No need sir but if I will do I will do PCR
Q- how you do PCR ?
A- ( I started to think but he shifted to another question , thanks bec I
don't know)
Q- causes of ocular pain and decreased VA in young guy?
A- Corneal ulcers or keratitis, iritis, acute attack of glaucoma
Q- and in post segment?
A- Optic neuritis (he want this answer)
Q- how optic N. cause pain
A- Bec the adhesion of MR and SR to optic N at thenorigin of these muscles
Q- how you treat him?
A- By 3 days IV prednisolone methyleacetate 250 mg 4 times followed by 11
days oral steroids 1.0 mg/KG/dayt
Q- what is the common cause in this age?
A- MS
Q- how you confirm
A- MRI
Q- what you will see on MRI
A- Periventricaular white plaques of demylinations
Q- what clinical test you do to confirm , clinical test (he stressed on
clinical test
A- APD by swinging test
Q- Yes, ok, any thing to inject than steroids?
A- Yes interferon
Q- how it works
A- I don't remember sir
( he laughed and said you don't remember!!!!!!! , no , no you did not
know, I smiled)
Q- what are percentage of people to get MS after ONeuritis
A- I said 34% (but the correct is 38% in kanski)
Q-a guy come to you with ptosis and variable diplopia, what do you think?
A- I will think of MG?
Q- what is MG (he need the definition)
A- It is autoimmune disorder affecting the AC receptors at synaptic nerve
ending causing………….
Q- how you confirm?
A- Simply by ice test or Edrophonuim test
Q- how you differentiate between between MG and Dystrophia Myotonia?
A- DM is AD with delayed relaxation….. bell rang
Thank to god , lastly I finished this difficult part
My clinical was 2 days later
Clinical exam
First station was posterior segment: 3
cases.
First case was mylinated N. fiber around the optic disc and surrounding
with white band at the periphery involving the whole circumference(it was
a circulage)
Q- did mylinated N. fiber affect VA or VF
A- No sir it just may cause enlarged blind spot in VF. DR with PRP
peripheral. RT ARMD with hage and exudates with severe MO and other eye
was soft drusen confluent Questions are just what is the diagnosis bec
time is v. short
Then the bell rang
Second station was neuro and ocular motility
:3 cases.
A Man in fifty age and asked me to do
Confrontation test I did it and it Was a case of Rt lower altitudinal
defect
Q- what is DD
A- Glaucoma, Ant ischemic ON , (I forgot BRVO or BRAO). Girl with dist XT
corrected with glass (he told me her glass is -1.50 OU) and asked me to do
Ocular motility. I asked him if I can do Cover uncover first he said do
it. I removed the glass and did it with and without then motility and it
was present altern XT on dist only when removing the glass.
Q- he asked me how to treat her
A- Just glass sir as she corrected by it. Rt brown syndrome
Q- how you treat him
A- As eyes are straighted in primary position and no head tilt so just
observation and FU
Third station was Oculoplasty and lid: 2
cases
Rt ptosis in a boy aged about 15y asked me
to do measures of ptosis by a ruler
Q- what test you must do ?
A- Coneal sensation, motility
Q- what else ?
A- Bell's phenom . Lady with Rt proptosis and left enophthalmous and
asymmetrical face. Asked me to do measures of proptosis and give me Hertel
and asked me what is this I said Hertel , he said ok use it , I said no
sir I don't use it But I use a ruler. He let me measure with the
ruler and it was 21 mm. He asked me what is possible cause of left
enophthlmous , I said may be Trauma and fracture bones of the face and
orbit (he did not comment)
Forth station was Anterior segment: 2
cases
Man with left sutured penetrated wound and the sutures not buried with
rupture cap with cataractous lens matter in the cap
Q- what you will do for him if come to you for first time?
A- I will do first x-ray or CT to exclude IOFFB then I will do primary
repair to close the eye and keep th integrity of the eye then next day I
will examine him copmpletly and manage according
Q- if x-ray or CT is not available what you will do?
A- I will do US on closed lid ……. , (she staring at me as if warning me )
… No , no Sir it is opened wound so I will do primary repair then next day
I will do everything for him. Second case was Lady with Rt Diffuse opacity
looks like macular dystrophy with 2 rubbing lashes and left Clear Graft
Q- what is the is the diagnosis?
A- I described what II see then asked him to examine the other eye , he
said ok then I told him it looks like Macular dystrophy bec the interval
between opacities are also opaque
Q- could the rubbing lashes causing this diffuse opacity?
A- I did not think that Sir
Q- why?
A- Bec Rubbing lashes causing epithelial opacity but this opacity is deep
and involving the stroma deeply
Q- if I told you that she did entropion operation in left eye (Grafted
eye)
A- No answer ( but the correct answer is she must do entropion operation
to keep her graft clear otherwise rubbing lashes will do opacity on it )
This was the last station in the clinical exam
I tried to write every thing with details
bec I know it will be beneficial for every colleague than just mention the
questions . I hope I did not forget anything. I will be happy to help any
one or answering any question about the exam
My email is Hassan_thabet@yahoo.com
Thank you v. much and best wishes for every one
Hassan Thabet
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