My personal experience in FRCS Glasgow examination Ahmad Muneer Otri

Dear colleagues,

 My name is Ahmad MuneerOtri, an ophthalmologist from Syria. Thanks Allah, I passed the final FRCS exam in Glasgow (June 2011) from the first attempt.

As one of colleagues said, this exam is very easy to pass and easier to fail.

Be confident and don’t believe all the myths about how difficult to pass this exam, you will pass….Otherwise, if you go there without self-confidence, you will fail…

I was extremely busy writing up my PhD thesis in Nottingham, UK when I decided to register in this exam, I was not sure if I would be able to study and write in the same time but I had the believe that I would pass and I passed (Thanks to Allah).

I dedicate my success to Allah, my country (beloved Syria) and my family, especially my parents, wife and sons who supported me without limits.

Please don’t hesitate to contact me should you need any help with your preparations for FRCS exam, my email is:

muneer_otri@hotmail.com

Let’s start talking about how to pass this exam?

For problem solving questions, Prof. Muthusamy virtual university was the first and most important source of success, his encouragement and support were always appreciated, he guided me and taught me how to answer the question properly and as he always used indicate: Even if you have the knowledge to pass, you should be able to show this to the examiners…He and his colleagues at the virtual university taught me how to show the examiners that I have the knowledge to pass, and I passed....His web site is http://www.mvupgo.com 

Also, FRCS yahoo group was of great help in viva and clinical exams.

Chua pageis a must and was invaluable in the viva. I have never seen a single source of knowledge like this page

Finally, Oxford handbook and Kanski were the main (and only) textbooks which I read for this exam

My experience in the final Part of FRCS in Glasgow June 2011

First day: Oral viva

The First station: Two examiners: Indian and British

The first examiner showed me a photo of red eye with follicular conjunctival reaction he said it is involving one eye and started one months ago, what is you’re the most likely diagnosis?

I mentioned about the Inclusion conjunctivitis and he was happy with the answer so he asked about the diagnosis and treatment in details. Then he asked me about what are the other possible DD? I mentioned about the drug toxicity, the oculoglandular syndrome, the adenoviral (he asked could this last for more than one month? I replied no..). In addition: I mentioned about the sarcoid and the lymphoma..He was happy with these DD

He also asked about the DD of esotropia in a child at age of 5, I mentioned about the accommodative and the neurological, he asked how to confirm the diagnosis of each one

The second examiner showed me a photo of corneal abscess and asked in details about the signs in this photo, I mentioned about all the signs (the epithelial defect, the infiltrate, the hypopyon the KPs and the corneal edema…He was especially interested in the corneal edema and the hypopyon as these were not very obvious in the photo and he he asked about the treatment, he asked what is the most likely reason of this ulcer in young patinets? I replied, the CL use, he was happy with this answer. Then he asked me what do you think the bacteria responsible of this infection, I said it could be PA because there is some melting and in CL wearer but we can’y make sure. He said could this be Acanthamoeba? I said yes but with super infection not just pure Acanthamoeba alone, he said OK.

The second station: Two examiners: Scottish and Indian

The first examiner showed me a photo of a old patient withproptosis, red eye and chemosis and crusty black discharges in one eye, she said what is the DD?

I replied it could be Mucormycosis! He replied nervously, is that your first DD?? I said no it could be related to tumours, trauma, vascular lesions, infections, inflammations, systemic diseases, thyroid related (although unlikely in one eye)

She asked me to give examples about each one of my DD, and I gave a lot of examples then she said: what is the first thing you should do in approaching this case? I started to mention about the investigations, but she interrupted me nervously again saying what you should be before that? I did not know what to say! She said what about the history? I said yeas of course!!

She said, ok this patient had had this proptosis post injection of anesthesia before cataract surgery, I said: Ohhh, it is retrobulbar hemorrhage…She started to ask me how to diagnose and treat this case, I replied quickly, she showed me that my answers were not ok to her (all the time) so I was really upset at the end.

The second examiner showed me a photo of failed corneal graft and said this happened 3 month after the graft (after a period of good vision and clear graft) I said this is most likely because of the graft rejection, he asked about the risk factors of the graft rejection in details..

Then he asked about the DD of lacrimation in one eye in an old patient, I mentioned about the ectropion and the obstruction of the nasolacrimal duct, he interrupted me and asked in details about the technique of probing

The third station: Two examiners, British and Indian

The first examiner gave me a scenario about a patient waiting for a cataract surgery and then the he developed severe palpitation, what is the DD?

I mentioned about the stress and the ectopias, he said OK what else? I said atrial tachycardia, he said yes but when you have severe atrial tachycardia, what this can lead to? I said: sorry I don’t know…He smiled and said atrial fibrillation, and then he said: ok what is the main risk of the atrial fibrillation? I said the coagulation and the embolus…He said how would you treat such patients prophylactically? I mentioned about the warferin and the Digoxin and the Beta blockers, he asked in details about the protocol of these drugs and the side effects related to eyes of Digoxin.(He was very cooperative and kind person)

The second examiner showed me a photo of papilloedema and asked me about the signs which I can see in this photo and the then he told me that you can see this in the other eye as well in a young lady, what is your DD? I mentioned about the idiopathic intracranial hypertension, he asked about this in details (diagnosis, treatment and prognosis). Then he asked about the mechanism of the carbonic anhydrase inhibitor in reducing the intracranial pressure, I could not give him a definite reply so he was not very happy with this last question

Finally, he showed me a photo of normal fundus with two cotton wall spots and asked: what is your DD (knowing that this patient had recent bone fracture)? I mentioned about Purtscher retinopathy!! He was not happy with my answer at all…So he asked about the mechanism of this Purtscher retinopathy, I mentioned about this in details and then I mentioned about the lipid embolus as one of the reasons…So he said, ok that is fine (e showed me that he was not very happy with my answers, in general!)

The second day: The clinical exam

8 stations

1- Patient with upper eyelid coloboma, when I examined him closely, there was a scar over the lid crease, so I said this could be a patient with previous upper eyelid tumor who had plastic surgery after excising the tumor (Tenzel flap) , he was happy with my answer, then he asked about the BCC and how to treat it?

2- Patient with bilateral proptosis and two small cysts at the temporal canthus in BE, I mentioned about the Thyroid eye disease in details but could not know what are these cysts, he said they are lipid prolapse!

3- Patient with bilateral krukenberg pigment distribution on the corneal endothelium and mid peripheral iris atrophy (important to examine by retoillumination), I mentioned in detailed about the pigmentary glaucoma, he asked specifically about the Myopia and the risk of RD in such patients (he was very satisfied with my answers)

4- Patient with thick spectacles, aphakia and artificial filtrating tube in the AC. The examiner was happy with my diagnosis of the link between the aphakic glaucoma and the tubes because of the refractory course of such glaucoma. The he asked me in details about the tubes, their indication, high risk glaucoma patients and when to used tubes and when to use MIT-C with Trab?

5- Patient with homonymous inferior quadratanopia by confrontation field, I mentioned about the parietal globe lesions and the diagnosis

6- Patient with defect in adduction and nystagmus on abduction (when looking to the left), I mentioned in details about the INO and the its diagnosis and the treatment

7- Patient with severe nystagmus, the examiner asked me to examine his fundus with 78D lens, I could not see anything apart from patches of white areas and pigmentation at the periphery, I said it could be choroidalcoloboma! He was not happy with my answer, the pupils were not dilated and the nystagmus was severe so I could not see properly (I think this case was albinism!).

(PS:  It is very important here, even if you don’t know the diagnosis, give detailed information about what you can see by your examination, that is may give you some credit)

8- The last case was a young lady who the examiner asked me to examine with the indirect ophthalmoscope, I examined the whole eye and could not find any abnormality, he asked me to look at the far upper temporal quadrant, I could not find any lesion again!!

He was not happy at all!

(The good point in this station was that all the candidates could not find any lesion as well!)

Many thanks and good luck

Yours sincerely,

Ahmad MuneerOtri

MD, MOphth, ICO, FRCS (Glasg)