Dear colleagues,

Thanks to Allah I passed part-3 FRCO exam in Glasgow held in June 2011 from the first hit. I hereby describe all the details of my experience hoping somebody finds it beneficial.

Regarding the best airways to book, I found the British airways fairly well. Through their website you can book a round-trip flight with one stop at London. They provide you with your baggage in Glasgow without the need to take them from one flight to another.

Regarding the accommodation, I stayed at Euro Hostel and I booked fairly cheap stay for only 29 GBP per night. You can book through https://bookings.seeglasgow.com . Its location is fairly close to the exam centers and you may take a walk to reach the exam centers or call a taxi which usually takes 3-4 GBP for the drive.

ORAL EXAM:

1- NEUROLOGY-MEDICINE:

NEURO-OPHTHALMOLOGY questions

a- IDIOPATHIC INTRACRANIAL HTN: A picture of marked disc swelling to describe the findings.

 Question on the DD (papilledema, papillitis, etc)

 The examiner then told me that this picture was for a 19-y old girl with an overweight, what is the most likely if she was complaining from severe headache and her BCVA was 6/6 bilaterally. I answered that a possibility of papilledema is very likely. He asked me what other fundus sign that may benefit me but it will be not possible to assess in a photo. I answered:”VENOUS PULSATIONS” and questions on its incidence in the normal population. Then he asked if I am asked to do just one investigation, what it should be, I answered

“NEUROIMAGING”. He asked why, I said:” to exclude possible intracranial space-occupying lesion”. Then he told me that if neuroimaging proved normal and a lumbar puncture revealed normal cytology but very high opening pressure what will be your suggestion, I answered:” benign increased intracranial pressure” especially that the lady is female and obese.

 Question on medications that can be used for management.

 Question on types of surgery that can be used.

b- FAT-EMBOLISM: Color Fundus picture showing 2 cotton-spots one at each temporal arcade.

 Question on the DD of cotton-wool spots. I answered:’ HTN, DM, HIV,CMV, systemic lupus, fat embolism”.

 He then mentioned that this picture is for a man brought in accident with multiple lower limb fractures He then asked about the visual prognosis, I really did not know but I said:” I think it is not that bad” the examiner smiled and said:” I say it is really good”

c- THYROID OPHTHALMOPATHY:

 A question on the most common cause of unilateral proptosis. I said:” thyroid eye disease”.

 Question on the thyroid status in such patients.

 Question on the possible systemic manifestaions in these patients if hyperthyroid and the possible investigations.

 Question on the ocular complications of thyroid ophthalmopathy and the indications for orbital decompression.

 Question on the commonest clinical presentation in thyroid eye disease in the eye clinic: dry eye

INTERNAL MEDICINE questions:

1- ATRIAL FIBRILLATION: Question on management of atrial fibrillation and possible complications

2- EPILEPSY: Question on management of a case of epilepsy in the ophthalmic clinic and importance of taking history in such patients and possible ocular toxicity from anti-epileptic drugs

3- VIRAL HEPATITIS: Question on management when we got a needle stick that is possible blood-contaminated and review of hepatitis virus immunization

4- CARDIOVASCULAR DISEASES: Question on effects of cardiovascular disease on the eye

2- OPHTHALMIC SURGERY & PATHOLOGY

OPHTHALMIC SURGERY

1- RETROBULBAR HEMATOMA: Picture of unilateral periorbital edema after ocular surgery for DD and question on risk factors and management of retrobulbar hematoma.

2- PSEUDOEXFOLIATION SYNDROME: Picture of pseudoexfoliation syndrome: problems during surgery, precautions during cataract surgery, and management of small pupil during cataract surgery.

3- PCO: Management of PCO and prevention of capsular opacification.

OPHTHALMIC PATHOLOGY

1- Graft rejection: Picture of eye with penetrating keratoplasty with marked C. edema, etc for DD. Question on the pathology and management of graft rejection.

2- Optic nerve glioma: case of NF-1 syndrome with enucleated blind right eye what is the expected cause of enucleation. Question on the pathology of glioma.

3. OPHTHALMIC MEDICINE:

 Question on the DD of esodeviation in a 3-year old child and leading questions on diagnosis of retinoblastoma

 Question on DD of a case of 40-y old with night blindness

 Picture of corneal abscess for DD, investigations, ttt

 Picture of episcleral nodular lesion for DD, investigations, tt

 Picture of scleral thinning for DD and leading questions on necrotizing scleritis, investigations, ttt

 Picture of hypopyon in the AC for DD, investigations with leading questions on endophthalmitis

 Question on side effects of systemic corticosteroids (what is the most common: osteoporosis)

CLINICAL EXAM:

1- Posterior segment:

Use: 78D lens to examine Case-1: Male patient with High risk NPDR with accidental perifoveal burn, questions on DD, management

Use: 78D lens to examine Case-2: Female patient with AMD with geographic atrophy on one eye and wet AMD on other eye

Use: indirect ophthalmoscope to examine Case-3: unilateral macular hole

2- Anterior segment:

Case-1: Male patient with Fuch endothelial dystrophy with MGD and acne rosacea

Case2: Male patient with Map-dot-fingerprint corneal dystrophy with nuclear cataract

3- Neurophthalmology:

Case-1: Male patient with senile ptosis asking on different measurements that need to be done and management

Case-2: Male patient with RAPD with possible DD (temporal arteritis)

4- Ocular motility:

Case-1: Female patient with thyroid ophthalmopathy (you have to know how to examine for systemic manifestation of thyroid eye disease and how to examine the thyroid gland itself)

Case-2: Male patient with orbital inflammatory disease

Recommendations:

1- For ophthalmology: Wong ophthalmopathy review is the best and it tells you the scenario of the exam. Kanski is enough so donot confuse yourself with other sources. Your clinical practice is essential and you should engage in examining the patients with subspecialities that you

are not familiar with and remember that you must convince the examiner that you have done such techniques hundred times before.

Be self-confident whenever sure about your answer and never appear aroused from any questions, simply say I cannot recall if you donot know. This saves time giving time for the examiner to ask you another question.

2- Donot miss Chua website, you cannot pass without it.

3- For internal medicine and emergency: Oxford emergency medicine is the best although long but be patient while you read it and pretend that you are called at night to see a relative of you with emergency and no doctors available.

Please let me know if you have any questions on : walidose2000@gmail.com