Thank God

I passed the FRCS exam in Amman , Jordan 2013

I am writing my experience hoping it might be of use and benefit for my colleagues .

My exam was on the 15th of April 2013

M first day was for the Oral exam

My first session was for Neuro-ophthalmology and Emergency medicine :

1st Examiner :

He first gave me a scenario of a female pt. who's overweight with optic disc swellings and He discussed with me the possible D.D. and management ( BIH , Papelledema ...etc ) .

Then He gave a photo of an Iris with multiple uniform lesions - I described the lesions ( size , colour , distribution ... etc ) and I told him my provisional diagnosis is Lisch nodules in NF 1 . He asked me how NF 1 affects the vision and I mentioned Glaucoma , meningioma and glioma ( I forgot to mention the lesions affecting the vision in anatomical order - I was supposed to tell him : lesions affecting the lid causing ptosis , lesions affecting the Iris , the angle , the lens ... etc ) .

Then he gave me a scenario of an old pt. waiting in my clinic for 4 hours and he fainted , he was cold and sweating but conscious . I gave a rapid DD including vasovagal attack , Hypoglycaemia and the most serious The MI and pulmonary embolism . I told him rapidly the general steps for management of Shock .

He asked what if it's MI - I started mentioning the management steps till the Oral aspirin then I've got a mental block and I didn't continue as if my memory was wipped out !!!! But he said to me " and you already called for help ... "!!!!!!

The second examiner was a Lady from Oman .

She gave me a scenario of a female child who's underdevelopped , of short stature and with poor VAs. OU .

I didn't know the DD nor the a Diagnosis so I started mentioning the steps of management including any maternal problems or infections during pregnancy , birth wait - prematurity .

I told the Lady how I am going to examine the pt. including VA., pupillary reflexes , fundus exam. to exclude optic nerve hypoplaesia  , VF. and ocular motility + referral for Neurologist/Neuroimaging , but she looked satisfied when I mentioned HORMONAL PROFILE .

She gave me a photo of a BRAO and I misdiagnosed it for CMV indolent retinitis !!!!!!

Then she asked me about craniopharygioma - I mentioned the signs , the typical VF defects and management but I forgot to tell about Hydrocephalus and HORMONAL PROFILE in children and she was keen to hear me saying it but again I had a mental block .

Then she asked what to do for a 12 ys. old female patient with a small glioma of the ON in her right eye with very mild proptosis and VA of 6/12 in the affected eye and 6/6 in the other eye . I said just for regular f/u and I must request Neuroimaging to exclude intracranial glioma which is devastating and fatal .

My second session was Ophthalmology Medicine :

The 1st examiner

He asked me about the manifestations of thyroid eye disease in details and how to manage them .

Then he showed me a photo of GPC with shield ulcer and How to manage .

Then he showed me a photo of CHRPE and what are the consequences .

The 2nd examiner

He showed me a photo of an eye with conjunctival injection tears and he told me this is the photo of a patient who had fever few days ago and now his eyes are like this - and I said " Pharyngoconjunctival Fever " , he asked me about the signs of the adenoviral keratoconj. and I mentioned the corneal subepithelial infiltrates . He asked me what else - but again I had a mental block ( I was supposed to say " Follicular conj. " and " lymphadenopathy " ) , so he asked me what's the lymphatic drainage of the eye and I answered but still I didn't say " lymphadenopathy " !!!!

Then He showed an unclear photo , I failed to see any criteria or signs , so he said " what if I told you that this patient had a hypermature cataract and IOP of 42 mmhg - I said it's a case of Phacoanaphylactic glaucoma .

He showed me a photo of a fundus with Best vitelliform dystrophy ( scrambled eggs stage ) and he asked about the investigations , the prognosis , the stages and what I would say to his family .

Then he showed me a photo of lattice corneal dystrophy and asked me about my diagnosis .

My last Oral session was Surgery and Pathology :

The 1rst examiner

He asked me about management of a pt. with Acute Angle Closure Glaucoma in details including the other eye , surgical and LASER PI ... etc .

He Then gave a scenario of a patient who had a severe blunt trauma causing Iridodialysis and how to manage in details even surgically and I started by saying " I wouldn't do it by myself " - but when he asked about the surgical management of the the Iris dialysis I said I don't know .

He also asked me about the possible complications to this type of trauma .

The 2nd examiner

He asked me about a pt. who underwent a successfull phaco. with IOL in his Rt. eye who came after 2 days complaining of pain in the affected eye with decreased VA - what are the possible causes then he discussed with me the management of Endophtalmitis in this patient in details .

He asked me about a patient who had been hit on his eye by a glass bottle and how to manage .

He asked me about a case of corneoscleral wound and how to manage . And if the wound is corneal but self sealed .

Then he showed me a photo of a large deeply infiltrating ulcer involving the temporal region and the upper and lower lids and I mentioned my DD starting with the BCC and SCC and I told him that my provisional diagnosis is " SCC " and he asked me why - I answered " due to the size , the site and the deep infiltration and shape of the base of the ulcer " ....Then he asked me how to manage it .

Two days later I had my clinical exam

In King Hussein Medical city in the LASIK center

My first session was RETINA :

The first examiner asked me to examine the fundud of a female patient by the indirect , I found her to have an Optic nerve Coloboma , He asked me about the associations and how to manage . He wanted to hear from me about the Amblyopia in the affected eye and management by patching .

The second examiner asked me to examine an old man with the Volk 90 lens on the slit lamp . I examined him , He had a large raised macular scar with drusen and exudate and I diagnosed it as a case of ARMD .

He asked me how to manage - When I reached the OCT and IVFA in my management He showed me the pt.'s IVFA photos and asked me to discribe them - It was a Predominently classic CNVM . He asked me how to manage and what are the ttt. options - When I mentioned the Anti-VEGF he asked what are the types and why I favour one over the other and what's the frequency of the post-injection F/Us .

My 2nd session was NEURO. and OCULAR motility

The first examiner asked me to examine the Ocular Motility of a young female patient .

She had a defective Elevation in the RT. eye on abduction and on adduction - I diagnosed it as case of DEP vs. Blow-out fracture of the orbital floor . He asked me in details about the signs , the symptoms and the management in details .

The second examiner asked me to examine a female pt. in her 30s by the VOLK 90 lens , It was acase of longstanding papilloedema and the cause was BIH ( IIH ) and he discussed me about the case in details .

My 3rd session was oculoplasty

The First Examiner showed a young male patient who had phthisis bulbi OD with sensory XT and mild Ptosis with Buphthalmos OS .

He asked me about the management and possible cosmetic surgeries and about the ptosis .He even asked me to perform the measurements for the levator function , Marin/reflex distance with a ruler - and I told him that under normal circumstances , in a case of ptosis , I would like to test the pt. for Bell's phenomenon esp. if it's a case of congenital ptosis .

The second examiner asked me to examine a 40-50 ys. pt. especially that he doesn't like his own appearance .

I examined him with my pen torch , he had Blepharochaleasis of the lower lids OU and a Cyst of Moll n the Rt. LL margin .

Then She , the examiner , asked me " Don't you want to examine this patient for PROPTOSIS ??? " and frankly I got confused because I missed it !!!!

But I examined the pt. again and I discovered that he has Rt mild proptosis !!!!

She asked me in details how to manage and what are the tests to be done in the clinic for this patient ? She discussed it with me in details .And when I told her about the need to measure the amont of Exophthalmos with the Hertel's exophthalmometer or a ruler , She rapidly gave me a Hertel's and asked if I am familiar with it and I said Yes and I took the measurements - I think , Thank GOD , it saved me from failing in this session .

She asked me what else - I mentioned the Ocular motility and she told me to perform it - I did and found the patient having limited adduction in the proptosed eye .

My 4th session was for the Anterior Segment :

The first examiner asked me to examine , on the slit lamp , a patient - He had bil. corneal central opacities , dense cataract and Pseudoexfoliation .

He asked me how to manage in details .

The second examiner showed me a young female patient on the slit lamp , she had Keratoconus in the Lt. eye and PKP in the Rt. eye .

He discussed the case with me in details and he even showed me her TMS photos .

And That's it ......

My personal advice is put all your Trust in GOD , use and study every thing on CHUA website in details especially the photo galleries and candidate experience .

Fear and mental Block and forgetting are normal in such exam. , try to keep yourself calm as much as you can .