FRCSEd

Centre: Cairo

Date:  Dec 2016

I am Dr Mona Abdelhafeez I took the  FRCSED PARTB in Cairo November 2016. Thank God, I passed 6 out of 8 stations in this exam. The first difficulty  I faced  is how to prepare for the exam and what are the commonly asked questions and unfortunately I did not find any past candidates experience for FRCSED Cairo for any year and as IBELIEVE these exams need orientation more than knowledge itself am reporting whatever  cases and questions asked to me hopefully it will be beneficial  for the newly sitting candidates .

the exam divided into  three parts

first  day

clinical stations they are3 stations

one anterior segment

one posterior segment

one neurology and motiliy

second day

refraction

third day

4 viva tables

one clinical ophalmoloy table

pathlogy table

neurology and medicine

good medical pracise and ethics 

clinical stations

ANTERIOR SEGMENT

TWO Egyptian examiners ,5 cases in the room

First case

A 40 yrs old male examiner ASKED ME TO EXAMINE left eye  in SL there was corneal tatooing eye is quite he asked what is this and why we did it

Then same pt examine the t eye ther was corneal graft with diffuse  corneal opacity he asked what is the level of this opaciy how you can exmine the endothelium by SL isaid specular illumination he asked me to do it then he said  ok do retro illumination then how can we mesuremesureT he  AC depth  by mm how you check for cells

Second case

Again bilateral corneal graft tell me your finding in AS

AGINdiffuse  CORNEAL OPACIIES OU there are surgical and traumaic PI in one eye with scleral fiated IOL    he asked me what are the indicaions for corneal grafting .

Third case

The straingest case in this exam young  adult with bilateral blue sclera he said what is your finding by inspection ISAID bilateral blue sclera what else I did not say any thing he asked me to put the pt in SL and surprisingl the rtee was artifical blue eye  then he said examine the othe eye there was blue sclera with corneal graf and surgical PI  he asked what is the DD of BLUE SCLERA  .

PSTERIOR SEGMENT STATION

Again 5 cases in one room with one indian examiner and one egyptian examiner

Examine this pt using indirect there was PRP marks flat retina under silicon with macular scar no disscusion only  what is your findings how do you know this is silicon

Second case was myopia he asked o examine using direct opthalmoscope and it was difficult to see so he asked me if you face difficulty  with direct what to do I said ndirect so he gave me the indirect there wastypical myopic fundus with multiple areas pfchorioretinal atrophies and fuchs spots with perpapillary atrophy again onl findings no questions

Third case was RP he asked me to examine by direct pthalmoscope there was typical picture of RP both eyes with macular edema I did not noticed the edema from te start only I mentioned waxy disc attenuated vesseles bone specules then he said wat about foveal reflex then Ioldes it is dim so most likely there is macular edema but ineed to confirm using 90 D Then he said can you just see by torch the anterior segment ther was pseudophakia he asked me is there any relation between all these findings I said es it is well known ocular associations of RP THEN HE SAID SO what are the other ocular associations isad glaucoma and KC .

FOURTH CASE

Examine using 90 d there was superotemporal BRVO treated with secoral PRP only asked  what is ur findings. No more discussion
 

Neuro/motility station
first case:
50 yr old female examined pupil. She has left amaurotic pupil, he asked me if you are alone in the clinic, and your consultant is not around, wt will u do for this patient ?

second case:
examine the ocular motility of this patient.
pt is young adult male with alternate exotropia
he asked how much this angle
differential diagnosis

third case:
young adult male, he asked me using direct ophthalmoscope, examine the optic nerve
there was bilateral optic atrophy
he said this patient presented with sever headache and vomiting, wt is your DDx
I ansered a space occupying lesion, mostl likely compressing the chiasm
he asked wt will u do for him?
referral to neurosurgery
wt he will do?>>>excisiobn

4^th case :
examine this patient with right partial 3^rd nerve palsy with pupillary affection and with aberrant  regeneration.
there was craniotomy scar
he wanted only examination and where is the lesion


1^st VIVA pathology table
1 Indian examiner
1 egyptian
1^st : mother brought her child complaining of whitish pupil of right eye
what is the DDx
when I mentioned retinoblastoma  he asked about types of cells I said rosette and flurett and homer wright, he showed me rosette picture. Which one is this one,then he asked wt will you do for pt. he dosnt like referral to oncologist. He discussed the options of management.
the Indian examiner asked me DDx of non axial proptosis then 2^nd question he showed fundus photo of malignant melanoma. What is your DDx , what you will do for the patient. Wt are the types of biopsy and cells of malignant melanoma you know. Then he showed me a picture of epitheloid cells and a picture of spindle cells, which one is the worst prognosis

2^nd VIVA: medicine and neurology
1^stquesion ( optic neuritis )
most common cause
how MS affects the motor system of the eye( he wants INO)
where is the lesion in INO

2^nd question:
wt r the indications of Tx in toxoplasmosis

3^rd question
DDx of papilledema
wt will u do 2 differentiate btw true and pseudo ( he wants FFA)
wt r the signs of early disc edema? I said starts nasally, he disagree and said superiorly
wt will u find in visual field>> enlarged blind spot
if pseudo, wt r the VF changes>>bitemporal field defects in tilted disc

4^th question
photo of man with left exotropia and ptosis
which type of 3^rd  nerve palsy u need 2 refer 2 neurologist, how u will follow

5th question
K/C of epilepsy, well controlled by Tx, suddenly her developed gazed evoked nystagmus, where is the lesion or defect happened ( cerebellum)

Clinical ophthalmology viva

Two Egyptian examiners

1-      What is the DD of irities associated with retinitis he wants herpes virus

2-      What is the effect of herpes virus in the eye

3-      How you will manage epithelial keratitis

4-      What is the pathophysiology of disciform keratitis

5-      If the pt developed vitrifies what investigations you will do he want vitreous tap and pcr what drug you will give intraviteraly

Other question about complications of cataract sx started from retrobulberhge ok how you will manage how exactly you will do canthotomycantholysis

What is the effect of local anesthesia on CNS?

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