Essay  Questions: (2 Hours)

A 30-year-old woman has a history of chronic uveitis and is blind in her left eye from complication. She present while 6 month pregnant with floaters and pain in her right eye with an  IOP of 45 mmHg. How would you manage this case and what are the treatment options? 

A 48-year-old man present with reduce vision in his right at 6/12 and he has slightly swollen right disc. 2 weeks later his vision deteriorated to hand movement right and 6/60 left with bilateral disc swelling. Give a differential diagnosis and explain how would you manage this patient? 

A 70-year-old man who is pseudophakic in his right eye present with spontaneous dislocation of his intra ocular implant into the vitreous cavity. Vision is reduced and there is marked corneal oedema. Describe the possible management option for this patient? 
Please remember the question heading (essay type not required) and proceed a if you are really treating this patient.

 MCQs (300 questions in 2 hours): 

The ophthalmology questions were difficult, even more difficult as stated by our colleagues who went through this exam earlier, the hardest ones were those of general medicine as well as neurology. There were questions about polymyositis, polycythaemia, and cardiac resuscitation. Aim at 150 correct answers if you can, this is said to be the safest way to pass with 6. 

Vivas: 

We were divided into two groups. I was in the first group. Every candidate must go to 3 stations. Each station had 2 examiners with 10 minutes each. Please remember that what is important is not only the answer you say, but also the way you say it, how to defend your opinion, and your reaction to the word “ no that’s wrong”. Avoid hesitation as well as over confidence. 

My first station was Ophthalmic Medicine:

My first question was, what is meant by iatrogenic? Medical, surgical,…. When I mentioned steroids, he went through the uses and complications in details, how to detect and how to treat each? Back to systemic drugs that have effect on the eye, retinopathy, keratopathy, lens,…..with detailed questions about each, reversible, irreversible, dose dependent…then to neuropathy with drugs in details (as usual..!!), changes, how to detect and how to manage. GCA in details Then the happiest moment, the bell rang.

The second examiner showed me a lot of photos what I remember are, CRAO, management, DD,…. PDR, how to manage, asked about laser, some discussion about diabetic treatment study and early treatment diabetic study,…one photo I didn’t know so I mentioned DD of neovascularization. Then the happy moment.

The second station was General Medicine and Neurology:

The questions were straight forward

Complications of glaucoma drugs in details,.. how to manage a patient with epileptic fit in the operating prior to a cataract surgery??...please don’t forget to say call for help while doing the fist aid measures,, drugs affecting lacrimation and salivation?....GCA in details, management, TAP?..... DM, management, hypoglycemic coma…..? Malignant Hypertension, ophthalmic picture, management in details ? .. Management of a renal hypertensive patient? What is your primary drug of choice..(ACEI) ,,why? ..does it have a role in DR?...then again steroids in details…. Then the bell…

My third station was Pathology and Surgery:

The first question was, when do you perforate the socket??!! The bony orbit he meant…orbitotomy,, indications, complications ,,types,,, then to blow out fracture, symptoms, signs, how to manage in details. then to DCR…, Epiphora, investigations, treatment.. medical and surgical. then the bell. 

The second examiner showed me a picture of old lady with entropion.. how to manage? Operations in details, with drawing.. what to do if she refused to go through surgery? Then to  recurrent chalazion with some pathology!! How to differentiate from sebaceous gland carcinoma (SGC)? How to treat SGC? Then to Phaco( finallyJJ) in myopes, challenges, in young male 8 years old, then he drew a diagram for an upper bulbous retinal detachment with a horse shoe tear at 1 o’clock.. how to manage, radial vs circumferential buckling…then the happiest moment ever, the bell.

I had one and half days to the clinical exam, which was as follows:

Case 1: 
Please do confrontation test….Rt central scotoma…what do you suspect, what would you like to examine ? the macula, please do with the 90 the with the direct., investigations….Rt macular hole.

Case 2: 
An 8  years old boy with Rt ptosis and Lt sling operation, with VKC, please examine with detailed disscusion (the boy had aponeurotic ptosis, with VKC)……

Case 3: 
18 years old young man with Rt vitrectomy, lensectomy, silicone filled, and laser marks.. please examine with the indirect, how do you know that he is silicone filled? How do you know that he is aphakic? What is the most possible cause? Then detailed questions about the optics of the indirect, lenses, then the direct what is the use of each filter? How is it used as a visuscope? Then the slit lamp with different filters? Then the applanation tonometer calibration , optics of the cone?

Case 4: 
12 years old girl with Rt aphkia and Lt posterior embryotoxon, examine then discussion.

Case 5: 
An old man with a crocodile shagreen under slit lamp

Then the hardest moment the bell and waiting for the results

One important tip that I learnt from a friend, but I couldn’t fully apply, is to examine the patient as if he is in your clinic. One more thing, sometimes “ I DON’T KNOW “ is the right answer as guessing may drive you to a dark allay so please don’t be shy to say it.

I reserve all the thanks to Allah, and I’ll be more than happy if I could be of benefit to any of the future candidates, so please don’t hesitate to contact me, my email is wdrn1@yahoo.com