An undergraduate prize examination will be sponsored again this year on a national basis by The Royal College of Ophthalmologists. This examination is intended for medical students who have completed their ophthalmology undergraduate teaching, but it is open to all medical undergraduates provided they have not graduated at the time of the examination.  Students may sit the examination on more than one occasion provided they have not yet graduated and have not previously won the prize.  There will be a cash prize of £400 for the candidate gaining the highest mark.  If there is more than one candidate gaining the highest mark this amount will be split respectively.  There is no second prize.

The examination consists of an extended matching question paper of 10 questions with 3 stems to each question. Candidates will have to pick their answer from a list of options.  Marking is on the basis of +1 for a correct answer and -0.5 for an incorrect answer, and 0 marks for no answer or "don't know”.

The standard is high and candidates should anticipate a stiffer examination than encountered in the undergraduate class.  Questions are mostly based on clinical ophthalmology but other areas covered include ocular physiology, anatomy and pathology as well as genetics of eye conditions and socioeconomic medicine relevant to ophthalmology e.g. blind registration or world blindness.  In the clinical questions all the sub-speciality areas within ophthalmology are covered including:

  • Cornea and external eye disease
  • Cataract
  • Glaucoma
  • Medical retina and vitreo-retinal surgery
  • Strabismus and paediatric ophthalmology
  • Neuro-ophthalmology
  • Ocular adnexal and orbital disease 
  • Refractive errors and optics
Extended matching questions are multiple choice items organised into sets that use one list of items in the set. The extended matching set includes four components:

1. A theme
2. An option list
3. A lead in statement
4. Three item stems

Example Questions

1. Options Theme/ Topic

A. Acute angle closure glaucoma
B. Age-related macular degeneration
C. Anterior ischemic optic neuropathy
D. Cataract
E. Central retinal artery occlusion
F. Optic neurtis
G. Papiloedema
H. Retinal detachment
I. Retinal vein occlusion
J. Vitreous haemorrhage

Lead in: For each patient with loss of vision select the most likely diagnosis.


1. An 80- year old Caucasian woman complains of recent problems with reading vision, specifically words appearing distorted and blank patches being present. 
Ans B

2. A 32- year old female patient experiencing weakness and numbness in her left arm gives a three day history of increasing loss of vision in her right eye and pain on moving the eye.
Ans F

3. A 54-year-old man complains of headaches that are made worse by coughing. They appear to be increasing in frequency. He admits to occasionally losing vision but only for a few seconds at a time. His visual acuities are normal.
Ans G

2. Options 

A. Bitemporal hemainopia
B. Fifth cranial nerve palsy
C. Fourth cranial nerve palsy
D. Homonymous hemianopia
E. Miosed pupil
F. Optic atrophy
G. Relative afferent papillary
H. Seventh cranial nerve palsy
I. Sixth cranial nerve palsy
J. Third cranial nerve palsy

Lead in: Select the most appropriate option that would fit with the clinical scenario.


1. A 68-year-old hypertensive man with poorly controlled diabetes (Type 2) presents with sudden onset horizontal diplopia. 
Ans H

2. A fit 48-year-old woman complains of a very severe headache and droopy left upper lid she gets double vision when she lifts up her eyelid. 
Ans J

3. An 82-year-old hypertensive woman collapses at home. In casualty she is found to have a right hemiparesis, an up-going planter reflex and is dysphasic. 
Ans D

3. Options

A. Aciclovir ointment
B. Antibiotic drops
C. Beta-blocker drops
D. Corticosteroids drops
E. Intravenous antibiotic
F. Oral acetazolamide
G. Oral acyclovir
H. Oral corticosteroids
I. Oral cyclosporin
J. Prostaglandin drops

Lead in: Select the most appropriate therapy for the clinical scenario.


1. A 55-year-old man has intra-ocular pressures of 32mmHg in each eye. His optic discs are pathologically cupped. He is using a salbutamol inhaler for his asthma. 
Ans J

2. A 73-year-old woman develops a painful rash on the right side of her forehead. Her right eye is closed because of associated lid oedema. She feels generally unwell. 
Ans G

3. A 32-year-old gardener develops a red eye with a purulent discharge. After two days it spreads to the other eye. His young daughter has a similar problem. 
Ans B 

4. Options

A. Amblyopia
B. Astigmatism
C. Congenital cataract
D. Congenital glaucoma
E. Hypermetropia
F. Myopia
G. Optic disc hypoplasia
H. Optic neuritis
I. Retinoblastoma
J. Retinopathy of prematurity

Lead in: What is the most likely cause of the poor vision?


1. A six-week-old baby is noted to have wobbly eyes and poor vision. On examination neither eye has a red reflex. There is a family history of eye disease. 
Ans C

2. A ten-year-old boy with past history of squint surgery is found to have poor vision in his left eye that cannot be improved with glasses.
Ans A

3. A three-year-old girl is found to have reduced vision in both eyes. Her vision improves with glasses with convex lenses. 
Ans E

5. Options

A. Anterior ischaemic optic neuropathy
B. Background diabetic retinopathy
C. Cataract
D. Central retinal artery occlusion
E. Diabetic maculopathy
F. Neovascular glaucoma
G. Optic neuritis
H. Proliferative diabetic retinopathy
I. Retinal detachment
J. Vitreous haemorrhage

Lead in: Select the most appropriate option that would fit with the clinical scenario.


1. A 46-year-old diabetic (Type 1) of 25 years duration and incipient renal failure presents with red, painful, blind right eye.
Ans F

2. A 42-year-old diabetic (Type 1) male complains of a sudden onset of floaters in his right eye. They gradually settle after one month. 
Ans J

3. A 46-year-old woman with Type 1 Diabetes has noticed gradually deteriorating vision in both eyes for 12 months. She is also troubled by glare, when driving her car at night. 
Ans C

Duke-Elder Examination