Candidate 104 

Final MRCOphth                                

Centre: Belfast                                

Date:    Sept,2007 


1. Endophthalmitis-management 


2. What is bevacizumab?what organisms cauese endoph after intravitreal bevacizumab? 

3. Keratoconus-Prussian blue stain of epithelium,.what are the characteristic features? 

4. Sebaceous gland carcinoma 

5. Basal cell carcinoma 

6. Large round lesions on the cornea-organisma causing and mechanism -wrote infectious crystalline keratopathy-biofilm by strep viridans  

7. Most common hormone secreted by pituitary and syndrome it causes, clinical manifestations-wrote prolactin,galactorrhea amenorrhea syndrome 

8. Very confusing - shown a globe enucleated with a gritty mass inside-what is the gene causing it? What is the syndrome associated, had no idea.(most people didnt know) thats all I remember everyone was short of time because there were too many sub-questions. Be prepared to think as you write and go fast from the word go every station the pathology paper is too long for the time given.

EMQS-were ok, only one on statistics about sensitivity, positive predictive value of a test.


Anterior  segment


1. Case of nebular corneal opacity, one half of iris atrophic with transillumination defect, one posterior synechiae, pigments on endothelium.said trauma as first diagnosis, then herpetic uveitis.was the latter. said will check corneal sensation to differentiate. Was asked to check for activity and was reprimaned for not increasing the magnification to see that. 

2. Case of lid scar of reconstruction surgery, with multiple freckle like lesions on face and elsewhere and a raised lesion on left cheek-was Gorlin Goltz syndrome. Was asked inheritance(didnt know).

3. Peripheral corneal thinning especially superiorly said terriens first and other PUKs as differential.

4. Conjunctiva showing uveal pigments showing thru at the inferotemporal limbus,part of iris missing in that area,itraocular lens and pigments on endothelium,said penetrating injury causing cataract as firast diagnosis. Was asked for alternate one-iris or ciliary melanoma resected-was asked prognosis, said better for iris melanomas.

Posterior segment

1. PRP scars on indirect-settings,common indication,rationale 

2. Juxtapapillary CNV with exudates-described what I saw, got the diagnosis only after prompting.

3. FFA of NPDR with capillary nonperfusion,idiopathic juxtafoveal telangiectasia,armd, and window defect

1. Aniridia with capsular tension ring, IOL and glaucomatous optic atrophy and trabeculectomy - said congenital but was post-trauma.

2. Pigment dispersion syndrome. 

3. Humphrey Visual Field test - was asked reliabilty indices, how the machine tests them, and to explain each figure on the printout including global indices.


1. Horners pupil-other causes of small pupil, including can an Adies pupli be small(yes, little old Adie).

2. Proptosis,down but said thyroid because had lid retraction and lid lag (asked to demonstrate)also inferior and medial rectus involvement) asked to examine thyroid,order of surgery.

3. Picture of child with inflamed looking proptosis, said orbital cellulitis and will also consider rhabdomyosarcoma.

1. Inferotemporal rd demarcated by laser -examination on 90d.asked will you differentiate.(why this case was kept in this station i quite beyond me).

2. Angioid straks, disc drusen and pigments at  macula. Was asked to look for systemic diagnosis. Looked at neck for chicken skin appearance( said puckered ) elbows and knees for Ehler-Danlos, acromegaly. Was pseudoxanthoma elasticum - what are the complications (valvular disease-which valve-didnt know,gi bleeds)what advice-avoid contact sports and trauma (choroidal rupture).

3. Precautions before steroid therapy (longterm) he wanted me to say varicella vaccination while I carried on about worsening of diabetes, osteoporosis etc - having not worked in the UK, needed to be prompted.

Child with juvenile rheumatoid arthritis needs catarct surgery, counsel mother.
Advised cataract extraction without IOL. Need for early surgery to avoid amblyopia and need for contact lenses. Mother kept on repeating any other options, kept on telling her she has to have contact lens correction. Then thought maybe she wanted me to say IOL ,so doubtfully gave her that option still saying it wouldd be inadvisable. In the discussion, examiner said you were right about management and said all the right reasons then why did you change, said that I thought she was leading me to that option, we dont implant lens in JRA in India where I work but not sure of the management in the UK. Examiners seemed quite pleased so was not worried.

In all,was a fairly good attempt because there were no CVS or neurological examination which I dreaded so I was lucky. Anyway,results out and passed, so thank god and thanks to Chua website. Three cheers and good luck to all ye who embark on this arduous journey.