Candidate 72                                                 Centre: Southampton 
Final MRCOphth                                                             Date: September, 2005
Pathology CRQs

1. Picture of macroscopic and microscopic histology of a pilomatrixoma stem –  Patient presented with a lesion diagnosed as a pilomatrixoma
Q1.  Give 4 histological features seen 
Q2.  Which 2 places are these commonly found?
Q3.  There are 2 syndromes in which these are found. Name one.

2. Picture of a corneal section. 20 yr old patient with worsening vision despite refraction.
Q1. What are the 3 histological features seen in the slide? ( Descemets break at the edge, but not much else seen except for artefactual stromal splitting)
Q2. What is the diagnosis?
Q3. What would you call it if there is a sudden break in the Descemet's in this condition?

3. Picture of a colour Doppler with an arrow at a stenosis. A 74 yr old presented with visual loss of less than 24 hours.
Q1. What is the name for this symptom?
Q2. What investigation is this?
Q3. What is the pathophysiology of this symptom?
Q4. What treatment would you recommend?
Q5. What evidence is there for this treatment?

4. Picture of exenterated orbit with large ulcer at the lateral canthus with 2 histological slides of BCC). A ~50 year old was operated on for a large ulcer at his lateral canthus.
Q1. What is the type of lesion?
Q2. What does this lesion cause around it within the dermal structures?
Q3. How would you excise this lesion if it wasn’t clinically obvious?

5. Picture of a (choroidal melanoma) invading through posterior sclera in a mushroom shape. A patient previously treated for ocular melanoma presented with pain and reduced vision. 
Q1. What are the histological features seen?
Q2. Give 4 modalities of treatment for this condition. 
Q3. What 2 investigations would you perform on this patient?

6. Microscopic histological picture of normal retina. Mark on the picture the layer in which each of these conditions present. 
Q1. Neovacularization in diabetes
Q2. Microcystoid degeneration.
Q3. Coats disease – where is the macrophage with ingested pigment
Q4. Drusen
Q5. Central retinal artery occlusion

7. Histological picture of a (ragged red muscle fibre). This patient presents with peripheral pigmentary retinopathy and ophthalmolplegia and had a muscle biopsy.
Q1. What is the diagnosis?
Q2. Which muscle would you biopsy?
Q3. How would you transport this specimen to the lab?
Q4. What is the diagnostic appearance of the biopsy for this condition?

8. Picture of lymphocytes in a vitreous tap. Patient presented with hazy vision with vitritis. CD 20+ cells found in this vitreous tap.
Q1. What is the diagnosis?
Q2. What is the prognosis?
Q3. What is the treatment?
Q4. What are the other simple investigations you would perform?

9. Picture of a corneal section (with ?vessels).  Patient who had a graft presented with worsening vision and an endothelial line. Not a recurrence of the primary cause for a graft.
Q1. What is the diagnosis?
Q2. What are the 4 causes of graft rejection
Q3. Which cells mediate rejection?
Q4. What are the histological features seen?

10. Picture of a ?dermoid cyst. This patient presents from birth but patient presented late due to failure to keeping appointment.
Q1. What is the diagnosis?
Q2. Where is the commenest site for this lesion?

11. Muscle histopathology slide. Muscle biopsy of a patient with proptosis
Q1. Describe the histopathological features
Q2. Which cells mediate this?
Q3. What is the diagnosis
Q4. Does treating the thyroid condition alter the TED?
Q5. What blood investigations would you perform?

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