Test 34
(New Matching Paper: Medicine and Neurology in relation to ophthalmology)
In response to considerable discussion the Examinations Committee of the College has decided to update the format of the Part 3 MRCOphth Examination from April, 2003.
An extended matching paper will replace the existing MCQs and they will be no negative marking. The test will probably be easier than the previous format. To familiarize the candidates with the new formats, test 34 and onward will follow the new style as described below by the College.
 
40 questions over a 3-hour period.
The questions will be divided as follows.
  • 5 pathology questions
  • 5 microbiology questions
  • 15 general ophthalmology questions
  • 15 Medicine and Neurology in relation to ophthalmology
Extended matching questions are multiple choice items organized 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.at least four item stems, as illustrated below 
This will involve 40 questions (probably 200 stems) over a period of 3 hours.

1. Match the stem questions (a-d) with the options (A-M) listed below:
 
A. III nerve palsy due to aneurysm of 
     the  posterior communicating artery
B. Multiple Sclerosis
C. Eyelid oedema 
D. Preganglionic Hornerís syndrome 
E. Postganglionic Hornerís syndrome 
F. Syringomyelia 
G. Diabetic III nerve palsy 
H. Myasthenia gravis
I. Chronic progressive external ophthalmoplegia
J. Myotonic Dystrophy
K. Kearns Sayre Syndrome 
L. Parkinsonís disease 
M. Blepharospasm
 
a. A 35 year old woman has a 10 year history of  progressive bilateral 
ptosis. There are bilateral cataract and weakness of lid closure. 
The ocular movement is normal. 


 
b. A 60 year old woman with a 4 week history of headache complains 
of horizontal double vision. Examination reveals a right sixth nerve 
palsy with mild ptosis and constricted pupil.


 

c. A 50 year old man who has polydipsia and polyuria develops a 
sudden onset vertical diplopia. Examination reveals a right 
hypotropia. Pupil examination is normal.


 

d. A 30 year old woman develops a binocular double vision. 
Examination reveals limited adduction in both eyes and fine 
nystagmus on abduction in either eye. Pupil examination 
reveals a right afferent pupillary defect.


2. Match the stem questions (a-d) with the options (A-M) listed below:
 
A. III nerve palsy due to aneurysm of 
     the  posterior communicating artery
B. Lambert-Eaton's syndrome
C. Eyelid oedema 
D. Neurofibromatosis 
E. Postganglionic Hornerís syndrome 
F. Syringomyelia 
G. Oculopharyngeal dystrophy
H. Myasthenia gravis
I. Chronic progressive external ophthalmoplegia
J. Apraxia of eyelid opening
K. Kearns Sayre Syndrome 
L. Pancoast's tumour 
M. Meig's syndrome

 
a. A 40 year old woman with a past history of autoimmune hypothyroidism 
has asymmetric ptosis and variable diplopia. She has recently developed 
dysphagia. 

b. A 40 year old man has a 5 year history of  progressive bilateral ptosis. 
There is restriction of eye movements. He has problem with swallowing. 
Muscle biopsy shows abnormal intranuclear inclusion bodies. 


 

c.  A 28 year old man has a 1 year history of right ptosis and miosis. 
Examination of the upper limbs reveal multiple scars with loss of sensation 
to pain but the joint position sense is normal. 

d.  A 25 year old woman has a 10 year history of  progressive bilateral ptosis. 
There is restriction of all eye movements but no complaint of diplopia. 
There is a pigmentary retinopathy evident. 

 
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