Test 40
(Matching Paper: Neuro-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 physical signs (a-d ) with the most likely diagnoses (A-N) listed below:
A. Anton's syndrome
B. Kennedy-Foster's syndrome
C. Waadenburg's syndrome
D. Wallenberg's syndrome
E. Millard-Gubler's syndrome
F. Gradenigo's syndrome
G. Weber's syndrome 
H. Raymond's syndrome
I.  Benedikt's syndrome
J. Parinaud's syndrome
K. Nothnagel's syndrome
L. Tolosa-Hunt's syndrome 
M. Foville's syndrome
N. Möebius's syndrome
a. A 50 year-old hypertensive man developed a sudden onset slurring of speech, 
vomiting and a right Horner's syndrome. He also had problem with standing up 
straight. Ocular examination also revealed a horizontal jerky nystagmus.

b. A 60 year-old hypertensive man developed a sudden onset right complete right 
third nerve palsy and a left hemiplegia. 


c. A 30 year-old man developed a right sixth nerve palsy and facial pain. CT scan revealed opacity of the mastoid air cells.

d. A 65 year-old diabetic woman developed a sudden-onset right facial palsy and a contralateral hemiplegia. Examination revealed a right abduction deficit.

2. Match the following findings (a-d) with the most likely cause or site of lesion (A-N) listed 

A. orbital apex
B. dilatation of the third ventricle
C. dilatation of the fourth ventricle
D. cavernous sinus
E. red nucleus
F. cerebral peduncle
G.superior orbital fissure
H. inferior orbital fissure
I.  cervicomedullary junction
J.  ventral pons
K. dorsal pons
L.  occipital lobe
M. pituitary gland
N.  hypothalamus
a. A 24 year-old girl developed morning headache and a bitemporal hemianopia. 
CT scan revealed dilated lateral ventricles and a space-occupying lesion in the 
brain stem. No lesions were seen in the pituitary or the hypothalamus region. 
What may be responsible for the visual field defect?


b. A 75 year-old woman developed a sudden onset right third nerve. In addition, she also
developed a left involuntary tremor.


c.  A 80 year-old man developed a right facial palsy and a right horizontal gaze palsy.
In addition, he had a right Horner's syndrome and loss of sensation to the right face.

d.  A 32 year-old woman developed a painful right eye and proptosis. Examination 
revealed normal vision but the movement of the right eye is restricted and the 
right forehead had decreased sensation to touch and pain. The left eye examination 
was normal.

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