I’ve just sat FRCOphth Part 1 in London (11 May 2009). There were about 70 candidates sitting the exam.

The first exam was supposed to be 120 single-best answer questions with a choice of 4 answers. A mistake was made with the printing so the paper only had 61 questions, although we were allocated the full 3 hours to complete it. The paper itself had the usual mix of questions on ocular anatomy, physiology, immunology, etc. Some questions were straightforward, whilst others did require knowledge of nitty-gritty facts here and there, which you would only know if you knew the subject inside out.

The second paper was 12 short answer questions (10 marks each) to be completed in 2 hours.

 

Question 1:

2 CT images of the orbit are given. No patient history given.

• Name the 4 bones marked with arrows.

• What is this investigation?

• What are the principles on which it is based?

• Describe the abnormality seen? (swelling of left medial rectus and intra-orbital optic nerve)

• What is the most likely diagnosis?

 

Question 2:

Diagram of the arterial supply of the globe and orbit.

• Name the 4 or 5 marked arteries

• Which artery supplies the lateral rectus?

• What is the arterial supply to the uveal tract?

• What is the venous drainage of the eye?

 

Question 3:

Picture of a gonioscopy lens shown.

• What is this?

• Draw a ray diagram of its action when placed on the front surface of the eye.

• What is the device used to view. Name a classification for the structure you identified.

 

Question 4:

Patient history: This elderly lady fell and fractured her orbit 2 days ago. She was making a good recovery in hospital but has now become tachycardic and tachypneic. Arterial blood gas given showing pH 7.48, PO2 10, PCO2 3.5, HCO3 24, BE 1 (normal values given)

Photograph of a lung with large area of black necrosis.

• What acid-base abnormality is this?

• Why has this arisen?

• What does the photograph show?

• What is the diagnosis?

 

Question 5:

Picture of duchrome test.

• What is this test?

• Draw a ray diagram to show the refraction of white light by the eye?

• Which letters on the test above does an uncorrected myope see most clearly?

• At the end of refraction, a myope sees the letters more clearly on the green side. What should be done?

• Does this test work in patients with red-green colour blindness?

 

Question 6:

Pictures of (A) LogMAR and (B) Snellen chart.

• What are these charts called?

• Given 3 disadvantages of chart A

• Give 1 disadvantage of chart B

• How is visual acuity written for each chart?

• Name 2 charts that can be used in illiterate patients

 

Question 7:

66D and 78D lens shown

• What sort of image is formed by these lenses?

• Which part of the eye are they used to view?

• Where is image formed when they are used with a slit lamp biomicroscope?

• Give 2 other methods of visualising this part of the eye? What images do they form?

 

Question 8:

Blood parameters shown for someone known to drink 1 bottle of wine a day and who has just undergone trabeculectomy surgery:

Hb 11. MCV 105 (normal values given)

• What type of anaemia is this?

• What is the likely cause of the anaemia in this patient?

• Give 4 symptoms the patient might complain of post-op.

• What are the effects of alcohol on the nervous system?

 

Question 9:

A patient wearing spectacles with a +10D lens wants to wear contacts lenses. BVD 10mm. What power of contact lens is required. The same patient undergoes cataract extraction in his other eye. Again, no lens is implanted by he requires a +10D lens in his glasses. He has hypertropia in the eye of 15 prism dioptres. Calculate the amount of lens decentration he requires to correct his hyperphoria.

 

Question 10:

A patient unable to speak English is referred by his optician. His vision is 6/9 in both eyes with IOP 18mmHg in both eyes. Heidelberg Retinal Tomography plot shown (normal). Humphrey visual fields shown for both eyes (show high fixation losses, zero false positives and high false negatives with clover-leaf pattern in one eye)

• What is total deviation?

• How is pattern deviation different?

• Is the visual field test reliable in this patient?

• Does this patient have glaucoma? Explain your answer.

 

Question 11:

Fluorescein angiogram showing CRVO

• What investigation is this?

• What properties of fluorescein make it suitable for use in this test?

• What abnormalities can be seen with this test?

• What does the investigation show? What is the diagnosis?

 

Question 12:

Biometry report shown in a myopic patient with axial length 28mm in one eye and 26mm in the other. This patient (whose work involves using computers) is to undergo cataract extraction.

• How much corneal astigmatism is there in _ eye?

• What type of myopia does this patient have?

• What power of IOL does he require? Explain your answer.

• What formula would you use to calculate the power of his required IOL.