Candidate 12 (FRCOphth Part 1 Oct 2009)


I am a ST2/ 2nd year SHO in ophthalmology and I have just finished part one today. I must thank you and the contributors for the past questions and information. Again, it proves that preparation with the mock questions in your question book and the website was immensely useful (despite the recent change to the style of examination)!
Part A MCQ:

Comparing with the mock questions in the book, the questions in the exam was a lot easier. There were heavy emphases on anatomy and optics, as well as quite detail genetics and immunology (e.g. what is PAX gene associated with?). Fortunately the latter topics were only tested in a handful of questions. Some of the biochemistry (e.g.
corneal collagens) and instrument (e.g. FFA) questions were almost carbon-copy of the questions on the website or in the book. Microbiology did not really involve details of each pathogen.
Part B SAQ:
This is the part that me and my colleagues felt quite tricky. Lot of pathology and optics that were NOT even in Elkington (!!!). I suppose being ST helps, because there are quite a few clinical questions. I put down the marks for each question (as far as I can remember) since I thought it is a good indicator of how much detail you need to put down. I would also hope that this feature could be included in your 2nd edition of mock question book.


1. Diagram of orbit and asked to name the bones + fissures/ foramen (1 mark each)


2. Patient underwent cataract surgery and developed endophthalmitis. Shown a picture of Bisected globe with ?iris prolapse, IOL and pus in vitreous

a. name the above mentioned structures (3 marks)

b. describe the sequence of events that might have led to endophthalmitis (3)

c. name the pathogen leading to endophthalmitis within 2 days, in 5 - 7 days and in 4 weeks (3)

d. what sample would be useful for culture and what is likelihood of positive results (1!)


3. Lady with PMH of metastatic bowel Ca. Picture of bisected globe with vitreous/ ?VH/ subretinal mass & histology of retina + mass

a. name the above (3)

b. what is the differential of the subretinal mass (2)

c. histology: name a: retina and b ?mass with vascular ingrowth (2)

d. what is the most likely diagnosis (1)

e. what is the treatment if the lady presented earlier, and what is the mode of action (2)


4. Optics of chromatic aberration

a. draw the ray diagram (2)

b. what test is based on this principle and how it works for myope (2)

c. 4 ways of eye limiting spherical aberration (4)

d. explain what is oblique astigmatism and coma (2)



5. Optics of keratometer (bear in mind that no one has seen one for a long time!!)

a. draw the ray diagram (3)

b. explain how radius could be derived from the keratometer (3)

c. explain the optical difference in von Helmholtz and Javal-Schiotz (2)

d. explain, with diagram, how doubling of images is achieved in either instrument (2)


6. Amsler grid

a. what is the instrument (2?)

b. what visual field does it test (2)

c. explain how the instrument should be used to test the visual field (4)

d. 2 conditions that is useful (2)


7. Optics (again) of slit lamp - this was very nasty!!

a. name 4 ways of slit-lamp exam of cornea (2)

b. draw optical diagrams of each of the examination techniques (2 marks each) - this was NOT in Elkington and most of us struggled. Would be interesting to see how it turns out. I based my answers on direct focal/ diffuse/ specular reflection and scleral scatter.


8. Electrophysiology

a. what are the main components of ERG and where are they derived (4,

very generous!)

b. where are the electrodes for ERG (2)

c. 2 TYPES of conditions in which ERG is affected (2)

d. what does EOG measure (1)

e. where are the electrodes for EOG (1)


9. Goldmann tonometer with labels & 3 diagrams of menisci

a. what is this and where is it rested on usually (2)

b. purpose of the prism/ calibration nob/ pressure dial (3)

c. cross section of the instrument (2! ?prism cross-section only? Or the whole tonometer??)

d. among the diagrams of menisci, which is the correct applanation (1)

e. which is the one when too much pressure exerted (1)

f. what would happen with thin corneas (1)


10. OCT of macula with CMO

a. what is the investigation (1)

b. explain the basis of the instrument (4)

c. 2 conditions that could be the cause of this (2)

d. 3 conditions where OCT is useful (3)


11. Visual field x 2, showing left homonymous superior quad.

a. how is SITA useful (2)

b. which of the field is more reliable and why (3)

c. what does it show (1)

d. where could the lesion be (2)

e. 2 conditions in which MD and PSD are different (2)


12. Statistics: 2 x 2 table of a screening test

a. Prevalence calculation

b. Yield calculation

c. Positive predictive value calculation

d. Sensitivity calculation

e. Specificity calculation

All 2 marks each, so I believe the maths working is required. They are straight forward enough not to require any calculators (so you should know that something is wrong if some funny fraction comes out!)


Overall, I felt the exam was just about being fair, considering the amount of difficult pathology and optics in part B.



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Examination results invalid, Royal College of Ophthalmologists President apologized for causing distress to candidates. All funds repaid.