Candidate 13 (FRCOphth Part 1 Jan 2010)


Paper 2

1. First question was a histopathology slide of the neurosensory retina, rpe and choriocapillary layer and labeling of layers (5)
Asked about intimate details of Bruch¡¦s membrane (3)
Asked about pathology of Bruch¡¦s membrane in AMD (2)

2. Scenario of a 76 year old gentleman, heavy alcohol intake, who is due for excision of a lower lid BCC and reconstruction. He has anaemia, and heart failure, and is on a statin, aspirin, ACE inhibitor and diuretic. He has aHb of 10.2, MCV of 83 fl and a urea of 7.2 and creatinine of 149.
Asked what could be 4 causes of his anaemia (4)
Asked what can we make of the urea and creatinine and the causes (2)
Asked what 3 investigations would we like to perform pre-operatively. (3)

3. Scenario of a woman who previously had metastatic breast CA who now had a biopsy of an orbital mass done. Showed a stained histopath slide of the lesion ¡V cells stained brown/black!!and asked to(not told what stain it was, mind you!)
Name the structures stained (1)
Is the result positive and why? (2)
What is the significance of oestrogen receptors in breast cancer? (2)
Name 5 other tumors or tumor like diseases of the orbit (5)

4. Name 2 other aberrations besides chromatic aberration that occurs in the eye (2)
Draw a ray diagram showing chromatic aberration (3)
Draw a ray diagram showing how myopes and hypermetropes would view the
Duochrome test (4)
If during subjective refraction, a myope says that they see green more clearly, what
has happened? (1)

5. What are lasers and what does the acronym stand for? (3)
What are the different laser-tissue interactions and what wavelengths can penetrate the eye? (4)
What does the international laser safety classn state? (ARGH ¡V personal note to self,  please read the entire book, even if it doesn¡¦t seem important!)

6. Series of fundus photographs showing some blood? and hard exudates in the distribution of the right superotemporal veins -„³ picture wasn¡¦t very clear. Followed up with questions

Shown a normal fundus photograph and asked what filter was used (1)
Shown a red free photograph and asked what filter was used (1)
Shown the FFA picture in arteriovenous/early venous phase with marked areas of hypofluorescence involving the macula. Asked what filter was used (2) What phase (1)
What is the diagnosis (1)
Asked why were there areas of hypofluorescence (4)
7. Showed a picture of a logMAR and Snellen chart complete with Worth¡¦s Four Dot Test

Asked to name the apparatus (2)
What is the difference between both charts (4)
What does it mean if the patient wears the red green glasses with the red glass over the right eye and says ¡§I see a) 5 dots b) 4 dots c) 3 dots and d) 2 dots.¡¨? (4)

8. Ishihara Pseudoisochromatic plates
How can it be used in illiterate subjects (2)
What are the principles? (3)

9. OCT. This one was tough. Showed an OCT image showing dome shaped elevation of RPE with separation of the neurosensory layers from the RPE
What does it show? (1) ¡V PED?
What are the factors that can degrade the resolution of the OCT image? (4)
What other investigations would you perform and why? (3)

10. Without instruments, how would you tell if a spectacle lens has a cylindrical component? (3)
Transpose a pair of cylindrical lenses (4) very generous!
Where would you place the incision in phaco? (1)

11. Showed a diagram of the visual pathway, with areas of the pathway marked and told to shade in visual field defects corresponding to anatomical site of lesions (10)

12. Can¡¦t remember the last one ¡V sorry Prof! maybe some other guys out there might like to help? Cheerio!

Result: Passed.



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