Candidate 14 (FRCOphth Part 1 May 2010)


I sat the FRCOphth Part 1 exam in London in May 2010. 

The first paper was 120 questions (Best of Four). In most questions it was easy enough to whittle down the choice of answers to 3, or in some cases, to 2 possibilities. After that, it was tough and required quite a deep understanding of the topics. There was the expected mix of questions on ocular anatomy and physiology, but there were also questions on general physiology.

The second (CRQ) paper was as follows:

Question 1:

Image of the eye developing in utero.

- Name labelled structures (lens vesicle, hyaloid artery)

- What will structure x develop into? (x points to outer layer of optic cup)

- Name 3 structures derived from structure y (y points to surface ectoderm)


Question 2:

-         Draw a diagram to illustrate spherical aberration

-         Draw a diagram to show how the eye overcomes spherical aberration

-         Name 3 other ways the eye overcomes spherical aberration

-         When considering IOLs used after cataract surgery, how are these designed to reduce spherical aberration?


Question 3:

Image of Humphrey visual field results for 55-year-old patient (both eyes). Right eye normal. Left eye shows superior nasal step.

-         What is this test?

-         Are the results reliable? Explain your answer

-         The patient did not require near addition during the test. What does this tell you about their refractive status.

-         What do the test results show?

-         What would you expect to find on fundal examination of the patient?


Question 4: 

-         Draw the optical diagram for the compound microscope

-         What is the nature of the image created

-         Other than the slit-lamp, name 2 other instruments containing a compound microscope


Question 5:

Image of (1) B-scan showing dome-shaped posterior pole lesion and (2) A-scan showing lesion to have low internal reflectivity

-         What investigations are shown above?

-         Describe the appearances in (1)

-         What is the most likely diagnosis?


Question 6:

Biometry of a patient with high myopia given (-9D right and -7D left). Axial length around 26mm each eye. Patient has nuclear sclerosis right eye.

Right eye keratometry: K1 41. K2 43.

-         How much astigmatism is there in the right cornea?

-         What type of myopia does this patient have?

-         What IOL power would you use? Explain

-         What is the A-constant for these lenses? (given on biometry print out)

-         Which IOL formula would you use?


Question 7:

Image of axial CT scan given. Large calcified lesion around the posterior lateral wall of the right orbit.

-         What is this scan?

-         Describe the findings of the scan (no need to give diagnosis)

-         Name labelled structure (?cerebral aqueduct)


Question 8:

Patient scenario outlined: increasing anxiety and tachycardia. Bloods reveal: high T4, low TSH and positive for antibodies against thyroid peroxidise.

-         What is the diagnosis?

-         Explain the blood results

-         Name 3 other reasons for a patient to have a high T4 level.

-         Give 5 possible signs on examination of this patients eyes.


Question 9:

Diagram of the cavernous sinus

-         Name 7 labelled structures (sella turcica; III; IV; Va; VI; internal carotid; sphenoid sinus)

-         Name 3 venous sinuses in direct communication with the cavernous sinus


Question 10:

ERG tracing shown.

-         Label A-D (a-wave, b-wave, oscillatory potentials, latency)

-         What is the origin of the a-wave?

-         What is the origin of the b-wave?

-         What is the origin of the oscillatory potentials?

-         Give 2 methods of isolating cone function in an ERG.


Question 11: 

A patient wears:

RE: +1.00 Add 2.00

LE: +4.00 Add 2.00

-         Calculate the difference in prismatic effect between the eyes if he was to read through the near segment (8mm below optical centre of main lens)

-         What rule are your calculations bases on?

-         What assumptions does this rule make?

-         Why might the prismatic effect you have calculated be different for this patient? Give 3 reasons


Question 12:

Patient scenario outlined. Young male with shortness of breath. Chest x-ray reveals bilateral hilar lymphadenoapthy and diffuse lung nodules. A diagnosis of sarcoidosis is made.

-       What other important diagnosis must be excluded?

-         What are the features of sarcoidosis on histological examination?

-         Give 4 ocular manifestations of sarcoidosis

Result: Passed


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