I sat the FRCOphth in May 2010 in London, one of 59 candidates. I passed, and pass on some notes below that may be of use to future candidates.

 

MCQ

This was quite challenging in parts, and although had some general neuroanatomy and physiology, went into some details about ocular embryology (development of trabecular meshwork etc). It contained plenty of detailed genetics, including designs of studies (GWAS etc) and went onto a phase of optics questions near the end.

 

CRQ

 

Question 1. (12)

Three slices through the brainstem at various axial levels.

• Through level of superior colliculus showing oculomotor nerve, red nuclei, cerebral peduncles.

• Through the floor of the fourth ventricle showing a cranial nerve wrapping around another nucleus, the medial longitudinal fasciculus

• Ventral prosection of brainstem – cranial nerve from cerebellopontine angle, medulla, inferior cerebellar peduncle.

 

Question 2 (12)

Blood results of an 88 year old lady who fell and sustained periorbital haematomas. Patient sustained fracture to left medial orbit. This was explained as to be managed conservatively

Hb 11, MCV 74, WCC 24 (lymphocytes 94%), platelets 140.

• Asked to explain anaemia (2)

• Asked to explain high white cell count and platelet count (4)

• Told that patient experienced diplopia on left lateral gaze. Why might this be? (2)

• Patient experienced swelling of left orbit when she blew her nose. Why is this? (2)

 

Question 3 (12)

• Diagram showing the venous sinuses of the brain projected onto the skull base.

• Name them (5) superior saggital sinus, sphenoparietal sinus, inferior and superior petrosal sinuses, transverse sinus.

• Given diagram of coronal section through cavernous sinus. Name the structures (5)

• Oculomotor, trochlear, V1, V2, sphenoidal sinus.

 

Question 4 (12)

Petri dishes showing organism in culture with discs impregnated with different antibiotics. History is given that patient recovering from corneal ulcer, went into hospital and developed pneumonia.

Told that organism was gram positive cocci organised in rows.

• What was organism? Pneumococcus (1)

• Which antibiotic will you use and why (2)

• Give three serious complications of corneal ulcers (3)

• Give three complications that elderly may develop whilst in hospital (3)

 

Question 5 (12)

OCT image demonstrating  sub-RPE mass elevating structures above it with some cystic lesions within the retinal substance.

• What is investigation? (1)

• Principles upon which it is based (2)

• Findings here (not asked for diagnosis) (2)

• Uses of this investigation (2) Macular disease; RNFL thickness in glaucoma

 

Question 6 (12)

• Hess chart recording. Showing weakness of right lateral rectus with overcorrection of medial rectus. Some minor abnormalities contralaterally.

• Asked to name investigation (1)

• What does hess chart require in binocular single vision – central fixation (1)

• What are characteristics of a mechanical defect? (3)

• Asked to state abnormalities. (3)

• What is the diagnosis? Duane’s/orbital trauma? TWO causes (2)

 

Question 7 (12)

• Lasers: what does it stand for (1)

• Draw a diagram illustrating the principles of energy that it uses (4)

• Name 3 lasers used in ophthalmology and the mechanisms they work by (3)

• What qualities does laser light have and explain them (2)

Question 8 (12)

• Given contrast sensitivity chart (Peill-Robson) and asked to name and what it is used for? (2)

• What adjustments can be made as part of the test? (2)

• Given dark adaptation chart with log light sensitivity against time showing a curve with two distinct phases. Asked to explain the two sections of the chart. (2)

• Asked how long a normal person takes to get to peak sensitivity. (1)

• 30 minutes

• In what conditions is contrast sensitivity reduced (2)  Cataract and Glaucoma

 

Question 9 (12)

Glaucoma with RNFL thickness right and left eye, and Humphrey perimetry for right and left eye. Both had high false negatives (right eye had clover shaped readout).

• Asked whether readings were reliable (3?)

• What is mean deviation, and why is pattern standard deviation different (3?)

• How to RNFL readings and perimetry compare? (2?)

• Does this patient have glaucoma? (2?)

 

Question 10 (12)

• Draw prism and diagram to show minimum angle of deviation (4) 3

• Fresnel prisms are used in glasses – how do the prisms differ from a standard prism (1) 0

• What are the characteristics of a prism image (erect, virtual, displaced to apex) (3) 1

• What is a dioptre of a prism? (2) 2

 

Question 11 (12)

FFA of a patient with central retinal vein occlusion. Given a short history of a 77 year old lady who presents with acute visual loss. Given  FFA series – 7 or 8 photos.

• What is the cause of three areas of hypofluorescence? (3)

• What is the cause of two areas of hyperflourescence? (2)

• What is the diagnosis? (1) CRVO

• What would the ERG show? (2) Normal a waves, reduced b waves

• Significance of RAPD in CRVO (1)

• What is the venous filling time? (1)

 

Question 12 (12)

Corneal topography.

• What is the investigation and what are the principles on which it is based? (2)

• The patient is seated facing a bowl containing an illuminated pattern, most commonly a series of concentric rings. The pattern is focused on the anterior surface of the patient's cornea and reflected back to a digital camera at the centre of the bowl. The topology of the cornea is revealed by the shape taken by the reflected pattern. A computer provides the necessary analysis, typically determining the position and height of several thousand points across the cornea.

• What is the axis of steepest curvature? (1)

• What is the degree of astigmatism? (1)

• What are the sources of error in the measurement? (3) (focusing errors, alignment and fixation errors with induced astigmatism, difficulty to calculate the position of the center from the small central rings, increased inaccuracy toward the periphery because the accuracy of each point depends on the accuracy of all preceding points, and other errors.)

• What are the uses of this device? (3)

• Diagnosis and treatment of a number of conditions

• In planning refractive surgery such as LASIK and evaluation of its results or in assessing the fit of contact lenses.

Result: Passed