Candidate 16 (FRCOphth Part 1 May 2011)


I sat the FRCOphth Part 1 exam in London on 9th of May 2011.
I studied from "The eye basic sciences in practice" John Forrester and "Clinical optics" Elkington. These 2 books were very close of being enough - except few topics - like general medicine, statistics, head and neck anatomy.

I felt the exam was just quiet fair with questions relevant for your clinical practice and without questions about the huge amount of useless details you will find in Forrester's book in some chapters.
As a foreigner I made some grammar mistakes and they were very kind to ignore them and to give me the marks only for my medical knowledge.

Paper 1 - 3 hours - MCQs:

120 multiple choice questions with the usual mixture of Anatomy(a fair number) and Embriology, Physiology( a fair number as well), Pathology, Pharmacology and of course Optics

Paper 2 - 2 hours - CRQ:

Question 1.

Diagram of the sympathetic supply of the eye with A,B and C letters set at different levels.

  • Where are the cell bodies of the three neurones? - 3 marks

  • A lesion at A (first you need to identify A=brain stem) has caused a right side Horner.List 2 other neurological abnormalities caused - 2 marks

  • List 2 possible causes of Horner due to abnormalities located at position B(you need to identify that B=pre-ggl) - 2 marks

  • A lesion at C(first you need to identify C=post-ggl), that was treated 8 years ago caused Horner.

  • How will RE and LE pupils respond to the following drugs: Phenylephrine 0,25%, Cocain 4% and Hydrxyamphetamine 1% - 3 marks

Question 2.

Photo A: histological slide H&E and photo B: macroscopic appearance of an eye with a tumor-mushroom shape.

  • Photo A: What cell type is shown?State the other main cell type in uveal melanoma - 2 marks

  • Photo B: explain the collar stud shape of the tumour - 2 marks

  • State 2 clinical and 2 pathological prognostic indicators - 3 marks

  • State 3 risk factors for uveal melanoma - 3 marks

Question 3.

Figure from "The eye..." Forrester, Box 4.5, Pg 186, Biochemistry chapter

  • Name the type of cell junctions illustrated by figures A,B and C - 3 marks. Answer: tight junctions, desmosomes and gap junction

  • What is the function of each type? - 3 marks

  • What number indentifies a hemidesmosome?Describe its importance in corneal eipth - 2 marks

  • What type of junctions are found between - corneal epith cells and PRE cells? - 2 marks

Question 4.

Scenario of a female patient listed for routine orbital procedure.Blood result shown:

  • What type of anaemia does she presents? - 2 marks Answer: anaemia with small red cell -iron deficiency

  • Give 2 possible causes - 2 marks

  • Give 2 possible causes for raised white cell count - 2 marks

  • What action would you take - 4 marks

Question 5.

  • Draw a diagram to show how an image of the retina is formed and viewed using a slit lamp and 90D lens - 4 marks

  • Describe the image formed by the 90D lens - 2 marks

  • What is the difference in image between 90D and 78D? - 2 marks

  • Describe why is not possible to view the retina with the slit lamp alone - 2 marks

Question 6.

  • Draw an annotated ray diagram to show how a compound microscope produces an image that can be viewed - 6 marks

  • The image formed is inverted. How is the erect image obtained? - 1 mark

  • Name 3 ophthalmic instruments which depend on the use of the compound microscope - 3 marks

Question 7.

History 1: a +4DS lens is moved 8 mm inferior and 2 mm nasal.

  • Which direction will the base be for the vertical prismatic effect in each eye? - 1 mark

  • Calculate the vertical prismatic effect showing your calculation - 1 mark

  • Which direction will the base be for the horizontal prismatic effect? - 1 mark

  • Calculate the horizontal prismatic effect......-1 mark
    History 2:a 10D lens is moved 2 mm away from the eye

  • What power of lens is required to produce the same correction and your calculations -3 marks

  • Transpose +3.00/-4.00X90 in plus cylinder - 3 marks

Question 8.

Photo with an Isihara book open shown

  • What is this test? - 1 mark

  • Describe the principles underlying - 2 marks

  • Name 2 different types of congenital colour defect that will be detected by the test - 2 marks

  • Name 2 different clinical conditions for which this test is used - 2 marks

  • How is this test used for illiterates - 1 mark

  • Name 2 other tests for colour vision - 2 marks

Question 9.

Details about an OHT study

  • What is the experimental design for this study - 1 mark

  • Why were the certified readers masked? - 1 mark

  • Explain what is meant by IOP declined by 4%+/-11% - 2 marks

  • Explain briefly the meaning of Hazard ratio - 3 marks

  • What is the meaning of 95% confidence interval -2 marks

  • What is the meaning of P<.0001? - 1 mark

Question 10.

Transverse view of the retina with an OCT shown

  • What is this test? - 1 mark

  • Describe the abnormalities with reference to retinal layers - 4 marks. Answer: intraretinal fluid, subretinal fluid, PED, increase foveal thickness

  • What is the likely diagn? - 1 mark. Answer wet AMD

  • List 4 factors that decrease resolution -2 marks

  • What is the significance of different colours? - 1 mark

  • What additional information does the b scan gave? - 1 mark

Question 11.

Several images of T1 weighted MRI scan of the brain

  • What is this test? - 1 mark

  • Describe the main abnormality - 2 marks. Answer: white, hyper reflective, plaques in periventricular white matter

  • What is the likely diagn? - 1 mark. Answer: MS

  • Give 2 possible visual complaints - 2 marks

  • What is the arterial blood supply of the 4 areas marked on the image? - 4 marks

Question 12.

Images of left eye fundus fluorescein angiography showing CRVO with macular oedema

  • What is this investigation? - 1 mark

  • What are the principle filters used? - 2 marks

  • Describe the abnormalities shown? - 4 marks. Answer: engorged veins, hyperfloresc areas in macular region due to leakage, staining of the collagen in the abnormal veins walls, hypofluoresc areas deep from retinal vessels plane but covering the choroidal fluorescence = intraretinal haemorrhages...

  • What is the likely diagn? - 1 mark

  • State 2 possible side effect of IV fluorescein - 2 marks

    Result - passed

    Good luck to all! OAV


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