Candidate 17 (FRCOphth Part 1 Oct 2011)



a. Identify & name actions (primary and secondary) of two extra ocular muscles from a photograph. (4)
b. Name two intra ocular arteries, state what they supply (again from a diagram). (4)
c. Name a nerve (nasocilary) on a diagram and state what it supplies. (2)

a. Where are the complement components synthesised and how do they activate inflammation? (4)
b. Complement may also be involved in non-inflammatory removal of cell debris. How does this occur. (2)
c. ARMD is associated with mutations in certain complement components. Which are these and how might mutations increase the risk of AMD? (4)

a. Describe the clinical feature on a photograph (follicular conjuntivitis). (1)
b. Give a differential diagnosis. (2)
c. Name the stain in another photo. What does it show? [Giemsa stain, cytoplasmic inclusion bodies]. (2)
d. Two other investigations that may be useful to confirm the diagnosis. (2)
e. How should the patient be treated. (1)
f. What inflammatory cells would you expect to see on a conjunctival smear from a patient with a) allergic conjunctivitis b) adenovirus conjunctivitis?

a. What is the cell of origin of the embryological germ layer of the structures at A, B & C (corneal stroma, lens, sclera). (3)
b. Explain how an iris coloboma develops. (2)
c. Names three congenital malformations of the lens. (3)
d. Name two congenetal abnormalities of the vitreous or hyaloid system. (2)
5. -Photo of 66 & 78D lenses
a. These lenses are used to provide an image of which part of the eye? (1)
b. What type of image is seen? (2)
c. Where is the image in relation to the instrument used (slit lamp) and the lens? (1)
d. If a 66D lens us used in place of a 78D lens, what image size difference is noted? What is the difference in the field of view? (2)
e. Name two other instruments used for the same purpose. What type of image do they produce? (4)

a. What is the approximate spectacle correction of a previously  emmetropic eye which is now aphakic? (1)
b. Draw two ray diagrams of an aphakic eye to illustrate the differing  image sizes with a contact lens and a spectacle lens? (4)
c. List three optical aberrations which may be apparent to a patient wearing an aphakic spectacle correction. (3)
d. A newly aphakic patient wants to wear contact lenses rather than spectacles . Rx of specs: +12 @ BVD of 10mm, what power of contact lens is needed? [equation given] (2)

a. What is this instrument? [ gonioscopy lens] (1)
b. Name two instruments that enable the peripheral angle of the anterior chamber to be observed clinically. (2)
c. What are the optical principles involved which allow this observation? (3)
d. Demonstrate these principles with ray diagrams. (4)

a. Name the investigation. [Ultrasound scan, A&B] (2)
b. Describe the principle features in each scan. [1x a scan image and 2x b scan images to interpret] (6)
c. What is the likely pathology and what cell types are to be found?
[further b scan, uveal melanoma] (2)

a. Name the investigation. [Humphery perimetery] (1)
b. What are the advantages of SITA? (1)
c. Which of the two tests shown are more reliable? [two perimetery outputs shown, have to interprate] )3)
d. Describe the visual field defect and where the lesion is likely to lie anatomically. (3) [sup. l. homonyous quadrantinopia -> meyers loop]
e. List two circumstances where there is likely to be a significant defference between pattern and total deviation. (2)

a. What types of photgraphs are these, what filter is used for each? (3) [fundal photography using: no filter, red free, FFA (green yellow for camera, blue for illumination)]
b. Describe the main abnormalities. (2) [of 4 FFA images]
c. Which phase of FFA is this image taken in? (1) [post venous]
d. What is the clinical diagnosis? (1) [central serous retinopathy]
e. Name two possible side effects of fluorescein. What precautions must be taken whilst performing this investigation? (3) [discoloured urine, anaphylaxis ,', need resus trolley]

a. Name the investigation? (1) [corneal topography]
b. What does it show? (2)
c. What is the clinical diagnosis? (1) [Keratoconus]
d. Name three other investigations useful in this condition. (3)
e. Name two conditions associated with this disorder. (2)
f. In which decade of life does this condition most commonly commence?

a. Define "double masked"? (1) [ie. define "double blind"]
b. What is the purpose of a placebo? (1)
c. Explain: "The visual acuity benefit (<15 letters lost) of verteporfin therapy was clearly demonstrated (67% vs 39%; p<0.001)". (4)
d. Define Absolute Risk Reduction (ARR). (1)
e. Calculate the ARR for this study. (1) [values in text, but formula
not given]
f. Define Number Needed to Treat (NNT). (1)
g. What is the NNT for this study? (1) [again, values in text, but formula not given]


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