Candidate 4 (Jan 2008)
We just finished the Part 1 FRCOphth today. First of all, Iíd like to thank you for the mock questions that you sent me. I have gone through them before I sat for the exam. They were very helpful in my preparation but quite tough. Thankfully, the 1st paper (BOF) that we had today were relatively easier than the ones in your mock exams. I was able to answer quite a substantial amount with confidence. To make things easier, we had Best of Four instead of Best of Five even though the cover of the questions said we had to choose the best answer from the five. There were about 50 people taking the exam at our centre.

Paper 1 had about 30 questions on anatomy, both ocular and general, and around 10 on physiology. There were about 30 questions on pharmacology, immunology, genetics and biochemistry. 20 questions on optics, 2 on lasers and the rest pathology. The questions werenít as tricky as the ones in your mock exams and the answers were more straightforward.

Paper 2 on the other hand was a nuisance. There were 12 questions given in a booklet and we had to answer in a marking sheet for each question over 2 hours. Below are the breakdown of the questions if I remember correctly:

3 diagrams of the brainstem were given. First diagram was an axial view at the superior colliculus level showing a nerve passing through a nucleus. Question asked which nerve, what nucleus does it pass through and what was the structure ventral to the nucleus. Second diagram was an axial view of a nerve looping around the nucleus of another nerve and question asked was what was the nerve and the nucleus and the structure anterior to it in the pons. Third diagram was a ventral view of the pons and nerve exiting from the pontomedullary junction near the midline. Asked what nerve and what were the structures inferior to it (pyramid and olivary nucleus).

Scenario of a 12 month old child presenting with leukocoria of the right eye needing enucleation. Below was given a HPE slide picture with arrows pointing to circularly arranged nucleus with neurofibrillary tangles inside. Asked what did the arrow point to and what other features can be found in this condition. Asked for diagnosis and differential diagnoses. Also asked regarding adverse prognostic factors.

Scenario of a man presenting with follicular conjunctivitis. Swab taken and HPE slide picture of cells with arrow pointing to cytoplasmic inclusion bodies. Asked what can cause follicular conjunctivitis. Asked what did the arrow point, what condition was it and the treatment. Also asked what stain was used and what other investigations can be done to confirm.

Pachymeter. Asked for 2 of its uses, draw a ray diagram, explain how it works and what other instrument can do the same thing.

Focimeter. Asked what 2 other instruments can do the same thing, draw ray diagram, why is green light used, how to measure angle of a prismatic lens using focimeter.

Given lens prescription. Right +5.5/-3 x 80 and Left +0.5/-1.5 x ??. Asked to transpose to positive cylinder, spherical equivalent, what is the problem in prescribing for this for a 2 year old, what can be done to overcome that. Also asked if in an adult who needs right eye phaco, where should the incision be to minimize astigmatism.

Bifocals. Asked difference between single-piece bifocal and fused bifocals. Asked for 4 problems with bifocals. Asked when in a child can executive bifocals be prescribe. Also asked 4 contraindications to prescribe bifocals.

Hess chart showing right inferior oblique underaction with left superior rectus over action. Also some left esodeviation. Asked what investigation was it. What can we see from the chart. What principles were used in this investigation. Which direction of gaze has the worst diplopia.

A series of FFA showing pooling with smooth edges the size of the optic disc at the left eye inferior to the fovea. Increasing intensity with time. Asked to describe what was seen. Asked what investigation and the optical principle of the investigation.

CT scan of the brain showing bilateral enlarged medial rectus. Also a calcification in the left temporal lobe. Arrows pointing to ethmoid sinus, optic chiasm and the calcification. Asked what investigation, what arrows were pointing and what abnormal findings. Also asked what other investigations should be done for the patient.

Humphrey perimetry showing homonymous left superior quadrantopia. Left eye fixation loss 2/13 but right eye 3/7. Both had low false positives and negatives and done over 5 minutes. Asked to describe abnormal finding. Asked where the most likely site of lesion. Asked if the investigation is reliable. 

Scenario of a middle age man presenting with cough, muscle ache, painful right eye, fever, hematuria and 10kg weight loss. Then provided with blood investigation results showing ureamia, high serum creatinine, mild anaemia, raised ESR, raised CRP, ANCA positive and some protein 3 raised. Asked to list down the problem with the investigation results. Asked what are the organ systems involved and what is the most likely diagnosis.

For me paper 2 was quite tough. Did quite badly with the pachymeter, bifocals and Wegenerís. I guess that balances out with the easier paper 1. 

Result: Passed


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