Candidate 106 

Final MRCOphth (passed)                          

Centre: Belfast                                

Date:    September, 2007 



Pathology/microbiology paper:
(can't remember all questions - its all a blur now):
1) Scenario of cases of endophthalmitis in your dept - how would you investigate? who should be involved etc?
2) Photo of post PK cornea with multiple satellite opacities - I thought it was a bacterial keratopahthy that was modified by the post op steroids the patient was on (looked like a crystalline type keratopathy) but gave a differential of other organisms.
3) The usual gram stain slide - -though at present can't remember what it was? (think a mirco slide is very common in the exam)
Glaucoma/VF/cataract -

  • Bitemporal hemianopia - realted questions on where/what lesion/what investigation

  • Next case was I think a traumatic caratact.

  •  One other case that I can't remember

Cornea and external eye diseases

  • Map-dot-fingerprint dystrophy

  • Iris cyst

  • Fuchs endothelial dystrophy

  • Psuedo-exfoliation case


  • PRP with NVE (they looked perfused and there was a pre-retinal haem) - got questions on how would you manage this pt.

  • Stage 3 macular hole - questions on macular hole surgery - what gases/why ILM peel/how to deal with post op complications e.g. raised IOP    (+when is the peak time for this/peak expansion time).

  •  Melanoma which looked like it had been treated with plaque brachytherapy (questions on progostic indicators of melanomas/treatment options)

Neuro/eye movements

  • Pendular nystagmus - fortnately saw an inferior PI - pt had had RD repairs BE as a child.

  • Abberent regeneration following CN VII palsy - was subtle - pt didn't blink as much on affected side + has twitching movements of the lip of the affected side on opening mouth


  • Blue sclera - osteogenesis imperfecta!!!      was tricky as examiner showed me a list of drugs with bisphosphonates on it - asked me what they were for and what situations would an ophthalmologist use them (i.e long term steroid use to prevent osteoporosis). On slit-lamp pt had mild anterio uveitis in the right eye with post synechiae in both. Initially I thought she was either on steroids for uveitis or maybe related to RA (with scleral thining etc) couldn't really tie it all together so described what I was thinking and gave a differential for blue sclerea - examiner seemed to like that (at the end the examiner told me the uveitis was a red herring).

  • RAPD - that was easy bit patient also has a VP shunt - examiner got me to feel the reservoir in her scalp. Pale discs with ?shunt ? collateral vessels - I can never get the terminology correct - we had a discussion on what the communication was.

Communications skills


Scenario was that a child was due to have convergent squint operatio but due to an extra case on the list/reshuffling of list when he got back to the ward mum noticed the other eye had been operated on. The mum wanted to speak to you (consultant has left and cannot be contacted as yet).
The actress was really very good- important to try and ignore the examiner - just do what you normally do and be nice to the patient & the usual things such allow them to voice their concerns/eye contact/comment you understand etc. I think I got across that it may not necessary be that he needs another operation or squint is worse as eyes work as a unit/sometimes we need to operate on the other eye for a squint but made sure she knew that we would have to re-assess the squint with orthoptics (do didn't give false expectations but gave her some hope not all was lost). told her what we would do next & what mechanisms were in place to make complaint/incident form/prevent this from happening again.
Felt it went very well as initially she was very angry/thumpping table/crying /etc but started to calm down. Think the best thing I did was to offer a cup of tea and biscuit at the end - made her laugh (and come out of character) - examiners laughed too - she said thank you that is very nice!  Which brought it all to a very nice conclusion. (cup of tea always makes things better )
Sorry can't remember everything. Managed to pass - must say I'm really surprised - at the time thought I had done really badly as examiners really push you with their questions and play games to make you doubt your diagnosis (e.g. one guy kept saying "Really doc is that what you think it is" to every differential I gave him!) It all goes very quickly and makes you feel that you really didn't get to show what you know and all that hard work was for nothing. All i can say is you never know what the result will be - just try to keep calm and not let examiners to get to you or it will affect the other stations.