Candidate 88                                              Centre: Glasgow
Final MRCOphth (Glasgow)                                        Date: Sept, 2006


1. Histopathological section of Bullous Keratopathy/ Fuch’s dystrophy.
• Histology of basement membrane
• Changes  in epithelium and BM 
• Clinical features of Bullous keratopathy
• Stains for stromal dystrophy ( Macular, Granular, Lattice)

2. Histopathological section of Cornea – Amyloid deposits.
• Diagnosis
• Name given for appearance with congo red stain – Apple green birefringence
• Gene mutation
• Other dystrophy associated with this mutation
• Mechanism of recurrence of Lattice dystrophy.

3. Patient listed for cataract surgery complains of burning micturition and has high temperature.
• How do you manage this patient?
• MC cause for UTI
• Antibiotic of choice
• If confirmed UTI – how will you further manage it?

4. Patient with Giant cell arteritis, on ACE inhibitor, Statins and diuretics for CCF.  Bloods – FBC, Hb, MCHC, CRP, ESR, U&E, Creatinine levels given.
• Rasons for abnormalities in the blood values
• What is the positivity rate for biopsy in GCA? And why
• If systemic steroids are already started, why do u still need to biopsy?

5. 65 yr old patient has had radiotherapy for upperlid lymphoma 10 yrs ago.He develops a lump in the upperlid and conjunctiva.Histpathology picture given.
• Describe the histology slide?
• What is the diagnosis and the usual site for this lesion?
• Predisposing lesions for it
• How do you treat it?

6. 40 yr old lady with conjunctival nodule – histology slide shown.
• What kind of inflammation does it show?
• Blood tests for sarcoidosis
• Investigations to confirm tuberculosis in a tissue biopsy specien.
• What is the histological picture of nodular scleritis?
• How do you send the specimen of conjunctival biopsy in conjunctival scarring?

7. 80 yr old female with Alzheimers disease ,ectropion and epiphora.
• Which of the corneal protective mechanisms are lost?
• Protective factors absent from tears in KCS.
• Organisms that can cause corneal infection and perforation?
• Stains used for fungus

8. Slide showing corneal ulcer and microscopy of fungus.
• What is the morphology of the fungus?
• Fungal infections in cornea
• Culture media 

9. Female with a medial canthal basal cell carcinoma excised has dacryocystitis.
• What is the evidence for usefulness of frozen section biopsy?
• Procedure for frozen section.
• Predisposing factors for wound infection
• Which is the most common organism involved?
• Which antibiotic is it sensitive to?

10. 75yr old male with past history of enucleation for malignant melanoma presents with a history of purulent discharge from right orbit and implant exposure. Picture of antiobiotic sensitivity and culture shown.
• Reasons for orbital implant exposure?
• Which family does proteus belong to?
• Which antibiotic is it sensitive to?( based on the photo)
• How do you mange this patient further?

11.  INR
• What does INR stand for? What does it indicate?
• Normal range of INR.
• INR values when anticoagulated ?
• What should INR be if cataract surgery is planned with needle to be used for anaesthetic injection?
• How will you achieve optimum INR levels?

12. 3yr old child with conjunctival chemosis and proptosis (clinical picture, macroscopic & histology slide).
• Describe the clinical features.
• Macroscopic features of the exenterated specimen.
• Diagnosis.
• Treatment options other than exenteration?

13. Fundus picture of BRVO.
• Clinical features describe.
• Systemic diseases associated.
• Long term complications and why?

14. Histological sections of Iris and Retina/Vitreous interface in PDR.
• Iris abnormality – Ectropion Uveae
• Iris neovascularization.
• Name given to the type of vacuolation seen in iris pigment epithelium and material deposited
• Abnormality in retina vitreous interface- fibrovascular changes

15. Picture /histology slide of herpetic stromal keratitis.
• Histological features in slide
• Investigations to confirm herpes infections
• Clinical features of primary herpes simplex keratitis.


Station 1: Anterior segments

Case1. Male with phthisis bulbi in RE and corneal scarring with iris tissue loss and PCIOL
• Reasons for this
• Causes of phthis bulbi
• Causes for microphthalmos
• Management of Corneal laceration.
• Complications in secondary cataract surgery.
• Irvine gass syndrome – FFA appearance.

Case 2 . Elderly lady with? Fuchs dystrophy and PK with PCIOL other eye.
• Reasons for interrupted and continuous suturing.
• Causes for wound leak.
• How will you detect it.
• Why do you use 2% fluorescein for it.
• Other complications of PK.

Station 2: Ocular motility and neuro-ophthalmology

Case 1 .
Young lady with AHP and right 4th nerve palsy.
• Asked to explain every step in OM examination.
• Parks 3 step test .reasons and findings in each step.
• Reasons for diagnosis
• Hess chart interpretation.
• Causes for bilateral palsy and clinical features.

Elderly gentleman – examine pupils ,had right amaurotic pupil ,total APD.
• Asked if RAPD or APD
• DD
• Clinical features for AION – NA and A.
• Asked to do direct ophthalmoscopy.

Case 3: Ophthalmology and medicine

Case 1 
Elderly gentleman – Slit lamp had miosed pupil with iris neovascularization and nuclear sclerosis
• DD
• Causes for ocular ischemia
• Pathogenesis of NVI in ischemia
• Other risk factors in DR
• Management of HTN and hypercholesterolemia
• Drugs used

Case 2
Indirect Ophthalmoscopy – Chorioretinal scarring more along arcades – did not look like typical PRP scars
• DD 
• Causes for perivascular chorioretinal scarring /why not PRP scars
• Investigations for posterior uveitis
• Medications

Station 4: Posterior segments

Case 1 
Elderly lady – 78D examination – Right dry AMD with Left macular scar.
• Describe lesions
• Causes for blot haemorrhages
• Diagnosis
• Not many questions

Case 2 
Indirect ophthalmoscopy ,history – night blindness, VA 3/60 since childhood
• Describe lesions – disc pallor , atteneuated vessels and hypopigmented patches in mid periphery no areas of hyper pigmentation.
• DD- Retinitis pigmentosa sine pigmento
• What other DD?
• White dot syndromes 
• Was actually Bird shot chorioretinopathy – couldn’t catch the clue abt HLA A29.

Station 5: Glaucoma and cataract

Case1 : Elderly lady with POAG (L>R) , notched inferiorly , R exotropia and macular scar
• Describe fundus
• Management if IOP’s 16.
• Reasons for R exo.
• Assessment of  Humphreys visual field – various parameters

Case 2 : Elderly lady with R post subcapsular cataract and Left pseudophakia 
• SL examn , findings
• Take history and assess if the patient needs right eye surgery.

Station 6: Counselling

You are an SHO in the preassessment clinic for cataract surgery.The patient is a myope with prescription of -8.00 D  and -14.00D  and has been listed for a left cataract surgery with a post op refraction aim of -3.00D. Counsel the patients about the risks and benefits of the cataract surgery and the need to leave her a bit short sighted , need for a second cararact surgery soon.

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