Candidate 98                                            Centre: Bristol
Final MRCOphth                                                        Date: March, 2007

PATHOLOGY -was very difficult. What I knew as follow:

1.Granular dystrophy-inheritance,stain,
2.Fungal hyphae-corneal ulcer management,
3.Endophthalmitis-management,what will you do if you were clinical director?,what will you look for in the patients notes?
4.Cavernous hemangioma
5.Blood test results showing anaemia
7.Tractional retinal detachment
8. CMV retinitis
Can't remember the rest.


  • Lots of questions on headache-different types including a man who got headache after on hallucinations,one refraction postop astigmatism,one on statistics.


Medicine and ophthalmology

  • A teenager on crutches - pigmented KPs, IOL with posterior synechiae, trabeculectomy done. Posterior segment showed sheathing of vessels near the optic disc -asked to correlate the signs. I mentioned juvenile rheumatoid arthritis with uveitis, cataract and glaucoma. Asked if posterior segment involvement was common. I said no. Also asked if she had macular oedema.

  • Asked to see skin - multiple freckles, few skin tags. I mentioned angiofibromas, shagreen patches on back. There was one large cafe' au lait as well but I said the signs are suggestive of tuberous sclerosis.

  • Neurology examination of the lower limbs, hypertonicity, decreased power and hyperereflexia with upgoing plantar of both legs-said upper motor neurone lesions and maybe multiple sclerosis.

  • A patient with dystonic movements of hands. Asked what were they called? I said dystonia(good!) What will you look for in the eye- Kayser-Fleischer's ring and sunflower cataract (good!). How will you look for internuclear ophthalmoplgeiga? I demonstrated saccadic movement.

Anterior segment

  • Bullous keratopathy in penetrating keratoplasty with bandage contact lens. I thought he had early Fuchs' dystrophy in the other eye but maybe mistaken.

  • Discussion on Fuchs - didn't go very well.
    Keratoconus with a rigid contact lens in both eyes. Asked all the signs, causes of the prominent corneal nerves.

  • Marcus-Gunn ptosis.

Posterior segment

  • Indirect but didn't see much. Only lattice degeneration. Don't know what he had. Asked about lattice degeneration and management.

  • Used super66 for posterior pole - choroidal folds, asked about possible causes.

  • Fundal photo of optic disc showing drusen and PED.


  • A lady with trab, posterior synechiae, glaucomatous optic atrophy. Also presence of cataract. Discussion did not go as well as I liked.

  • A patient with ongenital glaucoma.

  • Visual fields with tunnel fields - causes?


  • Patient gave a history of ptosis. Asked to counsel about levator resection. This station was fine.


  • Direct ophthalmoscopy- the patient had disc drusen. Ask to chart out blind spot.

  • Facial nerve palsy in post surgery acoustic neuroma