1.  Retinoblastoma 
• Describe histological slide: FW rosettes and fleurettes 
• Prognostic factors 
• 4 possible differential diagnosis for retinoblastoma i.e. leukocoria 
• Tumour suppressor gene and its role in retinoblastoma 

2.  Choroidal melanoma 
• (It might have been choroidal haemangioma) 
• Describe pathological specimen and histological slide (low magnification) 
• What other cells would you see i.e. on high magnification 
• Ultrasound characteristics 

3.  Giant cell arteritis 
• Describe histological features i.e. slide of blood vessel shown 
• Why could it still be GCA even if the biopsy is negative? 
• 3 ocular complications 
• 2 non ocular complications 

4.  Prion diseases 
• What is a prion? 
• How do prions cause disease? 
• Name 3 prion diseases 
• How would you prevent the risk of prion diseases in ophthalmology? 
• A case scenario of a young keratoconic patient awaiting corneal grafting and he is concerned about this risk.  How would you counsel him? 

5.  Vasculitis 
• What is the clinicopathological classification? 
• Wegener’s and role of ANCA 
• Describe histological slide 
• Complications of Wegener’s 

6.  Pleomorphic adenoma 
• Describe CT 
• Describe histological slide 
• Malignant lacrimal gland tumours 

7. Endophthalmitis 
• Patient presents “2 days” following phaco with endophthalmitis 
• Name 2 most likely organisms 
• Name most important procedure for diagnosis 
• What 4 culture media would you request for culture? 
• 2 advantages of vitrectomy 
• Another patient has a penetrating trauma related endophthalmitis.  Name 4 likely Gram -ve organisms. 

8. MRSA 
• Describe the picture: Agar plate showing colonies.  4 circular pieces of paper impregnated with antibiotics, only sensitive to vancomycin. 
• What is the organism? 
• Management of MRSA patient on the ward 

9.  Acanthamoeba 
• Name 2 routine stains used (not calcofluor white) 
• In what forms do acanthamoeba exist? 
• Name 2 treatment used 
• What culture medium would you use for fungal keratitis? 

10.  Conjuntival slides 
• Rather odd looking, supposedly according to the caption there is elastotic degeneration 
• 3 possible causes for this picture 
• How would you differentiate them clinically and histologically? 

11. Ocular cicatricial pemphigoid 
• Describe immunofluorescence slides 
• Name one linear IgG disease with systemic manifestations 
• Stevens Johnson: What are the immunological mechanisms and histopathological features? 

12. Retina 
• Histological slide of retina showing all the layers.  Mark on the drawing where you would expect the pathology to be: 
• Hard exudates 
• Retinitis pigmentosa 
• Cotton wool spots 
• Glaucoma 
• Sturge-Weber 

13.  Phacolytic glaucoma 
• Describe slide of drainage angle 
• Mechanism of raised IOP 
• Name 4 ocular tissues affected by high IOP 

14.  Optic neuritis 
• Visual prognosis in optic neuritis 
• What is the risk of MS? 
• What are the histopathological features of MS? 

15.  Giant papillary conjunctivitis

CRQs  MRCOphth Part 3:  Southampton,September 2005

1. Picture of macroscopic and microscopic histology of a pilomatrixoma stem –  Patient presented with a lesion diagnosed as a pilomatrixoma 
Q1.  Give 4 histological features seen 
Q2.  Which 2 places are these commonly found? 
Q3.  There are 2 syndromes in which these are found. Name one. 

2. Picture of a corneal section. 20 yr old patient with worsening vision despite refraction. 
Q1. What are the 3 histological features seen in the slide? ( Descemets break at the edge, but not much else seen except for artefactual stromal splitting) 
Q2. What is the diagnosis? 
Q3. What would you call it if there is a sudden break in the Descemet's in this condition? 
3. Picture of a colour Doppler with an arrow at a stenosis. A 74 yr old presented with visual loss of less than 24 hours. 
Q1. What is the name for this symptom? 
Q2. What investigation is this? 
Q3. What is the pathophysiology of this symptom? 
Q4. What treatment would you recommend? 
Q5. What evidence is there for this treatment? 
4. Picture of exenterated orbit with large ulcer at the lateral canthus with 2 histological slides of BCC). A ~50 year old was operated on for a large ulcer at his lateral canthus. 
Q1. What is the type of lesion? 
Q2. What does this lesion cause around it within the dermal structures? 
Q3. How would you excise this lesion if it wasn’t clinically obvious? 
5. Picture of a (choroidal melanoma) invading through posterior sclera in a mushroom shape. A patient previously treated for ocular melanoma presented with pain and reduced vision. 
Q1. What are the histological features seen? 
Q2. Give 4 modalities of treatment for this condition. 
Q3. What 2 investigations would you perform on this patient? 
6. Microscopic histological picture of normal retina. Mark on the picture the layer in which each of these conditions present. 
Q1. Neovacularization in diabetes 
Q2. Microcystoid degeneration. 
Q3. Coats disease – where is the macrophage with ingested pigment 
Q4. Drusen 
Q5. Central retinal artery occlusion 
7. Histological picture of a (ragged red muscle fibre). This patient presents with peripheral pigmentary retinopathy and ophthalmolplegia and had a muscle biopsy. 
Q1. What is the diagnosis? 
Q2. Which muscle would you biopsy? 
Q3. How would you transport this specimen to the lab? 
Q4. What is the diagnostic appearance of the biopsy for this condition? 
8. Picture of lymphocytes in a vitreous tap. Patient presented with hazy vision with vitritis. CD 20+ cells found in this vitreous tap. 
Q1. What is the diagnosis? 
Q2. What is the prognosis? 
Q3. What is the treatment? 
Q4. What are the other simple investigations you would perform? 
9. Picture of a corneal section (with ?vessels).  Patient who had a graft presented with worsening vision and an endothelial line. Not a recurrence of the primary cause for a graft. 
Q1. What is the diagnosis? 
Q2. What are the 4 causes of graft rejection 
Q3. Which cells mediate rejection? 
Q4. What are the histological features seen? 
10. Picture of a ?dermoid cyst. This patient presents from birth but patient presented late due to failure to keeping appointment. 
Q1. What is the diagnosis? 
Q2. Where is the commenest site for this lesion? 
11. Muscle histopathology slide. Muscle biopsy of a patient with proptosis 
Q1. Describe the histopathological features 
Q2. Which cells mediate this? 
Q3. What is the diagnosis 
Q4. Does treating the thyroid condition alter the TED? 
Q5. What blood investigations would you perform? 


1. The patient has a certain systemic syndrome associated with a Pituitary mass. 
• Cut-off limit of pituitary mass , Macroscopic differentiation on size
• MC Hormone secreted and ass syndrome
• Features of ''mass effect'' of pituitary lesions. 
• Endocrine effects of pituitary mass lesions in Males & Females. 
• DD for calcification
• Visual field defect

2.  Photomicrographs of Exenteration specimen shown. 
• MC malignant orbital tumor in adults
• MC orbital tumour in children
• What do you see in cross section
• What do you see in the histological section( Sebaceous cell ca)
• 3 other malignat orbital tumours

3. Scenario of 25-yr old soft contact lens wearer with painful red eye. 
• Types of ulcers? 
• Appropriate investigations? 
• Treatment of choice? 
• Types of culture media? 
(Question was regarding P Aeruguinosa )

4. Known pt. with AIDS , specimen is being transported to the LAB. 
• Precautions for the Porter? 
• Precautions for the LAB staff? 
• Common HIV related eye conditions? 

5. 77- yr old man with history of blurring of vision for 1 week. 
    (Coloured photograph shown.) 
• Diagnosis – BRAO / Cilio retinal BRAO
6. 61- yr old patient with Bilateral upper eyelid yellowish lesions 
• Diagnosis – Xanthelesma
• Histology – describe
• Systemic conditions associated with it

7. Retinoblastoma

8. Herpes Zoster Ophthalmicus –picture of globe
• Gross features
• Long term complications
• Histological features of scleral inflammation
• From which stage can virus be isolated

9. A lady with medial canthal swelling 
• Diagnosis-  Acute dacryocystitis
• Gram staining – positive/Negative
• What could the organism be?
• Management

More candidates' experience