Test 37
(Matching Paper: Pathology)

In response to considerable discussion the Examinations Committee of the College has decided to update the format of the Part 3 MRCOphth Examination from April, 2003.

An extended matching paper will replace the existing MCQs and they will be no negative marking. The test will probably be easier than the previous format. To familiarize the candidates with the new formats, test 34 and onward will follow the new style as described below by the College.
 

40 questions over a 3-hour period. The questions will be divided as follows. 5 pathology questions 5 microbiology questions 15 general ophthalmology questions 15 Medicine and Neurology in relation to ophthalmology Extended matching questions are multiple choice items organized into sets that use one list of items in the set. The extended matching set includes four components  1.A theme  2.an option list  3.a lead in statement  4.at least four item stems, as illustrated below  This will involve 40 questions (probably 200 stems) over a period of 3 hours.

1. Match the slides (a-d) with the options ie. stain used (A-N) listed below:
 

A. Sudan black B. masson trichrome C. Congo red D. oil red O E.  Giemsa stain  F.  alcian blue G. Prussian blue

H. calcoflour white I.   von Kossa J.   Ziehl -Neelsen K.  toluidine blue L.  Gram stain M. Gomori–methenamine silver N.   periodic acid schiff

 

Answer a = E. Giemsa stain showing cytoplasmic inclusion bodies of chlamydia capping  the nucleus of the host cells. b = M. Gomori methenamine silver stain of a cornea with Fusarium (a fungal) keratitis. c = D. Sebaceous cell carcinoma of the lid stained with oil red O to show the  presence of lipid within the neoplastic cells. d = I. von Kossa stain of a cornea with band keratopathy. The black deposit represents calcium salt within the Bowman's membrane.

2. Match the following slides (a-d) with the options (A-N) listed below. The slides show 
    tissues taken from the orbit:
 

A. mucomycosis B. pleomorphic adenoma C. lymphoma D. cavernous haemangioma E. optic glioma F.  myositis G. lymphangioma

H.  neuroblastoma I.   rhabdomyosarcoma J.   retinoblastoma K.  meningioma L.  thyroid eye disease M. neurofibroma N.  dermoid

 

a.	Answer K.Meningioma. The slide shows whirls of fibrous tissue which are characteristic of meningioma. The other feature of meningioma not seen here  is calcified psamomma bodies.
b.	Answer J. Retinoblastoma. The slide shows small round cells with large hyperchromatic  nuclei and scanty cytoplasm. There are also Flexner Wintersteiner  rosettes which are clusters of cuboidal or short columnar cells  arranged around a central lumen
c.	Answer D. Cavernous haemangioma. The lesion contains varying sized vascular channels with large  lumina, sclerotic wall and flattened endothelial cells
d.	Answer C. Lymphoma. The slide shows monotonous sheets of small blue  cells. Systemic evaluation is necessary for extraorbital lymphoma.  The majority of the lymphomas are monoclonal B cell proliferation.  Irradiation is the treatment of choice for lymphoma confined to  orbit and the result is good. Systemic lymphoma can present years  after having isolated orbital disease and long-term follow up is  essential.

 

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