Many thanks for your website that without it I truly wouldn't have stood a chance. Here is my contribution:

MCQs more difficult than CRQs.  

Questions from FRCOphth Part 1 - October 2013

Question 1:

-Compose visual field charts for each of the lesions labelled a – j on the normal visual field charts provided (10)

Similar to the diaphragm in ferris Q&A page 48 and kanski except had lesions on the retina itself that were tricky.

Question 2:

-In photograph A (choroidal melanoma histology slide, picture in forrester / kanski), what cell type is present? State the other main cell type in uveal melanoma. (2)

·         Epitheloid cells, Spindle cells

-In photograph B, explain the collor stud shape of the tumour (2)

·         Breach of bruch’s membrane & RPE

-State two clinical (1 mark) and two pathological (2) prognostic indicators.

·         Clinical – size, extent of invasion, eg scleral invasion

·         Pathological – Trisomy 3 -> increased risk of metastatsis, Spindle cell histology -> better prognosis (Kanski)

-State three risk factors for the development of a malignant melanoma of the uveal tract (3)

·         Age

·         Ethnicity

·         Sun exposure Kanski

Question 3:

Hx (30 year old female gardening, wears CL, had sx of microbial keratitis, given abx with no improvement, ?ulcer on cornea

-From the information of the history, give three possible diagnosis. (3)

·         Microbial keratitis, FB, allergic eye disease

-What are her risk factors for developing this corneal problem (2)

·         Soft contact lens wearer

·         Gardener - > high risk of FB

-Microbial examination of the corneal scrapes was negative and there was no improvement with topical antibiotics. The lesion worsened to involve the entire cornea and there was an area of threatened performation. The patient underwent a penetrating keratoplasty. The diseased corneal button, having been stained by Grocott’smethenamine silver stain, is the image shown in photogram A (forrester, fungal histology picture, pale green with black bodies

-What is staining blue-green (1 mark) and black (1)?

-A tissue sample was sent to microbiology. What further tests by the microbiologists would be appropriate? (2 marks)

·         PAS staining

·         Sab culture

-Which pharmacological agent is the organism likely to be sensitive to? (1)

Question 4

-State two methods for measure the power of an unknown lens (2)

-Without the use of any instruments, how can you identify whether a patient has a cylindrical correction in their spectacles? (3)

-Transpose the following lens prescription into positive cylinder format. (4)

Right +2.75 / -1.50 axis 70

Left +3.00 / -3.75 axis 95

-What is the spherical equivalent for the right eye? (1)

Question 5

-Draw a ray diagram to demonstrate the optics of a compound microscope. (5)

-Describe the image seen using a compound microscope (2)

-Other than the slit lamp, name two clinical instruments that use a compound microscope (2)

-Clinical microscopes incorporate a porro prism. What is the effect of this? (1)

Question 6

-State whether each of the lenses in images 1 and 2 are used to correct myopia or hypermetropia. If each lens is moved to the right, in which direction does the image move? (4) images are  lens with magnified and diminished pictures through lens

-For what purpose is the device in image 3 used (Maddox rod) (1)

-Describe what a normal person sees through this device and in what position (1)

Question 7

-Describe what is represented in illustration A (1) (spherical aberration)

-What features lead you to this conclusion (1)

-What can be done to reduce / correct this (1)

Same questions again for chromatic aberration and Coma aberration

-For coma, pathological condition may lead patients to experience coma aberration? (keratoconus)

Question 8

-List 3 investigations, other than a tensilon test, which are appropriate in the diagnosis of ocular myasthenia (OM). State the diagnostic value for each test (3)

-What is the neuropharmacological basis for the Tensilon test? You may wish to illustrate your answer with a diagram of the appropriate neuro-muscular junction. (3)

-List two complications of a Tensilon test and two precautious which should be taken when performing the test. (4)

Question 9 picture of CT head axial

-What is this investigation and its orientation (1)

-Describe underlying principles of this test (2)

-report the abnormality (3) ?unsure

-give two possible diagnosis other than lacrimal gland tumour (2)

-State two further noninvasive investigations which should be done and why? (2)

Question 10 (picture of corneal topography)

-what is this investigation (1)

-What does it show (don’t state diagnosis) (2)

-what is the unit of measurement of the scale on the left side of the chart (1)

-Name three circumstances when this might be a useful Ix (3)

-what other instruments may give the same info (2)

-what is the axis of the +vecyl in the patients best spectactle correction (1)

Question 11 (fig A karyotype, fig B - family tree,)

Questions regarding risks of inheritance, modes.Specifics useless without diagram.

-The disorder is known to be due to mutations in a single well studied gene, there being no genetic heterogeneity. The prevalence in all populations is estimated to be in 1 in 10,000. Which law of population genetics can be invoked to calculate the carrier frequency in population? (1)

HARDY-WEINBERG EQUILIBRIUM

-RS1: c.574C>T, p.P192S. Heterozygous. What does the “T” stand for in this report? (1)

Question 12 (STATS, 2X2 TABLE)

-What is false negative rate (1)

-What is the sensitivity (1), and specificity (1). Show how you reached answers (2)

-Is this new test better at ruling in condition X or ruling it out? Explain (2) (specificity higher than sens, better ruling out)

-what is the positive predictive value (PPV) of this new test? Explain (2)

-what does PPV indicate with regard to individual patient (1)

Result: Passed