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Ophthalmology Fact Fixer 240 MCQs with explanatory answers Chung Nen Chua Li Wern Voon and Siddhartha Goel Radcliffe Medical Press Radcliffe Medical Press Ltd 81 Marcham daoR Abingdon Oxon OX14 1AA United Kingdom www.radcliffe-oxford.com ehT Radcliffe Medical sserP electronic catalogue and online ordering facility. Direct selas to anywhere ni the world. © 2002 The authors All rights .devreser No part of this publication may be reproduced, stored ni a retrieval system or transmitted, ni any form or by any ,snaem electronic, mechanical, photocopying, recording or otherwise without the prior permission of the copyright owner. hsitirB Library Cataloguing ni Publication Data A catalogue record for this book si available from ehT hsitirB Library. NBSI 1 57758 809 7 Typeset by Aarontype ,dtL ,notsaE lotsirB Printed and bound by JT International ,dtL Padstow, Cornwall Preface This book is designed to help residents, ophthalmologists and optometrists prepare for the MRCOphth, MRCS, FRCS and final optometry examinations respectively. It also serves as a guide to help comprehensive ophthalmologists update and expand their knowledge of ophthalmology. It is a useful aid for continuing medical education. The content includes updates in recent scientific trials and studies, medical thera peutics and surgical procedures, covering the subspecialities of cornea and external disease, refractive surgery, cataract, glaucoma, orbital disease and oculoplastics, surgi cal and medical retina, paediatric ophthalmology, neuro-ophthalmology, uveitis, ocular oncology and pathology. To our knowledge, many of the other previously published self-assessment books have been found to be deficient in these aspects. A Fact Finder is provided at the back of the book. Chung Nen Chua September 2002 tuobA eht srohtua Chung Nen Chua tsilaicepS rartsigeR Oxford eyE Hospital Oxford iL Wern Voon Clinical laenroC wolleF Oxford eyE Hospital dna dleiffuN Laboratory of Ophthalmology University of Oxford Oxford dna rartsigeR ehT eyE Institute Department of Ophthalmology naT Tock gneS Hospital eropagniS Siddhartha Goel Ophthalmologist tneK County Ophthalmic dna Aural Hospital Maidstone How to master MCQs Multiple choice questions (MCQs) are an effective way of assessing the candidate's knowledge and are an important part of the final MRCOphth/MRCS. Apart from possessing good knowledge of the subject, we suggest the following tips which we hope will help you excel in the examination. Remember ot answer hguone snoitseuq The questions featured in the MRCOphth/MRCS/FRCS examinations are similar. Each question has five parts to be answered. Answers may be True, False or Don't know. + 1 mark is given for a correct answer and -1 mark for an incorrect one. No marks are given or deducted for an unanswered question. This system of marking is called nega tive marking. The fear of making mistakes may lead to answering too few questions. If the pass mark is 50%, and only half of the questions have been answered with confidence, one may score poorly, as a significant number of answered questions may be wrong. It is recommended that candidates attempt two-thirds of the questions. While this implies making guesses for some of the questions, an intelligent guess based on some back ground knowledge will more often be right than wrong. skcirT desu yb eht examiners 1 Pay attention to the phrasing of the question. Phrases that contain the words 'never' or 'always' are usually false, whereas phrases with the word 'may be' are usually true. Good MCQs tend to avoid using these words as much as possible. Other examples are words such as 'typical' or 'rarely'. A sentence may be correct in essence, but not when these phrases are used. For example: Retinoblastoma: si inherited ni the majority of sesac sesira from receptor sllec of the retina si detaicossa with deletion of chromosome 31 si typically present with pseudo hypopyon that involves the optic nerve sah poor .sisongorp Question illustrates the delicacy of correct phrasing. Pseudohypopyon si a known presentation of retinoblastoma, however, it si not typical. 2 Beware of statements that contain dual information. The first part of the statement may be correct, whereas the second part si incorrect. Mistakes can easily be made if the question si read ni a hurry. For example: nI malignant hypertension: intracranial erusserp si desiar a macular rats si desuac by the breakdown of the tight junction of the retinal pigment epithelium there si bilateral optic csid swelling with a relative afferent pupillary defect fluorescein angiography may show a dark choroid due to choroidal ischaemia phaeochromocytoma si the most common .esuac nI this example, question <,~:L< contains a correct statement ni the first part of the question .e.i( malignant hypertension sesuac bilateral optic disc swelling) but na incorrect statement in the last part .e.i( relative pupillary defect si not a feature of malignant hypertension). 3 Numerical serugif in questions era tricky, sa they can easily be altered to trick the unwary. It si advisable not to answer these questions sselnu there si great certainty. roF example: ehT following era true about primary open-angle glaucoma: relatives of the affected have na increased incidence of steroid-induced glaucoma the incidence of a first-degree relative developing the emas condition si 1 % dilatation of the pupil always sesaercni the intraocular erusserp abnormality of the trabecular meshwork si often observed during gonioscopy lausiv dleif ssol nac occur in the presence of normal cup:disc ratio. When answering this question, en)( may vaguely remember the value 1 % and be pleased to ees it ni question . ehT true answer si in fact 10%. 4 Avoid reading too much into the question. For example: sitirI si a feature :fo systemic supul erythematosus psoriatic arthropathy ulcerative colitis s'techeB esaesid rheumatoid arthritis. While rheumatoid arthritis does not cause ,SitIrI some may reason that rheumatoid arthritis-induced scleritis or peripheral corneal melts can give esir to cells in the anterior chamber and hence iritis. 5 Some easy questions may be rendered unanswerable by the use of uncommon vocabulary. For example: Deuterano maly: si desuac by na abnormal eneg ni the X-chromosome si desuac by na abnormality ni the neerg pigment occurs ni about 5% of the naeporuE population si more common than protanomaly is associated with decreased visual acuity. nI the question above, deuteranomaly si another term for red-green colour .ssendnilb fI one si uncertain of the medical term, it may dael to difficulties ni answering the question. Noting the slraep above will eb useful nI helping candidates lecxe nI any multiple choice question examination.

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