Paper 3 CRQ

Question 1

What does the term cutis refer to

Answer 1

The outer layers of the skin

Question 2

What layers of the skin does the cutis comprise of

Answer 2

Superficial epidermis
Deeper dermis

Question 3

Micronodular vs Nodular BCC. Which one is more aggressive

Answer 3

Micronodular- subclinical spread with potential to spread beyond macroscopic boundaries making it harder to clear margins during excision

Question 4

What are the 4 histological subtypes of BCC

Answer 4

Nodular (solid)
Superficial
Infiltrative (morphoeic)
Micronodular

Question 5

Histological features of Nodular BCC

Answer 5

Well circumscribed with clear palisading and easily excised

Question 6

Histological features of Superficial BCC

Answer 6

Appear as lobules localised to dermal - epidermal junction

Question 7

Histological features of Morphoeic BCC

Answer 7

Grow aggressively in strands with reduced peripheral palisading and an indistinct border

Question 8

Histological features of Micronodular BCC

Answer 8

Multiple small nodular aggregates of tumour

Question 9

Which 2 types of BCC have the potential for subclinical spread

Answer 9

Both infiltrative BCCs and micronodular BCCs

Question 10

Exenteration vs Enucleation vs Evisceration

Answer 10

Exenteration: Removal of all contents of orbits including EOM

Enucleation: Removal of eye leaving EOM and other contents behind

Evisceration: Removal of globe contents leaving sclera, fat, EOM and other adjacent structures of the eye intact and sometimes the cornea in place

Question 11

2 principal risk factors for developing BCC

Answer 11

Sun exposure
Fair skin

Question 12

Treatment for superficial BCC

Answer 12

Imiquimod- an effective topical treatment for superficial BCCs with histological clearance rates of 82–90%

Question 13

Inherited syndromes with multiple BCC’s

Answer 13

• Gorlin Goltz- AD
• Xeroderma pigmentosum- AS
• Albinism- AR
• Bazex syndrome (Bazex–Dupré–Christol syndrome)- X linked recessive

Question 14

What distortion do high powered convex lens cause

Answer 14

Pincushion distortion
Jack in the box
Ring phenomenon

Question 15

What distortion do high powered concave lenses cause

Answer 15

Barrel distortion

Question 16

Prismatic power formula

Answer 16

P=FxD
P is the induced prismatic power in prism dioptres;
F is the power of the decentered lens in dioptres; and
D is the decentration in centimetres.

Question 17

Antibody associated with hyperthyroidism

Answer 17

Thyroid stimulating hormone (TSH) receptor antibodies (TRAb)

Question 18

Is radioiodine contraindicated in pregnancy

Answer 18

Yes

Question 19

Sight threatening complications of Thyroid eye disease

Answer 19

Exposure keratopathy
Acute optic neuropathy

Question 20

Which blood retinal barrier is primarily affected in diabetic maculopathy/retinopathy

Answer 20

breakdown of the inner blood–retinal barrier with extensive leakage from capillaries and microaneurysms

Question 21

Between which layers of the retina does the oedema occur first in diabetic retinopathy

Answer 21

between the inner nuclear and outer plexiform layers

Question 22

How does aflibercept work

Answer 22

a recombinant fusion protein which binds VEGF block these actions, and can stabilise or improve vision by reducing macular oedema.

Question 23

Aetiology of CN VI palsy

Answer 23

• Microvascular ischaemia
• Tumours (e.g. cavernous sinus lesion, acoustic neuroma)
• Basal skull fracture
• Vasculitis (e.g. GCA)
• Demyelination
• Raised intracranial pressure (usually bilateral, unlike this case)

Question 24

When does the lens vesicle separate from the surface ectoderm

Answer 24

at the start of day 36, i.e. after 5 weeks.

Question 25

What is coma aberration

Answer 25

a variant of spherical aberration which occurs with light originating from points away from the principal axis. Light rays passing through the lens periphery are deviated more than those passing through the central portion of the lens. This consequently leads to a composite image that is elongated like the tail of a comet.

Question 26

What type of aberration are people with keratoconus susceptible to

Answer 26

Coma aberration

Question 27

In using the red green chart post refraction in a colour blind patient, how do you use it

Answer 27

asked whether the letters are clearer on the upper or lower row

Question 28

Which type of aberration does mydriasis induce

Answer 28

Spherical aberration

Question 29

Types of defects causing hyperfluorescence on FFA

Answer 29

Leakage Pooling Staining Window

Question 30

Types of defects causing hypofluorescence on FFA

Answer 30

Blockage Filling defect

Question 31

How is ischaemia detected on FFA

Answer 31

The findings of new vessels (neovascularisation) and capillary dropout indicate ischaemia.

Question 32

How is the blood retinal barrier maintained

Answer 32

maintained by tight junctions between retinal capillary endothelial cells and the outer blood–retinal barrier (maintained by tight junctions between retinal pigment epithelium cells)

Question 33

Incidence of anaphylaxis in FFA

Answer 33

incidence of severe anaphylaxis is 1:1,900, and of fatal anaphylaxis is 1:220,000.

Question 34

Incidence of seizures in FFA

Answer 34

The risk of seizures is reported as 1:14,000.

Question 35

What does Neisseria Gonorrhoea appear like under staining

Answer 35

Gram-negative Diplococcus

Question 36

Microbes causing Ophthalmia Neonatorium

Answer 36

Neisseria Gonorrhea Chalmydia Trachomitis

Question 37

Growth medium for Neisseria Gonorrhoea

Answer 37

Chocolate agar is a non-selective growth medium whereas Thayer-Martin is selective for Neisseria.

Question 38

Between Chlamydia and Gonorrhea which is the most common cause of neonatal conjunctivitis

Answer 38

Chlamydia

Question 39

How to test for Chlamydia

Answer 39

* Immunofluorescent staining (monoclonal antibody fluorescence microscopy) * Polymerase chain reaction (PCR) or other nucleic acid amplification tests (NAAT) * Enzyme-linked immunosorbent assay (ELISA) * Culture * Giemsa stain

Question 40

Optics of the compound microscope

Answer 40

The compound microscope consists of two lenses. The objective lens has the higher power of the two, and the object is placed very near it, just outside of its principal focus. The real, magnified, inverted image formed, image I1, then acts as the object for the eyepiece lens. However, this time the ‘object’ (image I1) falls within the principal focus and so the final image seen by the observer through the eyepiece lens is virtual, further magnified and remains inverted. Importantly, it is further from the eyepiece lens (and the observer) than image I1, which makes it easier to view.

Question 41

Difference between lenses in Compound microscope and Keplerian Telescope

Answer 41

consist of two convex lenses. The compound microscope, with the objective as the more powerful lens, magnifies very close objects. Conversely, the astronomical telescope has a more powerful eyepiece lens and magnifies very distant objects .

Question 42

In a compound microscope what is the sum of the focal lengths of the lenses in relation to the distance between them

Answer 42

the sum of the focal lengths is smaller than the distance between the lenses.

Question 43

Which prism can be used to invert an inverted image

Answer 43

Porro Prism- deviates by 180 to make image erect

Question 44

How does a slit lamp use compound microscopes to give a binocular view

Answer 44

Two compound microscopes (one for each eye) are used, mounted at a 13–14 degree angle to each other.

Question 45

What is the statistical definition of the median

Answer 45

is the age of the patient who is younger than half of the patients in that arm and older than the other half, i.e. the patient at the 50th percentile

Question 46

Formula to calculate the NNT

Answer 46

1/ARR

Question 47

What is a type 1 error

Answer 47

the null hypothesis is rejected when it is true, i.e. a ‘false positive’

Question 48

What is a type 2 error

Answer 48

when a study fails to reject a null hypothesis when it is false (i.e. a ‘false negative’)

Question 49

What is the statistical definition of the P value

Answer 49

The probability of finding a difference at least as dramatic as that seen in the results as a chance occurrence.