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					THE ROYAL COLLEGE OF OPHTHALMOLOGISTS

   DUKE ELDER PRIZE EXAMINATION 2009




     INFORMATION FOR CANDIDATES
                        Duke Elder Prize Examination May 2009



              Please read the following information carefully


This examination is intended for medical students who have completed their
ophthalmology undergraduate teaching, but it is open to all medical
undergraduates provided they have not graduated at the time of the
examination.

Students may take the examination on more than one occasion provided they
have not yet graduated and have not previously won the prize.

All candidates will be given a PASS or FAIL mark, a percentage score and a
rank.

Candidates will be charged a cheque deposit of £15. If you attend this
examination your deposit will be returned to you. (Cheques should be made
payable to “The Royal College of Ophthalmologists”).

The 1 ½ hour examination will be held on Wednesday 6 May 2009 at 2.30pm.

Candidates should liaise with the Medical School Organiser if they wish to sit
this examination. The College is only able to accept applications via UK
medical schools. We are not able to accept individual applications.

Candidates must ensure that they have given their name prior to their Medical
School Organiser prior to the closing date of 11 March 2009. Medical School
Organisers will then submit the names of their medical students wishing to sit
the examination to the Royal College of Ophthalmologists. No candidate will
be accepted after 11 March 2009.

If you have any further queries please contact the:

Examinations Department
Royal College of Ophthalmologists
17 Cornwall terrace
London
NW1 4QW
Email: exams@rcophth.ac.uk




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                        Duke Elder Prize Examination May 2009


  THE DUKE-ELDER UNDERGRADUATE PRIZE IN OPHTHALMOLOGY

An undergraduate prize examination will be sponsored again this year on a
national basis by The Royal College of Ophthalmologists. This examination is
intended for medical students who have completed their ophthalmology
undergraduate teaching, but it is open to all medical undergraduates provided
they have not graduated at the time of the examination.

Students may sit the examination on more than one occasion provided they
have not yet graduated and have not previously won the prize. There will be
a cash prize of £400 for the candidate gaining the highest mark. If there is
more than one candidate gaining the highest mark this amount will be split
respectively. There is no second prize.

The examination consists of an extended matching question paper of 20
questions with 3 stems to each question. Candidates will have to pick their
answer from a list of options. Marking is on the basis of +1 for a correct
answer and 0 marks for an incorrect answer.

The standard is high and candidates should anticipate a stiffer examination
than encountered in the undergraduate class. Questions are mostly based
on clinical ophthalmology but other areas covered include ocular physiology,
anatomy and pathology as well as genetics of eye conditions and
socioeconomic medicine relevant to ophthalmology e.g. blind registration or
world blindness. In the clinical questions all the sub-speciality areas within
ophthalmology are covered including:

Cornea and external eye disease
Cataract
Glaucoma
Medical retina and vitreo-retinal surgery
Strabismus and paediatric ophthalmology
Neuro-ophthalmology
Ocular adnexal and orbital disease
Refractive errors and optics




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                          Duke Elder Prize Examination May 2009


Extended matching questions are multiple choice items organised 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.   Three item stems


                               Example Questions


1. Options –Theme/ Topic

   A. Acute angle closure glaucoma
   B. Age-related macular degeneration
   C. Anterior ischemic optic neuropathy
   D. Cataract
   E. Central retinal artery occlusion
   F. Optic neurtis
   G. Papiloedema
   H. Retinal detachment
   I. Retinal vein occlusion
   J. Vitreous haemorrhage

Lead in: For each patient with loss of vision select the most likely diagnosis.

Stems:

1. An 80- year old Caucasian woman complains of recent problems with
reading vision, specifically words appearing distorted and blank patches
being present.                 Ans B

2. A 32- year old female patient experiencing weakness and numbness in her
left arm gives a three day history of increasing loss of vision in her right eye
and pain on moving the eye Ans F

3. A 54-year-old man complains of headaches that are made worse by
coughing. They appear to be increasing in frequency. He admits to
occasionally losing vision but only for a few seconds at a time. His visual
acuities are normal.          Ans G



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                         Duke Elder Prize Examination May 2009


2. Options

   A. Bitemporal hemainopia
   B. Fifth cranial nerve palsy
   C. Fourth cranial nerve palsy
   D. Homonymous hemianopia
   E. Miosed pupil
   F. Optic atrophy
   G. Relative afferent papillary
   H. Seventh cranial nerve palsy
   I. Sixth cranial nerve palsy
   J. Third cranial nerve palsy

Lead in: Select the most appropriate option that would fit with the clinical
scenario.

Stems:

1. A 68-year-old hypertensive man with poorly controlled diabetes (Type 2)
presents with sudden onset horizontal diplopia.     Ans I

2. A fit 48-year-old woman complains of a very severe headache and droopy
left upper lid she gets double vision when she lifts up her eyelid.
                                     Ans J

3. An 82-year-old hypertensive woman collapses at home. In casualty she is
found to have a right hemiparesis, an up-going planter reflex and is
dysphasic.                         Ans D




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                         Duke Elder Prize Examination May 2009
3. Options

  A. Aciclovir ointment
  B. Antibiotic drops
  C. Beta-blocker drops
  D. Corticosteroids drops
  E. Intravenous antibiotic
  F. Oral acetazolamide
  G. Oral acyclovir
  H. Oral corticosteroids
  I. Oral cyclosporin
  J. Prostaglandin drops

Lead in: Select the most appropriate therapy for the clinical scenario.

Stems:

1. A 55-year-old man has intra-ocular pressures of 32mmHg in each eye. His
optic discs are pathologically cupped. He is using a salbutamol inhaler for his
asthma.                            Ans J

2. A 73-year-old woman develops a painful rash on the right side of her
forehead. Her right eye is closed because of associated lid oedema. She
feels generally unwell.            Ans G

A 32-year-old gardener develops a red eye with a purulent discharge. After
two days it spreads to the other eye. His young daughter has a similar
problem.                           Ans B




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                         Duke Elder Prize Examination May 2009
4. Options

  A. Amblyopia
  B. Astigmatism
  C. Congenital cataract
  D. Congenital glaucoma
  E. Hypermetropia
  F. Myopia
  G. Optic disc hypoplasia
  H. Optic neuritis
  I. Retinoblastoma
  J. Retinopathy of prematurity

Lead in: What is the most likely cause of the poor vision?

Stems:

1. A six-week-old baby is noted to have wobbly eyes and poor vision. On
examination neither eye has a red reflex. There is a family history of eye
disease.                     Ans C

2. A ten-year-old boy with past history of squint surgery is found to have poor
vision in his left eye that cannot be improved with glasses.
                                Ans A

3. A three-year-old girl is found to have reduced vision in both eyes. Her
vision improves with glasses with convex lenses.
                                Ans E




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                         Duke Elder Prize Examination May 2009
5. Options

   A. Anterior ischaemic optic neuropathy
   B. Background diabetic retinopathy
   C. Cataract
   D. Central retinal artery occlusion
   E. Diabetic maculopathy
   F. Neovascular glaucoma
   G. Optic neuritis
   H. Proliferative diabetic retinopathy
   I. Retinal detachment
   J. Vitreous haemorrhage

Lead in: Select the most appropriate option that would fit with the clinical
scenario.

Stems:

1. A 46-year-old diabetic (Type 1) of 25 years duration and incipient renal
failure presents with red, painful, blind right eye.
                                      Ans F

2. A 42-year-old diabetic (Type 1) male complains of a sudden onset of
floaters in his right eye. They gradually settle after one month.
                                     Ans J

3. A 46-year-old woman with Type 1 Diabetes has noticed gradually
deteriorating vision in both eyes for 12 months. She is also troubled by glare,
when driving her car at night.       Ans C




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                                 Duke Elder Prize Examination May 2009


                                        Name: Mr J Smith
                                         Number: 12345
                           THE ROYAL COLLEGE OF OPHTHALMOLOGISTS
                            DUKE ELDER PRIZE EXAMINATION MAY 2009

Instructions to candidates taking Extended Matching Question
papers
1)      CANDIDATES MUST USE THE PENCIL PROVIDED ON THE DESK TO
        COMPLETE EMQ ANSWER SHEETS. BIROS AND PENS MUST NOT BE USED.

2)      Candidates must PRINT their names on the EMQ Answer Sheet and fill in the box headed
        Candidate Number.

The Royal College of Ophthalmologists
                                                        Candidate Number
 Last Name          Smith                           1   =1= =2= =3= =4= =5=
 Other Names        John                            2   =1= =2= =3= =4= =5=
 Examination        Duke Elder Prize                3   =1= =2= =3= =4= =5=
                                                    4   =1= =2= =3= =4= =5=
                                                    5   =1= =2= =3= =4= =5=

     3) Candidates must decide which item is correct and mark the Answer Sheet BOLDLY with the
        pencil provided by filling in the appropriate response for each item.

        e.g. If you think the answer to question 1 is E then complete the mark sheet as follows:
1.
                  =A= =B= =C= =D= =E= =F= =G= =H= =I= =J=

        ONLY ONE BOX SHOULD BE FILLED IN FOR EACH ITEM.

4)      CANDIDATES SHOULD MARK THEIR ANSWERS CLEARLY.

5)      THE FOLLOWING SYSTEM OF MARKING WILL APPLY:

        1 CORRECT
        0 INCORRECT

6)      Candidates may change their selection by erasing them completely with the rubber provided and
        may then make an alternative selection.

7)      Candidates are advised to go right through the paper, answering what questions they can, and then
        return to the other questions. PLEASE MAKE SURE YOU LEAVE ENOUGH TIME TO TRANSFER
        YOUR ANSWERS TO THE ANSWER SHEET.

8)      CANDIDATES SHOULD REMAIN IN THEIR PLACES AT THE END OF THE EXAMINATION until
        their Question Papers, Answer Sheets, pencils and rubbers have been collected by an Invigilator.

        EMQ PAPERS, CANDIDATE NAME CARDS, TIMETABLES AND INSTRUCTIONS ON THE
        COMPLETION OF EMQ PAPERS MUST NOT BE REMOVED FROM THE EXAMINATION HALL.
        IF ANY OF THESE GO MISSING, THE CANDIDATE CAN BE IDENTIFIED AND THE MATTER
        WILL BE REFERRED TO THE COLLEGE COUNCIL.

        TIME ALLOWED FOR EACH EXAMINATION: 1½ HOURS




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