ico inst bk basic sc text-cvr 2014

7/25/2019 ICO Inst Bk Basic Sc Text-cvr 2014

1/20

International Examinations

TheInternationalCouncilo

fOphthalmology

ExaminationsforO

phthalmolo

gists

Basic Science

Instructions for Candidates


2/20


3/20

Introduction

The International Council of Ophthalmology is the executive body of the InternationalFederation of Ophthalmological Societies. One of the objectives of the Council is to advanceophthalmic education. The International Basic Science Examination is part of that initiative.

Objectives of the International Basic Science Examination

The members of the International Council of Ophthalmology are of the opinion that everyophthalmologist, wherever they are working, are required to have a good knowledge of basicscience in order to understand the principles underlying their clinical practice.

Testing Knowledge:

The primary objective of the Examination is to discover whether a candidate has acquiredthe breadth and depth of knowledge necessary to understand the scientific basis of

ophthalmology. The aim is to achieve a uniformly high standard throughout the world.

Effect on Training Programmes:

The existence of an international examination provides the possibility for eye departmentswith residents in training, or for the candidates themselves, to assess their performance inrelation to a universal standard.

Effect on Promotion:

Heads of eye departments throughout the world have great difficulty in deciding on thelevel of competence and knowledge of a particular candidate applying for training in

ophthalmology, or in promotion from one post to another. The acquisition of thisqualification will indicate the level of theoretical knowledge of the candidate in relationshipto an international standard. This can be of particular importance if a candidate is movingfrom one country to another to undertake further training.

Relationships to other Diplomas:

The International Basic Science Examination is intended to complement but not to replaceexisting examinations in basic science. However, certain countries and examining bodieshave accepted this Examination as equivalent to the basic science part of their examinations.Candidates should check with their own ophthalmological society or examining body to

ascertain the status of the Examination in their own country.

Structure of the Examination

The Basic Science Examination is aimed at doctors in training who wish to becomeophthalmologists. The Examination will be directed by the Examiners appointed by theExamination Committee of the International Council of Ophthalmology. At present theoffices of this Committee are in London, England.

1


4/20

a) The Examination shall be held annually in April. At present it is conducted inChinese, English, French, Portuguese and Spanish.Other languages will be considered if there are sufficient numbers of candidates to

justify the additional translation of the questions. The Examination will normallybe held in the candidates own country.

b) The Basic Science Examination will consist of 80 multiple-choice questions (MCQ)over a 2 hour period. Examples of the method used for these questions and theinstructions can be found on pages 1516.

c) The candidates will enter their answers on the Answer Paper which will becomputer marked. A positive mark will be awarded for each correct answer. Nomark is given to those questions marked incorrectly or left blank. Thecomputerised results are then analysed by the Examiners.

d) Questions will be asked from all or some of the following:

Basic Science subjects related to Ophthalmology

Part 1 i) Anatomy of the Eye, the Orbit and related structuresii) Embryologyiii) Neuro-Anatomyiv) Principles of General Physiologyv) Vision, Ocular Physiology and Biochemistryvi) Pharmacologyvii) Epidemiology and Statisticsviii) Geneticsix) Pathology including Micro-biology

A syllabus will be found on pages 514 of this booklet.

The MCQ papers are not available to candidates after the examination.

e) Basic Science:the candidates will be informed if they have failed, passed, passedwith merit or, exceptionally, passed with distinction.The marks for each section will be given to each candidate to enable themto assess their strengths and weaknesses.

f) To aid the Examiners and to ensure the quality of the questions, the answers toeach part of each question are also analysed. This information is used to identifythe core knowledge questions and those which can compare different groups ofcandidates in different years. This information is used to determine the pass mark,

which ensures that the results of the Examination are comparable from year toyear.

g) Visual Acuities will be given in LogMAR with, in brackets, the metric Snellen, theimperial Snellen and the decimal notations. For example, Visual acuity wasLogMAR 0.48 (6/6, 20/60, 0.33).

h) Answering all the questions accurately is the best way of obtaining a pass gradebut because accuracy of answers is very important and takes time it is stillpossible to pass the examination without completing all the questions.

i) The question bank is large and questions are not repeated from year toyear. Candidates are warned that, although good for practice, using books ofquestions and answers may be misleading.

2


5/20

Certificates

A candidate will be given a signed certificate indicating whether she/he has

a) passed the Basic Sciencepassed with distinction

passed with merit

Unless candidates have passed the complete Basic Science Examination (or been grantedexemption from it) they cannot normally proceed to the Clinical Sciences Examination. Inorder not to delay their training, candidates may re-take the Basic Science and/or TheoreticalClinical Optics and Refraction at the same time as taking the Clinical Sciences Examination.However under these circumstances certificates will only be issued if all sections are passed.

Examination regulations

1. The structure of the examination is described on pages 1 and 2.

2. The certificate will be presented to those who have achieved the appropriate levelin the Examination and who have complied with the regulations.

3. The fees and dates of the Examination are obtainable from the:

Examination Office,International Council of Ophthalmology,Unit 2, Forest Industrial Park, Redbridge, London IG6 3HLE-mail: [email protected]

to whom all enquiries should be addressed.

4. Application forms must reach the Examination Office before the closing date

24th January.Applications received after the closing date will not be processed.

5. The appropriate fee must be paid and cleared before the closing date.

6. Applications for admission to the Examination must be accompanied by aphotocopy of the candidates medical qualification and certificate of registration,together with a small passport-size photograph. (No certificates are requiredfor 2nd and subsequent entries.)

7. Candidates wishing to withdraw their applications must do soin writing. Forwithdrawals received before 24th January a refund will be given, but there will

be a 30% deduction to cover administrative charges. No fee refund will be givento candidates wishing to withdraw after the closing date for applications 24th

January.

8. A candidate withdrawing an application on or after the closing date forapplications - as shown in the Examination Calendar - or who fails to appear forthe Examination for which his entry fee has been accepted,will not be entitled toany refund or transfer of the fee.

9. A candidate who may desire to make representations with regard to the conduct oftheir Examination must address them to the Examination Executive and not,in any circumstance, to an Examiner.

3


6/20

10. The Examination Committee may refuse to admit to an Examination, or to proceedwith the Examination of any candidate who infringes any of the regulations, orwho is considered by the Examiners to be guilty of behaviour prejudicial to theproper management and conduct of the Examination.

11. Candidates may be admitted to the International Basic Science Examination for

Ophthalmologists provided they possess a medical qualification acceptable in thecountry in which the Examination is taken.

12. The above conditions may be modified at the discretion of the ExaminationCommittee.

13. If a candidate is determined by the Examinations Committee to have cheated inthe examination, he or she will not have their answer sheet marked and they will

be determined as having failed the examination. She/he will not be allowed to re-sit the examination for a period of 1 to 5 years and they may be reported to theirlocal Ophthalmological Society and/or Ministry of Health.

On the day of the Examinations candidates must provide their own HB pencils, a sharpener anderasers. The answer papers cannot be marked with a pen or biro. Only HB pencils may be used.

4


7/20

Guide to Candidates

CURRICULUMThe ICO Curriculum is published in Klinische Monatsbltter fr Augenheilkunde

November 2006, pages S1S48. It was drawn up by a task force under the leadership of

Professors M.F.Goldberg, A.G.Lee and M.O.M.Tso

SYLLABUSfor the Basic Science Examination

A syllabus is indicative of the areas of knowledge expected of candidates. The syllabus is,

however, not intended to be exhaustive or to exclude other items of knowledge which are

of similar relevance. Questions will be based on the main sections below.

BASIC SCIENCE EXAMINATION

Anatomy of the eye, orbit and related structuresA Orbit

1. Sinuses2. Bones comprising the orbital walls3. Orbital foramina, ducts, canals, and fissures

B Eyelids1. Anatomy, histology and innervation

a. Skinb. Orbicularis musclec. Orbital septum

d. Levator muscle, Mllers musclee. Tarsusf. Conjunctivag. Plica semilunaris and caruncle

2. Vascular supply

C Lacrimal Gland1. Anatomy and histology2. Function3. Innervation4. Vascular supply

5. Accessory glands6. Lacrimal excretory system anatomy and histology

D Globe1 Changes with age2. Blood supply3. Vortex veins

E Conjunctiva and Tenons Capsule1. Histology2. Zones3. Vascular supply

5


8/20

F Tear Film1. Structure2. Function

G Cornea1. Topography

2. Histology3. Composition

H Sclera

I Anterior Chamber1. Angle structures2. Aqueous pathway3. Relation to the limbus4. Outflow structures5. Clinical anatomy - gonioscopy

J Lens and Zonules1. Size and change with age2. Histology

K Extraocular Muscles1. Origin2. Insertion3. Blood supply4. Two types of muscle fibres

L Uvea1. Attachments to the sclera2. Iris

a. Vascular supplyb. Innervation

3. Ciliary bodya. Function

b. Blood supply4. Choroid

a. Ultrastructure of the vascular systemb. Ultrastructure of the Bruchs membranec. Function

M Retina1. Retinal pigment epithelium

a. Ultrastructureb. Function

2. Neurosensory retinaa. Ultrastructure

b. Regional differencesc. Vascular supplyd. Maculae. Ora serrata

6


9/20

N Vitreous1. Composition2. Attachments

Embryology

A Ocular Development1. Chronological sequence of events in the formation of the eye2. Neuroectoderm - differentiation3. Surface ectoderm - differentiation

a. Lidsb. Lens

4. Neural crest cells - differentiationa. Uvea

b. Corneac. Chamber angle

5. Vascular system

Neuro Anatomy

A Optic Nerve including the Nerve Head or Papilla1. Anatomy2. Blood Supply3. Arrangement of Neuro fibres and their connections4. Pia, Dura and Arachnoid sheaths

B Optic chaism1. Anatomy and relationships2. Arrangement of fibers3. Blood supply

C Optic Tracts1. Anatomy

D Lateral Geniculate Body1. Anatomy and connections

E Optic Radiations1. Anatomy and connections

F Optic Cerebral Cortex1. Anatomy and connections

G Cranial Nerves1. Olfactory nerve

a. Central and peripheral courseb. Function

2. Optic Nervea. Central and peripheral course

b. Blood supply of different topographical areasc. Meningeal sheaths

7


10/20

3. Oculomotor nervea. Nuclear anatomy

b. Anatomical central and peripheral anatomical coursec. Function

4. Trochlear nerve

a. Anatomical central and peripheral courseb. Function5. Trigeminal nerve

a. Nuclear complexb. Anatomical central and peripheral coursec. Function

6. Abducens nervea. Anatomical central and peripheral course

b. Function7. Facial nerve

a. Anatomical and peripheral course

b. FunctionH Parasympathetic Ganglia

1. Composition2. Synapses3. Function

I Other visual pathways1. Mid brain2. Cerebellum3. Frontal cortex

Principles of General PhysiologyA Cell Structure and Function

1. Homeostasis and characteristics of control systemsa. Nervous

b. Hormonal2. Body fluids

a. Volumeb. Osmolarityc. Electrolyte (including H+) concentrations

3. Cells, cell membranes and intracellular structure4. Extracellular matrix5. Excitable tissues

a. Membrane potentialb. Generator potentialc. Action potentiald. Nerve conductione. Synapsef. Motor end-plateg. Muscle

6. Blooda. Plasma composition and functions

b. Immune mechanisms

8


11/20


12/20

A Colour vision1. Colour discrimination2. Luminosity3. Spectral sensitivity4. Colour detection

5. Colour blindnessB Electrophysiology

1. Photoinduction2. Single cell potential3. Retinal connections4. Neurotransmitters5. Electroretinogram6. Electroculogram7. Visually evoked potential8. Receptive fields9. Receptor/neural cell responses

10. Ganglion cell responses

C Binocular vision1. Stereopsis and Depth perception2. The horopter3. Image disparity4. Retinal rivalry

D Visual System1. Magnocellular pathways2. Parvocellular pathways3. Pre Striate and Striate cortical pathways and processing4. Control of Ocular Movements5. Mid brain control6. Cerebellar function

Ocular Physiology, Biochemistry and Cell Biology

A General1. Oxidative metabolism and ATP production2. Glucose metabolism and tissue Glycation3. Oxidation and reduction4. Free radical production

5. Lipid metabolismB Tear film

1. Constitution2. Production3. Control

C Conjunctiva1. Physiological characteristics

10


13/20

D Cornea and sclera1. Corneal transparency2. Metabolism3. Wound healing4. Fluid transport

E Uveal Tract1. Blood supply2. Function of the iris, ciliary body, choroid and its components3. Blood aqueous barrier4. Metabolism including eicosanoids, detoxification and antioxidation5. The outflow system6. Control of aqueous secretion

F Lens1. Lens transparency2. Transmission and structural properties

3. Transport of nutrients4. Lens metabolism5. Age changes and free radical damage

G Vitreous1. Architectural properties2. Physico chemical properties3. Diffusion

H Retina1. Glucose metabolism2. Protein metabolism

3. Lipid metabolism4. Photochemical reactions5. Synaptic connections6. Dopamine reactions7. Blood flow8. Bloodretinal barrier9. Metabolism, restoration and renewal

10. Rhodopsin11. Photoreceptor proteins12. Mechanisms of damage

I Retinal Pigment Epithelium1. Functions of the RPE2. Transport in the RPE

Pharmacology

A Basic Principles1. Pharmacokinetics2. Pharmacodynamics

11


14/20

B Pharmacotherapeutics1. Cholinergic agents

a. Muscarinic agentsb. Nicotinic agents

2. Adrenegic agents

a. Alpha-adrenergicb. Beta-adrenergic(1) Agonists(2) Antagonists

3. Carbonic anhydrase inhibitors4. Osmotic agents5. Prostaglandins6. Anti-inflammatory agents

a. Glucocorticoidsb. Non-steroidal agentsc. Antihistamines

d. Antimetabolites7. Antibioticsa. Antibacterials

b. Antifungalsc. Antiviralsd. Therapy for endophthalmitis

8. Anaestheticsa. Local

b. General

Principles of Ophthalmic Epidemiology

1. Prevalence, Incidence and Distribution of Visual Impairment and Blindness2. Patterns of sight-threatening eye disease3. Epidemiological methodology4. Cross-sectional, case control and cohort studies5. Visual impairment and blindness in children6. Prevention strategies

Statistics

A basic understanding is required of:Arithmetic mean

MedianModeBimodal distributionStandard deviationConfidence intervalsp valuesAnalysis of variance, Students t test

Chi-squared (2 test)Mann-Whitney test

12


15/20

Relative riskRisk reductionOdds ratioCorrelation coefficientRegression

Survival analysisHazard ratioSensitivity, specificity, predictive valueIncidencePrevalence

Genetics

A Terminology1. Familial2. Hereditary3. Congenital

4. Genotype5. Phenotype6. Phenocopy

B Genes and Chromosomes1. DNA, RNA2. Codon3. Exon4. Intron5. Base Pairs

a. Adenine - thymine

b. Guanine - cytosine6. Transcription7. Translation8. Lyon hypothesis

a. Barr bodiesb. Random inactivation

9. Allelea. Homozygote

b. Heterozygote

C Patterns of Genetic Transmission1. Autosomal dominant

a. Penetranceb. Expressivityc. Pleiotropismd. Recurrence risk

2. Autosomal Recessivea. Heterozygotes

b. Recurrence risk(1) Gene frequency(2) Heterozygote frequency(3) Consanguinity

13


16/20

3. X-Linked Inheritancea. Hemizygous

b. Heterozygousc. Lyon hypothesis

4. Polygenic and Multifactorial Inheritance

General Principles of Pathology and Microbiology

A Inflammation/Immunologya. Humoral immunity

b. Cell mediated immunityc. Hypersensitivity

1. Types of inflammatory cellsa. Cytologic features

b. Function2. Patterns of inflammation

a. Acute

b. Chronic(1) Granulomatous(2) Nongranulomatous(3) Vasculitis

3. Causes of inflammationa. Infectious agents

(1) Staining properties, morphology(2) Reaction pattern - (acute, chronic, etc.)

b. Noninfectious(1) Trauma(2) Systemic conditions(3) Immune mediated

4. Sequelae of inflammation - repair

B Cell Growth1. Hyperplasia2. Metaplasia3. Dysplasia4. Neoplasia5. Apoptosis

C Microbiology1. General microbiology2. Cocci3. Bacilli4. Chlamydia5. General virology6. Herpes viruses7. Airborne and enteric viruses8. Hepatitis B, Hepatitis C and HIV9. Fungi

10. Protozoa11. Antimicrobial agents

14


17/20

Guidance on Multiple Choice Questions

1 Documents

On your desk you will find the following:

(a) An ANSWER PAPER (response sheet)(b) A QUESTION BOOK

2 DO NOT USE PEN OR BIRO -USE ONLY AN HB PENCILUse ahigh qualityeraser whichdoes not smudgeand bring 2 HB pencils, and a pencilsharpener to the examination.Do not fold or crease the Answer Paper.

3 Identification

Please check that theNameandCentreon your Answer Paper are correctbefore answering the questions.

Please fill in the stage of training on the Answer Paper.

Please check your name and number on the front cover of the question book.

4 Method of answering

There are 80 Multiple Choice Questions. The answer paper is numbered 180.All 80 questions are of the four options multiple-choice type with only one correctanswer. Each question has four statements. Stems a, b, c, and d.On the ANSWER PAPER there are corresponding boxes for each statement.IT IS ESSENTIAL THAT YOU MARK EACH ANSWER CLEARLY.

Specimen Question

Regarding the embryology of ocular tissues, which one of the following structuresis derived from ectoderm?

a) Corneal endothelium. ( )b) Eyelashes. ( )c) Levator palpebrae. ( )d) Tarsal plate. ( )

IMPORTANT

It is vital to use only a horizontal, clear line. If any line is other than horizontal, the

whole question will not be marked and will not score.You are advisedinitiallyto mark your answers in the QUESTION BOOK. Whenyou are satisfied with your answers, you MUST transfer them to the AnswerPaper. The transfer of the answers MUST be made within the period allotted forthe examination. Disqualification will occur if the candidate does not stop writingwhen instructed by the invigilator.

If you decide to change a response, careful rubbing out is essential beforeentering the new mark as smudge marks may be misread as a response.Should your ANSWER PAPER be spoilt a spare paper can be obtained from theinvigilator.

15


18/20

5 Markingeach itemis as follows:CORRECT: +1 Mark NO ANSWER / INCORRECT ANSWER 0 Mark

6 Confidentiality

THE QUESTION BOOK MUST NOT BE REMOVED NOR MAY ANY PARTS OFIT COPIED. IT WILL BE COLLECTED FROM YOU BY THE INVIGILATORS,TOGETHER WITH THE ANSWER PAPER.

16


19/20


20/20

TheInternationalCouncilo

fOphthalmology

ExaminationsforO

phthalmolo

gists

( )