Ophthalmology MCQs (25 Questions): Key Differences for MRCP Part 1

TL;DR

Ophthalmology questions in MRCP Part 1 are fewer in number but highly predictable, focusing on recognising classic presentations and distinguishing similar conditions. This article outlines the most tested differences, common traps, a sample MCQ with explanation, and a practical checklist to help you secure straightforward marks with efficient revision.

Why ophthalmology matters in MRCP Part 1

Many candidates under-prioritise ophthalmology, assuming it is a niche specialty. In reality, MRCP examiners favour integrated clinical medicine, and eye findings are frequently used to test neurology, endocrinology, rheumatology, and infectious disease knowledge.

According to the official MRCP(UK) syllabus, candidates are expected to recognise common ophthalmic presentations and their systemic associations rather than manage complex eye disease (MRCP(UK) Examination Syllabus).

Scope of ophthalmology in the exam

You should expect roughly 20–30 questions across the paper, often embedded in broader medical scenarios. Typical question stems focus on:

• Sudden or progressive visual loss

• Painful vs painless red eye

• Fundoscopic clues

• Eye signs of systemic disease

• Ophthalmic emergencies

The 5 most tested ophthalmology subtopics

1. Acute visual loss

A core discriminator is painful vs painless and arterial vs venous pathology. Central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO) are classic contrasts.

2. Red eye differentials

MRCP Part 1 frequently tests your ability to separate benign causes (conjunctivitis) from sight-threatening ones (acute angle-closure glaucoma, anterior uveitis).

3. Optic nerve disorders

Optic neuritis, papilloedema, and ischaemic optic neuropathy are examined using age, pain, and visual field patterns.

4. Glaucoma

Open-angle glaucoma is tested in screening and risk factors; angle-closure glaucoma is tested as an acute medical emergency.

5. Systemic disease and eye signs

Diabetes, hypertension, sarcoidosis, rheumatoid arthritis, and thyroid disease all have characteristic ophthalmic findings that are repeatedly examined.

High-yield differences you must know

1. CRAO vs CRVO

   • CRAO: sudden, profound, painless visual loss; pale retina with a cherry-red spot

   • CRVO: subacute loss; “blood and thunder” fundus with dilated veins

2. Optic neuritis vs ischaemic optic neuropathy

   • Optic neuritis: young adults, pain on eye movement, association with multiple sclerosis

   • Ischaemic: older patients, vascular risk factors, altitudinal field defects

3. Open-angle vs angle-closure glaucoma

   • Open-angle: chronic, asymptomatic, raised intraocular pressure

   • Angle-closure: painful red eye, haloes, headache, nausea, mid-dilated pupil

4. Conjunctivitis vs anterior uveitis

   • Conjunctivitis: discharge, normal vision

   • Uveitis: photophobia, reduced vision, small irregular pupil

5. Papilloedema vs optic disc swelling from neuritis

   • Papilloedema: bilateral disc swelling, vision initially preserved

   • Optic neuritis: early visual impairment

6. Background vs proliferative diabetic retinopathy

   • Background: microaneurysms, dot-blot haemorrhages

   • Proliferative: neovascularisation, vitreous haemorrhage

7. Scleritis vs episcleritis

   • Scleritis: severe pain, systemic autoimmune association

   • Episcleritis: mild discomfort, self-limiting

Quick comparison table (exam favourite)

Feature	CRAO	CRVO
Onset	Sudden	Subacute
Pain	None	None
Fundoscopy	Pale retina, cherry-red spot	“Blood and thunder”
Risk factors	Atherosclerosis, emboli	Hypertension, glaucoma

Mini-case MCQ

Question A 29-year-old woman presents with acute unilateral visual loss and pain on eye movement. Examination reveals reduced visual acuity and a swollen optic disc. Which association is most likely?

A. Temporal arteritisB. Diabetes mellitusC. Multiple sclerosisD. HypertensionE. Amyloidosis

Correct answer: C — Multiple sclerosis

Explanation This presentation is classic for optic neuritis: young age, painful eye movements, and acute visual loss. In MRCP Part 1, optic neuritis is strongly linked with multiple sclerosis, whereas temporal arteritis causes ischaemic optic neuropathy in older adults.

You can practise similar pattern-based questions in the Crack Medicine question bank:👉 https://crackmedicine.com/qbank/

Common traps candidates fall into

• Treating conjunctivitis and uveitis as interchangeable

• Missing acute angle-closure glaucoma as an emergency

• Assuming papilloedema causes early visual loss

• Ignoring systemic disease associations

• Over-focusing on rare retinal signs instead of classic patterns

Practical study-tip checklist

• Revise ophthalmology by symptom, not by anatomy

• Memorise 2–3 distinguishing features per condition

• Always link eye signs to systemic disease

• Use short, repeated MCQ sessions

• Confirm exam readiness with timed practice tests

Structured teaching sessions are available in the Crack Medicine lectures hub:👉 https://crackmedicine.com/lectures/

FAQs

How important is ophthalmology in MRCP Part 1?

It represents a small proportion of the paper, but questions are highly predictable and efficient to score with focused revision.

Do I need detailed fundoscopy knowledge?

No. The exam focuses on classic, recognisable patterns rather than subtle retinal pathology.

Are ophthalmology questions linked with other specialties?

Yes. Neurology, endocrinology, rheumatology, and infectious diseases are commonly integrated.

What is the best way to revise ophthalmology?

Symptom-based learning combined with repeated MCQs and mock tests is most effective.

Ready to start?

Consolidate these differences with timed practice from our MRCP Part 1 overview hub and reinforce weak areas using the question bank and mock tests.

Sources

• MRCP(UK) Examination Syllabus: https://www.mrcpuk.org/mrcpuk-examinations/examination-syllabus

• Oxford Handbook of Ophthalmology (Oxford University Press)

• Kumar & Clark’s Clinical Medicine