100+ Free FRCOphth Part 2 Oral Practice Questions

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Part 1 FRCOphth Examination

Practice Questions100 questions

Part 2 Written FRCOphth Examination

Practice Questions100 questions

Sample FRCOphth Part 2 Oral Practice Questions

Try these sample questions to test your FRCOphth Part 2 Oral exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 68-year-old presents 4 weeks after uneventful phacoemulsification with reduced vision, a hypopyon and worsening pain. OCT shows cystoid macular oedema and the anterior chamber is hazy. Which organism is the most likely cause of this delayed-onset, low-grade post-operative endophthalmitis?

A.Cutibacterium (Propionibacterium) acnes

B.Staphylococcus epidermidis

C.Pseudomonas aeruginosa

D.Streptococcus pneumoniae

Explanation: Cutibacterium acnes is the classic cause of chronic, delayed-onset (weeks to months) post-operative endophthalmitis, often sequestered in the capsular bag with a low-grade granulomatous picture and a characteristic white capsular plaque. It responds poorly to vitreous tap-and-inject alone, frequently requiring intracapsular vancomycin or capsulectomy.

2At an OSCE anterior-segment station you examine a patient with a central corneal ulcer, a 2 mm hypopyon and a feathery-edged infiltrate after wearing soft contact lenses in a hot tub. Which investigation is most important to establish the diagnosis before starting treatment?

A.Anterior segment OCT of the lesion

B.Corneal scrape for microscopy, culture and sensitivities

C.Confocal microscopy only

D.Serum inflammatory markers

Explanation: Microbial keratitis requires a corneal scrape for Gram stain, culture and sensitivities before commencing intensive topical antibiotics, as it guides targeted therapy and identifies organisms such as Acanthamoeba, fungi or resistant bacteria. In the UK, central or sight-threatening ulcers are scraped before empirical fortified or fluoroquinolone drops.

3A 24-year-old with progressive blurred vision has scissoring of the retinoscopy reflex, Fleischer ring, Vogt striae and inferior corneal steepening on topography. Both eyes show increasing astigmatism. What is the most appropriate intervention to halt progression at this stage?

A.Penetrating keratoplasty

B.Intrastromal corneal ring segments

C.Corneal collagen cross-linking

D.Rigid gas-permeable contact lenses only

Explanation: Corneal collagen cross-linking (CXL) with riboflavin and UV-A is the established intervention to halt progression of keratoconus by stiffening the corneal stroma, and is indicated in documented progressive disease in a young patient. NICE supports CXL for progressive keratoconus.

4During an OSCE station a patient describes severe ocular pain, photophobia and a small, irregular, painful pupil. Slit-lamp examination shows ciliary flush, anterior chamber cells and keratic precipitates. What is the first-line treatment to relieve symptoms and prevent posterior synechiae in acute anterior uveitis?

A.Topical antihistamine

B.Topical antibiotic drops

C.Systemic aciclovir

D.Topical corticosteroid plus a cycloplegic agent

Explanation: Acute anterior uveitis is treated with intensive topical corticosteroid to control inflammation and a cycloplegic/mydriatic (e.g. cyclopentolate) to relieve ciliary spasm pain and break or prevent posterior synechiae. Underlying systemic associations (e.g. HLA-B27) are sought if recurrent.

5You are shown a slit-lamp video of a cornea with a dendritic epithelial lesion that stains with fluorescein and has terminal end-bulbs. The patient has reduced corneal sensation. What is the most appropriate first-line management?

A.Topical aciclovir 3% ointment or ganciclovir gel

B.Topical corticosteroid monotherapy

C.Therapeutic bandage contact lens

D.Topical fortified gentamicin

Explanation: A true dendritic ulcer with terminal bulbs and reduced corneal sensation is herpes simplex epithelial keratitis, treated with topical antiviral such as aciclovir 3% ointment or ganciclovir 0.15% gel. Topical steroids alone are contraindicated as they worsen epithelial disease.

6A 30-year-old of African heritage has bilateral granulomatous anterior uveitis, mutton-fat keratic precipitates, raised serum ACE and bilateral hilar lymphadenopathy on chest imaging. Which complication should you specifically monitor for at the posterior pole?

A.Macular hole

B.Cystoid macular oedema

C.Lacquer cracks

D.Angioid streaks

Explanation: Sarcoid uveitis frequently causes cystoid macular oedema, a leading cause of vision loss in chronic uveitis, and OCT monitoring is essential. Other sarcoid posterior findings include periphlebitis (candle-wax drippings) and choroidal granulomas.

7A patient on long-term topical prostaglandin and beta-blocker therapy presents for cataract surgery. Intraoperatively the pupil dilates poorly and the iris billows and prolapses toward incisions despite no use of tamsulosin. Which preoperative drug history most likely explains intraoperative floppy iris syndrome?

A.A carbonic anhydrase inhibitor

B.A topical beta-blocker

C.An alpha-1 adrenergic antagonist

D.A prostaglandin analogue

Explanation: Intraoperative floppy iris syndrome (IFIS) is most strongly associated with systemic alpha-1 adrenergic antagonists such as tamsulosin, used for benign prostatic hyperplasia, which cause iris dilator atony. Even past use can produce IFIS, so a careful drug history is essential and strategies (iris hooks, intracameral phenylephrine) are planned.

8A patient develops acute corneal oedema and Descemet membrane folds two days after cataract surgery, with a clear cause traced to instrument or solution contamination. The graft-like central oedema spares the periphery. What is the most likely diagnosis of this sterile, non-infective post-operative reaction?

A.Fuchs endothelial dystrophy decompensation

B.Acute endophthalmitis

C.Herpes simplex endotheliitis

D.Toxic anterior segment syndrome

Explanation: Toxic anterior segment syndrome (TASS) is an acute sterile inflammation typically within 12-48 hours of anterior segment surgery, caused by contaminants in instruments, solutions or intraocular agents, producing diffuse limbus-to-limbus corneal oedema and anterior chamber reaction that responds to intensive topical steroids. The absence of pain disproportionate to signs and a negative culture distinguish it from endophthalmitis.

9A 55-year-old presents with a chronic, unilateral, red eye, scleral thinning with a bluish hue and severe boring pain that wakes them at night. There is no discharge. Which systemic association most warrants urgent investigation in necrotising scleritis?

A.Granulomatosis with polyangiitis

B.Hay fever

C.Hypertension

D.Type 2 diabetes mellitus

Explanation: Necrotising scleritis is strongly associated with systemic vasculitides, particularly granulomatosis with polyangiitis (ANCA-associated) and rheumatoid arthritis, which require urgent systemic immunosuppression. Investigation includes ANCA, ANA, RF and inflammatory markers because untreated disease threatens both sight and life.

10A contact-lens wearer has a painful red eye with a ring-shaped corneal infiltrate, radial perineuritis and pain markedly out of proportion to clinical signs, unresponsive to broad-spectrum antibiotics. Which diagnosis must be excluded?

A.Staphylococcal marginal keratitis

B.Acanthamoeba keratitis

C.Adenoviral keratoconjunctivitis

D.Exposure keratopathy

Explanation: Acanthamoeba keratitis classically affects contact-lens wearers with pain disproportionate to signs, radial perineural infiltrates and a ring infiltrate, and is confirmed by corneal scrape, confocal microscopy (double-walled cysts) or culture on non-nutrient agar with E. coli overlay. It is treated with biguanides (PHMB) and diamidines.

About the FRCOphth Part 2 Oral Exam

The Part 2 Oral FRCOphth is the final clinical component of the FRCOphth, taken after the Part 2 Written exam. It combines a 5-station OSCE (hybrid real-patient and video) plus a Communication Skills station with a 5-station Structured Viva, testing the depth of applied ophthalmic knowledge expected of an independent (consultant-level) ophthalmologist.

Assessment

Two components assessed by examiners: a hybrid real-patient and video OSCE (5 clinical stations plus a Communication Skills station) and a 5-station Structured Viva covering investigations, management, ethics and research.

Time Limit

Each Structured Viva station and the Communication Skills station last 10 minutes; OSCE clinical stations are timed precisely, with the assessment held across the examination day(s).

Passing Score

Standard set by the borderline candidate method (Hofstee for smaller overseas cohorts); candidates must pass both the OSCE and the Structured Viva, with limited cross-compensation within the standard error of measurement.

Exam Fee

GBP 1,395 in the UK (2026 RCOphth fee schedule); international centres are charged at higher rates. Verify the current fee on the RCOphth Exam Fees page. (Royal College of Ophthalmologists (RCOphth))

FRCOphth Part 2 Oral Exam Content Outline

11%

Anterior Segment

Cornea, ocular surface, lens, anterior uveitis, cataract surgery and its complications (OSCE Station 1).

12%

Glaucoma and Lid

Open- and closed-angle glaucoma, secondary and congenital glaucoma, eyelid malpositions, lid tumours and lacrimal disease (OSCE Station 2).

14%

Posterior Segment

Medical and surgical retina, AMD, diabetic eye disease, vascular occlusions, detachment, dystrophies and posterior uveitis (OSCE Station 3).

11%

Strabismus and Orbit

Paediatric and adult strabismus, amblyopia, thyroid eye disease, orbital trauma and tumours (OSCE Station 4).

12%

Neuro-ophthalmology

Optic nerve disease, pupil abnormalities, ocular motor palsies, visual fields and neurological emergencies (OSCE Station 5).

Communication Skills

Breaking bad news, consent, shared decision-making, interpreters and de-escalation, assessed with a lay examiner (OSCE Station 6).

Investigations and Data Interpretation

Visual fields, OCT, angiography, biometry, ultrasound, topography and electrophysiology (Viva Station 1).

12%

Patient Management

Applied management of medical and surgical ophthalmic conditions and emergencies (Viva Stations 2-3).

Attitudes, Ethics and Responsibilities

Consent, capacity, confidentiality, probity and GMC professional duties (Viva Station 4).

Audit, Research and Evidence-Based Practice

Audit cycle, critical appraisal, study design, statistics and health promotion (Viva Station 5).

How to Pass the FRCOphth Part 2 Oral Exam

What You Need to Know

Passing score: Standard set by the borderline candidate method (Hofstee for smaller overseas cohorts); candidates must pass both the OSCE and the Structured Viva, with limited cross-compensation within the standard error of measurement.
Assessment: Two components assessed by examiners: a hybrid real-patient and video OSCE (5 clinical stations plus a Communication Skills station) and a 5-station Structured Viva covering investigations, management, ethics and research.
Time limit: Each Structured Viva station and the Communication Skills station last 10 minutes; OSCE clinical stations are timed precisely, with the assessment held across the examination day(s).
Exam fee: GBP 1,395 in the UK (2026 RCOphth fee schedule); international centres are charged at higher rates. Verify the current fee on the RCOphth Exam Fees page.

Keys to Passing

Work through all 100 available questions
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FRCOphth Part 2 Oral Study Tips from Top Performers

1Practise structured, time-pressured answers out loud for 10-minute viva stations, justifying management decisions as an independent consultant rather than reciting lists.

2Drill data interpretation (visual fields, OCT, angiography, biometry, B-scan and topography) so you can describe findings and their clinical implications quickly and confidently.

3Rehearse communication and ethics scenarios (breaking bad news with SPIKES, consent, capacity, duty of candour, DVLA advice) since these are scored against patient-centred, GMC-aligned behaviours.

Frequently Asked Questions

What is the structure of the FRCOphth Part 2 Oral exam?

It has two components: a 5-station OSCE using a hybrid of real patients and videos plus a separate 10-minute Communication Skills station, and a 5-station Structured Viva in which each station lasts 10 minutes and is divided into four sections scored 1-3.

How is the FRCOphth Part 2 Oral exam marked and passed?

Pass marks are set using the borderline candidate method (Hofstee is preferred for smaller overseas cohorts). Candidates must pass both the OSCE and the Structured Viva, with only limited cross-compensation allowed within the standard error of measurement.

How many attempts are allowed and how often is the exam held?

Candidates are permitted a maximum of four attempts at the Part 2 Oral component. The exam is held multiple times a year at UK and international centres.

How much does the FRCOphth Part 2 Oral exam cost?

The UK fee is GBP 1,395 under the 2026 RCOphth fee schedule, with international centres charged at higher rates. Always confirm the current fee on the RCOphth Exam Fees page before booking.