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100+ Free FRCOphth Part 2 Written Practice Questions

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A 67-year-old with type 2 diabetes has reduced vision and OCT shows increased central retinal thickness with intraretinal cysts involving the fovea. According to UK practice, what is the first-line treatment for centre-involving diabetic macular oedema with significant thickening?

A
B
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D
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Sample FRCOphth Part 2 Written Practice Questions

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

1A 32-year-old contact lens wearer presents with a painful red eye, a 2 mm central corneal infiltrate with an overlying epithelial defect, and a hypopyon. What is the single most appropriate initial management?
A.Start topical aciclovir ointment five times daily
B.Corneal scrape for microscopy and culture, then start intensive topical fluoroquinolone monotherapy
C.Prescribe topical dexamethasone to reduce inflammation
D.Patch the eye and review in 48 hours
Explanation: A central infiltrate with epithelial defect and hypopyon in a contact lens wearer is presumed bacterial keratitis. Standard UK practice is to scrape for microscopy and culture before starting intensive topical fluoroquinolone monotherapy, which has efficacy comparable to fortified antibiotics for most cases.
2A 24-year-old man has progressive blurred vision. Slit-lamp examination shows central corneal thinning with a Fleischer ring and Vogt's striae, and topography demonstrates inferior steepening with skewed radial axes. Which intervention is most likely to halt disease progression?
A.Rigid gas-permeable contact lens fitting
B.Penetrating keratoplasty
C.Corneal collagen cross-linking with riboflavin and UVA
D.Topical ciclosporin 0.05%
Explanation: The findings describe keratoconus. Corneal collagen cross-linking stiffens the stroma by inducing collagen cross-links and is the only intervention shown to halt progression of the ectasia, ideally performed while corneas are >400 microns thick.
3A 70-year-old develops gradually worsening vision after uneventful cataract surgery 8 years earlier. Examination shows corneal stromal oedema, guttae on the endothelium, and microcystic epithelial oedema worse in the morning. What is the most likely diagnosis?
A.Map-dot-fingerprint dystrophy
B.Posterior polymorphous corneal dystrophy
C.Lattice corneal dystrophy
D.Fuchs endothelial corneal dystrophy
Explanation: Guttae with progressive stromal and epithelial oedema, worse on waking due to overnight reduced evaporation, are characteristic of Fuchs endothelial corneal dystrophy. Endothelial cell loss from prior surgery accelerates decompensation.
4A 45-year-old farmer presents 5 days after a corneal injury with a thorn. There is a feathery-edged stromal infiltrate with satellite lesions and minimal hypopyon. Gram stain shows septate hyphae. Which topical antifungal is the most appropriate first-line agent?
A.Natamycin 5%
B.Chloramphenicol 0.5%
C.Ganciclovir 0.15%
D.Cefuroxime 5%
Explanation: Feathery infiltrates with satellite lesions after vegetable matter trauma and septate hyphae indicate filamentous fungal keratitis. Topical natamycin 5% is the first-line agent of choice, particularly for Fusarium, supported by the MUTT trial.
5A patient with recurrent unilateral corneal stromal inflammation has reduced corneal sensation, ghost vessels, and a history of childhood interstitial keratitis. Which investigation is most likely to identify the underlying cause?
A.HLA-B27 typing
B.Treponemal serology
C.Serum ACE level
D.Anti-CCP antibodies
Explanation: Bilateral or unilateral interstitial keratitis with ghost vessels and reduced sensation is classically caused by congenital syphilis. Treponemal serology (e.g. TPPA) is the key investigation to confirm the diagnosis.
6A 58-year-old with rheumatoid arthritis presents with a painful red eye, a crescentic peripheral corneal ulcer with stromal thinning and an inflamed adjacent limbus. What is the most appropriate management?
A.Topical aciclovir and oral valaciclovir
B.Topical steroid monotherapy
C.Systemic immunosuppression with corticosteroids and a steroid-sparing agent, with rheumatology referral
D.Bandage contact lens alone
Explanation: Peripheral ulcerative keratitis in rheumatoid arthritis reflects systemic vasculitis and signals a risk to life as well as sight. Systemic immunosuppression with steroids plus a steroid-sparing agent, alongside rheumatology input, is essential; topical therapy alone is inadequate.
7A contact lens wearer has severe pain disproportionate to signs, perineural infiltrates, and a ring-shaped stromal infiltrate. Confocal microscopy shows double-walled cysts. Which is the most appropriate treatment?
A.Oral doxycycline
B.Topical natamycin 5%
C.Intravenous aciclovir
D.Topical biguanide (polyhexamethylene biguanide) with a diamidine
Explanation: Pain out of proportion to signs, perineural infiltrates, a ring infiltrate, and double-walled cysts on confocal microscopy indicate Acanthamoeba keratitis. Treatment is with topical biguanides (PHMB) combined with a diamidine such as propamidine or hexamidine.
8Which corneal graft technique is most appropriate for a patient with Fuchs endothelial dystrophy and otherwise clear stroma?
A.Descemet membrane endothelial keratoplasty (DMEK)
B.Penetrating keratoplasty (PK)
C.Deep anterior lamellar keratoplasty (DALK)
D.Anterior lamellar keratoplasty (ALK)
Explanation: Fuchs dystrophy is an endothelial disease with healthy stroma, so selective endothelial replacement is preferred. DMEK replaces only Descemet membrane and endothelium, giving faster visual recovery and lower rejection rates than PK or DSEK.
9A 20-year-old with atopy has bilateral itchy eyes, large cobblestone papillae on the upper tarsal conjunctiva, limbal Horner-Trantas dots, and a shield ulcer. What is the diagnosis?
A.Giant papillary conjunctivitis
B.Vernal keratoconjunctivitis
C.Atopic keratoconjunctivitis
D.Acute allergic conjunctivitis
Explanation: Giant cobblestone papillae, Horner-Trantas dots and a shield ulcer in a young atopic patient are hallmarks of vernal keratoconjunctivitis. It is typically seasonal and affects children and young adults.
10A patient is listed for cataract surgery. According to UK practice, intracameral injection of which antibiotic at the end of surgery is recommended to reduce the risk of postoperative endophthalmitis?
A.Vancomycin
B.Gentamicin
C.Cefuroxime
D.Ceftazidime
Explanation: The ESCRS study and UK guidance support intracameral cefuroxime 1 mg in 0.1 mL at the conclusion of cataract surgery to reduce the incidence of postoperative endophthalmitis. It is the licensed preparation (Aprokam) in the UK.

About the FRCOphth Part 2 Written Exam

The Part 2 Written FRCOphth is a single-best-answer examination of 180 questions across two 90-question papers, taken to around ST6 level. It is blueprinted on the entire Ophthalmic Specialist Training curriculum and, with the Part 2 Oral, forms the synoptic exit examination for Fellowship.

Assessment

Two single-best-answer MCQ papers of 90 questions each (180 total), sat on the same day, blueprinted across the full Ophthalmic Specialist Training curriculum.

Time Limit

Two papers of 2 hours each (120 minutes per paper), with a break between papers.

Passing Score

Pass mark set in advance using the Ebel method; candidates must reach the pass mark plus one standard error of measurement (no fixed percentage).

Exam Fee

£725 (2026 RCOphth fee for the Part 2 Fellowship Written examination). (Royal College of Ophthalmologists (RCOphth))

FRCOphth Part 2 Written Exam Content Outline

9%

Cornea and external eye disease

Microbial, immune and dystrophic corneal disease, ocular surface disorders and keratoplasty decision-making.

7%

Cataract and lens

Cataract assessment, biometry and IOL choice, phacoemulsification and management of intraoperative complications.

9%

Glaucoma

Open-angle and angle-closure glaucoma, NICE-guided care, perimetry interpretation, laser and surgical management.

13%

Medical retina

Diabetic eye disease, AMD, retinal vascular occlusions, inherited retinal disease and intravitreal therapy.

6%

Vitreoretinal and surgical retina

Retinal detachment, macular surgery, vitrectomy, tamponade agents and retinopathy of prematurity.

7%

Uveitis and ocular inflammation

Infectious and non-infectious uveitis, scleritis, systemic associations and immunosuppression.

11%

Neuro-ophthalmology

Optic neuropathies, visual pathway and pupil disorders, cranial nerve palsies and neuro-imaging.

11%

Paediatric ophthalmology and strabismus

Amblyopia, strabismus surgery, congenital ocular disease and phakomatoses.

8%

Oculoplastics, orbit and lacrimal

Eyelid malpositions and tumours, thyroid eye disease, orbital and lacrimal disorders.

5%

Optics and refraction

Clinical and physical optics, refractive error and surgery, and ophthalmic instrumentation.

4%

Ocular oncology and pathology

Intraocular and surface tumours, histopathology and systemic malignancy in the eye.

5%

General medicine and pharmacology

Systemic disease, ocular drug toxicity, trauma and patient safety.

5%

Evidence-based medicine, statistics and ethics

Study design, statistics, screening, consent and medico-legal standards.

How to Pass the FRCOphth Part 2 Written Exam

What You Need to Know

  • Passing score: Pass mark set in advance using the Ebel method; candidates must reach the pass mark plus one standard error of measurement (no fixed percentage).
  • Assessment: Two single-best-answer MCQ papers of 90 questions each (180 total), sat on the same day, blueprinted across the full Ophthalmic Specialist Training curriculum.
  • Time limit: Two papers of 2 hours each (120 minutes per paper), with a break between papers.
  • Exam fee: £725 (2026 RCOphth fee for the Part 2 Fellowship Written examination).

Keys to Passing

  • Complete 500+ practice questions
  • Score 80%+ consistently before scheduling
  • Focus on highest-weighted sections
  • Use our AI tutor for tough concepts

FRCOphth Part 2 Written Study Tips from Top Performers

1Work systematically through every subspecialty in the OST curriculum, prioritising the higher-weighted areas of medical retina, neuro-ophthalmology, glaucoma and paediatrics/strabismus.
2Anchor management answers to current UK guidance (NICE, RCOphth and the diabetic eye screening grading) rather than international practice, since the exam reflects UK standards.
3Practise single-best-answer reasoning under timed conditions to build the pace needed for 90 questions in two hours, and review why each distractor is wrong, not just the correct answer.

Frequently Asked Questions

How many questions are on the FRCOphth Part 2 Written exam?

The examination consists of 180 single-best-answer multiple-choice questions delivered as two papers of 90 questions, each lasting two hours and sat on the same day.

What is the pass mark for the Part 2 Written FRCOphth?

There is no fixed percentage. The pass mark is set in advance using the Ebel standard-setting method, and candidates must achieve the pass mark plus one standard error of measurement.

How much does the Part 2 Written FRCOphth cost in 2026?

The 2026 RCOphth fee for the Part 2 Fellowship Written examination is £725. Candidates are allowed a maximum of four attempts.

Who can sit the Part 2 Written FRCOphth and when is it held?

Candidates must first pass Part 1 FRCOphth and the Refraction Certificate. It is aimed at trainees in years 4 to 7 of Ophthalmic Specialist Training and is held twice yearly, in June and late November or December.