Medical Quiz PDF

Which one of the following bacteria evade s phagocytosis in the absence of antibody and complement because of polysaccharide encapsulation? A. Staphylococcus aureus B. Staphylococcus epidermidis C. Streptococcus pneumoniae D. Pseudomonas aeruginosa ANSWER: C Which one of the following antibiotics is...

Which one of the following bacteria evade s phagocytosis in the absence of antibody and complement because of polysaccharide encapsulation? A. Staphylococcus aureus B. Staphylococcus epidermidis C. Streptococcus pneumoniae D. Pseudomonas aeruginosa ANSWER: C Which one of the following antibiotics is the treatment of choice for life-threatening Staphylococcus aureus systemic infection? A. Penicillin B. Vancomycin C. Gentamicin D. A cephalosporin ANSWER: B Which one of the following antibiotics is the treatment of choice for Streptococcus pyogenes infections (e.g., strep throat, impetigo)? A. Penicillin B. Vancomycin C. Gentamicin D. A cephalosporin ANSWER: A All except which one of the following is true about Lyme disease? A. It is tick-borne. B. Late manifestations are seen in the skin, joints, and nervous system. C - It is usually diagnosed by bacterial culturing. D. The organism is sensitive to tetracycline. ANSWER: C Which one of the following statements is NOT correct about herpes zoster? A. Primary infection usually occurs in childhood in the form of chickenpox (varicella). B. No systemic antiviral treatment exists at this time. C. Post-herpetic neuralgia may occur. D. Herpes zoster occurs after a reactivation of a latent nerve infection. ANSWER: B Health care workers exposed to HIV may be given immediate treatment with which one of the following medications? A. Zidovudine (Retrovir) B. Saquinavir (Invirase) C. Ganciclovir (Cytovene) D. HIV vaccine ANSWER: A β1-Adrenergic receptor site stimulation causes all except which one of the following? A. Vasoconstriction B. Tachycardia C. Increased myocardial contractility D. Bronchoconstriction ANSWER: D The annual mortality rate of patients with asymptomatic carotid bruit has been estimated at 4%. The most likely cause of death is which one of the following? 1 A. Non-hemorrhagic stroke B. Hemorrhagic stroke C. Subarachnoid hemorrhage D. Complications of heart disease ANSWER: D Which one of the following is most sensitive in distinguishing a myocardial infarction from unstable angina or non-cardiac chest pain? A. Elevation of the ST segment on the electrocardiogram B. Echocardiogram C. Elevated serum cardiac enzymes D. Depression of the ST segment on exercise stress testing ANSWER: C All but which one of the following may be indicated for the management of congestive heart failure? A. α-Adrenergic antagonists B. Digitalis C. The calcium channel blocker diltiazem (Cardizem) D. β-Adrenergic antagonists ANSWER: C Which one of the following does not increase serum high-density lipoprotein cholesterol (HDL-C)? A. Aerobic exercise B. Moderate alcohol consumption C. Gemfibrozil (Lopid) D. Lovastatin (Mevacor) ANSWER: D Hypercholesterolemia is a risk factor for all but which one of the following? A. Arteritic ischemic optic neuropathy B. Ischemic heart disease C. Cerebrovascular disease D. Peripheral vascular disease ANSWER: A Which one of the following is most indicative of restrictive pulmonary disease? A. Abnormal-appearing chest radiograph B. FEV1 less than 80% predicted C. Low PO2 in arterial blood gas D. Total lung capacity less than 70% predicted ANSWER: D Which one of the following is the best test to monitor heparin therapy? A. Prothrombin time (PT) B. Partial thromboplastin time (PTT) C. Bleeding time D. Platelet count ANSWER: B Which one of the following is not used to dissolve existing clots? A. Streptokinase B. Urokinase C. Heparin D. Tissue plasminogen activator 2 ANSWER: C Which one of the following statements is not correct about rheumatoid arthritis? A. It tends to affect the large joints. B. Approximately 80% of patients are positive for rheumatoid factor. C. Stiffness at rest often improves with use. D. Extra-articular disease may be found. ANSWER: A A 50-year-old white male presents with acute nongranulomatous anterior uveitis. He has had chronic back pain for years. Which one of the following does NOT fit with his clinical syndrome? A. Sacroiliitis on radiography B. Spinal ankylosis on radiography C. Positive HLA-DR4 D. Restrictive lung disease ANSWER: C Which one of the following is the most common ophthalmologic manifestation of systemic lupus erythematosus? A. Cranial nerve palsies B. Retinal vascular disease C. Cortical blindness D. Sjögren’s syndrome ANSWER: B Renal disease is associated with all but which one of the following diseases? A. Rheumatoid arthritis B. Scleroderma C. Polyarteritis nodosa D. Wegener granulomatosis ANSWER: A Which one of the following is most effective for treating Wegener granulomatosis? A. Aspirin B. Nonsteroidal anti-inflammatory agents C. Cyclophosphamide D. Methotrexate ANSWER: C The definitive test for giant cell arteritis is which one of the following? A. Wintrobe sedimentation rate B. Westergren sedimentation rate C. C-reactive protein D. Temporal artery biopsy ANSWER: D In addition to uveitis, with or without hypopyon, which one of the following is the most common ophthalmic manifestation of Behcet’s syndrome? A. Glaucoma B. Retinal vasculitis C. Corneal disease D. Eyelid ulcers ANSWER: B Nonsteroidal anti-inflammatory agents include all but which one of the following? A. Aspirin 3 B. Ibuprofen (Advil, Motrin) C. Cyclosporine D. Rofecoxib (Vioxx) ANSWER: C Type 2 diabetes is characterized by all but which one of the following? A. Genetic predisposition B. Low basal insulin secretion early in the disease C. Later age of onset than with type 1 diabetes D. Increased visceral fat ANSWER: B The Diabetes Control and Complications Trial showed a decreased risk of all but which one of the following? A. Hypoglycemia B. Development and progression of retinopathy C. Development and progression of nephropathy D. Development and progression of neuropathy ANSWER: A Which one of the following is not used to diagnose diabetes mellitus? A. Random blood glucose exceeding 200 mg/dL B. Glucose level exceeding 200 mg/dL during glucose tolerance test C. Glycosylated hemoglobin (HbA1c) D. Fasting serum glucose exceeding 126 mg/Dl ANSWER: C Which one of the following choices is preferred for a diabetic patient about to undergo major surgery? A. Light breakfast with full regular insulin dose in early AM B. Fasting with reduced insulin dose in AM C. Fasting, withhold insulin, and in preoperative area start a dextrose IV and give half of an insulin dose D. Switch from insulin to oral hypoglycemic agent preoperatively ANSWER: C The most sensitive and specific test(s) for screening for thyroid disease is which one of the following choices? A. T3 level B. Free T4 and sensitive TSH levels C. Radioactive iodine uptake D. Thyroid-binding globulin level ANSWER: B Which one of the following ocular structures is the most radiosensitive? A. Lens B. Cornea C. Retina D. Optic nerve ANSWER: A Cancer is predominantly a genetic disease. Which one of the following cancers may have a viral cause? A. Breast B. Colon C. Lung D. Cervical ANSWER: D Which one of the following statements is not correct about bipolar disorder, formerly known as 4 manic depression? A. It is the most common form of depression. B. There may be alternating periods of depression and elevated mood. C. It is treated with psychotherapy. D. It is treated with lithium. ANSWER: A Which one of the following best describes the patient who claims to be unable to work but has no organic basis for visual loss? A. Conversion disorder B. Hypochondriasis C. Factitious disorder D. Malingering ANSWER: D Fetal alcohol syndrome includes all but which one of the following? A. Blepharophimosis B. Cataract C. Telecanthus D. Optic nerve hypoplasia ANSWER: B The barbiturates have all but which one of the following effects? A. Sedative B. Hypnotic C. Antidepressive D. Anticonvulsive ANSWER: C Antidepressants include all but which one of the following? A. Lithium B. Monoamine oxidase inhibitors C. Fluoxetine (Prozac) D. Haloperidol (Haldol) ANSWER: D Parkinson disease is characterized by all but which one of the following? A. Increased rigidity B. Excess dopamine production C. Potential worsening of symptoms with neuroleptic drugs D. Loss of neurons in the substantia nigra ANSWER: B Alzheimer disease is characterized by all but which one of the following? A. Neurofibrillary tangles B. Progressive dementia in later life C. A toxic cause in most cases D. Extraneuronal amyloid plaques ANSWER: C Vaccines are currently available for all but which one of the following? A. Rabies B. Influenza types A and B C. Meningococcus 5 D. Haemophilus influenza ANSWER: A Which one of the following would argue against widespread screening for a disease? A. It is treatable or preventable. B. It has a low prevalence. C. It is generally asymptomatic. D. The cost of the disease and its complications is high. ANSWER: B Which one of the following is not a risk factor for breast cancer? A. Fibrocystic disease B. First-degree relative with breast cancer C. Early menarche D. Nulliparity ANSWER: A Routine childhood vaccinations include all but which one of the following? A. HiB B. Varivax C. HepB D. Influenza ANSWER: D Which one of the following should be immediately available during an edrophonium (Tensilon) test? A. Atropine sulfate B. Epinephrine C. Pyridostigmine (Mestinon) D. Propranolol ANSWER: A An anesthesiologist would avoid which one of the following in a patient with history of malignant hyperthermia? A. Thiopental sodium B. Nitrous oxide C. Midazolam (Versed) D. Succinylcholine ANSWER: D Which one of the following medications would be the most important for a preoperative patient to take the morning of surgery? A. Antihypertensive agent B. Digoxin C. Thyroid medication D. Estrogen supplements ANSWER: A Which one of the following studies would best demonstrate the incidence of a disease? A. Case series B. Case-control study C. Cohort study D. Randomized, prospective, controlled clinical trial ANSWER: C Advantages of interventional studies include all but which one of the following? A. Low cost 6 B. Low risk of bias C. Best way to establish efficacy of treatment D. Effective for establishing rates of complications of treatment ANSWER: A For populations with a normal distribution, the range of observations with a mean ±3 standard deviations would include what percentage of observations? A. 68.3% B. 95.5% C. 99.7% D. 100% ANSWER: C Which one of the following statistical tests would be best for studying the effects of gender, smoking, cholesterol levels, blood pressure, diabetes, and family history of heart disease on the incidence of heart attack? A. Student's t-test B. Chi-square test C. Analysis of variance D. Multivariable analysis ANSWER: D Which of the following conditions is most likely to be diagnosed of diabetes mellitus? A. Fasting plasma glucose of 110 mg/dL B. Random non-fasting plasma glucose of 130 mg/dL C. Random non-fasting HbA1C of 7.0% D. Two hours post-pandrial plasma glucose of 150 mg/dL E. Symptoms of polyuria for the past one month ANSWER: C Which one of the following is NOT a systemic feature of Acquired Immune Deficiency Syndrome (AIDS)? A. Cerebral hemorrhage B. Kaposi’s Sarcoma C. Pneumocystis carinii D. Encephalomyelitis E. Progressive dementia ANSWER: A Which of the following is the common ophthalmic manifestation of systemic lupus erythematosus (SLE)? A. Nodular scleritis B. Recurrent anterior uveitis with hypopyon C. Disciform keratitis D. Retinal and choroidal microvascular lesions E. Exophthalmos ANSWER: D Which of the following muscles does NOT originate from the annulus of Zinn? A. Medial rectus B. Lateral rectus C. Superior rectus D. Superior oblique E. Inferior rectus ANSWER: D Which of the following bony structures is NOT the part of medial wall of the orbit? 7 A. Lamina papyracea B. Frontal process of the maxilla C. Greater wing of the sphenoid D. Lacrimal bone E. Orbital plate of the ethmoid ANSWER: C The main mechanism for holding the LASIK flap in place after surgery is A. endothelial-Descemet’s membrane interaction B. adhesive property of the stromal collagen fibers C. adhesive property of the extracellular mucopolysaccharides D. endothelial pump E. fibronectin and hemidesmosomes of corneal epithelium ANSWER: D All of the following structures is derived from neural crest, EXCEPT: A. Corneal endothelium B. Connective tissue of iris C. Ciliary muscle D. Crystalline lens E. Ciliary ganglion ANSWER: D Patients with protanopia have abnormal function of which of the following cells? A. L-cones (570 nm) B. M-cones (540 nm) C. S-cones (440 nm) D. Amacrine cells E. Retinal pigment epithelium (RPE) ANSWER: A Which of the following pairs of ophthalmic drug and its mechanism of action is INCORRECT? A. Latanoprost – prostaglandin F2 receptor agonist B. Timolol – beta adrenergic agonist C. Acetazolamide – carbonic anhydrase inhibitor D. Gentamicin – binding the 30S subunit of bacterial ribosome E. Moxifloxacin – blocking bacterial DNA gyrase enzyme ANSWER: B All of the followings are side-effects of oral carbonic anhydrase inhibitors, EXCEPT A. Dry mouth B. Increased urination C. Weight loss D. Metabolic alkalosis E. Paresthesia ANSWER: D Which of the following is NOT the function of retinal pigment epithelium (RPE)? A. Maintain inner blood retinal barrier B. Phagocytosis of the photoreceptor outer segments C. Absorption of light (reduction of scatter) D. Vitamin A metabolism E. Adhesion of the sensory retina 8 ANSWER: A Mutations in the rhodopsin gene are associated with which inherited ocular disease? A. Juvenile glaucoma B. Leber optic neuropathy C. Retinitis pigmentosa D. Stargardt disease E. Optic nerve pit ANSWER: C Chronic progressive external ophthalmoplegia (CPEO) is a disease with the mode of transmission of A. Autosomal dominant B. Autosomal recessive C. X-link recessive D. X-link dominant E. Mitochondrial transmission ANSWER: E Which statement is true regard to the eyelids? A. The tarsal plate is a continuation of the orbital septum B. The meibomian glands secrete mucin rich secretion C. The orifices of the meibomian glands are anterior to the root of eyelashes D. The lower lid is supplied by the maxillary division of the trigeminal nerve exclusively E. There are more meibomian glands in the lower than upper lids ANSWER: A Which statement is true regard to the lacrimal gland? A. The palpebral part is larger than the orbital part B. Both palpebral and orbital portions have ductules that open separately into the conjunctiva C. The ductules open into the conjunctiva at the upper border of the upper tarsus D. Biopsy of the orbital part is more likely to impair tear production than biopsy of the palpebral part E. Lacks a true capsule ANSWER: E Acanthamoeba is classified as A. Gram positive bacteria B. Gram negative bacteria C. Virus D. Fungus E. Protozoa ANSWER: E Phacoantigene endophthalmitis is caused by: A. Anaphylactic hypersensitivity B. Mast cells and eosinophils C. Granulomatous inflammation to lens protein D. Necrotiserende ontsteking necrotizing inflammation E. Antibody reaction to soluble lens protein ANSWER: C Which of the following concerning polar cataracts is CORRECT? A. Anterior polar cataract usually cause more visual disturbance than posterior polar cataracts B. posterior polar cataracts have been associated with remnants of the tunica vasculosa lentis C. both anterior and posterior polar cataracts can be sporadic or recessively inherited 9 D. posterior polar cataracts invariably progress to complete cataracts ANSWER: B A dispersive viscoelastic used in phacoemulsification has which of the following properties? A. adheres to and protects endothelium from damage B. easy to remove at end of case C. retained viscoelastic does not cause increase in IOP postoperatively D. prevents collapse of the anterior chamber during high vacuum ANSWER: A During a complicated cataract removal case, the lens and capsular bag were both removed and an anterior chamber lens was placeD. following measure would be most effective? A. topical glaucoma medications and close observation B. laser peripheral iridetomy C. increased frequency of the topical steroid D. paracentesis to release aqueous fluid ANSWER: B A patient has with the rule astigmatism. During uncomplicated cataract surgery, a toric posterior chamber intraocular lens (IOP) is p rotated 90˚. Which of the following statements is most accurate? A. lens explant is necessary because the lens in not stable B. the measured astigmatism has increased C. the lens should have been placed in the ciliary sulcus D. rotation of the lens can be done anytime during the first 3 months ANSWER: B Which of the following is NOT associated with microspherophakia? A. small stature, stubdy fingers, reduced joint mobility B. alport’s syndrome C. congenital rubella D. hyperlysinemia ANSWER: D What is the cause for posterior capsular opacification following phacoemulsification and implantation of an IOL? A. fibrovascular ingrowth stimulation by the lens B. bacterial sequestration and colonization C. proliferation of residual lens epithelium D. toxicity of the IOL ANSWER: C Which of the following is NOT a reported complication following yttrium-aluminum-garnet (YAG) capsulotomy? A. Iristis B. Retinal detachment C. Corneal edema D. Subluxation of the lens ANSWER: C Which of the following is true concerning the different designs of phacoemulsification machines? A. the peristaltic pump requires a slow building of vacuum for aspiration B. the diaphragm pump allows instantaneous vacuum C. the venturi pump has stepwise increases in vacuum D. the speed of rollers in the peristaltic pump allows linear control of vacuum ANSWER: D Excessive iris prolapse during extracapsular cataract extraction via phacoemulsification may be 10 caused by all of the following EXCEPT: A. infusion bottle height high B. would size too large for phacoemulsification tip C. excessive phacoemulsification power D. suprachoroidal hemorrhage ANSWER: C A 60-years-old man successfully undergoes phacoemulsification of the nuclear sclerotic cataract in his right eyE. The surgeon accidentally leaves a moderate amount of viscoelastic in his eye. How long after completion of the case might be patient experience a significant spike in IOP? A. 30 minutes B. 4 hours C. 10 hours D. 24 hours ANSWER: B A patient with the preoperative refraction OD of -3.00 + 2.00 x 90 has a visually significant cataract in this eyE. Keratometry is 40.00 @ 180 and 42.00 @ 90. Which length and location of the cataract scleral tunnel might help decrease the amount of late postoperative astigmatism for the patient? A. 3.5-mm scleral incision superiorly B. 6.0-mm scleral incision superiorly C. 3.5-mm scleral incision temporally D. 6.0-mm scleral incision temporally ANSWER: B After removal of the anterior chamber IOL, you decide to place a scleral-sutured posterior chamber IOL. The needle should be passed approximately how far posterior to the limbus? A. 2.0 mm B. 1.5 mm C. 0.75 mm D. 0.25 mm ANSWER: C What is the incidence of clinical cystoid macular edema following uncomplicated extracapsular cataract extraction? A. less than 1% B. 1% to 2% C. 10% D. 20% ANSWER: A Compared with plasma, aqueous humor has an increased concentration of which one of these components? A. Protein B. Ascorbate C. Glucose D. Carbon dioxide ANSWER: A Which vessel(s) provide the predominant blood supply to the surface nerve fiber layer of the optic nerve head? A. Short posterior ciliary artery B. Peripapillary choroidal vessels C. Pial Vessels D. Central Retinal Artery ANSWER: D Which one of the following statements is FALSE concerning the condition depicted in Figure 9-1? 11 A. It has a worse prognosis than primary open angle glaucoma (POAG) B. It may be monocular or binocular C. Lans extraction alleviates the condition D. The IOP is often higher than in POAG ANSWER: C Which one of the following is NOT a risk factor for POAG? A. Topical corticosteroid response B. African American heritage C. Positive family history D. Diabetes mellitus ANSWER: A Which drug used during general anesthesia is associated with an increase in intraocular pressure (IOP)? A. Halothane B. Ketamine C. Valium D. Phenobarbital ANSWER: B Patients with homocystinuria are at increased risk for the following: A. Lens subluxation B. Angle closure glaucoma C. Intravascular thrombosis with general anesthesia D. All of the above ANSWER: D Indentation tonometry gives falsely low reading under all of the following conditions EXCEPT: A. High myopia B. Decreased central corneal thickness C. Excessive fluorescein D. Greater than 3 D of with-the-rule astigmatism ANSWER: C The reliability of visual field testing becomes suspect when pupil diameter decreases below: A. 4 mm B. 3 mm C. 2 mm D. 1 mm ANSWER: B Which test object has four times the area and same light intensity as the goldmann II4e target? A. III4e B. II2e C. II4c D. V2a ANSWER: A A patient is tested on the Humphrey automated perimeter. The machine projects a light at his blind spot and the patient presses the button. What does this patient’s response represent? A. false-positive response B. fixation loss C. short-term fluctuation D. false-negative response 12 ANSWER: B Typically, the first of antibody produced against a newly encountered antigen is: A. IgA B. IgE C. IgG D. IgM ANSWER: D The cornea has: A. 5 layers B. 4 layers C. Epitheliual covering which is not capable of regenation. D. higher water content than adjacent sclera. ANSWER: A The corneal has a refractive power : A. A greater than the lens. B. Capable of producing astigmatism in certain condition. C. Decreasing as the corneal flattens D. All of above. ANSWER: D The Normal cornea has not : A. A abundant blood vessels seen only with high magnification. B. Rich sensory innervation. C. The ability to regenerate Bowman”s membrane D. one layer endothelium. ANSWER: C Band shaped keratopathy is commonly caused by deposition of: A. Magnesium salt B. Calcium salt C. Ferrous salt D. Copper salt ANSWER: B Irrespective of the etiology of a corneal ulcer, the drug always indicated is: A. Corticosteroids B. Cycloplegics C. Antibiotics D. Antifungals ANSWER: B Dense scar of cornea with incarceration of iris is known as: A. Adherent Leucoma B. Dense leucoma C. Ciliary staphyloma D. Iris bombe ANSWER: A Corneal sensations are diminished in: A. Herpes simplex B. Conjunctivitis 13 C. Fungal infections D. Marginal keratitis ANSWER: A The color of fluorescein staining in corneal ulcer is: A. Yellow B. Blue C. Green D. Royal blue ANSWER: C Phlycten is due to: A. Endogenous allergy B. Exogenous allergy C. Degeneration D. Conjunctival dystrophy ANSWER: A A recurrent bilateral conjunctivitis occurring with the onset of hot weather in young boys with symptoms of burning, itching, and lacrimation with large flat topped cobble stone papillae raised areas in the palpebral conjunctiva is: A. Trachoma B. Phlyctenular conjunctivitis C. Mucopurulent conjunctivitis D. Vernal keratoconjunctivitis ANSWER: D Which of the following organism can penetrate intact corneal epithelium? A. Strept pyogenes B. Staph aureus C. Pseudomonas pyocyanaea D. Corynebacterium diphtheriae ANSWER: D A 12 years old boy receiving long term treatment for spring catarrh, developed defective vision in both eyes. The likely cause is: A. Posterior subcapsular cataract B. Retinopathy of prematurity C. Optic neuritis D. Vitreous hemorrhage ANSWER: A A 16 years old girl receiving long term treatment for spring catarrh, developed defective vision in both eyes. The likely cause is: A. suddenly change of corneal refractive power B. Retinopathy of prematurity C. Optic neuritis D. Glaucoma with increased IOP ANSWER: A A young child suffering from fever and sore throat began to complain of lacrimation. On examination, follicles were found in the 14 lower palpebral conjunctiva with tender preauricular lymph nodes. The most probable diagnosis is: A. Trachoma B. Staphylococal conjunctivitis C. Adenoviral conjunctivitis D. Phlyctenular conjunctivitis ANSWER: C Patching of the eye is contraindicated in: A. Corneal abrasion B. Bacterial corneal ulcer C. Mucopurulent conjunctivitis D. After glaucoma surgery ANSWER: C Ten years old boy complains of itching. On examination, there are mucoid nodules with smooth rounded surface on the limbus, and mucous white ropy mucopurulent conjunctival dischargE. He most probably suffers from: A. Trachoma B. Mucopurulent conjunctivitis C. Bulbar spring catarrh ( Allergy of conjunctiva) D. Purulent conjunctivitis ANSWER: C In viral epidemic kerato-conjunctivitis characteristically there is usually: A. Copious purulent discharge B. Copious muco-purulent discharge C. Excessive watery lacrimation D. Mucoid ropy white discharge ANSWER: C Which one of the following signs would not be expected with a classic migraine? A. Premonitory aura B. Scintillating lights C. Headache D. Persistent leg tingling and weakness ANSWER: D Which one of the following is not a criterion for the diagnosis of pseudotumor cerebri (idiopathic intracranial hypertension)? A. Normal cerebrospinal fluid composition B. Elevated opening pressure on lumbar puncture C. Bilateral papilledema D. Normal neuroimaging studies ANSWER: C A 22-year-old man presents to the emergency department with a 1-day history of diplopiA. Examination reveals limitation of abduction of the right eye and limitation of elevation of the left eyE. The pupils measure 7 mm OD and 8 mm OS with poor reaction to light and accommodation. Bilateral ptosis is present. The least useful test needed to confirm the diagnosis is: A. Clostridium botulinum toxin test B. tensilon test 15 C. lumbar puncture D. GQ1b antibody test ANSWER: B A 68-year-old man developed a sudden onset of vomiting, imbalance, and double vision. On examination, he had a concomitant 10 PD left hypertropia and ataxiA. What test should be ordered? A. Cerebral arteriography B. Cerebral MRI and arteriography C. Tensilon test D. Carotid ultrasonography ANSWER: B A 41-year-old woman presents with a 3-month history of shimmering photopsias in the left eye in association with a “dark spot” temporal to fixation in that eye which has gradually increased in sizE. The least likely diagnosis is: A. cancer-associated retinopathy B. acute zonal occult outer retinopathy (AZOOR) C. MS D. gyrate atrophy ANSWER: D Which muscles are affected most commonly in thyroid eye disease? A. Medial rectus, inferior rectus B. Superior rectus, inferior oblique C. Lateral rectus, superior oblique D. Inferior oblique, inferior rectus ANSWER: A Which treatment in the Optic Neuritis Treatment Trial (ONTT) had the highest rate of recurrence? A. Oral prednisone alone B. IV methylprednisolone alone C. IV methylprednisolone and oral prednisone D. Observation ANSWER: A The most common cause of binocular transient visual loss lasting 30 minutes in a 29-year- old woman is A. Migraine B. Thromboembolism C. Pseudotumor cerebri D. Giant cell arteritis ANSWER: A A 69-year-old woman reports awakening 2 days earlier with blurred vision in the inferior visual filed OS. This morning, she noted extension of visual loss to the superior visual field OS. Over the past month, she has felt weak and tired, and recently she developed a headachE. Examination reveals visual acuity of hand motions in the affected eye, with an afferent pupillary defect and pale optic disc edemA. The following statements are true except A. This clinical scenario most likely represents arteritis anterior ischemic optic neuropathy (AION). B. Initial management include evaluation of sedimentation rate and C-reactive protein. C. Corticosteroids therapy should be initiated after return of a positive temporal artery result. D. The major ophthalmic goal of therapy in arteritis AION is to prevent visual loss in the fellow eyE. ANSWER: C Which of the following is most useful in distinguishing the case of anisocoria that is greater in dark than in light? A. Cocain 10% B. Pilocarpine 0.1% 16 C. Pilocarpine 1% D. Pilocarpine 2.5% ANSWER: A Parasympathetic fibers destined for the pupil reside in the A. Medulla B. Medial portion of CN III C. Posterior communicating artery D. Pons ANSWER: B A 65-year-old male presents with a 1-hour history of acute right homonymous hemianopiA. Which imaging modality would best demonstrate an acute infarct of the left occipital lobe? A. CT With contrast B. Cerebral angiogram C. TI-weighted MRI D. Diffusion-weighted MRI ANSWER: D A Lesion of the lift occipital lobe A. Results in an incongruous right homonymous hemianopic visual filed defect, which may demonstrate sparing of the fixation region B. Is usually associated with impaired visual acuity C. Is typically associated with impaired optokinetic nystagmus with targets moving to the left D. May show a monocular right temporal visual field defect ANSWER: D A 27-year-old man was struck in the right forehead during a fight. He presented to the emergency department complaining of inability to see out of his right eyE. The examination results revealed vision of light perception in the right eye, 20/20 in the left eyE. Confrontation field testing was normal in the left eyE. Eye movements were full, and there was evidence of orbital traumA. Pupils were equal in size and reacted well, with no evidence of an afferent pupillary defect. Which of the following is the most likely diagnosis? A. Indirect traumatic optic neuropathy B. Optic tract injury C. Occipital lobe contusion D. Functional visual loss ANSWER: D Which of the following is not a typical feature of the dorsal midbrain syndrome (also known as Parinaud syndrome or pretectal syndrome)? A. Lid retraction B. Convergence-retraction nystagmus C. Small pupils that react poorly to light and briskly to near D. Saccadic paresis of upgaze ANSWER: C The Optic Neuritis Treatment Trial (ONTT) and follow-up studies indicate all of the following except A. Intravenous methylprednisolone may speed visual recovery during the first 2-3 weeks after onset but has no lasting visual benefit. B. Oral prednisone alone at 1mg/kg/day may increasing recurrence ratE. C. The overall 10 year risk of developing multiple sclerosis after isolated optic neuritis is approximately 38%. D. Intravenous methylprednisolone administered within 8 days after visual loss significantly reduces the 10 year risk of developing MS. ANSWER: D A 22 –year- old woman was referred due to anisocoriA. The patient had not been aware of the problem. The right pupil was 3 mm and slightly oval in shape, and the left pupil was 5 mm and rounD. 17 The right pupil reacted poorly to light but promptly to near, whereas the left pupil reacted normally to both light and near. Which of the following is the most likely diagnosis? A. Old Adie’s pupil, right eye B. acute Adie’s pupil, left eye C. Argyll-Robertson pupils D. Physiologic anisocoria ANSWER: A All of the following are true about cerebrovascular disease causing transient monocular visual loss except A. The incidence of permanent blindness is low. B. The transient visual loss may be a harbinger of strokE. C. Depending on the degree of carotid stenosis, carotid endarterectomy may be warranteD. D. Visual loss generally lasts more than 15 minutE. ANSWER: D All of the following would be expected to show restriction during forced duction testing except A. Thyroid-associated orbitopathy B. Internuclear ophthalmoplegia C. orbital fracture with inferior rectus entrapment D. Congenital fibrosis of the extraocular muscles ANSWER: B Which of the following is not a feature of myotonic dystrophy? A. Hatchet face B. Inability to relax one’s grasp C. Subluxed lenses D. Ophthalmoplegia ANSWER: C Which of the following is not considered to be an illusion? A. Pulfrich phenomenon B. Metamorphopsia C. Micropsia D. Palinopsia ANSWER: D A previously healthy 25-year-old woman presents with acute visual loss OD (20/20) and a right relative afferent pupillary defect (RAPD). MRI show 2 ovoid periventricular T2 hyper-intensities. Which of the following statements is false? A. She has 50%-60% chance of developing multiple sclerosis over the next 10 years. B. He vision will most likely not recover. C. Treatment with oral corticosteroids alone will increase her risk of future attacks of visual loss. D. She will have clinically definite multiple sclerosis if she experiences even one more unex-plained neurologic event lasting 48 hour. ANSWER: B Which of the following is most likely to prompt additional evaluation in a patient with facial palsy? A. Simultneous bilateral facial palsy B. Recovery of facial nerve function that occurs 3 weeks after the facial palsy. C. Facial palsy occurring in a patient older than 50 years of agE. D. Upper and lower facial musculature equally affecteD. ANSWER: A An underlying condition is most likely to be determined in a patient with isolate eye pain and A. Pain for greater than 2 years 18 B. Ipsilateral facial numbness C. Normal neuroimaging of the brain and orbits D. Poor response to tricyclic antidepressants ANSWER: B A 1- year-old child presents with monocular vertical nystagmus. What is the best course of action? A. Follow the case to see whether head nodding develops. B. Follow the case to see whether abnormal head position develops. C. Undertake drug toxicology screening. D. Undertake neuroimaging (preferable MRI) ANSWER: C In automated perimetry A. Static technique, indicating a nonmoving target of varying intensity, is commonly used B. For displayed decibel values, a higher number indicates worse visual sensitivity C. The mean deviation is a measure of localized deviations from normal D. The visual threshold is the maximum visual stimulus seen at a point ANSWER: A Optic disc drusen typically demonstrate all of the following features except A. Arcuate visual field defects B. High reflective signal on B-Scan ultrasonography C. Visual acuity loss D. Optic disc elevation and blurred margins ANSWER: C After a motor vehicle accident, a young man presents with unilateral marked proptosis, displopia, and prominent episcleral vessels. He complains of a rushing sound in his heaD. Which of the following is the most likely possibility? A. Posteriorly draining dural shunt B. Carotid-cavernous fistula C. Retro-orbital hemorrhage D. orbital floor fracture ANSWER: B A 45-year-old present with painful left Horner syndrome of 3 days duration. The most appropriate imaging would be A. CT, head B. MRI, neck C. Catheter floor fracture D. MR/MRA, brain and neck ANSWER: D All of the following are common causes of transient visual loss except A. Nonarteritic ischemic optic neuropathy B. Migraine C. Giant cell arteritis D. Pseudotumor cerebri ANSWER: A Which eye movement disorder is most commonly seen in patients with paraneoplastic syndrome? A. Downbeat nystagmus B. Upbeat nystagmus C. Superior oblique myokymia D. Opsoclonus 19 ANSWER: D Lesions involving the optic chiasm A. Commonly include pituitary adenomas, meningiomas, craniopharyngiomas, and stroke B. May show markedly asymmetric involvement of the temporal visual fields C. Do not demonstrate afferent pupillary defects D. Often are associated with papilledema ANSWER: B Diplopia with associated bilateral abduction defects and pupillary constriction upon attempted lateral gaze is most likely due to A. Bilateral sixth nerve palsies B. Myasthenia gravis C. Spasm of the near reflex D. Graves disease ANSWER: C Interruption of visual information between the occipital lobe and the dominant angular gyrus cause A. Gestmann syndrome B. Alexia without agraphia C. Simulatanagnosia D. Balint syndrome ANSWER: B A patient presents with CN VI and CN VII palsies. The most likely lesion location is the A. Midbrain B. Pons C. Cavernous sinus D. Medulla ANSWER: B Optic atrophy A. Is an early sign of outer retinal layer damage B. Usually requires 4-8 weeks to develop after optic nerve injury C. Is never segmental D. Is always associated with a central scotoma ANSWER: B A 32-year-old woman develops visual loss in the right eyE. She has a right RPAD and a moderately swollen optic nerve with flame-shaped hemorrhages. Previous history includes Bell’s palsy on 2 occasions and several episodes of “Pink eye" over the last 5 years. The most hlpfl diagnostic testing would be A. Bartonella henselae titers B. An MRI C. A chest x-ray and angiotensin-converting enzyme D. Lumbar puncture ANSWER: C A 30-year-old woman reports a 2-month history of headaches and progressive visual loss OS. She takes no medications and is not obesE. Examination reveals visual acuity of 20/20 OD and 20/70 OS, with a generally depressed visual field OS. There is an afferent pupillary defect OS, and the optic discs show bilateral edema, slightly paler on the left. The most important next diagnostic step is A. MR scan of the brain B. A lumbar puncture C. CBC with sedimentation rate D. Ultrasonography of the orbits 20 ANSWER: A A 55- year-old patient with diabetes presents with double vision. Which of the following finding would lead you to order MRI of the brain as the initial diagnostic test? A. Isolated pupil-sparing complete third cranial nerve palsy of 3 days’ duration B. Right fourth cranial nerve palsy with bilateral ptosis that clearly gets worse as the day progresses, present for 1 week C. Isolated pupil-sparing complete third cranial nerve palsy of 8 months duration D. Lid retraction OU, restriction of upgaze OU, injection over the medial and lateral recti muscles OU, and elevation of intraocular pressure from 16 to 28 mm Hg in both eyes with upgaze ANSWER: C Techniques for entropion repair include all this followings except: A. lid retractor reattachment. B. botulinum toxin injection. C. Quickert-Rathbun sutures. D. transverse tarsorrhaphy. E. Kuhnt-Szymanowski procedure. ANSWER: E Distichiasis is characterised by all of the following except: A. An extra row of cilia is present B. Normal row of cilia is present anterior to the openings of the meibomian glands C. Extra row of cilia occupies a position posterior to the openings of the meibomian glands D. Cilia of the extra row may rub the cornea ANSWER: C In severe cases of essential blepharospasm, one may see all the followings except: A. bruxism. B. decreased tear production. C. brow ptosis. D. ectropion. E. oromandibular dystonia. ANSWER: D Complications of exenteration include all the following except: A. severe blood loss. B. cerebrospinal fluid leakage. C. “phantom limb” pain from the cut optic nerve. D. skin graft infection. E. chronic sino-orbital fistulas. ANSWER: C Stye is an acute suppurative inflammation of: A. Gland of Zeis B. Gland of Moll C. Meibomian gland D. All of the above ANSWER: A Hordeolum internum is a suppurative inflammation of the: A. Gland of Zeis B. Gland of Moll C. Meibomian gland D. All of the above 21 ANSWER: C Of the following conditions most painful is: A. Stye B. Hordeolum internum C. Ulcerative blepharitis D. Inflammation of gland of Moll ANSWER: B In a chalazion with multiple recurrences at the same site the incision and currettage should be: A. Followed by cauterisation with carbolic acid B. Preceded by cryotherapy C. Preceded by intralesional injection of triamcinolone D. Replaced by excision biopsy ANSWER: D Pseudotrichiasis is seen in: A. Entropion B. Ectropion C. Distichiasis D. Healed membranous conjunctivitis ANSWER: A Simple and effective method of treatment for segmental trichiasis is: A. Epilation B. Electrolysis C. Cryolysis D. Surgical correction ANSWER: C All of the following operations are employed to correct senile entropion except: A. Modified Wheeler’s operation B. Modified Ketssey’s operation C. Weiss operation D. Bick’s procedure with Reeh’s modification ANSWER: B Which of the following types of entropion is not known: A. Spastic entropion B. Paralytic entropion C. Cicatricial entropion D. Involutional entropion ANSWER: B Senile ptosis is: A. Neurogenic B. Myogenic C. Aponeurotic D. Mechanical ANSWER: C Severe ptosis in a new born should be operated at the age of: A. 1 year B. 3 years C. 5 years 22 D. Earliest possible ANSWER: D All of the following are pre-cancerous conditions of the lids except: A. Naevi B. Solar keratosis C. Xeroderma pigmentosa D. Carcinoma-in-situ ANSWER: A The commonest malignant tumour of the lids is: A. Basal-cell carcinoma B. Squamous cell carcinoma C. Adenocarcinoma D. Melanocarcinoma ANSWER: A The most common site of basal cell carcinoma of the lids is: A. Upper lid B. Lower lid C. Medial canthus D. Lateral canthus ANSWER: B Neuroblastoma that is metastatic to the orbit:except: A. arises in the abdomen in 90% of cases. B. first appears as an orbital mass in 8% of cases. C. is the second most common malignant orbital tumor of childhood. D. affects both orbits in 40% of children. E. rarely advances to orbital bones. ANSWER: E Hydroxyapatite orbital implant after enucleation: except A. is usually wrapped in donor sclera. B. receives the four rectus muscles. C. requires a peg to produce maximal movement of the implant. D. may be rejected by the body’s immune system. E. generally undergoes drilling 6 to 12 months after placement. ANSWER: D Epiphora in a patient with seventh nerve palsy is most likely due to: A. Eversion of lower punctum B. Lateral lower lid ectropion C. Failure of lacrimal pump system D. All of the above ANSWER: C Ptosis with lid lag is seen in: A. Traumatic ptosis B. Myogenic ptosis C. Synkinesis D. Congenital ptosis ANSWER: D The commonest fungal lesion of the eyelid is: 23 A. Candida B. Aspergillosis C. Sporothrix D. None ANSWER: A Epilation is not indicated in: A. Ulcerative blepharitis B. Phthiriasis C. Trichiasis D. Madarosis ANSWER: D Sling surgery should be avoided in cases of ptosis with: A. Very poor levator action B. Poor Bell’s phenomenon C. Weak Muller’s muscle D. Multiple failed surgeries ANSWER: B All are complications of chronic staphylo-coccal blepharoconjunctivitis except: A. Chalazion B. Marginal conjunctivitis C. Follicular conjunctivitis D. Phylectenular conjunctivitis ANSWER: A Fasanella Servat operation is specifically indicated in: A. Congenital ptosis B. Steroid induced ptosis C. Myasthenia gravis D. Horner’s syndrome ANSWER: D The operation of plication of inferior lid retractors is indicated in: A. Senile ectropion B. Senile entropion C. Cicatricial entropion D. Paralytic entropion ANSWER: B A recurrent chalazion should be subjected to histopathologic evaluation to exclude the possibility of: A. Squamous cell carcinoma B. Sebaceous cell carcinoma C. Malignant melanoma D. Basal cell carcinoma ANSWER: B What is the definition of blindness as per World Health Organization (WHO) standards? A. vision 20/200 or worse. B. vision 20/400 or worse. C. vision worse than 20/400. D. vision worse than counting fingers (CF) at 3 feet. ANSWER: D 24 Approximately how many people in the world currently blind ? A. 217 million. B. 253 million C. 45 million. D. 36 million. ANSWER: D What is the current prevalence of blindness in Cambodia ? A. 1.2 % B. 1.0 % C. 2.5 % D. 0.37 % ANSWER: D What is the main cause of blindness in Cambodia ? A. Refractive error B. Cataract C. Glaucoma D. Cornea Scar ANSWER: B VISION 2020 – The Right to Sight which is the global initiatives to fight against blindness between WHO and IAPB was launched in the year ? A. 1998 B. 1999 C. 2000 D. 2001 ANSWER: B Blinding disease Control in VISION 2020 ? A. Cataract B. Refractive Error C. Trachoma D. All of above ANSWER: D Strategy does not include in VISION 2020 A. Blinding Disease Control B. Human Resource Development C. Appropriate Technology D. Advanced research on Blinding disease ANSWER: D According to "The Global Initiative for the Elimination of Avoidable Blindness (VISION 2020, the Right to Sight)", what is the most cost effective intervention for prevention visual impairment? A. Correction of refractive error B. Screening program for DR C. Screening examination of premature infants for ROP D. Screening program for early detection in POAG ANSWER: A According to WHO, what is the main cause of globally visual impairment? A. Uncorrected refractive error B. Cataract C. Glaucoma 25 D. AMD E. Diabetic retinopathy ANSWER: A Percentage of children in low income country ? A. 10 % B. 20% C. 30% D. 40% ANSWER: D Prevalence of Childhood Blindness in developing country? A. 1.2 /1000 B. 0.9 /1000 C. 0.6 /1000 D. 0.3 / 1000 ANSWER: A Avoidable Child hood Blindness ? A. Vitamin A deficiency B. Measles C. Ophthalmia Neonatorium D. All of above ANSWER: D Most comment Cause of Childhood Blindness in Low income country A. Congenital Cataract B. Congenital Glaucoma C. Corneal scar due to measles D. Globe abnormalities ANSWER: C In trachoma the patient is infectious when there is: A. Arlt's line B. Herbert's pits C. Post-trachomatous concretions. D. Follicles and papillae in the palpebral conjunctiva ANSWER: D What is a posterior extension of the pars plana epithelium onto the retinal side of the ora serrata? A. enclosed ora bay B. meridional complex C. dentate process D. peripheral retinal excavation ANSWER: A What is a clinical feature of the multiple evanescent white dot syndrome (MEWDS)? A. RPE scarring B. gray-white, poorly demarcated, patchy, outer-retinal lesions C. severe vitreous cellular reaction D. gray, granular pigmentation of the fovea ANSWER: B Bull’s eye lesion seen with: A. Chloroquine 26 B. Dapsone C. Rifampicin D. Ethambutol E. Gold ANSWER: A Which of the following agents is not used the treatment of Diabetic Macular Edema/ Retinopathy: A. Ruboxistaurim B. Pyridazinones C. Benfotiamine D. Tamoxifen ANSWER: D Vortex Vein invasion is commonly seen in: A. Retinoblastoma B. Malignant melanoma C. Optic nerve glioma D. Medullo-epithelioma ANSWER: B The following are true about sympathetic ophthalmia: A. bilateral granulomatous pan-uveitis is not a feature B. Auorescein angiography is useful for diagnostic purposes C. removal of the injured eye should be performed within a week to avoid this complication D. the choroid is typically thickened with occlusion of the choriocapillaris E. Dalen-Fuchs' nodules are found on the retinal side of Bruch' s membrane. ANSWER: E One of the earliest histologic findings in the retina of patients with diabetes is: A. death of retinal capillary endothelial cells. B. budding of new capillaries from venules. C. apoptosis of retinal capillary pericytes. D. proliferation of retinal capillary pericytes. E. proliferation of retinal capillary endothelial cells. ANSWER: C Histopathologic study of Coats’ disease demonstrates: A. sclerosed narrow vessels. B. ischemic retinal atrophy. C. thinning of the affected segment of retina. D. preservation of photoreceptors. E. periodic acid-Schiff-positive material spreading to the outer layers of the neural retina. ANSWER: E A 65-year-old black woman has presenting symptoms of choroidal neovascularization and multiple tiny lid nodules. The most likely diagnosis is: A. syphilis. B. tuberculosis. C. sarcoidosis. D. toxoplasmosis. E. toxocariasis. ANSWER: C Detached retinal pigment epithelium (RPE. may be caused by all the following except: 27 A. fibrovascular tissue beneath the RPE. B. hemorrhage beneath the RPE. C. chloroquine maculopathy. D. fluid beneath the RPE. E. coalescence of drusen. ANSWER: C Which one of the following does not occur with high myopia? A. subnormal visual acuity. B. suboptimal binocularity. C. abnormal color vision. D. image magnification. E. impaired dark adaptation. ANSWER: D Cystoid macular edema has been seen with all the following except: A. retinal capillary hemangioma. B. topical epinephrine. C. choroidal hemangioma. D. oral tetracycline. E. oral nicotinic acid. ANSWER: D A 65-year-old welder comes to the emergency department directly from work and complains of bilateral pain and photophobiA. The most likely cause is: A. infrared burn to the eyes. B. acute photic keratitis. C. ultraviolet absorption by the lens. D. secondary anterior uveitis. E. retinal toxicity and secondary choroiditis. ANSWER: B A male child who is otherwise completely normal has leukokoria and a small eye (present at birth). The condition is probably caused by: A. retinoblastoma. B. persistent hyperplastic primary vitreous. C. retinopathy of prematurity. D. toxocariasis. E. Coats’ disease. ANSWER: B When compared to blood, vitreous humour has higher concentration of A. Glucose B. Potassiun C. Sodium D. Ascorbate ANSWER: D Which of the following is not an ocular emergency? A. Ocular trauma B. Sympathetic ophthalmitis C. CRAO D. CRVO 28 E. Endophthalmitis ANSWER: D First sign in sympathetic ophthalmitis A. Aqueous flare B. Keratic precipitates C. Retrolental flare D. Constriction of the pupil E. Delen fuchs’ nodules ANSWER: C Earliest symptom of sympathetic ophthalmitis is: A. Photophobia B. Pain C. Loss of near vision D. Loss of distant vision E. Loss of accommodation ANSWER: C Granulomatous uveitis is seen in A. Vogt-Koyanagi-Harada' s disease B. Fuchs' heterochromic iridocyclitis C. Behcet' s disease D. Psoriatic arthritis ANSWER: A Primary objective of use of atropine in anterior uveitis is A. Relaxation of ciliary muscle B. Increase blood flow C. Prevent posterior synechiae formation D. Increase supply of antibodies E. Reduce accommodation ANSWER: A Which of the following has been most strongly correlated with photic maculopathy following cataract surgery? A. hypoxemia during surgery. B. preoperative high myopia. C. duration of surgery. D. preoperative glaucoma. E. extracapsular cataract surgery. ANSWER: C Cigarette smoking has been most strongly associated with which manifestation of age-related macular degeneration? A. hard drusen. B. soft drusen. C. focal retinal pigment epithelium (RPE. hyperplasia. D. choroidal neovascularization. E. geographic atrophy. ANSWER: D The following statements are true regarding dry age-related macular degeneration (AMD): A. it will typically have a visual acuity of 6/60 or worse within 2 years 29 B. the optimal management is with low visual aids C. the contralateral eye will be simultaneously affected in all cases D. the patient should be promptly referred for fluorescein angiography E. dry AMD can be treated with photodynamic therapy without verteporfin ANSWER: B In AZOOR (acute zonular occult outer retinopathy): A. photopsia is a recognized feature B. visual loss is caused by retinal necrosis C. fluorescein angiogram is useful for diagnosis D. most affected patients are over the age of 40 E. oral prednisolone is the treatment of choice ANSWER: A In PIC (primary idiopathic choriodopathy): A. myopia is an association B. more male than female are affected C. vitritis is common D. viral prodrome is common E. both eyes are affected in 25% of cases ANSWER: A Diabetic microangiopathy include: A. Endothelial vascular proliferation B. Proliferation of pericytes associated with microaneurysms C. Deposition of calcium in the intima D. Thickening of the basement membrane E. Necrosis of the endothelium ANSWER: D Retinal dialysis: A. Is associated with posterior vitreous detachment B. Is associated with myopia C. Has a mobile posterior flap D. Can be treated by cryotherapy, encirclement and a local scleral buckle E. Is commonest in the superior temporal quadrant ANSWER: D The following conditions are inherited in an autosomal recessive patterns: A. Protanopia B. Congenital retinoschisis C. Sturge-Weber's syndrome D. Neurofibromatosis type II E. Blue cone achromatopsia ANSWER: E The following are true about intravitreal injection: Except A. it can cause secondary retinal tear B. it can cause cataract C. C3F8 has a longer half life than SF6 D. SF6 is more expansile than C3F8 E. SF6 causes more significant increase in the intraocular pressure than C3F8 ANSWER: D 30 In peripheral iridotomy with laser: A. dark colour iris responds poorly to argon laser iridotomy B. more energy is needed for argon laser than YAG laser for a given size iridotomy C. steroid pre-treatment is effective in decreasing the intraocular pressure D. presence of red reflex during the procedure indicate the iridotomy is patent E. significant cataract develops in 50% of cases following treatment ANSWER: B The inner plexiform layer contains the following cells except: A. photoreceptors B. Müller cells C. ganglion cells D. bipolar cells E. amacrine cells ANSWER: A With respect to the posterior pole: A. the macula lutea is 3 disc diameters lateral to the optic disc B. the macula lutea is yellow due to beta-carotene, a pigment found in milk and some vegetables C. the clivus is the sloping edge of the macula D. the ganglion cell layer remains a constant thickness E. the foveola is avascular and contains only cone photoreceptors ANSWER: E The neural retina: A. is made up of 6 cell types B. contains synapses between photoreceptors and amacrine cells C. contains within its outer nuclear layer the cell bodies of bipolar, horizontal amacrine, interplexiform and Muller cells D. has synapses between bipolar and ganglion cells within the inner plexiform layer E. contains myelinated fibres ANSWER: D The photoreceptors: A. number about 100 per ganglion cell B. are present in uniform concentration throughout the retina C. shed most of their discs at night D. both contain rhodopsin and iodopsin E. have outer and inner segments joined by a central connecting stalk which contains a modified cilium ANSWER: A With respect to the cells of the retina:except: A. the horizontal cells form the anatomical basis of lateral inhibition B. the amacrine cells are an homogenous population of cells C. the amacrine cells contribute to centre-surround characteristics of ganglion cells D. interplexiform cells are both pre- and post-synaptic to amacrine processes and can synapse on amacrine cell bodies E. the interplexiform cells are associated with the phasic reponse of ganglion cells ANSWER: B Typical peripheral cystoid degeneration of the retina: A. is associated with high myopia B. produces cystic spaces in the nerve fibre layer 31 C. increases the risk of retinal detachment D. has overlying liquefied vitreous E. gives rise to retinoschisis through coalescence of the cystic spaces ANSWER: E The following are true about retinocytoma: A. it is the result of spontaneous regression of retinoblastoma B. necrosis is a common feature C. Homer-Wright rosettes are common D. mitosis is rare E. calcification does not occur ANSWER: D The following histological feature are present in lattice degeneration: Except: A. overlying liquefied vitreous B. atrophy of the outer layer of the retina C. adherence of vitreous to the margin of the lesion D. closure of the retinal vessels E. discontinuity of the inner limiting membrane ANSWER: D In central retinal artery occlusion:Except: A. the occlusion typically occurs near the optic nerve head B. the most common cause is arteriosclerosis of the retinal artery C. liquifactive infarction of the retinal nerve fibre layer is a feature D. gliosis is a prominent repair mechanism E. the photoreceptors undergo atrophy ANSWER: D With regard to the inner nuclear layer of the retina, which statement is LEAST likely to be correct? A. Amacrine cells have their cell bodies along the border with the inner plexiform layer B. Bipolar cell bodies occupy the border with the outer plexiform layer C. It contains the nuclei of the Müller's cells D. The cell bodies of the horizontal cells lie mainly along the border of the inner nuclear layer and the outer plexiform layer ANSWER: B With regard to the chemical reactions occurring during phototransduction, which statement BEST describes the sequence which leads to an electrical response? A. Closure of cation channels as a result of hydrolysis of cAMP by phosphodiesterase B. Closure of cation channels as a result of hydrolysis of cGMP by phosphodiesterase C. Opening of cation channels as a result of hydrolysis of cAMP by phosphodiesterase D. Opening of cation channels as a result of hydrolysis of cGMP by phosphodiesterase ANSWER: B With regard to retinal bipolar cells, which statement is LEAST likely to be correct? A. Acetylcholine is the major neurotransmitter that conveys excitatory signals from amacrine cells to bipolar cells B. Bipolar cells form synapses with rods or cones but not both C. GABA is a neurotransmitter that conveys excitatory signals from horizontal cells to bipolar cells D. Glutamate is the major neurotransmitter between photoreceptor cells and bipolar cells ANSWER: A Which ONE of these is an early pathological feature of diabetic retinopathy? A. Capillary basement membrane thinning 32 B. Increased retinal blood flow C. Loss of capillary pericytes D. Retinal capillary closure ANSWER: C Autoimmune disease may be caused by a defect in which ONE of these? A. Immune complex formation B. MHC Class II antigens C. Topoisomerase D. T regulatory cells ANSWER: D A patient is diagnosed with acute central retinal artery occlusion. Which of the following evaluations should be included in the initial working up? A. Neck X-Ray B. Prothrombine time C. Cardiac catheterization D. Westergren Sedimentation rate ANSWER: D To enhance the visual contrast, the horizontal cell in the retina produce: A. Convergence. B. Divergence. C. Lateral inhibition. D. Lateral excitation. E. Summation ANSWER: C A study is called classic double blind study when: A. Treatment assignments are masked from patients but not observer. B. Treatment assignments are masked from observer but not patient. C. Treatment assignments are masked both from patient and observer. D. Patient and observer are not known to each other. E. All observations and calculations are being done by a computer. ANSWER: C Sensitivity is dependant on: A. Number of abnormals who screen positive in total population. B. Number of abnormals who screen negative in total population. C. Number of abnormals detected as abnormal by parameter in question. D. Number of normals who screen positive in total number of normals. E. Number of abnormals who screen negative in total number of abnormals. ANSWER: C Which one of the following statements regarding Coat’s disease is MOST likely to be correct? A. Anti-VEGF is the first line treatment B. It can present in adults C. Telangiectasia is limited to the macula region D. Treatment often includes vitrectomy and laser treatment ANSWER: B As per the NICE guideline (TA274) on diabetic macular oedema (DMO), what is the MOST likely initial treatment option for DMO more than 400um with foveal involvement? A. Argon laser treatment B. Dexamethasone implant 33 C. Fluocinolone acetonide implant D. Intravitreal course of Ranibizumab injections ANSWER: D The most common cause for Anton’s syndrome is A. Bilateral occipital lobe infarction B. Head injury C. Falcotentorial meningioma D. Multiple metastasis ANSWER: A The primary action of superior oblique is A. Abduction B. Intorsion C. Depression D. Adduction ANSWER: B Which of the following pairs are yolk muscles? A. RSR and LIR B. RSR and LSO C. LSR and RIO D. LSO and RIO ANSWER: C The cell type commonly seen in the most malignant form of choroidal melanoma is A. Spindle A B. Spindle B C. Epitheloid D. Mixed ANSWER: C Which is not true for Lebers hereditary optic neuropathy? A. Commences around 20 years of age B. It is a retrobulbar neuropathy C. Females affected more D. Transmission is by mutations in mitochondrial DNA ANSWER: C Induction movements, which muscle help in elevation A. SO in adduction B. IO in adduction C. SR in adduction D. SO in abduction ANSWER: B While doing retinoscopy, red reflex moves in opposite direction to the mirror in A. Hypermetropia B. Myopia greater than ID C. Myopia of ID D. Myopia lesser than ID ANSWER: B The number of blind people in India is approximately A. 37 million 34 B. 45 million C. 20 million D. 9 million ANSWER: D The near point of convergence is approximately A. 70 cm B. 100 cm C. 50 cm D. 25 cm ANSWER: A Steroid drop with the greatest anti inflammatory action is A. Loteprednol 0.2% B. Fluromethalone 0.1% C. Medrysone 1.0% D. Prednisolone acetate 1.0% ANSWER: D Image formed by a prism is A. Virtual, erect, displaced towards its apex B. Inverted, real, displaced towards apex C. Virtual, inverted displaced towards apex D. Real, erect, displaced towards apex ANSWER: A Which of these statements is false regarding retinoblastoma? A. Mutation in the RB1 gene B. Lactase dehydrogenase higher within aqueous than serum C. Flexner wintersteiner rosettes indicative of poorly differentiated tumour D. Lactase dehydrogenase activity higher in aqueous than serum ANSWER: C Which is not true about Vogt Koyanagi Harada dyndrome? A. Chronic granulomatous uveitis B. Involves parotid glands C. Commoner in Asians D. Auto immune response against melanocytes ANSWER: B Average endothelial cell loss following a normal cataract surgery is A. 2-10% B. 8-15% C. 12-16% D. 16-20% ANSWER: A Neurotrophic keratopathy is caused by A. Symblepharon B. Herpetic keratitis C. Deep coma D. Paralysis of orbicularis oculi ANSWER: B Which statement is not true about cornea verticillata? 35 A. Seen in fabry disease B. Caused by long term use of chloroquine C. Involves corneal endothelium D. Reversible condition ANSWER: C True about adenoviral conjunctivitis A. Genome is a linear double stranded DNA B. Incubation period of 3 weeks C. Formation of true membrane D. Ganciclovir only modality of treatment ANSWER: B All are brances of ophthalmic artery except A. Central retinal artery B. Anterior choroidal artery C. Anteriorciliary artery D. Short posterior ciliary artery ANSWER: B Causes of decreased corneal sensation are all exept A. Herpes simplex keratitis B. Acanthamoeba keratitis C. Post keratoplasty D. Acoustic neuroma ANSWER: C Unilateral mydriasis is seen in A. Adie’s tonic pupil B. Argyl Robertson pupil C. Horner syndrome D. Pontine bleed ANSWER: A Thinnest part of retina is A. Macula B. Around optic disc C. Equator D. Ora serrata ANSWER: D Capacity of the orbit is A. 15 cc B. 18 cc C. 30 cc D. 45 cc ANSWER: C Refractive index of vitreous humour is A. 1.42 B. 1.37 C. 1.39 D. 1.33 ANSWER: D 36 Which is not true for sympathetic ophthalmitis? A. Never seen within a week of injury B. Retrolental flare is an early sign C. Non granulomatous panuveitis D. Auto immune aetiology ANSWER: C Extra ocular muscles develops from A. Neural crest B. Neural ectoderm C. Surface ectoderm D. Mesoderm ANSWER: D Which of these developmental cataracts is not genetically inherited? A. Zonular cataract B. Cataracta coerulea C. Cataracta centralis pulverulenta D. Coralliform cataract ANSWER: B All these conditions cause a salt and pepper fundus picture except A. Rubella B. Lebers congenital amaurosis C. Cytomegalo virus D. Syphilis ANSWER: C Depth perception in and infant develops by the age of A. 3 months B. 8 weeks C. 12 months D. 6 months ANSWER: D Which of this is a photo disruptive laser? A. Nd YAG laser B. Frequency doubled Nd YAG laser C. Diode laser D. Argon laser ANSWER: A Rate of formation of aqueous humor is A. 3.2 ul/minute B. 3.4 ul/minute C. 2.9 ul/minute D. 2.3 ul/minute ANSWER: D The instrument generally used to measure intraocular pressure in a scarred cornea is A. Pulse air B. Airpuff C. Tonopen D. Perkins 37 ANSWER: C Which of these anti glaucoma drugs are contraindicated in patients with sulpha allergy? A. Bimatoprost B. Brinzolamide C. Timolol maleate D. Travoprost ANSWER: B Which of these bacterior can penetrate an intact corneal epithelium? A. Listeriamonocytogenes B. Ecoli C. Klebsiella D. Pseudomonas ANSWER: A In contact lens users the most common cause of infection is A. Pneumococcus B. Streptococcus C. Pseudomonas D. Staphylococcus ANSWER: C All are true about arcussenilis except A. Seen in elderly B. Lipoid infiltration in corneal epithelium C. Seen in the corneal stroma D. Clear area between limbus and arcus ANSWER: B Most common type of corneal dystrophy is A. Meesman B. Microcystic C. Macular D. Granular ANSWER: B All of these diagnostic tests are useful in evaluation of a patient with a retained magnetic intraocular foreign body EXCEPT: A. Indirect ophthalmoscopy B. Computed tomography C. Electrophysiology D. Magnetic resonance imaging E. Echography ANSWER: D Which vitreoretinal abnormality is most likely to lead to retinal detachment? A. Lattice with atrophic holes B. Operculated holes C. Acute horseshoe retinal tear D. Meridional complex E. Acute posterior vitreous detachment ANSWER: C In phakic asymptomatic patients, which of the following types of retinal break is almost always treated, while the others are rarely treated? 38 A. Operculated tears B. Lattice degeneration with or without hole C. Retinal dialysis D. Atrophic holes ANSWER: C Blunt trauma may be associated with the development of all of the following EXCEPT: A. Macular hole B. Multiple retinal breaks at the vitreous base C. Retinal dialysis D. Commotio retinae (Berlin’s edema) E. Branch retinal vein occlusion ANSWER: E Which of the following statements describing eyes with retained lens fragments after phacoemulsification is INCORRECT? A. Marked intraocular inflammation is common. B. Secondary glaucoma is caused by lens particles and proteins obstructing the trabecular meshwork. C. The cumulative rate of retinal detachment is approximately 15% in these eyes during follow-up. D. The visual prognosis is generally poor in spite of treatment. ANSWER: D Which of the following complications of panretinal photocoagulation can be caused by excessive treatment? A. Angle-closure glaucoma B. Peripheral visual field loss C. Exudative retinal detachment D. All of the above ANSWER: D Which of the following is LEAST likely to be present in an eye with a purely tractional retinal detachment? A. Concave surface B. Sickle cell retinopathy C. Smooth retinal surface D. Extension of detachment to the midperiphery E. Tobacco dust ANSWER: E Which of the following is most characteristic of exudative retinal detachment? A. Shifting fluid B. Tobacco dust C. Fixed folds D. Equatorial traction folds E. Demarcation lines ANSWER: A Signs of chronic retinal detachment include all of the following EXCEPT: A. Multiple demarcation lines B. Subretinal deposits C. Red vitreous hemorrhage D. Intraretinal cysts ANSWER: C Based on ETDRS reports, which of the following statements regarding the use of aspirin is INCORRECT? A. No effect on visual acuity 39 B. No effect on progression of retinopathy C. No effect on rates of vitreous hemorrhage D. No effect on rates of progression to high-risk PDR E. Significantly increases the rate of vitrectomy for non-clearing vitreous hemorrhage ANSWER: E Based on DCCT reports, which of the following statements is INCORRECT? A. Intensive glycemic control reduced the risk of new-onset diabetic retinopathy. B. Intensive glycemic control reduced the progression of existing diabetic retinopathy. C. Intensive glycemic control reduced the incidence of laser treatment for more severe retinopathy. D. The DCCT results can be applied to all insulin-dependent diabetic patients. E. The DCCT results do not apply to non–insulin-dependent type 2 patients. ANSWER: D As defined by the Diabetic Retinopathy Study, all of the following features are significant in determining the presence of high-risk proliferative diabetic retinopathy EXCEPT: A. The presence of new vessels B. Location of new vessels on or near the optic disc C. The presence of vitreous hemorrhage D. Localized tractional retinal detachment E. Moderate to severe NVE ANSWER: D Regarding aldose reductase in patients with diabetes mellitus, which of the following statements is INCORRECT? A. Aldose reductase is the rate-limiting first enzyme in the polyol pathway. B. Aldose reductase converts glucose into sorbitol. C. Sorbitol accumulation in the crystalline lens may cause lens swelling and cellular damage. D. Aldose reductase has been detected in retinal pericytes and in renal glomeruli. E. Aldose reductase inhibitors have been demonstrated to slow the progression of retinopathy in a large multicenter clinical trial. ANSWER: E The test or sign that appears to be most helpful in predicting the development of iris neovascularization in eyes with ischemic central retinal vein occlusion is A. Increased intraretinal blood B. Pupillary measurements C. Fluorescein angiography D. Electroretinography E. Intraocular pressure ANSWER: C Most eyes with the ocular ischemic syndrome have an ipsilateral carotid artery stenosis of at least A. 25% B. 50% C. 70% D. 90% E. 100% ANSWER: D Carotid endarterectomy has been shown to reduce the incidence of disabling stroke in symptomatic patients with A. Ulcerated carotid plaques B. 0%–29% carotid stenosis C. 70%–99% carotid stenosis 40 D. 100% carotid stenosis E. None of the above ANSWER: C Threshold retinopathy of prematurity consists of A. 8 total, or 5 confluent, clock hours of extra-retinal neovascularization B. Plus disease C. Zone I or II disease D. A and C E. A, B, and C ANSWER: E Which of the following features is NOT characteristic of Coats disease? A. Predominance of males B. Unilaterality C. Exudative response D. Retinal neovascularization E. Idiopathic ANSWER: D Complications of retinal arterial macroaneurysm include A. Exudation B. Retinal arterial obstruction C. Vitreous hemorrhage D. A and C E. A, B, and C ANSWER: E What percent of eyes with acute central retinal artery obstruction have visible emboli in the affected fundus? A. 10% B. 20% C. 50% D. 75% E. 100% ANSWER: B Causes of central artery obstruction include all of the following EXCEPT: A. Hemorrhage under an atherosclerotic plaque B. Dissecting aneurysm C. Emboli D. Thrombi E. Vascular rupture ANSWER: E All of the following statements about cotton-wool spots are true EXCEPT: A. They often cause severe visual loss. B. Diabetic retinopathy is the most common cause. C. They often resolve within 5–7 weeks. D. They are typically indicative of a serious underlying systemic disease. E. They occur secondary to axoplasmic damming in areas of focal retinal ischemia. ANSWER: A Features of the ocular ischemic syndrome include all of the following EXCEPT: A. Ocular pain 41 B. Prolonged recovery following exposure to bright light C. Decreased vision D. 5-year mortality of 40% E. Stroke as the leading cause of death ANSWER: E A reduced and delayed cone b-wave is consistent with all of the following diagnoses EXCEPT: A. Retinitis pigmentosa B. Central retinal vein occlusion C. Cone dystrophy D. Syphilitic chorioretinitis E. Sectorial retinitis pigmentosa ANSWER: E Congenital stationary night blindness (with a normal fundus) is generally characterized by A. Absent off-responses in the retina B. A “negative-type” electroretinogram C. Delayed regeneration of rhodopsin D. Mizuo-Nakamura phenomenon E. A tritan (blue-yellow) color defect ANSWER: B The most critical and constant finding in retinitis pigmentosa is A. Dense bone speckle pigmentation in the retinal periphery B. An abnormality in the rhodopsin gene C. Acquired red-green color deficiency D. A significantly reduced electroretinogram E. Small tubular visual fields ANSWER: D In treating CNV associated with ocular histoplasmosis, the ophthalmologist can decrease the risk of recurrent CNV by A. Using krypton red laser rather than argon green laser B. Using durations of 0.5 seconds C. Covering the entire lesion with laser treatment D. Attaining a uniform white intensity of the area of photocoagulation at least as great as the minimal intensity standard published by the Macular Photocoagulation Study E. C and D ANSWER: E An individual who is born without red-sensitive cone pigment function (protanopia) is likely to A. Have poor visual acuity B. Confuse blue and yellow C. Perceive the long-wavelength portion of the spectrum as being darker than normal D. Manifest photophobia E. Be hypersensitive to green ANSWER: C Primary dysfunction of the cone system (achromatopsia, rod monochromatism) is characterized by all of the following EXCEPT: A. Decrease in visual acuity B. Photophobia C. Absent color discrimination D. Poor night vision 42 E. Nystagmus ANSWER: D A 52-year-old man with a complaint of poor vision for approximately 20 years is seen. Fundus examination reveals well-delineated, atrophic macular areas with some yellowish marginal material. No other family members are available for examination, but he states that his maternal grandfather, his mother, and his maternal uncle also had poor vision, with onset in the mid-30s. Work-up reveals a visual acuity of 20/200 in each eye, central scotoma with full peripheral visual fields, a few errors with the Farnsworth Panel D-15, an electro-oculogram ratio of 1.30, and a normal photopic and scotopic electroretinogram. The most likely diagnosis is A. Central areolar choroidal dystrophy B. Old disciform macular degeneration C. Best disease D. Retinitis pigmentosa E. Stargardt’s disease ANSWER: C Which of the following statements is FALSE in relation to X-linked ocular albinism? A. Iris is translucent. B. Carrier females cannot be detected. C. Macromelanosomes are found in the retinal pigment epithelium. D. Macular hypoplasia is present. E. Nystagmus and reduced vision are features of the disorder. ANSWER: B A bull’s-eye maculopathy is MOST likely to be found in which of the following hereditary macular dystrophies? A. Cone–rod dystrophy B. Vitelliform macular dystrophy C. Central areolar dystrophy D. Stargardt’s disease E. Pericentral retinitis pigmentosa ANSWER: A A normal electroretinogram is usually found in all of the following diseases affecting the retina EXCEPT: A. Vitelliform dystrophy B. Dominant drusen C. Juvenile retinoschisis D. X-linked ocular albinism E. Pattern dystrophy ANSWER: C Laser photocoagulation of subfoveal choroidal neovascularization in age-related macular degeneration has been shown to be successful in certain cases that meet which of the following criteria? A. Evidence of classic CNV B. No evidence of occult CNV C. No evidence of blood D. Well-demarcated boundaries E. A and D only ANSWER: E A 75-year-old patient with AMD and a disciform lesion in one eye and soft drusen with focal hyperpigmentation and 20/30 vision in the fellow eye is best managed by A. Prophylactic krypton red laser therapy to parafoveal drusen B. Self-monitoring with an Amsler grid C. Repeat fluorescein angiography on a tri-monthly basis to detect subretinal neovascularization 43 D. Initiation of systemic vitamin E therapy E. Protection from ultraviolet light ANSWER: B All of the following conditions predispose patients to develop a retinal detachment EXCEPT: A. Lattice degeneration B. Cataract extraction C. Cobblestone degeneration D. Cystic or vitreoretinal tufts ANSWER: C Features of degenerative retinoschisis include A. Relative scotoma B. Superior nasal location C. Frequent retinal detachment D. Two separate peripheral retinal layers identified with scleral depression ANSWER: D All of the following statements about anterior PHPV are correct EXCEPT: A. It must be considered in the differential diagnosis of leukocoria. B. It is unilateral in as many as 90% of cases. C. It is associated with intraocular calcification. D. It has recently been renamed persistent fetal vasculature (PFV). ANSWER: C Permanent visual loss after blunt trauma may be caused by A. Choroidal rupture with or without secondary subretinal neovascularization B. Traumatic pigmentary maculopathy C. Retinitis sclopetaria D. Macular hole E. All of the above ANSWER: E All of the following are signs of shaken baby syndrome EXCEPT: A. Intraretinal hemorrhages B. Retinoschisis cavities C. Lethargy, irritability, seizures, and Hypotonia D. Optic nerve hypoplasia ANSWER: D Sympathetic ophthalmia A. Occurs in approximately 1 in 1500 penetrating injuries B. Never causes permanent loss of sight C. May be avoided by early enucleation of unsalvageable eyes D. Does not cause exudative detachment ANSWER: C Radiation retinopathy A. May occur following external-beam or plaque radiotherapy for choroidal melanoma B. May be seen after radiation therapy of sinus or orbital tumors C. Typically presents with microaneurysms, intraretinal hemorrhages, telangiectasia, and exudation D. May occur after as little as 15 Gy of external-beam radiation E. All of the above ANSWER: E 44 Posterior vitreous detachment is associated with all of the following EXCEPT: A. Flashes and floaters B. Hemorrhages at the vitreous base C. A Weiss ring D. Tobacco dust pigment E. Vitreous hemorrhage ANSWER: D Photodynamic therapy for eyes with neovascular AMD should be considered in cases of A. Subfoveal occult CNV B. Subfoveal classic CNV C. Subfoveal predominantly classic CNV D. A, B, and C E. B and C ANSWER: E Clinical management decisions based on which of the following diagnostic procedures have been shown to affect visual outcomes in randomized clinical trials of patients with CNV? A. Fluorescein angiography B. Indocyanine video-angiography C. Optical coherence tomography D. A and B ANSWER: A In the International Vitreomacular Traction Study Classification system which one of the following is LEAST likely to be correct? A. Classification is based on macula OCT findings B. Full thickness macular holes 10Δ with simultaneous prism and cover testing B. Evidence of central fusion without peripheral sensory fusion C. Evidence of peripheral sensory fusion without central fusion D. Evidence of peripheral sensory fusion without motor fusion ANSWER: C Botulium toxin is an effective treatment for which of the following disorders? A. Ptosis B. Phthisis C. Dry eye D. Essential blepharospasm ANSWER: D Which systemic medication is the most appropriate treatment for an infant with ophthalmia neonatorum secondary to Chlamydia trachomatis? A. Erythromycine B. Doxycycline C. Ofloxacin D. Azithromycine ANSWER: A An 11-year-old patient presents with red, itchy eyes. On examination, gray, jellylike limbal nodules with vascular cores are seen. This is suggestive of what diagnosis? A. Phlyctenular keratoconjunctivitis B. Atopic keratoconjunctivitis C. Vernal keratoconjunctivitis D. Superior limbic keratoconjunctivitis ANSWER: C The majority of congenital glaucoma cases are inherited based on the following pattern: A. Autosomal dominant B. Sporadic C. X-linked recessive D. Autosomal recessive ANSWER: B The mechanism of glaucoma in Sturge-Weber syndrome is A. Increased episcleral venous pressure + B. Angle-closure glaucoma C. Neovascular glaucoma D. Pupillary block glaucoma ANSWER: A A 1-month-old baby is diagnosed with unilateral anterior polar cataract that is approximately 1.5 mm in diameter. The most appropriate initial management is A. Close observation B. Lensectomy C. Lensectomy with intraocular lens implant D. Chronic dilation ANSWER: A A newborn infant with nystagmus is diagnosed with aniridiA. Optic nerve examination is most likely to reveal A. Coloboma 64 B. Pollar C. Hypoplasia D. Swelling ANSWER: C A 12-year-old boy is diagnosed with well-controlled intermittent exotropiA. Stereopsis testing is most likely to reveal A. Monofixation syndrome B. No stereopsis because of temporal hemiretinal suppression C. No stereopsis because of diplopia D. Excellent stereopsis ANSWER: D In which of the following conditions does increased episcleral venous pressure not play a role in elevated IOP? A. Superior Vena cava Syndrome B. Pseudotumor of the orbit C. Thyroid eye disease D. Primary open angle glaucoma ANSWER: D The highest prevalence of angle closure glaucoma is found in which of the following? A. Individual of Asian Ancestry B. Individual of African ancestry C. Individual of European Ancestry D. The Alaskan Inuit ANSWER: D Which of the follow risk factors is probably the least significant for POAG? A. Myopia B. Race or Ethnic C. Family History D. Level of IOP ANSWER: A Factor that may increase IOP include all of the following except: A. Valsava Maneuver B. Aerobic Exercise C. Ketamine D. Blepharospasm ANSWER: B The measurement of IOP: A. Can be obtained via applanation methods, which are based on the Imbert-Fick Principle B. Shows almost no variation throughout the day C. Using applanation puts the patient at significant risk of permanent cornea damage D. Is not affected by cornea edema, as long as the patient is lying down ANSWER: A Which of the following is an accurate statement about IOP? A. IOP is distributed normally when measured in large epidemiologic studies. B. IOP varies 2-6 mmHg in individual without glaucoma over the course of 24hours C. IOP is often transiently increased following alcohol consumption D. IOP is linearly related to central cornea thickness. ANSWER: B 65 During automated static perimetry, a patient responds when no stimulus is presenteD. What type of error Is this? A. Short term fluctuation B. Fixation loss C. False-negative error D. False-positive error ANSWER: D The optic nerve finding most suggestive of glaucoma is A. Asymmetry of the cups B. Progressive enlargement of the cup C. Generalized pallor D. Exposed Laminar cribrosa (Lamina dot sign) ANSWER: B What is the mode of inheritance of Axenfeld-Reiger syndrome? A. X linked B. Sporadic C. Autosomal recessive D. Autosomal dominant ANSWER: D Which ocular condition is associated with an increased risk of complications with cataract surgery? A. Ocular hypertension B. Exfoliation syndrome C. Pigment dispersion syndrome D. Angle recess ANSWER: B According to OHTS, which one of the following is associated with an increased risk of converting from ocular hypertension to POAG? A. A history of diabetic mellitus B. Decreasing age C. Smaller cup disc ratio D. Lower central cornea thickness ANSWER: D Which multiple randomized clinical trial evaluated the long-term effect of treating patient with newly diagnosed OAG with trabeculectomy versus medical therapy? A. Early manifest glaucoma trial (EMGT) B. Collaborative initial glaucoma treatment study (CIGTS) C. European Glaucoma Prevention study (EGPS) D. Ocular hypertension treatment study (OHTS) ANSWER: B Which glaucoma is caused by the leakage of lens proteins through the capsule of a mature or hypermature cataract? A. Phacomorphic glaucoma B. Lens particle glaucoma C. Ectopia lentis D. Phacolytic glaucoma ANSWER: D Which of the following is the best method to determine whether a patient is at risk of angle closure? A. Gonioscopy B. Darkroom prone position test 66 C. Pharmacological pupillary dilation D. Darkroom test ANSWER: A In which of the following is peripheral iridotomy is the treatment of choice? A. Secondary angle closure following dense Pan retinal Photocoagulation B. Iridocorneal Endothethelial dystrophy C. Phacoanaphylactic glaucoma D. Phacomorphic Glaucoma ANSWER: D A 14 years old boy with bilateral iris atrophy and corectopia is found to have elevated IOPs. His father has a similar condition. Which of the following is the most likely diagnosis? A. ICE Syndrome B. Lowe Syndrome C. Axenfeld-Reiger Syndrome D. Hallermann-Streiff syndrome ANSWER: C What anatomical modification is found in increased frequency in primary congenital glaucoma? A. Increased axial Length B. Hyperopia C. Hypoplastic optic nerve D. Decreased corneal diameter ANSWER: A Mutation in the TIGR/Myocilin gene are associated with which of the following disorders? A. Pigment dispersion syndrome B. Pseudoexfoliation syndrome C. Juvenile OAG D. Nanophthalmos ANSWER: C Which of the following medication is contraindicated in the treatment of glaucoma in a toddler? A. Dorzolamide B. Latanoprost C. Brimonidine D. Timolol ANSWER: C Which of the following is the preferred initial surgical procedure for an infant with primary congenital glaucoma and corneal clouding? A. Goniotomy B. Trabeculectomy C. Cyclophotocoagulation D. Trabeculotomy ANSWER: D In marfan syndrome the lens is displaced A. into the anterior chamber B. downward and outward C. upwards and outward D. downward and inward ANSWER: C The wavelength of ND-YAG laser is 67 A. 532nm B. 1064nm C. 840nm D. 647nm ANSWER: B Which is not an ocular feature of Down’s syndrome? A. Mongoloid slant B. Iris Hypoplasia C. Cataract D. Aniridia ANSWER: D Features of Crouzon’s Syndrome are all except: A. Syndactyly B. Mutation in FGFR2 gene C. Proptosis D. V Pattern Exotropia ANSWER: A Nevus Flammeus is associated with A. Von Recklinghausen’s Disease B. Tuberous Sclerosis C. Sturge Webber Syndrome D. Coat’s Disease ANSWER: C The commonest primary orbital tumor in children is A. Optic nerve glioma B. rhabdomyosarcoma C. orbital lymphoma D. optic nerve shealth meningioma ANSWER: B When a small target oscillated In front of a patient with binocular vision is seen the move in an elliptical rather to and fro path, the phenomenon is called: A. Oppenhein phenomenon B. Pulfrich phenomenon C. Uthoff phenomenon D. Paroxysmal Covergence spasm ANSWER: B Which of these is found in excess of aqueous humor compared to blood A. Ascorbic Acid B. Lactic Acid C. Glutathione D. Sorbitol ANSWER: B Which structure does not develop from Neural ectoderm A. Tarsal gland B. retina C. smooth muscle of iris D. optic cup 68 ANSWER: A An inert intraocular Foreign body is A. Copper B. iron C. nickel D. Platinum ANSWER: D A 75 years old diabetic presented with sudden loss of vision in one eyE. Fundus examination showed multiple flame shaped hemorrhage in retinA. Probable diagnosis is: A. Central retinal Vein occlusion B. Retinal detachment C. Proliferative retinopathy D. Cystoid macular edema ANSWER: A photo stress test is performed to diagnose A. Macular disease B. Optic Nerve disease C. Glaucoma D. Nerve Conduction ANSWER: A Prominent Corneal nerve are a feature of all except A. Acanthamoeba keratitis B. Keratoconus C. Fuch Endothelial dystrophy D. Mycotic Keratitis ANSWER: D Which of the following is a dystrophy involving bowman layer of cornea? A. Granular dystrophy of groenouwe B. Meesman Corneal dystrophy C. Thielbehnke Corneal dystrophy D. gelatinous drop like cornea dystrophy ANSWER: C Following are associations of Goldenhar syndrome except: A. limbal dermoid B. Mandibular hypoplasia C. microtia D. tower skull ANSWER: D the optic nerve head in the region of lamina cribrosa is supplied by A. branches from recurrent cilary artery B. Cilioretinal artery C. branch of posterior cilary artery D. (A. and (c) ANSWER: C Paralysis of lateral rectus, ipsilateral facial palsy and contralateral hemiplegia is seen in: A. foville syndrome B. benedicts syndrome 69 C. milardgurbler syndrome D. webers syndrome ANSWER: C The thin elastic membrane lining the inner side of choroid is A. epiretinal membrane B. lamina vitrea C. lamina fusca D. lamina papyracea ANSWER: B a child with retinitis pigmentosa has a bird shaped head and normal pressure hydrocephalus, probable diagnosis is A. Kearne Sayre syndrome B. Usher syndrome C. Cockayne syndrome D. Bassen-Kornzewig syndrome ANSWER: C Approximate number of retinal photoreceptors cell A. 1 million B. 25 million C. 10 million D. 125million ANSWER: D which is not true of the parvocellular type of retinal ganglion cells? A. they are color sensitive B. predominantly seen in macular region C. transmit motion related information D. cells have thinner axons of small calibre ANSWER: C the normal resolution of visual acuity level of 6/6 is attained at the age of A. 6 years B. 4 years C. 3 years D. 8 years ANSWER: A Weber’s syndrome is A. ipsilateral 3rd nerve palsy and jerky movement of contralateral side B. ipsilateral 6th and 7th nerve palsy and contralateral hemiplegia C. ipsilateral 6th nerve palsy, tinnitus, deafness and nystagmus D. ipsilateral 3rd nerve palsy, contralateral hemiplegia and UMN facial palsy ANSWER: D Which is not a viscoelastic? A. 1% sodium hyaluronate B. 3% methyl cellulose C. 5% acetyl cysteine D. 2% hypermellose ANSWER: C Contrast sensitivity is affected in 70 A. diabetic retinopathy B. optic neuritis C. myopia D. astigmatism ANSWER: B The average corneal endothelial cell count is A. 2000/mm2 B. 1800/mm2 C. 3500/mm2 D. 2800/mm2 ANSWER: D Adies’ tonic pupil A. is smaller than its fellow B. does not dilate with atropine C. constrict with 0.1% pilocarpine drops D. does not react to light ANSWER: C Which of these help in visualization of corneal cells? A. Confocal microscope B. Optic coherence tomography C. Pachymetry D. Slit lamp biomicroscope. ANSWER: A All are features of Behcet’s disease except A. Significant association with HLA B27 antigen B. Orogenital ulceration C. Obliterative retinal vasculitis D. Hypopyon uveitis ANSWER: A Conjunctival mucous is deficient in all these conditions except: A. Old trachoma B. Steven Johnson syndrome C. Ocular pemphigoid D. Sjogrens syndrome ANSWER: D Following are examples of direct goniolenses except A. Koeppe B. Barkan C. Zeiss D. Swan Jacob ANSWER: C Which is not a feature of keratomalacia? A. Necrosis and melting of cornea B. Inflamed eye C. Is a cause of childhood blindness D. Seen in protein energy malnutrition ANSWER: B 71 To maintain a normal transparency of cornea, the endothelial cell count should be at least A. 1000/mm2 B. 2300/mm2 C. 500/mm2 D. 2000/mm2 ANSWER: C Which is not a feature of Stargardts’ disease? A. Progressive tapetoretinal dystrophy B. Beaten bronze appearance of fovea C. Dark adaptation affected D. Leakage of dye on fluorescein angiography ANSWER: D Acute retinal necrosis is caused mainly by A. Varizella zoster B. Cytomegalo virus C. Syphilis D. Leptospira ANSWER: A Which holds true for congenital retinoschisis? A. Splitting of retina at outer plexiform layer B. Sparing of fovea C. Splitting of retina in the nerve fibre layer D. Extends up to ora serrata ANSWER: C Which of these materials is deposited in the neurons in Taysachs’ disease? A. Lipofuscin B. Sphingomyelin C. Ceroid D. Ganglioside Gm2 ANSWER: D Which does not hold true for central serous choroidopathy? A. Smoke stack appearance of FFA B. Ink blot appearance on FFA C. Flower petal appearance on FFA D. Vision correctable by convex lenses ANSWER: C All statements hold true for retinal tamponade using silicon oil except A. Produces secondary glaucoma B. Expands with changing atmospheric pressure C. To be removed after 8-12 weeks D. Reduces tendency for proliferative vitreoretinopathy ANSWER: B Which is the faise statement regarding Lebers congenital amaurosis? A. Blindness in early infancy B. Mutation in RPE65 gene C. Coarse nystagmus D. Autosomal dominant inheritance 72 ANSWER: D All are true of homocystinuria except A. Disorder of methionine metabolism B. Severe myopia C. Ectopia lentis D. Autosomal dominant inheritance ANSWER: D Lisch nodule in iris is seen in A. Syphilis B. Sturge weber syndrome C. Von-hippel-lindau syndrome D. Neurofibromatosis ANSWER: D Which of these statements hold true for basal cell carcinoma of the lids? A. Spreads to local lymph nodes B. Commonest malignant tumour of the lids C. Predilection for the lower lid D. Cryotherapy is the treatment of choice ANSWER: B Congenital anomalies of the optic disc include all except: A. Coloboma B. Drusen C. Hypoplasia D. Medullated nerve fibres ANSWER: D Normally retinal fibres are: A. Medullated B. Non-medullated C. Medullated in childhood and become non- medullated in old age D. Non-medullated in childhood but become medullated in old age ANSWER: B All of the following are true for medullated nerve fibres of the retina except: A. Appear as a whitish patch usually present around the disc B. Are commonly seen at birth in premature children C. Disappear in patients with optic atrophy D. May cause enlargement of blind spot ANSWER: B All of the following are features of central retinal artery occlusion except: A. Marked narrowing of retinal arterioles B. ‘Cherry red spot’ at macula C. Retinal oedema D. Multiple superficial haemorrhages ANSWER: D The most common site of obstruction in central retinal artery is: A. In front of the lamina cribrosa B. At the lamina cribrosa C. Behind the lamina cribrosa 73 D. The point where the artery enters the optic nerve ANSWER: B Dot and blot (round) retinal haemorrhages are situated at the level of: A. Ganglion cell layer B. Nerve fibre layer C. Inner nuclear layer D. Outer plexiform layer ANSWER: D Risk factors for development of diabetic retino pathy include: A. Duration of diabetes B. Heredity C. Pregnancy D. All of the above ANSWER: D Diabetic retinopathy is essentially an angiopathy affecting retinal: A. Precapillary arterioles B. Capillaries C. Venules D. All of the above ANSWER: D All of the following are true for anaemic retinopathy except: A. Occurs when haemoglobin level falls below 5 gm percent B. Arterioles become pale C. Veins are pale and narrow D. Superficialretinalhaemorrhagesandsubhyaloid haemorrhage are seen invariably ANSWER: C Is not true about soft exudates (cotton wool patches on retina): A. Are a sign of retinal hypoxia B. Formed due to swelling of nerve fibre layer C. Frequently change their shape D. In late stages are converted into hard exudates ANSWER: D Hard exudates are seen in the following except: A. Hypertensive retinopathy B. Diabetic retinopathy C. Leukemic retinopathy D. Exudative retinopathy of Coat’s ANSWER: C All of the following are true for retinopathy of prematurity except: A. Occurs in premature infants due to late crying B. Due to hypoxia there occurs neovascularization followed by fibroproliferation C. End result is bilateral blindness D. Blindness can be prevented by early diagnosis and ablation of vascular premature retina with cryotherapy or photocoagulation ANSWER: A Most common mode of inheritance for retinitis pigmentosa is: A. Autosomal recessive 74 B. Autosomal dominant C. Sex linked D. None of the above ANSWER: A Following are the ocular association of retinitis pigmentosa except: A. Myopia B. Primary angle closure glaucoma C. Microphthalmos D. Conical cornea ANSWER: B Retinitis pigmentosa forms a constituent of all the following syndromes except: A. Lowe’s syndrome B. Refsum’s syndrome C. Usher’s syndrome D. Hallgren’s syndrome ANSWER: A All of the following are causes of night blindness except: A. Retinitis punctate albescens B. Choroideremia C. Retinitis pigmentosa D. Retinitis of Roth ANSWER: D ‘Bull’s eye’ lesion in macular region is seen in: A. Progressive cone dystrophy B. Choroquine maculopathy C. Both of the above D. None of the above ANSWER: C Cherry red spot at macula is seen in all of the following except: A. Tay-Sach’s disease B. Letterer-Siwe disease C. Niemann-Pick disease D. Commotio retinae ANSWER: B Photoretinitis results from: A. Infra-red rays of sunlight B. Ultraviolet rays of sunlight C. Both of the above D. None of the above ANSWER: A Spontaneous regression of proliferative retinopathy may occur in: A. Diabetic retinopathy B. Proliferative sickle retinopathy C. Retinopathy of prematurity D. All of the above E. None of the above ANSWER: D 75 In central serous retinopathy, in the macular region, there occurs: A. Spontaneous detachment of neuro-sensory retina B. Macular oedema C. Detachment of pigment epithelium D. Detachment of choroid ANSWER: A Macular scar is formed in which of the following diseases: A. Papillitis B. Hypertension C. Neuroretinitis D. Papilloedema E. All of the above ANSWER: E In cystoid macular edema fluid collects in the macular region at the level of: A. Outer nuclear layer B. Outer plexiform layer C. Inner plexiform layer D. Between pigment epithelium and neurosensory retina ANSWER: B In cystoid macular edema, basic defect is: A. Breakdown of inner blood retinal barrier B. Breakdown of outer blood retinal barrier C. Increased permeability of the choriocapillaris D. All of the above ANSWER: A Retinal degenerations predisposed to retinal detachment include all of the following except: A. Lattice degeneration B. Snail track degeneration C. Focal pigment clumps D. Pavingstone degeneration ANSWER: D All of the following are the causes of exudative retinal detachment except: A. Retinopathy of toxaemia of pregnancy B. Retinopathy of prematurity C. Exudative retinopathy of Coats D. Sympathetic ophthalmia ANSWER: B Shifting fluid is pathognomonic of: A. Solid retinal detachment B. Rhegmatogenous retinal detachment C. Tractional retinal detachment D. Choroidal detachment ANSWER: A All of the following are true about incidence of retinoblastoma except: A. Is the most common intraocular tumour of childhood B. Occurs in 1 in 14000–34000 live births C. No sex predisposition