Optometry Review Question and Answers PDF

CHAPTER 15 Posterior Segment Diseases Questions 1. Anatomically, what is the approximate length o the 5. Myelination is MOS COMMONLY associated with intraorbital portion o the...

CHAPTER 15 Posterior Segment Diseases Questions 1. Anatomically, what is the approximate length o the 5. Myelination is MOS COMMONLY associated with intraorbital portion o the optic nerve? which o the ollowing sections or regions o the optic nerve? (A) 1 mm (B) 14 to 20 mm (A) Nerve iber layer (C) 4 to 10 mm (B) Prelaminar region (D) 25 to 30 mm (C) Laminar region (D) Retrolaminar region 2. All o the ollowing are true concerning the physio- logical cupping o the optic disc EXCEP : 6. Which o the ollowing anatomical structures is NO associated with the human pupil photic pathway? (A) Widely variable between patients (B) Less than 0.2 asymmetry is acceptable (A) Optic tract (C) Increase with age is acceptable (B) Lateral geniculate body (D) Fellow eye utilized or comparison (C) Superior colliculus (D) Pretectal nucleus 3. Which o the ollowing statements is FALSE concern- ing the vascular supply o the optic nerve head? 7. Which is FALSE concerning an a erent pupillary de ect? (A) ONH mostly supplied by the central retinal artery (A) Pathognomonic or an optic nerve conduction (B) CRA normally traverses lamina cribrosa as one de ect vessel (B) Also called a Marcus Gunn pupil (C) CRV normally traverses lamina cribrosa as one (C) Requires the swinging lashlight test vessel (D) Comparison o pupillary responses between (D) ONH bold supply is highly both eyes compartmentalized 8. Which o the ollowing conditions involving the optic 4. Which o the ollowing anatomical sections o the nerve DOES NO usually present with a red-green optic nerve head is associated with the border tissue color de ect? o Elschnig? (A) Optic neuropathy (A) Sur ace layer (B) Optic nerve and visual pathway disease (B) Prelaminar region (C) Leber’s optic atrophy (C) Laminar region (D) Glaucoma (D) Retrolaminar region 201 202 Lange Q&A Optometry Review: Basic and Clinical Sciences 9. All o the ollowing are true concerning the light 14. All o the ollowing are characteristics o congenital comparison test EXCEP : macrovessels EXCEP : (A) Utilizes white light (A) Single, abnormally large retinal vessel (B) Comparison o intensity o light between the (B) Usually a retinal vein two eyes (C) Usually traverses the macula to service both (C) A ected eye sees a lower intensity o light sides o the horizontal raphe (D) ypically more reliable (sensitive) than the red (D) Arteriovenous communications have not been cap test associated 10. Which o the ollowing neurological signs is LEAS 15. Racemose angioma is a rare variant o which o the LIKELY associated with demyelinating disease? ollowing congenital retinal conditions? (A) Uhtho ’s sign (A) Macrovessels (B) L’Hermitte’s sign (B) Prepapillary loops (C) Pain on eye movement (C) Cilioretinal vessels (D) Walking heel to toe (D) Persistent hyaloid artery 11. All o the ollowing are true concerning a persistent 16. O the ollowing statements, which is FALSE con- hyaloidal artery EXCEP : cerning cilioretinal vessels? (A) Also called Bergmeister’s papillae (A) Usually a retinal arteriole (B) Incomplete regression o the hyaloid artery and (B) Derived primarily rom the central retinal glial sheath artery (C) 3% incidence in premature in ants (C) 90% are located temporally on the disc (D) ypically a white, glial appearance (D) Incidence o approximately 20% o eyes by ophthalmoscopy 12. Which o the ollowing characteristics is FALSE con- cerning congenital prepapillary vascular loops? 17. All o the ollowing are clinical signs o myelinated nerve bers EXCEP : (A) Majority are arterial (B) Usually bilateral (A) Super icial, white patches on the retina (C) Usually asymptomatic (B) Feathery peripheral edges noted (D) Usually benign and stable (C) May produce localized, absolute visual ield de ects 13. Which o the ollowing is NO a complication o (D) Usually noted continuous with the optic disc a typically noted congenital prepapillary vascular loop? 18. Which o the ollowing is LEAS associated with choroidal crescents? (A) Amaurosis ugax (A) Myopia (B) Vitreal hemorrhage (B) Atrophy (C) BRVO (C) Choroiditis (D) BRAO (D) Choroidal sclerosis  Posterior Segment Diseases 203 19. T e MOS COMMONLY reported symptom asso- 24. Which o the ollowing is NO a characteristic o ciated with choroidal and scleral crescents is: optic nerve coloboma? (A) Decreased VA (A) De ined as a missing part or tissue (B) Relative visual ield de ects (B) May a ect the optic disc alone (C) No symptoms reported (C) Does not involve adjacent retina and choroid (D) Metamorphopsia (D) Autosomal dominant heredity pattern noted in some cases 20. Which o the ollowing is NO associated with con- genital malinsertion o the optic nerve head? 25. Clinical signs o optic nerve coloboma include all o the ollowing EXCEP : (A) Oblique insertion through scleral canal (B) Vertical oval optic disc (A) Large, white excavation noted an optic disc (C) Nasal rim appears elevated (B) Abnormal blood vessel pattern noted (D) Nasal scleral crescent common (C) Usually in erior disc involvement (D) Over 50% incidence o rhegmatogenous retinal 21. O the listed clinical signs, which is LEAS consistent detachment with a diagnosis o true tilted disc syndrome? 26. Which o the ollowing is FALSE concerning retino- (A) Horizontal oval optic disc choroidal coloboma? (B) Scleral crescent common (C) Superior or superior nasal staphyloma noted (A) May occur as an isolated chorioretinal de ect (D) Relative temporal or bitemporal visual ield (B) May occur as multiple chorioretinal de ects de ect noted (C) Does not extend to involve the optic disc (D) May be unilateral or bilateral in presentation 22. Which o the ollowing is FALSE concerning con- genital peripapillary staphyloma? 27. All o the ollowing are clinical signs o retinochoroi- dal coloboma EXCEP : (A) Relatively uncommon condition (B) Usually unilateral presentation (A) O ten large, white chorioretinal de ect with (C) Believed caused by a ailure o posterior sclera distinct borders to develop (B) May or may not present with pigmentation (D) Strong association with retinal detachment (C) ypically in erior or in erior-nasal retina involvement 23. All o the ollowing clinical signs are associated with (D) Nonrhegmatogenous retinal detachment o ten congenital peripapillary staphyloma EXCEP : associated (A) Vertical oval optic disc 28. Approximately, what percent o morning glory disc (B) Peripapillary retina and choroid show atrophic anomalies are complicated by a serous, nonrheg- pigmentary changes matogenous retinal detachment? (C) Associated with high myopia in the a ected eye (A) 25% o all cases (D) Staphylomatous excavation o generally − 8 to (B) 33% o all cases − 20 D (C) 50% o all cases (D) 75% o all cases 204 Lange Q&A Optometry Review: Basic and Clinical Sciences 29. Which o the ollowing is FALSE concerning morning 35. Pseudopapilledema secondary to optic nerve head glory disc anomaly? drusen is associated with all o the ollowing clinical ndings EXCEP : (A) Possible variant o optic nerve coloboma (B) Usually bilateral presentation (A) Indistinct optic disc margins (C) rue etiology unknown (B) Optic disc edema evident (D) A ected optic disc is typically larger than una - (C) Vessels clearly visible on the sur ace o the ected optic disc optic disc (D) Loss o the optic nerve physiological cup 30. All o the ollowing are true concerning optic pits EXCEP : 36. All o the ollowing are true concerning dominant juvenile optic atrophy EXCEP : (A) Usually bilateral presentation (B) No de initive heredity pattern evident (A) Relatively rare condition (C) Commonly located on the temporal rim o the (B) Least common o the heredo amilial optic optic disc atrophies (D) Cilioretinal artery association common (C) Usually bilateral, but o ten asymmetric presentation 31. Visual eld de ects have been associated with congeni- (D) Usually insidious onset between 4 and 8 years tal optic pits in: o age (A) 20% o cases 37. Which o the ollowing clinical sings is NO asso- (B) 40% o cases ciated with recessive congenital—early in antile optic (C) 60% o cases atrophy? (D) 80% o cases (A) Marked temporal pallor o the optic discs 32. Unilateral cases o optic nerve hypoplasia demonstrate (B) Nystagmus usually evident which o the ollowing sexual predilections? (C) ERG indings typically normal (D) Severe dyschromatopsia noted (A) 25% male (B) 50% male 38. Which o the ollowing is FALSE concerning Leber’s (C) 75% male hereditary optic atrophy? (D) No sexual predilection (A) Also called Leber’s disease 33. Which o the ollowing is NO a characteristic o optic (B) Classically, autosomal recessive heredity pattern nerve hypoplasia? noted (C) Predominantly males a ected (A) Small, o ten pale disc (D) ypically, age o onset between 18 and 30 years (B) Partial or total double ring sign (C) ypically abnormal retinal vascular pattern noted 39. Which o the ollowing clinical signs is NO associ- (D) Strabismus common ated with acute Leber’s hereditary optic atrophy? (A) Bilateral presentation 34. Which o the ollowing is FALSE concerning optic nerve head drusen? (B) Elevated, swollen optic disc (C) No retinal involvement noted (A) Unrelated to retinal drusen (D) ypically accompanied with headache (B) Irregular autosomal dominant heredity pattern noted (C) Bilateral presentation common (D) Most common is black patients  Posterior Segment Diseases 205 40. What is the MOS common etiology or an acute 46. A 63-year-old emale with hypertension presents with in ammatory optic neuropathy? sudden, painless loss o vision in one eye. Fundus examination reveals a swollen disc with associated (A) In ection multiple ame-shaped hemorrhages in the a ected (B) Demyelination eye. What is the MOS appropriate diagnosis? (C) Compression (A) Papilledema (D) Idiopathic (B) Arteriosclerotic ION 41. Which o the ollowing optic neuropathies is MOS (C) Pseudotumor cerebri LIKELY to a ect children? (D) Papillitis (A) Neuroretinitis 47. What is the MOS common laboratory test utilized (B) Retrobulbar optic neuritis to di erentiate arteritic AION rom nonarteritic (C) Papillitis AION? (D) Ischemic optic neuropathy (A) CBC with di erential 42. Clinical signs o retrobulbar optic neuritis include all (B) Cholesterol pro ile o the ollowing EXCEP : (C) Sedimentation rate (D) riglyceride pro ile (A) Disc edema with or without hemorrhage (B) Positive Marcus Gunn pupil 48. Which o the ollowing is FALSE concerning diabetic (C) Positive red cap test AION? (D) Central/paracentral scotomata (A) Also called diabetic papillopathy 43. Demyelinating optic neuropathy typically involves (B) Small vessel disease o the optic disc which anatomical portion o the optic nerve? (C) Considered a result o microangiopathy (D) ypically older, type 2 diabetic patients appear (A) Nerve iber layer susceptible (B) Prelaminar (C) Laminar 49. All o the ollowing are clinical signs o papillophlebitis (D) Retrobulbar EXCEP : (A) Variable lame-shaped hemorrhages 44. Which o the ollowing clinical signs and symptoms is MOS o ten associated with demyelinating optic (B) Dilated, tortuous retinal arteries neuropathy? (C) Variable disc edema (D) Collateral vessel ormation later (A) Negative Marcus Gunn pupil (B) Negative red cap test 50. What is the classical visual eld de ect commonly (C) Negative Uhtho ’s sign associated with nutritional and alcohol–tobacco (D) Negative undus signs amblyopia? (A) Centrocecal 45. Which o the ollowing is FALSE concerning idio- pathic (nonarteritic) ischemic optic neuropathy? (B) Arcuate (C) Altitudinal (A) ypically one attack per eye (D) Paracentral (B) Peak incidence at 60 to 70 years o age (C) In arction o retrobulbar optic nerve (D) Approximately 40% second eye involvement 206 Lange Q&A Optometry Review: Basic and Clinical Sciences 51. T e MOS bene cial therapeutic measure you can 57. All o the ollowing are true pertaining to the embryo- take with an acute toxic optic neuropathy is: logical development o the human retinal vasculature EXCEP : (A) Medical consult or possible anemia (B) B-complex vitamin supplements (A) Cords o mesenchymal cells invade super icial (C) Elimination o o ending substance retina (D) High-protein diet (B) Di erentiate into epithelial cells (C) Channelize to orm capillaries 52. Which o the ollowing is FALSE concerning true (D) Capillaries undergo remodeling to orm arteries papilledema? and veins (A) Secondary to increased intracranial pressure 58. All o the ollowing are characteristics o retinal veins (B) ypically unilateral presentation EXCEP : (C) ypically develops slowly over days (A) hin walled (D) Vascular and mechanical pathogenesis theories (B) Abundant elastic tissue 53. What is the classical visual eld de ect MOS o ten (C) Blood–retinal barrier associated with acute, ully developed papilledema? (D) No insulating glial membrane present (A) Centrocecal 59. Which o the ollowing retinal areas is NO devoid (B) Arcuate o retinal capillaries? (C) Altitudinal (A) Ora serrata (D) Enlarged blind spot (B) Perivascular 54. Which o the ollowing is NO a clinical sign o (C) Fovea chronic papilledema? (D) Peripapillary (A) Physiological cup re orms 60. Which o the ollowing is FALSE concerning peripheral (B) Optic disc edema resolves capillary dropout with age? (C) Hemorrhages and exudates resolve (A) Expected involutional retinal change (D) Optic atrophy ensues (B) Results rom loss o pericytes 55. Which o the ollowing clinical signs is NO associ- (C) Causes adjacent veins to dilate, orm collaterals ated with an optic nerve melanocytoma? and microaneurysms (D) Appears as isolated dot–blot hemorrhages in ar (A) Elevated lesion retinal periphery (B) Black lesion (C) No nerve iber layer involvement 61. Which o the ollowing is FALSE concerning the (D) Possible disc edema choriocapillaris? (A) rue capillary bed o choroid 56. All o the ollowing are true concerning retinoblas- toma EXCEP : (B) Larger than retinal capillaries (C) Non enestrated capillary structure (A) Primary ocular tumor (D) Receives blood rom anterior and posterior (B) Undi erentiated neuroglial cells ciliary arteries (C) Highly malignant (D) Considered congenital  Posterior Segment Diseases 207 62. Which o the ollowing is NO a characteristic o the 68. All o the ollowing are true concerning retinal tran- human choroid? sudates EXCEP : (A) Multilayered structure (A) Readily noted with ophthalmoscopy (B) Devoid o immune cells (B) Large serum component (C) Sympathetic-like nerve control (C) Minimal protein component (D) Eliminates heat rom light absorption o the RPE (D) Minimal lipoprotein component 63. What characteristic is NO commonly associated 69. Which blood plasma component is considered respon- with human retinal vessels? sible or retinal hard exudate ormation? (A) Flow rate astest in center o vessel (A) Serum (B) Vessels dilate with hypoxia (B) High molecular weight proteins (C) Vessels constrict with hyperoxia (C) Lipoproteins (D) Sympathetic-like innervation (D) White blood cells 64. All o the ollowing are true pertaining to preretinal 70. Which o the ollowing is FALSE concerning retinal hemorrhages EXCEP : cotton wool spots? (A) Lie immediately inner to the internal limiting (A) rue retinal exudate membrane (B) Lie within the nerve iber layer (B) Super icial capillary bed involvement (C) Focal retinal capillary in arct (C) ypically ound within the posterior pole (D) ypically within posterior pole (D) Resolve without retinal compromise 71. Which o the ollowing posterior segment anomalies 65. Which o the ollowing is FALSE concerning ame- is associated with retinal cytoid bodies? shaped retinal hemorrhages? (A) Dot–blot retinal hemorrhage (A) Lie within the nerve iber layer (B) Retinal transudate (B) Super icial capillary bed involvement (C) Circinate hard exudate (C) ypically ound within the posterior pole (D) Retinal cotton wool spot (D) Commonly associated with reduced VA 72. All o the ollowing are true concerning retinal micro- 66. Which o the ollowing is RUE concerning retinal aneurysms EXCEP : dot–blot hemorrhages? (A) ypically less than 60 µm in diameter (A) Lie deep between the photoreceptor and RPE (B) Usually not visible without FA layers (C) Microscopic ballooning o a capillary wall (B) Deep capillary bed involvement (D) Leakage stops spontaneously within 1 to (C) Associated with arterial based diseases 2 months (D) ypically ound within the mid-periphery 73. Which o the ollowing is FALSE pertaining to retinal 67. Which o the ollowing ocular posterior segment macroaneurysms? hemorrhages o ten ail to resorb without trace or (A) Focal ballooning o a retinal vein or venule complications? (B) Leakage very common (A) Preretinal (C) ypical age o onset between 50 and 80 years (B) Flame shaped (D) Strong association with systemic hypertension (C) Dot–blot (D) Vitreal 208 Lange Q&A Optometry Review: Basic and Clinical Sciences 74. Which o the ollowing is RUE concerning congeni- 80. Which retinal vein branch is MOS o ten involved tal para oveal telangiectasia? in BRVO? (A) Usually bilateral presentation (A) Superior nasal (B) Increased incidence in emales (B) In erior nasal (C) ypically late-li e onset (C) Superior temporal (D) Decreased VA secondary to macular edema (D) In erior temporal 75. Which o the ollowing statements concerning retinal 81. Which o the ollowing clinical signs is typically NO collateral vessels is FALSE? associated with a nonischemic BRVO? (A) ypically adjacent to areas o nonper usion (A) Dilated, tortuous veins (B) Response to retinal ischemia (B) Dot–blot hemorrhages (C) ypically leak plasma components (C) Flame-shaped hemorrhages (D) ypically located at the level o the deep (D) Intraretinal edema capillary beds 82. Retinal neovascularization is associated with BRVO 76. All o the ollowing are true concerning retinal neo- in what percent o cases? vascularization EXCEP : (A) 10% (A) ypically ound on super icial retina (B) 20% (B) Seldom associated with ibrosis (C) 30% (C) Pathogenesis remains controversial (D) 40% (D) hin, ragile blood vessels 83. Which o the ollowing is NO involved in the 77. Which o the ollowing is NO considered an etiology etiology o a CRVO? or acquired venous sheathing? (A) Arteriolar sclerosis (A) Multiple sclerosis (B) Hypertension (B) Sarcoidosis (C) Diabetes (C) Pars planitis (D) Cardiovascular disease (D) Arteriosclerosis 84. Which o the ollowing clinical signs is typically NO 78. Dilated undus examination o an asymptomatic patient associated with venous stasis retinopathy according to reveals no pathology except or thin, cream colored Hayreh? peripheral vessels OD and OS. What would be the (A) Decrease in IOP most appropriate laboratory test to order on this patient? (B) Cotton wool spots (A) Serum cholesterol (C) Dot–blot hemorrhages (B) Serum triglyceride (D) Dilated, tortuous veins (C) CBC with di erential (D) F A-abs 85. A Hollenhorst plaque consists o which o the ollow- ing materials? 79. T e MOS common cell type associated with idio- (A) Platelet– ibrin pathic epiretinal membranes is: (B) Calcium (A) Collagen (C) Cholesterol (B) Glial (D) alc (C) Fibrin (D) RPE  Posterior Segment Diseases 209 86. All o the ollowing are clinical signs o a BRAO 92. Studies o juvenile insulin dependent diabetics reveal EXCEP : what percent incidence o retinopathy over 30 years? (A) Narrowing o a ected arteriole distal to in arct (A) 70% (B) A ected region o retina appears hazy white (B) 80% (C) Causative emboli usually not observed (C) 90% (D) Segmental optic atrophy later (D) 100% 87. Which o the ollowing is FALSE concerning CRAO? 93. All o the ollowing are clinical signs o mild nonpro- li erative diabetic retinopathy EXCEP : (A) O ten milky white appearance o retina (B) Generalized attenuation o arterioles (A) Microaneurysms (C) otal optic atrophy later (B) Dot–blot hemorrhages (D) Retinal neovascularization common (C) Hard exudates (D) Cotton wool spots 88. All o the ollowing are considered characteristic o sclerotic hypertensive retinopathy EXCEP : 94. Background (mild nonproli erative) diabetic retinopa- thy should be care ully monitored at least every: (A) Generalized arteriolar constriction (B) Focal arteriolar constriction (A) 12 months (C) Arteriolar sclerosis (B) 6 months (D) Flame-shaped hemorrhages (C) 3 months (D) 6 weeks 89. According to Scheie’s classi cation o hypertensive retinopathy, grade 3 hypertensive retinopathy would 95. Which o the ollowing clinical signs is LEAS likely include all o the ollowing EXCEP : to indicate a moderate nonproli erative diabetic retinopathy? (A) Swollen optic disc (B) Cotton wool spots (A) Flame-shaped hemorrhages (C) Hard exudates (B) Dot–blot hemorrhages (D) Flame-shaped hemorrhages (C) Cotton wool spots (D) Venous beading 90. Choroidal in arcts associated with systemic hyperten- sion are called: 96. Proli erative diabetic retinopathy is associated with all o the ollowing clinical signs EXCEP : (A) Elschnig pearls (B) Elschnig spots (A) Choroidal neovascularization (C) Elschnig membrane (B) Vitreal hemorrhages (D) Elschnig bodies (C) Vitreal ibrosis (D) raction retinal detachment 91. Which o the ollowing has NO been implicated in the pathogenesis o diabetic retinopathy? 97. All o the ollowing are true concerning venous stasis retinopathy according to Kerns and Hollenhorst or (A) Increased platelet adhesion posterior ocular ischemic syndrome EXCEP : (B) Increases blood viscosity (C) Increased erythrocyte aggregation (A) Decreased retinal arterial per usion pressure (D) Increased erythrocyte de ormability (B) Associated retinal emboli (C) Ipsilateral mid-peripheral dot–blot hemorrhages (D) Ipsilateral venous tortuosity 210 Lange Q&A Optometry Review: Basic and Clinical Sciences 98. Which o the ollowing is NO a typical clinical sign 103. All o the ollowing undus signs are associated with o Eales’ disease? the cicatricial stage o retinopathy o prematurity EXCEP : (A) Venous sheathing (B) Flame-shaped hemorrhages (A) Peripheral pigment irregularities (C) Collateral vessel ormation (B) Shunt vessel ormation (D) Retinal neovascularization (C) Vitreoretinal membrane development (D) Pale disc and temporally dragged retinal vessels 99. Which o the ollowing hemoglobin types is charac- terized by a genetic de ect in the rate o synthesis o 104. Which o the ollowing is FALSE concerning retinal the entire protein chain? cavernous hemangioma? (A) A (A) Exceedingly rare (B) S (B) Predominantly a ects black patients (C) C (C) Usually unilateral (D) halassemia (D) Autosomal dominant inheritance 100. Which o the ollowing genetic hemoglobin combina- 105. All o the ollowing are clinical signs o retinal cavern- tions is known to result in an increased incidence o ous hemangioma EXCEP : sickle cell retinopathy? (A) Dark red, saccular clusters (A) AA (B) Lie within inner retinal layers (B) SC (C) Overlying epiretinal membrane (C) AS (D) Marked leakage common (D) SS 106. All o the ollowing are characteristics o angiomatosis 101. Angioid streaks are believed to occur in approximately retinae EXCEP : what percent o sickle cell retinopathy cases? (A) Also called Leber’s miliary aneurysms (A) 2% (B) Autosomal dominant inheritance (B) 4% (C) O ten bilateral (C) 6% (D) Associated intracranial and somatic organ (D) 8% mal ormations 102. Which o the ollowing is FALSE concerning reti- 107. Which o the ollowing is NO a clinical sign o nopathy o prematurity? angiomatosis retinae? (A) First identi ied in the early 1940s (A) Large, pink, balloon-like lesion (B) Incidence declined with curtailment o oxygen (B) Choroidal neovascularization therapy (C) Retinal hemorrhage (C) Incidence increasing since the early 1970s (D) Retinal exudation (D) Retinopathy now limited by monitoring o blood gases 108. Which o the ollowing is FALSE concerning retinal telangiectasia? (A) Congenital (B) More common in emales: 4 to 1 (C) Usually unilateral involvement (D) Usually peripheral involvement  Posterior Segment Diseases 211 109. A young patient presents or an annual eye examina- 114. Which o the ollowing is NO a characteristic o so t tion with no ocular complaints. Binocular indirect (granular) drusen? ophthalmoscopy reveals dilated, tortuous vessels in (A) Hyaline material the nasal periphery o the right eye with severe retinal exudation, collateral and neovascularization orma- (B) Large, irregular shape tion, and retinal hemorrhage. What is the MOS (C) Pale, yellow color appropriate clinical diagnosis? (D) Beneath RPE on Bruch’s membrane (A) Retinal cavernous hemangioma 115. All o the ollowing are true concerning a classical (B) Retinal capillary hemangioma RPE detachment EXCEP : (C) Leber’s miliary aneurysms (A) Clear dome with indistinct borders (D) Coats’ disease (B) Fluid between RPE and Bruch’s membrane 110. Which o the ollowing is FALSE concerning the (C) O ten overlying sensory detachment clinical posterior pole? (D) Di icult to identi y with direct ophthalmoscopy (A) Equivalent to the macula lutea (B) Approximately 1.5 mm in diameter 116. Which o the ollowing is NO a clinical character- (C) Contains high density RPE cells istic o choroidal neovascularization? (D) Contains xanthophyll pigment (A) Compromised RPE-Bruch’s membrane complex 111. Which o the ollowing is FALSE concerning the oveola? (B) O ten grayish green color (C) Rarely associated serous retinal detachment (A) Approximately 0.35 mm in diameter (D) O ten associated retinal exudation (B) Central loor o the oveal pit (C) Contains the majority o retinal cones 117. Which o the ollowing is FALSE concerning dry age (D) Called the ovea by clinicians related macular degeneration? (A) Present in 15% o eyes over 80 years o age 112. All o the ollowing are true about retinal drusen EXCEP : (B) Less visually devastating than wet variety (C) O ten unilateral presentation (A) ypically an involutional process (D) Familial tendency reported (B) Appears hypo luorescent with FA (C) Secondary to compromised RPE metabolism 118. Which o the ollowing is considered the EARLIES (D) Associated with ocal choriocapillaris disease de nitive clinical sign o ARMD? (A) RPE pigmentary disturbance 113. What type o drusen is MOS commonly associated with retinal neovascularization? (B) Formation o macular drusen (C) RPE cell loss (A) Hard drusen (D) Photoreceptor cell loss (B) So t drusen (C) Calci ic drusen 119. Which o the ollowing is FALSE concerning the (D) Basal laminar drusen prognosis and management o dry ARMD? (A) Nonprogressive (B) Possible vitamin and mineral therapy (C) Home amsler grid daily (D) Patient education 212 Lange Q&A Optometry Review: Basic and Clinical Sciences 120. All o the ollowing are clinical signs o wet age related 126. Angioid streaks have been associated with all o the macular degeneration EXCEP : ollowing conditions EXCEP : (A) Disci orm scar (A) Ehlers–Danlos syndrome (B) RPE detachment (B) Paget’s disease (C) Serous retinal detachment (C) Pseudoxanthoma elasticum (D) Retinal neovascularization (D) rauma 121. Which o the ollowing is NO a clinical sign o 127. Which o the ollowing is NO a clinical character- choroidal rupture? istic o idiopathic central serous choroidopathy? (A) Single or multiple lesions (A) No apparent underlying cause (B) Jagged yellow-white lines radiating out rom (B) Localized RPE detachments within the macula disc (C) ypically a ects young adult patients (C) Possible retinal hemorrhage (D) Spontaneous resolution common with 3 to (D) Possible choroidal neovascularization 6 months 122. rue degenerative myopia a ects approximately what 128. T e de nitive diagnosis o cystoid macular edema is percent o the United States population? BES made with which o the ollowing clinical procedures? (A) 2% (B) 4% (A) Binocular indirect ophthalmoscopy (C) 7% (B) Direct ophthalmoscopy (D) 9% (C) Biomicroscopy with undus lens (D) Fluorescein angiography 123. Which clinical characteristic is NO associated with true degenerative myopia? 129. CME has been associated with which o the ollowing topical glaucoma agents in aphakic and pseudophakic (A) Lacquer cracks eyes? (B) Fuchs spots (C) Choroidal atrophy (A) Beta blockers (D) Choroidal crescent (B) Prostaglandin analogs (C) Parasympathomimetics 124. All o the ollowing are optic nerve changes associated (D) Carbonic anhydrase inhibitors with degenerative myopia EXCEP : 130. Cystoid macular edema has been associated with all (A) Vertical oval presentation o the ollowing ocular conditions EXCEP : (B) ypical nasal tilt (C) ypical scleral crescent (A) CRAO (D) Supertraction (B) BRVO (C) Diabetic retinopathy 125. Angioid streaks are known to be caused by a pathologi- (D) Ocular ischemic syndrome cal alteration o which layer o Bruch’s membrane? 131. T e MOS common etiology or the development o (A) Basal lamina o choriocapillaris macular cysts and holes is now believed to be: (B) Outer collagenous lamina (C) Elastic lamina (A) rauma (D) Inner collagenous lamina (B) Cystoid macular edema (C) Macular degeneration (D) Vitreal traction  Posterior Segment Diseases 213 132. Which o the ollowing is FALSE concerning a ull 138. Which o the ollowing is a primary ocular nding thickness macular hole? with ocular toxoplasmosis? (A) Round to oval depression (A) Optic neuritis (B) Cu o subretinal edema (B) Retinal vasculitis (C) Yellow-white color (C) Anterior uveitis (D) Small yellow dots o level o RPE (D) Focal necrotizing retinitis 133. Solar maculopathy is MOS o ten associated with 139. reatment o ocular toxoplasmosis, as discussed in which o the ollowing clinical retinal signs? lecture, would NO include which o the ollowing agents? (A) Macular cysts (B) Lamellar macular holes (A) Pyrimethamine (C) Full thickness macular holes (B) Sul adiazine (D) Normal macular tissue (C) Amoxicillin (D) Corticosteroids 134. Presumed ocular histoplasmosis syndrome is now known to be caused by what type o organism? 140. Which o the ollowing is known to be the de nitive host or the typical ocular toxocara organism? (A) Bacteria (B) Virus (A) Dog (C) Fungus (B) Cat (D) Protozoan (C) Man (D) Rat 135. Which o the ollowing clinical signs is NO typically associated with presumed ocular histoplasmosis? 141. Which o the ollowing is NO a clinical sign o ocular toxocariasis? (A) Overlying vitritis (B) Peripapillary choroiditis (A) Small, round granuloma (C) Disseminated choroiditis (B) O ten RPE hyperplasia (D) Choroidal neovascularization (C) O ten vitreal strands (D) ypically involves the mid-periphery 136. Ocular toxoplasmosis is MOS correctly classi ed as a: 142. All o the ollowing are clinical ocular signs o sarcoid- osis EXCEP : (A) Retinitis (B) Retinochoroiditis (A) Nongranulomatous uveitis (C) Choroiditis (B) Retinal perivasculitis (D) Chorioretinitis (C) Vitreal exudates (D) Lacrimal gland involvement 137. Congenital ocular toxoplasmosis has an af nity or what area o the human retina? 143. What is the MOS common ocular clinical sign noted in the AIDS patient? (A) Macula (B) Mid-periphery (A) Macular edema (C) Far periphery (B) Retinal hemorrhages (D) Pars plana (C) Cotton wool spots (D) Kaposi’s sarcoma 214 Lange Q&A Optometry Review: Basic and Clinical Sciences 144. Which o the ollowing is RUE concerning acute 150. T e development o the tertiary vitreous begins in posterior multi ocal placoid pigment epitheliopathy? which month o gestation? (A) Usually emales a ected (A) First month (B) Usually associated with choroidal vascular (B) Second month problems (C) hird month (C) Usually older adults a ected (D) Fourth month (D) Usually unilateral presentation 151. Which o the ollowing is FALSE concerning the 145. Which o the ollowing is NO a characteristic o vitreal cortex? geographic helicoid peripapillary choroidopathy? (A) Fully developed prior to birth (A) Chronic and progressive condition (B) 2% o total vitreous body (B) ypical unilateral presentation (C) Contains majority o vitreal cells (C) RPE and choroidal atrophy results (D) Associated with hyaluronic acid production (D) Etiology unknown 152. Which o the ollowing is known as the metabolic 146. All o the ollowing are true concerning recurrent center o the vitreous? multi ocal choroiditis EXCEP : (A) Primary vitreous (A) Usually males a ected (B) Secondary vitreous (B) Usually young adults a ected (C) Vitreal cortex (C) May be unilateral or bilateral (D) ertiary vitreous (D) Recurrences common 153. Which o the ollowing is the common dynamic tech- 147. Which is NO a clinical sign o multiple evanescent nique utilized when examining the human vitreous? white dot syndrome? (A) Ascension phenomenon (A) Discrete white dots (B) Distension phenomenon (B) Granular RPE appearance within macula (C) Restriction phenomenon (C) Fovea typically a ected (D) Retraction phenomenon (D) Overlying vitreal cells common 154. A thorough vitreous examination is BES per ormed 148. All o the ollowing are clinical signs o pigmented utilizing which o the ollowing instruments? paravenous retinochoroidal atrophy EXCEP : (A) Direct ophthalmoscope (A) Peripapillary RPE degeneration (B) Binocular indirect ophthalmoscope (B) Perivenous RPE degeneration (C) Biomicroscope (C) Pigment migration and clumping (D) Biomicroscope with undus lens (D) Macular involvement common 155. Which o the ollowing is NO associated with vitreal 149. All o the ollowing are true concerning the embryo- lique action? logic secondary vitreous EXCEP : (A) Depolymerization o hyaluronic acid (A) Re erred to as de initive vitreous (B) Vitreal condensation (B) Makes up most o the vitreous body (C) Lacunae ormation (C) Contains parts o the hyaloid artery system (D) Gel to liquid state (D) Contains the condensation layer  Posterior Segment Diseases 215 156. A symptomatic patient without observed PVD should 162. Which o the ollowing is NO a clinical sign o be ollowed within: primary amilial amyloidosis? (A) 1 week (A) Massive, white vitreal deposits (B) 4 weeks (B) Retinal hemorrhage (C) 6 weeks (C) Cotton wool spots (D) 3 months (D) Choroidal neovascularization 157. Which o the ollowing is NO a clinical sign o vitre- 163. What is the MOS consistent clinical sign associated ous base separation? with juvenile retinoschisis? (A) Veil o hyaloid membrane noted (A) Foveal schisis (B) Sha er’s sign common (B) Peripheral schisis (C) O ten associated with retinal dialysis (C) Peripheral vitreal veils (D) Anterior segment complications uncommon (D) Vitreal hemorrhage 158. Which o the ollowing is RUE concerning asteroid 164. Juvenile retinoschisis exhibits which type o inheri- hyalosis? tance pattern? (A) Usually young patients a ected (A) Autosomal dominant (B) Majority bilateral (B) Autosomal recessive (C) Cholesterol crystals (C) X-linked recessive (D) Etiology unknown (D) No pattern identi ied 159. Sha er’s sign is considered virtually pathognomonic 165. Clinical signs o amilial exudative vitreoretinopathy or: are similar to which o the ollowing ocular posterior segment conditions? (A) Acute anterior vitreal detachment (B) Full thickness retinal break (A) Coats’ disease (C) Hereditary vitreoretinal degeneration (B) Para oveal telangiectasia (D) Choroidal neovascularization (C) Epiretinal membrane (D) Retinopathy o prematurity 160. Which o the ollowing is RUE concerning synchy- sis scintillans? 166. Goldmann–Favre’s vitreotapetoretinal degeneration has clinical signs similar to all o the ollowing EXCEP : (A) Large, white spherical vitreal bodies (B) Usually unilateral (A) Wagner’s vitreoretinal degeneration (C) Not attached to collagen ibril network (B) Stargardt’s disease (D) Seldom associated with degenerative ocular (C) Juvenile retinoschisis disease (D) Retinitis pigmentosa 161. Clinical signs o Wagner’s vitreoretinal degeneration 167. Which o the ollowing is NO a clinical character- include all o the ollowing EXCEP : istic o PHPV? (A) Myopia less than 5 D (A) Developmental abnormality (B) Vitreous lique action and syneresis (B) Failure o primary vitreous to properly regress (C) Epiretinal membrane ormation (C) Predominantly bilateral (D) Absence o retinal tears and detachments (D) ypically associated with other ocular anomalies 216 Lange Q&A Optometry Review: Basic and Clinical Sciences 168. Which o the ollowing is FALSE concerning vortex 171. Nonspeci c chorioretinal scars are typically noted in varices? what area o the human retina? (A) Elevation o vortex ampulla (A) Posterior pole (B) Benign phenomenon (B) Equator (C) Noted in primary gaze o patient (C) Periphery (D) Flattens upon pressure to globe (D) Anywhere 169. Which o the ollowing is FALSE concerning periph- 172. Which o the ollowing is FALSE concerning typical eral senile pigmentary degeneration? peripheral cystoid degeneration? (A) Aging change o peripheral RPE (A) Most common peripheral retinal degeneration (B) Approximately 100% o patients over 40 years (B) 100% o patients by 8 years o age o age (C) Cystic spaces within nerve iber layer (C) ypically bilateral (D) 100% bilaterality (D) rophic degeneration 173. All o the ollowing are characteristics o reticular 170. An adult male patient presents or a routine eye peripheral cystoid degeneration EXCEP : examination with no visual complaints. Fundus (A) Continuous with and posterior to typical examination reveals multiple at, white lesions with cystoid degeneration pigmented borders and traversing red vessels located near in erior ora in both eyes. What is the MOS (B) Reticular pattern corresponding to retinal appropriate diagnosis? vessels (C) Very ine stippled inner layer or sur ace (A) apetochoroidal degeneration (D) Involves inner nuclear and outer plexi orm (B) Paving stone degeneration layers (C) Post in lammatory chorioretinal scars (D) Lattice degeneration  Answers and Explanations 1. (D) T e extra length o the optic nerve within 9. (D) White light comparison has been ound to be the orbit allows or ull range o ocular motility less sensitive and there ore, less reliable than red color (Alexander, 2002, p. 210). comparison testing (Alexander, 1994, p. 17). 2. (C) T e size o the physiological cup is normally sta- 10. (C) Pain upon ull eye excursion is not considered an ble throughout li e. Any increase in size over time is absolute sign o optic neuropathy (Alexander, 1994, unacceptable and requires investigation (Alexander, p. 73). 2002, p. 211). 11. (C) Persistent hyaloid artery remnants are present in 3. (A) Most o the blood supply to the optic nerve 95% o premature in ants (Alexander, 2002, p. 214). head originates rom the short posterior ciliary arteries, posterior ciliary arteries, and the pial artery 12. (B) T ere is only a low incidence o bilaterality asso- (Alexander, 2002, pp. 212–213). ciated with prepapillary vascular loops (Alexander, 2002, p. 215). 4. (B) Border tissue o Elschnig is collagenous tissue which separates the choroid rom the optic nerve 13. (C) Approximately 95% o all prepapillary vascu- within the prelaminar region o the optic nerve lar loops are considered arterial. T ere ore, retinal (Alexander, 2002, p. 213). venous occlusion is not a commonly noted complica- tion (Alexander, 2002, p. 215). 5. (D) T e insulating myelin sheath is typically associ- ated with the retrolaminar region o the optic nerve 14. (D) Congenital macrovessels are usually retinal veins, (Alexander, 2002, p. 213). and commonly demonstrate arteriovenous commu- nications (Alexander, 2002, p. 217). 6. (B) T e associated pupillary bers exit the optic tract prior to the lateral geniculate body and course 15. (A) Racemose angioma is a rare and extreme vari- along the brachium o the superior colliculus to the ant o congenital macrovessels (Alexander, 2002, pretectal nucleus (Kline, 2008, p. 125). p. 217). 7. (A) Unilateral or markedly asymmetric retinal and 16. (B) Cilioretinal vessels are derived rom the short macular lesions may result in an a erent pupillary posterior ciliary system and the choroidal vascular de ect without actual optic nerve involvement (Kline, system (Alexander, 2002, p. 217). 2008, pp. 130–131). 17. (C) Myelinated retinal nerve bers have the potential 8. (D) Glaucoma has been commonly associated to cause mild, relative visual eld de ects at thresh- with an acquired blue-yellow color vision de ect old levels, not absolute de ects (Alexander, 2002, (Alexander, 1994, p. 15). pp. 218–219). 217 218 Lange Q&A Optometry Review: Basic and Clinical Sciences 18. (A) High myopia is most o ten associated with scleral 29. (B) Morning glory disc is characterized by a unilat- crescents due to elongation o the eyeball resulting eral enlarged, unnel-shaped central area o the optic in separation o the retinal pigment epithelium and disc (Alexander, 2002, p. 230). choroid rom the optic disc margin (Alexander, 2002, pp. 219–220). 30. (A) Congenital optic pits are most typically unilateral in presentation (Alexander, 2002, pp. 234–238). 19. (C) T ere are no particular signs or symptoms associ- ated with choroidal and scleral crescents (Alexander, 31. (C) Approximately up to 60% o patients with 2002, pp. 219–220). optic pits present with an accurate visual eld de ect (Alexander, 2002, p. 236). 20. (D) Malinserted optic discs are typically characterized by nasal rim elevation with temporal rim depression, 32. (D) Congenital optic nerve hypoplasia may occur uni- and associated temporal scleral crescent (Alexander, laterally or bilaterally, and has been ound to demon- 2002, pp. 221–223). strate no sexual predilection (Alexander, 2002, p. 239). 21. (C) rue tilted disc syndrome is usually associated 33. (C) Congenital optic nerve hypoplasia is character- with a nasal or in erior nasal posterior staphyloma ized by a relatively normal optic disc vasculature that (Alexander, 2002, p. 222). exits and enters the optic disc centrally (Alexander, 2002, p. 241). 22. (D) Congenital peripapillary staphyloma dem- onstrates no strong predilection toward retinal 34. (D) Optic nerve head drusen are ound primarily in detachment, as does colobomatous retinal lesions white patients (Alexander, 2002, p. 245). (Alexander, 2002, pp. 223–224). 35. (B) Pseudopapilledema secondary to optic nerve 23. (A) T e optic disc appears essentially round in con- head drusen is characterized by little to no true optic genital peripapillary staphyloma, not demonstrating disc edema (Alexander, 2002, pp. 245–248). the classical oval shape associated with the other reti- nal staphylomas (Alexander, 2002, p. 223). 36. (B) With an incidence o 1 in 50,000, autosomal dominant juvenile optic atrophy is a relatively 24. (C) Optic nerve coloboma may o ten involve the common heredo amilial optic atrophy (Alexander, adjacent in erior retina and choroid (Alexander, 2002, 2002, p. 249). p. 226). 37. (A) Autosomal recessive congenital optic atrophy 25. (D) Optic nerve coloboma has a strong associa- is characterized by total optic disc pallor at birth tion with nonrhegmatogenous retinal detachment (Alexander, 2002, p. 251). (Alexander, 2002, pp. 228–229). 38. (B) T e true heredity pattern o Leber’s hereditary 26. (C) Retinochoroidal coloboma may o ten extend to optic atrophy remains questionable with males pri- involve the optic disc (Alexander, 2002, p. 226). marily a ected (Alexander, 2002, p. 251). 27. (D) Retinochoroidal coloboma has a strong associa- 39. (C) T e acute Leber’s hereditary optic atrophy attack tion with rhegmatogenous retinal detachment, not is characterized by optic disc edema, circumpapillary nonrhegmatogenous retinal detachment (Alexander, telangiectasia and opaci cation o the peripapillary 2002, p. 229). retinal nerve ber layer (Alexander, 2002, p. 254). 28. (B) Morning glory disc has a strong association with 40. (A) Acute in ammatory optic neuropathy is an nonrhegmatogenous retinal detachment, up to 33% in ammatory reaction to an in ectious agent o all cases (Alexander, 2002, pp. 230–234). (Alexander, 2002, p. 283).  Posterior Segment Diseases 219 41. (C) Papillitis is the most common orm o optic neu- 52. (B) Papilledema secondary to increased cerebral spi- ropathy in children (Alexander, 2002, p. 283). nal uid pressure results in a bilateral presentation o optic disc edema (Alexander, 2002, p. 305). 42. (A) Retrobulbar optic neuropathy typically presents with an acute loss o vision, but no discernible retinal 53. (D) T e classical visual eld de ect associated with or optic disc abnormalities (Alexander, 2002, p. 286). an acute, ully developed papilledema is an enlarged blind spot (Alexander, 2002, p. 307). 43. (D) Demyelinating optic neuropathy is best known as a retrobulbar optic neuropathy with little to no 54. (A) Chronic, long standing papilledema typically retinal signs (Alexander, 2002, p. 286). results in optic atrophy, and permanent loss o the physiological cup (Alexander, 2002, pp. 305–315). 44. (D) ypically there are no appreciable ophthalmo- scopic retinal or optic nerve head changes noted with 55. (C) A melanocytoma is an elevated, black lesion acute demyelinating optic neuropathy (Alexander, associated with the optic nerve, and may enlarge to 2002, pp. 286–287). involve the peripapillary nerve ber layer (Alexander, 2002, pp. 52–54). 45. (C) Nonarteritic anterior ischemic optic neuropathy is a small vessel disease a ecting the prelaminar por- 56. (B) Retinoblastoma is a malignant, primary intraoc- tion o the optic nerve (Alexander, 2002, p. 291). ular tumor derived rom embryologic retinoblasts believed to be undi erentiated rod and cone cells 46. (B) Acute nonarteritic (arteriosclerotic) optic neu- (Alexander, 2002, p. 61). ropathy is characterized by a swollen, edematous optic disc with multiple ame-shaped hemorrhages 57. (B) Embryologic mesenchymal cells di erentiate on the optic disc, and is o ten associated with elderly, into cords o endothelial cells that continue on to hypertensive patients (Alexander, 2002, pp. 291–292). orm capillaries, arteries and veins (Alexander, 2002, p. 328). 47. (C) An immediate Westergren erythrocyte sedimen- tation rate and c-reactive protein level will help to di - 58. (D) Retinal veins are insulated rom retinal tissue erentiate between arteritic and nonarteritic ischemic by the glial perivascular limiting membrane o optic neuropathy (Alexander, 2002, p. 293). Kruckmann (Alexander, 2002, p. 329). 48. (D) Diabetic ischemic optic neuropathy is commonly 59. (D) T e peripapillary retinal zone does have retinal associated with young, type 1 diabetic patients typi- capillaries unlike the ora serrata, macula, and perivas- cally in their 20s to 30s (Alexander, 2002, p. 299). cular retinal zones (Alexander, 2002, p. 329). 49. (B) Papillophlebitis is a variation o central retinal 60. (C) With age, some ar peripheral retinal capillaries vein in ammation that leads to partial venous occlu- shut down resulting in adjacent capillaries to dilate, sion. T e central retinal artery remains relatively orm collaterals and microaneurysms as an expected una ected (Alexander, 2002, p. 301). involutional process (Alexander, 2002, p. 330). 50. (A) oxic optic neuropathy classically presents with a 61. (C) T e choriocapillaris vessels are larger in caliber central cecal visual eld de ect, and a gradual bilateral than retinal capillaries, and are enestrated to allow loss o vision (Alexander, 2002, p. 303). or ree movement o uid in and out o the vessels (Alexander, 2002, p. 331). 51. (C) T e most important and bene cial treatment or toxic optic neuropathy is the elimination o the 62. (B) T e choroid contains immunologic cells that rep- o ending substance, i possible (Alexander, 2002, resent a source o in ammatory choroidal and retinal pp. 303–305). disease (Alexander, 2002, p. 331). 220 Lange Q&A Optometry Review: Basic and Clinical Sciences 63. (D) T ere is no known autonomic nerve innerva- 73. (A) Retinal macroaneurysms are a ocal dilation tion o human retinal blood vessels. Retinal vessel or ballooning o a larger retinal artery or arteriole changes are controlled by local metabolic regulation (Alexander, 2002, p. 347). (Alexander, 2002, pp. 328–330). 74. (D) Congenital para oveal (juxta oveal) retinal tel- 64. (A) Preretinal hemorrhages lie just under the internal angiectasia is typically unilateral in presentation, limiting membrane, and in ront o the retinal nerve usually occurs in males, and typically has a mid-li e ber layer (Alexander, 2002, p. 335). onset. Visual acuity is o ten reduced due to macular edema (Alexander, 2002, pp. 349–350). 65. (D) Flame-shaped retinal hemorrhages lie within the nerve ber layer, involve the super cial capillary 75. (C) Retinal collateral vessels develop within the bed, and usually have no particular e ect on vision ramework o the existing vascular network, are stable, (Alexander, 2002, p. 336). and typically do not leak (Alexander, 2002, p. 352). 66. (B) Dot–blot retinal hemorrhages lie within inner 76. (B) Retinal neovascularization is characterized by nuclear and outer plexi orm layers, and involve the thin, ragile and leaky vessels typically associated with deep retinal capillary bed (Alexander, 2002, p. 338). vitreal brosis called brotic sca olding (Alexander, 2002, p. 356). 67. (D) Vitreal hemorrhages o ten resolve slowly, and produce brotic changes within the vitreous that 77. (D) Acquired venous sheathing is a collagenous or may result in complaints o oaters and possible lipohyaline thickening o the vessel wall, and typi- vitreoretinal adhesions (Alexander, 2002, pp. 340– cally associated with chronic venous congestion or 341). in ammatory periphlebitis rom multiple sclerosis, sarcoidosis, and pars planitis (Alexander, 2002, p. 361). 68. (A) Retinal transudates are composed mainly o serum caused by a localized vascular hydrostatic 78. (B) Lipemia retinalis is characterized by creamy, imbalance, and are o ten missed with ophthalmos- salmon colored retinal blood vessels secondary to copy (Tasman and Jaeger, 2005, Vol. 3, Chap. 13, severely elevated serum triglyceride levels (Alexander, p. 4). 2002, p. 362). 69. (C) Hard exudates develop secondary to an accu- 79. (A) T e etiology o epiretinal membranes is contro- mulation o lipoprotein within the inner nuclear versial and not completely understood. Multiple his- and outer plexi orm retinal layers (Alexander, 2002, tologic cell types have been associated with epiretinal pp. 344–345). membrane development. Collagen has been most o ten associated with the idiopathic variety o epireti- 70. (A) Cotton wool spots are a mani estation o retinal nal membrane (Alexander, 2002, p. 369). ischemia within the nerve ber layer caused by a ocal capillary in arct and resulting retinal hypoxia 80. (C) T e superior temporal vein is most o ten involved (Alexander, 2002, pp. 342–343). in BRVO due to the increased number o A/V cross- ings as compared to the other retinal vein branches 71. (D) Retinal cytoid bodies are associated with cotton (Alexander, 2002, p. 373). wool spots, and result rom leakage o axonal cellu- lar debris into the retinal nerve ber layer (Alexander, 81. (C) A mild, nonischemic BRVO is typically not char- 2002, p. 343). acterized by super cial ame-shaped hemorrhages (Alexander, 2002, p. 373). 72. (D) Retinal microaneurysms o ten stop leaking spon- taneously due to hyalonization o the retinal capillary 82. (C) Retinal neovascularization is common in patients wall. T e entire process may take up to 1 to 2 years with BRVO, and may occur in approximately 25% (Alexander, 2002, p. 346). to 30% o cases (Alexander, 2002, p. 375).  Posterior Segment Diseases 221 83. (A) Arteriolar sclerosis does not appear to play the 93. (D) T e development o retinal cotton wool spots in same important role in CRVO as it does in BRVO diabetic retinopathy represents an advancement in (Alexander, 2002, p. 381). retinal damage, and indicates an increase in retinal hypoxia and ischemia (Alexander, 2002, p. 420). 84. (B) Mild, nonischemic CRVO also called venous sta- sis retinopathy o Hayreh is typically not characterized 94. (A) Acceptable retinal ollow up intervals or dia- by the presence o retinal cotton wool spots (Alexander, betic retinopathy vary according to the severity o 2002, p. 383). presenting retinopathy. A yearly monitoring schedule is appropriate or mild, nonproli erative retinopathy 85. (C) Hollenhorst plaques are endogenous retinal (Alexander, 2002, pp. 419–420). emboli consisting o cholesterol crystals (Alexander, 2002, pp. 365–368). 95. (B) Dot–blot retinal hemorrhages are typically considered mild diabetic retinal charges, and not 86. (C) T e causative emboli o a BRAO is typically indicative o advancing retinal hypoxia and ischemia visible, and most o ten noted at a retinal artery bi ur- (Alexander, 2002, p. 419). cation (Alexander, 2002, p. 392). 96. (A) Proli erative diabetic retinopathy is associated 87. (D) Retinal neovascularization associated with with retinal neovascularization o the disc or else- CRAO is considered rare. CRAO, with resulting where, not choroidal neovascularization (Alexander, retinal cell death, typically does not stimulate new 2002, p. 426). vessel growth as does CRVO (Alexander, 2002, pp. 394–396). 97. (B) Posterior ocular ischemic syndrome or venous stasis retinopathy o Kerns and Hollenhorst is a rela- 88. (D) Flame-shaped hemorrhages are associated with tively uncommon condition secondary to decreased retinal capillary changes secondary to uncontrolled arterial per usion to the posterior segment o the systemic hypertension, and are considered more eye. T e most common etiology is carotid occlu- severe retinopathy than the early arteriolar sclerotic sive disease, not retinal emboli (Alexander, 2002, changes (Alexander, 2002, p. 399). p. 406). 89. (A) Optic disc edema indicates an advancement o 98. (B) Eales disease or retinal periphlebitis is an hypertensive retinopathy beyond that o Grade 3 into uncommon, bilateral, peripheral periphlebitis o Grade 4 retinopathy (Alexander, 2002, p. 399). undetermined etiology. Fundus signs typically include venous sheathing, capillary nonper usion, 90. (B) Uncontrolled systemic hypertension may a ect dot–blot hemorrhages, collateral vessel ormation, the choroidal vessels as well as the retinal vessels. and retinal neovascularization (Alexander, 2002, Choroidal in arcts with overlying RPE alterations are pp. 437–438). known as Elschnig spots (Alexander, 2002, pp. 399– 400). 99. (D) T alassemia is a human hemoglobin type which demonstrates an abnormal rate synthesis o the entire 91. (D) Diabetic retinopathy pathogenesis has been protein chain (Alexander, 2002, p. 439). associated with increased aldose reductase, increased platelet adhesion, increased blood viscosity, increased 100. (B) Hemoglobin SC and ST al are known to pro- erythrocyte aggregation, and decreased erythro- duce a higher incidence o proli erative retinopathy cyte de ormability (Alexander, 2002, pp. 416– than the other sickle hemoglobin types (Alexander, 418). 2002, pp. 439–441). 92. (C) T e incidence o diabetic retinopathy is known to 101. (C) Angioid streaks are ound in approximately 6% increase with the duration o the diabetes (Alexander, o all sickle cell retinopathy cases (Alexander, 2002, 2002, p. 412). p. 439). 222 Lange Q&A Optometry Review: Basic and Clinical Sciences 102. (D) Rates o retinopathy o prematurity have risen 113. (B) So t drusen are much more closely associated with the technological advancement in neonatology. with the development o choroidal neovascular mem- Retinopathy is now limited by early surgical inter- branes (Alexander, 2002, p. 78). vention prior to discharge rom the neonatal inten- sive care unit (Alexander, 2002, pp. 443–444). 114. (A) So t or granular drusen are known to be col- lagenous material, not hyaline material (Alexander, 103. (B) Neovascularization and shunt vessel ormation 2002, p. 78). are typically associated with the vasoproli eration stage o retinopathy o prematurity, not the cicatricial 115. (A) T e classical RPE detachment is described as (scaring) stage (Alexander, 2002, p. 444). an opaque, yellowish dome with district borders. However, the color may vary due to the turbidity o 104. (B) Retinal cavernous hemangiomas predominantly the causative uid (Alexander, 2002, pp. 81–82). a ect white patients, not black patients (Alexander, 2002, p. 31). 116. (C) Any compromise in the RPE-Bruch’s membrane complex coupled with relative hypoxia, may stimulate 105. (D) T e saccular dilations o retinal veins associated the development o a choroidal neovascular membrane. with cavernous hemangiomas are made up o non e- An overlying serous retinal detachment is a common nestrated endothelial cells that prevent leakage and associated clinical nding (Alexander, 2002, p. 81). retinal exudation (Alexander, 2002, p. 31). 117. (C) Dry age related macular degeneration is con- 106. (A) Angiomatosis retinae or retinal capillary heman- sidered to be a bilateral condition secondary to its gioma is also known as von Hippel disease, not underlying etiology. However, asymmetric clinical Leber’s miliary aneurysms (Alexander, 2002, p. 27). presentations are o ten noted (Alexander, 2002, pp. 95–98). 107. (B) Choroidal neovascularization is not an associated clinical nding o angiomatosis retinae (Alexander, 118. (B) T e presence o macular drusen that were pre- 2002, pp. 27–28). viously undetected is considered the rst de nitive clinical sign o ARMD (Alexander, 2002, p. 96). 108. (B) Retinal telangiectasia or Coat’s disease is congeni- tal, typically unilateral, typically involves the periph- 119. (A) Dry ARMD is characterized by a progressive eral retina, and a ects males 4 to 1 over emales atrophy o the RPE and overlying photoreceptor cells (Alexander, 2002, p. 37). within the clinical (Alexander, 2002, pp. 96–97). 109. (D) T e patient’s clinical signs are consistent 120. (D) Wet or exudative age related macular degeneration with severe retinal telangiectasia or Coat’s disease is characterized by a choroidal neovascular membrane, (Alexander, 2002, pp. 37–38). RPE detachment, serous retinal detachment, and dis- ci orm scar ormation (Alexander, 2002, pp. 100–101). 110. (B) T e clinical posterior pole which is bordered by the superior and in erior temporal vascular arcades meas- 121. (B) A choroidal rupture is characterized by one or ures approximately 5.5 mm in diameter (Alexander, more yellowish-white concentric lines with the con- 2002, p. 76). cavity toward the optic disc (Alexander, 2002, p. 110). 111. (C) T e oveola contains the greatest density o cone 122. (A) rue degenerative or pathologic myopia has a photoreceptor cells, but only approximately 0.2% o prevalence o approximately 2% in the United States all retinal cones (Alexander, 2002, p. 76). (Alexander, 2002, p. 116). 112. (B) Retinal drusen are known to hyper uorescence, 123. (D) Degenerative myopia is most o ten associated with not hypo uorescence with uorescein angiography a temporal myopic scleral crescent (Alexander, 2002, (Alexander, 2002, pp. 78–79). pp. 116–118).  Posterior Segment Diseases 223 124. (B) Degenerative myopia is characterized by a verti- 134. (C) Presumed ocular histoplasmosis syndrome is cal oval disc with a discernible temporal tilt second- known to be caused by the ungus Histoplasma capsu- ary to the macular staphyloma (Alexander, 2002, latum (Alexander, 2002, p. 146). pp. 116–118). 135. (A) Presumed ocular histoplasmosis is not commonly 125. (C) Angioid streaks are caused by a pathological associated with an active vitritis or anterior uveitis alteration o the elastic lamina o Bruch’s membrane (Alexander, 2002, p. 148). (Alexander, 2002, p. 119). 136. (B) Ocular toxoplasmosis primarily a ects the retina 126. (D) Angioid streaks have not been associated ocular and secondarily a ects the choroid, hence the clas- trauma. Blunt ocular trauma o ten results in choroi- si cation as a retinochoroiditis (Alexander, 2002, dal rupture, not angioid streaks (Alexander, 2002, p. 155). p. 119). 137. (A) Congenital ocular toxoplasmosis is known to have 127. (B) Idiopathic central serous choroidopathy or ICSC an af nity or the macula and the brain (Alexander, is characterized by localized serous sensory retinal 2002, pp. 157–159). detachments within the posterior pole o otherwise healthy young adults (Alexander, 2002, p. 124). 138. (D) A ocal necrotizing retinitis is the primary ocu- lar sign in acquired ocular toxoplasmosis (Alexander, 128. (D) T e classical petaloid appearance o cystoid 2002, p. 158). macular edema is o ten dif cult to visualize without uorescein angiography or macular OC (Alexander, 139. (C) Pyrimethamine, sul adiazine and corticoster- 2002, p. 130). oids have all been recommended or the treatment o active ocular toxoplasmosis (Alexander, 2002, 129. (B) T e topical epinephrine and prostaglandin ana- p. 163). log agents have been shown to stimulate cystoid macular edema in some aphakic and pseudophakic 140. (A) T e most common ocular parasitic larvae in esta- patients (Alexander, 2002, p. 130). tion in the United States is toxocara canis, with the dog as its de nitive host (Alexander, 2002, p. 163). 130. (A) Retinal venous occlusion has been associated with the development o cystoid macular edema, typ- 141. (D) Ocular presentation o toxocariasis typi- ically not retinal artery occlusion (Alexander, 2002, cally involves the immediate posterior pole or ar pp. 130–131). peripheral retina, not the equator or mid-periphery (Alexander, 2002, p. 165). 131. (D) Although ocular trauma, cystoid macular edema and macular degeneration have all been associated 142. (A) Sarcoidosis is most o ten associated with a granu- with macular hole ormation, vitreal traction (direct lomatous anterior uveitis (Alexander, 2002, p. 169). or tangential) is now commonly believed to be the most common etiology (Alexander, 2002, p. 137). 143. (C) T e most common ocular nding associated with AIDS is retinal cotton wool spots (Alexander, 2002, 132. (C) Full thickness macular holes are known to be p. 455). dark red in color, not yellow-white (Alexander, 2002, p. 139). 144. (B) Acute posterior multi ocal placoid pigment epi- theliopathy is considered a relatively benign, bilateral 133. (A) Following the resolution o the acute yellow condition a ecting young adults with no sexual pre- subretinal exudate o solar maculopathy, a small dilection. An associated underlying choroidal vascular red oveal lesion or macular cyst usually develops problem appears to be the cause (Alexander, 2002, (Alexander, 2002, p. 145). p. 174). 224 Lange Q&A Optometry Review: Basic and Clinical Sciences 145. (B) Geograph