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MBBS V - Senior Clerkship - Block C CCT > Ophthalmology CCT > Flashcards

Ophthalmology CCT Flashcards

1
Q

30yo man presented with bilateral red eye and tearing for three days. There was no associated photophobia or pain. He has 20/20 vision in both eyes. Upon examination, there is diffuse conjunctival injection, sparing the limbal vessels. What is the most likely diagnosis?

A. Acute iritis
B. Microbial keratitis
C. Acute angle closure episode
D. Acute conjunctivitis

A

Ans: D

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2
Q

25yo woman presented with right eye redness with associated photophobia. Upon slit lamp examination, there were anterior chamber cells and flare. Vitreous clear, no cell. What is the most likely diagnosis?

A. Acute iritis
B. Microbial keratitis
C. Acute angle closure episode
D. Acute conjunctivitis

A

A. Acute iritis

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3
Q

80 yo man with a history of AF presented with acute loss of vision in his left eye. RAPD negative. Upon fundus examination, he has retinal pallor with a cherry red spot. What is the most likely diagnosis?

A. Central retinal vein occlusion
B. Central retinal artery occlusion
C. Anterior ischaemic optic neuropathy
D. Exudative age-related macular degeneration

A

Ans: B

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4
Q

30yo man was hit by a football in his right eye, and presented with periorbital oedema. Visual acuity 12/20. Upon fundus examination, multiple blood clots were observed in the vitreous humor, obscuring the view of the retina. What is the most likely condition?

A. Central retinal vein occlusion
B. Vitreous haemorrhage
C. Anterior ischaemic optic neuropathy
D. Exudative age-related macular degeneration

A

Ans: B

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5
Q

85yo man complained of progressive worsening of vision for a few months. He had bilateral cataract surgery 5 years ago with uneventful recovery. Fundus examination showed drusens and retinal pigmentary mottling around the macula. What is the most likely diagnosis?

A. CRAO
B. CRVO
C. Anterior ischaemic optic neuropathy
D. Dry age-related macular degeneration

A

Ans: D

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6
Q

40yo woman had a traffic accident recently. She complained of vertical diplopia and presented with a head tilt to the left. What is the most likely diagnosis?

A. Abducens nerve palsy
B. Oculomotor nerve palsy
C. Trochlear nerve palsy
D. Myasthenia gravis

A

Ans: C

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7
Q

30year old man suffered from a slip and fall injury. On examination of his eye, there is uveal prolapse and a distorted pupil, what is the most likely diagnosis?
A. Eyelid laceration
B. Open globe injury
C. Orbital fracture
D. Chemical injury

A

Ans: B

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8
Q

4 year old girl with left congenital ptosis presented with decreased visual acuity in the left eye. She has normal visual acuity in the right eye. Which of the following is the most likely cause of the decreased visual acuity in the left eye?
A. Anisometropia
B. Congenital cataract
C. Intermittent exotropia
D. Amblyopia

A

Ans: D

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9
Q

21 year old woman presented with a decrease in vision over the past three days. There is present of RAPD. She also complained of decreased red-green saturation. What is the most likely diagnosis?
A. CRVO
B.
C. Optic neuritis

A

Ans: C

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10
Q

20 year old man presented with eye redness and photophobia. On slit-lamp examination, anterior chamber cells and flare, keratic precipitate and posterior synechiae were detected. What is the most likely diagnosis?
A. Acute iritis
B. Epidermal keratoconjunctivitis
C. Acute keratitis
D. Acute conjunctivitis

A

A. Acute iritis (anterior uveitis)

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11
Q

A 22-year-old woman with a history of soft contact lens wear presented with a painful red eye. Examination of the cornea shows a confluent epithelial defect measuring 3mm by 2mm in size. Infectious keratitis is therefore suspected. What is the most likely causative organism?
A. Bartonella henselae
B. xx
C. Pseudomonas aeruginosa
D. xx

A

Ans: C

And staph aureus

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12
Q

M/80, OS pain & blur x 5 d, N/V. P/E: OS corneal haziness, mid-dilated fixed pupil. Dx?
A. Acute iritis
B. Acute microbial keratitis
C. Acute angle closure episode
D. Acute conjunctivitis

A

C. Acute angle closure episode

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13
Q

F/80, old age home. OS red & discharge x 1 w. P/E: OS copious discharge, conjunctiva injected, sparing limbic (?) vessels. Dx?
A. Acute iritis
B. Acute microbial keratitis
C. AACG
D. Acute conjunctivitis

A

D. Acute conjunctivitis

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14
Q

A 30-year-old lady with a history of systemic lupus erythematosus presents with right visual loss for 3 days. Examination reveals right relative afferent pupillary defect. Fundi examination reveals diffuse flame-shaped haemorrhages and cotton-wool spots. Which is the MOST LIKELY diagnosis?
A. Central retinal vein occlusion
B. Central retinal artery occlusion
C. Anterior ischaemic optic neuropathy
D. Exudative age-related macular degeneration

A

A. Central retinal vein occlusion

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15
Q

A 65-year-old man presents with progressive blurring of vision over the past 2-3 years, affecting both of his eyes. Examination revealed bilateral nuclear sclerosis cataracts. Fundi examination revealed no other abnormalities. Which is the MOST LIKELY cause of this patient’s blurring of vision?
A. Cataract
B. Primary open angle glaucoma
C. Diabetic macular oedema
D. Dry age-related macular degeneration

A

A. Cataract

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16
Q

M/60, poorly controlled HTN and hyperlipidaemia, lateral diplopia, failed Rt abduction. Dx?
A. Oculomotor nerve palsy
B. Trochlear nerve palsy
C. Abducens nerve palsy
D. Optic nerve atrophy

A

C. Abducens nerve palsy

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17
Q

Which of the following is an intraocular mass that is potential familial malignancy?
A. Retinoblastoma
B. Persistent hyperplastic primary vitreous
C. Toxocariasis
D. Congenital cataract

A

A. Retinoblastoma

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18
Q

Blurring of vision, photophobia, eye redness. Diagnosed to be panuveitis. Also erythema nodosum in lower limbs and history of aphthous and genital ulcers. What is the most likely systemic disease associated?
A. Behcet’s disease
B. Diabetes mellitus
C. Stevens Johnson syndrome
D. Grave’s disease

A

A. Behcet’s disease

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19
Q

Patient presented with right eye redness, tearing and discomfort. Physical examination revealed tender preauricular lymph nodes. Diagnosis?
A. Acute iritis
B. Microbial keratitis
C. Acute angle closure episode
D. Epidemic keratoconjunctivitis

A

D. Epidemic keratoconjunctivitis

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20
Q

Objects fly into eye. Worry of what?
A. ?
B. Corneal abrasion
C. Acute angle closure glaucoma
D. Intraocular foreign body

A

D. Intraocular foreign body

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21
Q

A 20 year-old female is presenting with right eye pain and redness for one day. She reported the use of cosmetic contact lenses the previous day. On examination, there is central corneal infiltrate measured 3mm x 2mm and haze. There is also a right eye hypopyon measured 1mm in diameter. What is the most likely diagnosis?
A. Acute iritis
B. Acute microbial keratitis
C. Acute conjunctivitis
D. Acute angle closure episode

A

B. Acute microbial keratitis

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22
Q

70 year-old female presenting with 2-day history of left eye metamorphosia and visual impairment. Found to have submacular edema and submacular haemorrhage. What is the diagnosis?
A. CRVO
B. CRAO
C. AION
D. Exudative type AMD

A

D. Exudative type AMD (metamorphopsia due to submacular edema)

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23
Q

78 year old male had a sudden loss of vision after he woke up. He admitted the use of viagra the night before. Examination reveals right RAPD. Fundus exam reveals right swollen optic disc + splinter hemorrhage. What is the most likely diagnosis
A. CRAO
B. CRVO
C. AION
D. Exudative AMD

A

C. AION

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24
Q

60-year-old man was found to be often bumping into his periphery for the last year. VA 20/25 in both eyes. IOP 30mmHg in both eyes. Fundus examination showed increased optic disc cupping. What is the MOST LIKELY diagnosis?
A. Cataract
B. Primary open angle glaucoma
C. Diabetic macular edema
D. Dry age-related macular degeneration

A

B. Primary open angle glaucoma (always suspect glaucoma when cup: disc ratio >0.5)

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25
Q

30 year old man with binocular diplopia with bilateral drooping eyelids. The condition exacerbate at the end of the workday.
What is the MOST LIKELY diagnosis?
A. Myasthenia gravis
B. Trochlear Nerve palsy
C. Muscular dystrophy
D. Oculomotor Nerve palsy

A

A. Myasthenia gravis

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26
Q

man blurring of vision for 1 yr, supratemporal retinal tear with subretinal fluid
A. Retinal detachment
B. SAH
C. Orbital fracture
D. CN4 palsy

A

A. Retinal detachment

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27
Q

2yo child with right esotropia. fully correctable with spectacles. diagnosis?
A. accommodative esotropia
B. CN6 palsy
C. Duane syndrome
D. intermittent exotropia

A

A. accommodative esotropia

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28
Q

Bitemporal hemianopia. What is the most likely type of neuropathy.
A. Compressive Neuropathy
B. Ischemic Neuropathy
C. Post-radiation Neuropathy
D. Neuropathy (?optic neuritis)

A

A. Compressive Neuropathy (optic chiasm: pituitary adenoma)

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29
Q

20 year old male. Slip and fall. Facial injury. VA 20/20. Binocular diplopia. Diagnosis?
A. Orbital fracture
B. Open Globe Injury
C. Trochlear Nerve Palsy
D. SJS/TEN

A

A. Orbital fracture

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30
Q

HT, Hyperlipidemia. Sudden visual loss, diagnosis?

A

Central retinal vein occlusion

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31
Q

DM patient, staging of disease?
Treatment modality

A

Proliferative diabetic retinopathy
Panretinal photocoagulation

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32
Q

Blurring of vision, dx?

A

Subretinal hemorrhage
Dresin
Dark spot (scotoma)

Wet age related macular degeneration

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33
Q

Asymptomatic, dx?

A

Glaucoma (increased cupt to risk ratio of at least 0.8)

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34
Q

Clinical sign?

A

Cotton wool spot

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35
Q

Smoker, swelling and proptosis, dx?

A

Thyroid eye disease

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36
Q

20/M with history of ankylosing spondylitis , redness, diagnosis?

A

Anterior uveitis

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37
Q

Rheumatoid arthritis patients, painful and red eye, diagnosis?

A

Scleritis

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38
Q

Poorly controlled DM, complication?

A

Neovascular glaucoma/rubeosis iridis

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39
Q
A

Non arteritic anterior ischemic otpic neuropathy (optic disc swelling and hyperemic (red))

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40
Q

Visual field loss, dx?

A

Retinal detachment

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41
Q

Clinical sign?

A

Drusen (due to absence of other signs of diabetic retinopathy: no dot and blot hemorrhages, no neovascularization)

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42
Q

Contact lens user, Pain, Photophobia, Diagnosis?

A

Infective keratitis

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43
Q

Pain, Headache, Nausea and vomiting, IOP 41 mmHg, Diagnosis?

A

Acute angle closure glaucoma

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44
Q

Clinical sign?

A

Leukocoria
Retinoblastoma, congenital cataracts

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45
Q

Hypertension, Hyperlipidemia, Painless visual loss, Diagnosis?

A

Right eye central retinal artery occlusion

Cherry red spot and pale retina
Abnormal blood vessel

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46
Q

dx?

A

Epiretinal membrane

This contracts and pulls on the vessels (hence the appearance of vessels reaching towards the white space)

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47
Q

Clinical sign?

A

Hollenhorst plaque/emboli

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48
Q

Doctor says the cataract is too hard to be removed by phacoemulsification. Give an alternative treatment.

A

Extracapsular cataract extraction

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49
Q
A

Hyphema (bleeding in anterior chamber of eye between iris and cornea)

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50
Q
A

Posterior synechiae

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51
Q

Picture of A: caustic soda; B: acidic cleaner)
Your patient accidentally splashes a large amount of A or B into his/her eyes. Does A or B cause more damage?

A
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52
Q

F/69 reported RE pain
1. What is the most likely diagnosis?
2. Give 1 risk factor for the condition
3. Systemic treatment?
4. Definitive treatment?

A
  1. Acute angle closure glaucoma
  2. female, old age, shallow anterior chamber, shorter axial length
  3. Decrease intraocular pressure: timolol 0.5% (B blocker)/ apraclonidine (a2 adrenergic agonist)/IV Acetazolamide / IV mannitol
  4. Laser peripheral iridotomy
53
Q

M/76 Blurring of vision for 3 yrs, bilateral eye VA 0.1, slit lamp showed bilateral cataract
5-6. 2 Risk factors for cataract
7-8. 2 Surgical options for cataract (full name preferred)

A

Diabetes, smoking, UV exposure, age, obesity, previous eye trauma, surgery
Phacoemulsification and extracapsular extraction (intracapsular extraction is not used anymore)

54
Q
  1. A 60-year-old girl had an incidental finding of optic nerve abnormality on fundoscopy. Her IOP was measured 19 mmHg. Angle was open, and the anterior chamber was not narrow. What is the diagnosis?
A

Normotension glaucoma

55
Q
A

Drusen (located at retinal pigment epithelial cells layer)
Age related macular degeneration

56
Q
A

Vitreous hemorrhage

57
Q
A

Subretinal hemorrhage (between retina and retinal pigment epithelium)

58
Q
A

Keratitis

59
Q

Risk factor of this condition (subconjunctival hemorrhage)

A

Hypertension, anticoagulants, coagulopathy, valsalva retinopathy (repeated vomiting causing raised intrathoracic pressure), trauma

60
Q
A

Corneal opacity/corneal clouding

61
Q
A

Tractional retinal detachment

62
Q
A

Neovascularization of optic disc

63
Q
A

Neovascular Glaucoma

64
Q
A

Branched Retinal Artery Occlusion

Partial visual field loss and no cherry red spot. White retina around the area of distribution of retinal artery.

65
Q
A

Branched Retinal Artery Occlusion

Partial visual field loss and no cherry red spot. White retina around the area of distribution of retinal artery.

66
Q
A

Weiss ring

67
Q
A

Laser peripheral iridotomy

68
Q
A

Bulls eye maculopathy

69
Q
A

Endophthalmitis

70
Q
A

Right CN3 palsy

71
Q
A

Macular hole (scotoma –> AMD)

72
Q
A

Retinitis pigmentosa

73
Q
A

Herpes keratitis

74
Q

50/M poorly controlled DM patient presents with sudden painless loss of vision. VA: only hand movement, loss of red reflex, fundi view blocked by a reddish clot. Which is the most likely cause?
A. CRVO
B. Vitreous haemorrhage
C. AION
D. Exudative age-related macular degeneration

A

B. Vitreous haemorrhage

75
Q

90/F progressive blurring of vision in last 5-6 years. Previous uneventful cataract surgery in both eyes 10 years ago. VA 20/20 both eyes. Multiple drusens in both maculae, with atrophic changes at macula. What is the most likely diagnosis?
A. Cataract
B. Primary open angle glaucoma
C. Diabetic macular edema
D. Dry age-related macular degeneration

A

D. Dry age-related macular degeneration (no macular hole/scotoma which would mean wet AMD)

76
Q

A 20-year-old lady has blurring of vision for 3-4 days. No history of trauma. She thinks the colour she sees is duller than before. There is pain associated with eye movement, no pain when resting. Failed Ishihara test. Which one is the most likely diagnosis?
A. Concussion
B. Optic neuritis
C. Orbital fracture
D. Trochlear nerve palsy

A

B. Optic neuritis

77
Q

Child has decreased VA on one or both eyes, otherwise normal. Most common cause
A. Anisometropia
B. Amblyopia
C. Intermittent exotropia
D. Congenital cataract

A

B. Amblyopia

78
Q

Elderly male with poor DM control presented to you with acute vision loss. Fundoscopy shows dot and blot haemorrhages over 4 quadrants with hard exudates over the macula. What is the most likely diagnosis?
A.
B. Diabetic macular oedema
C. ARMD

A

B. Diabetic macular oedema

Dot and blot hemorrhages (small vessel disease –> DM)
Hard exudates (lipid and protein leakage from impaired blood retinal barrier)

79
Q

Elderly(?) man with progressive reduction in visual acuity over the past 2 years. Dim red reflex. Which is the most likely diagnosis?
A. Cataract
B. Acute angle closure glaucoma
C. ARMD

A

A. Cataract

80
Q

40 year old construction site worker complained of acute left eye pain, redness and tearing after accidental spillage of industrial corrosive fluid. He didn’t wear goggles when handling the fluid. What is the most appropriate immediate management?

A. Skull X-ray
B. Topical application of broad spectrum antibiotics
C. Copious irrigation of ocular surface
D. Evisceration

A

C. Copious irrigation of ocular surface

81
Q

40/M, high myopia, 1 day history of left nasal visual loss, 2 weeks history of floater and flashes. BE VA normal (20/20), confrontation test left nasal visual loss. What is the most important diagnosis to look for.

A. Acute Posterior vitreous detachment
B. Retinal detachment
C. Acute anterior uveitis
D. Compressive optic neuropathy

A

B. Retinal detachment (can become blind)

Floaters = PVD –> which can lead to retinal detachment

82
Q

29 year old female, acute blurring vision right eye, pain on eye movement but not at rest. There is RAPD and red-green desaturation on right eye.

A. Optic neuritis
B. Compressive optic neuropathy
C. AION
D. Radiation optic neuropathy

A

A. Optic neuritis

83
Q

A 55-year-old lady presents with left partial ptosis for several weeks. On examination, she has anisocoria that is exacerbated in dim light. What is the MOST LIKELY diagnosis?

A. Horner syndrome
B. Myasthenia gravis
C. Botulism
D. Tolosa-Hunt syndrome

A

A. Horner syndrome

84
Q

An 80 year-old male presented with metamorphopsia and blurring of vision since two days ago. Fundoscopy showed submacular exudates and submacular haemorrhages.
What is the MOST LIKELY diagnosis?

A. central retinal vein occlusion
B. central retinal artery occlusion
C. Anterior Ischemic Optic Neuropathy
D. Exudative Age-related Macular Degeneration

A

D. Exudative Age-related Macular Degeneration

85
Q

70/F, sudden right eyebrow pain, redness, blurring of vision. IOP 65mmHg. Corneal edema, fixed mid-dilated pupil.

A. Acute iritis
B. Acute microbial keratitis
C. Acute angle closure attack
D. Acute conjunctivitis

A

C. Acute angle closure attack

86
Q

An 80-year-old man, with a history of atrial fibrillation, presented with right eye sudden onset loss of vision three days ago. There was right relative afferent pupillary defect. Fundoscopy examination showed right retina pallor with a ‘cherry red spot’ noted. What is the MOST LIKELY diagnosis?

A. Central retinal vein occlusion
B. Central retinal artery occlusion
C. Anterior ischemic optic neuropathy
D. Exudative age-related macular degeneration

A

B. Central retinal artery occlusion

Cherry red spot as it has seperate blood supply (from choroid: short and long posterior ciliary arteries)
The surrounding retina is ischemic is white (supplied by retinal artery)

87
Q

An 80-year-old lady presents with sudden onset right eye severe pain, tearing and loss of vision. She had just undergone right eye cataract extraction and intraocular lens implantation just four days ago. On examination, her right eye vision was light perception only. She had marked corneal oedema, copious cells in the anterior chamber and a large hypopyon. There was no fundal view. She was afebrile. What is the MOST LIKELY diagnosis?

A. Postoperative endophthalmitis
B. Endogenous endophthalmitis
C. Infective keratitis
D. Acute anterior uveitis

A

A. Postoperative endophthalmitis

Hypopyon (WBC in anterior chamber)

88
Q

Which of the following measures can be used to detect acute exudative changes in age related macular degeneration?
A. Annual Fundus Photo
B. Annual Humphrey Visual Field
C. Annual FFA
D. Self amsler grid

A

D. Self amsler grid

89
Q

M/ Asymptomatic, Bilateral cup-disc ratio of 0.8, what investigation should be done to diagnose glaucoma?

A. Neuroimaging
B. Lumbar puncture
C. HESS Test
D. Humphrey visual field
E. FFA

A

D. Humphrey visual field

90
Q

infective cause of leukocoria in children
A. Toxocariasis
B. Persistent hyperplastic vitreous vasculature
C. Retinoblastoma
D. Coats Disease
E. Congenital Cataract

A

A. Toxocariasis

91
Q

What are the characteristic clinical signs of Diabetic Retinopathy?
A. Flame-shaped haemorrhages
B. Drusens
C. Subretinal haemorrhages
D. Hard exudates, dot & blot hemorrhages, microaneurysms
E. Angioid streaks

A

D. Hard exudates, dot & blot hemorrhages, microaneurysms

92
Q

25/M, Contact lens wearer. Just after taking off soft contact lens, eye sudden severe pain and tearing. Fluorescein stain shows 3X5mm corneal defect. Seidel sign -ve. Most likely cause?
A. Acute chemical injury of the eye
B. Open globe injury with Intraocular Foreign body
C. Blunt trauma
D. Corneal abrasion
E. Corneal ulcer

A

D. Corneal abrasion

93
Q

60 yo male with DM retinopathy. Acute onset of loss of vision of R eye, worse in the morning and improve over days. Loss of red reflex due to opacity. Fundoscopy of R eye failed because of media opacity. Examination revealed the other eye have proliferative DM retinopathy What’s the dx?
A. AAION
B. CRVO
C. CRAO
D. Vitreous hemorrhage
E. Optic neuritis

A

D. Vitreous hemorrhage

94
Q

what is the most appropriate management for a small horse-shoe tear in supterotemporal peripheral retina without subretinal fluid?
A. Reassurance
B. PRP
C. Barrier laser
D. Grid/focal laser
E. Peripheral iridotomy

A

C. Barrier laser

95
Q

A child with right ptosis covering pupillary axis. What is the reason for his right eye amblyopia
A.
B. Strabismic amblyopia
C. Anisometropia amblyopia
D. Sensory deprivation amblyopia
E. Refractive amblyopia

A

D. Sensory deprivation amblyopia

96
Q

What is the only treatable risk factor for glaucoma ?
A. Sex
B. Intraocular pressure
C. Cigarette smoking
D. Alcohol
E. Obesity

A

C. Cigarette smoking

97
Q

What disease is scleritis most commonly associated with ?
A. Behcet disease
B. Systemic lupus erythematosus
C. Rheumatoid arthritis
D. Ankylosing spondylitis
E. Giant cell arteritis

A

C. Rheumatoid arthritis

98
Q

25 years old Chinese woman presented with sudden onset visual loss of the right eye. Fundus photo shows right central retinal vein occlusion of her right eye. Which of the following is the most likely cause?
A. Protein C deficiency
b. Factor V Leiden Deficiency
C. Multiple myeloma
D. Use of oral contraceptive pills
E. Trauma

A

A. Protein C deficiency

99
Q

what’s the clinical finding of consequence of chronic poorly controlled HT?
A. Drusens
B. Dot-and-blot hemorrhage
C. AV nicking
D. Subretinal hemorrhage
E. Angioid streaks

A

C. AV nicking

Drusens (AMD)
Dot and blot hemorrhage: DM (leaky vessels)
Subretinal hemorrhage (DM)

100
Q

which of the following is most commonly associated with endogenous endophthalmitis in diabetic patients?
A. Candida albicans
B. Propionibacterium acnes
C. Klebsiella pneumoniae
D. MTB
E.

A

C. Klebsiella pneumoniae

101
Q

Hammering, Aqueous leaking out; skull x-ray reveal hyperdense lesion in eye
A. Chemical irritation
B. Open globe injury with intraocular foreign body
C. Blunt trauma of eye
D. Corneal abrasion
E. Sympathetic ophthalmia

A

B. Open globe injury with intraocular foreign body

102
Q

Acute visual loss, photophobia… Dendritic ulcer. What is the diagnosis?
A. Uveitis
B. Acutemicrobialkeratitis
C. Scleritis
D. Conjunctivitis

A

B. Acutemicrobialkeratitis

103
Q

The only modifiable risk factor for Grave’s ophthalmopathy
A. Sex
B. Race
C. Smoking
D. Alcohol
E. Obesity

A

C. Smoking

104
Q

A woman with right partial ptosis. Anisocoria exacerbated in dim light. How to confirm the diagnosis?
A. Tensilon
B. Pilocarpine
C. Pseudoephrine
D. Cocaine
E. Levofloxacin

A

D. Cocaine

105
Q

An elderly patient suffers from cataract. After cataract surgery and IOL placement, VA improved from 20/200 to 20/25. 1 year later, there was gradual painless loss of vision to 20/70 currently.
Which is the most likely cause?
A. IOL dislocation
B. Posterior capsular opacification
C. Steroid-induced glaucoma

A

B. Posterior capsular opacification

Clouding of the thin membrane (lens capsule) that surrounds the newly implanted IOL. Common complication that can occur months or years afterward, causing fuzzy vision.

106
Q

Which of the following is true when managing a 4-year boy with amblyopia?
A. Occlusive therapy is not effective in this age
B. The reflactive error of both eyes should be fully corrected by spectacles

A

A. Occlusive therapy is not effective in this age

107
Q

Fluorescein angiography is used as an emergency investigation for
A. Age related macular degeneration
B. Proliferative DMR

A

B. Proliferative DMR

108
Q

Latent squint is confirmed by
A. Alternating cover test
B. Cover-uncover test
C. The less existence of conjunctiva and sclera medially
D. The less existence of conjunctiva and sclera temporally
E. The reflection of the torch shine on the cornea is not located at the centre of the pupil

A

A. Alternating cover test

109
Q

Convergent squint is confirmed by
A. Alternate test
B. Cover and uncover test
C. Less exposure of conjunctiva and sclera at nasal side
D. Less exposure of conjunctiva and sclera at temporal side
E. Reflection of torch located on cornea not at center

A

E. Reflection of torch located on cornea not at center

Corneal reflex test
If light is reflected towards nasal side (divergent squint) with eye deviated outwards. If light reflects towards temporal side (convergent squint) with eye deviated inwards.

110
Q

How to differentiate scleritis and conjunctivitis?
A. Tensilon Test
B. Apply Phenylepinephrine
C. Hirschberg Light Reflex Test
D. Flurorescein Dye
E. Schirmer’s Test

A

B. Apply Phenylepinephrine

Constricts superficial vessels only

111
Q

A 60 years old female presents with progressive visual loss of the left eye. Visual acuity shows RE 0.3, LE 0.1. Anterior segment has 1+ nuclear sclerosis bilaterally. Dilated fundus shows striae (wrinkling) of macula and a hole in centre.
What would be the most appropriate management?
A. Laser photocoagulation to prevent retinal detachment
B. Peripheral cryoplexy
C. Penetrating keratoplasty
D. Pneumatic retinopexy
E. pars plana vitrectomy

A

E. pars plana vitrectomy

Indications include removal of vitreous opacities, relieving vitreoretinal traction, restoring the normal anatomical relationship of the retina and retinal pigment epithelium (RPE), and accessing the subretinal space.

112
Q

A 63-year-old man complains of a 2-month history of severe visual loss in the right eye. Visual Acuity was 0.05 in the right eye and 0.7 in the left eye. Intra-ocular pressure was 38mmHg in the right eye and 12mmHg in the left eye. In the right eye, tiny blood vessels were visible on iris surface and 2+ NS cataract was found. On dilated fundal examination, optic disc edema, intraretinal haemorrhage over all 4 quadrants and macular edema were found in the right eye. The patient has systemic hypertension.
The patient should undergo:
A. Panretinal photocoagulation
B. Laser photocoagulation of iris vessels
C. Immediate Argon Laser Iridotomy
D. Macular grid laser photocoagulation
E. Pars plana vitrectomy

A

C. Immediate Argon Laser Iridotomy
Relieve the pressure and maintain drainage of aqueous humor into trabecular meshwork

113
Q

A man with glaucoma was prescribed some medication. After using it he experienced conjunctival hyperemia, periorbital skin hyperpigmentation and foreign body sensation in his eyes. Which drug was he likely prescribed?
A. Alpha-2 agonist
B. Beta blocker
C. Carbonic anhydrase inhibitor
D. Prostaglandin analogue
E. Miotics

A

D. Prostaglandin analogue (latanoprost and bimatoprost)

114
Q

Which of the following structure produces aqueous humor of the eye?
A. choroid
B. iris
C. cornea
D. ciliary body
E. sclera

A

D. ciliary body

115
Q

A 64 year old lady presented with a progressive onset of diplopia and ptosis for 8 months. On examination, left eye was normal; right eye had a 4mm ptosis, with eye movements in all directions limited, pupil nonreactive to light and was not dilated in dark and corneal sensation was also absent. Which of the followings is the most possible diagnosis?
A. Graves ophthalmopathy
B. Intracarvernous meningioma
C. Midbrain glioma
D. Aneurysm in posterior communicating artery
E. Myasthenia gravis

A

B. Intracarvernous meningioma

Surgical CN3 palsy (parasympathetic fibers affected first (outer) causing dilated pupil)

116
Q

An elderly woman, who is an Ex-sex worker. On PE, she is found to have small irregular pupil +light near dissociation. What is the infectious agent involved?
A. HSV
B. syphilis
C. HIV

A

B. syphilis

Argyll Robertson pupils are constricted pupils in someone who has late-stage syphilis (neurosyphilis)

117
Q

Which of the following drug is contraindicated in angle closure glaucoma?
A. Pilocarpine
B. Carbonic anyhydrase inhibitor
C. Steroid drops
D. Mydriatic drops
E. Brimonidine tartrate drops

A

D. Mydriatic drops

118
Q

Which of the following are common features of optic neuropathy?
A. Decreased visual acuity
B. Loss of color vision
C. Visual field defect
D. Relative afferent pupillary defect, due to unilateral / asymmetrical disease
E. All of the above

A

E. All of the above

119
Q

A (elderly) ?-year-old man with progressive deteriorating vision complaints of loss of central vision. He reported that he had been seeing crooked lines in the past. Examination of the fundus found a patch of blood in the macular area. A diagnosis of wet-type age-related macular degeneration is suspected. Where does the bleeding in the macular area come from?
A New vessels from the retina
B Central retinal vein
C New vessels from the choroid
D Vitreous haemorrhage
E Vessels from the optic disc

A

C New vessels from the choroid
Choroidal neovascularization

120
Q

How to differentiate congenital and late onset Horner’s syndrome?
A. Miosis
B. Ptosis
C. Anhydrosis
D. Iris heterochromia
E. Hypersensitivity to 0.1% pilocarpine

A

D. Iris heterochromia

Congenital or acquired Horner’s syndrome in children can lead to heterochromia iridis. Sympathetic stimulation has a trophic effect on iris melanocytes, and denervation impairs melanin pigmentation, making the affected eye lighter.

121
Q

What is a feature of right INO
A. Left eye nystagmus upon right lateral conjugate gaze
B. Left eye nystagmus upon left lateral conjugate gaze
C. The right eye fails to abduct.
D. The left eye fails to adduct.

A

B. Left eye nystagmus upon left lateral conjugate gaze

122
Q

Diplopia due to left iv nerve palsy what would be the position to minimize diplopia?
A.Head tilt left
B.Head tilt right
C.Head turn
D. Tilt face left
E. Tilt face right

A

B.Head tilt right

123
Q

Most easily ruptured in blunt trauma
A. Central cornea
B. Peripheral cornea
C. Limbus
D. Anterior insertion of rectus muscle on sclera
E. Posterior sclera

A

C. Limbus

124
Q

A 75 year old man with confluent drusen and pigmentary degeneration presents with blurring and distortion of central vision for few months . He has quitted smoking ten years ago. He had a mild heart attack lately . Which of the following are recommended ?
A. Bilateral intravitreal anti VEGF injection
B. Photodynamic therapy
C. Multivitamins and antioxidants
D. Intravitreal steroid injection
E. Macular grid laser

A

C. Multivitamins and antioxidants

125
Q

Child 14yo, right eye 6/24, left eye 24/24. Esotropia. What is the cause
A. Strabismic amblyopia
B. Anisometropia amblyopia
C. Sensory deprivation amblyopia

A

A. Strabismic amblyopia

126
Q

Which of the following is a sign suggestive of orbital cellulitis?
A. Limited EOM
B. Periorbital swelling
C. Fever
D. Wound on the lid
E. Subcutaneous lid swelling on CT

A

A. Limited EOM (post septal cellulitis –> medical emergency as it involves the EOM and fat)

Most cases tend to preseptal cellulitis: symptoms include periorbtial swelling, there may be eye pain/tenderness, no pain in EOM

127
Q

Amsler grid has sudden central scotoma. What could be the cause?
A. AACG
B. Macular hole
C. Corneal ulcer
D. Retinal tear
E. Haemorrhage

A

B. Macular hole

128
Q

Which of the following signs is NOT found in retinal vein occlusion?
A. Retinal haemorrhage
B. Cotton wool spot
C. Macular edema
D. Macular hole
E. Venous engorgement

A

D. Macular hole

129
Q

What feature distinguish PVD from Retinal break?
A. High myopia
B. Schaffer’s sign
C. Visual field defect
D. Reduced visual acuity
E. Flashes

A

C. Visual field defect

MBBS V - Senior Clerkship - Block C CCT (52 decks)

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