Blue Misc 1

Question 1

What is Bruch’s membrane (BM) and its structure?

Answer 1

BM is a pentalaminar structure between RPE and choriocapillaris: RPE basement membrane, inner collagenous zone, central elastic fibers, outer collagenous zone, choriocapillaris basement membrane.

Question 2

Which diseases are associated with Bruch’s membrane?

Answer 2

Retinitis pigmentosa, AMD, pseudoxanthoma elasticum, Sorsby’s fundus dystrophy, Malattia Leventinese.

Question 3

What structures pass through the superior orbital fissure (SOF) mnemonic ‘SINA-LFTs’?

Answer 3

S = superior division CN III, I = inferior division CN III, N = nasociliary, A = abducens (inside ring); L = lacrimal, F = frontal, T = trochlear, s = superior ophthalmic vein (outside ring).

Question 4

Which cranial nerve fibers decussate to supply the contralateral superior rectus?

Answer 4

Fibers to superior rectus muscle decussate; damage to right oculomotor nucleus may cause bilateral superior rectus palsy.

Question 5

When do Y-sutures of the lens form and where?

Answer 5

At 8 weeks’ gestation; erect Y-suture anteriorly, inverted Y-suture posteriorly.

Question 6

What is thicker: anterior or posterior lens capsule?

Answer 6

The anterior lens capsule is thicker.

Question 7

What are the key rosettes seen in retinoblastoma histology?

Answer 7

Homer–Wright pseudo-rosettes (neuroblastic), Flexner–Wintersteiner (early retinal), fleurettes (photoreceptor).

Question 8

Are psammoma bodies seen in retinoblastoma?

Answer 8

No, they are seen in meningiomas and other tumors, not retinoblastoma.

Question 9

How many glucose transporter proteins (GLUTs) are encoded by the human genome?

Answer 9

14 GLUTs.

Question 10

Which GLUT is primarily involved in glucose homeostasis?

Answer 10

GLUT4.

Question 11

What ocular structures arise from surface ectoderm?

Answer 11

Eyelid epidermis, conjunctiva, corneal epithelium, lens, lacrimal glands.

Question 12

What arises from neuroectoderm in the eye?

Answer 12

Iris and ciliary epithelium, RPE, optic nerve.

Question 13

What eye structures are derived from neural crest cells?

Answer 13

Corneal stroma, Descemet’s, endothelium, sclera, iris stroma, ciliary muscles, trabecular meshwork.

Question 14

What eye structures come from mesoderm?

Answer 14

Vitreous, choroid, sclera, endothelial lining of vessels, EOMs.

Question 15

What are phakomatoses and how are they inherited?

Answer 15

NF-1, NF-2, tuberous sclerosis, VHL—autosomal dominant.

Question 16

Are Sturge–Weber and Wyburn–Mason true phakomatoses?

Answer 16

No, they are sporadic.

Question 17

Which chromosome harbors the RB1 gene?

Answer 17

Chromosome 13.

Question 18

What is the “two-hit hypothesis” in retinoblastoma?

Answer 18

Both RB1 alleles must be inactivated—heritable in familial bilateral form.

Question 19

Is LAMA1 implicated in primary open angle glaucoma?

Answer 19

No, it’s associated with Poretti–Boltshauser syndrome.

Question 20

What is the unit of analysis issue in studies?

Answer 20

Using multiple observations per patient inflates sample size and violates independence assumption.

Question 21

What is a Type I error?

Answer 21

False rejection of a true null hypothesis; alpha is set in advance.

Question 22

What is a Type II error?

Answer 22

Failure to reject a false null hypothesis; probability is beta and depends on sample size.

Question 23

When are parametric tests used?

Answer 23

When complete population info is available (e.g., t-tests, ANOVA).

Question 24

When are non-parametric tests used?

Answer 24

When population info is unavailable (e.g., Wilcoxon, Mann–Whitney).

Question 25

What did the ACCORD Eye study show about fenofibrate?

Answer 25

With simvastatin, fenofibrate reduced retinopathy progression by 40% over 4 years.

Question 26

What did the FIELD study show about fenofibrate?

Answer 26

Reduced laser need (NNT=17) and prevented progression (NNT=9) in retinopathy.

Question 27

What were the three arms of the Collaborative Ocular Melanoma Study?

Answer 27

Observation (small tumors), brachytherapy vs enucleation (medium), radiotherapy pre-enucleation (large).

Question 28

What was the outcome of COMS for medium melanomas?

Answer 28

Brachytherapy was as effective as enucleation.

Question 29

What are the key conclusions of HEDS 1?

Answer 29

Topical steroids improve stromal HSK; oral acyclovir adds no extra benefit in stromal HSK.

Question 30

What are the key conclusions of HEDS 2?

Answer 30

Oral acyclovir reduces HSV recurrence; stress not a recurrence trigger.

Question 31

What were the ONTT treatment arms?

Answer 31

IVMP + oral steroids, oral steroids alone, placebo.

Question 32

What was the visual outcome in ONTT?

Answer 32

No difference at 15 years; IVMP improved early recovery only.

Question 33

What was ONTT’s finding on MS risk?

Answer 33

IVMP reduced short-term risk, not long-term.

Question 34

What did NASCET show about CEA in severe carotid stenosis?

Answer 34

CEA significantly reduced ipsilateral stroke risk (ARR 17%, NNT 6).

Question 35

What was the CEA recommendation from NASCET?

Answer 35

Do CEA if symptomatic 50–99% stenosis or asymptomatic 60–99%, with acceptable perioperative risk.

Question 36

What did AREDS 1 and 2 show?

Answer 36

AREDS 1: C, E, zinc, copper, β-carotene. AREDS 2: lutein/zeaxanthin are safer than β-carotene for smokers.

Question 37

What is Gillick competence?

Answer 37

A child under 16 can consent to treatment if they understand the implications.

Question 38

What are the five layers of Bruch’s membrane from inside to outside?

Answer 38

Basement membrane of RPE, inner collagenous zone, central elastic layer, outer collagenous zone, basement membrane of choriocapillaris.

Question 39

What diseases are associated with Bruch’s membrane involvement?

Answer 39

Retinitis pigmentosa, AMD, pseudoxanthoma elasticum, Sorsby’s fundus dystrophy, Malattia Leventinese.

Question 40

Which bones form the borders of the superior orbital fissure (SOF)?

Answer 40

Greater and lesser wings of the sphenoid bone.

Question 41

What structures pass through the SOF within the tendinous ring (mnemonic: SINA)?

Answer 41

Superior & Inferior divisions of CN III, Nasociliary nerve (V1), Abducens nerve (CN VI).

Question 42

What structures pass through the SOF outside the tendinous ring (mnemonic: LFTs)?

Answer 42

Lacrimal nerve (V1), Frontal nerve (V1), Trochlear nerve (CN IV), Superior ophthalmic vein.

Question 43

Which oculomotor muscle fibres decussate to innervate the contralateral eye?

Answer 43

Fibres to the superior rectus muscle.

Question 44

What is the pattern of lens sutures during embryologic development?

Answer 44

Anterior erect Y-suture and posterior inverted Y-suture.

Question 45

Which capsule of the lens is thicker—anterior or posterior?

Answer 45

Anterior capsule.

Question 46

Which side of the lens contains epithelium—anterior or posterior?

Answer 46

Only the anterior capsule contains epithelium.

Question 47

What histologic patterns are seen in retinoblastoma?

Answer 47

Homer–Wright pseudo-rosettes, Flexner–Wintersteiner rosettes, fleurettes, calcification.

Question 48

What are GLUTs and how many are there in the human genome?

Answer 48

Integral membrane glucose transporters with 12 helices; 14 types exist.

Question 49

Which GLUT isoform regulates whole-body glucose homeostasis?

Answer 49

GLUT4.

Question 50

What is the embryologic origin of the corneal epithelium and lens?

Answer 50

Surface ectoderm.

Question 51

What structures arise from the neuroectoderm?

Answer 51

Iris and ciliary epithelium, RPE, optic nerve.

Question 52

What structures are derived from neural crest cells?

Answer 52

Corneal stroma and endothelium, sclera, trabecular meshwork, iris and ciliary stroma.

Question 53

What ocular structures arise from mesoderm?

Answer 53

Choroid, vitreous, endothelium of ocular vessels, extraocular muscles.

Question 54

What are the true phakomatoses?

Answer 54

NF-1, NF-2, tuberous sclerosis, von Hippel–Lindau (VHL); all autosomal dominant.

Question 55

What distinguishes Sturge–Weber and Wyburn–Mason syndromes from true phakomatoses?

Answer 55

They occur sporadically.

Question 56

What gene is mutated in retinoblastoma, and on which chromosome is it found?

Answer 56

RB1 gene on chromosome 13.

Question 57

What does the 'two-hit hypothesis' explain in retinoblastoma?

Answer 57

Bilateral familial cases occur when both RB1 alleles are mutated early in life.

Question 58

Which gene is *not* associated with primary open-angle glaucoma?

Answer 58

LAMA1 (linked instead to Poretti–Boltshauser syndrome).

Question 59

What is a unit of analysis issue in clinical research?

Answer 59

Using multiple observations per patient as independent data violates assumptions of independence.

Question 60

What defines a Type I error?

Answer 60

Incorrect rejection of a true null hypothesis; set in advance as alpha.

Question 61

What defines a Type II error?

Answer 61

Failure to reject a false null hypothesis; probability is beta.

Question 62

When are parametric tests used?

Answer 62

When population parameters are known or assumed to be normal.

Question 63

What did ACCORD Eye and FIELD trials show about fenofibrate?

Answer 63

It reduces progression of diabetic retinopathy and need for laser therapy.

Question 64

What were the key findings of the Collaborative Ocular Melanoma Study (COMS)?

Answer 64

Brachytherapy is effective for medium tumors; no benefit from preoperative radiotherapy for large ones.

Question 65

What are the three forms of COMS by tumor size?

Answer 65

Small (1.5–2.4 mm), medium (2.5–10 mm), large (>10 mm height).

Question 66

What did HEDS 1 show regarding treatment of stromal HSK?

Answer 66

Topical steroids reduce treatment failures; oral acyclovir adds no benefit.

Question 67

What did HEDS 2 find about prophylactic oral acyclovir?

Answer 67

Reduces recurrence risk, especially for stromal keratitis.

Question 68

What were the three treatment arms in ONTT?

Answer 68

IVMP + OP, OP alone, placebo.

Question 69

What were ONTT findings regarding recurrence and MS risk?

Answer 69

Oral prednisone alone increased recurrence; IVMP reduced MS risk for 2 years.

Question 70

What did NASCET show regarding carotid endarterectomy (CEA)?

Answer 70

CEA is beneficial in symptomatic 50–99% stenosis if perioperative risk is low.

Question 71

What change did AREDS 2 make to the original formula?

Answer 71

Replaced β-carotene with lutein + zeaxanthin due to lung cancer risk in smokers.

Question 72

What is Gillick competence?

Answer 72

A child under 16 can consent to treatment if they fully understand the implications.

Question 73

What is the Fraser guideline specifically for?

Answer 73

Contraception and sexual health decisions in minors.