LE1 - Optha Flashcards
(149 cards)
1
Q
Colored halos seen around a point of light could be caused by:
Choices:
a) Corneal edema
b) Corneal abrasion
c) Corneal pannus
d) None of the above
A
a) Corneal edema
Rationale:
Colored halos around lights are commonly seen in conditions that affect the cornea and lead to edema, causing light to scatter.
2
Q
Hollenhorst plaque seen in retinal vein occlusions is a:
Choices:
a) Cholesterol embolus
b) Calcific embolus
c) Fibrin embolus
d) None of the above
A
a) Cholesterol embolus
Rationale:
Hollenhorst plaques are typically cholesterol emboli originating from carotid artery disease.
3
Q
A recurrent bilateral conjunctivitis occurring with the onset of hot weather in a 6-year-old boy with symptoms of burning, itching, and lacrimation with large flat-topped cobblestone papillae raised areas in palpebral conjunctiva is:
Choices:
a) Phlyctenular conjunctivitis
b) Trachoma
c) Vernal keratoconjunctivitis
d) None of the above
A
c) Vernal keratoconjunctivitis
Rationale:
Vernal keratoconjunctivitis is a seasonal allergic condition commonly affecting children and characterized by the described symptoms and findings.
4
Q
The following organisms can present with a palpable preauricular lymph node and eye discharge EXCEPT:
Choices:
a) Chlamydia trachomatis
b) Neisseria gonorrhoeae
c) Adenovirus
d) None of the above
A
b) Neisseria gonorrhoeae
Rationale:
Neisseria gonorrhoeae does not typically cause palpable preauricular lymph nodes.
5
Q
All of the following can be caused by chlamydial infection EXCEPT:
Choices:
a) Inclusion conjunctivitis
b) Lymphogranuloma venereum
c) Trachoma
d) Neither
A
d) Neither
Rationale:
Chlamydial infections can cause inclusion conjunctivitis, lymphogranuloma venereum, and trachoma.
6
Q
Which of the following is an example of a normal optic nerve?
A
c) Option 3
Rationale:
A normal optic nerve head should have a clear margin, a pink color, and a central cup. Option 3 in the image provided appears to match these criteria.
7
Q
A white opacity caused by a scar or corneal infiltrate is called a:
Choices:
a) Corneal leukoma
b) Pannus
c) Keratic precipitates
d) Corneal edema
A
a) Corneal leukoma
Rationale:
A corneal leukoma is a dense white opacity on the cornea resulting from scarring.
8
Q
A major risk for the development of bacterial keratitis is:
Choices:
a) Diabetes mellitus
b) Age
c) Contact lens wear
d) None of the above
A
c) Contact lens wear
Rationale:
Contact lens wear is a significant risk factor for developing bacterial keratitis due to potential contamination and improper hygiene.
9
Q
The most common ophthalmic manifestation in thyroid-associated orbitopathy is:
Choices:
a) Proptosis
b) Lid retraction
c) Conjunctivitis
d) Chemosis
A
b) Lid Retraction
• Lid retraction is the most common and characteristic feature of thyroid-associated orbitopathy. • It results from the increased sympathetic tone and fibrosis of the levator palpebrae superioris muscle and Müller’s muscle. • Clinical Features: • The upper eyelid is higher than normal when the eyes are in the primary position, which gives the eyes a “staring” appearance. • It can cause exposure of the cornea, leading to dryness and discomfort. • The sclera is visible above the corneal limbus.
Other Manifestations
• Proptosis (Choice a): • Also known as exophthalmos, it is a forward protrusion of the eye. While common in TAO, it is not as frequently the first or most prominent sign as lid retraction. • Conjunctivitis (Choice c): • Inflammation of the conjunctiva can occur secondary to exposure and dryness but is not the most common initial presentation. • Chemosis (Choice d): • Refers to swelling (edema) of the conjunctiva. It can occur in severe cases of TAO but is less common as an initial finding compared to lid retraction.
10
Q
A 60-year-old male came into the clinic because he cannot see the side mirror properly whenever he drives. One of his siblings is experiencing the same symptoms. The appropriate diagnostic work-ups/examinations for this condition is/are:
Choices:
a) Perimetry
b) Tonometry
c) Both
d) Neither
A
c) Both
Rationale:
Perimetry (visual field testing) and tonometry (measuring intraocular pressure) are both important in diagnosing conditions like glaucoma, which can cause peripheral vision loss.
11
Q
The most common cause of chronic proptosis in an adult is:
Choices:
a) Orbital pseudotumor
b) Orbital varix
c) Thyroid-associated orbitopathy
d) Orbital tumor
A
c) Thyroid-associated orbitopathy
Rationale:
Thyroid-associated orbitopathy, also known as Graves’ orbitopathy, is the most common cause of chronic proptosis in adults due to inflammation and tissue expansion within the orbit.
12
Q
Pharyngoconjunctival fever (PCF) is an acute and highly infectious illness characterized by fever, pharyngitis, acute follicular conjunctivitis, and enlarged preauricular adenopathy. This is most frequently associated with:
Choices:
a) Adenovirus types 3 and 7
b) Adenovirus types 1 and 21
c) Enterovirus 70
d) Coxsackie A24
A
a) Adenovirus types 3 and 7
Rationale:
Pharyngoconjunctival fever is most frequently associated with adenovirus types 3 and 7, which cause the characteristic symptoms of this condition.
13
Q
A 45-year-old farmer presents with a wing-like structure found at the nasal side of the cornea at the palpebral fissure. What is your diagnosis?
Choices:
a) Pterygium
b) Episcleritis
c) Pinguecula
d) None of the above
A
a) Pterygium
Rationale:
A pterygium is a wing-like fibrovascular growth on the conjunctiva that extends onto the cornea, typically found on the nasal side.
14
Q
The pupil in an eye with iridocyclitis typically is somewhat bigger than the other eye due to reflex spasm of the iris sphincter muscle.
Choices:
a) True
b) False
A
b) False
Rationale:
The pupil in an eye with iridocyclitis is typically smaller due to reflex spasm of the iris sphincter muscle, not bigger.
15
Q
Which of the following statements is true?
Choices:
a) All of the above
b) Episcleritis blanches with 10% Phenylephrine drops
c) Episcleritis is an inflammation of the superficial episcleral layer of the eye
d) Episcleritis is relatively common, benign, and self-limiting
A
a) All of the above
Rationale:
Episcleritis is an inflammation of the superficial episcleral layer, is relatively common, benign, self-limiting, and blanches with 10% Phenylephrine drops.
16
Q
Optic neuritis is commonly associated with what medical condition?
Choices:
a) Giant cell arteritis
b) Multiple sclerosis
c) Takayasu’s arteritis
d) None of the above
A
b) Multiple sclerosis
Rationale:
Optic neuritis is commonly associated with multiple sclerosis, an autoimmune disease affecting the central nervous system.
17
Q
A 75-year-old male came in due to a “salmon patch” appearance in the bulbar conjunctiva for almost 2 years. Your most likely diagnosis will be:
Choices:
a) Conjunctival squamous papilloma
b) Chalazion
c) Conjunctival lymphoma
d) None of the above
A
c) Conjunctival lymphoma
Rationale:
A “salmon patch” appearance in the bulbar conjunctiva is characteristic of conjunctival lymphoma.
18
Q
A technique used to differentiate angle-closure glaucoma from open-angle glaucoma by viewing the anatomical angle formed between the eye’s cornea and iris is:
Choices:
a) Perimetry
b) Gonioscopy
c) Fluometry
d) Tonometry
A
b) Gonioscopy
Rationale:
Gonioscopy is a technique used to view the anatomical angle formed between the eye’s cornea and iris, helping differentiate angle-closure glaucoma from open-angle glaucoma.
19
Q
Causes of acute visual loss, EXCEPT:
Choices:
a) Vitreous hemorrhage
b) Central retinal artery occlusion
c) Retinitis pigmentosa
d) Migraine
A
c) Retinitis pigmentosa
Rationale:
Retinitis pigmentosa is a chronic, progressive condition leading to visual loss over time, not typically associated with acute visual loss.
20
Q
A degenerative lesion of the bulbar conjunctiva that occurs adjacent to the limbus in the interpalpebral zone, most often nasally, is:
Choices:
a) Conjunctival granuloma
b) Chalazion
c) Phlyctenulosis
d) Pinguecula
A
d) Pinguecula
Rationale:
A pinguecula is a degenerative lesion of the bulbar conjunctiva that occurs adjacent to the limbus, most often nasally, in the interpalpebral zone.
21
Q
Acute painful vision loss could be due to the following, EXCEPT:
Choices:
a) Angle closure glaucoma
b) Corneal disease
c) Diabetic retinopathy
d) Anterior uveitis
A
c) Diabetic retinopathy
Rationale:
Diabetic retinopathy typically causes painless vision loss, not acute painful vision loss.
Vision Loss Associated with Pain
- Corneal Disease• Conditions: Corneal abrasions, corneal edema, contact lens overwear.
• Symptoms: Acute vision loss due to compromised cornea.
• Diagnosis: Fluorescein staining, slit lamp examination. - Acute Glaucoma• Cause: Sudden rise in intraocular pressure.
• Symptoms: Vision loss due to corneal edema; referred pain in the forehead or brow.
• Diagnosis: Slit lamp examination, tonometry. - Anterior Segmental Inflammation• Condition: Iritis/iridocyclitis.
• Symptoms: Pain, especially with iris movement; patients avoid light due to discomfort.
• Diagnosis: Slit lamp examination.
22
Q
Patient is a 75-year-old female with uncontrolled diabetes for 3 years who came to the clinic complaining of this pattern of vision loss. What will be your working impression?
Choices:
a) Glaucoma
b) Cataract
c) Maculopathy
d) None of the above
A
c) Maculopathy
Rationale:
Uncontrolled diabetes can lead to diabetic maculopathy, a condition affecting the macula and causing central vision loss.
23
Q
Indication for surgery in this eye condition includes:
Choices:
a) Induced astigmatism of more than -2.50 D Cylinder
b) Excessive tearing
c) Both
d) Neither
A
c) Both
Rationale:
Indications for surgical excision of a pterygium include significant astigmatism (more than -2.50 D Cylinder) and bothersome epiphora (excessive tearing). The provided image and information confirm these indications.
24
Q
The majority of the aqueous humor flows out of the angle of the anterior chamber through which channel?
Choices:
a) Trabecular meshwork
b) Uveoscleral outflow
c) Both
d) Neither
A
a) Trabecular meshwork
Rationale:
The majority of the aqueous humor flows out through the trabecular meshwork, which is located at the angle of the anterior chamber.
25
Treatment for allergic conjunctivitis:
Choices:
a) Cetirizine 10 mg tablet
b) Olopatadine eyedrops
c) Both
d) Neither
c) Both
26
True of Giant Cell Arteritis:
Choices:
a) Symptoms include headache and pain over the temples
b) Treatment is typically with high doses of steroids
c) Both
d) None of the above
c) Both
Rationale:
Giant cell arteritis typically presents with symptoms like headache and pain over the temples, and treatment often involves high doses of steroids.
27
The classical triad of symptoms of vision loss, periocular pain, and dyschromatopsia is typically seen in:
Choices:
a) Retrobulbar neuritis
b) Optic neuritis
c) Both
d) Neither
c) Both
Rationale:
The classical triad of symptoms—vision loss, periocular pain, and dyschromatopsia—is typically seen in both retrobulbar neuritis and optic neuritis. Both conditions involve inflammation of the optic nerve and can present with these symptoms. The provided information confirms that these symptoms are associated with optic nerve diseases, including retrobulbar optic neuritis and optic neuritis.
28
True of Giant Cell Arteritis EXCEPT:
Choices:
a) It typically occurs in those over the age of 50
b) Mainstay of management is corticosteroid
c) It is a vasculitis involving medium-sized vessels
d) Headache is the most common symptom
e) None of the above
c) It is a vasculitis involving medium-sized vessels
Rationale:
Giant cell arteritis is a vasculitis involving large and medium-sized vessels, not exclusively medium-sized vessels.
29
Ankyloblepharon is an adhesion between:
Choices:
a) Upper eyelid and lower eyelid
b) Iris and lens
c) Bulbar conjunctiva and palpebral conjunctiva
d) None of the above
a) Upper eyelid and lower eyelid
Rationale:
Ankyloblepharon is defined as an adhesion between the upper and lower eyelids. This condition often results from chronic inflammation and scarring, as seen in diseases like cicatricial pemphigoid. The provided information confirms this definition.
Cicatricial pemphigoid is a chronic autoimmune disorder characterized by subepithelial blistering that leads to scarring. It primarily affects mucous membranes, including the conjunctiva of the eyes, which can result in blindness if untreated.
Ankyloblepharon is a condition where the eyelids are partially or completely fused together. This can be congenital or acquired due to trauma or inflammation.
Symblepharon is the adhesion of the eyelid to the eyeball, usually due to inflammation or injury. This can limit eye movement and cause discomfort or vision problems.
30
Drusen is a characteristic finding of:
Choices:
a) Diabetic retinopathy
b) Hypertensive retinopathy
c) Glaucoma
d) Age-related macular degeneration
d) Age-related macular degeneration
Rationale:
Drusen are yellow deposits under the retina and are characteristic findings in age-related macular degeneration.
31
Painless acute vision loss without clear media can be caused by:
Choices:
a) Macular disease
b) Vitreous hemorrhage
c) Both
d) Neither
b) Vitreous hemorrhage
Explanation:
Painless acute vision loss without clear media is typically due to conditions where the media (cornea, lens, vitreous) is not transparent, obstructing the view to the retina. Vitreous hemorrhage is a condition where blood accumulates in the vitreous humor, which leads to such vision loss without a clear media.
Macular disease, on the other hand, usually involves clear media but results in central vision loss due to retinal issues, not because the media itself is unclear. Therefore, the correct answer is b) Vitreous hemorrhage.
32
What is not a typical exam finding in conjunctivitis?
Choices:
a) Red conjunctiva
b) Subepithelial corneal infiltrate
c) Anterior chamber cell and flare
d) Eyelid erythema
c) Anterior chamber cell and flare
Rationale:
Anterior chamber cell and flare are typical findings in uveitis, not conjunctivitis. Conjunctivitis usually presents with red conjunctiva, possible subepithelial corneal infiltrates, and eyelid erythema.
33
All of the statements are true regarding the aqueous humor outflow EXCEPT:
Choices:
a) Uveoscleral outflow constitutes the majority of the mechanism of how the aqueous humor exits the eye
b) Trabecular outflow constitutes the minority of the mechanism of how the aqueous humor exits the eye
c) Both
d) Neither
C. Neither
Rationale: The majority of aqueous humor outflow in the eye occurs through the trabecular meshwork pathway, not the uveoscleral pathway. The trabecular outflow accounts for around 85-90% of aqueous humor drainage, while the uveoscleral pathway constitutes the minority (approximately 10-15%) of outflow. Therefore, both statements A and D are incorrect.
34
It is when an eyelid turns in toward the eye with the lashes contacting the globe surface.
Choices:
a) Entropion
b) Ectropion
c) Ptosis
d) Lagophthalmos
a) Entropion
Rationale:
Entropion is the condition where the eyelid turns inward toward the eye, causing the lashes to contact the globe surface.
35
Schirmer's test is used for diagnosing:
Choices:
a) Dry eye syndrome
b) Glaucoma
c) Uveitis
d) Corneal abrasion
a) Dry eye syndrome
Rationale:
Schirmer's test measures tear production and is used to diagnose dry eye syndrome.
36
The diagnostic gold standard for Giant cell arteritis is:
Choices:
a) Temporal artery biopsy
b) Lumbar tap
c) MRI
d) None of the above
a) Temporal artery biopsy
Rationale:
The diagnostic gold standard for Giant cell arteritis is a temporal artery biopsy.
37
The presence of symblepharon can be seen in:
Choices:
a) Stevens-Johnson syndrome
b) Ocular cicatricial pemphigoid
c) Both
d) Neither
c) Both
Rationale:
Symblepharon, or adhesions between the conjunctiva of the eyelid and the eyeball, can be seen in both Stevens-Johnson syndrome and ocular cicatricial pemphigoid.
38
Monocular loss of vision developing over hours to days with no abnormalities seen in ophthalmic examination, associated with pain on movement of eyes, is typically seen in:
Choices:
a) Optic neuritis
b) Retrobulbar neuritis
c) Papilledema
d) None of the above
b) Retrobulbar neuritis
Rationale:
Retrobulbar neuritis is characterized by monocular loss of vision developing over hours to days, with no abnormalities seen in the ophthalmic examination, and associated with pain on eye movement.
39
A scanty, white, stringy discharge can be seen in:
Choices:
a) Keratoconjunctivitis sicca (KCS) / Dry eye syndrome
b) Allergic conjunctivitis
c) Both
d) Neither
**c) Both**
**Explanation:**
- **Keratoconjunctivitis sicca (KCS) / Dry eye syndrome** can present with a scanty, white, stringy discharge due to the chronic dryness and irritation of the eyes.
- **Allergic conjunctivitis** also often presents with a stringy, white discharge due to the allergic reaction and inflammation of the conjunctiva.
Therefore, the correct answer is **c) Both**.
40
The treatment for a branch-like lesion (dendritiform) in the cornea is:
Choices:
a) Ganciclovir
b) Nystatin
c) Albendazole
d) Polymyxin
a) Ganciclovir
Rationale:
A branch-like (dendritiform) lesion in the cornea is typically caused by herpes simplex virus, and the treatment is antiviral therapy with ganciclovir.
41
All of the following can be signs of red eye except:
Choices:
a) Reduced visual acuity
b) Halos of light
c) Conjunctival hyperemia
d) Ciliary flush
b) Halos of light
Rationale:
Halos of light are typically associated with corneal edema or acute angle-closure glaucoma, not a red eye. Reduced visual acuity, conjunctival hyperemia, and ciliary flush are signs of red eye.
42
Ciliary flush is manifested in which photo?
Choices:
a) Option 1
b) Option 2
a) Option 1
Rationale:
Ciliary flush is characterized by a ring of redness around the cornea, typically more intense near the limbus. The image in Option 1 shows this characteristic redness around the corneal margin, indicative of ciliary flush.
43
A scanty, white stringy discharge could be secondary to:
Choices:
a) Allergic conjunctivitis
b) Keratoconjunctivitis sicca
c) Both
d) Neither
c) Both
44
The following are some of the causes of an acute painful red eye EXCEPT:
Choices:
a) Scleritis
b) Iritis
c) Subconjunctival hemorrhage
d) None of the above
c) Subconjunctival hemorrhage
Rationale:
Subconjunctival hemorrhage typically presents as a painless red eye, whereas scleritis and iritis are associated with acute painful red eye.
45
Ankyloblepharon refers to the adhesion of the bulbar and palpebral conjunctiva. TRUE or FALSE?
Choices:
a) True
b) False
b) False
Rationale:
Ankyloblepharon refers to the adhesion between the upper and lower eyelids, not the bulbar and palpebral conjunctiva.
46
Cycloplegic drugs are given to uveitis patients to avoid the adhesion of iris structures and lens capsule. This is referred to as:
Choices:
a) Posterior synechia
b) Peripheral anterior synechia
c) Iris bombe
d) None of the above
a) Posterior synechia
Rationale:
Cycloplegic drugs are given to prevent posterior synechia, which is the adhesion of the iris to the lens capsule in uveitis patients.
47
Which of the following terms refers to the presence of red blood cells in the anterior chamber?
A. Hypopyon
B. Keratitis
C. Hyphema
D. Synechia
c) Hyphema
Rationale:
The presence of red blood cells in the anterior chamber is referred to as hyphema.
48
Foreign body sensation can be produced by all of the following EXCEPT:
Choices:
a) Trichiasis
b) Viral conjunctivitis
c) Contact lens wear
d) None of the above
d) None of the above
Rationale:
Foreign body sensation can be produced by trichiasis, viral conjunctivitis, and contact lens wear, so there is no exception among the choices.
49
Disc swelling, venous engorgement, cotton wool spots, and diffuse retinal hemorrhages are characteristic findings in:
Choices:
a) Central retinal artery occlusion
b) Papilledema
c) Central retinal vein occlusion
d) None of the above
c) Central retinal vein occlusion
Rationale:
Disc swelling, venous engorgement, cotton wool spots, and diffuse retinal hemorrhages are characteristic findings in central retinal vein occlusion.
50
Cherry-red spot is seen in:
Choices:
a) Central retinal artery occlusion
b) Central retinal vein occlusion
c) Papilledema
d) None of the above
a) Central retinal artery occlusion
Rationale:
A cherry-red spot is seen in central retinal artery occlusion.
51
Prolonged use of topical corticosteroids can cause:
Choices:
a) Corneal damage
b) Cataract
c) Both
c) Both
Rationale:
Prolonged use of topical corticosteroids can cause both corneal damage and cataract formation.
52
Management of central retinal artery occlusion (CRAO) includes the following, EXCEPT:
Choices:
a) Ocular massage
b) Intravenous acetazolamide
c) Both
d) Neither
b) Intravenous acetazolamide
Rationale:
While ocular massage, medications to lower intraocular pressure, vasodilators, and paracentesis of the anterior chamber are mentioned as part of the management for central retinal artery occlusion (CRAO), intravenous acetazolamide is not typically included in the standard management protocol. Acetazolamide is usually administered orally for lowering intraocular pressure.
53
Functional disorder is defined as loss of vision with organic basis. TRUE or FALSE?
Choices:
a) True
b) False
b) False
Rationale:
A functional disorder is defined as a loss of vision without an organic basis. An organic disorder has a physical basis, which contradicts the definition of a functional disorder.
54
The color of the fluorescein staining in corneal ulcer is:
Choices:
a) Magenta
b) Purple
c) Green
d) Yellow
c) Green
Rationale:
Fluorescein staining in corneal ulcers appears green under cobalt blue light.
55
The relative normal intraocular pressure (mmHg) is:
Choices:
a) 22-30
b) 10-21
c) 5-11
d) None of the above
b) 10-21
Rationale:
The normal intraocular pressure (IOP) range is typically 10-21 mmHg.
56
A 72-year-old male farmer who has been experiencing chronic eye redness for 2 years. What is the most likely diagnosis?
Choices:
a) Pinguecula
b) Conjunctival lymphoma
c) Pterygium
d) Conjunctival squamous cell carcinoma
d) Conjunctival squamous cell carcinoma
Rationale:
The image and patient history of chronic eye redness in a 72-year-old male farmer suggest a more serious condition than benign growths like pinguecula or pterygium. Conjunctival squamous cell carcinoma can present with persistent redness, irritation, and sometimes a visible lesion, fitting the clinical presentation shown in the image.
57
By referring to the photo shown, which of the following is NOT true of papilledema?
Choices:
a) Flame-shaped hemorrhages
b) Elevated disc
c) Normal retinal veins
d) Microvascular congestion on the disc
c) Normal retinal disc
Rationale:
In papilledema, the optic disc is elevated and its margins are indistinct, there is microvascular congestion, and flame-shaped hemorrhages can be present. A normal retinal disc is not a characteristic finding of papilledema.
58
Feathery edges (satellite lesions) of corneal infiltrate is normally seen in:
Choices:
a) Fungal keratitis
b) Acanthamoeba keratitis
c) Herpes simplex keratitis
d) None of the above
a) Fungal keratitis
**Rationale:**
- **Fungal keratitis:** This condition is known for its characteristic feathery edges and satellite lesions in the corneal infiltrate. The branching, feathery appearance of the infiltrate is due to the fungal hyphae invading the corneal tissue.
- **Acanthamoeba keratitis:** This type of keratitis is usually associated with ring-shaped stromal infiltrates and severe pain. It is often related to contact lens use and can have a prolonged course with various clinical presentations, but feathery edges are not typical.
- **Herpes simplex keratitis:** This type of keratitis typically presents with dendritic or geographic ulcers on the cornea, which are distinct from the feathery edges seen in fungal keratitis. The ulcers caused by herpes simplex virus have a branching, linear appearance with terminal bulbs, not the feathery pattern.
- **None of the above:** This option is incorrect because feathery edges are specifically indicative of fungal keratitis, not seen in other types of keratitis listed.
59
An elevation in the intraocular pressure is not necessarily present in the diagnosis of glaucoma. TRUE or FALSE?
Choices:
a) True
b) False
a) True
Rationale:
Glaucoma can be diagnosed based on optic nerve damage and visual field loss, even if intraocular pressure is within the normal range (normal-tension glaucoma).
60
Trachoma, which is one of the leading causes of preventable irreversible blindness in the world, is usually caused by:
Choices:
a) Chlamydia
b) Corynebacterium
c) Both
d) Neither
a) Chlamydia
Rationale:
Trachoma is caused by Chlamydia trachomatis and is a leading cause of preventable irreversible blindness.
61
A patient manifesting with eye redness and a moderate amount of eye pain with a history of granulomatosis with polyangiitis can be associated with which clinical picture?
a) Option 2
Rationale:
The provided image shows a severe redness and violaceous hue typical of scleritis, which is associated with granulomatosis with polyangiitis (GPA). Scleritis involves deeper scleral tissues and is often painful, which matches the clinical presentation. Option 1 depicts these characteristics clearly, while Option 2 is more consistent with episcleritis, which involves superficial inflammation and is less severe.
62
A 59-year-old Asian female presents with a sudden increase of intraocular pressure to 55 mmHg in the left eye. Gonioscopic examination demonstrates a closed angle with trabecular meshwork obstruction. Which of the following is NOT a likely presenting symptom in this patient:
Choices:
a) Halos around lights
b) Nausea/vomiting
c) Ocular pain
d) Eye redness
e) None of the above
e) None of the above
Rationale:
All the symptoms listed—halos around lights, nausea/vomiting, ocular pain, and eye redness—are likely presenting symptoms in a patient with acute angle-closure glaucoma.
63
Trantas dots can be seen in Vernal Keratoconjunctivitis. These characteristic cells are composed of:
Choices:
a) Neutrophils
b) Eosinophils
c) Macrophages
d) Lymphocytes
b) Eosinophils
Rationale:
Trantas dots in Vernal Keratoconjunctivitis are composed of eosinophils.
64
Cycloplegic drugs are given to uveitis patients to avoid the adhesion of iris structures and lens capsule. This is referred to as:
Choices:
a) Posterior synechia
b) Peripheral anterior synechia
c) Iris bombe
d) None of the above
a) Posterior synechia
Rationale:
Cycloplegic drugs are given to prevent posterior synechia, which is the adhesion of the iris to the lens capsule in uveitis patients.
65
Symptom of retinal detachment:
Choices:
a) Curtaining of vision
b) Tunneling of vision
c) Wavy vision
d) None of the above
a) Curtaining of vision
Rationale:
• Curtaining of vision (choice a) is a classic symptom of retinal detachment. Patients often describe it as a shadow or curtain coming down over their field of vision, typically starting from the periphery and moving inward.
• Tunneling of vision (choice b) is more characteristic of advanced glaucoma, where peripheral vision is lost, leading to a “tunnel vision” effect.
• Wavy vision (choice c), also known as metamorphopsia, is more commonly associated with macular diseases like macular degeneration.
66
1. Culture media for Neisseria gonorrhoeae:
A. Chocolate agar plate
B. Both
C. Neither
D. Thayer-Martin media
B. Both
Rationale:
Neisseria gonorrhoeae can be cultured on both Chocolate agar plate and Thayer-Martin media, which is a selective medium containing antibiotics to suppress the growth of contaminating organisms.
67
2. Subconjunctival hemorrhage represents an accumulation of blood:
A. Behind the retina
B. Within the anterior chamber
C. In the vitreous
D. Underneath the conjunctiva
D. Underneath the conjunctiva
Explanation:
A subconjunctival hemorrhage occurs when small blood vessels break beneath the conjunctiva, the clear surface of the eye, leading to a red or bloodshot appearance. It is generally painless and harmless, often caused by minor trauma, sneezing, or coughing. The other options refer to different locations within the eye where blood could accumulate, but they do not pertain to subconjunctival hemorrhage.
68
3. The presence of symblepharon can be seen in:
A. Both
B. Ocular cicatricial pemphigoid
C. Neither
D. Stevens-Johnson syndrome
A. Both
Rationale:
Symblepharon, or adhesions between the conjunctiva of the eyelid and the eyeball, can be seen in both ocular cicatricial pemphigoid and Stevens-Johnson syndrome.
69
4. Eye discharge seen in allergic conjunctivitis is commonly described as:
A. Watery stringy
B. None of the above
C. Reddish
D. Mucopurulent
A. Watery stringy
Rationale:
The eye discharge seen in allergic conjunctivitis is commonly described as watery and stringy.
70
6. A 59-year-old Asian female presents with a sudden increase of intraocular pressure to 55 mmHg in the left eye. Gonioscopic examination demonstrates a closed angle with trabecular meshwork obstruction. Which of the following is NOT a likely presenting symptom in this patient:
A. Ocular pain
B. Eye redness
C. None of the above
D. Nausea/vomiting
E. Halos around lights
C. None of the above
Rationale:
All listed symptoms (ocular pain, eye redness, nausea/vomiting, and halos around lights) are likely presenting symptoms in a patient with acute angle-closure glaucoma with an intraocular pressure of 55 mmHg.
71
7. A 72-year-old male farmer who has been experiencing chronic eye redness for 2 years. What is the most likely diagnosis?
A. Conjunctival Squamous Cell Carcinoma
B. Pterygium
C. Conjunctival Lymphoma
D. Pinguecula
A. Conjunctival Squamous Cell Carcinoma
72
8. The color of the fluorescein staining in corneal ulcer is:
A. Purple
B. Magenta
C. Yellow
D. Green
D. Green
Rationale:
Fluorescein staining in corneal ulcers appears green under cobalt blue light.
73
9. What is not a typical exam finding in conjunctivitis?
A. Eyelid erythema
B. Subepithelial corneal infiltrate
C. Anterior chamber cell and flare
D. Red conjunctiva
C. Anterior chamber cell and flare
Rationale:
Anterior chamber cell and flare are typical findings in uveitis, not conjunctivitis. Conjunctivitis usually presents with red conjunctiva, possible subepithelial corneal infiltrates, and eyelid erythema.
74
10. Sudden painful loss of vision that may be associated with multiple sclerosis could be due to:
A. Retinal detachment
B. Both
C. Optic neuritis
D. None of the above
C. Optic neuritis
Rationale:
Sudden painful loss of vision that may be associated with multiple sclerosis is typically due to optic neuritis.
75
11. A hyperacute, hyperpurulent discharge is a clinical manifestation of:
a. Chlamydial conjunctivitis
b. Allergic conjunctivitis
c. Gonococcal conjunctivitis
d. Adenoviral conjunctivitis
c. Gonococcal conjunctivitis
Rationale:
Hyperacute, hyperpurulent discharge is a clinical manifestation of gonococcal conjunctivitis caused by Neisseria gonorrhoeae.
76
12. A technique used to differentiate angle closure glaucoma from open angle glaucoma by viewing the anatomical angle formed between the eye's cornea and iris:
A. Gonioscopy
B. Perimetry
C. Fluorometry
D. Tonometry
A. Gonioscopy
Rationale:
Gonioscopy is a technique used to view the anatomical angle formed between the eye's cornea and iris, helping to differentiate angle-closure glaucoma from open-angle glaucoma.
77
Schirmer's test is used for diagnosing:
A. Corneal abrasion
B. Dry eye syndrome
C. Uveitis
D. Glaucoma
B. Dry eye syndrome
Rationale:
Schirmer's test measures tear production and is used to diagnose dry eye syndrome.
78
Most frequent etiologic agent of conjunctivitis:
A. Adenovirus
B. Neither
C. Herpes simplex
D. Both
A. Adenovirus
Rationale:
The most frequent etiologic agent of conjunctivitis is adenovirus.
79
A 53-year-old female with a history of recent bronchial asthma attack woke up this morning with a red eye and has no other symptoms. Upon examination, you note a temporal sector of the eye that is red without injection of the conjunctival vessels. What is your most likely diagnosis?
A. Scleritis
B. Pinguecula
C. Conjunctivitis
D. Subconjunctival hemorrhage
D. Subconjunctival hemorrhage
Rationale:
A red eye with a localized area of redness without injection of conjunctival vessels is most likely a subconjunctival hemorrhage.
80
Pharyngoconjunctival fever (conjunctivitis with fever and sore throat) is associated with what strains?
A. Adenovirus 3
B. Neither
C. Both
D. Adenovirus 11
A. Adenovirus 3
81
Hollenhorst plaque seen in retinal vein occlusions is a:
A. Calcific embolus
B. Fibrin embolus
C. Cholesterol embolus
D. None of the above
C. Cholesterol embolus
82
Management of central retinal artery occlusion (CRAO) includes the following, EXCEPT:
A. Intravenous acetazolamide
B. Ocular massage
C. Both
D. Neither
A. Intravenous acetazolamide
83
Ankyloblepharon is an adhesion between:
A. Upper eyelid and lower eyelid
B. None of the above
C. Iris and lens
D. Bulbar conjunctiva and palpebral conjunctiva
A. Upper eyelid and lower eyelid
84
One of the indications in pterygium excision is significant induced astigmatism. True or false:
A. True
B. False
A. True
Rationale:
Significant induced astigmatism is one of the indications for pterygium excision.
85
A recurrent bilateral conjunctivitis occurring with the onset of hot weather in a 6-year-old boy with symptoms of burning, itching, and lacrimation with large flat-topped cobblestone papillae raised areas in palpebral conjunctiva:
a. Trachoma
b. None of the above
c. Vernal keratoconjunctivitis
d. Phlyctenular conjunctivitis
c. Vernal keratoconjunctivitis
Rationale:
Vernal keratoconjunctivitis is characterized by recurrent bilateral conjunctivitis, especially in hot weather, with symptoms such as burning, itching, and lacrimation, and large flat-topped cobblestone papillae in the palpebral conjunctiva.
86
Cherry-red spot is seen in:
A. Central retinal artery occlusion
B. Central retinal vein occlusion
C. None of the above
D. Papilledema
A. Central retinal artery occlusion
Rationale:
A cherry-red spot is seen in central retinal artery occlusion due to the contrast between the pale retina and the preserved red choroid at the fovea.
87
The treatment for a branch-like lesion (dendritiform) in the cornea is:
A. Ganciclovir
B. Polymyxin
C. Nystatin
D. Albendazole
A. Ganciclovir
Rationale:
The treatment for a branch-like lesion (dendritiform) in the cornea, typically caused by herpes simplex virus, is ganciclovir, an antiviral medication.
88
A 45-year-old farmer presents with a wing-like structure found at the nasal side of the cornea at the palpebral fissure. What is your diagnosis?
a. Pinguecula
b. Episcleritis
c. None of the above
d. Pterygium
d. Pterygium
Rationale:
A wing-like structure on the nasal side of the cornea is indicative of a pterygium, which is a benign growth of the conjunctiva.
89
The tissue between the border of the cup and the optic disc:
A. Rods and cones
B. Lamina cribrosa
C. Neuroretinal rim
D. Fovea
C. Neuroretinal rim
Rationale:
The tissue between the border of the cup and the optic disc is the neuroretinal rim, which contains the retinal nerve fibers.
90
True of Giant Cell Arteritis EXCEPT:
A. It is a vasculitis involving medium-sized vessels
B. None of the above
C. It typically occurs in those over the age of 50
D. Headache is the most common symptom
E. Mainstay of management is corticosteroid
A. It is a vasculitis involving medium-sized vessels
Rationale:
Giant Cell Arteritis primarily involves large vessels such as the temporal artery. Thus, the statement that it involves medium-sized vessels is incorrect.
91
A 36-year-old man complained of a 3-day history of redness, severe pain, and intense sensitivity to light of his left eye. He denies any trauma to the affected eye. Which among the following signs will convince you that the patient DOES NOT have conjunctivitis?
A. Ciliary flush
B. Visual acuity of 20/200
C. Both
D. Neither
A. Ciliary flush
Rationale:
Ciliary flush indicates inflammation of the uvea (iritis or keratitis) rather than conjunctivitis. Conjunctivitis typically does not present with a ciliary flush.
92
Prolonged use of topical corticosteroids can cause:
A. Cataract
B. Both
C. Corneal damage
D. Neither
B. Both
Rationale:
Prolonged use of topical corticosteroids can cause both cataract formation and corneal damage.
93
The effective treatment for Herpes Zoster ophthalmicus is:
A. Natamycin
B. Artificial tears
C. Metronidazole
D. Acyclovir
D. Acyclovir
Rationale:
The effective treatment for Herpes Zoster ophthalmicus is acyclovir, an antiviral medication.
94
A major risk for the development of bacterial keratitis is:
A. Age
B. Contact lens wear
C. Diabetes mellitus
D. None of the above
B. Contact lens wear
Rationale:
Contact lens wear is a major risk factor for the development of bacterial keratitis due to potential contamination and hypoxia of the cornea.
95
All of the statements are true regarding the aqueous humor outflow EXCEPT:
A. Uveoscleral outflow constitutes the majority of the mechanism of how the aqueous humor exits the eye
B. Both
C. Neither
D. Trabecular outflow constitutes the minority of the mechanism of how the aqueous humor exits the eye
C. Neither
Rationale: The majority of aqueous humor outflow in the eye occurs through the trabecular meshwork pathway, not the uveoscleral pathway. The trabecular outflow accounts for around 85-90% of aqueous humor drainage, while the uveoscleral pathway constitutes the minority (approximately 10-15%) of outflow. Therefore, both statements A and D are incorrect.
96
Disc swelling, venous engorgement, cotton wool spots, and diffuse retinal hemorrhages are characteristic findings in:
A. Central retinal artery occlusion
B. None of the above
C. Papilledema
D. Central retinal vein occlusion
D. Central retinal vein occlusion
Rationale:
Disc swelling, venous engorgement, cotton wool spots, and diffuse retinal hemorrhages are characteristic findings in central retinal vein occlusion.
97
Defect of central vision in which the shapes of objects appear distorted:
A. Metamorphopsia
B. Heteromatopia
C. None of the above
D. Dyschromatopsia
A. Metamorphopsia
Rationale:
Metamorphopsia is a defect of central vision where the shapes of objects appear distorted. It is often associated with conditions affecting the macula, such as age-related macular degeneration.
98
The relative normal intraocular pressure (mmHg) is:
A. None of the above
B. 10-21
C. 22-30
D. 5-11
B. 10-21
Rationale:
The normal range of intraocular pressure is 10-21 mmHg.
99
Most common ophthalmic manifestation in thyroid-associated orbitopathy is:
A. Conjunctivitis
B. Lid retraction
C. Proptosis
D. Chemosis
B. Lid retraction
Rationale:
The most common ophthalmic manifestation in thyroid-associated orbitopathy is lid retraction.
100
36. The most common cause of red eye and chronic eye proptosis in an adult is:
A. None of the above
B. Orbital tumor
C. Orbital cellulitis
D. Thyroid orbitopathy
D. Thyroid orbitopathy
Rationale:
The most common cause of red eye and chronic eye proptosis in an adult is thyroid orbitopathy, also known as Graves' orbitopathy. This condition is frequently associated with thyroid disease and leads to inflammation and swelling of the eye muscles and tissues behind the eye, causing proptosis (bulging eyes) and redness.
101
Red painful eye with purulent discharge and decreased vision, discrete corneal opacity seen with penlight:
A. Ruptured globe
B. Acute angle-closure glaucoma
C. Corneal ulcer
D. Orbital cellulitis
C. Corneal ulcer
Rationale:
A red painful eye with purulent discharge, decreased vision, and a discrete corneal opacity seen with a penlight is indicative of a corneal ulcer.
102
All of the following can be caused by chlamydial infection EXCEPT:
A. Neither
B. Trachoma
C. Inclusion conjunctivitis
D. Both
A. Neither
Rationale:
Both trachoma and inclusion conjunctivitis can be caused by chlamydial infection, so neither statement that excludes them is correct.
103
The histology of pterygium includes:
A. Neither
B. Fibrovascular overgrowth of the bulbar conjunctiva
C. Precancerous stage
D. Both
B. Fibrovascular overgrowth of the bulbar conjunctiva
Rationale:
The histology of pterygium includes fibrovascular overgrowth of the bulbar conjunctiva.
104
An elevation in the intraocular pressure is not necessarily present in the diagnosis of glaucoma. True or false?
A. True
B. False
A. True
Rationale:
An elevation in intraocular pressure is not necessarily present in the diagnosis of glaucoma, as normal-tension glaucoma can occur without elevated IOP.
105
A 35-year-old patient with a hyperpurulent discharge of 1-day duration, marked chemosis of the bulbar conjunctiva, and clear cornea. What is your tentative diagnosis?
a. Adenoviral conjunctivitis
b. Chlamydial conjunctivitis
c. Gonococcal conjunctivitis
d. Herpes simplex keratoconjunctivitis
c. Gonococcal conjunctivitis
Rationale:
A hyperpurulent discharge with marked chemosis and a clear cornea suggests gonococcal conjunctivitis, which is known for its rapid onset and severe purulent discharge.
106
Treatment for allergic conjunctivitis:
A. Neither
B. Olopatadine eyedrops
C. Cetirizine 10 mg tablet
D. Both
A. Neither
107
True or false: This diagnostic modality is typically used to diagnose both glaucoma and retinopathy.
A. True
B. False
B. False
Rationale:
The diagnostic modality used to diagnose glaucoma (tonometry, gonioscopy) is different from those typically used to diagnose retinopathy (fundoscopy, OCT).
108
Monocular loss of vision developing over hours to days / no abnormalities seen in ophthalmic examination associated with pain on movement of eyes:
A. Papilledema
B. Optic neuritis
C. None of the above
D. Retrobulbar neuritis
D. Retrobulbar neuritis
Rationale:
Monocular loss of vision developing over hours to days with no abnormalities seen in ophthalmic examination and associated with pain on movement of eyes is typical of retrobulbar neuritis.
109
A degenerative lesion of the bulbar conjunctiva that occurs adjacent to the limbus in the interpalpebral zone, most often nasally:
a. Phlytenulosis
b. Pinguecula
c. Conjunctival granuloma
d. Chalazion
b. Pinguecula
Rationale:
A pinguecula is a degenerative lesion of the bulbar conjunctiva occurring adjacent to the limbus in the interpalpebral zone, most often nasally.
110
Functional disorder is defined as loss of vision with organic basis. True or false?
A. True
B. False
B. False
Explanation:
A functional disorder refers to a loss of vision without an organic basis. This means that while the patient experiences vision loss, there is no detectable structural or organic cause for it. Examples include conditions like conversion disorder or malingering.
111
Purulent discharge can be seen in:
A. Dysfunctional tear syndrome
B. Viral conjunctivitis
C. Allergic conjunctivitis
D. Bacterial conjunctivitis
D. Bacterial conjunctivitis
Rationale:
Purulent discharge is typically seen in bacterial conjunctivitis.
Discharge
* Types and Causes:
* Purulent or Mucopurulent: Bacterial.
* Serous (Watery, Clear, or Yellow-Tinged): Viral.
* Scant, White, Stringy Discharge: Allergic and Keratoconjunctivitis Sicca (KCS).
Preauricular Lymph Node Enlargement
* Sign of: Viral conjunctivitis.
112
Foreign body sensation can be produced by all of the following EXCEPT:
A. Contact lens wear
B. Trichiasis
C. None of the above
D. Viral conjunctivitis
C. None of the above
Rationale:
Foreign body sensation is produced by contact lens wear and trichiasis (misdirected eyelashes), but not typically by viral conjunctivitis.
113
Symptom of retinal detachment:
A. None of the above
B. Tunneling of vision
C. Wavy vision
D. Curtaining of vision
D. Curtaining of vision
Rationale:
A symptom of retinal detachment is the sensation of a curtain coming down over the field of vision.
114
Which of the following statement/s is true?
A. Episcleritis blanches with 10% Phenylephrine drops
B. Episcleritis is an inflammation of the superficial episcleral layer of the eye.
C. All of the above
D. Episcleritis is relatively common, benign, and self-limiting
C. All of the above
Rationale:
All the statements are true: episcleritis blanches with 10% Phenylephrine drops, it is an inflammation of the superficial episcleral layer of the eye, and it is relatively common, benign, and self-limiting.
115
Pharyngoconjunctival fever (conjunctivitis with fever and sore throat) is associated with what strain/s?
A. Adenovirus 3
B. Both
C. Adenovirus 11
D. Neither
A. Adenovirus 3
116
Management of central retinal artery occlusion (CRAO) includes the following, EXCEPT:
A. Ocular massage
B. Neither
C. Both
D. Intravenous acetazolamide
D. Intravenous acetazolamide
Rationale:
Management of central retinal artery occlusion (CRAO) includes ocular massage to help dislodge the embolus and other measures to lower intraocular pressure, but intravenous acetazolamide is not typically included.
117
What layer of the cornea regenerates rapidly following injury?
A. Endothelium
B. Bowman's membrane
C. Corneal stroma
D. Epithelium
D. Epithelium
Rationale:
The epithelium of the cornea regenerates rapidly following injury due to its high regenerative capacity.
Anterior EPITHELIUM
Bowman's Layer
Central Stroma
Descemet's Membrane
Endothelium
118
A 75-year-old male came in due to a "salmon patch" appearance in the bulbar conjunctiva for almost 2 years. Your most likely diagnosis will be:
A. Conjunctival lymphoma
B. Conjunctival squamous papilloma
C. None of the above
D. Chalazion
A. Conjunctival lymphoma
Rationale:
A "salmon patch" appearance in the bulbar conjunctiva is characteristic of conjunctival lymphoma.
119
Drusen is a characteristic finding of:
A. Glaucoma
B. Diabetic retinopathy
C. Hypertensive retinopathy
D. Age-related macular degeneration
D. Age-related macular degeneration
Rationale:
Drusen are yellow deposits under the retina often found in age-related macular degeneration.
120
Which of the following terms refers to purulent matter in the anterior chamber?
A. Keratitis
B. Synechia
C. Hypopyon
D. Hyphema
C. Hypopyon
Rationale:
Hypopyon refers to the presence of purulent matter in the anterior chamber of the eye.
121
The following may lead to the formation of pterygium EXCEPT:
A. None of the above
B. Frequent exposure to smoke
C. Exposure to ultraviolet rays
D. Living in a tropical area
B. Frequent exposure to smoke
Rationale:
Pterygium is primarily associated with exposure to ultraviolet rays and living in a tropical area, but not typically linked to frequent exposure to smoke.
122
What are the features of anterior uveitis?
A. Redness
B. Both
C. Neither
D. Photophobia
B. Both
Rationale:
Features of anterior uveitis include redness and photophobia.
123
Trantas dots can be seen in Vernal Keratoconjunctivitis. These characteristic cells are composed of:
A. Neutrophils
B. Lymphocytes
C. Eosinophils
D. Macrophages
C. Eosinophils
Rationale:
Trantas dots, seen in Vernal Keratoconjunctivitis, are composed of eosinophils.
124
Trachoma, which is one of the leading causes of preventable irreversible blindness in the world, is usually caused by:
A. Corynebacterium
B. Neither
C. Both
D. Chlamydia
D. Chlamydia
Rationale:
Trachoma, one of the leading causes of preventable irreversible blindness in the world, is usually caused by Chlamydia trachomatis.
125
Which of the following terms refers to the presence of red blood cells in the anterior chamber?
A. Keratitis
B. Hypopyon
C. Synechia
D. Hyphema
D. Hyphema
Rationale:
Hyphema refers to the presence of red blood cells in the anterior chamber of the eye.
126
An inflammatory adhesion between the iris and the peripheral corneal endothelium is termed as:
A. Hypopyon
B. None of the above
C. Peripheral corneal synechia
D. Posterior synechia
C. Peripheral corneal synechia
Rationale:
An inflammatory adhesion between the iris and the peripheral corneal endothelium is termed peripheral corneal synechia.
127
Which among the following would NOT manifest with palpable preauricular lymphadenopathy?
A. Adenoviral conjunctivitis
B. Neither
C. Neisseria gonorrhoeae
D. Chlamydial conjunctivitis
C. Neisseria gonorrhoeae
Rationale:
Neisseria gonorrhoeae typically does not manifest with palpable preauricular lymphadenopathy, whereas adenoviral and chlamydial conjunctivitis can.
128
Ankyloblepharon refers to the adhesion of the bulbar and palpebral conjunctiva. TRUE or FALSE?
A. True
B. False
**B. False**
**Explanation:**
Ankyloblepharon refers to the adhesion or fusion of the upper and lower eyelids, not the bulbar and palpebral conjunctiva. It is a condition where the eyelids are partially or completely fused together, which can be congenital or acquired.
Therefore, the correct answer is **B. False**.
129
True of Giant Cell Arteritis EXCEPT:
A. It is an inflammation of the small blood vessels
B. None of the above
C. Symptoms include headache and pain over the temples
D. Treatment is typically with high doses of steroids
A. It is an inflammation of the small blood vessels
Rationale:
Giant Cell Arteritis primarily involves medium and large blood vessels, not small vessels. Therefore, the statement that it is an inflammation of small blood vessels is incorrect.
130
A 70-year-old male with a history of hypertension comes into the emergency room with complaints of a rapid unilateral loss of vision an hour prior. He also complains of temporal headache and jaw claudication. What is your tentative diagnosis?
A. Acute angle closure glaucoma
B. Corneal ulcer
C. Optic neuritis
D. Temporal arteritis
D. Temporal arteritis
Rationale:
The symptoms of rapid unilateral loss of vision, temporal headache, and jaw claudication are highly suggestive of temporal arteritis (giant cell arteritis).
131
A healthy 18-year-old African man presents with a total hyphema after being struck in the right eye with a tennis ball. Visual acuity is hand motions, and the intraocular pressure is normal. Which one of the following would be appropriate in the management of this patient?
A. Topical steroids and a cycloplegic
B. Bed rest, elevation of the head
C. Oral aminocaproic acid
D. All of the above
D. All of the above
Rationale:
The management of a total hyphema includes topical steroids and a cycloplegic to reduce inflammation and pain, bed rest with elevation of the head to facilitate the settling of the blood, and oral aminocaproic acid to reduce the risk of re-bleeding.
132
A 12-year-old female sustained a laceration on her right upper eyelid. On gross examination, you note fat prolapse from the laceration. You advise the parents that a referral to an ophthalmologist needs to be made and inform them that a possible sequelae even after repair of the laceration includes:
A. Epiphora/tearing
B. Eyelid retraction
C. Eyelid notching
D. Eyelid ptosis
D. Eyelid ptosis
Rationale: Fat prolapse from an eyelid laceration suggests that the injury may involve deeper structures, potentially including the levator muscle or its aponeurosis, which are responsible for elevating the eyelid. Damage to these structures during the injury or subsequent repair can lead to eyelid ptosis as a sequela. Other options such as epiphora, eyelid retraction, and notching are less likely directly related to a laceration with fat prolapse.
133
A 25-year-old male got into a car accident, sustaining a full thickness eyelid laceration 5mm from his eyelid margin. What layers of the eyelid were involved in his injury?
A. Skin, orbicularis, fat, conjunctiva
B. Skin, orbicularis, septum, tarsus
C. Skin, orbicularis, tarsus, conjunctiva
D. Skin, orbicularis, tarsus, septum
C. Skin, orbicularis, tarsus, conjunctiva
Rationale:
A full-thickness eyelid laceration involves all the layers of the eyelid, which include the skin, orbicularis muscle, tarsus, and conjunctiva.
134
A 76-year-old female, known hypertensive, noted a sudden loss of vision in her left eye 2 weeks prior. She felt no pain and did not experience any trauma. The examination of her right eye is unremarkable. For the left eye, vision is light perception, with (+) RAPD, EOMs are full, intraocular pressure is within the normal range, cornea is clear, anterior chamber is clear, the lens is slightly yellowish. What characteristic finding do you expect on examination of her retina on the left eye?
A. Cherry red spot
B. Dot and blot hemorrhages
C. Flame-shaped hemorrhages
D. Multiple exudates and cotton wool spots
A. Cherry red spot
Rationale:
Sudden painless loss of vision with a cherry red spot on retinal examination is characteristic of central retinal artery occlusion.
135
What is the first thing you should do when you encounter a patient with a history of chemical trauma to the external eye?
A. Obtain a complete and extensive history
B. Check the visual acuity
C. Assess the extent of damage to the cornea
D. Immediate and copious irrigation of the ocular surface with water
D. Immediate and copious irrigation of the ocular surface with water
Rationale:
The first and most important step in managing a chemical trauma to the eye is immediate and copious irrigation to remove the chemical and minimize damage.
136
Best imaging modality for orbital fractures:
A. Skull x-ray
B. Orbital ultrasound
C. Orbital CT scan
D. Orbital MRI
C. Orbital CT scan
Rationale:
The best imaging modality for assessing orbital fractures is an orbital CT scan due to its high resolution and ability to visualize bone and soft tissue structures.
137
A 70-year-old male with a history of hypertension comes into the emergency room with complaints of a rapid unilateral loss of vision an hour prior. He also complains of temporal headache and jaw claudication. What is your tentative diagnosis?
A. Acute angle closure glaucoma
B. Corneal ulcer
C. Optic neuritis
D. Temporal arteritis
D. Temporal arteritis
Rationale:
The symptoms of rapid unilateral loss of vision, temporal headache, and jaw claudication are highly suggestive of temporal arteritis (giant cell arteritis).
138
A 50-year-old male sought consult for severe vision loss in his left eye. His vision on that eye is counting fingers at 2 feet, not improved with pinhole. You do a pupillary exam and note that the patient has a (-) RAPD. Which among the following is a possible consideration for this patient?
A. Post-traumatic optic neuropathy
B. Retinal detachment
C. Central retinal artery occlusion
D. Vitreous hemorrhage
B. Retinal detachment
Rationale:
Severe vision loss with a pupillary exam showing no relative afferent pupillary defect (RAPD) suggests a condition that primarily affects the retina, such as retinal detachment.
139
How do strong alkalis cause penetration into the corneal stroma?
A. Increased hyperosmolarity in tissues
B. Caseous necrosis in cell membranes
C. Denature and precipitate proteins in the tissues they contact
D. Saponification of fatty acids in cell membranes
D. Saponification of fatty acids in cell membranes
Rationale:
Strong alkalis penetrate the corneal stroma by causing saponification of fatty acids in cell membranes, which leads to deeper tissue penetration and damage.
140
A 27-year-old contact lens wearer presents to the ER complaining of ocular irritation. On exam, he has a 2mm corneal abrasion. Which of the following should you do:
A. Treat the patient with topical steroids
B. Treat the patient with a topical antibiotic
C. Bandage contact lens for comfort and to speed up reepithelialization
D. Patch the eye and follow-up in 72 hours
B. Treat the patient with a topical antibiotic
Rationale: A contact lens wearer with a corneal abrasion is at increased risk for infection, so treatment with a topical antibiotic is recommended to prevent microbial keratitis.
141
A 63-year-old female came in for her check-up due to blurring of vision associated with occasional eye pain and redness. She is referred to an ophthalmologist, and the ophthalmologist takes Optic Disc photos of the patient's eyes. The presence of which of the following findings will make you suspect the presence of glaucoma in this patient?
A. Artery to Vein Ratio of 1:3
B. Vertical cup to disc ratio of 0.8
C. Indistinct disc borders
D. Pale optic disc
B. Vertical cup to disc ratio of 0.8
Rationale: A high cup to disc ratio, such as 0.8, is a typical finding in glaucoma due to the loss of retinal ganglion cells and optic nerve fiber layer, leading to an enlarged optic cup.
142
A patient who was in a vehicular accident was referred from another hospital with a diagnosis of traumatic optic neuropathy. Which of the following examinations will help confirm the diagnosis?
A. Hirschberg light reflex test
B. Swinging flashlight test
C. Seidel test
D. Extraocular muscle movement test
B. Swinging flashlight test
Rationale: The swinging flashlight test is used to detect a relative afferent pupillary defect (RAPD), which can help confirm the diagnosis of traumatic optic neuropathy.
143
A 7-year-old boy presents with a grossly swollen eyelid. His mother can't think of anything that would have set this off. Which of the following characteristics, if present, will make you suspect orbital cellulitis?
A. Chemosis
B. Warmth and erythema of the eyelid
C. Tenderness of the eyelid
D. Proptosis
D. Proptosis
Rationale: Proptosis (bulging of the eye) is a key distinguishing feature of orbital cellulitis, which differentiates it from preseptal cellulitis.
144
A 23-year-old male construction worker came to the ER with a chief complaint of right eye pain and redness after he had been splashed on his right eye by cement. You manage the patient by copious irrigation with sterile water. When do you stop irrigation?
A. When the eye is no longer red
B. When the pH of the conjunctival sac normalizes
C. When you have consumed 2L of water
D. When you have spent 2 hours irrigating the eye
B. When the pH of the conjunctival sac normalizes
Rationale: Irrigation should continue until the pH of the conjunctival sac returns to normal, as this ensures that the chemical irritant has been sufficiently removed.
145
A metallic corneal foreign body usually does not produce scarring, unless it is embedded in which layer of the cornea?
A. Epithelium
B. Corneal stroma
C. Bowman's layer
D. Anterior chamber
C. Bowman's layer
Rationale: Scarring is most likely to occur when a foreign body is embedded in Bowman's layer, which is a tough, acellular layer of the cornea.
146
In the overwhelming majority of cases of primary open-angle glaucoma, the obstruction to outflow seems to be at which of the following sites:
A. In the episcleral veins
B. At the scleral spur
C. At the trabecular meshwork
D. Schlemm's canal
C. At the trabecular meshwork
Rationale: In primary open-angle glaucoma, the main site of outflow obstruction is at the trabecular meshwork.
147
What anatomic structure is responsible for aqueous humor formation?
A. Ciliary processes
B. Corneoscleral meshwork
C. Trabecular meshwork
D. None of the above
A. Ciliary processes
Rationale: The ciliary processes are responsible for the formation of aqueous humor.
148
Given a 30-year-old female patient with an IOP of 15 mmHg and a C/D ratio of 0.3. She has no history of glaucoma in the family, no hypertension, no diabetes. How would you consider her level of glaucoma risk?
A. Low level of glaucoma risk
B. Moderate level of glaucoma risk
C. High level of glaucoma risk
D. Very high level of glaucoma risk
A. Low level of glaucoma risk
Rationale: Given the patient's IOP of 15 mmHg, a C/D ratio of 0.3, and no risk factors for glaucoma, she is considered to have a low level of glaucoma risk.
149
The following findings indicate optic nerve damage, EXCEPT:
A. Decreased color vision
B. Diplopia
C. (+) RAPD
D. Visual field loss
B. Diplopia
Rationale: Diplopia (double vision) is not typically a finding indicative of optic nerve damage; it is more associated with issues related to ocular muscle function or alignment.
