VISUAL BIOLOGY 1

Question 1

Health workers conducted medical mission at a certain barangay in Manila. Free Medical, Dental and Optometric
services were given. A 5 y/o male child undergone tooth extraction. He was advice for dental and oral care after
tooth extraction. After 2 days, the child notice swelling of the face at the side where tooth had been extracted.
They consulted a MD and was given antibiotic.
1. What is the possible diagnosis manifested by swelling of the face as complication after tooth extraction?

A. maxillary sinusitis
B. ethmoiditis
C. frontal sinusitis
D. mastoiditis

Answer 1

A

Question 2

If the infection extends to the orbit, what is the inflammation/infection affecting the orbital contents?

A. ethmoiditis
B. orbital cellulitis
C. retrobulbar neuritis
D. panophthalmitis

Answer 2

B

Question 3

One of the paranasal sinuses is affected in this case, which of the following sinuses is NOT a paranasal sinus?

A. ethmoid sinus
B. frontal sinuses
C. maxillary antrum
D. mastoid antrum

Answer 3

D

Question 4

Which the sinuses is the largest?
A. ethmoid sinus
B. frontal sinuses
C. maxillary antrum
D. mastoid antrum

Answer 4

C

Question 5

Which of the sinuses contains the “os planun or lamina papyracea”?
A. ethmoid sinus
B. frontal sinuses
C. maxillary antrum
D. sphenoid sinus

Answer 5

A

Question 6

This sinus is characterized by “honey-comb” appearance:
A. ethmoid sinus
B. frontal sinuses
C. maxillary antrum
D. sphenoid sinus

Answer 6

A

Question 7

This sinus has sella turcica wherein the master gland is embedded:
A. ethmoid sinus
B. frontal sinuses
C. maxillary antrum
D. sphenoid sinus

Answer 7

D

Question 8

Which is the “master gland”?
A. pituitary gland
B. pineal gland
C. adrenal glands
D. hypothalamus

Answer 8

A

Question 9

Is there supposed to be ocular manifestation if there is infection affecting the maxillary sinus?

a. No since there is thick bone separating the maxillary sinus and bony orbit
b. Yes since there is thin bone separating the maxillary sinus and bony orbit
c. Yes since there is thin bone separating the maxillary sinus and root of the teeth
D. No since there is thick bone separating the maxillary sinus and root of the teet

Answer 9

A

Question 10

Yes since the cancer cells can readily invade the thick bone separating the maxillary sinus and bony
orbit
B. C. No since the cancer cells cannot invade the thick bone separating the maxillary sinus and bony orbit
No since the cancer cells cannot invade the thick bone separating the maxillary sinus and root of the
teeth
D. Yes since the cancer cells can readily invade the thin bone the separating the maxillary sinus and root
of the teeth

Question 11

Another 2 y/o child was examined and has left exotropia. She undergone ocular examination and eye refraction.
The child was allow to fix the eye at the fingertip starting from one foot until it become closer to the nose.

However, the left eye suddenly moves to the temporal side leaving the right moving toward the nose. Eye
refraction reveals that the left eye has -5.00s and right eye is 20/20.

11. As an optometrist, what orthoptics procedure you will advise to the parent of the child?
    A. eye patch to left eye to force the lazy EOM to contract
    B. eye patch to right eye to force the lazy EOM to contract
    C. eye patch both eyes to relax the lazy EOM
    D. eye patch both eyes to force the lazy EOM to contract

Answer 11

B

Question 12

Another 2 y/o child was examined and has left exotropia. She undergone ocular examination and eye refraction.
The child was allow to fix the eye at the fingertip starting from one foot until it become closer to the nose.

However, the left eye suddenly moves to the temporal side leaving the right moving toward the nose. Eye
refraction reveals that the left eye has -5.00s and right eye is 20/20.

What EOM is weak in this case?
A. lateral rectus
B. superior rectus
C. inferior rectus
D. medial rectus

Answer 12

D

Question 13

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Answer 13

—

Question 14

Which of the EOM is the longest from the origin up to its insertion at the eyeball?
A. superior rectus
B. superior oblique
C. inferior oblique
D. inferior rectus

Answer 14

B

Question 15

15. Which of the EOM is the shortest from the origin up to its insertion at the eyeball?
    A. superior rectus
    B. superior oblique
    C. inferior oblique
    D. inferior rectus

Answer 15

C

Question 16

16. Which of the EOM is the strongest?
    A. medial rectus
    B. lateral rectus
    C. superior oblique
    D. inferior rectus

Answer 16

A

Question 17

Where is the origin of the EOM?
A. zonules of Zinn
B. annulus of Zinn
C. ligament of Lockwood
D. check ligament

Answer 17

B

Question 18

18. What is the orbital bone wherein the origin of EOM is located?
    A. greater wing of sphenoid bone
    B. lesser wing of sphenoid bone
    C. ethmoid bone
    D. frontal bone

Answer 18

B

Question 19

19. What is the bone wherein the optic foramen is located?
    A. greater wing of sphenoid bone
    B. lesser wing of sphenoid bone
    C. ethmoid bone
    D. frontal bone

Answer 19

B

Question 20

Which of the EOM has no tendon?
A. inferior rectus
B. medial rectus
C. inferior oblique
D. superior rectus

Answer 20

C`

Question 21

21. Which of the following is NOT synergistic EOM during abduction?
    A. lateral rectus
    B. superior oblique
    C. inferior oblique
    D. superior rectus

Answer 21

D

Question 22

22. Which of the following is NOT synergistic EOM during adduction?
    A. medial rectus
    B. superior rectus
    C. inferior oblique
    D. inferior rectus

Answer 22

C

Question 23

Which of the EOM has no secondary and tertiary function?
A. lateral rectus
B. superior oblique
C. inferior oblique
D. superior rectus

Answer 23

A

Question 24

24. Antagonist of superior oblique for abduction?
    A. inferior oblique
    B. superior rectus
    C. lateral rectus
    D. none of the above

Answer 24

a

Question 25

25. Agonist of superior oblique for intorsion: A. inferior oblique B. superior rectus C. lateral rectus D. inferior rectus

Answer 25

B

Question 26

Primary function of the superior rectus? A. elevation B. intorsion C. adduction D. excycloduction

Answer 26

A

Question 27

27. Secondary function of the superior rectus? A. elevation B. intorsion C. adduction D. excycloduction

Answer 27

B

Question 28

28. Tertiary function of the superior rectus? A. elevation B. intorsion C. adduction D. excycloduction

Answer 28

C

Question 29

What is the EOM which elevate the eyeball when the eyeball is adducted? A. inferior oblique B. superior rectus C. lateral rectus D. inferior rectus

Answer 29

B

Question 30

30. What is the EOM which depress the eyeball when the eyeball is abducted? A. lateral rectus B. superior oblique C. inferior oblique D. superior rectus

Answer 30

B

Question 31

Another 30 y/o male was examined and has anisocoric pupils. Several tests had been done to confirm the possible diagnosis including light and dark room tests. 31. If both eyes are dilated in dark room. Swinging flashlight test was done which give the following findings: left eye constrict on direct light while the right remains dilated. Then light pass the right eye, pupils on both eyes remain dilated. What is the possible diagnosis? A. Horner’s syndrome B. Argyll-Robertson pupil C. Marcus Gunn Pupil D. Adie’s syndrome

Answer 31

C

Question 32

Another 30 y/o male was examined and has anisocoric pupils. Several tests had been done to confirm the possible diagnosis including light and dark room tests. If both eyes are dilated in dark room. Swinging flashlight test was done which give the following findings: left eye constrict on direct light while the right remains dilated. Then light pass the right eye, pupils on both eyes remain dilated. What is the possible diagnosis? 32. What is the eye affected? A. left eye B. right eye C. both eyes are affected D. both eyes are normal

Answer 32

B

Question 33

Another 30 y/o male was examined and has anisocoric pupils. Several tests had been done to confirm the possible diagnosis including light and dark room tests. If both eyes are dilated in dark room. Swinging flashlight test was done which give the following findings: left eye constrict on direct light while the right remains dilated. Then light pass the right eye, pupils on both eyes remain dilated. What is the possible diagnosis? What part of the pupillary pathways is affected in MARCUS GUNN A. retina and or optic nerve B. bilateral pretectal nuclei at the brain C. sympathetic pathways D. parasympathetic oculomotor nerve

Answer 33

A

Question 34

If the result is positive for Swinging flashlight test, what is the result if accommodation is done? A. patient cannot read at near B. patient can read at near C. patient pupils remains dilated D. ciliary muscles are relax thus patient cannot read at far

Answer 34

B

Question 35

If another patient has history of syphilis (sexually transmitted disease) 5 years ago and on examination the patient has anisocoric pupils. What is the possible initial diagnosis by medical history alone and ocular examination? A. Horner’s syndrome B. Argyll-Robertson pupil C. Marcus Gunn Pupil D. Adie’s syndrome

Answer 35

B

Question 36

36. What is the response of the pupils on direct light reflex if history reveals previous syphilis and anisocoric pupils on examination? A. left eye constrict while right eye remains dilated B. right eye constrict while left eye remains dilated C. both eyes remains dilated D. both eyes constrict

Answer 36

C

Question 37

37. What is the response of the pupils on consensual light reflex if history reveals previous syphilis and anisocoric pupils on examination? A. left eye constrict while right eye remains dilated B. right eye constrict while left eye remains dilated C. both eyes remains dilated D. both eyes constrict

Answer 37

C

Question 38

What is the response of the pupils during near point-accommodation reflex if history reveals previous syphilis and anisocoric pupils on examination? A. left eye constrict while right eye remains dilated B. right eye constrict while left eye remains dilated C. both eyes remains dilated D. both eyes constrict Another 26 y/o female was examined and has anisocoric pupils. On dark room test, the examiner noticed that the left eye is dilated and right eye is constricted.

Answer 38

C

Question 39

39. What is the possible diagnosis in this case? A. Horner’s syndrome B. Argyll-Robertson pupil C. Marcus Gunn Pupil D. Adie’s pupil

Answer 39

A

Question 40

40. What other ocular manifestation should be present in this case suggestive of your possible diagnosis? A. complete blepharoptosis B. partial blepharoptosis C. unilateral proptosis D. bilateral proptosis

Answer 40

B

Question 41

What nerve is affected in this case? A. parasympathetic efferent oculomotor nerve B. sympathetic efferent nerve C. central bilateral pre-tectal nucleus D. retina and optic nerve

Answer 41

B

Question 42

42. What eye is affected in this case? A. OD B. OS C. OU

Answer 42

A

Question 43

43. What is the abnormal response of the effected eye if it is instilled with 5% cocaine in this case? A. affected pupil will dilate B. affected pupil remains constricted C. both pupils dilate D. both pupils constrict

Answer 43

B

Question 44

44. If the affected pupil does not respond to 5% cocaine, 1% hydroxyamphetamine will be instilled to the affected pupil. If the abnormal pupil respond to 1% hydroxyamphetamine after instillation, where is the lesion located? A. pre-ganglionic sympathetic neuron B. central superior cervical ganglion C. central ciliary ganglion D. post-ganglionic sympathetic neuron

Answer 44

D

Question 45

Time interval before 1% hydroxyamphetamine should be instilled after the 5% cocaine: A. 1-2 days after cocaine instillation B. 1-2 hours after cocaine instillation C. 30 minutes after cocaine instillation D. immediately once pupil failed to respond

Answer 45

A

Question 46

Another 33 y/o female was examined and has also anisocoric pupils. On dark room test, the examiner noticed that both eyes are dilated. Direct light was shine on both eyes simultaneously and the examiner noticed that the right eye constrict but the left eye remains dilated. 46. What is the possible diagnosis in this case? A. Horner’s syndrome B. Argyll-Robertson pupil C. Marcus Gunn Pupil D. Adie’s syndrome 47. What nerve is affected in this case? A. parasympathetic efferent oculomotor nerve B. sympathetic efferent nerve C. central bilateral pre-tectal nucleus D. retina and optic nerve 48. What eye is affected in this case? A. OD B. OS C. OU D. both eyes are norma

Answer 46

D A B

Question 47

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Answer 47

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Question 48

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Answer 48

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Question 49

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Answer 49

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Question 50

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Answer 50

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Question 51

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Answer 51

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Question 52

A 50 y/o male was suffering from sudden blindness. There is ciliary injection on external ocular. Digital palpation shows very tense right eyeball. Applanation tonometry was done which gives a value of 28 mmHg. Shadow test using penlight reveals wide black shadow at periphery of the cornea. Confrontation visual testing was also done to assess central and peripheral field of vision. Examiner noticed there are some part which cannot be seen by the patient. So he was referred for automated perimetry (Octopus) which show significant findings. 52. What is the probable initial diagnosis in this case? A. senile cataract B. angle closure glaucoma C. open angle glaucoma D. retinal detachment 53. If ophthalmoscopy was done and reveals cup: disc ratio of 0.7 mm, what is your impression? A. senile cataract B. glaucoma C. retinopathy D. retinal detachment 54. Complication of elevated IOP which cause sudden blindness: A. lens subluxation B. cataract formation C. retinal detachment D. optic nerve atrophy

Answer 52

C B D

Question 53

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Answer 53

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Question 54

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Answer 54

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Question 55

A 50 y/o male was suffering from sudden blindness. There is ciliary injection on external ocular. Digital palpation shows very tense right eyeball. Applanation tonometry was done which gives a value of 28 mmHg. Shadow test using penlight reveals wide black shadow at periphery of the cornea. Confrontation visual testing was also done to assess central and peripheral field of vision. Examiner noticed there are some part which cannot be seen by the patient. So he was referred for automated perimetry (Octopus) which show significant findings. What causes elevated IOP in this case? A. increase lacrimal glands secretion and decrease outflow to lacrimal passages B. increase aqueous humor secretion and decrease trabecular outflow C. increase aqueous humor secretion and decrease lacrimal passage outflow D. increase lacrimal glands secretion and decrease trabecular outflow

Answer 55

B