1st LE Ophthalmology (2 Files Merged)

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Ophthalmology 1 LE feedback (2015 A) 1. The site of the detailed for central vision is: a. Optic nerve b. Pars plana c. Ora Serrata d. Macula 2.

The aqueous humor is formed by secretion and diffusion of ciliary processes. Its functions are: a. To maintain the intraocular pressure b. Provides metabolism to the lens c. Provide nutrition to the posterior cornea d. all of the above

3.

the aqueous layer of the tear film is mainly derived from a. Lacrimal glands b. Meibomian glands c. Goblet cells d. All of the above

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The anterior liquid layer of the tear film is mainly derived from a. Accessory lacrimal gland of Krause and Wolfring b. Crypts of Henle c. Meibomian glands d. All of the above

5.

The thin mucin layer of the tear film: a. Maintains stability of the tear film b. Contains glucose immunoglobulins c. Prevents evaporation d. Provides water tight seal

6.

The main source of nutrition of the sclera a. Cornea b. Aqueous Humor c. Choriocapillaries d. Episclera

7.

The process by which light absorbed by the photoreceptors is converted to electrical energy: a. Photosynthesis b. Accommodation c. Visual Transduction d. None of the above

8.

The electrophysiologic test used to evaluate the optic nerve a. Electro‐oculography b. Electroretinography c. Visual Evoked Response d. All of the above

9.

The simultaneous movement of the eye directed to an object in the mid body plane a. Version b. Duction c. Vergence d. Torsion

10. The muscle responsible for abduction: a. Medial rectus b. Lateral rectus c. Superior rectus d. Inferior rectus 11. The muscle responsible for intorsion: a. Superior rectus b. Superior oblique c. Inferior oblique d. Inferior rectus 12. In the elucidation of the patient’s chief complaint: a. It should be stated in the physician’s words using concise medical terminology b. The complaints of lesser importance should not be cited along with the chief complaint c. It should document the patient’s point of view, which may be distinct from the physician d. It may include three or more complaints with their respective duration 13. Which of the following are considered general categories for complaints? a. Ocular pain and discomfort b. Abnormal appearances c. Abnormal ocular secretions d. All of the above 14. In taking the history of present illness (HPI) a. An ocular complaint which is bilateral can give the physician an idea that the problem may have a systemic etiology or genetic predisposition b. Clarifying complaints will uselessly lengthen the process c. The physician’s medical terminology should be used for uniformity, to represent what the patient said d. Negative symptomatology should always be ignored and not included in the documentation of the HPI

15. The chief complaint was blurring of vision on the right eye (OD). The history of a 58 y/o man diabetic, non hypertensive patient states that there is a gradual painless blurring of vision which is worsened b exposure to sunlight, but has better vision at night. The clue in the patient’s history that may connote that it may be a non‐ emergency is the a. Better vision at nighttime b. Worsening of vision when exposed to sunlight c. Painless blurring of vision d. Gradual progression of the blurring of vision 16. The patient consults at the emergency room after being doused by an acid solution in her face and eyes. The first thing to do at the emergency room is: a. Get a good history to make sure of the kind of chemical injury and perform a proper PE specifically visual acuity first for medico‐legal documentation b. Call the ER resident for immediate management c. Irrigate the eye immediately with normal saline solution d. Instill anesthetic to the eye to ease the ocular pain the patient feels 17. A 65 years old nervous lady who came to your clinic has a chief complaint of double vision of two days duration. You must ask for her: a. Social history b. Family history c. Past medical history including medications d. All of the above 18. The mnemonic “COLDER” in taking the history of present illness (HPI) includes all of the following EXCEPT: a. Chief complaint b. Location c. Onset d. Duration 19. Visual acuity charts (eg. Snellen Chart) are normally placed a. 10 feet from the patient b. 15 feet from the patient c. 20 feet from the patient d. 30 feet from the patient 20. If a patient reads 20/200 line in the distance visual acuity chart (unaided) and later reads 20/25 with pinhole, the patient has: a. Retinal problem b. Error of refraction c. Glaucoma d. Mature cataracts 21. Marcus‐Gunn pupil is best observed using which of the following eye maneuver? a. Swinging flashlight test b. Cover‐uncover test c. Confrontation test d. Prism‐cover test

22. Peripheral visual field testing in the clinic can be simply done by the: a. Confrontation test b. Amsler Grid test – test for macula c. Octopus Test – operated perimetry d. Frequency doubling perimeter 23. Steeper corneal curvatures are associated with a. Hyperopia b. Myopia c. Presbyopia – accommodation problem d. Metamorphopsia – problem with macular degeneration 24. Correction for hyperopia is accomplished with: a. Minus lenses b. Plus lenses c. Combination of concave and cylindrical lenses d. Flat lenses (M ‐ myopia, mahaba, minus lens; H – hyperopia, Hindi Mahaba) 25. One of the following cannot be used to correct astigmatism a. Presbyopic reading glasses b. Toric contact lenses c. Cylindrical spectacle lenses – ideal lens d. Cataract extraction with toric intraocular lens implantation 26. Far‐sighted individuals a. have long eyeballs b. have to bring objects closer to see them clearly c. have narrow slit‐like palpebral fissures d. have short eyeballs ‐ Hyperopia 27. individuals with astigmatism a. see better with convex lenses b. see better with concave lenses c. see better through pinholes d. see better at night 28. A condition characterized by difficulty in reading fine print resulting from loss of crystalline lens: a. cataract b. presbyopia c. myopia d. astigmatism rd 29. A 3 year medical student complains of sudden blurry vision on both eyes rendering him unable to read since 2 hours ago. Examination showed fully dilated, non‐reactive pupils on both eyes. The rest of the eye and physical examination showed normal findings. It is likely that: a. Visual acuity by pinhole will show no improvement in vision b. Stronger light will constrict the pupil back to normal c. The patient is malingering d. The patient was pharmacologically dilated

30. Myopia is likely present when: a. A person needs to hold his cellphone very close to his eyes to real his text message b. A person needs to hold his cellphone at arm’s length to read his text message c. A person needs to squint and make his palpebral fissure small to read his text message d. A person needs to turn his head to the right and look through the corner of his eyes to read his text message 31. Myopic correction is accomplished with a. Convex lenses b. Concave lenses c. Toric lenses d. Cylinders 32. The focal point in an uncorrected myopia is located a. before the retina b. after the retina c. On the retina d. before and after the retina 33. A 41 year old insurance executive complains of temporal headaches noted usually in the late afternoon after a day of heavy computer work relieved by sleep. She claims to have had perfect vision all her life and never had to wear glasses. She was advised by her boss to consult a neurologist but wanted to have her eye checked first. Your primary consideration is: a. Glaucoma b. Systemic hypertension c. Psoriasis d. Presbyopia 34. A blow‐out fracture of the orbit occurs when an external force strikes the orbital cavity. Which of the following walls is fractured the most? a. Orbital roof b. Orbital floor c. Medial wall d. lateral wall 35. An ophthalmic surgery that involves removal of the whole globe is called? a. evisceration b. enucleation c. exenteration d. excision 36. A 62 year old female sought consult due to foreign body sensation and eye redness on the left eye. On examination, the left lower eyelid margin was noted to turn inward causing eyelash‐corneal touch. The most probable diagnosis is? a. Ectropion b. Entropion c. Blepharoptosis d. Blepharitis

37. A small abscess caused by an acute staphylococcal infection of the meibomian gland is called a. internal hordeolum – Most commonly caused by staphylococcus b. external hordeolum c. blephritis – not abscecss d. chalazion 38. A 6 year old male was noted to have a waxy and nodular lesion with central umbilication at the eyelid margin. What is the moste likely diagnosis? a. Xanthelasma b. Molluscum contagiosum c. Cutaneous horn d. Seborrheic keratosis 39. A 60 year old farmer sought consult due to a pigmented lesion on the left lower eyelid. It was described to like a “rodent ulcer” what is the most likely diagnosis? a. Basal cell carcinoma b. Squamous cell carcinoma c. Sebaceous adenocarcinoma d. Kaposi’s sarcoma 40. The eyelid malignancy may arise spontaneously or from areas of solar injury and actinic keratosis. It is usually metastasize through the lymphatics, blood or direct extension a. Sebaceous adenocarcinoma b. Basal cell carcinoma c. Squamous cell carcinoma d. Kaposi’s sarcoma 41. A 35 y/o patient previously diagnosed with AIDS presented with a reddish dermal mass in the left lower eyelid. The most likely diagnosis is: a. Basal cell carcinoma b. Kaposi’s sarcoma c. Malignant Melanoma d. Sebaceous adenocarcinoma 42. In congenital nasolacrimal duct obstruction, there is usually a membranous block at: a. Common canaliculus b. Inferior puncta c. Valve of Rosenmuller d. Valve of Hasner – most common site (70 – 80% resolve in 6 months) 43. What is the most common pathogen seen in patients with Canaliculitis? a. Staphylococcus aureus b. Streptococcus sp. c. Actinomyces israelii d. Pseudomonas Aeroginosa

44. A 42 year old female sought consult due to chronic tearing on the right eye for 5 years. She was diagnosed with acquired nasolacrimal duct obstruction. What is the most common cause? a. Naso‐orbital trauma b. Chronic sinus disease c. Dacryocystitis d. Involution stenosis

51. A clinical clerk referring a patient to an ophthalmology resident describes the redness seen in the eye of a 24 y/o patient complaining of eye redness and photophobia as “ciliary injection” This redness is most likely due to: a. Adenovirus conjunctivitis b. Allergic conjunctivitis c. Iridocyclitis – give atropine to relieve pain d. Pterygium

45. The single layer of cells which keeps the cornea in a relative state of dryness/dehydration is the: a. Corneal epithelium b. Bowman’s membrane c. Descemet’s membrane d. Corneal endothelium – sodium potassium pump

52. One of the leading causes of irreversible blindness due to infectious disease in the 3 world is: a. Cataract b. Glaucoma c. Fungal Keratitis d. Trachoma

46. The cornea is avascular and therefore gets its nutrition from the: a. Limbal blood vessels b. Aqueous humor c. Tears d. All of the above

53. “Munson’s Sign” is pathognomonic for: a. Trachoma b. Keratomalacia c. Keratoconus d. Pinguecula

47. Physiology and Biochemistry, respectively is the study of the processes in living matter: a. Function b. Organization c. Formation d. Terminology

and chemical

54. The term “keratomalacia” is synonymous to: a. Dry eyes b. Asian corneas c. Corneal melting d. Corneal leukomas 55. No picture, not audible (sorry guys)

48. Among the following ocular signs which may be seen in patients presenting with a red eye, which would most likely suggest a viral form of conjunctivitis? a. Water discharge b. Purulent discharge c. Eye tenderness d. Stringy discharge 49. Among the following ocular signs which may be seen in patients presenting with a red eye, which would most likely suggest bacterial conjunctivitis? a. Water discharge b. Purulent discharge c. Eye tenderness d. Stringy discharge 50. Among the following ocular signs which may be seen in patients presenting with a red eye, which would most likely suggest vernial conjunctivitis? a. Water discharge b. Purulent discharge c. Eye tenderness d. Stringy discharge

56. One of the ff is not a major function of the crystalline lens: a. Maintain its own clarity b. Absorb UV light c. Refractive power of ‐30 OD d. Accomodation 57. The ff is not a major component of the crystalline lens: a. capsule (anterior & posterior) b. lens endothelium c. lens epithelium d. cortex and nucleus 58. “Second Sight” myopic shift is related to what type of cataract? a. Subcapsular b. Cortical c. Lamellar d. Nuclear

rd

59. Which of the ff chemistry of the normal crystalline lens is not true? a. Adult lens contains approximately 66% water and 33% protein b. Lens cortex is less hydrated than the lens nucleus c. Lens dehydration is maintained by an active Na, K ion water pump d. Lens contains most K ion and less Na ions

66. The changing of the crystalline lens shape during accommodation is controlled by? a. Zonular fiber b. Ciliary body c. Ciliary muscle d. Vitreous body

60. One of the ff is not associated with ectopia lentis: a. Marfan Syndrome b. Well‐ Marhesam Syndrome c. Rubella Syndrome d. Homocystonuria

67. The uveal layer of the human eye is composed of the: a. Cornea and sclera b. Iris, ciliary body, and choroid c. Sclera and uvea d. Retina and Choroid

61. This layer of the crystalline lens is responsible for changing the shape of the lens during accommodation? a. Cortex b. Nucleus c. Lens Capsule – where zonular fibers are attached d. Lens epithelium

68. Features of the sclera include w/c of the ff? a. It covers the ¼ of the total eyeball b. It serves as the insertion of the extracapsular muscles c. It is opaque, white, fibrous tissue. Composed of different types of collagen and is almost acellular d. The optic nerve runs through its equator

62. Which of the ff symptoms is/are associated w/ posterior subcapsular cataract? a. Good near vision but blurred far vision b. Good distance vision but typically have blurred near vision – because it is near the macula c. Good far and near vision d. Good near vision cycle

69. Which of the ff is false regarding episcleritis? a. It is more common in males in their 20s and 30s b. It is characterized by engorgement of episcleral vessels which run in radial direction c. It may be localized and benign or does not signify and underlying systemic disease d. Tenderness, discomfort and sometimes neuralgia are sometimes present

63. Which type of cataract surgery is ideal for most senile (age related) cataract? a. Intracapsular cataract extraction b. Extracapsular cataract extraction c. Aspiration lensectomy – done in soft lens (senile and babies) d. Phacoemulsification 64. A 65 y/o female complained of painful blurring of vision in her right eye of 5 days duration. Right eye examination revealed a hazy cornea, shallow AC, mid‐dilated pupil and intermittent lens. What is the most likely diagnosis? a. Phacolytic glaucoma b. Phacomorphic glaucoma – morphologically block aqueous outflow c. Phacoanaphylactic glaucoma d. Neovascular glaucoma 65. Type of cataract that results from the development of vacuoles and water clefts in the lens. Fibers giving rise to a pearl like appearance: a. Nuclear Cataract b. Polar Cataract c. Cortical Cataract – earliest sign is the formation of water vacuoles d. Posterior Subcapsular Cataract

70. A patient presented with a circumscribed mass as large as a lentil about 2‐3 mm away from limbus in the temporal area of the eye. It was hard, tender and immovable with the conjunctiva moving freely over it. It is traversed by deeper episcleral vessels hence purple in color and is not bright red. There is mild tenderness and discomfort. This patient most likely has: a. Nodular scleritis b. Nodular episcleritis c. Diffuse scleritis d. Diffuse episcleritis 71. A 36 y/o woman came in with a red eye with profound pain and some photophobia. The eye is violecious red which does not blanch with the application of epinephrine. This patient most likely has: a. Episcleritis b. Uveitis c. Scleritis d. Staphyloma

72. The patient came in with sclera necrosis characterized by severe thinning and melting of sclera. His eye is red painful and has worsening of symptoms as days progress. There is associated anterior uveitis and was diagnosed by her dermatologist to have Wegener’s Granulomatosis. The condition is best managed by? a. Oral NSAIDs and topical ????? b. Oral NSAIDs, topical Prednisolone and abundant lubrication c. Oral prednisone at 1mg/kg/day, topical Prednisolone, and oral immunosuppressants d. Surgical management with sclera patch graft 73. Which of the ff is NOT an accepted treatment for posterior scleritis a. IV methylprednisolone b. Subconjunctival triameionolone injections c. Antibiotics for infectious sclera disorders d. Oral prednisone at 1 mg/kg BW 74. A patient presents with an ocular staphyloma. Examination reveals iris incarceration. This patient has: a. Anterior staphyloma b. Ciliary staphyloma c. Interciliary staphyloma d. Posterior staphyloma 75. A congenital development anomaly in the development of the iris, resulting to an absence of the inferior portion of the iris revealing a “key hole” pupil called: a. Iris coloboma b. Aniridia c. Rubeosis iridis d. Heterochromia iridis 76. Exudation of proteinaceous material in the anterior chamber of the eye produces which clinical age of anterior uveal inflammation? a. Anterior chamber cells b. Anterior chamber flare c. Nodules d. 77. The currently used classification used in uveitis disease is: a. International Uveitis Study Group (IUSG) Classification b. ??? Classification c. MEEI Harvard School Classification d. Standardization of Uveitis Nomenclature (SUN) Classification 78. Which of the ff is not a primary determinant of IOP? a. Rate of aqueous humor incretion b. Pupil dilation in myopia c. Aqueous humor outflow faculty d. Episcleral venous pressure

Working

Group

79. The mean value for outflow faculty in normal eyes is? a. 0.05 uL/min/mmHg b. 0.15 uL/min/mmHg c. 0.28 uL/min/mmHg d. 0.48 uL/min/mmHg 80. Conjunctival hyperemia, growth of eyelashes, ocular pruritus, ocular dryness, visual disturbance, ocular burning, foreign body sensation, eye pain, pigmentation of the periocular area, blepharitis, cataract, eyelid erythema, eyelash darkening, are ADVERSE REACTIONS associated with this anti‐glaucoma medication: a. Betaxolol b. Bimatoprost c. Brinzolamide d. Pilocarpine 81. Which of the ff best characterizes primary open angle glaucoma (POAG)? a. POAG usually presents with higher pressures compared to normal tension glaucoma b. POAG is a gradually progressive irreversible blinding disease c. POAG presents with higher eye pressures compared to congenital glaucoma d. POAG is usually seen in hyperopia 82. One of the following is a risk factor for development for glaucoma a. Prolonged use of computers b. Intake of oral steroids – even topical steriods c. Prolonged exercise d. Intake of antihypertensive medications 83. A 60 y/o Asian female complains of difficulty in driving characterized as inability to see the sidewalk for the past 6 months. Past health history is significant for diabetes of 5 years. She claims to have a sister who is blind. Eye examinations showed a visual acuity of 20/20 on both eyes, eye pressure