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SECOND LONG EXAM FEEDBACK FEEFEEDBACK Dr. Reyes

September 09, 2013

1. Conjunctival hyperemia, growth of eyelashes, ocular pruritus, ocular dryness, visual disturbance, ocular burning, foreign body sensation, eye pain, pigmentation of the periocular skin, blepharitis, cataract, superficial punctate keratitis, eyelid erythema, ocular irritation, eyelash darkening are Adverse Reactions associated with this antiglaucoma medication: A. Betaxolol C. Pilocarpine B. Brinzolamide D. Travoprost Travaprost is a synthetic prostaglandin analogue (clue: eyelash darkening). 2. Which of the following best characterizes primary open angle glaucoma (POAG)? A. POAG usually presents with higher eye pressures compared to acute angle closure glaucoma. B. POAG is characterized as having nasal step defects on visual field exam C. POAG presents with higher eye pressures compared to congenital glaucoma. D. POAG is characterized by optic nerve damage, central scotomatas, and eye pressures of 20 mmHg. 3. One of the following is a risk factor for development for glaucoma: A. Prolonged TV viewing C. Intake of anti TB medications B. Prolonged exercise D. Intake of oral steroids 4. A 60 year old 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 headaches and diabetes of 1 year. She claims to have a cousin who is blind. Eye examination showed a visual acuity of 20/20 on both eyes, eye pressure of 20mmHg, open angles on gonioscopy on both eyes, cup disk ratios of 0.5 on both eyes, and visual field defects characterized as bitemporal hemianopsia. The most likely diagnosis would be: A. Acute angle closure glaucoma C. Glaucoma suspect B. Primary open angle glaucoma D. Pituitary tumor 5. The diagnostic test that would identify functional progression in glaucoma: A. Gonioscopy C. Visual field examination B. Fundoscopy D. Corneal topography 6. The most preferred first-line treatment for newly diagnosed mild open angle glaucoma: A. Trabeculectomy C. Diode tras-scleral Cyclophotocoagulation B. Latanoprost D. Laser Iridotomy A is for refractory glaucoma, C is for absolute glaucoma 7. In the treatment of glaucoma, timolol maleate should not be given to patients with: A. Bronchial Asthma C. Hemorrhoids B. Systemic hypertension D. Psoriasis 8. Aqueous fluid exits from which chamber? A. Anterior chamber C. Posterior chamber B. Vitreous chamber D. Trabecular chamber

9. The most common mechanism identified in patients with primary angle closure glaucoma is: A. Pupillary block C. Angle recession B. Plateau iris D. Retinal detachment Retinal detachment would cause 3rd spacing, hence hypotony, therefore no glaucoma 10. A 35 year old male came in for a comprehensive eye examination as part of his annual eye check. The following were significant eye findings: Unremarkable family history, past health history of trauma to left eye 20 years ago, visual acuity 20/20 on both eyes, suspicious visual field loss on the left eye, nerve cupping on the left eye, eye pressure of 15 on the right eye and 23mmHg on the left eye, and asymptomatic. Gonioscopy showed angle recession on the left eye. The most likely diagnosis would be: A. Glaucoma suspect C. Secondary open angle glaucoma B. Acute angle closure glaucoma D. Error of refraction 11. If left untreated, primary angle closure glaucoma can lead to permanent and total loss of vision due to: A. Cataract formation C. Corneal edema B. Retinal Nerve fiber layer thinning D. Mid-dilated pupils 12. In the treatment of acute angle closure glaucoma, this medication has the shortest duration of action and has the greatest intraocular pressure lowering effect: A. Mannitol C. Timolol B. Latanoprost D. Bimatoprost 13. Laser treatment of mild open angle glaucoma is best achieved with: A. Pan retinal photocoagulation C. Laser Iridotomy B. Selective laser trabeculoplasty D. Laser Assisted In-Situ Keratomilieusis (LASIK) 14. Drowsiness, paraesthesia, ataxia, dizziness, thirst, anorexia, headache; confusion, malaise, depression; GI distress, metabolic acidosis, polyuria, hyperuricaemia, renal calculi, nephrotoxicity, hepatic dysfunction ,and Potentially Fatal skin reactions or blood dyscrasias are Adverse Reactions seen with this anti glaucoma medication: A. betaxolol C. acetazolamide B. latanoprost D. pilocarpine 15. A woman presents to you complaining of a sticky red eye for the past two days with stinging and some photophobia. Her vision has dropped slightly to 20/30. She has a history of diabetes and taking drops for glaucoma, but is otherwise healthy. The most likely cause of her eye redness is: A. Acute angle-closure glaucoma C. Diabetic retinopathy B. Viral conjunctivitis D. Papilledema 16. A mother brings in her two-year old child because she is concerned that her baby is cross-eyed. Which of the following is an inappropriate statement: A. The baby may maintain 20/20 vision
 B. The esotropia could lead to permanent vision loss
 C. The esotropia might be corrected with glasses alone
 D. Surgical treatment should be delayed until adolescence 17. What antibiotics would you use in a newborn with suspected chlamydial conjunctivitis? A. Ciprofloxacin drops
 C. Oral Doxycyline B. Erythromycin drops D. Erythromycin drops and oral erythromycin 18. You are measuring the deviation in a child with strabismus. The corneal light reflex is 2mm temporal to the pupil in the right eye. How much deviation would you estimate? A. 10 diopters esotropia
 C. 30 diopters esotropia


B. 20 diopters exotropia


D. 40 diopters exotropia

2mm x 15 diopters= 30 19. The pupillary light reflex can be shown to develop at approximately what age? A. 20 weeks gestation C. 4 weeks postnatal B. 30 weeks gestation D. 8 weeks postnatal 20. Which of the following tests will always be normal in severe unilateral optic nerve hypoplasia A. Visual acuity test C. Electroretinography B. Swinging flashlight test D. Visual evoked responses 21. Which of the following is the most common presentation for retinoblastoma? A. Decreased vision C. Strabismus B. Orbital cellulitis D. Leukocoria 22. Which of the following concerning risk factors for development of ROP (retinopathy of prematurity) is true? A. Gestational age at birth is inversely proportional to the probability of development of ROP B. Incidence and severity of ROP increases directly with average arterial oxygenation C. Asians may tend to develop less severe forms of the disorder D. Necrotizing enterocolitis is an independent risk factor for development of ROP 23. Which of the following congenital cataract scenarios mandates the most urgent surgical intervention? A. Monocular anterior polar cataract C. Monocular lamellar cataract B. Binocular posterior lenticonus D. Monocular nuclear cataract 24. Symptoms or signs of infantile glaucoma includes: A. Tearing C. Photophobia B. Enlargement of corneal diameter D. All of the above 25. The normal growth and development of the human eye includes all of the following except A. A 4-mm increase in axial length of the eye during the first 6 months of life B. A corneal diameter of 10.5mm at birth, increasing to 12mm by age 2 C. An increase in corneal power during the first 6 months of life D. A dramatic increase in lens power over the first year of life 26. Which of the following statements regarding the pathophysiology of amblyopia is true? A. Changes in the nerve fiber layer of the retina are characteristic of strabismic amblyopia B. The visual acuity of an amblyopic eye may be better when measured in the presence of contour interaction (crowding) C. The most significant change in the visual cortex of an amblyopic patient is loss of binocular cells D. The sensitive period for the development of deprivation amblyopia begins earlier and lasts longer than that for strabismic or anisometropia amblyopia 27. Which antibiotic should be given for suspected neonatal Neisseria conjunctivitis? A. Intravenous ceftriaxone C. Oral amoxicillin B. Topical ciprofloxacin D. Topical gentamicin 28. The inability to direct both eyes at the same object is called? A. Strabismus C. Chalazion B. Glaucoma D. Vitreoretinopathy

29. A 4-month-old boy presents with leukocoria of the right eye. A B-scan (ocular ultrasound) showed multiple foci of hype reflectivity in the posterior pole. The most likely diagnosis is? A. Persistent primary vitreous C. Retinal detachment B. Retinoblastoma D. Congenital cataract 30. Screening test used to detect presence of leukocoria A. Corneal light reflex test C. Bruckner test B. Hirschberg test D. Cover-uncover test 31. The visual axis structure with the greatest refractive power is the: A. Cornea C. Crystalline lens B. Aqueous humor D. Vitreous humor 32. This visual axis structure is a significant component of the optical system, reducing the amount of light that enters the eye and aberrations, and it can increase the depth of focus: A. Retina C. Crystalline lens B. Vitreous D. Pupil 33. A condition when parallel light rays from an object are focused at the plane of the retina when the eye is in a relaxed state: A. Emmetropia C. Myopia B. Hyperopia D. Atigmatism 34. With time, changes occur that decreases the elasticity of the lens fibers or hardening of the lens that results in less change in the curvature of the lens when focusing on near objects. This condition is called: A. Cataracts C. Far-sightedness B. Presbyopia D. Keratoconus Questions 35-36: A 30y/o male non-diabetic with a “type A” personality and no history of intraocular surgery complains of sudden onset painless BOV OS. VA 20/40 with unremarkable anterior segment findings. ONH findings are WNL but the posterior pole shows a shallow round elevation of the sensory retina with loss of foveal reflex. 35. The primary consideration is: A. Central serous chorioretinopathy B. Cystoid macular edema

C. Age-related macular degeneration D. Central retinal artery occlusion

36. The above patient’s BOV is described as: A. Central scotoma C. Metamorphopsia B. Decreased color vision D. All of the above Questions 37-38: A 50 y/o hyperopic female experienced right-sided headache and sudden onset painful BOV OD. Generalized eye redness with a hazy cornea is noted on the affected eye, shallow anterior chambers and an IOP 40 was measured by applanation tonometry. 37. The primary consideration is: A. Acute angle closure glaucoma B. Acute anterior uveitis

C. Primary open angle glaucoma D. Uncorrected ammetropia

38. The above patient’s BOV is described as: A. Decreased color vision C. Metamorphopsia B. Iridescent vision D. Nyctalopia

39. A 25y/o female is diagnosed to have MS by her neurologist, who noted ONH finding of unilateral blurred disc margins and mild disc hyperemia. These disc findings are consistent with: A. Optic disc edema C. Optic neuritis B. Papillitis D. All of the above 40. The above patient’s BOV is described as: A. Acute visual impairment C. Impaired color perception B. Cecocentral scotoma D. All of the above 41. A 55y/o male complaining of chronic headache with on and off BOV of 1year duration, was noted to have an intracranial tumor on CT scan. His neurologist noted ONH findings of a swollen disc with obliteration of physiologic cup and peripapillary splinter hemorrhages. These disc findings are consistent with: A. Neuroretinitis C. Papilledema B. Papillitis D. Optic nerve drusen 42. The above patient’s BOV is described as: A. Halo vision C. Metamorphopsia B. Transient visual obscurations D. Nyctalopia 43. A 21y/o female consults at the OPD for painless BOV unresolved by combination antibiotic and steroid eye drops given by a GP. Slit-lamp examination and fluorescein staining showed a central dendritic ulcer. Our primary consideration is: A. Acanthamoeba keratitis C. Keratomycoses B. Bacterial keratitis D. Herpes simplex virus keratitis 44. A 12y/o boy experiences localized tenderness on the lower eyelid due to an external hordeolum. Pain perception in this case is from the: A. Infraorbital nerve C. Frontal nerve B. Lacrimal nerve D. Nasociliary nerve 45. Posterior synechiae are adhesions between: A. Cornea & iris C. Bulbar & palpebral conujunctiva B. Anterior lens capsule & iris D. None of the above 46. The following are symptoms of retinal detachment except: A. Flashes of light C. Floaters B. Sectoral or diffuse visual field defect D. None of the above 47. Which of the following is a component for the pathogenesis of rhegmatogenous retinal detachment? A. Acute posterior vitreous detachment C. Proliferative diabetic retinopathy B. Hypertensive retinopathy D. Non-proliferative diabetic retinopathy 48. Type of Age-related macular degeneratiosn (AMD) that is also known as exudative AMD: A. Atrophic C. Neovascular B. Dry D. Non-neovascular 49. The following statements are true regarding choroidal neovascularization in AMD, except: A. It is less common than atrophic AMD but is more serious B. Metamorphopsia is an initial symptom C. A very early “lacy” filling pattern may be seen in Optical Coherence Tomography

D. Most lesions on the retina are not visible clinically 50. Treatment for proliferative diabetic retinopathy which aims to diminish the formation of vasoformative substance: A. Scleral Buckling C. Posterior Vitrectomy B. Laser Panretinal Photocoagulation D. Flourescein Angiography 51. Which of the following is the most common cause of Central Retinal Artery Occlusion (CRAO)? A. Antithrombin III deficiency C. Protein S deficiency B. Atherosclerosis D. Antiphospholipid antibody syndrome Questions 52-54: A 59-year old male came in to the ER with a chief complaint of peripheral visual field defect on the infero-nasal quadrant of the right eye. This was preceded by photopsias and floaters a few days prior to the development of his visual field defect. He is a known diabetic and hypertensive. Pertinent findings on examination are as follows: visual acuity of 20/40, OU, with unremarkable external and anterior eye examination. 52. Based on the data above, the following may be included in your differential diagnosis, except: A. Retinal detachment C. Central Retinal Artery Occlusion B. Vitreous Hemorrhage D. Branch Retinal Artery Occlusion 53. Which of the following findings on fundoscopy may lessen the likelihood of diagnosing rhegmatogenous retinal detachment? A. Peripheral retinal (lattice) degeneration C. Retinal break(s) B. Loss of choroidal pattern D. Neovascularization on the retina 54. The following are treatment modalities possible for the patient if he was diagnosed with rhegmatogenous retinal detachment, except: A. Scleral buckling B. Intravitreal injection of anti-vasoformative substance (i.e., anti-VEGF) C. Posterior vitrectomy D. Laser photocoagulation Questions 55-57: An 80-year old female presents to you with distorted vision, with no other subjective complaints. After thorough history taking, and physical and ophthalmologic examination, your initial impression for the patient’s condition is exudative AMD. 55. Retinal findings for exudative AMD include the following except: A. Pinkish-yellow subretinal lesions with fluid B. Subretinal blood C. Lipid exudation D. Retinal arterial narrowing 56. To confirm your diagnosis, which imaging modality will you request for? A. B-scan ultrasound C. Flourescein Angiography B. Perimetry D. Pachymetry 57. Which of the following is a possible subsequent course for the patient’s condition if it progresses? A. Geographic RPE atrophy C. Disciform scarring of the retina B. Drusen formation D. Rhegmatogenous retinal detachment Questions 58-60:

A 42-year old male comes to you with progressive blurring of vision and floaters of several months duration in both eyes. He was recently diagnosed with uncontrolled diabetes and hypertension, and has been uncompliant with all of his medications. His visual acuity is CF 5ft OU. On fundoscopy, you see diffuse vitreous hemorrhage, defined disc borders, an AVR of 1:3, a CDR of 0.3, tractional retinal detachment along the vascular arcades, multiple microaneurysms, dot and blot intraretinal hemorrhages, lipid exudates, macular edema, and neovascularization on the disc and elsewhere in both fundi. 58. What is your diagnosis? A. Very severe Non-proliferative Diabetic Retinopathy B. Proliferative Diabetic Retinopathy, high-risk C. Grade 4 Hypertensive Retinopathy D. Exudative Age-related Macular Degeneration 59. Photographic documentation of this patient’s retinal condition may be performed using: A. B-scan ultrasonography C. Flourescein Angiography B. Perimetry D. Pachymetry 60. Possible treatment modalities that may be used for the patient? A. Panretinal Photocoagulation C. Both a and b B. Posterior Vitrectomy D. None of the above 61. In a patient with an eye that has engorged blood vessels, what physical examination should be done to rule out a CC fistula? A. Exophthalmometry C. Tonometry B. Visual field test D. Auscultation 62. What pupillary response would one look for in doing a swinging flashlight test in a patient with optic neuritis? A. Initial constriction C. No response B. Initial dilatation D. Neither 63. How would you know if the patients eye has a retinal or optic nerve problem? A. Check for red color desaturation C. Funduscopy B. Do fluorecein angiography D. Visual field exam 64. In a patient with hyperthyroidism, what eye sign would make you suspicious of Graves Ophthalmopathy? A. Ptosis C. Muscle palsy of recti muscles B. Exophthalmos D. Lid lag 65. What cranial nerve supplies the cornea? A. Cilary nerve C. Frontal nerve B. Trigeminal nerve D. Maxillary nerve 66. Chiasmatic compression gives what kind of visual field defect? A. Pie in the sky C. Sectoral defects B. Pie on the floor D. Junctional scotoma A would be due to temporal lobe lesion and B due to parietal lobe lesion 67. What visual field defect would you expect in a patient with a left temporal lobe lesion? A. Right homonymous hemianopsia with scotoma denser superiorly B. Right homonymous hemianopsia with scotoma denser inferiorly C. Bitemporal hemianopsia D. Altitudinal defects

68. Where would you find temporal islands of vision in patients with brain lesions? A. Frontal lobe lesions C. Parietal lobe lesions B. Temporal lobe lesions D. Occipital lobe lesions 69. What is the reason for complete preservation of central vision in a patient with occipital lobe vascular lesion? A. Dual blood supply C. Is not true B. Triple blood supply D. Unexplained

70. What is the main difference between an optic nerve type defect and a non optic nerve the defect? A. Optic nerve type defects respect vertical meridian B. Optic nerve type defects respect horizontal raphe C. Optic nerve type defects originate from the normal blindspot D. Optic nerve type defects are sometimes unilateral 71. What innervates the constrictor muscle of the iris? A. Ciliary ganglion C. 1st order neuron B. Near synkinetic reflex D. 3rd order neuron 72. The separation of pathways of constriction and dilatation can explain this condition: A. Argyll Robertson pupil in Syphilis C. Tonic pupil B. Adies pupil D. Pharmacologic pupil 73. What is the triad of Horners syndrome? A. Ptosis, anhydrosis, miosis C. Ptosis, miosis, convergence B. Ptosis anhydrosis, dilatation D. Ptosis, miosis, accommodation 74. A tumor in the apex of the lung can affect what order neuron? A. First order C. Third order B. Second order D. Does not affect pupil 75. What test can diagnose Horners syndrome? A. Paredrine test C. Cocaine test B. Hydroxyamphetamine test D. Marijuana test 76. Which of the following congenital cataract mandates the MOST urgent surgical intervention? A. Monocular anterior polar cataract C. Monocular nuclear cataract B. Binocular lenticular cataract D. Monocular zonular or lamellar cataract 77. Which of the following maternal fetal infection WILL NOT cause congenital cataract? A. Rubella C. Cytomegalic inclusion disease B. Toxoplasmosis D. Herpes simplex virus infection (HSV) 78. A 4 year old male presents with leukocoria in the left eye. On eye examination, both eyes are normal in size, on indirect ophthalmoscopy, there is retinal detachment noted. Question: Which of the following ocular disease is LEAST LIKELY diagnosis? A. Toxocariasis C. Persistent hyperplastic primary vitreous (PHPV) B. Coats’ disease D. Retinoblastoma 79. Which of the following diagnostic test is MORE sensitive in detecting calcification? A. B-scan ultrasonography C. CT-scan

B. Fluorescein angiography (FA)

D. MRI

80. Exophytic type of retinoblastoma tumor usually leads to: A. Cataract C. Glaucoma B. Total retinal detachment D.Central retinal vein occlusion (CRVO) 81. First pathognomonic sign of active retinopathy of prematurity (ROP) A. Demarcation line C. Fibrovascular proliferation B. Ridge D. Subtotal retinal detachment 82. The MOST common ocular sign of ocular toxocariasis. A. Leukocoria C. Ocular infection B. Vitritis D. Strabismus 83. Which of the following ocular disease will lead to exudative retinal detachment? A. Retinopathy of prematurity (ROP) C. Persistent hyperplastic primary vitreous (PHPV) B. Toxocariasis D. Coats’ disease 84. What is the suggested management for bilateral retinoblastoma? a. Enucleation of both eyes b. Bilateral exenteration followed by radiotherapy and chemotherapy c. Enucleation of severely affected eye and conservative treatment with less affected eye d. No surgical intervention (only radiotherapy and chemotherapy) Questions 85 - 87 A 12 year old male complain of progressive, painless blurring of vision in the right eye, negative history of eye trauma, on eye examination, there is white pupillary reflex noted in the right eye, on fundus examination, the right eye revealed a typical vascular abnormalities with lipid deposition and subretinal exudates and exudative retinal detachment. Patient left eye is normal. 85. What is the MOST LIKELY diagnosis? A. Retinoblastoma B. Toxocariasis

C. Coats’ disease D. Retinopathy of prematurity (ROP)

86. Which of the following diagnostic test is NOT needed in the diagnosis? A. A-scan ultrasonography C. Fluorescein Angiography (FA) B. B-scan ultrasonography D. CT-scan 87. The following are treatment modalities for this condition, EXCEPT. A. Laser photocoagulation C. Cryotherapy/Diathermy B. Enucleation D. Scleral buckling procedure for retinal detachment

88. Which of the following is NOT a cause of rhegmatogenous retinal detachment? A. Eye trauma C. Intraocular surgery B. High myopia D. Toxocariasis 89. How you differentiate between an Optic nerve and a retinal pathology? A. Do visual fields C. Do tonometry B. Do Ishihara color test D. Do refraction 90. What is the significance of the thickness of the arcuate nerve fiber bundle? A. It explains the immediate swelling of the optic nerve head in early disc edema

B. It’s the thinnest of the 3 nerve fiber bundles C. It protects the papillomacular bundle from injury outside the globe D. Its where you find the greatest injury in papilledema 91. Where does the main blood supply of the eye come from? A. External carotid artery C. Ophthalmic artery B. Internal carotid artery D. Central retinal artery 92. What is the longest portion of the optic nerve? A. Intraocular C. Intraorbital B. Intracanalicular D. Intracranial 93. What blood supply gives Anterior Ischemic Optic Neuropathy when blocked? A. Central Retinal Artery C. Short posterior ciliary artery B. Long posterior ciliary artery D. Ophthalmic artery 94. One of the following is not a type of pseudopapilledema. A. Papillitis C. Disc at risk B. Optic disc drusen D. Myelinated disc A is already an optic neuritis 95. What symptom does not fit with Papilledema? A. Diplopia C. Transient visual obscurations B. Sudden loss of vision D. Spontaneous venous pulsation 96. How would you go about treating papilledema? A. Give oral steroids immediately B. Work up patient by doing CT scan, chest X-ray, CBC with differential count, PPD C. Refer to neurologist right away D. Confine patient immediately 97. Using the Frisen scale to stage papilledema, at what stage do you find a complete halo around the optic nerve head? A. Stage 1 C. Stage 3 B. Stage 2 D. Stage 4 98. The following cause typical optic neuritis: A. NMO C. Ethambutol B. TB infection D. Multiple Sclerosis 99. What other eye signs would be attributed to an optic nerve vs retina problem? A. Blurring of vision C. RAPD B. Slight pain on eye movement D. Vomiting 100. What part of the optic nerve is most susceptible to injuries or nerve compression? A. Intraocular C. Intracanalicular B. Intraorbital D. Intracranial