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Transcript
1. Wilson's disease: a. autosomal dominant b. cavitation and neuronal loss in putamen and globus pallidus c. low ceruloplasmin d. Kayser-Fleischer ring persists despite treatment e. Kayser-Fleischer ring is due to deposition of copper in Descemet membrane 2. Retinoblastoma: a. is the commonest intraocular tumour of infancy and childhood b. constitute about 10% of childhood malignancies c. the diffuse infiltrating type usually affects girls d. perivascular mantles of surviving cells enclosed by white necrotic tissue is pathognomonic e. Flexner-Wintersteiner rosette is a pathological feature. 3. Homocystinuria: a. is associated with retinal detachment b. increase blood methionine level c. X-linked recessive d. associated with lens subluxation e. risks of thrombosis under general anaesthesia 4. Neurofibromatosis is associated with: a. bilateral glaucoma b. Lisch nodules c. pulsating exophthalmos d. S-shaped nodule e. cafe-au-lait spots 5. Mooren's ulcer: a. better prognosis if less than 40 years old b. is painful c. most rapid growth centrally d. conjunctival resection occasionally useful e. 2-5% bilateral 1 6. Superior oblique palsy commonly associated with: a. a blow on the vertex b. congenital malformation c. medial orbital wall fracture d. myokymia e. internal hydrocephalus 7. Coloboma of the choroid and retina: a. is usually autosomal recessive b. is associated with retinal detachment c. is usually inferotemporal d. does not involve the macula e. causes autofluorescein 8. Ocular cicatricial pemphigoid: a. causes intra-epithelial bullae b. has antibodies to basement membrane c. is autosomal recessive d. dry eye is an early presentation e. steroid alone is ineffective 9. Acanthoamoeba keratitis can be confirmed by: a. Grams stain b. Giemsa stain c. non-nutrient agar overlaid by E.coli d. indirect immunofluorescent antibody stain e. Saboraoud's agar 10. Blow-out fracture is associated with: a. decrease elevation b. decrease depression c. decrease abduction and adduction d. enophthalmos e. lateral canthus displaced downwards. Past MRCOphth/MRCS questions: 2 2 1. After cataract extraction: a. plus cylinder at the meridian of right suture b. plus cylinder at 900 from meridian of a removed tight suture c. minus cylinder at 600 meridian relieved by suture removal at 1500 d. minus cylinder at 200 aggravated by suture removal at 1100 e. minus cylinder at 1300 relieved by suture removal at 900 2. Optic nerve trauma in head injury: a. usually involves the intracranial portion b. commonly produces altitudinal defects c. often complicated by optic atrophy d. causes contralateral relative afferent pupillary defect e. visual evoked potential showed delayed latency 3. Causes of rubeosis iridis include: a. choroidal melanoma b. stage 2 retinopathy of prematurity c. irradiation treatment d. aortic arch syndrome e. total retinal detachment 4. Adult type retinoschisis: a. is bilateral b. split at outer plexiform and inner nuclear layers c. usually found in the superotemporal quadrant d. the fluid in the cavity derives from vitreous e. 2% incidence in autopsy 5. Cycloplegic refraction in neonates: a. 0.5% cyclopentolate can cause seizure b. 2.5% phenylephrine can cause increase blood pressure and central nervous system haemorrhage c. 0.5% proparacaine decreases the blinking reflex and potentiate cyclopentolate action d. physostigmine subcutaneously is used to treat atropine poisoning e. cyclopentolate poisoning causes decrease gastric acid and volume 6. Apparent divergent squint can occur in: a. fixation disparity b. wide inter pupillary distance c. exophthalmos d. wide papillary aperture e. epicanthal folds 3 7. Aqueous tear deficiency is affected by: a. pilocarpine b. antihistamine c. atropine d. tricyclic antidepressants e. acetazolamide 8. Cluster headache: a. is more common in females b. pain is persistent for 1-2 days c. associated with Horner's syndrome d. associated with epiphora e. relieved by propanolol prophylaxis 9. Optic nerve drusen: a. associated with autofluorescence b. early staining in fluorescein angiography c. causes subretinal neovascularization d. is associated with retinitis pigmentosa e. is associated with abnormal branching of the retinal vessels 10. Vernal conjunctivitis is characterized by: a. cobble stone papillae b. Trantas' dots c. mucus secretion d. superior peripheral ulcer e. recurrent uveitis Past MRCOphth/MRCS questions: 3 1. Red-green colour defect occurs in: a. Stargardt's disease b. autosomal dominant optic nerve drusen c. toxic optic neuropathy d. optic neuritis 4 e. glaucoma 2. Benign intracranial hypertension: a. is associated with tetracycline use b. diagnosed by CT scan c. is associated with frontal headache d. can be treated with oral steroids e. causes hard exudate in the macular 3. Lyme's disease: a. is caused by Borrelia burgdoferi b. is a louse born disease c. is treated with doxycycline in stage 1 d. is associated with pathognomonic erythema migrans e. causes sight threatening panuveitis 4. In cataract extraction: a. intracapsular cataract extraction is used for subluxated lens b. cystoid macular oedema is more common in ICCE than ECCE c. ICCE is associated with a higher incidence of retinal detachment than ECCE d. in pseudoexfoliation syndrome, ECCE put less stress on the zonule than phacoemulsification e. posterior capsule rupture is associated with an increased incidence of cystoid macular oedema 5. Keratoconus: a. is associated with Down's syndrome b. is associated with Leber's congenital amaurosis c. can be treated by epikeratophakia in early stage d. is more common in teenage body e. commonly gives rise to eccentric in inferotemporal quadrant. 6. The following are true about systemic lupus erythematosus: a. the retina is the most commonly involved ocular structure b. Sjogren's syndrome is a recognized complication c. it can give rise to positive VDRL d. it gives rise to ischaemic choroidopathy e. it produces lupus anticoagulant which is associated with central retinal vein occlusion 5 7. The following are true about pupil reaction: a. Argyll Robertson's pupils are typically small and irregular b. a small pupil excludes Adie's pupil c. dilated pupil is a feature of advanced optic atrophy d. spherical aberration decreases with pupil constriction e. following radial sphincterectomy, pupil constriction does not occur 8. The following are true about refractive errors: a. more plus lens should be added if the patient sees the red letters clearer in Duochrome test b. more plus lens will be needed if the patient is on MAO inhibitors c. more plus lens is needed in a patient who accommodates excessively d. more minus lens is required in poorly controlled diabetes e. hypermetropic shift occurs in nuclear sclerosis. 9. Aneurysms of the following vessels causes third nerve compression: a. posterior cerebral artery b. inferior cerebral artery c. internal carotid artery d. posterior communicating artery e. anterior communicating artery 10. The following are true about contact lens: a. the power is higher than spectacle prescription in myopia b. contact lens made off silicone-hydrogel has a higher oxygen transmission rate than PMMA c. it is the treatment of choice in paediatric aphakia d. soft contact lens can not be used to correct astigmatism e. rigid gas permeable lens has a bigger diameter than soft contact lens Past MRCOphth/MRCS questions: 4 1. Man with X-linked retinitis pigmentosa: a. must have an affected mother b. must have a carrier mother 6 c. 50% of sons affected d. daughters must be affected e. tends to have poor visual prognosis than autosomal dominant type 2. Cerebral hemisphere lesion: a. homonymous hemianopia b. bitemporal hemianopia c. dysphasia d. focal epilepsy e. intentional tremor 3. The following are true about botulinum toxin: a. cannot be used under general anaesthesia b. can only be used for the horizontal recti c. ptosis is one of the complications when used for blepharospasm d. will develop antibodies in blood e. the onset of action takes 24 hours 4. Regarding ultrasound biometry: a. higher frequency gives better resolution b. wider beam width gives more accurate result than narrower beam width c. a central fixation target gives more accurate result d. modern instruments allows 0.01 mm resolution e. measurements repeated in a pseudophakic patient gives same result as in pre-operative state 5. In ophthalmic ultrasound: a. lower frequency gives better resolution than higher frequency b. sound wave is refracted in the lens c. highest signal in ocular tissues is from the sclera d. high internal reflectivity in melanomas e. will not show up retinoblastoma calcification 6. SF6: a. is lipid soluble b. causes posterior subcapsular cataract c. absorbs nitrogen from vein rapidly d. will not expand with a mixture of 40% SF6 and 60% air e. no electrophysiological evidence of damage to photoreceptors 7 7. With regard to electro-oculogram (EOG): a. it arises from extraocular muscles b. its potentials come from retinal ganglion cells c. its potentials arise from retinal pigment epithelium d. it is a better test than ERG for Best's disease e. patients with abnormal ERG usually have abnormal EOG 8. Optic nerve trauma in head injury: a. usually involves intracranial portion b. commonly produces altitudinal defects c. often complicated by optic atrophy d. causes contralateral relative afferent pupillary defect e. visual evoked potential (VET) shows delayed latency 9. Moron's ulcer: a. is a slowly progressive unilateral disease b. is usually preceded by a viral prodromal phase c. begins as a grey peripheral infiltrate which breaks down into a ulcer furrow d. the margin of the ulcer is infiltrated with monocytes and plasma cells e. it is similar to corneal melting associated with connective tissue diseases such as rheumatoid arthritis in that the sclera is involved 10. In corneal graft rejection: a. 90% of immune graft rejection occurs within the first year b. one ore more pregnancies in the past increases the risk c. previous grafting in the fellow eye increases the risk d. one or more blood transfusion in the past increases the risk e. prior to rejection there is an increase in corneal vascularization. Past MRCOphth/MRCS questions: 5 1. Exudation into the suprachoroidal space: a. occurs as a complication of trabeculectomy b. is a complication of scleritis c. occurs in nephrotic syndrome d. may be mistaken as a ring melanoma of the ciliary body e. the effusion extends forwards in the superficial layers of the ciliary body as far as the scleral spur 8 2. Posterior subcapsular cataract is a complication of: a. irradiation b. prednisolone c. ethambutol d. gentamicin e. chlorpromazine 3. With regard to orbital infection in children: a. preseptal cellulitis is more common than orbital cellulitis b. ocular motility defect is a feature of orbital cellulitis c. CT scan is useful in differentiating preseptal and orbital cellulitis d. frontal and maxillary sinusitis are common causes e. the most common pathogens are Pneumococcus, Haemophilus inluenzae, Staphylococcus 4. The following are true about trachoma: a. mini-pannus is common b. Tranta's dots occurs in the inferior cornea c. superior tarsal conjunctiva is more commonly affected than inferior tarsal conjunctiva d. it is a sexually transmitted disease e. tetracycline is useful as treatment 5. Goldenhar's syndrome has the following features: a. hypertelorism b. iris and choroid coloboma c. decreased corneal sensation d. microphthalmos e. under-development of the mandible 6. Rubella cataract: a. can be unilateral b. is usually cortical c. 50% of congenital cataract in the UK is caused by rubella d. is the commonest presentation of congenital rubella e. usually occurs when the mother acquires the disease in the third trimester 7. Sympathetic ophthalmia: a. about 80% occurs within the first week of ocular trauma b. causes granulomatous inflammation c. causes Dalen-Fuch's nodules within the retina 9 d. is curative by removing the inciting eye e. can occur following cataract surgery 8. Dermolipoma: a. occurs most common in the supero-nasal quadrant b. is a harmatoma c. requires early excision as 1/3 of them turns malignant d. can infiltrate into orbital fat e. is associated with Goldenhar's syndrome 9. In a baby with epiphora: a. conservative treatment until 3 years of age is recommended b. endotracheal tube should be inserted, if syringing and probing were to be performed under general anaesthesia c. recurrent orbital cellulitis is a common complications d. congenital glaucoma needs to be excluded e. the obstruction is usually at the common canaliculus 10. PHPV (persistent hyperplastic primary vitreous): a. is caused by failed reabsorption of the hyaloid vascular system b. is usually unilateral c. causes angle closure glaucoma d. causes cataract e. is a cause of intraocular calcification in the neonate Past MRCOphth/MRCS questions: 6 1. In corneal grafts: a. anterior synechia increases the chances of rejection b. specific allograft rejection often occurs within 2 weeks of transplantation if the host cornea is vascularized c. graft failure during the first 2 weeks may be due to reactivation of herpes simplex d. topical steroids have a lympholytic effect on killer lymphocytes which are responsible for endothelial rejection e. subepithelial infiltrates, epithelial oedema and keratitic precipitates are signs of rejection 10 2. The following are true about anti-glaucoma drugs: a. pilocarpine reduces production of aqueous by exerting an inhibitory action on the ciliary epithelium b. sympathomimetics reduce intraocular pressure by increasing uveal scleral outflow d. carbachol increases aqueous outflow via the trabecular meshwork thereby lowering intraocular pressure d. pilocarpine induced miosis begins 5-10 minutes after instillation and lasts 4-8 hours e. echothiophate iodide has accommodation spasm, cataractogenicity, iris cysts and retinal detachment side-effects. 3. With regard to the cranial nerves: a. trochlear nerve paralysis may be idiopathic in 1/3 of cases b. trochlear nerve paralysis is commonly caused by diabetes mellitus c. abducens nerve paralysis is frequently caused by diabetes mellitus d. the tricolour nerve is more frequently damaged by neoplasms than the abducens nerve e. trochlear nerve paralysis, can be caused by intracranial aneurysms. 4. In the treatment of retinoblastoma: a. reduction of the total dose given by avoiding usage of supervoltage equipment reduces the complications of irradiation b. Group III B tumours should be enucleated c. gold spheres should be used after enucleation as adjunctive radiotherapy may be required. d. CNS spread of tumour treated with intrathecal methotrexate can result subacute leukoencephalopathy e. external beam irradiation results in posterior subcapsular cataract in 20% of cases 5. In cataract surgery: a. phacoemulsification has the advantage of a smaller section resulting in less astigmatism b. YAG capsulotomy for thickened posterior capsule can result in retinal detachment c. uveitis-glaucoma-hyphaema syndrome is an early post-operative complication of cataract extraction d. with the rule astigmatism is associated with loose sutures e. the extracapsular technique can cause sensitization to the endothelial cells resulting in corneal decompensation 6. Temporal lobe tumours: a. causes homonymous hemianopia b. are associated with formed visual hallucinations c. may present with psychomotor epilepsy d. may cause Foster-Kennedy syndrome 11 e. may cause ataxic nystagmus 7. Optic nerve glioma: a. is more common in children than in adults b. originates form the myelin sheath of the optic nerve fibres c. causes erosion of the optic foramen margin which is demonstratable radiologiacally d. causes loss of vision early e. causes axial proptosis 8. Sturge-Weber's syndrome is: a. associated with adenoma sebaceum b. associated with unilateral congenital glaucoma c. associated with retinal capillary haemangioma d. autosomal; dominant e. associated with intracranial calcifications 9. Parinaud's syndrome consists of: a. ataxia b. vertical gaze paralysis c. pupillary areflexia to light d. optic atrophy e. convergence weakness 10. The following may be causes of unilateral oculomotor palsy with pupil involvement: a. migraine b. herpes zoster c. myasthenia gravis d. diabetes mellitus e. posterior communicating artery aneurysm. Past MRCOphth/MRCS questions: 7 1. Advantages of cryotherapy over diathermy include: a. cryotherapy causes little or no scleral damage b. cryotherapy shrinks the sclera thus facilitating closure of the drainage site 12 c. cryotherapy does not force fluid from the eye thus maintaining a reasonable intraocular pressure cryotherapy can be safely applied over staphylomatous sclera e. cryotherapy causes no damage to the vortex vein or ciliary arteries 2. Juvenile retinoschisis: a. is an autosomal recessive condition b. there is classical cystoid oedema at the macula c. the split is in the nerve fibre layer d. is a bilateral disease e. it is most commonly seen in the superior nasal quadrant 3. Complications of retinal detachment operations include: a. strabismus b. refractive error c. macular pucker d. anterior segment necrosis e. angle closure glaucoma 4. Regarding buckles: a. encirclage reduces vitreous traction in the eye b. scleral dissection is required in explants c. encirclage is indicated when there is evidence of proliferative vitreo-retinopathy d. an encirclage can be used if no holes are found on examination e. maximal reduction of vitreous traction can be achieved only if the encircling band constricts the vitreous base. 5. After retinal detachment: a. protein synthesis in the retina is increased b. intraretinal oedema appears c. there is a disruption of the photoreceptors d. retinal pigment epithelial cells can proliferate and they appear as subretinal white dots e. large intraretinal cysts form after a short period of time 6. Syphilitic keratitis is characterized by: a. early pain and photophobia b. diffuse vascularization c. stromal haze heaviest in the centre d. lack of corneal sensitivity e. punctate epithelial keratopathy 13 7. Keratopathies in which fat is a prominent feature include: a. arcus senilis b. lipid dystrophy c. keratitis centralis annularis d. chronic scleritis e. Stocker's line 8. Macular dystrophy is characterized by: a. diffuse and rapidly progressing cloudiness b. superficial lesions in central cornea c. stromal lesion in peripheral cornea d. early impairment of visual acuity e. autosomal dominant inheritance 9. Band keratopathy: a. appears in children with Still's disease b. is associated with arthritis and iritis c. appears in the interpalpebral area d. slit lamp reveals dark holes in bowman's membrane e. may be removed with sodium EDTA 10. Recurrent corneal erosions: a. improve during the waking hours b. can be treated with topical steroids in acute phase c. results from epithelium removal by the lids in sleep d. characteristically causes symptoms in the evening e. can be treated with a bandage contact lens. Past MRCOphth/MRCS questions: 8 1. Trachoma follicles: a. occur in the conjunctival stroma b. consist of lymphocytes in early stage c. may show necrosis in the central zone d. are not accompanied by submucosa inflammation e. are pathognomonic of the disease 14 2. Pseudomembranes are produced in: a. gonorrhoeal ophthalmia b. pneumococcal conjunctivitis c. meningococcal conjunctivitis d. Steven-Johnson syndrome e. herpes simplex conjunctivitis 3. There is an association between the following: a. iris coloboma and lens dislocations b. spherophakia and Weill Marchesani syndrome c. ataxia telangiectasia and rubeosis irides d. juvenile chronic rheumatoid arthritis and band keratopathy e. Bardet-Biedl syndrome and night blindness 4. Retinoblastoma: a. 90% of patients have a germ line mutation b. is associated with an abnormality of the short arm of chromosome 13 d. rarely shows calcified flecks e. is classified according tot he Callender system 5. Ocular manifestations and syndromes recognized associations are: a. eyelid coloboma and Treacher-Collins b. keratoconus and Down c. convergent squint and Crouzon's d. hypertelorism and Kleinfelter e. limbal dermoids and von Recklinghausen 6. Retinopathy of prematurity: a. apnoea is a risk factor b. often regresses spontaneously c. is associated with hypovitaminosis E d. is treated with cryotherapy at stage 2a e. is associated with myopia 7. Aniridia: 15 a. is inherited as an autosomal recessive disease b. rarely leads to glaucoma c. often causes photophobia d. is associated with nephroblastoma e. mainly affects oculocutaneous albinos 8. Following penetrating ocular injury: a. cryotherapy must be applied to sites of scleral rupture greater than 6 mm from the limbus b. vitreous incarceration invariably leads to retinal detachment c. posterior vitreous detachment usually occurs within the first 48 hours d. fibronectin may play a role in wound healing e. vitrectomy is invariably carried out when removing intraocular foreign bodies 9. Behcet's disease: a. is commonly associated with HLA B5 and HLA BW51 b. oral ulcers are the most frequently seen clinical feature c. arthritis is not a feature d. confusional state is well recognized e. is associated with retinal infiltrates 10. Infants: a have average ocular axial lengths of approximately 17 mm b. ideally require implants of approximately 35 dioptres for vision after cataract extraction c. with congenital cataracts often have small miosed pupils d. after unilateral congenital cataract surgery should have at least 3 hours patching a day to the better day e. have less post-operative inflammation after cataract surgery adults do. Past MRCOphth/MRCS questions: 9 1. Recognized side effects of cyclopsorin A include: a. renal toxicity b. cerebellar deficit c. hirsutism d. gingival hyperplasia e. hepatotoxicity 16 2. Disc drusen: a. are familial b. show pseudofluorescence c. usually cause central field loss d. may be associated with disc haemorrhage e. become less obvious with increasing age 3. The diagnosis of an orbital blow out fracture is suggested by: a. enophthalmos b. hypoanaethesia of the gum c. restricted down-gaze d. positive forced duction test e. orbital margin tenderness 4. Multiple sclerosis can cause: a. diplopia b. abduction nystagmus c. internuclear ophthalmoplegia d. unilateral optic disc oedema e. lateral rectus saccadic paresis during versions 5. Which of the following are true of lacrimal gland tumours: a. benign mixed tumours (pleomorphic adenomas) constitute 50% of all lacrimal gland swellings b. adenoid cystic carcinoma is the commonest epithelial tumour of the lacrimal gland c. pleomorphic adenoma may undergo malignant change d. pain is a predominant feature in malignant lesions e. suspected benign mixed tumours need to be biopsied for tissue diagnosis prior to a definitive treatment 6. Treatment of benign intracranial hypertension includes: a. acetazolamide b. weight reduction c. steroids d. limbo peritoneal shunt e. anti-prostaglandins 17 7. Drusen of the optic nerve head are associated with: a. refractile bodes b. leakage of fluorescein on angiography c. no filed defects d. central serious retinopathy e. peripaillary haemorrhages 8. Six months after resolution of an acute attack of retrobulbar neuritis the following are often present: a. defects of the nerve fibre layer b. impaired colour vision c. normal visual acuity d. altitudinal field defects e. Marcus Gunn pupil 9. Pigmentary retinopathy is a recognized feature of: a. dystrophic myotonica b. chloroquine toxicity c. Duchenne muscular dystrophy d. thioridazine toxicity e. mitochonridal myopathies 10. True statements include: a. the Steel-Richardon syndrome is associated with slow saccades b. lesions in the posterior commissure cause abnormalities in horizontal eye movements c. the maximum velocity for pursuit movements is 400 degrees per second d. frontal eye fields generate ipsilateral saccades e. phenytoin may cause defective pursuit Past MRCOphth/MRCS questions: 11 1. Corneal sensation: a. is always decreased in neurofibromatosis b. corneal hyperaesthesia is a form of diabetic sensory neuropathy, and is seen in patients with proliferative diabetic retinopathy c. neuropathic keratopathy is a contraindication for performing laser panretinal photocoagulation in eyes with proliferative diabetic retinopathy 18 d. is reduced following herpes zoster keratitis e. is reduced by prolonged hard contact lens wear 2. Pigmentary glaucoma: a. typically occurs in patients from 20 to 50 years of age b. there is often a positive family history of pigmentary glaucoma c. the onset is usually rapid with corneal oedema and blurring of vision d. pigmentary glaucoma is commonly caused by diabetes mellitus e. is often seen in high myopes with shallow anterior chambers 3. In central retinal vein occlusion: a. there may be a reversible shallowing of the anterior chamber following vein occlusions, sufficient to cause angle closure glaucoma b. neovascular glaucoma usually develop within five weeks of the development of central vein occlusion c. the neovascular glaucoma that occurs secondary to occlusion of the central retinal vein is best treated by an iridectomy d. neovascular glaucoma is best treated with cycloplegic agents and steroid e. the pupillary light reflex is not useful in the assessment of retinal ischaemia 4. In glaucoma: a. visual field loss may be aggravated by systemic hypotension b. an arcuate scotoma can be increased by artificial elevation of the intraocular pressure c. size and depth of cupping of the disc is always related to the field defects d. there may be arteriorsclerotic changes in nutrient vessels 1-2 mm behind the optic nerve head e. nasal step usually precedes arcuate scotoma 5. Pilocarpine is: a. a lactone of pilocarpine acid b. a contractor of ciliary muscle and sphincter c. more effective as its concentration is increased d. useful in the treatment of malignant glaucoma e. the first line of treatment of open angle glaucoma in 30 years old 6. Chronic retinal detachments: a. are usually mobile b. may show high water marks 19 c. are associated with retinal cysts d. may be associated with subretinal fibrosis e. causes shrinkage of the globe 7. Proliferative vitreoretinopathy: a. is an uncommon cause of failure in retinal detachment surgery b. Grade C may involve all 4 quadrants c. Grade D2 implies that the optic disc is visible d. is more commonly with larger retinal tear e. is unlikely to be helped by surgery 8. Pulsation of orbital contents may occur in: a. orbital varix b. carotid cavernous fistula c. neurofibromatosis d. thyrotoxicosis e. blow out fracture of the orbital roof 9. Angoid streaks are associated with: a. sickle cell anaemia b. pseudoexfoliation c. Marfan's syndrome d. myopic degeneration e. tuberous sclerosis 10. With regard to trauma: a. in a Le Fort type I fracture, fracture lines are found through the maxilla, orbital floor and lateral wall of the orbit b. following a blunt injury with hyphaema some degree of angle recession will be evident in approximately 5% of cases c. topical steroid drops should be used to suppress collagenase activity during the second week following an alkaline burn d. the second commonest site of blow out fracture of the orbit is the roof of the orbit e. iron containing intraocular foreign bodies must be removed within 12 hours of injury if siderosis bulbi is to be prevented 20 Past MRCOphth/MRCS questions: 12 1. Paving-stone retinal degeneration: a. is present in 50% of patients b. is located superiorly c. is located posterior to the equator d. does not predispose to retinal breaks e. is most prevalent in younger age groups 2. The following are causes of non-rhegmatogenous retinal detachment: a. eclampsia of pregnancy b. Wagner's vitreoretinal degeneration c. malignant hypertension d. Coat's disease e. haemangioma 3. In toxic amblyopia: a. both eyes are usually involved within 3 months of each other b. treatment consists of abstention from tobacco and alcohol plus cyanocobalamin injections c. improvement is usually seen in 3 months if patient adheres to the prescribed regimen d. visual fields abnormalities may include junctional scotoma e. the scotomas are larger for red and green targets than for blue 4. In retinitis pigmentosa: a. perifoveal telangiectasia have been reported b. use of recombinant probe shows a locus on the long arm of the X chromosome in X linked retinitis pigmentosa c. there may be serum lipid abnormalities in some cases d. fluorescein angiogram may show a subtle bulls eye pattern 21 e. optic nerve pallor is not a diagnostic criteria 5. In Bird-shot chorioretinopathy: a. mild anterior chamber reaction is often seen b. arteriolar narrowing and vascular sheathing can be seen c. ERG shows decreased amplitude d. there is an associations with HLA-A 29 e. there is a sensitization to retinal S antigen 6. Acute retinal necrosis: a. is associated with retinal tears and retinal detachment b. is caused by cytomegalovirus c. is caused by herpes zoster virus d. acyclovir given early is useful in presenting retinal detachment e. Bechet's disease is a differential diagnosis 7. Regarding intraocular gases (SF6) used in retinal detachment surgery: a. sulfur hexafluoride is highly lipid soluble b. there is rapid influx of venous nitrogen into the intravitreal pocket of gas c. a mixture of 40% SF6 and 60% air does not increase in volume when left in the eye d. posterior capsular cataracts are a complications e. there is no electrophysiologic evidence of toxicity 8. With regard to ultrasound: a. a choroidal haemangioma shows a highly reflective A-scan pattern b. a choroidal melanoma shows a highly reflective A-scan pattern c. a metastatic carcinoma has medium high retinal reflectivity d. a disciform scar has high reflectivity e. a fresh subretinal haemorrhage has low reflectivity 9. In retinoblastoma: a. the ratio of aqueous to plasma lactate dehydrogenase is 22 elevated b. the ratio of aqueous to plasma phosphoglucose isomerase is reduced c. aqueous and vitreous aspirate for cytology may help differentiate retinoblastoma from other lesions d. a CT scan is useful to detect intraocular tumours with calcification e. there is an association with deletion of specific band in chromosome 13p14 10. Vitamin B deficiency: a. may produce a decrease in central vision with relative sparing of peripheral vision b. colour vision is not involved c. in long-standing cases temporal pallor of the optic nerve is always present d. retinal haemorrhages may be present e. is actually the cause of alcohol-tobacco amblyopia. Past MRCOphth/MRCS questions: 10 1. Retinal laser treatment should be: a. heavy in pan-retinal photocoagulation b. gentle for subretinal neovascular membrane c. heavy for macular grids d. gentle for retinal breaks e. gentle for exudative maculopathy 2. The optokinetic nystagmus (OKN) response: a. is impaired when the OKN drum rotates towards the side of a deep parietal lesion b. is impaired when the OKN drum rotates towards the side of a unilateral lesion of the vestibular nucleus c. is accompanied by convergence retraction nystagmus in cases of pineal tumours when the OKN drum is rotated in an upward direction d. is reversed in congenital nystagmus e. is usually normal in malingerers 23 3. Chronic progressive external ophthalmoplegia: a. diplopia is a common feature b. is usually seen in the under 20 age group c. is associated with ocular pharyngeal dystrophy d. has a good prognosis e. is a feature of Kerans-Sayre syndrome 4. The following are true: a. X-linked retinoschisis usually involves the central and peripheral retina b. retinoschisis is usually treated surgically c. sickle cell retinopathy is characterized by "sunburst" lesions d. sickle cell retinopathy is a feature of sickle cell trait e. haemoglobin SC disease is often associated with "sea fan" 5. Keratoplasty in the infant: a. a fFieringa ring should be attached to the infant globe before surgery b. the infant pupil may not dilate postoperatively because of hypoplasia of the musculature of the iris c. it is best to use donor tissue from children or infant in keratoplasty where the host is child or infant d. it is best not to use continuous suture technique with buried knot e. repeated, frequent examinations under anaesthesia are important in follow up 6. Keratoconus: a. this condition is most often a bilateral impairment b. visual impairment stems from the irregular hyperopic astigmatism c. this is a non-inflammatory condition found usually in adolescents d. abnormally low ocular rigidity is found to be characteristic of most patients with keratoconus e. may be caused by soft contact lens 7. Bilateral corneal crystalline deposits may occur in: a. cystinosis b. gout 24 c. monoclonal gammanopathy d. Salzmann's dystrophy e. Schnyder's dystrophy 8. Treatment modalities which may be used in the treatment of herpes simplex keratitis include: a. oral acyclovir b. oral steroids c. topical trifluorothymidine d. mechanical debridement e. corneal graft 9. Interstitial keratitis may be present in: a. syphilis b. herpes zoster c. neurofibromatosis d. Cogan's syndrome e. Lyme's disease 10. Immunosuppressive therapy may be beneficial in: a. retinoblastoma b. Coats' disease c. Mooren's ulcer d. Terrien's peripheral ulcer e. Behcet's disease Past MRCOphth/MRCS questions: 13 1. With regard to nutrition: a. zinc deficiency is commonly associated with difficulty of dark adaptation - unresponsive to vitamin A treatments b. cystinosis results in a peripheral pigmentary retinopathy c. gyrate atrophy is a dominantly inherited disease d. restriction of arginine and administration of pyridoxine is helpful in gyrate atrophy e. Menkes' syndrome is associated with copper excess 2. Diabetic retinopathy: 25 a. is more prevalent in young men than young women b. is primarily a disease of the posterior retina c. an early histopathologic finding is relative loss of endothelial cells d. new blood vessels come mainly from the arterial side of the circulation e. depends mainly on the duration of the disease 3. The ideal contact lens: a. should have a high DK value for gas permeability b. should be soft c. should give clear vision d. should be durable e. should not be resistant to deformation 4. Hard contact lenses can be made from: a. PMMA - polymethylmethacrylate b. CAB - cellulose-acetyl-butyrate c. HEMA - hydroxyethelmethacrylate d. silicone and PMMA copolymer e. glass 5. Hard contact lenses are better than soft contact lens because: a. they are more permeable to oxygen b. they are easily processible c. they are smaller in diameter d. they are easier to sterilize e. they are not hydrophilic 6. Soft contact lenses are better than hard contact lenses because they: a. do not cause overwearing syndrome b. do not cause spectacle blur c. scratch less easily d. do not not cause refractive changes e. dislocate less less easily 7. Residual astigmatism is: a. astigmatism due to corneal distortion b. astigmatism which cannot be corrected with glasses c. astigmatism which cannot be corrected with contact lens 26 d. astigmatism due to lenticular distortion e. correctable by photorefractive surgery 8. Giant papillary conjunctivitis is related to: a. contact lens deposits b. an autoimmune reaction c. soft contact lenses d. hard contact lenses e. cold sterilization of contact lenses 9. Acetzolamide: a. is know to cause aplastic anaemia b. may cause a metabolic acidosis c. may cause a metallic taste in the mouth d. causes paraesthesia in 30% of patients on treatment e. may precipitate liver failure in cirrhosis 10. Latanoprost: a. inhibits cyclo-oxygenases b. decreases aqueous production c. causes cystoid macular oedema in aphakic patients d. causes pigment dispersion syndrome e. increases aqueous outflow through the trabecular meshwork Past MRCOphth/MRCS questions: 14 1. The following substances usually lower the intraocular pressure: a. para-amino clonidine b. salbutamol c. ethyl alcohol d. marijuana e. the prostaglandin PGF2 alpha 27 2. Fuchs' endothelial dystrophy: a. is the most common reason for penetrating keratoplasty in developed countries b. is more common in men c. causes worsening of vision during the course of a day d. may be helped by using a hair dryer on the eye e. is often associated with other systemic diseases 3. Acanthamoeba keratitis: a. is caused by Acanthamoeba castellani b. is caused by Acanthamoeba polyphaga c. has not been successfully treated medically d. is charateristically painless e. may be successfully cultured on Escerichia coli enriched chocolate agar 4. Intraocular gases used in retinal detachment surgery: a. pure sulphur hexafluoride is non-expansile b. a one ml bubble of C3F8 disappears in 10 days c. pneumatic retinopexy is not recommended in patients with glaucoma d. are best injected into the most dependant part of the eye e. should not be used with nitrous oxide anaesthesia because this causes an immediate decrease in bubble size 5. Light-near dissociation occurs in: a. myotonic dystrophy b. chronic progressive external ophthalmoplegia c. Holmes-Adie pupil d. Parinaud's syndrome e. Wernicke's pupil 6. Disc drusen: a. are similar histologically to retinal drusen b. become progressively embedded with age c. may cause arcuate field defects d. may cause sudden loss of vision e. may be associated with anomalous retinal vessel patterns 7. In the optic tract: a. the macular fibres lie centrally 28 b. lesion causes sectorial optic atrophy c. lesion may be associated with a contralateral /Marcus-Gunn pupil d. lesion causes congruous homonymous hemianopia e. carries 60% of its fibres to the lateral geniculate body 8. Persistent hyperplastic primary vitreous: a. is unilateral in 90% of cases b. is associated with calcification early c. is associated with elongated ciliary processes d. has an abnormal aqueous/serum lactate dehydrogenase level e. exhibits relative microphakia 9. Mooren's ulcer: a. are painful b. run a chronic course of 10-30 years c. may show scleral involvement d. are not associated with uveitis e. only occurs in elderly patients 10. The following are true about corneal sensation: a. panretinal photocoagulation therapy may cause a reduction in corneal sensation b. corneal hypoesthesia is a form of diabetic sensory neuropathy, and is seen in patients with proliferative diabetic retinopathy c. neuropathic keratopathy is a contraindication for performing laser panretinal photocoagulation in eyes with proliferative diabetic retinopathy d. corneal hypoesthesia may be seen in patients with background diabetic retinopathy e. cataract surgery can lead to corneal hypoesthesia. Past MRCOphth/MRCS questions: 15 1. Chemical burns: a. acid solution readily penetrate the corneal epithelium but are repelled by the lipoprotein cell walls of the lkeratocytes b. alkaline corneal burns are less destructive than acid burns c. solutions of alkaline pH readily penetrate and spread deep into the corneal stroma and into the anterior chamber d. acid burns of the cornea are usually sharply demarcated because of the buffering action fo the tissues 29 e. refrigerant and bleach are common causes of alkali burns 2. The Kayser-Fleischer ring: a. consists of copper deposits in Bowman's membrane b. gives a green-brown, grey, orange or brown appearance tot he corneal periphery c. initially appears as a thin crescent at the 3 and 9 o'clock positions of the cornea d. may regress with D-penicillamine therapy e. cannot result from copper intraocular foreign bodies 3. Cogan's syndrome is: a. a form of acquired syphilis b. characterized by deafness c. occasionally associated with lupus erythematousus d. occasionally associated with polyarteritis nodosa e. characterized by interstitial keratitis 4. Causes of aqueous tear deficiency: a. practolol b. tricyclic anti-depressants c. facial nerve palsy d. antihistamines e. atropine 5. Mucopolysaccharidoses associated with corneal clouding: a. Hurler b. Hunter c. Scheie d. Morquio e. Sanfilippo 6. Keratoconus: a. should be suspected in an adolescent with progressive myopic astigmatism b. does not exhibit corneal epithelial thinning c. is accompanied by Bowman's membrane d. may be associated with Vogt's striae which are fine vertical folds in the deep stroma e. can be optically corrected with hard contact lenses 7. Causes of chronic conjunctivitis: 30 a. chlamydial infection b. cosmetics c. molluscum contagiosum d. chronic meibomitis e. psoriasis 8. Bilateral corneal crystalline deposits may occur in: a. cystinosis b. gout c. monoclonal gammopathy d. Salzmann's dystrophy e. Schnyder's dystrophy 9. Indications for a larger donor button in keratoplasty: a. phakic patient b. shallow anterior chamber c. peripheral corneal thinning d. prior history of uveitis e. aphakic patient 10. Exclusion criteria for donor cornea: a. previous intraocular surgery b. retinoblastoma c. death of unknown cause d. bowel cancer e. Creutzfeldt-Jakob disease Past MRCOphth/MRCS questions: 16 1. Preservation of donor corneas: a. McCarey-Kaufman preserves endothelial viability up to 6 days b. moist chamber stored corneas should be transplanted within 48 hours c. TC 199 is a component of McCarey-Kaufman medium d. organ culture allows preservation up to one month e. McCarey-Kaufman eyes should be stored at 10C 31 2. Mooren's ulcer: a. about 2.5% of cases are bilateral b. is associated with much pain c. satisfactory results have occasionally been obtained by resection of the limbal conjunctiva adjacent to the lesion d. the most rapid movement of the ulcer is centrally with the leading edge de-epithelialized and undermined e. is associated with a better prognosis in patients below their fourth decade of life 3. Band keratopathy can be seen in: a. adult rheumatoid arthritis b. sarcoidosis c. iridocyclitis d. vitamin D toxicity e. juvenile rheumatoid arthritis 4. Hassal-Henle warts are associated with: a. appearance in the central cornea b. thinning of endothelial cytoplasm near wart c. fissures over and into substance of wart d. mouths of fissures beneath endothelial cells e. there are structural differences from guttae located elsewhere 5. Corneal involvement in leprosy include: a. superficial punctate keratitis b. disciform keratitis c. pannus d. deep interstitial keratitis e. neurotrophic keratopathy 6. Stargardt's disease: a. is characterized by nyctalopia b. peripheral fields and colour vision are normal c. patients present in second and third decade of life d. has an autosomal recessive as well as dominant mode of inheritance e. is characterized by an abnormal EOG early in the course of the disease. 32 7. The following are associated with congenital cataracts: a. incontinentia pigmenti b. intrauterine hypoxia c. Lowe's syndrome d. Patau's syndrome e. Rubenstein-Taybi syndrome 8. The ocular complications of bone marrow transplantation include: a. keratoconjunctivitis sicca b. cataracts c. herpes simplex infections d. cicatricial lagophthalmos e. corneal keratinization 9. Congenital nystagmus: a. is binocular and uniplanar b. is dampened with fixation effort c. is usually horizontal, but may be vertical, circular, pendular or jerky d. may be alleviated with the use of base-in prism glasses e. may be treated surgically with he Kestenbaum procedure 10. Regard topical corticosteroids: a. dexamethasone phosphate does not penetrate the uninflammed cornea whereas dexamethasone alcohol does b. topical steroid solutions penetrate the cornea better than steroid suspensions c. steroid eye cream achieves a higher concentration in the eye than drops due to a longer contact time d. topical steroids reduce corneal polymorphonuclear leukocyte invasion better than subconjunctival injections of steroid e. sudden cessation of topical steroids in corneal inflammation can cause a rebound nercotizing inflammation. Past MRCOphth/MRCS questions: 17 1. Regarding common ophthalmic antibiotics: a. chloramphenicol inhibits bacterial protein synthesis 33 b. chloramphenicol is bactericidal to Haemophilus influenza c. gentamicin prevents folate synthesis in bacterial cells but not in human ocular tissue d. polymyxin B is effective against all Gram negative bacteria e. polymyxin B exerts its effect by disrupting bacterial cell membranes 2. Lid retraction may be found in: a. Parinaud's syndrome b. dysthyroid eye disease c. neurosyphilis d. congenital oculomotor nerve palsy e. Wegener' granulomatosis 3. Optociliary shunt vessels on the disc are found in: a. patients after central retinal vein occlusion b. proliferative diabetic retinopathy after laser photocoagulation c. orbital meningioma d. congenital anomaly e. von Hippel-Lindau's retinal angiomatosis 4. In benign intracranial hypertension, the following amy be present: a. normal CT scan b. normal visual fields c. normal CSF pressure d. transient obscurations o f vision on lateral gaze. e. spontaneous resolution 5. Recurrent corneal erosions: a. are often caused by corneal embedded foreign bodies b. superficial corneal dystrophy patients are more likely to get epithelial erosions c. regeneration of corneal basal epithelial cells require up to 2 months to form new basement membrane complexes d. 5% hypertonic saline cream and drops are used in erosions for up to 1 year e. soft extended wear contact lenses are worn continuously for up to 7-10 days after an erosion recurrence. 6. In inflammation of the conjunctiva: a. phylctenules are localized necrotic infiltrates with plasma cells which occur on cornea and conjunctiva b. follicles are subepithelial infiltration which are 34 histologically characterized by central Leber cells and surrounding lymphocytes c. follicles occur most commonly on the upper palpebral conjunctiva and the upper fornix d. papillae histologically have a central fibrovascular core surrounded by acute inflammatory cells e. the follicle correlates to cellular antibody production 7. Regarding the use of culture media in bacterial keratitis: a. blood agar only grows aerobic bacteria b. chocolate agar enhances the isolation of Morexella, Neisseria and Haemophilius species c. Sabouraud's agar contains yeast extracts and antibiotics and is for fungal isolation d. brain heart media is best used for anaerobes e. thioglycolate broth is for anaerobic and microareophilic bacteria 8. Prolapse of the lacrimal gland may occur in: a. trauma b. increased intraorbital pressure c. spontaneous hereditary blepharochalasis d. usually involves the palpebral lobe of the gland e. may present as a subconjunctival mass 9. Pseudoxanthoma elasticum: a. is autosomal dominant b. is more common in men c. is also called Groenbland-Strandberg syndrome d. is associated with hypertension e. when associated with diabetes mellitus often results in florid proliferative diabetic retinopathy 10. A falciform fold of the retina: a. can occur in retinopathy of prematurity b. can occur in toxoplasmosis c. can occur in trisomy 21 d. is usually bilateral e. is usually associated with hypermetropia 35 Past MRCOphth/MRCS questions: 18 1. Retinoblastoma: a. can present with rubeosis iridis b. Flexner Wintersteiner rosettes surround a hyaluronidase resistant and mucopolysaccharide b. Homer Wright rosettes may also be found in medulloblastoma and neuroblastoma d. fleurettes represent the least differentiated tumour e. trilateral tumour has a better diagnosis 2. Cytomegalovirus infection: a. is diagnosed by intramitochondrial inclusions of infected cells b. in utero results in congenital deformities in 8-% of cases c. in an adult is commonest in AIDS and presents with retinal necrosis and haemorrhage d. causes deafness, choroiditis and cerebral calcifications e. is caused by DNA herpes virus and responds to acyclovir 3. The CT scan findings in thyroid ophthalmopathy are: a. enlargement of extraocular muscle bellies b. enlargement of tendons of extraocular muscles c. enlargement of lacrimal gland d. thickening of optic nerve e. medial bowing of lacrimal papyracea 4. In radiation and thermal burns: a. radiation therapy to the paranasal sinuses or pituitary lesions exposes the optic nerves to direct ionising radiation b. optic nerve radionecrosis occurs within 3 years of treatment c. thermal burns of the body can cause optic neuropathy d. thermal burn optic neuritis is due to septicaemia or circulatory failure e. the optic nerve is more resistant than lens to radiation 36 5. In the pharmacology of anti-glaucoma drugs: a. pilocarpine reduces production of aqueous by exerting an inhibitory action on the ciliary epithelium b. sympathomimetics reduce intraocular pressure by increasing uveal scleral outflow c. carbachol increases aqueous outflow via the trabecular meshwork thereby lowering intraocular pressure d. pilocarpine induced miosis begins 2-10 minutes after instillation and lasts 4-8 hours e. echothiophate iodide causes accommodation spasm, cataractogenciity, iris cysts and retinal detachment as side-effects 6. Optic nerve glioma: a. is more common in children than in adults b. originates from the myelin sheath of the optic nerve fibres c. causes erosion of the optic foramen margin which is demonstrable radiologically d. causes loss of vision early e. causes axial proptosis 7. Advantages of cryotherapy over diathermy include: a. cryotherapy causes little or no scleral damage b. cryotherapy shrinks the sclera thus facilitating closure of the drainage site c. cryotherapy does not force fluid from the eye thus maintaining a reasonable intraocular pressure d. cryotherapy can be safely applied over staphylomatous sclera e. cryotherapy causes no damage to the vortex veins or ciliary arteries 8. Complications of retinal detachment operations include: a. strabismus b. refractive error c. macular pucker d. anterior segment necrosis e. angle closure glaucoma 37 9. Regarding buckles: a. encirclage reduces vitreous traction in the eye b. scleral dissection is required in explants c. encirclage is indicated when there is evidence of proliferative vitreoretinoapthy d. an encirclage can be used if no holes are found on examination e. maximal reduction of vitreous traction can be achieved only if the encircling band constricts the vitreous base. 10. Pseudomembranes are produced in: a. gonorrheal ophthalmia b. pneumococcal conjunctivitis c. meningococcal conjunctivitis d. Stevens-Johnson syndrome e. herpes simplex conjunctivitis Past MRCOphth/MRCS questions: 19 1. Trachoma follicles: a. occur in the conjunctival stroma b. consist of lymphocytes in early stages c. may show necrosis in the central zone d. are not accompanied by submucosal inflammation e. are pathognomonic of the disease 2. Carbonic anhydrase inhibitors: a. can cause exfoliation dermatitis b. are hyperosmotic agents c. encourage renal stone formation d. can result in metabolic acidosis e. can cause potassium depletion 3. Lattice degeneration: a. is usually found at the equator b. is associated with abnormal vitreous retinal adhesions c. develops from paving stone degeneration 38 d. sometimes requires prophylactic treatment e. is associated with horseshoe breaks 4. A tumour of the temporal lobe can: a. produce a homonymous hemianopia b. produce visual hallucinations c. simulate migraine d. VIth nerve palsy e. disturbance of the medial longitudinal bundle 5. The herpes simplex virus can: a. cause disciform keratitis b. cause corneal hypoaesthesia c. be a conjunctival commensal d. be activated by sunlight e. produce marginal keratitis 6. Regarding episcleritis: a. episcleritis nearly always accompanies scleritis b. episcleritis clears without treatment c. simple episcleritis is sectoral in 70% of cases and generalized in 30% d. vascular congestion is mainly in the superficial conjunctiva plexus e. nodular episcleritis may progress to anterior nodular scleritis 7. Regarding scleritis: a. posterior scleritis is seldom related to a systemic disease b. the most benign form of scleritis is the nodular anterior type c. most patients with inflammatory necrotizing scleritis die within a few years of onset of disease d. scleromalacia perforans occur in most connective tissue disease e. scleromalacia perforans will response well to pulse dose methyl prednisolone and cyclophosphamide 39 8. Regarding orbital trauma: a. orbital blow-out fractures result when the bony orbit is injured by an object characteristically smaller than the orbital rim b. orbital emphysema is a sign of fracture of a sinus wall and is frequently following ethmoid fractures c. naso-orbital fractures often affect the medal canthal tendon d. visual loss can be a result of posterior ciliary arterial damage e. an afferent pupillary defect and visual loss immediately following surgery should be treated with systemic steroids 9. Concerning lesion of the optic disc: a. 40% of patients with central congenital optic disc pits develop serous detachment of the macula b. optic disc drusen are situated in the retrolaminar zone of the optic nerve c. optic disc drusen are often associated with anomalous configuration of the disc vessels d. in optic disc melanocytomas the visual field defect is determined by the size of the lesion e. primary optic atrophy is characterized by marked proliferation of glial and fibrous connective tissue on the optic disc 10. The following are true: a. in unilateral cases of optic nerve hypoplasia there may be a disparity in the size of the optic foramina b. optic nerve glioma in adults usually presents like an acute optic neuritis c. the temporal field defect in tilted disc can be reduced by the appropriate refractive correction d. myelinated nerve fibres can be present at birth e. congenital disc coloboma can be associated with absent septum pellucidum Past MRCOphth/MRCS questions: 20 40 1. In fractures of the orbit: a. pure blow out fractures of the floor are commonest b. trauma to the infraorbital nerve causes anaesthesia to the lips and gum c. enophthalmos on initial examination indicates a large fracture fo the floor d. early surgical intervention is indicated in the presence of diplopia and infraorbital anaesthesia e. marked orbital and lid swelling is common following repair of blow-out fractures 2. In papilloedema: a. axonal distension occurs as the first sign b. it takes 24-48 hours for early papilloedema to occur and one week for it to develop fully c. is usually asymmetric and greater on the side of a supratentorial lesion d. a fully developed papilloedema fully resolves in four weeks with adequate treatment e. it can be associated with sudden visual loss after sudden decrease in systolic perfusion pressure 3. Regarding blow out fractures: a. forced duction test is useful in differentiating tissue prolapse from muscle shortening b. the inferior oblique is more prone to nerve paresis than the inferior rectus c. surgery should only be performed after documentation that there is no further worsening of ocular motility d. mydriasis is more likely to be seen in medial wall fractures than floor fractures e. enophthalmos due to muscle fibrosis and shortening is difficult to correct 4. Retinoblastoma: a. is caused by a genetic abnormality on chromosome 14q13 b. is inherited with a visible chromosomal defect in most cases c. is inherited in an autosomal dominant fashion d. is associated with esterase D deficiency in most case e. is due to somatic mutation in most cases 41 5. Retinoblastoma tends to present with: a. leukocoria b. squint c. microphthalmia d. cataract e. a painful red eye 6. Risk factors for metastatic retinoblastoma are: a. a short optic nerve stump at enucleation ie. less than 5 mm b. a large tumour size c. optic nerve invasion of any degree d. choroidal invasion of any degree e. anterior segment involvement 7. Coat's disease: a. tends to occur in females b. usually presents before the age of four years c. is usually bilateral d. is inherited as an autosomal dominant fashion e. is indistinguishable from retinoblastoma on ultrasonography 8. Birdshot choroidopathy: a. tends to be unilateral b. is associated with HLA A-29 antigen c. is associated with cystoid macular oedema d. can be treated with steroids e. rarely occurs after the age of 50 9. Acute multifocal placoid pigment epitheliopathy: a. usually has a good visual prognosis b. usually occurs in elderly individuals over the age of 50 c. may be unilateral or bilateral d. can be associated with cerebral vasculitis e. can cause a serious retinal detachment 42 10. Sympathetic ophthalmia: a. is best prevented by early enucleation of the traumatized eye b. should be treated by enucleation of the exciting eye c. usually develops between 2 weeks and 3 months in most cases d. causes multiple pinpoint hyperfluorescence spots in angiography e. can be prevented by prophylactic steroids Past MRCOphth/MRCS questions: 21 1. Retinitis pigmentosa: a. results in a n abnormal EOG with a normal ERG b. can be regional or diffuse c. is most severe in autosomal dominant disease d. can result in early visual loss from macular oedema e. can be associated with deafness 2. Sulphur hexafluoride: a. is used to tamponade a retinal break b. has a longer half life than perfluoropropane c. has a lower lower surface tension than silicone d. expands to about five times its volume in 24 hours e. can cause cataract 3. A circumferential buckle: a. is indicated if there are multiple breaks in several quadrants b. may cause fishmouthing of a retinal break c. is preferably used in combination with a radial buckle d. tends to cause less volume displacement than a radial buckle e. can be supported by lamellar scleral flaps instead of sutures 4. Drainage of subretinal fluid: 43 a. is indicated if there is significant vitreoretinal traction b. should be performed as close to the retinal hole as possible c. can help to localize the retinal hole d. is useful for softening the eye e. should be performed before buckling 5. With iris tumours, risk factors for tumour growth are: a. tumour vasculairty b. medial location c. ectropion d. extension to angle e. glaucoma 6. Uveal melanoma: a. rarely occurs in children b. is commoner in whites than blacks c. can cause dilatation of the episcleral vessels d. tends to metastasize to the liver e. tends to show optic nerve invasion 7. Subretinal nevoascularization: a. can occur in choroidal melanomas b. occurs in retinitis pigmentosa c. is successfully treated by laser in most cases d. is stimulated by vasoproliferative factors produced in response to choroidal ischaemia e. results in serous detachment, hard exudates, haemorrhage and degeneration of the photoreceptors 8. After penetrating ocular trauma: a. all prolapsed uveal tissue should be excised to prevent sympathetic opthalmia b. scleral wounds extending posterior to the rectus muscle insertions have worse prognosis than corneoscleral laceration ending anterior to the rectus c. epithelial downgrowth is a complication d. phacoanaphylactic glaucoma is a complication if the lens capsule is damaged e. all intraocular foreign body should be removed. 44 9. Conditions associated with poliosis include: a. Behcet's disease b. Vogt-Koyanagi-Harada syndrome c. sympathetic ophthalmia d. leprosy e. ocular albinism 10. Eyelid retraction occurs in: a. facial nerve palsy b. thyroid eye disease c. use of iodipine d. Parinaud's syndrome e. tricyclic antidepressants Past MRCOphth/MRCS questions: 22 1. Duane's syndrome: a. is an autosomal dominant condition b. is associated with aplasia of the sixth nerve nucleus c. causes palpebral narrowing on abduction d. can be classified according to the age of onset e. is rarely bilateral 2. Down's syndrome is associated with: a. posterior subcapsular cataract b. glaucoma c. keratoconus d. peripheral retinal pigmentation e. myopia 3. Regarding onchocerciasis: a. the ocular lesions are due to direct invasion of the cornea by the adult worm b. the inflammation is reduced when the nematode dies c. deer and antelope act as animal reservoirs 45 d. diethydcarbamazine kills the adult worm e. the larvae are transmitted to humans by the bites of the male black fly (Simulium) 4. Loss of cornea sensation occurs in: a. leprosy b. tuberculosis c. Bell's palsy d. acoustic neuroma e. Lyme's disease 5. Staphylococcal infections can cause the following ocular disease: a. angular blepharitis b. toxin epithelial keratitis c. dacryocystitis d. haemorrhagic conjunctivitis e. eczematoid blepharodermatitis 6. Regarding herpes virus infections: a. conjunctival swapings for lipschutz bodies are typical findings in herpes simplex virus b. Giemsa staining of epithelial cells helps diagnosis of herpes simplex virus c. fluorescent antibody technique staining demonstrates intracellular herpetic inclusion bodies d. varicella zoster infection os the lids can be confirmed by staining of Henderson Patterson bodies c. idoxuridine drops are effective treatment for zoster keratitis 7. In Terrien's marginal degeneration: a. begin typically at 12 and 6 O'clock on the corneal periphery b. causes progressive ulceration spreading around the cornea c. the central wall is steep while the peripheral wall slopes gradually d. spontaneous perforation occurs rarely 46 e. annular lamellar corneoscleral grafting may be helpful 8. Map dot fingerprint dystrophy: a. is the most common corneal anterior dystrophy b. there is thickened corneal epithelial basement membrane c. there is fibrillar material between Bowman's layer and epithelial basement membrane d. recurrent erosions occur in the majority of these patients e. inheritance is autosomal recessive 9. The following pigmentations appear on the cornea: a. Ferry's line occurs in descemets membrane due to chalosis b. Stockers' iron line occurs next to a filtering bleb c. Hudson Stahli line occurs on lower 1/3 of the cornea in elderly adults only d. Kayser Fleishcer ring occurs in progressive intraherpatic cholestasis of childhood e. chrysiasis has gold deposition in he deep corneal stroma 10. Brown's syndrome: a. is caused by abnormality of the inferior oblique muscle b. causes hypotropia of the affected eye c. is associated with spinal abnormality d. is more common in male than female e. is bilateral in 10% of cases Past MRCOphth/MRCS questions: 23 1. Visible enlarged corneal nerves can occur in: a. keratoconus b. ichthyosis c. endocrine neurofibromatosis d. Hansen's disease 47 e. Refsum's syndrome 2. Regarding corneal grafting: a. congenital rubella is a contra-indication for taking graft material b. infant donor tissue is a good graft material c. tissue culture medium can store donor corneas viably for up to 3 months d. glycerin preserved corneal tissue may be useful for lamellar keratoplasty e. cryopreservation allows corneal storage for up to a year 3. Pertaining to cranial nerves: a. trochlear nerve paralysis may be idiopathic in 1/3 of cases b. trochlear nerve paralysis is commonly caused by diabetes mellitus c. abducens nerve paralysis is frequently caused by diabetes mellitus d. the trochlear nerve is more frequently damaged by neoplasms than the abducens nerve e. trochlear nerve paralysis can be caused by intracranial aneurysm 4. Temporal lobe tumours: a. cause homonymous hemianopia b. are associated with formed visual hallucinations c. may present with psychomotor epilepsy d. may cause Foster-Kennedy Syndrome e. may cause ataxic nystagmus 5. Parinaud's syndrome consist of: a. ataxia b. vertical gaze paralysis c. pupillary areflexia to light d. optic atrophy e. convergence weakness 6. The following may be causes of unilateral oculomotor palsy 48 with pupil involvement: a. migraine b. herpes zoster c. myasthenia gravis d. diabetes mellitus e. posterior communicating artery aneurysm 7. Multiple sclerosis can cause: a. diplopia b. abduction nystagmus c. internuclear ophthalmoplegia d. unilateral optic disc oedema e. lateral rectus saccadic paresis during versions 8. The following are complications of LASIK: a. epithelial downgrowth b. corneal perforation c. reduced visual acuity d. stromal opacity e. reduced contrast sensitivity 9. The following conditions are associated with retinal artery occlusion: a. Behcet's disease b. Wegener granulomatosis c. pancreatitis d. syphilis e. sickle cell trait 10. The following are advantages of Moh's micrographic excision of skin tumour: a. tissue conservation b. differentiating squamous cell carcinoma from basal cell carcinoma c. useful in the diagnosis of basal cell carcinoma d. reduced incidence of tumour recurrence e. faster tissue healing 49 Past MRCOphth/MRCS questions: 24 1. Chronic closed angle glaucoma: a. can always be treated by cataract extraction alone b. tropical medication is the first line of treatment c. is common in Pekinese dogs d. the prevalence of the disorder in indigenous people varies with longitude e. iridotomy alone is the adequate treatment in advanced disease 2. Pseudoexfoliation syndrome: a. is always eventually complicated by glaucoma b. is associated with pseudoexfoliation in the orbit c. the exfoliative material contains laminin d. Sampaolesi's line is a characteristic feature e. is common in France 3. Photodynamic therapy of subretinal neovascular membrane: a. causes cataract b. involves the injection of fluorescein at the time of treatment c. is not suitable for pigment epithelium detachment d. is not suitable for foveal subretinal neovascular membrane e. is contraindicated in the presence of diabetic retinopathy 4. Age related macular degeneration: a. may be dominantly inherited b. is commoner in dark skinned race c. is usually a unilateral condition d. may undergo spontaneous functional improvement e. soft drusen have a better prognosis than that of hard drusen 5. The following statements are true: a. fundus flavimaculatus masks choroidal fluorescence b. type B personalities are common in patients with 50 central serious retinopathy c. different pattern dystrophies occur in the same family d. Best's disease causes an enhanced EOG e. central retinal artery occlusion abolishes the a wave of the ERG 6. Cataract: a. is a complication of lactose intolerance b. may be a late sequel of severe dehydration c. is reversible in diabetes d. complicates blunt eye injuries e. may be prevented by aspirin 7. The following complications are well-recognised: a. retinopathy due to tamoxifen b. cataract due to ibuprofen c. cornea verticillata due to chloroquine d. palinopsia due to chlorpromazine e. optic atrophy due to ethambutol 8. In patients with visual field loss: a. wedge scotomata result from lateral geniculate body pathology b. junctional scotoma and Foster-Kennedy syndrome may occur in the same patient c. macular sparing is the hallmark of occipital tumour formation d. arcuate scotomata can occur with chiasmal compression e. central scotoma complciate retrochiasmal dysfunction 9. Accommodation: a. is impaired in Adie's syndrome b. produces tension in the lens capsule c. is impaired following traumatic hyphaema d. is enhanced by beta blockers e. is reduced by alpha agonists 10. The following drugs or techniques can be used to reduce 51 intraocular pressure: a. hypoventilation b. ketamine c. intravenous sucrose d. halothane e. nitrous oxide Past MRCOphth/MRCS questions: 25 1. Ocular manifestations and syndromes with recognized associations are: a. eyelid coloboma and Treacher-Collins b. keratoconus and Down's syndrome c. Convergent squint and Crouzon's syndrome d. hypertelorism and Kleinfelter's e. limbal dermoids and von Recklinghausen's disease 2. Keratoconus: a. may become stationary at any time b. onset is usually in the early twenties c. the Fleischer ring consists of melanin pigments d. hydrops is caused by endothelial decompensation e. may be associated with retinitis pigmentosa 3. Aniridia: a. is inherited as an autosomal recessive disease b. rarely leads to glaucoma c. often causes photophobia d. is associated with nephroblastoma e. mainly affects oculocutaneous albinos 4. Macular dystrophy is characterized by: a. diffuse and rapidly progressive cloudiness b. superficial lesions in central cornea 52 c. stromal lesion in peripheral cornea d. early impairment of visual acuity e. autosomal dominant inheritance 5. The following may be causes of unilateral oculomotor palsy with pupil involvement: a. migraine b. herpes zoster c. myasthenia gravis d. diabetes mellitus e. posterior communicating artery aneurysm 6. Juvenile retinoschisis: a. is an autosomal recessive condition b. there is classical cystoid oedema at the macula c. the split is in the nerve fibre layer d. is a bilateral disease e. it is most commonly seen in the superior nasal quadrant 7. A circumferential buckle: a. is indicated if there are multiple brakes in several quadrants b. may cause fishmouthing of a retinal break c. is preferably used in combination with a radial buckle d. tends to cause less volume displacement than a radial buckle e. can be supported by lamellar scleral flaps instead of sutures 8. Sulphur hexafluoride: a. is used to tamponade a retinal break b. has a longer half life than perfluoropropane c. has a lower surface tension than silicone d. expands to about five times its volume in 24 hours e. can cause cataract 9. Retinitis pigmentosa: a. results in abnormal EOG with a normal ERG b. can be regional or diffuse c. in most severe in autosomal dominant disease 53 d. can result in early visual loss from macular oedema e. can be associated with deafness 10. The following topical medications are contraindicated in post-cataract patients due to the risk of cystoid macular oedema: a. latanoprost b. beta blocker c. alpha blocker d. acetazolamide e. adrenaline Past MCQs for Paper one 1. Genetic questions on the mode of inheritance of the following condition: a. choroidaemia b. congenital retinoschisis c. xeroderma pigmentosa d. pigmentosa incontentia e. protanopia 2. Giant cell arteritis: a. histology is based on fragmentation of the internal intimal b. anterior cerebral artery is often involved c. C-reactive protein is always raised d. giant cell is needed for diagnosis 3. Staining techniques useful for diagnosis: a. Gram negative diplococcus in neonatal conjunctivitis b. ostium tetraoxide for electron microscopy c. Haematoxylin and eosin for collagen and haemtoxylin stain collagen and eosin stain mucopolysaccaride 4. Choroidaemia: 54 a. female carrier has abnormal retinal features b. present in the second decade of life c. ERG shows abnromality early in the disease 5. In congenital retinoschisis: a. maculopathy is 50% of patient b. peripheral retinopathy in 50% c. involved retinal shows retinal elevation d. female carrier develop fundal changes 6. Leber's optic neuropathy: a. female carrier never affected b. more than 75% occurs in male c. optic disc is pale in the early stage 7. The following conditons are pre-malignant: a. actinic keratosis b. oncocytoma of the caruncle c. squamous papilloma 8. Glaucoma due to steroid: a. commonest cause of secondary glaucoma in the Middle East b. commoner in type 1 diabetic mellitus c. is seen in 15% of the population d. progressive damage is prevented on stopping steroid e. manifest as low tension glaucoma 9. Pigment dispersion syndrome: a. raised intraocular pressure with mydriasis b. complete escape from beta blocker after a few months c. peripheral transillumination d. commoner in diabetic melliuts 10. Iris melanoma: a. infiltrate corneal stroma b. infiltrate trabecular meshwork c. invade lens cortex d. heterochromia is a feature 11. Follwoing biopsy report may be found with rheumatoid arthritis: a. posterior scleritis b. loss of goblet cells in the conjunctiva 55 c. episcleral necrotic tissue 12. Panphotocoagulation in dibaetic mellitus is indicated for: a. preprolifertive b. ischameic maculopathy c. new vessels at the disc d. retinal cottol wool spots 13. Hypoxic damage in diabetic mellitus is suggested by: a. nerve fibre layers haemorrhage b. iris neovascularization c. anterior uveitis d. decrease jard exidate e. vascular loop 14. Angioid streaks are seen in: a. sickle cell anaemia (HbSS) b. myeloma c. leukaemia d. Ehler-Danlos syndrome 15. Retinal detachment: a. SF4 lasts longer than C3F8 16. Inantile glaucoma is associated with: a. axial iris stromal abnormality b. aniridia c. Sturge-Weber syndrome 17. Albinism: a. hair bulb for tyrosin positivity test is useful when the child is 5 year old b. is associated with platelets abnormality especially with aspirin c. complete decussation is invariable in all albinism d. is associated with thrombosis under general anaesthesia 18. Major hyphaema: a. raised intraocular pressure in the first 24 hours and then normalize b. 20% rebleed 56 c. less than 50% have angle recession d. corneal staining is irreversible 19. Optic nerve avulsion: a. seen in 1% of baby with high forcep delivery b. 20% of patients with frontal lacrimal bone fracture c. in dense vitreous haemorrhage ERG is useful for diagnosis 20. Optic nerve glioma: a. is assoicated with neurfibromatosis type I b. increased incidence after 30 year old c. majorty is of pilocytic astrocytoma d. rarely infiltrate perineural tissue 21. Nystamus: a. manifest latent nystagmus in unilateral congenital cataract b. see-saw nystamus associated with homonymous hemianopia c. down-beat with foramen magnum lesion d. gaze-evoked is a specific sign 22. Vernal keratoconjunctivitis: a. usually unilateral b. eosinophil is common in the paillae c. can be of limbal type alone 23. Audit: a. collect data against activity b. penalised health profession c. improve quality of care 24. Mutton-fat keratic precipitate are seen in: a. uveal effusion syndrome b. tuberculosis c. Fuch's heterochromia cyclitis d. sarcoidosis 57 25. Medications for glalucoma: a. beta blocker is contraindicated in primary heart block b. beta-blocker is contraindicated in those on nifedipine c. acetazolamide is contraindicated in allergy to sulphonamide d. acetazolamdie needs potassium supplement 26. Gout: a. purine metabolism disorder b. high incidence of scleritis c. tophi found in extraocular muscle tendon d. related to alcohol consumption directly d. related to alcohol consumption directly e. crystal found in deep stroma 27. Corneal dystrophy may contain the following substance: a. mucopolysaccharides b. cholesterol c. amylodiosis d. uroprohyrin e. urate 28. Seen in vitreous: a. amyloid b. lipofusin c. haemosiderin d. clacium 29. Melanocytoma: a. associated with clear cell carcinoma of the kidney b. contain plump black naevus cells c. metastasize to the lungs 30. Lacrimal gland tumour: ametastasize along the orbital nerve b. commonly metastasize throught eh lymphatic drainage c. early metasis to the lung d. Merkel cell carcinoma can occur 31. Retinoblastoma: 58 a. 50% inherited b. due to 11q14 deletion c. rosettes suggest good prognosis Past MCQs for Paper two 1. Superior oblique palsy: a. 25% congenital b. bilateral causes has V esotropia c. bilateral has more than 10 degrees of excyclotorsion d. hypertropia increases on gaze to opposite side 2. The following are true about inferior oblique muscle operion: a. ipsilateral myectomy is performed for fourth nerve palsy b. myectomy is more effective than recession c. haematoma is common 3. Ciliary body melanoma: a. has a better prognosis than choroidal melanoma b. may be amelanotic c. more radiosensitive than choridal melanoma 4. Cataraacts are asscoaited with: a. Lowe's syndrome b. Usher's syndrome c. Wilson's syndrome d. Klipper-Field's syndrome e. pseudoxanthoma elasticum 5. Syphilis: a. teritary syphilis causes inflammation of zonules, lens and retina b. commonest cause of interstitial keratitis 59 6. High AC/A ratio: a. phosphholine iodide decreases it b. increase iwth age c. rrequires fixed working distance for measurement d. can be corrected by executivd bifocal e. congenital esotropia is associated with high ratio 7. Laser trabeculoplasty: a. is successful in 80% of cases b. may induce cataract c. can reduce the pressure in the other eye d. can increase field loss e. casues fall in pressure in 2 hours 8. Acute mullfifocal placoid punctaate epitheliopathy: a. is usually unilateral b. on fluorrescein angiography, masking is seen in the initial stages c. is associated iwth increased calcium concentration in the serum d. improves spontaneouslly 9. Malignant melanoma of chorid have a worse prognosis with: a. patients older than 70 years old b. icnreaseing size c. scleral extension d. anergy to BCG e. loss of humoural antiobodies with tumour 10.In optic nerve trauma: a. intracranial part is most commonly affected b. optic atrophy is common 11. Dissociated vertical deviation: a. commonly bilateral and asymmetrical b. the covered eye goes up and intorts and rapidly comes down on removal of cover c. associated with latent nystagmus d. assocaited with heterotropia 60 12. Optic disc ppit: a. associated iwth retinal serous dtachment in 10% of cases b. inferonasal typical but can be anywhere 13. SF6: a. is highly lipid soluble b. does not affect ERG c. causes posterior subcapsular cataract 14. Idiopathic macular hole: a. commoner in females b. may close spontaneously c. 90% biolateral d. can occur with posterior vitreous detachment 15. Advantages of MRI over CT scan: a. can be used in pacemaker b.can be used to identify bony lesion c. less radiatioon d. all axis without moving patient 16. Retinal breeeeaks due to blunt trauma: a. usually forms 7 days later b. pigment epithleial proliferaiton 10 days post injury . frequently associated with large oval breaks in quadrant opposite to impact d. anterior dialysis is commonlly superonasal quadrant e. arise due to compression of vitreous face 17. In rod monochromatism: a. cones are totally absent b. ERG at 30Hz is flt c. dark adapted eye will have a cone response 18. Retinoschsis: a. is commonly bilateral b. is nearly always present in nasl quadrnat 61 c. juvenile type is frequently associated with macular schisis d. split present in outer plexiform layer e. inner layer breaks require treatment 19. Wernicke's encephalopathy: a. large doses of vitamin B12 is useful b. patients develop long-standing epilepsy c. lesion is in the wall of the fourth ventricle d. only occur in the alcoholic e. puillary reflexes and extraocular muscles are affected 20. Primary hyperplastic persistent vitreous: a. unilateral in otherwise healthy child b. presents in neonatal period c. causes cataract d. causes angle closure glaucoma e. duje to persistence of secondary and tertiary vitreous 21. Posterior inferior cerebellary artery thrombosis: a. causes infarction of lateral medulla b. painful trigeminal area on the same side c. Horner's syndorme 22. Spasmus nutans: a. fine jerky nystagmus usually monocular b. rarely resolves spontaneously c. present between 2 and 12 months of age 23. Aniridia may be associated with: a. short arm of chromosome 11 deletion b. naterior polar cataract c. pannus c. hypernephroma c. optic disc hypoplasia 62 24. Damage to the optic nerve from head injury: a. is usually in the intracranial part b. result in optic atrophy nasally c. usually causes an afferent pupillary defect in the other eye d. cuases an altitudinal field defect 25. V phenomenon occurs in: a. superior rectus weakness b. superior oblqieu wekaness c. too high insertion of medial wall d. may be treated by sagitalisation of inferior oblique in appropriate cases e. is always pathological 26. In severe diabetic retinopathy: a. absence of cotton wool spots b. increased foveal avascular zone Past MCQs from FRCS (Ed) 2000 1. Corneal epithelium a. Is ten cells thick b. Has microplicae c. Has microvilli d. Has zonulae occludens e.Hemidesmosomes attach to basal layer 2. Regarding anatomy of sac region a.MPL is attached to posterior lacrimal crest b.Angular vein is superficial to MPL c.MPL is the tendon of orbicularis oculi 3. Myasthenia gravis a.20% present before 20 years of age 63 b.90% has anti acetyl choline antibody 4. Regarding SLE a.Commonest manifestation is SLE retinopathy 5. Retinoblastoma a.More common in boys b.Has deletion of 13q14 c.Bilateral is always hereditary d.Endophytic has better prognosis 6. Diabetic retinopathy a.Endothelial proliferation is characteristic b.Basement membrane thickening is a late feature c.Pericyte is reduced 7. Behcet's disease 8. Angiod streak associations a.Acromegaly b.Sickle cell anemia c.Pseudo xantoma elasticum d.Erhler Danlos 9. Migraine a.Aura is due to vasospasm and cortical ischemia b.Classical migraine can occur with aura and no headache 10. Adeno viruses a.Incubation period of Adeno virus is two weeks 11.Common organisms causing ophthalmia neonatorum are a.Chlamydiae 64 b.Hemophilus c.Pneumococcus d.Herpes virus type 2 e.Streptococcus 12. Acanthamoeba keratitis a.Is common in immunocompromised b.Disinfection doesnot clear amoeba from contact lens c.Perineural infiltrates characteristic 13. Thyroid ophthalmopathy 14. Sympathetic ophthalmia 15.Ankylosing Spondylitis a.90% of patients are positive for HLA B 27 b.15% have acute iritis 16.Contra-indication for eye donations a.Acute conjunctivitis b.Creutzfeld Jacob disease 17.PRK a.Is an established technique for myopia 18.Lyme disease a.Caused by Borrelia burgdoferi b.Tetracycline is used for treatment c.Erythema chronican migrans can occur 18.Toxoplasmosis 20.In ultra sound B-scan RD vs PVD a.Attached to optic nerve in most sections indicate RD 65 b.Mobility is more with PVD c.After movement is suggestive of PVD 21.Ocular Albinism a.X-linked inheritance b.90% crossing in chiasma c.Bruising is exaggerated with aspirin d.Fovea may not be formed 22.Treatment of Superior oblique palsy a.Ipsilateral IR recession 23.MRI a.Doesnot image bone b.Calcification is better seen with MRI 24.Cataract a.Christmas tree cataract is seen with myotonic dystroph 25. Homocystinuria a.Lens dislocation can occur in any direction 26. Wegener's granulomatosis 27. Progressive supranuclear palsy a.Can be caused by degenerative condition b.Can be caused by pinealoma 28. Pituitary adenoma a.Bromocriptine can shrink prolactinoma in 24 hrs. b.Acromegaly field defect can be true/false 66 Neuroophthalmology 1. The following are true about isolated fourth (trochlear nerve) palsy: a. head trauma is the most common cause in children b. aneurysm is a common cause in adult c. the head is usually tilted away from the palsied side d. congenital form tends to have a large vertical fusional range e. vertical prism is useful in correcting the torsional diplopia 1. a.F b.F c.T d.T e.F 2. The following signs are useful in distinguishing between the congenital and acquired form of Horner's syndrome: a. absent light reflex of the affected eye b. lighter iris colour of the affected eye c. decreased facial sweating of the affected side d. dilatation of the affected pupil with 10% cocaine e. dilatation of the affected pupil in response to 1% adrenaline 2. a.F b.T c.F d.F e.F 3. Palinopsia occurs in: a. use of hallucinogens b. parietal lobe lesion c. occipital lobe lesion 67 d. frontal lobe lesion e. migraine 3. a.T b.T c.T d.F e.T 4. In spasmus nutans: a. the age of onset is usually between 4 and 18 months of age b. the nystagmus is classically horizontal c. the condition does not requires further investigation d. the eye movement is symmetrical e. spontaneous resolution commonly occurs 4. a.T b.F c.F d.F e.T 5. Downbeat nystagmus occurs in: a. lithium toxicity b. alcohol intake c. Arnold-Chiari's syndrome d. middle ear diseases e. spinocerebellar degeneration 5. a.T b.T c.T d.F e.T 6. Bitemporal hemianopia may be seen in: a. tilted disc b. bilateral ischaemic optic neuropathy c. dermatochalasia 68 d. sectorial retinitis pigmentosa e. retinoschisis 6. a.T b.F c.T d.T e.T 7. Vertical gaze is impaired in the following conditions: a. internuclear ophthalmoplegia b. walled-eye syndrome c. juvenile Gaucher disease d. progressive supranuclear palsy e. Sylvian aqueduct syndrome 7. a.F b.F c.T d.T e.T 8. The following findings make benign intracranial hypertension unlikely: a. bilateral sixth nerve palsy b. morning headache and nausea c. increased protein in the cerebrospinal fluid d. enlarged ventricle on brain scan e. hard exudate in the macula 8. a.F b.F c.T d.T e.F 9. Optic nerve hypoplasia is associated with: a. maternal diabetes mellitus b. maternal alcoholism c. hypopituitarism 69 d. maternal use of phenytoin e. maternal folate deficiency 9. a.T b.T c.T d.T e.F 10. In a patient with bilateral centrocecal scotoma, the following tests are useful in diagnosis: a. full blood count b. serum folate level c. liver function tests d. serum copper level e. ESR 10. a.T b.F c.T d.F e.F 11. In non-arteritic ischaemic optic neuropathy: a. optic disc oedema is common b. embolism is the cause in the majority of cases c. visual loss is usually more severe than arteritic ischaemic optic neuropathy d. a small cup-to-disc ratio is a risk factor e. optic nerve fenestration is useful in improving final visual outcome 11. a.T b.F c.F d.T e.F 12. In contrast to surgical third nerve palsy, medical third nerve palsy: a. does not affect pupillary response to light b. does not affect accommodation 70 c. does not cause upper lid elevation on attempted downgaze d. does not cause complete ptosis e. causes a decreased in intraocular pressure 12. a.T b.T c.T d.F e.F 13. In optic neuritis: a. there is usually progression over the first three weeks from onset b. pain on ocular movement is usually worse on adduction c. the central scotoma may worsen with raised in body temperature d. systemic steroid has been shown to affect the final visual outcome e. a swollen disc make the diagnosis unlikely 13. a.F b.T c.T d.F e.F 14. In myasthenia gravis: a. the horizontal recti are more commonly affected than the vertical recti b. there is a delayed tendon reflex c. the pupillary response to light is not affected d. steroid may worsen the muscular problems e. neonates born to mother with the disease may be affected due to the anticholinesterase receptor antibodies closing the placenta 14. a.F b.F c.T d.T e.T 15. The following are true: a. opticokinetic drum can be used to differentiate a lesion in the parietal lobe from that of a occipital lobe. 71 b. cerebral dyschromatopsia is associated with bilateral superior homonymous hemianopia. c. postfixation visual loss in bitemporal hemianopia d. afferent pupillary defect and homonymous hemianopia in lesion of the optic tract e. sensory inattention is associated with left inferior homonymous quadrinopia in a right handed person 15. a.T b.T c.T d.T e.T 16. In Parinaud's syndrome: a. the lesion is in the dorsal mid-brain b. light-near dissociation is a feature c. accommodative spasm occurs on attempted upgaze d. convergence-retraction nystagmus occurs with vertical saccades e. demyelination is a known cause 16. a.T b.T c.T d.T e.T 17. The following are true: a. Uhtoff's symptom refers to a decrease in vision with an increase in body temperature b. prosopagnosia occurs with a bilateral medial occipitotemporal lesion c. in Riddoch phenomenon, the patient can perceive objects in motion but not stationary objects. d. skew deviation occurs in lesion of the supraneuclear vertical gaze pathway e. Anton's syndrome is associated with denial of blindness 72 17. a.T b.T c.T T d.T e.T 18. In Benedikt's syndrome: a. third nerve palsy is present b. there is a contralateral weakness c. there is a contralateral tremor d. there is contralateral sensory loss e. the facial nerve is involved. 18. a.T b.F c.T d.T e.F 19. In Leber's optic neuropathy: a. DNA analysis is useful b. the offsprings of an affected man have a 50% chance of acquiring the disease c. in the acute phase a macular star is typically seen d. the optic disc is hyperaemic with telangiectatic capillaries e. fluorescein angiography in the acute phase shows leakage in the optic disc 19. a.T b.F c.F d.T e.F 20. In thyroid eye disease: a. the medial and inferior recti are the most commonly affected extraocular muscles. b. smoker is more likely to be affected than non-smoker c. optic nerve fenestration is useful in patients with optic nerve compression 73 d. upgaze is most commonly affected in patients with ocular motility problems e. the thyroid function test always shows hyperthyroidism 20. a.T b.T c.F d.T e.F 21. In Argyll-Robertson's pupils: a. the condition occurs in acquired but not congenital syphilis b. the pupils dilate poorly with atropine c. the irregularity of the pupils are caused by iritis d. the pupils dilate with topical cocaine e. the lesion is in the rostral area of the Edinger-Westphal nucleus. 21. a.F b.T c.T d.F e.T 22. In Adie's (tonic) pupil: a. the pupil may not respond to light or accommodation in the acute stage b. Guillain-Barré syndrome is a known cause c. the pupil constricts with 2.5% mecholyl solution d. there is usually a permanent loss of accommodation e. the condition may be confused with Argyll-Robertson's pupil. 22. a.T b.T c.T d.F e.T 23. In a dilated pupil: a. a light-near dissociation is seen with third nerve palsy b. failure of constriction to 1% pilocarpine is seen in third nerve palsy 74 c. failure of constriction to 1% pilocarpine occurs with mydriasis induced by atropine d. problem with accommodation is a useful sign in distinguishing mydriasis induced by atropine from that caused by third nerve palsy e. consensual light reflex of the normal eye is absent in third nerve palsy 23. a.F b.F c.T d.F e.F 24. The following are true: a. Cogan's rule: a patient with homonymous hemianopia but otherwise neurologically intact is caused by a lesion in the occipital lobe b. Wernicke's hemianopic pupillary response: occurs in optic tract field defect c. Gertman's syndrome: lesion in the non-dominant parietal lobe d. Marcus Gunn's pupil: diagnostic of optic neuritis e. Foster-Kennedy's syndrome: lesion in the optic tract 24. a.T b.T c.F d.F e.F 25. The following are true about visual field defects: a. macular sparing is commoner with an anterior rather than a posterior lesion of the calcarine cortex b. horizontal sectoranopia is a feature of lateral geniculate body lesion c. an unilateral field loss rules out a lesion in the post-chiasmal region d. a homonymous hemianopia with temporal sparing is seen in lesion of the posterior calcarine cortex 75 e. altitudinal defect is a feature of glaucoma 25. a.T b.T c.F d.T e.F 26. In a left optic tract lesion: a. a right afferent pupillary defect may be present b. the visual field shows congruous homonymous hemianopia c. the left optic disc may show temporal pallor d. the right optic disc may show nasal pallor e. the lesion may result from a pituitary adenoma 26. a.T b.F c.T d.T e.T 27. Optic nerve gliomas: a. usually occur in the third decade of life b. proptosis is the most common presentation c. are usually bilateral d. cause death through cerebral invasion e. require early surgical excision 27. a.F b.F c.F d.F e.F 28. Tuberous sclerosis has the following features: a. mental retardation b. ashleaf lesion best seen with Wood's light c. mulberry tumours which contain calcification d. presence of café au lait patches 76 e. over 90% of the cases have a positive family history 28. a.T b.T c.T d.T e.F 29. In visual evoked potential (VEP): a. the latency is prolonged in recovered optic neuritis b. the amplitude is normal in recovered optic neuritis c. it is essentially a test of the macula d. the result is abnormal in patients with ocular albinism e. it can be used to detect malingering 29. a.T b.T c.T d.T e.T 30. In type 1 neurofibromatosis, the following signs may be seen: a. pulsatile proptosis b. bilateral acoustic neuroma c. Lisch's nodules d. cerebral meningioma e. cavernous haemangioma of the retina 30. a.T b.F c.T d.T e.F Glaucoma 1. The following visual field defects are typically seen in primary open angle glaucoma: a. centrocecal scotoma 77 b. nasal step c. central scotoma d. paracentral scotoma e. altitudinal field loss 1. a.F b.T c.F d.T e.F 2. Early signs of glaucomatous damage include: a. splinter haemorrhage of the optic disc b. glaucoflecken c. vertical elongation of the cup d. loss nerve fibre layer e. peripapillary atrophy 2. a.T b.F c.T d.T e.F 3. Static perimetry include: a. Lister perimeter b. Goldmann perimeter c. tangent screen d. Octopus e. Humphrey 3. a.T b.T c.T d.F e.F 4. The following are direct gonio lenses: a. Koeppe b. Goldmann c. Thorpe d. Zeiss 78 e. Barkan 4. a.T b.F c.T d.F e.T 5. In pigmentary dispersion syndrome: a. the pigments is caused by the release of melanin from the anterior surface of the iris b. the incidence of affected male to female is 5:1 c. peripupillary retroillumination is a feature d. heterochromia can occur e. latanoprost should be avoided as it increases the release of pigments 5. a.F b.T c.F d.T e.F 6. Blood in Schlemm's canal is seen in: a. Sturge-Weber's syndrome b. carotid-cavernous fistula c. angle recession glaucoma d. hypotony e. neurofibromatosis 6. a.T b.T c.F d.T e.F 7. The following are true about lens induced glaucoma: a. laser iridotomy is ineffective against pharcomorphic glaucoma b. phacolytic glaucoma is characterized by blockage of the trabecular meshwork by protein laden marcophages c. phacolytic glaucoma typically occurs following cataract extraction 79 d. phacolytic glaucoma is associated with Morgagnian cataract e. phacoanaphylactic glaucoma is associated with granulomatous inflammation 7. a.F b.T c.F d.T e.T 8. In a patient with angle recession glaucoma, gonioscopy may reveal: a. separation of the ciliary body from its attachment to the scleral spur b. increased visibility of the scleral spur c. torn iris process d. marked variation in the ciliary body width in different quadrant of the same eye e. new vessels at the angle 8. a.F b.T c.T d.T e.F 9. In primary congenital glaucoma: a. the incidence is 1:12,500 births b. the corneal diameter is usually greater than 8 mm c. gonioscopy reveals iris hypoplasia d. the cup: disc ratio is greater than 0.3 e. males are more commonly affected than females 9. a.T b.F c.F d.T e.T 10. Sampaolesi's line: a. is a pigmented line anterior to Schwalbe's line b. occurs in pseudoexfoliation syndrome c. is seen in pigment dispersion syndrome 80 d. occurs in iris melanoma e. is seen in siderosis bulbi 10. a.T b.T c.T d.T e.F 11. In uveitic glaucoma: a. pilocarpine is the treatment of choice in patient who can not take beta blockers b. girls with pauciarticular juvenile rheumatoid arthritis are more likely to develop glaucoma than their male counterpart c. simple trabeculectomy is associated with high failure rate d. iridocyclitis is often associated with low rather than high intraocular pressure e. iris bombe is a common complication of Posner-Schlossman syndrome 11. a.F b.T c.T d.T e.F 12. In Humphrey automated perimeter, the following definition are true: a. a false-negative response: failure to respond to a suprathreshold stimulus at a location that the patient would be expected to see b. fixation loss: occurs when the patient responds to a target shown at his blind spot c. high positive rate is seen in trigger happy patient d. short term variation is greater in glaucomatous than normal population e. short term variation refers to change in sensitivity when the same area is retested. 12. a.T b.T c.T d.T e.T 81 13. The following glaucoma are associated with bilateral primary abnormalities of the corneal endothelium: a. Axenfeld's anomaly b. Peter's anomaly c. Cogan-Reese syndrome d. posterior polymorphous membraneous dystrophy e. essential iris atrophy 13. a.F b.F c.F d.T e.F 14. True statements about topical beta blockers include: a. 10% of patients do not show therapeutic response b. therapeutic response is reduced in patients on systemic beta-blockers use c. the additive effect on glaucoma is increased if it is combined with topical adrenaline than with topical acetazolamide d. betaxolol is more effective than timolol in lowering intraocular pressure e. bradycardia is less with carteolol than timolol 14. a.T b.T c.F d.F e.T 15. The risk of developing steroid-induced glaucoma is increased in the following conditions: a. myopes b. patients with a history of primary open angle glaucoma c. history of angle closure glaucoma d. diabetes mellitus e. posterior synechiae 82 15. a.T b.T c.F d.T e.F 16. The following are true about laser peripheral iridotomies: a. Nd:YAG laser requires fewer application compared with argon laser b. bleeding is less common with argon than Nd:YAG laser c. late closure of the iridotomies is commoner with argon than Nd:YAG laser d. iris oedema is commoner with argon than Nd:YAG laser e. pupillary distortion is commoner with argon than Nd:YAG laser 16. a.T b.T c.T d.T e.T 17. True statements about systemic acetazolamide include: a. it should be avoided in patients allergic to sulphonamides b. it is associated with metabolic acidosis c. it is associated with renal calculi d. it causes transient myopia e. it should be avoided in patient with hepatic encephalopathy 17. a.T b.T c.T d.T e.T 18. The following are true about aqueous drainage devices: a. all contain a silicone tube attached to a synthetic plate b. corneal decompensation is a known complication c. Molteno's tube contains pressure sensitive device d. post-operative hypotony is commoner with Ahmed's valve than Molteno's tube 83 e. Krupin's valve contains pressure sensitive valve 18. a.T b.T c.F d.F e.T 19. Regarding anti-metabolites: a. they are applied to the scleral flap during trabeculectomy b. they increase the incidence of post-operative endophthalmitis c. they inhibit DNA synthesis and therefore cellular proliferation d. 5-fluorouracil is more likely to cause hypotony than mitomycin C e. mitomycin C is associated with a higher incidence of wound leak than 5-fluorouracil 19. a.F b.T c.T d.F e.T 20. Apraclonidine: a. is an alpha 2 agonist b. causes conjunctival hyperaemia c. causes increased uveoscleral outflow d. produces miosis e. causes lid retraction 20. a.T b.F c.F d.F e.T Test 11 (paediatric ophthalmology) 1. Causes of poor vision in aniridia include: a. macular hypoplasia 84 b. glaucoma c. cataract d. retinitis pigmentosa e. optic nerve hypoplasia a.T b.T c.T d.F e.T 2. True statements about aniridia include: a. it is sporadic in one third of cases b. familial cases are autosomal dominant c. vision can be improved with tinted glasses d. Wilm's tumour occurs in one third of sporadic aniridia e. Wilm's tumour does not occur in familial aniridia a.F b.F c.T d.T e.F 3. The following features are seen in Leber's congenital amaurosis: a. nystagmus b. normal fundus at the early stage c. myopic refraction d. absent pupil responses to light e. arteriolar narrowing in later stage a.T b.T c.F d.T e.T 4. Chickenpox in expectant mother can produce the following ocular abnormalities in the newborn: a. Horner's syndrome 85 b. optic nerve hypoplasia c. aniridia d. chorioretinitis e. cataract a.T b.T c.F d.T e.T 5. In de Morsier's syndrome: a. the condition is hereditary in the majority of cases b. optic atrophy is a feature c. agenesis of the septum pellucidum is a feature d. the corpus callosum may be malformed. e. hypothalamic dysfunction is common a.F b.F c.T d.T e.T Lens and cataract 1. The following are true about cataract: a. it is the most common cause of blindness in the world b. nuclear sclerosis reduces the distant vision more than near c. posterior subcapsular cataract is more likely to cause problem with distant vision than near d. more females than males have cataract surgery e. outdoor workers are more likely to develop cataract than indoor workers 1. a.T b.T c.F d.T e.F 2. True association include: 86 a. Wilson's disease - sun-flower cataract b. myotonic dystrophy - Christmas tree cataract c. amiodarone - anterior capsular cataract d. Alport's syndrome - posterior lenticonus e. Down's syndrome - cerulean (blue-dot) cataract 2. a.T b.T c.T d.F e.T 3. The following are true about microspherophakia: a. it is associated with myopia b. it can cause pupillary block glaucoma which should be treated with mydriatic c. it is associated with short stature and stiff joints d. anterior dislocation is a known complication e. it can be an autosomal recessive disorder. 3. a.T b.T c.T d.T e.T 4. The following metabolic disorders are associated with cataract: a. hyperlysinemia b. hypercalcemia c. hypocalcemia d. hypoglycaemia e. uraemia 4. a.F b.F c.T d.T e.F 5. Drug-induced cataract include: a. phenothiazine 87 b. echothiopate c. aspirin d. lovastatin e. systemic beta-blockers 5. a.T b.T c.F d.T e.F 6. True statements about the ocular effects of congenital rubella include: a. eye defect typically occurs with infection during the first trimester of pregnancy b. lamellar cataract is the most common type of cataract seen in congenital rubella c. viral particles usually remain in the lens particle long after birth d. myopia is common e. congenital rubella causes progressive chorioretinitis. 6. a.T b.F c.T d.F e.F 7. The following are true about blunt trauma on the lens: a. Vossius ring is caused by the imprint of the pupillary pigment on the lens b. Vossius ring causes decreased vision in the majority of patients c. Vossius ring is a permanent sign d. contusion cataract is usually rosette-shaped e. contusion cataract typically involves the anterior cortex 7. a.T b.F c.F d.T e.F 8. In congenital cataract: a. patients with severe bilateral cataract should have the cataracts removed before three months of age 88 b. intraocular lens should be used c. the posterior capsule is usually left intact d. post-operative visual acuity is usually better in patients with unilateral cataract than bilateral cataract e. visual prognosis is poor in patients who develop nystagmus 8. a.T b.F c.F d.F e.T 9. With regard to the materials used in intraocular lens: a. PMMA is the most common material used in making foldable lens b. PMMA transmits a broader spectrum of light than natural lens c. silicone is associated with increased capsular fibrosis d. silicone lens tends to be thinner than PMMA for the same dioptre power e. hydrogel lens has a lower tensile strength than PMMA 9. a.F b.T c.T d.F e.T 10. Regarding eye drops used in cataract surgery: a. flurbiprofen is used to dilate pupil b. flurbiprofen prevents post-operative inflammation c. phenylephrine stimulates the alpha receptors d. phenylephrine should be avoided in patients on monoamine oxidase inhibitors e. cyclopentolate acts on the constrictor muscle of the iris 10. a.F b.F c.T d.T e.T 11. Homocystinuria: a. is an autosomal recessive condition b. causes inferonasal subluxation of the lens 89 c. is associated with raised serum methionine d. is associated with mental retardation e. causes osteoporosis 11. a.T b.T c.T d.T e.T 12. The histological features of the following are true: a. Elschnig pearls - proliferation of lens epithelium onto the posterior capsule b. posterior subcapsular cataract - bladder cells c. cortical cataract - morgagnian globules d. glaucoflecken - Wedl cells e. Soemmerring ring - sequestration of proliferating lens fibres in the equatorial region of the capsule 12. a.T b.T c.T d.F e.T 13. In a 6 month old baby with bilateral cataract, urine test is useful in: a. homocystinuria b. galactosemia c. Lowe's syndrome d. abetalipoproteinemia e. cystinosis 13. a.F b.T c.T d.F e.F 14. In galactosemia: a. the condition is autosomal dominant b. the most common form is caused by galatose-a-phosphate uridyl transferase deficiency c. mental retardation is a feature in untreated cases d. the cataracts usually assume oil droplet appearance 90 e. early cataracts are reversible with dietary restriction 14. a.F b.T c.T d.T e.T 15. Factors that can increase intravitreal pressure during phacoemulsification include: a. excessive peribulbar anaesthesia b. patient taking deep breadth c. pressure from the speculum d. choroidal haemorrhage e. a high bottle height 15. a.T b.F c.T d.T e.F 16. With regard to viscoelastics: a. they are cleared in an unmetabolised state by filtration through the trabecular meshwork b. sodium hyaluronate has a higher pseudoplastic behaviour than chondroitin sulphate c. they are toxic to the endothelium if not removed at the end of the surgery d. methylcellulose is cheaper than sodium hyaluronate e. Viscoat is made up sodium hyaluronate and chondroitin sulphate 16. a.T b.T c.F d.T e.T 17. Pseudoexfoliation syndrome: a. is commonly seen in glass blowers b. is most commonly in the fifth decade of life c. causes mid-periphery transillumination d. causes iridonosis 91 e. is associated with poor pupillary dilatation 17. a.F b.F c.F d.T e.T 18. The advantages of capsulorrhexis over capsulotomy include: a. easier delivery of the nucleus during extracapsular cataract operation b. holds the nucleus in the capsular bag during phacoemulsification c. better centration of the intraocular lens d. less likelihood of capsular contraction e. less likelihood of anterior capsular tear extending into the posterior capsule 18. a.F b.T c.T d.F e.T 19. Cataract extraction in an eye that had previous par plana vitrectomy is associated with an increased risk of : a. zonular dehiscence b. suprachoroidal haemorrhage c. posterior capsule rupture d. globe collapse e. cystoid macular oedema 19. a.T b.F c.T d.F e.T 20. True statements about the aspiration systems used in phacoemulsification include: a. diaphragm pump produces the slowest build up of vacuum b. peristaltic pump allows linear control of vacuum c. Venturi pump is associated with the highest risk of inadvertent engagement of unwanted tissue 92 d. Venturi pump gives the most rapid rise in vacuum e. high aspiration is needed during the early stage of phacoemulsification 20. a.T b.T c.T d.T e.F Test I (for final FRCOphth / MRCOphth) 1. Gorlin's syndrome: a. Is an inherited condition b. Is associated with multiple basal cell carcinoma c. Increases the incidence of cataract d. Is associated with liver carcinoma e. Increases the risk of retinal detachment 2. Posterior polymorphous dystrophy : a. Is present at birth b. Causes corectopia c. Is inherited in an autosomal recessive fashion d. Causes blindness in over 90% of sufferers e. Can be treated with lamellar corneal grafts 3. Crystalline deposits in the conjunctiva may be found in: a. Amyloidosis b. Cystinosis c. Gold treatment d. Contact lens wear e. Uraemia 4. The histology of pterygium includes: a. Myxoid degeneration b. Epithelial inclusion bodies 93 c. Precancerous changes d. Squamous metaplasia of the epithleium e. Elastotic degeneration 5. The following may be found in conjunctiva in keratoconjunctivitis sicca a. Dysplasia of the epithelium b. Keratinisation c. Eosinophils d. Numerous goblet cells e. Lymphocytic infiltrates 6. Merkel cell carcinoma: a. Is most common in the bulbar conjunctiva b. Is associated with good prognosis c. Is an APUD cell tumour d. Is associated with ultraviolet exposure e. Produces corneal pigmentation 7. Histological changes in lens induced uveitis include: a. Ghost cells b. Giant cell reaction c. Amyloid in the cornea d. Vasculitis e. Non-caseating granuloma 8. Xeroderma pigmentosa is associated with: a. Intraouclar tumours b. Metabolic disorders c. Photosensitivity d. Autosomal recessive inheritance e. Squamous cell carcinoma 94 9. Pathological changes in thyroid ophthalmopathy includes: a. Lymphocytic infiltrates b. Giant cell reaction c. Muccopolysaccharides d. Fat cells e. Fibroblast proliferation 10. In histological stains: a. Chlamydia inclusion bodies stain with Giemsa b. Osmium tetroxide is the stain used in electron microscopy c. Fungi stain with Fuelgin's stain d. Eosin stains the nuclei blue e. Haematoxylin stains the nuclei pink Click for answers 11. Sympathetic ophthalmitis a. Is characterised by Dellen-Fuchs' nodule b. Prevented by removal of the exciting eye within 6 weeks of injury c. Pigment laden macrophages are diagnostic d. Is associated with poliosis and vitiligo e. Is a common cause of visual loss in traumatic eye injury 12. Abnormal material which may be present in the vitreous include: a. Exfoliation b. Lipofuscin c. Haemosiderin d. Amyloidosis e. Calcium 13. In giant cell arteritis: 95 a. Histological diagnosis is based on fragmentation of the internal intimal b. C-reactive protein is always raised c. Giant cell is needed for diagnosis d. Anterior cerebral artery is often involved e. Anaemia is a feature 14. The following conditions are pre-malignant: a. Oncocytoma of the caruncle b. Actinic keratosis c. Bowen's disease d. Squamous papilloma e. Syringoma 15. Hypoxic damage in diabetic mellitus is suggested by: a. Nerve fibre layers haemorrhage b. Iris neovascularisation c. Anterior uveitis d. Vascular loop e. Decreased hard exudate 16. The following biopsy report may be found with rheumatoid arthritis: a. Posterior scleritis b. Loss of goblet cells in the conjunctiva c. Episcleral necrotic tissue d. Giant cell reaction e. Vasculitis 17. The following report is associated with increased mortality in an enucleated eye with retinoblastoma: a. Involvement of the optic nerve b. Presence of calcification within the tumours c. Necrosis within the tumours d. Exophytic retinoblastoma e. Presence of retinal detachment 96 18. Diabetic microangiopathy include: a. Endothelial vascular proliferation b. Proliferation of pericytes associated with microaneurysms c. Deposition of calcium in the intima d. Thickening of the basement membrane e. Necrosis of the endothelium 19. Optic nerve glioma: a. Is associated with neurofibromatosis type I b. Increased incidence after 30 years old c. Majority is of pilocytic astrocytoma d. Rarely infiltrate the perineural tissue e. Mortality of 40% 20. Mutton fat keratic precipitates are seen in: a. Uveal effusion syndrome b. Tuberculosis c. Fuch's heterochromia cyclitis d. Sarcoidosis e. Fungal infection Click for answers 21. Albinism: a. Hair bulb for tyrosine positivity test is useful only when the child is 5 years old b. Is associated with platelets abnormality especially with aspirin c. Complete decussation is invariable in all albinism d. Is associated with thrombosis under general anaesthesia e. Causes macular hypoplasia 22. Infanitle glaucoma is associated with: 97 a. Aniridia b. Sturge-Weber syndrome c. Albinism d. Axial iris stromal abnormality e. Von Hippel-Lindau's syndrome 23. The following are true about nystagmus: a. See-saw nystagmus is associated with homonymous hemianopia b. Down-beat nystagmus is associated with lesion in the foramen magnum c. Manifest latent nystagmus occur in unilateral congenital cataract d. Gaze-evoked nystagmus is specific for cerebellar lesion e. Convergence retraction nystagmus is associated with mid-brain tumours 24. Melanocytoma: a. Contains plump black naevus cells b. Metastasises to the brain c. Is commoner in temperate than tropical countries d. Does not cause optic nerve compression e. Is associated with renal tumour 25. Retinoblastoma: a. Is inherited in 50% of cases b. Is caused by deletion of 11q14 c. Rosettes suggest good prognosis d. There is an increased incidence of osteosarcoma e. Causes death in 60% of sufferers in the UK 26. Corneal dystrophy may contain the following substances: a. Muccopolysaccharides b. Cholesterol 98 c. Amyloidosis d. Uroprophyrin e. Urate 27. Lacrimal gland tumour of the adenocytic type: a. Has a peak incidence of around 60 years b. Has well-defined capsule c. Spread through perineural tissue d. Metastasise to the brain early e. Causes mortality in over 90% of cases in the UK 28. Dissociated vertical deviation: a. Hyperdeviation on abduction and adduction b. Began at 2 to 3 years old c. Poor binocular single vision d. Inferior recession is the treatment of choice e. Highest incidence with congenital esotropia 29. Duane type A: a. Causes limited abduction and adduction b. Widening of the palpebral fissure on abduction c. Sixth nerve palsy is an associated problem d. Causes head tilt more commonly than other types e. Is associated with six cranial nerve nucleus aplasia 30. Retinoschisis: a. Should be treated with laser to prevent progression b. Causes absolute scotoma c. Is associated with water mark d. Is bilateral in the majority of cases e. Does not cause retinal detachment 99 Click for answers 31. Medications for glaucoma: a. Beta-blocker is contraindicated in primary heart block b. Beta-blocker is contraindicated in those on nifedipine c. Acetazolamide is contraindicated in allergy to sulphonamide d. Acetazolamide needs potassium supplement e. Latanoprost is contraindicated in patient with uveitis 32. Dendritic ulcers may be treated by: a. Argon laser b. Iodination c. Topical acyclovir d. Systemic acyclovir e. Tarsorrhaphy 33. In choroidaemia: a. Pigmentary changes occurs in carriers b. Carriers may have abnormal EOG c. The mode of inheritance is autosomal dominant d. Arginine free diet is beneficial e. Central vision is lost early 34. Deafness is associated with: a. Cockayne's syndrome b. Alstrom's syndrome c. Alport's syndrome d. Usher's syndrome e. Abetalipoproteinaemia 35. Prominent corneal nerves are seen in : 100 a. Ectodermal dysplasia b. Ichythyosis c. Refsum's syndrome d. Macular dystrophy e. Acanthoamoeba keratitis 36. The following are recognised association: a. Abetalipoproteinaemia and acanthocytosis b. Refsum's disease is associated with cerebellar ataxia c. Spinocerebellar ataxia in Friedrich's ataxia d. Homocystinuria and recurrent deep vein thrombosis e. Paget's disease and deafness 37. Keratoconus is associated with: a. Down's syndrome b. Ehlers-Danlos' syndrome c. Marfan's syndrome d. Usher's syndrome e. Atopic keratoconjunctivitis 38. In acquired syphilis: a. Interstitial keratitis is a recognised feature b. The infection is most infectious in the secondary stage c. Causes secondary uveitis d. Treatment is with procaine penicillin e. May present with a rash which is highly infectious 39. Reduced blink reflex occurs in: a. Alcohol intoxication b. Parkinsonism c. Progressive supranuclear palsy d. Myasthenia gravis e. Hypothyroidism 101 40. In heterochromic cyclitis: a. 60% of patients develop glaucoma b. Show a good response when treated with steroids c. Lens implantation following cataract surgery is contraindicated d. Hyphaema during cataract surgery is due to iris neovascularization e. Is associated with iris transillumination Click for answers 41. Retinal dialysis: a. Is associated with posterior vitreous detachment b. Is associated with myopia c. Has a mobile posterior flap d. Can be treated by cryotherapy, encirclement and a local scleral buckle e. Is commonest in the superior temporal quadrant 42. Ocular bobbing: a. Is associated with pontine haemorrhages b. Is only seen in comatose patients c. Is associated with loss of doll's head movement d. Is associated with glioblastoma e. Occurs in bilateral cerebral infarction 43. The following tests may be useful in the assessment of a patient with sarcoidosis: a. Chest X-ray b. ACE c. Conjunctiva biopsy d. Serum calcium e. Gallium scan 102 44. In Holmes-Adie pupil: a. There is absent or retarded pupil reactions to light and near b. Most cases are bilateral c. Commoner in male than female d. Causes reduced or absent accommodation e. Constricts with 2.5% methacholine 45. A fixed dilated pupil which does not react to direct or consensual light stimulus could be caused by: a. Optic nerve avulsion b. Due to blunt trauma c. Orbital apex syndrome with third nerve palsy d. Topical application of atropine e. Siderosis bulbi 46. Leber's optic neuropathy: a. Typically presents in the fourth decade of life b. Males do not transmit the disease c. Usually affect the males more than the females d. Is inherited in autosomal X-link fashion e. The optic disc is pale early in the disease 47. In acute AMPPE: a. Bilateral in the majority of cases b. Hypofluorescence in early stage of fluorescein angiography c. Spontaneous recovery is common d. 80% of patients have exudative vasculitis e. Anterior uveitis is a prominent feature 48. In central serous retinopathy: 103 a. Abnormalities recorded on the Amsler's chart are uncommon b. Often shows focal leakage on fluorescein fundus photography c. A macular hole is a common end result d. The image perceived by the patient on the affected side in unilateral cases is bigger than on the normal side e. A dense central scotoma is the most common presentation 49. Kayser-Fleishcher's rings: a. Caused by copper in the Bowman's membrane b. Has brown-green, grey or orange colour c. Decreases with D-penicllamine treatment d. Can occur with copper intraocular foreign body e. Starts at 3 and 9 O'clock 50. Corneal grafts have: a. Host epithelium b. Host endothelium c. Host keratocytes d. Host basement and descemet's membrane e. Host nerves 51. Vernal keratoconjunctivitis: a. Is usually unilateral b. Eosinophil is common in the papillae c. Can be of limbal type alone d. Is commoner in adult than children e. Causes corneal melt 52.The following conditions are inherited in an autosomal recessive patterns: a. Protanopia b. Congenital retinoschisis 104 c. Sturge-Weber's syndrome d. Neurofibromatosis type II e. Blue cone achromatopsia 53. Coat's disease: a. Has equal sex incidence b. Caused by peripheral neovascularization c. Is inherited in an autosomal dominant pattern d. Causes rhegmatogenous detachment e. Can be treated with laser 54. With regard to laser: a. Xanthophll absorb green light b. Diode laser penetrate vitreous haemorrhage c. Argon blue-green is commonly used for grid laser d. YAG laser produces red colour e. Ophthalmic laser is classified as type I laser 55. Roth's spots contain: a. Positive staphylococcus bacteria b. Purulent exudates c. Vascular occlusion d. Lymphoblasts e. Eosinophils 56. Breaks in descemet's membrane occur in: a. Keratoconus b. Fuch's dystrophy c. Acute glaucoma d. Lattice dystrophy e. Congenital glaucoma 57. Acute glaucoma is suggested by: 105 a. Sphincter paralysis b. Cataract c. Ectopia uvea d. Posterior subcapsular cataract e. Recurrent corneal erosion 58. In blow-out fracture: a. A step on the orbital rim is palpable b. Adduction problem occur c. Surgical emphysema is a recognised feature d. Immediate treatment is important e. Decreased sensation at the tip of the nose is common 59. Persistent hyperplastic primary vitreous: a. Caused elongated ciliary muscles b. Angle closure glaucoma is a recognised feature c. Optic disc abnormality is seen d. Causes microphthalmic eye e. Visual prognosis is good if treated early 60. Pars planitis: a. Is frequently associated with retinal detachment b. Causes vitreous haemorrhage c. Has poor visual prognosis d. Causes cyclitic membrane e. Has a peak incidence at the fifth decade Click here for Answers Multiple Choice Questions on Medical Retina (click the number for the answers) 106 True statements about exudative vitreoretinopathy include:1. a. it is an autosomal recessive disorder b. it has a fundal appearance similar to patients with retinopathy of prematurity c. the main cause of visual loss is retinal detachment d. peripheral retinal neovascularization is a common features e. the condition has a relentless progression leading to severe visual loss. In AZOOR (acute zonular occult outer retinopathy):2. a. photopsia is a recognized feature b. visual loss is caused by retinal necrosis c. fluorescein angiogram is useful for diagnosis d. most affected patients are over the age of 40 e. oral prednisolone is the treatment of choice In PIC (primary idiopathic choriodopathy):3. a. myopia is an association b. more male than female are affected c. vitritis is common d. viral prodrome is common e. both eyes are affected in 25% of cases The following are true about IPCV (idiopathic polypoidal4. choriodal vasculopathy): a. it is seen exclusively in patients of African origin. b. it causes recurrent vitreous haemorrhage 107 c. it has a better visual prognosis than age-related macular degeneration d. the condition is characterized by dilated choroidal is best seen with indocyanine green angiography e. the lesions respond well to laser treatment. Stickler's syndrome:5. a. is an autosomal dominant condition b. is associated with retinal detachment in 20% of the patients c. shows abnormal uvula d. is associated with pigmentation along the peripheral retinal vessels e. has abnormal type II collagen The differences between ARN (acute retinal necrosis) and PORN6. (progressive outer retinal necrosis) include: a. ARN is associated with herpes simplex virus but not PORN b. ARN has a worse visual prognosis than PORN c. ARN is associated with AIDS but not PORN d. retinal detachment is common in ARN but not in PORN e. vitritis is more severe in ARN than in PORN True statements about vigabatrin include:7. a. it is the first line of treatment in patient with petit mal b. it is a GABA transaminase inhibitors c. it causes vortex keratopathy 108 d. it causes visual field defect in 30% of users e. stopping the vigabatrin can reverse the visual field loss Oguchi's disease:8. a. is an autosomal dominant condition b. is characterized by stationary night blindness c. is associated with colour blindness d. is characterized by Mizuo-Nakamura phenomenon e. causes significant visual loss before the age of 50 Retinal crystals are seen in the use of:9. a. tamoxifen b. hydroxychloroquine c. canthaxanthin d. desferrioxamine e. magnesium silicate In retinopathy caused by shaken baby syndrome:10. a. the patient is usually between the age of 3 and 5 years of age b. the retinopathy may resemble central retinal vein occlusion c. neurological damage is common d. skull fracture is always present e. the visual prognosis is good 109 The following signs favour the diagnosis of central retinal 11. artery occlusion rather than ophthalmic artery occlusion: a. the presence of cherry red spot b. the presence of relative afferent pupillary defect c. reduction of both a and b wave on the electroretinogram (ERG) d. delayed choroidal circulation in fluorescein angiography e. absence of pigmentary changes in the posterior segment The following conditions can give rise to the clinical appearance of12. cystoid macular oedema but without fluorescein angiographic evidence of late fluorescein leakage: a. epiretinal membrane b. Irvine-Gass syndrome c. juvenile retinoschisis d. nicotinic acid maculopathy e. Goldman-Favre syndrome The following retinal findings are associated with rhegmatogenous 13. retinal detachment: a. paving stone degeneration b. cystic retinal tuft c. pars plana cyst d. congenital hypertrophy of retinal pigment retinal epithelium e. meridonal folds 110 Features of acute macular neuroretinopathy include:14. a. paracentral scotoma b. mild vitritis c. presence of a triangular shape dark lesion in the macula d. abnormal electroretinogram e. profound visual loss with only 5% recover 6/36 vision In von Hippel-Lindau's disease:15. a. retinal angioma is seen in 50% of the patients b. angioma of the disc may mimic choroidal neovascularization. c. any retinal angioma should be treated early as spontaneous regression is rare d. treatment of the retinal angioma can give rise to subretinal exudation e. the main cause of visual loss is exudative maculopathy True statements about Stargardt's disease include:16. a. the majority of the cases are inherited in an autosomal dominant pattern b. the condition is symptomatic in the first or second decade of life c. abnormal red-green colour vision is common d. histopathology reveals the presence of subretinal lipofuscin substance e. macular oedema is a common cause of visual loss In Wyburn-Mason's syndrome:17. a. is an X-linked inheritance 111 b. the fundal appearance is caused by arteriovenous communication c. exudative maculopathy is the main cause of visual loss d. skull X-ray reveals tram-line calcification e. visual field defect occurs in one third of the patient The following statements are true:18. a. electroretinogram is diagnostic of Stargardt's disease b. amplitude of electroretinogram is reduced in carriers of choroideremia c. electro-oculogram light peak to dark trough ratio is normal in adult onset foveomacular dystrophy d. electroretinogram is diagnostic of Leber's congenital amaurosis e. electroretinogram is useful in detecting carrier of X-linked retinitis pigmentosa Bietti's crystalline dystrophy:19. a. is commoner in females than males b. causes choroidal atrophy c. has abnormal crystalline deposits in the cornea and lymphocytes d. produces crystalline deposits in all layers of the retina e. is associated with abnormal electroretinogram The following mucopolysaccharidosis are associated with 20. pigmentary retinopathy: a. Hunter's syndrome 112 b. Sanfilippo's syndrome c. Scheie's syndrome d. Morateaux-Lamy's syndrome e. Sly's syndrome The following conditions are associated with an optically empty 21. vitreous and peripheral pigmentary changes: a. Jansen's disease b. Wagner's disease c. X-linked retinoschisis d. Favre-Goldmann's syndrome e. Kearn-Sayre's syndrome The following statements are true about Jansen's disease and Wagner's 22. disease: a. both conditions have autosomal dominant inheritance b. both conditions are associated with increased retinal detachment rate c. the ERG are reduced in both conditions d. the EOG are normal in both conditions e. high myopia are common in both conditions Features of macroaneurysms include:23. a. more common in women than men b. more common in the temporal arcade than the nasal arcade 113 c. retinal artery occlusion d. occurs in IRVAN syndrome e. progressive enlargement and therefore early treatment with treatment with laser photocoagulation is recommended In carcinoma associated retinopathy (CAR):24. a. the condition is a paraneoplastic syndrome b. colour vision and night blindness are typical presentation c. melanoma is the most common type of carcinoma seen d. autoantibodies are seen in the blood e. plasmaphoresis is useful in restoring the visual function Deafness and pigmentary retinopathy are seen in the following 25. conditions: a. Usher's syndrome b. congenital rubella c. congenital syphilis d. Hunter's syndrome e. Refsum's syndrome Norrie's disease has the following features:26. a. mental retardation b. histology of the retina reveals rosette formation c. X-linked inheritance d. deafness e. leukocoria which may be mistaken for retinoblastoma 114 In X-linked retinoschisis:27. a.the splitting of the retina occurs at the level of inner plexiform layer b. electrophysiology reveals negative ERG c. the main cause of visual loss is recurrent retinal detachment d. DNA analysis is useful in detecting carrier of the condition e. myopia is common In ETDRS (Early Treatment Diabetic Retinopathy Study) significant28. macular oedema is defined as: a. hard exudates within 500um of the fovea b. retinal thickening within 500um of the fovea c. macular staining in fluorescein angiography d. retinal thickening greater than one disc area in size and within one disc diameter of the centre of the fovea e. macular haemorrhage within 500um of the fovea The following are true regarding the recommendations of the Branch29. Retinal Vein Occlusion Study for patient with branch retinal vein occlusion: a. fluorescein angiography should be performed within four weeks of the onset of branch retinal vein occlusion b. presence of more than 5 disc diameter of ischaemia should be treated with pan-photocoagulation c. macular oedema should be treated within 2 months of the onset of branch retinal vein occlusion d. macular laser is useful in patient who has macular ischaemia e. 30% of branch retinal vein occlusion develops neovascularization 115 The following are the findings from the Diabetes Control and 30. Complications Trial: a. tight glycaemia control reduces the progression of diabetic retinopathy in both insulin and non-insulin dependent diabetic b. the need for macular laser treatment is decreased in wellcontrolled group c. worsening of the retinopathy can occur during the initial phase of tight control d. attack of hypoglycaemia is increased in tightly controlled group e. the incidence of cataract is reduced. Click here for the answers Oculoplatic and lacrimal 1. With regard to ptosis: a. the most common abnormality in congenital ptosis is in the levator muscle b. lid lag on downgaze is a feature of senile ptosis c. in Horner's syndrome, ptosis is due to paralysis of the Muller's muscle d. the levator function is good in aponeurotic defect e. raised skin crease is a feature of congenital ptosis. 1. a.T b.F c.T d.T e.F 2. True statements about eyelid lesions include: 116 a. basal cell carcinoma affects the upper lid more commonly than the lower lid b. recurrent follicular conjunctivitis can be the result of molluscum contagiosum c. keratoacanthoma can resolve spontaneously without treatment d. sebaceous cell carcinoma has a worse prognosis than squamous cell carcinoma e. basal cell carcinoma is common in patients with xeroderma pigmentosa 2. a.F b.T c.T d.T .eT 3. The following are true about tumours arising from hair follicles: a. trichoepithelioma is commoner in women than men b. women with multiple trichilemmomas have an increased risk of breast cancer c. calcification is a feature of pilomatrixoma d. pilomatrixoma is commoner in children than adult e. malignant transformation is common in pilomatrixoma 3. a.T b.T c.T d.T e.F 4. In blepharochalasis: a. most affected patients are in their 40s b. there are recurrent lid oedema c. there are levator disinsertion d. the condition is associated with Ascher's syndrome e. systemic steroid is useful 4. a.F b.T c.F d.T e.F 117 5. The nasolacrimal canal is made up of the following bones: a. maxillary b. lacrimal c. inferior turbinate d. palatine e. frontal 5. a.T b.T c.T d.F e.F 6. The Müller's muscle: a. is innervated by the parasympathetic nerve b. has the peripheral arcade of the upper lid running on its anterior surface c. is about 5 mm long d. arises from the superior rectus e. elevates the upper lid by about 2 mm 6. a.F b.T c.F d.F e.T 7. The following are true about the treatment of basal cell carcinoma: a. Mohs' micrographic excision should be performed in all cases of lower lid basal cell carcinoma b. Mohs' micrographic excision is useful for the diagnosis of basal cell carcinoma c. Mohs' micrographic excision allows three dimensional examination of tumour margins d. aggressive tissue removal is avoided in Mohs' micrographic excision e. before Mohs' tissue excision the skin is spread with zinc sulphate paste 118 7. a.F b.F c.T d.F e.F 8. The following are true: a. in epicanthus tarsalis, the medial canthal skin fold arises from the lower lid b. epicanthus inversus is a cause of in-growing eye lashes c. euryblepharon is a feature of Treacher-Collin's syndrome d. in distichiasis, there is an extra row of eyelashes in the orifices of the meibomian gland e. ankyloblepharon refers to the fusion of the upper and lower eyelids 8. a.F b.F c.T d.T e.T 9. Blepharophimosis: a. is an autosomal dominant condition b. epicanthus inversus is a feature c. has nasal bridge hypoplasia d. has hypertelorism e. is associated with mental retardation 9. a.T b.T c.T d.T e.F 10. In congenital obstruction of the nasolacrimal duct: a. the success rate of probing at 12 months of age is about 60% b. 85% of the cases are bilateral c. the blockage is found most commonly at the common canaliculus d. in congenital dacryocystocele, the skin is usually inflamed and hot e. in congenital dacryocystocele, the sac contains amniotic fluid 119 10. a.F b.F c.F d.F e.T 11. Upper lid retraction may be seen in: a. Grave's eye disease b. an eye with contralateral ptosis c. hepatic failure d. hydrocephalus in children e. Parinaud's syndrome 11. a.T b.T c.T d.T e.T 12. During dacryorhinostomy, the following are usually removed: a. maxillary bone b. frontal bone c. lacrimal bone d. lacrimal fossa e. ethmoid bone 12. a.T b.F c.T d.T e.F 13. The following are true about chronic canaliculitis caused by Actinomyces: a. it is the most common cause of chronic canaliculitis b. this infection is caused by a fungus c. bloody tear is a feature d. syringing is usually normal despite epiphora e. dacryorhinostomy is the treatment of choice 13. a.T b.F c.T d.T e.F 120 14. Features of eyelid keratoacanthoma include: a. malignant transformation in 50% of cases b. loss of eyelashes c. rapid growth d. ulcerated surface filled with keratin e. spontaneous resolution 14. a.F b.T c.T d.T e.T 15. Features of Goldenharg's syndrome: a. eyelid coloboma b. Duane's syndrome c. optic nerve hypoplasia d. ptosis e. lipodermoid 15. a.T b.T c.T d.F e.F 16. Hypertelorism is seen in: a. Curzon's syndrome b. frontal encephalocele c. blepharophimosis d. capillary haemangioma e. Turner's syndrome 16. a.T b.T c.F d.F e.T 17. The following are contributory factors in senile (involution) entropion: 121 a. atrophy of the orbital fat b. migration of the preseptal orbicularis over the pretarsal muscle c. dehiscence of the lower lid retractor d. horizontal lower lid laxity e. fat herniation through the orbital septum 17. a.T b.T c.T d.T e.F 18. The following are true about Jones dye test in epiphora: a. it is used to diagnose complete obstruction of the lacrimal drainage system b. if the Jones 1 (primary) test is normal, the cause may be due to hypersecretion of tear c. if the Jones 1 (primary) test is negative, the obstruction is in the common canaliculus d. if the Jones II (secondary) test is negative, the abnormality may be due to pump failure e. if the Jones II (secondary) test is positive, there is a partial nasolacrimal duct obstruction 18. a.F b.T c.F d.T e.T 19. True statements about cavernous haemangioma include: a. it is commoner is female than male b. spontaneous resolution is common c. it is well-encapsulated d. retina striae is a recognized sign e. the proptosis increases with Valsalva's manoeuvre 19. a.T b.F c.F d.T e.F 122 20. In a patient with laceration to the upper lid: a. the presence of fat herniation indicates the orbital septum is penetrated b. the presence of lacrimal gland indicates the orbital septum is penetrated c. the orbital septum should be resutured if penetrated d. in the presence of ptosis, exploration should be delayed for at least 72 hours to avoid retrobulbar haemorrhage e. ptosis is usually caused by damage to the oculomotor nerve 20. a.T b.T c.F d.F e.F MCQs on Ocular Motility (click the question number for the answers) A 8 year-old girl was referred with a history of sore eyes when watching TV and reading the blackboard. Her parents complained that her eye appeared to wonder out at times. The visual acuity was 6/6 in both eyes. Alternate cover test revealed exophoria with slow recovery with the angle of deviation measuring 35 prism dioptre at distance and 10 prism dioptre at near. Following a patch test, she measured 35 prism dioptre at distance and 15 dioptre at near. (Questions 1 3) 1. The following are true regarding this patient: a. the patient has intermittent exotropia of the divergence excess type b. binocular single vision may be suppressed for distant fixation but normal with near fixation c. patching of the eye suspend the tonic fusional convergence d. a V-pattern deviation is common on upgaze 123 e. spontaneous resolution is common as the patient ages 2. The following treatments are appropriate: a. tinted glasses b. over minus glasses if refraction revealed myopia c. orthoptic exercise d. miotic e. base-in prisms 3. Operation was carried out with bilateral lateral rectus recession. One day post-operative, the patient measured 10 prism dioptres of consecutive esotropia. The following are true: a. patching of the good eye should be carried out b. prescribe prism to maintain binocular fusion c. the eye should be explored for slipped lateral rectus d. overcorrection of exotropia is desirable and the patient should be reassured e. the esotropia will lessen with time A 6 year-old gird was referred having moved into your area. She was previously under the care of another hospital and had squint operation for a convergent squint which was present since infancy. Her visual acuity was 6/9 in the right eye and 6/6 in the left. Cover test revealed a small right exotropia of 5 prism dioptres. The covered eye showed elevation and nystagmus was observed when either eye was covered.The nystagmus was absent when both eyes were uncovered. (Questions 4 - 6) 4. The following are true: a. the esotropia prior to the surgery was likely to be more than 30 prism dioptres b. the patient is likely to have high hypermetropia in the right eye 124 c. binocular single vision is usually better than 60 degrees of arc d. asymmetrical optokinetic nystagmus is common e. further surgery is likely to be needed. 5. True statements about elevation of the covered eye include: a. it is caused by inferior oblique muscle overaction b. the eye demonstrates Bielchowsky phenomenon c. the elevation increases on adduction d. the elevated eye usually demonstrate extortion as it elevates e. the condition is usually bilateral but may be asymmetrical 6. With regard to the nystagmus: a. it is termed manifest latent nystagmus b. the fast phase is toward the side of the uncovered eye c. the intensity of the nystagmus increases on abduction d. the nystagmus has a similar waveform to congenital nystagmus e. it is caused by cerebellar dysfunction A 5 year-old child is referred the orthoptic because of strabismus. The findings include an esotropia of 20 prism dioptre in the primary position with limited abduction of the right eye. On adduction, there is narrowing of the lid fissure and upshooting ot he right. The right eye was normal. (Questions 7 - 9) 7. The following is true: a. the child is likely to be male than female b. the patient is likely to have a right face turn c. the narrowing of the lid is caused by aberrant regeneration of the third nerve 125 d. amblyopia is found in 90% of patients with this condition e. the diagnosis is type II Duane's retraction syndrome 8. The following may be associated with this condition: a. Marcus Gunn Jaw winking b. crocodile tears c. glaucoma d. cataract e. microphthalmos 9. True statements of this condition include: a. the strabismus is concomitant b. surgery is useful to restore normal ocular motility c. surgery is indicated in patient with abnormal head posture d. resection of the muscles may worsen narrowing of the lid e. Faden procedure can reduce the upshoot A 24 year-old man was referred to the eye casualty because of intermittent vertical diplopia. Alternating cover test revealed a vertical phoria and when looking at a white dot through Maddox rods through both eyes he described the lines as follow: (Questions 10 - 13) 10. The following are true if the patient had a fourth nerve palsy: a. the patient has a right fourth nerve palsy b. when the vertical diplopia is present, the left eye may be hyperdeviated c. with the first step of the three step tests, the right eye will show hyperphoria 126 d. with the second step of the three step test, the left eye will show hyperphoria in left gaze e. with the third step of the three step test, the right eye will show hyperphoria with right head tilt 11. The following features favours a congenital to an acquired fourth nerve palsy: a. absence of cyclotorsion b. abnormal head posture c. V pattern on upgaze d. vertical fusional amplitude greater than 4 prism dioptre e. absence of binocular single vision 12. The following favours a bilateral to an unilateral fourth nerve palsy: a. extorsion of more than 10 degrees b. an abnormal head posture consists mainly of chin depression c. positive Bielchowsky head tilt test to either side d. significant hyperdeviation in the primary position e. large V pattern 13. Surgical treatment in this patient may include: a. right inferior oblique recession b. right super rectus recession c. left inferior rectus recession d. right Harada-Ito procedure 127 e. Faden's procedure of the right superior oblique muscle A 64 year-old man complains of horizontal diplopia which is worse on right gaze. (Questions 14 - 17) 14. The following are true if he had a sixth nerve palsy: a. a right esotropia which is worse for distance than near b. a face turn to the left c. improved right eye movement when the left eye is closed d. V pattern on upgaze e. upshooting of the right eye on left gaze 15. The following muscle sequelae may occur if he had a sixth nerve palsy: a. contraction of the right lateral rectus b. contraction of the right medial rectus c. inhibitional palsy of the left lateral rectus d. overaction of the left medial rectus e. contraction of the left lateral rectus 16. The following additional signs and the location of the lesion are true: a. bilateral swollen disc - posterior fossa tumour b. right miosis and ptosis - cavernous sinus lesion c. fourth nerve palsy - orbital lesion d. right facial nerve palsy and analgesia and loss of taste to anterior two third of the tongue - dorsal pon 128 e. left hemiplegia - ventral pon 17. Treatment of this patient may include: a. injection of botulinum toxin into the right medial rectus b. base out Fresnel prism over the right eye c. Faden operation of the left medial rectus d. recession of the left medial rectus and resection of the right lateral rectus e. recession of the right medial rectus and resection of the left lateral rectus 18. True statements about microtropia include: a. it may result from operation for congenital esotropia b. the angle of deviation is typically between 15 and 20 prism dioptres c. stereopsis is usually absent d. anisometropia is a common feature e. a base out 4 dioptre prism can be used to detect central scotoma 19. Spasmus nutans: a. usually begins at 3 years of age b. is associated with head nodding c. has jerky and large amplitude nystagmus d. is rarely associated with neurological disorders e. usually resolves spontaneously. 20. The following are true about accommodative esotropia: 129 a. usually begins around the age of 2 years b. may be caused by a high AC/A ratio c. there is usually hypermetropia of more than + 3.00 D d. diplopia is rare e. amblyopia is uncommon. Test two (for final FRCOphth/MRCOphth) 1. Optic neuropathy have been reported with: a. ethambutol b. penicillin c.chloramphenicol d. isoniazid e. tobultamide 2. The following are known features of ocular hypotony: a. optic oedema b. cataract c. retinal detachment d. corneal oedema e. choroidal ischaemia 3. True statements about ankylosing spondylitis include: a. HLA-B27 is found in 90% of sufferers b. uveitis is found in 15 to 20% of sufferers c. the condition is commoner in female 130 d. female sufferers have a more severe course than male e. the radiological changes can occur in the spine before symptoms 4. In scleritis: a. scleromalacia perforans are more commonly associated with systemic diseases than posterior scleritis b. pain is not a prominent feature c. retinal detachment is a known complication d. systemic steroid is indicated in all scleritis e. glaucoma is a known complication 5. The following parasites can cause ocular problems: a. Trichinella spiralis b. Schistosoma haemolytica c. Ascaris lumbricoides d. Loa loa e. Leishmania donovani 6. In uveal melanoma: a. the condition is more common in Caucasian than other races b. the incidence is higher in female than males c. the optic nerve is commonly infiltrated by the tumour d. epithelioid cell type has poorer prognosis than other cell type e. abdominal CT scanning is more sensitive than blood test in detecting hepatic metastasis 7. Concerning Marfan's syndrome: 131 a. the condition is inherited in autosomal dominant manner b. it is caused by defect in the formation of type I collagen c. the lens typically shows upper nasal subluxation d. the patients have a higher incidence of hypermetropic refractive error e. the sufferers tend to be mentally subnormal 8. The following are true about measles: a. it is an RNA virus b. causes Koplik's spots on the conjunctiva c. acute catarrhal conjunctivitis is a known features d. causes blinding keratitis in the presence of vitamin A deficiency e. causes subacute sclerosing panencephalitis 9. Cyclosporin A: a. is a fungal metabolite b. has poor tissue penetration when applied topically c. is the drug of choice in Behcet's disease d. causes hepatotoxicity as the main side effects e. hirsutism and gingival hyperplasia are known side effects 10. Phlyctenular conjunctivitis: a. the most common cause is tuberculosis b. the lesions are typically found near the limbus c. should not be treated with steroid d. predominantly affects children e. is a type IV hypersensitivity reaction 132 11. The following are true about thiamine deficiency: a. external ophthalmoplegia is a typical feature b. failure of the pupils to respond to light c. the condition is found in patients with gastric carcinoma d. post-mortem reveals perivascular haemorrhages in the region of the fourth ventricle and aqueduct e. the condition responds to high dose vitamin B12 12. Features of tentorial herniation include: a. vomiting b. deterioration of consciousness c. dilated pupil d. impaired respiration e. hemiparesis 13. Features of Lawrence-Moon-Biedle's syndrome include: a. hypogonadism b. obesity c. polydactyly d. mental retardation e. pigmentary retinopathy 14. Sarcoidosis: a. is associated with HLA B1 b. is commoner in elderly people c. causes caseating granuloma d. produces bilateral hilar lymphadenopathies in the absence of pulmonary symptoms e. causes lymphocytosis 133 15. With regard to sickle cell disease: a. 25% of the black population have sickle cell disease b. the most severe form of sickle cell retinopathy is associated with SS disease c. optic disc is the first site of neovascularization in patient with severe retinal ischamia d. salmon patches are the result of ischaemia e. choroidal ischaemia is the main cause of visual loss 16. Alport's syndrome is associated with: a. neuro-sensory deafness from birth b. posterior lenticonus c. retinal detachment d. peripheral retinal fleck e. haemorrhage nephritis 17. Corneal deposits are seen in: a. Hurler's syndrome b. Morquio's syndrome c. myeloma d. cystinosis e. Sanfilippo's syndrome 18. The following are true about central retinal artery occlusion: a. it is a common cause of rubeosis iridis b. can cause neovascularisation of the retina c. is a recognized complication of atrial fibrillation d. fluorescence angiography typically shows delayed hyperfluorescence of the choroidal circulation e. causes optic atrophy within the first week 134 19. In accommodative esotropia: a. there is an increased incidence of hypermetropia b. the patients typically presents after the age of 18 months c. bifocal glasses are commonly prescribed for these patients in the United Kingdom d. the binocular fusion is usually poor e. inferior oblique overaction is a common feature 20. With regard to the use of phopholine iodide in the treatment of esotropia: a. it can be used to correct hypermetropic accommodative esotropia b. it is used in patients with esotropia due to high AC/A ratio c. it can cause iris cysts the incidence of which can be reduced with concurrent treatment with phenylephrine d. it causes retinal detachments e. it should be stopped in patients about to undergo strabismus surgery 21. In infantile esotropia: a. amblyopia is uncommon b. the majority of patients have associated neurological deficit c. a high refractive error is common d. dissociated vertical deviation is found in 75% of cases e. monocular opticokinetic asymmetry is a feature 22. The following can occur with congenital nystagmus: a. there is inverse opticokinetic nystagmus b. the nystagmus is worse with convergence 135 c. the nystagmus is worse when one eye is covered d. oscillopsia is a common complaint e. paradoxical pupillary constriction to darkness 23. In Brown's syndrome: a. there is downshooting of the ipsilateral eye on adduction b. there is associated superior rectus overaction in the contralateral eye c. may resolve spontaneously d. can be treated by inferior rectus recession in the contralateral eye e. can be treated by inferior oblique recession in the ipsilateral eye 24. Unilateral internuclear ophthalmoplegia is associated with: a. reduced adduction on the affected side b. reduced convergence c. nystagmus on abduction in the affected side d. diplopia can occur e. there is abnormal opticokinetic nystagmus 25. The following are features of aberrant third nerve regeneration: a. reduced abduction of the ipsilateral eye b. pupillary constriction on abduction c. cyclotorsion on elevation d. elevation of the contralateral lid on lateral gaze e. elevation of the lid on ipsilateral 136 adduction 26. The following are true about Holme-Adie's pupil: a. the diagnosis can be confirmed with edrophonium b. females are more commonly affected than males c. causes problem with reading that can be corrected with plus lenses d. constriction of pupil can occur e. partial relative afferent pupillary defect is seen in 50% of cases 27. Angioid streaks occur in: a. Sturge-Weber's syndrome b. Sickle cell disease SS c. pseudoexfoliation syndrome d. septo-optic dysplasia e. Ehlers-Danlos syndrome 28. The following are true about latanaprost: a. it is a prostaglandin inhibitors b. it reduces the intraocular pressure by increasing the uveal scleral outflow c. it has a greater effect than beta blockers in reducing the intraocular pressure d. hypertrichosis is a known side effects e. it is contra-indicated in patients with corneal graft rejection 29. Features of pigmentary glaucoma include: a. it is commoner in females than males b. it is a features of Chandler's syndrome c. the pressure can be controlled with argon 137 laser trabeculoplasty d. there is sectorial iris transillumination e. the intraocular pressure may rise sharply following exercise 30. In benign intracranial hypertension: a. there is a restriction of upgaze b. normal ventricles is found in 50% of cases c. brain scan is important in young woman to exclude saggital sinus thrombosis d. optic nerve fenetration should be performed early before the vision is affected e. ventricular-peritoneal shunt is indicated in the majority of patients 31. The following medications may interfere with contact lens wear: a. rifampicin b. contraceptive pill c. oral penicillin d. erythromycin e. digoxin 32. Gout: a. is caused by purine metabolism disorder b. causes scleritis c. causes tophi in the extraocular muscle tendon d. is directly related to alcohol consumption e. uric crystals may be found in the deep stroma 33. The following are true about iron deposition in the cornea: 138 a. Fleischer's ring is found at the apex of keratoconus b. Hudson-Stahli line is found in recurrent erosion syndrome c. Stocker's line is associated with pterygium d. Ferry's line is found at the front of a trabeculectomy bleb e. iron deposition occurs in radial keratotomy 34. The following are true about corneal grafts: a. zenografts refers to transplant between different species b. isografts refers to transplant between the same species c. lamellar keratoplasty is useful in patient with Fuch's dystrophy d. previous blood transfusion increases the incidence of rejection e. broken corneal suture can elicit rejection 35. Features of Goldenhar's syndrome include: a. unilateral epibulbar dermoids b. presence of preauricular skin tag c. presence of syndactyly d. increased incidence of angle closure glaucoma e. loss of pigments on eyelashes 36. Red-green colour defect is found in: a. optic neuritis b. Stargardt's disease c. tobacco amblyopia d. macular degeneration e. primary open angle glaucoma 139 37. The following clinical features are suggestive of a cavernous sinus lesion in a patient with unilateral third nerve palsy: a. dilatation of the pupil b. impaired ipsilateral corneal reflex c. constriction of pupil d. failure of the eye to abduct e. hearing loss 38. Features of carotid-cavernous fistula include: a. dilated superior ophthalmic vein on CT scan b. blood in the Schlemmn's canal c. proptosis of contralateral eye suggests bilateral carotid-cavernous fistula d. dural fistula is the commonest type seen following head injury e. traumatic fistula rarely close spontaneously 39. The following conditions are X-linked: a. Fabry's disease b. Refsum's disease c. Norries's disease d. choroideremia e. rod monochromatism 40. In mesodermal dysgenesis: a. Axenfeld's syndrome has posterior embryotoxon and iris hypoplasia b. Axenfeld's syndrome is inherited as an autosomal recessive disorder c. Rieger's anomaly is associated with dental and facial hypoplasia d. Peter's anomaly is associated with bilateral corneal opacities e. Peter's anomaly is associated with glaucoma in 50% of cases 41. In lattice degeneration: 140 a. 8% of the population have the condition b. photocoagulation is recommended for extensive cases c. holes should be treated d. it has a higher incidence amongst high myopes e. 25% of retinal detachment is due to lattice degeneration 42. The indication for subretinal fluid drainage include: a. immobilized retina b. bullous lesion where tear cannot be identified c. hypotony d. superior retinal detachment e. presence of blood in the vitreous 43. The following are true about intravitreal injection: a. it can cause secondary retinal tear b. it can cause cataract c. C3F8 has a longer half life than SF6 d. SF6 is more expansile than C3F8 e. SF6 causes less increase in the intraocular pressure than C3F8 44. In ptosis operation: a. brow suspension is the treatment of choice in severe congenital ptosis b. Fasavella-Servant is the treatment of choice in patients without levator function c. posterior approach is the recommended procedure in patient with previous ptosis surgery d. maximal resection is recommended in patients with mitochondrial myopathy e. Bell's phenomenon and corneal 141 sensation should be carefully assessed before surgery 45. Fourth nerve palsy can be treated with: a. ipsilateral superior recession b. ipsilateral inferior oblique recession c. contralateral inferior rectus resection d. ipsilateral superior oblique tucking e. ipsilateral inferior rectus recession 46. The following are true about corneal blood staining: a. it occurs in about 5% of hyphema b. it is related to the severity of the hyphaema c. it is commoner in decompensated cornea d. it is caused by red blood cells migrating into the stroma e. spontaneous clearing of the hyphema typically begins centrally 47. In acute bacterial endophthalmitis following cataract operation: a. Staphylococcus aureus is the most common pathogen b. presents within 48 hours of surgery in the majority of cases c. topical and systemic antibiotic are usually adequate to control the infection d. steroid is contraindicated e. it is often difficult to differentiate bacterial from mycotic causes 48. In peripheral iridotomy with laser: a. dark colour iris responds poorly to argon laser iridotomy b. more energy is needed for argon laser 142 than YAG laser for a given size iridotomy c. steroid pre-treatment is effective in decreasing the intraocular pressure d. presence of red reflex during the procedure indicate the iridotomy is patent e. significant cataract develops in 50% of cases following treatment 49. Unsuitable donor for corneal graft include: a. a history of conjunctivitis b. history of hepatitis A c. less than 10 years old d. endothelial cell count of less than 2000 per square mm e. senile dementia 50. In argon laser trabeculoplasty: a. the success rate is proportional to the energy used b. the results are better in the elderly than the young c. the intraocular pressure is reduced due to decreased aqueous production d. typically produce a drop in the intraocular pressure of between 10 and 15 mmHg e. it is used as an adjunctive treatment to maximal medical therapy 51. In refractive surgery; a. radial keratotomy may be used in myopes of 10D or more b. radial keratotomy is a well-established safe techniques with predictable result c. post-operative astigmatism may be reduced by removing the suture along the axis of the largest plus cylinders d. post-operative astigmatism may be reduced by removing sutures in the 143 flatter axis e. keratomileusis involves using a donor cornea 52. The following techniques are useful in reducing post-operative astigmatism: a. phacoemulsification rather than extracapsular technique b. the use of foldable lens c. a limbal incision rather than a corneal incision d. superior corneal approach rather than temporal approach e. divide and conquer technique during phacoemulsification rather than phacochop 53. The following are true about anterior capsule removal in cataract surgery: a. capsulorrhexis produces a stronger edge than can-opener capsulotomy b. capsulorrhexis requires less viscoelastic than can-opener capsulotomy c. displacement of the intraocular lens is less common with capsulorrhexis than can-opener capsulotomy d. hydrodissection of the lens is not required with capsulorrhexis e. capsulorrhexis is an easier technique to master than can-opener capsulotomy 54. Inferior oblique recession: a. need careful prism measurement b. is performed in ipsilateral fourth nerve palsy to remove cyclotorsion c. is performed in V-pattern esotropia d. is performed in contralateral superior rectus palsy 144 e. is easier to perform than inferior oblique myectomy 55. In unrecovered sixth nerve palsy: a. surgery can speed up recovery b. botulinum toxin injection into the ipsilateral medial rectus speeds up recovery c. resection/recession is in appropriate d. no more than two muscles should be operated e. can be treated with Faden's procedure on the contralateral medial rectus 56. The following are true about cystoid macular oedema: a. it causes visual impairment in 10% of uncomplicated extracapsular cataract operation b. the incidence of cystoid macular oedema is higher in intracapsular cataract extraction than extracapsular cataract operation c. the risk of cystoid macular oedema is increased in patients who have postoperative corneal oedema d. vitreous prolapsed is a known precipitating factor for cystoid macular oedema e. malpositioned of intraocular lens is a recognized factor for cystoid macular oedema 57. The following are true about the classification of retinopathy of prematurity: a. Stage 1: normal retina b. Stage 2: presence of demarcation lines that protrude into the vitreous c. Stage 3: presence of fibrovascular 145 proliferation in the peripheral retina d. Stage 4: total retinal detachment e. Stage 5: proliferative vitreous retinopathy 58. The following are true about pseudoexfoliation syndrome: a. the age when glaucoma develops is older than primary open angle glaucoma b. the intraocular pressure always responds better to medical treatment than primary open angle glaucoma c. asymmetrical glaucoma is more common than primary open angle glaucoma d. there is an increased pigment deposition in the trabecular meshwork e. trabeculectomy is less successful in controlling the pressure than in primary open angle glaucoma. 59. In radiation retinopathy: a. the main pathology is occlusive microangiopathy b. the lowest dose of radiation required to cause radiation retinopathy is 11 Gy c. the photoreceptors are more sensitive to radiation than the retinal vascular cells d. patients on chemotherapy are more vulnerable to radiation retinopathy e. hyperbaric oxygen is useful in preventing the progression of radiation retinopathy 60. The following are true about local anaesthesia: a. peribulbar anaesthesia requires a longer time than retrobulbar anaesthesia to achieve akinesia b. lignocaine requires a shorter time than marcaine to achieve anaesthesia c. lignocaine has a longer duration of 146 action than marcaine d. topical amethocaine is inadequate for iris anaesthesia e. retrobulbar haemorrhage increases the risk of expulsive haemorrhage Test 12 (neuro-ophthalmology) 1. The following are true about neuroretinitis caused by cat-scratch fever: a. the pathogen is Bartonella henselae b. the disease is usually acquired from cat under one year of age c. skin test is commonly used to diagnose the condition d. lymphadenopathy is common e. low-grade fever is usually present a.T b.T c.F d.T e.T 2. Neuroretinitis from cat-scratch fever: a. shows optic nerve swelling b. macular star is typical c. the vision usually returns to normal even without treatment d. antibiotics shorten the course of the disease e. is usually bilateral a.T b.T c.T d.T e.F 147 3. The following are true about cat-scratch fever: a. it is caused by a Gram positive bacillus b. caseating granulomas are seen in lymph node c. in patients who develop neuroretinitis, visual loss is typically preceded by systemic illness d. it is a cause of Parinaud's oculoglandular fever e. an aching neck with cough or movement is common a.F b.T c.F d.T e.T 4. Cecocentral scotoma occurs in: a. vitamin A deficiency b. vitamin B12 deficiency c. folate deficiency d. thiamine deficiency e. vitamin E deficiency a.F b.T c.T d.T e.F 5. The following are features of nutritional optic neuropathy: a. temporal pallor of the optic discs b. relative afferent pupillary defect c. constricted visual fields d. loss of the fibres in the papillomacular bundle. e. colour vision loss a.T b.F c.F d.T e.T 148 Test 13 (uveitis) 1. The following are true about TINU (tubulointerstitial nephritis uveitis) syndrome: a. the median age is 15 years of age. b. females are more frequently affected than males. c. sarcoidosis is the most common cause d. the uveitis typically occurs before the renal problems e. the most common type of uveitis in TINU syndrome is bilateral anterior uveitis a.T b.T c.F d.F e.T 2. The following are true about TINU syndrome: a. ibuprofen is associated with TINUS b. the uveitis must occur within 12 months of the acute interstitial nephritis. c. permanent visual loss occurs in 25% of patients d. the renal lesion is characterized by T-cell infiltration. e. chronic renal disease is uncommon a.T b.T c.F d.T e.T 3. The following are commonly seen in TINU syndrome: a. anaemia b. raised ESR c. elevated immunoglobulins 149 d. elevated creatinine e. increased urinary beta-2-microglobulin. a.T b.T c.T d.T e.T 4. The following HLA types are associated with increased risk of uveitis: a. HLA B51 b. HLA B7 c. HLA A29 d. HLA DR3 e. HLA DR2 a.T b.T c.T d.T e.T 5. The following conditions can give rise to both uveitis and erythema nodosum : a. Crohn's disease b. Behcet's disease c. sarcoidosis d. rheumatoid arthritis e. systemic lupus erythematosus a.T b.T c.T d.F e.T More MCQs Test 14 (neuro-ophthalmology) 1. The following signs and symptoms are useful for differentiating 150 between papilloedema and optic neuritis: a. central scotoma. b. decreased visual acuity c. optic disc swelling d. history of recurrent transient arm weakness e. pain behind eye a.T b.T c.F d.T e.T 2. In a patient with optic neuritis, the following signs are suggestive of multiple sclerosis: a. muscle weakness after taking a hot bath b. difficulty in walking heel to toe c. urine incontinence d. wasting of small muscles of the head e. nystagmus a.T b.T c.T d.F e.T 3. Syringobulbia causes: a. nystagmus b. dysphagia c. tongue wasting d. bilateral Babinski's signs e. impaired perception of pain and temperature with preserved light touch and propioception in the upper extremities a.T b.T c.T d.T e.T 4. In a patient with optic atrophy, the following signs are useful in 151 differentiating subacute combined degeneration of the cord from multiple sclerosis: a. absent ankle jerk b. bilateral Babinski signs c. sensory loss in a stocking distribution d. macrocytic anaemia e. ataxia a.T b.F c.T d.T e.F 5. In a patient with ptosis and diplopia, the following findings are suggestive of myasthenia gravis : a. symmetrical involvement b. thymoma on CT chest scan c. increased serum creatinine phosphokinase d. improved lid movement after applying ice cube to the lid e. absent tendon reflexes a.F b.T c.F d.T e.F Test 15 (optic discs) 152 Refer to this picture for question 1, 2 & 3 1. The following conditions are associated with the picture above: a. pseudoxanthoma elasticum b. retinitis pigmentosa c. age-related macular degeneration d. retinal detachment e. retinoschisis a.T b.T c.F d.F e.F 2. The following are true: a. the lesions are situated within the myelinated part of the optic disc b. they occur more commonly in patients with small discs c. they can be inherited as a autosomal recessive trait d. ultrasound is useful for diagnosis e. MRI is useful for diagnosis. a.F b.T c.F d.T e.F 3. Visual loss can result from a. optic atrophy b. retinal detachment 153 c. papilloedema d. venous occlusion e. peripapillary choroidal neovascularization. a.T b.F c.F d.T e.T Refer to the picture above for question 4. 4. Ocular association include: a. lens coloboma b. foveal hypoplasia c. serous macular detachment d. aniridia e. persistent hyperplastic primary vitreous a.T b.T c.T d.T e.T Refer to the picture above for question 5 154 5. Conditions associated with the picture include : a. trisomy 22 b. trisomy 21 c. trisomy 18 d. trisomy 13 e. Turner's syndrome a.T b.F c.T d.T e.F Test 16 (ocular parasitology) Refer to the picture above for question 1, 2 & 3 1. This parasite is found in the following regions of the world: a. Far East b. South America c. Southern Europe d. South Africa e. West Africa a.F b.T c.F d.F e.T 2. The vector for the parasite above is: 155 a b c d e. a.F b.F c.T d.F e.F 3. Causes of blindness include: a. trichiasis b. keratitis c. optic neuritis d. chorioretinitis e. chronic non-granulomatous iridocyclitis a.F b.T c.T d.T e.T 156 Refer to the above picture for question 4, 5 & 6 4. The above patient has been doing some country walking recently, which pest(s) are likely to be the cause of this skin lesion: a b c d e 157 a.F b.T c.F d.T e.F 5. The patient develops arthralgia and conjunctivitis a few weeks later. Which organism is the most likely cause? : a. b. c. 158 d. e. a.T b.F c.F d.F e.F 6. The following are true about the ocular manifestations: a. it is commoner in Europe than in North America b. conjunctivitis is commoner than uveitis c. the uveitis is typically non-granulatomatous d. uveitis usually occurs in the first stage of the disease e. systemic antibiotic has no effect on the course of the ocular disease a.T b.T c.F d.F e.F 159 Test 17 (paediatric ophthalmology) Refer to the picture above for question 1. 1. The organisms responsible for the above appearance include: a. 160 b. c. d. e. a.T b.T c.F d.T e.F 161 Refer to this picture for question 2. 2. The following conditions are associated with the picture above: a. b. 162 c. d. e. a.T b.T c.F d.T e.T 163 Refer to the picture above for question 3. 3. Related features in this boy include:: a. b. c. 164 d. e. a.F b.T c.F d.T e.F Refer to this picture for question 4. 4. Associated features include: a. 165 b. c. d. e. a.T b.T c.F d.F e.T 166 Refer to the picture above for question 5. 5. The following investigation(s) is/are useful for confirming the diagnosis: a. b. c. d. 167 e. a.F b.F c.T d.F e.F An albino retina vs a normal retina. Note the absence of pigments in the RPE. Test 17 (paediatric ophthalmology) 168 Refer to the picture above for question 1, 2 & 3. 1. You are asked to examine the fundi of a baby with suspected non-accidental injury and find the above appearance. The following are possible causes: a. coagulopathy b. normal vaginal delivery c. proliferative diabetic retinopathy d. glutaric aciduria e. optic nerve glioma a.T b.T c.F d.T e.F 2. The paediatrician suspects shaken baby syndrome and order some radiological investigations. The following pictures are consistent with the suspicion: a. 169 b. c. d. 170 e. a.T b.T c.T d.F e.F 3. The final diagnosis was shaken baby syndrome. The following are true about the ocular features: a. retinoschisis is a cause of ocular scarring b. the retinal haemorrhages are confined to the superficial layer c. retinal haemorrhages are necessary for the diagnosis of shaken baby syndrome d. the main cause of visual loss in this condition is retinal haemorrhages. e. ERG is useful in distinguishing between ocular and brain causes of visual loss. a.T b.T c.T d.T e.T 171 This is the fundal appearance of a child with mental retardation. Refer to this picture for question 4 & 5. 4. The mother of this child may have the following skin lesion in her first trimester: a. b. c. d. 172 e. a.F b.T c.F d.F e.F 5. The following signs may be seen: a. b. c. 173 d. e. a.T b.F c.T d.T e.T ' Test 17 (phakomatoses) Refer to the pictures above for question 1 & 2 1. Other ocular manifestations of the above condition include: 174 a. b. . c. d. 175 e. a.F b.T c.T d.T e.F 2. Other manifestations of this condition include: a. b. 176 c. d. e. a.F b.T c.T d.T e.F 177 Refer to the picture above for question 3 3. Systemic associations include: a. b. 178 c. d. e. a.F b.T c.T d.T e.F Refer to the above picture for question 4 4. The following are associated features: 179 a. b. c. d. 180 e. a.T b.T c.F d.F e.T Refer to the picture above for question 5 5. Associated features for the above condition include : a. b. 181 c. d. e. a a.T b.F c.T d.T e.F More MCQs Test 20 (systemic diseases and ophthalmology) 182 Refer to this picture for question 1. 1. The following can precipitate or result from the condition shown in the picture above: a. b. c. 183 d. e. a.T b.T c.T d.F e.T Refer to these picture for question 2. The figures show the same patient before and after an intravenous injection. 2. The following can be associated with the pictures above: 184 a. b. c. 185 d. e. a.T b.T c.T d.T e.T Refer to this picture for question 3. a 3. The following are associated with the sign shown above: 186 a. b. c. d. 187 e. a.T b.T c.T d.T e.F e d Refer to this picture for question 4. 4. Systemic association include: a. 188 b. c. d. e. a.T b.T c.T d.T e.T 189 Refer to the picture above for question 5. 5. The child may have the following additional signs: a. b. c. 190 d. e. a.T b.T c.T d.F e.T More MCQs Test 21 (systemic diseases) Refer to this picture for question 1. 191 1. Related features include: a. b. c. d. 192 e. a.T b.T c.T d.T e.T Refer to this picture for question 2. 2. Blood films related to the above appearance include: a. 193 b. c. d. e. a.T b.F c.T d.T e.T 194 Refer to this picture for question 3. 3. The above condition can be caused by: a. b. c. 195 d. e. a.T b.T c.T d.T e.T Refer to the picture above for question 4. 4. Recognized causes for the above condition include: a. 196 b. c. d. 197 e. a.T b.T c.T d.T e.T Refer to the picture above for question 5. 5. Causes of the above appearance include: a. 198 b. c. d. 199 e. a.F b.F c.F d.F e.F More MCQs Test 22 (neuro-ophthalmology) Refer to this picture for question 1. 1. The following signs may occur in this patient: a. 200 b. c. d. e. a.T b.F c.T d.F e.F 201 Refer to this picture for question 2 2. Condition that can give rise to this picture include: a. b. 202 c. d. e. a.T b.T c.F d.F e.F 203 ... The two pictures (before and after treatment) were taken about 20 years apart. 3. The following are true: a. craniotomy scar is likely to be present b. abdominal scar is likely to be present c. if he fails to take his medication, hypotension and hyperkalaemia will occur. d. bitemporal hemianopia may be present e. junctional scotoma may be seen a.F b.T c.T d.T e.T Refer to the picture above for question 4. 4. The right pupil is dilated and the result of the swinging light test is as shown above. The following may account for the findings: a. the examination is normal b. the patient may have a right optic atrophy c. the patient may have a left optic atrophy 204 d. the patient may have advanced left glaucoma e. the patient may have a right macular hole a.F b.T c.F d.F e.F Refer to this picture for question 5. 5. Drugs which can precipitate myasthenia gravis include: a. b. 205 c. d. e. a.T b.T c.T d.F e.T More MCQs 206 Test 23 (anterior segment) a. 1. b. c. d. e. f. 2. 3. 4. 5. 6. Match the clinical pictures (in alphabets) with the appropriate histological changes (in numbers). a. 1. b. 2. c. 3. 207 d. 4. e. 5. f. 6. a=4; b=3; c=6; d=1; e=2; f=5. More MCQs Test 24 (eyelids) a. b. c. d. 208 e. f. 1. 2. 3. 4. 5. 6. Match the eyelid skin lesions (in alphabets) with their histological appearance (in numbers) a. 1. b. 2. c. 3. d. 4. 209 e. 5. f. 6. a=4; b=5; c=6; d=2; e=1; f=3 More MCQs questions Test 25 (conjunctiva) a. b. c. d. e. 1. 2. 3. 4. 5. Match the conjunctival disorders (in alphabets) with their histological appearance (in numbers). 210 a. 1. b. 2. c. 3. d. 4. 211 e. 5. a=5; b=1; c=2; d=3; e=4. Test 26 (neuro-ophthalmology) 1. The following are features of melanoma-associated retinopathy: a. central scotoma b. night vision impairment c. abnormal electroretinogram d. antibody to rods e. presence of distant skin melanoma rather than choroidal melanoma a.F b.T c.T d.T e.T 2. Features of cancer-associated retinopathy include: a. narrowing of the retinal artery b. abnormal electroretinogram c. stationary bilateral visual loss 212 d. optic atrophy e. the most common underlying cause is breast carcinoma a.T b.T c.F d.T e.F 3. In Leber's hereditary optic neuropathy: a. visual recovery is usually poor b. peripapillary telangiectasia is a late feature of the disease c. 14484 mutation at the mitochondria is associated with a better visual prognosis d. 17788 mutation is the most common mitochondrial mutation seen in this condition e. only male patients are affected. a.T b.F c.T d.T e.F. 4. The following are true about ocular myasthenia gravis: a. thymomectomy is usually performed to improve the ocular signs b. application of ice to a ptotic eye may worsen the symptom c. the majority of myasthenic patients have ocular involvement d. squint operation should never be carried out on myasthenic patients e. single fibre electromyography of the orbicularis oculi may show increased jitter a.F b.F c.T d.F e.T 5. True statements about non-arteritic ischaemic optic neuropathy 213 include: a. more common in males than females b. headache is not a feature c. it is associated with an increased incidence of hypertension and diabetes mellitus d. optic nerve fenestration is beneficial e. aspirin can improve the visual prognosis of the affected eye a.T b.T c.T d.F e.F More MCQs Test 27 (Medical retina) 1. Differentiating classic and occult neovascular membranes is possible using: a. Amsler grid b. indocyanine green c. fundus fluorescein angiography d. optical coherence tomography e. B-scan ultrasound a.F b.T c.T d.F e.F 2. The following are true about choroidal neovascular membranes (CNV): a. subfoveal CNV is best treated with direct focal argon laser 214 b. juxtafoveal CNV is 0-200um from the foveal avascular zone c. extrafoveal CNV is more than 200um from foveal avascular zone d. optic nerve pit is a cause of CNV e. optic disc drusen is a cause of CNV a.F b.T c.T d.F e.T 3. The following statements are true regarding dry age-related macular degeneration (AMD): a. it will typically have a visual acuity of 6/60 or worse within 2 years b. the optimal management is with low visual aids c. the contralateral eye will be simultaneously affected in all cases d. the patient should be promptly referred for fluorescein angiography e. dry AMD can be treated with photodynamic therapy without verteporfin a.F b.T c.F d.F e.F 4. Photodynamic therapy (PDT) is useful for the following conditions resulting from age-related macular degeneration : a. retinal pigment epithelium detachment b. disciform macular degeneration c. geographic atrophy d. occult subfoveal neovascular membrane 215 e. classic subfoveal neovascular membrane a.F b.F c.F g d.T e.T 5. The following are true about verteporfin used in photodynamic therapy (PDT): a. verteporfin is activated by green laser light b. verteporfin is a derivative of prophyrin c. it generates free radicals which causes blood clotting local to the lesion d. it destroys the new vessels through heat e. it is contraindicated in pseudophakia a.F b.T c.T d.F e.F More MCQs Test 28 (Uveitis) For more information on the topics below, click here to download an update on uveitis by the American Academy of Ophthalmology. 1. The following medications are effective against toxoplasma tissue cysts: a. clindamycin b. pyrimethamine c. sulphonamides d. azithromycin e. atovaquone a.F b.F c.F d.T e.T 216 2. In an immunocompromised patient with retinitis, a diagnosis of toxoplasma retinitis is favoured over cytomegalovirus (CMV) retinitis by the presence of: a. ocular pain b. dense vitreous reaction c. retinal haemorrhages d. granulomatous anterior chamber reaction e. scattered small lesion throughout the posterior segment a.T b.T c.F d.T e.T 3. The following are true about active ocular toxoplasmosis: a. the antibodies are always present b. the central nervous system should be evaluated for toxoplasmosis in all immunocompromised patients c. indocyanine green can be used to detect clinically invisible active satellite lesions d. the border of the lesion is sharply defined e. it is the commonest cause of retinitis in AIDS patients a.F b.T c.F d.F e.F 4. The following drugs are known to cause uveitis : a. rifabutin b. cidofovir c. methotrexate d. latanoprost 217 e. chloramphenicol a.T b.T c.F g d.T e.F 5. HAART (Highly Active Anti-virus Therapy) a. uses a combination of antiretroviral therapy b. decreases the incidence of CMV retinitis c. reduces the need for long-term maintenance therapy in patients with established CMV retinitis d. increases the number of CD4+ lymphocytes e. causes uveitis during treatment a.T b.T c.T d.T e.T More MCQs Test 29 (Herpetic eye disease) 1. The following are true about herpes simplex: a. herpes keratitis in infants is caused mainly by type II herpes simplex b. ocular disease is the most common manifestation of primary type I herpes simplex c. herpes simplex can be contracted from pests d. ocular recurrence is usually caused by virus reactivation within the trigeminal ganglia e. ocular recurrence is more common than either genital or oral recurrence a.T b.F c.F d.T e.F 218 2. With regard to herpes epithelial ulcer: a. the sensation is reduced b. the disease usually presents initially as punctate keratitis c. geographical ulcer occurs as a result of inappropriate use of topical steroid d. the ulcer has typical tapering endings e. Rose Bengal stains infected epithelial cells a.T b.T c.T d.F e.T 3. The following are true about acyclovir a. topical acyclovir is more effective than oral acyclovir in the treatment of herpes simplex epithelial keratitis b. valacyclovir is the prodrug of acyclovir c. the dosing frequency is less with valacyclovir than acyclovir d. oral acyclovir reduces the incidence and severity of postherpetic neuralgia e. oral acyclovir given daily can reduce the recurrent of herpes simplex epithelial keratitis a.F b.T c.T d.F e.T 4. In the treatment of herpes simplex ocular disease : a. oral acyclovir has no effect on the development of stromal keratitis in the subsequent year when given during active herpes simplex keratitis b. oral acyclovir reduces the development of iritis in the subsequent year when given during active herpes 219 simplex keratitis c. in patients with previous herpes simplex stromal keratitis, oral acyclovir reduces the likelihood of recurrent stromal disease d. stopping oral acyclovir in a patient with previous herpes simplex stromal keratitis causes rebound of herpes simplex disease e. oral acyclovir has no effect on herpes simplex iritis a.T b.F c.T d.F e.F 5. In the treatment of herpes simplex stromal disease, HEDS (Herpetic Eye Disease Studies) show that: a. topical steroid reduces the duration of the disease b. patients on topical steroid has better visual outcome at six months review than the non-steroid treated group c. topical steroid increases the likelihood of epithelial disease d. systemic steroid is useful in the management of necrotizing stromal keratitis e. oral acyclovir has added benefit in patients treated with topical steroid and trifluridine a.T b.F c.F d.F e.F More MCQs Test 30 (Neuro-ophthalmology) 1. Vertical nystagmus: a. occurs in phenytoin toxicity b. in an unconscious patient suggests thalamic lesion 220 c. can present with oscillopsia d. if upbeating indicates cerebellar tonsillar ectopia e. if downbeating indicates a lesion in the pons a.T b.F c.T d.F e.F 2. The following are true about blepharospasm: a. it is commoner in males than females b. a brain scan should always be performed c. it is often caused by compression of the facial nerve by intracranial artery d. orbicularis oculi stripping is the treatment of choice e. neuroleptic drug is a common cause a.F b.F c.F d.F e.F 3. In Creutzfeldt-Jakob disease (CJD): a. the protein content of the cerebrospinal fluid is raised b. EEG shows characteristic waveform c. death usually occurs within 12 months of onset d. cortical blindness is common e. the causative agent is a retrovirus a.F b.T c.T d.T e.F 4. In multiple sclerosis : a. onset with optic neuritis or sensory symptoms tend to have better prognosis 221 b. low amplitude of visual evoked potential strongly support optic nerve involvement c. CSF lymphocytosis is a feature d. oligoclonal band in the CSF supports the diagnosis e. the prognosis is worse for males than females a.T b.F c.F d.T e.T 5. In Bell's palsy: a. mild pain in the mastoid area is common at the onset b. corneal sensation is reduced c. the blink reflex is impaired d. complete facial palsy is associated with poor prognosis e. electrophysiological testing is useful in predicting prognosis a.T b.F c.T d.T e.T More MCQs Test 31 (glaucoma) 222 Refer to question 1 1. The above picture is taken from a patient in his mid-20s. The following are true: a. the iris is likely to be convex b. there is posterior insertion of the iris root c. lattice degeneration is common d. the sex distribution of this condition is the same e. the risk of glaucoma development is commoner in females than males a.F b.T c.T d.T e.F Refer to question 2 223 2. The above is an appearance obtained through gonioscopy: a. the angle is at risk of closure b. there may be peripupillary transillumination c. the patient may be pseudophakic d. the pressure is likely to be above 21mmHg e. the patient may be a poorly controlled diabetic a. F b.T c.T d.F e.T Refer to question 3 3. The following are true with regard to the picture above: a. the patient may be of tall stature and myopic b. deafness may be present c. there may be arachnodactyly d. there is a risk of lens dislocation e. if the pressure is raised, the treatment of choice is intensive pilocarpine 224 a.F b.T c.F d.T e.F Question 4 4. Regarding the above picture: a. it is obtained with OCT (optical coherence topography) b. it is obtained with the use of laser c. it is used to analyse nerve fibre layer thickness d. the blue area has more nerve fibres than the red area e. it can be used to diagnose glaucoma on its own a.F b.T c.T d.F e.F 225 Refer to question 5 5. With regard to the above visual field results: a. it is obtained with octopus perimeter b. the test uses yellow light c. the M cells are tested d. it tests neurones that are sensitive to low-contrast stimulus e. it can theoretically detect glaucoma at an early stage a.F b.F c.T d.T e.T More MCQs Test 32 (Thyroid eye disease) 1. Thyroid eye disease is exacerbated by: a. radio-iodine treatment of hyperthyroidism b. development of hypothyroidism after treatment of hyperthyroidism 226 c. smoking d. male sex e. presence of diabetes mellitus a.T b.T c.T d.T e.F 2. Upper eyelid retraction in thyroid eye disease is caused by: a. adrenergic stimulation of the Muller's muscle b. superior oblique muscle fibrosis c. inferior rectus fibrosis d. fibrosis of the levator e. fatty infiltration of the levator a.T b.F c.T d.T e.F 3. Thyroid eye disease: a. is seen in 40% of patients with Graves' disease b. does not occur in Hashimoto's thyroiditis c. is not a feature of thyroid cancer d. tends to peak 6 months from onset e. usually cease to be active 18 months after onset a.T b.F c.T d.T e.T 4. The following are true about the radiological features of thyroid eye disease: a. inferior and lateral recti are the two extraocular muscles most often involved 227 b. the tendon of the affected muscle is not involved c. medial rectus enlargement is more likely than inferior rectus enlargement in causing compressive optic neuropathy d. oedema of the extraocular muscle is best diagnosis with B-scan e. STIR-sequence MRI is useful in assessing the activity of thyroid eye disease a.F b.T c.T d.F e.T 5. The following are true about thyroid eye disease: a. the orbital tissue is infiltrated by B cells during the active phase b. when performing orbital decompression for optic neuropathy, the medial wall should be removed c. lacrimal gland enlargement is common d. bicoronal flap is the best approach for orbital decompression e. diplopia is a common complication of orbital decompression a.F b.T c.F d.F e.T More MCQs Test 33 (External eye disease) 228 1. This patient has this appearance in both eyes, the following are true: a. the condition is autosomal dominant b. vision is rarely affected until middle age c. recurrent erosion affects more than 50% of the patients d. the endothelium is normal e. the lesion is best stained with alcian blue a.T b.T c.F d.T e.F 2. This patient underwent a corneal procedure recently and complains of photophobia and pain. The opacities do not stain with fluorescence. The likely procedure is: 229 a. excimer laser b. EDTA removal of band keratopathy c. radial keratotomy d. LASIK e. micropuncture of the cornea a.F b.F c.F d.T e.F 3. The above picture is taken of a patient who has had a corneal graft. The following are true: a. the picture shows an early sign of graft rejection b. the graft is at risk of dysfunction unlike treated with intensive steroid c. the line seen above is located in the posterior stroma of the cornea d. untreated, the line will move across the cornea e. the line is made up of aggregates of macrophages a.F b.T c.F d.T e.F 230 4. This patient presents with bilateral photophobia without conjunctivitis. No history of infective conjunctivitis is known. Fluorescence shows epithelial stainings. The slit-lamp features are as shown above. The following are true: a. anterior uveitis is likely to be present b. vision is likely to be impaired due to corneal scarrings c. the corneal sensation is reduced d. topical acyclovir is useful e. topical steroid is useful a.F b.F c.F d.F e.T 5. This patient complains of foreign body sensation and photophobia. There are no signs of cells in the anterior chamber or foreign body. The following is true: 231 a. the patient usually have bilateral red eyes in primary position b. the patient is likely to be female than male c. follicular conjunctivitis of the upper lid is a feature d. the cornea is not affected e. RGP (rigid gas permeable) contact lens wear is a cause a.F b.T c.F d.F e.T MCQs on Uveitis 1. The matching of the following diseases and their HLA association are true: a. sympathetic ophthalmitis b. par planitis HLA-A11 HLA-DR2 c. cicatricial pemphigoid HLA-B5 d. Posner-Schlosmann syndrome e. Vogt-Koyanagi-Harada 1. a.T b.T c.F d.T HLA-BW5 HLA-B22 e.T 2. Severe vitritis is a feature of: a. cytomegalovirus retinitis b. serpigionous choroidpathy c. presumed ocular histoplasmosis 232 d. acutre retinal necrosis e. toxoplasma retinochoroidopathy 2. a.F b.F c.F d.T e.T 3. In ocular toxocarisis: a. a history of visceral larva migrans is always present b. examination of the patient's stool is useful in diagnosing the disease c. bilateral ocular involvement should make one doubt the accuracy of the diagnosis d. ultrasound of the granuloma typically shows calcification e. oral thiabendazole is useful 3. a.F b.F c.T d.F e.F 4.In juvenile chronic arthritis-related uveitis: a. the uveitis is usually granulomatous b. the eyes are typically white c. the uveitis usually precedes arthritis d. it is associated with positive rheumatoid factor e. cystoid macular oedema is an important cause of poor vision 4. a.F b.T c.F d.F e.F 5. The following are true with regard to cataract in juvenile chronic arthritis: a. cataract should not be performed before the patients is 8 year-old b. operation should be performed only when the anterior chamber is free of flare 233 c. removal of the cataract should be combined with anterior vitrectomy d. hypotony is a known post-operative complication in these patients e. only heparin-coated intraocular lens should be implanted. 5. a.F b.F c.T d.T e.F 6. The following are true about cytomegaloviral retinitis: a. it is rarely seen in patients with a CD 4+ counts of more than 50 cells/ul b. it causes full thickness retinal necrosis c. frosted branch retinitis is a known clinical feature d. spontaneous resolution in about 30% of patients without treatment e. anti-CMV antibody is useful for diagnosis 6. a.T b.T c.T d.F e.F 7. In the treatment of CMV retinitis: a. ganciclovir, foscanet and cidofovir are all virostatic b. ganciclovir causes bone marrow suppression c. foscanet is associated with renal impairment d. cidofovir is associated with hepatic dysfunction e. recurrent CMV retinitis is rare in patients on a maintenance dose of ganciclovir, foscanet or cidofovir 7. a.T b.T c.T d.F e.F 234 8.True statements about HAART (highly active anti-retroviral therapy) include: a. it reduces the recurrent rate of CMV retinitis b. it is useful in maintaining a high level of CD 4+ counts c. it is useful in treating acute retinal necrosis d. it causes increased vitritis e. there is an increased risk of cystoid macular oedema 8. a.T b.T c.F d.T e.T 9. In AIDS patients with toxoplasma retinitis: a. brain abscess occurs in 40% of cases b. the retinitis is more severe than immunocompetent patients c. treatment is only needed in patients with impaired vision d. retinal detachment is a common cause of visual loss e. steroid is contraindicated 9. a.T b.T c.F d.F e.T 10. A pregnant woman develops toxoplasmosis in her first trimester of pregnancy. The following are true: a. there is a 40% chance of the fetus acquiring the infection b. subsequent offsprings are at risk of infections c. the Ig M antibody will be raised d. abortion is advised due to the high risk of fetal malformation e. sulphadiazine is the preferred treatment than clindamycin 10. a.T b.F c.T d.F e.F 235 11. True statements about pars planitis include: a. it is associated with multiple sclerosis in 5% of cases b. sheathing of the vein is caused by perivascular cuffing of lymphocytes c. snowbanking is the result of hard exudate d. vitreous balls are composed of epitheloid cells and multinucleated giant cells e. vitreous haemorrhage is the most common cause of visual loss 11. a.T b.T c.F d.T e.F 12. A 20 year-old man complains of decreased right vision. Four weeks earlier, he had undergone an extensive bowel operation for Crohn's disease and had received hyperalimentationa dn intravenous antibiotics since the operation. On fundal examination, a fluffy white choroidal lession is seen near the macula. There is minimal vitritis. The following are true about the organisms most likely to be responsible for this condition: a. culture of the blood is usually positive b. although commonly seen in the respiratory tract, it rarely causes pneumonia c. this organism will grow on the Sabouraud's culture within 48 hours d. the organism rarely invade the retina e. intravenous vancomycin is the treatment of choice 12. a.F b.T c.T d.F e.F 13. In serpiginous choroiditis: a. there is loss of retinal pigment epithelium and the choroid b. the lesion typically begins near the optic disc 236 c. visual loss is caused chiefly by cystoid macular oedema d. fluorescein angiography in the acute phase reveals early hyperfluorescence of the lesions e. systemic cyclosporine is the treatment of choice 13. a.T b.T c.F d.F e.F 14. True statements about APMPPE (acute posterior multifocal placoid pigment epitheliopathy) a. females are more commonly affected than males b. recurrence does not occur c. in the later phase of the fluorescein angiography, the lesions appears hyperfluorescent d. pigmentary disturbance is common in the recovery phase e. most patients maintain normal vision on recovery 14. a.F b.F c.T d.T e.T 15. The following drugs are known to cause anterior uveitis: a. topical alphagan b. rifabutin c. rifampicin d. digoxin e. alpha-chymotrypsin 15. a.T b.T c.F d.F e.T 16. In Schwartz's syndrome: a. there is raised intraocular pressure 237 b. the underlying cause is rhegmatogenous retinal detachment c. granulomatous uveitis is a feature d. there is forward movement of the lens-iris diaphragm e. macular oedema is a main cause of visual loss 16. a.T b.T c.F d.F e.F 17. In Fuch's heterochromic cyclitis: a. Koeppe's nodules are seen b. abnormal vessels are seen bridging the angle of the trabecular meshwork c. cataract is seen in 50% of the cases d. glaucoma is seen in 15% of the cases e. there is an increased vitreous loss during phacoemulsification 17. a.T b.T c.T d.F e.F 18. Posner-Schlossman syndrome: a. is painless b. does not cause glaucomatous field loss c. is associated with hypopyon in the majority of cases d. is a self-limiting condition e. should be treated with systemic steroid 18. a.F b.F c.F d.T e.F 19.The following immunosupprassants and their side-effects are true: a. cyclophophamide - haemorrhagic cystitis b. cyclosporine - bone marrow dysplasia 238 c. azathioprine - nephrotoxicity d. methotrexate - hepatic fibrosis e. tacrolimus (FK506) - hyperglycaemia 19. a.T b.F c.F d.T e.T 20. A 25 year-old man from the Middle East complains of blurred right vision. On examination, he was found to have a small hypopyon in the right anterior chamber. Posterior segment of the right eye reveals sheathing of the blood vessels with retinal haemorrhages. He gave a past history of painful lesions in his mouth and his genitals. The following are true about this condition: a. histopathology of the painful lesion reveals pathognomonic feature b. puncturing the skin with an hypodermic needle may be useful in diagnosis c. the posterior segment pathology is caused by inflammation of the retina and choroid d. oral steroid alone is usually effective in preventing relapse of the ocular inflammation e. unless treated aggressively, the ocular inflammation will become chronic 20. a.F b.T c.F d.F e.F Return to the main page Cornea MCQs 1. Conditions that can give rise to the following appearance include: 239 a. superior limbic keratoconjunctivitis b. Sjogren's syndrome c. Bell's palsy d. Thygeson's keratitis e. adenoviral keratitis a.F b.T c.T d.F e.F 2. Conditions that may be associated with the following cornea appearance include: a. Sjogren's syndrome b. cerebrovascular accident c. prolonged patching d. iritis e. herpes simplex keratitis a.T b.T c.T d.F e.F 3. With regard this physical sign: 240 a. the abnormality is seen in the stroma b. the underlying condition is inherited in an autosomal dominant fashion c. its absence makes the diagnosis of the underlying condition unlikely d. it usually begins at the nasal limbus e. a brain MRI scan may of this patient may show the picture below a.F b.F c.F d.F e.T 4. The following are true about this condition: 241 a. it is related to solar damage b. it is seen in chronic corneal inflammation c. the Bowman's membrane is replaced by scar tissue d. histology shows amyloid deposits e. penetrating keratoplasty is useful in patients with involvement of the visual axis a.F b.T c.T d.F e.F 5. This is the corneal appearance of a contact lens wearer. The picture on the right is the organism responsible: Figure 1 a. the organism originates in the tap water b. a corneal biopsy may show the picture below (Figure 3) c. the condition is responsive to gentamicin d. ciprofloxacin can be used as monotherapy e. the organism is difficult to eradicate 242 Figure 2 Figure 3 a.F b.F c.T d.T e.F Click here for more MCQs Cornea MCQs 1. The following specimen is taken from a patient who has bilateral abnormal corneal appearance. Similar corneal changes are also seen in some of his relatives. True statements include: a. this is an autosomal recessive condition b. glaucoma occurs in 50% of the cases c. corneal decompensation is common by 40 years of age d. the slit-lamp examination may be similar to figure1 (below) e. the electron microscopy may show changes similar to figure 2 (see below) 243 Figure 1 a.F b.F c.F d.T Figure 2 e.T 2. The following corneal appearance belongs to a patient who had had blunt ocular trauma:: a. it is commoner in secondary hyphaema than primary hyphaema b. high intraocular pressure favors this appearance c. histology will reveals red blood cells in the stroma d. clearing of the opacity usually begins in the periphery e. visual disturbance is usually minimal a. T b.T c.F d.T e.F 3. With regard to the following condition: 244 a. the Bowman's layer is seldom involved. b. there are three components (ie. a head, cap and body) to this tissue. c. the whole abnormal structure is adherent to the corneal surface. d. it is commoner in white than black population. e. the following corneal topography may be taken from a patient with this condition. a.F b.T c.T d.F e.T 4. The following corneal topography is taken from a patient with bilateral poor vision: 245 a. there is inferior thinning of the cornea b. against the rule astigmatism is common c. iron deposition on the cornea is rare d. corneal neovascularization is a common complication. e. acute hydrop secondary to Descemet's membrane break can occur a.T b.T c.T d.F e.T 5. True statements about the following corneal appearance include: a. endothelial count is reduced b. topical steroid is contraindicated in this condition c. associated with sudden onset hearing loss d. can occur after tick bite e. corneal biopsy is useful for diagnosis a.T b.F c.T d.T e.F 246 Click here for more MCQs Cornea MCQs 1. The tissue below is taken from a patient who had had a corneal graft. The following are true about this condition: a. the tissue has been stained with PAS b. the picture above shows multiple abnormal endothelial cells c. the patient is more likely to be a female than male d. vision is typically worse towards the end of the day e. the condition is painless a.T b.F c.T d.F e.F 2. True statements about ferritin lines include: 247 a. ferritin line around keratoconus (A) is called the Fleischer's ring b. ferritin line at the edge of a trabeculectomy bleb (B) is called the Stocker's line c. ferritin line seen in the elderly cornea (C) is called the Henle's line d. ferritin line at the edge of pterygium (D) is called the Ferry's line e. ferritin lines result from iron deposition from the tear a.T b.F c.F d.F e.T 3. True statements about this corneal condition include: Slit-lamp appearance a. it is an autosomal dominant condition b. the corneal appearance usually appears in the third decade of life 248 Histology c. ferritin lines are commonly seen on the epithelium d. the corneal abnormality involves the Bowman's membrane e. irregular astigmatism is a common cause of poor vision a.T b.F c.T d.T e.T 4. Anterior segment signs associated with the appearance of these hands include: a. b. 249 c. d. a.T b.T c.T d.F e. e.F 5. This is the corneal appearance of a patient with poor vision. The eye is white. a. the patient is more likely to be a male than female b. the poor vision is due to corneal astigmatism c. lipid deposit in the cornea is a common feature d. fluorescence staining shows epithelial defect in the periphery e. descemetocele does not develop a.T b.T c.T d.F e.F Click here for more MCQs 250 Cornea MCQs 1. The following are true with regard to this condition: a. this is an example of hamartoma b. astigmatism is a common cause of poor vision in this condition c. there may be problem with abduction d. deafness is a recognized association e. histology shows mainly adipose tissue only a.F b.T c.T d.F e.F 2. True statements about the following corneal condition include: 251 a. it occurs at the junction between the Descemet's membrane and the endothelium b. it has an autosomal dominant inheritance c. glaucoma occurs in 90% of cases d. it is a feature in Chandler's syndrome e. it occurs in Peter's anomaly a.F b.T c.F d.F e.T 3. This patient has this corneal conditions in both eyes. The following are true: a. the lesions first appears in the deep corneal stroma b. corneal graft is usually needed by the age of 30 c. the chance of the offsprings with this condition is 50% d. enlarged corneal nerves are commonly seen e. the following cornea specimen is taken from a patient with similar condition a.F b.F c.T d.F e.F llllllll 252 4. Association with the following appearance include: a. past history of breast carcinoma b. high serum creatinine c. history of osteoarthritis d. history of schizophrenia e. history of coronary artery bypass a. F b.T c.T d.T e.T 5. True statements about this corneal specimen include: 253 a. the specimen is stained with alcian blue b. the peripheral cornea is typically involved c. the condition is inherited in an autosomal dominant fashion d. recurrent erosion may be a presenting symptom e. it may be seen in the corneal button of this patient (picture below) who has had a corneal graft a.T b.T c.F d.T e.T Click here for more MCQs Paper I (answers) 1. a.T b.T c.F d.F e.F Gorlin's syndrome (basal cell naevus syndrome) 2. a.T rare, autosomal dominant and multisystem disorder characterised by multiple basal cell carcinoma, jaw cysts, skeletal anomalies, ectopic calcification of the falx cerebri and pitting of the hand and feet ocular features also include hypertelorism, lateral displacement of the medial canthi and prominent supraorbital ridges b.T c.F d.F e.F Posterior polymorphous dystrophy: a bilateral dominantly inherited dystrophy vesicular polymorphous deposits with clear halos in Descemet's membrane usually asymptomatic, rarely endothelium decompensation requiring penetrating corneal graft 254 3. the abnormal endothelium may extend into the trabecular meshwork and iris glaucoma can occur as a result of trabecular meshwork involvement iris involvement can lead to corectopia and ectopia simulating iridocorneal endothelial syndrome except that the later is unilateral a.T b.T c.T d.F e.T Crystalline deposits occurs with: 4. myloidosis as in multiple myeloma cystinosis treatment with gold uric acid from uraemia a.T b.F c.F d.F e.T Pterygium: 5. a.T fibrovascular overgrowth of the bulbar conjunctiva the stroma shows basophilic degeneration (elastotic) of collagen the epithelium is often thin but may show hyperplasia or dysplasia it is not regarded as precancerous b.T c.F d.T e.T Keratoconjunctivitis sicca (dry eyes): 6. a.F causes dysplasia of the epithelium which may eventually become keratinise the goblet cells may increase due to chronic irritation from dry eyes in Sjogren's syndrome, there is lymphocytic infiltration of the lacrimal and accessory glands b.F c.T d.F e.F Merkel cell carcinoma: 7. a.F an aggressive primary tumour of the skin, arising from papillary dermis usually presents as a firm non-tender solitary skin nodule on the face and neck early metastasis through the lymphatic channels contains APUD (amine precursor and uptake decarboxylation) cells b.T c.F d.F e.T 255 Lens-induce uveitis: - three types hacoanalphylactic endophthalmitis - severe granulomatous inflammation when the lens protein is exposed - zonal granulomatous reaction surrounding the exposed lens material. The inflammation include neutrophils, epihtelioid cells, macrophages and giant cells phacotoxic uveitis - nongranulomatous inflammation when the lens protein is exposed. - non-specific inflammation with lymphocytes, macrophages and occasional giant cells phacolytic glaucoma - occurs when the hypermature cataract leaks out protein - macrophages laden with eosinophilic lens materials are seen in the anterior chamber and the trabecular meshwork 8 a.F b.F c.T d.T e.T Xeroderma pigmentosa: inheritance is autosomal recessive marked sensitive of skin to sunlight malignant skin tumours including squamous cell tumour, basal cell carcinoma and fibrosacorma main defect is due to the inability of the cells to repair damaged DNA following ultraviolet exposure 9. a.T b.F c.T d.T e.T Pathology of thyroid ophthalmopathy: 10. there is enlargement and inflammation of orbital tissue especially the extraocular muscles histologically there is interstitial oedema and inflammatory cell infiltration (mainly lymphocytes, plasma cells and sometimes mast cells) thecondition tend to involve the nontendinous part of extraocular muscle the endomysial fibroblasts produces mucopolysaccharide especially hyaluronic acid the muscles are initially inflammed and at later stage undergoes fibrosis and shows fatty infiltrate a.T b.T c.T d.F e.F Histological staining: Giemsa stain can demonstrate inclusion body such as chlamydia osmium tetroxide is used to fix and stain myelin for electron microscopy yeast and fungi can be stained with Fuelgin's stain, PAS, Luxol blue fast and 256 11. Gomori methenamine silver eosin stains the cytoplasm pink whereas haematoxylin stains the nuclei blue a.T b.F c.F d.T e.F Sympathetic ophthalmitis 12. a uncommon bilateral granulomatous panuveitis which occurs after penetrating ocular injury or intraocular surgery the inflammation usually begins 4 to 8 weeks after the injury Dellen-Fuch's nodules are seen at the level of Bruch's membrane and represent aggregates of epitheloid cells, it is not diagnostic as the nodules also occur in VKH syndrome may have systemic manifestation identical to Vogt-Koyanagi-Harada syndrome with cerebrospinal fluid pleocytosis, miningismus, alopecia, vitiligo and poliosis prevention is only useful if the injured eye were removed within the first 2 weeks after injury a.T b.F c.T d.T e.T Abnormal material in the vitreous include: 13. pseudoexfoliation in pseudoexfoliation syndrome haemosiderin from vitreous haemorrhage amyloidosis in familial amyloidosis calcium in asteroid hyalosis a.T b .T c.F d.F e.T Giant cell arteritis: 14. disease of the elderly sudden, painless and profound visual loss female more susceptible than male head ache, low grade fever, anorexia, weight loss, tenderness upon brushing hair and jaw claudication ESR and C-reactive proteins are always raised but not diagnostic of the condition diagnosis is base on biopsy which reveal fragmentation of the internal elastic lamina and giant cell infiltration of the tunica media of the artery. However, giant cells are not essential for diagnosis. a.F b.T c.T d.F e.T The following conditions are pre-malignant: actinic keratosis is the result of metaplasia due to ultraviolet light 257 Bowen's disease Oncocytoma of the caruncle results from metaplasia of the accessory gland and is not thought to be pre-malignant Squamous papilloma is benign hyperplasia of the skin Syringoma is benign tumour of the sweat glands 15. a.T b.T c.T d.T e.F Hypoxic damage in diabetic mellitus is suggested by: 16. cotton-wool spots extensive IRMA vascular beading extensive retinal haemorrhages iris neovascularization a.T b .F c.T d.F e.T Biopsy report in rheumatoid arthritis include posterior scleritis episcleral necrotic tissue vasculitis The dry eye in rheumatoid arthritis is caused by aqueous deficiency and not goblet cell dysfunction 17. a.T b.F c.F d.F e.F The prognosis of retinoblastma is detemined by: evidence of external spread such as optic nerve involvement size of the tumours cell differentiation Calcification and necrosis are common in retinoblastoma. 18. a.F b.F c.F d.T e.F Microangiopathy in diabetes mellitus is characterised by: microvascular obstruction and non-perfusion of capilaries retinal capillary microaneurysms absent membrane thickening loss of pericytes intraretinal microvascular abnormality 258 19. a.T b.F c.T d.T e.F Optic nerve glioma: 20 associated with type I neurofibromatosis most common type is pilocytic (hair-like) astrocytoma the age of onset is usually before the age of 10 low-grade and rarely infiltrate the perineural tissue reactive meningeal hyperplasia good long-term survival a.F b.T c.F d.T e.T Mutton fat keratic precipitates: - occurs in chronic granulomatous uveitis and seen in 21. tuberculosis fungal leprosy syphilis sarcoidosis juvenile xanthogranuloma histiocytosis X sympathetic ophthalmia Vogt-Koyanagi-Harada syndrome toxoplasmosis a.F b.T c.F d.F e.T Albinism: 22. can be of oculocutaneous or ocular types oculocutaneous types can be divided into tyrosinase-positive and tyrosinasenegative types. Hair bulb test is useful to differentiate the two within the first three years of life is associated with abnormal platelet aggregation in Hermansky-Pudlak syndrome poor vision is usually due to macular hypoplasia a.T b.T c.F d.T e.F Congenital glaucoma: - may be primary - secondary to: aniridia Sturge-Weber's syndrome 259 23. anterior chamber angle cleavage syndrome such as Peter's anomaly or Axenfeld's syndrome a.F bT c.T d.F e.T Nystagmus: 24. see-saw nystagmus is seen with bitemporal hemianopia down-beat nystagmus occurs with lesion in the cervico-medullary junction at the foramen magnum manifest latent nystagmus is a type of horizontal jerk nystagmus which increases in amplitude when one eye is covered. It occurs in strabismus, amblyopia or uniocular pathology such as cataract gaze-evoked potential is not specific for cerebellar lesion, it occurs when the eyes are unable to maintain an eccentric gaze position through weakness of muscle tone in the agonist muscle convergence retraction nystagmus occurs with mid-brain tumours such as pinealoma a.T b.F c.F d.F e.F Melanocytoma: 25. benign, highly pigmented tumour arising from melanocytes most commonly found in optic nerve head histologically shows plump polyhedral cells equally sex incidence commoner in black population usually asymptomatic but may show enlargement of blind spots 50% have associated choroidal naevus rarely the tumour shows necrosis, vascular obstruction and optic nerve compression a.F b.F c.T d.T e.F Retinoblastoma: most cases are due to new gene mutation only 10% is inherited caused by deletion of 13q14 rosettese suggests cell differentiation and therefore better prognosis; however other factors such as size and optic nerve involvement may be more important has increased risk of osteosarcom (the oncogene of which is also located on chromosome 13) prognosis is generally good at around 90% 260 26. a.T b. T c.T d.F e.F Corneal dystrophy: - inherited and bilateral conditions - the following abnormal substance are documented: 27. lycoaminoglycan (macular dystrophy, fleck dystrophy) yaline degeneration (granular dystrophy) amyloid (lattice dystrophy) lipid (fleck dystrophy) cholesterol (central crystalline dystrophy) a.T b.F c.T d.T e.T Adenocystic carcinoma of the lacrimal gland: 28. the most common malignant tumour of the lacrimal gland has no well-defined capsule invade perineural tissue causing pain and metastasise early to the brain 5 histologic patterns: cribriform (Swiss cheese and of lower grade), solid (basaloid), sclerosing,comedocarcinomatous and tubular (ductal) treatment is with orbital exenternation and removal of involved bone the prognosis is very poor a.F b.T c.T d.F e.T Dissociated vertical deviation: 29. refers to the phenomenon in which the eye elevates when the amount of light entering it is reduced usually begins between 2 to 3 years of age associated with infantile esotropia the binocular vision is usually poor surgery of choice is either superior rectus recession or Faden's procedure a.T b.T c.F d.F e.T Duane type A: Brown's classification Type A: limited abduction and less marked adduction limitation Type B: limited abduction and normal adduction Type C: limitation of adduction exceeds the limitation of abduction widening of the palpebral fissure on abduction globe retraction and palpebral narrowing on adduction face turns to the affected side is common 261 30. caused by innervation of the lateral rectus by a branch of third nerve in place of absent sixth nerve sixth nerve nucleus aplasia has been documented a.F b.T c.F d.T e.F Retinoschisis: 31. presents in 5% of the population and is caused by the splitting of the neurosensory retinal in the outer plexiform layer often bilateral arises from coalescence of peripheral cystoid degeneration associated with hypermetropia asymptomatic but can cause absolute scotoma (cf with retinal detachment which causes relative scotoma) does not cause water mark which is a feature of retinal detachment and is due to transformation of escaped retinal pigment epithelial cells renal breaks on the internal layer is common but if associated with breaks in the outer layer, there is a risk of retinal detachment a.F b.F c.T d.T e.T Anti-glaucoma medications: 32. beta-blocker causes slowing of heart rate but is not contra-indicated in primary heart block ( prolonged PR interval) beta-blocker should be avoided in patients taking centrally acting calcium channel blocker such as verapamil. Nifedipine acts peripherally acetazolide contains structure similar to sulphonamide and should be avoided in those who is allergic to it acetazolamide causes diuresis and loss of potassium, supplement may be needed latanoprost is contraindicated in patients with intraocular inflammation a.F b.T c. T d.T e.F Dendritic ulcer of the cornea can be treated with: 33. iodination debridement topical or systemic acyclovir a.T b.F c.F d.F Choroidaemia: 262 e.F 34. X-linked recessive disorder characterised by progressive degeneration of the choriocapillaris and RPE typically affects male onset is in the first decade with night blindness central vision is affected late ERG shows reduced a and b waves female carriers may shows peripheral pigmentary changes a.T b.T c.T d.T e.F Deafness occurs in: 35. Cockayne's syndrome: premature ageing, dwarfism, bird like facies and retinal degeneration Altroem's syndrome: retinitis pigmentosa, deafness, obesity and diabetes mellitus Alport's syndrome: haematuria, sensorineural deafness, anterioir lenticonus Usher's syndrome: neurosensory deafness, retinitis pigmentosa a.T b.T c.T d.F e.T Enlarged corneal nerves occur in: 36. multiple endocrine adenomatosis keratoconus ichthyosis Refsum's disease Fuchs' corneal dystrophy neurofibromatosis leprosy trauma congenital glaucoma failed corneal graft keratoconjucntivitis sicca advanced age acanthoamoeba keratitis a.T b.T c.T d.F e.T The following association are true: abetalipoproteinaemia with acanthocytosis Refsum's disease with cerebellar ataxia Friedrich'a ataxia with spinocerebellar degeneration Paget's disease and deafness Homocystinuria causes recurrent aterial thrombosis 263 37. a.T b.T c.T d.F e.T Keratoconus occurs in: 38. connective tissue disorders such as Ehlers-Danlos's syndrome and Marfan's syndrome atopic eye conditions such as atopic keratoconjunctivitis Down's syndrome a.F b.F c.T d.T e.F Acquired syphilis: causes painless ulcer in the primary stage which is highly infectious in the secondary stage, the patient may develop a rash which is non-infectious uveitis can occur in the secondary stage treatment is with penicillin Interstitial keratitis is a feature of congenital syphilis 39. a.T b.T c.T d.F e.F Reduced blinking occurs in: 40. Parkinson's disease progressive supranuclear palsy alcohol intoxication neurotrophic keratitis contact lens wear a.F b.F c.F d.T e.T Heterochromic cyclitis: 41 chronic uveitis associated with cataract and glaucoma glaucoma develops in 20% of patients iris atrophy causes transillumination Amsler's sign occurs during cataract extraction and is due to wispy iris vessels which extends from the iris to the trabecular meshwork and do not cause anterior synechiae is resistant to steroid treatment a. F b.F c.F d.T 264 e.F Retinal dialysis: 42. caused by full hickness separation of the retina at the ora serrata traumatic dialysis is most often found in the superonasal quadrant idiopathic dialysis is most often in the inferotemporal quadrant can be closed with cryotherapy to the base of the dialysis followed by local scleral buckle a.T b.F c.T d.T e.F Ocular bobbing: 43. conjugate involuntary recurrent downward movement of the eyes rapid downward movement with a slower return to the neutral position absent horizontal movements occurs in patients with acute pontine lesion who are either comatose or locked-in state can occur with tumour in the pontine a.T b.T c.T d.T e.T Investigation of sarcoidosis: 44. chest X-ray typically shows bilateral hilar lymphadenopathy, there may also be interstitial infiltrate ACE concentration is increased conjunctival biopsy may show non-caseating granuloma serum calcium may be raised in sarcoidosis gallium scan shows increase in parts of body affected by sarcoidosis a.T b.F c.F d.T e.T Holme-Adie's pupil: 45. there is light-near dissociation however there may be delayed or absent pupil reaction to both the condition is usually unilateral women are affected more often than men due to paralysis of the ciliary muscle, the accommodation is impaired denervation hypersensitivity is demonstrated by constriction to 2.5% methacholine and 0.1% pilocarpine a.F b.T c.T d.T e.T Absent of pupil response to direct and consensual light response: 265 - occur when the iris of the affected eye is paralysed and this occur in 46. blunt trauma third nerve palsy atropine siderosis bulbi a.F b.T c.T d.F e.F Leber's optic neuropathy: 47. a mitochondrial inherited disease bilateral loss of central vision which is severe and painless typically in the second decade of life classic early picture shows a triad of circumpapillary telangiectatic microangiopathy, pseudoedema of the disc and absent fluorescein staining a.T b.T c.T d.F e.F AMPPE: 48. typically affects healthy young adults who presents with sudden onset central or paracentral visual loss after a flu like illness scattered, patchy creamy lesions at the level of the retinal pigment epithelium layers the lesions fade after one to two weeks leaving behind granular pigmentary changes fluorescein angiography shows early blockage of choroidal circulation by these lesions but in the late phase the lesions show late staining other findings: uveitis, serous retinal detachment, cerebral vasculitis, cerebrospinal fluid pleocytosis, headache, hearing loss and tinnitus spontaneous resolution is common and systemic steroid has not been shown to be useful a.F b.T c.F d.F e.F Central serous retinopathy: 49. the patient usually presents with distorted vision without significant central visual loss Amsler's chart testing usually shows distortion of lines or scotoma the image appears smaller than the unaffected eye a.T b.T c.T d.T 266 e.F Kayser-Fleishcer's ring: 50. occurs in Wilson's disease and intraocular copper foreign body the ring is caused by copper deposited in Descemet's membrane which may be orange, brown, green- brown or grey in colour it begins superiorly then inferiorly and finally circumferentially regresses with D-penicillamine treatment a.T b.F c.T d.F e.T In corneal graft: 51. the epithlium, keratocytes, nerves and epithelium will eventually be replaced by the host tissue the endothelium does not regenerate and therefore will remains that of donor. the descemet's membrane is produced by the endothelium and will therefore remains that of donor a.F b.T c.T d.F e.F Vernal keratoconjunctivitis: 52. affects mainly young people an allergic inflammatory condition characterised by giant papillae in the tarsal conjunctiva the limbal type is found commonly in black with typical Horner-Trantas' dots which are giant papillae containing eosinophils causes keratitis and corneal ulcer / scarring treatment is avoidance of allergens, mast cell stabilisers and short course of steroid in acute phase a.F b.F c.F d.F e.T The following conditions are inherited as: 53. X-linked in protanopia (red-green colour blindness) and juvenile retinoschisis autosomal dominant in neurofibromatosis autosomal recessive in blue cone achromatopsia non-inherited in Sturge-Weber's syndrome a.F b.F c.F d.F e.T Coat's disease: non-hereditary, unilateral congenital disorder characterised by abnormal 267 54. telangiectatic and aneurysmal retinal vessels in the peripheral retina male outnumber female by 3 to 1 presents with leukocoria and strabismus. Untreated can lead to exudative retinal detachment, glaucoma and pthisical eye laser is useful in destroying the abnormal blood vessels a.F b.T c.F d.F e.F Laser: 55. green light is not absorbed by xanthophyll and therefore it is theoretically more advantageous to use green laser in the macular area diode laser penetrate vitreous haemorrhage well and is therefore ideal in vitreous haemorrhage YAG laser is colourless and therefore require neodymium to give it red colour for targeting used in ophthalmic practice is classified as type IV laser a.T b.T c.F d.T e.F Roth's spots: 56. many causes including subacute bacterial endocarditis, leukaemia, anaemia etc contain white areas in the centre of retinal haemorrhage the white areas may contain immunocomplex, lymphoblasts or purulent exudates in subacute bacterial endocarditis, the white centres may contain organisms, although the majority are sterile and consists mainly of white blood cells and fibrin thrombus at the site of extravasation of blood a.T b.F c.F d.F e.T Breaks in Descemet's membrane occurs in: 57. trauma as in forcep delivery keratoconus congenital glaucoma a.T b.T c.F d.F e.F Stigma of acute angle closure glaucoma: iris atrophy sphincter paralysis due to ischaemia pigment dispersion glaukomflecken which is white opacities on the anterior surface of the lens caused 268 by necrosis of the anterior lens capsule 58. a.T b.T c.T d.F e.F In blow-out fracture: 59. the orbital rim may be fracture or intact. In the former a step can be felt occur only when the air sinuses have develop surgical emphysema is a feature although typically cause problem with upgaze, the horizontal recti have connective tissue that extends to the orbital floor and therefore horizontal movement may be impaired to some extent the infraorbital nerve is involved but the nerve does not supply the tip of the nose which is by nasociliary nerve a.T b.T c.T d.T e.T Persistent hyperplastic primary vitreous: 60. caused by abnormal regression of primitive hyaloid vascular system typically there is a fibrovascular stalk extending from optic disc and form a retrolental membrane the membrane extend to the ciliary process and if contract can lead to elongation of the ciliary processes causes shallow anterior chamber and acute glaucoma in untreated cases the prognosis is good if treated early especially if the retina were normal a.F b.T c.F d.T e.F Pars planitis: commonly affect young adult and children presents with folater or decreased visual acuity due to cystoid macular oedema 80% bilateral clinical examination shows inflammatory cells and snowball opacity in vitreous main complications are cataract and cystoid macular oedema. However, the visual prognosis is usually good rare complication include band keratopathy, glaucoma, vitreous organisation, tractional retinal detachment and vitreous haemorrhage. treatment is indicated only with decreased visual acuity from CMO and severe inflammation treatment include: periocular steroid, cryotherapy to vitreous base, par plana vitrectomy and use of immunosuppresive agents. Click here to return to Questions Answers on Medical Retina 269 (click on the number to return to the questions) 1. a.F b.T c.T d.T e.T Familial exudative vitreoretinopathy FEVR is normally an autosomal dominantly inherited disease but X-linked inheritance has been described. although both eyes are affected, the degree of involvement may be very asymmetrical. the fundus appearances may be confused with retinopathy of prematurity (ROP) it is characterized by peripheral areas of avascularity in the peripheral retina, almost indistinguishable from ROP. The lack of history of premature birth, low birth weight, or oxygen therapy differentiates this condition from retinopathy of prematurity. dragging of the retina temporally with vessel straightening, subretinal exudation, cicatrization and retinal detachment are all features of this condition. Complications include neovascularisation in the peripheral retina. treatment with cryotherapy to neovascular areas, and scleral buckling and vitrectomy procedures for tractional detachments have all been used in the treatment. relentless progression is uncommon. Visual impairment tends to occur early and it is rare to lose vision after the age of 30 unless the patient develops tractional retinal detachment. 2. a.T b.F c.F d.F e.F Acute zonal occult outer retinopathy (AZOOR): 270 an idiopathic conditions which may be precipitated by punctate inner choroiodapthy (PIC), multifocal choroiditis (MIC) or multiple evasnescent white dot syndrome (MEWDS) it is characterized by a rapid loss of visual field which cannot be explained by the ophthalmoscopic changes 3. a.T majority of the sufferers are healthy young white myopic females. initial presentation is with photopsia and increased blind spot in the presence of normal visual acuity. Later, the visual field is decreased with decreased visual acuity. fluorescein angiography is not helpful as it is normal or might only show the precipitation condition initially. In electrophysiology, the electro-oculogram (EOG) light rise is often reduced and the ERG is usually very abnormal. there is no effective treatment. In some patients, the vision returns spontaneously. b.F c.F d.F e.F Punctate idiopathic choriodopathy (PIC) is commoner in myopic women in their 30s and 40s. patients presents with blurred vision, paracentral scotoma and photopsia. the condition is bilateral in the majority of the patients the acute lesions are small yellow lesions with slightly fuzzy borders. there are no cells or other signs of inflammation in the vitreous or anterior chamber. the lesions gradually evolve into well defined scars and slowly become more pigmented. viral prodrome is not associated with PIC the visual prognosis of eyes with that do not develop subfoveal CNV is very good. 4. a.F b.T c.T d.T e.T 271 Idiopathic polypoidal choroidal vasculopathy (IPCV) 5. a.T is also known as posterior uveal bleeding syndrome and multiple recurrent serosanguineous REP detachment syndrome. although originally described in black hypertensive females in middle age. It is now been recognized in other races. the characteristic lesion appears to be an inner choroidal vascular network of vessels ending in an aneurysmal bulge or outward projection. recurrent and multiple REP detachments with or without the associated subretinal bleeding (posterior uveal bleeding syndrome) may then occur. the absence of drusen, retinal vascular disease and intraocular inflammation is characteristic of the condition. Vitreous haemorrhage may also occur. the lesions were originally described to be peripapillary in location, but pure macular lesions have also been reported. indocyanine green angiography is most helpful in identifying polyps. it has a better prognosis than other causes of haemorrhagic detachments of the retina. Direct laser therapy to the lesion appears to carry a better prognosis in IPCV compared to laser therapy of CNV in AMD patients. b.F c.T d.T e.T Stickler's syndrome: autosomal disorders associated with abnormal production of type II collagen 272 ocular features include myopia, cataracts, strabismus, and optically-empty vitreous vitreous traction and lattice degeneration multiple retinal breaks occurs in more than 75% of the patients. systemic manifestation include maxillary and mandibular hypoplasia, cleft palate, abnormal uvula, neurosensory hearing loss and skeletal abnormalities with joint hyperextensibility, and marfanoid habitus 6. a.F b.F c.F d.T e.T Difference between ARN and PORN: both conditions are associated with herpes virus chiefly herpes simplex and zoster both conditions can lead to retinal detachment ARN is seen both in healthy and immunocompromised patients whereas PORN is seen exclusively in AIDS or immunocompromised patients vitritis is often severe in ARN but is usually minimal or absent in PORN ARN responds to intravenous acyclovir but PORN responds poorly and PORN patients usually have poorer eventual visual outcome 7. a.F b.T c.F d.T e.F Vigabatrin: indicated only when all other appropriate antiepileptic drug combinations have proved ineffective or poorly tolerated is an GABA transaminase inhibitor indicated as first line therapy only in infantile spasm about 1/3 of epilepsy patients using it have characteristic visual field defects which can vary from asymptomatic to severe and disabling the defect is not reversible even with cessation of the therapy the cause of the visual field loss is unknown not recommended in patients with pre-existing visual field defects 273 8. a.F b.T c.F d.T e.F Oguchi disease: is a form of congenital stationary night blindness is characterized by a golden/grey-white discoloration of the retina giving a metallic sheen to the back of the eye. This disappeared when the fundus was viewed after some time in the dark and has become known as the Mizuo-Nakamura phenomenon. visual acuity, colour vision and visual fields are usually normal in Oguchi disease. two genes involved in Oguchi disease have been identified and include: arrestin, a gene located in the region of the distal arm of chromosome 2q, and rhodopsin kinase. The arrestin mutations are more common in Japanese Oguchi disease, and rhodopsin kinase in European Oguchi disease. patients are asymptomatic in light, but are night blind. dark adaptation shows extremely retarded rod function. 9. a.T b.F c.T d.F e.F Retinal crystals are seen in: drug-induced: tamoxifen canthaxanthin talc methoxyflurane metabolic disorders cysintonosis primary oxalosis type 1 274 others Bietti retinal dystrophy Sjorgren-Larsson syndrome 10. a.F b.T c.T d.F e.F Shaken baby syndrome: typically occurs in children less than 3 years of age and results from violent shaking there is no external eye injury but the posterior segment shows retinal haemorrhages (both intra and subretinal) and vitreous haemorrhage skull fracture is uncommon but CT scan reveals subarachnoid or intracerebral haemorrhages vomiting, lethargy and focal neurologic findings are common the visual prognosis is poor due to macular scarring, vitreous haemorrhage and retinal detachment 11. a.F b.F c.F d.T e.T In central retinal artery occlusion and ophthalmic artery occlusion: both give cherry-red spot in the acute phase both causes relative afferent pupillary defect in ophthalmic artery occlusion, the a and b waves on the ERG are abnormal due to insult to the outer and inner retina in ophthalmic artery occlusion, both the choroidal and retinal circulation are delayed in ophthalmic artery occlusion, the REP is disturbed resulting in pigmentary changes at a later date 12. a.F b.F c.T d.T e.T Cystoid macular oedema without fluorescein leakage occurs in: 275 some cases of retinitis pigmentosa X-linked juvenile retinoschisis Goldman-Favre syndrome nicotinic acid maculopathy 13. a.F b.T c.F d.F e.T Rhegmatogenous retinal detachment is associated with: posterior vitreous detachment lattice degeneration cystic retinal tuft meridonal folds white without pressure 14. a.T b.F c.T d.F e.F Acute macular neuroretinopathy: 15. an uncommon condition which causes paracentral scotoma in young adult fundoscopy reveals dark lesion in the macula which is typically triangular in shape otherwise the fundus is normal the lesion is confined to the macula and therefore the ERG is normal the visual loss is mild and spontaneous recovery is common a.T b.T c.T d.T e.T von Hippel-Lindau's syndrome: is an autosomal dominant condition with variable penetrance 276 50% of the patients has angiomatosis retinae which may be found in the optic disc or the periphery those in the optic disc or juxtapapillary may mimic choroidal neovascularization the angioma enlarges slowly leading to visual loss mainly through exudative maculopathy and also vitreous haemorrhage, tractional retinal detachment or epiretinal membrane 16. a.F b.T c.T d.F e.F Stargardt's disease: is usually inherited in an autosomal recessive inheritance it is regarded as a type of fundus flavimaculatus lipofuscin substance is found within the REP cells which give rise to dark choroid during fluorescein angiography colour vision defect along the red-green axis is common in late stage the macula can assume bull's eye maculopathy most patients become symptomatic within the first or second decade of life 17. a.F b.T c.F d.F e.T Wyburn-Mason's syndrome: a type of phakomatoses sporadic condition characterized by arteriovenous communications of the retina and brain beginning in adolescence the arteriovenous communications of the retina gives rise to racemose aneurysm of the retina unlike von Hippel Lindau syndrome, exudative maculopathy is uncommon instead the visual loss is due to the loss of capillary bed or overlying of the vessels over the macula tram-line calcification seen in skull X-ray is characteristic of SturgeWeber's syndrome visual field defect is seen in one-third of the patient due to the vascular abnormalities 18. a.F b.F c.T d.T e.T Electrophysiology: EOG is useful in detecting Best's disease but is normal in adult onset foveomacular dystrophy electroretinogram is abnormal in carrier of X-linked retinitis pigmentosa and is diagnostic in Leber's congenital amaurosis 277 in Stargardt's disease, the ERG is variable and is therefore not useful for diagnosis carrier of choroideremia has normal ERG despite changes in the peripheral retina 19. a.F b.T c.T d.T e.T Bietti's crystalline dystrophy: it is an autosomal recessive disorders is characterized by crystalline deposits in all layers of the retina, cornea and also in the lymphocytes the crystals are made up of cholesterol and lipid REP and choroidal atrophy are common features patients present with night blindness and progressive visual loss ERG and EOG are abnormal 20. a.T b.T c.T d.F e.F Mucopolysaccharidosis associated with pigmentary retinopathy include: Type I-H (Hurler) Type I-S (Scheie) Type II (Hunter) Type III (Sanfilippo's) Type IV (Morquio's) Type VI (Maroteaux-Lamy's syndrome) and type VII (Sly's syndrome) are not associated with pigmentary retinopathy 21. a.T b.T c.F d.T e.F Optically empty vitreous (due to vitreous liquefaction) and peripheral retinal pigmentary changes occur in: Stickler's syndrome Jansen's disease Wagner's disease Goldmann-Favre disease 278 22. a.T b.F c.T d.T e.T Jansen's disease and Wagner's disease: both conditions are autosomal dominant high myopia, cataract and glaucoma are common in both conditions the ERG are abnormal in both conditions the EOG are normal in both conditions the main distinguishing feature is the increased risk of retinal detachment in Jansen's disease which is not seen in Wagner's disease 23. a.T b.T c.T d.T e.F Macroaneurysms: are more common in women than men found mainly along the temporal arcade causes retinal artery occlusion, retinal haemorrhages and vitreous haemorrhages symptomatic only if it bleeds or causes exudative maculopathy, spontaneous closure is common due to thrombosis IRVAN syndrome is made up of Idiopathic Retinal Vasculitis, Aneurysms and Neuroretinitis. It is characterized by bilateral multiple bilateral macroaneurysms 24. a.T b.T c.F d.T e.F Carcinoma associated retinopathy (CAR): is a paraneoplastic syndrome colour vision defect, night blindness and rapid visual loss are typical presentation the condition may present before the diagnosis of the primary tumour which is typically oat cell carcinoma of the lung autoantibodies are commonly seen in the blood both rod and cone ERG are abnormal there is no effective treatment 25. a.T c.T c.T d.T e.T Deafness and pigmentary retinopathy are seen in the following conditions: 279 26. Congenital syphilis Congenital rubella Usher's syndrome Cockaryne's syndrome Alstroms syndrome Leber's amaurosis Alport's syndrome Hunter's syndrome (MP II) San Fillipo's disease (MP III) a.T b.T c.T d.T e.T Norrie's disease: 27. a rare X-linked disorders bilateral blindness with abnormal retina development rosette formation is common in retina histology 1/3 has hearing abnormality retrolental masses are common which may be mistaken for retinoblastoma a.F b.T c.F d.T e.F X-linked retinoschisis: splitting of the retina occurs at the nerve fibre layer electrophysiology reveals negative ERG with normal a wave but reduced b wave the main cause of visual loss is central macular abnormalities other causes of visual loss include retinal detachment and vitreous haemorrhage hypermetropia is an association DNA analysis is useful in detecting the carrier, the abnormal gene is located at XLRS1gene on the short arm of the X-chromosome 28. a.F b.T c.F d.T e.F Significant macular oedema as defined by ETDRS are: 280 29. retinal thickening within 500 microns of the centre of the fovea hard exudate within 500 microns of the centre of the fovea with adjacent retinal thickening one disc area of retinal thickening, any part of which is within 1 disc diameter of the centre of the fovea a.F b.F c.F d.F e.F Branch Retinal Vein Occlusion Study: no treatment for macular oedema for at least 3 months fluorescein angiography is not useful at the time of presentation due to retinal haemorrhages, it is only useful when the haemorrhages clear laser treatment is useful in patients with vision of 6/12 or less and without evidence of macular ischaemia on fluorescein angiography although sectorial panphotocoagulation is useful in reducing the risk of vitreous haemorrhage in those patients who have more than 5 disc diameter of ischaemia, the recommendation is for the PRP to be performed only in the presence of neovascularization and not based on ischaemia of more than 5 disc diameter as the majority of the eyes do not develop neovascularization 30. a.F b.T c.T d.T e.F Findings of the Diabetes Control and Complications Trial are: intensive insulin treatment resulted in a statistically significant reduction in incidence and progression of DR and the need for macular laser panphotocoagulation or PRP these only apply to insulin dependent diabetic initial worsening during the first year was noted in some eyes, but after 3 years there was a beneficial effect on progression of DR severe hypoglycaemia was more common in the tight control group Click here to return to the questions Click here to return to the main page Answers on Ocular Motility 281 (click on the answer number to return to the questions) 1. a.T b.T c.T d.T e.F This patient has intermittent exotropia of the divergence excess type because there is a difference of greater than 10 prism dioptre between near and distance and the patching did not eliminate this difference. Binocular single vision is often suppressed on distant fixation when the exotropia is manifested, but it is usually normal with near fixation Patching is useful to suspend the tonic fusional convergence and to reveal the full latent deviation at near. Spontaneous resolution is uncommon for intermittent exotropia. 2. a.T b.T c.T d.F e.T In intermittent exotropia: 3. tinted glasses are useful if bright light constitutes a major dissociative factor and allow the patient better control the deviation concave glasses are useful in stimulating accommodation and convergence orthoptic exercise is useful but is rarely successful if the deviation is more than 15 prism dioptre base-in prism is used preoperative to control the deviation and is usually in combination with exercise miotic decreases accommodation and therefore make the exotropia worse a.F b.F c.F d.T e.T Post-operative esotropia: a small degree of consecutive esotropia is desirable and usually decreases as the effect of the surgery is lessen. postoperative diplopia is common and usually resolves within 2 282 weeks. patching is not needed as the patient is now 8 year-old and amblyopia is unlikely to develop. 4. a.T b.F c.F d.T e.F The history and the orthoptic findings suggest that the patient has consecutive exotropia with dissociated vertical deviation and latent nystagmus. The underlying condition prior to surgery is likely to be infantile esotropia. The majority of infantile esotropia has a deviation of greater than 30 prism dioptres. The binocular single vision is usually subnormal even with early surgery. Asymmetrical optokinetic nystagmus is common. A small exotropia is cosmetically acceptable and does not require surgery. 5. a.F b.T 6. a.F b.T c.F d.T e.T The diagnosis is dissociated vertical deviation. It is seen in 60 to 90% of infantile esotropia. Bielchowsky phenomenon refers to elevation of the eye when the light entering that eye is reduced. The majority of the cases are bilateral but may be asymmetrical. In inferior oblique muscle overaction, the eye does not elevate when it is covered but shows elevation on adduction. c.T d.F e.F 283 The patient has latent nystagmus. Manifest latent nystagmus is present when the nystagmus remains when both eyes are uncovered. The fast phase is toward the side of the uncovered eye and increases on abduction. Unlike congenital nystagmus, the wave form has a decreasing velocity slow phase. The cause is unknown but is not associated with cerebellar dysfunction. 7. a.F b.T 8. a.T b.T c.F d.F e.F Duane's retraction syndrome is more common in female than male and more likely to affect the left than right eye. The type of Duane's retraction syndrome is type II Narrowing of the lid is caused by globe retraction. Amblyopia is uncommon and found in only 10% of the patient. c.F d.T e.T Associated signs are: cataract heterochromia iridies microphthalmos crocodile tears Marcus Gunn Jaw winking Goldenhar's syndrome Klippel-Feil's syndrome 9. a.F b.F c.T d.T 284 e.T 10. a.T The strabismus is incomitant. Surgery is indicated to reduce or eliminate the abnormal head posture, or place the field of binocular single vision more central and enlarge the field. However, the ocular movement does not improve with surgery. Resection can worsen the globe retraction and narrowing of the lid fissure. Faden procedure is useful in reducing the upshoot. b.T c.T d.F e.T In fourth nerve palsy: 11. a.T The affected side is hyperdeviated and therefore the image is seen as lower and in addition the eye is extorted and therefore the image will also appear intorted giving the diagram as shown with the point of the V pointing towards the abnormal side deviation of the eye in fourth nerve palsy depends on which eye is the fixating eye. If the fixating eye is the right eye, then the left eye will become hypodeviated and vice versa in the three step test, the right eye is hyperdeviated in the primary position, on left gaze and right head tilt b.F c.F d.T e.F Feature of congenital fourth nerve palsy include: absence of cyclotorsion higher vertical fusional amplitude Abnormal head posture occurs in any long-standing fourth nerve 285 palsy as a compensatory device and is not specific to congenital palsy. 12. a.T b.T c.T d.F e.T Features in favour of bilateral fourth nerve palsy include: slight hyperdeviation in primary position reversal of hyperdeviation and diplopia on lateral versions large V pattern chin depression being the main abnormal head posture with little or no head tilt extorsion of more than 10 degrees positive Bielchowsky head tilt test with head tilt to either shoulder 13. a.T b.F c.T d.F e.F Surgical treatment may involve: 14. a.T right inferior oblique recession or left inferior rectus recession to control the vertical deviation right Harada-Ito's procedure to control the cyclotorsion b.F c.T d.T e.F Sixth nerve palsy: this patient has a right sixth nerve palsy the esotropia is worse for distant than near face turn to the affected side and therefore the right duction is better than version and therefore the ocular movement is better when the unaffected side is closed V pattern is common on upgaze 286 15. a.F b.T c.T d.T e.F Muscle sequelae are: 16. overaction of the left medial rectus contraction of the right medial rectus secondary inhibitional palsy of the left lateral rectus a.F b.T c.F d.T e.T Additional signs and location: 17. a.T both sixth nerve palsy and swollen discs can result from raised intracranial pressure and are of not localizing value presence of Horner's syndrome point to a lesion in the cavernous sinus presence of fourth nerve palsy can result from a lesion in the cavernous sinus Folville's syndrome result from a lesion in the dorsal pons with ipsilateral abduction weakness, ipsilateral facial weakness and analgesia, ipsilateral peripheral deafness, loss of taste from the anterior two-third of the tongue and ipsilateral Horner's syndrome. Millard-Gubler's syndrome result from a lesion in the ventral pons. The signs in additional to those seen in Folville's syndrome has an additional contralateral hemiplegia. b.T c.T d.T e.T Treatment of right sixth nerve palsy: the use of botulinum toxin into the right medial rectus will reduce the contracture of the right medial rectus use of base out Fresnel prism over the paralysed can help to fuse 287 the double images in patient without inhibitional palsy of the left lateral rectus, the following operation may be used: a. recession of the left medial rectus combined with resection of the paresed lateral rectus b. Faden operation on the left medial rectus 18. a. T in patient with fully developed muscle sequelae, the choice of surgery is recession of the right medial rectus combined with resection of the right lateral rectus. b.F c.F d.T e.T Microtropia: 19. a common form of anomalous binocular single vision the strabismus is 10 prism dioptres or less the squinting eye has reduced vision anisometropia is found in most cases stereopsis is reduced but rarely absent foveal suppression scotoma is present in the affected eye and can be tested by placing a base out 4 dioptre prism over the affected eye; there is absent of eye movement. a.F b.T c.F d.T e.F Spasmus nutans: consists of nystagmus, involuntary head movement and abnormal head posture usually begins between 3 to 18 months of age nystagmus is jerky but of small amplitude and high frequency involuntary head movement can be either head nodding or shaking or both most resolves by 3 years of age 288 20. a.T rarely associated with neurologic dysfunction but in some cases may be associated with glioma of the chiasm b.T c.T d.T e.F Accommodative esotropia: usually occurs around 2 years of age patients with accommodative esotropia usually suppress the deviating eye and therefore diplopia is uncommon; however due to the suppression amblyopia is common unless the patient has alternating esotropia there is usually hypermetropia of greater than +3.00D or a high AC/A ratio 289
