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M.C.Qs. for November 2005 exam Please select the one most appropriate answer: 1. The sixth nerve may be involved in all of the following except: A. Benign increased intracranial pressure ( psuedotumor cerebri) B. Pontine infarction C. Occipital lobe infarction D. Orbital apex syndrome 2. Regarding internuclear ophthalmoplegia all the following are true except: A. The lesion is in the brainstem B. Resulting squint is incommitant C. Multiple sclerosis is a common etiology D. The connections between the forth & fifth nerve nuclei are involved 3. Regarding the occipital lobe all the following are true except: A. It has dual blood supply B. Lesions affecting it produce homonymous hemianopia C. The field defect is on the opposite side of the lesion D. The macula is represented by a small area near the base of the lobe 4. Regarding fast eye movements (saccadic movements) all the following are true except: A. They originate from the opposite frontal lobe B. Vision is suppressed during the movement C. Eyes move in opposite directions D. Can be tested by optokinetic drum 1 5. Pituitary tumors can present by any of the following except: A. Congruous homonymous hemianopia B. Headache C. Hormonal disturbances D. Acute loss of vision 6. Regarding highly selective prostaglandins ( e.g. Xalatan eye drops) all the following are true except: A. Are best used for inflammatory glaucomas B. Increase uveoscleral outflow C. Can cause elongation of eyelashes D. Can change the color of the iris 7. The angle is usually open in all the following glaucomas except: A. Phacolytic Glaucoma B. Phacomorphic Glaucoma C. Pseudo exfoliation syndrome D. Posner-Schlossman syndrome 8. Regarding trabeculectomy all the following are true except: A. Failure of the bleb can be reduced by using intraoperative mitomicin C (MMC) B. Postoperative hypotony can be due to choroidal effusion C. It is the procedure of choice in neovascular glaucoma D. Endophthalmitis rate may be increased with mitomicin C (MMC) use 9. One of the following is better avoided in the management of neovascular glaucoma except: A. Cyclocryotherapy B. Diode laser cycloablation C. Trabeculectomy with valve implantation D. Pilocarpine eye drops. 2 10. Investigations for systemic causes of uveitis are indicated in all the following except: A. Unilateral acute anterior non granulomatous uveitis B. Anterior chronic granulomatous uveitis C. Posterior granulomatous uveitis D. Exudative retinal detachment 11. All the following are contraindications for contact lens wear except: A. Mucopurulent conjunctivitis B. Corneal abscess C. Keratoconus D. Acute glaucoma 12. One of the following can only be corrected by contact lenses (not glasses): A. Hypermetropic astigmatism B. Myopic astigmatism C. Hypermetropia D. Irregular astigmatism 13. The spherical equivalent (-2.50) can be due to any of the following combinations except: A. -3.00/+1.00 Axis 180 B. -3.50/+2.00 Axis 90 C. -2.00/-1.00 Axis 90 D. -2.50/+1.00 Axis 180 14. All the following is true regarding color vision except: A. The incidence is more in males than females B. There are five types of color receptors in the retina C. Color blindness can be acquired D. Acquired color blindness can be progressive 15. Regarding accommodation all the following are true except: A. The lens become more spherical with accommodation B. Myopic patients need reading glasses at an earlier age than hypermetropic patients C. It is usually accompanied by convergence D. Can be abolished by cycloplegics 3 16. All the following can be causes of dim red reflex except: A. Corneal opacity B. High myopia C. Optic atrophy D. Cataract 17.All the following are risk factors for open angle glaucoma except: A. High myopia B. Family history of glaucoma C. Congenital color blindness D. Prolonged topical use of steroids 18. Regarding Jaxonian cross cylinder used in objective refraction all the following are true except: A. It is used to verify the axis of the cylindrical lens B. It is used to verify the power of the cylindrical lens C. its spherical equivalent is zero D. It is used to verify the power of the spherical lens 19. All the following can occur if the center of the lens in the spectacle is not in front of the pupil except: A. Headache B. Image magnification C. Double vision (diplopia) D. Eye strain 20. A patient complains of eye strain following prescription of -3.00 cylindrical lens axis 180 for both eyes. One of the following cannot be the cause of his eye strain: A. Vertical displacement of one of the lanses B. Horizontal displacent of one of the lenses C. Tilting of the frame D. An error in the power of one of the lenses 4 21. Regarding contact lenses all the following are true except: A. The contact lens rests on the cornea B. The surface of the contact lens replaces that of the anterior surface of the cornea C. The magnification of hypermetropic glasses is more than that of contact lenses D. Infective keratitis is more common among contact lens users than the general population 22. One of the following layers actively pumps the fluid out of the cornea: A. Endothelium B. Bowman’s membrane C. Stroma D. Epithelium 23. Regarding the tear film all the following are true except: A. The oily layer minimizes evaporation of tears B. The aqueous layer is the outermost layer C. The mucous layer facilitates spreading of tear film over the cornea D. The oily layer is mainly secreted by the meibomian glands 24. All the following are true regarding anterior chamber except: A. The iris separates the anterior chamber from the posterior chamber B. The anterior chamber volume is smaller than the posterior chamber C. Flare is due to the increased protein contents of the aqueous D. Hypopyon is due to the increased cellular content of the aqueous 25. Regarding the visual acuity all the following are true except: A. It is a measure of the power of resolution of the eye B. It measures both the cone & rod functions C. It can be affected by the size of the pupil D. It doesn’t give a clue about the cause of deterioration of vision 26. Regarding intraocular pressure all the following are true except: A. It is a major risk factor in the development of glaucoma but not the only one B. It is usually decreased in anterior uveitis C. Goldmann tonometer is more accurate than Schiotz tonometer D. A pressure of less than 21 mm Hg excludes glaucoma 5 27. Bull’s Eye Maculopathy is a clinical feature of All of the following are true except: A. Stargardt Disease B. Concentric Annular Macular Dystrophy C. Fundus Albipunctatus D. Cone Dystrophy E. Chloroquine / Hydroxychloroquine toxicity 28. Cherry Red Spot is a clinical feature of All of the following are true except: A. Central Retinal Artery Occlusion B. Central Retinal Vein Occlusion C. Tay-Sachs Disease D. Niemann-Pick Disease E. Gentamicin Toxicity 29. Chorioretinal Folds can be a clinical feature of: All of the following are true except: A. Age Related Macular Degeneration B. Hypotony Maculopathy C. Idiopathic Chorioretinal Folds D. Retrobulbar Tumour E. Sympathetic Ophthalmia 30. Cotton Wool Spots are a clinical feature of: All of the following are true except: A. Purtscher’s Retinopathy B. Diabetic Retinopathy C. Retinal Vascular Occlusions D. Choroidal Melanoma E. Leukemic Retinopathy 6 31. Cystoid Macular Oedema is a clinical feature of: All of the following are true except: A. Post-Intraocular Surgery CME B. Interferon Toxicity C. Retinal Vein Occlusions D. Diabetic Retinopathy E. Vitreoretinal Traction Syndrome 32. Choroidal Neovascularization can be a clinical feature of: All of the following are true except: A. Nicotinic Acid Maculopathy B. Age Related Macular Degeneration C. Angioid Streaks D. Myopia E. Multifocal Choroiditis 33. Flecked Retina Syndromes can be a clinical feature of: All of the following except: A. Fundus Albipunctatus B. Stargardt’s Disease C. Vitreoretinal Traction Syndrome D. Alport’s Syndrome E. Flecked Retina of Kandori 34. Intraretinal Haemorrhages can be a clinical feature of All of the following except: A. Diabetic Maculopathy B. Hypertensive Retinopathy C. Macular Phototoxicity D. Sickle Cell Retinopathy E. Radiation retinopathy 35. Lipid Exudates can be a clinical feature of All of the following except: A. Pattern Dystrophy B. Hypertensive Retinopathy C. Coat’s Disease D. Chronic Central Serous Chorioretinopathy E. Juxtafoveal Retinal Telangiectasis 7 36. Preretinal Haemorrhage can be a clinical feature of: All of the following are true except: A. Diabetic Retinopathy B. Terson’s Syndrome C. Tamoxifen Toxicity D. X-Linked Juvenile Retinoschisis E. Leukemic Retinopathy 37. Pigmented Lesions can be a clinical feature of All of the following are true except: A. Toxoplasmosis B. Choroidal Naevus C. Melanocytoma D. Lyme Disease E. Choroidal Melanoma 38. White-Centered Haemorrhages clinical features All of the following are true except: A. Diagnostic only for anaemia B. Intraretinal haemorrhage with white center C. Local capillary rupture produces haemorrhage D. white fibrin-platelet center during repair E. Can be seen in anaemia/thrombocytopenia, leukemia, diabetic retinopathy and subacute bacterial endocarditis 39. White Dot Syndromes clinical features All of the following are true except: A. White dots or patches located at the level of the RPE or choroid B. May affect children or adults C. May be unilateral or bilateral D. Can be seen only in Multiple evanescent white dot syndrome E. May be associated with ocular inflammation 40. Achromatopsia clinical features All of the following are true except: A. Congenital nystagmus at birth or early in life B. Autosomal recessive C. Photophobia with better vision in dim light D. Partial color blindness with good visual acuity E. ERG shows absence of cone responses and normal rod responses 8 41. Progressive Cone Dystrophy clinical features All of the following are true except: A. Reduced VA, altered color vision and photophobia B. Autosomal dominant, X-linked recessive and some sporadic cases C. Normal cone-mediated ERG’s D. Fundoscopy shows early pigment disturbance or typical Bull’s eye maculopathy E. Variable age of onset in first decade or early adulthood 42. Stargardt’s disease clinical features All of the following are true except: A. Early onset and Progressive loss of central vision B. Good preservation of peripheral and night vision C. Round, linear or pisciform lesions throughout the posterior pole D. Generally autosomal dominant E. Deposition of lipofuscin in the RPE layer gives rise to the “dark choroid” sign on FFA 43. Best Disease (Vitelliform macular dystrophy) clinical features All of the following are true except: A. Age of onset is usually during childhood or adolescence B. Initially, a bright yellow cyst forms under the RPE beneath the macula with normal or near normal vision C. EOG is normal D. Autosomal dominant E. Classical lesion is round or oval, yellow “egg yolk” lesion at the macula 44. Leber Congenital Amaurosis clinical features All of the following are true except: A. Roving eye movements and unable to fix and follow at birth or in first few weeks of life B. Infants may have photophobia and eye-poking (Franceschetti’s sign) C. Autosomal recessive D. Pupil reactions are sluggish, occasionally with a paradoxical response E. Early widespread retinopathy with peripheral pigmentation, vessel attenuation and optic disc pallor 9 45. Intravitreal Steroids All of the following are true except: A. Can be used in cases of uveitis, retinal vascular diseases, choroidal neovascularization and as a surgical adjunct B. Main complications are increased IOP, cataract , endophthalmitis, haemorrhage and retinal detachment C. Do not cause optic neuritis or atrophy D. Can be given without using a sterile technique E. Can cause a pseudohypopyon (pseudoendophthalmitis) 46. All the following are true regarding the extra ocular muscles Except: A. They contain two types of muscle cells. B. Each of the extra ocular muscles receives two arterial branches except the lateral rectus muscle C. The inferior oblique arises from the orbital floor near the rim D. The superior rectus lies superior to the superior oblique E. The lateral rectus arises from the roof of the orbit 47. All the following statements regarding colobomas are true Except that they: A. Usually located superotemporally B. May be unilateral or bilateral C. Are termed atypical if located outside the region of the embryonic fissure D. Produce an absolute scotoma if they involve the retina E. Result from incomplete closure along the embryonic fissure 48. Ocular features associated with Down's Syndrome include all the following Except: A. B. C. D. E. Lisch nodules Brushfield spots Myopia Strabismus keratoconus 10 49. Each of the following is a feature associated with hyperplastic primary vitreous Except: A. B. C. D. E. High myopia Mostly unilateral Microphthalmos Elongated ciliary processes leukocoria 50. All the following are causes of pseudo-papilledema Except: A. B. C. D. E. Bergmeister papilla Optic nerve head drusen Hyperopia Diabetic papillopathy Pseudo tumor cerebri 51. Choose the structure that is incorrectly paired with the fissure or foramen through which it passes: A. B. C. D. E. Nasolacrimal canal—infraorbital nerve (trigeminal, second division) Superior orbital fissure—abducens nerve Inferior orbital fissure—inferior ophthalmic vein Anterior ethmoidal foramen—anterior ethmoidal nerve Optic foramen—ophthalmic artery 52. The bones of the orbit are: A. B. C. D. E. Frontal-zygoma-palatine-maxilla-parietal-sphenoid and lacrimal Frontal-zygoma-maxilla-ethmoid-temporal-lacrimal and sphenoid Frontal-zygoma-maxilla-sphenoid-mandible-lacrimal and ethmoid Frontal-zygoma-palatine-maxilla-ethmoid-sphenoid and lacrimal Frontal-palatine-maxilla-ethmoid-nasal-sphenoid and lacrimal 53. What is the spherical equivalent refraction of (+1.5- 5.00×90°): A. B. C. D. E. +0.5 +1.00 0D -1.00 -2.00 11 54. All are true regarding pinhole aperture Except: A. An eye with a pupil that is miosed from the use of pilocarpine will measure an artificially close near point of accommodation B. The ideal diameter of a pinhole for screening refractive errors in the 5 to+5 range is 1.2mm C. Patients with small uncorrected refractive errors often squeeze eyes to achieve a pinhole effect D. If a pinhole aperture is too small visual acuity will still improve and not be affected by diffraction of rays 55. All the following are possible treatments for intermittent exotropia Except: A. B. C. D. E. Miotics Eye muscle surgery Orthoptics Alternate patching Overminus or underplus lenses 56. A 3 year old boy presents with a history of crossing of the eyes for several months. You find equal vision of 6/12 in each eye, a distance esotropia of 20Δ, and a cycloplegic refraction of +3.5 diopters in each eye, your initial treatment is: A. B. C. D. E. Observation and follow up Alternate patching +2.50 eyeglasses +3.50 eyeglasses Bilateral medial rectus recession 57. A 4 year old girl on a routine visit is found to have uncorrected distance visual acuity of 6/60 in her right eye and 6/6 in her left eye. Cycloplegic refraction is -6.00 right eye and plano left eye. The best initial treatment is: A. B. C. D. E. A contact lens in the right eye Full time glasses -4.00 right eye and plano left eye Full time glasses -4.00 right eye and +2.00 left eye Full time glasses -6.00 right eye and plano left eye Occlusion of the left eye 12 58. The main indication for strabismus surgery in congenital nystagmus is: A. B. C. D. E. To dampen nystagmus To improve visual acuity To correct a head turn To correct strabismus None of the above 59. The muscles that have attachment to the dural sheath of the optic nerve at their origin are: A. B. C. D. E. Medial rectus and lateral rectus Medial rectus and inferior rectus Medial rectus and superior rectus Lateral rectus and inferior rectus Lateral rectus and superior rectus 60. A 39 year old female diabetic reports blurred vision for distance of one week duration. She has never worn glasses. Which of the following would you do: A. B. C. D. E. Perform an atropine refraction Perform manifest refraction and order accordingly Send her to her endocrinologist Give temporary glasses Do a stress refraction 61. In performing Douchrome test, a patient reports that the letters on the green side are clearer. What should you do: A. B. C. D. E. Add more minus sphere Take away plus sphere Add more plus sphere Add minus cylinder None of these 62. The longest acting cycloplegic agent is: A. B. C. D. Atropine Homatropine Cyclopentolate Tropicamide E. Eucatropine 13 63. The Weseley ring represents: A. B. C. D. Iron deposition in the stroma of a herpetic keratitis Melanin deposition in infected cells with herpes keratitis Ring of melanin surrounding filtering blebs Ring of antigen antibody complexes in the stroma of inflamed corneal lesion 64. Complications of continuous wear hydrogel contact lens include all Except: A. Infection B. Corneal vascularisation C. Giant papillary reaction D. Opacification of contact lens due to lipoprotein coating or calcium deposition E. corectopia 65. Conditions causing enophthalmus include: A. B. C. D. E. Horner's Syndrome Neurofibromatosis Blow out fracture Metastatic scirrhous carcinoma of the breast All of the above 66. All of the following are true about rhabdomyosarcoma Except that: A. B. C. D. E. It is the most common primary orbital tumor in children It is histologically similar to leiomyosarcoma The usual age of onset is from 5-10 years It is usually unilateral The alveolar type has the worst prognosis 67. Causes of lid retraction , other than Graves' disease include all Except: A. B. C. D. E. Cirrhosis of the liver Hydrocephalus Hypokalemic periodic paralysis Contralateral ptosis Orbital lymphangioma 14 68. All of the following are seen with Marfan's Syndrome Except: A. B. C. D. E. Hyperplasia of the dilator muscle of the iris Ectopia lentis Increased incidence of myopia and megalocornea Maldeveloped ciliary processes Peripheral retinal degeneration 69. Trouton's giant cells are found in: A. B. C. D. E. Xeroderma Pigmentosa Juvenile xanthogranuloma Kaposi's sarcoma Werner Syndrome Icthyosis 70. The triad of brittle bones, blue sclera and otosclerosis is characteristic of: A. B. C. D. E. Homocystinuria Marfan's Syndrome Osteopetrosis Osteogenesis imperfecta Sturge Weber Syndrome 71. All the following are generally accepted methods of management of keratoconus except: A. Penetrating keratoplasty B. Intracorneal rings (INTACS) C. Deep lamellar keratoplasty (DLK) D. Contact lenses E. LASIK 72. All the following are keratconjunctivitis except: FALSE regarding adenoviral A. Involvement of both eyes is the rule B. Topical acyclovir is the treatment of choice C. Nummular keratitis is a rare complication D. The disease is not contagious E. Pre-auricular lymphadenitis when present is helpful in diagnosis 15 A 55-year old female patient calls you at night telling you that she has severe pain in her right eye for the past two hours. 73. All the following data may help you to shorten the list of possible diagnosis except: A. History of hypermetropia B. History of trauma C. History of myopia D. History of previous attacks E. History of wearing contact lenses 74. All the following are true regarding ocular herpes simplex infection except: A. Positive Ig-G titre denotes previous exposure B. Topical acyclovir is usually the first line of treatment for dendretic keratitis C. Herpetic uveitis can be associated with increased intraocular pressure D. Dendritic keratitis is best treated by intensive steroid drops E. Ocular involvement is usually unilateral 75. All the following are false regarding congenital ptosis except: A. Levator muscle resection is indicated if levator muscle function is less than 4 mm B. If the pupil is covered surgery should be performed without delay C. Absent Bell's phenomenon is a good prognostic sign D. The best time to do fascia lata frontalis muscle suspension is at the age of one year 76. All the following are true regarding glaucoma medications except: A. Atropine can be used in neovascular glaucoma B. Pilocarpine is the drug of choice in neovascular glaucoma C. Steroid eye drops are useful in hypertensive uveitis D. Timolol is the first line of treatment in open angle glaucoma 77. The least possible complication of LASIK among the following is: A. Endophthalmitis B. Lost flap C. Overcorrection D. Undercorrection E. Decentered ablation 16 78. In a patient with high myopia & moderate cataract the best course of action is: A. LASIK B. Phakic intraocular lens C. Cataract extraction with intraocular lens implantation D. INTACS (intracorneal rings). E. Radial keratotomy (R.K.). 79. All the following are true regarding herpes zoster ophthalmicus infections except: A. Involvement of the tip of the nose may indicate that the eye will be involved B. Systemic acyclovir treatment is most effective when given after the formation of pustules C. Should be considered in the differential diagnosis of hypertensive uveitis D. The dose of acyclovir needed for treatment is higher than that needed for herpes simplex virus infections 80. All the following corneal lesions will become worse with topical steroids except: A. Fungal keratitis B. Bacterial keratitis C. Herpes simplex virus dendretic keratitis D. Nummular keratitis 81. All the following are known causes of lower lid ectropion EXCEPT A. Age related changes B. Tumours C. Trachoma D. Burns 82. In stage 3 hypertensive retinopathy all the following are present except: A. Cotton-wool spots B. Focal arteriolar narrowing C. Optic disc swelling D. Exudates 17 83. All the following corneal dystrophies are inherited as autosomal dominant traits except: A. Lattice dystrophy B. Macular dystrophy C. Granualr dystrophy D. Reis-Bucklers' dystrophy 84. All the following are true regarding dysthyroid eye disease except: A. The lateral rectus muscle is the most frequently involved B. Orbital C. T. scan is helpful in diagnosis C. Optic nerve compression is an indication for systemic steroid therapy D. Muscle surgery is better delayed till the disease is inactive 85. The differential diagnosis of cicatrized conjunctiva includes all the following except: A. Chemical burns B. Stevens-Johnsons' syndrome C. Trachoma D. Seasonal allergic conjunctivitis 86. Clinically Significant Macular Edema in Diabetic Retinopathy is characterized by: A. Thickening of the retina at or within 500 microns of the center of the macula B. Hard exudates at or within 500 microns of the center of the macula, if associated with thickening of adjacent retina C. A zone or zones of retinal thickening 1 disc area or larger, any part of which is within 1 disc diameter of the center of macula D. Any of the above E. None of the above 87. All the following should be considered in the differential diagnosis of sympatheic ophthalmia except: A. Traumatic iritis B. Vogt-Koyanagi-Harada syndrome C. Age-related macular degeneration D. Phacoanaphylaxis 18 88. All the following conditions are associated with eye lid retraction except: A. Thyroid disease B. Blowout fracture with inferior rectus entrapment C. Midbrain lesions D. Horner syndrome 89. Deafness is usually a clinical finding in the following disorders except: A. B. C. D. Vogt-Koyanagi-Harada Syndrome Intra uterine Rubella infection Wilson's disease Aminoglycoside toxicity 90. All the following statements regarding psuedoexfoliation syndrome are true except: A. Medical treatment is usually the same as in primary open angle glaucoma B. Laser trabeculoplasty has a low success rate C. Trabeculectomy has results similar to primary open angle glaucoma D. Zonule is weaker than that of normal eyes 91. The treatment of neonatal chlamydial conjunctivitis requires systemic therapy with erythromycin because: A. Topical antibiotics are not effective in children B. Topical antibiotics promote resistance C. Pneumonitis or pneumonia frequently accompany chlamydial conjunctivitis D. Systemic erythromycin therapy is less expensive than topical treatment 92. Systemic Steroid therapy is useful in all the following conditions except: A. A 67-year old man with artertic type of ischemic optic neuropathy. B. A 55-year old woman with Fuchs heterochromic iridocyclitis. C. A 28- year-old woman with sudden decrease of vision in her only eye to hand movement secondary to optic neuritis. D. A 24-year-old man with active toxoplasma retinitis involving the macula together with proper antiparasitic cover. 19 93. All the following tests are of diagnostic importance in Myasthenia Gravis except: A. B. C. D. Tensilon Test. CT scan of the chest. Electromyography Erythrocyte sedimentation rate (ESR) 94. One of the following is false regarding Mitomycin C: A. B. C. D. Is an antibiotic drug isolated from Streptomces caespiousus. It might cause scleral melting. The use of Mitomycin C in conjunction with Trabeculectomy has no effect on the incidence of late onset endophthalmitis. It decreases haze after photorefractive keratectomy (PRK) 95. Coat’s Disease is characterized by one of the following: A. B. C. D. Both eyes are affected. Females are more affected than males. Retinal neovascularization. leukcoria 96. Rubeosis iridis may be associated with all the following conditions except: A. B. C. D. Diabetes Mellitus cone- rode dystrophy Central retinal vein occlusion. Ocular ischemic syndrome. 97. Blunt trauma to the eye can cause all the following except: A. B. C. D. E. Nummular keratitis Diplopia Enophthalmos Macular hole Visual field loss (partial or complete) 20 98. One of the following is true regarding corneal dystrophies: A. All types are inherited by autosomal recessive way. B. Usually occur in one eye only. C. May recur after lamellar but not penetrating corneal graft. D. Phototherapeutic keratectomy (PTK) might be effective procedure for selected cases. 99. All the following may be associated with Behcet’s Disease except: A. B. C. D. E. Familial predisposition is common. Genital ulcers. Recurrent aphthous ulcers. Thrombosis of inferior vena cava. Retinal neovascularization. 100. One of the following is true about lid tumors: A. B. C. D. Squamous cell carcinoma constitutes 90% of all primary cancers of eye lid. Basal cell carcinoma is a common finding in Xeroderma Pigmentosum. Sebaceous carcinoma may mimic chronic blepharitis Keratoacanthoma of the lid metastasizes by blood route only. GOOD LUCK 21 22