FEU PRACTICE QUESTIONS (LE1)

Question 1

A 25-year-old male was seen at the OPD complaining of hyperacute purulent conjunctivitis. Gram stain of his eye discharge would show this result:
Select one:
a. Pleomorphic rod
b. Dumbbell-shaped diplococci
c. Gram (+) cocci in clusters
d. Gram (-) diplococci

Answer 1

d. Gram (-) diplococci

Rationalization:
* Pleomorphic rod: This refers to bacteria that can vary in shape. It’s not typically associated with hyperacute purulent conjunctivitis.
* Dumbbell-shaped diplococci: This description doesn’t correspond to a known common bacterial shape associated with conjunctivitis.
* Gram (+) cocci in clusters: This typically describes Staphylococcus species (Bacterial Conjunctivitis)
* Gram (-) diplococci: This typically describes Neisseria gonorrhoeae, which is a common cause of hyperacute purulent conjunctivitis.

Question 2

On VA testing, the patient was unable to read even the first line of the Snellen chart with his left eye despite moving him closer to a distance of 1 meter. What should you do next?
Select one:
a. Repeat VA testing using pinhole
b. Instruct the patient to count your extended fingers at a distance of less than 1 meter
c. Shine your penlight on his left eye to check for pupillary light reflex
d. Replace the Snellen Chart since it is possible that the patient is not familiar with the figures

Answer 2

b. Instruct the patient to count your extended fingers at a distance of less than 1 meter

1 meter = 3 feet

Rationalization:
- Repeat VA testing using pinhole: This helps determine if the decreased vision is due to a refractive error. If the patient cannot see the chart even at 1 meter, it’s unlikely that pinhole testing will yield useful results at this stage.
- Instruct the patient to count your extended fingers at a distance of less than 1 meter: This is a standard practice for assessing very low vision. If the patient cannot see the largest optotype on the Snellen chart at 1 meter, the next step is usually to check if the patient can see hand movements or count fingers.
- Shine your penlight on his left eye to check for pupillary light reflex: This is useful for checking the function of the optic nerve and pathway but does not assess visual acuity.
- Replace the Snellen Chart since it is possible that the patient is not familiar with the figures: This would be considered only if there was a clear indication that the patient cannot recognize the letters, which is unlikely in this context.

Question 3

Which of the following is in systematic order in observing your fundus?
Select one:
a. Macula, retinal background, retinal vessels, optic media, optic disc
b. Optic media, macula, optic disc, retinal vessels, retinal background
c. Optic media, optic disc, retinal vessels, retinal background, macula
d. Optic disc, optic media, retinal vessels, retinal background, macula

Answer 3

c. Optic media, optic disc, retinal vessels, retinal background, macula

Rationalization:
- The systematic order typically begins with the optic disc, then the retinal vessels, retinal background, and finally the macula.

Question 4

Which type of age-related cataracts causes myopic shift?
Select one:
a. Diabetic cataract
b. Nuclear sclerosis
c. Posterior subcapsular
d. Cortical

Answer 4

b. Nuclear sclerosis

Rationalization:
- Diabetic cataract: Related to diabetes, not specifically age-related myopic shift.
- Nuclear sclerosis: This type of cataract often causes a myopic shift due to changes in the lens.
- Posterior subcapsular: Causes glare and difficulty reading but not typically myopic shift.
- Cortical: Causes glare and monocular diplopia but not typically myopic shift.

Question 5

A post-menopausal patient is complaining of intermittent blurring of vision, OU. She also complains of redness, tearing, and burning sensation in both eyes. Which of the following tests will you perform to help with the diagnosis of dry eye syndrome?
Select one:
a. Corneal sensitivity, corneal and conjunctival staining
b. Seidel’s test, phenylephrine test
c. Tear break-up time, Schirmer’s test
d. Dilated fundus exam, Watzke-Allen test

Answer 5

c. Tear break-up time, Schirmer’s test

Rationalization:
- Corneal sensitivity, corneal and conjunctival staining: Useful for other conditions but not specific for dry eye.
- Seidel’s test, phenylephrine test: Seidel’s test is for detecting aqueous humor leakage, phenylephrine test for diagnosing Horner’s syndrome.
- Tear break-up time, Schirmer’s test: Both are standard tests for diagnosing dry eye syndrome.
- Dilated fundus exam, Watzke-Allen test: Used for evaluating the retina, not specific for dry eye.

Question 6

This structure is triangular in shape with smooth muscle fibers that is responsible for accommodation.
Select one:
a. Ora serrata
b. Lamina cribrosa
c. Ciliary body
d. Lens

Answer 6

c. Ciliary body

Rationalization:
- Ora serrata: The serrated junction between the retina and the ciliary body.
- Lamina cribrosa: A sieve-like structure in the sclera where the optic nerve fibers pass.
- Ciliary body: Contains smooth muscle fibers responsible for changing the shape of the lens (accommodation).
- Lens: Changes shape to focus light but does not contain smooth muscle fibers.

Question 7

This condition is commonly associated with a viral or bacterial infection. A noted feature is inflamed blood vessels at the scleral area which do not move upon manipulation.
Select one:
a. Scleromalacia perforans
b. Necrotizing scleritis
c. Diffuse scleritis
d. Posterior scleritis

Answer 7

c. Diffuse scleritis

Rationalization:
- Scleromalacia perforans: Thinning of the sclera, typically in rheumatoid arthritis, not commonly associated with infection.
- Necrotizing scleritis: Severe form of scleritis with tissue necrosis.
- Diffuse scleritis: Generalized inflammation of the sclera, often associated with infection.
- Posterior scleritis: Involves the back part of the sclera, less visible on the surface.

Question 8

What test provides a gross evaluation of the visual fields?
Select one:
a. Perimetry
b. Confrontation test
c. Farnsworth-Munsell 100 Hue Test
d. Pseudochromatic chart

Answer 8

b. Confrontation test

Rationalization:
- Perimetry: Detailed evaluation of visual fields.
- Confrontation test: Simple, gross assessment of visual fields.
- Farnsworth-Munsell 100 Hue Test: Evaluates color vision.
- Pseudochromatic chart: Used for color blindness testing.

Question 9

This type of scleritis has the poorest prognosis among the following:
Select one:
a. Necrotizing scleritis
b. Diffuse scleritis
c. Nodular scleritis
d. Posterior scleritis

Answer 9

a. Necrotizing scleritis

Rationalization:
- Necrotizing scleritis: Most severe and destructive form, often associated with systemic diseases, and has the poorest prognosis.
- Diffuse scleritis: Generalized inflammation, better prognosis.
- Nodular scleritis: Localized, better prognosis.
- Posterior scleritis: Can be severe but typically not as poor prognosis as necrotizing.

Question 10

Which part of the optic media has the highest refractive power?
Select one:
a. Aqueous humor
b. Vitreous
c. Cornea
d. Crystalline lens

Answer 10

c. Cornea

Rationalization:
- Aqueous humor: Refractive index is low.
- Vitreous: Refractive index is low.
- Cornea: Has the highest refractive power due to its curvature.
- Crystalline lens: Has significant refractive power but less than the cornea.

Question 11

A 40-year-old farmer felt foreign body sensation, OD while harvesting corn. This persisted for 3 days. On the 5th day, there was redness and tearing. One week later, a small central white opacity appeared, which he noticed to slowly increase in size in the next few days. You see him 2 weeks after the onset of symptoms with a corneal ulcer 3.5mm in diameter. What is your primary impression?
Select one:
a. Fungal keratitis
b. Moraxella keratitis
c. Neisseria gonorrhea keratitis
d. Acanthamoeba keratitis

Answer 11

a. Fungal keratitis

Rationalization:
- Fungal keratitis: Common in farmers due to trauma with organic matter (e.g., plants), and often presents with a gradually enlarging corneal ulcer.
- Moraxella keratitis: Typically occurs in individuals with compromised immunity or chronic eye diseases, not commonly associated with trauma.
- Neisseria gonorrhea keratitis: Rapidly progressive and severe, usually associated with gonococcal conjunctivitis, not typically seen in this context.
- Acanthamoeba keratitis: Associated with contact lens wearers and exposure to contaminated water, not typically linked to trauma with organic material.

Question 12

This surgical technique involves removal of the entire lens:
Select one:
a. Phacoemulsification
b. Extracapsular Cataract Extraction
c. Intracapsular Cataract Extraction
d. MSICS

Answer 12

c. Intracapsular Cataract Extraction

Rationalization:
- Phacoemulsification: Modern technique where the lens is emulsified and aspirated, lens capsule remains.
- Extracapsular Cataract Extraction: Lens is removed, but posterior capsule remains intact.
- Intracapsular Cataract Extraction: Entire lens, including the capsule, is removed.
- MSICS (Manual Small Incision Cataract Surgery): A variant of extracapsular extraction, smaller incision.

Question 13

Which of the following is metabolically active?
Select one:
a. Lens epithelial cells
b. Lens cortex
c. Lens nucleus
d. Anterior lens capsule

Answer 13

a. Lens epithelial cells

Rationalization:
- Lens epithelial cells: Responsible for maintaining lens metabolism and transparency.
- Lens cortex: Less metabolically active, consists of elongated fiber cells.
- Lens nucleus: Central, older, and least metabolically active part of the lens.
- Anterior lens capsule: Protective layer, not metabolically active.

Question 14

A 3-day-old newborn was brought to the OPD for consultation due to purulent discharge of both eyes. Which of the following statements is NOT true?
Select one:
a. Erythromycin eye ointment is effective for inclusion conjunctivitis
b. This may be caused by Pseudomonas aeruginosa
c. Diagnosis is Ophthalmia Neonatorum
d. The most serious etiology is Neisseria gonorrhea

Answer 14

b. This may be caused by Pseudomonas aeruginosa

Rationalization:
- Erythromycin eye ointment is effective for inclusion conjunctivitis: True, commonly used for Chlamydia trachomatis.
- This may be caused by Pseudomonas aeruginosa: Not typical for Ophthalmia Neonatorum, which is usually caused by Neisseria gonorrhoeae or Chlamydia trachomatis.
- Diagnosis is Ophthalmia Neonatorum: True, the term for neonatal conjunctivitis.
- The most serious etiology is Neisseria gonorrhea: True, can cause severe corneal damage if not treated.

Question 15

The common definition of a Snellen’s index with a vision of less than 3/200 is:
Select one:
a. Partially seeing
b. Hand movement
c. Travel vision
d. Minimal reading

Answer 15

b. Hand movement

Rationalization:
- Partially seeing: This term usually refers to visual acuity that is better than 3/200 but not normal.
- Hand movement: Describes a very low level of vision where the person can only see hand movements but cannot read any letters on the Snellen chart, which corresponds to visual acuity of less than 3/200.
- Travel vision: Generally refers to vision sufficient for basic mobility and navigation, but not specific to the less than 3/200 criteria.
- Minimal reading: Refers to vision just adequate for reading very large print, which would be better than 3/200.

Question 16

An elderly patient comes in with redness and unilateral blurring of vision as well as vesicles on the right forehead. On examination, he was found to have a corneal dendrite. The following supports your diagnosis of varicella zoster infection versus herpes simplex infection, EXCEPT?
Select one:
a. Dichotomous branching of dendrites with terminal bulbs
b. Hutchinson’s sign on the tip of the patient’s nose
c. Vesicular lesions on the face respecting the midline
d. Non-dichotomous branching of dendrites without terminal bulbs

Answer 16

a. Dichotomous branching of dendrites with terminal bulbs:

This is a feature of herpes simplex keratitis, not varicella zoster. Herpes simplex virus (HSV) dendrites tend to have dichotomous branching and terminal bulbs.

Other Options Explanation:

• b. Hutchinson’s sign on the tip of the patient’s nose: This is indicative of varicella zoster infection, particularly herpes zoster ophthalmicus. It suggests that the nasociliary branch of the trigeminal nerve is involved.
• c. Vesicular lesions on the face respecting the midline: This is characteristic of herpes zoster (shingles) infection, which follows a dermatomal pattern and does not cross the midline.
• d. Non-dichotomous branching of dendrites without terminal bulbs: This description fits the dendrites seen in varicella zoster virus (VZV) keratitis.

Question 17

In the management of fungal keratitis, which of the following is contraindicated?
Select one:
a. Corneal keratectomy for better penetration of topical anti-fungal medication
b. Topical antibiotic drops to cover for possible concomitant bacterial infection
c. Corneal scraping for gram stain, Giemsa staining, and culture studies
d. Topical steroid antibiotic drops to cover for inflammation, chemosis, and possible secondary bacterial infection

Answer 17

d. Topical steroid antibiotic drops to cover for inflammation, chemosis, and possible secondary bacterial infection

Rationalization:
- Corneal keratectomy for better penetration of topical anti-fungal medication: This can be beneficial.
- Topical antibiotic drops to cover for possible concomitant bacterial infection: Common practice.
- Corneal scraping for gram stain, Giemsa staining, and culture studies: Standard diagnostic procedure.
- Topical steroid antibiotic drops to cover for inflammation, chemosis, and possible secondary bacterial infection: Steroids are contraindicated in fungal keratitis as they can exacerbate the infection.

Question 18

Which of the following is correctly matched?
Select one:
a. cc - without correction
b. OU - both eyes
c. OD - left eye
d. sc - with correction (corrective glasses)

Answer 18

b. OU - both eyes

Rationalization:
- cc - without correction: Incorrect, it means “with correction”.
- OU - both eyes: Correct, OU stands for “oculus uterque”.
- OD - left eye: Incorrect, OD stands for “oculus dexter” (right eye).
- sc - with correction (corrective glasses): Incorrect, it means “without correction”.

Question 19

Multiple, elevated, polygonal hyperemic mounds with a central fibrovascular core characterize this conjunctival inflammatory response of lymphocytes and plasma cells.
Select one:
a. Follicular response
b. Phlyctenular response
c. Ligneous response
d. Papillary response

Answer 19

d. Papillary response

Rationalization:
- Follicular response: Typically seen in viral and chlamydial infections, not characterized by a central fibrovascular core.
- Phlyctenular response: A localized nodular response, often related to hypersensitivity.
- Ligneous response: Rare and involves the formation of wood-like pseudomembranes.
- Papillary response: Characterized by multiple, elevated, polygonal hyperemic mounds with a central fibrovascular core, seen in allergic conjunctivitis.

Question 20

Infection or inflammation of the cornea is generally called keratitis. This may affect all layers of the cornea. The layers of the cornea from innermost to outermost are the following:
Select one:
a. Epithelium, Bowman’s, stroma, Descemet’s, endothelium
b. Endothelium, Descemet’s, stroma, Bowman’s, epithelium
c. Endothelium, Descemet’s, Bowman’s, stroma, epithelium
d. Epithelium, Bowman’s, stroma, Descemet’s, endothelium

Answer 20

b. Endothelium, Descemet’s, stroma, Bowman’s, epithelium

Question 21

Question 21
In performing direct fundoscopy, at what angle do you come closer to the patient’s line of sight?
Select one:
a. About 15 degrees temporally
b. About 25 degrees nasally
c. About 15 degrees nasally
d. About 25 degrees temporally

Answer 21

a. About 15 degrees temporally
Rationalization:
* About 15 degrees temporally: This is the correct angle to view the optic disc directly in direct fundoscopy.
* About 25 degrees nasally: Not typically used for direct visualization of the optic disc.
* About 15 degrees nasally: Incorrect angle for direct fundoscopy.
* About 25 degrees temporally: This angle is too wide for direct fundoscopy.

Question 22

Question 22
A patient came in for a consult due to blurring of vision. While taking the visual acuity, the patient was unable to see the largest letter on the Snellen chart at 20 feet. What will be your next step to obtain the visual acuity?
Select one:
a. Use penlight to determine if the patient can correctly detect the direction of the light source
b. Ask the patient to count fingers at 3 feet
c. Bring the patient closer to the chart until he/she is able to read the 20/200 line.
d. Determine if the patient can distinguish the presence or absence of Hand Movement (HM)

Answer 22

c. Bring the patient closer to the chart until he/she is able to read the 20/200 line.
Rationalization:
* Use penlight to determine if the patient can correctly detect the direction of the light source: This is a method to check light perception, not visual acuity.
* Ask the patient to count fingers at 3 feet: This is used if the patient cannot see any letters on the chart even when moved closer.
* Bring the patient closer to the chart until he/she is able to read the 20/200 line: Correct procedure to determine the visual acuity when the patient cannot see the chart at 20 feet.
* Determine if the patient can distinguish the presence or absence of Hand Movement (HM): This is used when vision is extremely poor and closer methods have failed.

Question 23

Question 23
Which of the following is TRUE regarding conjunctivitis?
Select one:
a. Perennial: Allergic conjunctivitis
b. Chronic: Viral conjunctivitis
c. Acute: Gonococcal conjunctivitis
d. Hyperacute: Chlamydial conjunctivitis

Answer 23

a. Perennial: Allergic conjunctivitis
Rationalization:
* Perennial: Allergic conjunctivitis: True, perennial allergic conjunctivitis occurs year-round due to allergens such as dust mites.
* Chronic: Viral conjunctivitis: Viral conjunctivitis is usually acute, not chronic.
* Acute: Gonococcal conjunctivitis: Gonococcal conjunctivitis is hyperacute, not acute.
* Hyperacute: Chlamydial conjunctivitis: Chlamydial conjunctivitis is chronic or subacute, not hyperacute.

Question 24

Question 24
Which of the following is true regarding diabetic cataracts?
Select one:
a. It is usually unilateral.
b. Diabetics develop cataracts later than non-diabetics.
c. Glucose is converted to sorbitol by aldose oxidase in the lens.
d. It can be treated with LASIK surgery.

Answer 24

c. Glucose is converted to sorbitol by aldose reductase in the lens.
Rationalization:
* It is usually unilateral: Diabetic cataracts are typically bilateral.
* Diabetics develop cataracts later than non-diabetics: Diabetics develop cataracts earlier than non-diabetics.
* Glucose is converted to sorbitol by aldose reductase in the lens: True, sorbitol accumulation leads to osmotic stress and cataract formation.
* It can be treated with LASIK surgery: LASIK is for refractive errors, not for treating cataracts.

Question 25

Question 25
Which of the following conditions can cause ectopia lentis?
Select one:
a. Error of refraction
b. Diabetes mellitus
c. Trauma
d. Hypertension

Answer 25

c. Trauma
Rationalization:
* Error of refraction: Does not cause lens dislocation.
* Diabetes mellitus: Not typically associated with lens dislocation.
* Trauma: A common cause of ectopia lentis (dislocation of the lens).
* Hypertension: Not associated with lens dislocation.

Question 26

Question 26
A 30-year-old male patient complained of loss of vision in his left eye after he sustained head trauma. Which part of the optic nerve is most susceptible to trauma?
Select one:
a. Intracanalicular
b. Intracranial
c. Intraorbital
d. Intraocular

Answer 26

a. Intracanalicular
Rationalization:
* Intracanalicular: This part of the optic nerve, located within the bony canal, is most susceptible to trauma due to its rigid surroundings.
* Intracranial: Located within the skull, less likely to be directly affected by trauma.
* Intraorbital: Although susceptible, it has more room for movement within the orbit.
* Intraocular: This part is protected within the eye.

Question 27

Question 27
This is a lens-induced ocular disease secondary to intumescent cataract.
Select one:
a. Phacodonesis
b. Phacomorphic glaucoma
c. Phacolytic glaucoma
d. Phacoantigenic glaucoma

Answer 27

b. Phacomorphic glaucoma
Rationalization:
* Phacodonesis: Refers to lens tremulousness or instability, not specifically related to intumescent cataracts.
* Phacomorphic glaucoma: Occurs when an intumescent (swollen) cataract causes secondary angle-closure glaucoma.
* Phacolytic glaucoma: Caused by leakage of lens proteins from a hypermature cataract, leading to an inflammatory response and glaucoma.
* Phacoantigenic glaucoma: An immune response to lens proteins following surgery or trauma.

Question 28

Question 28
Which of the following conditions causes secondary angle closure glaucoma?
Select one:
a. Microspherophakia
b. Mittendorf dot
c. Aniridia
d. Lens coloboma

Answer 28

a. Microspherophakia
Rationalization:
* Microspherophakia: A condition where the lens is abnormally small and spherical, leading to angle closure glaucoma.
* Mittendorf dot: A remnant of the hyaloid artery on the posterior lens capsule, not associated with glaucoma.
* Aniridia: Absence of the iris, can lead to various issues but not specifically secondary angle closure glaucoma.
* Lens coloboma: A congenital defect of the lens, not typically causing angle closure glaucoma.

Question 29

Question 29
Non-specific conjunctival response more obvious on the upper tarsal conjunctiva presenting as a fine mosaic pattern of dilated telangiectatic blood vessels.
Select one:
a. Papillary conjunctivitis
b. Follicular conjunctivitis
c. Hemorrhagic conjunctivitis
d. Membranous conjunctivitis

Answer 29

a. Papillary conjunctivitis
Rationalization:
* Papillary conjunctivitis: Characterized by a fine mosaic pattern of dilated telangiectatic blood vessels on the upper tarsal conjunctiva.
* Follicular conjunctivitis: Characterized by lymphoid follicles on the conjunctiva, not a fine mosaic pattern.
* Hemorrhagic conjunctivitis: Characterized by subconjunctival hemorrhages.
* Membranous conjunctivitis: Characterized by the formation of membranes or pseudomembranes on the conjunctiva.

Question 30

Question 30
What is the major function of the lens?
Select one:
a. Main refractive media
b. Acts as a diaphragm
c. Refraction
d. Highest diopter power

Answer 30

c. Refraction
Rationalization:
* Main refractive media: While the lens does contribute to refraction, the cornea is the main refractive medium.
* Acts as a diaphragm: This is the function of the iris.
* Refraction: The lens primarily helps to focus light onto the retina.
* Highest diopter power: The cornea has the highest diopter power, not the lens.

Question 31

Question 31
Which of the following is a component of pupil examination?
Select one:
a. Assessment of reaction to light
b. Assessment of involuntary eye movement
c. Assessment of pressure
d. Assessment of extraocular movement

Answer 31

a. Assessment of reaction to light
Rationalization:
* Assessment of reaction to light: This is a key part of the pupil examination to check for direct and consensual light reflex.
* Assessment of involuntary eye movement: This relates to nystagmus, not specifically to pupil examination.
* Assessment of pressure: This is related to intraocular pressure, typically assessed in glaucoma exams.
* Assessment of extraocular movement: This is related to eye movement testing, not specifically pupil examination.

Question 32

Question 32
Which of the following statements is/are TRUE of Visual Acuity (VA) Testing?
Select one or more:
a. VA testing should be done after manipulation of the eye
b. VA testing is the fundamental element of the basic eye examination
c. VA testing is only for patients over 35 years of age
d. VA testing is used to assess the function of peripheral retina

Answer 32

b. VA testing is the fundamental element of the basic eye examination
Rationalization:
* VA testing should be done after manipulation of the eye: Incorrect. VA testing should be done before any manipulation to get an accurate baseline measurement.
* VA testing is the fundamental element of the basic eye examination: Correct. It is a primary assessment to determine the clarity or sharpness of vision.
* VA testing is only for patients over 35 years of age: Incorrect. VA testing is performed on patients of all ages.
* VA testing is used to assess the function of peripheral retina: Incorrect. VA testing primarily assesses central vision, not peripheral retinal function.

Question 33

Question 33
What structure is visible as dark blue/gray scleral patches among patients with recurrent scleritis?
Select one:
a. Retina
b. Uvea
c. Blood vessels
d. Vitreous

Answer 33

b. Uvea
Rationalization:
* Retina: Not visible as dark blue/gray patches in scleritis.
* Uvea: The underlying uvea can appear as dark blue/gray patches when the sclera thins in scleritis.
* Blood vessels: Not typically described as dark blue/gray patches in this context.
* Vitreous: Not visible as dark blue/gray patches in scleritis.

Question 34

Question 34
In EOM testing, you note that the patient is unable to abduct his left eye. Movement was full on all positions of gaze for the right eye. This would imply weakness of which muscle in his left eye:
Select one:
a. Medial rectus
b. Lateral rectus
c. Superior rectus
d. Inferior rectus

Answer 34

b. Lateral rectus
Rationalization:
* Medial rectus: Responsible for adduction (moving the eye inward), not abduction.
* Lateral rectus: Responsible for abduction (moving the eye outward), so inability to abduct suggests lateral rectus weakness.
* Superior rectus: Responsible for elevation and some adduction, not abduction.
* Inferior rectus: Responsible for depression and some adduction, not abduction.

Question 35

Question 35
Which of the following is TRUE of the Tenon’s capsule?
Select one:
a. It is composed of 2 to 5 layers of stratified columnar epithelial cells
b. It is held in place by suspensory ligaments
c. It secretes mucin for the maintenance of the precorneal tear film
d. It is continuous with the extraocular muscles

Answer 35

d. It is continuous with the extraocular muscles
Rationalization:
* It is composed of 2 to 5 layers of stratified columnar epithelial cells: Incorrect. This description does not apply to Tenon’s capsule.
* It is held in place by suspensory ligaments: Incorrect. This refers more to the lens.
* It secretes mucin for the maintenance of the precorneal tear film: Incorrect. This is the function of the goblet cells in the conjunctiva.
* It is continuous with the extraocular muscles: Correct. Tenon’s capsule envelops the extraocular muscles.

Question 36

Question 36
What type of distance vision chart is used for illiterate or pre-verbal children?
Select one:
a. Bailey-Lovie chart
b. Picture chart
c. ETDRS chart
d. Snellen chart

Answer 36

b. Picture chart
Rationalization:
* Bailey-Lovie chart: Used for assessing visual acuity, but typically not for illiterate or pre-verbal children.
* Picture chart: Correct. Picture charts use recognizable images that children can identify.
* ETDRS chart: Used for research and clinical trials, not specifically designed for children.
* Snellen chart: Standard chart for literate individuals.

Question 37

Question 37
This photoreceptor is extrafoveal in location and is used for night vision.
Select one:
a. Cones
b. Bipolar
c. Rods
d. Ganglion

Answer 37

c. Rods
Rationalization:
* Cones: Located in the fovea and used for color vision and fine detail.
* Bipolar: These are not photoreceptors; they are intermediate cells in the retina.
* Rods: Correct. Located outside the fovea and responsible for night vision.
* Ganglion: These are not photoreceptors; they transmit visual information from the retina to the brain.

Question 38

Question 38
The patient was able to read all the letters in Line 6 and 2 letters at Line 7. What is the visual acuity of the patient?
Select one:
a. 20/25 - 2
b. 20/30 + 2
c. 20/25 + 2
d. 20/30 - 2

Answer 38

b. 20/30 + 2
Rationalization:
* 20/25 - 2: Incorrect. This would imply the patient missed 2 letters on the 20/25 line.
* 20/30 + 2: Correct. This means the patient read all the letters on the 20/30 line and 2 letters on the next line (20/25).
* 20/25 + 2: Incorrect. This would imply the patient read all the letters on the 20/25 line and 2 letters on the next line (20/20).
* 20/30 - 2: Incorrect. This would imply the patient missed 2 letters on the 20/30 line.

Question 39

Question 39
What test provides a more detailed evaluation of the visual field?
Select one:
a. Pseudoisochromatic chart
b. Farnsworth-Munsell 100 hue test
c. Perimetry
d. Confrontation test

Answer 39

c. Perimetry
Rationalization:
* Pseudoisochromatic chart: Used for color vision testing.
* Farnsworth-Munsell 100 hue test: Used for detailed color vision testing.
* Perimetry: Correct. Provides detailed evaluation of the visual field.
* Confrontation test: A basic and gross assessment of the visual field.

Question 40

Question 40
In cases of microbial keratitis, the etiologic organism is confirmed by:
Select one:
a. Giemsa stain
b. Periodic Acid Schiff stain
c. Gram stain
d. Culture studies

Answer 40

d. Culture studies
Rationalization:
* Giemsa stain: Useful for detecting intracellular organisms, not definitive for all microbial keratitis pathogens.
* Periodic Acid Schiff stain: Used for fungal infections, not comprehensive for all microbial keratitis.
* Gram stain: Useful for initial identification of bacteria but not definitive for all pathogens.
* Culture studies: Correct. The gold standard for identifying the specific causative organism in microbial keratitis.

Question 41

Question 41
Which of the following characteristics of the crystalline lens is TRUE?
Select one:
a. It is supported by the zonules.
b. It is highly vascular.
c. It is avascular.
d. It is biconcave.

Answer 41

c. It is avascular.
Rationalization:
* It is supported by the zonules: This is true, but another choice is more specific.
* It is highly vascular: Incorrect. The lens is avascular.
* It is avascular: Correct. The crystalline lens does not contain blood vessels.
* It is biconcave: Incorrect. The lens is biconvex, not biconcave.

Question 42

Question 42
Which of the following is true of cataracts?
Select one:
a. It is defined as the presence of any opacity in the lens.
b. It is treated with anti-cataract eyedrops.
c. It is not seen in infants.
d. The most common cause is trauma followed by diabetes.

Answer 42

a. It is defined as the presence of any opacity in the lens.
Rationalization:
* It is defined as the presence of any opacity in the lens: Correct. Cataracts are characterized by clouding or opacity in the lens.
* It is treated with anti-cataract eyedrops: Incorrect. Cataracts are typically treated with surgical removal, not eyedrops.
* It is not seen in infants: Incorrect. Cataracts can be congenital or develop in infants.
* The most common cause is trauma followed by diabetes: Incorrect. Aging is the most common cause of cataracts.

Question 43

Question 43
Which of the following is true regarding presbyopia?
Select one:
a. Inability to read at far distance
b. Needs concave corrective glasses
c. Ciliary body sclerosis
d. Physiologic loss of accommodation due to aging

Answer 43

d. Physiologic loss of accommodation due to aging
Rationalization:
* Inability to read at far distance: Incorrect. Presbyopia affects near vision.
* Needs concave corrective glasses: Incorrect. Convex (plus) lenses are used to correct presbyopia.
* Ciliary body sclerosis: Incorrect. Presbyopia is due to lens changes, not ciliary body sclerosis.
* Physiologic loss of accommodation due to aging: Correct. Presbyopia is the age-related decline in the eye’s ability to focus on close objects.

Question 44

Question 44
Non-specific conjunctival response composed of smooth nodules with avascular apices surrounded by fine vessels at their bases often seen in adenoviral, chlamydial as well as toxic conjunctivitis:
Select one:
a. Membranous conjunctivitis
b. Hemorrhagic conjunctivitis
c. Follicular conjunctivitis
d. Papillary conjunctivitis

Answer 44

c. Follicular conjunctivitis
Rationalization:
* Membranous conjunctivitis: Involves formation of membranes on the conjunctiva.
* Hemorrhagic conjunctivitis: Characterized by subconjunctival hemorrhages.
* Follicular conjunctivitis: Correct. Characterized by smooth nodules with avascular apices and fine vessels at their bases, seen in viral and chlamydial infections.
* Papillary conjunctivitis: Characterized by a cobblestone appearance on the conjunctiva, usually in allergic reactions.

Question 45

Question 45
Which of the following is true of spherophakia?
Select one:
a. Usually results in astigmatism
b. Treated by trabeculectomy
c. Lens subluxation is common due to weak zonular support
d. Large lens with decreased anterior and posterior curvature

Answer 45

c. Lens subluxation is common due to weak zonular support
Rationalization:
* Usually results in astigmatism: Incorrect. Spherophakia typically causes myopia and lens subluxation.
* Treated by trabeculectomy: Incorrect. This procedure is used for glaucoma, not spherophakia.
* Lens subluxation is common due to weak zonular support: Correct. The small, spherical lens can become subluxated due to weak or abnormal zonules.
* Large lens with decreased anterior and posterior curvature: Incorrect. Spherophakia involves a small, spherical lens with increased curvature.

Question 46

Question 46
What is the expected visual function of a patient with a vision of less than 10/200?
Select one:
a. Can recognize form and motion at 1 meter
b. Can read 14-point type but with marked difficulty
c. Can read headlines but not 14-point type
d. Cannot read headlines

Answer 46

d. Cannot read headlines
Rationalization:
* Can recognize form and motion at 1 meter: This would be possible, but it is not specific enough compared to the other options.
* Can read 14-point type but with marked difficulty: This visual acuity is too poor to read even large print.
* Can read headlines but not 14-point type: This visual acuity is too poor to read headlines.
* Cannot read headlines: Correct. A vision of less than 10/200 indicates significant vision loss, making it impossible to read headlines.

Question 47

Question 47
What structure separates the anterior chamber from the posterior chamber of the eye?
Select one:
a. Choroid
b. Zonules
c. Lens
d. Iris

Answer 47

d. Iris
Rationalization:
* Choroid: Incorrect. The choroid is a vascular layer between the retina and sclera.
* Zonules: Incorrect. Zonules suspend the lens, not involved in separating chambers.
* Lens: Incorrect. The lens is located behind the iris and separates the posterior chamber from the vitreous chamber.
* Iris: Correct. The iris separates the anterior chamber (in front of the iris) from the posterior chamber (behind the iris).

Question 48

Question 48
In vernal conjunctivitis, the clumps of calcific degeneration and eosinophils at the limbus of the cells are called:
Select one:
a. Von Arlt’s line
b. Horner-Trantas dots
c. Herbert’s pits
d. Fuchs’ spots

Answer 48

b. Horner-Trantas dots
Rationalization:
* Von Arlt’s line: Associated with trachoma.
* Horner-Trantas dots: Correct. These are white clumps seen at the limbus in vernal conjunctivitis.
* Herbert’s pits: Associated with trachoma.
* Fuchs’ spots: Associated with pathological myopia.

Question 49

Question 49
Which of the following is correctly matched?
Select one:
a. cc - without correction
b. OU - both eyes
c. OD - left eye
d. sc - with correction (corrective glasses)

Answer 49

b. OU - both eyes
Rationalization:
* cc - without correction: Incorrect. “cc” means “with correction.”
* OU - both eyes: Correct. OU stands for “oculus uterque,” meaning both eyes.
* OD - left eye: Incorrect. OD stands for “oculus dexter,” meaning the right eye.
* sc - with correction (corrective glasses): Incorrect. “sc” means “without correction.”

Question 50

Question 50
A patient with long-standing Rheumatoid Arthritis consults with a big blue-gray to dark patch at the sclera. What is most likely your diagnosis?
Select one:
a. Diffuse anterior scleritis
b. Necrotizing scleritis
c. Episcleritis
d. Scleromalacia perforans

Answer 50

d. Scleromalacia perforans
Rationalization:
* Diffuse anterior scleritis: Would present with redness and pain, not typically a blue-gray patch.
* Necrotizing scleritis: Would be painful and more severe.
* Episcleritis: Less severe, typically presents with sectoral redness and not associated with dark patches.
* Scleromalacia perforans: Correct. A painless thinning of the sclera, leading to blue-gray patches, commonly seen in patients with long-standing rheumatoid arthritis.

Question 51

Question 51
Which extraocular muscle’s insertion is nearest to the limbus?
Select one:
a. Medial Rectus
b. Superior Rectus
c. Inferior Oblique
d. Inferior Rectus

Answer 51

a. Medial Rectus
Rationalization:
* Medial Rectus: Correct. The insertion of the medial rectus is closest to the limbus.
* Superior Rectus: Incorrect. It inserts further from the limbus compared to the medial rectus.
* Inferior Oblique: Incorrect. It does not insert near the limbus but attaches to the posterior aspect of the eyeball.
* Inferior Rectus: Incorrect. It inserts near the limbus but not as close as the medial rectus.

Question 52

Question 52
Synapses between bipolar cells to ganglion cells are found in which nerve layer in the retina?
Select one:
a. Outer Nuclear Layer
b. Ganglion cell layer
c. Retinal Pigment Epithelium
d. Inner Plexiform Layer

Answer 52

d. Inner Plexiform Layer
Rationalization:
* Outer Nuclear Layer: Contains the cell bodies of photoreceptors.
* Ganglion cell layer: Contains the cell bodies of ganglion cells.
* Retinal Pigment Epithelium: Supports photoreceptors, not involved in synapses between bipolar and ganglion cells.
* Inner Plexiform Layer: Correct. This is where synapses between bipolar cells and ganglion cells occur.

Question 53

Question 54
Which of the following is the primary function of the ciliary body?
Select one:
a. Accommodation and light regulation
b. Accommodation and aqueous humor production
c. Aqueous humor production and outflow
d. Aqueous humor production and light regulation

Answer 53

b. Accommodation and aqueous humor production
Rationalization:
* Accommodation and light regulation: Incorrect. The iris, not the ciliary body, regulates light entering the eye.
* Accommodation and aqueous humor production: Correct. The ciliary body is responsible for adjusting the lens for focusing (accommodation) and producing aqueous humor.
* Aqueous humor production and outflow: Incorrect. The ciliary body produces aqueous humor, but outflow is primarily through the trabecular meshwork and Schlemm’s canal.
* Aqueous humor production and light regulation: Incorrect. Light regulation is done by the iris.

Question 53

Question 53
Which of the following best describes posterior lenticonus?
Select one:
a. Peripheral in location
b. Unilateral
c. Less common than anterior lenticonus
d. Tear-shaped deformation of the lens

Answer 53

d. Tear-shaped deformation of the lens
Rationalization:
* Peripheral in location: Incorrect. Posterior lenticonus is central, not peripheral.
* Unilateral: Often unilateral but not defining the best description.
* Less common than anterior lenticonus: Incorrect. Posterior lenticonus is more common than anterior lenticonus.
* Tear-shaped deformation of the lens: Correct. Posterior lenticonus is characterized by a conical or tear-shaped protrusion of the posterior lens capsule.

Question 54

Question 55
Which of the following would have a decrease in vision disproportionate to the size of cataract?
Select one:
a. Posterior subcapsular cataract
b. Anterior subcapsular cataract
c. Cortical cataract
d. Nuclear cataract

Answer 54

a. Posterior subcapsular cataract
Rationalization:
* Posterior subcapsular cataract: Correct. This type of cataract can cause significant visual impairment even when small because it affects the central visual axis.
* Anterior subcapsular cataract: Typically does not cause as significant a decrease in vision as posterior subcapsular cataracts.
* Cortical cataract: These often cause glare and peripheral vision issues but the impact on vision is more related to the size.
* Nuclear cataract: Generally causes gradual vision loss proportional to the size and density of the cataract.

Question 55

Question 56
These are lymphocytic nodules representing a delayed hypersensitivity reaction to staphylococcal bacteria and may be seen progressing across the cornea causing neovascularization and scarring
Select one:
a. Phylecten
b. Pterygium
c. Pyogenic granuloma
d. Pinguecula

Answer 55

a. Phlycten
Rationalization:
* Phlycten: Correct. Phlyctenulosis is characterized by small, white, raised nodules on the conjunctiva or cornea resulting from a hypersensitivity reaction to bacterial antigens, commonly staphylococcal.
* Pterygium: A benign growth of the conjunctiva that can extend onto the cornea.
* Pyogenic granuloma: A benign vascular lesion often occurring on the skin or mucous membranes.
* Pinguecula: A yellowish, benign growth on the conjunctiva, usually near the cornea, but not typically associated with hypersensitivity reactions.

Question 56

Question 57
The cornea is composed of 71% collagen by dry weight. It consists mainly of what type of collagen?
Select one:
a. Type IV
b. Type II
c. Type I
d. Type III

Answer 56

c. Type I
Rationalization:
* Type IV: Found in basement membranes, not the main type in the cornea.
* Type II: Found in cartilage, not the main type in the cornea.
* Type I: Correct. The primary collagen type in the cornea, providing structural integrity and transparency.
* Type III: Found in reticular fibers, not the main type in the cornea.

Question 57

Question 58
What is the expected visual function of a patient with a vision of less than 20/200?
Select one:
a. Can read 14-point type but with marked difficulty
b. Cannot read headlines
c. Can read headlines but not 14-point type
d. Can recognize form and motion at 1 meter

Answer 57

c. Can read headlines but not 14-point type
Rationalization:
* Can read 14-point type but with marked difficulty: Incorrect. A vision of less than 20/200 is too poor for reading 14-point type.
* Cannot read headlines: Incorrect. While very poor, vision of less than 20/200 can still allow reading large headlines.
* Can read headlines but not 14-point type: Correct. This visual acuity is sufficient for reading large print, like headlines, but not smaller print.
* Can recognize form and motion at 1 meter: This is a lower level of visual function, not specific enough for the description.

Question 58

Question 59
On slit-lamp examination, this type of cataract appears as gold-white granules:
Select one:
a. Posterior subcapsular cataract
b. Cortical cataract
c. Anterior subcapsular cataract
d. Nuclear cataract

Answer 58

a. Posterior subcapsular cataract
Rationalization:
* Posterior subcapsular cataract: Correct. This type of cataract often appears as gold-white granules on slit-lamp examination.
* Cortical cataract: Typically presents as spoke-like opacities or clefts.
* Anterior subcapsular cataract: Typically appears as a white opacity under the anterior lens capsule.
* Nuclear cataract: Typically appears as a yellow or brown discoloration of the central lens.

Question 59

Question 60
Which of the following is a thin membranous structure that covers the posterior surface of the eyelids?
Select one:
a. Fornices
b. Palpebral conjunctiva
c. Tarsus
d. Bulbar conjunctiva

Answer 59

b. Palpebral conjunctiva
Rationalization:
* Fornices: The junctions where the palpebral conjunctiva meets the bulbar conjunctiva, not covering the posterior surface of the eyelids.
* Palpebral conjunctiva: Correct. This thin membrane covers the posterior surface of the eyelids.
* Tarsus: Dense connective tissue that gives structure to the eyelids, not a membranous structure.
* Bulbar conjunctiva: Covers the anterior surface of the eyeball, not the posterior surface of the eyelids.

Question 60

Question 61
Which of the following BEST describes the method of viewing the fundus?
Select one:
a. Indirect ophthalmoscopy has a closer working distance with the patient.
b. Indirect ophthalmoscopy has brighter illumination.
c. Direct ophthalmoscopy has stereopsis.
d. Direct ophthalmoscopy has 5X magnification.

Answer 60

b. Indirect ophthalmoscopy has brighter illumination.
Rationalization:
* Indirect ophthalmoscopy has a closer working distance with the patient: Incorrect. Indirect ophthalmoscopy has a longer working distance.
* Indirect ophthalmoscopy has brighter illumination: Correct. It provides a wider field of view and better illumination.
* Direct ophthalmoscopy has stereopsis: Incorrect. Indirect ophthalmoscopy offers stereoscopic (3D) viewing.
* Direct ophthalmoscopy has 5X magnification: Incorrect. Direct ophthalmoscopy has approximately 15X magnification.

Question 61

Question 62
The blood supply of the outer third of the retina comes from which structure?
Select one:
a. Central retinal artery
b. Choriocapillaries
c. Suprachoroid
d. Posterior ciliary artery

Answer 61

b. Choriocapillaries
Rationalization:
* Central retinal artery: Supplies the inner two-thirds of the retina.
* Choriocapillaries: Correct. Supplies the outer third of the retina, including the photoreceptors.
* Suprachoroid: Incorrect. This is a potential space within the choroid.
* Posterior ciliary artery: Supplies the choroid, which in turn supplies the outer retina through the choriocapillaries.

Question 62

Question 63
Aqueous humor is produced by which of the following structures?
Select one:
a. Trabecular meshwork
b. Iris stroma
c. Ciliary body
d. Iris epithelium

Answer 62

c. Ciliary body
Rationalization:
* Trabecular meshwork: Involved in the drainage of aqueous humor, not its production.
* Iris stroma: Incorrect. It does not produce aqueous humor.
* Ciliary body: Correct. The ciliary processes of the ciliary body produce aqueous humor.
* Iris epithelium: Incorrect. It does not produce aqueous humor.

Question 63

Question 64
Which of the following is the longest part of the optic nerve?
Select one:
a. Intraocular
b. Intracanalicular
c. Intraorbital
d. Intracranial

Answer 63

c. Intraorbital
Rationalization:
* Intraocular: Shortest segment, located within the eye.
* Intracanalicular: Segment within the optic canal.
* Intraorbital: Correct. This segment is the longest, located within the orbit, providing some slack for eye movements.
* Intracranial: Segment within the cranial cavity, shorter than the intraorbital part.

Question 64

Question 65
A patient complained of his red eye being recurrent. He says that when he puts on on the counter eye drops, it disappears. It also disappears at times. No blurring of vision, no eye pain appreciated. You suspect a scleral disease. If so, this is the most probable diagnosis.
Select one:
a. Necrotizing scleritis
b. Scleromalacia perforans
c. Diffuse anterior scleritis
d. Episcleritis

Answer 64

d. Episcleritis
Rationalization:
* Necrotizing scleritis: More severe, associated with significant pain and vision loss.
* Scleromalacia perforans: Associated with rheumatoid arthritis, painless, but not typically responding to over-the-counter drops.
* Diffuse anterior scleritis: Painful and more severe.
* Episcleritis: Correct. This condition presents with recurrent, mild redness that responds to over-the-counter drops, with no significant pain or vision loss.

Question 65

Question 66
An ultrasonically driven tip is used to emulsify the lens nucleus and remove the fragments with an automated aspiration system.
Select one:
a. MSICS
b. Extracapsular cataract extraction
c. Phacoemulsification
d. Intracapsular cataract extraction

Answer 65

c. Phacoemulsification
Rationalization:
* MSICS: Manual Small Incision Cataract Surgery, does not use ultrasonic energy.
* Extracapsular cataract extraction: Involves removing the lens nucleus in one piece without emulsification.
* Phacoemulsification: Correct. Uses an ultrasonic tip to break up and aspirate the lens nucleus.
* Intracapsular cataract extraction: Involves removing the entire lens and capsule.

Question 66

Question 67
Where does the conjunctiva, Tenon’s capsule, and sclera fuse?
Select one:
a. Equator
b. Limbus
c. EOM insertion
d. Iris

Answer 66

b. Limbus
Rationalization:
* Equator: Middle portion of the eye, not where these structures fuse.
* Limbus: Correct. The junction of the cornea and sclera where the conjunctiva, Tenon’s capsule, and sclera meet.
* EOM insertion: The location where extraocular muscles attach to the sclera.
* Iris: The colored part of the eye, not related to the fusion of these structures.

Question 67

Question 68
Which of the following is INCORRECT regarding bacterial keratitis?
Select one:
a. Fungi: slow progression
b. Pseudomonas: rapid progression
c. Moraxella: fast progression
d. Neisseria: protracted progression

Answer 67

d. Neisseria: protracted progression
Rationalization:
* Fungi: slow progression: Correct for fungal keratitis.
* Pseudomonas: rapid progression: Correct. Pseudomonas can rapidly progress and cause severe keratitis.
* Moraxella: fast progression: Correct. Moraxella can progress quickly in immunocompromised patients.
* Neisseria: protracted progression: Incorrect. Neisseria gonorrhoeae keratitis typically progresses rapidly and is severe.

Question 68

Question 69
The most recently formed fibers make up the _______ of the lens.
Select one:
a. Capsule
b. Cortex
c. Nucleus
d. Zonules

Answer 68

b. Cortex
Rationalization:
* Capsule: The outermost layer of the lens, not where new fibers are formed.
* Cortex: Correct. The outer layer of the lens where new fibers are added.
* Nucleus: The central, older part of the lens.
* Zonules: Fibers that hold the lens in place, not part of the lens structure itself.

Question 69

Question 70
The lens is dehydrated and has higher levels of:
Select one:
a. Water
b. Sodium
c. Potassium
d. Chloride

Answer 69

c. Potassium
Rationalization:
* Water: Incorrect. The lens is relatively dehydrated.
* Sodium: Incorrect. The lens has lower sodium levels compared to its surroundings.
* Potassium: Correct. The lens has higher levels of potassium.
* Chloride: Incorrect. The lens has lower chloride levels compared to its surroundings.

Question 70

Question 71
Which of the following BEST describes the cornea?
Select one:
a. Vascular, high refractive index, and tough
b. Vascular, semitransparent, and highly sensitive to touch
c. Avascular, semitransparent, and tough
d. Avascular, transparent, and sensitive to touch and pain

Answer 70

d. Avascular, transparent, and sensitive to touch and pain
Rationalization:
* Vascular, high refractive index, and tough: Incorrect. The cornea is avascular.
* Vascular, semitransparent, and highly sensitive to touch: Incorrect. The cornea is avascular and transparent.
* Avascular, semitransparent, and tough: Incorrect. The cornea is transparent, not semitransparent.
* Avascular, transparent, and sensitive to touch and pain: Correct. The cornea is avascular, transparent, and has a high density of nerve endings, making it very sensitive to touch and pain.

Question 71

Question 72
Conjunctival phlyctenulosis is classified under what type of hypersensitivity reaction.
Select one:
a. Delayed hypersensitivity
b. IgE mediated
c. Immune complex
d. Cytotoxic hypersensitivity

Answer 71

a. Delayed hypersensitivity
Rationalization:
* Delayed hypersensitivity: Correct. Conjunctival phlyctenulosis is a type IV hypersensitivity reaction.
* IgE mediated: Incorrect. This describes type I hypersensitivity reactions.
* Immune complex: Incorrect. This describes type III hypersensitivity reactions.
* Cytotoxic hypersensitivity: Incorrect. This describes type II hypersensitivity reactions.

Question 72

Question 73
Advantage of using an Indirect Ophthalmoscope in posterior segment examination:
Select one:
a. It gives the observer a wide field of view for examination of the posterior segment.
b. It gives an inverted image
c. It is easy to learn.
d. It has low magnification.

Answer 72

a. It gives the observer a wide field of view for examination of the posterior segment.
Rationalization:
* It gives the observer a wide field of view for examination of the posterior segment: Correct. Indirect ophthalmoscopy provides a wider field of view.
* It gives an inverted image: While true, this is not an advantage.
* It is easy to learn: Incorrect. Indirect ophthalmoscopy is more challenging to learn than direct ophthalmoscopy.
* It has low magnification: Incorrect. This is not an advantage.

Question 73

Question 74
A patient with 20/50 vision indicates…
Select one:
a. That the patient can see at 20 feet what a person with normal visual acuity can see at 50 feet
b. That the patient can see at 50 feet what a person with normal visual acuity can see at 50 feet
c. That the patient can see at 20 feet what a person with normal visual acuity can see at 20 feet
d. That the patient can see at 50 feet what a person with normal visual acuity can see at 20 feet

Answer 73

a. That the patient can see at 20 feet what a person with normal visual acuity can see at 50 feet
Rationalization:
* That the patient can see at 20 feet what a person with normal visual acuity can see at 50 feet: Correct. This is the definition of 20/50 vision.
* That the patient can see at 50 feet what a person with normal visual acuity can see at 50 feet: Incorrect. This describes normal vision (20/20).
* That the patient can see at 20 feet what a person with normal visual acuity can see at 20 feet: Incorrect. This also describes normal vision (20/20).
* That the patient can see at 50 feet what a person with normal visual acuity can see at 20 feet: Incorrect. This describes vision better than normal (20/20).

Question 74

Question 75
Some degree of nuclear sclerosis and yellowing is normally seen in patients:
Select one:
a. 30 years old
b. 20 years old
c. 40 years old
d. above 50 years old

Answer 74

d. above 50 years old
Rationalization:
* 30 years old: Incorrect. Nuclear sclerosis and yellowing are not typically seen at this age.
* 20 years old: Incorrect. Nuclear sclerosis and yellowing are not typically seen at this age.
* 40 years old: Incorrect. While changes may begin in the 40s, they are not typically noticeable.
* above 50 years old: Correct. These changes are commonly seen in patients over 50 years old due to the natural aging process of the lens.

Question 75

Question 76
What is the normal range of intraocular pressure?
Select one:
a. 10-21 mmHg
b. 41-50 mmHg
c. 22-30 mmHg
d. 31-40 mmHg

Answer 75

a. 10-21 mmHg
Rationalization:
* 10-21 mmHg: Correct. This is the normal range for intraocular pressure.
* 41-50 mmHg: Incorrect. This is abnormally high and indicative of severe glaucoma.
* 22-30 mmHg: Incorrect. This is elevated intraocular pressure, indicative of potential glaucoma.
* 31-40 mmHg: Incorrect. This is also abnormally high and indicative of glaucoma.

Question 76

Question 77
Which of the following is part of the middle / pigmented layer of the eye?
Select one:
a. Iris
b. Cornea
c. Sclera
d. Retina

Answer 76

a. Iris
Rationalization:
* Iris: Correct. The iris is part of the uvea, the pigmented middle layer of the eye.
* Cornea: Incorrect. The cornea is the transparent front part of the eye.
* Sclera: Incorrect. The sclera is the white, outer layer of the eye.
* Retina: Incorrect. The retina is the inner layer of the eye.

Question 77

Question 78
The standard distance for measuring Near Visual Acuity is:
Select one:
a. 14 meters
b. 14 centimeters
c. 14 feet
d. 14 inches

Answer 77

d. 14 inches
Rationalization:
* 14 meters: Incorrect. This is not a standard distance for near visual acuity.
* 14 centimeters: Incorrect. This is too close for standard near visual acuity testing.
* 14 feet: Incorrect. This is a distance for measuring distance visual acuity.
* 14 inches: Correct. The standard distance for near visual acuity measurement.

Question 78

Question 79
Pre-auricular lymph nodes are NOT usually seen in this condition:
Select one:
a. Moraxella conjunctivitis
b. Adenoviral conjunctivitis
c. Inclusion conjunctivitis
d. Gonorrheal conjunctivitis

Answer 78

a. Moraxella conjunctivitis
Rationalization:
* Moraxella conjunctivitis: Correct. This condition typically does not involve pre-auricular lymphadenopathy.
* Adenoviral conjunctivitis: Incorrect. Often associated with pre-auricular lymphadenopathy.
* Inclusion conjunctivitis: Incorrect. Often associated with pre-auricular lymphadenopathy.
* Gonorrheal conjunctivitis: Incorrect. Can be associated with pre-auricular lymphadenopathy.

Question 79

Question 80
Which blood vessel passes through the superior orbital fissure?
Select one:
a. Ophthalmic artery
b. Superior ophthalmic vein
c. Inferior ophthalmic vein
d. Optic nerve

Answer 79

b. Superior ophthalmic vein
Rationalization:
* Ophthalmic artery: Incorrect. It enters the orbit through the optic canal with the optic nerve.
* Superior ophthalmic vein: Correct. This vein passes through the superior orbital fissure.
* Inferior ophthalmic vein: Incorrect. This vein passes through the inferior orbital fissure.
* Optic nerve: Incorrect. The optic nerve passes through the optic canal, not the superior orbital fissure.

Question 80

Question 81
Which of the following disorders is characterized by scleral thickening?
Select one:
a. Posterior Scleritis
b. Scleromalacia Perforans
c. Necrotizing Scleritis
d. Diffuse Anterior Scleritis

Answer 80

a. Posterior Scleritis
Rationalization:
* Posterior Scleritis: Correct. Characterized by inflammation and thickening of the sclera.
* Scleromalacia Perforans: Characterized by thinning of the sclera, often associated with rheumatoid arthritis.
* Necrotizing Scleritis: Characterized by severe inflammation and necrosis, not specifically thickening.
* Diffuse Anterior Scleritis: Characterized by diffuse inflammation of the anterior sclera, not necessarily thickening.

Question 81

Question 82
Among the different parts of the conjunctiva, this one is the most adherent to the tarsus:
Select one:
a. Palpebral
b. Forniceal
c. Semilunar fold and caruncle
d. Bulbar

Answer 81

a. Palpebral
Rationalization:
* Palpebral: Correct. The palpebral conjunctiva is tightly adherent to the tarsus.
* Forniceal: Looser and not as adherent.
* Semilunar fold and caruncle: Located at the medial canthus, not associated with the tarsus.
* Bulbar: Covers the eyeball and is not tightly adherent to the tarsus.

Question 82

Question 83
What does a vision of 20/40 mean?
Select one:
a. It indicates that the patient can see at 40 feet what a normal person can see at 20 feet.
b. The patient can see clearly at 40 feet
c. It indicates that the patient can see at 20 feet what a person with normal acuity can see at 40 feet
d. The patient can see clearly at 20 feet

Answer 82

c. It indicates that the patient can see at 20 feet what a person with normal acuity can see at 40 feet
Rationalization:
* It indicates that the patient can see at 40 feet what a normal person can see at 20 feet: Incorrect. This would be reversed vision acuity.
* The patient can see clearly at 40 feet: Incorrect. This does not provide the correct comparison for vision acuity.
* It indicates that the patient can see at 20 feet what a person with normal acuity can see at 40 feet: Correct. This describes 20/40 vision.
* The patient can see clearly at 20 feet: Incorrect. This does not describe the comparative aspect of visual acuity.

Question 83

Question 84
This portion of the optic nerve is the shortest and serves as a funduscopic landmark.
Select one:
a. Intraocular
b. Intraorbital
c. Intracanalicular
d. Intracranial

Answer 83

: a. Intraocular
Rationalization:
* Intraocular: Correct. This portion is the shortest and can be seen during funduscopic examination.
* Intraorbital: Longer segment within the orbit.
* Intracanalicular: Segment within the optic canal.
* Intracranial: Segment within the cranial cavity.

Question 84

Question 85
Which blood vessel passes through the optic canal?
Select one:
a. Ophthalmic artery
b. Inferior ophthalmic vein
c. Trochlear nerve
d. Superior ophthalmic vein

Answer 84

a. Ophthalmic artery
Rationalization:
* Ophthalmic artery: Correct. The ophthalmic artery passes through the optic canal with the optic nerve.
* Inferior ophthalmic vein: Passes through the inferior orbital fissure.
* Trochlear nerve: Passes through the superior orbital fissure.
* Superior ophthalmic vein: Passes through the superior orbital fissure.

Question 85

Question 86
The T-sign for scleral imaging is seen in which of the following diagnostic tests?
Select one:
a. MRI
b. CT Scan
c. B-scan Ultrasonography
d. OCT Scan

Answer 85

c. B-scan Ultrasonography
Rationalization:
* MRI: Not typically used for detecting the T-sign in scleral imaging.
* CT Scan: Not typically used for detecting the T-sign in scleral imaging.
* B-scan Ultrasonography: Correct. The T-sign is seen in B-scan ultrasonography and is indicative of posterior scleritis.
* OCT Scan: Not typically used for detecting the T-sign in scleral imaging.

Question 86

Question 87
Hypotony in Scleromalacia Perforans is due to perforation of the globe.
Select one:
a. True
b. False

Answer 86

b. False
Rationalization:
* True: Incorrect. Scleromalacia perforans typically involves scleral thinning and atrophy without perforation, and hypotony is usually due to the decreased production of aqueous humor or increased outflow through compromised structures.
* False: Correct. Hypotony is not due to perforation but to other mechanisms related to the scleral thinning and atrophy.

Question 87

Question 88
A 50-year-old patient complains of difficulty reading the newspaper. On examination, the distance visual acuity is 20/20 in both eyes. Near visual acuity, however, is J16. What condition does the patient have?
Select one:
a. Hyperopia
b. Presbyopia
c. Astigmatism
d. Myopia

Answer 87

b. Presbyopia
Rationalization:
* Hyperopia: Incorrect. This condition affects both near and distance vision.
* Presbyopia: Correct. Difficulty reading close up with normal distance vision in an older patient suggests presbyopia, which is age-related loss of accommodation.
* Astigmatism: Incorrect. This condition affects both near and distance vision, causing blurred vision.
* Myopia: Incorrect. This condition affects distance vision more than near vision.

Question 88

Question 89
A 35-year-old male is at the ER for bilateral purulent eye discharge of 3 days duration. On initial exam, you note that the cornea is clear but the conjunctiva is chemotic. Upon further probing, he discloses having unusual penile discharge for more than a week. You find yourself cleaning the eye discharge every 10 minutes or so. What is your primary consideration?
Select one:
a. Bacterial conjunctivitis, OU, probably due to Neisseria gonorrhea
b. Viral conjunctivitis, OU, probably due to herpes simplex virus
c. Bacterial conjunctivitis, OU, probably due to Chlamydia trachomatis
d. Viral conjunctivitis, OU, probably due to adenovirus 8,11,19

Answer 88

a. Bacterial conjunctivitis, OU, probably due to Neisseria gonorrhea
Rationalization:
* Bacterial conjunctivitis, OU, probably due to Neisseria gonorrhea: Correct. The severe, purulent discharge and association with penile discharge suggest gonococcal conjunctivitis.
* Viral conjunctivitis, OU, probably due to herpes simplex virus: Incorrect. HSV conjunctivitis usually involves corneal involvement (dendritic ulcers).
* Bacterial conjunctivitis, OU, probably due to Chlamydia trachomatis: Incorrect. Chlamydial conjunctivitis typically has a more chronic presentation.
* Viral conjunctivitis, OU, probably due to adenovirus 8,11,19: Incorrect. Adenoviral conjunctivitis typically presents with watery discharge and preauricular lymphadenopathy.

Question 89

Question 90
The standard distance of a patient from the Visual Acuity chart is:
Select one:
a. 6 inches
b. 6 meters
c. 6 feet
d. 6 centimeters

Answer 89

b. 6 meters
Rationalization:
* 6 inches: Incorrect. Too close for standard visual acuity testing.
* 6 meters: Correct. This is the standard distance used for visual acuity testing.
* 6 feet: Incorrect. Visual acuity testing uses 20 feet or 6 meters.
* 6 centimeters: Incorrect. Too close for standard visual acuity testing.

Question 90

Question 91
A contact lens wearer comes in with severe eye pain, OS. On further examination, you note just slight redness and small, punctate white opacities on the cornea. You elicit a history of swimming in a public pool. Which of the following is the likely etiology?
Select one:
a. Staphylococcus aureus
b. Klebsiella sp.
c. Acanthamoeba sp.
d. Neisseria gonorrhoeae

Answer 90

c. Acanthamoeba sp.
Rationalization:
* Staphylococcus aureus: Less likely; typically causes more obvious conjunctival redness and discharge.
* Klebsiella sp.: Less common in contact lens-related infections.
* Acanthamoeba sp.: Correct. Common in contact lens wearers with a history of exposure to contaminated water, presenting with severe pain and punctate keratitis.
* Neisseria gonorrhoeae: Causes rapid, purulent conjunctivitis, not typically associated with punctate keratitis.

Question 91

Question 92
This space is bounded by the cornea anteriorly and posteriorly by the iris.
Select one:
a. Uvea
b. Anterior Chamber
c. Choroid
d. Posterior Chamber

Answer 91

b. Anterior Chamber
Rationalization:
* Uvea: Incorrect. The uvea is the middle layer of the eye, including the iris, ciliary body, and choroid.
* Anterior Chamber: Correct. The space between the cornea and the iris.
* Choroid: Incorrect. Part of the uvea, located behind the retina.
* Posterior Chamber: Incorrect. The space between the iris and the lens.

Question 92

Question 93
Which of the following supplies blood to the inner two-thirds of the retina?
Select one:
a. Ophthalmic artery
b. Choriocapillaries
c. Major arterial circle
d. Central retinal artery

Answer 92

d. Central retinal artery
Rationalization:
* Ophthalmic artery: Supplies blood to the eye and orbit, but not directly to the retina.
* Choriocapillaries: Supply the outer third of the retina.
* Major arterial circle: Incorrect term; does not supply the retina.
* Central retinal artery: Correct. Supplies blood to the inner two-thirds of the retina.

Question 93

Question 94
For the Snellen eye chart test results, if the denominator becomes larger, you expect your patient to have _____ vision:
Select one:
a. Better vision
b. Fluctuating vision
c. Poorer vision
d. No change in vision

Answer 93

c. Poorer vision
Rationalization:
* Better vision: Incorrect. A larger denominator indicates worse visual acuity.
* Fluctuating vision: Incorrect. The denominator does not indicate fluctuations.
* Poorer vision: Correct. A larger denominator (e.g., 20/200) means poorer vision compared to a smaller denominator (e.g., 20/20).
* No change in vision: Incorrect. A change in the denominator indicates a change in visual acuity.

Question 94

Question 95
Which of the following conditions is caused by the obstruction of the trabecular meshwork by lens particles and macrophages?
Select one:
a. Phacomorphic glaucoma
b. Phacodonesis
c. Phacolytic glaucoma
d. Phacoantigenic glaucoma

Answer 94

c. Phacolytic glaucoma
Rationalization:
* Phacomorphic glaucoma: Caused by lens swelling leading to secondary angle closure.
* Phacodonesis: Trembling or instability of the lens.
* Phacolytic glaucoma: Correct. Caused by leakage of lens material through the capsule, leading to obstruction of the trabecular meshwork by lens particles and macrophages.
* Phacoantigenic glaucoma: Caused by an immune response to lens proteins following trauma or surgery.

Question 95

Question 96
Which of the following statements is TRUE of Visual Acuity (VA) Testing?
Select one:
a. VA testing is only for patients over 35 years of age
b. VA testing should be done after manipulation of the eye
c. VA testing is the fundamental element of the basic eye examination
d. VA testing is used to assess the function of peripheral retina

Answer 95

c. VA testing is the fundamental element of the basic eye examination
Rationalization:
* VA testing is only for patients over 35 years of age: Incorrect. VA testing is performed on patients of all ages.
* VA testing should be done after manipulation of the eye: Incorrect. VA testing should be done before any eye manipulation to get an accurate baseline measurement.
* VA testing is the fundamental element of the basic eye examination: Correct. VA testing is essential to assess the clarity or sharpness of vision.
* VA testing is used to assess the function of peripheral retina: Incorrect. VA testing primarily assesses central vision.

Question 96

Question 97
This is an ocular misalignment wherein the corneal light reflection is displaced laterally in the non-fixating eye.
Select one:
a. Exotropia
b. Hypertropia
c. Hypotropia
d. Esotropia

Answer 96

d. Esotropia
Rationalization:
* Exotropia: Incorrect. In exotropia, the corneal light reflection is displaced medially.
* Hypertropia: Incorrect. In hypertropia, the corneal light reflection is displaced downward.
* Hypotropia: Incorrect. In hypotropia, the corneal light reflection is displaced upward.
* Esotropia: Correct. In esotropia, the corneal light reflection is displaced laterally.

Question 97

Question 98
On EOM testing, you note that the patient is unable to abduct his left eye. Movement was full on all positions of gaze for the right eye. This would imply weakness of his left…
Select one:
a. Superior rectus
b. Inferior rectus
c. Medial rectus
d. Lateral rectus

Answer 97

d. Lateral rectus
Rationalization:
* Superior rectus: Incorrect. Responsible for upward movement.
* Inferior rectus: Incorrect. Responsible for downward movement.
* Medial rectus: Incorrect. Responsible for inward movement (adduction).
* Lateral rectus: Correct. Responsible for outward movement (abduction), so inability to abduct suggests lateral rectus weakness.

Question 98

Question 99
The patient was able to read only 3 letters at Line Number 5 of the Snellen Chart, what is the Visual Acuity of the patient?
Select one:
a. 20/50 + 3
b. 20/40 - 2
c. 20/40
d. 20/40 + 3

Answer 98

b. 20/40 - 2
Rationalization:
* 20/50 + 3: Incorrect. This would imply the patient read 3 additional letters on the 20/50 line.
* 20/40 - 2: Correct. This indicates the patient missed 2 letters on the 20/40 line.
* 20/40: Incorrect. This would indicate reading all letters on the 20/40 line without missing any.
* 20/40 + 3: Incorrect. This would indicate the patient read 3 additional letters beyond the 20/40 line.

Question 99

Question 100
Leakage of lens proteins from hypermature cataract can cause ___________.
Select one:
a. Phacodonesis
b. Phacomorphic glaucoma
c. Phacoantigenic glaucoma
d. Phacolytic glaucoma

Answer 99

d. Phacolytic glaucoma
Rationalization:
* Phacodonesis: Incorrect. Refers to lens tremulousness or instability.
* Phacomorphic glaucoma: Incorrect. Caused by lens swelling leading to angle closure.
* Phacoantigenic glaucoma: Incorrect. Caused by an immune response to lens proteins.
* Phacolytic glaucoma: Correct. Caused by leakage of lens proteins from a hypermature cataract, leading to obstruction of the trabecular meshwork and increased intraocular pressure.