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LE2 Flashcards

1
Q
  1. Culture media for Neisseria gonorrhoeae:

A. Chocolate agar plate
B. Both Chocolate agar and Thayer-Martin media
C. Neither
D. Thayer-Martin media

A

B. Both Chocolate agar and Thayer-Martin media

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2
Q
  1. Subconjunctival hemorrhage represents an accumulation of blood:

A. Behind the retina
B. Within the anterior chamber
C. In the vitreous
D. Underneath the conjunctiva

A

D. Underneath the conjunctiva

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3
Q
  1. The presence of symblepharon can be seen in:

A. Both ocular cicatricial pemphigoid and Stevens-Johnson syndrome
B. Ocular cicatricial pemphigoid
C. Neither
D. Stevens-Johnson syndrome

A

A. Both ocular cicatricial pemphigoid and Stevens-Johnson syndrome

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4
Q
  1. Eye discharge seen in allergic conjunctivitis is commonly described as:

A. Watery stringy
B. None of the above
C. Reddish
D. Mucopurulent

A

A. Watery stringy

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5
Q
  1. Identify the picture:

A. Neither
B. Induced astigmatism of more than -2.50 D Cylinder
C. Excessive tearing
D. Both

A

D. Both

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6
Q
  1. A 59-year-old Asian female presents with a sudden increase of intraocular pressure to 55 mmHg in the left eye. Gonioscopic examination demonstrates a closed angle with trabecular meshwork obstruction. Which of the following is NOT a likely presenting symptom in this patient?

A. Ocular pain
B. Eye redness
C. None of the above
D. Nausea/vomiting
E. Halos around lights

A

C. None of the above

Explanation: A sudden increase in intraocular pressure with a closed angle and trabecular meshwork obstruction, as seen in acute angle-closure glaucoma, typically presents with symptoms such as ocular pain, eye redness, nausea/vomiting, and halos around lights. Therefore, all listed symptoms are likely presenting symptoms in this patient.

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7
Q
  1. A 72-year-old male farmer has been experiencing chronic eye redness for 2 years. What is the most likely diagnosis?

A. Conjunctival Squamous Cell Carcinoma
B. Pterygium
C. Conjunctival Lymphoma
D. Pinguecula

A

A. Conjunctival Squamous Cell Carcinoma

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8
Q
  1. The color of the fluorescein staining in corneal ulcer is:

A. Purple
B. Magenta
C. Yellow
D. Green

A

D. Green

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9
Q
  1. What is not a typical exam finding in conjunctivitis?

A. Eyelid erythema
B. Subepithelial corneal infiltrate
C. Anterior chamber cell and flare
D. Red conjunctiva

A

C. Anterior chamber cell and flare

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10
Q
  1. Sudden painful loss of vision that may be associated with multiple sclerosis could be due to:

A. Retinal Detachment
B. Both Retinal Detachment and Optic Neuritis
C. Optic Neuritis
D. None of the Above

A

C. Optic Neuritis

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11
Q
  1. A hyperacute, hyperpurulent discharge is a clinical manifestation of:

A. Chlamydial conjunctivitis
B. Allergic conjunctivitis
C. Gonococcal conjunctivitis
D. Adenoviral conjunctivitis

A

C. Gonococcal conjunctivitis

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12
Q
  1. A technique used to differentiate angle closure glaucoma from open angle glaucoma by viewing the anatomical angle formed between the eye’s cornea and iris:

A. Gonioscopy
B. Perimetry
C. Fluorometry
D. Tonometry

A

A. Gonioscopy

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13
Q
  1. Schirmer’s test is used for diagnosing:

A. Corneal abrasion
B. Dry eye syndrome
C. Uveitis
D. Glaucoma

A

B. Dry eye syndrome

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14
Q
  1. Most frequent etiologic agent of conjunctivitis:

A. Adenovirus
B. Neither
C. Herpes simplex
D. Both Adenovirus and Herpes simplex

A

A. Adenovirus

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15
Q
  1. A 53-year-old female with a history of recent bronchial asthma attack woke up this morning with a red eye and has no other symptoms. Upon examination, you note a temporal sector of the eye that is red without injection of the conjunctival vessels. What is your most likely diagnosis?

A. Scleritis
B. Pinguecula
C. Conjunctivitis
D. Subconjunctival hemorrhage

A

D. Subconjunctival hemorrhage

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16
Q
  1. Pharyngoconjunctival fever (conjunctivitis with fever and sore throat) is associated with what strains?

A. Adenovirus 3
B. Neither
C. Both Adenovirus 3 and Adenovirus 11
D. Adenovirus 11

A

A. Adenovirus 3

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17
Q
  1. Hollenhorst plaque seen in retinal vein occlusions is a:

A. Calcific embolus
B. Fibrin embolus
C. Cholesterol embolus
D. None of the above

A

C. Cholesterol embolus

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18
Q
  1. Management of central retinal artery occlusion (CRAO) includes the following, EXCEPT:

A. Intravenous acetazolamide
B. Ocular massage
C. Both of the above
D. Neither of the above

A

A. Intravenous acetazolamide

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19
Q
  1. Ankyloblepharon is an adhesion between:

A. Upper eyelid and lower eyelid
B. None of the above
C. Iris and lens
D. Bulbar conjunctiva and palpebral conjunctiva

A

A. Upper eyelid and lower eyelid

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20
Q
  1. One of the indications for pterygium excision is significant induced astigmatism. True or False?

A. True
B. False

A

A. True

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21
Q
  1. A recurrent bilateral conjunctivitis occurring with the onset of hot weather in a 6-year-old boy, with symptoms of burning, itching, and lacrimation, and large flat-topped cobblestone papillae raised areas in the palpebral conjunctiva:

A. Trachoma
B. None of the above
C. Vernal keratoconjunctivitis
D. Phlyctenular conjunctivitis

A

C. Vernal keratoconjunctivitis

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22
Q
  1. Cherry-red spot is seen in:

A. Central retinal artery occlusion
B. Central retinal vein occlusion
C. None of the above
D. Papilledema

A

A. Central retinal artery occlusion

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23
Q
  1. The treatment for a branch-like lesion (dendritiform) in the cornea is:

A. Ganciclovir
B. Polymyxin
C. Nystatin
D. Albendazole

A

A. Ganciclovir

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24
Q
  1. A 45-year-old farmer presents with a wing-like structure found at the nasal side of the cornea at the palpebral fissure. What is your diagnosis?

A. Pinguecula
B. Episcleritis
C. None of the above
D. Pterygium

A

D. Pterygium

Rationale: A pterygium is a wing-shaped, fibrovascular growth extending from the conjunctiva onto the cornea, often on the nasal side at the palpebral fissure. It is commonly associated with prolonged exposure to sunlight, wind, and dust, which are common in farmers. In contrast, a pinguecula is a yellowish, non-invasive lesion that does not extend onto the cornea.

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25
Q
  1. The tissue between the border of the cup and the optic disc is called:

A. Rods and cones
B. Lamina cribrosa
C. Neuroretinal rim
D. Fovea

A

C. Neuroretinal rim

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26
Q
  1. True of Giant Cell Arteritis EXCEPT:

A. It is a vasculitis involving medium-sized vessels
B. None of the above
C. It typically occurs in those over the age of 50
D. Headache is the most common symptom
E. The mainstay of management is corticosteroids

A

A. It is a vasculitis involving medium-sized vessels

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27
Q
  1. A 36-year-old man complained of a 3-day history of redness, severe pain, and intense sensitivity to light in his left eye. He denies any trauma to the affected eye. Which of the following signs will convince you that the patient DOES NOT have conjunctivitis?

A. Ciliary flush
B. Visual acuity of 20/200
C. Both
D. Neither

A

A. Ciliary flush

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28
Q
  1. Prolonged use of topical corticosteroids can cause:

A. Cataract
B. Both cataract and corneal damage
C. Corneal damage
D. Neither

A

B. Both cataract and corneal damage

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29
Q
  1. The effective treatment for Herpes Zoster ophthalmicus is:

A. Natamycin
B. Artificial tears
C. Metronidazole
D. Acyclovir

A

D. Acyclovir

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30
Q
  1. A major risk for the development of bacterial keratitis is:

A. Age
B. Contact lens wear
C. Diabetes mellitus
D. None of the above

A

B. Contact lens wear

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31
Q
  1. All of the statements are true regarding the aqueous humor outflow:

A. Uveoscleral outflow constitutes the majority of the mechanism of how the aqueous humor exits the eye
B. Both
C. Neither
D. Trabecular outflow constitutes the minority of the mechanism of how the aqueous humor exits the eye

A

C. Neither

Rationale: The majority of aqueous humor outflow in the eye occurs through the trabecular meshwork pathway, not the uveoscleral pathway. The trabecular outflow accounts for around 85-90% of aqueous humor drainage, while the uveoscleral pathway constitutes the minority (approximately 10-15%) of outflow. Therefore, both statements A and D are incorrect.

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32
Q
  1. Disc swelling, venous engorgement, cotton wool spots, and diffuse retinal hemorrhages are characteristic findings in:

A. Central retinal artery occlusion
B. None of the above
C. Papilledema
D. Central retinal vein occlusion

A

D. Central retinal vein occlusion

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33
Q
  1. Defect of central vision in which the shapes of objects appear distorted:

A. Metamorphopsia
B. Heteromatopia
C. None of the above
D. Dyschromatopsia

A

A. Metamorphopsia

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34
Q
  1. The relative normal intraocular pressure (mmHg) is:

A. None of the above
B. 10-21
C. 22-30
D. 5-11

A

B. 10-21

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35
Q
  1. The most common ophthalmic manifestation in thyroid-associated orbitopathy is:

A. Conjunctivitis
B. Lid retraction
C. Proptosis
D. Chemosis

A

B. Lid retraction

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36
Q
  1. The most common cause of red eye and chronic eye proptosis in an adult is:

A. Thyroid orbitopathy
B. None of the above
C. Orbital tumor
D. Orbital cellulitis

A

A. Thyroid orbitopathy

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37
Q
  1. Red painful eye with purulent discharge and decreased vision, discrete corneal opacity seen with penlight:

A. Ruptured globe
B. Acute angle-closure glaucoma
C. Corneal ulcer
D. Orbital cellulitis

A

B. Acute angle-closure glaucoma

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38
Q
  1. All of the following can be caused by chlamydial infection EXCEPT:

A. Neither
B. Trachoma
C. Inclusion conjunctivitis
D. Both

A

A. Neither

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39
Q
  1. The histology of pterygium includes:

A. Neither
B. Fibrovascular overgrowth of the bulbar conjunctiva
C. Precancerous stage
D. Both

A

B. Fibrovascular overgrowth of the bulbar conjunctiva

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40
Q
  1. An elevation in intraocular pressure is not necessarily present in the diagnosis of glaucoma. True or False?

A. True
B. False

A

A. True

Rationale:
An elevation in intraocular pressure is not necessarily present in the diagnosis of glaucoma, as normal-tension glaucoma can occur without elevated IOP.

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41
Q
  1. A 35-year-old patient presents with a hyperpurulent discharge of 1-day duration, marked chemosis of the bulbar conjunctiva, and a clear cornea. What is your tentative diagnosis?

A. Adenoviral conjunctivitis
B. Chlamydial conjunctivitis
C. Gonococcal conjunctivitis
D. Herpes simplex keratoconjunctivitis

A

C. Gonococcal conjunctivitis

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42
Q
  1. Treatment for allergic conjunctivitis includes:

A. Neither
B. Olopatadine eyedrops
C. Cetirizine 10 mg tablet
D. Both

A

D. Both

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43
Q
  1. True or false: This diagnostic modality is typically used to diagnose both glaucoma and retinopathy.

A. True
B. False

A

B. False

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44
Q
  1. Monocular loss of vision developing over hours to days with no abnormalities seen in the ophthalmic examination, associated with pain on movement of the eyes:

A. Papilledema
B. Optic neuritis
C. None of the above
D. Retrobulbar neuritis

A

D. Retrobulbar neuritis

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45
Q
  1. A degenerative lesion of the bulbar conjunctiva that occurs adjacent to the limbus in the interpalpebral zone is:

A. Phlyctenulosis
B. Pinguecula
C. Conjunctival granuloma
D. Chalazion

A

B. Pinguecula

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46
Q
  1. Functional disorder is defined as loss of vision with an organic basis. TRUE or FALSE?

A. True
B. False

A

B. False

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47
Q
  1. Purulent discharge can be seen in:

A. Dysfunctional tear syndrome
B. Viral conjunctivitis
C. Allergic conjunctivitis
D. Bacterial conjunctivitis

A

D. Bacterial conjunctivitis

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48
Q
  1. Foreign body sensation can be produced by all of the following EXCEPT:

A. Contact lens wear
B. Trichiasis
C. None of the above
D. Viral conjunctivitis

A

C. None of the above

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49
Q
  1. Symptoms of retinal detachment include:

A. None of the above
B. Tunneling of vision
C. Wavy vision
D. Curtaining of vision

A

D. Curtaining of vision

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50
Q
  1. Which of the following statements is true regarding episcleritis?

A. Episcleritis blanches with 10% Phenylephrine drops
B. Episcleritis is inflammation of the superficial episcleral layer of the eye
C. All of the above
D. Episcleritis is relatively common, benign, and self-limiting

A

C. All of the above

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51
Q
  1. Pharyngoconjunctival fever (conjunctivitis with fever and sore throat) is associated with which strain/s?

A. Adenovirus 3
B. Both Adenovirus 3 and Adenovirus 11
C. Adenovirus 11
D. Neither

A

A. Adenovirus 3

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52
Q
  1. Management of central retinal artery occlusion (CRAO) includes the following, EXCEPT:

A. Ocular massage
B. Neither
C. Both
D. Intravenous acetazolamide

A

D. Intravenous acetazolamide

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53
Q
  1. What layer of the cornea regenerates rapidly following injury?

A. Endothelium
B. Bowman’s membrane
C. Corneal stroma
D. Epithelium

A

D. Epithelium

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54
Q
  1. A 75-year-old male presents with a “salmon patch” appearance in the bulbar conjunctiva for almost 2 years. Your most likely diagnosis will be?

A. Conjunctival lymphoma
B. Conjunctival squamous papilloma
C. None of the above
D. Chalazion

A

A. Conjunctival lymphoma

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55
Q
  1. Drusen is a characteristic finding of:

A. Glaucoma
B. Diabetic retinopathy
C. Hypertensive retinopathy
D. Age-related macular degeneration

A

D. Age-related macular degeneration

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56
Q
  1. Which of the following terms refers to purulent matter in the anterior chamber?

A. Keratitis
B. Synechia
C. Hypopyon
D. Hyphema

A

C. Hypopyon

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57
Q
  1. The following may lead to the formation of pterygium EXCEPT:

A. None of the above
B. Frequent exposure to smoke
C. Exposure to ultraviolet rays
D. Living in a tropical area

A

B. Frequent exposure to smoke

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58
Q
  1. What are the features of anterior uveitis?

A. Redness
B. Both redness and photophobia
C. Neither
D. Photophobia

A

B. Both redness and photophobia

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59
Q
  1. Trantas dots can be seen in Vernal Keratoconjunctivitis. These characteristic cells are composed of:

A. Neutrophils
B. Lymphocytes
C. Eosinophils
D. Macrophages

A

C. Eosinophils

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60
Q
  1. Trachoma, which is one of the leading causes of preventable irreversible blindness in the world, is usually caused by:

A. Corynebacterium
B. Neither
C. Both
D. Chlamydia

A

D. Chlamydia

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61
Q
  1. Which of the following terms refers to the presence of red blood cells in the anterior chamber?

A. Keratitis
B. Hypopyon
C. Synechia
D. Hyphema

A

D. Hyphema

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62
Q
  1. An inflammatory adhesion between the iris and the peripheral corneal endothelium is termed as:

A. Hypopyon
B. None of the above
C. Peripheral corneal synechia
D. Posterior synechia

A

C. Peripheral corneal synechia

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63
Q
  1. Which among the following would NOT manifest with palpable preauricular lymphadenopathy?

A. Adenoviral conjunctivitis
B. Neither
C. Neisseria gonorrhoeae
D. Chlamydial conjunctivitis

A

C. Neisseria gonorrhoeae

64
Q
  1. Ankyloblepharon refers to the adhesion of the bulbar and palpebral conjunctiva. TRUE or FALSE?

A. True
B. False

A

B. False

65
Q
  1. True of Giant Cell Arteritis EXCEPT:

A. It is an inflammation of small blood vessels
B. None of the above
C. Symptoms include headache and pain over the temples
D. Treatment is typically with high doses of steroids

A

A. It is an inflammation of small blood vessels

66
Q
  1. How do strong alkalis penetrate the corneal stroma?
    A. Increased hyperosmolarity in tissues
    B. Caseous necrosis in cell membranes
    C. Denaturing and precipitating proteins in the tissues they contact
    D. Saponification of fatty acids in cell membranes
A

D. Saponification of fatty acids in cell membranes

67
Q
  1. Which anatomical structure is responsible for the formation of aqueous humor?
    A. Ciliary Processes
    B. Corneoscleral meshwork
    C. Schlemm canal
    D. Trabecular meshwork
A

A. Ciliary Processes

68
Q
  1. What is the tissue located between the border of the cup and the optic disc called?
    A. Rods and cones
    B. Lamina cribrosa
    C. Neuroretinal rim
    D. Fovea
A

C. Neuroretinal rim

69
Q
  1. What is the gold standard for measuring intraocular pressure (IOP)?
    A. Digital tonometry
    B. Goldmann applanation tonometry
    C. Non-contact tonometry
    D. Pneumatic tonometer
A

B. Goldmann applanation tonometry

70
Q
  1. In patients with orbital fractures, which nerve is most commonly damaged?
    A. Infraorbital nerve
    B. Short ciliary nerve
    C. Long ciliary nerve
    D. Optic nerve
A

A. Infraorbital nerve

71
Q
  1. Glaucomatous optic neuropathy is primarily associated with damage to which type of retinal cells?
    A. Amacrine cells
    B. Ganglion cells
    C. Bipolar cells
    D. Photoreceptor cells
A

B. Ganglion cells

72
Q
  1. What is the tissue between the border of the cup and the optic disc?
    A. Rods and cones
    B. Lamina cribrosa
    C. Neuroretinal rim
    D. Fovea
A

C. Neuroretinal rim

73
Q
  1. Which of the following is a common risk factor for Primary Open-Angle Glaucoma (POAG)?
    A. Old age
    B. Steroid use
    C. History of eye trauma
    D. Congenital iris malformation
A

A. Old age

74
Q
  1. A patient presents with a history of severe blunt trauma, bullous subconjunctival hemorrhage, irregular pupil, and hypotony of the eye. What is the most likely diagnosis?
    A. Orbital cellulitis
    B. Ruptured globe
    C. Corneal foreign body
    D. Orbital apex fracture
A

B. Ruptured globe

75
Q
  1. In cases of a ruptured globe from blunt trauma, where is the globe most commonly ruptured?
    A. In front of the insertion of the recti muscles
    B. In front of the insertion of the oblique muscles
    C. Behind the insertion of the recti muscles
    D. Behind the insertion of the oblique muscles
A

C. Behind the insertion of the recti muscles

76
Q
  1. Given a 30-year-old female patient with an IOP of 15 mmHg and a C/D ratio of 0.3, how would you assess her level of glaucoma risk?
    A. Low level of glaucoma risk
    B. Moderate level of glaucoma risk
    C. High level of glaucoma risk
    D. Very high level of glaucoma risk
A

A. Low level of glaucoma risk

77
Q
  1. What diagnostic test is typically ordered when screening for visual field dysfunctions?
    A. Fluorescein angiography
    B. Optical coherence tomography of the optic disc
    C. Perimetry
    D. Ocular ultrasound
A

C. Perimetry

78
Q
  1. Investigating the type of material involved in suspected corneal foreign bodies is crucial. What type of material is linked to an increased risk of infection?
    A. Glass
    B. Metal
    C. Plastic
    D. Vegetable matter
A

D. Vegetable matter

79
Q
  1. What is the primary risk factor associated with the development of glaucoma?
    A. Increased intraocular pressure
    B. Female gender
    C. Long axial length of the eyeball
    D. Positive family history of glaucoma
A

A. Increased intraocular pressure

80
Q
  1. What is the gold standard for measuring intraocular pressure?
    A. Digital tonometry
    B. Goldmann applanation tonometry
    C. Non-contact (air puff) tonometry
    D. Pneumatic tonometer
A

B. Goldmann applanation tonometry

81
Q
  1. Which of the following shows the correct order of aqueous humor flow within the eye?
    A. Ciliary process - pupil - anterior chamber - trabecular meshwork - Schlemm canal - venous system
    B. Ciliary process - pupil - anterior chamber - Schlemm canal - trabecular meshwork - venous system
    C. Ciliary process - pupil - posterior chamber - trabecular meshwork - Schlemm canal - venous system
    D. Ciliary process - pupil - posterior chamber - Schlemm canal - trabecular meshwork - venous system
A

A. Ciliary process - pupil - anterior chamber - trabecular meshwork - Schlemm canal - venous system

82
Q
  1. The following are indications for surgical repair of orbital floor fractures EXCEPT:
    A. Diplopia on downgaze
    B. Enophthalmos of >2 mm on the affected side
    C. Bone displacement >50%
    D. Hypesthesia
A

D. Hypesthesia

83
Q
  1. Dorzolamide lowers IOP by:
    A. Increasing uveoscleral outflow
    B. Decreasing aqueous humor production
    C. Increasing conventional (trabecular meshwork) outflow
    D. Decreasing episcleral venous pressure
A

B. Decreasing aqueous humor production

84
Q

A 70-year-old male with a history of hypertension comes into the emergency room with complaints of rapid unilateral loss of vision one hour prior to consultation. He also complains of a temporal headache and jaw claudication. What is your tentative diagnosis?

A. Acute angle closure glaucoma
B. Corneal ulcer
C. Optic neuritis
D. Temporal arteritis

A

D. Temporal arteritis
Temporal arteritis (giant cell arteritis) typically presents with unilateral vision loss, temporal headache, and jaw claudication, particularly in elderly patients with a history of vascular disease.

85
Q

A healthy 18-year-old African man presents with a total hyphema after being struck in the right eye with a tennis ball. Visual acuity is hand motions, and the intraocular pressure is normal. Which one of the following would be appropriate in the management of this patient?

A. Topical steroids and a cycloplegic
B. Bed rest, elevation of the head
C. Oral aminocaproic acid
D. All of the above

A

D. All of the above

Rationale: Management of a traumatic hyphema typically involves several approaches to reduce inflammation, control pain, prevent rebleeding, and ensure proper healing:
• Topical steroids and a cycloplegic (Option A): Topical steroids help reduce inflammation, and cycloplegic agents prevent painful spasms of the iris and ciliary body.
• Bed rest with head elevation (Option B): Elevating the head minimizes the chance of rebleeding and helps the blood settle inferiorly, away from the visual axis.
• Oral aminocaproic acid (Option C): Aminocaproic acid can help reduce the risk of rebleeding by stabilizing clot formation.

86
Q

A 12-year-old female sustained a laceration on her right upper eyelid. On gross examination, you note fat prolapse from the laceration. You advise the parents that a referral to an ophthalmologist needs to be made, and inform them that a possible sequelae even after repair of the laceration includes:

A. Epiphora/tearing
B. Eyelid retraction
C. Eyelid notching
D. Eyelid ptosis

A

D. Eyelid ptosis
Prolapse of fat from an eyelid laceration indicates orbital septum damage, which can lead to levator muscle injury, resulting in eyelid ptosis after repair.

87
Q

A 25-year-old male got into a car accident, sustaining a full thickness eyelid laceration 5mm from his eyelid margin. What layers of the eyelid were involved in his injury?

A. Skin, orbicularis, fat, conjunctiva
B. Skin, orbicularis, septum, tarsus
C. Skin, orbicularis, tarsus, conjunctiva
D. Skin, orbicularis, tarsus, septum

A

C. Skin, orbicularis, tarsus, conjunctiva
A full-thickness eyelid laceration involves these layers, including the tarsus, a dense connective tissue that supports the eyelid.

88
Q

A 76-year-old female, known to be hypertensive, noted a sudden loss of vision in her left eye two weeks prior to consultation. She felt no pain and did not experience any trauma. The examination of her right eye is unremarkable. For the left eye, vision is light perception, with a positive relative afferent pupillary defect (RAPD). Extraocular movements (EOMs) are full, intraocular pressure is within normal range, cornea is clear, anterior chamber is clear, and the lens is slightly yellowish. What characteristic finding do you expect on examination of her retina in the left eye?

A. Cherry red spot
B. Dot and blot hemorrhages
C. Flame-shaped hemorrhages
D. Multiple exudates and cotton wool spots

A

A. Cherry red spot
A cherry red spot is characteristic of central retinal artery occlusion, which is consistent with the sudden, painless vision loss and a positive RAPD.

89
Q

What is the first thing you should do when you encounter a patient with a history of chemical trauma to the external eye?

A. Obtain a complete and extensive history
B. Check the visual acuity
C. Assess the extent of damage to the cornea
D. Immediate and copious irrigation of the ocular surface with water

A

D. Immediate and copious irrigation of the ocular surface with water
The first and most urgent step in chemical eye injuries is irrigation to remove the harmful substance before any other assessment.

90
Q

What is the best imaging modality for orbital fractures?

A. Skull x-ray
B. Orbital ultrasound
C. Orbital CT scan
D. Orbital MRI

A

C. Orbital CT scan
A CT scan is the best imaging modality for diagnosing orbital fractures as it provides detailed views of the bone and soft tissues.

91
Q

A 70-year-old male with a history of hypertension comes into the emergency room with complaints of rapid unilateral loss of vision one hour prior to consultation. He also complains of temporal headache and jaw claudication. What is your tentative diagnosis?

A. Acute angle closure glaucoma
B. Corneal ulcer
C. Optic neuritis
D. Temporal arteritis

A

D. Temporal arteritis
This is a repeat of question 1 with the same diagnosis: temporal arteritis, characterized by the clinical triad of rapid vision loss, headache, and jaw claudication.

92
Q

A 50-year-old male sought consult for severe vision loss in his left eye. His vision in that eye is counting fingers at 2 feet, not improved with pinhole. You perform a pupillary exam and note that the patient has a negative relative afferent pupillary defect (RAPD). Which among the following is a possible consideration for this patient?

A. Post-traumatic optic neuropathy
B. Retinal detachment
C. Central retinal artery occlusion
D. Vitreous hemorrhage

A

D. Vitreous hemorrhage
The absence of RAPD suggests the issue is not optic nerve-related but rather something within the eye, such as vitreous hemorrhage, causing severe vision loss.

93
Q

How do strong alkalis cause penetration into the corneal stroma?
A. Increased hyperosmolarity in tissues
B. Caseous necrosis in cell membranes
C. Denature and precipitate proteins in the tissues they contact
D. Saponification of fatty acids in cell membranes

A

D. Saponification of fatty acids in cell membranes
Alkalis cause damage by saponifying lipids in cell membranes, allowing deeper penetration into the cornea and severe damage.

94
Q

A 27-year-old contact lens wearer presents to the ER complaining of ocular irritation. On exam, he has a 2mm corneal abrasion. Which of the following should you do?
A. Treat the patient with topical steroids
B. Treat the patient with a topical antibiotic
C. Use a bandage contact lens for comfort and to speed up re-epithelialization
D. Patch the eye and follow up in 72 hours

A

B. Treat the patient with a topical antibiotic
Topical antibiotics are used to prevent infection in corneal abrasions, especially in contact lens wearers who are prone to bacterial infections like Pseudomonas.

95
Q

A 63-year-old female came in for her check-up due to blurring of vision associated with occasional eye pain and redness. She is referred to an ophthalmologist, who takes optic disc photos of the patient’s eyes. The presence of which of the following findings will make you suspect the presence of glaucoma in this patient?
A. Artery to vein ratio of 1:3
B. Vertical cup to disc ratio of 0.8
C. Indistinct disc borders
D. Pale optic disc

A

B. Vertical cup to disc ratio of 0.8
A vertical cup-to-disc ratio greater than 0.6 suggests significant optic nerve damage, commonly seen in glaucoma.

96
Q

A patient who was in a vehicular accident was referred from another hospital with a diagnosis of traumatic optic neuropathy. Which of the following examinations will help confirm the diagnosis?
A. Hirschberg light reflex test
B. Swinging flashlight test
C. Seidel test
D. Extraocular muscle movement test

A

B. Swinging flashlight test
The swinging flashlight test assesses for a relative afferent pupillary defect (RAPD), which is a key indicator of optic nerve damage in traumatic optic neuropathy.

97
Q

A 7-year-old boy presents with a grossly swollen eyelid. His mother can’t think of anything that would have set this off. Which of the following characteristics, if present, will make you suspect orbital cellulitis?
A. Chemosis
B. Warmth and erythema of the eyelid
C. Tenderness of the eyelid
D. Proptosis

A

D. Proptosis
Proptosis, or forward displacement of the eye, is a sign of orbital cellulitis, differentiating it from more superficial infections like preseptal cellulitis.

98
Q

A 23-year-old male construction worker came to the ER with a chief complaint of right eye pain and redness after he had cement splashed in his right eye. You manage the patient by copious irrigation of sterile water. When do you stop irrigation?
A. When the eye is no longer red
B. When the pH of the conjunctival sac normalizes
C. When you have consumed 2 liters of water
D. When you have spent 2 hours irrigating the eye

A

B. When the pH of the conjunctival sac normalizes
Irrigation should continue until the pH normalizes, indicating that the chemical has been sufficiently washed out.

99
Q

A metallic corneal foreign body usually does not produce scarring, unless it is embedded in which layer of the cornea?
A. Epithelium
B. Corneal stroma
C. Bowman’s layer
D. Anterior chamber

A

C. Bowman’s layer

Rationale: Scarring is most likely to occur if a foreign body is embedded in Bowman’s layer of the cornea. This layer, located just beneath the epithelium and above the stroma, is acellular and does not regenerate. Any injury involving Bowman’s layer can lead to permanent scarring, unlike superficial injuries confined to the epithelium.

100
Q

In the overwhelming majority of cases of primary open-angle glaucoma, the obstruction to outflow seems to be at which of the following sites?
A. In the episcleral veins
B. At the scleral spur
C. At the trabecular meshwork
D. Schlemm’s canal

A

C. At the trabecular meshwork
In primary open-angle glaucoma, the trabecular meshwork becomes dysfunctional, impeding aqueous humor outflow and leading to increased intraocular pressure.

101
Q

What anatomical structure is responsible for aqueous humor formation?
A. Ciliary processes
B. Corneoscleral meshwork
C. Schlemm’s canal
D. Trabecular meshwork

A

A. Ciliary processes
The ciliary processes are responsible for the production of aqueous humor in the eye.

102
Q

Given a 30-year-old female patient with an intraocular pressure (IOP) of 15 mmHg and a cup-to-disc (C/D) ratio of 0.3. She has no history of glaucoma in the family, no hypertension, and no diabetes. How would you consider her level of glaucoma risk?
A. Low level of glaucoma risk
B. Moderate level of glaucoma risk
C. High level of glaucoma risk
D. Very high level of glaucoma risk

A

A. Low level of glaucoma risk
With a normal intraocular pressure and a small cup-to-disc ratio, the patient has a low risk of glaucoma, especially without other risk factors.

103
Q

The following findings indicate optic nerve damage, EXCEPT:
A. Decreased color vision
B. Diplopia
C. (+) RAPD
D. Visual field loss

A

B. Diplopia
Diplopia (double vision) is not typically associated with optic nerve damage but more with issues related to ocular muscle alignment or cranial nerve dysfunction.

104
Q

A 26-year-old female came for consult at the ER due to sustaining an eyelid laceration 15mm from the eyelid margin. You notice fat prolapsing through the laceration. What can be a possible complication if the laceration is not appropriately repaired?
A. Ptosis due to damage of the orbital septum
B. Ptosis due to damage of Muller’s muscle
C. Ptosis due to damage of the levator muscle
D. Ptosis due to damage of the orbicularis muscle

A

C. Ptosis due to damage of the levator muscle
Fat prolapse suggests damage to deeper structures, including the levator muscle, which can lead to ptosis if not properly repaired.

105
Q

You suspect an orbital “blowout” floor fracture in a patient. You want to check for the presence of enophthalmos in the patient’s affected eye. You observe the patient from a “worm’s eye view.” Which structure do you observe from this view?
A. Anterior-most portion of the cornea
B. Anterior-most portion of the orbital rims
C. Anterior-most portion of the lower eyelids
D. Anterior-most portion of the upper eyelids

A

A. Anterior-most portion of the cornea

106
Q

A 3-year-old female was brought to the ER by her mother. Five days prior to consultation, the patient had colds. No consults were done, and no medications were taken. Two days prior, the patient developed fever with red, swollen right upper and lower eyelids, mild proptosis, and impaired eye movement. What is the most likely diagnosis?
A. Orbital cellulitis
B. Preseptal cellulitis
C. Internal hordeolum
D. Chalazion

A

A. Orbital cellulitis
Orbital cellulitis presents with fever, proptosis, impaired eye movement, and swollen eyelids, often following a sinus infection.

107
Q

What is the tissue between the border of the cup and the optic disc called?
A. Rods and cones
B. Lamina cribrosa
C. Neuroretinal rim
D. Fovea

A

C. Neuroretinal rim
The neuroretinal rim is the tissue between the optic cup and the optic disc and is important for assessing glaucoma damage.

108
Q

What is the laser treatment most commonly undertaken for patients with open-angle glaucoma who are unresponsive to medications?
A. Gonioplasty
B. Iridotomy
C. Trabeculotomy
D. Trabeculoplasty

A

D. Trabeculoplasty
Laser trabeculoplasty is often performed to enhance aqueous outflow in patients with open-angle glaucoma unresponsive to medication.

109
Q

Which of the following is a consequence of untreated primary open-angle glaucoma (POAG)?
A. Loss of central visual acuity
B. Shallowing of the anterior chamber angle
C. Thinning of the optic nerve cup-to-disc space
D. Corneal endothelial cell loss

A

B. Shallowing of the anterior chamber angle

110
Q

Glaucoma is defined as a disease that manifests with the development of distinctive patterns of visual dysfunction, brought about by damage to which anatomic structure?
A. Anterior chamber angle
B. Ciliary processes
C. Optic nerve
D. Trabecular meshwork

A

C. Optic nerve
Glaucoma is characterized by optic nerve damage, leading to visual field loss and other visual dysfunctions.

111
Q

A 3-month-old male was brought to the hospital because the mother noticed an enlargement of his right eye associated with corneal haze. You suspect congenital glaucoma. The enlargement of the eye in these cases is called which of the following?
A. Exophthalmos
B. Buphthalmos
C. Macrophthalmos
D. Ophthalmos globus

A

B. Buphthalmos
Buphthalmos refers to the enlargement of the eye seen in congenital glaucoma due to increased intraocular pressure.

112
Q

What are the goals of treatment in corneal abrasions?
A. Promote rapid healing
B. Relieve pain
C. Prevent infections
D. All of the above

A

D. All of the above
Treatment goals for corneal abrasions include promoting rapid healing, relieving pain, and preventing infections.

113
Q

What is the first step that should be taken once a globe rupture is suspected?
A. Call the operating room to schedule eye surgery
B. Place a shield over the affected eye
C. Start intravenous antibiotics
D. Give the patient pain medications

A

B. Place a shield over the affected eye
Shielding the eye protects it from further trauma and prevents extrusion of intraocular contents until surgery can be performed.

114
Q

A patient presents with a history of severe blunt trauma, bullous subconjunctival hemorrhage, irregular pupil, and hypotony of the eye. Which of the following is the most likely diagnosis?
A. Orbital cellulitis
B. Ruptured globe
C. Corneal foreign body
D. Orbital apex fracture

A

B. Ruptured globe
Signs of a ruptured globe include irregular pupil, bullous subconjunctival hemorrhage, and hypotony, indicating ocular contents are leaking.

115
Q

A patient came to the ER after experiencing a vehicular accident. You suspect an orbital fracture and refer to an ophthalmologist. You notice the ophthalmologist observe the patient from a worm’s eye view. What is the ophthalmologist trying to assess?
A. Presence of limited upgaze (decrease in the ability to look upward)
B. Presence of gross proptosis
C. Presence of foreign bodies on the inner aspect of the upper eyelid
D. Presence of blood in the anterior chamber

A

B. Presence of gross proptosis
The worm’s eye view allows the ophthalmologist to assess for proptosis (forward displacement of the eye) due to orbital fractures or masses.

116
Q

Glaucomatous optic neuropathy is associated with damage to which type of retinal cells?
A. Amacrine cells
B. Ganglion cells
C. Bipolar cells
D. Photoreceptors

A

B. Ganglion cells
Glaucomatous optic neuropathy is associated with the loss of retinal ganglion cells, leading to visual field defects.

117
Q

The following are conditions associated with open-angle glaucoma EXCEPT:
A. African ancestry
B. High myopia
C. Macular degeneration
D. Diabetes mellitus

A

C. Macular degeneration
Macular degeneration is not typically associated with open-angle glaucoma, while African ancestry, high myopia, and diabetes are risk factors.

118
Q

In patients with orbital floor fractures, one common feature is decreased sensation over the cheek and upper lip. Which nerve is damaged in these cases?
A. Infraorbital nerve
B. Short ciliary nerve
C. Long ciliary nerve
D. Lacrimal nerve

A

A. Infraorbital nerve
The infraorbital nerve runs along the floor of the orbit and provides sensation to the cheek and upper lip. It can be damaged in orbital floor fractures.

119
Q

A 65-year-old male complained of sudden unilateral visual loss associated with jaw claudication, tenderness over the forehead and scalp, and pain with chewing food. Which of the following pairs correspond with the patient’s condition for confirmation of your primary impression?
A. Elevated ESR to confirm temporal arteritis
B. Temporal artery biopsy to confirm temporal arteritis
C. Orbital MRI to check for optic nerve swelling to confirm optic neuritis
D. Fluorescein angiography to check for artery occlusion to confirm central retinal artery occlusion

A

B. Temporal artery biopsy to confirm temporal arteritis
Temporal arteritis is confirmed by a temporal artery biopsy, especially in cases with jaw claudication, visual loss, and scalp tenderness.

120
Q

What diagnostic test is usually ordered when screening for any visual field dysfunctions?
A. Fluorescein angiography
B. Ocular coherence tomography of the optic disc
C. Perimetry
D. Ocular ultrasound

A

C. Perimetry
Perimetry, or visual field testing, is used to detect visual field defects, which are important in diagnosing glaucoma and other optic neuropathies.

121
Q

This type of glaucoma is characterized by appositional or synecchial closure of the drainage angle of the eye.
A. Neovascular glaucoma
B. Open-angle glaucoma
C. Angle-closure glaucoma
D. Congenital glaucoma

A

C. Angle-closure glaucoma
Angle-closure glaucoma is characterized by closure of the drainage angle, leading to increased intraocular pressure.

122
Q

What is a characteristic ophthalmoscopic feature of a central retinal artery occlusion (CRAO)?
A. Large flame-shaped hemorrhage in the macula
B. Cotton-wool spots
C. Cherry red spot
D. Pigment in the shape of a bull’s eye in the macula

A

C. Cherry red spot
A cherry red spot at the macula is the classic ophthalmoscopic finding in central retinal artery occlusion (CRAO).

123
Q

The mechanism of action of the following drugs involves suppression of aqueous production, EXCEPT:
A. Alpha agonist
B. Beta blockers
C. Carbonic anhydrase inhibitors
D. Prostaglandin analogues

A

D. Prostaglandin analogues
Prostaglandin analogues increase aqueous outflow, while alpha agonists, beta blockers, and carbonic anhydrase inhibitors reduce aqueous production.

124
Q

Which of the following physical exam findings would indicate that there is optic nerve damage after trauma?
A. Diplopia on downgaze
B. Pain in the affected eye
C. Limitation of eye movement in the affected eye
D. (+) RAPD in the affected eye

A

D. (+) RAPD in the affected eye
A relative afferent pupillary defect (RAPD) is a key sign of optic nerve damage following trauma.

125
Q

Which of the following shows the correct order by which the aqueous flows inside of the eye?
A. Ciliary process → Pupil → Anterior chamber → Trabecular meshwork → Schlemm’s canal → Venous system
B. Ciliary process → Pupil → Anterior chamber → Schlemm’s canal → Trabecular meshwork → Venous system
C. Ciliary process → Pupil → Posterior chamber → Trabecular meshwork → Schlemm’s canal → Venous system
D. Ciliary process → Pupil → Posterior chamber → Schlemm’s canal → Trabecular meshwork → Venous system

A

A. Ciliary process → Pupil → Anterior chamber → Trabecular meshwork → Schlemm’s canal → Venous system
This describes the correct pathway of aqueous humor flow in the eye.

126
Q

The following findings can be seen in a glaucomatous optic disc, EXCEPT:
A. Enlarged cup-to-disc ratio
B. Nasalization of the central retinal artery and vein
C. Thinning of the neuroretinal rim
D. Optic disc pallor

A

D. Optic disc pallor
Optic disc pallor is not a typical feature of glaucomatous optic neuropathy but rather of optic atrophy.

127
Q

The following are indications for surgical repair in cases of orbital floor fractures, EXCEPT:
A. Diplopia on downgaze
B. Enophthalmos of >2mm on the affected side
C. Bone displacement >50%
D. Hypoesthesia

A

D. Hypoesthesia
Hypoesthesia (reduced sensation) is common but not an indication for surgical repair. Indications include diplopia, enophthalmos, and significant bone displacement.

128
Q

Which among the following is a common risk factor for primary open-angle glaucoma (POAG)?
A. Old age
B. Steroid use
C. History of eye trauma
D. Congenital iris malformation

A

A. Old age
Age is a well-known risk factor for primary open-angle glaucoma, along with other factors like African ancestry and family history.

129
Q

What is the gold standard in measuring intraocular pressure?
A. Digital tonometry
B. Goldmann applanation tonometry
C. Noncontact (air puff) tonometry
D. Pneumatic tonometer

A

B. Goldmann applanation tonometry
Goldmann applanation tonometry is considered the gold standard for measuring intraocular pressure.

130
Q

What type of lens is used to view the anterior chamber angle of the eye?
A. Soft contact lens
B. Gonioscopic lens
C. Magnifying lens
D. 20 D lens

A

B. Gonioscopic lens
A gonioscopic lens is used to view the anterior chamber angle, essential for diagnosing angle-closure glaucoma.

131
Q

A 76-year-old female came in for consult due to gradually progressive decrease in vision, associated with occasional eye pain and headaches. No previous ophthalmologic consults were done or medications taken. No history of trauma. On physical examination, the patient’s vision is 20/100 in the right eye, not corrected on pinhole examination, and 20/40 in the left eye, not corrected on pinhole examination. Intraocular pressure is 35mmHg in both eyes. The lenses in both the right and left eyes appear cataractous. On fundoscopic examination, the cup-to-disc ratio is 0.7 in the right eye and 0.6 in the left. What is the most likely diagnosis?
A. Primary open-angle glaucoma
B. Juvenile open-angle glaucoma
C. Steroid-induced glaucoma
D. Angle recession glaucoma

A

A. Primary open-angle glaucoma
The patient presents with high intraocular pressure, enlarged cup-to-disc ratio, and gradual vision loss, typical of primary open-angle glaucoma.

132
Q

Investigating the type of material involved in each patient suspected of corneal foreign bodies is important. What type of material is associated with an increased risk of infection?
A. Glass
B. Metal
C. Plastic
D. Vegetable matter

A

D. Vegetable matter
Organic material like vegetable matter has a higher risk of infection due to the potential for fungal contamination.

133
Q

A patient presents with a sudden increase in intraocular pressure to 55 mmHg in the left eye. Gonioscopic examination demonstrates a closed angle with trabecular meshwork obstruction. Which of the following is not a likely presenting symptom in this patient?
A. Blurring of vision
B. Diplopia
C. Ocular pain
D. Headache

A

B. Diplopia
Diplopia is not a typical symptom of acute angle-closure glaucoma. Symptoms include blurred vision, ocular pain, and headache.

134
Q

The following are risk factors in developing angle-closure glaucoma, EXCEPT:
A. Hyperopia
B. Myopia
C. Thick lens
D. Small corneal diameter

A

B. Myopia
Myopia (nearsightedness) is not a risk factor for angle-closure glaucoma; hyperopia, small corneal diameter, and a thick lens are.

135
Q

Prostaglandin analogues lower intraocular pressure predominantly by which one of the following mechanisms?
A. Increased uveoscleral outflow
B. Enhanced aqueous outflow by stimulation of ciliary muscle contraction
C. Reduced vitreous volume
D. Reduced aqueous production

A

A. Increased uveoscleral outflow
Prostaglandin analogues primarily lower intraocular pressure by increasing uveoscleral outflow.

136
Q

The most severe chemical injuries are caused by what type of chemicals?
A. Alkali
B. Acid
C. Corrosives
D. Irritants

A

A. Alkali
Alkali substances cause the most severe chemical injuries due to their ability to penetrate deeper into the eye tissues.

137
Q

In cases of ruptured globe from blunt trauma to the eye, the globe most commonly ruptures where the sclera is thinnest and weakest. This area is found:
A. In front of the insertion of the recti muscles
B. In front of the insertion of the oblique muscles
C. Behind the insertion of the recti muscles
D. Behind the insertion of the oblique muscles

A

C. Behind the insertion of the recti muscles
The sclera is thinnest just behind the insertion of the recti muscles, making it the most common site of rupture in globe injuries.

138
Q

A 21-year-old male patient comes to the ER after some metal shrapnel hit his left eye while he was grinding metal. You want to check if the patient has a penetrating injury through the cornea. What test would you perform?
A. Seidel test
B. Schirmer test
C. Dye disappearance test
D. Rose Bengal test

A

A. Seidel test
The Seidel test checks for the presence of a penetrating injury by observing for leaking aqueous humor from the cornea.

139
Q

A 17-year-old male came to the ER with right eye pain, tearing, and foreign body sensation. On physical examination, you note several fine vertical abrasions on the upper to middle two-thirds of his cornea. What maneuver should you do next in your physical examination?
A. Place a bandage contact lens to decrease the pain
B. Place a firm pressure patch over the eye to hasten the healing process
C. Evert the ipsilateral upper eyelid to check for any retained foreign bodies
D. Evert the contralateral upper eyelid to complete a comprehensive ophthalmologic exam

A

C. Evert the ipsilateral upper eyelid to check for any retained foreign bodies
Vertical corneal abrasions are often caused by foreign bodies lodged under the upper eyelid, so everting it to inspect is essential.

140
Q

What elements of the ocular examination would suggest globe rupture?
A. Shallow anterior chamber
B. Diplopia
C. Swollen upper eyelids
D. All of the above

A

D. All of the above

141
Q

A construction worker is brought to the ER with complaints of sudden ocular pain in his left eye while hammering a nail onto a wall. Ocular examination reveals the following: irregular pupil with a brownish discoloration of the conjunctiva, hypotonic eyeball, blood in the anterior chamber, and hazy media. What is your diagnosis?
A. Scleral laceration
B. Melanoma of the iris
C. Traumatic glaucoma
D. Orbital floor “blowout” fracture

A

A. Scleral laceration
The irregular pupil, blood in the anterior chamber, and hypotony (low intraocular pressure) are signs of a penetrating injury such as a scleral laceration.

142
Q

In cases of corneal lacerations needing surgical repair, when should the repair be performed to prevent prolapse of intraocular tissues, suprachoroidal hemorrhage, infection, intraocular inflammation, or lens opacity?
A. Within 5-7 days
B. Within 72 hours
C. Within 36 hours
D. Within 5 hours

A

C. Within 36 hours
Corneal lacerations should be repaired within 36 hours to prevent complications such as tissue prolapse, infection, and hemorrhage.

143
Q

Lacerations in the medial area of both the upper and lower eyelids must be carefully examined because it is the weakest part of the eyelid anatomically. What important structure in the lacrimal drainage system lies within this area?
A. Lacrimal gland
B. Canaliculi
C. Lacrimal sac
D. Nasolacrimal duct

A

B. Canaliculi
The canaliculi are part of the lacrimal drainage system located medially in the eyelids and are susceptible to injury in this area.

144
Q

Which of the following findings is essential in order to diagnose glaucoma?
A. Neuroretinal rim thinning
B. Visual acuity loss
C. Family history of glaucoma
D. African American race

A

A. Neuroretinal rim thinning
Neuroretinal rim thinning is a hallmark of glaucoma, while the other options are risk factors or associated features, but not diagnostic criteria.

145
Q

A 16-year-old male was playing around with some alkaline batteries when he accidentally got some of the fluid in both of his eyes. He immediately irrigated his eyes with running water and was brought to the ER by his uncle. At the ER, you assess him and note that he has a corneal epithelial defect with stromal haze in both eyes, as well as limbal ischemia affecting less than 1/3 of the limbus. He asks you if he has a good chance of recovering his vision to normal. What is his visual prognosis?
A. Good
B. Guarded
C. Poor
D. He will completely lose his vision

A

A. Good
The patient irrigated his eyes promptly, and since the limbal ischemia affects less than 1/3 of the limbus, the visual prognosis is good.

146
Q

A 23-year-old female came in for consult due to frequent headaches. Visual acuity is 20/20 for both eyes. Her intraocular pressure is 18mmHg for both eyes. On fundoscopic examination, her cup-to-disc ratio is 0.7 for both eyes. Which of the following makes her susceptible to further workup to check for the presence of glaucoma?
A. Patient’s age
B. Visual acuity of 20/20
C. Intraocular pressure of 18mmHg
D. Cup-to-disc ratio of 0.7

A

D. Cup-to-disc ratio of 0.7
A cup-to-disc ratio of 0.7 is concerning for glaucoma and warrants further investigation, even in the absence of visual acuity loss or elevated intraocular pressure.

147
Q

Dorzolamide lowers intraocular pressure by:
A. Increasing uveoscleral outflow
B. Decreasing aqueous production
C. Increasing conventional (trabecular meshwork) outflow
D. Decreasing episcleral venous pressure

A

B. Decreasing aqueous production
Dorzolamide is a carbonic anhydrase inhibitor that lowers intraocular pressure by reducing the production of aqueous humor.

148
Q

Severe ocular chemical burns can cause limbal ischemia. Why is the most unfavorable visual prognosis associated with extensive limbal epithelial damage?
A. Because the limbus has many blood vessels
B. Because the limbus is close to the conjunctiva
C. Because the limbus encircles the cornea
D. Because the limbus contains corneal epithelial stem cells

A

D. Because the limbus contains corneal epithelial stem cells
Damage to the limbus, which houses the stem cells

149
Q

What is the primary risk factor associated with the development of glaucoma?
A. Increased intraocular pressure
B. Female gender
C. Long eyeball
D. Positive family history of glaucoma

A

A. Increased intraocular pressure
Elevated intraocular pressure is the primary modifiable risk factor for the development of glaucoma.

150
Q

Corneal abrasion is usually associated with immediate pain, foreign-body sensation, and discomfort with blinking. The sensory innervation of the cornea is supplied by which cranial nerve?
A. Oculomotor nerve
B. Trochlear nerve
C. Trigeminal nerve
D. Facial nerve

A

C. Trigeminal nerve
The cornea is innervated by the ophthalmic branch of the trigeminal nerve, which is responsible for the pain and discomfort associated with corneal abrasions.

151
Q

The following are parts of the anterior chamber angle, EXCEPT:
A. Schlemm’s canal
B. Trabecular meshwork
C. Ciliary body
D. Iris

A

C. Ciliary body
The ciliary body is not part of the anterior chamber angle, which includes Schlemm’s canal, trabecular meshwork, and iris.

152
Q

Which of the following corresponds with a glaucomatous visual field defect?

A

D: Displays an arcuate-shaped visual field defect, which is characteristic of glaucomatous damage.

153
Q

What is the goal of current available glaucoma therapy?
A. To preserve visual function by lowering intraocular pressure to a level that is likely to prevent further optic nerve damage
B. To preserve visual function by lowering intraocular pressure to a level that is between 10-21 mmHg
C. To preserve visual function by lowering intraocular pressure sufficiently, so that surgical management can be performed safely
D. To preserve visual function by lowering intraocular pressure sufficiently, so that laser procedures can be performed safely

A

A. To preserve visual function by lowering intraocular pressure to a level that is likely to prevent further optic nerve damage
The primary goal of glaucoma therapy is to lower intraocular pressure to a level that prevents further damage to the optic nerve and maintains visual function.

154
Q

A 25-year-old male came in for regular eye screening since he was applying for his first job. Vision is 20/20 in both eyes. For both eyes, the cornea and lens are clear. His intraocular pressure for both eyes is 30 mmHg. On direct funduscopy, he has a yellow-orange disc with a cup-to-disc ratio of 0.4 and an artery-to-vein ratio of 2:3. Which of his physical examination findings warrants further investigation for glaucoma?
A. Intraocular pressure of 30 mmHg
B. Yellow-orange disc
C. Cup-to-disc ratio of 0.4
D. Artery-to-vein ratio of 2:3

A

A. Intraocular pressure of 30 mmHg
An intraocular pressure of 30 mmHg is significantly elevated and warrants further investigation for glaucoma, even with normal visual acuity and a normal cup-to-disc ratio.

155
Q

How would you test for the presence of a corneal abrasion in the Emergency Room?
A. Add a fluorescein drop to the affected eye and examine the eye under white light
B. Add a drop of proparacaine and examine the eye at the slit lamp
C. Add a drop of proparacaine and examine under a cobalt blue filter
D. Add a drop of proparacaine to a fluorescein strip and put a drop in the eye, then examine the eye under a cobalt blue filter

A

D. Add a drop of proparacaine to a fluorescein strip and put a drop in the eye, then examine the eye under a cobalt blue filter
Fluorescein staining with a cobalt blue filter is the standard method to detect corneal abrasions, with proparacaine providing anesthesia for patient comfort.

0 - Ophthalmology (5 decks)

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