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0 - Ophthalmology > LE3 > Flashcards

LE3 Flashcards

1
Q
  1. In III nerve palsy, the eye is:

A. Adducted, depressed
B. Abducted, depressed
C. Abducted, elevated
D. Adducted, elevated

A

B. Abducted, depressed

In III nerve palsy, the lateral rectus and superior oblique muscles are unopposed, resulting in the eye being abducted and depressed

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2
Q
  1. An aneurysm in which location may cause isolated III nerve palsy?

A. Anterior communicating artery
B. Middle cerebral artery
C. Posterior communicating artery
D. Posterior cerebral artery

A

C. Posterior communicating artery

An aneurysm in the posterior communicating artery can compress the oculomotor nerve, leading to isolated III nerve palsy.

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3
Q
  1. In question no. 2, the pupil will be:

A. Fixed, dilated
B. Constricted
C. Normally reactive
D. Teardrop-shaped

A

A. Fixed, dilated

A compressive lesion, such as an aneurysm, typically affects the parasympathetic fibers of the III nerve, leading to a fixed, dilated pupil.

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4
Q
  1. Actions of the superior oblique muscle are:

A. Elevation, adduction, intorsion
B. Depression, adduction, extorsion
C. Depression, abduction, intorsion
D. Elevation, abduction, intorsion

A

C. Depression, abduction, intorsion

The superior oblique muscle primarily depresses, abducts, and intorts the eye.

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5
Q
  1. The agonist muscle of the right lateral rectus is:

A. Left medial rectus
B. Left lateral rectus
C. Right medial rectus
D. Left superior oblique

A

A. Left medial rectus

The left medial rectus works as the yoke muscle of the right lateral rectus, coordinating horizontal eye movements.

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6
Q
  1. Yoke or agonist muscles receive approximately similar innervation according to:

A. Sherrington’s law
B. Müller’s law
C. Hering’s law
D. Murphy’s law

A

C. Hering’s law

Hering’s law states that yoke muscles receive equal innervation for conjugate eye movements.

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7
Q
  1. Optic neuritis may be an initial manifestation of:

A. Multiple myeloma
B. Subacute sclerosing panencephalitis
C. Systemic lupus erythematosus
D. Multiple sclerosis

A

D. Multiple sclerosis

Optic neuritis can be an initial presentation of multiple sclerosis.

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8
Q
  1. By itself, which of the following is NOT a cause of Marcus Gunn pupil?

A. Dense cataract
B. Total retinal detachment
C. Optic atrophy
D. Retrobulbar optic neuritis

A

A. Dense cataract

A dense cataract does not affect the afferent visual pathway and therefore does not cause a Marcus Gunn pupil.

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9
Q
  1. Which of the following is a strengthening procedure?

A. Resection
B. Recession
C. Tenotomy
D. Faden procedure

A

A. Resection

Resection is a surgical procedure that strengthens a muscle by shortening it.

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10
Q
  1. Which of the following visual field defects is due to a temporal optic radiation lesion?

A. Homonymous hemianopsia
B. Bitemporal hemianopsia
C. “Pie in the sky” visual field defect
D. Inferior quadrantanopia

A

C. “Pie in the sky” visual field defect

A lesion in the temporal optic radiation affects the superior visual field, resulting in a “pie in the sky” defect.

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11
Q
  1. A patient with superior oblique palsy primarily presents with which of the following?

A. Hypertropia
B. Esotropia
C. Exotropia
D. Hypotropia

A

A. Hypertropia

Superior oblique palsy typically causes hypertropia, where the affected eye is higher than the unaffected eye.

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12
Q
  1. A 40-year-old male consulted for blurring of vision in the right eye. He also experienced pain around the right eye on eye movement. On examination, the visual acuity was counting fingers up to 1 foot. Intraocular pressure was normal, and funduscopy was normal. There was a Marcus Gunn pupil. What is the most likely diagnosis?

A. Papillitis
B. Papilledema
C. Retrobulbar optic neuritis
D. Central retinal artery occlusion

A

C. Retrobulbar optic neuritis

The combination of pain on eye movement, decreased visual acuity, and a Marcus Gunn pupil with a normal fundus suggests retrobulbar optic neuritis.

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13
Q
  1. A 1-year-old boy is brought to you by his parents, who noted that he was “duling” (cross-eyed). On examination, the corneal light reflexes were centered in both eyes. Visual acuity was grossly normal. What is the diagnosis?

A. Esophoria
B. Exophoria
C. Esotropia
D. Pseudoesotropia

A

D. Pseudoesotropia
Pseudoesotropia is suggested when the corneal light reflexes are centered and visual acuity is normal, but the eyes appear crossed due to facial features.

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14
Q
  1. All of the following muscles arise from the annulus of Zinn EXCEPT:

A. Superior rectus
B. Inferior oblique
C. Superior oblique
D. Inferior rectus

A

B. Inferior oblique
The inferior oblique muscle arises from the maxillary bone, not from the annulus of Zinn.

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15
Q
  1. The surgical management of congenital esotropia is:

A. Medial rectus recession
B. Medial rectus resection
C. Lateral rectus recession
D. Lateral rectus tenotomy

A

A. Medial rectus recession
Medial rectus recession is the preferred surgical management for congenital esotropia to weaken the overactive medial rectus muscles.

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16
Q
  1. Which lenses are used to correct astigmatism?

A. Concave lenses
B. Convex lenses
C. Cylindrical lenses
D. Spherical lenses

A

C. Cylindrical lenses
Cylindrical lenses are used to correct astigmatism by compensating for the irregular curvature of the cornea or lens.

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17
Q
  1. Which of the following is true about concave lenses?

A. They converge light rays
B. They magnify
C. They diverge light rays
D. They correct hyperopia

A

C. They diverge light rays
Concave lenses diverge light rays and are used to correct myopia (nearsightedness).

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18
Q
  1. A +2.00 spherical lens has a focal length of:

A. 1 meter
B. 0.5 meter
C. 0.33 meter
D. 2 meters

A

B. 0.5 meter
The focal length of a +2.00 diopter lens is calculated as 1 divided by the lens power in diopters (1/2.00 = 0.5 meters).

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19
Q
  1. A complete CN III palsy has all the following features EXCEPT:

A. Dilated pupil
B. Ptosis
C. Divergent strabismus
D. Esotropia

A

D. Esotropia
A complete CN III palsy causes divergent strabismus (the eye is turned outward), not esotropia.

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20
Q
  1. Which one of the following four patients would you emergently evaluate and refer? An acquired…

A. CN IV palsy
B. CN III palsy, pupil dilated
C. CN III palsy, pupil spared
D. CN VI palsy

A

B. CN III palsy, pupil dilated
A CN III palsy with a dilated pupil is an emergency, often indicating compression from an aneurysm or other serious condition, requiring immediate evaluation.

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21
Q
  1. A lesion in the right optic tract typically produces what type of visual field defect?

A. Bitemporal hemianopsia
B. Macular sparing
C. Right homonymous hemianopsia
D. Left homonymous hemianopsia

A

D. Left homonymous hemianopsia
A lesion in the right optic tract causes a loss of vision in the left visual field of both eyes, known as left homonymous hemianopsia.

22
Q
  1. What action is appropriate for a patient you discover to have bilateral papilledema?

A. Make a neurology appointment in the next two weeks
B. Neurology referral ASAP
C. Obtain head CT scan with attention to the orbits
D. Obtain disc photos and re-evaluate in a week

A

B. Neurology referral ASAP

Rationale: Bilateral papilledema is an alarming sign that indicates increased intracranial pressure, which can be caused by serious conditions such as a brain tumor, intracranial hemorrhage, or pseudotumor cerebri. This requires urgent evaluation, as delayed diagnosis and treatment can lead to permanent vision loss or other neurological complications. Therefore, an immediate referral to neurology (or neuro-ophthalmology) for further workup is essential. Other options, such as re-evaluating in a week or scheduling a delayed neurology appointment, would not address the urgency of the situation.

23
Q
  1. Unilateral optic disc swelling is usually associated with all of the following EXCEPT:

A. RAPD (relative afferent pupillary defect)
B. Bitemporal hemianopsia
C. Central scotoma
D. Decreased visual acuity

A

B. Bitemporal hemianopsia
Unilateral optic disc swelling is not associated with bitemporal hemianopsia, which typically occurs with lesions at the optic chiasm.

24
Q
  1. What is the major complaint of a patient with left VI nerve palsy?

A. Vertical diplopia, greatest on downgaze
B. Horizontal diplopia, greatest on gaze right
C. Pain on attempted gaze right
D. Horizontal diplopia, greatest on gaze left

A

D. Horizontal diplopia, greatest on gaze left
In left VI nerve palsy, the lateral rectus muscle of the left eye is weakened, causing horizontal diplopia, which is worse when looking to the left.

25
Q
  1. What contributes most to the refractive power of the eye?

A. Cornea
B. Lens
C. Aqueous humor
D. Vitreous humor

A

A. Cornea
The cornea provides the majority of the eye’s refractive power due to its curvature and air interface.

26
Q
  1. Which of the following is true of a myopic eye?

A. Cornea is less steep
B. Corrected by convex lenses
C. Shorter than normal
D. Longer than normal

A

D. Longer than normal
In myopia, the eye is longer than normal, causing light to focus in front of the retina.

27
Q
  1. Patients with myasthenia gravis may have one of the following EXCEPT:

A. Ptosis
B. Diplopia
C. Relative afferent pupillary defect
D. Difficulty swallowing

A

C. Relative afferent pupillary defect
Myasthenia gravis affects the muscles controlling eye movement and eyelids, but it does not cause a relative afferent pupillary defect, which is associated with optic nerve pathology.

28
Q
  1. Occlusion treatment for amblyopia:

A. Patch the eye with poorer vision
B. Patch the eye with better vision
C. Patch eyes alternately
D. Patch any eye

A

B. Patch the eye with better vision
Occlusion treatment involves patching the stronger eye to force the weaker eye to work harder, thus improving vision in the weaker eye.

29
Q
  1. The corneal light reflex is noted to be about 2 mm temporally off the center of one eye. The patient has:

A. Esotropia
B. Exotropia
C. Hypertropia
D. Hyperopia

A

B. Exotropia
A temporally displaced corneal light reflex indicates exotropia, where the eye turns outward.

30
Q
  1. The law of reciprocal innervation (Sherrington’s law) states that:

A. When one muscle contracts, its agonist contracts
B. When one muscle contracts, its agonist relaxes
C. When one muscle contracts, its antagonist contracts
D. When one muscle contracts, its antagonist relaxes

A

D. When one muscle contracts, its antagonist relaxes
Sherrington’s law of reciprocal innervation states that when a muscle contracts, its antagonist relaxes to allow smooth movement.

31
Q
  1. In right lateral rectus palsy, there is:

A. Diplopia greatest on left gaze
B. Diplopia lessened by turning head to left
C. Diplopia greatest on right gaze
D. Diplopia lessened by tilting head to right

A

C. Diplopia greatest on right gaze
In right lateral rectus palsy, diplopia is greatest on right gaze due to the weakness of the right lateral rectus muscle, which is responsible for abducting the eye.

32
Q
  1. On examining a patient, pointing a penlight to the left eye reveals constriction of the left pupil. Swinging the penlight to the right eye, the right pupil is noted to dilate. What does this indicate?

A. This is a normal finding
B. Vision of the left eye is probably poor
C. There is probably optic neuropathy of the right eye
D. There is probably optic neuropathy of the left eye

A

C. There is probably optic neuropathy of the right eye
A relative afferent pupillary defect (RAPD) is indicated when the right pupil dilates upon shining light in the right eye. This suggests optic nerve dysfunction in the right eye.

33
Q
  1. Which cranial nerve arises from the dorsal aspect of the brainstem?

A. CN III
B. CN IV
C. CN V
D. CN VI

A

B. CN IV
The trochlear nerve (CN IV) arises from the dorsal aspect of the brainstem.

34
Q
  1. Which cranial nerve is adjacent to the posterior communicating artery?

A. CN II
B. CN IV
C. CN V
D. CN VI

A

A. CN II
The optic nerve (CN II) is adjacent to the posterior communicating artery, making it susceptible to compression from aneurysms in this region.

35
Q
  1. What is true of a hyperopic eye?

A. Cornea is more steep
B. Corrected by concave lenses
C. Shorter than normal
D. Longer than normal

A

C. Shorter than normal
A hyperopic (farsighted) eye is shorter than normal, causing light to focus behind the retina.

36
Q
  1. “Pie on the floor” visual field defect is characteristic of which of the following?

A. Temporal optic radiations
B. Parietal optic radiations
C. Main radiation lesion
D. Anterior visual cortex lesion

A

B. Parietal optic radiations
A lesion in the parietal optic radiations causes a “pie on the floor” visual field defect (inferior quadrantanopia).

37
Q
  1. Which of the following is true about LASIK?

A. Never has complications
B. Always results in 20/20 vision
C. Makes the cornea more steep
D. Makes the cornea less steep

A

D. Makes the cornea less steep
LASIK reshapes the cornea by making it less steep, which corrects refractive errors like myopia.

38
Q
  1. A child is seen to have the right eye turned inward. On covering the left eye, the right eye takes up fixation (looks straight ahead). On uncovering the left eye, the right eye turns inward while the left eye takes up fixation (looks straight ahead). What is the most appropriate diagnosis?

A. Alternating esotropia, right eye preference
B. Left monocular esotropia
C. Left esophoria
D. Alternating esotropia, left eye preference

A

A. Alternating esotropia, right eye preference
Alternating esotropia is indicated when fixation alternates between the eyes, but there is a slight preference for the right eye in this case.

39
Q
  1. Which of the following is true about retinal detachment?

A. Higher risk of retinal detachment in hyperopia
B. Higher risk in myopia
C. Higher risk in astigmatics
D. Risk not related to refractive error

A

B. Higher risk in myopia
Myopic (nearsighted) individuals have a higher risk of retinal detachment due to the elongation of the eye, which can lead to retinal thinning and detachment.

40
Q
  1. Which is the most commonly involved muscle causing hypertropia?

A. Superior rectus
B. Inferior rectus
C. Superior oblique
D. Inferior oblique

A

C. Superior oblique
The superior oblique muscle is most commonly involved in causing hypertropia when it’s weak or paralyzed, leading to vertical misalignment of the eyes.

41
Q
  1. Which of the following eyes is hyperopic?

A. Aphakic eye (eye with no lens)
B. Longer than normal eye
C. Eye where the image is focused in front of the retina
D. Eye with steep cornea

A

A. Aphakic eye (eye with no lens)
An aphakic eye is hyperopic because, without the lens, the eye cannot focus light properly, leading to far-sightedness.

42
Q
  1. Which of the following is present if strabismus develops in older children or adults?

A. Diplopia
B. Suppression
C. Amblyopia
D. Diminished light sensitivity

A

A. Diplopia
Strabismus that develops in older children or adults often results in diplopia (double vision) because the brain cannot suppress the image from one eye as effectively as in younger patients.

43
Q
  1. Conductive keratoplasty is a treatment for:

A. Hyperopia
B. Astigmatism
C. Myopia
D. Glaucoma

A

A. Hyperopia
Conductive keratoplasty is a treatment used to correct mild to moderate hyperopia (farsightedness).

44
Q
  1. In right homonymous hemianopsia:

A. Patient has blurred temporal visual fields
B. Patient has blurred vision in the right eye alone
C. Patient has blurred right temporal and blurred left nasal visual fields
D. The visual field defect is represented by shading the left half of each eye

A

C. Patient has blurred right temporal and blurred left nasal visual fields
Right homonymous hemianopsia results in a loss of the right visual field of both eyes, affecting the right temporal field and the left nasal field.

45
Q
  1. A lesion at the optic chiasm, for example due to a pituitary tumor, will cause:

A. Homonymous hemianopsia
B. Bitemporal hemianopsia
C. Binasal hemianopsia
D. “Pie in the sky” visual field defect

A

B. Bitemporal hemianopsia
A lesion at the optic chiasm, such as from a pituitary tumor, results in bitemporal hemianopsia, where the temporal visual fields of both eyes are lost.

46
Q
  1. Sudden, severe headache; stiff neck; loss of consciousness, and preretinal hemorrhages indicate:

A. Subarachnoid hemorrhage
B. Subdural hemorrhage
C. Occlusion of the posterior cerebral artery
D. Occlusion of the basilar artery

A

A. Subarachnoid hemorrhage
Sudden severe headache, stiff neck, loss of consciousness, and preretinal hemorrhages are classic signs of subarachnoid hemorrhage.

47
Q
  1. Diplopia when fatigued may indicate:

A. VI nerve palsy
B. Aneurysm
C. Myasthenia gravis
D. Error of refraction

A

C. Myasthenia gravis
Diplopia when fatigued is a characteristic symptom of myasthenia gravis, as muscle weakness worsens with exertion.

48
Q
  1. Which is NOT true of disorders of the retrochiasmal visual pathways?

A. Homonymous
B. Partial lesions are incongruous
C. The more posterior the lesion, the more incongruous
D. There may be associated neurologic symptoms and signs

A

C. The more posterior the lesion, the more incongruous
This statement is incorrect; the more posterior the lesion, the more congruous the visual field defects tend to be.

49
Q
  1. In heterophoria or latent strabismus:

A. Strabismus is present under normal binocular viewing conditions
B. Strabismus is present when one eye is covered
C. No movement with cover/uncover test
D. Associated with amblyopia

A

B. Strabismus is present when one eye is covered
In heterophoria (latent strabismus), strabismus manifests when binocular fusion is disrupted, such as when one eye is covered.

50
Q
  1. In hypertropia:

A. One eye is elevated
B. There may be an associated accommodative esotropia
C. There is a weakness in the elevators of the eye
D. The eyeball is longer than normal

A

A. One eye is elevated
Hypertropia is a condition where one eye is abnormally elevated compared to the other.

0 - Ophthalmology (5 decks)

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