OPHTHALMOLOGY Flashcards

1
Q

Funduscopy of the right eye should be made in the following order, except:
A) the examiner sits or stands on the right side of the patient
B) the retinoscope is held in the right hand of the examiner and he/she examines with the right eye
C) possibly performs the examination in a dark room
D) the left hand is positioned on the forehead of the patient and with her/his thumb lifts the upper eyelid
E) asks the patient to look directly into the light

A

E) asks the patient to look directly into the light

Patients should not look directly into the light, because in that case the pupil narrows and the peripheral part of the fundus cannot be observed.

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2
Q
The following reflexes are needed to watch nearby objects, except:
A)  	convergence
B)  	pupillary dilation
C)  	contraction of the ciliary muscle
D)  	thickening of the crystalline lens
E)  	enlarged refraction
A

B) pupillary dilation

To watch nearby object, accommodation is needed, in that case the pupil is not dilating, on the contrary it is narrowing.

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3
Q

The most important cause of the visual deterioration in people over 80 years:
A) diabetes mellitus
B) myopia
C) age-related macular degeneration (AMD)
D) glaucoma
E) cataract

A

C) age-related macular degeneration (AMD)

The age-related macular degeneration affects approximately 30% of the people above the age of 80 yrs.

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4
Q

The most important early characteristics of hypertensive retinopathy:
A) arteriovenous crossing
B) constriction of arterioles
C) widening of the light reflex of the arterioles
D) copper wire arterioles
E) silver wire arterioles

A

B) constriction of arterioles

Hypertension starts with the constriction of the smallest vessels, this sign is specific. The other signs can be found not exclusively in hypertension and occurs in the later phase of hypertension.

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5
Q

The one-sided subconjunctival hemorrhage which is not associated with pain, nor visual disturbances refers to:
A) acute glaucomatous attack
B) usually thrombocytopenia is in the background
C) usually it is caused by arteriolosclerosis
D) urgent, severe ophthalmic disturbance which needs emergency care
E) usually harmless idiopathic disturbance

A

E) usually harmless idiopathic disturbance

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6
Q
In a teenager boy due to eye trauma the vision decreases suddenly. The physical examination reveals blood in the anterior chamber. This is called:
A)  	hypopyon
B)  	conjunctival hemorrhage
C)  	corneal abrasion
D)  	hyphema
E)  	vitreous hemorrhage
A

D) hyphema

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7
Q
Which is the most characteristic visual field defect from the followings in a hypophyseal tumor?
A)  	complete homonym hemianopsia
B)  	lower homonym hemianopsia
C)  	bitemporal hemianopsia
D)  	upper homonym hemianopsia
E)  	monocular blindness
A

C) bitemporal hemianopsia

The hypohysis tumor presses the chiasm centrally. The crossing fibers arriving here from the nasal retina, they transmit visual stimuli from the temporal visual field. The damage of these nerve fibers causing bilateral temporal visual field defect.

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8
Q
Red eye can be observed in the followings, except:
A)  	keratitis cum hypopyo
B)  	acute conjunctivitis
C)  	acute glaucomatous attack
D)  	acute iridocyclitis
E)  	corneal sign of the Wilson disease
A

E) corneal sign of the Wilson disease

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9
Q
The most likely diagnose in case of multiple, small, light diffuse retinal changes, if no other retinal pathology can be observed:
A)  	inveterated chorioretinitis
B)  	hypertensive retinopathy
C)  	diabetic retinopathy
D)  	drusen
E)  	sclerosis of the retinal arterioles
A

D) drusen

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10
Q
If you observe in front of the retina a semicircle, in the upper part a horizontal shape hemorrhage during funduscopy, what do you think?
A)  	superficial intraretinal hemorrhage
B)  	preretinal hemorrhage
C)  	deep intraretinal hemorrhage
D)  	vitreous hemorrhage
E)  	chorioideal hemorrhage
A

B) preretinal hemorrhage

The shape is horizontal in only that cases when the bleeding is between the retina and the detached posterior vitreous.

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11
Q

The malignant melanoma of the eye can be differentiated most accurately from the benign nevus by which of the following signs?
A) colour
B) shape
C) size
D) localization
E) does it lift (grows) above the plane of the retina

A

E) does it lift (grows) above the plane of the retina

The tumour is heighted largely above the plane of the retina. Nevi are usually in the plane of the retina or very flat. In case of uncertain diagnosis fluorescein angiography is necessary.

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12
Q

The venous pulsation within the papilla:
A) normal sign
B) means enlarged intracranial pressure
C) can be observed following retinal vein occlusion
D) glaucoma should be suspected / anticipated
E) sign of papillitis

A

A) normal sign

The retinal venous pulsation is a normal finding. The pressure in central retinal vein is approximately the same with the intraocular pressure. During systole the intraocular pressure increasing by 1-2 mmHg, by this way the soft vein wall is compressed. This changing with the increasing minimal pressure rise is enough to cause venous pulsation. If venous outflow is blocked, spontaneous vein pulsation stops.

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13
Q
A patient perceives a sudden opacity in front of one eye. Some weeks later a progressive peripheral visual field defect is started in that particular eye. The most likely diagnosis:
A)  	retinitis pigmentosa
B)  	luxation of the crystalline lens
C)  	iritis
D)  	macular degeneration
E)  	retinal detachment
A

E) retinal detachment

The sudden peripheral visual filed defect – especially following vitreous floaters – sign of retinal detachment. In macular degeneration central visual filed defect is the consequence. In pigmentary retinitis the peripheral visual filed narrowing lasts longer, to years or to decades.

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14
Q
The cause of bilateral exophthalmos:
A)  	orbital pseudotumor
B)  	lymphoma
C)  	thyroid induced exophthalmos
D)  	dermoid
E)  	tumor of the cavernous sinus
A

C) thyroid induced exophthalmos

Bilateral exophthalmos is caused most frequently by thyroid dysfunction and consequently the retrobulbar tissue and the extraocular muscles at the beginning are thickened, edematous, later starts to fibrose.

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15
Q
The meaning of the chemosis:
A)  	conjunctivitis
B)  	bleeding in the anterior chamber
C)  	conjunctival edema
D)  	scleral bleeding
E)  	periorbital edema
A

C) conjunctival edema

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16
Q
Normal intraocular pressure does not exceed:
A)  	7 mmHg
B)  	11 mmHg
C)  	14 mmHg
D)  	18 mmHg
E)  	22 mmHg
A

E) 22 mmHg

The normal intraocular pressure is below 22 mmHg.

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17
Q

The most important urgent thing to do in case caustic (chemical) damage of the surface of the eye:
A) to remove the caustic materials and to wash out the eye with ample water
B) antibiotic eye drops hourly
C) subconjunctival corticosteroid injection
D) to pad the eye
E) referral to hospital (inpatient)

A

A) to remove the caustic materials and to wash out the eye with ample water

In case of caustic (chemical) injury of the ocular surface, the most important is to remove the caustic agent from the eye with ample water irrigation. It is very important to examine the upper fornix. To evert the upper eyelid is possible only with the Desmarres equipment. With only a glass stick, the fornix cannot be visualized.

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18
Q
Ectropium often presents together with:
A)  	pterygium
B)  	entropium
C)  	pinguecula
D)  	epiphora
E)  	ptosis
A

D) epiphora

If the lower eyelid is ectropic, usually the lower punctual point is everted outward also. Therefore tearing (epiphora) is the consequence, because the drainage of the tear is impaired, the lower punctual point is not reaching the tear level.

19
Q

A 25-year-old male patient complains in the emergency room of having an inflamed red eye. Fluorescein staining shows branch like corneal ulcer. The most likely diagnosis:
A) corneal abrasion
B) foreign body in the cornea
C) heat induced corneal damage
D) bacterial origin of corneal inflammation (keratitis)
E) herpetic infection

A

E) herpetic infection

20
Q
The diagnosis of proliferative diabetic retinopathy can be established by the following signs:
A)  	cotton-wool type degenerative spots
B)  	microaneurysms
C)  	neovascularization
D)  	point-like bleedings
E)  	retinal edema
A

C) neovascularization

In the proliferative stadium of diabetic retinopathy neovascularization is the most characteristic sign, other signs may occur in the non-proliferative stadium as well.

21
Q

A 67 year-old man suddenly loses his vision in the right eye. Funduscopy reveals a pale retina, in the macular area a cherry-red spot can be detected. What is the most likely diagnosis?
A) occlusion of the central retinal vein
B) multiple sclerosis
C) carotidal aneurysm
D) diabetic retinopathy
E) occlusion of the central retinal artery

A

E) occlusion of the central retinal artery

The sudden loss of central vision means the quick deterioration of the central fovea, which is a consequence of the occlusion of the central retinal artery. The retina getting edematous, within 24 hrs it is going to have a milky white color. This bleaching effect does not occur in the area of the central fovea, therefore its colour stays red (cherry red spot) after the occlusion of the central retinal artery. In this area the four inner layer of the retina are missing, therefor the red colour of the choroid can be detected.

22
Q
From the below mentioned symptoms which might be found both in keratitis, iritis, and in acute glaucomatous attack?
A)  	corneal precipitates
B)  	corneal blur
C)  	dilated pupil
D)  	circumcorneal or ciliary injection
E)  	subconjunctival bleeding
A

D) circumcorneal or ciliary injection

This sign labels inflammations, congestion within the iris, ciliary body and this can occur in glaucoma as well.

23
Q
In which disease can occur the so called “band keratopathy”?
A)  	syphilis
B)  	hyperlipidemia
C)  	older age
D)  	hypercalcemia
E)  	Wilson disease
A

D) hypercalcemia

24
Q

In case of dry eye syndrome, which examination should be performed first?
A) conjunctival biopsy
B) tonometry
C) Schirmer test
D) fluorescein staining of the cornea
E) measuring the lizozyme enzyme activity

A

C) Schirmer test

25
Q

The most frequent complication of severe myopia
A) posterior uveitis
B) cataract
C) angioid streaks
D) atrophic chorioideal area in the posterior pole
E) iris rubeosis

A

D) atrophic chorioideal area in the posterior pole

In severe myopia in the posterior pole of the eye, staphylomata may occur, which causing a circulatory deficiency and leading to atrophic area in the choroid. The stretching of the sclera is not followed by the retina and choroid. With the rupture of the blood vessels bleeding might occur in the atrophic areas (Fuchs spots).

26
Q

The therapeutic effects of the lasers can be mostly used in:
A) refractive surgery
B) the fundus changes caused by diabetes mellitus
C) conjunctival suffusion
D) endogenous uveitis
E) malposition of the lids

A

B) the fundus changes caused by diabetes mellitus

The therapeutic effects of lasers can be most efficiently used in the treatment of the fundus changes in diabetes mellitus. The timely performed pancoagulation may stop the progressive neovascular stadium, if the glucose level of the patient is also controlled (the last one is the most important).

27
Q
In which of the below listed diseases you would suspect retinal microaneurysm regarding differential diagnosis?
A)  	diabetes mellitus
B)  	retinal branch (venous) occlusion
C)  	hypertensive retinopathy
D)  	hereditary retinal degeneration
E)  	occlusion of retinal artery
A

A) diabetes mellitus

Microaneurysms are most characteristic in retinopathy due to diabetes mellitus. In the capillaries pericytes die and the vessel walls thicken unevently. This process is the first symptom of the microangiopathy in diabetes.

28
Q

Characteristics of senile macular degeneration, except:
A) slow progression
B) does not cause full blindness
C) peripheral vision is affected
D) it can be confused with systemic disease

A

C) peripheral vision is affected

Senile macular degeneration never affects the retinal periphery, the changes are in the macula.

29
Q
In case of malfunction of the rectus superior muscle in which direction of the looking is affected?
A)  	inward and downward
B)  	outward and downward
C)  	inward and upward
D)  	upward
E)  	outward and upward
A

C) inward and upward

The examiner should ask the patient to look in- and upward in order to control the function of the superior rectus muscle, because this muscle pulls the eye upward and inward.

30
Q
In narrow (closed) angle glaucoma which of the below mentioned medication is contraindicated?
A)  	betoptic
B)  	atropine
C)  	acetazolamide
D)  	pilocarpin
A

B) atropine

31
Q
In which of the below mentioned diseases causing dry eye syndromes?
A)  	ankylopoietic spondylarthrosis
B)  	Sjögren syndrome
C)  	paresis of the facial nerve
D)  	Horner syndrome
A

B) Sjögren syndrome

32
Q
In an aphakic state following cataract operation which of the below listed provides the best correction?
A)  	contact lens
B)  	intraocular artificial lens
C)  	spectacles
D)  	refractive surgery (PRK)
A

B) intraocular artificial lens

The intraocular artificial lens gives the most accurate imaging of the objects in the retina. If the refraction of the artificial lens equals to the refraction of the removed crystalline lens, the image produced in the retina will have the same size as the (preoperative) original size of the image.

33
Q
With the pseudoisochromatic charts can be examined the:
A)  	adaptation
B)  	accommodation
C)  	colour perception disturbances
D)  	anomalic quotiens
E)  	fusion frequency
A

C) colour perception disturbances

34
Q

From the below listed questions, choose the incorrect sentence
A) In the cornea and sclera collagen fibres can be founded
B) the physiologic function of the Schlemm’s channels to drain the aqueous from the anterior chamber
C) the anterior and posterior surface of the iris is covered by multilayer squamous epithelium
D) parts of the uvea: iris, ciliary body, chorioid

A

C) the anterior and posterior surface of the iris is covered by multilayer squamous epithelium

Anterior surface is covered by endothelial cells, the posterior surface is covered by pigment epithelium.

35
Q

Among the below listed structure-funtion pairs which one is incorrect?
A) ciliary processes – aqueous production
B) sclera – insertion site of the extraocular muscles
C) lacrimal gland - to produce serous liquid
D) papilla (optic nerve head) – place of sharp vision

A

D) papilla (optic nerve head) – place of sharp vision

The site of sharp vision is the central fovea in the central part of the macula.

36
Q

In case of damage of the visual pathway which of the below listed visual filed defect does not correlate with the anatomical localization?
A) crossing fibers of the chiasm – bitemporal heteronym hemianopia
B) left optical tract – right sided homonym hemianopsia
C) left lingular gyrus – right sided lower quadrant anopia
D) left temporal lobe – right sided upper quadrant anopia

A

C) left lingular gyrus – right sided lower quadrant anopia

The damage of the left lingular gyrus causing right sided temporal peripheral defect in the visual field.

37
Q
Which of the below listed nerves is damaged least of all by a tumour localized in the posterior part of the skull (posterior scala)?
A)  	hypoglossal nerve
B)  	facial nerve
C)  	optic nerve
D)  	vagal nerve
A

C) optic nerve

38
Q
Which of the below listed entities not leading to the medial concha?
A)  	medial ethmoideal cells
B)  	nasolacrimal duct
C)  	maxillary sinus
D)  	frontal sinus
A

B) nasolacrimal duct

The nasolacrimal duct entering the lower concha.

39
Q

Which is not a cause of the glaucoma from the below listed entities?
A) closed chamber angle
B) pupillary block
C) obstruction of Schlemm channels
D) damage of the secretory epithelium of the ciliary body
E) obstruction of the trabecular meshwork around the Fontana spaces

A

D) damage of the secretory epithelium of the ciliary body

40
Q

The cause of retinal cotton-wool spots:

1) lipid deposition
2) drusen
3) chorioiditis
4) infarct of the retinal nerve fibers

A)  	1st, 2nd and 3rd answers are correct
B)  	1st and 3rd answers are correct
C)  	2nd and 4th answers are correct
D)  	only 4th answer is correct
E)  	all of the answers are correct
A

D) only 4th answer is correct

The microinfarct of the retinal nerve fibers causing the cotton-wool spots.

41
Q

Which of the below listed originating from the ectoderm?

1) sclera
2) crystalline lens
3) chorioid
4) retina

A)  	1st, 2nd and 3rd answers are correct
B)  	1st and 3rd answers are correct
C)  	2nd and 4th answers are correct
D)  	only 4th answer is correct
E)  	all of the answers are correct
A

C) 2nd and 4th answers are correct

42
Q

At the contraction of the ciliary muscle:

1) decreasing the pulling effect of the lens zonules
2) the crystalline lens thickens
3) the refractive power increased
4) the pupil dilates

A)  	1st, 2nd and 3rd answers are correct
B)  	1st and 3rd answers are correct
C)  	2nd and 4th answers are correct
D)  	only 4th answer is correct
E)  	all of the answers are correct
A

A) 1st, 2nd and 3rd answers are correct

During the constriction of the ciliary muscle the pupillary reaction does not change, but on the other hand the refraction increases, because the lens zonules relax and the crystalline lens thickens (becomes more convex).

43
Q

Function of the vitreous:

1) to transmit the light
2) to support the crystalline lens and retina
3) to deliver metabolic products to the retina
4) tear production

A)  	1st, 2nd and 3rd answers are correct
B)  	1st and 3rd answers are correct
C)  	2nd and 4th answers are correct
D)  	only 4th answer is correct
E)  	all of the answers are correct
A

A) 1st, 2nd and 3rd answers are correct

The vitreous is a gel like material filling the inside of the eye, has nothing to do with tear production, but it transmits the light, give a support to the crystalline lens and transports metabolic products to the retina.