Ophthalmology (43) Flashcards
EYE - 1
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
ANSWER
E) asks the patient to look directly into the light
EXPLANATION
During direct funduscopy the right eye should be examined by the right eye, the left eye with the left one, the approach is easier that way. The examination should be carried out in a dark room, eyelid might be lifted. 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.
EYE - 2
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
ANSWER
B) pupillary dilation
EXPLANATION
To watch nearby object, accommodation is needed, in that case the pupil is not dilating, on the contrary it is narrowing.
EYE - 3
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
ANSWER
C) age-related macular degeneration (AMD)
EXPLANATION
The age-related macular degeneration affects approximately 30% of the people above the age of 80 yrs.
EYE - 4
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
ANSWER
B) constriction of arterioles
EXPLANATION
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.
EYE - 5
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
ANSWER
E) usually harmless idiopathic disturbance
EXPLANATION
The cause is rupture of one (or more) conjunctival vessels, there is no visual consequence, painless
EYE - 6
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
ANSWER
D) hyphema
EXPLANATION
If blood appears in the anterior chamber, it is called hyphema.
EYE - 7
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
ANSWER
C) bitemporal hemianopsia
EXPLANATION
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.
EYE - 8
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
ANSWER
E) corneal sign of the Wilson disease
EXPLANATION
In Wilson disease a greenish-yellowish ring can be observed at the limbus (Kayser-Fleischer ring). Red eye is not observed in Wilson disease.
EYE - 9
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
ANSWER
D) drusen
EXPLANATION
It is drusen, in any other cases other changes can also be observed in the fundus.
EYE - 10
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
ANSWER
B) preretinal hemorrhage
EXPLANATION
It is preretinal bleeding. The shape is horizontal in only that cases when the bleeding is between the retina and the detached posterior vitreous.
EYE - 11
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
ANSWER
E) does it lift (grows) above the plane of the retina
EXPLANATION
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.
EYE - 12
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
ANSWER
A) normal sign
EXPLANATION
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.
EYE - 13
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
ANSWER
E) retinal detachment
EXPLANATION
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.
EYE - 14
The cause of bilateral exophthalmos:
A) orbital pseudotumor
B) lymphoma
C) thyroid induced exophthalmos
D) dermoid
E) tumor of the cavernous sinus
ANSWER
C) thyroid induced exophthalmos
EXPLANATION
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.
EYE - 15
The meaning of the chemosis:
A) conjunctivitis
B) bleeding in the anterior chamber
C) conjunctival edema
D) scleral bleeding
E) periorbital edema
ANSWER
C) conjunctival edema
EXPLANATION
Conjunctival edema.
EYE - 16
Normal intraocular pressure does not exceed:
A) 7 mmHg
B) 11 mmHg
C) 14 mmHg
D) 18 mmHg
E) 22 mmHg
ANSWER
E) 22 mmHg
EXPLANATION
The normal intraocular pressure is below 22 mmHg.
EYE - 17
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)
ANSWER
A) to remove the caustic materials and to wash out the eye with ample water
EXPLANATION
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.
