OPTHA LE5 Flashcards

1
Q

Retinal vascular changes most commonly seen in acute severe hypertensive patients:

A. Flame-shaped hemorrhages
B. Cotton-wool patches
C. Lipid exudates
D. A & B
E. A & C

A

D. A & B (Flame-shaped hemorrhages and Cotton-wool patches)

Rationale: Acute severe hypertension often leads to retinal vascular damage, presenting as flame-shaped hemorrhages and cotton-wool patches. These changes result from capillary damage and ischemia affecting the superficial layers of the retina.

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2
Q

Retinal vascular changes seen in patients with chronic hypertension:

A. Copper or silver wiring of the arterioles
B. Lipid exudates
C. Flame-shaped hemorrhages
D. Cotton-wool patches
E. All of the above

A

E. All of the above

Rationale: Chronic hypertension induces a spectrum of retinal changes. These include copper or silver wiring of arterioles due to sclerosis, lipid exudates from increased vascular permeability, and flame-shaped hemorrhages and cotton-wool patches due to ischemic damage.

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3
Q

Hallmark of malignant hypertension:

A. Flame-shaped hemorrhages
B. Cotton-wool patches
C. Optic disc swelling
D. Lipid exudates
E. All of the above

A

C. Optic disc swelling

Rationale: Malignant hypertension is characterized by severe, uncontrolled blood pressure leading to optic disc swelling (papilledema). This is a key feature, indicating increased intracranial pressure and significant damage to the optic nerve.

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4
Q

A transient ischemic attack involving the ocular circulation may manifest with the following ocular manifestation(s):

A. Monocular dimming of vision
B. Sudden transient, painless visual loss
C. Sudden transient, painful visual loss
D. A & B
E. A & C

A

D. A & B (Monocular dimming of vision and Sudden transient, painless visual loss)

Rationale: A transient ischemic attack (TIA) of the ocular circulation, known as amaurosis fugax, typically presents as sudden, transient, painless visual loss or monocular dimming of vision. This occurs due to temporary arterial occlusion, often associated with emboli.

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5
Q

Most common source of emboli in the elderly:

A. Emboli of cardiac origin
B. Fibrin and cholesterol from carotid artery plaques
C. Talc
D. Fat
E. None of the above

A

B. Fibrin and cholesterol from carotid artery plaques

Rationale: In elderly patients, emboli commonly originate from ulcerated plaques in the carotid arteries, composed of fibrin and cholesterol. These emboli can travel to the ocular arteries, causing vision disturbances such as amaurosis fugax.

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6
Q

Central retinal vein occlusion:

A. Sudden persistent, painless loss of vision
B. Retinal hemorrhages and cotton-wool patches
C. Narrowed retinal arterioles and a pale retina
D. A & C
E. A & B

A

E. A & B (Sudden persistent, painless loss of vision and Retinal hemorrhages and cotton-wool patches)

Rationale: Central retinal vein occlusion (CRVO) typically presents as a sudden, painless loss of vision and is associated with retinal hemorrhages and cotton-wool patches. It occurs due to the obstruction of the central retinal vein, leading to increased retinal venous pressure.

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7
Q

The most common type of intraocular malignancy in adults:

A. Primary ocular melanoma
B. Large cell lymphoma
C. Metastatic carcinoma
D. A & B
E. None of the above

A

C. Metastatic carcinoma

Rationale: Metastatic carcinoma is the most common type of intraocular malignancy in adults, often originating from primary tumors in the breast or lung. These metastases commonly affect the choroid due to its rich vascular supply.

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8
Q

The most common site for ocular metastasis:

A. Cornea
B. Lens
C. Vitreous
D. Choroid
E. Iris

A

D. Choroid

Rationale: The choroid is the most common site for ocular metastasis because of its high blood flow, which makes it a frequent target for metastatic tumor cells from systemic malignancies.

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9
Q

The most common ocular manifestation of patients with connective tissue disorders:

A. Episcleritis
B. Scleritis
C. Iritis
D. Keratoconjunctivitis sicca
E. Peripheral corneal ulceration

A

D. Keratoconjunctivitis sicca

Rationale: Keratoconjunctivitis sicca, or dry eye syndrome, is the most common ocular manifestation of connective tissue disorders like rheumatoid arthritis. It results from reduced tear production due to inflammation of the lacrimal glands.

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10
Q

The most common severe ocular manifestation of systemic lupus erythematosus:

A. Keratoconjunctivitis sicca
B. Scleritis
C. Peripheral corneal ulcers
D. Retinopathy and optic neuropathy
E. None of the above

A

D. Retinopathy and optic neuropathy

Rationale: Systemic lupus erythematosus (SLE) can cause severe ocular manifestations such as retinopathy and optic neuropathy, which are associated with vasculitis and ischemic damage to retinal and optic nerve tissues.

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11
Q

This condition is a widespread inflammatory disease affecting small and medium-sized blood vessels, most commonly in middle-aged men:

A. Periarteritis Nodosa
B. Giant cell arteritis
C. Ankylosing spondylitis
D. Systematic Lupus Erythematosus
E. Rheumatoid Arthritis

A

A. Periarteritis Nodosa

Rationale: Periarteritis nodosa (also known as polyarteritis nodosa) is a systemic vasculitis that affects small and medium-sized arteries, leading to inflammation and damage. It commonly presents in middle-aged men with symptoms that can affect multiple organs, including the eyes.

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12
Q

Ocular complications may occasionally be the presenting feature of this disease and do not correlate with the severity or course of the systemic signs:

A. Rheumatoid Arthritis
B. Juvenile Rheumatoid Arthritis
C. Hypertension
D. Diabetes Mellitus
E. None of the above

A

B. Juvenile Rheumatoid Arthritis

Rationale: In juvenile rheumatoid arthritis (JRA), ocular complications such as iritis or uveitis may be present even in mild cases of the disease and do not necessarily correlate with the severity of joint involvement. Regular ophthalmic screening is recommended for early detection and management.

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13
Q

Ocular manifestations of this disease are most often seen in patients with more active and severe forms of the disease and in those with extraarticular complications:

A. Ankylosing spondylitis
B. Periarteritis nodosa
C. Juvenile rheumatoid arthritis
D. Rheumatoid arthritis
E. Osteoarthritis

A

D. Rheumatoid arthritis

Rationale: In rheumatoid arthritis, ocular manifestations such as scleritis, episcleritis, and peripheral corneal ulcers are more common in patients with severe disease and extraarticular complications, indicating a higher level of systemic inflammation.

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14
Q

Which condition is characterized by inflammation of the superficial tissue overlying the sclera, typically presenting with mild to moderate pain, tenderness, and localized or diffuse redness of the eye?

A. Scleritis
B. Uveitis
C. Episcleritis
D. Blepharitis
E. A & B

A

C. Episcleritis

Rationale: Episcleritis is a benign inflammatory condition affecting the episclera, the tissue between the conjunctiva and sclera. It presents with mild to moderate pain and localized redness and often resolves without specific treatment.

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15
Q

Most common presentation of giant cell arteritis:
A. Non-embolic central retinal artery occlusion
B. Ischemic optic neuropathy
C. Cranial motor nerve paralysis
D. Keratoconjunctivitis sicca
E. Uveitis

A

B. Ischemic optic neuropathy

Rationale: Giant cell arteritis most commonly presents with ischemic optic neuropathy, leading to sudden, severe vision loss. It is an inflammatory condition affecting large and medium-sized arteries, including those supplying the optic nerve.

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16
Q

Management of the congestive phase of thyroid ophthalmopathy:
A. Tear substitutes
B. Corticosteroids
C. Orbital irradiation
D. Surgical decompression
E. All of the above

A

E. All of the above

Rationale: Management of thyroid ophthalmopathy in the congestive phase includes tear substitutes for dryness, corticosteroids to reduce inflammation, and, in severe cases, orbital irradiation or surgical decompression to alleviate pressure on the optic nerve and prevent vision loss.

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17
Q

An autoimmune disease affecting the acetylcholine receptors, causing a conduction defect at the neuromuscular junction:
A. Multiple Sclerosis
B. Thyroid disorders
C. Myasthenia gravis
D. Ankylosing Spondylitis
E. Systemic Lupus Erythematosus

A

C. Myasthenia gravis

Rationale: Myasthenia gravis is an autoimmune disorder that affects the neuromuscular junction by targeting acetylcholine receptors, leading to muscle weakness. Ocular symptoms often include ptosis and diplopia.

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18
Q

Optic neuritis:
A. Acute painful vision loss in one or both eyes
B. Treat initial episode with intravenous methylprednisolone
C. Acute painless vision loss in one or both eyes
D. A & B
E. B & C

A

D. A & B (Acute painful vision loss in one or both eyes and Treat initial episode with intravenous methylprednisolone)

Rationale: Optic neuritis typically presents with acute, painful vision loss in one or both eyes. Treatment with intravenous methylprednisolone can accelerate visual recovery and reduce the risk of developing multiple sclerosis.

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19
Q

A 75-year-old female presents with ptosis and diplopia noted a few days prior. Associated symptoms are headache and scalp tenderness. Ocular examination reveals an outward deviation of the eye on the involved side, with sparing of the pupil. Fundoscopy shows arteriosclerotic arterioles and occasionally lipid exudates. What is your tentative diagnosis?
A. Thyroid ophthalmopathy
B. Giant cell arteritis
C. Myasthenia gravis
D. Diabetic Neuropathy
E. None of the above

A

B. Giant cell arteritis

Rationale: The presentation of ptosis, diplopia, headache, and scalp tenderness, along with ocular findings, suggests giant cell arteritis. This condition can lead to cranial nerve palsies due to ischemia, and timely diagnosis is crucial to prevent bilateral vision loss.

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20
Q

Giant cell arteritis
What additional examination(s) would you have done to confirm the diagnosis?
A. Fasting blood sugar
B. Thyroid function test
C. Erythrocyte Sedimentation Rate
D. Tensilon testing
E. All of the above

A

C. Erythrocyte Sedimentation Rate

Rationale: An elevated erythrocyte sedimentation rate (ESR) is a key diagnostic marker for giant cell arteritis. It helps confirm the diagnosis, and prompt treatment with corticosteroids can prevent complications such as vision loss.

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21
Q

What is the pathophysiology of the cranial motor nerve paralysis?
A. Conduction defect at the neuromuscular junction due to involvement of the acetylcholine receptors
B. Nerve ischemia resulting from occlusion of the vascular supply to the nerve
C. Enlargement of the extraocular muscles secondary to lymphocytic infiltration
D. Intracranial tumor
E. None of the above

A

B. Nerve ischemia resulting from occlusion of the vascular supply to the nerve

Rationale: Cranial motor nerve paralysis can result from ischemia due to compromised blood supply. This is commonly seen in conditions such as diabetes and giant cell arteritis, where vascular insufficiency affects the cranial nerves.

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22
Q

What cranial nerve is involved?
A. Cranial nerve VI
B. Cranial nerve V
C. Cranial nerve III
D. Cranial nerve IV
E. Cranial nerve VII

A

C. Cranial nerve III

Rationale: Cranial nerve III (oculomotor nerve) is commonly affected in ischemic conditions, leading to symptoms such as ptosis and outward deviation of the eye, often with sparing of the pupil.

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23
Q

Cranial motor nerve paralysis
How would you manage the patient?
A. Tear substitute
B. Muscle/Lid surgery
C. Corticosteroids
D. Insulin
E. Tensilon

A

C. Corticosteroids

Rationale: Management of cranial motor nerve paralysis, particularly when associated with giant cell arteritis, includes corticosteroids to reduce inflammation and prevent further vascular damage.

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24
Q

A young woman presents with visual loss. Ophthalmoscopic evaluation reveals a pale swollen disc. What is your tentative diagnosis?
A. Systemic lupus Erythematosus
B. Rheumatoid arthritis
C. Ankylosing spondylitis
D. Central Retinal Artery Occlusion
E. Giant cell arteritis

A

A. Systemic lupus erythematosus (SLE)

Rationale: SLE can cause optic neuropathy and retinal vasculitis, which can present with a pale, swollen optic disc. The presence of visual loss and optic disc changes can be consistent with lupus involvement of the optic nerve, particularly in young women.

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25
Q

A 35-year-old female presents with lid retraction and proptosis of the right eye accompanied by tearing, photophobia, redness, and foreign-body sensation. What is your tentative diagnosis?
A. Thyroid Ophthalmopathy
B. Myasthenia Gravis
C. Giant cell arteritis
D. Sjögren’s syndrome
E. All of the above

A

A. Thyroid Ophthalmopathy

Rationale: The presence of lid retraction and proptosis along with symptoms like tearing, photophobia, redness, and a foreign-body sensation are characteristic features of thyroid ophthalmopathy. This condition, also known as Graves’ orbitopathy, is often associated with hyperthyroidism and involves inflammation and swelling of the extraocular muscles, leading to proptosis and other ocular symptoms.

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26
Q

A 45-year-old non-insulin-dependent male patient of 10-year duration presents with ophthalmoscopic findings of microaneurysms, flame-shaped hemorrhages, and occasional lipid exudates. Visual acuity is 20/20 Jaeger 1 with prescription glasses. What is your diagnosis?
A. Early non-proliferative diabetic retinopathy
B. Advanced non-proliferative diabetic retinopathy
C. Proliferative diabetic retinopathy
D. Vitreous hemorrhages
E. Macular edema

A

A. Early non-proliferative diabetic retinopathy

Rationale: The presence of microaneurysms, flame-shaped hemorrhages, and lipid exudates in a diabetic patient with preserved visual acuity is consistent with early non-proliferative diabetic retinopathy. This stage involves mild retinal changes without significant vision loss, and early detection is key for monitoring and preventing progression.

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27
Q

Early NPDR
How would you manage this patient?
A. Strict blood sugar control
B. Annual ophthalmological examinations
C. Ophthalmoscopy by primary-care physician for signs at other intervals
D. Laser panretinal photocoagulation
E. A, B & C

A

E. A, B & C

Rationale: Management of early non-proliferative diabetic retinopathy includes strict blood sugar control (to prevent progression), annual ophthalmological examinations for monitoring, and ophthalmoscopy by a primary-care physician at other intervals to detect any changes. Laser panretinal photocoagulation is not indicated at this early stage.

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28
Q

Any patient with ptosis and diplopia of unclear etiology, especially if variable and worsening with fatigue, should be presumed to have:
A. Giant cell arteritis
B. Periarteritis
C. Myasthenia Gravis
D. Thyroid Ophthalmopathy
E. Diabetes Mellitus

A

C. Myasthenia Gravis

Rationale: Myasthenia gravis presents with fluctuating muscle weakness that worsens with fatigue. Ocular symptoms often include ptosis and diplopia, which are key features for suspecting this autoimmune disorder affecting neuromuscular transmission.

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29
Q

Within 5 years of an episode of optic neuritis, more than 40% of women aged 20 to 40 will manifest signs and symptoms of:
A. Systemic Lupus Erythematosus
B. Multiple Sclerosis
C. Giant cell Arteritis
D. Ethambutol toxicity
E. Ankylosing Spondylitis

A

B. Multiple Sclerosis

Rationale: Optic neuritis is often an early manifestation of multiple sclerosis (MS), particularly in women aged 20 to 40. MS is a demyelinating disease of the central nervous system, and optic neuritis can be a precursor to more generalized neurological symptoms.

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30
Q

Diplopia in thyroid ophthalmopathy is due to:
A. Extraocular muscle involvement secondary to lymphocytic infiltration
B. Optic nerve compression
C. Lid retraction
D. Proptosis

A

A. Extraocular muscle involvement secondary to lymphocytic infiltration

Rationale: Thyroid ophthalmopathy causes inflammation and lymphocytic infiltration of the extraocular muscles, leading to their enlargement. This results in restricted eye movement and subsequent diplopia (double vision).

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31
Q

Diplopia in thyroid ophthalmopathy is due to:
A. Extraocular muscle involvement secondary to lymphocytic infiltration
B. Optic nerve compression
C. Lid retraction
D. Proptosis

A

A. Extraocular muscle involvement secondary to lymphocytic infiltration

Rationale: In thyroid ophthalmopathy, inflammation and lymphocytic infiltration lead to hypertrophy of the extraocular muscles. This results in restricted eye movement, which causes diplopia (double vision).

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32
Q

An adult patient with a 15-year history of non-insulin-dependent diabetes comes to your office for the first time. She tells you that she has never seen an ophthalmologist nor has had a dilated ophthalmoscopic examination. Her visual acuity is normal, but on dilated fundus examination, you find neovascularization of the optic disc. What is your diagnosis?
A. Central retinal vein occlusion
B. Macular edema
C. Early non-proliferative diabetic retinopathy
D. Advanced non-proliferative diabetic retinopathy
E. Proliferative diabetic retinopathy

A

E. Proliferative diabetic retinopathy

Rationale: The presence of neovascularization of the optic disc indicates proliferative diabetic retinopathy, an advanced stage of diabetic retinopathy characterized by the growth of new, fragile blood vessels on the retina in response to ischemia.

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33
Q

Proliferative diabetic retinopathy
What would be the best management for this patient?
A. Strict blood sugar control
B. Fluorescein angiography
C. Pan retinal laser photocoagulation
D. Vitrectomy
E. A, B & C

A

E. A, B & C

Rationale: Management of proliferative diabetic retinopathy includes strict blood sugar control, fluorescein angiography to evaluate the extent of neovascularization, and panretinal laser photocoagulation to reduce the risk of vision loss by preventing further neovascular growth.

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34
Q

A 45-year-old man comes to your office complaining of headaches and nosebleeds. His blood pressure is 180/120 mm Hg. On dilated fundus examination, you find numerous exudates, flame-shaped hemorrhages, cotton-wool spots, and severe attenuation of the arterioles. You do not find AV crossing changes, and the arteriolar light reflex is normal. What is your diagnosis?
A. Chronic hypertension
B. Acute, severe hypertension
C. Papilledema
D. Hyperviscosity syndromes
E. Central retinal artery occlusion

A

B. Acute, severe hypertension

Rationale: The findings of numerous exudates, flame-shaped hemorrhages, cotton-wool spots, and severe attenuation of the arterioles are consistent with acute, severe hypertension, which causes retinal damage due to the rapid rise in blood pressure. Immediate blood pressure control is critical to prevent further complications.

Acute vs Chronic Hypertension:

Acute Hypertension: Often presents with retinal findings such as flame-shaped hemorrhages, cotton-wool spots, and severe attenuation of arterioles. These changes result from a rapid rise in blood pressure causing damage to the retinal microvasculature.

Chronic Hypertension: Usually presents with more permanent retinal changes, including arteriolar narrowing, arterio-venous crossing changes (AV nicking), and a copper or silver wiring appearance of the arterioles due to thickening of vessel walls. Chronic damage results from prolonged exposure to elevated blood pressure.

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35
Q

A 67-year-old man experienced sudden loss of vision in the left eye 3 hours ago. You record VA as OD 20/20 and OS no light perception. The right pupil responds to light directly but not consensually. The left eye responds to light consensually but not directly. Dilated fundus examination of the right eye is normal. The left eye shows a white opacified retina, a cherry-red spot in the macula, and a sluggish retinal circulation. What is your diagnosis?
A. Central retinal artery occlusion OS
B. Central retinal vein occlusion OS
C. Optic atrophy OS
D. Optic neuritis OS

A

A. Central retinal artery occlusion OS

Rationale: The presence of a cherry-red spot at the macula, a white opacified retina, and sudden profound visual loss are characteristic features of central retinal artery occlusion. It results from an embolic event leading to ischemia of the retina. Immediate intervention is crucial to attempt to restore circulation, although prognosis for visual recovery is generally poor.

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36
Q

Central retinal artery occlusion OS
What is the proper management for the patient?
A. Pan retinal laser photocoagulation
B. Intermittent pressure on the affected eye in the hope that the induced alterations of intraocular pressure may dislodge an embolus
C. Detection of underlying disease (such as giant-cell arteritis) or a site of embolus formation (such as carotid atheroma) that may lead to future vascular occlusions
D. A, B, & C
E. B & C

A

E. B & C

Rationale: Management of central retinal artery occlusion includes applying intermittent pressure to the affected eye to potentially dislodge the embolus, as well as detecting underlying conditions (such as giant-cell arteritis or carotid atheroma) to prevent future vascular occlusions.

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37
Q

A man who has recently moved to the area is referred to you by a friend. He reports feeling tired lately, becoming fatigued after only moderate activity. He is also concerned about his vision; everything seems “dingy” or “yellow” to him. He’s not sure when the visual symptom started. The patient has a history of heart disease, for which he takes cardiac medications. Examination reveals no health problems, other than his heart disease, which appears stable. What is the ophthalmological diagnosis?
A. Digitalis Toxicity
B. Amiodarone Toxicity
C. Ethambutol Toxicity
D. Chloroquine Toxicity
E. Thioridazine Toxicity

A

A. Digitalis Toxicity

Rationale: The visual symptoms of “yellow” vision, known as xanthopsia, are a classic sign of digitalis toxicity. Digitalis is a cardiac medication that can cause visual disturbances, particularly in patients on long-term therapy.

Toxicity Keypoints:

Digitalis Toxicity: Causes visual disturbances such as yellow vision (xanthopsia), blurred vision, and occasionally central scotomas. It is associated with dosage levels and long-term use.

Amiodarone Toxicity: Can lead to corneal deposits (seen as whorl keratopathy), which are usually asymptomatic but may cause halos or visual disturbances. Long-term use can also lead to optic neuropathy.

Ethambutol Toxicity: Associated with dose-related optic neuropathy, which can present as decreased visual acuity and color vision defects. It is often reversible if detected early.

Chloroquine Toxicity: Causes bull’s eye maculopathy, which is characterized by concentric rings of pigment changes in the retina, potentially leading to irreversible vision loss if not monitored.

Thioridazine Toxicity: Can cause pigmentary retinopathy, especially with long-term use, leading to symptoms such as reduced night vision and peripheral vision loss.

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38
Q

A busy student comes to you during exam week because she is experiencing severe headaches. As part of a complete physical, you perform a basic eye examination. During ophthalmoscopy, you cannot fully see the optic disc because the patient’s pupil is very small. You find no contraindications to dilate the pupil, so you decide to do so to facilitate ophthalmoscopy. Your patient is brown-eyed, 20 years old, and has no other health complaints. Which of the following drugs would you select to dilate the pupils?
A. Phenylephrine hydrochloride 0.12%
B. Phenylephrine hydrochloride 2.5%
C. Phenylephrine hydrochloride 10%
D. Atropine sulfate 1%
E. Tropicamide plus phenylephrine hydrochloride 2.5%

A

E. Tropicamide plus phenylephrine hydrochloride 2.5%

Rationale: When maximum mydriasis is required, particularly to examine the far periphery of the retina, phenylephrine in combination with tropicamide is ideal due to their additive effects. This combination is also effective for dilating the pupil of a brown iris, which tends to be less responsive to mydriatics than a blue iris. The 2.5% solution of phenylephrine is preferred over the 10% solution to minimize the risk of acute hypertension or myocardial infarction.

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39
Q

Topical ocular diagnostic drug extremely helpful in detecting abrasions of the corneal surface:
A. Tropicamide
B. Sodium fluorescein
C. Proparacaine hydrochloride 0.5%
D. Timolol
E. Pilocarpine

A

B. Sodium fluorescein

Rationale: Sodium fluorescein is a topical dye used in ophthalmology to detect corneal abrasions or epithelial defects. It highlights areas of damage by staining them, making them easily visible under blue light.

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40
Q

Originally used to treat malaria and now used to treat rheumatoid arthritis, lupus erythematosus, and other autoimmune disorders:
A. Digitalis
B. Amiodarone
C. Ethambutol
D. Chloroquine
E. Thioridazine

A

D. Chloroquine

Rationale: Chloroquine was initially used to treat malaria but is also effective in treating autoimmune disorders like rheumatoid arthritis and lupus erythematosus due to its immunomodulatory properties.

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41
Q

Chloroquine
Ocular side effects of the drug mentioned in #40?
A. Corneal deposits
B. Bull’s eye macular lesions
C. Ophthalmoplegia
D. A & B
E. All of the above

A

D. A & B (Corneal deposits and Bull’s eye macular lesions)

Rationale: Chloroquine, which is mentioned in #40, can cause several ocular side effects, including corneal deposits and bull’s eye macular lesions. Corneal deposits are due to the accumulation of chloroquine in the corneal epithelium, while bull’s eye maculopathy is a distinctive retinal finding that occurs with prolonged use and high cumulative doses, resulting in concentric rings of pigment changes around the macula. Ophthalmoplegia is not typically associated with chloroquine toxicity.

42
Q

May produce dosage-related cerebellar-vestibular effects. Ocular side effects are horizontal nystagmus in lateral gaze, vertical nystagmus in up gaze, and even diplopia with mildly elevated blood levels of the drug:
A. Amiodarone
B. Ethambutol
C. Diphenylhydantoin
D. Chloroquine
E. Thioridazine

A

C. Diphenylhydantoin

Rationale: Diphenylhydantoin (phenytoin) is an anticonvulsant that can cause cerebellar-vestibular effects, including nystagmus and diplopia, particularly when blood levels are elevated. These effects are dosage-related, and careful monitoring of drug levels is required to avoid toxicity.

43
Q

May produce a dosage-related optic neuropathy. This drug is useful in the chemotherapy of tuberculosis:
A. Amiodarone
B. Diphenylhydantoin
C. Chloroquine
D. Thioridazine
E. Ethambutol

A

E. Ethambutol

Rationale: Ethambutol is an antimycobacterial drug used to treat tuberculosis, but it can cause optic neuropathy, especially at higher doses or with prolonged use. This condition is characterized by decreased visual acuity, color vision defects, and can be irreversible if not detected early.

44
Q

Commonly used to treat patients with psychoses, it may produce pigmentary retinopathy after long-term use:
A. Amiodarone
B. Diphenylhydantoin
C. Digitalis
D. Thioridazine
E. Ethambutol

A

D. Thioridazine

Rationale: Thioridazine, an antipsychotic, is known to cause pigmentary retinopathy, especially after long-term use at high doses. This condition can lead to reduced night vision and peripheral vision loss due to retinal toxicity.

45
Q

Long term use of topical corticosteroids may cause EXCEPT:
A. Cataracts
B. Glaucoma
C. Corneal fungal infections
D. Iritis
E. A and B

A

D. Iritis

Rationale: Long-term use of topical corticosteroids can cause cataracts, glaucoma, and corneal fungal infections. However, iritis (inflammation of the iris) is not a side effect of corticosteroids; in fact, corticosteroids are often used to treat inflammatory conditions like iritis.

46
Q

True of topical ocular anesthetics EXCEPT:
A. To remove superficial corneal foreign body
B. To perform tonometry
C. To relieve pain in corneal abrasions
D. Inhibits mitosis and cellular migration thus may lead to corneal ulceration and permanent corneal scarring
E. To facilitate examination of a damaged cornea

A

C. To relieve pain in corneal abrasions

Rationale: Topical ocular anesthetics are used for procedures like tonometry, removal of superficial corneal foreign bodies, and examination of a damaged cornea. However, they should not be used for pain relief in corneal abrasions because they inhibit mitosis and cellular migration, leading to corneal ulceration and permanent scarring if used repeatedly.

47
Q

Ophthalmoscopic signs of advanced non-proliferative diabetic retinopathy EXCEPT:
A. Cotton-wool spots
B. Venous beading
C. Dilated, tortuous intraretinal vessels
D. Extensive retinal hemorrhages
E. Neovascularization

A

E. Neovascularization

Rationale: Advanced non-proliferative diabetic retinopathy is characterized by cotton-wool spots, venous beading, dilated tortuous intraretinal vessels, and extensive retinal hemorrhages. Neovascularization, however, is a hallmark of proliferative diabetic retinopathy, not non-proliferative.

48
Q

Widely used in the treatment of glaucoma:
A. Timolol
B. Betaxolol
C. Pilocarpine
D. Dipivefrin
E. All of the above

A

E. All of the above

Rationale: Timolol, betaxolol, pilocarpine, and dipivefrin are all drugs commonly used in the treatment of glaucoma. They work by reducing intraocular pressure either by decreasing aqueous humor production or by increasing its outflow.

49
Q

They are advertised as effective in relieving the eye due to minor eye irritations. May cause rebound vasodilation of blood vessels with overuse:
A. Tropicamide
B. Betaxolol
C. Pilocarpine
D. Naphazoline hydrochloride 0.012%
E. Proparacaine 0.5%

A

D. Naphazoline hydrochloride 0.012%

Rationale: Naphazoline hydrochloride is a vasoconstrictor used to relieve redness due to minor eye irritation. However, with overuse, it can cause rebound vasodilation, leading to chronic redness and dependency.

50
Q

An adult insulin-dependent diabetic patient complains of sudden painless loss of vision in the right eye. Ophthalmoscopic examination is difficult because the media is very hazy. What is your probable diagnosis?
A. Central retinal vein occlusion
B. Vitreous hemorrhage
C. Central retinal artery occlusion
D. Intumescent cataract
E. Age-related macular degeneration

A

B. Vitreous hemorrhage

Rationale: Sudden painless loss of vision with a hazy media in a diabetic patient is most consistent with a vitreous hemorrhage. This can occur due to bleeding from neovascular vessels associated with proliferative diabetic retinopathy. The other options, such as central retinal vein occlusion or cataract, do not typically present with a hazy media of acute onset.

51
Q

An autoimmune disorder affecting acetylcholine receptors, causing a conduction defect at the neuromuscular junction is:
A. Multiple sclerosis
B. Thyroid disorders
C. Temporal arteritis
D. Myasthenia gravis
E. A & B

A

D. Myasthenia gravis
Rationale: Myasthenia gravis is an autoimmune disorder where antibodies attack acetylcholine receptors at the neuromuscular junction, impairing signal transmission and causing muscle weakness.

52
Q

The most common ocular manifestation in patients with connective tissue disorders is:
A. Episcleritis
B. Dysfunctional Tear Syndrome/Dry Eye Syndrome
C. Scleritis
D. Peripheral corneal ulceration
E. None of the above

A

B. Dysfunctional Tear Syndrome/Dry Eye Syndrome
Rationale: Dry eye syndrome is the most common ocular manifestation in connective tissue disorders such as Sjögren’s syndrome, characterized by decreased tear production and ocular surface dryness.

53
Q

Non-proliferative diabetic retinopathy is characterized by the following EXCEPT:
A. Flame-shaped hemorrhages
B. Microaneurysms
C. Cotton-wool exudates
D. NVD and NVE
E. Lipid exudates

A

D. NVD and NVE
Rationale: NVD (neovascularization of the disc) and NVE (neovascularization elsewhere) are features of proliferative diabetic retinopathy, not non-proliferative diabetic retinopathy. Non-proliferative diabetic retinopathy includes microaneurysms, flame-shaped hemorrhages, cotton-wool spots, and lipid exudates.

54
Q

This transient ischemic attack involving the ocular circulation typically causes monocular dimming of vision lasting for a few minutes:
A. Papilledema
B. Central retinal artery occlusion
C. Amaurosis fugax
D. Ischemic optic neuropathy
E. Migraine

A

C. Amaurosis fugax
Rationale: Amaurosis fugax is a transient ischemic attack that causes temporary monocular vision loss, often due to emboli in the retinal or ophthalmic arteries.

55
Q

The most common type of intraocular malignancy in adults is:
A. Primary ocular melanoma
B. Large cell lymphoma
C. Retinoblastoma
D. Metastatic carcinoma
E. Rhabdomyosarcoma

A

D. Metastatic carcinoma
Rationale: The most common intraocular malignancy in adults is metastatic carcinoma, often spreading from primary cancers such as breast or lung cancer.

56
Q

The hallmark of malignant hypertension is:
A. Flame-shaped hemorrhages
B. Lipid exudates
C. Cotton-wool patches
D. Optic disc swelling
E. None of the above

A

D. Optic disc swelling
Rationale: Malignant hypertension is characterized by optic disc swelling (papilledema) due to severely elevated blood pressure affecting the ocular circulation.

57
Q

The most common ocular manifestation of intracranial hypertension is:
A. Cotton-wool exudates
B. Flame-shaped hemorrhages
C. Lipid exudates
D. Papilledema
E. All of the above

A

D. Papilledema
Rationale: Papilledema, or swelling of the optic disc, is the most common ocular manifestation of increased intracranial pressure.

58
Q

Cotton-wool patches are caused by:
A. Abnormal vascular permeability
B. High levels of lipids in the blood
C. Rupture of blood vessels into the vitreous cavity
D. Occlusion of the pre-capillary arterioles and retinal ischemia
E. B & C

A

D. Occlusion of the pre-capillary arterioles and retinal ischemia
Rationale: Cotton-wool patches are caused by occlusion of retinal pre-capillary arterioles, leading to localized retinal ischemia and infarction.

59
Q

In the elderly, the most common source of emboli to the ophthalmic or retinal vessels is:
A. Talc
B. Fat emboli
C. Fibrin-platelet emboli
D. Fibrin or cholesterol emboli

A

D. Fibrin or cholesterol emboli
Rationale: In elderly patients, fibrin or cholesterol emboli, often from atherosclerotic plaques, are the most common cause of emboli to the retinal vessels.

60
Q

A widespread inflammatory disease affecting small and medium-sized blood vessels, most commonly in middle-aged men is:
A. Rheumatoid arthritis
B. Temporal arteritis
C. Systemic lupus erythematosus
D. Periarteritis nodosa

A

D. Periarteritis nodosa
Rationale: Periarteritis nodosa (now commonly referred to as polyarteritis nodosa) is a systemic vasculitis affecting small and medium-sized arteries, typically occurring in middle-aged men.

61
Q

The most common manifestation of temporal arteritis is:
A. Central retinal artery occlusion
B. Ischemic optic neuropathy
C. Cranial motor nerve palsy
D. Central retinal vein occlusion

A

B. Ischemic optic neuropathy
Rationale: Temporal arteritis (giant cell arteritis) commonly manifests as ischemic optic neuropathy, leading to sudden, painless vision loss, typically in older adults.

62
Q

Neoplasms arising from the uveal tissue give rise to:
A. Large cell lymphoma
B. Primary ocular melanoma
C. Retinoblastoma
D. Rhabdomyosarcoma

A

B. Primary ocular melanoma
Rationale: Primary ocular melanoma is the most common malignancy arising from the uveal tissue, which includes the iris, ciliary body, and choroid.

63
Q

This may have its initial presentation in the vitreous cavity of elderly individuals:
A. Primary ocular melanoma
B. Retinoblastoma
C. Large cell lymphoma
D. Metastatic carcinoma

A

C. Large cell lymphoma
Rationale: Large cell lymphoma can initially present in the vitreous cavity in elderly individuals, often manifesting as vitreous opacities or “floaters.”

64
Q

The most common classic lesions of HIV infection are EXCEPT:
A. Dysfunctional tear syndrome
B. Cotton-wool spots
C. Kaposi’s sarcoma
D. Cytomegalovirus retinitis

A

A. Dysfunctional tear syndrome
Rationale: The classic ocular lesions of HIV infection include cotton-wool spots, Kaposi’s sarcoma, and cytomegalovirus retinitis. Dysfunctional tear syndrome is not a classic HIV-related lesion.

65
Q

Inflammation of the superficial tissue surrounding the sclera is known as:
A. Conjunctivitis
B. Episcleritis
C. Scleritis
D. Iritis

A

B. Episcleritis
Rationale: Episcleritis is inflammation of the superficial tissue surrounding the sclera, often causing redness and discomfort.

66
Q

Optic neuritis may be the initial manifestation of:
A. Temporal arteritis
B. Multiple sclerosis
C. Myasthenia gravis
D. Ankylosing spondylitis

A

B. Multiple sclerosis
Rationale: Optic neuritis is a common initial manifestation of multiple sclerosis, presenting with sudden visual loss and pain with eye movement.

67
Q

Which of the following statements about optic neuritis is NOT true?
A. It manifests with acute painless visual loss in one or both eyes
B. 70% of eyes with optic neuritis recover spontaneously within 3 to 6 months
C. It may be treated with IV methylprednisolone
D. It may be the initial manifestation of multiple sclerosis

A

A. It manifests with acute painless visual loss in one or both eyes
Rationale: Optic neuritis typically presents with painful visual loss, especially with eye movement, rather than painless loss.

68
Q

A characteristic ophthalmoscopic feature of central retinal artery occlusion is:
A. Flame-shaped hemorrhage in the macula
B. Pigment in the shape of a bull’s-eye in the macula
C. Cotton-wool spots
D. Cherry-red spot

A

D. Cherry-red spot
Rationale: A cherry-red spot in the macula is the hallmark feature of central retinal artery occlusion, surrounded by a pale retina due to ischemia.

69
Q

The most common severe manifestation of systemic lupus erythematosus is:
A. Keratoconjunctivitis sicca
B. Scleritis
C. Retinopathy and optic neuropathy
D. Peripheral corneal ulceration

A

C. Retinopathy and optic neuropathy
Rationale: Severe ocular manifestations of systemic lupus erythematosus (SLE) include retinopathy and optic neuropathy, which can lead to vision loss.

70
Q

Sudden loss of vision is NOT caused by:
A. Optic neuritis
B. Central retinal artery occlusion
C. Central retinal vein occlusion
D. Senile cataract

A

D. Senile cataract
Rationale: Senile cataract causes gradual, progressive vision loss, not sudden loss, unlike conditions such as optic neuritis, central retinal artery occlusion, and central retinal vein occlusion.

71
Q

A 75-year-old female presents with ptosis and diplopia noted a few days prior. Associated symptoms include headache and scalp tenderness. Ocular examination reveals an outward deviation of the eye on the involved side, with sparing of the pupil. Funduscopy shows sclerotic arterioles, occasional lipid exudates, no microaneurysms, and no hemorrhages. What is your tentative diagnosis?
A. Thyroid ophthalmopathy
B. Giant cell arteritis
C. Myasthenia gravis
D. Diabetic neuropathy

A

B. Giant cell arteritis
Rationale: The patient’s age, ptosis, diplopia, headache, scalp tenderness, and vascular findings are consistent with giant cell arteritis, which can cause ischemia to the cranial nerves, particularly the third nerve, leading to ptosis and outward deviation of the eye.

72
Q

What additional examination(s) would you perform to confirm the diagnosis?
A. Fasting blood sugar
B. Thyroid function tests
C. Erythrocyte sedimentation rate
D. Tensilon testing
E. All of the above

A

C. Erythrocyte sedimentation rate
Rationale: Giant cell arteritis is associated with elevated erythrocyte sedimentation rate (ESR). A high ESR supports the diagnosis, and immediate corticosteroid treatment is critical to prevent complications such as vision loss.

73
Q

What is the pathophysiology of the cranial motor nerve paralysis?
A. Intracranial tumor
B. Nerve ischemia resulting from occlusion of the vascular supply of the nerve
C. Enlargement of the extraocular muscles secondary to lymphocytic infiltration
D. Conduction defect at the neuromuscular junction due to involvement of the acetylcholine receptors

A

B. Nerve ischemia resulting from occlusion of the vascular supply of the nerve
Rationale: Giant cell arteritis causes ischemia to the affected cranial nerves due to inflammation and occlusion of the blood vessels supplying the nerve, particularly the posterior ciliary arteries.

74
Q

Which cranial nerve is involved?
A. Cranial nerve III
B. Cranial nerve IV
C. Cranial nerve V
D. Cranial nerve VI
E. Cranial nerve VII

A

A. Cranial nerve III
Rationale: The third cranial nerve (oculomotor nerve) is involved, causing ptosis and outward deviation of the eye. The sparing of the pupil suggests a partial third nerve palsy, often seen in ischemic cases.

75
Q

How would you manage your patient?
A. Tear substitutes
B. Muscle/lid surgery
C. Corticosteroids
D. Insulin
E. Tensilon

A

C. Corticosteroids
Rationale: High-dose corticosteroids are the first-line treatment for giant cell arteritis to prevent further ischemic damage, including blindness.

76
Q

A 56-year-old woman with a 15-year history of diabetes on oral medications comes to you for the first time. Her visual acuity is 20/30 OU, Jaeger 7 OU. Funduscopy reveals microaneurysms, lipid exudates forming a circinate pattern temporal to the disc, flame-shaped hemorrhages, and occasional cotton-wool exudates. What is your diagnosis?
A. Error of refraction, presbyopia
B. Early non-proliferative diabetic retinopathy
C. Advanced non-proliferative diabetic retinopathy
D. A & B
E. A & C

A

C. Advanced non-proliferative diabetic retinopathy
Rationale: The presence of microaneurysms, lipid exudates, flame-shaped hemorrhages, and cotton-wool spots is consistent with advanced non-proliferative diabetic retinopathy, a later stage of retinal changes due to diabetes.

77
Q

What diagnostic examination(s) would you request to aid you in the diagnosis and management of the patient?
A. Fasting blood sugar determination
B. Fluorescein angiography
C. Refraction
D. Erythrocyte sedimentation rate
E. A, B & C

A

E. A, B & C (Fasting blood sugar determination, Fluorescein angiography, Refraction)
Rationale: Fasting blood sugar is important to assess glycemic control, fluorescein angiography helps evaluate the extent of retinal vascular damage, and refraction is necessary to correct visual acuity issues.

78
Q

How would you manage this patient?
A. Strict blood sugar control
B. Panretinal laser photocoagulation
C. Vitrectomy with endophotocoagulation
D. A & B
E. All of the above

A

D. A & B (Strict blood sugar control and Panretinal laser photocoagulation)
Rationale: Strict blood sugar control slows the progression of retinopathy, while panretinal laser photocoagulation treats retinal ischemia and reduces the risk of progression to proliferative retinopathy.

79
Q

An adult insulin-dependent diabetic patient complains of sudden painless loss of vision in the right eye. Ophthalmoscopic examination of the right eye is difficult due to hazy media. The left eye shows microaneurysms, lipid exudates, cotton-wool spots, retinal vein dilatations with NVD and NVE. What is your diagnosis?
A. Early non-proliferative diabetic retinopathy
B. Advanced non-proliferative diabetic retinopathy
C. Proliferative diabetic retinopathy
D. Vitreous hemorrhage
E. C & D

A

E. C & D (Proliferative diabetic retinopathy and Vitreous hemorrhage)
Rationale: The sudden vision loss and hazy media suggest vitreous hemorrhage, which is a complication of proliferative diabetic retinopathy characterized by neovascularization (NVD, NVE) seen in the left eye.

80
Q

What is the definitive management for this patient?
A. Strict blood sugar control
B. Panretinal laser photocoagulation
C. Vitrectomy
D. All of the above

A

D. All of the above (Strict blood sugar control, Panretinal laser photocoagulation, Vitrectomy)
Rationale: Management includes strict blood sugar control, panretinal laser photocoagulation to treat retinal ischemia, and vitrectomy to clear the vitreous hemorrhage and prevent further complications.

81
Q

The most common site of ocular metastasis is:
A. Cornea
B. Lens
C. Iris
D. Vitreous
E. Choroid

A

E. Choroid
Rationale: The choroid is the most common site of ocular metastasis due to its rich vascular supply, which allows metastatic cells to lodge and grow.

82
Q

Diplopia in thyroid ophthalmopathy is due to:
A. Extraocular muscle involvement secondary to lymphocytic infiltration
B. Optic nerve compression
C. Lid retraction
D. Corneal surface complications
E. Proptosis

A

A. Extraocular muscle involvement secondary to lymphocytic infiltration
Rationale: In thyroid ophthalmopathy, the extraocular muscles are infiltrated by lymphocytes, causing inflammation and fibrosis, which leads to restricted eye movements and diplopia.

83
Q

A 35-year-old woman presents with visual loss. Ophthalmoscopic evaluation reveals a pale swollen disc. What is your tentative diagnosis?
A. Systemic lupus erythematosus
B. Ankylosing spondylitis
C. Giant cell arteritis
D. Rheumatoid arthritis
E. Central retinal artery occlusion

A

E. Central retinal artery occlusion
Rationale: A pale swollen optic disc suggests ischemia, which is characteristic of central retinal artery occlusion. This condition can lead to sudden visual loss.

84
Q

Ocular manifestations of this disease are most often seen in patients with the more active and severe forms of the disease and in those with extra-articular complications:
A. Juvenile rheumatoid arthritis
B. Systemic lupus erythematosus
C. Osteoarthritis
D. Ankylosing spondylitis
E. Rheumatoid arthritis

A

E. Rheumatoid arthritis
Rationale: Ocular manifestations, such as scleritis and episcleritis, are more common in patients with severe rheumatoid arthritis and extra-articular manifestations.

85
Q

Iritis in juvenile rheumatoid arthritis:
A. Classically occurs late in the disease and causes few complications
B. Is usually associated with the polyarticular form of the disease
C. Correlates well with the severity or course of the disease
D. Can lead to cataract formation and band keratopathy

A

D. Can lead to cataract formation and band keratopathy
Rationale: Iritis associated with juvenile rheumatoid arthritis can result in complications such as cataract formation and band keratopathy if not properly managed.

86
Q

A 30-year-old female with complaints of painful loss of vision in the right eye noted a few days prior. No history of diabetes or hypertension. Pertinent eye findings: Gross examination shows an afferent pupillary defect in the right eye; Visual acuity: OD Counting fingers at 1 foot; OS 20/30. Funduscopy in the right eye shows a markedly engorged optic disc. What is your tentative diagnosis?
A. Myasthenia gravis
B. Rheumatoid arthritis
C. Thyroid ophthalmopathy
D. Optic neuritis
E. Temporal arteritis

A

D. Optic neuritis
Rationale: The presentation of painful vision loss, afferent pupillary defect, and optic disc swelling is consistent with optic neuritis, often associated with multiple sclerosis.

87
Q

A 75-year-old patient complains of diplopia in the right eye noted a few hours prior. What is your tentative diagnosis?
A. Myasthenia gravis
B. Rheumatoid arthritis
C. Thyroid ophthalmopathy
D. Optic neuritis
E. Temporal arteritis

A

E. Temporal arteritis
Rationale: Diplopia in an elderly patient, especially with sudden onset, can be caused by ischemia due to temporal arteritis, which affects the cranial nerves controlling eye movements.

88
Q

A 40-year-old female complains of inflammation in the nasal portion of the left eye associated with moderate pain on movement. Funduscopy is normal. The patient has a history of recurrent joint pains and is on anti-inflammatory medications. What is your tentative diagnosis?
A. Myasthenia gravis
B. Rheumatoid arthritis
C. Thyroid ophthalmopathy
D. Optic neuritis
E. Temporal arteritis

A

B. Rheumatoid arthritis
Rationale: The history of joint pain and inflammation around the eye suggests episcleritis or scleritis, which are common ocular manifestations of rheumatoid arthritis.

89
Q

A 50-year-old male complains of a foreign-body sensation in both eyes noted several weeks prior, associated with intermittent tearing, mild conjunctival congestion, and photophobia. Gross examination reveals relative lid retraction in the right eye compared to the left eye. What is your tentative diagnosis?
A. Myasthenia gravis
B. Rheumatoid arthritis
C. Thyroid ophthalmopathy
D. Optic neuritis
E. Temporal arteritis

A

C. Thyroid ophthalmopathy
Rationale: Lid retraction, tearing, and conjunctival congestion are classic signs of thyroid ophthalmopathy, commonly associated with hyperthyroidism.

90
Q

A 25-year-old female with sudden onset of bilateral ptosis, limited eye movements, and diplopia worsening in the late afternoon:
A. Myasthenia gravis
B. Rheumatoid arthritis
C. Thyroid ophthalmopathy
D. Optic neuritis
E. Temporal arteritis

A

A. Myasthenia gravis
Rationale: The hallmark of myasthenia gravis is fluctuating muscle weakness, including ptosis and diplopia, which worsen with activity and later in the day due to muscle fatigue.

91
Q

Dosage-related cerebellar-vestibular effects are caused by:
A. Digitalis
B. Diphenylhydantoin
C. Chloroquine
D. Thioridazine
E. Ethambutol

A

B. Diphenylhydantoin
Rationale: Diphenylhydantoin (phenytoin), an antiepileptic drug, can cause cerebellar-vestibular effects such as ataxia and nystagmus, especially at higher doses.

92
Q

Dosage-related optic neuropathy is caused by:
A. Digitalis
B. Diphenylhydantoin
C. Chloroquine
D. Thioridazine
E. Ethambutol

A

E. Ethambutol
Rationale: Ethambutol, an anti-tuberculosis medication, is known to cause optic neuropathy, which can lead to vision loss, particularly with prolonged use or high doses.

93
Q

Pigmentary retinopathy is caused by:
A. Digitalis
B. Diphenylhydantoin
C. Chloroquine
D. Thioridazine
E. Ethambutol

A

D. Thioridazine

Rationale: Thioridazine, an antipsychotic, is known to cause pigmentary retinopathy, especially after long-term use at high doses. This condition can lead to reduced night vision and peripheral vision loss due to retinal toxicity.

94
Q

Blurred vision or abnormally-colored vision is caused by:
A. Digitalis
B. Diphenylhydantoin
C. Chloroquine
D. Thioridazine
E. Ethambutol

A

A. Digitalis
Rationale: Digitalis toxicity can lead to blurred vision and disturbances in color vision, such as seeing objects with a yellowish tinge.

95
Q

Bulls-eye maculopathy is caused by:
A. Digitalis
B. Diphenylhydantoin
C. Chloroquine
D. Thioridazine
E. Ethambutol

A

C. Chloroquine
Rationale: Chloroquine can cause a characteristic “bulls-eye” pattern of macular damage, leading to vision loss, especially with prolonged use.

96
Q

This drug dilates the pupil by paralyzing the iris sphincter:
A. Phenylephrine hydrochloride 0.5%
B. Sodium fluorescein dye
C. Proparacaine hydrochloride
D. Timolol maleate 0.5%
E. Tropicamide 0.5%

A

E. Tropicamide 0.5%
Rationale: Tropicamide is a mydriatic agent that works by paralyzing the iris sphincter, causing pupil dilation.

97
Q

This is extremely useful in detecting lesions of the corneal epithelium:
A. Phenylephrine hydrochloride 0.5%
B. Sodium fluorescein dye
C. Proparacaine hydrochloride
D. Timolol maleate 0.5%
E. Tropicamide 0.5%

A

B. Sodium fluorescein dye
Rationale: Sodium fluorescein dye is used to highlight corneal epithelial defects by staining the areas where the epithelium is damaged.

98
Q

This drug inhibits mitosis and cellular migration and can lead to corneal ulceration and permanent scarring, and is toxic to the corneal epithelium when prescribed for repeated use:
A. Phenylephrine hydrochloride 0.5%
B. Sodium fluorescein dye
C. Proparacaine hydrochloride
D. Timolol maleate 0.5%
E. Tropicamide 0.5%

A

C. Proparacaine hydrochloride
Rationale: Proparacaine hydrochloride is a topical anesthetic that, if used repeatedly, can be toxic to the corneal epithelium and lead to severe complications like corneal ulceration.

99
Q

This drug reduces the formation of aqueous humor by the ciliary body and thereby reduces intraocular pressure:
A. Phenylephrine hydrochloride 0.5%
B. Sodium fluorescein dye
C. Proparacaine hydrochloride
D. Timolol maleate 0.5%
E. Tropicamide 0.5%

A

D. Timolol maleate 0.5%
Rationale: Timolol is a beta-blocker that reduces intraocular pressure by decreasing the production of aqueous humor, making it useful for managing glaucoma.

100
Q

This drug dilates the pupil by stimulating the pupillary dilator muscle:
A. Phenylephrine hydrochloride 0.5%
B. Sodium fluorescein dye
C. Proparacaine hydrochloride
D. Timolol maleate 0.5%
E. Tropicamide 0.5%

A

A. Phenylephrine hydrochloride 0.5%
Rationale: Phenylephrine is an alpha-adrenergic agonist that stimulates the dilator muscle of the iris, causing pupil dilation.