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OPHTHALMOLOGY SECOND LONG EXAM

BAPS 2014A

1. Which of the following is not a primary determinant of IOP?


A. Rate of aqueous humor secretion
B. Pupil dilation in myopia pupil constriction provides better access to trabecular
meshwork & better aqueous outflow
C. Aqueous humor outflow facility
D. Episcleral venous pressure
2. The mean value for outflow facility in normal eyes is:
A. 0.05 mcl/min mmHg
B. 0.15 mcl/min mmHg
C. 0.28 mcl/min mmHg
D. 0.48 mcl/min mmHg
3. Conjunctival hyperemia, growth of eyelashes, ocular pruritus, visual disturbance,
ocular burning, foreign body sensation, eye pain, pigmentationof periocular skin,
blepharitis, cataract, superficial punctal keratitis, eyelid erythema are adverse reactions
associated with this anti-glaucoma medication:
A. Betaxolol cause bronchial asthma attack in COPD and asthma
B. Bimatoprost prostaglandin analog along with Latanoprost&Travprost;also cause
iris discoloration &poliosis
C. Brinzolamide topical carbonic anhydrase inhibitor
D. Pilocarpine Direct-acting cholinergic; chronic use causes cataract formation and
posteriossynechia
4. Which of the following best characterizes primary open angle glaucoma?
A. Usually presents with higher eye pressure compared to normal tension
B. is gradually progressive, reversible blinding disease irreversible once there is
Optic Nerve Hypoplasia
C. Presents with higher eye pressure compared to congenital glaucoma
D. Is usually seen in hyperopes
8. The diagnostic test that would identify the mechanism of glaucoma:
A. Gonioscopy check for trabecular damage
B. Fundoscopy
C. Visual field exam
D. Corneal topography
9. In the treatment of glaucoma, timolol maleate should not be given to patients with:
A. Hemorrhoids
B. psoriasis
C. Systemic hypertension
D. Bronchial asthma contraindicated (see #3, Betaxolol)
10. Acqueous fluids exit the eye through
A. Lacrimal duct
B. Vitreous collagenous
C. Na-K pump on corneal endothelium
D. Trabecular meshwork

11. The most common mechanism identified in patients with primary angle closure
glaucoma:
A. Pupillary block iris dilates, pupil dilates, then it crowds out the angle, and the
pressure can go up
B. Plateau iris
C. Angle recession
D. retinal detachment
*Normally, lights off pupil dilates, angles close; lights off pupils constrict, angles open.
12. A 35 year old male came in for a comprehensive eye examination as part of his
annual eye check. The following were the significant eye findings: unremarkable family
and past health history, visual acuity _____ on both eyes, suspicious visual field damage
on both eyes, suspicious nerve cupping on both eyes, IOP 23 mmHg on both eyes, and
asymptomatic. The most likely diagnosis would be:
A. Glaucoma suspect
B. Acute angle closure glaucoma
C. Secondary open angle glaucoma
D. Error of refraction
Glaucoma suspects: No Glaucoma; Pressure suspiciously high for the eye; suspicious
optic nerve damage; suspicious visual field damage
13. Position of papillomacular nerve bundle as it exits the globe
A. Nasal aspect of optic n.
B. Temporal aspect of optic n.
C. Central aspect of optic n.
D. Inferior aspect of optic n.
14. Optic nerve is made up of axons arising from:
A. Retinal ganglion cells
B. Photoreceptors
C. Pigment epithelium
D. Outer plexiform layer
15. Visual field defect in optic chiasm involvement
A. Central scotoma
B. temporal arcade defect
C. Altitudinal defect
D. Bitemporal hemianopsia
16. Length of the optic nerve
A. 30-40mm
B. 40-50mm
C. 50-60mm
D. 10-30mm ?
Intraorbital portion: 25-30mm (longest portion)
Intracanalicular portion: 4-9mm
Intracranial portion: 10mm

17. What is the reason for pain on movement of the eyeball in optic neuritis?
A. Extraocular muscles end close to swalbes line
B. Extraocular muscles converge in the annulus of rinn that surrounds optic nerve
C. Part of the inflammation of the optic nerve
D. Due to swollen nerves
18. Where do you see the thickest portion of the intraocular portion of the optic nerve
head?
A. superior
B. nasal
C. inferior and superior portion
D. superior and temporal portion
19. What is the longest portion of the optic nerve?
A. intraocular
B. intraorbital
C. intracanalicular - shortest
D. intracranial
20. What blood vessel when blocked produces an altitudinal defect?
ANS: Posterior Ciliary Artery
21. Occlusion of what blood vessel produces the cherry red spot?
A. Anterior choroidal artery
B. long ciliary artery
C. Central retinal artery
D. Short ciliary artery causes anterior ischemic optic neuropathy
22. What is the most distinguishing characteristic differentiating papillitis from
papilledema?
A. Disc edema
B. loss of SVP
C. Vision loss acute loss of vision within 1-5 days from onset of
inflammation
D. Ptosis
Papillitis: Dull pain of involved eye on movement ; Almost always unilateral in adults;
always bilateral in children
Papilledema: bilateral; progressive headache, projectile vomiting
23. The choice of treatment for acute optic neuritis
ANS: IV Methylprednisone then oral prednisone
24. What is the best management for a patient diagnosed to have papilledema?
A. MRI of the brain and orbits
B. CT scan of the brain
C. Immediate hospitalization always an emergency
D. Refer to a neurologist

*Do immediate hospitalization and refer to a neurologist for confinement and joint
management
25. Versus direct ophthalmoscopy, indirect ophthalmoscopy has the following advantage:
A. Upright image
B. Larger magnification
C. Wider field of view
D. Absence of depth perception
26. A painful end-stage complication of advanced vascular retinopathies brought on by
progressive retinal ischemia:
A. Neovascularrubeotic glaucoma
B. Tractional retinal detachment
C. Vitreous hemorrhage
D. Absence of depth of perception
27. Which of the following is a known risk factor for retinal detachment?
A. Malay race
B. male sex
C. Presbyopia
D. Myopia
28. A 57 year old man complains of flashing lights and a shade of darkness over his
inferior nasal quadrant in one eye. On exam the VA in this eye is 20/20. You found the
pressure a little lower on the affected eye and pigment cells behind the crystalline lens.
What condition would lead you to perform immediate surgical intervention?
A. Macula-off rhegmatogenous retinal detachment
B. Epi-retinal membrane involving the macula
C. Dense vitreous hemorrhage in the inferior nasal quadrant
D. Mid-peripheral horseshoe retinal tear with surrounding sub-retinal fluid
(macula-on)
* Rhegmatogenous retinal detachment you see vestiges of a flap; posterior edge is
being rolled in itself; Macula on detachment is considered an emergency because you
need to save the macula to preserve the eyesight
29. Put the following retinal layers in order from inside (next to vitreous) to outside:
A. Ganglion cells, photoreceptors, choroid, then sclera on the outside
B. Photoreceptors, ganglion cells, choroid, then sclera on the outside
C. Choroid, photoreceptors, ganglion cells, then sclera on the outside
D. Choroid, ganglion cells, photoreceptors, then sclera on the outside
30. The most common cause of visual loss in diabetic retinopathy is:
A. Macular edema
B. Vitreous hemorrhage
C. Acute neovascular glaucoma
D. Traction retinal detachment
31. Proliferative diabetic retinopathy denotes presence of:
A. Hard lipid exudates consequence of chronic leakage in diabetic retinopathy

B. dot and blot hemorrhages non specific in diabetic retinopathy


C. Intraocular neovasvularization hallmark
D. Cotton wool spots - non-proliferative diabetic retinopathy
32. The layer of the retina where the individual cell apices have
interdigitatingzonulaoccludens that comprise the outer blood-retina barrier:
A. Internal limiting membrane
B. Nerve fiber layer
C. Photoreceptor layer
D. Retinal pigment epithelium
33. Symptom associated with subduration?
ANS: visual field defect
Questions 34-36
42 year old male, with chief complaint of progressive blurring of vision and floaters on
both eyes. PE revealed VA is CF 5 ft OU, fundoscopy shows diffuse vitreous hemorrhages,
defined disc borders, an AVR of 1:3, CDR of 0.3,tractional retinal detachment along the
vascular arcades, multiplemicroaneurysms, dot and blotintraretinal hemorrhages, lipid
exudates,macular edema and neovascularization on the disc and elsewhere in both
fundi.
34. What is the most likely diagnosis?
A. Very severe non-neovascular diabetic retinopathy
B. Proliferative diabetic retinopathy, high-risk
C. Grade 4 hypertensive retinopathy
D. Exudative neovascular age-related macular degeneration
35. Photographic documentation of the patient's retinal condition can be performed
using
A. B-scan ultrasonography
B. perimetry
C. Florescein angiography
D. Pachymetry
36. Possible treatment modalities that may be used for the patient?
A. Panretinal photocoagulation halt progression of diabetic retinopathy by
diminishing formation of VEGF
B. Posterior Vitrectomy reduces traction
C. Both A and B
D. NOTA
37. Congenital ptosis is most commonly due to:
A. Dehiscense of the levator muscle in the upper eyelid
B. Dystrophy of levator muscle in upper eyelidshould also be correct accdg. to
V&A
C. Congenital CN3 palsy
D. Aberrant degeneration of CN3
38. Corneal opacity caused by forceps injury during birth is due to:
A. Faulty development of the corneal endothelium

B. Persistent cornea-lens attachments


C. Rupture of Descemets membrane
D. Mucopolysaccharide deposition in the cornea
39. Aniridia or absence of iris is frequently associated with
A. Retinoblastoma leukocoria
B. Wilms tumor
C. Optic nerve glioma
D. Fetal hypoplasia
40. Congenital rubella during the first trimester is often associated with:
A. Congenital glaucoma
B. congenital cataract
C. Persistent hyperplastic primary vitreous
D. Congenital obstruction of nasolacrimal duct
41. Leukocoria is a common manifestation of these except:
A. Error of refraction
B. congenital cataract
C. PHPV
D. Retinoblastoma
42. "Double ring sign" is caused by the ff except:
A. Oblique entrance to globe
B. less axons in the optic nerve
C. Circumpapillary halo of scleral canal
D. Small optic nerve
43. A child who presents with epiphora and recurrent dacrocystitis most probably has:
A. Inflammation of anterior segment
B. congenital nasolacrimal duct obstruction
C. Lid abnormalities - ptosis
D. Congenital glaucoma Photophobia and epiphora
44. Most common infectious cause of conjunctivitis in the newborn?
A. Chlamydial infection give Erythromycin
B. chemical trauma d/t silver nitrate drops; self-limited
C. Herpes simplex infection causes giant cell and viral inclusions
D. Staphylococcal infection give Pen G or Ceftriaxone
45. 29 weeks, 1250g, leukocoria
A. Congenital cataract
B. PHPV
C. retinopathy of prematurity
D. Retinoblastoma
*Usually in LBW and premature infants
46. A 2 year old patient withleukocoria on the right eye. The right eye was noted to turn
in-ward as well. On Ocular UTZ, calcifications were seen. The most likely diagnosis is:
A. Congenital Cataract

B. Retinoblastoma
C. PHPV
D. Retinopathy of prematurity
47. A 6 month old infant born to an alcoholic was rushed to the ER with depressed
sensorium. Upon retinal examination, patient had retinal hemorrhages. A CT scan was
done and a subdural hematoma was seen. The most likely diagnosis:
A. leukemia
B. Vitamin K deficiency
C. Shaken baby syndrome
D. Von Willebrand disease
48. A remnant of the hyaloids artery that would present as leukocoria is due to:
A. Congenital cataract
B. PHPV
C. Retinopathy of prematurity
D. Retinoblastoma
49. Which sequence of visual axis structures from anterior to posterior is correct?
A. Optic nerve, vitreous, lens, anterior chamber, pupil, cornea, tear film
B. Tear film, camera, lens, pupil, vitreous, retina, and optic nerve
C. Optic nerve, retina, lens, pupil, anterior chamber, cornea, tear film
D. tear film, cornea, anterior chamber, pupil, lens, vitreous, optic nerve
50. 70 year old, with cherry red spots, pale retina and blurring of vision
A. Cataracts
B.Central retinal vein occlusion
C. Primary open angle glaucoma
D. Central retina artery occlusion
51. A 70 year old female diabetic patient complains of progressive painless BOV
described as cloudiness with monocular diplopia and glare. The primary consideration is:
A. Cataract most common cause of monocular diplopia presenting with clouding of
vision with color vision abnormalities.
B. Anterior chamber optic neuropathy
C. Age-related macular degeneration distorted vision or metamorphosia
D. Intermittent angle closure glaucoma painful BOV
54. This sign commonly occurs in uveitis
A. Miotic pupil
B. mid- dilated nonreactive pupil Acute Angle Closure Glaucoma
C. Iridodialysis Traumatic hyphema
D. AOTA

55. Vision threatening red eye disorder


A. Subconjunctival hemorrhage
B. pterygium
C. Meibomian cyst
D. Endopthalmitis

56. White plaque-like corneal lesion with satellite infiltrates is noted


A. dysfunctional tear syndrome dry eyes syndrome with decreased
central/peripheral vision
B. gonococcal conjunctivitis purulent discharge
C. HSV dendritic patternof fluorescein uptake
D. Keratomycosis
57. Presents with photophobia
A. Branch retinal artery occlusion
B. uveitis
C. Presbyopia
D. Nasolacrimal duct obstruction
58. A 12 year old boy experiences localized tenderness on the temporal upper eyelid due
to a hordeolum. Pain perception in this case is from the:
A. Infratrochlear nerve supplies inferior medial corner
B. Lacrimal nerve
C. Frontal nerve supplies EOMs
D. Nasociliary nerve supplies cornea, ciliary body, TM, sclera, medial angle and
eyelid, caruncle, canaliculi, lacrimal sac
Questions 59-60. 40 year old female complained of pain in the inferior medial canthal
area associated with focal swelling of the area, epiphora and mucopurulent discharge.
59. The primary consideration is
A. Hordeolum
B. dacrocystitis
C. Chalazion
D. Canaliculitis
60. pain perception in this case is from the
A. Nasociliary nerve
B. infraorbital nerve
C. Infratrochlear nerve
D. AOTA - but according to the lecture / trans, the inferior medial canthal area is
only subserved by nasociliary and infraorbital nerve.
61. Not a common cause of maternal infection leading to congenital cataract
A. CMV
B. Rubella
C. Herpes Simplex Virus
D. Toxocariasis
62. Which of the following is characteristic of exophytic type of retinoblastoma?
A. Associated with vitreous seeding
B. Secondary calcifications
C. Total retinal detachment
D. Cottage cheese appearance

63. Which of the following is FALSE regarding retinoblastoma?


A. Female and male predominance the same
B. 60% of cases present with leukocoria
C. No racial predilection
D. 60-70% has bilateral involvement 60-70% unilateral involvement
64. Who should be screened for retinopathy of prematurity?
A. All infants weighing > 3000g and at least 36 weeks AOG
B. All full term infants supplemented with oxygen at birth
C. All infants weighing < 1500g and 25 weeks AOG ROP screening should be
done on eyes of all infants 1) born at less than 36 weeks, 2) weighing less than 1500
grams, & 3) given supplemental oxygen
D. All born twins
65. Stage 2 of Retinopathy of Prematurity
A. The development of a thin tortuous gray white line stage 1
B. Development of new vessels, neovascularization
C. Fibrovascular proliferation stage 3
D. Tractional retinal detachment stage 4 (subtotal retinal detachment, tractional
type)
Note: stage 5 total retinal detachment
66. Which of the following is not a key feature of PHPV?
A. Leukocoria
B. microphthalmia
C. Megalocornea patient presents with small eye
D. Cataract
67. The following are major causes of visual acuity loss in ocular toxocariasis EXCEPT
A. vitreitis
B. cystoid macular edema
C. Tractional retinal detachment
D. Cataract
68. False about Coat's disease?
A. Usually unilateral
B. male predominance
C. Average age of diagnosis is18months - 3years should be 8-16 years old
D. No hereditary predilection
69. Stage 4 of Coat's disease
A. Telangiectasias and exudation stage 1
B. subtotal retinal detachment stage 3
C. Total retinal detachment with glaucoma
D. End stage disease stage 5
70. The following can lead to tractional retinal detachment, except
A. Ocular toxocariasis
B. Coat's disease exudative retinal detachment
C. PHPV
D. ROP

71. Best treatment for ocular toxocariasis


A. Anti-helminthics
B. steroid
C. Vitrectomy
D. Prevent infection by eliminating contact between children and pets
72. At birth, a baby presents with leukocoria in the right eye. What 2 ocular disturbances
are the most likely diagnosis?
A. ROP and infantile cataract accdg to V&A: screening for ROP should begin at 2-4
weeks after birth (so baka d pa sya nagppresent at birth? Not sure.)
B. retinoblastoma and PHPV Rb age of onset at 18 months 3 years
C. Congenital cataract and PHPV
D. Coat's disease and ocular toxocariasis Coats dse average age of diagnosis at 816 y.o.,
73. Best diagnostic tool to appreciate calcifications
ANS: CT scan
74. What is the most common presenting sign of conjunctival epithelial tumor?
A. Redness d/t conjunctival injection or hyperemia
B. white nodule or leukoplakia, due to hyperkeratinization
C. Foreign body sensation
D. Blurring of vision
75. The most common site of dermoid cyst in children
A. Superior temporal orbit
B. infraorbital
76. Which of the ff histological features in retinoblastoma does not correlate with tissue
differentiation
A. Flexner-Wintersteiner rosettes
B. Homer Wright rossettes
C. Pseudorossettes circumferential arrangements of viable basophilic tumor
cells around blood vessels
D. Fleurettes
78. According to the Callendar classification, which cell type gives the poorest prognosis?
A. Spindle A best prognosis (92% survival rate)
B. Spindle B 75%
C. Epithelioid 28%
D. Mixed 41%
E. necrotic 41%
79. What is the treatment of choice for a 1 year old with capillary hemangioma?
A. Observation
B. intralesional steroid
C. Complete surgical removal
D. Combined surgery and radiotherapy

80. Infraorbital rupture of dermoid cyst will result to:


A. Cyst recurrence
B. keloid
C. Malignant transformation
D. Granulomatous formation rupture causes a severe inflammatory response
creating a big mass
81. Which feature in retinoblastoma is LEAST associated with POOR prognosis?
A. Extraocular spread
B. Optic nerve invasion
C. Presence of fleurettes presence of fleurettes indicates greater degree of
differentiation, thus not an indicator for poor prognosis.
D. Choroidal involvement
82. Which of the following is the MOST UNLIKELY differential diagnosis to retinoblastoma?
A. Coats disease
B. PHPV
C. Retinopathy of prematurity
D. Choroidal Melanoma
Other DDx for Rb: Posterior cataract, coloboma of choroid or optic disc, uveitis,
toxocariasis, organizing vitreous hemorrhage
83. What is the most common presenting sign of retinoblastoma in children MORE THAN
5 years old?
A. Strabismus 2nd most common sign in patients <5 yo, 3rd most common in >5 yo
B. Leukocoria it is the most common presenting sign in Rb in all ages (> 5 or <5
yo)
C. Decreased vision 2nd most common in >5 yo
D. Eye pain
84. What is the most common site of distant metastasis of choroidal melanoma?
A. Liver
B. Brain
C. GIT
D. Bones
85. Intracameral administration of medications is the infusion of drugs into the space:
A. Between the Tenons capsule and episclera sub-Tenons space
B. Within the muscle cone formed by the EOMs peribulbar
C. Surrounded by the retina and the lens
D. Bordered by the cornea and the iris
86. Medications that are better absorbed by ocular tissue are those drugs that are:
A. Ionized
B. Lipid soluble
C. Water insoluble
D. AOTA

Better absorbed drugs: lipid soluble, non-ionized, water soluble, more viscous, presence
of surfactants and polymers.
87. Medications have to pass through this barrier formed by the nonpigmented ciliary
epithelium and endothelium of the iris vessels to attain therapeutic intraocular
concentrations:
A. Corneal barrier
B. blood aqueous barrier
C. Blood retinal barrier junction between retinal pigmented epithelium & retinal
vessel endothelium
D. Episcleral vessel wall
Question 88-90.
88. A 20 year old male patient consults at the OPC because of BOV for near vision of the
right eye 4 days after applying 3 days of self-prescribed eye medications in a red-capped
bottle. On examination you note anisocoria with a dilated non-reactive pupil on the right
eye. The eye medication used is most likely:
A. Phenylephrine
B. Tropicamide
C. Atropine long-acting; anisocoria & dilated non-reactive pupil observed even
days after appn
D. Combination of Phenylephrine and Tropicamide
89. The patient begins to complain of headache, eye pain and worsening BOV the
following day. He notes halos and colors around light. A few hours later he begins to
experience nausea and vomiting because of worsening right-sided headache. He is
transferred to the ER and initial examination reveals a hazy cornea OD and shallow
anterior chambers OU on oblique penlight test. The patient most likely developed:
A. Hypersensitivity reaction
B. Acute angle closure glaucoma
C. Migraine
90. His condition deteriorated and he was weak and obtunded. Tonometry revealed an
IOP of OD50 and OS19. Initial management at the ER:
A. Acetazolamide
B. glycerin
C. Mannitol used to lower IOP in AACG by dehydrating vitreous body
D. Propacainex
91. A 35 year old consults at the OPC because of painless progressive BOV. Patient was
prescribed with
93. A glaucoma patient treated with anti-glaucoma eye drops on right eye develops
redness and itchiness OD. You note that his right eye has palpebral conjunctival injection
with papillary reaction. This is most likely:
A. Betaxolol
B. brinzolamide
C. Brimonidine side effects include allergic or papillary conjunctivitis (presents
with redness, itchiness and papillary reaction)
D. Bimatoprost

96. This anti-allergy eye medication is a mast cell stabilizer


A. Ketofen
B. phenramine maleate
C. Naphazoline
D. Antazoline

97. Antiglaucoma drug that causes poliosis and discoloration of iris


A. Cabachol
B.
C. Travapost and other PG analogs (-prosts)
D. Levobunolol
98. This medication is used intraoperatively during trabeculectomy to improve success
rate by modulating wound healing
A. Hyaluronidase for increased absorption in peribulbar or retrobulbar tissue
B. mitomycin C
C. Flubiprofen NSAID, used preoperatively to prevent miosis intraoperatively
D. Tryptan blue stains the anterior capsule, used in capsullorhexis and
microcataract formation
99. When given systemically, this medication makes blood plasma hypertonic to acqeous
and vitreous humor resulting from fluid drawn from the eye to the intravascular space
with resultant decrease in IOP
A. Acetazolamide
B. 5-FU
C. Trifluridine
D. Mannitol hyperosmotic agent, makes plasma hypertonic to aqueous humor;
other examples: glycerin, isosorbide, urea
100. Fluorescein dye is used for corneal abrasion because exposed corneal stroma is
A. Lipophilic
B. lipophobic
C. Hydrophilic
D. Hydrophobic