‫بسم هللا الرحمن الرحيم‬

‫جياد السعدي‬
MCQuestions
EYELIDS, CONJUNCTIVA, CORNEA AND SCLERA
1.Distichiasis is:
a. Misdirected eyelashes
b. Accessory row of eyelashes
c. Downward drooping of upper lid
d. Outward protrusion of lower lid
ANSWER: B
2. Band shaped keratopathy is commonly caused by deposition of:
a. Magnesium salt
b. Calcium salt
c. Ferrous salt
d. Copper salt
ANSWER: B
3. Irrespective of the etiology of a corneal ulcer, the drug always
indicated is:
a. Corticosteroids
b. Cycloplegics
c. Antibiotics
d. Antifungals
ANSWER: B
4. Dense scar of cornea with incarceration of iris is known as:
a. Adherent Leucoma
b. Dense leucoma
c. Ciliary staphyloma
d. Iris bombe
ANSWER: A
5. Corneal sensations are diminished in:
a. Herpes simplex
b. Conjunctivitis
c. Fungal infections
d. Marginal keratitis
ANSWER: A
6. The color of fluorescein staining in corneal ulcer is:
a. Yellow
b. Blue
c. Green
d. Royal blue
ANSWER: C
7. Phlycten is due to:
a. Endogenous allergy
b. Exogenous allergy
c. Degeneration
d. None of the above
ANSWER: A
8. A recurrent bilateral conjunctivitis occurring with the onset of hot
weather in young boys with symptoms of burning, itching, and
lacrimation with large flat topped cobble stone papillae raised areas in
the palpebral conjunctiva is:
A. Trachoma
B. Phlyctenular conjunctivitis
C. Mucopurulent conjunctivitis
D. Vernal keratoconjunctivitis
ANSWER: D
9. Which of the following organism can penetrate intact corneal
epithelium?
A. Strept pyogenes
B. Staph aureus
C. Pseudomonas pyocyanaea
D. Corynebacterium diphtheriae
ANSWER: D
10. A 12 years old boy receiving long term treatment for spring catarrh,
developed defective vision in both eyes. The likely cause is:
a. Posterior subcapsular cataract
b. Retinopathy of prematurity
c. Optic neuritis
d. Vitreous hemorrhage
ANSWER: A
11. A young child suffering from fever and sore throat began to
complain of lacrimation. On examination, follicles were found in the
lower palpebral conjunctiva with tender preauricular lymph nodes. The
most probable diagnosis is:
a. Trachoma
b. Staphylococal conjunctivitis
c. Adenoviral conjunctivitis
d. Phlyctenular conjunctivitis
ANSWER: C
12. Patching of the eye is contraindicated in:
a. Corneal abrasion
b. Bacterial corneal ulcer
c. Mucopurulent conjunctivitis
d. After glaucoma surgery
ANSWER: C
13. Ten years old boy complains of itching. On examination, there are
mucoid nodules with smooth rounded surface on the limbus, and
mucous white ropy mucopurulent conjunctival discharge. He most
probably suffers from:
a. Trachoma
b. Mucopurulent conjunctivitis
c. Bulbar spring catarrh
d. Purulent conjunctivitis
ANSWER: C
14. In viral epidemic kerato-conjunctlvitis characteristically there is
usually:
a. Copious purulent discharge
b. Copious muco-purulent discharge
c. Excessive watery lacrimation
d. Mucoid ropy white discharge
ANSWER: C
15. Corneal Herbert's rosettes are found in:
a. Mucopurulent conjunctivitis
b. Phlyctenular keratoconjunctivitis
c. Active trachoma
d. Spring catarrh
ANSWER: C
16. A patient complains of maceration of skin of the lids and conjunctiva
redness at the inner and outer canthi. Conjunctival swab is expected to
show:
a. Slaphylococcus aureus.
b. Streptococcus viridans.
c. Streptococcus pneumonae
d. Morax- Axenfeld diplobacilli
ANSWER: D
17. Tranta's spots are noticed in cases of:
a. Active trachoma
b. Bulbar spring catarrh
c. Corneal phlycten
d. Vitamin A deficiency
ANSWER: B
18. A painful, tender, non itchy localized redness of the conjunctiva can
be due to:
a. Bulbar spring catarrh.
b. Episcleritis.
c. Vascular pterygium.
d. Phlyctenular conjunctivitis.
ANSWER: B
19. In trachoma the patient is infectious when there is:
a. Arlt's line
b. Herbert's pits
c. Post-trachomatous concretions.
d. Follicles and papillae in the palpebral conjunctiva.
ANSWER: D
20. A female patient 18 years old, who is contact lens wearer since two
years, is complaining of redness, lacrimation and foreign body
sensation of both eyes. On examination, visual acuity was 6/6 with
negative fluorescein test. The expected diagnosis can be:
a. Acute anterior uveitis.
b. Giant papillary conjunctivitis.
c. Bacterial corneal ulcer.
d. Acute congestive glaucoma
ANSWER: B
21. Fifth nerve palsy could cause:
a. Ptosis
b. Proptosis
c. Neuropathic keratopathy
d. Lagophthalmos
ANSWER: C
22. Topical steroids are contraindicated in a case of viral corneal ulcer
for fear of:
a. Secondary glaucoma
b. Cortical cataract.
c. Corneal perforation
d. Secondary viral infection.
ANSWER: C
23. The sure diagnostic sign of corneal ulcer is
a. Ciliary injection
b. Blepharospasm
c. Miosis
d. Positive fluorescein test.
ANSWER: D
24. The effective treatment of dendritic ulcer of the cornea is:
a. Surface anesthesia
b. Local corticosteroids
c. Systemic corticosteroids
d. Acyclovir ointment
ANSWER: D
25. Herpes simplex keratitis is characterized by:
a. Presence of pus in the anterior chamber
b. No tendency to recurrence
c. Corneal hyposthesia
d. Tendency to perforate
ANSWER: C
26. Bacteria, which can attack normal corneal epithelium:
a. Neisseria gonorrhea.
b. Staphylococcal epidermidis
c. Moraxella lacunata.
d. Staphylococcal aureus
ANSWER: A
27. Advanced keratoconus is least to be corrected when treated by:
a. Hard contact Lens,
b. Rigid gas permeable (RGP) contact lens
c. Spectacles.
d. Keratoplasty.
ANSWER: C
28. Organisms causing angular conjunctivitis are:
a. Moraxella Axenfeld bacilli
b. Pneumococci
c. Gonococci
d. Adenovirus
ANSWER: A
29. Chalazion is a chronic inflammatory granuloma of
a. Meibomian gland
b. Zies’s gland
c. Sweat gland
d. Wolfring’s gland
ANSWER: A
30. Deep leucoma is best treated by:
A. Tattooing
B. Lamellar keratoplasty
C. Keratectomy
D. Penetrating keratoplasty
ANSWER: D
31. Blood vessels in a trachomatous pannus lie:
a. Beneath the Descemet's membrane.
b. In the substantia propria.
c. Between Bowman's membrane & substantia propria.
d. Between Bowman's membrane & Epithelium.
ANSWER: D
32. In vernal catarrh, the characteristic cells are:
a. Macrophage
b. Eosinophils
c. Neutrophils
d. Epitheloid cells
ANSWER: B
33. Ptosis in Horner's syndrome, is due to paralysis of:
a. Riolan's muscle
b. Horner's muscle
c. Muller's muscle
d. The levator palpebral muscle
e. Orbicularis oculi muscle
ANSWER: C
34. Severe congenital ptosis with no levator function can be treated by:
A. Levator resection from skin side
B. Levator resection from conjunctival side
C. Fascia lata sling operation
D. Fasanella servat operation
ANSWER: C
35. The commonest cause of hypopyon corneal ulcer is:
a. Moraxella
b. Gonococcus
c. Pneumococcus
d. Staphylococcus
ANSWER: C
36. Irrespective of the etiology of a corneal ulcer, the drug always
indicated is:
a. Corticosteroid
b. Atropine
c. Antibiotics
d. Antifungal
ANSWER: B
37. Fleischer ring is found in:
a. Keratoconus
b. Chalcosis
c. Argyrosis
d. Buphthalmos
e. None of the above
ANSWER: A
38. Intercalary staphyloma is a type of:
a. Equatorial staphyloma
b. Posterior staphyloma
c. Scleral staphyloma
d. Anterior staphyloma
ANSWER: C
39. Cornea is supplied by nerve fibers derived from:
a. Trochlear nerve
b. Optic nerve
c. Trigeminal nerve
d. Oculomotor nerve
ANSWER: C
40. Ciliary injection is not seen in:
a. Herpetic keratitis
b. Bacterial ulcer
c. Chronic iridocyclitis
d. Catarrhal conjunctivitis
e. Acute iridocyclitis
ANSWER: D
41. Most of the thickness of cornea is formed by:
a. Epithelial layer
b. Substantia propria
c. Descemet's membrane
d. Endothelium
ANSWER: B
42. A 30 years old male presents with a history of injury to the eye with a
leaf 5 days ago and pain, photophobia and redness of the eye for 2 days.
What would be the most likely pathology?
a. Anterior uveitis
b. Conjunctivitis
c. Fungal corneal ulcer
d. Corneal laceration
ANSWER: C
43. Ptosis and mydriasis are seen in:
a. Facial palsy
b. Peripheral neuritis
c. Oculomotor palsy
d. Sympathetic palsy
ANSWER: C
44. Commonest cause of posterior staphyloma is:
a. Glaucoma
b. Retinal detachment
c. Iridocyclitis
d. High myopia
ANSWER: D
LACRIMAL SYSTEM
45. In DCR, the opening is made at:
a. Superior meatus
b. Middle meatus
c. Inferior meatus
ANSWER: B
46. Schirmer’s test is used for diagnosing:
a. Dry eye
b. Infective keratitis
c. Watering eyes
d. Horner’s syndrome
ANSWER: A
48. 3 months old infant with watering lacrimal sac on pressing causes
regurgitation of mucopus material. What is the appropriate treatment?
a. Dacryocystorhinostomy
b. Probing
c. Probing with syringing
d. Massage with antibiotics up to age of 6 months
e. Dacryocystectomy
ANSWER: D
ORBIT
49. Most common cause of adult unilateral proptosis
a. Thyroid orbitopathy
b. Metastasis
c. Lymphoma
d. Meningioma
ANSWER: A
50. Evisceration is:
a. Excision of the entire eyeball
b. Excision of all the inner contents of the eyeball including the uveal tissue
c. Photocoagulation of the retina
d. Removal of orbit contents
ANSWER: B
51. Lagophthalmos can occur in all of the following except;
a. 7th cranial nerve paralysis
b. 5th cranial nerve paralysis
c. Thyrotoxic exophthalmos
d. Symblepharon
ANSWER: B
52. The most important symptom differentiating orbital cellulitis from
panophthalmitis is:
a. Vision
b. Pain
c. Redness
d. Swelling
ANSWER: A
53. The commonest cause of unilateral exophthalmos is:
a. Thyroid eye disease
b. Lacrimal gland tumour
c. Orbital cellulitis
d. Cavernous sinus thrombosis
ANSWER: A
54. Proptosis is present in the following condition except:
a. Horner's syndrome
b. Orbital cellulitis
c. Thyroid ophthalmopathy
d. Cavernous sinus thrombosis
ANSWER: A
UVEA
55. All of the following are part of uvea except:
a. Pars plicata
b. Pars plana
c. Choroid
d. Schwalbe’s line
ANSWER: D
56. One of the earliest features of anterior uveitis includes:
a. Keratic precipitates
b. Hypopyon
c. Posterior synechiae
d. Aqueous flare
ANSWER: D
57. In anterior uveitis the pupil is generally:
a. Of normal size
b. Constricted
c. Dilated
ANSWER: B
58. Koeppe’s nodules are found in:
a. Cornea
b. Sclera
c. Iris
d. Conjunctiva
ANSWER: C
59. Aqueous humour is formed by:
a. Epithelium of ciliary body
b. Posterior surface of iris
c. Lens
d. Pars plana
ANSWER: A
60. The earliest feature of anterior uveitis includes:
a. Keratic precipitates
b. Hypopyon
c. Posterior synechiae
d. Aqueous flare
ANSWER: D

LENS
61. Which laser is used for capsulotomy?
a. Diode laser
b. Carbon dioxide laser
c. Excimer laser
d. ND: YAG laser
ANSWER: D
62. Unilateral aphakia is likely to be corrected by any of the following
except:
a. Anterior chamber intraocular lens
b. Posterior chamber intraocular lens
c. Contact tens
d. Glasses
ANSWER: D
63. Phakolytic glaucoma is best treated by:
a. Fistulizing operation
b. Cataract extraction
c. Cyclo-destructive procedure
d. Miotics and Beta blockers
ANSWER: B
64. Lens induced glaucoma is least likely to occur in:
a. Intumescent cataract.
b. Anterior lens dislocation,
c. Posterior subcapsular cataract
d. Posterior lens dislocation
ANSWER: C
65. Earliest visual rehabilitation occurs with:
a. Phacoemulsification plus intraocular lens implantation
b. Intracapsular cataract extraction plus intraocular lens implantation
c. Extracapsular cataract extraction plus intraocular lens implantation
d. Small incision cataract extraction
ANSWER: A
66. Best site where intraocular lens is fitted:
a. Capsular ligament
b. Endosulcus
c. Ciliary supported
d. Capsular bag
ANSWER: D
67. After 48 hours of a cataract extraction operation, a patient
complained of ocular pain and visual loss. On examination, this eye
looked red with ciliary injection, corneal oedema and absent red reflex.
The first suspicion must be:
a. Secondary glaucoma.
b. Anterior uveitis.
c. Bacterial endophthalmitis.
d. Acute conjunctivitis
ANSWER: C
GLAUCOMA
68. All the following associated open angle glaucoma include all the
following except:
a. Roenne’s nasal step
b. Enlarged blind spot
c. Generalized depression of isopters
d. Loss of central fields
e. Tubular vision
ANSWER: D
69. The treatment of choice for the other eye in angle closure glaucoma
is:
a. Surgical peripheral iridectomy
b. Yag laser iridotomy
c. Trabeculotomy
d. Trabeculectomy
ANSWER: B
70. Topical atropine is contraindicated in:
a. Retinoscopy in children
b. Iridocyclitis
c. Corneal ulcer
d. Primary angle closure glaucoma
ANSWER: D
71. Neovascular glaucoma follows:
a. Thrombosis of central retinal vein
b. Acute congestive glaucoma
c. Staphylococcal infection
d. Hypertension
ANSWER: A
72.A one-month old baby is brought with complaints of photophobia
and watering. Clinical examination shows normal tear passages and
clear but large cornea. The most likely diagnosis is:
a. Congenital dacryocystitis
b. Interstitial keratitis
c. Keratoconus
d. Buphthalmos
ANSWER: D
73. You have been referred a case of open angle glaucoma. Which of the
following would be an important point in diagnosing the case?
a. Shallow anterior chamber
b. Optic disc cupping
c. Narrow angle
d. visual acuity and refractive error
ANSWER: B
74. Number of layers in neurosensory retina is:
a. 9
b. 10
c. 11
d. 12
ANSWER: A
75. In retinal detachment, fluid accumulates between:
a. Outer plexiform layer and inner nuclear layer.
b. Neurosensory retina and layer of retinal pigment epithelium
c. Nerve fiber layer and rest of retina.
d. Retinal pigment epithelium and Bruch’s membrane.
ANSWER: B
76. 100 days glaucoma is seen in:
a. Central Retinal Artery Occlusion
b. Branch Retinal Artery Occlusion
c. Central Retinal Vein Occlusion
d. Branch Retinal Vein Occlusion
ANSWER: C
77. A young patient with sudden painless loss of vision, with systolic
murmur and ocular examination reveals a cherry red spot with clear
AC, the likely diagnosis is:
a. Central Retinal Artery Occlusion
b. Central Retinal Vein Occlusion
c. Diabetes Mellitus
d. Branch Retinal Vein Occlusion
ANSWER: A
78. Amaurotic cat's eye reflex is seen in:
a. Papilloedema
b. Retinoblastoma
c. Papillitis
d. Retinitis
ANSWER: B
79. Commonest lesion which hinders vision in diabetic retinopathy is:
a. Macular oedema
b. Microaneurysm
c. Retinal hemorrhage
d. Retinal detachment
ANSWER: A
80. Commotio retinae is seen in:
a. Concussion injury
b. Papilloedema
c. Central retinal vein thrombosis
d. Central retinal artery thrombosis
ANSWER: A
81. Night blindness is caused by:
a. Central retinal vein occlusion
b. Dystrophies of retinal rods
c. Dystrophies of the retinal cones
d. Retinal detachment
ANSWER: B
82. In Central retinal artery occlusion, a cherry red spot is due to:
a. Hemorrhage at macula
b. Increased choroidal perfusion
c. Increase in retinal perfusion at macula
d. The contrast between pale retina and reddish choroids
ANSWER: D
83. The most common primary intraocular malignancy in adults is:
a. Retinoblastoma
b. Choroidal melanoma
c. Squamous cell carcinoma of conjunctiva
d. Iris nevus
ANSWER: B
84. A patient of old standing diabetes mellitus noticed sudden muscae
volitanes. On examination, the red reflex was dim, with no details of
fundus could be seen. He might have:
a. Non proliferative diabetic retinopathy
b. Cystoid macular edema
c. Vitreous hemorrhage
d. Central retinal vein occlusion
ANSWER: C
85. Occlusion of the lower nasal branch of the central retinal artery
results in one of the following field defects:
a. Lower nasal sector field defect
b. Upper nasal sector field defect
c. Upper temporal field defect
d. Lower temporal sector field defect
ANSWER: C
OPTIC NERVE
86. Primary optic atrophy results from:
a. Retinal disease
b. Chronic glaucoma
c. Papilledema
d. Neurological disease
ANSWER: D
87. Retro-bulbar optic neuritis is characterized by:
a. Marked swelling of the optic disc.
b. Impaired direct light reflex in the affected eye
c. Impaired consensual light reflex in the affected eye
d. Normal visual acuity
ANSWER: B
88. The type of optic atrophy that follows retro-bulbar neuritis is:
a. Secondary optic atrophy
b. Consecutive optic atrophy
c. Glaucomatous optic atrophy
d. Primary optic atrophy
ANSWER: A
89. A male patient 30 years old with visual acuity of 6/6 in both eyes.
Twelve hours ago he presented with drop of vision of the left eye. On
examination, visual acuity was 6/6 in the right eye and 6/60 in the left
eye. Fundus examination showed blurred edges of the left optic disc.
The most probable diagnosis is:
a. Raised intra cranial pressure
b. Raised ocular tension
c. Central retinal artery occlusion
d. Optic neuritis
ANSWER: D
90. All are seen in 3rd nerve palsy except:
a. Ptosis
b. Diplopia
c. Miosis
d. Outwards eye deviation
ANSWER: C
91. Homonymous hemianopia is due to lesion at:
a. Optic tract
b. Optic nerve
c. Optic chiasma
d. Retina
e. Occipital cortex
ANSWER: A
92.Which is not found in papilloedema?
a. Blurred vision
b. Blurred margins of disc
c. Cupping of disc
d. Retinal edema
ANSWER: C
93. Optic disc diameter is:
a. 1 mm
b. 1.5 mm
c. 2 mm
d. 3 mm
ANSWER: B
94. Optic nerve function is best studied by:
a. Direct Ophthalmoscope
b. Retinoscope
c. Perimetry
d. Gonioscopy
ANSWER: C
NEUROPHTHALMOLOGY
95. Optic nerve axon emerges from:
a. Ganglion cells
b. Rods and cones
c. Amacrine cells
d. Inner nuclear layer
ANSWER: A
96. Papilloedema has all the following characteristics except:
a. Marked loss of vision
b. Blurring of disc margins
c. Hyperemia of disc
d. Field defect
ANSWER: A
97. Homonymous hemianopia is the result of a lesion in:
a. Optic chiasma
b. Retina
c. optic tract
d. Optic nerve
ANSWER: C
98. Mydriasis is present in all the following except:
a. Third nerve lesion
b. Pontine haemorrhage
c. Datura poisoning
d. Fourth stage of anesthesia
ANSWER: B
99. D-shaped pupil occurs in:
a. Iridocyclitis
b. Iridodenesis
c. Cyclodialsis
d. Iridodialysis
ANSWER: D
100. In complete third nerve paralysis the direction of the affected eye in
the primary position is:
a. Inward
b. Outward
c. Outward and up
d. Outward and down
ANSWER: D
STRABISMUS
101. All the following are extraocular muscle of eye except:
a. Superior rectus
b. Ciliary muscle
c. Inferior oblique
d. Superior oblique
ANSWER: B
102. The action of superior rectus is:
a. Elevation, intorsion, abduction
b. Elevation, intorsion, adduction
c. Elevation, extorsion, adduction
d. Elevation, extorsion, abduction.
ANSWER: B
103. The action of inferior oblique is:
a. Depression, extorsion, abduction
b. Depression, extorsion, adduction
c. Elevation, extorsion, adduction
d. Elevation, extorsion, abduction
ANSWER: D
104. The only extraocular muscle which does not arise from the apex of
the orbit is:
a. Superior rectus
b. Superior oblique
c. Inferior oblique
d. Inferior rectus
ANSWER: C
105. In concomitant squint:
a. Primary deviation > Secondary deviation
b. Primary deviation < Secondary deviation
c. Primary deviation = Secondary deviation
d. None of the above
ANSWER: C
106. In paralytic squint, the difference between primary and secondary
deviation in the gaze of direction of the paralytic muscle:
a. Increases
b. Decreases
c. Remains the same
ANSWER: A
107. In grades of binocular vision; grade 2 is:
a. Simultaneous macular vision
b. Fusion
c. Stereopsis
ANSWER: B
108. The best treatment for amblyopia is:
a. Orthoptic exercises
b. Occlusion
c. Surgery
d. Best treat after age 10 years

ANSWER: B

‫لستة جديدة‬
1. Which conjunctivitis is least likely to occur bilaterally?

a. allergic
b. viral
c. bacterial
d. vernal

Answer: The correct answer is (c) bacterial. Allergies are likely to affect both eyes and
present with itching and watering. Vernal is a type of seasonal allergy you see in young
boys. Viral conjunctivitis usually starts in one eye, but hops to the other eye as it is very
contagious. Bacterial conjunctivitis can occur bilaterally, but of the available choices is
most likely to occur in just one eye.

2. You’re consulted by an intern from the ICU because his ventilated patient, with
a head injury, has a fixed and dilated pupil. The intern is concerned for acute
glaucoma. What do you tell him?

a. find a Tono-Pen and check the pressure

b. call his upper-level fellow immediately
c. taper the patient’s benzos
d. increase the PEEP ventilator setting

Answer: Well, you need more history, of course, but any blown pupil in a trauma-ICU
makes me think of an uncal-herniation and impending death. Tell him to (b) find his
senior resident immediately and call you back if they still want an eye-consult.

3. Which optic nerve finding is most concerning for glaucomatous damage?

a. large disk size

b. horizontal cupping
c. vertical cupping
d. disk tilt

Answer: The correct answer is (c) increased vertical cupping, which would go against
the ISNT rule (the Inferior and Superior neural rim is normally the thickest). Many
patients have large myopic (near-sighted) eyes with resulting large optic disks and disk
“tilting” from the angle at which the nerve enters the back of the eye – this is
physiologically normal and not concerning for glaucoma.

4. A young 23-year-old black man presents with a hyphema in the right eye after
blunt injury. All of the following are acceptable initial treatments except?

a. sleep with the head elevated

b. prednisolone steroid eye drops
c. cyclopentolate dilating drops
d. carbonic anhydrase inhibitor pressure drops
Answer: The correct answer is (d). For patients with hyphema (blood in the eye) advise
them to avoid straining and sleep with their heads elevated to allow the blood to settle.
Use steroids to decrease the inflammation and a medium-acting cycloplegic to dilate the
eye for comfort and to keep the inflamed iris from “sticking” to the lens underneath. If
the pressure is high, you can use pressure drops, but we avoid CAIs in African
Americans as it induces RBC sickling in sickle-cell patients. You can get a sickle prep if
you are suspicious for this disease.

5. A 7-year-old boy presents with a grossly swollen eyelid. His mother can’t think
of anything that set this off. What finding is most characteristic of orbital
cellulitis?

a. chemosis
b. warmth and erythema of the eyelid
c. physically taut-feeling eyelid
d. proptosis

The correct answer is (d). With any eyelid cellulitis, you must determine if the infection is
pre-septal or post-septal (i.e. orbital cellulites). While chemosis is certainly seen with
orbital infection, proptosis is even more indicative of orbital infection. Other signs
include decreased eye-movement, pain with eye-movement, and decreased vision.

6. What location for a retinal detachment would be most amenable to treatment by

pneumatic retinopexy?

a. inferior rhegamatogenous detachment

b. superior tractional retinal detachment
c. superior rhegamatogenous detachment
d. traumautic macular hole

Answer: This question covers several concepts. Rhegamatogenous detachments are

the classic detachment occuring from a break in the retina. A pneumatic retinopexy is
the technique of injecting a gas bubble into the eye that floats and tamponades the
break. Gas bubbles require careful head-positioning and work best for superior breaks
(patients can’t stand on their heads for weeks for inferior breaks). The correct answer is
therefore (c).

7. A mother brings in her two-year old child because she is concerned that her
baby is cross-eyed. Which of the following is an inappropriate statement:

a. the baby may maintain 20/20 vision

b. the esotropia could could lead to permanent vision loss
c. the esotropia might be corrected with glasses alone
d. surgical treatment should be delayed until adolescence
Answer: Answer (d) is the inappropriate statement. Esotropia (cross-eyed) is a common
finding in the pediatric clinic. There are many causes, and one of them is poor vision in
one eye. Spectacle vision can help anisometropic eyes fuse images properly and
correct the alignment problem. This condition should be treated promptly, via spectacle
correction, and possibly patching the strong eye to avoid amblyopia – if the crossing
doesn’t correct with these measures, then you procede to surgical options. A child may
maintain good vision in each eye if the kid learns to cross-fixate (switch eye dominance
depending upon what direction the child is looking). There is no point in waiting until
adolescence – you want to avoid an amblyopic eye and give the child a chance to
develop good stereopsis at an early age.

8. Which of the following is the biggest risk factor for primary open angle
glaucoma?

a. Asian ancestry
b. smaller diurnal pressure IOP changes
c. thin corneas
d. large optic disks

Answer: Asians are more likely to develop acute angle-closure glaucoma, not POAG.
Everyone has diurnal eye pressure changes, and there is some evidence that
glaucomatous patients have larger shifts in their pressure throughout the day. Large
optic disks aren’t concerning, though large cupping of a disk could indicate nerve fiber
loss from glaucoma. Thin corneas ARE associated with glaucoma, as shown by the
famous OHTS clinical trial. We measure every new glaucoma patient’s corneal
thickness with a small ultrasound pachymeter. The correct answer is (c).

9. A 27-year-old contact lens wearer presents to the ER complaining of ocular

irritation. On exam he has a small 2mm corneal abrasion. You should

a. treat with erythromycin ointment

b. treat with ciprofloxacin drops
c. bandage contact lens for comfort and speed reepitheliazation
d. patch the eye and follow-up in 72 hours

Answer: You need to be concerned for pseudomonas infection in any contact lens
wearer. Erythromycin is great stuff, but these higher risk patients should get something
stronger like a fluoroquinolone (cipro). A bandage contact lens can help with painful
abrasions, but I’d avoid one in this patient as the abrasion isn’t big, and you typically
don’t patch ulcers. Patching can also be used to help with lubrication and comfort, but I
never patch a potential infection, as bacteria like to grow in dark warm environments. If
you decide to patch, you need to see daily to make sure nothing is brewing under that
lens. The most appropriate answer is (b).

10. A woman presents to you complaining of a red, watering eye for the past two
days with stinging and some photophobia. Her vision has dropped slightly to
20/30. She has a history of diabetes and taking drops for glaucoma, but is
otherwise healthy. The most likely cause of her redness is:

a. angle-closure glaucoma
b. viral conjunctivitis
c. diabetic retinopathy
d. papilledema

This woman probably has a history of POAG (primary open angle glaucoma) if she is on
drops. If she were to have an acute angle closure, then her eye would be very painful
and the vision would have gotten much worse from corneal edema. Diabetic retinopathy
is usually a background finding of leaky vessels in the retina and doesn’t create this
picture. She merits a full eye exam, but her symptoms are consistant with “pink eye”
with viral conjunctivitis being the most common cause in an adult. The correct answer is
therefore (b).

11. A patient presents after MVA with a fracture of the orbital floor. What would be
the indication for surgery in the near future?

a. double vision that worsens with upgaze

b. chemosis and moderate proptosis
c. restricted forced ductions
d. decreased extraocular movement

Answer: Floor fractures are very common and these patients always look impressively
bad on exam, with marked swelling and subconjunctival bleeding. They can have
decreased EOMs and proptosis from this swelling alone, which shouldn’t concern you.
More worrisome is entrapment of the inferior rectus muscle in the orbital floor – this
entrapement can only be determined by forced ductions … grab the limbus with forceps
and tug on the eye to see if movement is restricted. The correct answer is (c).

12. A 64-year-old man presents to you with new onset of “crossed-eyes.” His left
eye can’t move out laterally and he has a chronic mild headache that he attributes
to eyestrain. Which of the following is least likely the cause of his condition:

a. hypertension
b. diabetes
c. aneurysm
d. increased intracranial pressure

Answer: The most common causes of all the ocular nerve palsies are from vasculitic
events secondary to diabetes or hypertension. It sounds like this patient has a CN6
palsy as he can’t abduct his eye. With abducens palsy you should always consider
increased intracranial pressure. A internal carotid aneurysm could hit the 6th nerve in
the cavernous sinus, but you would expect other findings with these cavernous lesions.
Aneurysms in general cause more third nerve palsies. Thus, the correct answer is (c).
13. The abducens nucleus would be most affected by a brainstem lesion at:

a. pons
b. mid-brain
c. medulla
d. foramen magnum

To answer this question you need to know where the 6th nerve nucleus is located. One
useful aid is the “4-4 Rule,” which states that the bottom four nuclei (CN 12,11,10,9) are
in the medulla, while the next four nuclei (CN 8,7,6,5) are in the pons. The correct
answer is therefore (a).

14. The pupillary defect that affects the afferent arm of the pupillary response is
the:

a. Marcus Gunn pupil

b. Argyl Robberson pupil
c. Adies pupil
d. Horners pupil

A Marcus Gunn pupil is the classic afferent pupillary defect (APD) that we check with
the swinging light test. The Argyl Robberson is the syphilitic pupil that reacts with near
vision, but doesn’t respond to light. Horners and Adies are disorders of the sympathetic
and parasympathetic efferent pupil response. The correct answer is (a).

15. Aqueous fluid is produced in which chamber?

a. anterior chamber
b. vitreous chamber
c. posterior chamber
d. trabecular chamber

There are actually three chambers in the eye. Aqueous is produced in the posterior
chamber where it flows forward into the anterior chamber and drains through the
trabecular meshwork into the canal of Schlemm. The vitreous chamber is the big one in
the back that is filled with jelly-like vitreous humor. The correct answer is therefore (c).

16. Which orbital bone is most likely to fracture with blunt trauma to the eye?

a. zygomatic
b. maxillary
c. ethmoid
d. sphenoid

Answer: The orbital floor, which is formed by the maxillary bone, is the most commonly
fractured wall of the orbit. Orbital fat will commonly herniate through this bone and
muscle can get stuck if the break acts like a trapdoor. The ethmoidal lamina papyracea
is also often broken because it is the thinnest, but this occurs less often because of
extensive bolstering. The lateral zygomatic component of the orbit is rarely broken, nor
the more posterior sphenoid. The correct answer is (b)

17. When a patient focuses on near objects, the lens zonules:

a. rotate
b. contract
c. relax
d. twist

Answer: The zonules connect to the lens periphery and suspend the lens like a
trampoline to the surrounding ciliary muscle. With near vision, the ciliary body contracts
like a sphincter, causing the zonules to relax, and the lens to get “rounder.” This
rounding of the lens increases its refractive ability and allows focusing of near objects.
With age, the lens hardens and loses its ability to round out – a process called
presbyopia. The correct answer here is (c).

18. What is glaucoma?

a. retinal damage from high intraocular pressure

b. optic nerve death caused by mechanical stretching forces
c. ischemic nerve damage from decreased blood perfusion gradients
c. none of the above

Answer: The best answer here is probably the last one, as no one really understands
the pathogenesis of glaucoma. Ultimately, it involves death of the nerve fibers and it
seems associated with high ocular pressure – this is certainly the only risk factor that we
can treat. However, there are plenty of patients out there with glaucoma damage and
normal eye pressure, so pressure isn’t the “ultimate cause.” There are many mechanical
and biochemical theories that explain glaucoma damage, and each has its merits and
faults.

19. Which condition would result in an inaccurately high reading with applanation
pressure measurement?

a. thin cornea
b. thick cornea
c. edematous cornea
d. keratoconus

Answer: We measure pressure by pushing the cornea with a weighted device – a

process I compare to kicking a car tire to determine the air pressure. Patients with thick
“truck-tire corneas” are going to feel hard when you measure them. Conversely, people
with thin “bicycle-tire” corneas are going to feel softer. Corneal edema also makes the
eye feel squishy (giving a falsely low pressure) and patients with keratoconus often
have thin corneas. The correct answer here is (b).

20. Gonioscopy overcomes the concept of:

a. angled biomicroscopy
b. spherical abberation
c. total internal reflection
d. specular microscopy

Answer: The trabecular meshwork can’t be visualized directly because light coming
from this angle bounces off the inner cornea back into the eye because of Snell’s Law
and total internal reflection. By placing a hard glass lens onto the eye, the cornea-air
interface is broken and light can escape and be seen through the microscope. The
correct answer is therefore (c).

21. A 32-year-old white man with a history of type-1 diabetes presents to you
complaining of decreased vision. He has not seen an eye doctor in years. On
exam, you find numerous dot-blot hemorrhages, hard exudates, and areas of
abnormal vasculature in the retina. Pan-retinal photocoagulation might be done in
this patient to:

a. kill ischemic retina

b. tamponade retinal tears
c. ablate peripheral blood vessels
d. seal off leaking blood vessels

Answer: PRP is performed to kill areas of peripheral ischemic retina. By doing so, less
VEGF is produced, leading to cessation and regression of neovascularization. While it is
true that we sacrifice some of the peripheral retina with PRP, it is worth it to save
important central vision. Lasers can be used to help peg down retinal tears and to help
with leaking vessels … but this is called “focal laser therapy.” The correct answer here
is (a).

22. Which of the following is a risk factor for retinal detachment?

a. black race
b. male sex
c. presbyopia
d. myopia

The correct answer is (d) myopia. Myopic (near-sighted) eyes are large eyes with a
stretched-out retina that is more likely to tear at the periphery. Neither blacks nor males
are at higher risk of RD. Presbyopic lens hardening doesn’t have anything to do with the
retina.
23. A 57-year-old man complains of flashing lights and a shade of darkness over
his inferior nasal quadrant in one eye. On exam you find the pressure a little
lower on the affected eye and a questionable Schaffer’s sign. What condition
would lead you to immediate treatment/surgery?

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 tear with sub-retinal fluid

Answer: Schaffer’s sign is when you see pigment behind the lens on slit-lamp exam,
and occurs with retinal detachments and the release of pigment into the vitreous
chamber. A macula-off retinal detachment is unfortunate, but isn’t an immediate
emergency – it certainly needs to be repaired, but can wait for a few days if necessary,
as the damage to the detached macular photoreceptors has already occured. Epi-retinal
membranes are common and aren’t an emergency unless actively creating a tractional
detachment. Vitreous hemorrhages are not emergencies either, assuming there isn’t a
detachment behind that blood on your ultrasound. Smaller retinal tears, however, need
to be treated early to make sure they don’t progress and peel off the macula. The
answer is (d).

24. Oral doxycycline helps blepharitis patients by:

a. therapeutic antibiotic tear secretion

b. changing lipid viscosity
c. inhibiting cytokine release
d. improved lacrimal gland excretion

Doxycycline changes the lipid viscosity of the meibomian gland secretions, improving oil
secretion from the gland into the tear film. This superficial lipid layer is needed to keep
the tears from evaporating too quickly. The correct answer is (b).

25. Put the following retinal layers in order from inside (next to the vitreous) to
outside:

a. Ganglion nerves, photoreceptors, choroid, then sclera on the outside.

b. Photoreceptors, ganglion nerves, choroid, then sclera on the outside.
c. Choroid, photoreceptors, ganglion nerves, then sclera on the outside.
d. Choroid, ganglion nerves, photoreceptors, then sclera on the outside.

Answer: The correct answer is (a). This question illustrates a few important concepts.
The first is that the photoreceptor cells lie relatively deep in the retina, such that light
has to pass through many layers to reach them. One of these layers is the ganglion
layer of nerve fibers that form the surface of the retina as they travel to the optic nerve.
The choroid is a deeper bed of blood vessels that nourishes the photoreceptors from
below, while the sclera is the tough collagen matrix that forms the outer wall of the eye.
26. In the absence of lens accommodation, a myopic eye focuses images:

a. in front of the lens

b. In front of the retina
c. behind the retina
d. Behind the cornea

Answer: The correct answer is (b). Myopic, or near-sighted eyes, are typically large
eyes that focus images in the middle of the eye, in front of the retina within the vitreous
chamber. These eyes require a minus concave-shaped lens in their glasses – this
effectively weakens the overall refractive power of the eye, allowing images to focus
further back on the retina.

27. A man calls the office complaining of splashed bleach in his eye. You should
instruct him to:

a. patch the eye and immediately go to the office

b. irrigate the eye for 15 minutes and then go to the office
c. immediately apply lubricating ointment and then go to the office
d. immediately wash the eye with contact saline solution and go to the office if he
notices any change in vision

Answer: The final visual outcome for a chemical burn is going to depend upon how
quickly the chemical is washed out of the eye, so have your patient wash out their eye
immediately! Chemical injury is one of the few eye problems that you treat prior to
checking vision. The correct answer here is (b).

28. What antibiotics would you use in a newborn with suspected chlamydial
conjunctivitis?

a. Ciprofloxacin drops
b. Erythromycin drops
c. Oral Doxycyline
d. Erythromycin drops and oral erythromycin

Answer: Chlamydia is one cause of conjunctivitis you should suspect in the newborn.
Treatment involves topical drops such as erythromycin and systemic coverage because
of concurrent respiratory symptoms these kids can develop (as chlamydia infects
mucous membranes and give a pneumonitis). You don’t use doxy in children.
Fluoroquinolones might work, but we don’t use them in children because of theoretical
bone suppression. The correct answer is (d).

29. You are measuring the deviation in a child with strabismus. The corneal light
reflex is 2mm temporal to the pupil in the right eye. How much deviation would
you estimate?
 a. 10 diopters esotropia
b. 20 diopters exotropia
c. 30 diopters esotropia
d. 40 diopters exotropia

Answer: You can estimate deviation using the Hirshburg rule – for every mm the reflex
is decentered, equals 15 diopters of deviation. This child has 30 diopters of deviation,
and an esotropia, so (c) is the correct answer.

30. Steroids typically induce what kind of cataract?

a. Nuclear sclerotic
b. Posterior polar
c. Posterior subcapsular
d. Cortical

Answer: Steroids and diabetes are classically known to cause posterior subcapsular
cataracts on the back surface of the lens. Nuclear sclerotic cataracts are common and
usually from aging. Posterior polar cataracts are often congenital. Cortical cataracts are
also common and have many causes. The correct answer is (c).

‫الجواب الخط الخشن‬

 1.        The first line of treatment in chemical injury is

a. admission if severe
b. topical antibiotics
c. topical cycloplegia
d. neutralization of pH by irrigation
e. oral analgesia

           2.   In blow out fracture the commonest bone to fracture is

a. maxillary (floor)
b. zygomatic (lateral wall)
c. lachrymal (medial wall)
 d. frontal (roof)
e. ethmoidal (medial wall)

            3.     Following are the features of orbital floor fracture

a. diplopa on upgaze and downgaze

b. damage to supra-orbital nerve
c. haemoptysis
d. numbness of lateral canthus
e. haziness of ethmiodal sinus on x ray

              4.     The commonest painless lid swelling is

                       a.         stye
                       b.         cyst of moll
                       c.           cyst of zeis
                       d.           internal hordeolum
                       e.          chalazion

        5.  The most commont cause of proptosis is

a. orbital infection
b. orbital hemorrhage
c. orbital tumor
d. orbital pseudo-tumor
e. thyroid ophthalmopathy

       6.    A patient presents with red eye, decreased visual acuity, raised Intraocular pressure &
shallow    anterior chamber. The likely diagnosis is

a. cataract
b. open angle glaucoma
c. retinal detachment
d. hyphema
e. acute angle closure glaucoma

   7.  Female with uncontrolled diabetes presents with painful red eye and visual acuity is also
decreased. On examination there was raised Intraocular Pressure and new blood vessels on
the iris. The treatment includes all except.
 a. atropine
b. beta blockers
c. steriods
d. pain killers
e. pilocarpine

           8.    The commonest cause of cataract is

a. trauma
b. diabetes
c. hypo-parathyroidism
d. TORCH infections
e. old age

          9.    Regarding Phaco-Emulsification, better visual outcome is expected when

a. Operation is performed via superior clear corneal incision

b. Operation is performed via superior scleral tunnel incision
c. Operation is performed via supero-temperal clear corneal incision
d. Operation is performed via temporal clear corneal incision
e. Operation is performed via temporal scleral tunnel operation

    10.  Phaco-Emulsification is done except in

a. Immature cataract
b. Mature cataract
c. Hyper-mature cataract
d. Hype-mature morgagnian cataract
e. Dislocated cataract

   11.  On gonioscopy following structures are visible

a. Most anterior is bowmans layer

b. Next is trabecular meshwork
c. Next scleral spur
d. Next ciliary body
e. And lastly iris recess

  
         12.  In Addition to High IOP and High vertical cup-disc ratio, risk factors for POAG include
all of the following except
          a.    Old age
           b.    Family history
          c.    Retinal nerve fibre defects
          d.    Parapapillary changes
          e.    Hypermetropia

   13.  The earliest visual field defect in POAG is

                      a.          Isolated paracentral nasal scotoma
                      b.             Bjerrums scotoma
                      c.              Arcuate scotoma
                      d.             Altitudinal Scotoma
                      e.             Centrocecal scotoma

     14. Chronic simple glaucoma, is a generally bilateral, but not always symmetrical disease,
characterized by:

a. An IOP  21mmHg.
b. Angle grade II.
c. Glaucomatous optic nerve head damage.
d. Altitudinal field defects

15.  Specific sign of glaucomatous damage is

a. Baring of circumlinear blood vessels

b. Bayoneting
c. The laminar dot sign
d. Disc haemorrhages
e. Superior or inferior polar notching of the cup

16.  in myopia

a. Length of eye ball is short

b. Corneal radius of curvature is less
c. Lens is less spherical
d. Image forms in front of the retina when the patient accommodates
e. Patient can see far objects clearly when he exerts accommodation

17.  Symptoms of cataract include all of the following except

a. Halos
b. Decreased vision in low illumination
c. Decreased vision in bright light
d. Glare
e. Sudden loss of vision
18.  Treatment options in POAG may include all except

a. pilocarpine
b. beta blockers
c. prostaglandin analogues
d. carbonic anhydrase inhibitors
e. atropine

19.  WHO grading of trachoma includes all except

a. TF follicles
b. TI inflammation
c. TS scarring
d. TT trichiasis
e. TP pannus

    20.  Least common cause of sudden loss of vision is

a. Vitreous hemorrhage
b. Optic neuritis
c. Central retinal venous occlusion
d. Central retina artery occlusion
e. Retinal detachment

    21.  Best vision in moderate myopia is achieved by

a. glasses
b. soft contact lenses
c. rigid gas permeable lenses
d. Laser vision correction procedures
e. kerato-melieusis

     22.  Complications of contact lenses include all of the following except

a. Allergy
b. Corneal infiltrates
c. Corneal ulcer
d. Permanent loss of vision
e. Corneal pigmentation
      23.  Pupil in acute anterior uveitis is

a. miosed and regular with poor reaction

b. miosed and irregular with poor reaction
c. dilated and irregular with good reaction
d. dilated and regular with poor reaction
e. mid-dilated and oval with poor reaction

     24.  According to WHO a person is blind when

a. vision in better eye is less than 2/60 and/or visual field is less than 30 degrees in better
eye
b. vision in better eye is less than 3/60 and/or visual field is less than 30 degrees in
better  eye
c. vision in better eye is less than 3/60 and/or visual field is less than 20 degrees in better
eye
d. vision in better eye is less than 3/60 and/or visual field is less than 60 degrees in better
eye
e. vision in better eye is less than 5/60 and/or visual field is less than 30 degrees in better
eye

    25.  The most common cause of reduced vision in the world is

a. trachoma
b. diabetic retinopathy
c. refractive errors
d. glaucoma
e. cataract

        26.   Ayoung male of 22years present with gradual decrease of visual acuity in both eyes and
change of refractive error on examination with retinoscope there was high astigmatism.
Give likely diagnosis?
                        a.             keratoglobus
                        b.            keratoconus
                        c.              megalocornea
                        d.              buphthalmos
                        e.              keratitis

          27.  A young boy presented in emergency with watering and photophobia in right eye. Which
test is appropriate?
                              a.          Schirmer test
                              b.         Tear breakup time
                              c.           Rose Bengal staining
                              d.           Applanation tonometry
                              e.           Flouroscine staining
          28.When the eye is medially rotated, the prime depressor muscle of eye ball 
                 a.                   Inferior rectus
                 b.                  Inferior oblique
                 c.                   Superior oblique
                 d.                  Inferior rectus and inferior oblique
                 e.                   Lateral rectus

           29.  A patient on slit lamp examination shows hypopyeon in anterior chamber after trauma,
which is due to
a.         Pus in anterior chamber
b.      Cells in anterior chamber
c.       Protein in anterior chamber
d.      Blood in anterior chamber
e.       Foreign body in anterior chamber

30.  A patient have blunt trauma with tennis ball and having hyphema, which is
                  a.       Pus in anterior chamber
                  b.      Foreign body in anterior chamber
                  c.       Uveal tissue
                  d.      Blood in anterior chamber
                  e.       Cells in anterior chamber
 
31.  Calculation of IOL power is called

a. Biometry
b. Pachymetry
c. Tonometry
d. Keratometry
e. Ophthalmoscopy

            32.   Benign tumors of eye except

           a.       Limbal dermoid
           b.      Chlazion
           c.       Orbital cyst
           d.      Dermoid cyst
           e.       Rhabdomyosarcoma

        33. An infant presented with sticky discharge both eyes and extreme congestion of
conjunctiva. Provisional diagnosis is the ophthalmia neonatroum which is caused by

a. Gonococcus
b. E.Coli
c. Staph.aureous
d. Streptococcus
 e. Diphtheria

            34.  Timolol is
                a.         Beta blocker
                b.          Carbonic anhydrase inhibitor
                c.          Antibiotic
                d.          Alpha blocker
                e.         Calcium channel blocker

            35.  Aphakia can be corrected by following

a. Specticles
b. Contact lenses
c. Anterior chamber IOL
d. Posterior chamber IOL
e. All of above

          36. A patient presented with diplopia in primary position along with ptosis in left eye. The
eye was deviated infrolaterally. The diagnosis will be

a. Fourth nerve palsy

b. Third nerve palsy
c. Sixth nerve palsy
d. Seventh nerve palsy
e. All above

     37.  Retinoscopy is done for

a. Examination retina
b. Examination optic nerve
c. Refractive power of eye
d. Axial length of eye
e. To find out the power of IOL

          38. A patient presented with sudden painless loss of vision in left eye. Patient is known
diabetic. How you are going to examine the patient except

a. Retinoscopy
b. Direct ophthalmoscopy
c. Indirect ophthalmoscopy
d. Slit lamp examination
e. Examination with triple mirror
            39.  A young patient presented with Rosette shaped cataract which is characteristic of

a. Senile cataract
b. Complicated cataract
c. Secondary to diabetes
d. Radiation induced cataract
e. Traumatic cataract with blunt trauma
            40.   A patient presented with photophobia and watering in left eye. On examination with
fluorescein staining revealed dendritic ulcer which is caused by

a. Staphylococci
b. Fungal
c. Herpes simplex virus
d. Herpes zoster virus
e. Mycobacterium

             41.     Distichiasis is
                a.   Misdirected eye lashes
                b.    Accessory row of lashes
                c.    Everted lid margin
                d.    Inverted lid margin
                e.     Drooping of upper lid

42. Traucoma is associated with except

a. Tranatas dots
b. Follicles
c. Papillae
d. Herbit pits
e. Corneal pannus

43. Nasolacrimal duct opens in

a. Superior meatus
b. Inferior meatus
c. Middle meatus
d. Nasopharynx
e. None of above

44.  A patient of 45 years old presented with facial palsy. The epiphora in this  patient was
due to
           a.       Ectropion
           b.      Entropion
           c.       Lagophthalmos
           d.      Lacrimal pump failure
           e.       Hyper screction of tears

45. foreign body sensation can be produced by all except

           a.       Allergic conjunctivitis
           b.      Viral conjunctivitis
           c.       Cataract
           d.      Contact lens wear
           e.       Trichiasis
 46. Exophthalmos associated with thyroid ophthalmopathy have following clinical signs
except
           a.       Proptosis
           b.      Ptosis
           c.       Lid retraction
           d.      Conjunctival chemosis
           e.       Extraocular muscle thickening

47. A patient presented with gross decrease of vision. On torch examination there was
conjunctival congestion and pupil miosed. Which is the probable diagnosis
           a.       Anterior uveitis
           b.      Acute congestive glaucoma
           c.       Conjunctivitis
           d.      Scleritis
           e.       Foreign body

48. A patient with sudden painless loss of vision and no fundal view was possible. Which of
the investigation is helpful to see the retina.
           a.       Keratometry
           b.      Pachymetry
           c.       B-Scan
           d.      A-Scan
           e.       Indirect ophthmoscopy

49.  A hypertensive and diabetic patient presented with sudden painless loss of  vision.
What are the possibilities except
           a.       CRAO
           b.      CRVO
           c.       Vitrous Hemorrhage
           d.      Retinal detachment
           e.       Neovascular glaucoma

50. Myopia is a condition which is

           a.       Farsightedness
           b.      Correction with concave lens
           c.       Correction with convex lens
           d.      Image formed behind the retina
           e.       Eye ball is small

51. Hypermetropia is a condition in which except 

           a.       Axial length of eye ball is small
           b.      Correction with convex lens
           c.       Image formed behind the retina
           d.      Refractive error can be diagnosed by retinoscopy
           e.       Rays of light converged behind the retina when accommodation reflex is active
 52. A patient who was operated for cataract four months back comes to you with foggy
vision. On examination there was posterior capsular thickening, which mode of treatment
is most useful.
           a.       Excimer laser
           b.      YAG-Laser
           c.       Argon laser 
           d.      Krypton laser
           e.       Diode laser

53. In diabetic retinopathy the new vessel formation is due to following pathology
           a.       Retinal hemorrhage
           b.      Vitreous hemorrhage
           c.       Retinal oedema
           d.      Retinal ischemia
           e.       Retinal breaks

54. Esotropia is
            a.       Divergent squint
            b.      Latent convergent squint
            c.       Associated with accommodation reflex
            d.      Associated with accommodation and hypermetropia
            e.       None of above

55. Exophoria is
            a.       Latent convergent squint
            b.      Alternate divergent squint
            c.       Associated with accommodation reflex
            d.      Latent divergent squint
            e.       None of above

56. Which of the following regarding atropine is true

            a.       Increases IOP
            b.      Used in neovasular glaucoma
            c.       Miosis
            d.      Atropine is weak cycloplegic
            e.       All of above

57. Pathognomic clinical signs of proliferative diabetic retinopathy is

            a.       Micro aneurysms
            b.      Hard exudates
            c.       Deep retinal hemorrhages
            d.      Neovascularization of retina
            e.       Vitreous hemorrhage
 58. A child of one year old presented with watering in left eye and sticky discharge. On
examination regurgitation test was positive. What is the diagnosis?
            a.       Nasolacrimal duct block
            b.      Common canaliculus block
            c.       Punctal atresia
            d.      Buphthalmos
            e.       None of above

59.  Regarding probing and syringing test, which statement is true

            a.       Recommended for acute dacryocystitis
            b.      Regurgitation is positive
            c.       Congental nasolacrimal duct block
            d.      Chronic dacryocystitis in old age
            e.       None of above

60. Optic disk oedema is seen in all except

            a.       Papilloedema
            b.      CRVO
            c.       Open angle glaucoma
            d.      Hypertensive retinopathy
            e.       Papilitis 

General Ophthalmology MCQs with their answers

‫االجوبة باالخير اعتذر‬

Q1. Superior tarsal muscle (Muller's muscle) is supplied

by the :
a- Third cranial nerve
b- Sympathetic nerve fibres
c- Parasympathetic nerve fibres
d- Seventh cranial nerve

 
 ***
Q2. The anterior most structure in the eyelid margin is
the :
a- mucocutaneous junction
b- gray line
c- meibomian gland orifices
d- lash line

***
Q3. The anterior lamella of eyelid contains :
a- Glands of Wolfring
b- Zeis glands
c- Glands of Krause
d- Meibomian glands

***
Q4. Which of these is a common occurence with
chalazia :
a- Complete spontaneous resolution with time
b- Conjunctival side of the lesion is reddish or purplish
c- Transformation to malignancy
d- Presentation as nodule in the intermarginal strip

***
Q5. The anterior and posterior lamellae of the lid can be
separated at the level of the lid margin by the :
a- lash line
b- line of meibomian gland orifices
c- gray line
d- mucocutaneous junction

***
Q6. Tylosis refers to :
a- loss of lashes
b- misdirection of lashes
c- blocked meibomian orifices
d- hypertrophied drooping lid

***
Q7. Digital pressure on the lid margin leads to a pasty
discharge from the meibomian gland orifices. Which of
the following statements is TRUE regarding this
patient :
a- Epiphora is a commom symptom
b- Treatment with tetracyclines for 2 weeks is curative
c- Punctate fluorescein staining of the ocular surface could be
present
d- Tear film break up time (TBUT) will be prolonged

***
Q8. Madarosis may be seen in :
a- eyelid neoplasm
b- chronic blepharitis
c- Hansen's disease
d- all of the above

 
 ***
Q9. Fibrin collarette around the base of the eyelashes in
children is due to :
a- squamous blepharitis
b- meibomian seborrhea
c- ulcerative blepharitis
d- meibomianitis

***
Q10. Chalazion :
a- is also called as tarsal cyst
b- can result in preseptal cellulitis if untreated
c- heals if the affected lash is pulled out
d- is a non-suppurative inflammation of a Zeis gland

***
Q11. Lid findings in Stevens Johnson syndrome includes
:
a- distichiasis
b- trichiasis
c- irregular posterior margin
d- All of the above
 
 
 

Q12. The vertical tautness of the lid can be restored in

involutional entropion by :
a- shortening the width of the tarsal plate
b- lateral tarsal strip procedure
c- reattachment of retractors to tarsal plate
d- all of the above

***
Q13. Which of the statements below regarding both
involutional type of entropion & ectropion is FALSE :
a- Lid laxity is an important causative factor
b- Lateral tarsal strip procedure attaching tarsus to lateral orbital
rim is useful in both cases
c- Tearing is a chief symptom
d- Conjunctival spindle excision below the punctum can help mild cases

***
Q14. Cicatricial ectropion can result from all of the
following EXCEPT :
a- chalazion treatment
b- burns
c- trauma
d- eyelid skin incision

***
Q15. Gold weight is placed pretarsally in the upper lid
in :
a- ankyloblepharon
b- involutional ectropion
c- lagophthalmos VII nerve palsy (Bell's palsy) e
d- spastic entropion of upper lid
 ***
Q16. Causes of spastic enropion include
a- Ocular bandaging
b- Chronic blepharitis
c- Stevens-Johnson syndrome
d- All of the above

***
Q17. Abnormal lid laxity is diagnosed if :
a- lid can be drawn away by more than 10 mm from the globe
b- the punctum is visible only when the lid is pulled down
c- pulling the lower lid laterally causes medial canthus displacement
more than 4 mm
d- the lid does not snap back immediately when drawn away from the
globe and released

***

Q18. Keratinization of the lid margin can result from :

a- Blepharospasm
b- Severe ectropion
c- Spastic entropion
d- Lagophthalmos

***
Q19. The lower lid is kept opposed to the globe by
which of the following mechanisms :
a- The capsnlopalpebral fascia acts as the lower lid retractor
b- The tarsal plate is attached to the bony orbit via taut canthal
ligaments
c- The pretarsal orbicularis has firm connections with the tarsus
d- All of the above

***
Q20.A male patient was complaining of continuous
redness of both eyes, foreign body sensation, and
frequent loss of lashes. On examination, the lid margins
were hyperaemic, and the lashes were matted with
yellow crusts, which left painful ulcers on trying to
move. The most reliable diagnosis is

A. Scaly blepharitis
B. Cicartricial entopion
C. Spastic entopion
D. Ulcerative blepharitis

***
Q21.Staphylococcal infection of sebaceous glands of the eye lids is
called
A. Blepharitis
B. Conjunctivitis
C. Keratitis
D. Hordeolum
 
 
Q22.Which of the following statements is most correct:
a- Hordeolum involves the meibomian glands whereas Styes and
Chalazions do not.

b- Chalazions are caused by infections (usually Staphylococcus aureus)

whereas hordeolums are not.

c- Chalazions are often painless

d- Hordeolums are bilateral and styes are unilateral

e- All of the above are correct

***
Q23. True or False? The two major types of ptosis are
congenital and acquired.
a- True
b- False
***
Q24. The most common type of congenital ptosis is :
a- Aponeurotic
b- Neurogenic
c- Traumatic
d- Myogenic
 ***
Q25. Extraocular movement testing in congenital
myogenic ptosis may reveal limited :
a- adduction
b- abduction
c- supraduction
d- infraduction
***
Q26. True or False? Acquired ptosis is devided into
myogenic,neurogenic,aponeurotic,mechanical,protective
and pseudoptosis causes.
a- True
b- False

***
Q27. Regarding Horner's syndrome
a- Ptosis of moderate to severe degree may be seen
b- The miotic pupil constricts to light
c- Loss of accomodation is seen in the case of third order neuronal
lesions
d- The near reflex is absent in the miotic pupil

***
Q28. Pupil involving third nerve palsy is caused in case
of
a- intracranial aneurysm
b- diabetes mellitus
c- hypertensin
d- all of the above

***
Q29. The position of the eye ball in a patient with total
III nerve palsy is
a- down & in
b- up & in
c- down & out
d- up & out

***
Q30. A 4 year old child with severe bilateral congenital
myogenic ptosis with poor elevator function
a- will have a chin up head position
b- will benefit from bilateral frontalis suspension procedure
c- is likely to have amblyopia
d- All of the above are true

***
Q31. Which of these acquired ptosis can be an indication
of life-threatening condition
a- ptosis with deep sulcus and lid drop in down gaze
b- ptosis with pupil sparing III nerve palsy in a 50 year old diabetic
c- ptosis due to isolated third nerve palsy following old closed head
injury
d- ptosis which increases by evening
 ***
Q32. True or False? Enophthalmos and microphthalmia
are included in congenital ptosis.
a- True
b- False

***
Q33. True or False? Lid tumors and cicatricial
conjunctivitis are included in mechanical acquired
ptosis.
a- True
b- False

***
Q34. Components in blepharophimosis include
a- horizontally elongated palpebral aperture
b- bilateral ptosis
c- epicanthus
d- all of the above

***
Q35. All of the following statements regarding
dermatochalasis are true EXCEPT
a- It commences during puberty
b- It results in pseudoptosis
c- Blepharoplasty can correct the disorder
d- There is redundant skin around the eye lids

***
Q36.Ectropion of the upper eyelid may be
a- senile
b- paralytic
c- congenital
d- None of the above

***
Q37.All of the following types of entropion are known
except
a- Spastic entropion
b- Senile entropion
c- Paralytic entropion
d- Cicatricial entropion

***
Q38.All of the following are causes of lagophthalmos
except
a- facial nerve palsy
b- proptosis
c- cicatricial ectropion
d- third nerve paralysis

***
Q39.Ectropion of the upper lid most commonly
a- Spastic ectropion
b- Senile ectropion
c- Paralytic ectropion
d- Cicatricial ectropion
***
Q40.Third cranial nerve innervates all of the following
except
a- Superior oblique muscle
b- Levator palpebrae muscle
c- Inferior oblique muscle
d- Medial rectus muscle

Answer key
1- B
2- D
3- B
4- B
5- C
6- D
7- C
8- D
9- C
10- A
11- D
12- C
13- D
14- A
15- C
16- A
17- D
18- B
19- D
20- D
21- D
22- C
23- A
24- D
25- C
26- B
27- B
28- A
29- C
30- A
31- D
32- B
33- A
34- A
35- A
36- D
37- C
38- D
39- D
40- A