Anatomy of the Eye, Orbit and related

structures 2016
Question 1
With regard to the anterior chamber, which of the following statements is most likely to be true?

a) It contains approximately 100 μl of aqueous humour.

b) Its posterior border is the anterior iris epithelial layer.
c) The depth reduces on accommodation.
d) The drainage angle cannot be viewed with simple magnification.

Answer 1 : d

The anterior chamber has a volume of approximately 250 μl although this clearly varies
between individuals, hypermetropes having smaller anterior chambers than myopes.
The anterior iris does not have an epithelium and the posterior border is the anterior border
layer of the iris which is modified stroma containing fibroblasts, melanocytes and a few
collagen fibrils.
A number of studies have shown that there is no significant change in anterior chamber depth
with accommodation.
Because of the angle of incidence of light from the drainage angle to the cornea there is total
internal reflection so it cannot be viewed with the slit lamp without neutralizing this effect
with a gonioscopy lens.

Question 2
With regard to the ciliary ganglion which of the following statements is most likely to be TRUE?

a) It is found between superior rectus and the optic nerve.

b) It transmits sensory nerves which join the nasociliary nerve .
c) The parasympathetic fibres which synapse in the ganglion supply dilator pupillae .
d) The sympathetic fibres which synapse in the ganglion originate in the superior cervical
ganglion.

Answer 2: b

The ciliary ganglion is found in the orbit anterior to the annulus of Zinn between lateral rectus and
the optic nerve. It transmits sensory, sympathetic and parasympathetic fibres but only the
parasympathetic fibres synapse in the ganglion. The sympathetic fibres arise from the superior
cervical ganglion. Preganglionic parasympathetic fibres are from the Edinger Westphal nucleus and
the postganglionic fibres supply sphincter pupillae and the ciliary muscle .
The sensory nerves are in the long and short ciliary nerves which after leaving the ganglion merge
with the nasociliary nerve.
Question 3
With regard to the human cornea, which of the following statements is most likely to be TRUE?

a) Bowmans layer is mainly type IV collagen between the epithelium and stroma.
b) Descemets membrane contains keratocytes.
c) The cells of the epithelium are held together by gap junctions .
d) The extracellular matrix of the stroma contains proteoglycans and crystallin proteins .

Answer 3 : d

Bowmans layer is mainly type I collagen fibrils and descemets membrane, which is an acellular
layer, type IV.
To prevent fluid loss and passage of pathogens the epithelial cells are held together by tight
junctions.
The corneal stroma contains keratocytes which secrete the extracellular matrix which consists of
collagen (types I and V), proteoglycans and crystallin proteins .

Question 4
With regard to the human lens, which of the following statements is most likely to be TRUE?

a) A simple cuboidal epithelium surrounds the lens fibres.

b) Supporting zonular fibres attach further posteriorly than anteriorly .
c) The capsule is thinner at the anterior pole than the posterior pole .
d) There are many gap junctions between the lens fibres .

Answer 4 : d

The lens epithelium is simple cuboidal but it is only found on the anterior surface of the lens .
The zonular fibres attach to the lens capsule approximately 2 m anterior to the equator and 1 mm
posterior.
The lens capsule is 3x thicker at the anterior pole than the posterior.
The function of the gap junctions is not completely clear but it may be to aid nourishment of the
compressed central cells.

Question 5
With regard to the lacrimal drainage system, which of the following statements is most likely to
be TRUE?

a) One third of the length of the nasolacrimal duct is intaosseous within the maxillary bone .
b) Orbicularis oculi lies anterior to the lacrimal sac.
c) The canaliculi are lined by non keratinized stratified squamous epithelium .
d) The medial canthal ligament contributes to the anterior larimal fascia
Answer 5: c

Unlike the lacrimal sac, the canaliculi are lined by keratinized stratified squamous epithelium .
The superficial head of orbicularis oculi is anterior to the lacrimal sac and attaches to the anterior
lacrimal crest. The deep head runs posterior to it to attach to the posterior lacrimal crest .
The lacrimal fascia is formed by a split in the periosteum at the posterior lacrimal crest and is itself
surrounded by fibres of orbicularis oculi.
The nasolacrimal duct has an approximately 12 mm superior intraosseous part within the maxillary
bone and 5mm inferior membranous part before opening below the inferior turbinate .

Question 6
With regard to the lacrimal gland, which of the following statements is most likely to be TRUE?

a) It is of mesenchymal origin.
b) It’s preganglionic parasympathetic nerve fibres are in the greater petrosal nerve .
c) The lacrimal fossa is formed from the frontal bone and frontal process of the maxilla .
d) The single main excretory duct opens into the superior fornix.

Answer 6 : b

The tears from the lacrimal gland drain directly into the superior conjunctival fornix through 3 – 5
excretory ducts from the orbital portion which join 5 – 7 from the palpebral portion.
The lacrimal fossa is in the upper outer orbit as a depression in the frontal bone.
The lacrimal gland develops from surface ectoderm although the surrounding mesenchyme plays
an important role in determining it’s normal development.

Question 7
Which ONE of these arteries provides NO blood supply to the superior rectus muscle?

a) Anterior ethmoidal artery

b) Lacrimal artery
c) Posterior ethmoidal artery
d) Supra-orbital artery

Answer 7 : a

The anterior ethmoidal artery, which is a branch of the ophthalmic artery, travels with the
nasociliary nerve and leaves the orbit through the anterior ethmoidal foramen. The only structure it
supplies in the orbit is the superior oblique muscle.

Question 8
With regard to the human retina, which of the following statements is most likely to be TRUE?
 a) Horizontal cells are the only cells which are oriented horizontally .
b) The cones are uniform in size but reduced in density towards the peripheral retina .
c) The inner nuclear layer contains the nuclei of the horizontal, bipolar, amacrine and Muller
cells.
d) The pigment epithelium is a single layer of columnar cells .

Answer 8 : c
At the fovea there are only cones, which are smaller here for optical efficiency. They are larger
throughout the rest of the retina but in much lower density relative to rods towards the periphery.
The pigment epithelium is a single layer of cuboidal cells, which support the neural retina .
Both horizontal and amacrine cells are horizontally oriented.

Question 9
With regard to the superior oblique muscle, which of the following statements is most likely to be
TRUE?

a) It inserts into the superolateral part of the globe.

b) It is the only extraocular muscle to insert behind the equator.
c) It originates from the superior part of the annulus of Zinn.
d) It passes through the trochlea at the upper medial orbital rim.

Answer 9 : a

The superior obliqe muscle originates from the orbital apex above the annulus of Zinn, passes
anteriorly along the superomedial orbital wall then turns posteriorly, inferiorly and laterally
through the trochlea at the medial end of the superior orbit rim to insert into the superolateral
globe behind the equator.
The inferior oblique muscle also inserts behind the equator.

Anatomy of the Eye, Orbit and related

structures 2015
Question 1
Which ONE of the following structures is normally avascular?
a) Descemet’s membrane.
b) Intra-orbital part of optic nerve.
c) Episclera.
d) Conjunctiva.
Answer 1 : a
Descemet’s membrane of the cornea has no blood supply, the others all do.

Question 2
Regarding the anterior chamber angle, which ONE of the following statements is MOST likely to
be TRUE?

a) The longitudinal muscle of the ciliary body is attached at Schwalbe’s line.

b) The trabecular meshwork is usually non-pigmented.
c) The scleral spur is posterior to the root of the iris.
d) Schwalbe’s line marks the termination of Descemet’s membrane.

Answer 2 : d
This diagram explains the relationships of the anterior chamber angle.
image feedback
This diagram explains the relationships of the anterior chamber angle.

Question 3
Which ONE of these structures passes through the superior orbital fissure?

a) The inferior ophthalmic vein.

b) The optic nerve and its sheath.

c) The zygomatic nerve.

d) The sympathetic nerve supply to the eye.

Answer 3 : a
This diagram explains the relationships of the superior orbital fissure.

Question 4
Regarding human extraocular muscles, which ONE of the following statements is MOST likely to
be TRUE?

a) The primary elevator of the eye in the primary position, is the superior rectus.

b) The primary extorter of the globe in the primary position is the superior oblique.

c) The primary depressor of the eye in the primary position is the inferior oblique.

d) The muscle with longest length of tendon is the inferior oblique.

Answer 4 : a

The primary elevator of the eye is the superior rectus, the main extorter is the inferior oblique, the
superior oblique is the main intorter. The main depressor is the inferior rectus, the inferior rectus,
by being inserted behind the equator elevates the eye, the superior oblique has the longest tendon.
Question 5
Regarding the anatomy of the cornea which ONE of the following statements is MOST likely to be
TRUE?

a) Bowman’s layer is the basal membrane of the corneal epithelium.

b) The density of corneal epithelial nerves stays constant with age.

c) The stroma makes up approximately 90% of the corneal thickness.

d) If the endothelial cell density decreases to 1000 cells per square millimetre, corneal oedema
may develop.

Answer 5 : c

The basement membrane of the corneal epithelium anchors the epithelium to Bowmans
membrane. The density of corneal epithelial nerves decreases with age. The corneal stroma is
about 90% of the thickness of the cornea (varying in different parts of the cornea. Density of
corneal endothelial cells below 800 cells per mm².

Question 6
Regarding the anatomy of the eyelids, which ONE of the following statements is MOST likely to
be TRUE?

a) The skin of the human eyelid is the thinnest in the body.

b) The inferior punctum is normally visible to the naked eye without eversion.

c) The eyelashes are arranged in a double row along the eyelid margin.

d) The loose connective tissue of the eyelid contains abundant fat.

Answer 6 : a

The eyelid skin is the thinnest in the body. The inferior punctum is not normally visible without
pulling the lid down. There is only a single row of lashes. The fat cells are found behind the orbital
septum.

Question 7
Regarding the anatomy of the macula, which ONE of the following statements is MOST likely to
be TRUE?

a) It is an area lying nasally to the optic nerve.

b) It has more than one layer of ganglion cells.

c) The foveola is the thickest part of the retina.

 d) The outer layers of the macula contain xanthophyll pigment.

Answer 7 : b

The macula is situated temporally to the optic disc. In the macula there are several layers of
ganglion cells. At the foveola the inner layers of the retina are displaced laterally.The foveola is
therefore thinner than further out in the macula. Xanthophyll is found throughout the macula and
is found in the cone axons, not in the outer layers of the macula.

Question 8
Which ONE of the following are actions of the inferior oblique muscle?

a) Elevation in adduction.
b) Elevation in abduction.
c) Depression in adduction.
d) Incyclotorsion.

Answer 8: a

The inferior oblique muscle elevates the eye in adduction. The superior oblique elevates the eye in
abduction. The inferior oblique extorts the eye.

Question 9
Regarding the orbit, which ONE of the following statements are most likely to be true?

a) It is formed from six main bony elements.

b) The orbital entrance averages about 45mm in height and 35mm in width.

c) The orbital roof is formed by the frontal bone and lesser wing of the sphenoid bone.

d) The medial orbital wall is the thickest of the orbital walls.

Answer 9: c

The orbit is made up of the frontal, sphenoid, zygoma, lacrimal, ethmoid and ethmoid bones. The
orbit is approximately 40mm in height, 40 mm in length and 40 mm in width. The orbital roof is
made of the frontal bones and lesser wing of sphenoid. The medial wall of the orbit is the thinnest
of the orbital walls.
Embryology and Development 2016
Question 1
Which ONE of the following structures develops from neural crest cells?

a) Bowmans membrane
b) Ciliary muscle
c) Descemets membrane
d) Retinal pigment epithelium

Answer 1 : c
Descemets membrane of the cornea together with the endothelium develop from neural crest cells
whereas Bowman’s membrane and the stroma are of mesodermal origin and the corneal
epithelium surface ectoderm.
The retinal pigment epithelium develops from the outer layer of the optic cup (neuroectoderm) and
the ciliary muscle is also of mesenchymal origin.

Question 2
During embryological development, which of the following is the earliest sign of ocular
development?

a) A bulge in the neuroectoderm corresponding to the underlying optic vesicle

b) Appearance of the optic sulci in the neural plate
c) Development of the optic stalk from the neuroectoderm
d) Thickening of the surface ectoderm

Answer 2 : b
The first sign of ophthalmic development is the appearance of the optic sulci at around day 22.
These invaginate to form the optic vesicles, which are adjacent to the surface ectoderm which
thickens to form the lens placode. This occurs at about the same time as the optic vesicle constricts
in its proximal part where it attaches to the forebrain. This constriction is the optic stalk.

Embryology and Development 2015

Question 1
Regarding the normal and abnormal development of the eye, which ONE of the following
statements is MOST likely to be TRUE?

a) The PAX6 gene is specific for eye development.

 b) The normal crystalline lens is formed from neurectoderm.
c) Cranial neural crest cells are vital in eye development.
d) Apoptosis (“programmed cell death”) does not occur in normal development.

Answer 1 : c

Mutations of the paired box 6 (PAX6) gene cause aniridia , other mutations cause Peters anomaly
and corneal dystrophy. PAX genes encode transcription factors in vertebrate and invertebrates and
are considered as the master controlling gene. While PAX 2 is only involved with optic stalk
development. PAX 6 has functions outside the eye development. The lens is derived from surface
ectoderm. Cranial neural crest cells develop into the sclera and stroma of the cornea. Apoptosis is an
essential part of ocular development.

Question 2
Which ONE of the following structures is derived from mesoderm?

a) Corneal stroma.
b) Ciliary body epithelium.
c) The ciliary ganglion.
d) Endothelial lining of all orbital and ocular blood vessels.

Answer 2 : d

The mesoderm is one of the three germinal layers that appears in the third week of embryonic
development. These cells go on to develop into muscle cartilage and bone, as well as blood vessels
and blood cells.

Question 3
In relation to Retinopathy of Prematurity (ROP) and the embryology of the retinal vasculature,
which ONE of the following statements is MOST likely to be TRUE?

a) Persistent hyperplastic primary vitreous occurs from retinal vascular development failure.
b) The retina develops cords of retinal vessels from the optic nerve from one month of
gestation.
c) The nasal retina is vascularized by 32 weeks gestational age.
d) The retinal vasculature achieves the full adult pattern by full term.

Answer3 : c

The hyaloid artery is incorporated into the choroidal fissure. Early in the 4th month angiogenic buds
develop from the hyaloid vessels at the optic disc. The nasal retina is vascularised by week 32. The
retinal vasculature continues to develop beyond full term.
Neuro-Anatomy 2016
Question 1
Which cranial nerve emerges from the midbrain at the pontomedullary junction into the prepontine
cistern?

a) Abducent
b) Oculomotor
c) Ophthalmic division of trigeminal
d) Trochlear

Answer 1: a
Cranial nerves III, IV and V emerge higher up through the pons with the IV nerve (trochlear) emerging
posteriorly.

Question 2
Which of the following structures lies most superiorly in the lateral wall of the cavernous sinus?

a) Abducens nerve
b) Oculomotor nerve
c) Ophthalmic division of the trigeminal nerve
d) Trochlear nerve

Answer 2: b
The nerves passing through the lateral wall of the cavernous sinus do so in number order starting superiorly
so the third cranial nerve, which is the first of the cranial nerves found in this position is the most superior.
The abducens nerve runs within the cavity of the cavernous sinus.

Question 3
The anterior communicating artery in the circle of Willis, links which of the following pairs of vessels?

a) Anterior cerebral artery and anterior choroidal artery

b) Anterior cerebral artery and middle cerebral artery
c) Internal carotid artery and anterior cerebral artery
d) Right and left anterior cerebral arteries

Answer 3 : c
The circle of Willis is an area of vascular anastomoses that links the anterior intracranial circulation from the
internal carotid artery to the posterior circulation from the basilar artery.
The internal carotid artery splits into the anterior and middle cerebral arteries in addition to giving rise to a
number of other arteries such as the ophthalmic and anterior choroidal.
The basilar artery divides to form the 2 posterior cerebral arteries. These link with the anterior circulation
through the posterior communicating arteries to the internal carotid artery.
The single anterior communicating artery completes the circle anteriorly by linking the 2 anterior cerebral
arteries.
Question 4
Which ONE of these structures passes through the foramen spinosum?

a) Accessory meningeal artery

b) Lesser petrosal nerve
c) Maxillary branch of trigeminal nerve
d) Middle meningeal artery

Answer 4 : d
The accessory meningeal artery and lesser petrosal nerve pass through the foramen ovale.
The maxillary branch of the trigeminal nerve passes through the foramen rotundum.

Question 5
Which part of the visual field is most likely to be represented by fibres of the optic radiation, which sweep
around the right lateral horn of the ventricle?

a) Left inferior field

b) Left superotemporal quadrant
c) Right inferonasal quadrant
d) Right superior field

Answer 5 : b
The lateral horn of the ventricle is in the temporal lobe. The fibres which loop back on themselves and pass
round the lateral horn are commonly referred to as Meyer’s loop and represent the superior visual field. A
focal lesion in this are is sometimes described as ‘pie in the sky.’
Each visual field is represented on the opposite side of the brain. Objects in the left visual field stimulate the
left nasal retina and the right temporal retina. The temporal retinal nerve fibres pass through the chiasm and
stay on the same side of the brain but the nasal fibres decussate (cross over) to the opposite side. This
means that after traversing the chiasm all the fibres from the left visual field are now on the right side of the
brain.

Question 6
With regard to the pituitary gland, which of the following statements is most likely to be TRUE?

a) It is connected by the infundibulum to the thalamus.

b) It is supplied by branches of the anterior cerebral artery.
c) It is surrounded by cerebrospinal fluid.
d) The hormone producing adenohypophysis is anterior to the neurohypophysis.

Answer 6: d

The blood supply is from the superior hypophyseal arteries, direct branches of the internal carotid, and the
inferior hypophyseal arteries which also receive blood from the internal carotid artery via the
meningohypophyseal trunk which leaves the internal carotid in the cavernous sinus.
The diaphragma sellae which is a fold of dura, separates the pituitary from CSF.
It is connected to the hypothalamus by the infundibulum which is sometimes referred to as the pituitary
stalk.
The anterior lobe (adenohyphysis) makes up about 80% of the pituitary glane and produces a number of
hormones. The posterior neurohypophysis stores hormones which are produced in the cell bodies of the
supraoptic and paraventricular nuclei of the hypothalamus, then releases them directly into the systemic
vasculature.

Neuro-Anatomy 2015
Question 1
Which one of these findings is MOST likely to present following a lesion within or around the cavernous
sinus?

a) Partial third (oculomotor) cranial nerve palsy.

b) Facial numbness.

c) Horner’s syndrome (oculosympathetic palsy).

d) Seventh (facial) cranial nerve palsy.

Answer 1: a

The third nerve is the only one of these nerves that pass through the cavernous sinus.

Question 2
The figure is of a coronal section through an adult human through the orbital apex. Items A-D are
structures to be identified. Which ONE of the statements is MOST likely to be TRUE?
 a) D is the right 4th (trochlear) cranial nerve.

b) C is the right inferior ophthalmic vein.

c) B are the maxillary sinuses.

d) A is the left ophthalmic artery.

Answer 2: d
A is the left ophthalmic artery which passes through the optic canal inferior to the optic nerve. B are the ethmoid
sinuses. C is the superior ophthalmic vein. D is the right 6th (abducent) cranial nerve.

Question 3
Regarding the anatomy of the third (oculomotor) cranial nerve, which ONE of the following statements is
MOST likely to be TRUE?

a) The fibres enter the superior oblique muscle from above.

b) It is inferior to the sixth (abducens) cranial nerve in the cavernous sinus.
c) It innervates Mullers (superior tarsal) muscle.
d) The nucleus is at the level of the superior colliculus.

Answer 3: d

The fourth cranial nerve innervates the superior oblique muscle. The third cranial nerve is supero-lateral to
the sixth nerve in the cavernous sinus. Mullers muscle is innervated by sympathetic fibres. The nucleus is at
the level of the superior colliculus in the mid brain.

Question 4
Regarding the ciliary ganglion, which ONE of the following statements is MOST likely to be TRUE?
 a) The motor root is longer than the sensory root.
b) Only the sympathetic fibres synapse in the ciliary ganglion.
c) Post ganglionic sympathetic roots innervate the iris sphincter muscles.
d) It is located anterior to the annulus of Zinn (annular tendon or common tendinous ring).

Answer 4: d

The sensory root is longer than the motor root. Only the parasympathetic nerves synapse in the ciliary
ganglion. The ciliary ganglion lies anterior to the common tendinous ring.

Question 5
Regarding the cranial nerves, which ONE of the following statements is MOST likely to be TRUE?

a) The third (oculomotor) cranial nerve carries cholinergic innervation to the pupillary sphincter.
b) The fourth (trochlear) cranial nerve contains the most nerve fibres of any cranial nerve.
c) The sixth (abducens) cranial nerve has the longest intracranial course of any cranial nerve.
d) The seventh (facial) cranial nerve is the only motor nerve to exit dorsally from the nervous system.

Answer 5: a

The oculomotor nerve carries cholinergic fibres to the pupillary sphincter. The troclear nerve is smaller than
the oculomotor nerve. The fourth nerve is the longest cranial nerve. It is the fourth nerve not the seventh
that exits dorsally.

Question 6
The figure is of an axial dissection through the human brain at the level of the optic chiasm and optic
nerves (as marked). Items A-D are arrows pointing to structures to be identified. Which ONE of the
following statements is MOST likely to be TRUE?
 a) A indicates the anterior cerebral artery.

b) B indicates the left lateral geniculate nucleus.

c) C indicates both 4th (trochlear) cranial nerves.

d) D indicates the posterior communicating artery.

Answer 6: a

This dissection illustrates the Circle of Willis and surrounding structures.

A indicates the middle cerebral artery/internal carotid artery.

B is the left optic tract.

C indicates both the oculomotor nerves.

D correctly indicates the posterior communicating artery.

Question 7
Regarding the pupillary light reflex, which ONE of the following statements is MOST likely to be TRUE?

a) The preganglionic fibres are carried in the long posterior ciliary nerve.
b) The preganglionic fibres of the 3rd (oculomotor) cranial nerve synapse in the ciliary ganglion.
c) Retinal ganglion cells project ipsilaterally to the pretectal nuclei.
d) The Edinger Westphal nucleus axons are part of the efferent pathway.

Answer 7: d

The pupillary light reflex comprises of an afferent and efferent pathway. The afferent pathway arises from
the retinal photoreceptors and ganglion cells. It passes via the optic nerve to the pretectal nuclei on both
sides of the upper midbrain, bypassing the lateral geniculate nuclei and the primary visual cortex. The
efferent pathway is from the pretectal nuclei to neurons in the Edinger-Westphal nucleus whose axons run
along both the left and the right oculomotor nerves. Parasympathetic neurons from the oculomotor nerve
synapse in the ciliary ganglion. Short ciliary nerves then leave the ciliary ganglion and innervate the iris
sphincter muscle.
Principles of General Physiology, Biochemistry
and Cell Biology 2016
1) With regard to aqueous humour, which of the following statements is most likely to be TRUE?
a) It has a deficit of chloride ions relative to plasma.
b) It is normally protein free in the anterior chamber.
c) It’s production is mainly by active secretion.
d) The blood aqueous barrier is due to tight junctions between the pigmented and non
pigmented cells of the ciliary epithelium.

Answer 1 : c
Aqueous has an excess of hydrogen, chloride and ascorbate relative to plasma and a deficiency of
bicarbonate.
Protein transudate from the ciliary body stroma passes into the iris stroma and into the anterior
chamber down a diffusion gradient so unlike posterior chamber aqueous, anterior camber aqueous
contains a small amount of protein.
There are large gap junctions between the two epithelial layers of the ciliary processes. The barrier
is due to tight junctions between the non pigmented ciliary epithelial cells .

2) With regard to the complement pathway, which of the following statements is most likely to
be TRUE?
a) Complement factors bind to toll like receptors (TLR) to initiate humoral immunity .
b) It acts as an opsonin to induce phagocytosis.
c) It is activated by free immunoglobulin in the circulation.
d) It is necessary for the development of acquired immunity .

Answer 2 : b
Toll like receptors are membrane bound, whereas the complement system is a soluble pattern
recognition receptor.
The activation of complement factor 1 is induced by binding to immune complexes (IgG or IgM
bound to an antigen.)
The complement pathway is a principal component of innate humoral immunity and has no role in
acquired immunity.

3) With regard to corneal would healing, which of the following statements is most likely to be
TRUE?
a) Endothelial cells repair by increased mitotic activity .
b) Following abrasion, limbal epithelial cells migrate across the stroma .
c) The epithelium is regenerated by mitotic activity in Bowman’s layer.
 d) When the stroma is breached keratocytes synthesize collagen and glycosaminoglycans.

Answer 3 : d
Human corneal endothelial cells do not normally undergo mitosis even following a perforating
injury. Following injury individual cells enlarge and slide in an attempt to close a defect .
The immediate response to a corneal abrasion is for the basal cells at the edge of the defect to
spread as a single cell layer across the exposed stroma. The main source of epithelial renewal in the
absence of trauma is from limbal cell cells with a small contribution from the basal layers.
Corneal epithelial regeneration is due to mitotic activity in the basal layers of the epithelium .
Corneal keratocytes respond to stromal penetration either surgical or traumatic by losing their
specialization and reverting to functioning like a fibroblast as in a cutaneous surface wound
producing collagen and glycosaminoglycans.

4) With regard to lens metabolism, which of the following statements is most likely to be TRUE?
a) Glucose enters the lens by passive diffusion.
b) Na+ is transported into the lens by Na+/K+ ATPase.
c) The lens has a high concentration of glutathione.
d) The pentose phosphate pathway metabolises 80% of the glucose.

Answer 4 : c
Glucose enters via an insulin-dependent glucose transporter in the plasma membrane.
Na+/K+ ATPase is in the lens epithelium and is responsible for transporting K+ into the lens and Na+
out.
Glutathione is in high concentration in the lens mostly in the reduced state and is responsible for
protecting cation -transporting membrane proteins.
%80of glucose metabolism is by anaerobic glycolysis. The pentose phosphate pathway uses about
10%. When glucose is in excess the sorbitol pathway is brought into play .

5) With regard to mast cells, which of the following statements is most likely to be TRUE?
a) They are a biomarker for type III immune responses .
b) They contain many mitochondria.
c) They have IgM receptors on the surface.
d) They synthesise prostaglandin D and platelet activating factor.

Answer 5 : d
Mast cells along with basophils and eosinophils are a marker for type 2 immune responses.
Mast cells have Ig E receptors, binding by which causes release of granules .
Mast cells have much cytoplasm, many large granules but few mitochondria .
Mast cells synthesise and release many substances as well as histamine. These include
prostaglandin D, leukotrienes and platelet activation factor.
6) With regard to contraction of a striated muscle, which of the following statements is most
likely to be TRUE?
a) Acetylcholine acts on the sarcolemma to make it more permeable to K+ then Na.+
b) Following contraction, calcium diffuses back into the sarcoplasmic reticulum .
c) Lactic acid is a byproduct of aerobic production of ATP.
d) Thick myosin myofilaments rotate on thinner actin myofilaments .

Answer 6 : d
The sarcolemma of a resting muscle is more permeable to potassium ions than sodium so more
potassium leaves than sodium enters creating a positive charge outside. Acetylcholine reverses this
permeability changing the electrical charge to positive inside and the difference between the
positive inside and negative outside is the action potential which causes release of calcium to
initiate the biochemical changes which result in muscle contraction.
Following contraction calcium is actively pumped back into the sarcoplasmic reticulum.
If muscles are unable to generate ATP rapidly enough by aerobic respiration, they start anaerobic
respiration, which produces lactic acid.
The rotation of myosin fibrils on actin is known as the sliding theory of muscle contraction .

7) Which of the following statements most accurately demonstrates Sherrington’s law?

a) Contraction of left lateral rectus and relaxation of left medial rectus

b) Contraction of left medial rectus and contraction of right lateral rectus
c) Contraction of right superior oblique and contraction of left inferior rectus
d) Contraction of right superior rectus and relaxation of left inferior oblique

Answer 7 : a
Sherrington’s law of reciprocal innervation states that contraction of a muscle is accompanied by
relaxation of its antagonist. It is not fully understood whether this is by inhibitory stimulation or
absence of stimulation to contract.
In order for left lateral rectus to be able to turn the eye to the left the left medial rectus must be
relaxed and lengthen. If both muscles contracted the eye would simply be retracted as sometimes
occurs in aberrant regeneration.
Contraction of the left medial rectus and right lateral rectus is demonstrating Hering’s law of equal
innervation and are called yoke muscles. In order for the left medial rectus to move the eye to the
right, the right lateral rectus must also act on the right eye to prevent diplopia .
Both the other pairs of muscles are yoke muscles not antagonists but only c is demonstrating
Hering’s law.

8) With regard to human tears, which of the following statements is most likely to be TRUE?
a) 95% of the tear film is the aqueous layer.
b) Parasympathetic activation reduces tear production.
 c) There is a higher concentration of vascular endothelial growth factor (VEGF) in tears than in
plasma.
d) They contain a low level of immunoglobulins.

Answer 8 : c
Although historically the aqueous layer was thought to constitute 95% of the tear film it has now
been demonstrated that it is around 60% with the mucous layer being thicker than previously
thought.
Tears have a higher concentration of lysozyme, lactoferrinphospholipase A2 and VEGF than plasma
but a lower level of albumen, transferrin, IgM and IgG .
The parasympathetic system increases tear production through an effect on myoepithelial cells
which surround the lacrimal acinar cells.
Tears have a high level of IgA and IgG.

9) With regard to colour perception in humans, which of the following statements is most likely
to be TRUE?
a) Defects in cortical area V4 can cause colour blindness .
b) There are 4 types of cone responsive separately to red, blue, yelllow and green.
c) Tritanopes are unable to detect red wavelengths.
d) Under photopic conditions each wavelength has equal luminosity .

Answer 9 : a
Colour vision is a combination of stimulation of cones with different visual pigments and processing
in the lingual or fusiform gyri (cortical area V4.)
We have 3 separate cone types with peak responsiveness to red, green and blue .
Tritanopes are unable to detect blue. Protanopes cannot distinguish red .
Under both photopic and scotopic conditions luminosity varies with wavelength. The peak
luminosity in photopic conditions is 555nm (yellow-green) whereas under scotopic conditions it is
500nm (blue-green.)

10) With regard to dark adaptation, which of the following statements is most likely to be true?
a) After dark adaptation rhodopsin regeneration takes approximately 5 minutes.
b) Increased rod sensitivity occurs before increased cone sensitivity .
c) It depends on the local concentration of 11-cis retinal.
d) It remains constant throughout life.

Answer 10 : c
Regeneration of rhodopsin takes about 30 minutes but it has a half life of 5 minutes.
The early part of the dark adaptation curve is due to increased cone sensitivity followed by a longer
phase due to increased rod sensitivity. The minimum light threshold is after approximately 30
minutes.
Dark adaptation and regeneration of rhodopsin depend on 11-cis retinal and how quickly it passes
to opsins. This process depends on a healthy retinal pigment epithelium, which is why dark
adaptation reduces with age.

11) When light stimulates a photoreceptor which of the following actions is initiated?
a) All-trans retinal is converted to 11-cis retinal before release from rhodopsin.
b) Changes in calcium ions in the photoreceptor cause bipolar cells to release glutamate .
c) Na+ channels in the outer segments are opened.
d) Transducin raises the cytoplasmic cGMP concentration.

Answer 11 : b
-11cis retinal is converted to all-trans retinal then to all-trans retinol a process which is much
quicker from cone opsins than rhodopsin in rods .
Photoreceptor outer segments, unlike other cells and particularly neurons, are depolarized by
having open Na+ channels. On stimulation by light these are closed so the outer segment becomes
relatively hyperpolarized. This triggers a calcium wave along the photoreceptor to the synapse with
a bipolar cell which is stimulated to release its transmitter, glutamate .
On stimulation of rhodopsin by light, transducin lowers the cytoplasmic cGMP which is responsible
for closure of the Na+ channels.

Principles of General Physiology, Biochemistry

and Cell Biology 2015
1) Which ONE of the following contributes to the immune-privileged status of the eye?
a) The enclosure of the lens within the lens capsule.
b) The relationships between retinal pigment epithelial cells and photoreceptors.
c) The desmosomes between both epithelial and endothelial cells.
d) The presence of lymphatic tissue in the inner structures of the eye.

Answer1 : a
The immune privilege status of the cornea retina and lens has been attributed to the lack of
circulation in the cornea and lens and the blood-retina barrier for the retina. There are no
intraocular lymphatics. Anterior chamber associated immune deviation (ACAID) is also of
importance as a type of tolerance.
2) Which one of these hormones is secreted by the anterior part of the pituitary gland?
a) Thyroxine.
b) Antidiuretic Hormone (ADH.)
c) Oxytocin.
d) Adrenocorticotrophin hormone (ACTH).

Answer2 : d
The anterior part of the pituitary gland secretes the trophic hormones adrenocorticotrophin,
thyroid stimulating hormone, luteinising hormone, follicle stimulating hormone, prolactin, leptin
and growth hormone. The posterior pituitary or neurohypophysis is not glandular but a neural
extension of the hypothalamus. Its specialised glial cells secrete oxytocin and vasopressin
(antidiuretic hormone). Thyroxine is secreted by the thyroid gland.

3) Regarding the physiological roles of Vitamin A, which ONE of the following statements is
MOST likely to be TRUE?
a) Sunlight is a vital source of vitamin A in adult humans.
b) Deficiency only occurs in under-developed countries.
c) It is produced by conversion of carotenoids in the liver.
d) It is important in maintaining epithelial integrity.

Answer3 : d
Vitamin A is a group of unsaturated nutritional organic compounds including retinol, retinal,
retinoic acid and beta-carotene. Vitamin A has many roles including growth and development and
maintenance of good vision. Retinal combines with opsin in the retina to form rhodopsin, essential
for scotopic and colour vision. Retinoic acid is a growth factor for epithelial cells. It is produced in
the small intestine by conversion of esters from foods of animal origin into retinol, the storage form
of Vitamin A. Vitamin A deficiency can occur in many countries around the world and not
exclusively in under developed countries.

4) Regarding Bruch’s membrane, which ONE of the following statements is MOST likely to be
TRUE?
a) It forms the outer blood-retina barrier.
b) It separates the retinal pigment epithelium from the choriocapillaris.
c) It decreases in thickness with age.
d) Defects can result in a pigment epithelial detachment.

Answer4 : b
Bruch’s membrane consists of 5 layers and separates the retinal pigment epithelium from the
choriocapillaris. It thickens with age, slowing the transport of metabolites and leading to drusen. It
can then fragment and defects within it can cause ingrowth of choroidal new blood vessels and
destruction of the outer retinal layers. The retinal pigment epithelium maintains the outer blood-
retina barrier.
5) The primary determinant of intraocular pressure is which ONE of the following?
a) Ciliary muscle function.
b) Arterial pulse pressure.
c) Aqueous humour outflow facility.
d) Central venous pressure.

Answer5 : c
Aqueous humour is secreted by the non-pigmented epithelium of the ciliary body (pars plicata). It
drains from the eye via the trabecular meshwork and Schlemm’s canal into the intrascleral venous
plexus. Facility of outflow is the balance of production versus drainage which influences intraocular
pressure. Central venous pressure, but not arterial pressure can have a small effect on intraocular
pressure but it is not the primary determinant.

6) Which ONE of these wavelengths is within the ultraviolet A range?

a) 415 nanometers
b) 390 nanometers
c) 1020 nanometers
d) 310 nanometers

Answer6 : b
UVA 320-400nm UVB 290-320nm UVC 100-290nm 1020nm is in the near infrared spectrum

7) Regarding corneal transparency, which ONE of the following statements is MOST likely to be
TRUE?
a) The refractive index of collagen fibrils and the stromal ground substance in the cornea are
the same.
b) The destructive interference of light scattered by collagen fibrils is important.
c) Non-axially aligned collagen fibrils absorb scattered light allowing axial light to pass.
d) Collagen fibrils of different diameters must be present.

Answer7 : b
Corneal transparency is maintained by the lattice arrangements of the collagen fibrils in the stroma.
The light scatter from the individual fibrils is cancelled by destructive interference from the
scattered light from the other individual fibrils. In addition, the spacing of the neighbouring collagen
fibrils must be less than 200nm for transparency to be created.

8) Which ONE of the following conditions adversely affect contrast sensitivity (CS?)
a) Reduced CS occurs with posterior subcapsular cataracts.
b) Reduced CS occurs with bright direct illumination of an object.
 c) Glare-induced CS correlates well with low visual acuity in patients with cataracts.
d) Multifocal intraocular lenses may significantly reduce CS.

Answer8 : d
Contrast sensitivity is greatly improved with direct illumination. It is reduced in nucleosclerotic
cataracts but less so in posterior subcapsular types. Cortical spoke cataract produce significant glare
but often little visual acuity reduction. Multifocal intraocular lenses may reduce CS because of the
multiple grooves on the surfaces.

9) Regarding the testing of visual acuity in adults, which one of the following statements is true?
a) It is not necessary to test near vision in illiterate people.
b) The larger the pupil, the better most adults can see.
c) LogMAR 0.10, 20/25, 6/7.5 and 1.0(decimal) are equivalent.
d) Whole Snellen letters subtend 10 minutes of arc at the distance stated.

Answer : c
Whole Snellen letters subtend 5 minutes of arc at the distance stated. When testing vision it is vital
to identify visual function in an environment that is close to real life. Although a patient may be
illiterate, testing of near vision with optotypes is still required to assess visual ability. A larger
diameter pupil aperture does not equate to better visual acuity.

10) Regarding the function of the lipid component of the tear film, which one of the following
statements is true?
a) It does not contribute to the optical properties of the tear film.
b) It washes away debris.
c) It is the first line of protection against bacterial infection.
d) It retards evaporation of tears.

Answer10 : d
All parts of the tear film contribute to its optical properties. The lipid component prevents rapid
tear evaporation. Other functions of the lipid layer include limiting the spillage of tears on to the
eyelids and protecting the tear film from the destabilizing effect of skin lipid contamination. It is the
aqueous portion of tears that plays a greater role in control of infectious agents and clearance of
debris.

11) Regarding the secretions of the Islets of Langerhans of the pancreas, which ONE of the
following statements is MOST likely to be TRUE?
a) They secrete as exocrine glands.
b) They secrete trypsin.
 c) They secrete glucagon.
d) They secrete amylase.

Answer11 : c
The Islets of Langerhans secrete as endocrine glands. They secrete glucagon, insulin, amylin,
somatostatin, pancreatic polypeptide and ghrelin directly into the bloodstream. The exocrine acini
of the pancreas secrete amylase and trypsin into the pancreatic duct.

Epidemiology and Statistics 2016

Question 1
Which of the following studies is BEST used in planning health care delivery?

a) Case control study

b) Cross sectional survey
c) Longitudinal study
d) Randomised controlled trial

Answer 1: b
A case control study takes people with a disease and compares their exposure to suspected
aetiological factors with others who do not have the disease to try and identify relevant risks.
A cross sectional survey would identify the prevalence of risk factors in a population so as to plan
interventions most likely to have an impact in the future or the prevalence of specific conditions
in the population to inform future planning.
Longitudinal studies particularly if a disease has low prevalence are likely to need considerable
time to have sufficient statistical power to help with planning.
A randomized control trial is an attempt to identify the efficacy of a treatment either against no
intervention or in comparison with a different treatment. In terms of health planning this can be
used to identify the best treatment for a specific group of patients.

Question 2
Which of the following is being measured with the formula TP / (TP+FP) x 100 (TP = true positive,
FP = false positive?)
 a) Positive predictive value
b) Prevalence of disease
c) Sensitivity
d) Specificity

Answer 2 : a
The positive predictive value tells you how many of the people who test positive for a disease
actually have the disease and is higher the higher the prevalence of the disease in the population
being tested.
Sensitivty and specificity are functions of the actual test
Sensitivity = TP / (TP+FN) x 100 (FN = false negative)
Specificity = TN / (TN+FP) x 100 (TN= true negative)
Prevalence = number with disease / whole population x 100

Epidemiology and Statistics 2015

Question 1
Regarding visual impairment in countries of low gross national income per capita, which ONE of
the following statements is MOST likely to be TRUE?

a) Technologically advanced treatment is the most effective solution.

b) The overall prevalence of blindness increases with age.

c) Infectious diseases are an increasing cause of visual impairment.

d) Untreated macular degeneration is the leading cause of blindness.

Answer 1: b

The overall prevalence of blindness increases with age (over 82% are aged 50 or above). The major
causes of visual impairment are uncorrected refractive errors, untreated cataract and glaucoma
(not ARMD). Visual impairment worldwide has decreased since the 1990s principally due to the
reduction in infectious diseases. Technologically advanced treatment is not the most effective
solution – improving infrastructure, socioeconomic development, public health action, availability
of eye services, general population education are much more effective.

Question 2
Which ONE of the following is NOT an accepted criteria for instituting a screening programme for
a disease?

a) There is a low prevalence of pre-clinical stage of disease.

 b) The disease is a serious problem in the society to be screened.

c) There are effective acceptable and safe treatments available.

d) There is a safe and acceptable diagnostic test.

Answer 2: a

For instituting a screening programme accepted criteria include: the disease is a serious problem in
the society to be screened; there are effective, acceptable and safe treatment available; there is a
safe and acceptable diagnostic test; there is a recognisable pre-clinical stage or an early
symptomatic stage in which the condition can be diagnosed which is of a high prevalence.

Question 3
Regarding terms used in statistics, which ONE of the following statements is MOST likely to be
TRUE?

a) The “prevalence” of a condition is the number of cases in a population that exist over a number of
years.
b) The “incidence” of a condition is the total number of cases that have already been diagnosed.

c) “Sensitivity” measures whether, if a patient has a disease, how often a test is positive.
d) “Specificity” measures whether, if a test is positive, the likelihood is that the patient actually has a
particular condition.

Answer 3: c

Prevalence is a measurement of all individuals affected by a disease at a particular time. Incidence

is a measure of the new individuals who contract a disease during a particular period of time.
Sensitivity is the ability of a test to correctly identify those with the disease (true positive rate) or if
a patient has a disease, how often a test is positive. Specificity is the ability of the test to correctly
identify those without the disease (true negative rate). The term positive predictive value is the
measure of the likelihood that the patient has a particular condition.
Genetics 2016
Question 1
Which ONE of the following chromosomal abnormalities interferes with the pairing of chromosomes
during meiosis with suppression of crossovers?

a) Deletion
b) Inversion
c) Point mutation
d) Translocation

Answer 1 : b

Deletions result in all the codons following the deletion being inaccurately read and sometimes resulting in
altered or non functioning protein.
Inversions result from breaks in the chromosome and the segment turning 180 degrees.
Point mutation affects a single nucleotide base resulting in a change in amino acid coding.
Translocation may lead to formation of a trivalent and a mixture of abnormal and normal karyotype in
anaphase.

Question 2
With regard to Lyonization, which of the following statements is most likely to be TRUE?

a) Females predominantly express the maternal X chromosome.

b) Inactivation occurs in all cells.
c) Inactivation occurs shortly after fertilisation.
d) The inactivated chromosome is the Barr body.

Answer 2 : d

Lyonization is the random inactivation of one X chromosome. It is random between the male and female X
chromosome and usually is approximately 50:50 but may result in a preponderance of one or the other.
Lyonization is a way to balance genetic coding between males and females as the Y chromosome contains
little genetic information.
It occurs in all somatic cells but not the germ cells in the ovary so each X chromosome is available to be
passed to the next generation.
Lyonization occurs in the trophoblast by day 12.

Question 3
Which one of the following terms describes the process whereby a strand of DNA forms a template for the
synthesis of messenger RNA?

a) Meiosis
b) Mitosis
c) Transcription
d) Translation
Answer 3 : c

Meiosis and mitosis are phases of cell division. In mitosis each chromosome replicates to produce two
identical daughter cells. Meiosis has two stages resulting in gametes with half the number of chromosomes
with a random selection of maternal and paternal origin.
Transcription results in the production of messenger RNA which is then a template on ribosomes for protein
synthesis (translation.)

Question 4
A young man presents with a disease. He has 2 sisters one of whom also has the disease. Their mother and
2 of her 3 brothers have the disease but not her 2 sisters, as does the patient’s maternal grandmother and
great grandfather. His grandmother has 2 affected sisters and 2 unaffected brothers. What is the
likliehood that the patient’s son will also be affected?

a) 1:2
b) 1:4
c) He will definitely be affected.
d) He won’t be affected.

Answer 4 : d

The likely mode of inheritance is X linked dominant as the disease occurs in every generation and affects
both males and females. As a man passes a Y chromosome to his son then a son cannot be affected.
However all his daughters will be.
An affected woman has a 50:50 chance of passing the affected X chromosome to both her sons and
daughters.

Genetics 2015
Question 1
Regarding the pedigree shown in the figure, which ONE of the following statements is MOST likely to be
TRUE?

a) Family members 4 and 5 are not blood related.

b) Family members 9 and 10 are non-identical twins.

c) Family member 8 was a stillborn female.

 d) Family member 1 is of indeterminate gender.

Answer 1 : d

Family members 4 and 5 are in a consanguineous marriage (so by definition are blood related). Family
members 9 and 10 are monozygotic (identical) twins. Family member 8 shows an abortion or stillbirth (sex
unspecified) therefore they may have been an aborted fetus rather than stillborn. Family member 1 shows
sex unspecified/indeterminate gender.

Question 2
With regard to transmission of an X-linked recessive disorder, which ONE of the following statements is
MOST likely to be TRUE?

a) All female children of a mother who is a carrier will be carriers.

b) Fifty percent of female children of an affected father will be carriers.
c) All male children of an affected father will develop the condition.
d) Affected males cannot transmit the condition to their own children.

Answer 2 : d

For a mother who is a carrier of an X-linked recessive disorder then 50% of female children will be carriers.
All female children of an affected father will be carriers. No male children of an affected father will develop
the condition. Affected males cannot transmit the condition to their own children, they simply pass the
carrier gene onto a daughter who then transmits the condition to 50% of her male offspring

Question 3
A 25 year old female has retinitis pigmentosa. Her father also had the condition. Her mother and older
sister are unaffected. Which is the most likely mode of inheritance?

a) Mitochondrial inheritance.
b) X linked recessive.
c) Autosomal recessive.
d) Autosomal dominant.

Answer 3 : d

The father has passed retinitis pigmentosa onto 50% of his offspring who are all female. This would be
autosomal dominant transmission. Mitochondrial inheritance would pass from mother to offspring (not from
father). X-linked recessive inheritance would lead to one daughter being a carrier but not exhibiting the
condition. In autosomal recessive 50% of offspring would be carriers and only if the mother passed down an
affected gene could the offspring become affected (as no mention is made of the mother it is assumed she is
unaffected.)

Question 4
Transcription is the synthesis of RNA under the direction of DNA. Which of the following are possible
correct messenger RNA sequences from the DNA …-A-G-A-T-C?…-
 a) …-U-C-U-A-G…-
b) …-T-C-T-U-G…-
c) …-T-C-T-A-G…-
d) …-A-G-A-T-C-…

Answer 4 : a

In transcription DNA base nucleotides code to RNA in the following sequence, A=U, C=G, G=C, T=A.

Question 5
Regarding mitochondrial inheritance, which ONE of the following statements is MOST likely to be TRUE?

a) Some male characteristics are inherited from spermatozoal DNA.

b) All human cells have mitochondria.
c) In humans, mitochondria are only inherited from the mother.
d) Mitochondrially inherited diseases only affect one organ system.

Answer 5 : c

In most multicellular organisms, mitochondrial DNA (mtDNA) is inherited from the mother (maternally
inherited). Mechanisms for this include simple dilution (an egg contains 100,000 to 1,000,000 mtDNA
molecules, whereas a sperm contains only 100 to 1000), degradation of sperm mtDNA in the fertilized egg,
and, at least in a few organisms, failure of sperm mtDNA to enter the egg. Whatever the mechanism, this
single parent (uniparental) pattern of mtDNA inheritance is found in most animals, most plants and in fungi
as well. Not all human cells have mitochondria or nuclei (red blood cells for example). Mitochondrially
inherited diseases affect many organ systems.
Pathology and Microbiology 2016
Question 1
Which of the following culture media would best be used to culture Neisseria gonorrhoea?

a) Blood Agar
b) Chocolate Agar
c) MacConkey Agar
d) Nutrient Agar

Answer 1 : b
Chocolate Agar (heated blood Agar) is used to culture fastidious organisms such as pneumococcus,
gonococcus, meningococcus and haemophilus. Heating the blood neutralizes some growth inhibitors.
Blood Agar is used to identify haemolysis around colonies eg streptococcus pyogenes.
MacConkey Agar is most commonly used for enterobacteria whereas nutrient Agar will support the growth
of all non fastidious bacteria

Question 2
Which of the following organisms is a gram positive rod on gram staining?

a) Clostridium difficile
b) Haemophilus influenzae
c) Neisseria meningitidis
d) Pseudomonas aeruginosa

Answer 2 : a
Neisseria meningitides (meningococcus) is a gram negative bacteria.
Pseudomonas aeruginosa and haemophilus influenzae are gram negative rods.

Question 3
With regard to herpetic infection, which of the following statements is most likely to be TRUE?

a) Following primary herpes simplex virus 1 infection, viral RNA can be found in the neurons of the
trigeminal ganglion.
b) Herpes simplex is best identified by viral culture.
c) Herpes zoster infection is more common than herpes simplex.
d) Primary herpetic infection is usually asymptomatic.

Answer 3 : d
Herpes simplex virus 1 is one of the most common eye infections worldwide.
PCR assay is a much quicker method of diagnosing herpetic infection than viral culture.
Following primary HSV 1 infection of the cornea, the virus passes with the corneal nerves to the trigeminal
ganglion where viral DNA can be identified.
Primary infection is usually asymptomatic but patients may get oral, genital and periocular lesions.

Question 4
Which of the following ocular pathogens is a protozoa?
 a) Acanthamoeba
b) Candida albicans
c) Chlamydia trachomatis
d) Toxocara canis

Answer 4 : a
Candida is a yeast.
Chlamydia trachomatis is a gram negative bacterium.
Toxocara canis is a helminth.

Question 5
With regard to giant cell arteritis, which of the following statements is most likely to be TRUE?

a) Eosinophils are the predominant inflammatory cell.

b) Histologic diagnosis requires the presence of multinucleated giant cells.
c) It predominantly affects small arteries.
d) Treatment with steroids makes no difference to the diagnostic value of a temporal artery biopsy.

Answer 5 : d
In the classic type, the predominant cell types are T cells and histiocytes. The atypical type which may be a
phase in the resolution of the classical on rare occasions has eosiophils present.
Multinucleated giant cells are found in fewer than 50% of cases and are non specific.
GCA predominantly affects medium sized and large arteries.
GCA can still be diagnosed from a biopsy particularly in the first 14 days post treatment.

Question 6
With regard to the pathophysiology of diabetes, which of the following statements is most likely
to be TRUE?

a) Failure of activation of protein kinase C results in increased vascular permeability.

b) Intraretinal microvascular abnormalities are due to endothelial cell proliferation.
c) New vessels arising mainly from retinal arterioles penetrate the inner limiting membrane.
d) Venous beading is due to increasing perfusion in a previously hypoxic area.

Answer 6 : b
Activation of protein kinase C by increased levels of diacylglycerol alters retinal blood dynamics
particularly flow and permeability, with leakage of fluid and proteinaceous material causing retinal
oedema.
The retinal new vessels seen in diabetic retinopathy form mainly from retinal venules. They
penetrate the inner limiting membrane and form a network between this layer and the posterior
hyaloid face.
Venous beading, loops and dilation are signs of increasing hypoxia.

Question 7
Which of the following lesions can be safely discharged from a clinic as they have no malignant
potential?
 a) Actinic keratosis
b) Leucoplakia
c) Pyogenic granuloma
d) Sebaceous naevus

Answer 7 : c
Actinic keratosis and Leucoplakia may develop into a squamous cell carcinoma.
A pyogenic granuloma is a benign rapidly growing solitary lesion which bleeds easily and the face is
one of the common sites for these to occur. They are often associated with trauma.
A sebaceous naevus is a premalignant condition leading to basal cell carcinoma.

Question 8
With regard to prion disease, which of the following statements is most likely to be TRUE?

a) Ninety five percent of cases of prion disease are sporadic.

b) In acquired cases the abnormal prion protein is absorbed into the blood stream and passes
to the brain.
c) It can be inherited as an autosomal dominant disease.
d) Prion protein is an abnormal protein in the brain.

Answer 8 : c
80% of cases of prion disease are sporadic, the rest being inherited or acquired. In acquired disease
the abnormal prion protein is ingested or inoculated (eg surgical instruments). The ingested prion
protein invades lymphatic tissue such as the tonsils and spleen and passes to the brain through the
nerves of the autonomic nervous system from the bowel.
Inheritance is autosomal dominant but it may appear to skip a generation if someone infected dies of
another cause before the disease becomes manifest but after they have passed the abnormal gene to
their children.
Normal prion protein is found in the brain but it’s function is as yet unknown. It is broken down by
enzymes in the body once its function is complete but the abnormal prion protein which is able to
convert the normal prion protein to the abnormal form are more resistant to this breakdown and
accumulate in the brain tissue.

Question 9
With regard to squamous cell carcinoma (SCC), which of the following statements is most likely to
be TRUE?

a) It can be differentiated from actinic keratosis by the presence of dermal invasion.

b) Mutations in chromosome 7 are found in 40-50% of patients with SCC.
c) Spindle cell type is the slowest growing.
d) The degree of differentiation correlates well with prognosis.

Answer 9 : b
Dermal invasion can occur in actinic keratosis but they retain squamous differentiation towards the
surface of the lesion.
P53 is a tumour suppression gene on chromosome 7 mutations of which have been found in 40-
50% of patients with SCC.
Other then very aggressive poorly differentiated lesions, prognosis has not been shown to correlate
with differentiation.
Spindle cell type is the fastest growing and correlates with neural invasion.

Pathology and Microbiology 2015

Question 1
Regarding the examination of a patient with a suspected acute corneal infection (keratitis), which
ONE of the following statements is MOST likely to be TRUE?

a) Bacterial corneal ulcers are initially poorly demarcated.

b) Adenovirus keratitis tends to be associated with a mucopurulent discharge.
c) Acanthamoeba keratitis typically shows peri-neural infiltrates.
d) Aspergillus and Fusarium keratitis typically cause ring ulcers.

Answer 1 : c

Acanthamoeba keratitis classically shows peri-neural infiltrates. Bacterial ulcers are usually well
defined from the outset. Viral ulcers are usually associated with a mucus discharge without pus.
Fungal ulcers such as those caused by aspergillus and fusarium species are usually indolent and
poorly demarcated. They often have satellite lesions around the main ulcer.

Question 2
Regarding the management of a patient with suspected acute keratitis, which ONE of the
following statements is MOST likely to be TRUE?

a) Gram staining does stain fungi.

b) Suspected fungal samples should be cultured on Chocolate Agar.
c) Fungal ulcers usually respond to broad-spectrum antibiotics.
d) Bacteriology scrapes of a corneal ulcer should be taken from the ulcer margin

Answer 2 : a
All corneal ulcers should be scraped from the centre of the ulcer, care being taken not to perforate
the cornea. Suspected fungal keratitis should be scraped and plated onto Sabouraud agar. Gram
staining stains cell walls and is useful for distinguishing different bacterial species. It will stain fungal
cells but is not helpful for diagnosis.

Question 3
Regarding mast Cells, which ONE of the following statements is MOST likely to be TRUE?

a) They are present in the conjunctiva.

b) They are present in the cornea.
 c) They are originally produced in the thymus.
d) They degranulate and release cytokines.

Answer 3 : a
Mast cells occur in mucosal tissue such as conjunctiva and are produced in the bone marrow. When
activated by an allergen binding to IgE present on the cell membrane, the mast cell degranulates
releasing histamine and other cytokines producing an allergic response.

Question 4
The two-year-old child in the photograph was healthy and had been fully vaccinated. He
presented with a two day history of redness and swelling of the left eye with fever but no
proptosis. Regarding this case, which ONE of the following statements is most accurate?

a) Systemic antibiotic treatment is not required.

b) It is likely to spread to the other eye.

c) Staphylococcus aureus is the most likely organism involved.

d) If a blood culture is taken there is no need to culture the conjunctival discharge.

Answer 4: c

Orbital cellulitis occurs most commonly in children prior to the development of the septum. Sinus
related infection is a common underlying source of infection, particularly ethmoidal sinusitis.
Hospital admission and intravenous antibiotic treatment against common pathogens
(Staphylococcus aureus and Streptococcus pyogenes) is essential in preventing complications such
as meningitis, cavernous sinus thrombosis and brain abscess. A culture of any pus is essential to
identify the organism.
Question 5
Regarding the blood cells that are most common in the photomicrograph, which ONE of the
following statements is MOST likely to be TRUE?

a) They are most commonly seen in chronic inflammatory responses.

b) The chief function of this cell is oxygenation.

c) They are the chief component of an acute hypopyon.

d) They are formed on-site from stem cells.

Answer 5 : c
The polymorphonuclear leukocyte forms the major component of a hypopion. It is an essential
component of the innate immune system and is formed from myeloblasts witihin bone marrow
before migrating to sites of acute inflammation. These cells are able to release lysosomal enzymes
which are lytic to bacteria.

Question 6
Regarding blood platelets which ONE of the following is MOST likely to be TRUE?

a) Platelets have small nuclei.

b) Platelets secrete factor X.
c) Platelets are abnormal in sickle cell disease.
d) Platelets release cytokines.

Answer 6 : d
Platelets are fragments of cytoplasm with no nucleus derived from megakaryocytes of the bone
marrow. They release cytokines which trigger the clotting coagulation cascade as well as physically
plugging any breaches in a blood vessel wall. It is the red blood cells which are abnormal in sickle
cell disease.
Pharmacology
Question 1
Which of the following drugs can bind to macromolecules in the cornea?

a) Amiodarone
b) Ethambutol
c) Hydroxychloroquine
d) Minocycline

Answer 1: b
Amiodarone and phenothiazines are photosensitizing agents, which can bind to macromolecules in
the cornea, retina and lens.
Ethambutol causes optic neuropathy and reduced vision and hydroxychloroquine is irreversibly
toxic to the retina when used above recommended dosage.
Minocycline is a tetracycline derivative that can cause raised intracranial pressure and
papilloedema with the potential for permanent visual loss.

Question 2
With regard to the pharmacology of drugs used in the control of intraocular pressure (IOP), which
of the following statements is most likely to be TRUE?

a) Apraclonidine stimulates receptors in the trabecular meshwork.

b) Betaxolol is a non selective β blocker.
c) Pilocarpine increases outflow by reducing resistance in the canal of Schlemm .
d) Prostaglandin analogues reduce the production of aqueous .

Answer 2: a
Apraclonidine stimulates receptors in the trabecular meshwork increasing intracellular and aqueous
cAMP levels which increases the facility of outflow .
Betaxolol is a selective β1 blocker.
Pilocarpine exerts a direct effect on the scleral spur opening up the channels of the trabecular
meshwork.
Prostaglandin analogues increase uveoscleral outflow of aqueous .

Question 3
With regard to the development of drug resistance in bacteria, which of the following statements
is most likely to be TRUE?

a) Acquired resistance is always due to the modification of or acquisition of new genetic

material.
 b) Most bacteria only exhibit a single mode of resistance.
c) Tetracycline resistance is due to enzymatic destruction in the cell.
d) Transduction is the acquisition by a bacteria of small bits of DNA from the surrounding
environment.

Answer 3: a
Transformation is the process whereby a bacteria acquires bits of DNA from the environment and
these are usually from dead or dying bacteria. Transduction is when bacteriophages (viruses)
transfer DNA between closely related bacteria.
Tetracycline resistance is due to active transport out of the cell.
Increasingly bacteria acquire a number of modes of resistance becoming resistant to multiple
different drug families.

Question 4
Which ONE of the following drugs may cause hirsutism?

a) Azathioprine
b) Ciclosporin
c) Cyclophosphamide
d) Tacrolimus

Answer 4: b
Hirsutism along with nephrotoxicity, hypertension, hyperliidaemia and gingival hyperplasia are
recognized side effects of ciclosporin.
Long term use of corticosteroids may also cause hirsutism.

Question 5
With regard to the tests used in the investigation of Horners syndrome, which of the following
statements is most likely to be TRUE?

a) Apraclonidine inhibits reuptake of norepinephrine at the synaptic cleft of the nerve endings.
b) Apraclonidine is a strong α1 agonist.
c) Hydroxyamphetamine 1% dilates the pupil if the post ganglionic fibres are affected .
d) Hydroxyamphetamine stimulates the release of endogenous norepinephrime .

Answer 5: d
The action of apraclonidine is due to denervation hypersensitivity so it has a powerful mydriatic
effect on the affected side but no or only mild effect on the normal side. It does not localize the site
of the lesion.
Apraclonidine is only a weak α1 agonist but a strong α2 agonist.
Hydroxyamphetamine 1% dilates a normal pupil but not one with damage to the postganglionic
(therefore third order neuron defect). If it is the first or second order neuron which is affected, the
pupil will dilate like the normal side.
Hydroxyamphetamine stimulates release of norepinephrine which acts directly on the
neuromuscular junction of dilator pupillae.

Question 6
With regard to local anaesthetic agents, which of the following statements is most likely to be
TRUE?

a) Sensory fibres are blocked more quickly than sympathetic fibres .

b) The addition of adrenaline slows hydrolysis of the local anaesthetic agent .
c) The effect is independent of the pH of the agent used.
d) Unmyelinated nerves are blocked more readily than myelinated.

Answer 6: b
Local anaesthetics block myelinated nerves more than unmyelinated.
Autonomic fibres are blocked most quickly, then sensory and more slowly the motor nerves which
on the whole are larger.
An agent with a high pH (alkaline) is more lipid soluble, so penetrates the myelin sheath better.

Question 7
Which ONE of the following is NOT a systemic effect of topically administered cyclopentolate?

a) Constipation
b) Facial flushing
c) Sweating
d) Tachycardia

Answer 7: a
Constipation is an effect associated with the use of α2 adrenoceptor agonists. The other effects are
all recognized systemic side effects of parasympathetic antagonists (antimuscurinic agents) such as
cyclopentolate.
Pharmacology 2015
Question 1
Regarding ocular hypotensive agents used in the treatment of glaucoma in adults, which ONE of
the following statements is MOST likely to be TRUE?

a) Cholinergic agents (e.g. pilocarpine) increase uveoscleral outflow.

b) Prostaglandin F2 agonists (e.g. latanoprost 0.005%) are contra-indicated for pregnant
women.
c) Beta blockers (e.g. timolol) increase trabecular outflow.
d) Brimonidine (Alphagan), an alpha2 adrenergic agonist, is commonly used as a first line
treatment in congenital glaucoma.

Answer 1: b

Cholinergic agents increase trabecular outflow rather than uveoscleral outflow. Prostaglandin
analogues such as latanoprost increase uveoscleral outflow and are contraindicated in pregnancy.
Beta blockers reduce aqueous humour production. Congenital glaucoma is often treated surgically
and any ocular hypotensive can be used in a secondary role.

Question 2
With reference to ocular pharmacology, which ONE of the following statements is MOST likely to
be TRUE?

a) Applying an eye drop topically confines its action to within the eye.
b) Pharmacokinetic processing of drugs is significantly increased in the elderly.
c) Thiomersal (Thiomerosal) is the safest eye drop preservative.
d) Compressing the nasolacrimal duct increases drug reservoir in the cornea.

Answer 2: d

Pharmacokinetics is usually slower in the elderly. An eye drop within the eye is rapidly carried down
the nasolacrimal system and absorbed by the gut. Compression of the lacrimal sac will prevent this
and improve ocular absorption. Benzylkonium chloride is the commonest and least toxic of eyedrop
preservatives.

Question 3
Regarding pilocarpine, which ONE of the following statements is MOST likely to be TRUE?

a) It is a prodrug.
b) Topical application increases accommodation.
c) It mainly suppresses production of aqueous humour.
d) It is an adrenergic drug.
Answer 3: b
Pilocarpine is a cholinergic drug and increases aqueous humour outflow. It will increase
accommodative drive and can cause headaches because of this.

Question 4
Topical application of timolol maleate (Timoptol, Timoptic) causes which ONE of the following?

a) Miosis.
b) Mydriasis.
c) Bradycardia.
d) Hypertrichosis.

Answer 4: c
Timolol is a beta blocker and will cause a bradycardia. It has no significant effect on pupil size or
eyelash length.

Question 5
Which ONE of the following eye drops are useful adjuvants (pharmacological or immunological
agents that modify the effect of other agents) following glaucoma filtering surgery?

a) Mitomycin B.
b) Azithromycin.
c) 5-fluorouracil.(5FU)
d) Trifluridine (trifluorothymidine or TFT).

Answer 5: c

-5Fluorouracil (5FU) and Mitomycin C (not B) are powerful anti-metabolites used in glaucoma
filtering surgery to prevent fibrosis and scarring of drainage blebs. TFT is an antiviral drug and
azithromycin is an antibiotic. Neither have a role in glaucoma surgery.

Question 6
Which one of the following conditions will INCREASE the bioavailability of topically administered
eye drops within the eye?

a) Corneal epithelial debridement.

b) Pseudophakia.
c) Squeezing or blinking after application.
d) Multiple drops at very short intervals.

Answer 6: a
The cornea, conjunctiva and sclera act as the main absorption routes for topical medication. De-
epithelialization of the corneal surface improves bioavailibity by removing a physical and ionic
barrier to penetration. The natural tear film also acts as a barrier to the absorption of eye drops,
and therefore patients with dry eye experience greater bioavailability. Squeezing the eye and
blinking after drop administration reduce efficacy by both displacing the eye drop and replenishing
the tear film.