332 MCQ - EyeQuiz

1. Which attribute of sebaceous cell carcinoma makes the oil-red-O stain helpful in confirming this diagnosis? A. Cell membrane B. Cell nucleus C. Intracellular mitochondria D. Intracellular lipid E. Intracellular protein 2. Which of the following statement about sebaceous cell carcinoma of the eyelid is TRUE? A. Biopsy specimens must be placed in alcohol- based fixative to allow for proper processing B. Intraepithelial spread is a common feature of this tumor C. It may originate in the glands of Moll D. It is rarely multicentric E. It tends to invade locally but rarely metastasizes 3. Adenovirus is most commonly associated with which of the following conditions? A. Pharyngoconjunctival fever B. Optic neuritis C. Iris inflammatory nodules D. Kerato-uveitis 4. To record strabismic deviation in degrees instead of prism diopters, 30 prism diopters would correspond to how many degrees? A. 8.66o B. 16.7o C. 23.4o D. 57.7o E. 86.6o 5. Which of the following is a significant risk factor for hyperopia? A. Congenital glaucoma B. Keratoglobus C. Megalocornea D. Short axial length 6. Ocular absorption of a medication is increased by all the following, EXCEPT: A. Administering the drug as a sub-Tenon's injection B. Decreasing the lipid solubility of the drug C. Digital compression of the nasolacrimal duct D. Waiting at least 10 minutes between administration of eye drops E. Increasing the viscosity of the vehicle 7. The inheritance of posterior polar cataracts is: A. Autosomal recessive B. Autosomal dominant C. X-linked recessive D. X-linked dominant 8. The SECOND most common primary malignant intraocular tumor in adults is: A. Uveal melanoma B. Lymphoma C. Medulloepithelioma D. Retinoblastoma 9. A 3-year-old is found to have vision of 6/120 OD and 6/7.5 OS. Cycloplegic refraction is -5.50 in the right eye with an improvement in vision to 6/15 and plano in the left. The best initial treatment would be which of the following? A. A contact lens in the right eye B. Full time spectacles of -3.50 OD and plano OS C. Full time spectacles of -3.50 OD and + 2.00 OS D. Full time spectacles of -5.50 OD and plano OS E. Near full time patching of the left eye 10. A central retinal vein occlusion can be differentiated from hypertensive retinal vascular disease by the presence of which of the following? A. Cotton wool spots in 4 quadrants B. Retinal hemorrhages in 4 quadrants C. Retinal neovascularization D. Venous tortuosity 11. In a 20 mL bottle of 2% pilocarpine, how many grams of pilocarpine are present? A. 0.2 g B. 0.3 g C. 0.4 g D. 0.5 g E. 0.6 g 12. Disadvantages of CT imaging scanning include all the following, EXCEPT? A. Cannot use contrast dye if the patient has renal insufficiency B. Cannot use with patients with a history of retinoblastoma C. Higher radiation dose exposure than other modalities D. Poor visualization of bony structures E. Metals (such as teeth filling) cause significant artifacts 13. Which of the following should NOT be in the differential diagnosis of ACUTE conjunctivitis? A. Allergic conjunctivitis B. Bacterial conjunctivitis C. Keratoconjunctivitis sicca D. Toxic conjunctivitis E. Viral conjunctivitis 14. Which of the following symptoms is most useful in supporting the diagnosis of central retinal artery occlusion? A. Visual dimness B. Sudden total vision loss C. Lack of vision in the lower half of both eyes D. Ocular pain 15. Risk factors for angle closure glaucoma include: A. Asian or Inuit race B. Myopia C. Male gender D. East European ethnicity 16. Which of the following is a risk factor for normal tension glaucoma? A. African American race B. History of eye trauma C. History of iridocyclitis D. Positive family history 17. Which of the following is NOT characteristic of optic neuritis associated with neuromyelitis optica spectrum disorder (NMOSD)? A. Bilateral optic nerve involvement B. Chiasm involvement C. Poor recovery D. Rapid recovery 18. In what percent of patients are optic disc drusen bilateral? A. 20% B. 40% C. 60% D. 80% 19. Cystoid macular edema has been associated with which of the following? A. Cataract surgery B. Diabetes C. Prostaglandin analog glaucoma medication D. Retinitis pigmentosa E. All the above 20. Which of the following is the most important factor to help distinguish non-arteritic anterior ischemic neuropathy (NAION) from arteritic anterior ischemic neuropathy? A. Age B. Patient race C. Presence of disc hemorrhage D. Presence of disc swelling 21. The advantage of planned extracapsular cataract extraction over phacoemulsification is that it provides: A. Less likelihood of a nucleus dislocating into the vitreous B. Easier cataract removal if performed through a small pupil C. A more stable refraction over time D. Suitability for a temporal incision 22. Which of the following class of medications has been associated with a change in cornea thickness? A. Alpha-agonists B. Alpha-antagonists C. Beta-blockers D. Carbonic anhydrase inhibitors E. Prostaglandin analogs 23. Which of the following is NOT included in the differential diagnosis of CMV retinitis? A. Acute retinal necrosis (ARN) B. Birdshot chorioretinopathy C. Progressive outer retinal necrosis (PORN) D. Toxoplasmosis retinitis 24. Which of the following has helped to make CMV retinitis less of a problem in HIV positive patients? A. Acyclovir B. Foscarnet C. Ganciclovir D. Highly active anti-retroviral therapy (HAART) 25. Which of the following is NOT associated with inflammatory bowel disease? A. Conjunctivitis B. Episcleritis C. Interstitial keratitis D. Iritis 26. Which of the following conditions is NOT associated with ptosis? A. Horner syndrome B. Multiple sclerosis C. Myasthenia gravis D. Myotonic dystrophy E. Third nerve palsy 27. All the following conditions are indications for placement of punctal plugs, EXCEPT: A. Reducing systemic absorption of topically administered drugs B. Neurotropic keratopathy C. Keratoconjunctivitis sicca D. Epiphora with increased Schirmer test 28. A 74 year old woman presents with headaches, jaw claudication, ischemic optic neuropathy and a sedimentation rate of 35 mm/hr. What is the most important next step? A. Beginning corticosteroid treatment B. Checking the C-reactive protein level C. Ordering an MRI scan D. Performing a temporal artery biopsy 29. Which finding should prompt additional evaluation in a patient with headaches? A. Headache that recurs in a different location B. Transient positive visual phenomena that occur 20-30 minutes before the onset of the headache C. Persistent visual field defect after the headache resolves D. A family history of headaches 30. Which of the following is the primary goal in managing patients with intraocular melanoma? A. Preserving life B. Preserving the globe C. Preserving the patient's self esteem D. Preserving vision 31. Which of the following is NOT on the differential diagnosis for neoplastic masquerade syndrome? A. Acute posterior multifocal placoid pigment epitheliopathy B. Age related macular degeneration C. Necrotizing herpetic retinitis D. Sarcoidosis E. Toxoplasmosis 32. Neovascular complications of a branch retinal vein occlusion may include which of the following? A. Choroidal neovascularization B. Iris neovascularization C. Optic disc neovascularization D. Retinal neovascularization 33. Intraocular lens (IOL) calculation can be most difficult in which category of patients? A. Status post refractive surgery B. Status post pars plana vitrectomy C. Status post pan retinal photocoagulation D. Status post scleral buckling surgery 34. Which of the following is the most common cause of ectopia lentis? A. Aniridia B. Homocystinuria C. Peters anomaly D. Trauma 35. Which one of the following is the least commonly associated with Treponema pallidum infection? A. Interstitial keratitis B. Chorioretinitis C. Ectopia lentis D. Glaucoma 36. Which paring of findings is LEAST likely to occur in congenital rubella? A. Retinopathy and cataract B. Glaucoma and cataract C. Glaucoma and retinopathy D. Cataract and deafness 37. Orbital cellulitis most commonly spreads to which sinus? A. Cavernous sinus B. Ethmoid sinus C. Maxillary sinus D. Sphenoid sinus 38. One feature shared by all myopic patients is: A. Corneal thinning B. Steep corneas C. Long axial length D. Better uncorrected vision at near than at distance 39. What is the sensitivity and specificity of Cogan's Lid Twitch for ocular myasthenia gravis? A. Sensitivity 50% specificity of 75% B. Sensitivity 60% specificity of 80% C. Sensitivity 75% specificity of 80% D. Sensitivity 75% specificity of 99% 40. A 70-year-old man has pain, redness, and decreased vision in the right eye for 2 days. He has chronic open angle glaucoma OU and underwent trabeculectomy with mitomycin C in the right eye 2 years ago. Best corrected visual acuity is 6/60, and slit lamp examination shows 3+ injection with a Seidel positive bleb and yellowish discharge. There is 1+ cell and flare in the anterior chamber. The most important condition to rule out is: A. Conjunctivitis B. Corneal abrasion C. Iritis D. Vitritis 41. The correct conversion of the refraction +2.00 -1.00 x 45 to plus cylinder notation is: A. +3.00 -1.00 x 135 B. +3.00 +1.00 x 135 C. +1.00 +1.00 x 135 D. -1.00 -1.00 x 135 42. Which of the following features assures a diagnosis of idiopathic central serous chorioretinopathy? A. No single feature is diagnostic B. Pigmented epithelial detachment C. Apprehensive patient D. Subretinal fluid 43. Anterior ischemic optic neuropathy is due to: A. An infarct of the anterior ciliary artery B. An infarct of the posterior ciliary artery C. An infarct of the ophthalmic artery D. A vein occlusion of the optic nerve 44. Which of the following increases the risk of developing steroid- induced glaucoma? A. Family history of glaucoma B. Hyperopia C. Male gender D. Systemic hypertension 45. A 45 year old male with Huntington's chorea presents with bilateral corneal edema and 20/100 vision in both eyes. Which of the following medications is the most likely cause? A. Amantadine B. Amiodarone C. Dopamine D. Levo-dopa 46. All the following are associated with apraxia of lid opening (ALO), EXCEPT? A. Multiple sclerosis B. Parkinson's disease C. Wilson disease D. Progressive supranuclear palsy E. Occipital lobe infarcts 47. The differential diagnosis of anterior basement membrane dystrophy includes all the following, EXCEPT: A. Herpes simplex keratitis B. Meesmann dystrophy C. Reis-Buckler dystrophy D. Recurrent corneal abrasion 48. Indications for repair of orbital blowout fractures include: A. Enophthalmos of greater than 2 mm, or a floor fracture involving greater than 50% of the floor by CT scan B. Abnormal pupil reaction C. Diplopia in downgaze D. Hyphema 49. Which of the following is most indicative of a Hollenhorst plaque? A. An emmetrope B. A hyperope C. A myope D. A patient with high astigmatism 50. Macular hole surgery: Is usually indicated for idiopathic holes present for >1 year Is never indicated for traumatic holes May be complicated by reopening of the hole, despite successful surgery Rarely requires gas tamponade 51. Glaucoma associated with scleritis is thought to be due to: A. Elevated episcleral venous pressure B. Intraocular inflammation C. Increased aqueous production D. Side effect of steroid usage 52. Patients with myasthenia gravis should have a work-up which includes: A. Emergent hospitalization if there is associated orbicularis weakness B. Thyroid evaluation for possible thyroidectomy to reduce risk of generalization C. Computed axial tomography (CT) scan of the chest D. Period Tensilon tests to monitor patient progress 53. In those patients who develop multiple sclerosis (MS) after an episode of optic neuritis, what percent will retain normal vision after 15 years? A. 20% B. 40% C. 60% D. 80% 54. The advantage of performing continuous curvilinear capsulorrhexis (CCC) during cataract surgery is: A. To optimize intraocular lens (IOL) centration B. To decrease the resistance of the capsular bag to tearing during surgery C. To stimulate posterior capsular opacification D. To maintain nuclear fragments in the capsular bag during phacoemulsification 55. Prior to cataract surgery, diabetic patients should undergo which of the following procedures to decrease the operative risks? A. Argon laser trabeculoplasty B. Focal laser photocoagulation to clinically significant diabetic macular edema C. Panretinal photocoagulation only if vitreous hemorrhage is present D. Laser in situ keratomileusis (LASIK) 56. Which of the following clinical features are associated with subacute angle closure? A. Posterior chamber pseudophakia B. Areas of peripheral anterior synechiae C. Deep anterior chamber depth D. Angle recession on gonioscopy 57. 44 year old female presents with gradual onset of diplopia. She has 3 mm of ptosis, no upgaze or adduction, and a marked reduction of abduction of the right eye. The pupil is 5 mm and poorly reactive, but there is no afferent pupillary defect. Visual acuity is normal, as are the external and fundus evaluations. The lesion most likely in which one of the following areas? A. Orbit B. Cavernous sinus C. Brain stem D. Neuromuscular junction E. Cerebellum 58. Which of the following statements is FALSE for Hering's Law? A. There is equal and simultaneous innervation to synergistic extraocular muscles. B. There is equal and simultaneous innervation to yoked extraocular muscles. C. When a muscle contracts, its direct antagonist relaxes to an equal extent allowing smooth movement. 59. Which of the following is the most likely cause of conjunctivitis that produces a watery, filmy discharge in a two week old infant delivered vaginally? A. Chlamydia B. Escherichia coli C. Neisseria gonorrhoeae D. Silver nitrate side effect 60. Maternal infection with rubella virus during the first trimester is associated with which of the following ocular anomalies? A. Chorioretinitis B. Interstitial keratitis C. Iritis D. Congenital cataract 61. The primary cause of aniseikonia is which of the following? A. A significant difference in accommodative amplitude between the two eyes B. Development of accommodative insufficiency C. Development of accommodative spasm D. Spectacle correction with a significant difference of power between the two eyes 62. The presence of ectropion and missing eyelashes should make one alert to the possibility of which of the following? A. Involutional changes B. Lateral canthal tendon disinsertion C. Malignancy D. Toxic drug reaction 63. All the following structures pass through the superior ophthalmic fissure, EXCEPT: A. Abducens nerve B. Lacrimal nerve C. Nasociliary nerve D. Pterygoid nerve E. Superior ophthalmic vein 64. Which of the follow is a TRUE statement about how light waves can interact with each other? A. Light waves may interact constructive to increase intensity at a given wavelength. B. Light waves may interact constructive to increase wavelength intensity at a given intensity. C. Light waves may interact destructively to decrease wavelength at a given intensity. D. Light waves may interact to change their angle of polarization. 65. Which of the following statements is FALSE for corectopia? A. It means displacement of the pupil. B. It is never an isolated finding. C. It may be associated with Axenfeld-Rieger syndrome. D. It may be associated with the ICE syndrome. E. It may be associated with ectopia lentis et pupillae. 66. The most common cause of bilateral proptosis is which of the following? A. Orbital cellulitis B. Orbital metastasis C. Orbital myositis (pseudotumor) D. Thyroid eye disease 67. Regarding patients with episcleritis who were started on oral NSAIDS. All the following are signs of NSAID toxicity, EXCEPT? A. Bleeding B. Changes in stool C. Changes in urination D. Increase in bruising E. Tachycardia 68. A patient with vertical diplopia also has an increase in intraocular pressure upon upgaze. Which is the most likely diagnosis? A. Myasthenia gravis B. Partial III nerve palsy C. Previous ocular trauma D. Thyroid ophthalmopathy 69. All the following are correct statements regarding a paradoxical pupillary reaction, EXCEPT? A. It may be seen in patients with achromatopsia. B. It may be seen in patients with congenital stationary night blindness. C. It may be seen in patients with optic nerve hypoplasia. D. It may be seen in patients with dense congenital cataracts. E. Is linked to intrinsic responses of melanopsin-containing ganglion cells, which continue to function even with defective photoreceptors. 70. What is Amalric sign? A. Adduction of the eye upon attempted upgaze B. Convergence of the eyes with attempted lateral gaze C. Blood or pigment accumulation on the cornea after macular hole surgery D. Triangular zone of pigment change in the retina due to choroidal vessel infarction 71. What percent of patients with retrobulbar optic neuritis have pain on eye movement? A. 25% B. 50% C. 70% D. 90% 72. The refraction -2.00 +2.00 X 90 is equivalent to which of the following refractions in minus notation? A. -4.00 - 2.00 x 180 –B. +2.00 - 2.00 x 180 –C. +2.00 - 0.00 x 180 –D. 0.00 - 2.00 x 180 –73. A patient comes in wearing glasses: OD +2.00, OS -2.00, and complains of vertical diplopia when reading. Both eyes are reading 5 mm down from the optical center. How much slab-off do you prescribe and which spectacle lens do you add it to? A. 2.00 prism diopters OD B. 2.00 prism diopters OS C. 4.00 prism diopters OD D. 4.00 prism diopters OS 74. Which of the following is commonly associated with patients who have a posterior subcapsular cataract? A. Asian ancestry B. Excessive vitamin A intake C. A history of severe asthma D. Old age 75. While performing cataract surgery on a patient who has had previous trabeculectomy with mitomycin-C, you notice shallowing of the anterior chamber even while increasing the bottle height. What is the most likely reason for this? A. Increased filtration from the trabeculectomy site B. Vitreous hemorrhage C. Zonular laxity D. Posterior pressure 76. Which of the following is an indication of posterior capsule rupture during phacoemulsification? A. Deepening of the anterior chamber B. Less power is required to perform phacoemulsification C. Loss of pupillary dilation D. Loss of the red reflex 77. What is the diameter of the cornea that a keratometer uses to determine curvature? A. 2 mm B. 3 mm C. 5 mm D. 8 mm E. 10 mm 78. Patients with primary open angle glaucoma have been found to have which of the following? A. lower cerebral spinal fluid pressure than normal controls B. Similar cerebral spinal fluid pressure to normal controls C. Higher cerebral spinal fluid pressure than normal controls D. None of the above 79. A patient misses 1 of 5 letters on the Snellen 6/12 line, 2 of 5 letters on the 6/9.5 line, 3 of 6 letters on the 6/7.5 line, and 4 of 6 letters on the 6/6 line. The proper recording of the visual acuity is which of the following? A. 6/6 B. 6/7.5 C. 6/9.5 D. 6/12 E. 6/15 80. All the following have been shown to affect the progression of diabetic retinopathy, EXCEPT? A. Cardiac ejection fraction B. Serum lipid levels C. Duration of diabetes D. Blood pressure 81. When the patient reports that the letters in the red and in the green on the duochrome test are equal, which color of light will be in the sharpest focus on the retina? A. Red B. Purple C. Yellow D. Blue E. Green 82. All the following statements about carotid endarterectomy are correct, EXCEPT: A. It reduces the risk of stroke in symptomatic patients with 70% or greater stenosis. B. Stroke reduction and surgical outcomes are not related to the surgical experience of the team at the treating medical center. C. Endarterectomy was not beneficial for patients with moderate (50%-69%) stenosis. D. Aspirin may be beneficial in patients with mild carotid occlusive disease. 83. A 60 year old patient presents with complaints of decreased vision. On exam, you find severe anterior basement membrane dystrophy and cataract. Which of the following tests would be most helpful in determining the main cause of the vision change? A. Contact lens over-refraction B. Corneal topography C. Glare testing D. Potential acuity meter 84. A 69-year-old male with glaucoma has VA 6/60 OD and 6/48 OS. IOP is 12 mm Hg OD and 10 mm Hg OS. He is on three different antiglaucoma drops OU. Anterior segment evaluation reveals 3+ nuclear sclerosis. Gonio shows grade IV angles with 2+ pigment in the trabecular meshwork. Both eyes have advanced cupping. The patient understands that part of his vision loss is due to cataract and wants cataract surgery. What is the preferred procedure of choice? A. Patient is at high risk for vision loss and should not have cataract surgery B. Combined cataract and glaucoma drainage implant C. Cataract surgery with IOP observation D. Combined cataract and glaucoma filtration surgery 85. The most common cause of acute hypopyon anterior uveitis is: A. HLA-B27 associated iritis B. Behcet disease C. Syphilis D. Endophthalmitis 86. The advantage of a can opener capsulotomy during cataract surgery is that: A. It enables the anterior capsule to support a posterior chamber intraocular lens (IOL) if the posterior capsule ruptures. B. It is unlikely that any of the multiple cuts in the anterior capsule will extend into the posterior capsule. C. It is more difficult to perform than continuous curvilinear capsulorrhexis (CCC) when visualization is poor. D. It is more likely to trap a large nucleus when being delivered via a standard manual extracapsular cataract extraction (ECCE). 87. The term cyclodialysis refers to which of the following? A. A tear between the ciliary body and the sclera B. A tear between the iris and the ciliary body C. A tear between the longitudinal and circular portions of the ciliary muscle D. A posterior displacement of the iris root without alteration of the ciliary body. 88. Topical NSAIDs are not effective for the treatment of which of the following? A. Episcleritis B. Inflammation following cataract surgery C. Non-infectious keratitis D. Scleritis 89. A patient has a dense cataract which precludes visualization of the posterior retina. Which of the following would be most helpful in determining the visual potential? A. B-scan ultrasound B. Laser interferometry C. Maddox rod test D. Photo-stress recovery test E. Specular microscopy 90. A patient complains of headache, and blurred vision. On exam there is a fixed mid-dilated right pupil. The left pupil is normal. The dilated pupil does not respond to one drop of pilocarpine 1%. What is the most likely cause? A. Intracranial aneurysm B. Vasculopathic oculomotor nerve (CN III) palsy C. Migraine D. Pharmacologic mydriasis 91. Which of the following conditions is associated with an increased blink rate? A. Amyloidosis B. Multiple sclerosis C. Parkinson's disease D. Schizophrenia 92. Which of the following causes of postoperative anterior chamber shallowing are associated with low intraocular pressure? A. Aqueous misdirection B. Wound leak C. Suprachoroidal hemorrhage D. Pupillary block 93. Which of the following is an essential part of the evaluation of a patient with an acute traumatic hyphema? A. Family history of eye disease B. Gonioscopy for angle recession C. Sickle cell screening if the patient is of African descent D. Slit lamp examination for corneal blood staining 94. Topical corticosteroid use is associated with which of the following? A. Allergic conjunctivitis B. Epiphora C. Increased subconjunctival hemorrhages 95. What percent of patients with Pseudoexfoliation syndrome have a variation in the LOXL1 gene? A. 25% B. 50% C. 75% D. 99% 96. Which of the following is the best management approach to intraoperative iris bleeding during anterior segment surgery? A. Air injection into the anterior chamber B. Sector iridectomy C. Antibiotic injection into the anterior chamber D. Placement of gel foam clotting agent in anterior chamber 97. All the following maneuvers might be helpful to recover a capsulorrhexis tear that is extending too far peripherally, EXCEPT? A. Check for and relieve any external pressure on the globe B. Insert a second instrument through a paracentesis to press down on the lens C. Refill the anterior chamber with air D. Refill the anterior chamber with viscoelastic E. Use the bent cystitome to redirect the tear centrally 98. Acetazolamide is contraindicated in which of the following conditions? A. Aortic valve disease B. Cardiovascular disease C. Kidney failure D. Liver failure 99. Signs of an intraoperative suprachoroidal hemorrhage include: A. Shallowing of anterior chamber B. Loss of red reflex C. Iris prolapse D. Self-delivery of the lens E. All the above 100. All the following statements are CORRECT, EXCEPT? A. Average axial length: 23.5 mm B. Average keratometry: 43.0 - 44.0 diopte–s C. Anterior chamber depth: 2.5 mm D. Average lens thickness: 4.6 mm 101. All the following are CORRECT for Schnabel's Cavernous Optic Atrophy, EXCEPT? A. A histopathologic finding that may be found in patients with glaucoma. B. A histopathologic finding that may be found in patients with ischemic optic neuropathy. C. It is characterized microscopically by large cystic spaces that are posterior to the lamina cribrosa. D. It consists of hyaluronic acid infiltration of the optic nerve from the vitreous. 102. In Snellen visual acuity charts, what is the change in letter size with each line? A. A factor of 1.1 B. A factor of 1.2 C. A factor of 1.25 D. A factor of 1.5 E. A factor of 2.0 103. Which class of glaucoma medication has been associated with blood dyscrasias such as aplastic anemia? A. Beta blockers B. Carbonic anhydrase inhibitors C. Parasympathomimetics D. Prostaglandin analogs 104. Which of the following is a risk factor for developing an operculated retinal hole? A. Diabetes mellitus B. Paving stone degeneration C. Ocular trauma D. Adolescent age 105. Which of the following phakomatoses have AR inheritance? A. Neurofibromatosis (von Recklinghausen disease) B. Encephalotrigeminal angiomatosis (Sturge-Weber syndrome) C. Von Hippel-Lindau disease D. Tuberous Sclerosis (Bourneville's disease) E. Ataxia-telangiectasia(Louis–Bar syndrome) 106. What is the next appropriate step in a patient on a prostaglandin analog and Cosopt with uncontrolled intraocular pressure, a best corrected visual acuity of 6/12, and evidence of mild visual field progression? A. Glaucoma drainage implant B. Transscleral laser cycloablation C. Laser trabeculoplasty D. Observation 107. Relative contraindications to laser trabeculoplasty include all the following, EXCEPT: A. Young age (< 50 years) B. Failed previous laser trabeculoplasty C. History of retinal tear D. Less than 180 degrees of open angle 108. All the following factors will increase penetrance of the blood ocular barrier for system medications, EXCEPT? A. Decreased molecular size B. Decreased protein binding C. Increased protein binding D. Increased lipid solubility 109. Thyroid ophthalmopathy tends to affect the extraocular muscles in which order? A. IR>LR>SR>MR B. IR>MR>SR>LR C. IR>SR>MR>LR D. IR>MR>LR>SR 110. The presence of upper eyelid retraction, especially when more pronounced laterally, is most suggestive of which of the following conditions? A. Thyroid associated orbitopathy B. Previous upper eyelid surgery with scarring C. Myasthenia gravis D. Parinaud's syndrome 111. How long after dimming the lights should one wait before checking for dilation lag? A. 5 – 10 seconds B. 10 – 15 seconds C. 15 – 20 seconds D. 20- 25 seconds 112. An object placed in front of a convex spherical mirror what have an image that is which of the following? A. Real, inverted, and magnified B. Real, inverted, and minified C. Real, upright, and magnified D. Virtual, upright, and minified E. Virtual, upright, and magnified 113. When a posterior capsular rupture is suspected, the first action should be which of the following? A. Lower the irrigation bottle height B. Raise the irrigation bottle height C. Prepare the vitrector D. Use a second instrument to bring lens sections to the phaco tip E. Return to foot position 1 and instill a dispersive viscoelastic through the side port 114. How will the pupil of a patient with anisocoria from a complete third nerve palsy change when fixing on a near target? A. There will be constriction, then release B. There will be no change C. There will be dilation D. There will be constriction 115. If a parent has a history of bilateral retinoblastoma, what is the chance that his child will also develop retinoblastoma? A. 5% B. 10% C. 25% D. 45% E. 85% 116. What is the mechanism of action of cromolyn? A. Inhibits cyclooxygenase pathway B. Inhibits release of arachidonic acid C. Inhibits release of lysosomal enzymes D. Reduces mast cell plasma membrane permeability E. Inhibits leukocyte migration 117. One feature shared by all myopic patients is: A. Corneal thinning B. Steep corneas C. Long axial length D. Better uncorrected vision at near than at distance 118. It is possible to modulate ultrasound power by programming the phaco machine to vary the delivery pattern during various stages of phacoemulsification. Doing so will result in which of the following outcomes? A. The burst mode is commonly used for sculpting. B. The continuous mode results in the greatest amount of energy delivered into the eye C. The pulse mode reduces the amount of total ultrasonic power, but it increases the repelling forces at the phaco tip. D. The burst mode increases the overall ultrasonic power delivered. 119. Myopia is associated with all the following, EXCEPT: A. Greater educational status B. Greater height C. Greater maternal age D. Greater paternal age E. Maternal smoking during pregnancy 120. Postoperative management options for handling vitreous incarceration in a cataract surgery wound includes all the following, EXCEPT: A. Corticosteroid drops to reduce secondary ocular inflammation B. Non-steroidal anti-inflammatory drug (NSAID) drops to reduce the risk of secondary cystoid macular edema (CME) C. Neosynephrine drops to prevent pupil synechiae formation D. Neodymium yttrium-aluminum-garnet (Nd:YAG) laser for lysis of fine vitreous strands E. Vitrectomy if there is considerable vitreous incarcerated in the wound with associated CME or uveitis that is unresponsive to medical or laser surgical therapy 121. With normal aging, which of the following is TRUE for the human crystalline lens? A. Develops an increasingly curved shape B. Develops an increasingly flatter shape C. Develops a higher index of refraction (from soluble protein particle buildup) D. Decreases in axial length 122. Which of the following statements is FALSE for the most common cause of uveitis in children? A. The most common cause of uveitis in children is Juvenile Rheumatoid Arthritis. B. In patients with the most common cause of uveitis in children, the serology for rheumatoid factor is negative. C. In patients with the most common cause of uveitis in children, ANA serology is positive. D. Patients with the most common cause of uveitis in children are more often boys. E. The most common cause of uveitis in children is associated with a pauciarticular arthritis. 123. Which of the following tends to have skip areas? A. Basal cell carcinoma B. Melanoma C. Sebaceous carcinoma D. Squamous cell carcinoma 124. A 20-year-old patient wants new glasses because of increasing headaches. Wearing +2.00 +1.00 X 90 in each eye, the patient reads 6/6 in each eye. Manifest refraction of +0.50 +1.00 X 90 in each eye results in 6/6 clearer vision in each eye. The test most likely to help achieve an accurate refraction is: A. Retinoscopy B. Cycloplegic refraction C. Autorefraction D. Keratometry 125. All following are associated with aphakic spectacles, EXCEPT: A. The image is magnified by 50% B. They induce a pincushion distortion C. They reduced the visual field size and have poor acuity away from optical center of the lens D. They cause a ring scotoma from prismatic effect of the edge of the convex lens which results in the jack in the box phenomenon. E. Because of the visual distortions they induce, there is an increased difficulty in eye-hand coordination. 126. Anterior chamber intraocular lens (IOL) implantation is an alternative to posterior IOL placement when: A. Biometry is unavailable B. A limbal incision is constructed for ECCE C. Capsular support is inadequate for posterior IOL D. Time does not permit a suture or sulcus fixation of IOL 127. Ciprofloxacin and other fluoroquinolones have a black box warning label for all the following conditions, EXCEPT: A. Retinal detachment B. Tendon rupture C. CNS toxicity D. Exacerbation of muscle weakness in patients with myasthenia gravis 128. All the following statements about the lens is TRUE, EXCEPT: A. Zonular fibers are composed of collagen filaments that merge with the lens capsule B. The lens epithelium resides beneath the anterior and equatorial capsule C. The posterior lens capsule is the thinnest D. The lens capsule is composed of basement membrane that stains positively with periodic acid- Schiff (PAS) E. The posterior Y suture is upright and the anterior Y suture is inverted 129. What percent of patients in the optic neuritis treatment trial had 6/12 or worse vision in both eyes 15 years after the initial episode? A. 2% B. 5% C. 10% D. 20% E. 50% 130. If a +15 D spectacle lens at a vertex distance of 13 mm corrects an aphakic eye for distance, power contact lens will be necessary to correct the eye? A. 13.8 D B. 16.2 D C. 17.3 D D. 18.6 D E. 18.9 D 131. Therapies for allergic conjunctivitis typically include all the following, EXCEPT: A. Topical histamine receptor antagonist B. Topical nonsteroidal anti-inflammatory drugs C. Topical mast cell stabilizers D. Topical corticosteroids E. Warm compresses 132. Neuroimaging should be performed for any patient with an ocular motor mononeuropathy if the diplopia has not resolved within what time frame? A. 1 month B. 2 months C. 3 months D. 4 months E. 5 months 133. Which of the following is CORRECT regarding accommodative convergence demand? A. A myope using contact lenses will require more accommodative convergence than when wearing spectacles. B. A myope using spectacles will require more accommodative convergence than when wearing contact lenses. C. A hyperope using contact lenses will require more accommodative convergence than when wearing spectacles. 134. Treatment for traumatic hyphema should avoid which of the following agents? A. Topical corticosteroids B. Topical antihistamines C. Nonsteroidal, anti-inflammatory agents D. Oral calcium channel antagonists 135. What is the anterior to posterior sequence of structures in the eyelid starting from the eyelashes? A. Gray line, meibomian gland orifices, mucocutaneous junction B. Gray line, mucocutaneous junction, meibomian gland orifices C. Meibomian gland orifices, gray line, mucocutaneous junction D. Meibomian gland orifices, mucocutaneous junction, gray line E. Mucocutaneous junction, gray line, meibomian gland orifices 136. What is the most common cause of crocodile tears? A. Abducens palsy (6th nerve) B. Bell's palsy (7th nerve palsy) C. Fourth nerve palsy D. Third nerve palsy 137. A 6-year-old patient with blurred vision is found to have a cycloplegic refraction of +7.00 OU, with best corrected visual acuity 6/12 OU. The most likely etiology for bilateral decreased vision is: A. Monofixation syndrome B. Conversion disorder C. Irregular astigmatism D. Amblyopia 138. Which of the following is the most serious complication of periocular steroid injection? A. Cataract formation B. Injection into the retinal circulation C. Intraocular pressure elevation D. Proptosis 139. All the following factors determine the intraocular pressure, EXCEPT: A. Diastolic blood pressure B. Episcleral venous pressure C. Rate of aqueous humor production D. Resistance to outflow across the trabecular meshwork 140. The inheritance of posterior polar cataracts is: A. Autosomal recessive B. Autosomal dominant C. X-linked recessive D. X-linked dominant 141. Which of the following are in the correct order of duration of cycloplegic effect? A. Atropine > Cyclopentolate > Homatropine > Scopolamine B. Atropine > Homatropine > Cyclopentolate > Scopolamine C. Atropine > Homatropine > Scopolamine > Cyclopentolate D. Atropine > Scopolamine > Homatropine > Cyclopentolate 142. All the following are contraindications for magnetic resonance imaging (MRI), EXCEPT? A. Ferromagnetic foreign body B. Pacemaker C. Metallic cardiac valve D. Cochlear implants E. Acrophobia 143. For streak retinoscopy, All the following are CORRECT, EXCEPT: A. The patient's retina reflects the streak retinoscope light through their eye to the examiner's. B. Aligning the streak exiting and entering the patient's eye determines the cylinder's axis. C. The reciprocal of the working distance must be added to the power of the lens that neutralized with and against motion. D. The reciprocal of the working distance must be subtracted from the power of the lens that neutralized with and against motion. E. A contact lens may be used to eliminate irregular astigmatism induced from the cornea 144. A 35 year old woman presents with acute loss of vision in one eye, with pain on eye movement. She has no white matter lesions on MRI scan. What is her chance of developing multiple sclerosis within the next 15 years? A. 5% B. 10% C. 15% D. 25% E. 70% 145. Consequences that are associated with intraoperative vitreous loss during cataract surgery include all the following, EXCEPT: A. Corneal erosion B. Cystoid macular edema C. Secondary glaucoma D. Endophthalmitis E. Retinal detachment 146. Consequences that are associated with intraoperative vitreous loss during cataract surgery include all the following, EXCEPT: A. Misshapen pupil B. Retained lens material C. Vitreous strands to incision D. Bullous keratopathy and endothelial decompensation E. Corneal erosion 147. Which of the following is CORRECT for Schnabel's Cavernous Optic Atrophy? A. A histopathologic finding that may be found in patients with glaucoma. B. A histopathologic finding that may be found in patients with ischemic optic neuropathy. C. It is characterized microscopically by large cystic spaces that are posterior to the lamina cribrosa. D. It consists of hyaluronic acid infiltration of the optic nerve from the vitreous. 148. Which of the following should be your first choice to treat iridocyclitis associated with herpes zoster ophthalmicus? A. Topical steroids and topical trifluorothymidine B. Topical corticosteroids and oral antiviral medication C. Oral corticosteroid and topical trifluorothymidine D. Oral corticosteroid and oral antiviral medication 149. What supplies blood to the nerve fiber layer of the optic nerve head? Branches of central retinal artery Anterior ciliary arteries Short posterior ciliary arteries Both ciliary and retinal circulations 150. The most effective treatment for a patient presenting with the first episode of acute unilateral iridocyclitis associated with pain, photophobia, and redness is: Topical corticosteroids and oral hydrocodone Oral ibuprofen and topical cycloplegics Topical corticosteroids and topical cycloplegics Oral ibuprofen 151. Which of the following would NOT reduce the risk of incision burn during phacoemulsification? Higher aspiration rates and vacuum levels A loose fit between the phaco and the incision Occlusion of the phaco tip Use of cohesive viscoelastic 152. What is the most frequent risk factor for bacterial keratitis in the developed countries? Contact lens wear Prior herpetic keratitis Prior glaucoma surgery Tear deficiency syndrome 153. What is the most frequent risk factor for bacterial keratitis in the developing countries? Contact lens wear Prior herpetic keratitis Prior glaucoma surgery Trauma 154. Cataract surgery is performed on a 75 year old patient with Pseudoexfoliation and a history of retinal detachment in the operated eye. During the procedure, a large zonular dehiscence occurs, and there is not enough capsular support to place a posterior chamber intraocular lens. Which of the following is the most appropriate next step? Scleral fixation of posterior chamber intraocular lens Insert a flexible, open-loop anterior chamber intraocular lens Insert a rigid anterior chamber intraocular lens Leave the patient aphakic and fit with a contact lens 155. The annual rate of malignant transformation of a choroidal nevus into a melanoma is estimated to be which of the following? 1 in 10 1 in 100 1 in 1,000 1 in 10,000 1 in 100,000 156. Which of the following increases the risk of peptic ulcer when systemic corticosteroids are used? Usage at a dosage >= 2 mg/kg/day Usage for more than 3 months Usage with systemic mycophenolate Usage with naproxen 157. Which of the following statements regarding retinoblastoma is TRUE? An exuberant immune response is responsible for large areas of necrosis often seen in these lesions Flexner-Wintersteiner and Homer Wright rosettes are unique to this tumor The constituent cells of this lesion stain negative for S-antigen and rhodopsin The most common route for extension of this condition from the eye is through extension through the optic nerve There is a positive family history of this disease in the majority of cases 158. Which of the following cataract surgery patients is at least risk for having a small pupil? Uveitis patient positive for HLA-B27 Glaucoma patient on miotic Myopic patient with map-dot-fingerprint dystrophy Glaucoma patient with Pseudoexfoliation 159. Which of the following is NOT commonly associated with N. gonorrhoeae conjunctivitis? Pseudomembrane formation Preauricular lymphadenopathy Purulent discharge Corneal ulcer formation 160. A patient presents with optic neuritis and has no unidentified bright objects (UBOs) on MRI imaging. What is the risk of developing multiple sclerosis over the next 15 years? 10% 25% 50% 75% 90% 161. All the following are indications for neuroimaging in a patient with an isolated ocular motor mononeuropathy, EXCEPT? Age under 50 Headache or other neurologic findings History of cancer History of hypertension Progressive course of diplopia 162. A 1.0 mm shift in the position of an intraocular lens (IOL) leads to what approximate diopter shift in post-operative refraction? 0.5 D 1.0 D 1.5 D 2.0 D 163. What vertically compensating prism is needed for an individual wearing +5.00D OD and +2.00D OS when they are viewed in the normal reading position of 8mm down from the optical center of the lens? 4 Prism Diopters base-down OS 1.6 Prism Diopters base-up OD 2.4 Prism Diopters base-up OS 2.4 Prism Diopters base-up OD 164. What condition is often associated with recurrent corneal erosions? Macular corneal dystrophy Corneal epithelial basement membrane dystrophy Granular corneal dystrophy Meesmann corneal dystrophy 165. Each of the following bones contributes to the nasolacrimal canal, EXCEPT: Inferior turbinate Lacrimal Maxillary Palatine 166. If a diagnosis of primary open angle glaucoma is based solely on the presence of typical optic nerve damage irrespective of intraocular pressure (IOP), what percent of these patients will have an IOP of less than 22? 10 - 20% 15 - 25– 20 - 30– 30 - 50– 167. W–rk up of possible intraocular lymphoma should include which of the following: Chest X-ray Fluorescein angiogram Visual field testing Vitreous biopsy 168. A 65 year old patient with acute onset of floaters and a vitreous hemorrhage must be evaluated using which of the following? Contact lens evaluation for possible macular hole Echography, if vitreous hemorrhage precludes adequate visualization of the retina Indirect ophthalmoscopy 90 diopter lens examination for vitreous pigment 169. The presence of a pharmacologically dilated pupil is best confirmed by which one of the following: Response to 1/10% pilocarpine Response to 1% pilocarpine Lack of response to 1/10% pilocarpine Lack of response to 1% pilocarpine 170. In varicella-zoster ophthalmicus, an appropriate treatment option would include: Topical trifluridine to treat pseudodendrites Oral antibiotics to prevent superinfection Topical antibiotics to prevent superinfection Topical steroids as a routine treatment for keratitis 171. Corneal edema frequently accompanies which of the following conditions? Staph marginal keratitis Dry eye syndrome Corneal lattice dystrophy Corneal abrasion 172. All the following are recommended screening tests for patients taking hydroxychloroquine, EXCEPT: Fluorescein angiography (FA) Fundus autofluorescence (FAF) Multifocal electroretinography (mfERG) Spectral domain optical coherence tomography (SD-OCT) Visual field testing (10-2) 173. Which of the following is the most appropriate treatment for a superficial corneal foreign body? Bandage contact lens Antibiotic drops Antibiotic ointment Removal of the foreign body Patch and shield 174. What is the incidence of retinal break in a patient with an acute PVD and vitreous hemorrhage? 20% 30% 50% 70% 90% 175. Which of the following is an appropriate method of managing a patient with symptomatic anisometropia after complicated cataract surgery? Refractive surgery Therapeutic prism To change the base curve of the patient's eyeglasses To change the vertex distance of the patient's eyeglasses 176. All the following may have intraocular cartilage, EXCEPT: Primary Hyperplastic Primary Vitreous Medulloepithelioma Retinoblastoma Teratoma Trisomy 13 177. All the following conditions should be considered in the differential when a superior punctate staining pattern is found with on the limbal conjunctiva with fluorescein, EXCEPT: Blepharitis Exophthalmic thyroid Floppy eyelid syndrome Superior limbic keratoconjunctivitis Thyroid eye disease 178. Which of the following has the greatest resistance to aqueous outflow? Uveal trabecular meshwork Corneoscleral trabecular meshwork Juxtacanalicular trabecular meshwork 179. How often do prism glasses provide satisfactory correction for diplopia due to a chronic fourth nerve palsy? 20% 40% 60% 80% 180. Which of the following is α2 agonist? Betaxolol Brimonidine Latanoprost Timolol 181. Which of the following would prevent the use of a toric intraocular lens in a 60 year old woman with astigmatism? Deep anterior chamber Large capsulorrhexis Large wound Torn capsulorrhexis 182. Which of the following lens types is the best choice for implantation in the ciliary sulcus? Crystal One-piece acrylic Plate haptic Three-piece Polymethylmethacrylate 183. Tumors often seen in patient with neurofibromatosis type 1 include all the following, EXCEPT: Acoustic neurofibroma Plexiform neurofibroma Meningioma Optic nerve glioma   184. Which of the following is the best medical therapy for anterior basement membrane dystrophy? Topical nonsteroid, anti-inflammatory drops Topical hypertonic solution or ointment Topical cyclosporin drops Topical corticosteroid drops 185. Medical therapy for anterior basement membrane dystrophy include all the following, EXCEPT: Topical nonsteroid, anti-inflammatory drops 5% Sodium chloride solution and/or ointment Artificial tears and ointment Pressure patch or bandage contact lens 186. Surgical therapy for anterior basement membrane dystrophy include all the following, EXCEPT: Epithelial debridement Anterior stromal puncture Phototherapeutic keratectomy (PTK) LASIK 187. Chronic iridocyclitis is typically characterized by which of the following symptom? Pain Redness Insidious onset Photophobia 188. Chronic iridocyclitis is typically characterized by all the following symptoms, EXCEPT: Photophobia Blurred vision Floaters No pain or redness 189. In Giant Cell Arteritis, how soon after starting systemic steroids should a biopsy of the superficial temporal artery be performed? 1 day 1 week 2 weeks 1 month 190. Contraindications to kerato-refractive surgery include ALL the following, EXCEPT: Corneal abnormalities Unstable refraction Cataract Glaucoma 191. Contraindications to kerato-refractive surgery include ALL the following, EXCEPT: High refractive errors Pregnancy Severe dry eye Unrealistic expectations 192. Which category of strabismus is associated with the highest risk for amblyopia? Intermittent, non-alternating fixation Intermittent, alternating fixation Constant, alternating fixation Constant, non-alternating fixation 193. A 75-year-old, bilateral pseudophakic patient presents with progressive decreased vision in the left eye. Examination reveals bilateral anterior chamber intraocular lenses (ACIOLs) and significant corneal edema. What is the most appropriate option in managing this condition? Starting the patient on topical hyperosmotic agent 2% or 5%, prescription of NaCl ointment for bedtime, and drops during the day Telling the patient that complication from this disorder is unlikely, and that the condition will improve with decreased oral fluid intake Telling the patient that this is common in patients with ACIOLs, and that it will resolve without treatment Starting the patient on a diuretic (Diamox or Lasix) to help decrease fluid retention in the cornea 194. Which of the following statements is CORRECT regarding the UGH Syndrome? UGH syndrome = Uveitis, glaucoma, and hyperopia. The UGH syndrome is only associated with anterior chamber lenses. The UGH syndrome is never associated with posterior chamber lenses with haptics that are in the capsular bag. Treatment of the UCH syndrome usually requires removal of the intraocular lens. 195. All the following statements regarding the UGH Syndrome are CORRECT, EXCEPT: Rapid reduction in vision (minutes) and gradual resolution (hours-days) Vision loss varies from clouding or blurring to loss of light perception  Some patients have ache in the affected eye Some patients may complain of a reddish tinge to their vision (erythropsia).  196. A 66-year-old female presents with vertical diplopia which seemed to vary in different lighting conditions. The tropia is comitant and she also has mild metamorphopsia on the Amsler grid test in the left eye. Which of the following is the most likely diagnosis? Dragged-fovea diplopia syndrome Fourth nerve palsy Myasthenia gravis Skew deviation Third nerve palsy 197. All the following are thought to be possible etiologies of ocular surface problems related to contact lens wear, EXCEPT: Direct mechanical trauma from the contact lens Hypoxic metabolic epithelial damage Immune mediated response to mechanical trauma Toxicity from contact lens solution Use of hard contact lenses rather than soft contacts 198. Which of the following is a common cause of chronic conjunctivitis? Herpes zoster virus Herpes simplex virus Adenovirus Keratoconjunctivitis sicca 199. Which of the following maneuvers is useful in identifying the cause of a spontaneous vitreous hemorrhage? Glucose tolerance test Gonioscopy A-scan echography B-scan echography 200. Aniseikonia following cataract surgery can be managed by which of the following? Astigmatic keratotomy IOL exchange Separate reading and distance eyeglasses Slab off adjustment to the lens over the affected eye 201. The photostress test is NOT accurate in cases where the visual acuity is less than: 6/120 6/60 6/30 6/24 6/15 202. What is the mechanism of action by which miotics reduce intraocular pressure? Reduce aqueous production by inhibiting Na/K pump By decreasing episcleral venous pressure By increasing aqueous outflow Reduce aqueous production by decreasing bicarbonate formation in the ciliary body epithelium 203. All the following are CORRECT regarding sympathetic nerves innervation to the eye, EXCEPT? They join the 6th cranial nerve in the cavernous sinus They join the 1st division of the 5th cranial nerve in the cavernous sinus They join the 2nd division of the 5th cranial nerve in the cavernous sinus They join the long ciliary nerve in the orbit to reach the pupil They innervate Mueller’s muscle by traveling with the ophthalmic artery 204. Relevant clinical findings in the presence of pterygia include which of the following? Increased intraocular pressure With the rule astigmatism Vogt's limbal girdle Irregular astigmatism 205. All the following are TRUE regarding Kayser Fleischer ring and Wilson's disease, EXCEPT: Approximately 95% of Wilson's disease patients presenting with neurological signs will have a Kayser Fleischer copper ring Kayser Fleischer ring is Descemet's membrane copper deposits Approximately 95% of WD patients presenting with hepatic signs will present with a Kayser Fleischer ring. A Kayser Fleischer ring may be seen in asymptomatic Wilson's disease patients. 206. The posterior surface of a cornea with a radius of curvature of 6.8 mm and a refractive index of 1.376 has a refracting power of? -55.3 D -5.88 D -4.76 D +5.76 D +202 D 207. During exam under anesthesia in a patient with ocular trauma, there is evidence that a sharp object has penetrated through the cornea, lens, vitreous, and posterior sclera. How should this injury be classified in the operative note? Globe laceration with contrecoup rupture Globe perforation Globe penetration Scleral perforation 208. All the following are frequent causes of sixth nerve palsies, EXCEPT: Diabetes Head trauma Hypertension Increased intracranial pressure Pituitary tumors 209. Each of the following can invade an intact corneal epithelium, EXCEPT: Corynebacterium diphtheriae Neisseria meningitidis Pseudomonas aeruginosa Shigella 210. What is the most effective treatment for the iridocyclitis associated with herpes zoster ophthalmicus in an immunocompetent patient? Oral ganciclovir Oral corticosteroids Topical corticosteroids and topical trifluorothymidine Topical corticosteroids and oral acyclovir 211. Symptoms of hyperthyroidism include all the following, EXCEPT: Brittle hair Sensitivity to heat Tremor Weight gain 212. All the following supply blood to the optic nerve head, EXCEPT: Terminal branches of the pial network Ophthalmic artery Short posterior ciliary arteries Choroidal arterioles 213. All the following are risk factors for non-arteritic anterior ischemic optic neuropathy (NAION), EXCEPT: A crowded disc  Diabetes  Myopia Hypertension Hyperlipidemia 214. During small incision cataract surgery on an 80-year-old woman with hypertension and high myopia, there is progressive shallowing of the anterior chamber. Which of the following is the most likely cause? A dropped nucleus Excessive irrigation Suprachoroidal hemorrhage Tight wound 215. All the following result in deeper anterior chamber, EXCEPT: A dropped nucleus Excessive irrigation Suprachoroidal hemorrhage Tight wound 216. The most common cause of unilateral proptosis is which of the following? Orbital cellulitis Orbital myositis Orbital disease from metastasis Thyroid eye disease 217. Which of the following necessitates additional evaluation in a patient with facial palsy?  Simultaneous bilateral facial palsy Recovery of facial nerve function 3 weeks after the onset of the facial palsy Facial palsy occurring in a patient older than 50 years of age  Upper and lower facial musculature equally affected 218. All the following are typical clinical features of toxic medication injury to the cornea, EXCEPT: Injection of the conjunctiva, greater inferiorly Epithelial defects of the cornea, superiorly Epithelial defects of the cornea, inferiorly Punctate corneal epithelial erosions 219. Which of the following statements about the cornea is TRUE? The cornea is a spherical surface with an average central refractive power of 43D The refractive index of the corneal stroma is 1.336 The tear-corneal interface is responsible for most of the eye's refractive power A keratoscopic image of high with-the-rule astigmatism is an ellipse with the long axis oriented horizontally 220. A patient sees 6/15 in the right eye with a best spectacle correction of -4.00 + 0.50 x 90. The patient can read 6/6 through a -3.75 rigid gas permeable contact lens. The most likely diagnosis is which of the following? Aniseikonia Anisometropia Irregular astigmatism Malingering 221. All the following are TRUE regarding ocular motility defect in patients with Parkinson's disease, EXCEPT: Accommodative spasm Convergence insufficiency Esotropia at near Difficulty with reading 222. Glare testing is indicated in which of the following situations? To evaluate early lens opacities in an asymptomatic patient To evaluate the effect of posterior capsular opacification on functional vision As a screening test for glaucoma As a test for malingering 223. Which of the following is the most common etiology of infectious neonatal conjunctivitis? Chlamydia Herpes simplex Group B streptococcus Neisseria 224. Bilateral abduction defects and pupillary constriction upon attempted lateral gaze is most likely due to: Bilateral sixth nerve palsies. Myasthenia gravis. Spasm of the near reflex. Graves' disease. 225. Prostaglandin analogues decrease intraocular pressure by all the following mechanisms, EXCEPT: Decreasing aqueous production by inhibiting the Na/K pump Decreasing aqueous production by inhibiting bicarbonate formation in the ciliary body epithelium Decrease episcleral venous pressure Increasing aqueous outflow 226. All the following structures are contained within the optic canal, EXCEPT: The optic nerve The fourth nerve Sympathetic fibers The ophthalmic artery 227. Which of the following are important history details when evaluating a patient with a possible traumatic open globe? Medications Status of tetanus prophylaxis Time of last food intake Visual acuity prior to the injury Work related injury and use of protective eyewear 228. A five year old with best corrected visual acuity of 6/12 in each eye has a cycloplegic refraction of + 7.00 sphere OU. Which of the following is the most likely reason for the decreased vision? Amblyopia Conversion disorder Irregular astigmatism Monofixation syndrome 229. 1 mm of deviation in the corneal light reflex equals to how many prism diopters of deviation? 5 diopters 10 diopters 15 diopters 20 diopters 230. Which of the following are correct regarding streak retinoscopy? The plano position for the Copland retinoscope is sleeve up and the Welch Allyn retinoscope is in the plano position with the sleeve down. The examiner is attempting to put the far point of the patient’s eye at the plane of the examiner’s pupil. When the reflex shows “against” motion, the far point plane lies between the patient’s eye and the examiner’s eye, indicating myopia. When the reflex shows “with” motion, the far point lies outside the interval between the patient’s eye and the observer’s eye, indicating hyperopia, emmetropia or mild myopia. 231. Which of the following are CORRECT? A soft contact lens should not move when the patient blinks. If a soft contact lens does not move when the patient blinks, the fit is too steep. If a soft contact lens does not move when the patient blinks, the fit is too flat. The spherical equivalent of the spectacle lens should be used for the soft lens prescription. 232. The etiology of orbital cellulitis may include all the following, EXCEPT: Dental abscess Orbital fracture Sinus infection Periocular skin infection Amyloidosis 233. Which of the following items is NOT helpful when considering the diagnosis of amblyopia as the reason for unexplained visual loss in an adult? A history of a weak eye, strabismus, strabismus surgery and/or patching therapy.  The presence of anisometropia, astigmatism, and/or small-angle heterotropia.  Determine if visual acuity improves with testing a single letter rather than an entire line. History of seizure disorder 234. The acute management of a 12 year old girl with a small orbital floor fracture should include which of the following? Immediate high dose corticosteroids Observation Prism glasses Urgent referral for consideration of surgery 235. Beta blockers decrease intraocular pressure by which of the following mechanisms? Decreasing aqueous production by inhibiting the Na/K pump Decreasing aqueous production by inhibiting bicarbonate formation in the ciliary body epithelium Decreasing episcleral venous pressure Increasing aqueous outflow 236. What is the mechanism of action by which carbonic anhydrase inhibitors reduce intraocular pressure? Reduce aqueous production by inhibiting Na/K pump By decreasing episcleral venous pressure By increasing aqueous outflow Reduce aqueous production by decreasing bicarbonate formation in the ciliary body epithelium 237. Which of the following statements about lens implant power calculations is TRUE? Corneal thickness measurement is important for regression formulas to predict the appropriate IOL power The calculated lens implant power for a sulcus placed IOL is less than that for a lens placed into the capsular bag The calculations for IOL will differ depending on the IOL material to be used (silicone, acrylic, or PMMA) Shorter axial lengths are obtained with immersion biometry as compared to contact biometry 238. Which of the following tests is the most sensitive for detecting ethambutol-induced optic neuropathy? Visual acuity Color vision  Visual fields  Optical coherence tomography (OCT) 239. Which of the following tests is the most sensitive for detecting ethambutol-induced optic neuropathy? Visual acuity Color vision  Pattern-VER Optical coherence tomography (OCT) 240. The best first step in managing an obese female patient with headaches and optic nerve swelling is? Diamox therapy Diuretic therapy IV corticosteroid therapy Lumbar puncture Neuroimaging 241. All the following are the components of color perception, EXCEPT: Hue Brightness Uniformity Saturation 242. Which of the following is CORRECT for Simultanagnosia? It is a problem of visual analysis.  It is the failure to perceive moving objects. It is a hallucination involving the persistence of previously seen images. It is an illusion involving the persistence of previously seen images. 243. What is the most common ocular opportunistic infection in patients with AIDS? Syphilitic chorioretinitis Cytomegalovirus retinitis Toxoplasma retinochoroiditis Progressive outer retinal necrosis 244. 226. All the following structures are contained within the optic canal, EXCEPT: The optic nerve The third nerve Sympathetic fibers The ophthalmic artery 245. A pathology report from a biopsy of a mass in the lacrimal gland area says "most of the normal lacrimal gland is replaced by aggregations of epithelioid cells. Around these aggregates are mantles of lymphocytes, with giant cells present but no necrosis." The most likely diagnosis is: Amelanotic melanoma Idiopathic orbital inflammation (pseudotumor) Sarcoidosis Tuberculosis Wegener's granulomatosis 246. Which of the following is at the highest risk for developing iridocyclitis? ANA negative boy with pauciarticular arthritis ANA positive boy with polyarticular arthritis ANA negative girl with pauciarticular arthritis ANA positive girl with pauciarticular arthritis ANA negative girl with polyarticular arthritis 247. Preoperative conditions that often result in a small pupil include ALL the following, EXCEPT: Alpha 1 - adrenergic –ntagonists Beta adrenergic antagonists Chronic pilocarpine therapy Pseudoexfoliation 248. Which of the following would NOT be detected with the use of Prussian blue stain? Ferry line Fleischer line Krukenberg spindle Stocker line 249. In patients with facial pain due to herpes zoster, how many days before the appearance of a rash does the pain typically begin? 1 day 3 days 7 days 10 days 250. Which one of the following conditions leads to a posterior vitreous detachment? Syneresis Severe coughing Psychological stress Developmental anomaly 251. Which of the following complications is most likely to occur during cataract surgery on a patient with an anterior polar cataract? Corneal decompensation Detachment of Descemet membrane Radial capsular tear Suprachoroidal hemorrhage Zonulysis 252. One of the following for image displacement in bifocal segment is TRUE: Is the effect of the prismatic effect of the distance lens and segment correction Is the effect of the prismatic effect of the distance lens  Is the effect of the prismatic effect of the segment correction Is minimized when the prismatic effect of the distance lens and segment are in the same direction 253. Each of the following may be caused by intraocular hemorrhage, EXCEPT: Ochre membrane Asteroid bodies Synchysis scintillans Hemosiderosis bulbi  Siderosis bulbi 254. All the following are associated with anterior uveitis characterized by elevated intraocular pressure, iris atrophy, and diffuse keratic precipitates, EXCEPT: Cytomegalovirus (CMV) Herpes simplex virus (HSV) Rubella Varicella zoster virus (VZV) Toxoplasmosis 255. All the following are associated with von Hippel-Lindau disease, EXCEPT: Cafe au lait cafés Lisch nodules Renal cell carcinoma Pancreatic cysts Pheochromocytoma 256. The most common malignant primary orbital tumor in children is: Wilms tumor Lymphoma Neuroblastoma Rhabdomyosarcoma 257. Which of the following is an IMPROPER technique for the management of iris prolapse during phacoemulsification cataract surgery? Incarceration of iris in wound closure Sector or peripheral iridectomy Change to alternate incision site Sweep iris from paracentesis site 258. All the following are CORRECT for sickle cell anemia and hyphema, EXCEPT: Beta-blockers are safe to use because they do not increase sickling. Carbonic anhydrase inhibitors should not be used because they increase sickling by decreasing pH. Epinephrine is safe to use because it does not increase sickling Alpha-agonists should not be used because they increase sickling because it they lead to vasoconstriction and hypoxia which increases sickling. Hyperosmotics should not be used because they increase sickling because they lead to hemoconcentration which increases sickling. 259. All the following are reported causes of trigeminal neuralgia, EXCEPT: Multiple sclerosis Tumor Blood vessel  Sinusitis 260. Which of the following are CORRECT regarding Collier's sign? It is seen in the dorsal midbrain syndrome. In older individuals is usually caused by a stroke. In young individuals it is usually caused by tumors, most often a pinealoma (intracranial germinomas). In women in their twenties and thirties the cause is usually multiple sclerosis. It is the eponym for bilateral retraction of the upper eyelids. 261. Inflammation is best visualized with which MRI technique? Diffusion weighted imaging (DWI) Fluid attenuated inversion recovery (FLAIR) Gadolinium contrast Coils 262. Which of the following is the most common postoperative complication of cataract surgery? Acute endophthalmitis Cystoid macular edema Intraocular lens displacement Retinal detachment 263. Anterior chamber hemorrhage upon entry into the eye is known as which of the following? Amsler's sign Hutchinson's sign Munson's sign Watzke's sign 264. Involvement of the tip of the nose in V1 herpes zoster dermatitis is known as which of the following? Amsler's sign Hutchinson's sign Munson's sign Watzke's sign 265. Disruption of the eyelid contour in keratoconus is known as which of the following? Amsler's sign Hutchinson's sign Munson's sign Watzke's sign 266. Discontinuous perception of a line of light in patients with full thickness macular holes is known as which of the following? Amsler's sign Hutchinson's sign Munson's sign Watzke's sign 267. A 4-month-old boy is brought to your office with a two month history of nystagmus. He does not fix or follow objects and the nystagmus is coarse and searching, with sluggish pupil reactions. Your next course of action should be which of the following? CT scan ERG examination under anesthesia metabolic workup visual evoked potential (VEP) 268. Recurrent, spontaneous vitreous hemorrhage may be due to which of the following reasons? Retinal detachment Scleral indentation Endophthalmitis Retinal neovascularization 269. Amaurosis fugax is associated with which of the following? Central retinal artery occlusion Central retinal vein occlusion Diabetic retinopathy Retinal macroaneurysm 270. Which of the following associated clinical presentations would require urgent cataract extraction in a patient with a hypermature cataract? Acute glaucoma Endophthalmitis Hand motion vision Retinal detachment 271. All the following are CORRECT for a direct ophthalmoscope, EXCEPT: The magnification obtained depends on the optics of the patient's eye to act as a simple magnifier. The image is inverted. An emmetropic has a power of about 60 diopters results in a 15 times magnification. An aphakic eye of 40 diopters results in a 10 times magnification. Magnification is based on the total refractive power of the eye. 272. A patient with recovered optic neuritis may experience transient reversible vision loss in association with: Extreme gaze to the left or right Changing from a sitting to a standing position Heat or exercise Antibiotic use 273. Which eye movement disorder is most commonly seen in patients with paraneoplastic syndromes?  Downbeat nystagmus  Upbeat nystagmus Superior oblique myokymia Opsoclonus 274. The prevalence of amblyopia in the general population is which of the following? 1% 2% 5% 10% 20% 275. A patient with uveitis is at increased risk of developing: Asteroid hyalosis Cataract Corneal dystrophy Retinoschisis 276. A patient on corticosteroid treatment is at increased risk of developing: Asteroid hyalosis Cataract Corneal dystrophy Retinoschisis 277. A patient with uveitis is at increased risk of developing: Asteroid hyalosis Glaucoma Corneal dystrophy Retinoschisis 278. A patient on corticosteroid treatment is at increased risk of developing: Asteroid hyalosis Glaucoma Corneal dystrophy Retinoschisis 279. A 70-year-old male presents with visual acuity of 6/6 in the right eye and HM in the left. He has an almost mature cataract in the left eye with mild exotropia and a history of blunt trauma in that eye 20 years ago. The right eye exam is normal. A relative afferent pupil defect in the left eye would lead one to suspect which of the following? The cataract is ready for removal There is a left Adie pupil There is a partial paresis of left cranial nerve  There is damage to the left optic nerve 280. Anisometropia can result in which of the following refractive disorders? Accommodative insufficiency Aniseikonia Horror fusionis Monocular diplopia 281. Which nicotinic antagonists cause extraocular muscle contraction and are contraindicated in the setting of a ruptured globe? Gallamine Pancuronium Succinylcholine 282. Which nicotinic antagonists cause extraocular muscle contraction and are contraindicated in the setting of a ruptured globe? Gallamine Pancuronium Decamethonium 283. Normal excursion of the upper eyelid (from downgaze to upgaze) is: 5 mm 10 mm 15 mm 20 mm 25 mm 284. "macula" in Latin means which of the following? Acute Center Pit Spot Yellow 285. Which of the following is usually a contraindication to MRI scanning unless special precautions are taken? Allergy to contrast material Claustrophobia Low back pain Obesity 286. Each of the following may involve the anterior segment during the first decade of life, EXCEPT: Acute myelogenous leukemia Juvenile xanthogranuloma Large cell lymphoma Medulloepithelioma Retinoblastoma 287. Which of the following symptoms MUST be present to diagnose primary open-angle glaucoma? Intraocular pressure (IOP) > 21 mm Hg Arcuate visual field defect Family history of glaucoma An open angle on gonioscopy 288. A change in intraocular lens (IOL) power of 1.0 correlates to what approximate change in post-operative refraction? 0.5 D 0.75 D 1.0 D 1.25 D 1.5 D 289. How does a person's astigmatism change over their lifetime? It does not change much in axis It tends to change from "with-the-rule" astigmatism to "against-the-rule" It tends to change from "against-the-rule" astigmatism to "with-the-rule" 290. Laser trabeculoplasty treatment is performed at which angle structure? Schwalbe's line Scleral spur Pigmented trabecular meshwork Junction of pigmented and nonpigmented trabecular meshwork 291. Risk factors for branch retinal artery occlusion include all the following, EXCEPT: Diabetes mellitus Hypertension Cardiac valvular disease Giant-cell arteritis 292. At what age would the visual evoked response acuity be expected to be present at the adult level? 1 week 2 months 6 months 2 years 293. Pleomorphic adenomas of the lacrimal gland. Which of the following is TRUE? Are usually malignant Are prone to recur after removal Are encapsulated with little tendency for local invasion Cause erosion of the adjacent orbital bone 294. Which of the following is CORRECT for Simultanagnosia? It is the failure to integrate multiple elements of a scene to form the total picture.  It is the failure to perceive moving objects. It is a hallucination involving the persistence of previously seen images. It is an illusion involving the persistence of previously seen images. 295. All the following statements regarding transient ischemic visual loss (amaurosis fugax) are CORRECT, EXCEPT?  The evaluation should exclude a carotid or cardiac source. The differential diagnosis includes embolic or thromboembolic cause.  The monocular visual loss typically lasts seconds to minutes.  An altitudinal field loss suggests migraine rather than transient ischemia from hypoperfusion, emboli, or thrombosis 296. Which of the following layers of the cornea have tight junctions? Bowman's membrane Descemet's membrane Endothelium Stroma 297. Which of the following layers of the cornea have tight junctions? Bowman's membrane Descemet's membrane Epithelium Stroma 298. All the following are associated with an increased rate of developing geographic atrophy or neovascular age-related macular degeneration EXCEPT: Body mass index Female sex Smoking White race 299. Which of the following precludes a diagnosis of intermediate uveitis? Choroidal granulomas Cystoid macular edema Pars plana exudates Retinal vascular sheathing 300. Which of the following statements regarding topical fluorescein is FALSE? It is a nontoxic, water-soluble dye It is used to detect disruptions of intercellular junctions It can be used to detect subtle epithelial irregularities even without an epithelial defect It has antiviral properties 301. What important diagnostic difference exists between a central retinal artery occlusion and a multiple branch retinal artery occlusion? Both types of occlusions are caused by emboli. Central retinal artery occlusions have worse visual outcomes. Giant cell arteritis causes only central retinal artery occlusions. Both types of occlusions are diagnostically equivalent. 302. Which of the following regarding the vitreous is FALSE? It is firmly attached at the vitreous base, optic disc margin, and posterior lens capsule It is composed mostly of collagen It is approximately 4 cc in volume It undergoes syneresis, which results in posterior vitreous detachment It can act as a scaffold for proliferative vitreoretinopathy 303. Which of the following is unlikely to cause inflammation following cataract surgery? Surgical trauma Endogenous uveitis Wound leak Exposure to toxic substances intraoperatively 304. Which of the following are CORRECT for Hydroxyamphetamine? Blocks reuptake of norepinephrine by nerve terminal synapse Prevents storage of norepinephrine at nerve terminal Increases release of norepinephrine from nerve terminal Decreases release of norepinephrine from nerve terminal 305. Asymptomatic retinal holes or tears have which of the following features? Associated floaters Macular occurrence Associated peripheral visual loss Low risk of retinal detachment 306. Which of the following is CORRECT for aqueous humor production? Production decreases 10% with sleep Production decreases 20% with sleep Production decreases 30% with sleep Production decreases 45% with sleep 307. 306. Which of the following is CORRECT for aqueous humor production? Production decreases 2%/decade Production decreases 3%/decade Production increases 2%/decade Production increases 3%/decade 308. The most common site for metastasis of choroidal melanoma is which of the following: bone brain liver lung 309. The differential diagnosis of normal tension glaucoma includes all the following, EXCEPT: Anterior ischemic optic neuropathy Compressive lesions of the optic nerve Intermittent elevation of intraocular pressure (e.g., Posner Schlossmann syndrome) Primary open angle glaucoma with large diurnal pressure variation Thick central cornea 310. A patient presents with multiple cranial nerve palsies and diplopia. Which of the following can help distinguish a cavernous sinus and orbital apex lesion? Frontal nerve involvement Horner syndrome Infraorbital nerve involvement Optic neuropathy 311. Which of the following is the most important sign suggesting a higher risk of ocular involvement with V1 division herpes zoster (shingles)? Forehead vesicles Hutchinson sign Lid margin lesions Periocular pain 312. Most cases of sympathetic ophthalmia occur how soon after penetrating trauma? 3 months 6 months 1 year 5 years 10 years 313. Which one of the following is characteristic of intermittent exotropia? Full ductions and versions Least common form of exodeviation Poor stereopsis Onset in adulthood 314. All the following are TRUE for intermittent exotropia, EXCEPT: Onset in adulthood May decompensate with age Most common type of exodeviation Worse when tired or sick 315. All the following are TRUE for intermittent exotropia, EXCEPT: Full ductions and versions Associated with low grade stereopsis Deviation often manifest during visual inattention Intermittent blurred vision and asthenopia 316. All the following should be in the differential diagnosis of leukocoria in an infant, EXCEPT: Cataract Coats disease Persistent fetal vasculature Retinoblastoma Shaken baby syndrome 317. All the following should be in the differential diagnosis of leukocoria in an infant, EXCEPT: Retinopathy of prematurity Toxocariasis Shaken baby syndrome Persistent fetal vasculature 318. A 65-year old woman experiences halos and streaks of light from a source of light a few weeks after uncomplicated cataract surgery. The patient reports no floaters or loss of vision. Which of the following best explains the patient's symptoms? Dislocated intraocular lens Intraocular inflammation with elevated pressure Multifocal optic Posterior vitreous detachment 319. A 45 year old male with Huntington's chorea presents with bilateral corneal edema and 6/30 vision in both eyes. Which of the following medications is the most likely cause? Amantadine Amiodarone Dopamine Levo-dopa 320. Which of the following is most likely to be produced by an aneurysm of the ophthalmic artery? A CN I neuropathy on the same side A CN II neuropathy on the same side A CN III palsy on the same side. A CN V neuropathy on the same side A CN VI palsy on the same side. 321. Which of the following corneal dystrophies is most likely to recur in a corneal graft? Fuchs Granular Lattice Macular 322. Which of the following corneal dystrophies does NOT typically recur in a corneal graft? Fuchs Granular Lattice Macular 323. Which of the following risk factors are associated with the development of retinopathy of prematurity? A. Septic shock B. Postnatal jaundice C. Maternal diabetes D. Low birth weight 324. A patient drinks a liter of water shortly before having his eye pressure checked. What might be the expected result? His intraocular pressure would be lower His intraocular pressure would be higher His intraocular pressure would be unchanged His intraocular pressure would be slightly lower 325. Early signs of possible thermal injury include which of the following symptoms? Subconjunctival hemorrhage Corneal epithelial sloughing at incision Difficulty in aspirating nuclear pieces Reflux of fluid around phacoemulsification tip 326. All the following statements about conjunctival nevi are CORRECT, EXCEPT? Conjunctival nevi are rarely found on the palpebral conjunctiva Nevus cells are confined to the substantia propria The diagnosis of a conjunctival nevus in a 40 year old man with a new, pigmented lesion of the bulbar conjunctiva is unlikely to be accurate Bulbar hyperpigmentation associated with oculodermal melanocytosis is due to episcleral melanosis rather than a true nevus of the conjunctiva 327. Which of the following is a potential complication of varicella-zoster virus keratitis? Cataract Interstitial keratitis Neurotrophic keratitis Corneal dellen 328. Which of the following enzymes break down norepinephrine? Monoamine oxidase Noradrenaline Reserpine Acetylcholinesterase 329. Which of the following enzymes break down norepinephrine? Noradrenaline Catechol-O-methyltransferase Reserpine Acetylcholinesterase 330. How does a person's astigmatism change over their lifetime? It does not change much in axis It changes by 3D It tends to change from "with-the-rule" astigmatism to "against-the-rule" It tends to change from "against-the-rule" astigmatism to "with-the-rule" 331. "Trap door" orbital floor fractures are typically seen in which of the following settings? Concomitant medial wall fractures Older patient age Patients with diabetes Younger patient age 332. A patient who underwent cataract surgery has a refraction of -0.25 + 0.25 x 80 with 6/6 vision in the right eye and -4.75 + 0.50 x 25 in the left. The patient complains of a difference in size of the images between the two eyes. Which of the following is the most likely cause? Anisometropia Incorrect intraocular lens calculation Induced prism Tilting of the intraocular lens implant