Free General Ophthalmology MCQs
A mixed sampler across all ophthalmology subspecialties to test your overall readiness.
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General Ophthalmology
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Full question bank
All 203 free General Ophthalmology MCQs, with answers and explanations
The quiz above serves a random 10 of these each time you retake it. Every question in the set is listed below — read the stem, commit to an option, then open the answer to check your reasoning against the explanation.
- 1
Uveoscleral outflow accounts for what percentage of aqueous outflow?
- A2%
- B5%
- C5–10%
- D10–50%
- E75–90%
Show answer and explanationHide answer
Answer: D — 10–50%
Uveoscleral outflow is pressure-independent. Normally contributes 10–50% of aqueous drainage.
- 2
Mean normal outflow facility is:
- A0.05 μL/min/mmHg
- B0.15 μL/min/mmHg
- C0.28 μL/min/mmHg
- D0.48 μL/min/mmHg
- E1.0 μL/min/mmHg
Show answer and explanationHide answer
Answer: C — 0.28 μL/min/mmHg
Normal range ≈ 0.22–0.28 μL/min/mmHg
- 3
Main reflex tear secretor?
- AGland of Wolfring
- BGland of Krause
- CLacrimal gland
- DMeibomian gland
Show answer and explanationHide answer
Answer: C — Lacrimal gland
Lacrimal gland → reflex tears; Krause + Wolfring → basal tears.
- 4
Which association is FALSE?
- AStromal wound healing → Type I collagen
- BDescemet membrane → Type IV collagen
- CVitreous → Type II collagen
- DLens capsule → Type IV collagen
Show answer and explanationHide answer
Answer: A — Stromal wound healing → Type I collagen
Stromal wound healing → Type III collagen; Corneal stroma → Type I collagen.
- 5
Normal aqueous humor production?
- A2 μL/min
- B4 μL/min
- C6 μL/min
- D8 μL/min
Show answer and explanationHide answer
Answer: A — 2 μL/min
Produced by non-pigmented ciliary epithelium.
- 6
Electrolytes present at half plasma concentration in aqueous humor?
- ANa+, K+
- BCa²⁺, PO₄²⁻
- CCl⁻, HCO₃⁻
- DCu²⁺, Zn²⁺
Show answer and explanationHide answer
Answer: B — Ca²⁺, PO₄²⁻
- 7
Most common primary orbital malignancy of childhood arises from:
- AMuscle
- BHistiocytes
- CMesenchyme
- DCapillary endothelial cells
Show answer and explanationHide answer
Answer: C — Mesenchyme
Rhabdomyosarcoma = most common primary orbital malignancy in children. Origin = undifferentiated mesenchymal cells.
- 8
Which statement concerning cornea is FALSE?
- AEpithelial oxygen comes from tears
- BEndothelium pumps water into aqueous
- CDescemet has fetal and adult layers
- DBowman membrane is a true basement membrane
Show answer and explanationHide answer
Answer: D — Bowman membrane is a true basement membrane
Bowman layer is not a true basement membrane; it is condensed anterior stromal collagen.
- 9
Thickest layer of tear film?
- AMarginal strip
- BLipid layer
- CAqueous layer
- DGlycoprotein layer
Show answer and explanationHide answer
Answer: C — Aqueous layer
Lipid ≈ 0.5 μm; Aqueous ≈ 7 μm; Mucin ≈ 0.1 μm.
- 10
NOT a feature of basal cell carcinoma?
- APearly elevated margins
- BSpread to regional lymph nodes
- CUlceration
- DTelangiectasia
Show answer and explanationHide answer
Answer: B — Spread to regional lymph nodes
BCC is the most common eyelid malignancy and rarely metastasizes.
- 11
Features suggesting malignant eyelid lesion?
- ATenderness, erythema, pigmentation
- BRaised pearly margin, pruritus
- CLash loss, central ulceration, rapid growth
- DHyperkeratosis with dark pigmentation
Show answer and explanationHide answer
Answer: C — Lash loss, central ulceration, rapid growth
- 12
Correct gland-secretory type match?
- AMoll-apocrine, Lacrimal-eccrine, Meibomian-apocrine
- BKrause-holocrine, Zeis-apocrine, Goblet-holocrine
- CWolfring-eccrine, Moll-apocrine, Goblet-holocrine
- DLacrimal-eccrine, Meibomian-holocrine, Zeis-apocrine
Show answer and explanationHide answer
Answer: C — Wolfring-eccrine, Moll-apocrine, Goblet-holocrine
High-Yield Table: | Gland | Secretion Type | | Lacrimal | Eccrine | | Krause | Eccrine | | Wolfring | Eccrine | | Meibomian | Holocrine | | Zeis | Holocrine | | Moll | Apocrine | | Goblet | Holocrine |
- 13
Physiologic diplopia occurs:
- AOn horopter
- BWithin Panum area
- CIn front of Panum area
- DNone
Show answer and explanationHide answer
Answer: C — In front of Panum area
Occurs in front of and behind Panum's area.
- 14
Rhabdomyosarcoma type with worst prognosis?
- ABotryoid
- BPleomorphic
- CAlveolar
- DEmbryonal
Show answer and explanationHide answer
Answer: C — Alveolar
Worst → Alveolar; Most common → Embryonal.
- 15
Protein accumulation causing brunescence cataract?
- AHigh molecular weight crystallin
- BAlpha crystallin
- CGamma crystallin
- DWater-insoluble protein
Show answer and explanationHide answer
Answer: D — Water-insoluble protein
- 16
Largest crystallin in human lens?
- Aβ-crystallin
- Bα-crystallin
- Cγ-crystallin
- DTaxon-specific crystallin
Show answer and explanationHide answer
Answer: B — α-crystallin
- 17
NOT protective against oxidation in lens?
- AGlutathione peroxidase
- BVitamin A
- CSuperoxide dismutase
- DCatalase
Show answer and explanationHide answer
Answer: B — Vitamin A
Glutathione, Catalase, Superoxide dismutase, Vitamins C & E.
- 18
Protective mechanism against lens oxidation?
- AGlutathione
- BVitamin A
- CAldose reductase
- DVitamin B12
Show answer and explanationHide answer
Answer: A — Glutathione
- 19
Best stain for sebaceous gland carcinoma?
- AGiemsa
- BH&E
- COil Red O
- DMethenamine silver
Show answer and explanationHide answer
Answer: C — Oil Red O
Oil Red O stains lipids.
- 20
Pagetoid spread is most associated with:
- AMelanoma
- BSCC
- CSebaceous gland carcinoma
- DMerkel cell tumor
Show answer and explanationHide answer
Answer: C — Sebaceous gland carcinoma
- 21
Melanoma with best prognosis?
- AIris
- BCiliary body
- CAnterior choroid
- DPosterior choroid
Show answer and explanationHide answer
Answer: A — Iris
Iris melanoma is often diagnosed early and can be excised completely.
- 22
Elderly woman with unilateral chronic blepharitis, thickened upper lid, lymphadenopathy?
- ABCC
- BKeratoacanthoma
- CMolluscum contagiosum
- DSebaceous gland carcinoma
Show answer and explanationHide answer
Answer: D — Sebaceous gland carcinoma
"Chronic unilateral blepharitis in elderly = sebaceous gland carcinoma until proven otherwise."
- 23
RPE characteristic NOT correct?
- ABasal Na-K pump maintains ion gradient
- BBlood-retinal barrier
- CRetinal adhesion
- DVitamin A isomerization
Show answer and explanationHide answer
Answer: A — Basal Na-K pump maintains ion gradient
Na-K ATPase is located on the apical surface.
- 24
RPE function NOT correct?
- ARetinal adhesion
- BVisual pigment regeneration
- CNutrient transport
- DPhagocytosis of photoreceptor inner segments
Show answer and explanationHide answer
Answer: D — Phagocytosis of photoreceptor inner segments
RPE phagocytoses outer segment tips.
- 25
Rods are how much more sensitive than cones?
- AEqual
- B10×
- C1000×
- D10,000×
Show answer and explanationHide answer
Answer: C — 1000×
- 26
Found in inner plexiform layer?
- AAxons of ganglion cells
- BAxons of amacrine cells
- CSynapses of photoreceptors
- DMüller cell footplates
Show answer and explanationHide answer
Answer: B — Axons of amacrine cells
IPL Contains: Ganglion dendrites, Bipolar axons, Amacrine processes.
- 27
Ocular gland statements true?
- A1 and 2
- B1 and 3
- C2 and 4
- D3 and 4
Show answer and explanationHide answer
Answer: B — 1 and 3
Accessory glands → basal tears; Main lacrimal gland → reflex tears; Meibomian glands are not associated with eyelashes.
- 28
Keratoconjunctivitis sicca staining occurs where?
- ASuperior third
- BMiddle third (interpalpebral)
- CInferior third
- DDiffuse
Show answer and explanationHide answer
Answer: B — Middle third (interpalpebral)
- 29
Corneal layer staining most with PAS?
- AEndothelium
- BBowman layer
- CWing cells
- DDescemet membrane
Show answer and explanationHide answer
Answer: D — Descemet membrane
PAS highlights basement membranes.
- 30
Tear layer containing IgA?
- AMucin layer
- BLipid layer
- CAqueous layer
- DGlycoprotein layer
Show answer and explanationHide answer
Answer: C — Aqueous layer
- 31
Contributes to aqueous layer of tear film?
- AWolfring glands
- BZeis glands
- CGoblet cells
- DMeibomian glands
Show answer and explanationHide answer
Answer: A — Wolfring glands
- 32
Correct corneal collagen association?
- ACorneal wound healing → Type III collagen
- BDescemet membrane → Type I collagen
- CBowman layer → Type IV collagen
- DStroma → Type II collagen
Show answer and explanationHide answer
Answer: A — Corneal wound healing → Type III collagen
- 33
False statement about homocystinuria?
- AOsteoporosis and renal dysfunction occur
- BAbnormal from birth with seizures and mental retardation
- CEctopia lentis occurs in >30%
- DLow methionine, high cysteine diet beneficial
Show answer and explanationHide answer
Answer: B — Abnormal from birth with seizures and mental retardation
Patients are usually normal at birth and develop symptoms later.
- 34
NOT a true basement membrane?
- ADescemet membrane
- BBruch membrane
- CLens capsule
- DBowman membrane
Show answer and explanationHide answer
Answer: D — Bowman membrane
- 35
False statement regarding lens structure?
- AY suture represents lens fiber ends
- BLens nuclei concentrated near equator
- CLens fibers in nucleus continue to divide throughout life
- DAnterior Y suture is upright
Show answer and explanationHide answer
Answer: C — Lens fibers in nucleus continue to divide throughout life
Division occurs in equatorial lens epithelium. Central lens fibers do not divide.
- 36
True statements concerning neonatal conjunctivitis include all EXCEPT:
- ADefinitive diagnosis can be made by identifying intracytoplasmic inclusion bodies on Giemsa stain
- BHerpes simplex is not an important cause in infants under 4 weeks of age
- CChlamydia is a common cause of ophthalmia neonatorum
- DGonococcal infection can rapidly involve the cornea
- ESystemic treatment is often required
Show answer and explanationHide answer
Answer: B — Herpes simplex is not an important cause in infants under 4 weeks of age
HSV is an important cause of neonatal conjunctivitis. Chlamydia is the most common infectious cause.
- 37
Cardinal signs of inflammation include all EXCEPT:
- ARedness
- BIrreversible architectural disruption
- CPain
- DLoss of function
- EWarmth
Show answer and explanationHide answer
Answer: B — Irreversible architectural disruption
Key Point — Five cardinal signs:; Rubor = Redness; Calor = Warmth; Dolor = Pain; Tumor = Swelling; Functio laesa = Loss of function
- 38
Which statement about trachoma is FALSE?
- ASerotypes A–C are responsible
- BBlindness is due to hypersensitivity response to Chlamydia
- CStages I & II have follicles without scarring
- DWHO grading includes follicles, scarring, trichiasis, corneal opacity
- EAntibiotic treatment must be prolonged because of resistance
Show answer and explanationHide answer
Answer: E — Antibiotic treatment must be prolonged because of resistance
Blindness results from cicatrization and scarring. Serotypes A, B, Ba, C cause trachoma.
- 39
Which disease is NOT caused by Chlamydia trachomatis?
- ALigneous conjunctivitis
- BAdult inclusion conjunctivitis
- CLymphogranuloma venereum
- DTrachoma
Show answer and explanationHide answer
Answer: A — Ligneous conjunctivitis
Trachoma → Serotypes A–C; Adult inclusion conjunctivitis → D–K; LGV → L1–L3
- 40
Association between microorganism and culture medium that is CORRECT?
- AMoraxella — Blood agar in 5–10% CO₂
- BFungi — Sabouraud agar with cycloheximide
- CMycobacterium tuberculosis — Loeffler medium
- DHaemophilus — Blood agar
Show answer and explanationHide answer
Answer: A — Moraxella — Blood agar in 5–10% CO₂
M. tuberculosis → Lowenstein–Jensen medium; Haemophilus → Chocolate agar; Ocular fungi → Sabouraud agar WITHOUT cycloheximide
- 41
Organism NOT usually a commensal of lids and lashes?
- AMoraxella catarrhalis
- BHaemophilus influenzae
- CPropionibacterium acnes
- DStaphylococcus epidermidis
Show answer and explanationHide answer
Answer: B — Haemophilus influenzae
Key Point — Normal lid flora:; Staphylococcus epidermidis; Corynebacterium; Moraxella catarrhalis; Streptococcus viridans
- 42
Most effective preoperative regimen to reduce conjunctival bacterial counts?
- ATopical antibiotic for 3 days
- BPovidone-iodine for 3 days
- CTopical antibiotic for 3 days + povidone-iodine at surgery
- DPovidone-iodine at surgery only
- EPovidone-iodine then saline flush
Show answer and explanationHide answer
Answer: C — Topical antibiotic for 3 days + povidone-iodine at surgery
Antibiotic pretreatment + povidone iodine gives maximal reduction.
- 43
Vaccination for varicella zoster virus — all true EXCEPT:
- ASingle dose adequate in children 1–12 years
- BTwo doses for patients >12 years
- CReduces incidence of shingles in adults with prior childhood varicella
- DContraindicated during pregnancy
- EAvoid salicylates for 6 weeks after vaccination
Show answer and explanationHide answer
Answer: C — Reduces incidence of shingles in adults with prior childhood varicella
Varivax prevents primary varicella. It is not intended to prevent shingles after prior infection.
- 44
Most likely extraocular focus in endogenous bacterial endophthalmitis?
- ALiver abscess
- BEndocarditis
- COrbital cellulitis
- DMeningitis
- ESeptic arthritis
Show answer and explanationHide answer
Answer: A — Liver abscess
Key Point — Most common sources:; Liver abscess; Endocarditis
- 45
Species most frequently implicated in adult preseptal cellulitis?
- AStaphylococcus species
- BStreptococcus species
- CHaemophilus species
- DPseudomonas species
- EBacillus species
Show answer and explanationHide answer
Answer: A — Staphylococcus species
Staphylococcus aureus is most common; Streptococcus is second.
- 46
Which hypersensitivity conjunctivitis takes the longest to develop?
- AToxic follicular conjunctivitis
- BToxic papillary conjunctivitis
- CContact dermatitis with conjunctivitis
- DAnaphylactoid reaction
- ENo pattern exists
Show answer and explanationHide answer
Answer: A — Toxic follicular conjunctivitis
May take weeks, months, or years.
- 47
Classic clinical sign of staphylococcal blepharoconjunctivitis?
- AInferior follicular conjunctivitis
- BScurf
- CLimbal papillae
- DCollarettes
- ESleeving of lashes
Show answer and explanationHide answer
Answer: D — Collarettes
Collarettes → Staphylococcus; Scurf → Seborrhea; Sleeves → Demodex
- 48
Most common cause of acute painful enlargement of lacrimal gland?
- ASarcoidosis
- BSjögren syndrome
- CBacterial dacryoadenitis
- DLeprosy
- EHerpes zoster
Show answer and explanationHide answer
Answer: C — Bacterial dacryoadenitis
Usually ascending staphylococcal infection. Viral dacryoadenitis is often painless.
- 49
Chronic asymptomatic dacryocystitis is most commonly caused by?
- AStaphylococcus aureus
- BStreptococcus pneumoniae
- CStaphylococcus epidermidis
- DHaemophilus influenzae
- EPseudomonas aeruginosa
Show answer and explanationHide answer
Answer: B — Streptococcus pneumoniae
Silent dacryocystitis classically caused by pneumococcus.
- 50
Which statement about postoperative endophthalmitis is TRUE?
- A7–10 days postop, Streptococcus most common
- B2–5 days postop, Streptococcus most common
- C2–5 days postop, Staphylococcus most common
- D7–10 days postop, Staphylococcus most common
- EOrganisms originate from surgeon flora
Show answer and explanationHide answer
Answer: C — 2–5 days postop, Staphylococcus most common
Most common organism: Staphylococcus epidermidis. Usually from patient's lid flora.
- 51
Features favoring herpes zoster ophthalmicus dendrites EXCEPT:
- ALarge frequently branching dendrite
- BPlaque of epithelial cells
- CNo terminal bulb
- DCoarse blunt-ended dendrites
- EDull fluorescein staining
Show answer and explanationHide answer
Answer: A — Large frequently branching dendrite
Key Point — HZO pseudodendrites:; Smaller; Less branching; No terminal bulbs; Blunt ends
- 52
Class I MHC:
- APresent on almost all nucleated cells
- BHLA-DR, DP, DQ
- CWorks with CD4 T cells
- DProcesses endocytosed antigens
Show answer and explanationHide answer
Answer: A — Present on almost all nucleated cells
Class I: HLA-A, B, C; CD8 T cells; present on almost all nucleated cells.; Class II: HLA-DR, DP, DQ; CD4 T cells.
- 53
Most abundant antibody in tear film?
- AIgE
- BIgM
- CIgA
- DIgG
Show answer and explanationHide answer
Answer: C — IgA
Secretory IgA is the dominant immunoglobulin in tears.
- 54
Immunoglobulin classes important in antigen reception on lymphocyte surfaces during primary immune responses?
- A1,2,3
- B1 and 3
- C2 and 4
- D4 only
- E1,2,3,4
Show answer and explanationHide answer
Answer: A — 1,2,3
Key Point — Surface immunoglobulins: IgM, IgD, IgG function as antigen receptors on B lymphocytes.
- 55
Which statement about prostaglandins is FALSE?
- ACOX pathway produces prostaglandins, prostacyclin, and thromboxane
- BIn general, prostaglandins cause mydriasis
- CCorticosteroids inhibit both COX and LOX pathways
- DLow-dose prostaglandins decrease IOP; high doses may increase IOP
- EProstacyclin is a vasodilator; thromboxane is a vasoconstrictor
Show answer and explanationHide answer
Answer: B — In general, prostaglandins cause mydriasis
Topical PGE and PGF cause miosis, not mydriasis. Steroids inhibit phospholipase A2 → block both COX and LOX pathways.
- 56
All methods increase ocular absorption of topical medications EXCEPT:
- AAdding a second eye drop immediately after the first
- BWaiting 5–10 min between medications
- CNasolacrimal occlusion
- DClosing eyes after administration
- EPrior topical anesthetic
Show answer and explanationHide answer
Answer: A — Adding a second eye drop immediately after the first
Second drop may wash out the first. One drop (~50 µL) exceeds conjunctival sac capacity (~10 µL).
- 57
Factors increasing corneal penetration EXCEPT:
- AHigher drug concentration
- BHigher vehicle viscosity
- CHigher pH of the drug
- DHigher lipid solubility
- EBenzalkonium chloride
Show answer and explanationHide answer
Answer: C — Higher pH of the drug
Extreme pH causes reflex tearing and dilution. BAK disrupts corneal epithelium and increases penetration.
- 58
NSAIDs block formation of all EXCEPT:
- AThromboxane
- BLeukotrienes
- CProstaglandins
- DProstacyclin
Show answer and explanationHide answer
Answer: B — Leukotrienes
NSAIDs block COX. Leukotrienes are produced through LOX pathway.
- 59
Aminoglycoside most commonly causing topical hypersensitivity?
- AGentamicin
- BTobramycin
- CKanamycin
- DAmikacin
- ENeomycin
Show answer and explanationHide answer
Answer: E — Neomycin
Most frequent topical allergic reactions among aminoglycosides. Hypersensitivity occurs in ~6–8%.
- 60
Which statement about vancomycin is FALSE?
- AInhibits cell wall synthesis
- BEmpiric use in neutropenia is recommended for prophylaxis
- CDrug of choice in filtering bleb-related endophthalmitis
- DUseful in pseudomembranous colitis
- ENephrotoxicity increased with aminoglycosides
Show answer and explanationHide answer
Answer: B — Empiric use in neutropenia is recommended for prophylaxis
CDC recommends avoiding routine empiric vancomycin due to resistance concerns.
- 61
All statements are true of diclofenac-class drugs EXCEPT:
- ACan cause corneal melt/perforation
- BUsed for postoperative inflammation
- CIncrease thromboxane production
- DDecrease prostaglandin synthesis
Show answer and explanationHide answer
Answer: C — Increase thromboxane production
NSAIDs decrease prostaglandins, prostacyclin, and thromboxane.
- 62
Ways to increase ocular absorption EXCEPT:
- APrior topical anesthetic
- BNasolacrimal occlusion
- CEye closure after drop instillation
- DIncreased hydrophilicity of the drug
Show answer and explanationHide answer
Answer: D — Increased hydrophilicity of the drug
Increased lipid solubility improves corneal penetration.
- 63
Higher uptake as ointment rather than drops EXCEPT:
- ATetracycline
- BChloramphenicol
- CFluorometholone
- DPenicillin
Show answer and explanationHide answer
Answer: D — Penicillin
Penicillin penetrates ocular tissues poorly.
- 64
Mitomycin-C has been used in all EXCEPT:
- AProliferative vitreoretinopathy after vitrectomy
- BConjunctival fibrosis after trabeculectomy
- CPterygium recurrence
- DStromal haze after PRK
Show answer and explanationHide answer
Answer: A — Proliferative vitreoretinopathy after vitrectomy
MMC is primarily used on external ocular surfaces.
- 65
Natamycin may be effective against all EXCEPT:
- AAspergillus
- BCandida albicans
- CFusarium
- DMucor
Show answer and explanationHide answer
Answer: D — Mucor
Mucor responds better to Amphotericin B.
- 66
Amphotericin B alone may be effective against all EXCEPT:
- AAspergillus
- BCandida
- CCryptococcus
- DMucor
Show answer and explanationHide answer
Answer: D — Mucor
Mucor generally requires Amphotericin B plus surgical debridement.
- 67
Effective agents for Acanthamoeba EXCEPT:
- ANeomycin
- BPolyhexamethylene biguanide (PHMB)
- CPropamidine
- DTrifluridine
Show answer and explanationHide answer
Answer: D — Trifluridine
Trifluridine is antiviral. PHMB + diamidines are classic therapy.
- 68
Side effects of systemic corticosteroids include all EXCEPT:
- AAseptic necrosis of hip
- BHypoglycemia
- CHypertension
- DGastric ulceration
Show answer and explanationHide answer
Answer: B — Hypoglycemia
Steroids cause hyperglycemia, not hypoglycemia.
- 69
Side effects of prostaglandin analogues EXCEPT:
- AConjunctival hyperemia
- BCystoid macular edema
- CDecrease in iris pigmentation
- DHypertrichosis
Show answer and explanationHide answer
Answer: C — Decrease in iris pigmentation
Prostaglandin analogues increase iris pigmentation.
- 70
Best topical beta-blocker for mild bronchoconstrictive disease?
- ATimolol
- BBetaxolol
- CMetipranolol
- DLevobunolol
Show answer and explanationHide answer
Answer: B — Betaxolol
Betaxolol is β1-selective. Preferred in mild pulmonary disease.
- 71
Least suitable IOP-lowering drug in mild bronchoconstrictive disease?
- ATimolol
- BBetaxolol
- CLatanoprost
- DBrimonidine
Show answer and explanationHide answer
Answer: A — Timolol
Non-selective β-blockers can cause bronchospasm.
- 72
Which statement about carbonic anhydrase inhibitors is FALSE?
- A>90% inhibition required before significant reduction in aqueous production
- BReduced urinary citrate/magnesium predisposes to kidney stones
- CCan cause acute transient myopia
- DMetabolic acidosis is greater with oral than IV acetazolamide
Show answer and explanationHide answer
Answer: D — Metabolic acidosis is greater with oral than IV acetazolamide
Metabolic acidosis is greater with IV acetazolamide.
- 73
Dipivefrin is converted to epinephrine in:
- ATears
- BConjunctiva
- CCornea
- DAqueous humor
- EIris stroma
Show answer and explanationHide answer
Answer: C — Cornea
Corneal esterases cleave dipivefrin to epinephrine.
- 74
Best single medication for POAG in an aphakic patient with chronic bronchitis, labile hypertension and depression on MAO inhibitors?
- AEpinephrine
- BDipivefrin
- CPilocarpine
- DTimolol
- EAcetazolamide
Show answer and explanationHide answer
Answer: C — Pilocarpine
Epinephrine/dipivefrin: risk of CME in aphakia.; Timolol: bronchospasm.; Acetazolamide: caution in depression.; Pilocarpine becomes safest option.
- 75
Corneal Collagen Lamellae?
- A50
- B100
- C200
- D300
Show answer and explanationHide answer
Answer: C — 200
Corneal stroma: ~90% corneal thickness, ~200–250 collagen lamellae centrally (more peripherally).
- 76
Decentered Ablation?
- AComa
- BTrefoil
- CSpherical aberration
- DQuadrafoil
Show answer and explanationHide answer
Answer: A — Coma
| Aberration | Cause | | Coma | Decentered ablation | | Spherical aberration | Small optical zone, post-LASIK | | Trefoil | Irregular optics | | Quadrafoil | Fourth-order aberration |
- 77
Conductive Keratoplasty?
- AAstigmatism
- BRegression of effect
- CUndercorrection
- DOvercorrection
Show answer and explanationHide answer
Answer: B — Regression of effect
CK uses radiofrequency to steepen central cornea for low hyperopia/presbyopia. Major problem: regression over time.
- 78
Optical Zone Size?
- A5.5 mm
- B6.0 mm
- C6.5 mm
- D7.0 mm
Show answer and explanationHide answer
Answer: B — 6.0 mm
Most modern LASIK uses 6.0–6.5 mm optical zone. Smaller optical zone → halos, glare, night vision symptoms.
- 79
Potential Vision Worse Than Post-op Vision?
- ACME
- BDilated pupil during testing
- CIrregular cornea
- DAmblyopia
Show answer and explanationHide answer
Answer: B — Dilated pupil during testing
Potential acuity can be falsely optimistic because of irregular cornea, pinhole effect, amblyopia underestimation. Pupil dilation does not produce falsely good results.
- 80
Wavefront Aberrations?
- AMyopia
- BPrism
- CHyperopia
- DAstigmatism
Show answer and explanationHide answer
Answer: B — Prism
| Order | Aberration | | 0th | Defocus | | 1st | Horizontal prism, Vertical prism | | 2nd | Myopia, Hyperopia, Astigmatism | | 3rd | Coma, Trefoil | | 4th | Spherical aberration, Quadrafoil |
- 81
Corneal Topography?
- AAxial map
- BInstantaneous map
- CSagittal map
- DPower map
Show answer and explanationHide answer
Answer: B — Instantaneous map
| Map | Best Use | | Axial (Sagittal) | Central cornea | | Instantaneous (Tangential) | Peripheral cornea | | Elevation | Keratoconus | | Difference map | Follow-up changes |
- 82
Peripheral Rays Focus in Front of Central Rays?
- AComa
- BTrefoil
- CSpherical aberration
- DQuadrafoil
Show answer and explanationHide answer
Answer: C — Spherical aberration
Positive spherical aberration: peripheral rays focus anteriorly, causing halos and night vision problems. Common after myopic LASIK.
- 83
Peripheral Corneal Relaxing Incisions Contraindicated?
- AHistory of PKP
- BArcus senilis
- CPseudophakia
- DTerrien marginal degeneration
Show answer and explanationHide answer
Answer: D — Terrien marginal degeneration
Why? Terrien: peripheral thinning, risk of perforation. Avoid relaxing incisions.
- 84
Best Astigmatism Evaluation Before LASIK?
- ARefraction
- BComputerized corneal topography
- CRetinoscopy
- DKeratometry
Show answer and explanationHide answer
Answer: B — Computerized corneal topography
Why? Detects forme fruste keratoconus, corneal irregularity, ectasia risk.
- 85
Post-RK Cataract Surgery?
- AAutomated keratometry
- BPre-RK calculations
- CManual keratometry
- DContact lens method
Show answer and explanationHide answer
Answer: C — Manual keratometry
After RK, central cornea flattened; automated K less reliable; manual keratometry preferred.
- 86
IOL Moves Anteriorly?
- AHyperopic shift
- BNo effect
- CMyopic shift
- DNot determinable
Show answer and explanationHide answer
Answer: C — Myopic shift
| Lens movement | Result | | Anterior | Myopic shift | | Posterior | Hyperopic shift |
- 87
Central Retinal Artery Occlusion (CRAO)?
- AHyperbaric oxygen
- BAnterior chamber tap
- CAcetazolamide + topical β-blockers
- DAnticoagulation with Coumadin
Show answer and explanationHide answer
Answer: D — Anticoagulation with Coumadin
CRAO treatments historically attempted: ocular massage, anterior chamber paracentesis, IOP lowering, hyperbaric oxygen, carbogen, intra-arterial tPA. Warfarin has no role in acute CRAO.
- 88
Uveal Effusion Syndrome?
- AOccurs in eyes with abnormally short axial length
- BPrevented by Flieringa ring
- CTreated by vitrectomy
- DAssociated with hypertension and atherosclerosis
Show answer and explanationHide answer
Answer: A — Occurs in eyes with abnormally short axial length
Uveal effusion syndrome: nanophthalmos, thick sclera, impaired vortex vein drainage, recurrent choroidal effusions. Association: short eye + thick sclera.
- 89
Fastest Expanding Intraocular Gas?
- AAir
- B100% C3F8
- C100% SF6
- D14% C3F8
Show answer and explanationHide answer
Answer: C — 100% SF6
| Gas | Expansion | | Air | None | | SF6 | Fastest | | C3F8 | Longest duration |
- 90
Silicone Oil Surface Tension?
- AGreater than C3F8
- BGreater than air
- CLess than SF6
- DEqual to water
Show answer and explanationHide answer
Answer: C — Less than SF6
All gases have higher surface tension than silicone oil. Gas tamponade > Silicone oil tamponade.
- 91
Coats Disease?
- AUsually unilateral
- BIncreased risk of rhegmatogenous RD
- CMale predominance
- DMay require laser photocoagulation
Show answer and explanationHide answer
Answer: B — Increased risk of rhegmatogenous RD
Classic Coats Disease: Young boys, unilateral, retinal telangiectasia, massive lipid exudation, exudative RD. ❌ Not rhegmatogenous RD.
- 92
Persistent Fetal Vasculature (PFV/PHPV)?
- AInitially associated with clear lens or mild opacity that later becomes dense cataract
- BOften bilateral
- CAssociated with low birth weight
- DAssociated with buphthalmos
Show answer and explanationHide answer
Answer: A — Initially associated with clear lens or mild opacity that later becomes dense cataract
PFV: Failure of hyaloid regression, microphthalmos, leukocoria, usually unilateral.; ROP: Prematurity, low birth weight.; PFV is NOT associated with low birth weight.
- 93
Presumed Ocular Histoplasmosis Syndrome (POHS)?
- AMild vitritis
- BChoroidal neovascularization
- CSmall punched-out chorioretinal scars
- DPeripapillary atrophy
Show answer and explanationHide answer
Answer: A — Mild vitritis
Punched-out scars, peripapillary atrophy, CNVM.
- 94
Young Patient with CRVO?
- AHypercoagulable condition
- BInfection
- CGiant cell arteritis
- DThromboembolic disease
Show answer and explanationHide answer
Answer: A — Hypercoagulable condition
Young CRVO (<50 years): hypercoagulable workup (APS, Protein C/S deficiency, Factor V Leiden).
- 95
Branch Retinal Artery Occlusion (BRAO)?
- AESR/CRP/Platelets
- BLower IOP
- CEmergent embolic workup
- DOcular massage
Show answer and explanationHide answer
Answer: C — Emergent embolic workup
BRAO = Stroke equivalent. Workup: carotid Doppler, echocardiography, brain imaging.
- 96
Ocular Ischemic Syndrome (OIS)?
- ACarotid occlusive disease
- BPDR
- CRVO
- DRadiation retinopathy
Show answer and explanationHide answer
Answer: A — Carotid occlusive disease
Mid-peripheral hemorrhages, iris neovascularization, ocular pain, delayed choroidal filling, low retinal arterial pressure.
- 97
Multiple Cotton-Wool Spots?
- ALiver transplantation
- BEpisodes of weakness and numbness
- CHigh-risk sexual behavior
- DPolyuria, polydipsia, polyphagia
Show answer and explanationHide answer
Answer: B — Episodes of weakness and numbness
Interferon retinopathy. Associated with liver transplant, hepatitis treatment, diabetes, HIV. Not multiple sclerosis.
- 98
Imaging Question: Most Specific Noninvasive Test for RPE Cell Death?
- AFAF
- BFluorescein angiography
- CFundus photography
- DOCTA
Show answer and explanationHide answer
Answer: A — FAF
Lipofuscin in RPE fluoresces. Dead RPE → loss of autofluorescence → dark lesions on FAF. FAF best for geographic atrophy, Stargardt disease, pattern dystrophies.
- 99
Electrophysiology Question: Direct Measure of Retinal Ganglion Cell Function?
- APERG
- BEOG
- CmfERG
- DVEP
Show answer and explanationHide answer
Answer: A — PERG
| Test | Measures | | PERG | Ganglion cells | | EOG | RPE function | | mfERG | Macular function | | VEP | Visual pathway |
- 100
Posterior Vitreous Detachment (PVD)?
- AMore common after intracapsular cataract surgery
- B<20% symptomatic PVD have retinal tears
- C>50% symptomatic PVD + vitreous hemorrhage have tear
- DPVD starts at optic disc and spreads temporally
Show answer and explanationHide answer
Answer: D — PVD starts at optic disc and spreads temporally
OCT shows PVD typically begins in perifoveal macula, NOT optic disc.
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Lattice Degeneration?
- APrevalence 5–10% of population
- B>75% RRD eyes have lattice
- CBilateral in >75%
- DLess common in myopes
Show answer and explanationHide answer
Answer: A — Prevalence 5–10% of population
Population prevalence 5–10%; bilateral 30–50%; present in 20–30% of RRD.
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Main Site of Resistance to Aqueous Outflow?
- AUveal trabecular meshwork
- BCorneoscleral trabecular meshwork
- CJuxtacanalicular trabecular meshwork
- DSchlemm's canal
Show answer and explanationHide answer
Answer: C — Juxtacanalicular trabecular meshwork
Trabecular meshwork layers: uveal meshwork, corneoscleral meshwork, juxtacanalicular meshwork (cribriform layer) ← greatest resistance. Most common glaucoma board question.
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Glaucoma Laser Trial (GLT)?
- ABetter visual field score with laser first
- BLower IOP with laser first
- CMost laser-treated eyes did not require medication
- DLaser trabeculoplasty ≈ timolol efficacy
Show answer and explanationHide answer
Answer: C — Most laser-treated eyes did not require medication
After 2 years: ~56% still required medications. ALT comparable to timolol.
- 104
Infantile Glaucoma Progression?
- AIncreasing axial length
- BAmblyopia
- CIncreasing horizontal diameter
- DIncreasing myopia
Show answer and explanationHide answer
Answer: B — Amblyopia
Increasing axial length, buphthalmos, increased corneal diameter, increasing myopia.
- 105
Late Bleb-Associated Endophthalmitis?
- AStaph epidermidis
- BStreptococcus pneumoniae
- CPseudomonas
- DPropionibacterium acnes
Show answer and explanationHide answer
Answer: B — Streptococcus pneumoniae
Late bleb infection → Streptococcus species or H. influenzae. Early postop cataract endophthalmitis → Staph epidermidis.
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Superior Visual Field Defect?
- AGlaucoma
- BLens rim artifact
- CHigh false-positive rate
- DPtosis
Show answer and explanationHide answer
Answer: C — High false-positive rate
High false-positive VF: "trigger-happy" patient, artificially better sensitivity, white scotomas.
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Most Urgent Post-Trabeculectomy Problem?
- AChoroidal hemorrhage
- BChoroidal effusion
- CShallow AC with lens-cornea touch
- DShallow AC with iris-cornea touch
Show answer and explanationHide answer
Answer: C — Shallow AC with lens-cornea touch
Lens-cornea touch causes corneal decompensation and cataract progression. Needs immediate intervention.
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Elevated IOP After Heavy PRP?
- ACycloplegic
- BLaser iridotomy
- CLaser iridoplasty
- DTrabeculectomy
Show answer and explanationHide answer
Answer: A — Cycloplegic
PRP → ciliary body edema → forward rotation of ciliary body → angle closure.
- 109
Earlier Detection of Glaucoma?
- ASuprathreshold testing
- BOCT
- CCSLO
- DFrequency-doubling technology (FDT)
Show answer and explanationHide answer
Answer: D — Frequency-doubling technology (FDT)
FDT targets magnocellular ganglion cells and can detect early glaucomatous damage.
- 110
Infantile Glaucoma with Corneal Clouding?
- ATrabeculectomy
- BTrabeculotomy
- CCyclophotocoagulation
- DGoniotomy
Show answer and explanationHide answer
Answer: B — Trabeculotomy
| Cornea | Surgery | | Clear | Goniotomy | | Cloudy | Trabeculotomy |
- 111
Apraclonidine (Iopidine)?
- AAlpha-1 agonist
- BMay cause transient lid retraction
- CCommonly causes hypotension
- DCauses CME in aphakia
Show answer and explanationHide answer
Answer: B — May cause transient lid retraction
Apraclonidine: alpha-2 agonist, conjunctival blanching, lid retraction, allergic blepharoconjunctivitis.
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Pilocarpine in Young Myope?
- ASmall pupil
- BIncreased myopia
- CRetinal detachment
- DIncreased hyperopia
Show answer and explanationHide answer
Answer: B — Increased myopia
Pilocarpine: accommodative spasm, lens thickening, forward lens movement, increased myopia.
- 113
Goldmann Applanation Tonometry?
- A3.06 mm
- B3.16 mm
- C3.10 mm
- D3.01 mm
Show answer and explanationHide answer
Answer: A — 3.06 mm
At 3.06 mm, corneal rigidity and tear-film surface tension cancel each other.
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Medication Causing Most Dermatitis?
- ALatanoprost
- BBrimonidine
- CDorzolamide
- DApraclonidine
Show answer and explanationHide answer
Answer: D — Apraclonidine
Apraclonidine: allergic dermatitis ≈ 40%, limits chronic use.
- 115
Herpetic Keratitis and Glaucoma Therapy?
- ALatanoprost
- BTimolol
- CBrimonidine
- DMethazolamide
Show answer and explanationHide answer
Answer: A — Latanoprost
Prostaglandin analogs may reactivate HSV keratitis, uveitis, CME. Avoid in these settings.
- 116
Visual Field Artifact and Pupil Size?
- A1.5 mm
- B2.5 mm
- C3.5 mm
- D4.5 mm
Show answer and explanationHide answer
Answer: B — 2.5 mm
Pupil <2.5 mm → generalized depression artifact on Humphrey VF.
- 117
Substance That Lowers IOP?
- AAlcohol
- BLSD
- CCaffeine
- DKetamine
Show answer and explanationHide answer
Answer: A — Alcohol
↓ IOP: Alcohol, Cannabis, Heroin; ↑ IOP: Ketamine, LSD
- 118
Image Question: Gray-White Lens Deposits?
- AAcute angle-closure glaucoma
- BChronic angle closure glaucoma
- CUveitic glaucoma
- DPseudoexfoliation glaucoma
Show answer and explanationHide answer
Answer: A — Acute angle-closure glaucoma
Glaukomflecken = anterior subcapsular lens epithelial necrosis caused by a previous acute angle-closure attack.
- 119
Closed-loop Anterior Chamber IOL with Corneal Edema?
- ACorneal pachymetry
- BGonioscopy
- CSpecular microscopy
- DCorneal topography
Show answer and explanationHide answer
Answer: D — Corneal topography
In pseudophakic bullous keratopathy:; Pachymetry → corneal thickness; Specular microscopy → endothelial count; Gonioscopy → haptic position; Topography → least useful
- 120
Shallow AC During Phaco with Intact Posterior Capsule?
- AEmpty infusion bottle
- BChoroidal hemorrhage
- CMisdirection syndrome
- DPatient maneuver
Show answer and explanationHide answer
Answer: C — Misdirection syndrome
Fluid passes through zonules behind capsule → posterior pressure → shallow AC.
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Prevention of Postoperative Endophthalmitis?
- A5% povidone-iodine preparation
- BTreat blepharitis preoperatively
- CAdd gentamicin to irrigating solution
- DAdhesive drape isolating lashes
Show answer and explanationHide answer
Answer: C — Add gentamicin to irrigating solution
Best proven prevention = povidone iodine.
- 122
Long-Term Sequela of Flat/Shallow AC?
- AGlaucomatous cupping
- BVitreous hemorrhage
- CCapsular block syndrome
- DCorneal decompensation
Show answer and explanationHide answer
Answer: D — Corneal decompensation
- 123
Risk Factor for Postoperative Corneal Edema?
- AAMD
- BTopical steroids
- CPosterior chamber phacoemulsification
- DFuchs dystrophy
Show answer and explanationHide answer
Answer: D — Fuchs dystrophy
Fuchs = endothelial failure → postop edema.
- 124
Contraindication to Topical Anesthesia?
- AMonocular patient
- BNystagmus
- CDementia
- DLong axial length
Show answer and explanationHide answer
Answer: B — Nystagmus
Continuous eye movement makes surgery unsafe under topical anesthesia.
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Triple Procedure (PK + Cataract Surgery)?
- ADecreased polymegathism
- BCorneal pachymetry >640 μm
- CDecreased pleomorphism
- DEndothelial count >1000/mm²
Show answer and explanationHide answer
Answer: B — Corneal pachymetry >640 μm
Fuchs dystrophy: pachymetry >640 μm → likely need corneal transplant.
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Ideal Continuous Curvilinear Capsulorrhexis (CCC)?
- ADetermined by staining zonules
- BFit within scotopic pupil
- CExpose all optic in multifocal IOL
- DOverlap anterior optic edge while allowing cataract removal
Show answer and explanationHide answer
Answer: D — Overlap anterior optic edge while allowing cataract removal
Ideal CCC: centered, covers optic edge 360°, prevents PCO.
- 127
Intumescent Cataract?
- AIris prolapse
- BChoroidal effusion
- CCorneal wound burn
- DCapsular radial tear
Show answer and explanationHide answer
Answer: D — Capsular radial tear
"Argentinian flag sign."
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Viscoelastic Material?
- ASodium hyaluronate
- BKeratan sulfate
- CHydroxypropyl methylcellulose
- DChondroitin sulfate
Show answer and explanationHide answer
Answer: B — Keratan sulfate
Sodium hyaluronate; Chondroitin sulfate; Hydroxypropyl methylcellulose
- 129
Retrobulbar Hemorrhage?
- AVitreous aspiration
- BLateral canthotomy ± paracentesis
- CGlobe massage
- DTarsorrhaphy
Show answer and explanationHide answer
Answer: B — Lateral canthotomy ± paracentesis
Emergency Pearl: Retrobulbar hemorrhage + rock-hard eye = immediate lateral canthotomy/cantholysis.
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Posterior Capsular Rupture with Vitreous Loss?
- AConvert to ECCE if needed
- BAutomated vitrectomy
- CInject viscoelastic under nucleus
- DContinue gentle phaco because phaco cuts vitreous
Show answer and explanationHide answer
Answer: D — Continue gentle phaco because phaco cuts vitreous
Never continue routine phaco in vitreous loss.
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Highly Myopic Eyes?
- ADeep and constant
- BDeep and fluctuating
- CShallow and constant
- DShallow and fluctuating
Show answer and explanationHide answer
Answer: B — Deep and fluctuating
High myopes: deep AC, marked fluctuations during phaco.
- 132
Refractive Surgery in a 54-Year-Old Engineer (-6.5 D)?
- AFull emmetropia LASIK
- BCorrect all but 1 D of myopia in each eye
- CMonovision
- DFull emmetropia PRK
Show answer and explanationHide answer
Answer: B — Correct all but 1 D of myopia in each eye
Presbyopic patient wanting computer vision → leave mild residual myopia (~1 D).
- 133
Use of Iris Hooks?
- APhacolytic glaucoma
- BExfoliation syndrome
- CDislocated crystalline lens
- DPositive vitreous pressure
Show answer and explanationHide answer
Answer: B — Exfoliation syndrome
Pseudoexfoliation: poor dilation, weak zonules, iris hooks frequently needed.
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Retinal Flap Tear Before Cataract Surgery?
- ALaser demarcation before cataract surgery
- BCataract surgery + intra-op laser
- CLaser after cataract surgery
- DCareful cataract surgery
Show answer and explanationHide answer
Answer: A — Laser demarcation before cataract surgery
Symptomatic retinal tear = treat first, cataract later.
- 135
IOL Formula for High Axial Hyperopia (Short Eye)?
- ASRK II
- BColenbrander
- CHoffer Q
- DSRK
Show answer and explanationHide answer
Answer: C — Hoffer Q
Formula Pearls:; Short eyes (<22 mm) → Hoffer Q; Average eyes → SRK/T; Long eyes → Holladay 2, Barrett, Haigis
- 136
Cataract Surgery in With-the-Rule Astigmatism?
- ASuperior scleral incision + LRIs at 180°
- BSuperior frown incision
- CToric IOL axis 180°
- DTemporal clear corneal incision + paired LRIs at 90°
Show answer and explanationHide answer
Answer: D — Temporal clear corneal incision + paired LRIs at 90°
With-the-rule astigmatism: steepen 180°, flatten 90°. LRIs placed in steep meridian (90°).
- 137
Diffusely Distributed Keratic Precipitates?
- AFuchs heterochromic iridocyclitis
- BSarcoidosis
- CVogt–Koyanagi–Harada syndrome
- DSyphilis
Show answer and explanationHide answer
Answer: C — Vogt–Koyanagi–Harada syndrome
Diffuse KPs → Fuchs, Sarcoidosis, Syphilis, Keratouveitis. VKH usually has inferior KPs.
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HLA-B27 Associated Disease?
- ABehçet disease
- BPsoriatic arthritis
- CCrohn disease
- DReactive arthritis
Show answer and explanationHide answer
Answer: A — Behçet disease
Behçet → HLA-B5 (Bw51), not HLA-B27.
- 139
Band Keratopathy in JIA?
- ACalcium carbonate at Descemet membrane
- BCalcium hydroxyapatite at Descemet membrane
- CCalcium carbonate at Bowman membrane
- DCalcium hydroxyapatite at Bowman membrane
Show answer and explanationHide answer
Answer: D — Calcium hydroxyapatite at Bowman membrane
Band keratopathy = calcium hydroxyapatite deposition in Bowman layer.
- 140
HLA-B27 Counseling?
- AAlmost 10% will develop AAU
- B8% of population is HLA-B27 positive, but only 0.012% develop AAU
- CTwo-thirds of HLA-B27 positives develop AAU
- DHLA-B27 is not associated with AAU
Show answer and explanationHide answer
Answer: B — 8% of population is HLA-B27 positive, but only 0.012% develop AAU
Only about 1 in 667 HLA-B27 positive individuals develop AAU.
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HLA-DR4 Association?
- AAcute anterior uveitis
- BBehçet disease
- CBirdshot chorioretinopathy
- DSympathetic ophthalmia
Show answer and explanationHide answer
Answer: D — Sympathetic ophthalmia
HLA-DR4 ↔ Sympathetic ophthalmia and VKH.
- 142
JIA Chronic Anterior Uveitis?
- ABand keratopathy
- BFibrinous AC reaction
- CHypopyon
- DVitritis
Show answer and explanationHide answer
Answer: A — Band keratopathy
JIA uveitis is chronic, silent, destructive → band keratopathy, cataract, posterior synechiae.
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SUN Classification of Recurrent Uveitis?
- ARecurrence <3 months after stopping treatment
- BRecurrence >3 months after treatment discontinued
- CRecurrence irrespective of treatment status
- DResolves in <3 months
Show answer and explanationHide answer
Answer: B — Recurrence >3 months after treatment discontinued
Acute: <3 months; Chronic: relapse <3 months after stopping therapy; Recurrent: relapse after >3 months of inactivity off treatment
- 144
Intermediate Uveitis with Multiple Sclerosis?
- ASC adalimumab
- BIV infliximab
- CIV methylprednisolone
- DSC etanercept
Show answer and explanationHide answer
Answer: C — IV methylprednisolone
Anti-TNF agents may worsen demyelinating disease.
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Drug Causing Human Anti-Chimeric Antibodies?
- AAbatacept
- BInfliximab
- CInterferon alfa-2a/2b
- DTacrolimus
Show answer and explanationHide answer
Answer: B — Infliximab
- 146
HLA-B27 Uveitis with Ankylosing Spondylitis?
- AUrinalysis
- BPathergy test
- CAqueous tap PCR
- DChest X-ray and cardiac echogram
Show answer and explanationHide answer
Answer: D — Chest X-ray and cardiac echogram
AS may be associated with pulmonary apical fibrosis and aortic regurgitation.
- 147
Scleritis and BRAO?
- AANA
- BLumbar puncture
- CUrinalysis
- DTemporal artery biopsy
Show answer and explanationHide answer
Answer: C — Urinalysis
Scleritis with tracheomalacia suggests relapsing polychondritis or systemic vasculitis. Urinalysis assesses renal involvement.
- 148
Embryonic Fissure Closure?
- ADay 17
- BDay 23
- CDay 27
- DDay 33
Show answer and explanationHide answer
Answer: D — Day 33
Embryonic (optic) fissure closure occurs around day 33 of gestation. Failure → coloboma.
- 149
Bony Boundaries of Nasolacrimal Sac?
- ALacrimal, ethmoid
- BMaxillary, ethmoid
- CNasal, lacrimal
- DLacrimal, maxillary
Show answer and explanationHide answer
Answer: D — Lacrimal, maxillary
The nasolacrimal sac sits in the lacrimal fossa, formed by the lacrimal bone and the maxillary bone (frontal process of maxilla).
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Epithelium of Nasolacrimal Duct System?
- AStratified squamous epithelium
- BPseudostratified columnar epithelium
- CCuboidal epithelium
- DStratified columnar epithelium with goblet cell overlay
Show answer and explanationHide answer
Answer: B — Pseudostratified columnar epithelium
Nasolacrimal drainage system is lined by pseudostratified columnar epithelium (respiratory-type).
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Nasolacrimal Duct Opening?
- AAbove the inferior turbinate
- BThrough the valve of Rosenmüller
- CThrough an ostium partially covered by a mucosal fold (Valve of Hasner)
- DInto the superior meatus
Show answer and explanationHide answer
Answer: C — Through an ostium partially covered by a mucosal fold (Valve of Hasner)
NLD opens into the inferior meatus under the inferior turbinate, partially covered by the valve of Hasner. Valve of Rosenmüller is at the common canaliculus–sac junction.
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Bones Forming the Orbital Floor?
- AMaxillary
- BLacrimal
- CZygomatic
- DPalatine
Show answer and explanationHide answer
Answer: B — Lacrimal
Orbital floor = maxilla (orbital plate), zygomatic bone, palatine bone. Lacrimal bone forms part of the medial orbital wall.
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Muscle Originating Above the Annulus of Zinn?
- ASuperior oblique
- BSuperior rectus
- CLateral rectus
- DInferior oblique
Show answer and explanationHide answer
Answer: A — Superior oblique
Superior oblique originates from the sphenoid bone superomedial to the optic canal, above the annulus of Zinn. All other EOMs arise from the annulus except inferior oblique (orbital floor).
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Myelinated Nerve Fibers?
- AMyelination begins at the lateral geniculate body and progresses anteriorly.
- BMyelination begins at the lamina cribrosa and extends posteriorly.
- CAbnormal myelination is due to a defect in the lamina cribrosa.
- DMyelination is completed after birth.
Show answer and explanationHide answer
Answer: B — Myelination begins at the lamina cribrosa and extends posteriorly.
Normal optic nerve myelination proceeds from the lateral geniculate body anteriorly toward the globe and stops at the lamina cribrosa. In myelinated nerve fibers, myelination extends past the lamina cribrosa through a defect/sieve in the lamina cribrosa.
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Ankyloblepharon?
- ASixth week
- BThird month
- CFifth month
- DEighth month
Show answer and explanationHide answer
Answer: C — Fifth month
Eyelids form and fuse by the 8th–9th week and reopen around the 5th–6th month. Ankyloblepharon (failure of complete separation of eyelid margins) is a fifth-month anomaly.
- 156
Lateral Orbital Tubercle of Whitnall?
- ACheck ligament of the lateral rectus
- BSuspensory ligament of the eyeball (Lockwood's ligament)
- CLateral canthal tendon
- DAponeurosis of the levator muscle
- EWhitnall's ligament
Show answer and explanationHide answer
Answer: E — Whitnall's ligament
Whitnall's (superior transverse) ligament is a fascial condensation of the levator aponeurosis; it does not insert into the lateral orbital tubercle. The tubercle gives attachment to the lateral check ligament, Lockwood's ligament laterally, lateral canthal tendon, and levator aponeurosis.
- 157
Ocular vs Generalized Myasthenia?
- AMore commonly associated with Graves' disease
- BMore responsive to anticholinesterase drugs
- CMore responsive to steroids
- DCompletely localized to ocular or bulbar involvement
Show answer and explanationHide answer
Answer: D — Completely localized to ocular or bulbar involvement
Ocular myasthenia is restricted to extraocular, levator, and orbicularis oculi muscles (± bulbar). It is less responsive to anticholinesterases than generalized disease and is not specifically linked to Graves' disease.
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Drug-Induced Myasthenia?
- AWarfarin
- BD-penicillamine
- CDiltiazem
- DRanitidine
Show answer and explanationHide answer
Answer: B — D-penicillamine
D-penicillamine is the classic drug causing an autoimmune myasthenic syndrome. Other reported agents include aminoglycosides, macrolides, fluoroquinolones, statins, and beta-blockers.
- 159
Migraine with Homonymous Hemianopia?
- ACerebral MRI
- BDiscontinue oral contraceptives
- CSumatriptan (Imitrex)
- DTangent screen
Show answer and explanationHide answer
Answer: A — Cerebral MRI
A new, persistent homonymous hemianopia in a migraine patient requires neuroimaging to rule out a posterior visual pathway lesion (stroke, mass, AVM). Aura is transient; persistent deficit is not typical aura.
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Indications for Treating Pseudotumor Cerebri (Idiopathic Intracranial Hypertension)?
- A1, 2, 3
- B1 and 3
- C2 and 4
- D4 only
- E1, 2, 3, 4
Show answer and explanationHide answer
Answer: C — 2 and 4
Treatment of IIH is indicated for debilitating headache and any visual field loss/threat to vision. Asymptomatic papilledema alone may be observed; obesity is a risk factor managed but is not itself an indication for acute IIH therapy.
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Permanent Visual Loss in Cavernous Sinus-Dural Fistula?
- ANeovascular glaucoma
- BCorneal exposure
- COpen-angle glaucoma
- DChoroidal effusions
- EStrabismus
Show answer and explanationHide answer
Answer: C — Open-angle glaucoma
Carotid-cavernous/dural fistulas can cause elevated episcleral venous pressure → impaired aqueous outflow → secondary open-angle glaucoma. This is the leading cause of permanent vision loss.
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Antidote for Edrophonium Overdose?
- AAtropine
- BDantrolene
- CEpinephrine
- DVerapamil
Show answer and explanationHide answer
Answer: A — Atropine
Edrophonium is a short-acting acetylcholinesterase inhibitor. Overdose causes cholinergic excess (bradycardia, bronchospasm, sweating, salivation). Atropine blocks muscarinic effects and is the antidote.
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Feature NOT Seen in Adie's Pupil?
- AVermiform movement of iris border
- BHypersensitivity to parasympathomimetic drugs
- CLight-near dissociation
- DAnisocoria greater in the dark
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Answer: D — Anisocoria greater in the dark
Adie's tonic pupil is larger than the fellow eye and shows light-near dissociation, segmental iris sphincter palsy (vermiform movements), and denervation supersensitivity to dilute pilocarpine. The anisocoria is typically greater in bright light (the Adie's pupil dilates poorly and constricts poorly).
- 164
Bilateral Optic Neuritis with Poor Recovery?
- AMultiple sclerosis
- BNeuromyelitis optica (NMO)
- CGiant cell arteritis
- DFingolimod adverse effect
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Answer: B — Neuromyelitis optica (NMO)
Bilateral, severe optic neuritis with poor visual recovery is classic for NMO (AQP4-IgG) rather than MS. MS-related optic neuritis is usually unilateral and has better recovery.
- 165
Post-Traumatic Headache, Ptosis, and Amaurosis Fugax?
- ACT brain and orbits
- BBilateral carotid Doppler study
- COrbital ultrasound
- DCT angiography (CTA) of the neck
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Answer: D — CT angiography (CTA) of the neck
The triad of post-traumatic headache, partial Horner syndrome (mild ipsilateral ptosis + miosis), and transient monocular vision loss is highly suggestive of carotid artery dissection. CTA/MRA of the neck is the investigation of choice.
- 166
Most Common Cause of Third Nerve Palsy in Children?
- ACongenital
- BTraumatic
- CInflammatory
- DTumor
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Answer: A — Congenital
In children, isolated third nerve palsy is most often congenital. Adults most commonly have microvascular ischemic palsies.
- 167
Most Common Cause of Third Nerve Palsy in Adults?
- AMicrovascular
- BTraumatic
- CAneurysm
- DTumor
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Answer: A — Microvascular
Microvascular ischemia (diabetes, hypertension) is the leading cause of isolated CN III palsy in adults. Aneurysm must be excluded if pupil is involved.
- 168
Timing of Strabismus Surgery in Graves' Ophthalmopathy?
- AOrbital decompression
- BOrbital radiation
- CTarsorrhaphy
- DEyelid surgery
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Answer: D — Eyelid surgery
Surgical sequence in thyroid eye disease: orbital decompression (if needed) → strabismus surgery → eyelid surgery. Strabismus surgery changes eyelid position; therefore eyelid surgery is last.
- 169
Hyphema Without Trauma in an Infant?
- AJuvenile xanthogranuloma (JXG)
- BHerpes simplex uveitis
- CLymphoma
- DRetinoblastoma
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Answer: C — Lymphoma
Non-traumatic hyphema in infants raises concern for JXG (iris lesions bleed), retinoblastoma (iris neovascularization), trauma (abuse), or viral uveitis. Lymphoma is rare in this age group.
- 170
Periorbital Ecchymosis in a 2-Year-Old?
- ANeuroblastoma
- BLeukemia
- CLymphangioma
- DDermoid cyst
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Answer: D — Dermoid cyst
Periorbital ecchymosis ("raccoon eyes") can result from metastatic neuroblastoma, leukemia, orbital lymphangioma, or trauma. Dermoid cyst typically presents as a painless superotemporal mass and does not cause ecchymosis.
- 171
Neuroblastoma Characteristics?
- AMetastasis from adrenal gland
- BPossible spontaneous regression
- CPoor prognosis if diagnosed before 1 year of age
- DPeriorbital ecchymosis
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Answer: C — Poor prognosis if diagnosed before 1 year of age
Neuroblastoma has a better prognosis in infants (<1 year) and can spontaneously regress. Metastasis to the orbit causes periorbital ecchymosis and proptosis.
- 172
Type 2 Duane Retraction Syndrome?
- APoor adduction and exotropia
- BPoor abduction and esotropia
- CPoor abduction and adduction
- DPoor abduction and exotropia
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Answer: A — Poor adduction and exotropia
Duane type 2 = limited adduction with exotropia in primary gaze. Type 1 = limited abduction + esotropia (most common). Type 3 = limitation of both abduction and adduction.
- 173
Best Use of Botulinum Toxin Type A in Strabismus?
- ASmall-angle esotropia
- BLarge-angle exotropia
- CA-pattern esotropia
- DChronic sixth nerve palsy
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Answer: A — Small-angle esotropia
Botulinum toxin is most effective for small-angle, comitant deviations (especially small-angle esotropia and sixth nerve palsy acutely). Large-angle or complex incomitant deviations respond less well.
- 174
Overcorrection After Bilateral Medial Rectus Recession?
- AExtraocular movement examination
- BStereopsis measurement
- CVertical deviation measurement
- DSlit lamp examination
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Answer: A — Extraocular movement examination
Early overcorrection after strabismus surgery requires assessment of ductions to detect a slipped or lost muscle before considering further intervention.
- 175
Spasmus Nutans vs Serious Pathology?
- AOptic nerve meningioma
- BParasellar glioma
- CPontine glioma
- DCerebellar astrocytoma
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Answer: B — Parasellar glioma
Spasmus nutans (nystagmus, head nodding, torticollis) is usually benign. It must be distinguished from optic pathway/chiasmal glioma, which can present similarly and requires neuroimaging.
- 176
Nystagmus Null Point and Prism Correction?
- ABase down both eyes
- BBase in both eyes
- CBase in OD and Base out OS
- DBase out OD and Base in OS
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Answer: C — Base in OD and Base out OS
Prisms shift the image toward the null point, reducing the head turn. Null point in right gaze with left head turn → use BO-OD / BI-OS (prism base direction opposite to head turn) to shift images rightward.
- 177
Initial Management of Accommodative Esotropia with Amblyopia?
- ABimedial recession
- BBilateral resection
- CHyperopic correction with bifocals
- DHyperopic correction + patching of good eye
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Answer: D — Hyperopic correction + patching of good eye
First-line treatment for accommodative esotropia is full cycloplegic hyperopic correction. If amblyopia is present, occlusion therapy of the better-seeing eye is started. Surgery is reserved for non-responders.
- 178
Axenfeld-Rieger Syndrome?
- A50% develop glaucoma
- BAssociated with PITX2 and FOXC1 mutations
- CSystemic abnormalities may occur
- DAutosomal recessive inheritance is most common
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Answer: D — Autosomal recessive inheritance is most common
Axenfeld-Rieger syndrome is autosomal dominant, caused most often by PITX2 or FOXC1 mutations. ~50% develop glaucoma; systemic features include dental, facial, and umbilical anomalies.
- 179
Causes of Heterochromia?
- AHorner syndrome
- BAlbinism
- CJuvenile xanthogranuloma
- DWaardenburg syndrome
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Answer: B — Albinism
Heterochromia can be congenital (Waardenburg, Horner due to sympathetic denervation) or acquired (iris melanoma, JXG, Fuchs heterochromic iridocyclitis, siderosis). Albinism causes reduced iris pigment but not heterochromia.
- 180
Most Common Ocular Manifestation of Abusive Head Trauma?
- ACorneal abrasion
- BHyphema
- CSubconjunctival hemorrhage
- DRetinal hemorrhage
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Answer: D — Retinal hemorrhage
Retinal hemorrhages (often multilayered, posterior pole, and bilateral) are the most characteristic ocular finding in shaken baby syndrome/abusive head trauma.
- 181
High Crossing Fibers at the Optic Chiasm?
- AOcular albinism
- BOptic nerve hypoplasia
- CAchromatopsia
- DMorning glory disc anomaly
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Answer: A — Ocular albinism
Ocular albinism is associated with misrouting of optic nerve fibers at the chiasm — excessive fibers cross to the contralateral hemisphere. Diagnosed with VEP asymmetry.
- 182
Best Visual Acuity Test for Preliterate Children?
- AHOTV
- BTumbling E
- CAllen Figures
- DLighthouse Chart
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Answer: A — HOTV
HOTV matching or recognition is the preferred standardized test for preschool/preliterate children. Allen figures are less uniform and not as well calibrated.
- 183
Comitant Deviation?
- ANasal wall fracture
- BInfantile esotropia
- CThyroid orbitopathy
- DSixth nerve palsy
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Answer: B — Infantile esotropia
Comitant strabismus = deviation is the same in all gazes (e.g., infantile esotropia). Incomitant deviations vary with gaze (restrictive, paralytic, orbital disease, cranial nerve palsy).
- 184
Strabismus Notation?
- AIntermittent
- BConstant
- CInward
- DOutward
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Answer: A — Intermittent
In clinical notation, "T" = tropia (manifest, constant) and "(T)" or "phoria" indicates intermittent. Often "(T)" denotes intermittent tropia.
- 185
Lateral Muscular Branch of Ophthalmic Artery?
- ASuperior rectus
- BMedial rectus
- CInferior rectus
- DInferior oblique
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Answer: A — Superior rectus
The lateral muscular branch supplies the superior rectus, levator palpebrae superioris, and superior oblique. The inferior muscular branch supplies the medial rectus, inferior rectus, and inferior oblique.
- 186
Surgery for Exotropia with Dense Amblyopia?
- A−1.50 D overminus lenses
- BBase-in prism
- CBilateral rectus recession
- DLeft lateral rectus recession + left medial rectus resection
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Answer: D — Left lateral rectus recession + left medial rectus resection
In unilateral or strongly asymmetric exotropia with one poorly seeing amblyopic eye, surgery on the amblyopic eye alone (unilateral recess-resect) is preferred to preserve the good eye.
- 187
Predictor of Postoperative Diplopia?
- AAge
- BSize of deviation
- CPreoperative prism adaptation testing
- DRefraction
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Answer: C — Preoperative prism adaptation testing
Prism adaptation testing (using Fresnel prisms to preoperatively simulate alignment) helps identify patients at risk for postoperative diplopia and can improve surgical planning.
- 188
Canthal Tendon Avulsion After Periorbital Trauma?
- APulling the eyelid and palpating the insertions of the tendon
- BObserving the contour of the eyelids and the position of the puncta
- CReviewing the medical history and the mechanism of the trauma
- DProbing and irrigating the lacrimal outflow
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Answer: A — Pulling the eyelid and palpating the insertions of the tendon
Physical examination with gentle traction on the eyelid and palpation over the normal insertion sites is the best bedside test for canthal tendon avulsion. Laxity or absence of a firm stop suggests avulsion.
- 189
Ptosis with Lid Lag in Downgaze?
- ACongenital ptosis
- BSuperior orbital mass
- COcular myasthenia
- DDehiscence of the aponeurosis
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Answer: A — Congenital ptosis
Congenital ptosis is characterized by decreased levator function and lid lag in downgaze (the ptotic lid remains higher or fails to descend normally). Aponeurotic ptosis typically worsens in downgaze.
- 190
Ptosis with Dysphagia and Respiratory Symptoms?
- AExternal levator resection
- BElectromyography and edrophonium (Tensilon) testing
- CInternal ptosis repair
- DAnti-acetylcholine receptor antibody testing
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Answer: B — Electromyography and edrophonium (Tensilon) testing
Fluctuating ptosis with systemic bulbar/respiratory symptoms suggests myasthenia gravis. EMG with repetitive nerve stimulation and edrophonium/Tensilon test are key diagnostic steps. Surgery is contraindicated before diagnosis.
- 191
Imaging After Blunt Orbital Trauma?
- ACT scan with contrast
- BMRI
- CCT scan without contrast
- DMRI with contrast
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Answer: C — CT scan without contrast
Non-contrast CT is the first-line imaging for orbital trauma because it best demonstrates bony fractures, orbital wall displacement, and intraorbital hemorrhage. MRI is reserved for soft-tissue/optic nerve evaluation.
- 192
Dermolipoma Excision and Dry Eye?
- ALacrimal gland ductules
- BMeibomian glands
- CGlands of Zeis
- DGlands of Wolfring
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Answer: A — Lacrimal gland ductules
Dermolipomas arise in the superotemporal fornix, close to the palpebral lobe of the lacrimal gland and its ductules. Over-aggressive excision can damage ductules → severe aqueous deficiency dry eye.
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New-Onset Thyroid Eye Disease?
- AEyelid retraction repair
- BOrbital decompression
- CThyroid lab testing
- DStrabismus surgery
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Answer: C — Thyroid lab testing
New-onset thyroid-associated orbitopathy requires biochemical confirmation (TSH, free T4, T3, TSH receptor antibodies) and assessment of disease activity before any surgical intervention.
- 194
Upper Lid Blepharoplasty Landmark?
- AOrbital septum
- BMüller muscle
- CLevator aponeurosis
- DConjunctiva
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Answer: B — Müller muscle
The peripheral arterial arcade runs along the anterior surface of Müller muscle. Encountering it during upper lid surgery indicates the dissection plane is at or just anterior to Müller muscle.
- 195
SOOF Equivalent?
- AOrbital fat
- BSubcutaneous fat
- CRetro-orbicularis oculi fat (ROOF)
- DTemporal fat pad
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Answer: C — Retro-orbicularis oculi fat (ROOF)
SOOF is the inferior (midface) counterpart of ROOF in the upper eyelid/forehead region. Both lie deep to the orbicularis oculi muscle.
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Acute Painful Proptosis in a Child?
- ACavernous hemangioma
- BSinusitis with orbital abscess
- CTraumatic retrobulbar hemorrhage
- DOrbital lymphangioma
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Answer: A — Cavernous hemangioma
Cavernous hemangioma is a slow-growing, painless, adult-onset benign tumor. It does not present with acute painful proptosis. The other options are classic causes of acute pediatric orbital presentation.
- 197
Acute Ecchymosis with Cystic Orbital Lesion?
- ARhabdomyosarcoma
- BCapillary hemangioma
- COrbital abscess
- DLymphangioma
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Answer: D — Lymphangioma
Orbital lymphangioma (lymphatic malformation) is characterized by cystic spaces that undergo spontaneous hemorrhage, producing acute proptosis and ecchymosis. Fluid-fluid levels on MRI are typical.
- 198
Most Common Primary Orbital Malignancy in Children?
- ANeuroblastoma
- BRhabdomyosarcoma
- CEwing sarcoma
- DNone of the above
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Answer: B — Rhabdomyosarcoma
Rhabdomyosarcoma is the most common primary malignant orbital tumor in children, usually arising from undifferentiated mesenchymal cells. It presents with rapid-onset proptosis.
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Painless Lacrimal Gland Swelling in Older Adult?
- APrimary lacrimal gland lymphoma
- BPleomorphic adenoma
- CAdenoid cystic carcinoma
- DMalignant pleomorphic adenoma
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Answer: A — Primary lacrimal gland lymphoma
Painless lacrimal gland enlargement in older adults with molding of bone on CT strongly suggests lymphoma. Pleomorphic adenoma typically shows smooth bony remodeling, while carcinomas are more destructive.
- 200
Enophthalmos Without Trauma?
- ACavernous hemangioma
- BMetastatic breast carcinoma in a woman
- COrbital cellulitis
- DAll of the above
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Answer: B — Metastatic breast carcinoma in a woman
Scirrhous metastatic breast carcinoma can cause enophthalmos due to orbital fibrosis and contraction. Cavernous hemangioma and cellulitis typically cause proptosis, not enophthalmos.
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Most Common Cause of Bilateral Adult Exophthalmos?
- ACavernous hemangioma
- BPseudotumor
- CThyroid-related orbitopathy
- DMetastatic disease
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Answer: C — Thyroid-related orbitopathy
Thyroid eye disease is the most common cause of bilateral proptosis in adults, especially women. It is also the leading cause of unilateral or asymmetric exophthalmos.
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Most Common Cause of Unilateral Childhood Exophthalmos?
- ACapillary hemangioma
- BThyroid-related orbitopathy
- COrbital hemorrhage
- DOrbital cellulitis
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Answer: D — Orbital cellulitis
Orbital cellulitis, often secondary to paranasal sinusitis, is the most common cause of unilateral proptosis in children and requires urgent treatment to prevent vision loss and intracranial spread.
- 203
Predisposing Conditions for Mucormycosis?
- ADiabetes
- BRenal disease
- CDehydration
- DAll of the above
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Answer: D — All of the above
Mucormycosis is an aggressive fungal infection seen in immunocompromised and metabolically deranged patients. Risk factors include uncontrolled diabetes (especially diabetic ketoacidosis), renal disease, dehydration, immunosuppression, and iron overload.
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