BaekSeungJu/OphtimusEval-Dataset · Datasets at Hugging Face

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Compared with plasma, aqueous humor has an increased concentration of which one of these components?	Protein	Ascorbate	Glucose	Carbon dioxide		b	Ascorbate
Which vessel(s) provides the predominant blood supply to the surface nerve fiber layer of the optic nerve head?	Short posterior ciliary artery	Peripapillary choroidal vessels	Pial vessels	Central retinal artery		d	Central retinal artery
Which one of the following is NOT a risk factor for POAG?	Topical corticosteroid response	African American heritage	Positive family history	Diabetes mellitus		a	Topical corticosteroid response
Which drug used during general anesthesia is associated with an increase in intraocular pressure (IOP)?	Halothane	Ketamine	Valium	Phenobarbital		b	Ketamine
Patients with homocystinuria are at increased risk for the following:	Lens subluxation	Angle closure glaucoma	Intravascular thrombosis with general anesthesia	all of the above		d	all of the above
Indentation tonometry gives falsely low readings under all of the following conditions EXCEPT:	High myopia	Decreased central corneal thickness	Excessive fluorescein	Greater than 3 D of with-the-rule astigmatism		c	Excessive fluorescein
The reliability of visual field testing becomes suspect when pupil diameter decreases below:	4mm	3mm	2mm	1mm		b	3mm
Which test object has four times the area and the same light intensity as the Goldmann II 4e target?	III 4e	II2e	II 4c	V2a		a	III 4e
A patient is tested on the Humphrey automated perimeter. The machine projects a light at his blind spot and the patient presses the button. What does this patient's response represent?	false-positive response	Fixation loss	Short-term fluctuation	false-negative response		b	Fixation loss
Based on histologic studies, what percentage of optic nerve axons may be lost before visual field changes are detected by Goldmann perimetry?	10%	15%	25%	50%		d	50%
All of the following are well established early signs of glaucomatous damage EXCEPT:	Vertical elongation of the cup	Peripapillary atrophy	Splinter hemorrhage on disc	Nerve fiber layer loss		b	Peripapillary atrophy
All of the following conditions are associated with increased pigmentation of the trabecular meshwork on gonioscopy EXCEPT:	Pseudoexfoliation syndrome (PXF)	Pigment dispersion syndrome	Prior trauma	all of the above		d	all of the above
Iris transillumination defects are present in all of the following conditions EXCEPT:	oculocutaneous albinism	PXF	plateau iris syndrome	pigment dispersion syndrome		c	plateau iris syndrome
The technique LEAST helpful in evaluating the appearance of a glaucomatous optic nerve is:	Direct ophthalmoscopy	slit-lamp examination using a contact lens	Indirect ophthalmoscopy using a 20 D lens	slit-lamp examination using a 90 D lens		c	Indirect ophthalmoscopy using a 20 D lens
Which of the following is LEAST likely to be found in a patient with primary congenital glaucoma?	IOP of 23 mmHg	Cup to disc ratio of 0.4	Corneal diameter of 10.0 mm	Open angle with high iris insertion on gonioscopy		c	Corneal diameter of 10.0 mm
With respect to uveitic glaucoma, all of the following are true EXCEPT:	Prostaglandins such as latanoprost should be used with caution	Argon laser trabeculoplasty (ALT) may be a helpful adjunct if medications are ineffective	Miotics are usually avoided	Treating the intraocular inflammation is as important as lowering IOP		b	Argon laser trabeculoplasty (ALT) may be a helpful adjunct if medications are ineffective
Which one of the following has NOT been suggested to be a possible pathophysiologic mechanism for optic neuropathy in patients suspected of having normal tension glaucoma (low tension glaucoma)?	Nocturnal systemic hypotension	Vasospasm	Shock (hypotensive) optic neuropathy	Systemic hypercholesterolemia		d	Systemic hypercholesterolemia
Which one of the following conditions does NOT have the same pathogenesis of glaucoma as the others?	Sturge-Weber syndrome	Thyroid eye disease	Aniridia	Carotid-cavernous sinus fistula		c	Aniridia
Which surgical procedure would be initially used to manage primary congenital glaucoma with a markedly cloudy cornea?	Trabeculectomy with mitomycin C	Cyclophotocoagulation	Goniotomy	Trabeculotomy		d	Trabeculotomy
Which one of the following chemical burns is MOST likely to be associated with an acute elevation of IOP?	Chlorine bleach	Sulfuric acid	Hydrogen peroxide	Sodium hydroxide		d	Sodium hydroxide
With respect to corticosteroid glaucoma, all of the following are true EXCEPT:	In most cases, after discontinuing the steroid, the IOP returns to normal over a few days to several weeks	The rise in IOP may be delayed for years after starting the steroid	Most cases are caused by long-term oral administration of steroids	Patients with POAG are more susceptible to steroid-induced rap elevations		c	Most cases are caused by long-term oral administration of steroids
Glaucomatous optic neuropathy is associated with damage to which types of retinal cells?	Amacrine cells	Ganglion cells	Bipolar cells	Photoreceptors		b	Ganglion cells
What is the best initial therapy for malignant glaucoma?	Pilocarpine 2%	Laser iridotomy	Mydriatic-cycloplegic therapy	Lens removal		c	Mydriatic-cycloplegic therapy
The MOST important treatment for a patient with diabetic neovascular glaucoma and good vision is:	atropine and topical steroids	Aqueous suppressants	Adequate blood sugar and blood pressure control	Panretinal photocoagulation		d	Panretinal photocoagulation
Which one of the following types of glaucoma is LEAST likely to respond to medical therapy alone?	Phacolytic glaucoma	Pigmentary glaucoma	Lens particle glaucoma	Pseudœxfoliation		a	Phacolytic glaucoma
The eye condition LEAST likely to be associated with aqueous misdirection syndrome is:	Angle closure glaucoma	Uveitis	Myopia	Nanophthalmos		c	Myopia
Topical beta-adrenergic antagonists are known to be associated with all of the following side effects EXCEPT:	Increased plasma high-density lipoprotein cholesterol levels	Bronchospasm and airway obstruction	weakened myocardial contractility	Exercise intolerance		a	Increased plasma high-density lipoprotein cholesterol levels
A patient who has recently undergone panretinal photocoagulation after a central retinal vein occlusion presents with corneal edema, neovascularization of the iris, and an IOP of 58 mmHg. All of the following medications are appropriate to use EXCEPT:	atropine	dorzolamide	apraclonidine	pilocarpine		d	pilocarpine
Ocular side effects of pilocarpine include all of the following EXCEPT:	Hyperopia	Retinal detachment	Exacerbation of pupillary block	Lacrimation		a	Hyperopia
Which one of the following is NOT considered a possible side effect of the hyperosmotic agents?	Congestive heart failure	Subdural hemorrhage	Worsening of obstructive pulmonary disease	Mental confusion		c	Worsening of obstructive pulmonary disease
Which statement about carbonic anhydrase inhibitors is FALSE?	Aqueous production in the eye is not significantly reduced until more than 90% of the carbonic anhydrase activity is inhibited.	Carbonic anhydrase inhibitors cause reduced excretion of urinary citrate or magnesium, therefore predisposing to formation of kidney stones.	Carbonic anhydrase inhibitors may cause idiosyncratic and transient acute myopIa.	Metabolic acidosis is greater with oral acetazolamide than with IV injection of acetazolamide.		d	Metabolic acidosis is greater with oral acetazolamide than with IV injection of acetazolamide.
What is the most common cause of bleb failure?	Bleb encapsulation (Tenon's cyst formation)	Episcleral fibrosis	Late bleb leak	Closure of the internal sclerostomy		b	Episcleral fibrosis
Which one of the following is the MOST important medication to discontinue as far before glaucoma surgery as possible?	Pilocarpine	Echothiophate	Dipivefrin	Timolol		b	Echothiophate
Medical management of bleb leaks involves all of the following EXCEPT:	Bandage soft contact lens	Autologous blood injection	Aqueous suppressants	5-fluorouracil (5-FU)		d	5-fluorouracil (5-FU)
Use of 5-FU following filtration surgery has been associated with all of the following EXCEPT:	Conjunctival wound leaks	Suprachoroidal hemorrhage	Hypotony maculopathy	Retinal detachment		d	Retinal detachment
Apraclonidine (Iopidine), an alpha2-adrenergic agonist, has all of the following side effects EXCEPT:	Systemic hypotension	Superior lid retraction	Dry mouth	Blanching of conjunctival vessels		a	Systemic hypotension
Dorzolamide (Trusopt) lowers IOP by:	Increasing uveoscleral outflow	Decreasing aqueous production	Increasing conventional (trabecular meshwork) outflow	Decreasing episcleral venous pressure		b	Decreasing aqueous production
What combination of medications is MOST effective in lowering IOP?	Timolol and a carbonic anhydrase inhibitor	Echothiophate and pilocarpine	Pilocarpine and dipivefrin	Timolol and dipivefrin		a	Timolol and a carbonic anhydrase inhibitor
Prostaglandin analogs lower IOP predominantly by which one of the following mechanisms?	Increased uveoscleral outflow	Enhanced aqueous outflow by stimulation of ciliary muscle contraction	Reduced vitreous volume	Reduced aqueous production		a	Increased uveoscleral outflow
Which one of the following statements about ALT is TRUE?	AL T achieves its effect by creating physical openings in the trabecular meshwork through which aqueous humor can pass from the anterior chamber into Schlemm's canal.	The chance of post-treatment IOP rise is not influenced by the number of laser burns applied in each treatment session.	The best location for laser burns with respect to minimizing complications of post-treatment IOP rise and peripheral anterior synechiae formation is the posterior trabecular meshwork.	Repeating ALT in eyes in which ALT was initially effective and in which IOP control was eventually lost may provide pressure control in one-third to one-half of cases, although 10% to 15% may have a sustained elevation of IOP.		d	Repeating ALT in eyes in which ALT was initially effective and in which IOP control was eventually lost may provide pressure control in one-third to one-half of cases, although 10% to 15% may have a sustained elevation of IOP.
Laser trabeculoplasty is most likely to be helpful in an eye with which one of the following types of uncontrolled glaucoma?	Pigmentary glaucoma	Angle recession glaucoma	Iridocorneal endothelial syndrome	Inflammatory glaucoma		a	Pigmentary glaucoma
Complications of ALT include all of the following EXCEPT:	Iritis with posterior synechiae	Postoperative IOP spike	Synechial angle closure	Cataract formation		d	Cataract formation
Which are the most appropriate laser settings for ALT?	Spot size: 50 μ, duration: 0.1 seconds, energy: 700m W	Spot size: 50 μ, duration: 0.5 seconds, energy: 500mW	Spot size: 500 μ, duration: 0.1 seconds energy: 200mW	Spot size: 500 μ, duration: 0.5 seconds energy: 800mW		a	Spot size: 50 μ, duration: 0.1 seconds, energy: 700m W
The advantages of selective laser trabeculoplasty (SLT) over ALT include all of the following EXCEPT:	SLT is more effective at lowering IOP	SL T uses a potentially repeatable laser	SL T selectively targets pigmented TM cells	General structure of TM intact post-SLT.		a	SLT is more effective at lowering IOP
In which condition would a laser peripheral iridectomy NOT be indicated?	Iris bombe	Neovascular glaucoma	Acute angle closure glaucoma	Prophylaxis in an eye with narrow angles		b	Neovascular glaucoma
Compared with the argon laser, the Nd:YAG laser is associated with which one of the following with respect to iridotomies?	Late closure of the iridotomy	Fewer total applications	Less frequent bleeding with application	More extensive histologic damage to the treatment site		b	Fewer total applications
In contrast to trabeculectomy without mitomycin, the use of mitomycin intraoperatively during trabeculectomy may be associated with:	Lower surgical success rate	Higher long-term risk of endophthalmitis	Higher risk of retinal detachment	More inflammation and a more vascular-appearing bleb		b	Higher long-term risk of endophthalmitis
Which one of the following procedures has the highest incidence of hypotony?	Full-thickness sclerectomy	Trabeculectomy with mitomycin C	Seton	Trabeculectomy with 5-FU		a	Full-thickness sclerectomy
The adjunctive use of antifibrotic agents in trabeculectomy is indicated in all of the following situations EXCEPT:	Previously failed filtering surgery	Young myopic patients	aphakic/pseudophakic patients	Neovascular glaucoma		b	Young myopic patients
The following are true about the drugs used to modulate wound healing post glaucoma surgery, EXCEPT:	BAPN (beta-aminoproprionitrile), an inhibitor of lysyl oxidase, blocks collagen cross-linking	5-FU inhibits fibroblast proliferation by acting selectively on the S phase of the cell cycle	mitomycin-C is an alkylating agent that decreases DNA synthesis by causing DNA cross-linking	Colchicine acts by inhibiting fibroblast migration and proliferation		d	Colchicine acts by inhibiting fibroblast migration and proliferation
Which of the following is a theoretical advantage of nonpenetrating glaucoma surgery (nonpenetrating deep sclerectomy /viscocanalostomy)?	Lower incidence of postoperative complications	Technically easier	Better IOP reduction when compared to standard trabeculectomy	None of the above		a	Lower incidence of postoperative complications
A 34 year-old lawyer is struck in the eye by a golf ball launched by an ophthalmologist. The ophthalmologist rushes the lawyer to his office and examines his eye. A 20 % hyphema is present in the anterior chamber. No rupture of the globe is present. The traumatized eye is at risk for developing all f the following types of glaucoma EXCEPT:	Angle closure glaucoma	Open angle glaucoma	Angle recession glaucoma	Phacolytic glaucoma		d	Phacolytic glaucoma
A 34 year-old lawyer is struck in the eye by a golf ball launched by an ophthalmologist. The ophthalmologist rushes the lawyer to his office and examines his eye. A 20 % hyphema is present in the anterior chamber. No rupture of the globe is present. Because the IOP is elevated in the traumatized eye, proper management of the hyphema could include all the following EXCEPT:	Corticosteroids	Beta blockers	Aminocaproic acid	Miotic agents		d	Miotic agents
A 34 year-old lawyer is struck in the eye by a golf ball launched by an ophthalmologist. The ophthalmologist rushes the lawyer to his office and examines his eye. A 20 % hyphema is present in the anterior chamber. No rupture of the globe is present. The hyphema clears within a week; however, the eye remains hypotonus for several months while retaining good vision. Suddenly, while on vacation in a remote region of the country, the lawyer experiences extreme pain and blurred vision in the previously traumatized eye. Hours later, he is examined in an emergency room of a local rural hospital; his eye has an IOP of 62 mmHg by Schiotz tonometry. Treatment with timolol drops and acetazolamide tablets is instituted, and the lawyer rushes home to the care of his ophthalmologist. What is the most likely cause for this sudden elevation in IOP?	Angle recession glaucoma	Ghost cell glaucoma	Recurrent hyphema	Spontaneous closure of a cyclodialysis cleft		d	Spontaneous closure of a cyclodialysis cleft
A mother brings in her 7-month-old son for evaluation of excessive tearing from both of his eyes. On examination, the patient is noted to be Photophobic, have bilateral corneal enlargement, and have corneal clouding. What is the best course of action to take?	Send the patient home and instruct the mother on how to perform nasolacrimal sac massage.	Perform corneal scrapings and treat as a corneal ulcer.	Examine the patient under general anesthesia.	Perform B-scan ultrasonography.		c	Examine the patient under general anesthesia.
A mother brings in her 7-month-old son for evaluation of excessive tearing from both of his eyes. On examination, the patient is noted to be Photophobic, have bilateral corneal enlargement, and have corneal clouding. This patient may experience visual loss for all the following reasons EXCEPT:	Anisometropic amblyopia	Hyperopic astigmatism	Corneal scarring	Optic nerve damage		a	Anisometropic amblyopia
A mother brings in her 7-month-old son for evaluation of excessive tearing from both of his eyes. On examination, the patient is noted to be Photophobic, have bilateral corneal enlargement, and have corneal clouding. Initial treatment options for this patient include all the following EXCEPT:	Goniotomy	Trabeculotomy	Medical therapy	Trabeculectomy		d	Trabeculectomy
Indications for surgical intervention after traumatic hyphema include all f the following EXCEPT:	Corneal blood staining	prolonged presence of a large clot after 15 days	Rebleeding	IOP greater than 45 mmHg despite maximum tolerated topical and systemic medications		c	Rebleeding
A 65-year-old phakic hyperopic woman undergoes trabeculectomy for uncontrolled POAG. On the first postoperative day, her IOP is 10 mmHg, a diffuse bleb is present, and the anterior chamber is deep. However, on the second postoperative day, the chamber is shallow with peripheral iridocorneal apposition and an IOP of 22 mmHg. Appropriate management includes all the following EXCEPT:	Topical cycloplegic medications	Peripheral laser iridotomy	Pars plana vitrectomy	Topical corticosteroids		c	Pars plana vitrectomy
A 65-year-old phakic hyperopic woman undergoes trabeculectomy for uncontrolled POAG. On the first postoperative day, her IOP is 10 mmHg, a diffuse bleb is present, and the anterior chamber is deep. However, on the second postoperative day, the chamber is shallow with peripheral iridocorneal apposition and an IOP of 22 mmHg. The patient is seen on postoperative day 3 and is noted to have a completely flat anterior chamber, no bleb, and an IOP of 45 mmHg. At this point, appropriate medical management includes each of the following EXCEPT:	Topical cycloplegic medications	Systemic and topical aqueous suppressants	Miotic medications	Topical corticosteroids		c	Miotic medications
A 72-year-old phakic African American man undergoes glaucoma filtration surgery for POAG. Adjunctive mitomycin C is used intraoperatively. Postoperatively, the IOP remains at 2 to 3 mmHg, and he develops choroidal effusions. Surgical intervention should be considered for all of the following EXCEPT:	Impending failure of the bleb	Continued hypotony beyond 4 weeks	Kissing choroidals	Flat anterior chamber with corneal decompensation		b	Continued hypotony beyond 4 weeks
A 60-year-old man from India presents with a painful red eye. He has had poor vision in this eye for years, but he feels it has worsened over the past 2 weeks. He denies any ocular trauma. On examination, he is noted to have epithelial edema, heavy flare and cell (large cells), and a dense, brunescent cataract. The IOP is 56 mmHg. What is the most likely diagnosis?	Phacomorphic glaucoma	Phacolytic glaucoma	Phacoanaphylactic glaucoma	Uveitic glaucoma		b	Phacolytic glaucoma
A 60-year-old man from India presents with a painful red eye. He has had poor vision in this eye for years, but he feels it has worsened over the past 2 weeks. He denies any ocular trauma. On examination, he is noted to have epithelial edema, heavy flare and cell (large cells), and a dense, brunescent cataract. The IOP is 56 mmHg. What is the definitive management of this condition?	Trabeculectomy	Anterior chamber washout	Extracapsular cataract extraction	Posterior pole vitrectomy		c	Extracapsular cataract extraction
According to the Laser Glaucoma Trial, all the following are true EXCEPT:	ALT is at least as effective at reducing IOP as one glaucoma medical agent, timolol.	The majority of patients treated with laser first did not require any additional medical therapy to maintain lOP control	Laser-treated eyes had a slightly lower lOP than medication-treated eyes	ALT is a safe alternate and may be offered as initial therapy to POAG patients		b	The majority of patients treated with laser first did not require any additional medical therapy to maintain lOP control
A 67-year-old Asian woman calls complaining of 3 hours of acute right eye pain, blurred vision, and redness of her eye. She has a cloudy cornea with epithelial edema, shallow anterior chamber, 4-mm nonreactive pupil, and IOPs of 62 mmHg OD and 17 mmHg OS. Gonioscopy of the left eye reveals a narrow potentially occludable angle with virtually no angle structures visible. She has never had any previous similar episodes. Other findings expected on examination include:	Keratic precipitates	Glaucomflecken	Optic nerve pallor and cupping	Optic nerve hyperemia and swelling		d	Optic nerve hyperemia and swelling
A 67-year-old Asian woman calls complaining of 3 hours of acute right eye pain, blurred vision, and redness of her eye. She has a cloudy cornea with epithelial edema, shallow anterior chamber, 4-mm nonreactive pupil, and IOPs of 62 mmHg OD and 17 mmHg OS. Gonioscopy of the left eye reveals a narrow potentially occludable angle with virtually no angle structures visible. She has never had any previous similar episodes. Which one of the following treatments should be attempted first?	Peripheral iridectomy	Laser trabeculoplasty	Trabeculectomy	Seton implant		a	Peripheral iridectomy
Primary angle closure glaucoma occurs most commonly in patients with shallow anterior chambers. Among the following, which does NOT contribute to a shallow anterior chamber?	Mature lens	Hyperopia	Ocular hypertension	Iris bombe		c	Ocular hypertension
Secondary angle closure glaucoma may be associated with each of the following conditions EXCEPT:	Intraocular tumor	Scleral buckle for retinal detachment	Nanophthalmos	Schwartz's syndrome		d	Schwartz's syndrome
A 72-year-old African American man had a cataract extraction with posterior chamber 10L in the right eye 7 years ago, and 5 years ago he developed a retinal detachment, which was repaired with a scleral buckle. He developed intractable glaucoma in that eye with an open angle on gonioscopy. Despite having undergone two sessions of laser trabeculoplasty and now being on maximum-tolerated medical therapy with a visual acuity of 20/200, the IOP remains at 28 mmHg. Slit-lamp examination reveals 360o of scarred and non-mobile conjunctiva, and there is almost total cupping of the nerve. Which one of the following procedures would be MOST indicated at this point in this patient's management?	Transscleral cyclophotocoagulation	Trabeculectomy with antimetabolite	Laser trabeculoplasty	Laser iridotomy		a	Transscleral cyclophotocoagulation
A 72-year-old African American man had a cataract extraction with posterior chamber 10L in the right eye 7 years ago, and 5 years ago he developed a retinal detachment, which was repaired with a scleral buckle. He developed intractable glaucoma in that eye with an open angle on gonioscopy. Despite having undergone two sessions of laser trabeculoplasty and now being on maximum-tolerated medical therapy with a visual acuity of 20/200, the IOP remains at 28 mmHg. Slit-lamp examination reveals 360o of scarred and non-mobile conjunctiva, and there is almost total cupping of the nerve. If a drainage implant were placed in this patient's eye, which type of implant would be indicated?	Double-plate Molteno implant	Krupin implant	Anterior chamber tube shunt	Ahmed implant		c	Anterior chamber tube shunt
A 55-year-old man undergoes extracapsular cataract surgery. Postoperatively, he has a peaked pupil, hypotony, and incarceration of iris into the wound with leakage. Two weeks later, a grayish white membrane with a scalloped, thickened leading edge was noted on the posterior corneal surface. Treatment of involved iris tissue with argon laser turns this membrane white. Appropriate treatment for this condition includes which one of the following?	X-irradiation to involved tissues	Beta-irradiation to involved tissues	Photocoagulation of involved iris tissues with cryotherapy to remaining membranes on corneal tissues	Excision of involved iris tissues with cryotherapy to remaining membranes on corneal tissues		d	Excision of involved iris tissues with cryotherapy to remaining membranes on corneal tissues
A diabetic patient has had a complicated retinal detachment repaired with silicone oil instillation. Which one of the following is true concerning the peripheral iridectomy?	It prevents pupillary block that can occur from neovascularization of the iris.	It allows for a much-needed alternate pathway for light entry into the eye.	It prevents pupillary block glaucoma that can occur with silicone oil.	The iridectomy should have been performed superiorly.		c	It prevents pupillary block glaucoma that can occur with silicone oil.
Which of the following statements is/are true with respect to the Collaborative Initial Glaucoma Treatment Study (CIGTS)?	The study was designed to address the question of medical therapy versus early filtration surgery on the long-term progression of glaucoma.	Patients in the early surgery group were more likely to lose visual acuity and visual field during the first few years of follow-up study.	After 4 years of follow-up, both groups (medical versus early surgery group) were similar in visual acuity and visual field.	All of the above are true.		d	All of the above are true.
A 75-year-old white man underwent intracapsular cataract extraction 25 years ago. Approximately 15 years ago, he underwent secondary anterior chamber lens placement. Two years ago, this eye underwent penetrating keratoplasty. Over the 'past year, he has had recurrent uveitis in this eye, and on referral evaluation in your office, his IOP is 25 mmHg. Gonioscopy reveals an open angle and a small hyphema. The MOST appropriate management of his eye would be:	Aminocaproic acid	Topical corticosteroids	Panretinal photocoagulation	Surgical removal of his anterior chamber lens		d	Surgical removal of his anterior chamber lens
A young man is seen in your office over a 5-year period with several episodes of unilateral elevation of IOP to the 40 to 50 mmHg range. During these episodes, fine keratic precipitates and faint flare are noted. A mild ciliary flush is noted. No iris changes are noted. Each episode seems to respond well to topical corticosteroids and topical and systemic aqueous suppression. What is the most likely cause of his episodic glaucoma?	Fuchs' heterochromic iridocyclitis	Juvenile rheumatoid arthritis	Posner-Schlossman syndrome	Sarcoidosis		c	Posner-Schlossman syndrome
All the following are true with respect to prostaglandin analogs EXCEPT:	Unoprostone isopropyl (Rescula) reduces lOP by increasing uveoscleral outflow	Latanoprost (Xalatan) is a prod rug that becomes biologically active after being hydrolyzed by corneal esterase	Bimatoprost (Lumigan) is a prostamide analog	Conjunctival hyperemia is a reported side effect of the prostaglandin analogs		a	Unoprostone isopropyl (Rescula) reduces lOP by increasing uveoscleral outflow
The diagnosis of this patient's condition could include each of the following EXCEPT:	Malignant glaucoma	Excessive filtration	Delayed suprachoroidal hemorrhage	Incomplete iridectomy with obstruction of sclerostomy		b	Excessive filtration
Ocular tumors can cause glaucoma through a variety of mechanisms. Malignant melanomas of the anterior uveal tract might cause glaucoma through each of the following mechanisms EXCEPT:	Direct extension of the tumor in the trabecular meshwork	Obstruction of the trabecular meshwork by macrophages laden with melanin	Seeding of tumor cells into the outflow channels	Increase in episcleral venous pressure		d	Increase in episcleral venous pressure
Reported side effects of the prostaglandin (PG) analog drops include all of the following EXCEPT:	Conjunctival hyperemia	Cystoid macular edema (CME)	Conjunctival melanosis	Increased iris pigmentation		c	Conjunctival melanosis
According to the Ocular Hypertension Treatment Study (OHTS) all of the following are risk factors for glaucoma EXCEPT:	African American race	Thick corneas	Increasing age	Optic nerve anatomy		b	Thick corneas
A 1-year-old presents with a round, well-demarcated mass at the super temporal rim. The lesion has been present since birth. The most likely diagnosis is:	Rhabdomyosarcoma	Neurofibroma	Dermoid cyst	Capillary hemangioma	Metastatic Ewing sarcoma	c	Dermoid cyst
A 40-year-old woman presents with a progressively enlarging clear cystic mass along the eyelid margin. The most likely diagnosis is:	Epidermal inclusion cyst	Apocrine hidrocystoma	Syringoma	Trichofolliculoma	Basal cell carcinoma	b	Apocrine hidrocystoma
Which of the following is the most common primary malignancy of the eyelid?	Basal cell carcinoma	Squamous cell carcinoma	Sebaceous carcinoma	Melanoma	Kaposi sarcoma	a	Basal cell carcinoma
Xanthelasma is associated with hyperlipidemia in:	10%	20%	33%	50%	70%	c	33%
In a patient with laceration to the upper lid, all are TRUE, EXCEPT:	the presence of fat herniation indicates the orbital septum is penetrated	the presence of lacrimal gland indicates the orbital septum is penetrated	the orbital septum should be resutured if penetrated	in the presence of ptosis, early repair is recommended	ptosis is usually caused by damage to the levator aponeurosis	c	the orbital septum should be resutured if penetrated
Features of eyelid keratoacanthoma include all the following EXCEPT:	Malignant transformation in 50% of cases	Loss of eyelashes	Rapid growth	Ulcerated surface filled with keratin	Spontaneous resolution	a	Malignant transformation in 50% of cases
The following are contributory factors in senile (involution) entropion EXCEPT:	Atrophy of the orbital fat	Migration of the preseptal orbicularis over the pretarsal muscle	Dehiscence of the lower lid retractor	Horizontal lower lid laxity	Fat herniation through the orbital septum	e	Fat herniation through the orbital septum
Upper lid retraction may be seen in all the following EXCEPT:	Grave's eye disease	An eye with contralateral ptosis	Heart failure	Hydrocephalus in children	Parinaud's syndrome	c	Heart failure
TRUE statements about eyelid lesions include all the following EXCEPT:	Basal cell carcinoma affects the upper lid more commonly than the lower lid	Recurrent follicular conjunctivitis can be the result of molluscum contagiosum	Keratoacanthoma can resolve spontaneously without treatment	Sebaceous cell carcinoma has a worse prognosis than squamous cell carcinoma	Basal cell carcinoma is common in patients with xeroderma pigmentosa	a	Basal cell carcinoma affects the upper lid more commonly than the lower lid
In blepharochalasis, all the following are TRUE, EXCEPT:	The condition begins in teenage years	There are recurrent lid oedema	There are levator disinsertion	The condition is associated with Ascher's syndrome	Treatment is blepharoplasty	c	There are levator disinsertion
In Blepharophimosis, one is FALSE:	Is an autosomal dominant condition	Epicanthus inversus is a feature	Has nasal bridge hypoplasia	Has hypertelorism	Is associated with mental retardation	e	Is associated with mental retardation
All of the following types of entropion are known EXCEPT:	Spastic entropion	Senile entropion	Paralytic entropion	Cicatricial entropion		c	Paralytic entropion
Six hours after a bilateral blepharoplasty, the patient complains of sudden pain near the right eye. The dressings are removed and the right eyelids are tense and ecchymotic. The first step would be to:	Open the wound to release a possible retrobulbar hemorrhage	Consider the possibility of a cavernous sinus thrombosis and check corneal sensation	Measure visual acuity and check pupillary responses	Begin treatment with ice packs	Begin treatment with warm compresses	c	Measure visual acuity and check pupillary responses
A 3-year-old girl bitten by a dog, had a 6 mm-wide block of upper eyelid margin hanging by a thread of tissue, leaving a defect in the upper eyelid of approximately the same size. The best treatment is to:	Send the block to pathology and repair the defect by approximation	Send the block to pathology and repair the defect by making a lateral canthotomy and approximation	Repair the eyelid by sewing the block into its normal anatomic position	Send the block to pathology and repair the defect by a transfer of tissue from the lower eyelid	Keep the block under refrigeration for later use if necessary and close the defect by approximation and lateral canthotomy	c	Repair the eyelid by sewing the block into its normal anatomic position
With regard to ptosis, one is FALSE:	The most common abnormality in congenital ptosis is in the levator muscle	Lid lag on down gaze is a feature of senile ptosis	In Horner's syndrome, ptosis is due to paralysis of the Muller's muscle	The levator function is good in aponeurotic defect	In congenital ptosis the levator muscle can neither relax nor contract.	b	Lid lag on down gaze is a feature of senile ptosis
The most important determinant in selecting a corrective procedure for any type of ptosis is:	Vertical height of the palpebral fissure	Age of the patient	Amount of levator function	Duration of the ptosis	Position of the upper eyelid margin relative to the corneal limbus	c	Amount of levator function
Risk factors for developing basal cell carcinoma include all of the following, EXCEPT:	History of smoking	Excessive sun exposure in the first two decades of life	Brown irides	Blond hair	Living in areas that receive high levels of UV radiation from the sun	c	Brown irides
A 74-year-old woman presents with a 2-year history of a painless, progressively enlarging mass in the central aspect of the upper eyelid. This has resulted in distortion of the eyelid margin and loss of eyelashes. The most likely diagnosis is:	Sebaceous gland carcinoma	Squamous cell carcinoma	Amelanotic melanoma	Basal cell carcinoma	Dermal nevus	d	Basal cell carcinoma
Entropion repair of the lower eyelid may utilize any of the following techniques EXCEPT:	Lower eyelid retractor advancement	Lateral canthal tightening	Taping of the eyelid	Mucous membrane grafting to the posterior eyelid	Skin grafting	e	Skin grafting
Essential blepharospasm is usually characterized by all of the following EXCEPT:	Unilaterality	Age of onset usually over 50 years	Visual incapacitation	Obscure etiology	Involuntary spasms of the orbicularis muscle	a	Unilaterality

Compared with plasma, aqueous humor has an increased concentration of which one of these components?

Protein

Ascorbate

Glucose

Carbon dioxide

b

Ascorbate

Which vessel(s) provides the predominant blood supply to the surface nerve fiber layer of the optic nerve head?

Short posterior ciliary artery

Peripapillary choroidal vessels

Pial vessels

Central retinal artery

d

Central retinal artery

Which one of the following is NOT a risk factor for POAG?

Topical corticosteroid response

African American heritage

Positive family history

Diabetes mellitus

a

Topical corticosteroid response

Which drug used during general anesthesia is associated with an increase in intraocular pressure (IOP)?

Halothane

Ketamine

Valium

Phenobarbital

b

Ketamine

Patients with homocystinuria are at increased risk for the following:

Lens subluxation

Angle closure glaucoma

Intravascular thrombosis with general anesthesia

all of the above

d

all of the above

Indentation tonometry gives falsely low readings under all of the following conditions EXCEPT:

High myopia

Decreased central corneal thickness

Excessive fluorescein

Greater than 3 D of with-the-rule astigmatism

c

Excessive fluorescein

The reliability of visual field testing becomes suspect when pupil diameter decreases below:

4mm

3mm

2mm

1mm

b

3mm

Which test object has four times the area and the same light intensity as the Goldmann II 4e target?

III 4e

II2e

II 4c

V2a

a

III 4e

A patient is tested on the Humphrey automated perimeter. The machine projects a light at his blind spot and the patient presses the button. What does this patient's response represent?

false-positive response

Fixation loss

Short-term fluctuation

false-negative response

b

Fixation loss

Based on histologic studies, what percentage of optic nerve axons may be lost before visual field changes are detected by Goldmann perimetry?

10%

15%

25%

50%

d

50%

All of the following are well established early signs of glaucomatous damage EXCEPT:

Vertical elongation of the cup

Peripapillary atrophy

Splinter hemorrhage on disc

Nerve fiber layer loss

b

Peripapillary atrophy

All of the following conditions are associated with increased pigmentation of the trabecular meshwork on gonioscopy EXCEPT:

Pseudoexfoliation syndrome (PXF)

Pigment dispersion syndrome

Prior trauma

all of the above

d

all of the above

Iris transillumination defects are present in all of the following conditions EXCEPT:

oculocutaneous albinism

PXF

plateau iris syndrome

pigment dispersion syndrome

c

plateau iris syndrome

The technique LEAST helpful in evaluating the appearance of a glaucomatous optic nerve is:

Direct ophthalmoscopy

slit-lamp examination using a contact lens

Indirect ophthalmoscopy using a 20 D lens

slit-lamp examination using a 90 D lens

c

Indirect ophthalmoscopy using a 20 D lens

Which of the following is LEAST likely to be found in a patient with primary congenital glaucoma?

IOP of 23 mmHg

Cup to disc ratio of 0.4

Corneal diameter of 10.0 mm

Open angle with high iris insertion on gonioscopy

c

Corneal diameter of 10.0 mm

With respect to uveitic glaucoma, all of the following are true EXCEPT:

Prostaglandins such as latanoprost should be used with caution

Argon laser trabeculoplasty (ALT) may be a helpful adjunct if medications are ineffective

Miotics are usually avoided

Treating the intraocular inflammation is as important as lowering IOP

b

Argon laser trabeculoplasty (ALT) may be a helpful adjunct if medications are ineffective

Which one of the following has NOT been suggested to be a possible pathophysiologic mechanism for optic neuropathy in patients suspected of having normal tension glaucoma (low tension glaucoma)?

Nocturnal systemic hypotension

Vasospasm

Shock (hypotensive) optic neuropathy

Systemic hypercholesterolemia

d

Systemic hypercholesterolemia

Which one of the following conditions does NOT have the same pathogenesis of glaucoma as the others?

Sturge-Weber syndrome

Thyroid eye disease

Aniridia

Carotid-cavernous sinus fistula

c

Aniridia

Which surgical procedure would be initially used to manage primary congenital glaucoma with a markedly cloudy cornea?

Trabeculectomy with mitomycin C

Cyclophotocoagulation

Goniotomy

Trabeculotomy

d

Trabeculotomy

Which one of the following chemical burns is MOST likely to be associated with an acute elevation of IOP?

Chlorine bleach

Sulfuric acid

Hydrogen peroxide

Sodium hydroxide

d

Sodium hydroxide

With respect to corticosteroid glaucoma, all of the following are true EXCEPT:

In most cases, after discontinuing the steroid, the IOP returns to normal over a few days to several weeks

The rise in IOP may be delayed for years after starting the steroid

Most cases are caused by long-term oral administration of steroids

Patients with POAG are more susceptible to steroid-induced rap elevations

c

Most cases are caused by long-term oral administration of steroids

Glaucomatous optic neuropathy is associated with damage to which types of retinal cells?

Amacrine cells

Ganglion cells

Bipolar cells

Photoreceptors

b

Ganglion cells

What is the best initial therapy for malignant glaucoma?

Pilocarpine 2%

Laser iridotomy

Mydriatic-cycloplegic therapy

Lens removal

c

Mydriatic-cycloplegic therapy

The MOST important treatment for a patient with diabetic neovascular glaucoma and good vision is:

atropine and topical steroids

Aqueous suppressants

Adequate blood sugar and blood pressure control

Panretinal photocoagulation

d

Panretinal photocoagulation

Which one of the following types of glaucoma is LEAST likely to respond to medical therapy alone?

Phacolytic glaucoma

Pigmentary glaucoma

Lens particle glaucoma

Pseudœxfoliation

a

Phacolytic glaucoma

The eye condition LEAST likely to be associated with aqueous misdirection syndrome is:

Angle closure glaucoma

Uveitis

Myopia

Nanophthalmos

c

Myopia

Topical beta-adrenergic antagonists are known to be associated with all of the following side effects EXCEPT:

Increased plasma high-density lipoprotein cholesterol levels

Bronchospasm and airway obstruction

weakened myocardial contractility

Exercise intolerance

a

Increased plasma high-density lipoprotein cholesterol levels

A patient who has recently undergone panretinal photocoagulation after a central retinal vein occlusion presents with corneal edema, neovascularization of the iris, and an IOP of 58 mmHg. All of the following medications are appropriate to use EXCEPT:

atropine

dorzolamide

apraclonidine

pilocarpine

d

pilocarpine

Ocular side effects of pilocarpine include all of the following EXCEPT:

Hyperopia

Retinal detachment

Exacerbation of pupillary block

Lacrimation

a

Hyperopia

Which one of the following is NOT considered a possible side effect of the hyperosmotic agents?

Congestive heart failure

Subdural hemorrhage

Worsening of obstructive pulmonary disease

Mental confusion

c

Worsening of obstructive pulmonary disease

Which statement about carbonic anhydrase inhibitors is FALSE?

Aqueous production in the eye is not significantly reduced until more than 90% of the carbonic anhydrase activity is inhibited.

Carbonic anhydrase inhibitors cause reduced excretion of urinary citrate or magnesium, therefore predisposing to formation of kidney stones.

Carbonic anhydrase inhibitors may cause idiosyncratic and transient acute myopIa.

Metabolic acidosis is greater with oral acetazolamide than with IV injection of acetazolamide.

d

Metabolic acidosis is greater with oral acetazolamide than with IV injection of acetazolamide.

What is the most common cause of bleb failure?

Bleb encapsulation (Tenon's cyst formation)

Episcleral fibrosis

Late bleb leak

Closure of the internal sclerostomy

b

Episcleral fibrosis

Which one of the following is the MOST important medication to discontinue as far before glaucoma surgery as possible?

Pilocarpine

Echothiophate

Dipivefrin

Timolol

b

Echothiophate

Medical management of bleb leaks involves all of the following EXCEPT:

Bandage soft contact lens

Autologous blood injection

Aqueous suppressants

5-fluorouracil (5-FU)

d

5-fluorouracil (5-FU)

Use of 5-FU following filtration surgery has been associated with all of the following EXCEPT:

Conjunctival wound leaks

Suprachoroidal hemorrhage

Hypotony maculopathy

Retinal detachment

d

Retinal detachment

Apraclonidine (Iopidine), an alpha2-adrenergic agonist, has all of the following side effects EXCEPT:

Systemic hypotension

Superior lid retraction

Dry mouth

Blanching of conjunctival vessels

a

Systemic hypotension

Dorzolamide (Trusopt) lowers IOP by:

Increasing uveoscleral outflow

Decreasing aqueous production

Increasing conventional (trabecular meshwork) outflow

Decreasing episcleral venous pressure

b

Decreasing aqueous production

What combination of medications is MOST effective in lowering IOP?

Timolol and a carbonic anhydrase inhibitor

Echothiophate and pilocarpine

Pilocarpine and dipivefrin

Timolol and dipivefrin

a

Timolol and a carbonic anhydrase inhibitor

Prostaglandin analogs lower IOP predominantly by which one of the following mechanisms?

Increased uveoscleral outflow

Enhanced aqueous outflow by stimulation of ciliary muscle contraction

Reduced vitreous volume

Reduced aqueous production

a

Increased uveoscleral outflow

Which one of the following statements about ALT is TRUE?

AL T achieves its effect by creating physical openings in the trabecular meshwork through which aqueous humor can pass from the anterior chamber into Schlemm's canal.

The chance of post-treatment IOP rise is not influenced by the number of laser burns applied in each treatment session.

The best location for laser burns with respect to minimizing complications of post-treatment IOP rise and peripheral anterior synechiae formation is the posterior trabecular meshwork.

Repeating ALT in eyes in which ALT was initially effective and in which IOP control was eventually lost may provide pressure control in one-third to one-half of cases, although 10% to 15% may have a sustained elevation of IOP.

d

Repeating ALT in eyes in which ALT was initially effective and in which IOP control was eventually lost may provide pressure control in one-third to one-half of cases, although 10% to 15% may have a sustained elevation of IOP.

Laser trabeculoplasty is most likely to be helpful in an eye with which one of the following types of uncontrolled glaucoma?

Pigmentary glaucoma

Angle recession glaucoma

Iridocorneal endothelial syndrome

Inflammatory glaucoma

a

Pigmentary glaucoma

Complications of ALT include all of the following EXCEPT:

Iritis with posterior synechiae

Postoperative IOP spike

Synechial angle closure

Cataract formation

d

Cataract formation

Which are the most appropriate laser settings for ALT?

Spot size: 50 μ, duration: 0.1 seconds, energy: 700m W

Spot size: 50 μ, duration: 0.5 seconds, energy: 500mW

Spot size: 500 μ, duration: 0.1 seconds energy: 200mW

Spot size: 500 μ, duration: 0.5 seconds energy: 800mW

a

Spot size: 50 μ, duration: 0.1 seconds, energy: 700m W

The advantages of selective laser trabeculoplasty (SLT) over ALT include all of the following EXCEPT:

SLT is more effective at lowering IOP

SL T uses a potentially repeatable laser

SL T selectively targets pigmented TM cells

General structure of TM intact post-SLT.

a

SLT is more effective at lowering IOP

In which condition would a laser peripheral iridectomy NOT be indicated?

Iris bombe

Neovascular glaucoma

Acute angle closure glaucoma

Prophylaxis in an eye with narrow angles

b

Neovascular glaucoma

Compared with the argon laser, the Nd:YAG laser is associated with which one of the following with respect to iridotomies?

Late closure of the iridotomy

Fewer total applications

Less frequent bleeding with application

More extensive histologic damage to the treatment site

b

Fewer total applications

In contrast to trabeculectomy without mitomycin, the use of mitomycin intraoperatively during trabeculectomy may be associated with:

Lower surgical success rate

Higher long-term risk of endophthalmitis

Higher risk of retinal detachment

More inflammation and a more vascular-appearing bleb

b

Higher long-term risk of endophthalmitis

Which one of the following procedures has the highest incidence of hypotony?

Full-thickness sclerectomy

Trabeculectomy with mitomycin C

Seton

Trabeculectomy with 5-FU

a

Full-thickness sclerectomy

The adjunctive use of antifibrotic agents in trabeculectomy is indicated in all of the following situations EXCEPT:

Previously failed filtering surgery

Young myopic patients

aphakic/pseudophakic patients

Neovascular glaucoma

b

Young myopic patients

The following are true about the drugs used to modulate wound healing post glaucoma surgery, EXCEPT:

BAPN (beta-aminoproprionitrile), an inhibitor of lysyl oxidase, blocks collagen cross-linking

5-FU inhibits fibroblast proliferation by acting selectively on the S phase of the cell cycle

mitomycin-C is an alkylating agent that decreases DNA synthesis by causing DNA cross-linking

Colchicine acts by inhibiting fibroblast migration and proliferation

d

Colchicine acts by inhibiting fibroblast migration and proliferation

Which of the following is a theoretical advantage of nonpenetrating glaucoma surgery (nonpenetrating deep sclerectomy /viscocanalostomy)?

Lower incidence of postoperative complications

Technically easier

Better IOP reduction when compared to standard trabeculectomy

None of the above

a

Lower incidence of postoperative complications

A 34 year-old lawyer is struck in the eye by a golf ball launched by an ophthalmologist. The ophthalmologist rushes the lawyer to his office and examines his eye. A 20 % hyphema is present in the anterior chamber. No rupture of the globe is present. The traumatized eye is at risk for developing all f the following types of glaucoma EXCEPT:

Angle closure glaucoma

Open angle glaucoma

Angle recession glaucoma

Phacolytic glaucoma

d

Phacolytic glaucoma

A 34 year-old lawyer is struck in the eye by a golf ball launched by an ophthalmologist. The ophthalmologist rushes the lawyer to his office and examines his eye. A 20 % hyphema is present in the anterior chamber. No rupture of the globe is present. Because the IOP is elevated in the traumatized eye, proper management of the hyphema could include all the following EXCEPT:

Corticosteroids

Beta blockers

Aminocaproic acid

Miotic agents

d

Miotic agents

A 34 year-old lawyer is struck in the eye by a golf ball launched by an ophthalmologist. The ophthalmologist rushes the lawyer to his office and examines his eye. A 20 % hyphema is present in the anterior chamber. No rupture of the globe is present. The hyphema clears within a week; however, the eye remains hypotonus for several months while retaining good vision. Suddenly, while on vacation in a remote region of the country, the lawyer experiences extreme pain and blurred vision in the previously traumatized eye. Hours later, he is examined in an emergency room of a local rural hospital; his eye has an IOP of 62 mmHg by Schiotz tonometry. Treatment with timolol drops and acetazolamide tablets is instituted, and the lawyer rushes home to the care of his ophthalmologist. What is the most likely cause for this sudden elevation in IOP?

Angle recession glaucoma

Ghost cell glaucoma

Recurrent hyphema

Spontaneous closure of a cyclodialysis cleft

d

Spontaneous closure of a cyclodialysis cleft

A mother brings in her 7-month-old son for evaluation of excessive tearing from both of his eyes. On examination, the patient is noted to be Photophobic, have bilateral corneal enlargement, and have corneal clouding. What is the best course of action to take?

Send the patient home and instruct the mother on how to perform nasolacrimal sac massage.

Perform corneal scrapings and treat as a corneal ulcer.

Examine the patient under general anesthesia.

Perform B-scan ultrasonography.

c

Examine the patient under general anesthesia.

A mother brings in her 7-month-old son for evaluation of excessive tearing from both of his eyes. On examination, the patient is noted to be Photophobic, have bilateral corneal enlargement, and have corneal clouding. This patient may experience visual loss for all the following reasons EXCEPT:

Anisometropic amblyopia

Hyperopic astigmatism

Corneal scarring

Optic nerve damage

a

Anisometropic amblyopia

A mother brings in her 7-month-old son for evaluation of excessive tearing from both of his eyes. On examination, the patient is noted to be Photophobic, have bilateral corneal enlargement, and have corneal clouding. Initial treatment options for this patient include all the following EXCEPT:

Goniotomy

Trabeculotomy

Medical therapy

Trabeculectomy

d

Trabeculectomy

Indications for surgical intervention after traumatic hyphema include all f the following EXCEPT:

Corneal blood staining

prolonged presence of a large clot after 15 days

Rebleeding

IOP greater than 45 mmHg despite maximum tolerated topical and systemic medications

c

Rebleeding

A 65-year-old phakic hyperopic woman undergoes trabeculectomy for uncontrolled POAG. On the first postoperative day, her IOP is 10 mmHg, a diffuse bleb is present, and the anterior chamber is deep. However, on the second postoperative day, the chamber is shallow with peripheral iridocorneal apposition and an IOP of 22 mmHg. Appropriate management includes all the following EXCEPT:

Topical cycloplegic medications

Peripheral laser iridotomy

Pars plana vitrectomy

Topical corticosteroids

c

Pars plana vitrectomy

A 65-year-old phakic hyperopic woman undergoes trabeculectomy for uncontrolled POAG. On the first postoperative day, her IOP is 10 mmHg, a diffuse bleb is present, and the anterior chamber is deep. However, on the second postoperative day, the chamber is shallow with peripheral iridocorneal apposition and an IOP of 22 mmHg. The patient is seen on postoperative day 3 and is noted to have a completely flat anterior chamber, no bleb, and an IOP of 45 mmHg. At this point, appropriate medical management includes each of the following EXCEPT:

Topical cycloplegic medications

Systemic and topical aqueous suppressants

Miotic medications

Topical corticosteroids

c

Miotic medications

A 72-year-old phakic African American man undergoes glaucoma filtration surgery for POAG. Adjunctive mitomycin C is used intraoperatively. Postoperatively, the IOP remains at 2 to 3 mmHg, and he develops choroidal effusions. Surgical intervention should be considered for all of the following EXCEPT:

Impending failure of the bleb

Continued hypotony beyond 4 weeks

Kissing choroidals

Flat anterior chamber with corneal decompensation

b

Continued hypotony beyond 4 weeks

A 60-year-old man from India presents with a painful red eye. He has had poor vision in this eye for years, but he feels it has worsened over the past 2 weeks. He denies any ocular trauma. On examination, he is noted to have epithelial edema, heavy flare and cell (large cells), and a dense, brunescent cataract. The IOP is 56 mmHg. What is the most likely diagnosis?

Phacomorphic glaucoma

Phacolytic glaucoma

Phacoanaphylactic glaucoma

Uveitic glaucoma

b

Phacolytic glaucoma

A 60-year-old man from India presents with a painful red eye. He has had poor vision in this eye for years, but he feels it has worsened over the past 2 weeks. He denies any ocular trauma. On examination, he is noted to have epithelial edema, heavy flare and cell (large cells), and a dense, brunescent cataract. The IOP is 56 mmHg. What is the definitive management of this condition?

Trabeculectomy

Anterior chamber washout

Extracapsular cataract extraction

Posterior pole vitrectomy

c

Extracapsular cataract extraction

According to the Laser Glaucoma Trial, all the following are true EXCEPT:

ALT is at least as effective at reducing IOP as one glaucoma medical agent, timolol.

The majority of patients treated with laser first did not require any additional medical therapy to maintain lOP control

Laser-treated eyes had a slightly lower lOP than medication-treated eyes

ALT is a safe alternate and may be offered as initial therapy to POAG patients

b

The majority of patients treated with laser first did not require any additional medical therapy to maintain lOP control

A 67-year-old Asian woman calls complaining of 3 hours of acute right eye pain, blurred vision, and redness of her eye. She has a cloudy cornea with epithelial edema, shallow anterior chamber, 4-mm nonreactive pupil, and IOPs of 62 mmHg OD and 17 mmHg OS. Gonioscopy of the left eye reveals a narrow potentially occludable angle with virtually no angle structures visible. She has never had any previous similar episodes. Other findings expected on examination include:

Keratic precipitates

Glaucomflecken

Optic nerve pallor and cupping

Optic nerve hyperemia and swelling

d

Optic nerve hyperemia and swelling

A 67-year-old Asian woman calls complaining of 3 hours of acute right eye pain, blurred vision, and redness of her eye. She has a cloudy cornea with epithelial edema, shallow anterior chamber, 4-mm nonreactive pupil, and IOPs of 62 mmHg OD and 17 mmHg OS. Gonioscopy of the left eye reveals a narrow potentially occludable angle with virtually no angle structures visible. She has never had any previous similar episodes. Which one of the following treatments should be attempted first?

Peripheral iridectomy

Laser trabeculoplasty

Trabeculectomy

Seton implant

a

Peripheral iridectomy

Primary angle closure glaucoma occurs most commonly in patients with shallow anterior chambers. Among the following, which does NOT contribute to a shallow anterior chamber?

Mature lens

Hyperopia

Ocular hypertension

Iris bombe

c

Ocular hypertension

Secondary angle closure glaucoma may be associated with each of the following conditions EXCEPT:

Intraocular tumor

Scleral buckle for retinal detachment

Nanophthalmos

Schwartz's syndrome

d

Schwartz's syndrome

A 72-year-old African American man had a cataract extraction with posterior chamber 10L in the right eye 7 years ago, and 5 years ago he developed a retinal detachment, which was repaired with a scleral buckle. He developed intractable glaucoma in that eye with an open angle on gonioscopy. Despite having undergone two sessions of laser trabeculoplasty and now being on maximum-tolerated medical therapy with a visual acuity of 20/200, the IOP remains at 28 mmHg. Slit-lamp examination reveals 360o of scarred and non-mobile conjunctiva, and there is almost total cupping of the nerve. Which one of the following procedures would be MOST indicated at this point in this patient's management?

Transscleral cyclophotocoagulation

Trabeculectomy with antimetabolite

Laser trabeculoplasty

Laser iridotomy

a

Transscleral cyclophotocoagulation

A 72-year-old African American man had a cataract extraction with posterior chamber 10L in the right eye 7 years ago, and 5 years ago he developed a retinal detachment, which was repaired with a scleral buckle. He developed intractable glaucoma in that eye with an open angle on gonioscopy. Despite having undergone two sessions of laser trabeculoplasty and now being on maximum-tolerated medical therapy with a visual acuity of 20/200, the IOP remains at 28 mmHg. Slit-lamp examination reveals 360o of scarred and non-mobile conjunctiva, and there is almost total cupping of the nerve. If a drainage implant were placed in this patient's eye, which type of implant would be indicated?

Double-plate Molteno implant

Krupin implant

Anterior chamber tube shunt

Ahmed implant

c

Anterior chamber tube shunt

A 55-year-old man undergoes extracapsular cataract surgery. Postoperatively, he has a peaked pupil, hypotony, and incarceration of iris into the wound with leakage. Two weeks later, a grayish white membrane with a scalloped, thickened leading edge was noted on the posterior corneal surface. Treatment of involved iris tissue with argon laser turns this membrane white. Appropriate treatment for this condition includes which one of the following?

X-irradiation to involved tissues

Beta-irradiation to involved tissues

Photocoagulation of involved iris tissues with cryotherapy to remaining membranes on corneal tissues

Excision of involved iris tissues with cryotherapy to remaining membranes on corneal tissues

d

Excision of involved iris tissues with cryotherapy to remaining membranes on corneal tissues

A diabetic patient has had a complicated retinal detachment repaired with silicone oil instillation. Which one of the following is true concerning the peripheral iridectomy?

It prevents pupillary block that can occur from neovascularization of the iris.

It allows for a much-needed alternate pathway for light entry into the eye.

It prevents pupillary block glaucoma that can occur with silicone oil.

The iridectomy should have been performed superiorly.

c

It prevents pupillary block glaucoma that can occur with silicone oil.

Which of the following statements is/are true with respect to the Collaborative Initial Glaucoma Treatment Study (CIGTS)?

The study was designed to address the question of medical therapy versus early filtration surgery on the long-term progression of glaucoma.

Patients in the early surgery group were more likely to lose visual acuity and visual field during the first few years of follow-up study.

After 4 years of follow-up, both groups (medical versus early surgery group) were similar in visual acuity and visual field.

All of the above are true.

d

All of the above are true.

A 75-year-old white man underwent intracapsular cataract extraction 25 years ago. Approximately 15 years ago, he underwent secondary anterior chamber lens placement. Two years ago, this eye underwent penetrating keratoplasty. Over the 'past year, he has had recurrent uveitis in this eye, and on referral evaluation in your office, his IOP is 25 mmHg. Gonioscopy reveals an open angle and a small hyphema. The MOST appropriate management of his eye would be:

Aminocaproic acid

Topical corticosteroids

Panretinal photocoagulation

Surgical removal of his anterior chamber lens

d

Surgical removal of his anterior chamber lens

A young man is seen in your office over a 5-year period with several episodes of unilateral elevation of IOP to the 40 to 50 mmHg range. During these episodes, fine keratic precipitates and faint flare are noted. A mild ciliary flush is noted. No iris changes are noted. Each episode seems to respond well to topical corticosteroids and topical and systemic aqueous suppression. What is the most likely cause of his episodic glaucoma?

Fuchs' heterochromic iridocyclitis

Juvenile rheumatoid arthritis

Posner-Schlossman syndrome

Sarcoidosis

c

Posner-Schlossman syndrome

All the following are true with respect to prostaglandin analogs EXCEPT:

Unoprostone isopropyl (Rescula) reduces lOP by increasing uveoscleral outflow

Latanoprost (Xalatan) is a prod rug that becomes biologically active after being hydrolyzed by corneal esterase

Bimatoprost (Lumigan) is a prostamide analog

Conjunctival hyperemia is a reported side effect of the prostaglandin analogs

a

Unoprostone isopropyl (Rescula) reduces lOP by increasing uveoscleral outflow

The diagnosis of this patient's condition could include each of the following EXCEPT:

Malignant glaucoma

Excessive filtration

Delayed suprachoroidal hemorrhage

Incomplete iridectomy with obstruction of sclerostomy

b

Excessive filtration

Ocular tumors can cause glaucoma through a variety of mechanisms. Malignant melanomas of the anterior uveal tract might cause glaucoma through each of the following mechanisms EXCEPT:

Direct extension of the tumor in the trabecular meshwork

Obstruction of the trabecular meshwork by macrophages laden with melanin

Seeding of tumor cells into the outflow channels

Increase in episcleral venous pressure

d

Increase in episcleral venous pressure

Reported side effects of the prostaglandin (PG) analog drops include all of the following EXCEPT:

Conjunctival hyperemia

Cystoid macular edema (CME)

Conjunctival melanosis

Increased iris pigmentation

c

Conjunctival melanosis

According to the Ocular Hypertension Treatment Study (OHTS) all of the following are risk factors for glaucoma EXCEPT:

African American race

Thick corneas

Increasing age

Optic nerve anatomy

b

Thick corneas

A 1-year-old presents with a round, well-demarcated mass at the super temporal rim. The lesion has been present since birth. The most likely diagnosis is:

Rhabdomyosarcoma

Neurofibroma

Dermoid cyst

Capillary hemangioma

Metastatic Ewing sarcoma

c

Dermoid cyst

A 40-year-old woman presents with a progressively enlarging clear cystic mass along the eyelid margin. The most likely diagnosis is:

Epidermal inclusion cyst

Apocrine hidrocystoma

Syringoma

Trichofolliculoma

Basal cell carcinoma

b

Apocrine hidrocystoma

Which of the following is the most common primary malignancy of the eyelid?

Basal cell carcinoma

Squamous cell carcinoma

Sebaceous carcinoma

Melanoma

Kaposi sarcoma

a

Basal cell carcinoma

Xanthelasma is associated with hyperlipidemia in:

10%

20%

33%

50%

70%

c

33%

In a patient with laceration to the upper lid, all are TRUE, EXCEPT:

the presence of fat herniation indicates the orbital septum is penetrated

the presence of lacrimal gland indicates the orbital septum is penetrated

the orbital septum should be resutured if penetrated

in the presence of ptosis, early repair is recommended

ptosis is usually caused by damage to the levator aponeurosis

c

the orbital septum should be resutured if penetrated

Features of eyelid keratoacanthoma include all the following EXCEPT:

Malignant transformation in 50% of cases

Loss of eyelashes

Rapid growth

Ulcerated surface filled with keratin

Spontaneous resolution

a

Malignant transformation in 50% of cases

The following are contributory factors in senile (involution) entropion EXCEPT:

Atrophy of the orbital fat

Migration of the preseptal orbicularis over the pretarsal muscle

Dehiscence of the lower lid retractor

Horizontal lower lid laxity

Fat herniation through the orbital septum

e

Fat herniation through the orbital septum

Upper lid retraction may be seen in all the following EXCEPT:

Grave's eye disease

An eye with contralateral ptosis

Heart failure

Hydrocephalus in children

Parinaud's syndrome

c

Heart failure

TRUE statements about eyelid lesions include all the following EXCEPT:

Basal cell carcinoma affects the upper lid more commonly than the lower lid

Recurrent follicular conjunctivitis can be the result of molluscum contagiosum

Keratoacanthoma can resolve spontaneously without treatment

Sebaceous cell carcinoma has a worse prognosis than squamous cell carcinoma

Basal cell carcinoma is common in patients with xeroderma pigmentosa

a

Basal cell carcinoma affects the upper lid more commonly than the lower lid

In blepharochalasis, all the following are TRUE, EXCEPT:

The condition begins in teenage years

There are recurrent lid oedema

There are levator disinsertion

The condition is associated with Ascher's syndrome

Treatment is blepharoplasty

c

There are levator disinsertion

In Blepharophimosis, one is FALSE:

Is an autosomal dominant condition

Epicanthus inversus is a feature

Has nasal bridge hypoplasia

Has hypertelorism

Is associated with mental retardation

e

Is associated with mental retardation

All of the following types of entropion are known EXCEPT:

Spastic entropion

Senile entropion

Paralytic entropion

Cicatricial entropion

c

Paralytic entropion

Six hours after a bilateral blepharoplasty, the patient complains of sudden pain near the right eye. The dressings are removed and the right eyelids are tense and ecchymotic. The first step would be to:

Open the wound to release a possible retrobulbar hemorrhage

Consider the possibility of a cavernous sinus thrombosis and check corneal sensation

Measure visual acuity and check pupillary responses

Begin treatment with ice packs

Begin treatment with warm compresses

c

Measure visual acuity and check pupillary responses

A 3-year-old girl bitten by a dog, had a 6 mm-wide block of upper eyelid margin hanging by a thread of tissue, leaving a defect in the upper eyelid of approximately the same size. The best treatment is to:

Send the block to pathology and repair the defect by approximation

Send the block to pathology and repair the defect by making a lateral canthotomy and approximation

Repair the eyelid by sewing the block into its normal anatomic position

Send the block to pathology and repair the defect by a transfer of tissue from the lower eyelid

Keep the block under refrigeration for later use if necessary and close the defect by approximation and lateral canthotomy

c

Repair the eyelid by sewing the block into its normal anatomic position

With regard to ptosis, one is FALSE:

The most common abnormality in congenital ptosis is in the levator muscle

Lid lag on down gaze is a feature of senile ptosis

In Horner's syndrome, ptosis is due to paralysis of the Muller's muscle

The levator function is good in aponeurotic defect

In congenital ptosis the levator muscle can neither relax nor contract.

b

Lid lag on down gaze is a feature of senile ptosis

The most important determinant in selecting a corrective procedure for any type of ptosis is:

Vertical height of the palpebral fissure

Age of the patient

Amount of levator function

Duration of the ptosis

Position of the upper eyelid margin relative to the corneal limbus

c

Amount of levator function

Risk factors for developing basal cell carcinoma include all of the following, EXCEPT:

History of smoking

Excessive sun exposure in the first two decades of life

Brown irides

Blond hair

Living in areas that receive high levels of UV radiation from the sun

c

Brown irides

A 74-year-old woman presents with a 2-year history of a painless, progressively enlarging mass in the central aspect of the upper eyelid. This has resulted in distortion of the eyelid margin and loss of eyelashes. The most likely diagnosis is:

Sebaceous gland carcinoma

Squamous cell carcinoma

Amelanotic melanoma

Basal cell carcinoma

Dermal nevus

d

Basal cell carcinoma

Entropion repair of the lower eyelid may utilize any of the following techniques EXCEPT:

Lower eyelid retractor advancement

Lateral canthal tightening

Taping of the eyelid

Mucous membrane grafting to the posterior eyelid

Skin grafting

e

Skin grafting

Essential blepharospasm is usually characterized by all of the following EXCEPT:

Unilaterality

Age of onset usually over 50 years

Visual incapacitation

Obscure etiology

Involuntary spasms of the orbicularis muscle

a

Unilaterality