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Exam 28-2-2013
.1Flouresciene angiography least used in
Retinoblastoma
-2four pictures which has the best prognosis after laser ttt
one for severe NPDR + maculopathy
one OCT foveal cyst
one FFA with petalloid appearance
one fundus picture with circinate exudate with HE in the fovea
.3Hamartoma choristoma Q
.4most difficult types of glaucoma to differentiate clinically
Acute narrow angle and chronic angle glaucoma
Phaco anti uveitis, phacomorphic glaucoma and phacoanaphylactic
Phaco morphic glaucoma and acute angle closure
Acute narrow angle and chronic open angle
.5orbascan post LASIK shows inferior steepening, central thining
both in anterior and posterior
The condition most likely
Forme froste KC
Pellucid marginal deg
Ectasia
KC
.6child post operative of both eyes lid surgery the lids where
continuous with the cheek skin and a picture shows upper and lower
lid vertical wounds in both eyes This is
Symblepharon
Cryptophthalmus
Ankyloblepharon

.7Orbascan showing crab claw sign in the lower cornea the max
meridian power 46 D the min 43 D
The thickness in the center 454 in the periphery 540um
Forme fruste KC
Pellucid marginal degeneration
KC
Keratoglobus???
40 .8yrs old man presented with granulomas in the orbit diagnosed
as sarcoidosis the systemic and ocular examination is otherwise
normal the examination with polarized microscope was positive this
is
Orbital sarcoidosis
TB
Wagner Granulomatosis
Ebenhiem scholer S ???

40 .9yrs old man shorteness of breath bilateral lacrimal gland


swelling seen as wedge shape in CT
Sarcoidosis
Wagner granulomatosis (unilateral)
.10Picture of skin lesions in the palms (rash) 45 yrs male late leakage
in macula CME with vitritis , anterior uveitis, history of genital
ulceration The ttt
Penicillin
Immunosuppressive
Systemic steroids
Follow up
.11child with bilateral opacity in the lens since 6 mth of age local
doctor adviced cataract at school age
The picture shows one eye with disc shaped cataract the diagnosis is
Zonullar
Pyramidal
Duplicate
.12compound myopic astigmatism the 2 focal lines
In front of the retina
.13Galilean telescope the objective 15 D the eye piece 90 D
The linear magnification
3x
6x
9x
12x

.14object 25 cm to the lt of -1 diopter lens the image will be


20cm to the rt
20cm to the rt
10cm to the lt
10cm to the rt
.15wich name has a grading classification of the angle by gonio lens
Von hiem
Spaeth
Fuch’s
.16
UBM of 35 yrs old man with acute angle closure Glaucoma
What is the most predominant diagnostic sign of his problem in the
picture
Steep insertion
Iris bombe
PAS
.17painfull swelling in the upper eye lid pic of everted lid
Common with rosacea and blepharitis
Local steroids cause pigmentation
.18mass removed from the lid diagnosed as keratoacanthoma , ptn
55 yrs his father died from colorectal cancer
Reexamine histology
Screen family members
Systemic investigations for other malignancy
Routine management of keratoacanthoma
.19which is not true about conjunctivitis
Chlamydial infection in new born infant diagnosed by follicular
reaction
50 .20yrs ptn refered from endocrine he is admitted for control of
hyper glycemia many yrs diabetic, on choline esterase inhibitor for
glaucoma, refraction was -3.5 and fundus no DR from 2 monthes,
now refraction -4.5
Redo fundus
Redo refraction after control bl glaucose
Prescribe new refraction
.21Best management of cataract in children
CCC and post CCC and IOL
ECCE
ICCE
Post CCC
.22Lens all are true except
AP 4.5 mm in adult
Equator 9-10 mm in adult
In ICCE the best place for cryo is the anterior pole

.23in SO under action


V pattern strabismus
Incommitent XT
Bilateral Brown S
.24In RT SO paralysis all are true except
LT IO recession
Rt SR recession
RT IO recession
RT SO tucking
.25patient with fundus showing dry ARMD which is not indicated by
AR medical ttt study group
Vit B6
Zinc
Beta carotene
.26ETDRS (early treatment diabetic retinopathy study) all false
except
Moderate vision loss is doubling of visual angle
.27the best way to detect moving membrane in the vitreous is
Real time B scan U/S
Real time UBM
Real time A scan U/S
.28patient diagnosed with Amyloidosis sample from vitreous can be
stained with all except
Oil red O
Congo red
Crystal violet???
Thioflavine T???
.30CT and photo of child with acute post traumatic proptosis the CT
shows medial sub periostal hematoma, VA decreasing, RAPD and
complete ophthalmoplegia
The best ttt
Systemic steroid
Observation
Evacuation of hematoma
.31ocular motor apraxia what is true
Associated with absent corpus callosum
.32fundus of 40 yrs with accident severe vitreous he, RAPD, 2 mm
self sealed corneal wound, mild cataract and vision HM good light
projection ,tension digitally soft, most probable Diagnosis
Vitreous hge + RD
Vitreous hge+ IOFB
Retinal dialysis
.33patient with acute Anterior uveitis Iris heterochromia, Pupillary
mydriasis and Brown deposits on the anterior lens with picture the
most probable D

Horners syndrom
Siderosis bulbi
VKH
Sympathetic ophthalmia
.34picture of PDR, vitreous he, tractional detachment
Which sign is not important in staging
NVD
NVE
Tractional Det
IRMA (intra retinal microvascular anomalies)

.35child 7 yrs sudden ET no diplopia, ttt with prism, the angle


increased, Free neorology and systemic exam .
ARC
Amblyopia
Undercorrection of prism
.36Best ttt for convergence paralysis
BI prisms for reading???????????
Training BO prisms
Bilateral MR resection
.37keratoacanthoma what is true
Slowly growing
Associated with HPV
Recurrence is not common
.38Child with bilateral nuclear cataract which is true
Possible aphakic glaucoma
Associated with thining of the central part of anterior capsule
.39Peter’s anomaly all true except
Unilateral??????????????
Cataract
Corneal opacity
Angle closure
.40corneal dystrophies the true statement
Granular hyaline sub

.41All cause endothelial dysfunction except


Fuch’s
CHED (cong hereditary end dystrophy)
Posterior polymorphs dystrophy
Fleck dystrophy
.42Mucopolysacharaidosis all true except
Sanflippo XL Hunter is the only sex linked
.43Cornea plana
Marfan????????
Anterior and posterior coloboma
Megalocornea
.44Behcet which is not major chch
Skin lesion
Arthritis
Oral ulcer
Genital ulcer
Anterior uveitis
.45Most common cause of dropped nucleus in phaco
Rent in posterior capsule
Irregular anterior capsulotomy
Low bottle height
Small CCC
Zonular weakness

.46Glaucomflekens
Small areas of cataract behind anterior capsule after attack of Acute
ACG
.47PVD all true except
Associated with pigment in the anterior vitreous
.48Another Question on PVD all true except
Weiss ring is detached vitreous around macula
.49Scleral buckle the true statement
Identification of all breaks and holes increase the success rate
.50Visual field central 10-2 Humphrey, tubular field, the
complication you should discuss with the patient that can happen
even with successful uneventful surgery.
Loss of central field.
.51Function of tear film is all except:
Lymphatic drainage
.52Lateral orbital walls
Perpendicular to each other

1-elderly patient unable to open his eyes for sevsral months,it


started as inttermittent and then bacame constant,wt is the work up:
a.botulinum toxin injected in the lid annulay
b.botulinum toxin injected to lid under electromyography
c.valium
d.orbicularis snip procedure

2-elderly pt with lower lid swelling,past history of sinus surgery with


systemic A/B and nasal packing..what is the diagnosis:
a.xanthelasma
b.lipogranuloma
c.sinus histocytosis

3-photo of upper palpebral swelling,what is it..chalazion..:


a.associated with rasaceae and chronic blepheritis
b.steriod is the best ttt
c.staph aurius cause lipogranuloma

CONJUNCTIVAL DISEASE
1-subconjuctival injection of drug will be transmitted to anterior
chamber by:
a.diffusion through sclera
b.through anterior ciliary artery at site of injection
c.venous rout.
d.tear film

2-cromolyn drop is used:


a.good antihistamine
b.increase the relese of esinophils
c.degranulate mast cells
d. decrease the need of steroids and has low side effects

CORNEAL DISEASE
1-what drug has better corneal penetration
a.dexamethasone alcohol solution
b.dexamethasone phosphate oinment
c.prednisolon acetate suspention
d.prednisolone phosphate solution
e.fluromethalone alcohol oinment

2-which organism can penetrate intact corneal epithelium


a.niesseria gonorrhea
b.strept
c.staph

3-pt with corneal ulcer treated with topical cefazoline and fortified
tobramycine for 2 wks,,this is the picture now:
central corneal ulcer with vascularasation
punctate epithelal infiltarations
diffuse conjuctival injection
periocular lid excrusion
what is the diagnosis:
a.fungal c.ulcer
b.drug toxcicity
c.neurotrophic ulcer
d.acanthemoeba c.ulcer

4-photo of post LASIK corneal topography [central purple circle in the


middle of red circle ]what is th ttt
a.corneal cross linking with riboflavin
b.rigid contact lens
c.deep lamelar keratopalsty
d.phakic IOL
1-pt present with traumatic cataract and zonulodyalisis 180..what is
the mode of action:
a.phaco,high power,low vacum,IOL in the bag
b.phaco,low vacum,IOL in the bag with capsular tension ring
c.phaco,low vacum,IOL and capsular tension ring ih sulcus
d.
2- zanular cataract +sutural opacities associated with chromosome:
a.17q11
b.4q24
c.17q24
d.
3- pt under went uneventful cataract surgery,6 days later he
develope sever ocular pain,hazy cornea,drop of vision..what should
you do:
a
b.

REFRACTIVE DISEASE

1-all are signs of graft rejection except:


a. khodadoust line
b.punctate epithelia deposits
c.endothelial...
d.mucopurulent conjunctivitis
2- in ten yrs old boy,what is the refractive error that will usually
present with 20/20 VA
a.-2.5 myopia
b.+2.5 hyperopia
c.compound astigmatism
d.mixed myopic astigmatism
e.mixed hyperopic astigmatism
3- photo of corneal topography(red color figure of 8 with upper circle
is larger) ..what is the idagnosis:
a.pellucid corneal degeneration
b.
c.

OPTICS

1-in compound myopic astigmatism:


a.both line lies in front of the retina
b.both lines behind the retina
c. one in front and one behind the retina
d.one is at 90 degree of the other
2-what is the most apprpriate type of glass foe a fisher man how find
glare when lookin in the sea:
a.polarazed glass
b.chromatic glass
c.
d.
3-young adult presnt with -2.5 D sph prescreption, his keratometric
reading is 90@44..what type of contact lense you would prescripe:
a.spherical rigid cl
b.spherical soft cl
c.toric
d. bitoric

OCULAR PATHOLOGY

1-juvinle xanthogranuloma,you may find


a.toton gient cell
b.langerhanz gient cell
c.
d.
2-dellen fuchs nodules are all except:
a. sub RPE epitheloid deposition
b.choroidal granuloma
c.can present in disease other than sympathetic ohthalmitis
d.removed after treatment(not sure about this)
3-Henderson peterson inclusion bodies are present in
a.tuberculosis
b.chlamydial infection
c.HSV/HZV infection
d.molluscum contagusum infection
e.CMV infection

ONCOLOGY

1-at what phase the diagnosis of retinoblastoma gene:


a.telephase
b.****phase
c.prophase
d.anaphase
e.interphase
2-the time for tensilon to start acting is
a.5-10 min
b.15-20 min
c.30-45 min
d.60 min
3-corticosteriod,pilocarpine and chloroquin can all cause:
a.cataract
b.open angle glaucoma
c.amblyopia
d.optic neuritis

LACRIMAL SYSTEM

1-which one of these glands present in fornix


a. kruse
b.wolfering
c.moll
d.zeis
2- 3 photos of pt underwent lacrimal surgery,1st photo discribe
cleaning the site of operation,2nd show blowing closed nose and
mouth,3rd recurrent syringing..what was the operation done:
a.canaliculoDCR
b.conjunctivoDCR
c.
d.reconstruction with plug
3-pt with dry eye undrer went punctal occlusion,now he is c/o
discharge,excrution of the plug..the most likely diagnosis is:
a.dacryocystitis
b.canaliculitis
c.cojunctivitis

-the lateral orbital walls lies:


a. 45 degree to each other
b. 67 degree to each other
c. parallel to each other
d. perpendicular to each other

2-pt present with superiotemporal lesion with hair on its surface,the


most acurrate diagnosis is:
a. lipodermoid
b. dermoid cyst
c....

3-the end time for lidocain in periocular/retrobulber anasthesia is:


a. 30 min
b. 60 min
c. 90 min
d. 120 min

GLAUCOMA

1-when using 4-mirror goniolens all are write except:


a.give mirror image to the angle
b. no need for coupling substance
c. used in setting position
d.cause narrowing of angle when pressing

2-photo showing large overhanging bleb,what to do:


a.autologous blood injection+ needling
b. compression sutures+ needling
c. bleb excision
d....

3- which one of the following drugs causes dry mouth:


a. ecothiophate
b. pilocarpine
c. timolol
d. epinephrine
e. meto...
4- the most confusing type of glaucoma are:
narrow angle glaucoma+ chronic glaucoma
b. narrow angle glaucoma+ phacomorphic
c.phacomorphic glaucoma+phacolytic glaucoma
d.phacomorphic+ phacoanaphylactic and narrow angle glaucoma

5-Argon laser trabeculoblasty is most effective in:


a. PEX
b. neovascular glaucoma
c. angle recession glaucoma
d. steroid ass. glaucoma
e.uveitic glaucoma

6-when applying dilatation to a pt his IOP rises from 15-45


mmhg,appropriate antiglaucoma medications given..what is the next
step:
a. trabeculectomy
b. periphral laser iridotomy
c. gonioscopy
d. mannitol

7-which one of these drugs can cause CMO:


a. ecothiophate
b.pilocarpine
c.timilol
d.epinephrine
e.metolamide

STRABISMUS

1-photo of 50 yrs old male squint surgery (SR,MR,LR muscle),this pt


develop corneal odema,descemet's membrane folds..no view to
anterior ad posterior champers,what to do:
a. give cyclopentolate
b. give systemic and topical steriods
c.give systemic antibiotics
d. do corneal scraping for better view

2- the time given to one muscle to constrict is equal to the


antagonised muscle in the same eye to relax is:
a. all or none law
b.Herring's law
c. Sherington's law
d. Kappa law

3-in treatment of RT SO palsy :


a. LT SR recession
b. RT IO recession
c. RT IO resection
d. LT IO recession
e. SO tucking

4-double elevator palsy is


a. SR and IO palsy of the same eye
b. SR palsy of both eyes
c. SR of one eye and IO of the other eye
d. SO palsy of one eye and SR palsy of the other eye
e. IO restriction

Exam 28-2-2013
1. Flouresciene angiography least used in
Retinoblastoma
2- four pictures which has the best prognosis after laser ttt
one for severe NPDR + maculopathy
one OCT foveal cyst
one FFA with petalloid appearance
one fundus picture with circinate exudate with HE in the fovea
3. Hamartoma choristoma Q
4. most difficult types of glaucoma to differentiate clinically
Acute narrow angle and chronic angle glaucoma
Phaco anti uveitis, phacomorphic glaucoma and phacoanaphylactic
Phaco morphic glaucoma and acute angle closure
Acute narrow angle and chronic open angle
5. orbascan post LASIK shows inferior steepening, central thining
both in anterior and posterior
The condition most likely
Forme froste KC
Pellucid marginal deg
Ectasia
KC
6. child post operative of both eyes lid surgery the lids where
continuous with the cheek skin and a picture shows upper and lower
lid vertical wounds in both eyes This is
Symblepharon
Cryptophthalmus
Ankyloblepharon

7. Orbascan showing crab claw sign in the lower cornea the max
meridian power 46 D the min 43 D
The thickness in the center 454 in the periphery 540um
Forme fruste KC
Pellucid marginal degeneration
KC
Keratoglobus
8. 40 yrs old man presented with granulomas in the orbit diagnosed
as sarcoidosis the systemic and ocular examination is otherwise
normal the examination with polarized microscope was positive this
is
Orbital sarcoidosis
TB
Wagner Granulomatosis
Ebenhiem scholer S

9. 40 yrs old man shorteness of breath bilateral lacrimal gland


swelling seen as wedge shape in CT
Sarcoidosis
Wagner granulomatosis
10.Picture of skin lesions in the palms (rash) 45 yrs male late leakage
in macula CME with vitritis , anterior uveitis, history of genital
ulceration The ttt
Penicillin
Immunosuppressive
Systemic steroids
Follow up
11. child with bilateral opacity in the lens since 6 mth of age local
doctor adviced cataract at school age
The picture shows one eye with disc shaped cataract the diagnosis is
Zonullar
Pyramidal
Duplicate
12. compound myopic astigmatism the 2 focal lines
In front of the retina
13. Galilean telescope the objective 15 D the eye piece 90 D
The linear magnification
3x
6x
9x
12x

14. object 25 cm to the lt of -1 diopter lens the image will be


20 cm to the rt
20 cm to the rt
10 cm to the lt
10 cm to the rt
15. wich name has a grading classification of the angle by gonio lens
Von hiem
Spaeth
Fuch’s
16.
UBM of 35 yrs old man with acute angle closure Glaucoma
What is the most predominant diagnostic sign of his problem in the
picture
Steep insertion
Iris bombe
PAS
17. painfull swelling in the upper eye lid pic of everted lid
Common with rosacea and blepharitis
Local steroids cause pigmentation
18.mass removed from the lid diagnosed as keratoacanthoma , ptn
55 yrs his father died from colorectal cancer
Reexamine histology
Screen family members
Systemic investigations for other malignancy
Routine management of keratoacanthoma
19. which is not true about conjunctivitis
Chlamydial infection in new born infant diagnosed by follicular
reaction
20. 50 yrs ptn refered from endocrine he is admitted for control of
hyper glycemia many yrs diabetic, on choline esterase inhibitor for
glaucoma, refraction was -3.5 and fundus no DR from 2 monthes,
now refraction -4.5
Redo fundus
Redo refraction after control bl glaucose
Prescribe new refraction
21. Best management of cataract in children
CCC and post CCC and IOL
ECCE
ICCE
Post CCC
22. Lens all are true except
AP 4.5 mm in adult
Equator 9-10 mm in adult
In ICCE the best place for cryo is the anterior pole

23. in SO under action


V pattern strabismus
Incommitent XT
Bilateral Brown S
24. In RT SO paralysis all are true except
LT IO recession
Rt SR recession
RT IO recession
RT SO tucking
25. patient with fundus showing dry ARMD which is not indicated by
AR medical ttt study group
Vit B6
Zinc
Beta carotene
26. ETDRS all false except
Moderate vision loss is doubling of visual angle
27. the best way to detect moving membrane in the vitreous is
Real time B scan U/S
Real time UBM
Real time A scan U/S
28. patient diagnosed with Amyloidosis sample from vitreous can be
stained with all except
Oil red O
Congo red
Crystal violet
Thioflavine T
30. CT and photo of child with acute post traumatic proptosis the CT
shows medial sub periostal hematoma, VA decreasing, RAPD and
complete ophthalmoplegia
The best ttt
Systemic steroid
Observation
Evacuation of hematoma
31. ocular motor apraxia what is true
Associated with absent corpus callosum
32. fundus of 40 yrs with MVA severe vitreous he, RAPD, 2 mm self
sealed corneal wound, mild cataract and vision HM good light
projection, tension digitally soft, most probable Diagnosis
Vitreous hge + RD
Vitreous hge+ IOFB
Retinal dialysis
33. patient with acute Anterior uveitis Iris heterochromia, Pupillary
mydriasis and Brown deposits on the anterior lens with picture the
most probable D
Siderosis bulbi
VKH
Sympathetic ophthalmia
34. picture of PDR, vitreous he, tractional detachment
Which sign is not important in staging
NVD
NVE
Tractional Det
IRMA

35. child 7 yrs sudden ET no diplopia, ttt with prism, the angle
increased, Free neorology and systemic exam.
ARC
Amblyopia
Undercorrection of prism
36. Best ttt for convergence paralysis
BI prisms for reading
Training BO prisms
Bilateral MR resection
37. keratoacanthoma what is true
Slowly growing
HPV is associated
Recurrence is not common
38. Child with bilateral nuclear cataract which is true
Possible aphakic glaucoma
Associated with thining of the central part of anterior capsule
39. Peter’s anomaly all true except
Unilateral
Cataract
Corneal opacity
Angle closure
40. corneal dystrophies the true statement
Granular hyaline sub

41. All cause endothelial dysfunction except


Fuch’s
CHED
Posterior polymorphs dystrophy
Fleck dystrophy
42. Mucopolysacharaidosis all true except
Hurler cause severe corneal opacity
Sanflippo XL
43. Cornea plana
Marfan
Anterior and posterior coloboma
Megalocornea
44. Behcet which is not major chch
Skin lesion
Arthritis
Oral ulcer
Genital ulcer
Anterior uveitis
45. Most common cause of dropped nucleus in phaco
Rent in posterior capsule
Irregular anterior capsulotomy
Low bottle height
Small CCC
Zonular weakness

46. Glaucomflekens
Small areas of cataract behind anterior capsule after attack of Acute
ACG
47. PVD all true except
Associated with pigment in the anterior vitreous
48. Another Question on PVD all true except
Weiss ring is detached vitreous around macula
49. Scleral buckle the true statement
Identification of all breaks and holes increase the success rate
50. Visual field central 10-2 Humphrey, tubular field, the
complication you should discuss with the patient that can happen
even with successful uneventful surgery.
Loss of central field.
51. Function of tear film is all except:
Lymphatic drainage
52. Lateral orbital walls
Perpendicular to each other

In retinoscopy:

Skew phenomenon

If we streak a meridian that is away from the meridian of the correct


axis,the streak reflex will tend to travel along the correct meridian
rather than follow the streak. This guides us back to the correct
meridian.

The first step in using Jackson cross cylinder is to determine the axis
of astigmatism.

The only organisms that can penetrate intact cornea are :Neisseria
gonorrhea, Corynebacterium diptheriae, Listeria monocytogenes,
Hemophylus egyptius.

EOG examines the function of RPE

The most powerful in penetrating the cornea:

- Prednisolone acetate
- Prednisolone phosphate
- Dexamethasone acetate
- Dexamethasone phosphate

Blunt trauma in a child 10 years old, you expect:

- Vit base detachment


- Retinal dialysis
- Rheg RD