60 samples questions and answers for

MRCOphth I
 

1. In the eyelids:

a. the tarsal plate is a continuation of  the orbital septum

b. the meibomian glands secrete mucin rich secretion
c. the orifices of the meibomian glands are anterior to the root of eyelashes
d. the lower lid is supplied by the maxillary division of the trigeminal nerve exclusively
e. there are more meibomian glands in the upper than lower lids
 
2. The inferior rectus muscle:
a. is inserted 6.5 cm behind limbus
b. is innervated from its inferior surface
c. is attached to the lower lid
d. is the main depressor of the globe when the eye is adducted
e. lies inferior to the inferior oblique muscle
 
3. The ciliary ganglion:
a. is found between the optic nerve and the medial rectus
b. contains sympathetic nerve that supplies the sphincter pupillae
c. is a parasympathetic relay ganglion for fibers from the Edinger-Westphal nucleus
d. contains sensory nerve
e. has a motor nerve that goes to the inferior oblique
 
4. The nasociliary nerve supplies:
a. the sphenoidal sinus
b. ethmoidal sinus
c. cornea
d. lacrimal sac
e. dilator pupillae
 
5. The cornea:
a. is thicker centrally than peripherally
b. contains 10,000 endothelium cells per square mm at birth
c.has an acellular collagenous stroma
d. contain Descemet's membrane is produced by the endothelium
e. has a refractive index of 1.38
 
6. The vitreous:
a. is firmly attached to the pars plana
b. has a high concentration of hyaluronic acid
c. is a hydrogel with a water content of 80%
d. contains calcium in asteroid hyalosis
e. contains collagen which is mainly type II
 
7. The globe:
a. is closer to the orbital floor than the roof
b. is closer to the lateral wall of the orbital cavity than to medial wall
c. has a vertical diameter less than the anteroposterior diameter
d. has an anterior segment which form 1/4 of the circumference
 e  is least protected laterally
 
8. The following are true about lacrimal gland:
a. the palpebral part drains into the superior conjunctival fornix through 12 ducts
b. the palpebral part of the gland is 1/3 the size of the orbital part
c. excision of palpebral but no the orbital part abolish the tear secretion by the gland
d. it receives secretomotor nerve from the third cranial nerve
e. the lymphatic drainage is to parotid gland
 
9. With regard to the lacrimal drainage system:
a. the upper lacrimal punctum is lateral to the lower punctum
b. the lacrimal canaliculi are lined by stratified squamous epithelium
c. nasolacrimal duct is narrowest at the lowest end
d. nasolacrimal duct runs downwards, lateral and forwards to the anterior part of inferior meatus
e. congenital blockage is due mainly to delay development of common canaliculus
 
10. The cells of the retinal pigment epithelium:
a. are of mesenchymal origin
b. are shorter at the fovea than else where in the retina
c. have intracellular melanosomes
d. regenerate visual pigment
e. form the inner outer blood-retina barrier
 
11. The optic chiasm:
a. forms the floor of the recess of the third ventricle
b. is inferior to the medial root of the olfactory tract
c. has the internal carotid artery as its immediate lateral relation
d. has the mamillary bodies lying immediately posterior to it
e. is in close relation to the oculomotor nerve inferiorly
 
12. True statement about the facial nerve include:
a its nucleus is in the floor of the fourth ventricle
b. its fibres reach the surface of the brain in the cerebellopontine angle
c. transmits taste fibres for the anterior half of the tongue
d. gives the deep petrosal nerve as branch to the sphenopalatine ganglion
e. has a sensory component that supplies the outer ear
 
13. The following are true about cerebrospinal fluid:
a. it is found in the space between the pia mater and the arachnoid
b. the normal amount in human being is about 500 ml
c. with the body lying in lateral horizontal position, the normal intracranial pressure is about 100 ml of
water
d. only the lateral ventricle contains choroidal plexus which secrete cerebrospinal fluid
e. cerebrospinal fluid contains the same concentration of glucose as the blood
 
14. The parotid gland:
a. contains a fascial sheath which is innervated by second cervical nerve
b. receives post-ganglionic parasympathetic nerve from the otic ganglion
c. contains a duct which opens into the mouth opposite the upper canine tooth
d. is composed of serous acini which contribute to the saliva
e. is covered by the massenter
 
15. In the head and neck:
a. the lymph from the upper lid drains to the parotid and submandibular lymph nodes
b. the facial nerve comes from the first pharyngeal arch
c. branches of the ophthalmic division of the trigeminal nerve supply the skin of the scalp as far backward
 as the vertex
d. the veins of the scalp are connected to both the diploic veins and the intracranial venous sinuses
e. an unilateral cleft lip is a failure of the maxillary process to fuse with the medial nasal process
 
16. In the development of the eye:
              a. the orbit is completed by 10th week of gestation
 b. the orbit arises from fusion between the lateral nasal process and the maxilla
              c. the lower eyelids are formed by the maxillary process
              d. upper lids arise from fronto-nasal process
              e. the nasolacrimal duct arises from the ectoderm of of nasolacrimal groove

 
17. The following structures are of ectodermal origin:

a. the retina and its retinal pigment epithelium

b. iris stroma
c. the sclera
d. the ciliary muscle
e. the corneal stroma
 
18. The hyaloid artery:
a. arises from the dorsal ophthalmic artery
b. communicates freely with the choroidal circulation throughout development
c. regresses after birth
d. Bergmeister's papillae is a remnant
e. forms part of the vascular propria lentis
 
19. With respect to lens development:
a. the lens first appears at 27 days of gestation
b. it is formed from neural crest cells
c. the lens first appears as a vesicles with a single layer of epithelial cells
d. Y suture is absent in the embryonic nucleus
e. the adult lens is more spherical than the foetal
 
20. The following structures arise from the first pharyngeal arch:
a. common carotid artery
b. mandible
c. facial nerve
d. orbicularis oculi
e. temporalis
21. Glucagon:
a. is secreted by beta-islet cell of pancreas
b. is a polypeptide hormone
c. has a positive cardiac inotropic effect
d. causes gluconeogenesis in the liver
e. causes glycogenolysis in the liver
 
22. Vergence movement:
a. is more rapid than pursuit movement
b. is required for stereoscopic vision
c. is stimulated by blurred images on the retina
d. is an involuntary eye movement
e. the extent of the movement is determined by the near point and far point of accommodation
 
23. During accommodation for near:
 a. the spherical aberration of the eye increases
b. the ciliary muscle relaxes
c. the field of vision decreases
d. the amount of light entering the eye increases
e. the thickness of the lens increases
 
24. In binocular vision:
a. only points on the horopter fall on the corresponding retinal point
b. points in front of the horopter will stimulate binasal retina
c. points outside the horopter is perceived doubly
d. the Panum's fusional area is wider in the centre than the periphery
e. sensory fusion refers to the cortical integration of images perceived by the two eyes
 
25. The following are true about entopic phenomenon:
a. it can be produced by cells in the vitreous
b. it can be produced by palpation of the eyeballs
c. the size of one's pupil can be observed with a pinhole
d. asteroid hyalosis causes significant visual disturbance due to entopic phenomenon
e. Haidinger's brushes are produced by the inner plexiform layers
 
26. The retinal pigment epithelium cells:
a. esterify and store excess retinol
b. transport retinol binding protein from blood to subretinal space
c. are secured laterally to each other by tight junction
d. are independent units and do not communicate electrically or metabolically with each other
e. dehydrate the subretinal space and create forces binding themselves to neurosensory retina
 
27. The intraocular pressure can fluctuate:
a. seasonally
b. diurnally
c. with eye movements
d. in optic neuritis
e. with fluid intake
 
28. The tear film:
a. contributes to the refractive function of the eye
b. is partly formed from the goblet cells
c. is 100um thick
d. its normal break-up time is 5 to 15 seconds
e. is decreased with topical atropine
 
29. The human lens:
a. has a higher refractive index in the nucleus than the cortex
b. contains a higher potassium concentration than the aqueous
c. contains a higher concentration of sorbitol in diabetic patient than normal population
d. glucose is metabolised mainly by aerobic glycolysis
e. contains nucleated cells mainly on its posterior surface
 
30. True statement about dark adaptation include:
a. there is a shift in peak spectral sensitivity from 555 nm to 505 nm with dark adaptation
b. rods are more sensitive than cone during dark adaptation
c. biphasic changes only occur in retina which processes both rods and cones
d. its takes about 30 seconds in man
e. it is delayed in patient with vitamin A deficiency
 
31. During phototransduction:
 a. hyperpolarisation occurs due to closure of the sodium channels
b. dark current only occurs in the presence of photoreceptors stimulation
c. 11-cis-retinal molecules are converted to all-trans-retinal
d. transducin, a G protein converts GDP to GTP
e. 10 photons are required to stimulate a single rod
 
32. With regard to the blood retina barrier:
a. the outer blood retina is formed by the retinal pigment epithelium cells and their junctions
b. the basement membrane of the retinal capillaries is a major component of the inner blood retina barrier
c. the blood retina barrier is typically defective in the immediate perpapillary region
d. the retinal vascular endothelial cells can actively transport fluid and anions from the extracellular space
of the retina into the circulation
e. inhalation of 10 % of carbon-dioxide causes rapid breakdown of the inner blood retinal barrier
 
33. True statements about the aqueous humour:
a. has a higher lactic acid concentration than in the plasma
b. the glucose levels is lower than that of the plasma levels
c. the ascorbic acid concentration is twice that of the plasma
d. it contains the same concentration of protein as in the plasma
e. the rate of formation is about 2.5ul/minute
 
34. True statements about ERG include:
a. it is abnormal in patient with amblyopia
b. it can be performed on anaesthetized patients
c. it is affected by optic neuritis
d. the a wave is produced by the photoreceptors
e. dark adaptation increase the amplitude of the a and b wave as well as the latency
 
35. True statements about EOG include:
a. it depends on a normal retinal pigment epithelium
b. it can be easily produced in the anaesthetized patients
c. the maximal dark response exceeds the light response in normal people
d. it is given in an absolute value in microvolts
e. in Best's disease, EOG is abnormal in the presence of normal ERG
 
36. Stretch reflex:
a. is a monosynaptic reflex with a response time of 1 msec
b. is enhanced by impulses from Golgi tendon organ
c. originates in the muscle spindle which sends off impulses in type Ia nerve fibres
d. is intensified by impulses in the gamma efferent fibres
e. is decreased in lesion of the motor cortex
 
37. Glycocylated haemoglobin:
a. is absent in the plasma of people without diabetes mellitus
b. the levels of Hb A1c are a good index of glucose-induced arteriolar dilatation and consequent damage to
renal function in diabetics
c. results from the combination of a HbA and a sugar
d. when measured as HbA1c in plasma gives a more accurate retrospective estimates of blood sugar levels
than other
    glycosylated products
e. is increased in diabetic patient with concurrent sickle cell disease
 
38. With regard to the autonomic nervous system:
a. the dorsal root ganglia is made up mainly of the cell bodies of the sympathetic nerves
b. the preganglionic sympathetic fibres are usually longer than preganglionic parasympathetic fibres
c. acetylcholine is the neurotransmitter at the ganglia of both sympathetic and parasympathetic nervous
 system
d. botulin toxin blocks acetylcholine receptors
e. hemicholinium blocks the synthesis of acetylcholine
 
39. The following are true about blood coagulation:
a. heparin inhibits blood coagulation through its interference with vitamin K metabolism in the liver
b. addition of vitamin K to freshly drawn blood delays clotting
c. thrombin converts fibrinogen to fibrin
d. platelets are essential for blood clot
e. vitamin K is responsible for the production of factors II, VII, IX and X
 
40. In the inner ear:
a. endolymph is found in the tunnel of Corti
b. the lowest tone that be heard is 300 Hz
c. the perilymph has the same composition as the cerebrospinal fluid
d. the longer fibers of the basilar membrane are found at the apex
e. linear acceleration is detected by maculae of the utricles
 
 
41. Regarding interferon:
a. it is a virus specific molecules
b. it acts by neutralizing exotoxin
c. it enhances the histocompatibility antigen on cell surface and thereby activate the T cells
d. it exerts its effect by integrating itself with the DNA of virus infected cells
e. it can inhibit cell division in normal tissue
 
42. Gram negative rods that are known to cause ocular diseases include:
a. Proteus vulgaris
b. Serratia marcescans
c. Pseudomonas aeruginosa
d. Moraxella lacunata
e. Haemophilus influenza
 
43. The following are true:
a. fusidic acid is used in staphylococcus aureus infection
b. intravenous vancomycin is useful in treating post-operative endophthalmitis
c. rifampicin is only effective against tuberculosis
d. gentamicin is effective against Gram positive coccus
e. penicillin is effect against Gram positive coccus, Gram negative bacilli and coccus
 
44. Endotoxins:
a. is involved in botulism
b. elicit an antibody response which may protect the host from future attack
c. is produced mainly by Gram positive bacterial
d. can often survive autoclaving
e. is found in the vesicle of bacterial cytoplasm
 
45 . The following virus are associated with human cancer:
a. herpes zoster
b. Epstein-Barr virus
c. human papillovirus
d. hepatitis type A
e. human immunodeficiency virus
 
46. Following an acute inflammation, the following may occur:
 a. complete resolution
b. abscess formation
c. chronic inflammation
d. scar tissue formation
e. loss of function
 
47 Acetazolamide causes the following:
a. metabolic acidosis
b. hyperkalaemia
c. hypernatraemia
d. renal calculi
e. hypercalcaemia
 
48. The effects of topically applied anticholinesterase on the eye include:
a. conjunctival hyperaemia
b. raised intraocular pressure
c. ciliary muscle contraction
d. sphincter pupillae muscle relaxation
e. retraction of the upper lids
 
49. Impaired accommodation occurs with:
a phenothiazine
b. topical pilocarpine
c. topical atropine
d. topical phenylephrine
e. topical cocaine
 
50. True statements about chloroquine include:
a. is safer than hydroxychloroquine at equivalent dose
b. can cause corneal deposition
c. causes posterior subcapsular cataract
d. chloroquine is bound to the melanin of the retinal pigment epithelium
e. causes reversible toxic maculopathy
 
51. At the adrenergic synapse, the concentration of adrenaline in synaptic cleft:
a. increased by cocaine which inhibit reuptake of adrenaline
b. decreased by MAO (monoamine oxidase) - inhibitors
c. controlled chiefly by the activity of the enzyme COMT
d. increased by noradrenaline receptor blockers
e. increased by partial agonist of noradrenaline receptors
 
52. True statements about the nucleic acid include:
a. contains purine and pyrimidine which are bound together by covalent bonds
b. there is always an equal concentration of purine and pyrimidine
c. in RNA, thymine  is replaced by uracil
d. introns is more common than exons on the DNA
e. the histones mark the excision site
 
53. In allergic reaction:
a. Arthus reaction is a type IV reaction
b. anaphylaxis occurs in patients who have had no previous exposure to the offending substance
c. contact dermatitis is a type IV reaction
d. positive Mantoux test is a type III reaction
e. urticaria is a type II reaction
 
54. With regard to immunoglobulin A:
 a. it is the heaviest immunoglobulin
b. it is the first immunoglobulin to be produced when the body is invaded by viruses
c. it is secreted by the lacrimal gland
d. it is secreted in the breast milk
e. it is an effective defense against gonococcus
 
55. The following are true about the viruses:
a. they contain either RNA or DNA nuclei acids only
b. HIV virus is a DNA virus
c. cytomegalovirus is a DNA virus
d. all herpes viruses are sensitive to acyclovir
e. viral replication within the host cells is inhibited by interferons
 
56. Recognized virulence factors in bacteria include:
a. Ig A-proteases
b. beta lactamases
c. gonococcal pili
d. streptococcal M protein
e. the capsular polysaccharides in Haemophilus influenzae
 
57. The following enzymes on the left are responsible for the synthesis of the neurotransmitters on the right:
a. monoamine oxidase: noradrenaline
b. cholinesterase: acetylcholine
c. catechol-o-methyl transferase: dopamine
d. dopa decarboxylase: adrenaline
e.  glutamic acid decarboxylase: gamma-aminobutyric acid (GABA)
 
58. The following are true about the DNA in mitochondria:
a. they are found in the ovum and not the spermatozoan
b. they have their own genome
c. they are expressed in muscle cells
d. an affected male with mitochondrial disorder can pass it on to his daughter only
e. they are responsible for coding enzymes used in oxidation
 
59. The following are true :
a. the HLA proteins are found within the cytoplasm of the cells
b. HLA class I antigens are expressed on all cells with nuclei
c. HLA class II antigens presents the virus infected cells to cytotoxic T lymphocytes
d. HLA genes are found on chromosome 6
e. HLA tissue typing is carried out in all forms of transplantation to prevent rejection
 
 60. True statements about chromosome include:
a. there are 23 pairs of autosomal chromosome traits
b. 23 chromosomes are found in germinal cells
d. in female only one chromosome is activated
c. the Barr body is due to inactivated X chromosome
e. Klinefelter's syndrome result from an extra X chromosome in male
Answers to the sample questions
1.    a.T    b.F    c.F    d.F    e.T

    In the eyelids:

 the orbital septum extends forward and thicken into the tarsal plate within the eyelid
 the meibomian gland secrete lipid rich secretion which is an important component of the
tear film
 the orifices of the meibomain glands are found posterior to the root of the eyelashes
 there are about 30 meibomian glands in the upper tarsal plate and slightly fewer in the
lower tarsal plate
 the lower eyelid is supplied by branches of infraorbital nerve (a division of maxillary
nerve ) and infratrochlear nerve ( a branch of the ophthalmic nerve)

2.    a.T    b.F    c.T    d.F    e.T

    The inferior rectus muscle:

 is inserted about 6.5 cm from the limbus

 arises from the tendinous ring
 is innervated by the inferior branch of the oculomotor nerve which enter the muscle on its
superior surface
 is attached to the lower lid via a band of connective tissue
 has the following action: depression, medial rotation of the eye ball and extorsion. The
effect of depression is greatest when the eyeball is abducted
 lies inferior to the inferior oblique muscle

3.    a.F    b.F    c.T    d.T    e.F

 

The ciliary ganglon is found between the optic nerve and the lateral rectus muscle
contains:

 parasympathetic ganglion which receives its parasympathetic preganglion fibres from the
Edinger-Westphal nucleus and supply the sphincter papillae
 sensory fibres from the eyeball
 sympathetic postganglionic fibres from the superior cervical    sympathetic ganglion
which supply the dilator pupillae
 

4.    a.T    b.T    c.T    d.T    e.T

    The nasociliary nerve supplies:

 the sphenoidal sinus and the ethmoidal sinus via the posterior ethmoidal nerve
 the cornea via the long ciliary nerves
 the lacrimal sac via the infratrochlear nerve
 the dilator pupillae via the long ciliary nerve

5.    a.F    b.F    c.F    d.T    e.T

    The cornea:

 is thicker peripherally (about 1.2 mm) than centrally (average 0.5 to 0.6 mm)
 contains about 350,000 cells ( about 3 to 4000 cells per square mm) at birth, the number
decreases with age
 contains Descemet's membrane which is produced by the endothelium and forms its
basement membrane
 contains flattened keratocytes within the stroma. Other cells such as
macrophages,lymphocytes or neutrophils may be seen
 has a refractive index of 1.83

6.    a. T    b.T    c.F    d.T    e.T

    The vitreous:

 is a viscoelastic gel containing 98% water

 has in it the main constituent of  type II collagen fibres which contains hyalonuric acid
molecules
 is firmly attached to the following:

        * the pars plana via the vitreous base

        * the posterior lens capsule
        * around the optic disc
        * along the blood vessels
 

7.    a.F    b.T    c.T    d.F    e.T

    The globe:

 is closer to the orbital roof than the orbital floor

 is closer to the lateral wall than the medial wall
 has a vertical diameter less than the anteroposterior diameter (23 vs 24 mm on average)
  has an anterior segment which form 1/6 of the circumference
  is least protected laterally

8.     a.T    b.T    c.F    d.F    e.T

    The lacrimal gland:

 contains two parts: palpebral and orbital parts. The former is about 1/3 the size of the
later
 contains 12 ducts that originate from the orbital part and pass into the palpebral parts and
open into the superior conjunctival fornix
 surgical excision of the palpebral part will cause scarring of the ducts whereas removal of
the orbital part will remove the nerve innervation and therefore excision of either part
will affect tear secretion
 receives its secretomotor nerve from the facial nerve
 contains lymphatic system that drains into the parotid gland

9.    a.T    b.T    c.F    d.F    e.F

    The lacrimal drainage system:

 the upper lacrimal punctum is medial to the lower punctum

 contains stratified squamous cells which line the canaliculi
 contains nasolacrimal duct which is narrowest in the middle than either end
 ontains nasolacrimal duct which runs downwards, backward and laterally to the inferior 
meatus
 blockage is usually due to failure of the lower end of the nasolacrimal duct becoming
patent

10.     a.F    b.F    c.T    d.T    e.F

    The cells of the retinal pigment epithelium:

 are of ectoderm origin

  are taller in the fovea and become flattened towards the periphery
 contain melanin granules which absorb excess light and prevent radical damage to the
cells
  phagocytose the photoreceptors segment and store vitamin A and therefore play an
important part in the regeneratoin of photoreceptors
 forms the outer blood-retina barrier

11.    a.T    b.T    c.T    d.F    e.F

    Optic chiasm:

 is found at the junction of the anterior wall and the floor of third ventricle
 is posterior and inferior to the olfactory tracts
 has the internal carotid arteries lying immediately lateral to it
 is separated from the mamillary body by the pituitary stalk
  has the oculomotor nerves lying on its lateral side

12.    a.T    b.T    c.T    d.F    e.T

    The facial nerve:

 has a nucleus which lies in the floor of the fourth ventricle

 the fibres exist the brain stem between the pons and the inferior cerebellar peduncle
 transmits taste fibres from the anterior half of the tongue via chorda tympani
 gives off greater petrosal nerve (Note: not deep petrosal nerve) which mediate tear
secretion
 contains tympani branches which are sensory nerve supplying the external acoustic
meatus  and the pinna

13.    a.T    b.F    .T    d.F    e.F

        Cerebrospinal fluid:

 found in the subarachnoid space ie between the pia mater and the arachnoid
 normal amount is 130 ml and the intracranial pressure is 100 ml of water (varying
between 60 to 150 ml of water)
 is produced by choroidal plexi by the lateral ventricle, third ventricle and the fourth
ventricle
   contains half the concentration of glucose found in the plasma. Few cells and trace
protein  are found in normal people

14.    a.T    b.T    c.F    d.T    e.F

 
        The parotid gland:

 is the largest salivary gland and contains serous acini

  the secretomotor nerve arises from the parasympathetic component within the
glossopharyngeal nerve. It then travels within the lesser petrosal nerve which synapses in
the otic ganglion. The post-ganglionic nerve reach the gland via the auriculotemporal  
nerve.

15.    a.F    b.F    c.T    d.T    e.T

    In the anatomy of the head and neck:

 the lymph from the upper lid drains into the superficial parotid gland
 the facial nerve derives from the second pharyngeal arch
 branch of the ophthalmic division of the trigeminal nerve supply the scalp as far back as
the scalp
 a lateral harelip (cleft lip) results from the failure of fusion between the maxillary process
and   the medial nasal process

16.    a.T    b.T    c.T    d.T    e.T

 
    Development of the eye:

  the face including the orbit begins its development in the 4th week of gestation and is
completed by 10th week
 the orbit is formed from fusion between the lateral nasal process and the maxillary
process
 the upper lids arise from the fronto-nasal process whereas the lower eyelids from the
maxillary process
 the nasolacrimal groove forms along the fusion between the lateral nasal swelling and the
maxillary process. The ectoderm in the groove invaginates to form nasolacrimal duct

17.    a.T    b.F    c.F    d.F    e.T

    The following structures are of ectodermal origin:

     retina
     retinal pigment epithelium
     epithelium of the ciliary body

    The sclera, iris stroma and the ciliary body are derived from the mesenchyme
 

18.    a.T    b.F    c.F    d.T    e.T

 
    The hyaloid artery:

 comes off the dorsal ophthalmic artery and supplies the lens and the inner layer of the
optic cup
 the choroidal circulation arises from the long and short posterior ciliary arteries and do
not communicate with the hyaloid artery
 regresses before birth
 Mitterdorf's dot is the anterior remnant of the hyaloid artery whereas the Bergmeister's
papillae is the posterior remnant
 forms vascular propria lentis which supplies the lens

 
19.    a.T    b.F    c.T    d.T    e.F

    Lens development:

  the lens first appears as a disc-shaped thickening on the ectoderm at 27th day gestation
 lens arises from the ectoderm
 lens vesicle becomes separated from the surface ectoderm at the 33rd day gestation and
contains a single layer of epithelial cells
 embryonic nucleus is formed from the primary lens fibres. The foetal lens arises from the
secondary fibres and contains Y sutures
 the foetal lens is spherical but as the lens grows it becomes ellipsoid

20.    a.F    b.T    c.F    d.F    e.T

 
    The first pharyngeal arch gives rise to:

 artery: terminal branch of maxillary artery

 skeletal elements: incus, malleus, mandible, maxilla, zygomatic, squamous portion of
temporal bone
  muscles: muscles of mastication (temporalis massenter and pterygoids), myelohyoid,
anterior belly of the digastric, tensor tympani and tensor veli palatini
 cranial nerve: maxillary and mandibular divisions of trigeminal nerve

    Muscle of facial expression including orbicularis and facial nerve arise from the second
pharyngeal arch. The common carotid artery arises from the third pharyngeal arch
 

21.    a.F    b.T    c.T    d.T    e.T

 
    The glucagon:

 is a polypeptide hormone secreted by the alpha islet cell of pancrease

 stimulates the release of glucose from glycogen storage in the liver ( glucogenolysis)
 stimulates the synthesis of glucose in the liver (glycogenolysis)
 has a positive inotropic effect on the myocardium

22.    a.F    b.T    c.T    d.F    e.T

 
    Vergence movement:
    - is a tracking movement which is slower than pursuit movement
    - is voluntary but can be stimulated by blurred images on the retina
    - is required for binocular single vision and stereopsis
    - is limited by the near point and the far point of accommodation
 

23.    a.F    b.F    c.T    c.F    e.T

    During accommodation:

 the ciliary muscle contracts and thus the lens becomes thicker
 the pupils constrict and therefore both the field of vision and the amount of light entering
the eye are reduced

24.    a.T    b.F    c.F    d.F    e.T

        Binocular vision:

 horopter represents the line in which all points along it will fall on the corresponding
retinal point
 points in front of the horopter will stimulate bitemporal retina whereas those distal to it
on binasal retina
  withint the Panum's area, point in front and distal to the horopter is perceived singly.
Panum's area is wider in the periphery than in the centre
 sensory fusion refers to cortical integration of the images perceived by the two eyes
whereas motor fusion refers to the correct alignment of the extraocular muscle on a target
of interest

25.    a.F    b.T    c.T    d.F    e.T

    The eye movement:

 saccade is controlled by contalateral supranuclear centre with a latency of 100 ms and

velocity of 100 degrees per second
 pursuit movement is controlled by ipsilateral supranuclear centre with a latency of 150ms
and velocity of 30-50 degrees per second. A slow moving object is needed to elicite the
pursuit movement
 the superior colliculus is an important centre for possessing the visual image and contor
control
 the cerebellum mediate the vestibulo=ocular reflex and help to stabilize the retinal image

26.    a.T    b.T    c.T    d.F    e.T

    Entopic phenomenon:

 visual perceptions that are produced by the sturctures of one's own eyes
 can be produced by cells in the vitreous or unformed images through palpation of the
eyeball
 when viewed through a pinhole against an uniformly illuminated background, the edge of
one's pupil can be seen
 asteroid hyalosis seldom produces significant visual problem
 Haidinger's brushes are produced when one viewed a diffusely illuminated plane-
polarised blue light. It is produced by the outer plexiform layers of the retina

27.    a.T    b.T    c.T    d.F    e.T

    The intraocular pressure flutuate:

 seasonally being higher in the winter

 diurnally with the cicadian rhythem being higher in the morning
 with eye movement being higher when the eye is moved away from the primary position
  with fluid intake; the intraocular pressure increases with increase body fluid

28.    a.T    b.T    c.F    d.F    e.T

    The tear film:

 has a convex surface and therefore contribute to the refractive index of the eye
  has three layers: mucous, aqueous and lipid. The thickness is about 8 to 10 um
  the break up time is about 30 seconds
  tear production is inhibited by atropine

29.    a.T    b.T    c.T    d.F    e.F

 
    The lens:

 has a higher refractive index in the central part of the lens

 contains a higher potassium concentration ( 125 mmole perkg lens water) than sodium
(17 mmol perkg lens water)
 has a higher concentration of sorbitol in diabetes mellitus. Excessive glucose is reduced
to sorbitol by aldose reductase
 85% of glucose is metabolised by anerobic glycolysis and only 15% by aerobic
glycolysis
 conatins nucleated cells mainly on its anterior surface

30.    a.T    b.T    c.T    d.F    e.T

    During dark adaptation:

 Purkinje's effect is seen in which there is a shift in peak spectral sensitivity from 555nm
to 505 nm with dark adaptation
 rods are 1000 times more sensitive than cones
 animals with only rods exhibit only monophasic change
 it may take up to 30 minutes
 it is delayed in hypovitaminosis A

31.    a.T    b.F   c.T    d.T    e.F

    Phototransduction

 dark current is present in the dark

 in the presence of light, the sodium channels close and give rise to hyperpolarisation
 11 cis-retinal molecules are converted into trans-retinal
  transducin is important in converting GDP to GTP

32.    a.T    b.F    c.T    d.T    e.T

 
    Blood retinal barrier:

 the outer blood retina barrier is formed by retinal pigment epithelium cells and their
junctions
 the inner blood retina barrier is formed by endothelial cells of the capillaries of the retinal
artery and their junctions
 inhalation of 10% carbon-dioxide causes dilatation of blood vessels but does not break
down the blood retinal barrier

33.     a.T    b.F    c.F    d.F    e.T

    The aqueous humour:

 the rate of formation is between 2 to 3 ul/minute

 it has a very low protein concentration compared with the blood the ascorbate is between
10 to 50 times that of the plasma
 glucose is lightly lower than that of the plasma
 the lactic acid is higher than that of the plasma

34.     a.F    b.T    c.F    d.T    e.T

    ERG:

 records retinal activity

 can be performed on anesthetized patients
  it is not affected by the ganglion cells and therefore not affected by optic neuritis
 is normal in patient with amblyopia
 contains upgoing a wave produced by photoreceptors and downgoing b wave produced
by Muller and bipolar cells
 dark adaptation increases the amplitude a and b wave as well as the latency
 

35.    a.T    b.F    c.F    d.F    e.T

 
    EOG:

 is an indirect measure of the standing potential of the eye

 depends on a normal retinal pigment epithelium
 requires co-operation of the patient who moves the eyes back and forth over a specific
distance
 the light response is higher than dark response
 the result is given as a ratio between light to dark response. The normal ratio is more than
180%
  in Best's disease, the EOG is abnormal early on in the disease

36.    a.T    b.F    c.T    d.T    e.F

    Stretch reflex:

 is a monosynaptic reflex characterized by knee and ankle jerk. It opposes muscle

stretching and the response time is short at 1 msec
 its amplitude is inhibited by impulses from Golgi tendon organs
 originates in the muscle fibers and the impulse is sent along the type Ia fibers
 gamma efferent fibers are excitatory nerve fibers which supply the muscle spindles.
Impulses along these fibers increases the intensity of the reflex
 is increased in upper motor neurone lesion

37.    a.F    b.T    c.T    d.F    e.F

 
    Glycocylated haemoglobin:

 is found in normal population but the percentage is lower than diabetic patients
 the risk of renal damage such as microalbuminuria increases when HbA 1c exceeds 8.1%
 it involves the non-enzymatic binding of a hexose to the N-terminal amino acid of the
beta-chain
 glycocylated serum proteins such as fructosamine are more accurate than glycocylated
haemoglobin
 patients with sickle cell disease and haemolytic diseases have decreased survival span of
red blood cells and therefore glycosylation is reduced

 
38.    a.T    b.F    c.T    d.F    e.T

    Autonomic nervous system:

 the cell bodies of the sympathetic nerves are found mainly in the lateral horn of the spinal
cord
 the preganglionic sympathetic fibers are longer than preganglionic parasympathetic fibers
because sympathetic preganglionic fibers lie relatively close to their emergence from the
spinal cord whereas parasympathetic relays are near or in the walls of the tissue or organs
supplied
 acetylocholine is found in autonomic ganglia
 botulin toxin inhibits the exocytosis of acetylcholine in the preganglionic fibers
 hemicholinum inhibits the uptake of choline and therefore synthesis of acetylcholine

39.    a.F    b.F    c.T    d.T    e.T

    Blood coagulation:

 heparin increases the activity of anti-thrombin III which inhibits the clotting cascade
 vitamin K is used in liver to produce clotting factors and on its own has no anti-
coagulation effect
 thrombin is important in the clotting cascade by releasing fibrin from fibrinogen
 platelets are essential for clotting
 factors II, VII, IX and X are produced in liver with vitamin K

40.    a.F    b.F    c.T    d.T    e.T

 
    The inner ear:

 the tunnel of the Corti is filled with cortilymph

 the lowest tone that can be heard is 30 Hz
 the perilymph is identical to cerebrospinal fluid and in infants this may communicate
with the subarachnoid fluid
 the longest fibers of the basilar membrane are found at the apex
 the maculae of the utricles detect linear acceleration

41.    a.F    b.F    c.T    d.F    e.T

     Interferon:
  is a glycoprotein produced by T lymphocytes and macrophages
 are of three types: alpha, beta and gamma
 has non-specific antiviral properties
 its effects include:

        * direct antiproliferative action on tumour and virus infected cells

        * activation of natural killer cells and macrophages
        * increased expression of class I HLA antigen on tumour or infected
          cells
 

42.    a.T    b.T    c.T    d.T    e.T

    Gram negative bacteria:

   proteus vulgaris and serratia marcescans have been reported in endophthalmitis and
keratitis
 haemophilus influenza can cause bacterial ocnjunctivitis
 moraxella lacunata is a gram negative diplococci that produces corneal ulcerations most
often after trauma in debilitated patients, diabetes and alcoholics
 pseudomonas aeruginosa causes a serious infection which can lead to perforation and is
the most common organisms associated with contact lens keratitis

43.    a.T    b.F    c.F    d.F    e.F

 
    Antibiotics:

 fusidic is effective against Staphylococcus aureus but resistance can occur easily
 rifampicin has been used in the prophylaxis against meningecoccus
 vancomycin is ineffective against endophthalmitis is given intravenous as the drug
penetration into the vitreous cavity is poor
 gentamicin is effective against mainly Gram negative bacteria
 penicillin is ineffective against Gram negative bacilli

44.    a.F    b.F    c.F    d.T    e.F

    Endotoxins:

 are lipopolysaccharides derived from the cell wall of gram negative bacteria
 are heat stable (cf with exotoxin)
  non-antigenic (cf with exotoxin)
   cause septicaemia and fever
  activates the alternative complement pathway

45.    a.F    b.T    c.T    d.F    e.T

    Viruses associated with human cancer:

 Epstein-Barr virus is associated with Burkitt's lymphoma and nasopharyngeal carcinoma

 human papilloma is asscoaited with cervical cancer
 hepatitis type B is associated with hepatic cancer
 human immunodeficiency virus is associated with Kaposi's sarcoma and non-Hodgkin's
lymphoma of the central nervous system

46.    a.T    b.T    c.T    d.T    e.T

    Acute inflammation:

 complete resolution is seen if the lesion is small and the tisuse involve can undergo
complete regeneration
 abscess is an example of a localised suppurative inflmmation. It is produced by the deep
seeding of the pyogenic bacteria into a tissue
 chronic inflmmation can occur if the inciting agent were removed
 repair by connective tissue can lead to scar tisuse formation and loss of function

47.    a.T    b.F    c.F    d.T    e.F

 
    Carbonic anhydrase inhibitors cause:

    metabolic acidosis
    hypokalaemia
    hyponatraemia
    renal calculi but not hypercalcaemia
    fatigue and paraesthesia of limbs
    Steven-Johnson's syndrome

48.    a.F    b.F    c.T    d.F    e.F

    Anticholinesterase:

 inactivate the cholinesterase and allow the chemical transmitter ie. acetylcholine to
persist and produce intense effect
 stimulate the parasympathetic pathway and therefore:

            * the sphincter muscle of the iris becomes contricted

            * the ciliary muscle contract and increases accommodation

    The blood vessels of the conjunctiva and the upper lids are controlled mainly by the
sympathetic pathway.
 

49.    a.T    b.F    c.T    d.F    e.T

    Accommodation:

  is controlled by the parasympathetic autonomic system

  is imparied by parasympathetic antagonists which affect the ciliary body and this
include:

            * atropine
            * cylopentolate
            * tropicamide
            * phenothiazine
 

50.    a.F    b.T    c.F    d.T    e.F

    Chloroquine:

 at the equivalent dose is more toxic to the retina than the hydroxychloroquine
 causes corneal deposition and anterior subcapsular cataract neither of which is of visual
significance
 bound to the melanin in the retinal pigment epithelium and is thought to be the reason for
its toxicity
 causes bull's eye maculopathy which may progress despite stopping the medication

51.    a.T    b.F    c.F    d.T    e.T

    The concentration of adrenaline in the synaptic cleft is increased in:

 the presence of cocaine which inhibits adrenaline reuptake

  the presence of MAO inhibitors which blocks the metabolism of adrenaline by MAO.
Although COMT is also involved in the metabolism of adrenaline this occurs in the blood
stream
 the presence of noradrenaline receptor blockers and partial agonist of noradrenaline
receptors.

52.    a.F    b.T    c.T    d.F    e.F

    The nucleic acids:

 the purine and pyrimidine in the DNA are bound by ionic bonds
 in RNA thymidine is replaced by uracil
 intron is the region of DNA which generates that part of precursor RNA which is excised
during transcription and does
 not form mRNA and therefore does not specify the primary structure of the gene product
 exon is the region of DNA which generates that part of precursor RNA which is not
excised during transcription and forms mRNA and thus specifies the primary structure of
the gene product
 there are more introns than extrons in the DNA
 histone is a protein which is rich in lysine and arginine and found in association with
DNA in chromosomes

53.    a.F    b.F    c.T    d.F    e.T

 
    Allergic reaction:

  Arthus reaction is not cell-mediated. It is type III hypersensitivity reaction and can be
defined as a localised area of tissue necrosis resulting from acute immune complex
vasculitis usually found in the skin
 anaphylaxis is a type I reaction and occur in patients who have had previous exposure to
the offending agents for example anaphylactic reaction to fluorescein angiography may
be due to previous exposure to iodine in sea food
 contact dermatitis and Mantoux test are both type IV reaction characterized by cell-
mediated hypersensitivity
 urticaria is a type I hypersensitivity reaction characterized by localised mast cell
degranulation and resultant dermal microvascular hyperpermeability, culminating in
prutitic wheals.

54.    a.F    b.F    c.T    d.T    e.T

    Immunoglobulin A:

 exists as a dimer whereas Ig M is a pentamer and therefore heavier

 is excreted in the tear and breast milk
 can activate complement by the alternative pathway
 is ineffective against gonococcus

55.    a.T    b.F    c.T    d.F    e.T

    Viruses:

 contain nuclei acids which are either DNA or RNA

 HIV virus is a retrovirus and contains RNA
 cytomegalovirus is a herpes virus and contains DNA, it is not sensitive to acyclovir
 induce interferon production which inhibits viral replication

56.    a.T    b.F    c.T    d.T    e.T

    Virulence factors:

 can be exotoxins or endotoxins (such as the cell wall of Haemophilus influenza)

 M protein on some bacteria prevent phagocytosis
 pili on gonococcus allow them to adhere to mucosal surface

    Beta lactamase or penicillaminase hydrolyses penicillin but has no direct effect on host tissue
 

57.    a.F    b.F    c.F    d.T    e.T

 
    Synthesis of neurotransmitter:

 both MAO and COMT are involved in the breakdown of adrenaline and noradrenaline
 cholinesterase is responsible for the breakdown of acetylcholine

58.    a.T    b.T    c.T    d.F    e.T

    Mitochondrial DNA are transmitted via the maternal line only. This is because the
mitochondrial DNA is found only in the  ovum and not in the spermatozoan. Mitochondrial DNA
is expressed in mitochondria rich tissue such as the muscles, the neural tissues and the
myocardium. Patients with mitochondrial disorders are therefore liable to develop myopathy and
cardiomyopathy. DNA in the mitochondria are coded for enzymes involved in oxidation and
energy production.
 

59.    a.F    b.T    c.F    d.T    e.F

 
    HLA antigen:

  the gene is coded by chromosome 6

  can be divided into two classes:

* class I antigen is found on the surface of all nucelated cells. The main function
is to allow cytotoxic T-lymphocytes to recognise and eleminate virus-infected
cells
* class II antigens are found on cells that interact with T-lymphocytes for example
Langerhans' cell. Their functions are to innitiate an immune response

 although graft rejection is reduce with HLA matching. Some rare transplant tissues such
as heart are limited to ABO matching

60.    a.F    b.T    c.T    d.T    e.F

    There are 22 pairs of autosomal chromosome and one pair of sex chromosome. Due to meiosis
only 23 chromosomesare found in the germinal cell. Female has two X chromosomes but only is
activated and the other stay domant as the Barr body. In Klinefelter's syndrome, the male cell has
an extra X chromosome.