Community and Public Health 1/50

Which ONE of the following is a valid criterion for screening a population for diseases?

 a.The disease should have political importance.

 b.There should be equity and access for the entire target population.
 c.Symptoms should be present at the outset of the disease.
 d.Screening should be limited to populations in cities.

 ICO Examinations

Lens and Cataract 2/5

The right eye shown in the photograph, is of an arthritic, asthmatic patient. The left eye shows a
similar picture. He complains of diminished vision for a few weeks. Which ONE of the following
statements is MOST likely to be TRUE?

 a.His posterior capsule is liable to rupture during surgery.

 b.His symptoms are worse when looking at near objects.
 c.He is likely to have been on corticosteroid treatment.
 d.Most of the symptoms are due to the anterior cortical opacity.

How certain are you about your answer? not certain reasonably certain very certain

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© 2017 International Council of Ophthalmology

Lens and Cataract 3/50

An elderly lady is referred by an optometrist because her reading vision is becoming inadequate for
her daily needs. The optometrist found bilateral posterior subcapsular cataracts. Which one of the
following symptoms or signs would suggest that the cataract is the most likely cause of the visual
loss?

 a.Greater difficulty with reading rather than distance vision.

 b.Glare when driving a motor vehicle at night.
 c.Asymmetrically defective colour discrimination.
 d.Bilateral defective colour discrimination.

Regarding Nd:YAG laser posterior capsulotomy, which ONE of the following statements is MOST
likely to be TRUE?

 a.The laser focusing beam is aimed just posterior to the capsule.

 b.It is best performed with the pupil undilated.
 c.Complications are rare, so consent is not needed.
 d.A continuous-wave YAG laser is used.

Clinical findings that may clearly suggest a rhegmatogenous retinal detachment as opposed to an
exudative or tractional retinal detachment include which ONE of the following?

 a.Shifting fluid.
 b.Corrugated retina undulating with eye movements.
 c.Prominent fibrotic tissues.
 d.Concave-shaped elevation with reduced retinal mobility.

Which ONE of the following anti-glaucoma medications act by predominantly increasing the outflow
of aqueous humour through the trabecular meshwork?

 a.Pilocarpine.
 b.Timolol.
 c.Acetazolamide.
 d.Latanoprost.

Regarding uveal melanoma, which ONE of the following statements is MOST likely to be TRUE?

 a.It is more common in black population.

 b.5 year survival is better than 95%.
 c.It can be associated with numerous cutaneous naevi.
 d.It is the most common childhood intraocular tumour in Africa.
A 32-year-old myopic contact lens wearing female developed a sore right eye following a flight from
Australia to Canada. Her eye felt uncomfortable when she removed her contact lenses. She presents 2
days later with the appearances seen in the photograph. What would be the MOST appropriate
immediate action for management?

 a.A Gram’s stain of a scrape of the margin of the corneal lesion.

 b.To test her corneal sensitivity.
 c.To aspirate some of the contents of the anterior chamber.
 d.To perform Laser Scanning Confocal Microscopy.

A 72-year old lady, on treatment for glaucoma, presents with the appearance on slit lamp examination
shown in the figure. The lesion transilluminates freely. Which ONE of the following diagnoses is
MOST likely to be TRUE?

 a.Malignant melanoma of the iris

 b.Iris cyst
 c.Mamillary body of the iris
 d.Neurofibroma

ma, Cornea and external eye disease 11/50

A seven-year-old boy attends ophthalmology outpatients with a one year history of both eyes itching,
worse in the last month and a previous history of eczema. He has punctate epithelial erosions in the
superior parts of both corneas. The photograph shows his everted right upper lid. Regarding this case,
which ONE of the following statements is MOST likely to be TRUE?

 a.The condition responds initially to mast cell stabilisers.

 b.The lesions seen are best removed surgically by curettage.
 c.Follicles are accumulations of exudates and granulation tissue.
 d.The lesions seen are giant follicles.

A 6-year-old girl presents with her parents for a routine pre-school eye examination. Although she
denies any ocular complaints and has a white eye, slit-lamp examination reveals 1+ aqueous cells and
small to medium keratic precipitates (KP). Her history reveals a diagnosis of acute inflammatory
arthritis 3 months ago. Which ONE of the following statements is MOST likely to be TRUE?

 a.There is a high correlation between the activity of joint and eye inflammation.
 b.The arthritis is likely to affect more than four joints.
 c.Her condition may present as strabismus, band keratopathy or cataract.
 d.Eye screening is not necessary if antinuclear antibody (ANA) and rheumatoid factor are not
found.

Regarding this boy who was hit in the left eye by a cricket ball, which one of the following statements
is most likely to be true? He is attempting to look upwards.

 a.Orbital decompression is required urgently.

 b.Enophthalmos of the left eye is likely.
 c.An MRI scan is a more appropriate test than a CT scan.
 d.He will adopt a chin-down abnormal head posture.
How certain are you about your answer?

The patient whose Hess chart is seen in the Figure had diplopia (double vision) following a
motorcycle accident. Which ONE of the following statements is most likely to be correct?

 a.There is a large left hyperphoria (latent vertical deviation).

 b.The patient has torsional diplopia.
 c.The right inferior rectus is overacting.
 d.The right inferior oblique is overacting.

Which ONE of the following statements is a conclusion of the Optic Neuritis Treatment Trial
(ONTT)?

 a.Routine blood tests help in diagnosing optic neuritis.

 b.Brain MRI is a powerful indicator of risk of Multiple sclerosis.
 c.Treatment with oral prednisolone alone improved visual outcome.
 d.Intravenous corticosteroids provided long term benefit in vision

Regarding a 67 year old female patient with an eyelid tumour which ONE of the following statements
is MOST likely to be TRUE?

 a.Basal cell carcinoma (BCC) is the most common malignant eyelid tumour.
 b.Squamous cell carcinoma (SCC) has a predilection for the upper lid.
 c.Sebaceous gland carcinoma occurs more commonly on the lower eyelid.
 d.Eyelid melanomas are all pigmented.
Regarding the slit-lamp photograph which is shown in the figure, which ONE of the following
statements is MOST likely to be TRUE?

 a.A continuous ring of posterior synechiae are visible.

 b.There is a central cataract.
 c.Anterior chamber “flare” is visible.
 d.There are "mutton-fat" keratic precipitates (KPs).

In which one of the following clinical situations is a mistaken diagnosis of retinoblastoma the most
significant possibility?

 a.A 6-month-old child with a diagnosis of unilateral posterior persistent foetal vasculature
(persistent hyperplastic primary vitreous).
 b.A two-year-old child with bilateral combined hamartoma of the retina and retinal pigment
epithelium.
 c.A three-year-old child with bilateral uveal coloboma.
 d.A 1-year-old child with a diagnosis of bilateral Toxocara canis endophthalmitis
The 21 year old female whose eyes are shown in the Figure was found to have an abnormal red reflex
on a photograph taken when she was 5 years old. She is employed as a motorcycle courier. She has no
symptoms now and her visual acuity in each eye is LogMAR 0.18 (6/9, 20/30, 0.67). An optometrist
refers her for evaluation. Which ONE of the following statements about this patient is most likely to
be true?

 a.She is likely to have a metabolic disease.

 b.Ultrasound fundus evaluation is needed prior to any surgery.
 c.Surgery is indicated.
 d.There is a 30-40 % chance that she has an affected parent.

Which ONE of the following disorders of the ocular adnexae is MOST likely to cause ocular surface
disease?

 a.Trichiasis (abnormally positioned eyelashes).

 b.Madarosis (absence of the eyelashes or eyebrows).
 c.Poliosis (reduced melanin in eyelashes or eyebrows).
 d.Blocked nasolacrimal duct.

Regarding the prevention of diabetes and diabetic retinopathy, which ONE of the following statements
is MOST likely to be TRUE?

 a.Type 1 diabetes is preventable.

 b.The risk of Type 2 diabetes can be reduced by exercise and a healthy diet.
 c.An estimated 70% of patients with Type 2 diabetes are at risk of developing diabetic
retinopathy.
 d.Newer blood pressure drugs prevent diabetic retinopathy better than older medicines.
The photograph illustrates the right eye of a 25 year old female. Which ONE of the following
statements is MOST likely to be TRUE?

 a.The eye is likely to be very painful.

 b.The other eye may be similarly affected.
 c.The patient is likely to have multiple joints affected by arthritis.
 d.The patient is likely to be rheumatoid factor positive.

The patient, whose eye photograph is shown in the figure, is a tall 25-year-old girl with an unaided
visual acuity of LogMAR 0.7 (6/30, 20/100, 0.2) in both eyes. Regarding this patient, which ONE of
the following statements is MOST likely to be TRUE?

 a.Lens aspiration and intraocular lens implantation is indicated now because of her visual
acuity.
 b.Her refraction includes a “plus” cylinder at 165 degrees.
 c.In her condition, the ciliary zonules are ruptured, not stretched.
 d.She should have an electroretinogram.

With regard to ptosis, which ONE of the following statements is MOST likely to be TRUE?

 a.It can be due to a dysfunction of the seventh (facial) cranial nerve.

 b.It can be the presenting feature of Myasthenia Gravis.
 c.A ptosis of 3 millimetres or more is a feature of Horner’s syndrome.
 d.The Marcus Gunn jaw-winking phenomenon is associated with systemic disease.
Which ONE of the following ocular conditions are associated with smoking?

 a.Cataract.
 b.Glaucoma.
 c.Iritis.
 d.Retinal detachment

An 89 year old male presented with sudden visual loss in the right eye following a period of jaw
claudication (aching jaw on chewing), general stiffness and feeling unwell. As part of his work-up he
had a temporal artery biopsy. Which ONE of the following features would make you think that Giant
Cell Arteritis (temporal arteritis) is the likely diagnosis?

 a.An absence of multinucleate cells in the biopsy specimen.

 b.A thickened tunica media in the temporal artery biopsy specimen.
 c.A raised erythrocyte sedimentation rate (ESR) of greater than 100mm/hr.
 d.The presence of a right central retinal artery occlusion.

A healthy 3-month-old baby develops an alternating esotropia (a manifest convergent strabismus) of

55 dioptres which does not vary throughout the day. Both eyes move fully to right and left, there is no
refractive error, his eyes are normal on examination and there is no family history. Regarding this
case, which one of the following statements is most likely to be true?

 a.If surgery is carried out before 1 year, full stereopsis will develop.
 b.Amblyopia is unlikely to be present.
 c.It is likely that there is a bilateral 6th (abducens) cranial nerve palsy.
 d.Treatment is primarily with bifocal spectacles.

How certain are you abo

Regarding this fundus photograph, which ONE of the following statements is MOST likely to be
TRUE?

 a.Flame-shaped, blot and pre-retinal haemorrhages are all present.

 b.There is optic disc swelling.
 c.There is a traction retinal detachment inferiorly.
 d.There is optic atrophy.

How certain are you about your an

Which ONE of these conditions is characterised by an altitudinal field defect?

 a.Anterior ischaemic optic neuropathy.

 b.Optic neuritis.
 c.Papilloedema.
 d.Primary optic atrophy.

Which ONE of the following statements is a contraindication for the use of Magnetic Resonance
Imaging (MRI) in neuro-imaging?

 a.Third trimester of pregnancy.

 b.Metallic intraocular foreign body.
 c.Titanium implants.
 d.Allergy to iodine compounds.

Cycloplegics are indicated as treatment in which ONE of the following conditions?

 a.Angle closure glaucoma.

 b.Open angle glaucoma.
 c.Congenital glaucoma.
 d."Absolute" (end-stage) glaucoma.

How certain are you a

Characteristic causes of entropion (in-turning of the lid) include which ONE of the following?

 a.Trachoma.
 b.Seventh (facial) cranial nerve palsy.
 c.Diabetes mellitus.
 d.Myasthenia gravis.
The 16-year-old patient whose left eye is shown in the photograph presented for the first time with the
complaint that the vision in both eyes had been equally blurred for several months. The unaided visual
acuity in both eyes was LogMAR 0.48 (6/18, 20/60, 0.33), correcting to LogMAR 0.18 (6/9, 20/30,
0.67). Which ONE of the following would be the MOST appropriate action?

 a.To wear spectacles.

 b.To have Deep Anterior Lamellar Keratectomy.
 c.To have a trial of soft contact lenses.


A patient presents with a painful inflamed left eye, 3 days after an uncomplicated left extracapsular
cataract surgery with an intraocular lens. The slit lamp findings are shown in the photograph. The
visual acuity has dropped from LogMAR 0.48 (6/18, 20/60, 0.33) pre-operatively to LogMAR 1.30
(6/120, 20/400,0.05) post-operatively. Regarding this patient, which ONE of the following statements
is MOST likely to be TRUE?

 a.Intravitreal steroid is the primary treatment.

 b.Infection is unlikely, as it usually manifests on the first post operative day.
 c.Toxic anterior segment syndrome should be a part of the differential diagnosis.
 d.The anterior uveitis should respond beneficially to prednisolone eye drops.
Hypercholesterolaemia may cause which ONE of the following?

 a.Arcus senilis/lipoides.
 b.Cataract.
 c.Iris nodules.
 d.Corneal endothelial dysfunction

Regarding gender (male/female) bias in eye diseases and blindness, which ONE of the following
statements is MOST likely to be TRUE?

 a.Women are more likely to get diabetic retinopathy.

 b.World-wide, men are more able than women to access eye care.
 c.Men are less likely to access treatment for blinding conditions.
 d.Worldwide, over 60 per cent of the total number of blind persons are men.

Which ONE of the following features can be associated with pseudoexfoliation?

 a.Corneal thickening.
 b.Dilated pupil.
 c.Phacodonesis
 d.Scleromalacia

Regarding gonioscopy, which ONE of the following statements is MOST likely to be TRUE?

 a.Posterior embryotoxon is a ridge at the anterior border of the trabecular meshwork.

 b.The 4 mirror gonioscopy lens requires use of a viscous coupling agent.
 c.In indirect gonioscopy, the scleral spur appears posterior to the trabecular meshwork.
 d.It is normal to find blood in Schlemm’s canal.

A 2 month old baby is taken by her parents to the clinic. Their complaint is tearing and matting of the
eyelashes in her right eye which becomes more noticeable when the child has a cold or upper
respiratory tract infection. Which ONE of the following statements is MOST likely to be TRUE?

 a.The most likely cause is a developmental anomaly of the lacrimal canaliculi.

 b.Epiphora affects approximately 40% of neonates.
 c.Spontaneous resolution occurs in 96% of such cases within the first 12 months.
 d.If symptoms persist beyond 12 months dacryocystorhinostomy should be performed.

Regarding retinopathy of prematurity (ROP), which ONE of the following statements is MOST likely
to be TRUE?

 a.Babies born before 31 weeks gestational age should be routinely screened.

 b.The first sign of pathology is the neovascularization of the optic disc.
 c.10% of cases of ROP regress spontaneously.
 d.Laser photocoagulation of avascular immature retina is not recommended in infants with
threshold disease.

How certain are you about your answer? not certain

Regarding this patient who was bitten by a dog, involving the lacrimal apparatus, which ONE of the
following statements is MOST likely to be TRUE?

 a.Direct suturing of the eyelids gives the best, symptom–free result.

 b.Tetanus booster is not needed as the patient was immunized 12 years previously.
 c.A 5/0 silk suture is appropriate for the grey line.
 d.The tarsal plate should be closed with 6/0 silk.

Argon laser photocoagulation is indicated in which ONE of the following conditions?

 a.Diabetic papillopathy.
 b.Macular ischaemia.
 c.Proliferative diabetic retinopathy.
 d.Vitreous haemorrhage.

The 10 year old healthy child with no symptoms whose left fundus is shown in the photograph
presented to you having failed a school vision test. Both eyes had visual acuities of LogMAR 0.18
(6/9, 20/30, 0.67); the colour vision and visual fields were normal and there was no other abnormality
found. Regarding this child, which ONE of the following statements is MOST likely to be TRUE?

 a.In five years, the visual acuity will be LogMAR 1.0 (6/60, 20/200, 0.1).
 b.The electroretinogram is likely to be abnormal.
 c.The electro-oculogram is likely to be abnormal.
  d.There is a 25% chance that other sibs are affected.
Regarding congenital glaucoma, which ONE of the following statements is MOST likely to be TRUE?

 a.It is often associated with microcornea.

 b.It is most commonly unilateral.
 c.Optic disc damage does not occur.
 d.Photophobia is a common presenting feature.

Regarding the pathology of chronic open angle glaucoma, which ONE of the following statements is
MOST likely to be TRUE?

 a.Genetic collagen synthesis defects cause reduced outflow in the trabecular meshwork.
 b.Heavily pigmented macrophages are present around the outflow system.
 c.In advanced disease, there is atrophy of pre-laminar optic nerve fibres.
 d.Atrophy of the retinal nerve fibres is most pronounced in the macular region.

This photograph is of the right eye of 4 day old baby in a middle income country. Regarding the
public health control of the condition, which ONE of the following would significantly and
economically reduce the incidence of vision loss?

 a.A nationwide programme of Azithromycin 1% drops instilled at birth.

 b.A nationwide programme of instillation of 2.5% povidone iodine at birth.
 c.Training of community health workers to book appointments for affected babies.
 d.A nationwide programme of urgent treatment of affected babies and mothers with systemic
tetracycline.
The figure shows the direct illumination (left picture) and iris retro-illumination (right picture) images
of a 20-year-old male patient’s eye. A male cousin is the only family member affected. Regarding this
patient, which ONE of the following statements is MOST likely to be TRUE?

 a.The inheritance is likely to be X-linked.

 b.His mother’s fundi are likely to be normal.
 c.Brown eyelashes means he cannot have an oculocutaneous condition.
 d.He is likely to have an abnormal flash electroretinogram (ERG).

Regarding myasthenia gravis, which ONE of the following statements is TRUE?

 a.It is more common in males.

 b.It may be associated with ptosis.
 c.It is worse in the mornings.
 d.Symptoms worsen with an ice pack.

Ipsilateral complete third (oculomotor) cranial nerve palsy with contra-lateral ptosis and superior
rectus palsy is seen with the lesion at the level of which ONE of the following?

 a.Third (oculomotor) cranial nerve nucleus.

 b.Cavernous sinus.
 c.Subarachnoid space.
 d.Intraorbital part of the third (oculomotor) cranial nerve
You are working as a cataract and general ophthalmic surgeon in a very low-income country where
there is a measles epidemic. The mother of a bottle-fed baby with diarrhoea brings her daughter to
you. The photograph shows the right eye. Both eyes were similarly affected but otherwise healthy.
Regarding this case, which one of the following would be the most appropriate course of action?

 a.Give initial oral Vitamin D.

 b.Suggest the mother obtains a traditional eye remedy.
 c.Treat the diarrhoea with oral fluids and dietary restriction.
 d.Enquire about the possibility of symptoms of night blindness.