2nd term ophthalmology training multiple

choice questions
Strabismus
1-Which of the following EOM arise from orbital floor :

A-superior rectus
B-inferior recus
C-superior oblique
D-inferior oblique
E-lateral rectus
Answer D

2-Which condition of the following cause pseudo-exotropia :

A-High Hypermetropia
B-High Myopia
C-Epicanthus
D-Small interpupillary distance
E-Medial Ankyloblepharon
Answer A

3-The cover of the squinting eye for treatment of amblyopia is done in which
of the following conditions:
A-Paralytic squint
B-Latent squint
C-Eccentric fixation
D-Superior orbital fissure syndrome
E-Irregular astigmatism
Answer C

4-Angle alpha is NEGATIVE in which of the following conditions:

A-Myopia
B-Hypermetropia
C-Astigmatism
D-Anisoconia
E-Amblyopia
Answer A

5-In the comitant squint , brain manipulates the diplopi by which of the
following conditions:
A-Facultative suppression
B-Acute depression
C-Compensatory head posture
D-Visual field defect
E-Paracentral scotoma
Answer A

6. The action of inferior oblique is:

a. Elevation, intorsion, adduction
b. Depression, extorsion, adduction
c. Elevation, extorsion, adduction
d. Elevation, extorsion, abduction
e. Depression, extorsion, abduction
ANSWER: D

7. initial treatment for amblyopia :

a. Orthoptic exercise
b. Surgery
c. penalization of the amblyopic eye
d. Occlusion of the Normal eye
e. Better if after age of 10 years
ANSWER: D

8. When the eye is medially rotated, the depressor muscle of eye ball
a. Inferior rectus
b. Inferior oblique
c. Superior oblique
d. Inferior rectus and inferior oblique
 e. Lateral rectus
ANSWER: C

9. Exophoria is
a. Latent convergent squint
b. Alternate divergent squint
c. Associated with accommodation reflex
d. Manifest divergent squint
e. Latent divergent squint
ANSWER: E

10. You are measuring the deviation in a child with strabismus. The corneal light
reflex is 2mm temporal to the pupil in the right eye. How much deviation would
you estimate?
a. 4 diopters esotropia
b. 8 diopters exotropia
c. 20 diopters esotropia
d. 60 diopters exotropia
e. 30 diopters esotropia
ANSWER: E

11- Reading is helped by which of the following muscles:

a. IR+ IO
b. IR + SO
c. MR + IO
d. MR+ SO
e. MR + IR
answer d

12. Nerve supply to inferior oblique is via

a. infraorbital nerve
b. 6th cranial nerve
c. 5th cranial nerve
d. 4th cranial nerve
e. 3rd cranial nerve
answer e

13. Bilateral medial rectus recession is useful for

a. esotropia
b. exotropia.
c. hypertropia.
d.hypotropia
e. amblyopia
answer a

14. False projection is a character of

a. accommodative esotropia
b. paralytic esotropia
c. infantile esotropia
d. cyclophoria
e. esophoria
answer b

15-The main action of the inferior oblique muscle is:

a) Abduction.
b) Extorsion.
c) Depression.
d) Intorsion.
e) Adduction.

Answer: B.

16-Causes of apparent convergent squint include:

a) High hypermetropia.
b) Large interpupillary distance.
c) Epicanthus.
d) Lateral Ankyloblepharon.
e) Ptosis.

Answer: C.

17-Features of left 6th cranial nerve palsy include:

a) Face turn to the right.
b) Left eye exotropia.
c) Diplopia on the right gaze.
d) Diplopia on the left gaze.
e) Limitations of ocular movement to the right.
Answer: D.

18-Treatment of concomitant esotropia include:

a) Medial rectus recession.
b) Medial rectus resection.
c) Later rectus recession.
d) Inferior oblique myotomy.
e) Superior rectus transposition.
Answer: A.

19-Clinical features of paralytic squint include:

a) Diplopia to the opposite direction of action of the paralyzed muscle.
b) False projection in the same direction of action of the paralyzed muscle.
c) Face turn to the opposite direction of action of the paralyzed muscle.
d) Under action of the ipsilateral antagonist.
e) Under action of the contralateral synergist.
Answer: B

20-A 3-year-old child presents with a convergent squint dating for one year.
The first step in management is:
a) cycloplegic refraction
b) Surgical correction
c) Training on the synoptophore
d) Prism prescription
e) Follow up
Answer a

21-Uncrossed diplopia is found with: D

a) superior rectus palsy
b) Medial rectus palsy
c) Inferior rectus palsy
d) Lateral rectus palsy
e) Third nerve palsy
Answer d

22-Which of the following is true regarding the action of the superior rectus
muscle:
a) It is an adductor, intortor and elevator
b) It is an abductor, intortor and depressor
c) It is an adductor, extortor and depressor
d) It is an abductor, intortor and elevator
e) It is an adductor, extortor and elevator
Answer a

23-Secondary angle of deviation refers to:

a) Angle of deviation of the normal eye when the paralytic eye is forced to fix
b) Angle of deviation of the paralytic eye when the normal eye is forced to fix
c) Angle of deviation when performing the alternate cover test
d) Ange of deviation when performing the cover uncover test
e) Angle of deviation during full accommodation
Answer a

24- Diplopia is the main symptom in the following condition:

a) 5th nerve palsy
b) 3rd nerve palsy
c) 6th nerve palsy
d) 7th nerve palsy
e) Optic atrophy
Answer c
25. The action of inferior oblique is:
a. Depression, extorsion, abduction
b. Depression, extorsion, adduction
c. Elevation, extorsion, adduction
d. Elevation, extorsion, abduction
ANSWER: D

26. In grades of binocular vision; grade 2 is:

a. Simultaneous macular vision
b. Fusion
c. Stereopsis
d.Abnormal retinal correspondence
e.diplopia
ANSWER: B

27- In concomitant squint:

a. Primary deviation > Secondary deviation
b. Primary deviation < Secondary deviation
c. Primary deviation = Secondary deviation
d. None of the above
e. Primary deviation >20 Secondary deviation
ANSWER: C

28. The only extraocular muscle not arise from the apex of the orbit is:
a. Superior rectus
b. Superior oblique
c. Inferior oblique
d. Inferior rectus
e.medial rectus
ANSWER: C Inferior oblique

29. In paralytic squint, the difference between primary and secondary deviation
in the gaze of direction of the paralytic muscle:
a. Increases
b. Decreases
c. Remains the same
d .decrease by 20 degree
e. more than the restrictive type
ANSWER: A Increases
Glaucoma
1-One of the following is a differential diagnosis of congenital glaucoma :

a- Keratoconus
b- Megalocornea
c- Trachomatous pannus
d- Keratomalacia
e- ROP
Answer B

2-Primary open angle glaucoma is not treated by :

a-PG analogue
b-Carbonic anhydrase inhibitors
c-Betablockers
d-Atropine
e-Glaucoma Filtering surgery
answer D

3-Lens induced glaucoma occurs in which of the following conditions :

a-Intumescent cataract
b-Anterior polar cataract
c-post subcapsular cataaract
d-nuclear cataract
e-cortical cataract
ANSWER A

4-Systemic carbonic anhydrase inhibitors have the following effect :

a-Paresthesia; tingling of fingers,hands & toes
b-Bronchospasm
c-Bradycardia
d-HTN
e-Hyperlipidemia
ANSWER A

5-In acute congestive glaucoma which of the following is true:

a-IOP is much decreased
b-ON head is normal
c-Usually asymptomatic
d-Angle gonioscopy shows 360 degrees iridocorneal apposition
e-eye is quite
answer d

6. A non contact method for IOP measurement is :

a. Indentation tonometry.
b. Goldman applanation.
c. Digital method.
d. Airpuff.
e. Perkins method.
Answer d

7. One of specific sign of optic nerve head change in glaucoma ;

a. Laminal dot sign
b. Nasal shift of blood vessels
c. Peripapillary atrophy
d. Bayontting of blood vessels
e. Focal notching of rim
answer e
8. Which of the following is not related to glaucomatous visual field changes :
a. Paracental sctoma
b. Siedle scotoma
c. Arcuate scotoma
d. Respecting vertical meridian
e. Tubular vision
answer d
9. In congenital glaucoma management, which is correct?
 a: Medical treatment may be enough.
b.Laser PI is an available option.
c. Drainage device is the best initial management.
d. Subscleral trabeculectomy may be an option.
e. Trabeculotomy requires a clear cornea.
Answer d
10. A primary open angle glaucoma patient on medical treatment complaining
of increased iris and lash pigmentation , which of the following drug is accused?
a. Beta blcker.
b. Alpha 2 agonist.
c. Miotics .
d. Prostaglandin analogue.
e. Carbonic anhydrase inhibitior.
Answer d
11. Beta blockers help to decrease IOP by
a. Increase aqueous outflow.
b. Decrease aqueous secreation.
c. Increase uveoscleral outflow.
d. Vitreous shrinkage.
e. Iris blood vessels dilatation.
Answer b
12. Regarding acute angle closure glaucoma, which of the following is most
effective initial management?
a. gonioscopy.
b.laser PI
c. IV hyper osmotic agents
d.sub scleral trabeculectomy
e.visual field.
Answer c
13. Which of the following is a method to assess anterior chamber angle?
a. visual field.
b. B scan.
c. UBM.
d. FFA.
e. slit lamp
answer c
14. Regarding the IOP measurement, which of the following can lead to high
false reading by Goldman applanation tonometer (GAT):
a) Too much fluorescein stain.
b) Associated conjuctivitis .
c) Corneal edema.
d) Repeated measurement over short period.
e) Thin cornea.

15. In phacolytic glaucoma , the best curative treatment is

a.topical steroid
b.beta blockers
c.subscleral trabeculectomy
d.cataract extraction.
e.laser PI
answer D
16-Regarding congenital glaucoma which of the following statement is true:
a) Refraction will show hypermetropia.
b) Usually unilateral.
c) Anterior chamber is shallow.
d) Haab’s striae represent vertical lines
e) corneal diameter increased.
Answer: E
17-Which of the following clinical features are associated with ocular
hypertension:
a) Increased IOP, abnormal optic disc and abnormal visual field.
b) Increased IOP, normal optic disc and normal visual field.
c) Normal IOP, abnormal optic disc, normal visual field.
d) Normal IOP, abnormal optic disc and abnormal visual field.
e) Normal IOP, normal optic disc and normal visual field.
Answer: B

18-Specific signs of optic disc changes in glaucomatous optic neuropathy

include:
a) Optic disc swelling.
b) Nasal shift of blood vessels.
c) Diffuse pallor of the neuro-retinal rim.
d) asymmetrical increase of C/D ratio.
e) Laminar dot sign.
f) Answer: D

19-Fixation loss in the visual field of glaucomatous patient represent affection

of which part of the retinal nerve fiber layer:
a) Upper temporal fibers.
b) Lower temporal fibers.
c) Macular fibers.
d) Lower nasal fibers.
e) Upper nasal fibers.
Answer: C

20-Cause of hypotony include:

a) Rupture globe.
b) Carotid cavernous fistula.
c) Long standing vitreous hemorrhage.
d) Intumescent cataract.
e) Longstanding steroid eyedrops intake.
Answer: A

21-Which of the following laser treatment can be used in cases of primary angle
closure glaucoma:
a) Argon laser trabeculoplasty.
b) YAG laser peripheral iridotomy.
c) Diode laser retinal photocoagulation.
d) Argon laser panretinal photocoagulation.
e) YAG laser capsulotomy.
Answer B:

22-Prostaglandin analogues reduce the IOP by the following mechanism:

a) Decreased aqueous humor production.
b) Withdrawal of fluid from the vitreous cavity with vitreous shrinkage.
c) Increase aqueous drainage through the trabecular meshwork.
d) Increase aqueous drainage through the uveoscleral pathway.
e) Reduction of episcleral venous pressure.
Answer: D.

23-In subscleral trabeculectomy, a fistulous traction is created to drain the

aqueous between which structures:
a) Vitreous cavity and episcleral space.
b) Suprachoroidal space and episcleral space.
c) Anterior chamber and posterior chamber.
d) Anterior chamber and episcleral/subconjunctival space.
e) Anterior chamber and suprachoroidal space.
Answer: D

24-The BEST mangment an attack of ACG is :

a-IV mannitol + oral acetazolamide + topical miotics
b-YAG capsulotomy
c-gonioscopy
d-systemic steroids
e-atropine eye drops
answer A

25-The 1st line for treating 1ry OAG (IOP:26 mmhg) in a asthmatic patient is :
a-Timolol E.D.
b-Acetazolamide tablet
c-Latanoprost E.D.
d-Flurometholone E.D.
e-Dexamethasone E.D.
ANSWER C

26-Hypotony occurs in which of the following conditions:

a-Corneal nebula
b-corneal ulcer
c-Cyclitis
d-Choroidal melanoma
e-retinoblastoma
ANSWER C

27-In the treatment of glaucoma 2ry to iridocyclitis, we give which of these

topical drugs:
a-mannitol
b-pilocarpine
c-Mydriatics
d-Antibiotics
e-PG analogue
ANSWER C

28-Treatment of buphthalmos is :
a-Medical
b-Surgical after 2 years
c-As early as possible surgical
d-Mannitol
e-enucleation at time of diagnosis
ANSWER C

29-Pupillary block glaucoma is found with:

a-Anterior lens dislocation
b-Posterior lens dislocation
c-Primary angle closure glaucoma
d-Anterior staphyloma
e-Posterior staphyloma
ANSWER A

30-secondary glaucoma due to iridocyclitis may be due to the following:

a-Decreased formation of the watery aqueous
b-Obstruction of the trabecular meshwork by the swollen lens
c-Organization of inflammatory exudates results in formation of P.A.S.
d-Pupillary block by anterior synechiae
answer c
31-Glaucoma suspected by :
a-deep anterior chamber.
b-heminopia
c-Edema of the optic nerve disc.
d-optic disc rim vertical notching.
e-Large Optic disc.
Answer d

32-Central field extends for ……… degrees in all directions from the fixation
point :

A-15

B-20

C-30

D-40

E-45

Answer c

33-IVI Mannitol is used for treatment of ACG as a hyperosmotic agent , its

mechanism of action to withdraw water from :

A-Aqeous humor

B-Vitreous humor

C-Trabecular meshwork

D-Crystalline lens

E-Episcleral veins

Answer b

34-Steriod responders were classified based on 6 weeks course of:

A- Topical Fluorometholone
B- Topical Dexamethasone
C- Topical Betamethasone
D- Systemic Triamcinolone
E- Intraviteral Anti-VEGF
Answer c

35. Topical atropine is contraindicated in:

a. Retinoscopy

b. Iridocyclitis

c. Corneal ulcer

d. Primary angle closure glaucoma

e. pupillary block glaucoma

ANSWER: D

36. The earliest visual field defect in POAG is

a. Isolated paracentral nasal scotoma

b. Bjerrums scotoma

c. Arcuate scotoma

d. Altitudinal Scotoma

e. Centrocecal scotoma

ANSWER: A

37. Timolol is:

a. Beta blocker

b. Carbonic anhydrase inhibitor

c. Antibiotic

d. Alpha blocker
 e. Calcium channel blocker

ANSWER:a

38. Neovascular glaucoma follows:

a. Central retinal vein occlusion

b. Central retinal artery occlusion

c. Acute congestive glaucoma

d. Staphylococcal infection

e. Open angle glaucoma

ANSWER: A

39. Best Investigation for follow up of Glaucoma:

a. Pentacam
b. Visual Field
c. OCT macula

d. Refraction
e. B scan

ANSWER: B

40-A female patient 60-year-old was complaining of right gradual painless

diminution of vision of one-year duration. Suddenly this eye became red and
painful. On examination, the visual acuity was hand motion, and the tension
was stony hard. The most suitable diagnosis is: C

a) Primary open angle glaucoma

b) Secondary open angle glaucoma

c) Lens induced glaucoma

d) Primary angle closure glaucoma

e) Pseudoexfoliation glaucoma

41- The best way of managing the above case is: C

a) Medical treatment by miotics and carbonic anhydrase inhibitors

b) Subscleral trabeculectomy

c) Cataract extraction

d) Laser trabeculoplasty

e) Panretinal photocoagulation

42-The treatment of choice for the other eye in angle closure glaucoma is: B

a) Surgical peripheral iridectomy

b) Yag laser iridotomy

c) Trabeculotomy

d) Trabeculectomy

e) Atropin eye drops

43-A one-month old baby is brought with complaints of photophobia and

watering. Clinical examination shows normal tear passages and clear but large
cornea. The most likely diagnosis is: D

a) Congenital dacryocystitis

b) Interstitial keratitis

c) Keratoconus

d) Buphthalmos

e) Neonatal conjunctivitis

44- Aqueous humour is produced by: B

a) Trabecular meshwork

b) Ciliary body

c) Iris

d) Schlemm’s canal
e) Zonules

f)

45-Carbonic anhydrase inhibitors reduce intraocular pressure by: D

a) Increased trabecular outflow

b) Increased uveoscleral outflow

c) Induction of miosis

d) Reduced aqueous production

e) Increased serum osmolarity

46. The mechanism of secondary glaucoma following central retinal vein

occlusion is:

a- Blood in trabecular meshwork

b- Rise in IOP following rise in systemic blood pressure

c- New vessel formation in the angle

d- Angle recession

e- trauma

Answer c- New vessel formation in the angle

True OR False
1-Regarding aqueos humor

a- secreted from ciliary processes

B-secretion occur by diffusion only

C-most of aqueous leave eye through uveo-scleral pathway

2-Regarding different methods of IOP measurment

A-Goldmann applanation tonometer not affected by corneal thickness

B-Tonopen is suitable in scarred or edematous cornea

C-Pneumotonometer need sterilization between patients

RETINA
1-Most common cause of diminution of vision in diabetic retinopathy is:
A-Vitreous hemorrhage
B-Proliferative diabetic retinopathy(PDR)
C-Neovascular glaucoma (NVG)
D- Tractional retinal detachment
E- Diabetic maculopathy
Answer e
2-Complications of retinal neovascularization include:
A-IRMA
B-CSME
C-Musca volitans
D-Decrease IOP
E-Tractional RD
Answer e

3-Regarding blood supply of retina, which is correct?

a.cilioretinal artery is the branch from central retinal artery.
b. outer retinal layers are supplied by CRA.
c.CRA is an end artery.
 d.retina is drained by ciliary veins.
e.fovea is the most vascular part.
Answer c
4-Differential diagnosis of cherry red spot include which of the following:
A-CRVO
B-BRVO
C-Quinine poisoning
D-Quinolone poisoning
E-Retinitis pigmentosa
Answer c

5- Panretinal Laser photocoagulation is indicated in which of the following

conditions:
a-retinoblastoma
b-Retinitis pigmentosa
c-Rhegmatogenous retinal detachment
d-Retinal break with subretinal fluid
e-Proliferative Diabetic Retinopathy
answer e

7-Most severe mode of inheritance in retinitis pigmentosa is:

A-AD
B-AR
C-XLR
D-Sporadic
E-Female carrier
Answer c

8-In areteriosclerotic retinopathy , the grade 4 characterized by:

A-Salus sign
B-Bonnet sign
C-Gunn sign
D-Copper wiring
E-Silver wiring
Answer e

9-The leading cause of blindness in developed countries is:

A-Diabetic retinopathy
B-Hypertensive retinopathy
C-Trachoma
D-ARMD
E-Mature cataract
Answer d

10-Risk factors of rhegmatogenous RD include:

A-High hypermetropia
B-High Myopia with lattice degeneration
C-Iridiocyclitis
D-Cyclodiode laser therapy
E-Rubeosis iridis

11-100 day glaucoma is a complication of:

A-CRAO
B-CRVO
C-Diabetic maculopathy
D-PDR
E-Vitreous he
Answer b

11. The investigation which is best to assess retinal vascular diseases is

a. OCT
b. FFA
c. B scan
d. UBM
e.MRI
answer b

12. Regarding ischemic CRVO, which is correct?

a. it presents with sudden painful diminution of vision.
b. it doesn’t need systemic work up.
c. OCT detects neovascularization.
d. gonioscopic examination is important.
e. CMO is treated with topical steroid.
Answer d
13. A 35 years old high myopic male presents to ER complaining of acute
painless diminution of vision in right eye. What is most probable diagnosis?
a. open angle glaucoma.
b. retinal detachment.
 c. posterior sub capsular cataract
d.acute angle closure glaucoma
e. toxic optic neuropathy

14. Which is a tool for daily monitoring of ARMD?

a. schiots
b. OCT
c. B scan
d. Hess screen
e. Amsler grid.
Answer e

25. B scan is of great value for diagnosing

a-papilledema
b.vitrous hemorrhage
c.optic atrophy.
d.open angle glaucoma.
e. diabetic maculopathy.
Answer b
26-The macula is defined histologically by having more than 1 layer of:
a) Rods.
b) Cones.
c) Bipolar cells.
d) Retinal pigment epithelial cells.
e) Ganglion cells.
Answer: E.
27-During funds examination, the image seen by indirect ophthalmoscope with
20D lens is characterized by:
a) Narrow field.
b) Greater magnification of 15X.
c) Binocular.
d) Upright image.
e) Black and white.
Answer: C.

Case: Questions (28-29):

A 41-year-old male patient with type 1 DM for 35 years came complaining of
sudden diminution of vision in his left eye (VA of HM). On examination, his
right eye VA was 6/36 with proliferative diabetic retinopathy changes and no
fundus view could be seen in the left eye.
Question no 28: Which of the following is the most appropriate management
for the left eye with vitreous hemorrhage:
a) Intravitreal steroid injection.
b) Reassurance and follow-up in 6 months.
c) Intravitreal Anti-VEGF injection.
d) B-scan ultrasound and follow-up weekly for 1 month.
e) Immediate panretinal photocoagulation.
Answer: D
Question no 29: Which of the following is the most appropriate management
for the right eye:
a) Intravitreal steroid injection.
b) Reassurance and follow-up in 6 months.
c) Intravitreal Anti-VEGF injection.
 d) Pars plan vitrectomy.
e) Immediate panretinal photocoagulation.
Answer: E
30-Retinitis pigmentosa is characterized by:
a) Color blindness.
b) Bone specular pigmentation starting in the foveal center.
c) Decreased scotopic response in ERG.
d) Enlargement of the blind spot in visual field testing.
e) Secondary optic atrophy with greyish dirty disc appearance.
Answer: C

31-Regarding central retinal vein occlusion, the most likely cause for vision loss
in early stages is:
a) Neovascular glaucoma.
b) Tractional retinal detachment.
c) Cystoid macular edema.
d) Vitreous hemorrhage.
e) Cataract formation.
Answer: C.

32-Risk factors for primary rhegmatogenous retinal detachment include:

a) Hypermetropia.
b) High myopia with lattice degeneration.
c) Acute congestive glaucoma.
d) Proliferative diabetic retinopathy.
e) Central retinal artery occlusion.
Answer: B.

33-Treatment of choice for a patient with tractional retinal detachment is:

a) Pars plan vitrectomy.
b) Pneumatic retinopexy.
c) Laser photocoagulation.
d) Scleral buckling.
e) Intravitreal anti-VEGF injection.
Answer: A.

34-Loss of vision in cases of wet-type age-related macular degeneration is due

to:
a) Multiple drusen.
b) RPE hyperpigmentation.
c) RPE atrophy.
d) Choroidal rupture.
e) Choroidal neovascular membrane.
Answer: E.
35. A 60 years old patient with sudden painless loss of vision, and ocular
examination reveals a cherry red spot with clear Anterior chamber, the most
likely diagnosis is:
a. Glaucoma
b. Central Retinal Vein Occlusion
c. Diabetes
d. Branch Retinal Vein Occlusion
e. Central Retinal Artery Occlusion
ANSWER: E
36. Which of the following is a risk factor for retinal detachment?
a. black race
b. male sex
c. presbyopia
d. hypermetropia
e. high myopia
ANSWER: E

37. What location for a retinal detachment would be most amenable to

treatment by pneumatic retinopexy?
a. inferior rhegamatogenous detachment
b. superior tractional retinal detachment
c. superior rhegamatogenous detachment
d. traumautic macular hole
e. inferior tractional retinal detachment
ANSWER: C

38- A patient with sudden painless loss of vision and no fundus view was
possible. Which of the investigation is helpful to see the retina?
a. Keratometry
b. Pachymetry
c. B-Scan
d. A-Scan
e. Indirect ophthmoscopy
ANSWER: C
39. In diabetic retinopathy the new vessel formation is due to following
pathology
a. Retinal hemorrhage
 b. Vitreous hemorrhage
c. Retinal oedema
d. Retinal ischemia
e. Retinal breaks
ANSWER: D

40. In retinal detachment, fluid accumulates between:

a. Outer plexiform layer and inner nuclear layer.
b. Neurosensory retina and retinal pigment epithelium
c. Nerve fiber layer and rest of retina.
d. Retinal pigment epithelium and Bruch’s membrane.
e. Retinal pigment epithelium and choroid
ANSWER: B

41. Night blindness is caused by:

a. Vitreous hemorrhage
b. Dystrophies of rods
c. Dystrophies of the cones
d. Retinal detachment
e. Macular edema
ANSWER: B

42. A patient of old standing diabetes mellitus noticed sudden muscae

volitanes. On examination, the red reflex was dim, with no details of fundus
could be seen. He might have:
a. Non proliferative diabetic retinopathy
b. Cystoid macular edema
c. Vitreous hemorrhage
d. Central retinal vein occlusion
e. Central retinal artery occlusion
ANSWER: C

43-Pathognomic clinical signs of proliferative diabetic retinopathy is

a. Micro aneurysms
b. Hard exudates
c. Deep retinal hemorrhages
d. Neovascularization of retina
e. Vitreous hemorrhage
ANSWER: D
44. In Central retinal artery occlusion, a cherry red spot is due to:
a. Hemorrhage at macula
b. Increased choroidal perfusion
c. Increase in retinal perfusion at macula
d. The contrast between pale retina and reddish choroids
e. Ischemia at macula
ANSWER: D

45-A 60 years old male suffering from diabetes mellitus for the last 20 years
presented with bilateral retinal hemorrhages and exaudates, with
neovascularization on the optic disc. The retina is still attached. The most
suitable management is: A
a) Panretinal photocoagulation
b) Medical control of diabetes
c) Vitrectomy
 d) Follow up
e) Antiglaucoma medications
46-A young male known to be a high myope complains of flashes of light in the
temporal field of his right eye of two days duration. The most expected cause:
D
a) corneal edema
b) Rise of intraocular pressure
c) Crystalline lens opacities
d) Retinal break
e) Rubeosis irides
47-The nutrition to the fovea is through: C
a) Long posterior ciliary arteries
b) Arterial circle of zinn
c) Choriocapillaris
d) Anterior ciliary arteries
e) Circulus arteriosus iridis major
48- The presence of central scotoma in a highly myopic patient may be due to:
C
a) Posterior staphyloma
b) Myopic crescent
c) Fuch’s spot
d) Peripheral myopic degeneration
e) Retinal break
49- A 30-year-old patient with renal failure presented for routine fundus check.
Examination revealed a raised optic nerve head with retinal hemorrhages in
both eyes. The first line of management is: B
a) Ultrasonography
 b) Measurement of blood pressure
c) CT scan
d) Flourescien angiography
e) Visual field
50-cotton wool spots: B
a) Indicate poor venous retinal outflow
b) Are microinfarcts of the nerve fiber layer
c) Are commonly seen in normal individuals
d) Are seen with retinitis pigmentosa
e-Can cause retinal detachmed

51.Occlusion of the lower nasal branch of the central retinal artery

results in one of the following field defects:
a. Lower nasal sector field defect
b. Upper nasal sector field defect
c. Upper temporal field defect
d. Lower temporal sector field defect
e.bundle defect
ANSWER: C Upper temporal field defect

53. Commotio retinae is seen in:

a. Concussion injury
b. Papilloedema
c. Central retinal vein thrombosis
d. Central retinal artery thrombosis
e. optic atrophy
ANSWER: A Concussion injury

54. 100 days glaucoma is seen in:

a. Central Retinal Artery Occlusion
b. Branch Retinal Artery Occlusion
c. Central Retinal Vein Occlusion
d. Branch Retinal Vein Occlusion
e. angle closure
ANSWER: C Central Retinal Vein Occlusion
55. Number of layers in neurosensory retina is:
a. 1
b. 10
c. 11
d. 12
e.9
ANSWER: e.9

56. Central retinal vein thrombosis manifestations do NOT include:

a- Retinal veins are dilated and tortuous
b- Severe pain & headache
c- Superficial haemorrhage all over the fundus
d- impairment of vision
e- Secondary rubeotic glaucoma
answer b. Severe pain & headache
 Optic Nerve

1-The type of optic atrophy that follows retrobulbar neuritis is:

a-Secondary optic atrophy
b-Consecutive optic atrophy
c-Glaucomatous optic atrophy
d-Primary optic atrophy
e-congenital optic atrophy
answer d
2-The type of optic atrophy that follows papilloedema is:
a-Secondary optic atrophy
b-Consecutive optic atrophy
c-Glaucomatous optic atrophy
d-Primary optic atrophy
e-congenital optic atrophy
answer a
3-Consecutive optic nerve atrophy can be directly due to:
a-Post glaucomatous
b-Dendritic corneal ulcer
c-optic neuritis
d-Retinitis pigmentosa
e-Toxic optic neuropathy
answer d

4-Most common cause of Arteritic AION is:

A-HTN
B-DM
C-Hyperlipidemia
D-GCA
E-Obstructive sleep apnea
Answer d

5-Treatment of Aretritic AION includes:

A-Topical steroids
B-Systemic steroids
C-Antiplatelets therapy
D-Vitamine B complex
C-Anticoagulants
Answer b
6. Optic nerve axons arise from:
a. Ganglion cells
b. Rods & cones
c. Amacrine cells
d. Inner nuclear layer
e. outer nuclear layer
ANSWER: A

7. Optic nerve function is best studied by:

a. Direct Ophthalmoscopy
b. Retinoscopy
c. field examination
d. Gonioscopy
e. Indirect Ophthalmoscopy
ANSWER: C

8. optic disc swelling can be caused by:

a. Retrobulbar neuritis
b. Increased intracranial pressure
c. Glaucoma
d. Optic atrophy
e. occipital blindness
ANSWER: B

9. 35 years old female present with headache and left ocular pain and blurring
of vision. On examination V/A is 6/6 (OD) , 6/18(OS), left RAPD . Fundus
examination shows left OD swelling. What is most probable diagnosis?
a. papilloedema
b. arteritic AION
c. non arteritic AION
d. papillitis
e. optic disc drusen.
E
10. Visual field defect in papilloedema is
a. seidle scotoma
b. arcuate scotoma
c.altitudinal field defect
d. enlarged blind spot
e. hemianopia
D
11. The most common known cause of optic neuritis is
a.infection
b. demyelination
c. ischemia
d. trauma
e. para infectious
B

12. Non arteritic AION is characterized by

a. occurs in young age.
b. high ESR
c. pulse steroid should be given.
d. altitudinal field defect
e. Large optic disc cup
d

13-Cause of secondary optic atrophy include:

a) Posterior ischemic optic neuropathy.
b) Retrobulbar optic neuritis.
c) Post papilledema.
d) CRAO.
e) Amaurotic family idiocy.
Answer: C.
Case questions (14,15):
25-year-old female patient sought medical advice due to sudden diminution of
vision in the right eye. There is no history of trauma, drug intake or any
systemic illness. On examination, visual acuity was 6/36, pupil showed RAPD
with impaired color vision, normal anterior segment exam, painful eye
movement, and fundus exam showed normal looking optic nerve head.
Question no 14: The most likely cause for this condition is:
a) Papillitis.
b) Anterior ischemic optic neuropathy.
c) Posterior ischemic neuropathy.
d) Retrobulbar neuritis.
e) Toxic optic neuropathy.
Answer: D.
Question no 15: The following treatment line can be used to hasten visual
recovery in this patient:
a) Systemic beta blockers.
b) Intravitreal steroid injection.
c) Systemic vasodilators.
d) Systemic antiplatelet (aspirin).
e) Systemic intravenous steroid injection.
Answer: E.

16- Anterior ischemic optic neuropathy commonly affects patients: C

a) In the first decade of life
b) In the third decade of life
c) In the seventh decade of life
d) In the second decade of life
 e) In the fourth decade of life

17- Homonimous hemianopia is the result of a lesion in: C

a) Optic chiasma
b) Retina
c) Optic tract
d) Optic nerve
e) Frontal lobe
18. Optic disc diameter is:
a. 1 mm
b. 1.5 mm
c. 2 mm
d. 3 mm
e.0.5 mm
ANSWER: B 1.5

19. Retro-bulbar optic neuritis is characterized by:

a. Marked swelling of the optic disc.
b. Impaired direct light reflex in the affected eye
c. Impaired consensual light reflex in the affected eye
d. Normal visual acuity
e. optic disc pallor
ANSWER: B. Impaired direct light reflex in the affected eye

Neuro-ophthalmology
1-Binasal Hemianopia results from lesion to:
A-Optic chiasma
B-Optic Radiation
C-L.G.B.
D-Occipital cortex
E-Temporal Lobe
Answer a

2-Bitemporal Hemianopia results from lesion to:

A-Optic chiasma
B-Optic Radiation
C-L.G.B.
D-Occipital cortex
E-Temporal Lobe
Answer a

3-The blind spot is the best example of:

A-absolute positive scotoma
B- absolute negative scotoma
C- relative positive scotoma
D- relative negative scotoma
E-Acute scotoma
Answer b

4-causes of central scotoma include:

A-Macular CNV
B-Progressive myopia
C-Papilloedema
D-Chronic glaucoma
E-Dissimeinated choroiditis
Answer a

5-Light-Near dissosciation occurs in:

A-Marcus-Gunn pupil
B-Wernickes hemianopic pupil
C-Argyll-Robertson syndrome
D-Horner syndrome
E-Margus-Gunn Jaw Winking syndrome
Answer c

6-Anisocoria is associated with from:

A-Afferent pupillary defect
B-Efferent pupillary defect
C-Intumescent cataract
D-Dark Adaptaion
E-5th stage of anaesthesia
b
7. In complete third nerve paralysis the direction of the affected eye in the
primary position is:
a. Inward
b. Outward
c. Outward and up
d. Outward and down
e.esotropia
ANSWER: D Outward and down

8. Regarding visual pathway, choose the correct order:

a. retina, optic nerve, optic tract, optic chiasm, optic radiation, cortex.
b. retina, optic nerve, optic tract, optic radiation, optic chiasm cortex.
c. retina, optic nerve, optic chiasm, optic tract, optic radiation, cortex.
d. retina, optic nerve, optic tract, optic radiation, cortex, optic chiasm.
e. retina, optic nerve, optic tract, optic radiation, cortex, optic chiasm.
b
9. Optic tract lesion causes
a. ipsilateral homonymous hemianopia.
b. contralateral homonymous hemianopia
c. altitudinal defect
d. scotoma rather than field defect.
e. nasal step.
B

10. RAPD doesn’t occur in

a. optic neuritis
b. papilledema
c. ischemic optic neuropathy.
d. traumatic optic neuropathy
e. total retinal detachment.
B

11.Horner syndrome is characterized by

a. heterochromia.
b. mydriasis
c. light near dissociation.
d. proptosis
e. anisometropia.
A

12. Which of the following is a cause for miosis?

a. pontine hemorrhage.
b. third nerve palsy.
c. 4th stage anaethesia.
d. acute glaucoma.
e. adies pupil.
A

13. The pupillary defect that affects the afferent arm of the pupillary response
is the:
a. Marcus Gunn’s pupil
b. Argyl Robberson pupil
c. Adie’s pupil
d. Horner’s pupil
e. Reactive pupil
ANSWER: A
14. The abducens nucleus would be most affected by a brainstem lesion at:
a. pons
b. mid-brain
c. medulla
d. foramen magnum
e. optic chiasma
ANSWER: A

15. Horner’s syndrome is characterized by:

a. Enopthalmos and Mydriasis
b. Enopthalmos and Miosis
c. Exopthalmos and Miosis
d. Lagopthalmos
e. Relative Afferent Pupillayy defect
ANSWER: B

16-Inferior right sided-quadrantic visual field defect occurs due to a lesion in:
a) Right temporal lobe.
b) Left temporal lobe.
c) Left lateral geniculate body.
d) Right parietal lobe.
e) Left parietal lobe.
Answer: E.

17-Adies tonic pupils is caused by a lesion affecting:

a) The pretectal nucleus.
b) The long ciliary nerves.
c) The ciliary ganglion.
 d) The Edinger-Westphal nucleus.
e) The dorsal midbrain.
Answer: C.

18-Regarding Horner syndrome, which of the following is true:

a) Post ganglionic causes include lung Pancoast tumor.
b) Preganglionic causes including cavernous sinus thrombosis.
c) The pupil will show relative afferent pupillary defect.
d) Both pupils are of equal size.
e) There is anisocoria with miosis on one side.
Answer: E.

19-Unilateral dilatation of the pupil occurs in: D

a) Adies pupil
b) Horner’s pupil
c) Argyll Robertson pupil
d) Pontine hemorrhage
e) Instillation of pilocarbine eye drops
20-which of the following field defects do pituitary gland tumours produce? B
a) Unilateral field defect
b) Bitemporal hemianopia
c) Homonymous hemianopia
d) Altitudinal field defect
e) Tubular vision
21-A diabetic patient aged 55 years presented with binocular diplopia. The
diagnostic test is: C
a) Refraction
b) Intraocular pressure
c) Ocular motility
d) Visual acuity
e) Corneal sensation

Trauma

1-Antidote for ocular injury by lime is:

A-aniline dyes
B-starch
C-EDTA
D-Alcohol 10%
E-milk
Answer c
2-UVR injury to eye may be complicated by:
A-Punctate corneal epithelial erosions
B-IOP elevation.
C-macular hge.
D-Amblyopia
E-Keratectasia
Answer a

3- Infrared rays injury to eye may be complicated by:

A-Punctate corneal epithelial erosions
B-Cataract
C-Solar retinopathy
D-pupillary block
E-Keratoconus
Answer b

4- In blow out fracture the commonest bone to fracture is

a. maxillary (floor)
b. zygomatic (lateral wall)
c. lachrymal (medial wall)
d. frontal (roof)
e. ethmoidal (medial wall)
ANSWER: A

5- The first line of treatment in chemical injury is

a. topical steroids
b. topical antibiotics
c. topical cycloplegia
d. neutralization of pH by irrigation
e. oral analgesia
ANSWER: D

6-Manifestaions of Siderosis bulbi due to IOFB include:

A-Sun flower cataract
B-Kayser-Fleisher ring
C-Krukenberg spindle
D-Seclussio-pupillae
E-Liver cirrhosis

7-Manifestaions of Chalcosis include:

A-Snow flake cataract
B-Kayser-Fleisher ring
C-Krukenberg spindle
D-central corneal thining
E-Heterochromia irides
Answer b
8. Commotio retinae is seen after:

a. Ocular trauma

b. Papilledema

c. Central retinal vein thrombosis

d. Central retinal artery thrombosis

e. Retinal detachment

ANSWER: A

9. Best management for rupture globe:

a. Systemic antibiotics

b. Patching and topical antibiotics

c. Follow up after 2 days

d. Hospital admission and primary repair

e. Evisceration

ANSWER: D

10. A patient had blunt trauma with tennis ball and having hyphema, which is

a. Pus in anterior chamber

b. Foreign body in anterior chamber

c. Blood in Vitreous cavity

d. Blood in anterior chamber

e. Cells in anterior chamber

ANSWER: D

11. Vossius ring is found in

a. Iridodyalisis.
b. Corneal foreign body.
c. Corneal blood staining
d. Traumatic cataract.
e. Berlins edema.
Answer d

12-Photophthalmia occurs secondary to ocular exposure to:

a) Solar rays by looking directly in the sun.
b) Ultraviolet rays from welding arcs.
c) Microwave rays.
d) Infrared waves in glass blowers.
e) Visual display units and TV sets.
Answer: B

13-Emmergency treatment for a case of chemical ocular exposure to a household

detergent is:
a) Topical steroid eyedrops.
b) Topical lubricant eyedrops.
c) Systemic analgesics.
d) Immediate copious irrigation with plain water or normal saline.
e) Topical antibiotic eyedrops.
Answer: D

14-Regarding sympathetic ophthalmia, which of the following is correct:

a) It never occurs during the 1st year following trauma to the exciting eye.
b) Usually complicates a non-perforating ocular trauma.
c) The sympathizing eye will show signs of previous ocular injury.
d) There is bilateral diffuse panuveitis.
e) Evisceration of the injured eye can prevent sympathetic ophthalmia.
Answer: D

15-A patient sustained an injury to his left eye with a tennis ball and presented to
the emergency with progressive proptosis, intense eyelids with high IOP and loss
of vision to the left eye. Which of the following is the etiology for his
presentation:
a) Rupture globe.
b) Blow out fracture.
c) Fracture base of the skull.
d) Retrobulbar hemorrhage.
e) Hyphema.
Answer: D.

16-Complications of Hyphema include:

a) Corneal blood staining.
b) Hypotony. Comment [h1]:

c) Secondary cataract.
d) Kyser-Fleisher ring.
e) Heterochromia iridis.
Answer: A
17-A patient had a penetrating injury in the cornea, the first aid management is:
A
a) Sterile bandage application
b) Washing with tape water
c) The application of eye ointment
d) The instillation of atropine drops
e) Ultrasonography
18-A patient had a blunt trauma to his left eye followed by double vision that
disappears on covering the left eye only. The search for the etiology would be in:
C
a) The angle of the anterior chamber
b) The extraocular muscles
c) The retina
d) The iris
e) The visual cortex

19. The major concern about vitreous detachment that it will lead to

a. retinal break (tear or hole) and detachment

b. retinal neovascularization.

c. vitreous bleeding.

d. macular degeneration

e. choroidal detachment.

Answer.a retinal break (tear or hole) and detachment.

20. Hyphaema:

a. is a layer of white blood cells in the inferior anterior chamber

b. is managed with oral NSAIDs.

c. may be associated with traumatic iritis

d. should be immediately surgical evacuated.

e. irrigation with copious water should be done.

Answer: c: may be associated with traumatic iritis

21.In a patient with 3rd cranial nerve palsy.Which of the following statements are
false about 3rd cranial nerve palsy?

a.ipsilateral ptosis.

b.Ipsilateral abduction limitation

c.Ipsilateral abduction and supraduction limitation

d.Ipsilateral Infraduction limitation .

e.mydriasis .

Answer:b. Ipsilateral abduction limitation