Correlative Study Questions

1. The leading cause of blindness in working-age Americans is:

a.  Hypertensive retinopathy.
b.  Optic neuritis.
c.  Corneal scarring caused by contact lenses.
d.  Complications from radial keratotomy.
e.  Diabetic retinopathy.

2. The uveal tract consists of:

a.  Iris, ciliary body and choroid.
b.  Iris, choroid and lens.
c.  Choroid, retina and optic nerve.
d.  Cornea, iris and sclera.
e.  Choroid, sclera and extraocular muscles.

3. Which of the following does not happen when we shift our gaze from a distant object to a near object?

a.  The lens becomes more rounded.
b.  The pupils constrict.
c.  The eyes converge.
d.  The lateral rectus muscle of each eye contracts.
e.  The medial rectus muscle of each eye contracts.

4. Which of the following statements regarding the retina is correct:

a.  Cone photoreceptors are responsible for black and white vision.  They function primarily in dim light.
b.  The photoreceptors in the foveola are all rods.  
c.  The nerve fiber layer is formed by the axons of the ganglion cells.  
d.  "Ora serrata" is another name for the optic disc.  
e.  The macula is easily identified histologically by the complete absence of ganglion cell nuclei.

5. Which of the following statements is false?

a.  In myopia (nearsightedness), light rays are brought to focus in front of the retina.  
b.  Accommodation is made possible by the fact that the cornea is readily able to 
change its shape when acted upon by the ciliary muscle.
c   Presbyopia is an age-related problem manifested by progressive difficulty in focusing on near objects.
d.  The structures of the eye which focus light rays are the cornea and the lens.
e.  The image that forms on the retina is inverted.

6. Which of the findings below may be seen in hypertensive retinopathy:

a.  Arteriolar narrowing.
b.  Flame-shaped retinal hemorrhages.
c.  Cotton-wool spots.
d.  Constriction of veins by arterioles at crossing points.
e.  All of the above.

7. The term "papilledema" refers to:

a.  Large papillae on the palpebral conjunctiva seen in allergic conjunctivitis.
b.  Pallor of the optic disc seen in patients with advanced glaucoma.
c.  A remnant of the hyaloid artery attached to the optic disc.
d.  Tumor nodules on the iris.
e.  Swelling of the optic disc caused by increased intracranial pressure.

8. A patient presents to the Emergency Department with sudden, painless loss of vision in one eye.  Your ophthalmoscopic exam reveals a diffusely pale retina, attenuated arterioles and a central cherry-red spot.  First on your list of differential diagnoses would be:

a.  Diabetic retinopathy.
b.  A compressive lesion in the optic chiasm.
c.  Sickle cell retinopathy.
d.  Central retinal artery occlusion.
e.  Hyperthyroidism.

9. Ocular manifestations of AIDS may include:

a.  Scattered cotton-wool spots on fundus exam.
b.  Cytomegalovirus retinitis.
c.  Herpes zoster ophthalmicus.
d.  Kaposi's sarcoma of the eyelid or conjunctiva.
e.  All of the above.

10.Which of the following is not included in the staging of Graves' Ophthalmopathy?

a.  Rapid, uncontrollable blinking.
b.  Proptosis.
c.  Extraocular muscle involvement.
d.  Corneal involvement.
e.  Sight loss due to optic nerve involvement.

11.Which of the findings below would you expect to see in non-proliferative diabetic retinopathy (NPDR)?

a.  Pus in the vitreous.
b.  Intraretinal hemorrhages and hard exudates.
c.  Occlusion of the central retinal artery.
d.  Malignant tumors of the choroid.
e.  Cytomegalovirus (CMV) infection of the retina.

12. Which of the statements below regarding proliferative diabetic retinopathy (PDR) is false?

a.  Neovascular fronds can create serious problems by bleeding into the vitreous.
b.  Neovascularization can occur on the iris.
c.  Fibrous proliferation can result in retinal detachment.
d.  PDR is treated with high doses of oral steroids.
e.  The prevalence of PDR is related to the duration of diabetes and the patient's age at the time of diagnosis.

13. Which statement regarding diabetic eye disease is correct?

a.  Macular edema is a harmless condition which does not affect vision.
b.  Diabetic retinopathy can worsen rapidly during pregnancy.
c.  Good glucose control is of no importance in the progression of the disease.
d.  Hard exudates are signs of bacterial infection of the retina.
e.  Normal retinal vessels leak fluid, diseased ones do not.

14. The detection and follow-up of diabetic retinopathy is facilitated by all the modalities below except:

a.  CT scans of the orbits.
b.  Referral of diabetic patients to ophthalmologists.
c.  Dilated ophthalmoscopy.
d.  Fundus photography.
e.  Fluorescein angiography.

15. Which of the following statements regarding the treatment of diabetic retinopathy is correct?

a.  Panretinal photocoagulation (PRP) requires a patient to be admitted to the hospital for two days.
b.  Proliferative diabetic retinopathy (PDR) is best treated with a combination of topical vasoconstrictors and antihistamines.
c.  Multivitamins are useful in reversing neovascularization.
d.  Macular edema is usually treated with focal laser photocoagulation to seal off leaking microaneurysms.
e.  In a vitrectomy, the diseased vitreous is evacuated and replaced with vitreous from a cadaver eye.

16. The most common type of glaucoma in the United States is:

a.  Congenital glaucoma.
b.  Primary open angle glaucoma.
c.  Glaucoma secondary to ocular trauma.
d.  Acute angle closure glaucoma.
e.  Glaucoma caused by a tumor within the eye.

17. Which of the statements below is false?

a.  Primary open angle glaucoma is often asymptomatic in the early stages.
b.  Glaucoma is more prevalent in African-Americans than in Caucasians.
c.  Aqueous humor is normally drained into the tear film.
d.  A family history of glaucoma is an important risk factor.
e.  Patients are usually not aware of early glaucomatous visual field loss.

18. Which of the findings below could indicate glaucoma?

a.  Asymmetry of optic disc cupping between the two eyes.
b.  Papilledema.
c.  Myelinated nerve fibers close to the optic disc.
d.  Areas of scarring adjacent to the disc.
e.  Hard exudates scattered in the macula.

19. Regarding acute angle closure glaucoma:

a.  Most attacks are painless.
b.  The anterior chamber of an affected eye is usually very deep.
c.  The intraocular pressure is usually only minimally elevated.
d.  Laser iridotomy is generally effective in relieving pupillary block.
e.  Angle closure glaucoma is not considered to be an emergency.

20. Regarding glaucoma treatment:

a.  The goal of treatment is to reduce the intraocular pressure in order to prevent further visual loss.
b.  Beta blockers lower intraocular pressure by decreasing aqueous production.
c.  Patients who do not respond to medications may need laser or surgery.
d.  Glaucoma medications may produce significant systemic side effects.
e.  All of the statements above are true.

21. During your evaluation of a patient with conjunctivitis, you suspect you are dealing with a viral infection.  Which of the findings below would be most helpful in confirming your suspicion?

a.  Dandruff-like scales on the eyelashes.
b.  Total loss of vision in the involved eye.
c.  A palpable preauricular lymph node.
d.  A thick, purulent discharge.
e.  Unilateral proptosis and pain on eye movement.

22. Which of the statements below is false?

a.  Normal tears possess both lubricating and bacteriostatic properties.
b.  Tears are essential for maintaining a healthy cornea and conjunctiva.
c.  Common "dry eye" symptoms include burning, foreign body sensation and reflex tearing.
d.  Exposure keratitis can result from incomplete lid closure during sleep.
e.  None of the above.

23. Which of the following statements regarding iritis is false?

a.  Common symptoms of acute iritis include pain, photophobia and decreased vision.
b.  The term "iritis" refers to inflammation of the cornea.
c.  The conjunctiva may show a pattern of circumcorneal redness.
d.  Iritis may be associated with a variety of systemic inflammatory conditions.
e.  Complications of iritis include glaucoma and cataract formation.

24. Potential side effects of topical steroids include:

a.  Enhanced corneal penetration of Herpes virus.
b.  Elevation of intraocular pressure.
c.  Cataract formation.
d.  Potentiation of fungal corneal ulcers.
e.  All of the above.

25. A 28 year-old male presents to your medicine clinic for an insurance H & P.  He asks you about a small, firm, painless subcutaneous nodule near the margin of the right upper lid which arose about two weeks ago.  His vision is normal and neither the eye nor the lid is inflamed.  The past ocular history is positive only for an occasional stye.  The most likely diagnosis is:

a.  Squamous cell carcinoma.
b.  Embedded foreign body.
c.  Chalazion.
d.  Orbital cellulitis.
e.  Obstructed nasolacrimal duct.

26. Which of the following statements about blepharitis is false?

a.  Blepharitis is typically classified as Staphylococcal, seborrheic or mixed.
b.  Common symptoms include foreign body sensation, burning and "mattering" of the lids and lashes.
c.  Signs of Staphylococcal blepharitis include lid crusting, redness and loss of lashes.
d.  Treatment of Staphylococcal blepharitis consists of using warm compresses, cleaning the lids  and lashes with baby shampoo and a 2 - 3 week course of antibiotic ointment applied to the lid  margins.
e.  Blepharitis is a common cause of glaucoma.

27. All of the following statements regarding chemical burns are correct except:

a.  Chemical burns are ocular emergencies.
b.  Alkali burns tend to be more serious than acid burns.
c.  Initial treatment of chemical burns consists of packing the eye with alcohol-soaked cotton  swabs.
d.  Late effects of alkali burns can include corneal melting and glaucoma.
e.  If possible, the involved eye should be irrigated by the patient before coming to the Emergency Department.

28. Which statement regarding bacterial conjunctivitis is false?

a.  Common causative agents in adults in adults include Staphylococcus and Streptococcus.
b.  Pseudomonas and gonococcus infections typically have a very mild, slow course.
c.  Bacterial conjunctivitis tends to produce a purulent discharge.
d.  Corneal opacification may be a sign of an associated keratitis or corneal ulcer.
e.  Mild, uncomplicated cases of conjunctivitis may be treated with topical antibiotics by the primary care physician.

29. Which of the following statements is correct?

a.  Contact lens overwear may result in a corneal abrasion.
b.  A fine, branching lesion in the cornea (dendrite) is the classic sign of Pneumococcal keratitis.
c.  Topical anesthetics may be used by patients as often as needed for pain control.
d.  Type II Herpes virus is a more common cause of keratitis than Type I.
e.  The term "hyphema" refers to pus inside the anterior chamber.

30. For an uncomplicated corneal abrasion in a healthy patient with no other ocular disorders, which course of management is most appropriate?

a.  Cycloplegic eye drop, antibiotic ointment & pressure patch.
b.  Systemic antibiotics and pilocarpine to constrict the pupil.
c.  Topical anesthetics every 2 - 3 hours.
d.  Hard contact lens.
e.  Daily steroid injections under the conjunctiva.