ICO Advanced 115 MCQs 2015-2019

ICO ADVANCED MCQs 3/2020
CATARACT AND LENS
1) Regarding intraoperative management of astigmatism during cataract surgery:

a. 2 mm corneal incisions are astigmatically neutral.
b. Against the rule astigmatism should be undercorrected.
c. Limbal landmarks should be marked with the patient erect.
d. Toric lenses cannot be used to treat more than 7 D of astigmatism.
e. 3.2 mm corneal incisions are astigmatically neutral.
Answer: (c)
2) You are a cataract surgeon performing a phacoemulsification under eye topical anesthesia
on a myopic patient with hard nuclear sclerosis. A small tear in the posterior capsule occurs
and much of the nucleus falls back into the posterior segment, out of view. Which of the
following would be the best course of action:
a. To convert to be a general anesthetic and call a vitreoretinal surgeon immediately.
b. To perform an anterior vitrectomy, close the wound and later refer to a vitreoretinal
surgeon.
c. Attempt to quickly retrieve the fragment from the vitreous.
d. Immediately terminate the case.
Answer: (b)
3) Regarding the use of femtosecond laser for cataract surgery:

a. It is especially useful for reducing phacoemulsification power needed in cases of mature
dense cataract.
b. It is particularly helpful for centering the rhexis in cases of corneal scarring.
c. It is particularly helpful for small pupil cases.
d. The order of performing the three main steps is as follows: first, anterior capsulotomy;
second, lens fragmentation and or liquefaction; and third, the corneal incisions.
e. The first step is corneal incision.
Answer: (d then a)
4) Regarding cataract surgery for patients with diabetes mellitus (DM):

a. Diabetic retinopathy (DR) must always be treated before cataract surgery is undertaken.
b. Elevated blood sugar on the day of surgery is a contra-indication to proceeding.
c. Pupil dilation may be reduced.
d. Uncomplicated cataract surgery is a proven independent risk factor for progression of
diabetic retinopathy.
Answer: (c)
(1)
5) Regarding biometry formulae for particular groups of patients:
a. Axial length 22-26 mm and Haigis.
b. Axial length greater than 26 mm and Hoffer Q.
c. Axial length less than 22 mm and SRK/T.
d. Previous refractive surgery and Haigis L.
Answer: (d)
6) While performing quadrant removal during phacoemulsification, it is difficult to engage the first
quadrant. What measure would be most likely to help:
a. Increase infusion pressure to anterior chamber.
b. Increase the vacuum setting in the machine.
c. Perform hydro-dissection again.
d. Occlude the phaco-tip with a piece of the nucleus.
Answer: (d)
7) A 75 year old patient presents with a painful right red eye and hypopyon 3 days after right
cataract surgery with best corrected visual acuity (BCVA) of light perception (PL) Which is the
most appropriate management:
a. Anterior chamber (AC) tap.
b. Pars plana vitrectomy (PPV).
c. Systemic antibiotics.
d. Vitreous tap and intravitreal antibiotics.
Answer: (d)
8) Regarding manual small incision cataract surgery (MSICS), which is the preferred incision:
a. Superior corneal tunnel incision parallel to the limbus.
b. Superior scleral tunnel incision with the center of the arc shaped incision closest to the
limbus (frown).
c. Superior scleral tunnel incision with the center of the arc shaped incision furthest to the
limbus (smile).
d. Temporal corneal tunnel incision parallel to the limbus.
Answer: (b)
9) Systematic review of studies comparing monofocal lens implants with multifocal lens implants
reveals which ONE:
a. Better unaided distance visual acuities in the monofocal group.
b. Higher incidence of haloes (rings round lights) in the multifocal group.
c. No differences in contrast sensitivity between the 2 groups.
d. No difference in rates of total freedom from glasses between the 2 groups.
Answer: (b)
(2)
10) Regarding the global burden and management of cataract and WHO definitions and figures:
a. Cataract is the leading cause of blindness but not visual impairment.
b. Cataract causes approximately 10% of the global burden of visual impairment.
c. Cataract is the leading cause of visual impairment but not blindness.
d. Cataract surgical rate is defined as the number of people operated on for cataract per
million population per year.
Answer: (a)
11) Regarding associations between following conditions and cataract morphology:

a. Amiodarone is associated with anterior subcapsular cataract.
b. Downs syndrome is associated with lamellar cataract.
c. Myotonic dystrophy is associated with sunflower cataract.
d. Wilson's disease is associated with Christmas tree cataract.
Answer: (a)
12) Regarding microspherophakia:

a. Associated pupillary block glaucoma should be treated with miotics.
b. It can be autosomal recessive disorder.
c. It is associated with hyperopia.
d. It is associated with long stature and hyperextensible joints.
Answer: (b)
13) Regarding Phacoemulsification:

a. If the capsulorhexis is lost or converted to a 'can opener' technique, divide and conquer
fragmentation of the nucleus is preferable to chopping.
b. Using a persistaltic system, the vacuum response time is relatively slow compared to a
venturi system.
c. When using burst mode, maximal depression of the foot pedal causes continuous mode.
d. Whichever pump system is used, the vacuum rise time is directly proportional to the
aspiration flow rate.
Answer: (c)
14) Regarding intra-ocular lens implant (IOL) materials:

a. Acrylic lenses are more often associated with anterior capsular phimosis than silicone
lenses.
b. Blue light filtering IOLs may have theoretical benefits for scotopic vision.
c. Blue light filtering IOLs may have theoretical protective effects against photoxicity.
d. Hydrophilic lenses have higher refractive indices than hyrdrophobic.
Answer: (c)
(3)
15) Which ONE is not a risk factor of nuclear cataract:
a. Diabetes Mellitus (DM).
b. Female.
c. Hypertension (HTN).
d. Ethnicity.
Answer: (b)
16) Regarding multi central trial on IOL vs. CL of pediatric groups (Infant aphakia treatment study
– IATS):
a. Re-operate after 1 year is higher in the IOL group.
b. Vision after 1 year is better in the IOL group.
c. Vision after 5 years is better in the IOL group.
d. Reduced post-operative glaucoma in the IOL group.
Answer: (a)
17) PMMA Lens irrigation prior to implantation due to:

a. To be more slippery.
b. To clean it.
c. To be easily injectable inside the eye.
d. To remove static charge.
Answer: (d)
18) In a child with previously cataract surgery, the rate of refractive growth depends on:
a. Age at which cataract surgery done.
b. Visual acuity.
c. IOL vs. Contact Lens.
d. Controlled glaucoma.
Answer: (a)
(4)
19) Figure showing pseudoexofilation syndrome (PEX):
a. Iris hooks can be used for anterior lens capsule if zonular dialysis is noted.
b. Modern phacoemulsification can be done safely.
c. Incidence of glaucoma is 70%.
d. Post operative complication rate is less than normal cataract surgery.
e. No risk of sublaxated or dislocated IOL postoperatively.
Answer: (a)
• Figure with superior iris traction and AC IOL (near to this figure but more clear cornea).
20) The iris shape is due to:

a. The foot plate of the IOL is pushing the iris upwards.
b. Complicated PHACO surgery and PCR.
c. The posterior chamber IOL has luxed into the anterior chamber.
d. Vision will be poor.
Answer: (a or b)
21) Management to be done:

a. Peripheral Iridotomy/Surgical iridectomy to be done.
b. This is due to the IOL type, should not be implanted.
c. This is IOL implanted in posterior chamber then displaced to anterior chamber
d. ………………………….
Answer: (a)
(5)
22) During phacoemulsification surgery, the surgeon notices that the capsulorhexis is extending
to the periphery. What best to be done:
a. Check positive vitreous pressure and release external pressure.
b. Inject viscoelastic into the anterior chamber.
c. …………………….
d. All of the above.
Answer: (d)
23) Regarding cataract surgery in an eye with axial length of 21 mm:

a. Peribulbar anesthesia is safer than topical anesthesia.
b. Haigis formula uses AC depth for IOL power calculation.
c. Sclera thickness increases.
d. ………………………………..
Answer: (b)
24) Regarding cataract surgery in an eye had previous vitrectomy:

a. Lower incidence of cystoid macular edema.
b. Increase incidence of intraoperative collapse.
c. Increase incidence of zonular dehiscence.
d. ………………………………..
Answer: (c)
25) Regarding small incision cataract surgery (SICS):

a. The Inner incision/tunnel (corneal) should be wider than the outer (Scleral).
b. Temporal SICS associated with increased risk of endophthalmitis.
c. …………………………………………………………………………………
d. …………………………………………………………………………………
Answer: (a)
(6)
CORNEA AND EXTERNAL DISEASES / REFRACTIVE SURGERY
• .
26) Regarding the corneal transplant for scarring due to the condition illustrated in the Figure 6:
a. Oral antivirals are generally taken for 1 months after surgery.
b. Oral antivirals taken post-operatively have no effect in decreasing graft failure.
c. Oral antivirals taken post-operatively have no effect in recurrence of disease.
d. This is the most common infective cause of corneal transplant in higher income countries.
Answer: (d)
27) Regarding the condition illustrated in Figure 6, systemic review of treatment trials suggest
which of the following:
a. Acyclovir is more effective than ganciclovir.
b. Acyclovir is more effective than idoxuridine.
c. Idoxuridine is more effective than trifluridine.
d. Trifluridine is more effective than acyclovir.
Answer: (b)
28) The cornea with neovascularization – illustrated in the figure – is treated with needle cautery
ablation, which is true:
a. It is more effective when combined with subconjunctival anti-vascular endothelial

growth factor (anti-VEGF ) injection.
b. It should be tried after a patient starts to have steroid related side effects.
c. It is unlikely to induce corneal astigmatism.
d. Nd:YAG laser treatment is an alternative.
Answer: (a)
(7)
29) Which is the procedure of of this pentacam:
a. Radial keratotomy.
b. Corneal ring.
c. LASIK ablation.
d. Hypermetropic correction.
Answer: (b)
30) Collagen cross linking (CXL) with riboflavin activated by ultraviolet A treats keratoconus by
which mechanism:
a. Activating collagen synthesis by keratocytes.
b. Causing epithelial stem cell proliferation.
c. Stimulating the endothelial proton pump.
d. Strengthening stromal collagen bonds.
Answer: (d)
31) Regarding collagen cross linking:

a. Accelerated technique acts on stroma near endothelium.
b. Use of riboflavin is to act on anterior stroma.
c. It only retards progression but does not improve the existing corneal curvature.
d. It does not affect the mechanical stability of the cornea.
Answer: (b)
32) The higher incidence of glaucoma is with:

a. Superficial lamellar keratoplasty.
b. Deep lamellar keratoplasty (DLK).
c. Penetrating keratoplasty (PKP)
d. Endotheilal transplant.
Answer: (c)
(8)
33) Which is most likely to be an advantage of DMEK (Descemet's membrane endothelial
keratoplasty) over DSAEK (Descemet's stripping endothelial keratoplasty) :
a. Better post-operative visual acuity.
b. Less endothelial detachment rate.
c. Lower intra-operative endothelial cell loss.
d. Technically easier unfolding in the anterior chamber.
Answer: (a)
34) Regarding comparing DALK (deep anterior lamellar keratoplasty) to PKP (penetrating
keratoplasty):
a. DALK has a higher incidence of post-operative complications than PK.
b. DALK has an increased risk of endothelial rejection compared to PK.
c. DALK has better best corrected visual acuity results than PK.
d. Endothelial cell loss is greater following PK than DALK.
Answer: (d)
35) Regarding the steroid for corneal ulcer trial (SCUT):

a. Severe corneal ulcers are more likely to benefit from steroids.
b. Steroids are associated with better visual acuities at 3 months.
c. Steroids are associated with a higher rate of corneal perforation.
d. Steroids are associated with a rise in intraocular pressure.
Answer: (a)
36) Regarding the mycotic ulcer treatment trial (MUTT):

a. The difference between the outcomes in the 2 treatment groups was accounted for by
the fusarium subgroup.
b. Topical treatment was given hourly for one week and then four times per day.
c. Voraconazole treatment resulted in better visual acuities at 3 months.
d. Voraconazole treatment resulted in fewer corneal perforations.
Answer: (a)
37) Regarding herpes simplex virus epithelial keratitis, which is the most effective treatment:
a. Epithelial debridement.
b. Idoxuridine.
c. Trifluridine (Trifluorothymidine).
d. Vidarabine.
Answer: (c)
(9)
38) Classic epidemic keratoconjunctivitis (EKC) is typically caused by:
a. Enterovirus type 70.
b. Adenovirus types 3 and 7.
c. Newcastle virus.
d. Adenovirus types 8 and 19.
Answer: (d)
39) Regarding pellucid marginal degeneration:

a. Inferior thinning is usually detectable before central corneal flattening.
b. It occurs more commonly in females.
c. Presenting age is usually 40-60 years.
d. Thinning typically occurs in an arcuate band of 1-2 mm between 4 and 8 o'clock.
Answer: (d)
40) Regarding cystinosis:

a. End stage renal failure develops by the age of 50.
b. It is inherited in an autosomal dominant pattern.
c. Oral cysteamine inhibits accumulation of corneal deposits.
d. Topical cysteamine inhibits accumulation of corneal deposits.
Answer: (d)
41) Regarding corneal transplant:

a. 5 year survival rate for penetrating keratoplasty for keratoconus is approximately 90%.
b. 5 year survival rate for penetrating keratoplasty for pseudophakic bullous keratopathy is
approximately 90%.
c. 5 year survival rates for repeat penetrating keratoplasty is approximately 20%.
d. Artificial corneas are now the preferred treatment for patients who have already failed
with conventional corneal transplant.
Answer: (a)
42) Regarding trials comparing treatment of moderate to high myopia with phackic intra-ocular
implants (IOLs) versus excimer laser:
a. Contrast sensitivity was better with phakic IOL compared with excimer.
b. Patients prefer excimer laser over phakic IOL.
c. Phakic IOLs achieved significantly higher rates of unaided visual acuities of logMAR 0.0
(Senellen 6/6, 20/20, decimal 1.0).
d. Risk of loss of best spectacle corrected visual acuity at 12 months was higher with phakic
IOL than excimer.
Answer: (a)
(10)
43) In normal cornea, MHC class-2 expression in:
a. Langerhans cells.
b. Descemet's.
c. Epithelium.
d. Endothelium.
Answer: (a)
44) Figure of corneal infection of acanthamoeba:

a. Common species are castellanii.
b. Not isolated from anywhere other than eye.
c. Acquiring the condition from contact of cystic form.
d. Contact lens wear is related less strongly to bacterial keratitis than this infection.
Answer: (a)
45) Regarding pre-operative evaluation of cornea in cataract surgery:
a. Corneal pachymetry should be performed late in the day, after the cornea has had
longer exposure to the environment.
b. In the presence of guttae, cataract surgery should be combined with corneal transplant
for speedy visual rehabilitation.
c. Norma corneal pachymetry measurements obtained in the early morning suggest that
the cornea will probably remain clear following the cataract.
d. Specular microscopy is the best means to predict how the cornea will respond post-
operatively.
Answer: (d)
46) Regarding LASIK metanalysis:
a. Less than 95% of patients were satisfied with their correction.
b. More than 95% of eyes were within ±1.00 D of their target 1 year postoperatively.
c. Corneal sensation lost but early nerve regains.
d. Holes persists despite modern methods.
Answer: (b)
47) Regarding SMILE vs. LASIK:
a. In SMILE corneal sensations are preserved as compared to LASIK.
b. We use femtosecond laser with SMILE to make lenticule.
c. ………………………………………………………………..
d. ………………………………………………………………..
Answer: (b)
(11)
48) Figure of DSAEK detachment, management of complication:
a. Fill air.
b. Fill OVD.
c. Intensive steroid.
d. …………………..
Answer: (a)
49) Figure of peripheral ulcerative keratitis (PUK), What is the management:

a. Topical steroids.
b. Oral steroids.
c. IV steroids.
d. …………….
Answer: (a)
50) Rapid method to diagnose acanthameba:

a. PCR.
b. Confocal microscopy.
c. Culture.
d. ………..
Answer: (b)
51) Regarding peripheral ulcerative keratitis (PUK), Which oral drug used to prevent
complications:
a. Cephalosporin.
b. Fluoroquinolones.
c. Tetracycline.
d. ………………..
Answer: (c)
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GLAUCOMA
52) Which of the following situations to be associated with the complications of glaucoma
drainage surgery shown in the figure:
a. Hypermetropia.
b. Low post-operative intraocular pressure (IOP).
c. Use of 5-fluorouracil (5FU) rather than mitomycin C (MMC).
d. Young age.
Answer: (b)
53) Which is the best management for the situation illustrated in the figure:
a. Conjunctival suturing.
b. Observation with topical antibiotics.
c. Removal of the device and proceed to trabeculectomy surgery.
d. Repair with a patch graft of donor sclera.
Answer: (d)
(13)
54) Figure 7 shows a slit lamp photograph of patient's right anterior segment:
a. Affected eyes often have darker appearing irides.

b. Around a quarter of patients will develop glaucoma.
c. FOX gene mutations are important in the pathogenesis.
d. It is clinically unilateral in the majority of patients at presentation.
Answer: (d)
55) Regarding the appearance shown in Figure 8 during gonioscopy:
a. Schwalbe's line is visible in this photo at the apex of the corneal wedge.
b. The condition associated with this appearance is primarily genetic.
c. There are sign of previous irido-trabecular contact.
d. This appearance is most commonly associated with pigment dispersion.
Answer: (d)
(14)
56) According to this figure (Peripapillary atrophy):
a. Enlarged blind spot.

b. Secondary Glaucoma.
c. Optic disc swelling.
d. Juxtapupillary choroidal neovascular membrane.
Answer: (a)
57) A 35 year-old female had old glaucoma surgery with subtotal optic cupping. She had never
complained of leaking or hypotony before. She went to ophthalmologist with a complaint of
gritty and foreign body sensations. What is your management:
a. Bandage contact lens and lubricants.

b. Double patching of the eye and start acetazolamide 6 hourly for accelerated bleb
closure.
c. Revision of the bleb.
d. Start antibiotic and give her another appointment with informing her when to visit ER if
needed.
Answer: (d)
(15)
58) Regarding the ocular hypertension treatment study (OHTS):
a. Around 50% of ocular hypertensives are at risk of developing glaucoma in 5 years.
b. Central corneal thickness is of importance in assessing intraocular pressure.
c. Having a thick cornea may be a risk factor for developing of glaucoma.
d. Treatment of ocular hypertension may prevent progression of glaucoma.
Answer: (d)
59) Regarding the ocular hypertension treatment study (OHTS):

a. Fewer than 10% of ocular hypertensives are at risk of developing glaucoma over 5 years.
b. Central corneal thickness is of no importance in measuring intraocular pressure.
c. Having a thick cornea may be a risk factor for developing of glaucoma.
d. Treatment of OHT had no benefit in prevention of development of glaucoma.
Answer: (a)
60) Regarding the finding of reduced vascular density in optical coherence tomography (OCTA)
of the optic nerve head in glaucoma:
a. It can be seen before detectable visual field defects.
b. It is less common in the presence of lamina cribrosa defects.
c. It is seen in normal tension glaucoma but not in primary open angle glaucoma.
d. It is seen in primary open angle glaucoma but not in normal tension glaucoma.
Answer: (a)
61) Regarding Neovascular glaucoma (NVG) , which is most likely to be associated:

a. Irido corneal endothelial (ICE) syndrome.
b. Ocular ischemic syndrome (OIS).
c. Uveitis glaucoma hyphema (UGH) syndrome.
d. Vitelliform maculopathy.
Answer: (b)
62) Regarding long-term follow up of visual fields:

a. Agreement on disease progression based on a visual field series is highly concordant
between glaucoma experts.
b. As regions of the visual field become more damaged measurement variability increases
making it more difficult to identify true changes.
c. Fatigue is less important in an experienced patient so near correction is not always
required.
d. Test-retest variability refers to true progression in visual field loss.
Answer: (b)
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63) Regarding the management of an over-draining bleb:
a. A Plamberg (compression mattress) sutures.
b. Botulinum induced ptosis.
c. Pilocarpine drops.
d. Xen implant.
Answer: (a)
64) Regarding acute graft rejection:

a. HLA class II matching is routinely performed in corneal transplantation.
b. It is an example of type 2 hypersensitivity.
c. It is predominantly antibody mediated.
d. It is predominantly cell mediated.
Answer: (d)
65) Regarding the use of cyclodiode laser for ciliary body ablation:
a. Audible pops suggest the need for lower power settings.
b. In uvetic glaucoma, higher power settings are used to fully ablate the ciliary processes.
c. There is a linear relationship between total power used and pressure lowering effect.
d. To be most effective, the laser is focused on the pars plana.
Answer: (a)
66) Regarding the measurement of intraocular pressure (IOP):

a. An increase in corneal thickness of 100 microns increases IOP by 1 mmHg.
b. IOP is always lower when lying down than when standing.
c. IOP levels normally reduce gradually in people over 65 years old.
d. IOP variations are more marked in patients with primary open angle glaucoma (POAG).
Answer: (d)
67) Regarding systematic reviews of evidence for surgical treatment of glaucoma:

a. Viscocanaliculostomy has equivalent pressure lowering effect to trabeculectomy.
b. Randomized controlled trials of tube/valve surgery versus trabeculectomy have shown
higher rates of adverse events following trabeculectomy.
c. There is no clear pressure lowering benefit from using 5 fluorouracil as antifibrotic adjunct
in trabeculectomy (compared to no adjunctive therapy).
d. There is no clear pressure lowering benefit from using beta-radiation as antifibrotic
adjunct in trabeculectomy (compared to no adjunctive therapy).
Answer: (b)
(17)
68) Regarding the evidence for efficacy of medical treatment for glaucoma:
a. Brimonidine has a stronger IOP lowering effect than timolol in normal tension glaucoma.
b. Dorzolamide has a stronger IOP lowering effect than timolol in normal tension glaucoma.
c. Latanoprost has a stronger IOP lowering effect than bimatroprost in primary open angle
glaucoma.
d. Latanoprost is better tolerated than bimatoprost in primary open angle glaucoma.
Answer: (d)
69) Regarding congenital glaucoma:

a. Children may present with sudden onset corneal clouding.
b. Corneal clearing after pressure lowering usually starts in the center of the cornea.
c. It is usually inherited in an autosomal recessive manner.
d. Pathological scleral enlargement ceases after the age of 3 years.
Answer: (a)
70) Regarding pseudoexfoliation (PEX):

a. It's invariable unilateral.
b. It may affects people above 50 years old.
c. Extracellular debris appears only in the eye.
d. Material is derived from lens and not seen in pseudophakia.
Answer: (b)
71) Evisceration is indicated in:

a. Phthisis.
b. Microphthalmia.
c. Trauma one week.
d. Rubeotic glaucoma.
Answer: (d)
72) A 35 year-old male patient, IOP was 42 mmHg unilateral, on examination there was uveitis
and CME. Gonioscopy showed increased pigmentation of the trabecular meshwork and open
angle. What is the management:
a. Peripheral iridotomy.
b. Topical eyedrops.
c. Baerveldt Shunt.
d. Trabeculectomy.
Answer: (b)
(18)
73) Regarding express shunt:
a. Direct shunt from anterior chamber to subtenon space.
b. It is a valve stanless shunt.
c. It is inserted under scleral flap to control hypotony.
d. Studies have shown that it is better than trabeculectomy in lowering IOP.
Answer: (c)
74) Regarding peripapillary nerve fiber layer vascularity by OCTA:

a. Decrease vascular density seen before visual field defect.
b. Less common than presence of lamina cribrosa defect.
c. Seen in NTG not POAG.
d. Seen in POAG not NTG.
Answer: (a)
75) Neovascular glaucoma (NVG) , Most common with:

a. Ocular ischemic syndrome (OIS).
b. Uveitis glaucoma hyphema (UGH) syndrome.
c. Irido corneal endothelial (ICE) syndrome.
d. Vitelliform macular dystrophy.
Answer: (a)
76) Figure showing periorbital and lid pigmentation, side effect of which drug:
a. Pilocarpine
b. Latanoprost
c. Brimonidine
d. Betaxolol
Answer: (b)
77) Regarding primary open angle glaucoma (POAG):

a. 25% caused by specific gene mutation.
b. Earlier/more common in females than males.
c. Lowering IOP to normal may reduce progression of visual field defects.
d. Visual field defect …….
Answer: (c)
78) Regarding primary angle closure glaucoma (PACG):
a. 50% worldwide …. have PACG.
b. Plateau iris is more common in males.
c. ……………………… d. ……………………….
Answer: (?)
(19)
NEURO-OPHTHALMOLOGY
79) A 25 year old man complained of blurred vision. Which of the following observed ophthalmic
abnormalities is most likely indicated the order of the MRI shown in the figure:
a. Downbeat nystagmus.
b. Homonymous hemianopia.
c. Oculomotor (III) cranial nerve palsy.
d. Relative afferent pupillary defect (RAPD).
Answer: (a)
80) An asymptomatic 45 year old woman is referred because work colleagues have noticed
intermittent distortion of her right pupil; she is usually well and on no regular medications.
Examination shows clinically normal pupils, lids, orbits and eye movements, but she is able to
show you a picture on her phone taken (as the figure) when the pupil abnormality was present.
Which is the most likely diagnosis:
a. Fuch’s heterochromic iridocyclitis.

b. Ocular mythenia.
c. Ophthalmoplegic migraine.
d. Tadpole pupil.
Answer: (d)
(20)
81) The visual fields - shown in the figure - show global constriction in the right eye and a
superotemporal scotoma in the left eye (arrows). This combination of field defects is most
likely to be associated with:
a. Chiasmal compression from a craniopharyngioma.

b. Demyelinating plaques in the right optic nerve and the right optic tract.
c. Left sided optic nerve compression from a sphenoid wing meningioma.
d. Right sided anterior chiasmal compression from a pituitary adenoma.
Answer: (d)
82) A 60 year old woman referred from a neurologist with the complaint of intermittent headache
around the eyes which wake her up in the evening for one month. She claims seeing flashing
lights around her eyes and blurred vision sometimes. She never had headache in the past. Her
eye examination was found to be normal by a previous eye doctor. Which is the most
appropriate further examination:
a. Brain MRA.
b. Brain MRI.
c. Gonioscopy.
d. Tear tests.
Answer: (c)
83) Regarding Myelin oligodendrocyte glycoprotein (MOG):
a. Antibodies to MOG are associated with a phenotype involving optic neuritis.
b. Antibodies to MOG are detectable in about 5 % of children with acute demyelination.
c. It is expressed on retinal ganglion cells.
d. MOG is more frequently associated with bilateral optic neuritis than AQP4.
Answer: (a)
(21)
84) Regarding acquired partial third nerve palsies:
a. Diplopia is reported invariably.
b. If the cause is compressive, the pupil will be enlarged.
c. Ptosis with normal pupil and normal ocular motility is a common presentation.
d. The cause may be ischemic.
Answer: (d)
85) Which of the following ocular motor abnormalities is most likely to be associated with
bitemporal defects that are dense inferiorly:
a. Downbeat nystagmus.
b. Exotropia
c. See-Saw nystagmus.
d. Up-gaze palsy.
Answer: (c)
86) Regarding anterior ischemic optic neuropathy (AION):
a. A large cup disc ratio is a risk factor for developing the disease.
b. Approximately 40% of patients experience spontaneous improvement in visual acuity.
c. Pain usually precedes the visual loss.
d. The risk of fellow eye involvement over 5 years is approximately 50%.
Answer: (b)
87) Regarding internuclear ophthalmoplegia (INO):

a. If the cause is ischaemia prognosis for recovery is poor.
b. Bilateral INO is usually associated with convergence weakness.
c. Reduced adducting saccadic velocity is a characteristic sign.
d. Unilateral INO is more likely to be associated with multiple sclerosis than with brainstem
infraction.
Answer: (c)
88) Regarding the findings of a recent multicenter treatment trial for idiopathic intracranial
hypertension for patients with mild visual loss:
a. Oral acetazolaide was shown to be of no additional benefit to a low sodium weight
reduction diet.
b. The most common baseline visual field deficit was an enlarged blind spot.
c. The most common baseline visual field deficit was an inferior partial arcuate deficit
combined with an enlarged blind spot deficit.
d. The most common baseline visual field deficit was a superior partial arcuate deficit
combined with an enlarged blind spot deficit.
Answer: (c)
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89) Regarding the long term outcomes of the optic neuritis treatment trial:
a. In the absence of demyelinating lesions on MRI, initial disc swelling was associated with
lower risk for later development of systemic disease.
b. In the absence of demyelinating lesions on MRI, male sex is a risk factor for later
development of systemic disease.
c. The presence of demyelinating lesions at baseline on magnetic resonance imaging (MRI)
ceases to be a risk factor for developing systemic disease, if it has not developed after 10
years.
d. Visual outcomes were poor in patients who developed systemic disease.
Answer: (a)
90) Regarding the role of a superficial temporal artery biopsy (STAB) in patient with suspected
giant cell (temporal) arteritis (GCA) who has presented with a unilateral ischaemic optic
neuropathy:
a. A negative STAB excludes temporal arteritis.
b. A STAB must be done before starting corticosteroid treatment.
c. Finding multinucleated giant cells in a STAB specimen is not essential to making the
histological diagnosis.
d. If the ESR is over 50 mm/hr, a STAB is not necessary.
Answer: (c)
91) A 40 year old hypertensive man has a twelve month history of excruciatingly severe left sided
pain behind and around the eye. It occurred daily, 1 or 2 times per day. For a few weeks at a
time. The first attack always started before his morning break at 11 am and the attacks lasted
15 to 60 minutes. His eye usually became red and his eye and nose watered and a droopy left
upper lid was occasionally noticed. Occasionally, a similar pain occurred on the right side.
Which ONE of the following is most likely to be TRUE:
a. A functional MRI is likely to show ipsilateral hypothalamic activation.
b. Early stereotactic radiosurgery (gamma knife) of the trigeminal nerve root is indicated.
c. It is likely to be improved by dihydroergotamine (Migranal) taken before the attack.
d. Remissions are usually longer than six months.
Answer: (a)
92) Regarding skew deviation:

a. Because the pathology is supranuclear, the patient does not experience diplopia.
b. The deviation is invariably incomitant.
c. The deviation is usually worse when the patient is supine compared to upright.
d. The hypertropic eye is usually intorted.
Answer: (d)
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93) Differentiation of skew deviation from 4th cranial nerve palsy:
a. Hypertropic eye shows excyclotorsion.
b. Hypertropic eye shows incyclotorsion.
c. Inferior oblique underaction.
d. Inferior oblique overaction.
Answer: (b)
94) The site of lesion that leading to both horner syndrome and 6th nerve palsy:
a. Cavernous sinus.
b. Cerebellopontine angle.
c. Meckel’s fossa.
d. Petrous apex.
Answer: (a)
95) Regarding Wolfram syndrome (DIDMOAD):

a. Diabetes Mellitus occurs before Diabetes Insipidus.
b. Vision is good prognosis.
c. It is an Autosomal Dominant inheritance.
d. It is due to Mitochondrial genome mutation .
Answer: (a)
96) A 60 year-old patient visit ER ophthalmology with sudden loss of vision superior attitudinal
field defect of the right eye, color fundus photo was normal and FFA showing superior disc
later hyper fluorescence. What's the cause of this visual field defect:
a. Hemodialysis.
b. Anemia from sever hemorrhage.
c. Alcohol consumption.
d. Viagra.
Answer: (d)
97) Regarding benign headache in children:

a. Age above 4 years
b. Always unilateral.
c. Increased with coughing and straining.
d. Waking the child from sleep and on early morning.
Answer: (a)
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98) A 65 year-old female with low vertical saccade and difficulty in opening eye, Diagnosis:
a. Hydrocephalus.
b. Pineal tumor.
c. Progressive supranuclear palsy
d. Wilson disease.
Answer: (c)
99) Idiopathic intracranial hypertension (IIH) appears in MRI as:
a. Empty sella.
b. Arachnoid cyst.
c. Chiari malformation.
d. Ventricular enlargement.
Answer: (a)
100) Regarding Adie's Pupil:

a. Slow miosis in convergence.
b. Light reaction present.
c. ……………………………
d. ……………………………
Answer: (a)
101) Marcus Gunn syndrome is a neural misdirection syndrome between which nerves:
a. Trigeminal (V) and Facial (VII).
b. Trigeminal (V) and Oculomotor (III).
c. ……………………………
d. ……………………………
Answer: (b)
102) Regarding traumatic optic neuropathy:

a. It happens in 0.2% of head injury.
b. Optic nerve swelling occurring early.
c. 40-60% spontaneous recovery.
d. …………………………………….
Answer: (c)
103) Figure of visual field defect:
a. Falx Meningioma over Left occipital lobe.
b. Left optic nerve.
c. Left optic chiasm & optic nerve.
d. ……………………………………….
Answer: (?)
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VITREO-RETINAL DISEASES
104) The fluorescein angiogram (FFA) shown in the figure was performed in an 18 month old
boy/girl. Which is the MOST likely reason that the investigation was performed:
a. Clinical suspicion of retinoblastoma.

b. Difficult performing fundoscopy.
c. Family history of Coats' disease.
d. Pigmentary skin rash.
Answer: (d)
105) Regarding the fundus photograph in the figure:
a. It is unlikely to be associated with visual loss.

b. It may be associated with hearing loss.
c. It may be caused by acute pancreatitis.
d. The lesions shown are retinal fat emboli.
Answer: (c)
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106) Regarding fundus photograph in the figure, which is the most likely diagnosis:
a. Choroidal detachment.
b. Exudative retinal detachment.
c. Rhegmatogenous retinal detachment.
d. Tractional retinal detachment.
Answer: (c)
107) The process illustrated in the OCT image in the figure, may lead to the development of
which condition:
a. Cystoid macular edema (CME).

b. Epi-retinal membrane (ERM)
c. Macular hole.
d. Rhegmatogenous retinal detachment (RD).
Answer: (c)
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108) Regarding the condition complicating retinal detachment shown in the figure:
a. It accounts for about a third of primary operative failure.

b. Superior hexafluoride (SF6) is as effective a tamponade as perfluoropropane (CF8) in
grade C or worse.
c. Superior retinectomy is a useful surgical technique for managing this condition.
d. The cumulative risk of developing is 5 - 10% of all retinal detachment repairs.
Answer: (d)
109) Regarding the clinical photograph shown in Figure 12:
a. A giant retinal tear is the most likely cause.

b. A superior retinal tear is the most likely cause.
c. It is likely to be exudative.
d. It shows proliferative vitreoretinopathy (PVR) grade 3.
Answer: (d)
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110) Regarding the syndrome shown in Figure 13:
a. It is likely to be associated with progressive myopia.

b. It is more common in boys.
c. It is usually inherited in an autosomal recessive pattern.
d. Recent evidence suggests that prophylactic retinal cryotherapy or 360 degree laser may
reduce risk of retinal detachment.
Answer: (d)
111) Regarding the fundus picture shown in Figure 15:
a. Compared to no treatment, repeated intravitreal injection of anti-VEGF agentmacular

edema improves visual outcomes at six months.
b. If macular odema is present it should be treated.
c. It affects both eyes in 1-2 % of cases.
d. The condition causes retinal ischaemia in about 50% of cases.
Answer: (a)
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112) Figure of fundus color photo, what is your diagnosis:
a. Clinically significant macular edema (CSME).

b. Gliosis.
c. Papilledema.
d. Optic disc drusen.
Answer: (d)
113) Regarding the figure (exam figure not like this, was in late stage), what is your diagnosis:
a. Macular edema.
b. FAZ enlargement.
c. Evidence of vasculitis.
d. Early A-V filling.
Answer: (b)
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114) Figure of fundus color photo, Diagnosis:
a. Branch retinal vein occlusion (BRVO).

b. Central retinal vein occlusion (CRVO) with cilioretinal artery occlusion,
c. Vasculitis.
d. Toxoplasma chorioretintis.
Answer: (b)
115) Figure of FFA, A 70 year-old vision complains from sudden reduction of vision:
a. Choroidal hemangioma.
b. Choroidal melanoma.
c. Retinal pigment epithelium (RPE) hyperplasia.
d. Retinal pigment epithelium (RPE) tear.
Answer: (d)
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116) 2 figures of fundus, one adapted to light and the other adapted to dark (Mizuo-Nakamura
Phenomenon (Oguchi disease), Associated with:
a. Autosomal dominant (AD) inheritance.

b. Nyctalopia.
c. Decreased Visual acuity.
d. Progressive.
Answer: (b)
117) Fundus color photo showing choroidal hemangioma (tomato ketchup sign):
a. Sturge-Weber syndrome (SWS).

b. Wyburn-Mason syndrome (WMS).
c. Neurofibromatosis type 1 (NF-1)
d. Neurofibromatosis type 2 (NF-2).
Answer: (a)
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118) Figure of fundus color photo of 50 year-old male patient with bilateral floaters and mild
visual loss, examination showed mild vitritis, what is the diagnosis:
a. Disseminated drusen.
b. Hypertensive retinopathy.
c. Birdshot retinochoroidopathy.
d. Multiple evanescent white dot syndrome.
Answer: (c)
119) A presentation of bilateral blurred vision with floaters and photopsia with vitritis and positive
HLA-A29 is most likely to be:
a. Acute zonal occult outer retinopathy.
b. Ankylosing spondylitis.
c. Behcet's uveitis.
d. Birdshot retinochoroidopathy.
Answer: (d)
120) Regarding the diabetic retinopathy vitrectomy study (DRVS):

a. At 4 year follow up, the visual benefit had disappeared.
b. The benefit was greater for patients with type 2 diabetes.
c. No benefit was demonstrated from early vitrectomy for patients with active fibrovascular
proliferation and useful vision.
d. Visual benefit for early versus deferred vitrectomy was demonstrated for patients who
had vitreous haemorrhage of more than one month's duration and a visual acuity of
logMAR 1.6 (Snellen 6/240, 5/200, decimal 0.025) or less.
Answer: (d)
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121) Regarding central serous retinopathy (CSR):
a. Fundus fluorescein angiography (FFA) has shown that the pathogenesis involves retinal
vasospasm.
b. Helicobacter pylori (H. pylori) is a possible risk factor.
c. Indocyanine green (ICG) angiography has shown that the pathogenesis involves
choroidal vasospasm.
d. Treatment with oral but not inhaled corticosteroids is a risk factor.
Answer: (b)
122) Regarding Age-Related Macular Degeneration (ARMD):

a. Central visual distortion is the most common initial symptoms in dry ARMD.
b. Dietary intake of lutein reduces the risk of developing ARMD.
c. It occurs less commonly in the Asian population compared to Caucasian population.
d. The presence of bilateral small macular drusen confers a 50% chance of developing
ARMD.
Answer: (b)
123) Regarding auto-immune retinopathy:

a. Clinical presentation is with unilateral or asymmetric visual loss.
b. Electroretinogram (ERG) changes are seen earlier than optical coherence tomography
(OCT) changes.
c. Histopathology shows predominantly inner retinal changes with the relative preservation
of the outer retina.
d. Low grade ocular pain often accompanies the visual loss.
Answer: (b)
124) Patients with an intraocular gas bubble should be advised of which of the following:
a. Not to fly in an aircraft.
b. That vision will be severely impaired until the gas bubble completely resolves.
c. To avoid general anaesthesia.
d. To lie face down for 50 minutes/hour until the gas bubble resolves.
Answer: (a)
125) Which of the following are associated with an increased risk of rhegmatogenous retinal
detachment:
a. Age under 40 years.
b. Female gender.
c. Increased social deprivation.
d. Peudophakia.
Answer: (d)
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126) Anterior vitreous base tear occurs most common in:
a. Stickler's syndrome.
b. Cockayne syndrome.
c. Cockayne syndrome.
d. Bardet–Biedl syndrome.
Answer: (a)
127) The most common cause of visual loss post successful buckle is :
a. Anterior segment ischemia.
b. Refraction error.
c. Glaucoma.
d. Epi-retinal membrane.
Answer: (b)
128) The most common type of retinal detachment (RD) in hypermetropic patient is:
a. Hemorrhagic.
b. Exudative.
c. Rhegmatogenous.
d. Tractional.
Answer: (c)
129) The apparatus that used to measure the amount of bleached rhodopsin in the outer
segments of the rod receptors and rate of RPE regeneration:
a. ERG.
b. VEP.
c. EOG.
d. Retinal densitometry.
Answer: (d)
130) Regarding retinitis pigmentosa , the first sign is:

a. Subretinal space abolation.
b. Rod outer segment degeneration.
c. Bony specule.
d. Thick bruch's membrane.
Answer: (b)
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131) Which of the following is most likely to be asymmetrical retinitis pigmentosa (RP):
a. Autosomal dominant (AD) inheritance.
b. Autosomal recessive (AR) inheritance.
c. Female carrier.
d. Male sporadic.
Answer: (c)
132) Perflorocarbon (PVC) liquid in vitreoretinal surgery:

a. Lower specific gravity than water.
b. High viscosity.
c. Used in superior breaks seal.
d. Retinotoxic, induce uveitis.
Answer: (d)
133) Regarding Stargardt disease, ABCA4 gene:

a. Heterozygous mutation occurs with deletion of 1 chromosome.
b. One heterozygous mutation.
c. Homozygous of both alleles is more in non-consanguinity.
d. 2 different heterozygous mutations in child and father.
Answer: (a)
134) Anti-VEGF intravitreal injection:

a. Responds well so frequency can be reduced (Less trials with time).
b. Increased IOP have not related to doses frequency.
c. Treat and extend regimen is initially 2 months interval.
d. According/comparable to study, in real life; resistance is frequently seen.
Answer: (a)
135) Figure of fundus color photo of morning glory syndrome, associated with:
a. Renal failure.
b. Hepatic fibrosis.
c. Ocular flatter.
d. Nystagmus.
Answer: (a)
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136) Figure of fundus with small infero-temporal retinal detachment (RD):
a. Scleral Buckle (SB) + cryotherapy.
b. Observe.
c. Pars plana vitrectomy (PPV) + silicone oil.
d. Pars plana vitrectomy (PPV) + gas tamponade.
Answer: (a)
137) OCT figure, Regarding epi-retinal membrane (ERM) symptoms:

a. Metamorphosia.
b. Photopsia.
c. Scotoma.
d. ……………….
Answer: (a)
138) Figure of optical coherence tomography (OCT):

a. Choroidal Hemangioma.
b. Choroidal neovascularization.
c. Dry ARMD.
d. Wet ARMD
Answer: (?)
139) Regarding Leber hereditary optic neuropathy:

a. Has mitochondrial inheritance so all mothers transmit the disease.
b. ………………..
c. ………………..
d. ………………..
Answer: (?)
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UVEITIS AND OCULAR INFLAMMATION
140) A 50 year old renal transplant patient was previously on immunosuppressives. The
photography shown in Figure 16 is the fundus:
a. Cytomegalovirus (CMV) retinitis.

b. Leukemia.
c. Lymphoma.
d. Metastatic carcinoma.
Answer: (a)
141) A 25 year-old patient of HIV retinopathy, on highly active antiretroviral therapy (HAART),
Regarding his current condition:
a. CD4 count is less than 200.

b. It is resistant to treatment.
c. Detectable viral load means less survival // Mortality related to live virus.
d. Best therapy is oral ganciclovir.
Answer: (c)
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142) Which condition is most likely to present with dense vitreous haze:
a. Acute retinal necrosis.
b. Birdshot retinochoroidopathy.
c. Cytomegalovirus retinitis.
d. Serpiginous choroidopathy.
Answer: (a)
143) Regarding cytomegalovirus (CMV) retinitis:

a. Frosted branch angiitis is rarely associated with CMV infection.
b. It causes full thickness retinal necrosis.
c. It is mostly seen in patients with a CD4 counts of more than 100 cell/ul.
d. Spontaneous resolution occurs in about 90% of patients without treatment.
Answer: (b)
144) In a patient with diffuse anterior scleritis, which test is most likely to be helpful in reaching a
systemic diagnosis:
a. Anti-neutrophil cytoplasmic antibody (ANCA).
b. Anti-nuclear antibody (ANA).
c. Rheumatoid factor (RF).
d. Serum angiotensin converting enzyme (ACE).
Answer: (c)
145) A patient presents with panopthalmitis and history of oro-genital ulceration. Which is the
most likely diagnosis:
a. Behcet's disease.
b. Crohn’s disease.
c. Lichen planus.
d. Reiter's syndrome.
Answer: (a)
146) In juvenile idiopathic arthritis (JIA), which is the most common presentation:
a. Bilateral chronic anterior uveitis with posterior synechiae and band keratopathy.
b. Bilateral intermediate uveitis associated with macular edema and epi-retinal membrane.
c. Posterior uveitis with vitritis and macular edema.
d. Recurrent unilateral hypertensive uveitis.
Answer: (a)
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147) Which agent is most likely to have a causative role in Fuch's uveitis:
a. Adenovirus.
b. Herpes simplex virus type 1 (HSV1).
c. Rubella virus.
d. Varicella zoster virus.
Answer: (c)
148) A 16 year old female presents with nyctalopia, macular edema and family history of visual
problems. Which is the most likely diagnosis:
a. Achromatopsia.
b. Intermediate uveitis.
c. Retinitis pigmentosa.
d. X-linked juvenile retinoschisis.
Answer: (c)
149) Regarding immune recovery uveitis seen in HIV positive patients after treatment with highly
active anti retro-viral medication:
a. It usually develops in eyes with active cytomegalovirus retinitis.
b. It usually occurs within 2 weeks of commencing treatment.
c. Treatment with cidofovir is a specific risk factor.
d. Vitritis is uncommon.
Answer: (c)
150) Regarding toxoplasma retino-choroiditis:

a. Prenatally and postnatally acquired infections can usually be distinguished clinically.
b. The risk of developing it during early childhood is approximately 20% after prenatal
toxoplasmosis.
c. There is evidence that use of antibiotics to treat the acute disease reduces risk of
blindness in the affected eye.
d. There is no evidence to suggest that long term antibiotic therapy prevents relapse.
Answer: (b)
151) Regarding Behcets uveitis:

a. Is associated with HLA-B27.
b. Is common in the eastern Mediterranean, south America and sub Saharan Africa.
c. The disease and visual prognosis tend to be more severe in males compared to females.
d. There is an 80% risk of blindness despite treatment.
Answer: (c)
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152) Regarding steroid treatment of uveitis:
a. If there is no recorded rise in intra-ocular pressure after a single dose of peri-ocular
triamcinolone acetonide, then there is unlikely to be pressure rise after future
adminstrations.
b. Intra-vitreal triamcinolone acetonide causes a rise in intra-ocular pressure requiring
treatment in about 10% cases.
c. The usual required dose interval for peri-ocular triamcinolone acetonide is 6 months.
d. Topical difluprednate, when dosed four times daily, has been found to be non-inferior to
prednisolone acetate 1%.
Answer: (d)
153) Regarding HSV uveitis, Which is the most common sign:

a. Diffuse iris atrophy.
b. Granulomatous keratitic precipitates (KPs).
c. Low intraocular pressure (IOP).
d. Segmental iridoplegia.
Answer: (b)
154) Regarding anterior uveitis with ankylosing spondylitis:

a. Common in females.
b. Peak age 50-60.
c. Posterior synechiae.
d. Granulomatous keratitic precipitates (KPs).
Answer: (c)
155) Regarding Vogt-Koyangi-Harada (VKH) disease:

a. Acute phase always includes intra & extraocular disease.
b. Chronic phase includes both intra & extraocular disease.
c. Prodormal phase mimic viral infection.
d. More common in males.
Answer: (c)
156) Regarding Vogt-Koyangi-Harada (VKH) disease, in the prodromal stage, the following
investigations is done to detect choroiditis:
a. Fluorescein angiography (FFA).
b. Optical coherence tomography (OCT).
c. Indocyanine green (ICG).
d. Visual field (VF).
Answer: (c)
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157) Regarding tuberculosis (TB) uveitis:
a. Rare without pulmonary tuberculosis foci.
b. Multi-choroiditis may be treated without need of cortisone.
c. It is caused by anaerobic bacteria, rarely arise in oxygenated organs.
d. Acute stage includes anterior uveitis.
Answer: (b)
158) Regarding cytomegalovirus (CMV) Uveitis:

a. Low yield on anterior chamber tap.
b. Posner-Schlossman syndrome (PSS) in immunocompetent.
c. Bilateral.
d. Posterior synechiae.
Answer: (b)
159) Which ONE of the following endogenous auto-immune uveitis entities is MOST likely to be
associated with the worst visual prognosis (leading to visual loss):
a. Behcet's.
b. HLA (Human Leucocyte Antigen) B27.
c. Idiopathic.
d. VKH (Vogt-Koyangi-Harada) disease / Sarcoidosis.
Answer: (a)
160) The most common type of endogenous immune uveitis / in European teens :
a. Behcet's.
a. VKH (Vogt-Koyangi-Harada) disease / HLA (Human Leukocyte Antigen) B27.
b. Idiopathic.
c. Sarcoidosis.
Answer: (c)
161) Regarding masquerade syndrome caused by primary central nervous system lymphoma
(PCNSL):
a. B cell lymphoma is more likely than T cell.
b. Creamy yellow subretinal infiltrates are a classic finding.
c. Sixth nerve palsy is the most common neurological sign.
d. Vitreous cells will not respond to steroids.
Answer: (a)
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162) Which drug not classified as TNF :
a. Infliximab.
b. Adalimumab.
c. Etanercept.
d. Rituximab.
Answer: (d)
163) The shortest life-span antibiotic used intravitreally that force us to shorten the time interval:
a. Ceftriaxone.
b. Ceftazidime.
c. Amikacin.
d. Vancomycin.
Answer: (c)
164) What is the steroid sparing drug is most effective in uveitis:

a. Cyclosporine.
b. Methotrexate.
c. Mycophenolate.
d. …………………..
Answer: (b)
165) Regarding White Dot Syndromes (WDS):

a. Acute zonal occult outer retinopathy (AZOOR) is more common in females.
b. Birdshot's retinopathy is common 2nd to 3rd decade of age.
c. Punctate inner choroiditis (PIC) occurs in young myopic males.
d. …………………………………………………………………………………
Answer: (a)
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OCULOPLASTIC SURGERY AND ORBIT
166) A 45 year old woman has noticed increasing proptosis for about 12 months, which is the
most likely diagnosis based on her CT scan shown in the figure:
a. Fibrous dysplasia.
b. Osteosarcoma.
c. Plasmocytoma.
d. Sphenoidal wing meningioma.
Answer: (d)
167) Regarding the condition illustrated in Figure 10, this 35 year old diabetic patient illustrated
initially sustained a minor lid laceration. Within hours she was pyrexial in shock and had the
appearance illustrated. Which ONE of the following statements is MOST likely to be TRUE:
a. Mortality associated with this condition is increasing.

b. The peri-orbital tissues are one of the commonest anatomical sites for this condition.
c. This condition commonly affects immunocompetent people.
d. Toxic shock is a rare complication.
Answer: (a)
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168) Regarding the image shown in Figure 9:
a. Inflatable orbit expanders reduce requirement for repeated general anesthetic exposure
b. Mutations in the OTX2 gene are associated with microphthalmos not anophthalmos.
c. The neonatal orbital volume is approximately 30 cubic centimeters.
d. The ultrasound reveals anophthalmia.
Answer: (a)
169) A 28 year-old male patient has noticed very gradual proptosis for 10 years with loss of
vision over the last three years. He has had progressive nerve deafness since 7 years old and
his left eyes has pre-retinal fibrosis which reduces his acuity to 6/12. His mother is deaf from
childhood. Diagnosis:
a. He has right optic nerve glioma.

b. He has right optic nerve meningioma.
c. He has somatic mutation in the Schwannomin (Merlin) gene.
d. He has more than 5 café au lait patches.
Answer: (c)
170) Regarding Moh's micrographic surgery for a biopsy proven lower lid lesion:
a. The technique is appropriate for actinic keratosis.
b. The technique is appropriate for Infiltrative basal cell carcinoma.
c. The technique is appropriate for malignant melanoma.
d. The technique is appropriate for Merkel cell carcinoma.
Answer: (b)
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171) Regarding periocular basal cell carcinoma:
a. Gorlin syndrome is an autosomal recessive (AR) disorder characterized by multiple
nevoid basal cell carcinomas.
b. The medial canthal area is the most commonly affected periocular site.
c. The pigmented type most commonly affects people of pigmented races.
d. The superficial type is the most common clinical appearance.
Answer: (c)
172) Regarding the lacrimal anatomy:

a. Fifteen percent of the population have a separate upper and lower canalicular opening
of the lacrimal sac.
b. The fundus of the lacrimal sac extends just above the superior margin of the medial
canthal tendon.
c. The suture Notha (longitudinal suture of Weber) is a surgical landmark also known anterior
lacrimal crest.
d. The unicnate process is the most variable structure in nasolacrimal anatomy.
Answer: (b)
173) Regarding orbital fracture repair:

a. A transcaruncular approach to the medial wall will avoid the complication of
postoperative lower lid retraction.
b. Split-thickness free calvarial bone grafts give good posterior curvature but will resorb
more than cancellous bone.
c. Surgery is best delayed until swelling settles in children with narrow trap door fractures
and muscle entrapment.
d. The main indications for surgery are muscle entrapment and significant exophthalmos.
Answer: (a)
174) Regarding orbital decompression in active, sight threatening Graves orbitopathy:

a. A transcaruncular medial wall approach to compression carries the lowest risk of post-
operative diplopia.
b. Lateral wall decompression surgery alone is the best approach to relieve optic nerve
compression.
c. Orbital decompression is a more appropriate initial treatment for dysthyroid optic nerve
neuropathy than intravenous methylprednisolone.
d. Partial lip anesthesia is a risk of orbital decompression surgery.
Answer: (d)
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175) A patient presents with unilateral lower lid entropion:
a. Botulinum toxin injections can offer a permanent solution to entropion.
b. Everting sutures should not be used as a treatment of entropion.
c. Lid taping is unlikely to help the patient.
d. Surgery should address lower lid laxity as well as lower lid retractors.
Answer: (d)
176) Regarding thyroid orbitopathy (TO):

a. Active disease is unlikely in patients who are euthyoid.
b. Insulin like growth factor receptor (IGF-1R) is expressed at higher levels in the orbital
connective tissue.
c. Rituximab is now the first line treatment of choice.
d. The active phase is self limiting usually lasting less than 6 months.
Answer: (b)
177) Regarding senile involutional ptosis:

a. Levator function is likely to be less than 5 mm.
b. Mulller muscle – conjunctival resection is contra-indicated.
c. Normal adult margin-to-reflex distance 1 (centre of pupil to upper lid magin) is
approximately 3 mm.
d. Ptosis (>4 mm) is associated with higer risk of surgical udercorrection.
Answer: (d)
178) Regarding the blepharochalasis syndrome:

a. It is characterized by repeated episodes of painless eyelid oedema with complete
recovery each time.
b. It mainly affects people over the age of 50.
c. Presence of ptosis exclud0es the condition.
d. The average duration of an attack is approximately 2 days.
Answer: (d)
179) Regarding post-herpetic canalicular obstruction:

a. It has only been described following herpes simplex infection.
b. Lester-Jones tubes are the preferred surgical treatment.
c. Most patients are under 20 years.
d. The common canaliculus is the usual site of obstruction.
Answer: (b)
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180) Regarding periocular haemangioma:
a. Gradual involution (spontaneous shrinkage of tumour) from birth onwards is the normal
natural history.
b. Histology shows benign proliferation of vascular epithelial cells.
c. Hypoglycaemia can be an adverse effect of treatment with propranolol.
d. It affects about 1% of infants.
Answer: (c)
181) A child with head trauma visit you with eye proptosis, you suspect retrobulbar hemorrhage
a. Lateral canthotomy must be done by trained ophthalmologist .
b. Lateral canthotomy site is start with lower eyelid edge at lateral side.
c. Eye wall fracture release pressure without need to do canthotomy.
d. Suture the wound with absorbable stitch.
Answer: (b)
182) A 60 year-old heavy female smoker complains of right eye epiphora and bloody tears. A
syringe and probing confirming a nasolacrimal duct obstruction, Diagnosis:
a. Inverted papilloma.
b. Lymphoma.
c. Metastatic melanoma
d. Squamous cell carcinoma.
Answer: (d)
183) A 15 years old male came with head trauma, on examination he suffered from nausea
when he gaze up, what's you first management:
a. Magnetic resonance imaging (MRI).
b. Computed tomography (CT) Urgent.
c. Un-displaced or hairline fracture, surgery is not required.
d. Observation.
Answer: (b)
184) Regarding orbital tumors:

a. Orbital metastasis counts 20% of orbital tumors.
b. Lymphoma is the most common orbital tumors.
c. Orbit is the most common ophthalmic site to metastasis.
d. The most common for secondary metastasis is from lung tumor.
Answer: (b)
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185) Figure of ectropion post trauma, What is the management:
a. Wedge resection with lid retractor plication.
b. Lateral tarsorrhaphy.
c. Lateral tarsal strip (LTS) with full thickness skin graft.
d. Split thickness skin graft.
Answer: (c)
186) A 25 year-old male with frontal baldness, ptosis and polychromatic lustre opacity in lens,
associated with:
a. Nystagmus.
b. Ocular flutter.
c. Optic atrophy.
d. Pupil reflex disturbed / light near dissociation.
Answer: (d)
187) Widening of orbital fissure called :

a. Eury-blepharon.
b. Ankylo-blepharon.
c. Epi-blepharon.
d. ……………….
Answer: (a)
188) Regarding ptosis clinical assessment:

a. In sever ptosis, the upper eyelid may cover the lower eyelid and the measure is in minus.
b. Measure levator function from 1ry position to upgaze with neutralized frontalis action.
c. ……………………… d. ………………………
Answer: (a)
189) Regarding xanthelasma:

a. More common in males.
b. More common in North Europe.
c. Low level HDL.
d. …………………
Answer: (c)
190) Figure of an elderly patient with normal/proptosed left eye and right eye shows:
a. Proptosis with thyroid eye disease (TED).
b. Proptosis with shallow orbit and penetrating trauma in the eye.
c. Enophthalmos due to breast cancer metastasis.
d. Orbital cellulitis.
Answer: (?)
(49)
PEDIATRIC OPHTHALMOLOGY AND STRABISMUS
191) Regarding juvenile idiopathic arthritis, the most risk factor for development is:
a. Absence of antinuclear antibody (ANA) positivity.
b. Female gender.
c. Involvement in more than 4 joints at onset.
d. Onset of arthritis under 5 years of age.
Answer: (d)
192) Which is a recognised clinical feature of Alport syndrome:

a. Conductive deafness from birth.
b. Dot and fleck retinopathy.
c. Posterior lenticonus.
d. Retinal detachment.
Answer: (b)
193) Testing of versions in a case of 'A' Pattern exotropia will mostly likely reveal:
a. Inferior oblique over action.
b. Inferior rectus over action.
c. Superior oblique over action.
d. Superior rectus over action.
Answer: (c)
194) Which of the following features is most characteristic of persistent fetal vasculature (PFV) in
an infant:
a. Developmental cataract.
b. Iris hypoplasia.
c. Longer than average axial length.
d. Traction of the ciliary processes.
Answer: (d)
195) A 15 year old male has a whitish retinal tumor that has not grown over 3 years of observation.
He also has a learning disability and seizure disorder. Which is most likely diagnosis:
a. Neurofibromatosis 1.
b. Neurofibromatosis 2.
c. Tuberous sclerosis.
d. Von Hippel Lindau syndrome.
Answer: (c)
(50)
196) Regarding Gonococcal neonatal conjunctivitis:
a. It can be associated with corneal perforation.
b. It is not seen in babies born by caesarian section.
c. It is usually treated with oral erythromycin.
d. It presents at 7-14 days after birth.
Answer: (a)
197) A 5 year-old child presents with a 1 year history of esotropia on alternate days while
appearing straight on the other alternate days (i.e. straight for one day then esotropia for one
day then straight again):
a. Management is conservative.
b. Stereopsis is excellent on days when eyes are straight.
c. Underlying neurological disease is likely.
d. Underlying psychological disease is likely.
Answer: (b)
198) A 6 year old child with undergoes bilateral lateral rectus recession for an intermittent
exotropia. One day post-operatively, the child has diplopia with full eye movement and an
esotropia of 15 prism diopters. Which is the most appropriate management:
a. Emergency theatre for exploration and surgery.
b. Patch one eye and 2 weeks follow up.
c. Planned return to theatre in 1 week for exploration and surgery.
d. Prismatic correction to control diplopia and 2 weeks follow up.
Answer: (d)
199) Regarding management of unilateral congenital cataract in infancy:

a. Even with early and high quality modern treatment, visual prognosis is poor.
b. Evidence shows that intra-ocular lenses are associated with better visual outcome than
contact lenses.
c. Foldable lenses are contra-indicated.
d. Visual acuity is better using a contact lens rather spectacles.
Answer: (d)
200) Regarding tuberous sclerosis, which ONE of the following is defined as a primary criterion:
a. A single artery retinal astrocytoma.
b. Bilateral renal cysts.
c. Shagreen patch.
d. Subpendymal nodule.
Answer: (d)
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201) Regarding infantile nystagmus syndrome (INS) in 4 year-old child:
a. Nystagmus is in direction of gaze.
b. It appears on monocular occlusion.
c. Downbeat nystagmus.
d. Seesaw nystagmus.
Answer: (a)
202) Increased Accommodative Convergence/Accommodation (AC/A) ratio in:

a. Accommodation insufficiency.
b. Accommodative spasm.
c. Convergence exxcess esotropia.
d. Fully accommodative.
Answer: (c)
203) Regarding the ultrasound picture from a 6 month old baby shown in Figure 11, which ONE is
the MOST likely association:
a. Anaemia.
b. Cardiac problems.
c. Hyperflexible joints.
d. Retinal detachment.
Answer: (b)
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204) Which is the likely cause of appearance of the baby photographed in the figure:
a. Herpes simplex virus (HSV).

b. Herpes zoster virus (HZV).
c. Human immunodeficiency virus (HIV).
d. Parvovirus.
Answer: (a)
205) A child with the condition illustrated in the figure is most likely to have:
a. Foveal hypoplasia.
b. Pigment dispersion glaucoma.
c. Retinitis pigmentosa.
d. See-Saw nystagmus.
Answer: (a)
(53)
206) Regarding this figure:
a. Peter's anomaly
b. Congenital glaucoma.
c. Congenital Hereditary Endothelial Dystrophy (CHED).
d. Corneal dermoid.
Answer: (a)
207) Figure, What is the diagnosis:
a. Duane retraction syndrome (DRS).

b. 6th nerve palsy.
c. ………………… d. …………………
Answer: (a)
208) Regarding this figure:
a. Goldenhar syndrome.
b. ……………….. c. ……………….. d. ………………..
Answer: (a)
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OCULAR ONCOLOGY
209) A 47 year old woman undergoing treatment for metastatic breast cancer is referred
because of deteriorating sight. She has visual acuities of logMAR 0.60 (Snellen 6/24, 20/80,
decimal 0.25) in both eyes and the following fundal appearance in the figure (similar changes
in both eyes). Which feature in her history is most likely to be relevant to her new visual problem:
a. She had a double mastectomy 3 years ago.

b. She had whole brain radiation for metastatic disease 10 months ago.
c. She had been on tamoxifen for the last 2 years.
d. She is thrombocytopenic needing regular platelet infusions.
Answer: (b)
210) Regarding uveal melanoma:
a. Chromosome 3 loss associated with a reduction of the 5-year survival probability from
approximately 100% to 50%.
b. The 10-year metastatic rate for a 1-mm-thick uveal melanoma is approximately 30%
c. The age of presentation for choroidal melanoma peaks at around 45 years.
d. The median survival from the time of the development of distant metastatic disease is 5
years.
Answer: (a)
211) Regarding the risk of being affected by retinoblastoma (Rb) to a relative of a child who has
or had retinoblastoma (Rb):
a. For a sibling of a child with bilateral or multifocal Rb without any other affected relative, it
is about 5%.
b. For a sibling of a child with Rb who has an affected relative, it is about 5%.
c. For the offspring of a child with bilateral or multifocal Rb without any other affected
relative, it is about 5%
d. For the offspring of a child who had Rb and also has an affected relative, it is about 5%.
Answer: (a)
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212) Regarding optic nerve glioma in neurofibromatosis type 1 (NF1):
a. It is commoner in girls than boys.
b. Nystagmus may be the presenting feature.
c. Spontaneous regression does not occur.
d. Vision usually progressively declines.
Answer: (b)
213) Regarding ocular tumours:
a. Epithelioid melanoma has a better prognosis than spindle cell melanoma.
b. Optic pathway glioma may arise as a complication of neurofibromatosis type 2.
c. Retinoblastoma are caused by a base deletion on chromosome 13q.
d. Acoustic neuroma may arise as a complication of neurofibromatosis type 1.
Answer: (c)
214) Regarding tumour suppression genes:

a. They are invariably inherited in an autosomal recessive manner within families.
b. They can be affected by germline mutations.
c. They produce proteins which are not involved in the cell cycle.
d. They produce proteins which are not transcription factors.
Answer: (b)
215) Which ONE of the following is a recognized histopathological feature of retinoblastoma:

a. Giant touton cells.
b. Granulomas.
c. Homer-Wright rosettes.
d. Large cysts.
Answer: (c)
216) Regarding retinoblastoma:

a. Intravitreal chemo is contraindicated due to risk of seeding in the tract.
b. Periocular given due to better absorption trains scleral.
c. Laser treatment is not effective for vitreous seeds.
d. Laser can be effective for larger tumors without combined chemo.
Answer: (c)
217) Regarding malignant melanomas of the choroid:

a. Iodine 125 brachytherapy (plaque therapy) is associated with visual loss.
b. The risk of subsequent metastases is not affected by tumour size.
c. They are most prevalent in the 60-75 age range.
d. They are significantly more common in females.
Answer: (a)
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218) Regarding choroidal melanoma, common metastasis site:
a. Liver.
b. Lung.
c. Bone.
d. Brain.
Answer: (a)
219) Regarding choroidal melanoma, common metastasis ocular site:

a. Sclera.
b. Optic nerve.
c. Vitreous.
d. Iris.
Answer: (a)
220) Regarding basal cell carcinoma (BCC), (about Wnt pathway signaling):
a. 1. 2 mm excision is required.
b. Gene is wnt.
c. Vismodegib is approved for advanced stage.
d. Morphoeic is most common variety.
Answer: (c)
221) Figure of conjunctival nevus or melanoma, the management is surgical excision then:
a. Intra-lesional bleomycin.
b. Oral propranolol.
c. Interferon alpha-2b.
d. Intra-lesional Steroids.
Answer: (c)
222) Regarding orbital lymphoma:
a. Excision surgery.
b. If Bilateral then radiotherapy is contraindicated.
c. ENMZ / MALT type is more aggressive than mantle cell type.
d. Thyroid eye disease (TED) mimic or misdiagnosed / not responds to treatment.
Answer: (d)
223) Regarding melanocytoma:

a. Only unilateral.
b. In the optic disc, there is no visual field defect.
c. In the optic disc, there is no relative afferent pupillary defect (RAPD).
d. Low risk of conversion to melanoma.
Answer: (d)
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224) Regarding malignant melanoma, the most important prognostic factor:
a. Monosomy 3.
b. Cellular type.
c. Partial duplication of chromosome 8q.
d. ………………………
Answer: (a)
225) Regarding to ocular surface squamous neoplasia (OSSN):

a. Its most common position in the temporal limbus.
b. It is caused by Human papillomavirus (HPV).
c. …………………………
d. …………………………
Answer: (b)
226) Two figures showing MRI of tumor in orbit, before and after chemo reduction:
a. Rhabdomyosarcoma.
b. Lymphangioma.
c. Retinoblastoma.
d. ……………………..
Answer: (c)
227) Regarding rhabdomyosarcoma prognosis:

a. The alveolar type has the worst prognosis.
b. ………………..
c. ………………..
d. ………………..
Answer: (a)
228) Two figures of fundus color photo and FFA of RPE Rip:
a. Hemangioma.
b. Melanoma.
c. …………………
d. …………………
Answer: (?)
(58)
OPHTHALMIC PATHOLOGY
229) Regarding melanosis of the conjunctiva:

a. 20% of malignant melanomas arise de novo.
b. Primary acquired melanosis (PAM) without atypia rarely progresses to melanoma.
c. Racial melanosis tends to be unilateral.
d. The smaller the area of primary acquired melanosis (PAM) with atypia, the greater the
chance of progression to conjunctival melanoma.
Answer: (b)
230) Regarding corneal dystrophies:

a. Hyaline bodies and keratinoid (keratin-like substance) are features of granular dystrophy.
b. Hyassel-Henle bodies are features of posterior polymorphous endothelial dystrophy.
c. Lattice dystrophy is an epithelial dystrophy.
d. Macular dystrophy is an autosomal dominant disorder.
Answer: (a)
231) Which of the following hypersensitivity reaction type is commonly associated with ocular
cicatricial pemphigoid (OCP):
a. Type I.
b. Type II.
c. Type III.
d. Type VI.
Answer: (b)
232) Which one of the following cells has distinct cell membrane:
a. Epithelioid.
b. Mixed.
c. Spindle A.
d. Spindle B.
Answer: (a)
233) Cell type for proliferative vitreoretinopathy (PVR): Repeated

a. RPE.
b. Macrophage.
c. Ganglion cell.
d. Asterocyte.
Answer: (a)
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234) In the practice of ophthalmic histopathology, differentiating between, which ONE of the
following pairs of diagnoses is MOST likely to cause difficulty:
a. Basal cell papilloma versus basal cell carcinoma of the skin.
b. Benign compound naevus versus malignant melanoma of the conjunctiva.
c. Meningioma versus neurofibroma of the optic nerve.
d. Pleomorphic adenoma versus adenoid cystic carcinoma of the lacrimal gland.
Answer: (a)
235) In the practice of ophthalmic histopathology, differentiating between, which ONE of the
following pairs of diagnoses is MOST likely to cause difficulty:
a. Chalazion versus sebaceous carcinoma.
b. Lattice dystrophy versus macular dystrophy.
c. Merkel cell carcinoma versus basal cell carcinoma.
d. Pilomatrixoma versus pilocytic astrocytoma.
Answer: (c)
236) Regarding the histopathology of herpes simplex keratitis:

a. Dendritic ulcers do not reach Bowman's membrane.
b. Disciform keratitis is associated with non-granulomatous inflammation at Descemet's
membrane.
c. Giemsa staining is usually negative.
d. Neurotrophic corneas have a decreased number of keratocytes.
Answer: (d)
237) Regarding histopathological examination of lid tumors:

a. Morpheoic: nodules palisades into the dermis.
b. Sebaceous gland carcinoma: pain with neural invasion and solar elastosis.
c. Pigmented basal cell carcinoma: if pre-existent pigmented nevus.
d. Sebaceous gland carcinoma: sebaceocytes with vacuolated cytoplasm.
Answer: (d)
238) Cell type for epi-retinal membrane (ERM):

a. Glial.
b. RBC.
c. Photo receptor.
d. …………………..
Answer: (a)
(60)
LOW VISION REHABLILATATION
239) Regarding low vision rehabilitation for a patient with age related macular degeneration
(ARMD):
a. If eccentric viewing is preferred, magnification is not useful.
b. The Amsler chart will pick up approximately 50% of central field defects.
c. Traditional automated visual field tests allow for eccentric retinal fixation.
d. Recommended reading print size should be one font size bigger than threshold
measured in clinic.
Answer: (b)
240) Regarding helping a patient with low vision, from age related macular degeneration
(ARMD), to read:
a. A typoscope (an overlay highlighting one word and masking out surrounding test) may
be used to reduce glare.
b. Amount of illumination is less important than the source of the illumination.
c. Contrast enhancement of text is not usually helpful.
d. Reading speed is proportional to text size.
Answer: (a)
241) The World Health Organization International Classification of Functioning , Disability and
Health is concerned primarily with which ONE of the following:
a. All of the below.
b. Impairment if bodily function.
c. Impairment of bodily structure.
d. Restriction of activity and participation.
Answer: (a)
242) Regarding cognitive visual processing, which ONE of the following functions is thought to be
principally involve the parietal lobe:
a. Face recognition.
b. Route recognition.
c. Simultaneous perception.
d. Word recognition.
Answer: (d)
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243) Regarding intraocular telescope:
a. Implanted in both eyes to avoid diplopia.
b. Used for CNVM related diseases.
c. Reduces peripheral field.
d. Improves near vision but not distance vision.
Answer: (c)
244) Regarding visual hallucinations in low-vision-aids patient:

a. Occurs in 90% of patients of age-related macular degeneration (ARMD).
b. Occurs while the eyes are open.
c. Psychological influence.
d. Occurs 1-2 times/day.
Answer: (b)
245) Cortical blindness improvement by:

a. Visual field test.
b. Electromagnetic stimulation waves of the brain.
c. Saccadic scanning test.
d. Prism.
Answer: (b)
246) ARMD patient wants to read:

a. Telescope.
b. Illumination.
c. Reading speed depends on letter size.
d. ………………………….
Answer: (a)
247) Regarding Charles Bonnet syndrome:

a. Visual hallucination in low vision patients.
b. It increases on closing eyes.
c. There is psychological insight about the unreal nature of the hallucinations.
d. ……………………………………..
Answer: (c)
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ETHICS AND PROFESSIONALISM
248) The ICO curriculum ethics section refers to which of the following standards:
a. Clinical trials procedures should adhere to the Geneva Convention.
b. Ensure that sponsors are not allowed to influence the content of ophthalmologic
presentations.
c. Fees/expenses can be claimed for defending the cause of external finding bodies (Not
relating to professional activity) as long as they are declared.
d. Informed consent for participation in clinical trials may not be necessary, in order to
avoid the Hawthorne effect.
Answer: (b)
249) A 60 year old woman with an amblyopic left eye develops cataract further reducing her
vision, has been referred to you because she is concerned that a cataract operation on the
left eye might harm the right eye which is completely normal. Which of the following is the
most appropriate advice:
a. She should have the operation because the risks are low and she might get better vision.
b. Surgery on the left eye should not be done under any circumstances.
c. The risk of sympathetic ophthalmia is about 1 in 14,000 and it is for her to decide.
d. The risks of sympathetic ophthalmia are small and the operation will prevent
complications.
Answer: (c)
250) You have invented a new surgical technique to incorporate a small piece of Fascia Lata
into the tendon of the superior oblique (SO) for severe Brown's (Tendon Sheath) syndrome. You
have achieved very impressive results for all of the six patients tou have operated on but you
wish to know whether the Fascia Lata is incorporated into the SO tendon or whether the
excellent results were obtained simply by division of the SO. The first operated patient develops
a severe, unsightly and uncomfortable chalazion (Meibomian cyst) in the nasal half of the
upper lid, on the same side as the SO procedure and wants to have it removed. Which of the
following would be the most appropriate course of action:
a. Obtain consent both to perform the surgery to the chalazion and to inspect the SO
tendon.
b. Obtain consent to remove the chalazion and inspect the SO tendon through a tiny
incision.
c. To operate on the chalazion but not to look at the SO tendon.
d. To operate neither on the chalazion nor to look at the SO tendon.
Answer: (a)
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251) Regarding the Helsinki declaration on human experimentation:
a. It also refers to animal experiments.
b. It ensures that scientific concerns achieve priority.
c. It is a statement of the World Medical Association.
d. It is legally binding.
Answer: (c)
252) A 9-year-old child is admitted for surgery for a penetrating eye injury. His maternal
grandmother died under anesthesia 20 years previously; his mother has never had an
anesthetic. How would an anesthetist best advise the family? Repeated
a. To proceed with the normal anaesthetic immediately avoiding the use of
Suxamethonium (succinylcholine, Scoline).
b. To have a muscle biopsy under local anaesthetic.
c. To proceed, avoiding Halothane and having Dantrolene (Dantrolen, Dantrium)
available.
d. To send blood for urgent mutation analysis.
Answer: (c)
253) You are planning to do cataract surgery for elderly female diagnosed to have dementia
which was stable over a long period and she signed consent and had a full explanation of
surgery. On the day of surgery in operating room she got agitated and anxious and she did
not now where she is. What is your next step: Repeated
a. To processed with surgery as she singed a consent.
b. To call her daughter and take permission and processed with surgery.
c. To ask asnthesiologist to give general anesthesia and processed with surgery.
d. To stop surgery until she is stable.
Answer: (d)
254) You are a part of a collaboration of 20 scientists. The journal allows you to cite only 10 people
on the cover of your story. Which of the following people have the right (as opposed to
privileges) to have their names printed:
a. Clinicians who contributed to the design of the study.
b. Sciences staff who helped with statistical analysis.
c. Anybody helped with typesetting of manuscript.
d. The head of the department who did not contribute to the study.
Answer: (a)
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255) Regarding genetic screening and therapy:
a. At any stage, consent must to be done
b. Unethical to screen if no treatment available for family.
c. Unethical to screen if > 3 month period for reporting to decrease anxiety.
d. No need for consent to avoid anxiety.
Answer: (a)
256) Regarding ICO ethics curriculum:

a. Transparent equitable resources allocation/distribution.
b. ……………..
c. ……………..
d. ……………..
Answer: (a)
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COMMUNITY EYE HEALTH
257) Regarding rapid assessment of avoidable blindness (RAAB):
a. At least 10 teams of local staff are required.
b. They are good strategy for case finding for a new cataract programme.
c. They are good way of investigating blindness levels in children and young adults.
d. They are good way of measuring cataract surgical outcomes.
Answer: (d)
258) Regarding the global burden of uncorrected refractive error:

a. Age standardized rates of disability (as measured by DALYs) are increasing.
b. It accounts for 7 millions cases of blindness.
c. It is more of a burden (in terms of disability adjusted life years DALYs) in middle-income
countries than in low-income countries.
d. It is now the leading cause of global blindness.
Answer: (b)
259) Regarding biostatistics. Which of the following pairs of concepts are least likely to be
paired together:
a. A new screening test and receiver operating curve.
b. Different techniques for measuring intraocular pressure and Bland Altman plot.
c. Time to failure of a trabeculectomy operation and Kaplan Meier plot.
d. Type 1 error and statistical power.
Answer: (d)
260) Which the following eye conditions has been demonstrated to have increased prevalence
in long-term tobacco smokers:
a. Age related macular degeneration (ARMD).
b. Congenital cataract in babies of mothers who smoke.
c. Metastases from choroidal melanoma.
d. Primary open angle glaucoma.
Answer: (a)
261) Regarding management of trachomatous trichiasis in endemic regions, which of the

following procedures is first line treatment:
a. Bilamellar tarsal rotation with absorbable sutures.
b. Bilamellar tarsal rotation with either absorbable or non-absorbable sutures.
c. Bilamellar tarsal rotation with non-absorbable sutures.
d. Mucous membrane graft to posterior lamella.
Answer: (b)
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262) Universal Eye Health: The World Health Organization Global Action Plan 2014-2019 is
underpinned by 5 principles and approaches. Which of the following is included:
a. Cost recovery wherever possible.
b. Evidence-based practice.
c. Prioritization for children.
d. Prioritization for women.
Answer: (b)
263) The commonest causative agents of corneal opacities in low-income include which of the
following:
a. Corneal dystrophies.
b. Genetic developmental anomalies.
c. Infectious keratitis.
d. Keratoconus.
Answer: (c)
264) Regarding Myopia:

a. Worldwide pevalence of 10%.
b. Incidence is approximately 2% in Asia.
c. It is more in Asia than the West.
d. Glaucoma association with population studies.
Answer: (c)
265) Regarding trachoma infection and immunity of involved child:

a. No recurrence (life-long immunity).
b. Recurrence with same duration and severity (no immunity).
c. Recurrence with less duration and severity (partial immunity).
d. Vaccine in progress.
Answer: (c)
266) Between 1980 and 2009, in UK and USA data, concerning diabetic retinopathy (DR)
prevalence and sight threatening diabetic retinopathy
a. DR prevalence was 30% and sight threatening DR was 7%.
b. DR prevalence was 50% and sight threatening DR was 15%.
c. DR prevalence was 70% and sight threatening DR was 30%.
d. …………………………………………………………………………..
Answer: (a)
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267) Regarding onchocerciasis:
a. It called river blindness as the worm breeds in fast flowing rivers.
b. The immune response triggered ….. by Wolbachia bacteria.
c. If it penetrates the eye then the disease spreads very fast.
d. …………………………………………………………………………...
Answer: (b)
268) Regarding Ebola virus:

a. Live Virus is detected in aqueous.
b. Most hazardous to the practitioner (via broken skin and mucosa).
c. ………………………………………………….
d. ………………………………………………….
Answer: (b)
269) Regarding case control study:

a. Matching carefully does not mitigate potential confounding variables.
b. A new drug can be tested to another.
c. ………………………………………………..
d. ………………………………………………..
Answer: (?)
(68)
MCQs Recalls Notes & Comments – 2017 & 2018
▪ Associations:
• Floppy iris with tamsulosin.

• Posterior synechiae in HLA- b27 positive.
▪ Criteria for Screening Test
• Should have latent period.

▪ Less than 40 percent defect in eye lid
• Treatment with semicircular flap.

▪ Child with inferior rectus entrapment
• Do computed tomography (CT).

▪ Bilateral ptosis:
• Kearns-sayre syndrome.
▪ Figure of Retinopathy of Prematurity (ROP) – Grade 2 , Management:
• Observe.
▪ Figure of Sturge Weber Syndrome (SWS) , associated with:
• Glaucoma.
▪ Figure of Purtscher's retinopathy, associated with:
• Acute pancreatitis.
▪ Figure of Blepharoconjunctivitis, associated with:
• Brimonidine.
▪ Figure of anterior segment of Stickler Syndrome, associated with:
• Cleft Palate.
▪ Fuchs' Heterochromic Iridocyclitis
• Triad of Pseudophakia, Trabeculectomy and Heterochromia

▪ Figure of Congenital retinal pigment epithelial hypertrophy (CHRPE) (bear track sign).
▪ Figure of Wyburn Mason Syndrome (WMS).
▪ Bilateral altitudinal visual field defects.
▪ Keratoplasty with a figure of dendritic ghost scar.
▪ ROP - Bevacizumab Study / BEAT ROP Trial.
▪ Amblyopia Study.
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ICO Advanced 115 MCQs 2015-2019

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ICO Advanced 115 MCQs 2015-2019

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ICO ADVANCED MCQs 3/2020

CATARACT AND LENS

1) Regarding intraoperative management of astigmatism during cataract surgery:

3) Regarding the use of femtosecond laser for cataract surgery:

4) Regarding cataract surgery for patients with diabetes mellitus (DM):

11) Regarding associations between following conditions and cataract morphology:

12) Regarding microspherophakia:

13) Regarding Phacoemulsification:

14) Regarding intra-ocular lens implant (IOL) materials:

17) PMMA Lens irrigation prior to implantation due to:

20) The iris shape is due to:

21) Management to be done:

23) Regarding cataract surgery in an eye with axial length of 21 mm:

24) Regarding cataract surgery in an eye had previous vitrectomy:

25) Regarding small incision cataract surgery (SICS):

a. It is more effective when combined with subconjunctival anti-vascular endothelial

31) Regarding collagen cross linking:

32) The higher incidence of glaucoma is with:

35) Regarding the steroid for corneal ulcer trial (SCUT):

36) Regarding the mycotic ulcer treatment trial (MUTT):

39) Regarding pellucid marginal degeneration:

40) Regarding cystinosis:

41) Regarding corneal transplant:

44) Figure of corneal infection of acanthamoeba:

49) Figure of peripheral ulcerative keratitis (PUK), What is the management:

50) Rapid method to diagnose acanthameba:

a. Affected eyes often have darker appearing irides.

55) Regarding the appearance shown in Figure 8 during gonioscopy:

a. Enlarged blind spot.

a. Bandage contact lens and lubricants.

59) Regarding the ocular hypertension treatment study (OHTS):

61) Regarding Neovascular glaucoma (NVG) , which is most likely to be associated:

62) Regarding long-term follow up of visual fields:

64) Regarding acute graft rejection:

66) Regarding the measurement of intraocular pressure (IOP):

67) Regarding systematic reviews of evidence for surgical treatment of glaucoma:

69) Regarding congenital glaucoma:

70) Regarding pseudoexfoliation (PEX):

71) Evisceration is indicated in:

74) Regarding peripapillary nerve fiber layer vascularity by OCTA:

75) Neovascular glaucoma (NVG) , Most common with:

77) Regarding primary open angle glaucoma (POAG):

a. Fuch’s heterochromic iridocyclitis.

a. Chiasmal compression from a craniopharyngioma.

87) Regarding internuclear ophthalmoplegia (INO):

92) Regarding skew deviation:

95) Regarding Wolfram syndrome (DIDMOAD):

97) Regarding benign headache in children:

100) Regarding Adie's Pupil:

102) Regarding traumatic optic neuropathy:

a. Clinical suspicion of retinoblastoma.

105) Regarding the fundus photograph in the figure:

a. It is unlikely to be associated with visual loss.

a. Cystoid macular edema (CME).

a. It accounts for about a third of primary operative failure.

109) Regarding the clinical photograph shown in Figure 12:

a. A giant retinal tear is the most likely cause.

a. It is likely to be associated with progressive myopia.

111) Regarding the fundus picture shown in Figure 15: