CHAPTER ONE
ANATOMY AND PHYSIOLOGY
(GENERAL AND OCULAR)
1. The Oculomotor nerve innervates the following muscles:
T a. Superior rectus
T b. Medial rectus
T c. Inferior rectus
T d. Levator palpebrae superioris
F e. Lateral rectus
2. Which glands produce the aqueous layer of the tear film?
F a. Glands of Zeis and Moll
T b. Glands of Kraus and Wolfring
T c. Lacrimal gland
F d. Goblet cells
F e. Glands of Manz
3. Which of the following is a bone of the orbit?
F a. Sacrum
T b. Sphenoid
F c. Sternum
T d. Ethmoid
F e. Fibula
4. The diameter and volume of the sphere of the adult eye is:
F a. 3.0cm in diameter and 9.5ml
F b. 3.00cm in diameter and 7.2ml
T c. 2.5cm in diameter and 6.5ml
F d. 2.5cm in diameter and 5.35ml
F e. 4.0cm in diameter and 7.2ml
5. The average axial length of the globe is:
F a. 26mm
F b. 28mm
F c. 20mm
F d. 2.2mm
T e. 24mm
6. The following are eyelid landmarks:
T a. Lacus lacrimalis
T b. Caruncula lacrimalis
T e. Plica semilunaris
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F d. Tenon’s capsule
F e. Lamina fusca
7. Aqueous drains through the following channels:
T a. Trabecular meshwork
T b. Collector channels
T c. Sinus venosus sclerae
T d. Aqueous veins
F e. Pars plans
8. Anatomical landmarks of the vitreous include:
T a. Hyaloid fossa
T b. Vitreous base
T c. Hyaloid canal
T d. Retrolental space
F e. Asteroid hyalosis
9. What part of the retina is avascular?
T a. Macula
F b. Optic nerve head
F c. Extreme periphery
T d. Fovea centralis
F e. None
10. The following statements are CORRECT about muscle tissues:
F a. Skeletal muscles are striated and involuntary muscle tissues
T b. Cardiac muscles have intercalated discs and centrally located nuclei
T c. Contraction in smooth muscles is involuntary and long-lasting
T d. Satellite cells are sources of regenerative cells in skeletal muscles
Fe. Cardiac muscles are used for locomotion, and phonation
11. These statements are CORRECT about the nervous tissue:
T a. Bipolar neurons are found in the retina
F b. Neurons are more than neuroglia in the mammalian brain
T c. Astrocytes are glial cells of the nervous tissue
T d. Neurons are classified based on structure and function
F e. Neurons are composed of perikaryon and dendrites only
12. The part(s) of the midbrain involved with eye and vision include(s)
T a. Superior colliculus
T b. Oculomotor nucleus
F c. Inferior colliculus
F d. Substantia nigra
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T e. Tectum
13. The following are types of connective tissues:
T a. Areolar connective tissue
T b. Adipose tissue
T c. Fibrous connective tissue
T d. Blood
T e. Hyaline cartilage
14. The following statements are CORRECT about muscle tissues
F a. Skeletal muscles are striated and involuntary
T b. Cardiac muscles have intercalated discs
T c. Contraction in smooth muscle is involuntary and long-lasting
T d. Satellite are precursor cells in skeletal muscles
F e. Cardiac muscles are used for mastication
15. Branches of inter-costal nerve are:
T a. Lateral cutaneous nerve
F b. Internal intercostal nerve
T c. Posterior cutaneous nerve
F d. Rami communicans nerve
T e. Anterior cutaneous nerve
16. The eye is embryologically derived from:
T a. Neuroectoderm of the forebrain
T b. Surface ectoderm of the head
T c. Mesoderm between the above layers
T d. Neural crest
F e. Mesenchyme
17. Orbital contents include:
T a. Optic nerve
T b. Ocular muscles and nerves
T c. Lacrimal gland and sac
T d. Fat and fascia
F e. Nasolacrimal duct
18. Orbital muscles include:
T a. Levator palpebrae superioris
F b. Palpebrae inferioris
T c. Rectus muscles
T d. Oblique muscles
F e. Ciliary muscle
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19. The cranial nerves innervating these extraocular muscles are:
T a. Levator palpebrae superioris: CN III
F b. Superior oblique: CN III
T c. Lateral rectus: CN VI
F d. Medial rectus: CN IV
F e. Inferior oblique: CN IV
20. The following are the blood supply to the orbital contents:
T a. Ophthalmic artery
F b. Brachial artery
F c. Cortical artery
T d. Infra-orbital artery
T e. Central retinal artery
21. Retina bipolar neurons can synapse with:
T a. Rods cells
T b. Cones cells
T c. Amacrine cells
F d. Pyramidal cells
T e. Ganglion cells
22. The following anatomical statements are CORRECT:
T a. Nasal optic nerve fibres decussate at optic chiasma
T b. Temporal optic nerve fibres do not decussate
F c. Optic tract is anterior to the optic chiasma
T d. Lateral geniculate body is posterior to the optic radiation
T e. Internal carotid arteries are lateral to the optic chiasma
23.
Innervation of the cornea includes:
F a. Optic nerve
T b. Ophthalmic nerve
F c. Mandibular nerve
F d. Maxillary nerve
F e. Facial nerve
24. The following are CORRECT about tears production:
F a. Oily layer is produced by goblet cells
T b. Aqueous layer is produced by lacrimal gland and accessory lacrimal glands
F c. Mucus layer is produced by meibomian and sebaceous gland
F d. Aqueous layer is produced by gland of Moll
T e. Oily layer is produced by the meibomian gland
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25. If Bowman membrane = 1, Epithelium =2, Descemet membrane = 3, Stroma = 4 and
Endothelium = 5. The CORRECT sequence of corneal layers from most external will be:
F a. 1, 2, 3, 4, 5
F b. 2, 3, 4, 5, 1
T c. 2, 1, 4, 3, 5
F d. 5, 4, 3, 2, 1
F e. 2, 5, 1, 4, 3
26.
If Foveola = 1, Para fovea = 2, Macula lutea =3, and Perifoveolar = 4. The
CORRECT sequence of central retina structures from the center to the periphery will be:
F a. 3, 4, 1, 2
F b. 4, 3, 2, 1
F c. 1, 2, 3, 4
T d. 1, 2, 4, 3
T e. 2, 1, 3, 4
27. In the retina, the closest layers to the rods and cones are:
F a. Choriocapillaris
T b. Pigment epithelium layer
T c. External limiting membrane
F d. Ganglion cell layer
F e. Internal limiting membrane
28. The following are CORRECT about visual pathway structures
F a. Optic nerve is connected to optic tract
F b. Optic tract is connected to optic radiation
T c. Lateral geniculate body is connected to optic radiation
T d. Optic nerve is connected to optic chiasma
F e. Optic chiasma is connected to optic radiation
29. Cornea is supplied by nerve fibres derived from:
F a. Trochlear nerve
F b. Optic nerve
T c. Trigeminal nerve
F d. Oculomotor nerve
F e. Abducens nerve
30.
Most of the thickness of cornea is formed by:
F a. Epithelial layer
T b. Substantia propria
F c. Descemet's membrane
F d. Endothelium
F e. Bowman's membrane
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31 All of the following are part of uvea EXCEPT:
F a. Pars plicata
F b. Pars plana
F c. Choroid
T d. Schwalbe’s line
F e. Iris
32.
Aqueous humour is formed by:
T a. Epithelium of ciliary body
F b. Posterior surface of iris
F c. Lens
F d. Pars plana
F e. Scleral spur
33.
Number of layers of neurosensory retina is:
F a. 8
T b. 9
F c. 10
F d. 11
F e. 12
34.
Optic disc diameter is about:
F a. 1mm
T b. 1.5mm
F c. 2mm
F d. 3mm
F e. 4mm
35. Optic nerve axon emerges from:
T a. Ganglion cells
F b. Rods receptors
F c. Amacrine cells
F d. Inner nuclear layer
F e. Cone receptors
36.
All the following are extraocular muscles EXCEPT:
F a. Superior rectus
T b. Ciliary muscle
F c. Inferior oblique
F d. Superior oblique
T e. Orbicularis oculi
37.
The action of superior rectus is:
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F a. Elevation, intorsion, abduction
T b. Elevation, intorsion, adduction
F c. Elevation, extorsion, adduction
F d. Elevation, extorsion, abduction
F e. None of the above
38. The action of inferior oblique is:
F a. Depression, extorsion, abduction
F b. Depression, extorsion, adduction
F c. Elevation, extorsion, adduction
T d. Elevation, extorsion, abduction
F e. Elevation, intorsion, adduction
39. The only extraocular muscle which does NOT arise from the apex of the orbit is:
F a. Superior rectus
F b. Superior oblique
T c. Inferior oblique
F d. Inferior rectus
F e. Medial rectus
40. The visual pathway starts at----and ends at----:
F a. Optic nerve, Visual cortex
F b. Optic nerve, Optic radiations
F c. Retinal photoreceptors, Lateral geniculate body
F d. Retinal photoreceptors, Visual cortex
T e. Optic nerve, Lateral geniculate body
41. Superior tarsal muscle is supplied by the:
F a. Third cranial nerve
T b. Sympathetic nerve fibres
F c. Parasympathetic nerve fibres
F d. Seventh cranial nerve
F e. Sixth cranial nerve
42. The MOST anterior structure in the eyelid margin is the:
F a. Mucocutaneous junction
F b. Gray line
F c. Meibomian gland orifices
T d. Lash line
F e. Tarsal plate
43. The anterior lamella of eyelid contains:
F a. Glands of Wolfring
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T b. Zeis glands
F c. Glands of Krause
F d. Meibomian glands
F e. Glands of Moll
44.
The anterior and posterior lamellae of the lid can be separated at the level of
margin by the:
F a. Lash line
F b. Line of meibomian gland orifices
T c. Gray line
F d. Mucocutaneous junction
F e. Layer of subcutaneous tissue
45. Third cranial nerve innervates:
F a. Superior oblique muscle
T b. Levator palpebrae muscle
T c. Inferior oblique muscle
T d. Medial rectus muscle
F e. Lateral rectus muscle
46. Which ocular structure is involved in accommodation?
F a. Cornea
F b. Retina
F c. Sclera
T d. Lens
F e. Optic nerve
47. Which of the following is NOT a fibre of the ciliary muscle?
F a. longitudinal fibres
F b. Radial fibres
F c. Circular fibres
T d. Diagonal fibres
T e. Collagen fibres
48. Which of the following is NOT a layer of the cornea?
T a. Anterior limiting membrane
F b. Descemet’s membrane
F c. Bowma.n’s membrane
T d. Basal layer
F e. Stroma
49. How many layers make up the cornea‘?
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F a. 4
T b. 5
F c. 7
F d. 3
F e. 8
50. How many layers make up the tear film‘?
F a. 2
T b. 3
F c. 4
F d. 5
F e. 6
51. Which of the following is a tear film layer?
T a. Mucin
F b. Vitreous
T c. Aqueous
F d. Lamina fusca
T e. Lipid
52. How many bones make up the orbit?
F a. 2
F b. 4
F c. 6
T d. 7
F e. 8
53. The following are orbital bones:
T a. Sphenoid
T b. Frontal
F c. Ethmoid
T d. Zygomatic
F e. Scapula
54. How many nerves make up the cranial nerves?
F a. 10
F b. 11
T c. 12
F d. 13
F e. 14
55. These are layers of the eyelid:
T a. Skin
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T b. Subcutaneous layer
T c. Muscular layer
F d. Endothelium
F e. Stroma
56. Which of the following is NOT a gland of the eyelid?
F a. Gland of Zeis
F b. Gland of Moll
F c. Meibomian gland
T d. Muscular gland
T e. Sweat gland
57. How many layers does the sclera have?
F a. 2
F b. 4
F c. 5
F d. 6
F e. 7
58.
Which layer is COMMON among the sclera and iris?
T a. Stroma
F b. Bowman’s membrane
F c. Endothelium
F d. Muscle layer
F e. Descemet’s membrane
59. Which of the following is NOT associated with the iris‘?
F a. Ciliary zone
T b. Neural zone
F c. Colarette
F d. Sphincter muscle
T e. Interfibrilar spacing
60.
How many layers does the retina have?
F a. 7
F b. 8
F c. 9
T d. 10
F e. 12
61.
Which nerve supplies the superior oblique muscle?
T a. Trochlear
F b. Oculomotor
F c. Trigeminal
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F d. Abducens
F e. Olfactory
62. The lateral rectus muscle is innervated by:
F a. Trochlear
F b. Oculomotor
F c. Olfactory nerve
T d. Abducens
F e. Glossopharyngeal
63. Which of the following extra-ocular muscles is NOT innervated by the oculomotor
nerve?
F a. Medial rectus
F b.Superior rectus
F c. Inferior rectus
T d. Lateral rectus
T e. Superior oblique
64. Nerves and blood vessels enter the orbit and globe through the following:
T a. Superior orbital fissure
T b. Inferior orbital fissure
T c. Optic canal
F d. The apex
F e. Sphenoid
65. Which of the following is a part of the orbital wall?
T a. Roof
T b. Floor
T c. Medial wall
F d. Diagonal wall
F e. Ethmoidal wall
66.
Which of these muscles are NOT innervated by CN III?
F a. Superior rectus
T b. Sphincter pupillae
F c. Inferior oblique
F d. Levator palpebrae superioris
F e. Inferior rectus
67. Which of the following is NOT associated with changes in the composition of the
vitreous?
F a. Myopia
F b. Ocular injuries
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F c. Uveitis
T d. Hyperopia
T e. Astigmatism
68. Muscles found in the eyelid include:
T a. Orbicularis oculi
F b. Sphincter pupillae
F c. Dilator pupillae
F d. Inferior oblique
T e. Levator palpebrae superioris
69.
Which cranial nerve supplies the levator palpebrae superioris?
F a. Olfactory nerve
F b. Abducens
F c. Trochlea
T d. Oculomotor
F e. Facial
70. The boundary between the lid and the orbital cavity is:
T a. Orbital septum
F b. Orbital foramen
F c. Orbital fissure
F d. Levator aponeurosis
F e. Palpebral fissure
71. The thickest region of the iris is known as:
F a. Ciliary zone
F b. Pupillary zone
F c. Stroma
T d. Colarette
F e. Endothelium
72. How many layers make up the lens?
F a. 2
F b. 3
T c. 4
F d. 5
F e. 6
73. Which of The following is a layer of the lens?
F a. Zonular layer
T b. Capsule
T c. Subcapsular layer
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T d. Cortex
F e. Collagen layer
74. The term “Anisocoria” is related to which of the following structures in the eye?
F a. Cornea
T b. Pupil
F c. Lens
F d. Retina
F e. Aqueous
75. What is the number of the optic nerve in the list of cranial nerves?
F a. 1
T b. 2
F c. 5
F d. 8
F e. 9
76. Which of following is/are TRUE of the aqueous humour?
F a. lt has a specific gravity of approximately 1.3306
T b. The refractive index is lesser than that of the lens
T c. lts chief functions are to nourish the cornea and lens
F d. The volume is approximately 150uL in the anterior chamber
T e. It is generated by the ciliary body
77.
Composition of the aqueous humour:
T a. It has similar composition with plasma
F b. lt contains more glucose than plasma
F c. It has a lower concentration of amino acids than plasma
F d. The colloid in the aqueous is much less than that in the plasma
T e. It contains glutathione and ascorbic acid
78. The following statements are true of the aqueous humour EXCEPT
F a. Sympathetic stimulation reduces IOP
F b. Parasympathetic stimulation increases IOP
F c. The average IOP of the eye ranges from 10 to 22mmHg
T d. It reaches the anterior chamber before the posterior chamber
F e. ln glaucoma outflow resistance increases the pressure within the eye
79. The following structures are related to the vitreous anteriorly:
T a. Anterior hyaloid
T b. Posterior hyaloid
T c. Ligamentum pectinatum
T d. Ora serrata
T e. Optic nerve disc
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80. Which among these statements is CORRECT?
T a. Space of Martegiani constitutes the Cloquet’s canal posteriorly to the optic nerve
head
F b. Wieger's ligament is about 16mm in diameter
T c. The retrolental space is central to the Wieger’s ligament
F d. Space of Erggelet constitutes the Cloquet‘s canal posteriorly in front of the lens
T e. The vitreous base is firmly attached to the posterior 2mm of the pars plana
81. The properties of the vitreous include:
T a. lt is 16.5mm in axial length, with a volume of approximately 4mL
T b. It has a specific gravity of approximately 1.0071 (between 1.0053 to 1.0089)
T c. It does not contain blood
F d. Its viscosity is 4 times that of water in ml
F e. lt has large amount of soluble proteins and small molecules
82.
Based on attachment, the vitreous is:
T a. Strongly attached to the vitreous base
F b. Weakly attached to the posterior lens capsule
T c. Attached at optic disc margins with collagen fibres
F d. Completely detached from the macula
T e. Loosely attached along the retinal vessels
83.
Based on the fovea:
T a. Fovea centralis has a diameter of about 1.5mm
F b. The average thickness of the retina in this area is about l.25mm
T c. The only supply to the fovea is via the choriocapillaris
T d. There are approximatelyl00 cones per 100um2 in the parafovea
F e. At the midperiphery cones are separated from each other by at least six rods
84. The following layers constitute parts of the photoreceptor layer EXCEPT:
T a. Inner nuclear layer
F b. Outer nuclear (granular) layer
F c. Outer plexiform or molecular (synapse) layer
T d. Inner plexiform layer
F e. External Limiting Membrane
85. The pigment epithelium functions to:
T a. Provide the receptors with nourishment and oxygen
F b. Transduce light signals to electrical signals
F c. Mediate signals that are responsible for colour and detail
T d. Digest the spent disc lamellae from the photoreceptors
T e. Act as reservoirs of useful substances, most important of which is vitamin A
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86. The optic nerve derives its blood supply from:
T a. The central retinal artery
T b. The pial perforators
F c. The long posterior ciliary arteries
T d. The short posterior ciliary arteries
F e. The palpebral arcades
87. Which of the following is/are NOT found in the cell membrane?
F a. Cholesterol
F b. Phospholipids
F c. Proteins
T d. Galactose
T e. Amino
88.
Which blood components play role in maintaining the osmotic pressure of blood?
T a. Albumin
F b. White blood cells
F c. Fibrinogen
T d. Globulins
F e. Vitamins
89.
The following contract together to pump blood:
F a. Right atrium with the right ventricle and left atrium with the left ventricle
T b. Right atrium with left atrium and right ventricle with left ventricle
F c. Tricuspid valve and mitral valve
F d. Aorta and pulmonary artery
F e. Vena cava and right atrium
90. An additional chemical defense found in tears and saliva is:
T a. Lymphocytes
F b. Saline
T c. Lysozyme
F d. Phagosomes
F e. Lipase
91.
Which part of the nephron removes water, ions and nutrients from the blood?
F a. Vasa recta
F b. Loop of Henle
F c. Proximal convoluted tubule
T d. Peritubular capillaries
F e. Collecting ducts
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92. The need to breathe is caused by;
F a. A decrease in blood pH
T b. An increase in blood pH
F c. A decrease in blood oxygen levels
F d. A decrease in carbon dioxide levels
F e. Increase in bicarbonates
93. _________ is released in the duodenum in response to acidic chime:
F a. Cholecystokinin
F b. Gastrin
T c. Secretin
F d. Peptide
F e. Renin
94. The following hormones react to a negative feedback EXCEPT:
F a. Progesterone
F b. Oestrogen
F c. Prolactin
T d. Oxytocin
F e. Testosterone
95.
The main endocrine glands are the following EXCEPT:
F a. Thyroid
T b. Liver
F c. Pancreas
F d. Gonads
T e. Mammary glands
96.
The T wave in an ECG shows:
F a. Resting potential
F b. Atrial depolarization
F c. SA node excitation
T d. Ventricle repolarization
F e. Ventricular depolarization
97. When neutrophils and macrophages squeeze out of capillaries to fight off infection
called:
F a. Phagocytosis
F b. Hemolysis
F c. Interleukin
T d. Diapedesis
F e. Haempoiesis
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98. When the ovaries stop producing oestrogen, ________________ occurs:
F a. Ovulation
F b. Implantation
F c. Premenstrual syndrome
T d. Menopause
F e. Anovulation
99.
Which of the following participates in the synthesis of haemoglobin and melanin?
T a. Copper
F b. Chloride
F c. Calcium
F d. Iron
F e. Vitamins
100. In a normal blood sample, which of the following cells will be the most abundant?
T a. Neutrophils
F b. Eosinophils
F c. Monocytes
F d. Lymphocytes
F e. Basophils
101. The total lung capacity is the:
T a. Vital capacity
F b. Tidal volume
F c. Expiratory reserve volume
F d. Inspiratory reserve volume
F e. Residual volume
102. Which among these statements is/are INCORRECT? The spinal cord is divided
into:
T a. Cervical region (7 segments).
F b. Thoracic region (12 segments)
F c. Lumber region (5 segments)
F d. Sacral region (5 segments)
T e. Thoracic region (11 segments)
103. Which of the following does NOT directly affect synaptic transmission?
F a. Hypoxia
T b. Insulin ‘
F c. Drugs
F d. PH
T e. Blood
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104. Which of the following is a sensory receptor?
F a. Adrenergic receptor
F b. Cholinergic receptor
F c. Dopaminergic receptor
T d. Chemoreceptor
T e. Proprioceptors
105. Functions of the sympathetic nervous system include:
F a. Contraction of the constrictor pupillae muscle
F b. Contraction of the ciliary muscle
T c. No effect or slight vasoconstriction of the cerebral blood vessels
F d. Secretory to the mucous glands in the air passages
T e. Pupillary dilatation
106. Eyesight decreases with age because:
T a. Older eyes receive much less light at the retina
T b. There are numerous eye diseases that can affect an older eye
T c. The extent to which the pupil dilates decreases with age
F d. The lens softens as age increases
F e. There is increasing levels of α-crystallin in the lens with increasing age
107. The refractive power of the eye is determined by all these structures EXCEPT:
F a. Cornea
T b. Sclera
F c. Crystalline lens
F d. Aqueous humour
T e. Iris
108. The refractive index is defined as follows: n=v/c; c in the equation is:
F a. The velocity of refraction
F b. The speed of light in vacuum
T c. The speed of light in a given substance
F d. The refractive power
F e. The angle of incidence
109.
The eye's ability to focus light sharply on the retina is based on the following
features EXCEPT:
F a. The curvature of the lens inside the eye
F b. The curvature of the cornea
T c. The viscosity of the aqueous humour
F d. The overall length of the eye
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T e. The viscosity of the vitreous humour
110. Which of these muscles regulate the size of the pupil?
T a. Sphincter muscle
T b. Dilator pupillae muscle
T c. Circular muscles
F d. Muscularis oculi
F e. Dilator palpebralis
111. Mydriasis could occur due to the following:
F a. Drugs decreasing serotonin
T b. Compression of oculomotor nerve
T c. Damage of the sphincter muscle of iris
T d. Drugs inhibiting epinephrine uptake
F e. Actions of morphine and heroine
112. Miosis could occur due to following EXCEPT:
F a. Brain haemorrhage
T b. Action of anticholinergic drugs
T c. Cocaine intake
T d. Amphetamines
F e. Cluster headaches
113 . Which of the following reflexes is NOT associated with optic nerve?
F a. Pupil dilation
F b. Menace response
T c. Intermediate response
F d. Fixating response
T e. Corneal reflex
114. Specific autonomic functions must maintain adjustment of some smooth muscles
in order for the eye to function properly, these muscles are the following EXCEPT:
F a. Smooth muscle of veins that drain blood from the eye
T b. Smooth muscles of the pupil
F c. Smooth muscle of arteries providing oxygen to the eye
F d. Smooth muscle of the iris
F e. Pupillary constrictor
115. Light reflex is regulated by the following structures EXCEPT:
T a. The conjunctiva
F b. The retina
F c. The pretectum
F d. The midbrain
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F e. The iris
116. The following are layers of tear film EXCEPT:
F a. Aqueous layer
F b. Mucous layer
F c. Lipid layer
T d. Meibum layer
T e. Basal layer
117. The following are composition of the vitreous humour EXCEPT:
T a. Fibrinogens
F b. Salt
F c. Protein
F d. Sugar
F e. Hyalocytes
118. Which of the following statements is TRUE about the physiologic variation of
intraocular pressure?
T a. Intraocular pressure decreases during exercise
F b. Caffeine may decrease intraocular pressure
T c. Alcohol consumption decreases intraocular pressure
T d. Increased intraocular pressure causes intraocular hypertension.
F e. Alcohol consumption increases intraocular pressure
119. Which of the following explains the transparency of the cornea?
T a. Regular lattice arrangement
F b. Density of the cornea
F CA Tear film layer
F d. Interface with the aqueous
T e. Inter fibrillar spacing
120. These are involved in the nourishment of the cornea:
T a. Tear film
F b. The eyelid
F c. Vitreous
F d. Sclera
T e. Aqueous
121. Which of the following is associated with eye colour?
F a. Cornea
T b. Melanin
T c. Iris
F d. Sclera
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F e. Conjunctiva
122. Which of the following is NOT a composition of the aqueous humour?
F a. Amino acid
F b. Electrolytes
F c. Vitamin C
T d. Adenosine triphosphate
T e. Nitrates
123. Which of these is NOT a composition of the lens?
F a. Water
F b. Proteins
F c. Salt
T d. Alcohol
T e. Lipids
124. The conversion of light energy into neural impulse is known as:
T a. Transduction
F b. Photoduction
F c. Trans-illumination
F d. Illumination
F e. Abduction
125. Heterochromia defines:
T a. Difference in iris colour
F b. Difference in corneal colour
T c. Difference in eye colour
F d. Difference in conjunctival colour
F e. Difference in scleral colour
126. Which of the following is involved in lens metabolism?
T a. Lens protein
T b. Anaerobic glycolysis
T c. Citric acid cycle
F d. Oxidation
F e. Transduction
127. The characteristic of the nervous system that makes it to be highly dynamic and
responsive to sensory experiences is:
F a. Electrical impulses
T b. Plasticity
F c. High sensitivity
F d. Intricate neuronal cell arrangement
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F e. None of the above
128. Features that contribute to the transparency of the cornea are:
F a. Non-uniformity in the arrangement of the epithelial cells
T b. Closely packed corneal lamellae
T c. State of deturgescence
T d. Absence of blood vessels
F e. Presence of cone cells
129. Which glands secrete the lipid layer of the tear film?
T a. The meibomian glands
T b. The glands of Zeis
F c. The lacrimal gland
T d. The gland ofMoll
F e. Goblet cells
130. Functions of the lipid layer of the tear film are:
F a. To combat bacterial infection of the cornea
T b. To increase surface tension and assist in veltical stability of the tear film
F c. To prevent elevation of intraocular pressure
T d. To reduce evaporation of the aqueous layer
T e. To lubricate the eyelid as they pass over the surface of the globe
131. The rod photoreceptors are used in:
T a. Dark adaptation
F b. Light adaptation
T c. Scotopic vision
T d. Detection of movement
F e. Photopic vision
132. The superior rectus muscle is involved in:
F a. Depression
T b. Elevation
F c. Abduction
T d. Adduction
T e. Intorsion
133. The superior oblique muscle is involved in:
T a. Depression
T b. Abduction
T c. Intorsion
F d. Elevation
F e. Extorsion
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134. Which muscles are responsible for moving the eyes down and to the right‘?
F a. Right Inferior Oblique
T b. Right Inferior Rectus
T c. Left Superior Oblique
F d. Right Superior Oblique
F e. Right Medial Rectus
135. The cone photoreceptors are used in:
T a. Central vision
T b. Colour vision
F c. Scotopic vision
T d. Detail and form
T e. Photopic vision
136. Which of the following is NOT a route for aqueous outflow?
F a. Trabecululum
F b. Uveal meshwork
F c. Corneo-scleral meshwork
T d. Punctum
F e. Schlemm’s canal
137. Rhodopsin is:
F a. A red pigment
T b. Regenerated when the eyes are closed
F c. Found in the inner segments of rods
T d. Most sensitive to light with a wavelength of 500nm
F e. Regenerated in the visual cortex
138. The Bruch’s membrane:
F a. Is 10pm in thickness
T b. Contains the basement of the choriocapillaries
T c. Increases in thickness with age
F d. Forms part of the blood-retinal barrier
T e. It is abnormally thin in Ehler-Danlos’ syndrome
139. The iris:
F a. Contains pigmented epithelium on its anterior surface
T b. Contains melanocytes in the stroma that determines the iris colour
F c. Colour is determined by sympathetic system
T d. Contains both the longitudinal and radial muscles
T e. Constrictor muscle is innervated by the parasympathetic system
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140. The sclera:
F a. Contains 50% of water
T b. Contains mainly type I and III collagen
F c. ls thinnest near the limbus
F d. ls penetrated by four vortex veins at its equator
F e. Contains mainly type I and II collagen
141. The optic canal is formed by:
F a. The greater wing of the sphenoid
T b. The lesser wing of the sphenoid
F c. The frontal bone
F d. The temporal bone
F e. The lacrimal bone
142. The following are TRUE:
F a. The sphenoid sinus drains into the superior meatus
F b. The frontal sinus drains into the superior meatus
T c. The maxillary sinus drains into the middle meatus
T d. The nasolacrimal duct drains into the anterior meatus
T e. The posterior ethmoidal sinus drains into superior meatus
143. The optic chiasma is supplied by:
T a. Anterior cerebral artery
F b. Ophthalmic artery
T c. Anterior communicating artery
T d. Posterior communicating artery
T e. Internal carotid artery
144. The fovea:
T a. Is about 1.5mm in diameter
T b. Has approximately the same diameter as the optic
F c. The foveola is superiorio-lateral to the optic disc
T d. There are no rods in the fovea
T e. No blood vessels are found in the fovea
145. The limbus:
F a. Measures about 5mm wide
T b. Is covered by the conjunctiva
T c. Marks the transition of cornea to sclera
F d. Is devoid of blood vessels
T e. Is covered by the tenon capsule
146. With regard to the third nerve nucleus:
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T a. The superior rectus muscle is supplied by contralateral oculomotor nucleus
T b. The lateral rectus muscle is supplied by the ipsilateral oculomotor nucleus
F c. The levator muscle is supplied by ipsilateral oculomotor nucleus
F d. The parasympathetic nucleus is situated anterior to the motor nucleus
T e. The motor nucleus is connected to the fourth and sixth nerve nucleus via medial
longitudinal fasciculus
147. The parasympathetic impulses reach the lacrimal gland through:
T a. Nervus intermedius
F b. Deep petrosal nerve
F c. Greater petrosal nerve
T d. Zygomaticotemporal nerve
F e. Superior branch of the oculomotor
148. The central retinal artery:
T a. Is the first branch of the ophthalmic artery
F b. Enters the orbit through the optic canal
F c. Enters the optic nerve at its intracanalicular portion
T d. Has a smaller diameter than the central retinal vein
F e. Supplies the rods and the cones
149. The canal of Schlemn:
F a. Lies posterior to the scleral spur
T b. Lies posterior to the Schwalbes line
T c. Is lined by endothelium
T d. Is separated from the trabecular meshwork by sinus
F e. Drains into the vortex vein
150. The aqueous component of tear film is produced by:
T a. Lacrimal gland
F b. Meibomian gland
F c. Goblet cell
F d. Gland of Krause
F e. Gland of Wolfring
151. The following structure(s) synapse(s) in the ciliary ganglion: l
F a. Nasociliary fibres
T b. Parasympathetic nerve fibres from oculomotor nerve
F c. Sympathetic nerve fibres from the carotid artery
F d. Parasympathetic nerve fibres from the facial nerve
F e. Abducent nerve fibres
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152. The nasolacrimal duct is covered by the following bones:
F a. Medial turbinate
T b. Inferior turbinate
T c. Maxillary bone
T d. Lacrimal bone
F e. Ethmoid bone
153. The annulus of Zinn is attached to the:
T a. Lesser wing of the sphenoid bone
T b. Greater wing of the sphenoid
T c. Ethmoid bone
F d. Zygomatic bone
F e. Lacrimal bone
154. The following are TRUE about the cornea:
T a. The peripheral cornea has twice the thickness of the central cornea
T b. It has a density of nerve ending which is 300 times that of the epidermis
T c. lt is more curved centrally than peripherally
F d. It is more curved in the horizontal than the vertical axis
T e. It has a refractive index of 1.36
155. A line connecting points of same or equal sensitivity on a visual field plot/chart is
called;
F a. Isometer
T b. lsopter
F c. Isomer
F d. Traquair
F e. Contour line
156. Accommodation involves the following EXCEPT:
F a. Ciliary muscle
T b. Ciliary body
F c. Anterior lens capsule
F d. Posterior lens capsule
T e. Orbicularis muscle
157. These are the four components of accommodation EXCEPT:
F a. Tonic accommodation
F b. Reflex accommodation
T c. Lenticular accommodation
F d. Convergence accommodation
T e. Scleral accommodation
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158. Presbyopia is a /an......................
F a. Refractive error
F b. Pupillary defect
T c. Age-related defect
F d. Fusional defect
T e. Accommodative defect
159. Small circular area representing size and location of that receptor’s sensitivity in
the visual field is called:
F a. Isopter
T b. Receptive field
F c. Receptors space
F d. Isocircles
F e. All of the above
160. The colour vision systems based on opponent theory are... and...
F a. Long and medium wavelength
F b. Achromatic and chromatic
F c. Spherical and coma aberration
F d. Trichromacy and dichromacy
T e. Trichromatic and achromatic
161. Homonymous hemianopia with macular sparing is caused by lesion in the:
T a. Occipital cortex
F b. LGB
F c. Optic chiasm
F d. Optic radiations
T e. Cerebral cortex
162. Total homonymous hemianopia occurs due to lesion in the:
F a. Occipital cortex
F b. Optic chiasm
T c. Optic tract
F d. LGB
F e. Optic radiation
163. In bright light, red and blue colours appear bright, but in dim light, red appears
nearly as black. This is called:
F a. Colour matching
F b. Colour saturation
F c. Purkinje after image
T d. Purkinje shift
F e. Colour blocking
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164. What colour is perceived if all three photoreceptors are activated by equal amounts
(equal S, M, and L responses)?
F a Perception would be dark
T b. Perception would be white
F c. Perception would be yellow
F d. Perception would be grey
F e. Perception would be blue
165. Mixing paints and lights are different:
T a. Paints = subtractive colour mixture
F b. Paints = additive colour mixture
T c. Lights = additive colour mixture
F d. Lights =subtractive colour mixture
F e. None of the above
166. These are attributes of colour:
T a. Saturation
T b. Luminance
T c. Hue
F d. Transparency
F e. Spectral sensitivity
167. IOP is highest at:
F a. 12pm
F b. 6pm
T c. 6am
T d. 3pm
F e. 12am
168. What is Blindsight?
T a. Visible discrimination in the absence of acknowledged awareness
T b. Poor shape discrimination
T c. Normal eyes but lesion in the visual cortex
T d. Can describe things but can’t say where they are
F e. Total blindness
169. The following statements are CORRECT about rhodopsin:
F a Concerned with bright vision
T b. Consists of opsin and retinene
T c. Increases in concentration during dark adaptation
F d. Identical with visual pigment in the cones
T e. Appears red in solution but becomes bleached after illumination
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170. The cones in the retina are:
T a. Responsible for colour vision
T b. More sensitive to light than the rods
F c. Not associated with maximum visual acuity
T d. Responsible for photopic vision
F e. Responsible for motion detection
171. The rods in the retina:
F a. Are more densely packed in the foveal region
T b. Are used for peripheral vision
T c. Are rendered insensitive by bright light
F d. Contain the visual pigment iodopsin
T e. Responsible for scotopic vision
172. The following are CORRECT in relation to colour:
T a. Red, green, yellow describe colour hue
P b. Red, green, yellow describe colour saturation
F c. Weak or strong colours describe colour hue
T d. Weak or strong colours refer to colour saturation
F e. Red, Green, white are primary colours
173. The functions of the limbus include provision of:
T a. Nutrition for the adjacent tissues including the cornea
F b. Innervation for the cornea
T c. Pathway for the aqueous drainage from the eye
F d. Lubrication for the cornea
F e. Innervation of scleral plexus
174. The following are CORRECT about reflex blinking:
T a. Corneal reflex is an example of tactile reflex
T b. Dazzle reflex is produced by bright shiny surface
T c. Menace reflex is produced by object coming into the field of View
T d. Tactile reflex follows afferent pathway of trigeminal nerve
T e. Tactile reflex efferent pathway is via seventh cranial nerve
175. Functions of tear film include:
T a. Maintaining an optically uniform corneal surface
F b. Protects the cornea against radiation
T c. Providing nutrients for the cornea
T d. Providing antibacterial substances for the cornea
T e. Mechanically flushing debris, and foreign matters from the cornea
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176. Functions of the lipid layers of tears include:
T a. Reducing the rate of evaporation of underlying tears
F b. Decreasing surface tension of tears
F c. Reducing vertical stability of tears
T d. Lubricating eyelids as they pass over the surface of the globe
T e. Acting as source of antibacterial substances
177. The light- sensitive chemical in the rods is called:
F a. Colour pigment
T b. Rhodopsin
T c. Visual purple
F d. lodopsin
F e. Chromatophore
178. Rhodopsin is a combination of:
T a. Scotopsin and retinene
T b. Scotopsin and ll cis retinal
F c. Scotopsin and melanin
F d. Scotopsin and keratin
F e. Scotopsin and ll cis retinol
179. Entoptic phenomena arising from the retinal vessels and capillary circulation is
used clinically to measure:
F a. The peripheral avascular zone of the fovea
T b. The central avascular zone of the fovea
F c. The central vascular zone of the fovea
F d. The central vascular zone of the macula
F e. The peripheral vascular zone of the fovea
80. Haidinger's brushes can be perceived by a normal eye while observing a surface
illuminated by:
T a. Plano-polarized white light
F b. Retinoscope
F c. Scattered light
F d. Scattered and unpolarized white light
F e. Ophthalmoscope
181. The fourth Purkinje image (P4) is formed by the:
F a. Anterior surface of the lens and erect
F b. Posterior surface of the lens and erect
F c. Inner surface of the cornea and inverted
T d. Posterior surface of the lens and inverted
F e. Anterior surface of the lens and inverted
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182. When viewing equidistant red and blue objects binocularly, the red ones often
appear nearer than the blue ones. This phenomenon can BEST be explained by:
F a. Trichromacy
F b. Monochromatic higher order aberrations
T c. Different retinal disparities for red and blue images
F d. Kinetic depth effect
F e. Chromatic aberration
183. The visual pathway consists of all EXCEPT:
F a. Optic tract
F b. Visual cortex
F c. Optic nerve
T d. Optic foramina
F e. Optic radiations
184. The optic nerve:
F a. Is the first cranial nerve
T b. Contains afferent pupillary fibres
T c. From the two eyes meet at the chiasma
T d. Originates from the optic disc
F e. Is the third cranial nerve
185. The following are parts of the optic nerve:
T a. Intraorbital
F b. Intravitreal
T c. lntraocular
T d. Intracranial
T e. Intracanalicular
186. Which pan of the optic nerve extends from the back of the eyeball to the optic
foramina?
F a. Intracranial
F b. Intracanalicular
T c. Intraorbital
F d. Intraocular
F e. Intravitreal
187. The part of the optic nerve that converges to fonn the optic chiasma is:
F a. Intraocular
F b. Intraorbital
F c. Intracanalicular
T d. Intracranial
F e. Intravitreal
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188. The cylindrical bundles of nerve fibres running from the posterolateral aspect of the
optic chiasma is called:
F a. Optic radiation
T b. Optic tract
F c. Optic foramina
F d. LGB
F e. Optic disc
189. The parastriate area of the visual cortex is termed area:
F a. 17
T b. 18
F c. 19
F d. a and b
F e b and c
190. Which of these consists of axons of the third order neurons of the visual pathway?
F a. Optic tract
F b. Optic nerve E
T c. Optic radiations
F d. Visual cortex
F e. Optic chiasma
191. Oval structures terminating at the optic tract are called:
T a. LGB
F b. Pupillary fibres
F c. Visual cortex
F d. Peristriate
F e. Optic radiations
192. The Primary visual cortex:
T a. Is the striate cortex
T b. Receives the most direct visual signal
F c. Includes areas 17, 18 & 19
T d. Is identified by line of Gennari
F e. All of the above
193. Which of the following is caused by trauma or tumours of the optic tract or
radiation?
F a. Quadrantanopia
F b. Bitemporal hemianopia
T c. Homonymous hemianopia
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F d. Meyers loop
F e. Binasal hemianopia
194. The part of the optic nerve that passes through the lamina cribrosa and appears
inside the eye as the optic disc is:
T a. lntraocular
F b. lntraorbital
F c. Intracanalicular
F d. Intracranial
F e. lntravitreal
195. The orbital floor is made up of:
T a. Maxilla
T b. Palatine
F c. Greater Wing of the sphenoid
T d. Zygomatic
F e. Ethmoid
196. Which extraocular muscles arise from the annulus of Zinn?
T a. Superior rectus
F b. Superior oblique
T c. Lateral rectus
F d. Inferior oblique
T e. Medial rectus
197. Which of the rectus muscles inserts CLOSEST to the limbus?
F a. Lateral rectus
T b. Medial rectus
F c. Superior rectus
F d. Inferior rectus
F e. Levator muscle
198. Which of the following structures is NOT part of the uveal tract of the eye?
F a. Iris
F b. Ciliary body
F c. Choroid
T d. Neurosensory retina
T e. Bulbar conjunctiva
199. Which of the following cranial nerves exits from the dorsal aspect of the midbrain?
F a. CN III
T b. CN IV
F c. CN V
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F d. CN VI
F e. CN II
200. Which muscle originates from the annulus of Zinn?
F a. Levator palpebrae superioris
F b. Superior oblique
T c. Lateral rectus
F d. Inferior oblique
F e. Orbicularis oculi
201. Oxygen delivery for essential metabolism of the cornea is delivered by:
F a. Perilimbal vessels
T b. Diffusion across the anterior surface
F c. Palpebral vessels
F d. Diffusion from the aqueous
F e. Diffusion from skin of eyelid
202. Sources of metabolites for the corneal tissue include:
T a The tears
T b. The limbal vessels
T c. The aqueous humour
F d. The vitreous humour
F e. The cerebrospinal fluid
CHAPTER TWO
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PATHOLOGY
(GENERAL AND OCULAR)
1. Superficial punctate keratopathy means the following:
T a. Staining on the cornea
T b. Inflammation
F c. Ulcer
F d. Infection
F e. Debridement
2. Degenerations in the vitreous include:
T a. Syneresis
T b. Synchesis scintillans
T c. Posterior vitreous detachment
F d. Rhegmatogenous detachment
F e. Follicles
3. Crocodile shagreen is seen on:
F a. Lids
F b. Sclera
F c. Iris
T d. Cornea
F e. Lens
4. Edema of the optic disc is caused by:
T a. Increased intracranial pressure
T b. Inflammation of the optic nerve
T c. Ischemia of the optic nerve
F d. Trauma to the globe
F e. CRAO/CRVO
5. Optic neuritis has the following signs and symptoms:
T a. Unilateral ocular pain
T c. Swelling of the optic disc
T c. Loss of central vision
T d. Afferent pupillary defect
F e. Raised intraocular pressure
6. Why does the macula look cherry red in CRAO or BRAO?
F a. The CRA still supplies blood to the macula
F b. The BRA still supplies blood to the macula
F c. The cilioretinal vessels supply blood to the macula
T d. The choroid supply blood to the macula
F e. The superior arcuate branch of the CRA supplies blood to the macula
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7. Which of the following statements about opacities is CORRECT?
T a. Opacities in the front of the lens move in the direction of eye movement
T b. Opacities behind the lens (Vitreous) move in the opposite direction
T c. Objects in the vitreous cast shadows on the retina
F d. Blood vessels cast shadows on the retina
T e. Ghost vessels cast shadows on the retina
8. Patients with congenital retinal pigment epithelial hypertrophy should be sent to
T a. Gastroenterologist
F b. Retinal specialist
F c. Optometrist
F d. Neurosurgeon
T e. Ophthalmologist
9. Glaucoma produces these defects:
T a. Bjerrum scotoma
T b. Paracentral scotoma
T c. Nasal step scotoma
T d. Arcuate scotoma
F e. Enlarge blindspot
10. A lesion of the right Meyer’s loop would cause:
F a. Bitemporal hemianopia
F b. Quadrantanopia of the upper right visual field
T c. Quadrantanopia of the upper left visual field
T d. Superior quadrantanopia of the left visual field
F e. Homonymous hemianopia
11. A lesion of the optic nerve would cause:
F a. An enlarged spot
F b. Bitemporal hemianopia
T c. Monocular blindness
F d. Homonymous hemianopia with macular sparing
F e. Homonymous hemianopia
12. A lesion to the occipital lobe would result in:
F a An enlarged blind spot
F b. Bitemporal hemianopia
F c. Monocular blindness
T d. Homonymous hemianopia with macular sparing
F e. Homonymous hemianopia
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13. A lesion located on the optic radiation would give a corresponding visual field loss
T a. Quadrantanopia
F b. Hemianopia
F c. Homonymous hemianopia
F d. Heteronymous hemianopia
F e. Bitemporal hemianopia
14. A lesion before the lateral geniculate nucleus would result in:
T a. Quadrantanopia
F b. Hemianopia
F c. Homonymous hemianopia
F d. Heteronymous hemianopia
F e. Bitemporal hemianopia
15. The following definitions of inflammation are CORRECT:
T a. Manifestation of vascular and cellular response of tissue to an injury
T b. Part of the body’s immune response to any infection tor damage to tissue
T c. Can eventually cause several disease conditions such as cancer and rheumatoid
arthritis
T d. The body’s way of signaling immune system to heal and repair damaged tissues
F e. The body’s way of signaling the end of a disease episode
16. Ocular inflammation can be due to the following:
T a. Iatrogenic injury
T b. Accidental injury
T c. Endogenous injury to eye e.g. vision loss, restricted eye movement
T d. Response to injury marked by production and release of mediators
F e. Response to injury marked by purulent discharge
17. Signs and symptoms of acute inflammation include:
T a. Redness
T b. Heat
T c. Tumour
T d. Pain
T e. Loss of function
18. Features of inflammatory processes include:
T a. Hyperemia
T b. Cellular inflltration
F c. Aneurysm
T d. Fibroblastic proliferation
T e. Vascularization
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19. The following are CORRECT about chalazion:
T a. It is a chronic inflammatory lipogranuloma of the tarsal gland
T b. It is caused by infection of retained sebaceous material in the meibomian gland
F c. It is a cyst
F d. It is wall consists of granulomatous tissue and epithelium
F e. It is an inflammation of the Zeis gland
20. The following are CORRECT about shock:
T a. It is a constellation of syndromes
T b. Characterized by low percussion
F c. It is associated with circulatory excess
F d. Excess blood flow is a feature
F e. None of the above is correct
21. The following are CORRECT about microphthalmos:
T a. It is congenitally smaller than normal eye
T b. It can be a pure microphthalrnos
T c. It may be nanophthalmos
F d. It may be associated with keratoconus
T e. Its co-morbidity may include glaucoma
22. The following are CORRECT about toxoplasmosis
T a. It is a protozoan infectious ocular disease
F b. The host of the parasite is the black fly
F c. lntermediate host may be cat
T d. The parasite invades retinal cells directly
T e. Infestation often starts as a focal area of retinitis
23. The following conditions are associated with retinopathies:
T a. Diabetes
T b. Prematurity
T c. HIV/AIDS
T d. Hypertension
F e. Sarcoidosis
24. Glaucoma is a syndrome characterized by:
T a. Visual field loss
F b. Monocular diplopia
F c. Blepharospasm
F d. Photophobia
T e. Increased intraocular pressure
25. A patient with Stargardt’s disease may presents with the followings:
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T a. Metamorphopsia
F b. Preference for low level of illumination
F c. Fast recovery of visual function from bright lights
T d. Contrast sensitivity (CS) loss
F e. Peripheral visual field loss
26. Signs and symptoms of episcleritis include:
T a. Localized area of intense and deep-seated redness
F b. Severe deep pain
T c. Lacrimation
F d. Perforation leading to scleromalacia perforans
F e. Itching
27. The following structures are affected in age-related macular degeneration
T a. Retinal pigment epithelium
T b. Bruch’s membrane
T c. Choriocapillaris
T d. Retinal pigment epithelium and Bruch’s membrane
F e. Ora serrata
28. These are relevant about Stargardt’s macular dystrophy:
T a. Most common form of inherited juvenile macular degeneration
F b. Results in progressive loss of rods
F c. Presence of dark flecks around the macula
T d. Autosomal recessive inherited
T e. Usually diagnosed in individuals under the age of twenty
29. The following are signs of ARMD:
T a. Presence of drusen
T b. Pigmentary alterations of the fundus, especially the macula
T c. Exudative changes and hemorrhages
F d. Poor peripheral vision
F e. Disc pallor
30. The following are NOT signs or symptoms of age-related macular degeneration:
F a. Central scotoma
F b. Metamorphopsia
T c. Preference for low level of illumination
F d. Slow recovery of visual function from bright lights
F e. Loss in contrast sensitivity
31. The following are TRUE about retinitis pigmentosa:
T a. Nyctalopia
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F b. Bone-spicule pigmentation in the central retina
T c. Attenuation of retinal arteries
T d. Visual field loss typically starts at mid periphery
F e. Poor central vision at early stage
32. Risk factors of cataract include the following:
T a. Ultraviolet radiation
T b. Diabetes
F c. Retinal detachment
T d. Previous eye trauma
F e. Corneal ulcer
33. Risk factors of glaucoma include:
T a. Advanced age
F b. Retinal detachment
T c. Increased intraocular pressure
T d. Heredity
F e. Keratitis
34. Acute painful ocular conditions include:
T a. Acute closed angle glaucoma
T b. Optic neuritis
F c. Papilledema
T d. Endophthalmifis
F e. Retinal detachment
35. Decreased vision with normal fundus occurs in the following:
T a. Retrobulbar neuritis
T b. Amblyopia
T c. Achromatopsia
F d. Stargardt’s syndrome
T e. Cortical visual impairment
36. Night blindness may be associated with:
T a. Vitamin A deficiency
T b. Pigmentary retinal dystrophy
F c. Uncorrected hyperopia
F d. Albinism
F e. Pseudomyopia
37. Causes of binasal hemianopsia include:
T a. Glaucoma
T b. Internal carotid artery pressure on optic chiasma
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T c. Bilateral occipital tumour
F d. Pituitary adenoma
F e. Cataract
38. The following diseases may affect the eye AND vision:
T a. HIV
F b. Parkinsonism
T c. Keratoconjunctivitisrsicca
F d. Dacryocystitis
F e. Hemiballismus
39. Cotton wool exudates are associated with the following:
T a. Diabetic retinopathy
T b. Hypertensive retinopathy
T c. Retinal vein occlusion
F d. HIV AIDS
F e. Age-related macular degeneration
40. Distichiasis is:
F a. Misdirected eyelashes
T b. Accessory row of eyelashes
F c. Downward drooping of upper lid
F d. Outward protrusion of lower lid
F e. White eyelashes
41. Band shaped keratopathy is commonly caused by deposition of:
F a. Magnesium salt
T b. Calcium salt
F c. Ferrous salt
F d. Copper salt
F e. Silver salt
42. Irrespective of the etiology of a corneal ulcer, the drug always indicated is:
F a. Corticosteroids
T b. Cycloplegics
F c. Antibacterials
F d. Antifungals
F e. Antivirals
43. Dense scar of cornea with incarceration of iris is known as:
T a. Adherent leucoma
F b. Dense leucoma
F c. Ciliary staphyloma
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F d. lris bombe
F e. Mooren’s ulcer
44. Corneal sensations are diminished in:
T a. Herpes simplex keratitis
F b. Superior limbic keratitis
F c. Marginal corneal ulcer
F d. Keratoconjunctivitis sicca
T e. Herpes zoster keratitis
45. The colour of fluorescein staining in corneal ulcer is:
T a. Yellow
F b. Blue
T c. Green
F d. Royal blue
F e. Orange
46. Phlycten is due to:
T a. Endogenous allergy
F b. Exogenous allergy
F c. Degeneration
F d. Bacterial invasion
F e. Viral infection
47. Signs and symptoms of vernal keratoconjunctivitis include:
F a. Burning and purulent discharge
T b. Burning, itching and lacrimation
F c. Itching and stringy discharge
T d. Cobble stone papillae
T e. Itching and mucopurulent discharge
48. Which of the following organisms can penetrate intact corneal epithelium?
F a. Streptococcus pyogenes
F b. Staphylococcus aureus
F c. Pseudomorzaspyocyanaea
T d. Corynebacterium diphtheria
F e. Staphylococcus epidermidis
49. Patching of the eye is contraindicated in:
F a. Corneal abrasion
F b. Bacterial corneal ulcer
T c. Mucopurulent conjunctivitis
F d. After glaucoma surgery
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F e. After cataract surgery
50. In viral epidemic kerato-conjunctivitis characteristically there is usually:
F a. Copious purulent discharge
F b. Copious muco-purulent discharge
T c. Excessive watery lacrimation
F d. Mucoid ropy White discharge
F e. Mild purulent discharge
51. Comeal Herbert's rosettes are found in:
F a. Mucopurulent conjunctivitis
F b. Phlyctenular keratoconjunctivitis
T c. Active trachoma
F d. Spring catarrh
F e. Vernal conjunctivitis
52. A patient complains of maceration of skin of the lids and conjunctival redness at the
inner and outer canthi. Conjunctival swab is expected to Show:
F a. Staphylococcus aureus
F b. Streptococcus viridans
F c. Streptococcus pneumoniae
T d. Morax- Axenfizld diplobacilli
T e. Staphylococcus epidermidis
53. Tranta's spots are noticed in cases of:
F a. Active trachoma
T b. Bulbar spring catarrh
F c. Corneal phlycten
F d. Vitamin A deficiency
T e. Vernal conjunctivitis
54. A painful, tender, non-itchy localized redness of the conjunctiva can be due to:
F a. Bulbar spring catarrh
T b. Episcleritis
F c. Vascular pterygium
F d. Phlyctenular conjunctivitis
F e. Bacterial conjunctivitis
55. In trachoma the patient is infectious when there is:
F a. Arlt's line
F b. Herbert‘s pits
F c. Post-trachomatous concretions
T d. Follicles and papillae in the palpebral conjunctiva
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F e. Tranta’s spots
56. Fifth nerve palsy could cause:
F a. Ptosis
F b. Proptosis
T c. Neuropathic keratopathy
F d. Lagophthalmos
F e. Blepharospasm
57. Topical steroids are contraindicated in a case of viral corneal ulcer for fear of:
F a. Secondary glaucoma
F b. Cortical cataract
T c. Corneal perforation
F d. Secondary viral infection
F e. Superimposed fungal infection
58. The sure diagnostic sign of corneal ulcer is:
F a. Ciliary injection
F b. Blepharospasrn
F c. Miosis
T d. Positive fluorescein test
F e. Conjunctival hyperemia
59. The effective treatment of dendritic ulcer of the cornea is:
F a. Surface anaesthesia
F b. Local corticosteroids
F c. Systemic corticosteroids
T d. Acyclovir ointment
F e. Antibacterials
60. Herpes simplex keratitis is characterized by:
F a. Presence of pus in the anterior chamber
F b. No tendency to recurrence
T c. Corneal hypoesthesia
F d. Tendency to perforate
F e. Presence of blood in the anterior chamber
61. Bacteria, which can attack normal corneal epithelium:
T a. Neisseria gonorrheae
F b. Staphylococcus epidermidis
F c. Moraxella lacunata
F d. Staphylococcus aureus
F e. Pseudomonas aeruginosa
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62. Organisms causing angular conjunctivitis are:
T a. Moraxella Axenfeld bacilli
F b. Pneumococci
F c. Gonococci
F d. Adenovinis
F e. Staphylococci
63. Chalazion is a chronic inflammatory granuloma of:
T a. Meibomian gland
T b. Zeis gland
F c. Sweat gland
F d. Wolfring gland
F e. Manz gland
64. Deep leucoma is best treated by:
T a. Tattooing
F b. Lamellar keratoplasty
F c. Keratectomy
F d. Penetrating keratoplasty
F e. Iridectomy
65. Blood vessels in a trachomatous pannus lie:
F a. Beneath the Descemet's membrane
F b. In the substantia propria
F c. Between Bowman's membrane and substantia propria
T d. Between Bowman's membrane and epithelium
F e. Between substantia propria and Descemet’s membrane
66. In vernal catarrh, the characteristic cells are:
F a. Macrophages
T b. Eosinophils
F c. Neutrophils
F d. Epitheloid cells
F e. Erythrocytes
67. Ptosis in Homer's syndrome is due to paralysis of:
F a. Riolan's muscle
F b. Horner's muscle
T c. Muller's muscle
F d. Levator palpebrae muscle
F e. Orbicularis oculi muscle
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68. Severe congenital ptosis with no levator function can be treated by:
F a. Levator resection from skin side
F b. Levator resection from conjunctival side
T c. Fascia lata sling operation
F d. Fasanella Servat operation
F e. Orbicularis resection
69. The COMMONEST cause of hypopyon corneal ulcer is:
F a. Moraxella
F b. Gonococcus
T c. Pnemnococcus
F d. Staphylococcus
F e. Aspergillus
70. Fleischer’s ring is found in:
T a. Keratoconus
F b. Chalcosis
F c. Argyrosis
F d. Buphthalmos
F e. Lagophthalmos
71. Intercalary staphyloma is a type of:
F a. Equatorial staphyloma
F b. Posterior staphyloma
T c. Scleral staphyloma
F d. Anterior staphyloma
F e. Conjunctival staphyloma
72. Ciliary injection is NOT seen in:
F a. Herpetic keratitis
F b. Bacterial ulcer
F c. Chronic iridocyclitis
T d. Catarrhal conjunctivitis
F e. Acute iridocyclitis
73. A 30-year-old male presents with a history of injury to the eye with a leaf 5 days
earlier and pain, photophobia and redness of the eye for 2 days. The MOST likely
pathology could be:
F a. Anterior uveitis
F b. Conjunctivitis
T c. Fungal corneal ulcer
F d. Corneal laceration
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F e. Bacterial keratitis
74. Ptosis and mydriasis are seen in:
F a. Facial palsy
F b. Peripheral neuritis
T c. Oculomotor palsy
F d. Sympathetic palsy
F e. Myasthenia gravis
75. COMMONEST cause of posterior staphyloma is:
F a. Glaucoma
F b. Retinal detachment
F c. Iridocyclitis
T d. High myopia
F e. Choroiditis
76. MOST common cause of adult unilateral proptosis is:
T a. Thyroid orbitopathy
F b. Metastasis
F c. Lymphoma
F d. Meningioma
F e. None of the above
77. Lagophthalmos can occur in all of the following EXCEPT:
F a. 7th cranial nerve paralysis
T b. 5th cranial nerve paralysis
F c. Thyrotoxic exophthalmos
F d. Symblepharon
F e. Ectropion
78. The MOST important symptom differentiating orbital cellulitis from panophthalmitis
is:
T a. Reduced vision
F b. Pain
F c. Redness
F d. Lid oedema
F e. Chemosis
79. The COMMONEST cause of unilateral exophthalmos is:
T a. Thyroid eye disease
F b. Lacrimal gland tumour
F c. Orbital cellulitis
F d. Cavemous sinus thrombosis
F e. Panophthalmitis
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80. Proptosis is present in the following conditions EXCEPT:
T a. Horner's syndrome
F b. Orbital cellulitis
F c. Thyroid ophthalmopathy
F d. Cavernous sinus thrombosis
F e. None of the above
81. One of the EARLIEST features of anterior uveitis includes:
F a. keratic precipitate
F b. Hypopyon
F c. posterior synechiae
T d. Aqueous flare
F e. Anterior synechiae
82. In anterior uveitis the pupil is generally:
F a. Of normal size
T b. Constricted
F c. Dilated
F d. Mid-dilated
F e. Fixed and dilated
83. Koeppe’s nodules are found in:
F a. Cornea
F b. Sclera
T c. Iris
F d. Conjunctiva
F e. Lid
84. Which laser is used for capsulotomy?
F a. Diode laser
F b. Carbon dioxide laser
F c. Excimer laser
T d. ND: YAG laser
F e. None of the above
85. Unilateral aphakia is likely to be corrected by any of the following EXCEPT:
F a. Anterior chamber intraocular lens
F b. Posterior chamber intraocular lens
F c. Contact lens
T d. Glasses
T e. Telescope
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86. Phakolytic glaucoma is BEST treated by:
F a. Fistulizing operation
T b. Cataract extraction
F c. Cyclo-destructive procedure
F d. Miotics and Beta blockers
F e. Sympathomimetics
87. Lens induced glaucoma is LEAST likely to occur in:
F a. Intumescent cataract
F b. Anterior lens dislocation
T c. Posterior subcapsular cataract
F d. Posterior lens dislocation
F e. Morgagnian cataract
88. BEST site where intraocular lens is fitted:
F a. Capsular ligament
F b. Endosulcus
F c. Ciliary supported
T d. Capsular bag
F e. Ciliary sulcus
89. After 48 hours of a cataract extraction operation, a patient complained of ocular pain
and visual loss. On examination, this eye looked red with ciliary injection, corneal
oedema and absence of red reflex. The first suspicion MUST be:
F a. Secondary glaucoma
F b. Anterior uveitis
T c. Bacterial endophthalmitis
F d. Acute conjunctivitis
F e. Panopthalmitis
90. The following are associated with open angle glaucoma EXCEPT:
F a. Roenne’s nasal step
F b. Enlarged blind spot
F c. Generalized depression of isopters
T d. Loss of central fields
F e. Tubular vision
91. The treatment of choice for the other eye in angle closure glaucoma is:
F a. Surgical peripheral iridectomy
T b. Yag laser iridotonfy
F c. Trabeculotomy
F d. Trabeculectomy
F e. None of the above
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92. Neovascular glaucoma follows:
T a. Thrombosis of central retinal vein
F b. Acute congestive glaucoma
F c. Staphylococcal infection
F d. Hypertension
T e. Diabetes mellitus
93. You have been referred a case of open angle glaucoma. Which of the following
would be the MOST important point in diagnosing the case?
F a. Shallow anterior chamber
T b. Optic disc cupping
F c. Narrow angle
F d. Visual acuity and refractive error
F e. Raised intraocular pressure
94. In retinal detachment, fluid accumulates between:
F a. Outer plexiform layer and inner nuclear layer
T b. Neurosensory retina and layer of retinal pigment epithelium
F c. Nerve fiber layer and rest of retina
F d. Retinal pigment epithelium and Bruch’s membrane
F e. Inner plexiform layer and ganglion cell layer
95. Ninety-day glaucoma is seen in:
F a. Central Retinal Artery Occlusion
F b. Branch Retinal Artery Occlusion
T c. Central Retinal Vein Occlusion
F d. Branch Retinal Vein Occlusion
F e. Carotid artery occlusion
96. A young patient with sudden painless loss of vision, with systolic murmur and
ocular examination reveals a cherry red spot with clear Anterior Chamber, the likely
diagnosis is:
T a. Central Retinal Artery Occlusion
F b. Central Retinal Vein Occlusion
F c. Diabetes Mellitus
F d. Branch Retinal Vein Occlusion
F e. Carotid artery occlusion
97. Amaurotic cat's eye reflex is seen in:
F a. Papilloedema
T b. Retinoblastoma
F c. Papillitis
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F d. Retinitis
F e. Optic neuritis
98. COMMONEST lesion which hinders vision in diabetic retinopathy is:
T a. Macular oedema
F b. Microaneurysm
F c. Retinal haemorrhage
F d. Retinal detachment
F e. Papilloedema
99. Commotio retinae is seen in:
T a. Concussion injury
T b. Papilloedema
F c. Central retinal vein thrombosis
F d. Central retinal artery thrombosis
F e. Retinitis pigmentosa
100. Night blindness is caused by:
F a. Central retinal vein occlusion
T b. Dystrophies of retinal rods
F c. Dystrophies of the retinal cones
F d. Retinal detachment
T e. Vitamin A deficiency
101. In central retinal artery occlusion, a cherry red spot is due to:
F a. Hemorrhage at macula
F b. Increased choroidal perfusion
F c. Increase in retinal perfusion at macula
T d. The contrast between pale retina and reddish choroid
F e. Hole in the macula
102. The MOST common primary intraocular malignancy in adults is:
F a. Retinoblastoma
T b. Choroidal melanoma
F c. Squamous cell carcinoma of conjunctiva
F d. Iris nevus
F e. None of the above
103. A patient of long-standing diabetes mellitus noticed sudden muscae volitantes. On
examination, the red reflex was dim, with no details of fundus seen. He might have:
F a. Non proliferative diabetic retinopathy
F b. Cystoid macular edema
T c. Vitreous haemorrhage
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F d. Central retinal vein occlusion
F e. Retinal detachment
104. Occlusion of the lower nasal branch of the central retinal artery results in one of the
following field defects:
F a. Lower nasal sector field defect
F b. Upper nasal sector field defect
T c. Upper temporal field defect
F d. Lower temporal sector field defect
F e. Bitemporal hemianopia
105. Primary optic atrophy results from:
F a. Retinal disease
F b. Chronic glaucoma
F c. Papilloedema
T d. Neurological disease
T e. Compression by tumours
106. Retro-bulbar optic neuritis is characterized by:
F a. Marked swelling of the optic disc
T b. Impaired direct light reflex in the affected eye
F c. Impaired consensual light reflex in the affected eye
F d. Normal visual acuity
T e. Pain on movement of the eyes
107. The type of optic atrophy that follows retro-bulbar neuritis is:
T a. Secondary optic atrophy
F b. Consecutive optic atrophy
F c. Glaucomatous optic atrophy
F d. Primary optic atrophy
F e. Leber’s hereditary optic atrophy
108. A male patient 30 years old with visual acuity of 6/6 in both eyes. Twelve hours
later, he presented with drop of vision of the left eye. On examination, visual acuity was
6/6 in the right eye and 6/60 in the left eye. Fundus examination showed blurred edges of
the left optic disc. The MOST probable diagnosis is:
F a. Raised intra cranial pressure
F b. Raised ocular tension
F c. Central retinal artery occlusion
T d. Optic neuritis
F e. Papilloedema
109. All are seen in 3rd nerve palsy EXCEPT:
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F a. Ptosis
F b. Diplopia
T c. Miosis
F d. Outwards eye deviation
F e. Mydriasis
110. Homonymous hemianopia is due to lesion at:
T a. Optic tract
F b. Optic nerve
F c. Optic chiasma
F d. Retina
F e. Occipital cortex
111. Which is NOT found in papilloedema?
F a. Blurred vision
F b. Blurred margins of disc
T c. Cupping of disc
F d. Retinal edema
F e. Enlarged blind spot
112. Papilloedema has all the following characteristics EXCEPT:
T a. Marked loss of vision
F b. Blurring of disc margins
F c. Hyperemia of disc
F d. Field defect
F e. Dilated retinal veins
113. Homonymous hemianopia is the result of a lesion in:
F a. Optic chiasma
F b. Retina
T c. optic tract
F d. Optic nerve
F e. Optic radiation
114. Mydriasis is present in all the following EXCEPT:
F a. Third nerve lesion
T b. Pontine haemorrhage
F c. Datura poisoning
F d. Fourth stage of anaesthesia
T e. Spasm of sphincter muscle
115. D-shaped pupil occurs in:
F a. Iridocyclitis
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F b. Iridodenesis
F c. Cyclodialysis
T d. Iridodialysis
F e. Iridoschisis
116. In complete third nerve paralysis the direction of the affected eye in the primary
position is:
F a. Inward
F b. Outward
F c. Outward and up
T d. Outward and down
F e. Inward and up
117. What tissue layer does ARMD affect MOST?
F a. Photoreceptors
T b. Retinal pigment epithelium
F c. Descemet’s membrane
F d. Nerve fibre layer
F e. Ganglion cell layer
118. The dry form of ARMD is associated with ----, and the wet form is associated with-T a. Drusen, neovascularization
F b. Neovascularization, drusen
F c. Drusen, copper wire reflex
F d. Copper wire reflex, neovascularization
F e. Copper wire reflex, drusen
119. Which of the following is NOT a risk factor for ARMD?
F a. Genetics
F b. Obesity
F c. Smoking
F d. Exposure to sunlight
T e. All the above are risk factors
120. The only known cure for wet AMD is:
F a. Nutraceuticals
F b. The AREDS formula 3x daily
F c. Keeping out of the sun entirely
F d. Quit smoking
T e. There is currently no cure
121. What signs would NOT be seen in Ocular Albinism?
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T a. White pupil
F b. Reddish fundus
F c. Depigmented Fundus
F d. Absent Foveal Light Reflex
F e. Strabismus
122. What is/are good adjunctive long-term therapy measure/s that Diabetic Retinopathy
(DR) patients can do to help prevent progression of non-proliferative DR?
T a. Vitamin E
F b. Silver nitrate
T c. Zinc
F d. Vitamin C
F e. Vitamin A
123. Which is NOT a drastic measure for dry eye treatment?
T a. Sunglasses
F b. Transplant
F c. Blood serum
F d. Limbal graft
T e. Artificial tears
124. In which condition would punctal occlusion be indicated?
T a. Keratoconjunctivitis sicca
F b. Tear osmolarity imbalance
F c. Epiphora
F d. Blepharospasm
F e. Lagophthalmos
125. Secondary disorders associated with progressive myopia include:
T a. Vitreous syneresis
T b. Posterior staphyloma
F c. Amblyopia
F d. Retinoblastoma
F e. Rheumatoid arthritis
126. Which of the following is NOT a management option for progressive myopia?
F a. Screenings and annual eye examinations
F b. Rigid gas permeable contact lenses
F c. Use of low dose of atropine
T d. Enucleation
F e. Laser eye surgery
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127. What are some environmental triggers for keratoconus?
T a. Atopic disease
T b. Eye rubbing
T c. Asthma
F d. Recurrent corneal erosions
T e. Sun exposure
128. With regard to Central Retinal Artery Occlusion (CRAO):
F a. Venous pulsation is present
T b. There is sudden loss of vision
T c. The retina appears white and swollen
F d. The retinal arterioles are dilated
T e. It can be caused by temporal arteritis
129. In a patient with CRAO, which of the following is NOT a clinical feature?
F a. Presence of a cherry-red macula, due to intact choroidal perfusion
F b. Attenuated retinal blood vessels, including "box-carring" of veins
F c. Presence of emboli
F d. Relative afferent pupillary defect in the affected eye
T e. All of the above are clinical features of CRAO
130. Which of the following is NOT a conventional treatment for CRAO?
T a. Intra-arterial fibrinolytic therapy
F b. Digital ocular massage
F c. Topical beta-blocker
F d. Carbogen therapy
F e. Ocular paracentesis
131. When treating patients with CRAO, why is fibrinolytic therapy considered a viable
option?
F a. A good visual prognosis can be achieved, even if treatment begins several days to
weeks after onset of occlusion
F b. It has been declared the most effective treatment, with full recovery of vision in
100% of subjects in all trials conducted
T c. Immediately after treatment, nearly complete recanalization of the retinal vessels is
detectable via fluorescein angiography
F d. There are no severe side-effects in patients that undergo fibrinolytic therapy
F e. All of the above
132. A strong predictor of herpes zoster (varicella zoster virus) is:
T a. Hutchinson's Sign
T b. Skin lesions at the tip, side, or root of the nose
F c. lritis
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F d. Neurotrophic ulcers
T e. Keratitis
133. A 75-year-old female comes into your office with erythematous skin lesions with
macules, papules, vesicles, pustules, and crusting lesions in the distribution of the
trigeminal nerve. She has had these symptoms for about 4 days now. What is the BEST
treatment for this scenario?
F a. Dexamethasone
T b. Acyclovir
F c. Amoxicillin
F d. Azithromycin
F e. Tetracycline
134. Pterygium is:
F a. Caused by chronic blepharitis
F b. Hyperplasia of the bulbar conjunctiva involving the cornea
F c. Psuedomembrane that attaches to the cornea
T d. Degenerative fibrovascular growth extending to the cornea
T e. Due to exposure to sunlight
135. Iron that is deposited in the corneal epithelium found at the head of the pterygium is
referred to as:
F a. Arlt's line
T b. Stocker's line
F c. Ferry's line
F d. Hudson-Stahli line
F e. Fleischer’s line
136. Which of the following are indications to refer for pterygium excision surgery?
T a. Motility restriction
T b. Cosmetic appearance
T c. Visual impairment
T d. Recurrent inflammation
T e. All of the above
137. Acceptable treatment for pterygium include:
T a. Restastis (Cyclosporin A)
T b. Artificial tears
F c. Exenteration
F d. Topical anti-virals
T e. Topical NSAIDS
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138. Immediately after pterygium surgery, the MOST appropriate course of action would
be to:
T a. Wear an eye patch for 6 hours, and use over the counter pain killers
F b. Head to the beach and start surfing
F c. Play racquetball with Kumar
F d. Take prophylactic Augmentin
F e. Use a bandage contact lens
139. Optic neuritis may be associated with:
T a. Diabetes mellitus
T b. Thyroid disease
F c. Hypertension
F d. Vitamin A deficiency
T e. Syphilis
140. One of the ancillary tests used in optic neuritis is:
F a. Visual field testing
F b. Transillumination
T c. Optical Coherence Tomography
F d. Fluorescein angiography
F e. Indirect ophthalmoscopy
141. Characteristics of chalazion include:
T a. Small ones may disappear spontaneously
T b. Conjunctival side of the lesion is reddish or purplish
F c. Transformation to malignancy
F d. Marked inflammatory signs
T e. Painless swelling
142. Chalazion:
T a. ls also known as tarsal cyst
F b. Can result in preseptal cellulitis if untreated
F c. Heals if the affected lash is pulled out
F d. Is a non-suppurative inflammation of the Zeis gland
T e. Is a painless swelling of the meibomian gland
143. Findings in Stevens Johnson syndrome include:
T a. Distichiasis
T b. Trichiasis
T c. Irregular posterior margin
T d. Symblepharon
T e. Keratoconjunctivitis sicca
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144. Regarding both involutional type of entropion and ectropion
T a. Lid laxity is an important causative factor
F b. Lateral tarsal strip procedure attaching tarsus to lateral orbital run is useful 1n both
cases
F c. Tearing is a chief symptom
T d. Conjunctival spindle excision below the punctum can help mild cases
F e. None of the above
145. Cicatricial ectropion can result from:
F a. Chalazion treatment
T b. Burns
T c. Trauma
T d. Eyelid skin incision
F e. Paralysis of the orbicularis muscle
146. Causes of spastic entropion include:
T a. Ocular inflammation
T b. Lid infection
F c. Stevens-Johnson syndrome
F d. Burns
F e. Trachoma
147. Keratinization of the lid margin can result from:
F a. Blepharospasm
T b. Severe ectropion
F c. Spastic entropion
F d. Lagophthalmos
T e. Stevens-Johnson syndrome
148. A male patient was complaining of continuous redness of both eyes, foreign body
sensation, and frequent loss of lashes. On examination, the lid margins were hyperaemic,
and the lashes were matted with yellow crusts, which left painful ulcers on trying to
move. The MOST reliable diagnosis is:
F a. Angular blepharitis
F b. Cicartricial entopion
F c. Spastic entopion
T d. Ulcerative blepharitis
F e. Herpes zoster ophthalmicus
149. Staphylococcal infection of the sebaceous glands of the eyelids is called:
F a. Blepharitis
F b. Conjunctivitis
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F c. Keratitis
T d. Hordeolum extema
F e. Hordeolum interna
150. Which of the following statements is CORRECT?
F a. Hordeolum interna involves the meibomian glands whereas stye and chalazion do not
F b. Chalazia are caused by infections (usually Staphylococcus aureus) whereas hordeola
are not
T c. Chalazia are often painless
F d. Hordeolurn externa involves meibomian glands while hordeolum interna involves
sebaceous gland
T e. Hordeolum interna involves meibomian glands while hordeolum externa involves
sebaceous gland
151. The MOST common type of congenital ptosis is:
F a. Aponeurotic
F b. Neurogenic
F c. Traumatic
T d. Myogenic
F e. None of the above
152. Extraocular movement testing in congenital myogenic ptosis may reveal limited:
F a. Adduction
F b. Abduction
T c. Supraduction
F d. Infraduction
F e. None of the above
153. Regarding Homer's syndrome:
F a. Ptosis of severe degree is seen
T b. The miotic pupil constricts to light
F c. Loss of accommodation is seen in the case of third order neuronal lesions
F d. The near reflex is absent in the miotic pupil
T e. There is slight elevation of the lower lid
154. The position of the eyeball in a patient with total 3rd nerve pals? is:
F a. down & in
F b. up & in
T c. down & out
F d. up & out
F e. out
155. Components in blepharophimosis include:
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T a. Horizontally elongated palpebral aperture
F b. Bilateral ptosis
F c. Epicanthus
T d. Pseudoptosis
F e. Widening of the palpebral fissure
156. Ectropion of the upper eyelid may be:
F a. Senile
F b. Paralytic
F c. Congenital
T d. Spasm of the orbicularis muscle
F e. Paralysis of the orbicularis muscle
157. Causes of lagophthalmos include:
T a. Facial nerve palsy
T b. Proptosis
T c. Cicatricial ectropion
F d. Third nerve paralysis
T e. Blunt trauma
158. Clinical features of non-proliferative diabetic retinopathy include:
T a. Microaneurysm
T b. Dark dot hemorrhages
T c. Cotton wool spots
F d. Retinal detachment
T e. Retinal edema
159. Clinical signs of anterior uveitis include:
T a. Ciliary injection
F b. Loss of transparency of the lens
T c. Keratic precipitates
T d. Hyphema
F e. Vitreous floaters
160. Factors that can cause fluctuations in IOP include:
T a. Time of day
F b. Reading
T c. Heartbeat
T d. Blood pressure
F e. Ocular infection
161. The following are clinical features of primary open angle glaucoma:
F a. Repeated IOP below 2lmmHg
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T b. Reduced visual acuity
F c. Deep anterior segment
T d. Excavation of the optic disc
T e. Constricted visual field
162. The clinical signs of ulcerative blepharitis include:
T a. Presence of yellow crusts which glue the lashes together
F b. The iris becomes dull
T c. The lids are reddened and swollen
F d. The eyelids fail to develop
F e. The lashes turn white in colour
163. The following are causes of nystagmus:
T a. Stroke
T b. Albinism
T c. Congenital cataract
T d. Drug toxicity
F e. Glaucoma
164. Peripheral field loss occurs with:
F a. Age-related macular degeneration
F b. Optic neuropathy
T c. Open-angle Glaucoma
T d. Chorioretinitis
T e. Retinitis pigmentosa
165. Central field loss occurs with:
T a. Macular holes
T b. Cone dystrophies
F c. Retinal detachment
T d. Optic neuropathy
F e. Branch retinal artery occlusion
166. Causes of corneal ulcers include:
T a. Viral infection
F b. Increased IOP
T c. Measles
T d. Vitamin A deficiency
F e. Cataract
167. Clinical features of vernal conjunctivitis include
T a. Itching
T b. Photophobia
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T c. Lid swelling
T d. Blurred vision
T e. Redness
168. Clinical features of a corneal abrasion include
T a. Severe pain
F b. Minor pain
T c. Lacrimation
F d. Redness on the conjunctiva
T e. Redness around the limbus
169. Clinical features of onchocerciasis include
F a. Optic disc pallor
T b. Itching
T c. Subcutaneous nodules
T d. Papular eruptions
F e. Floaters
170. Signs in ocular albinism include:
T a. Foveal hypoplasia
F b. Foveal hyperplasia
T c. De-pigmented fundus
F d. Retinal hemorrhage
F e. Foveal light reflex
171. Clinical features of central retinal artery occlusion include:
T a. Presence of a cherry-red macula
T b. Attenuated retinal blood vessels
T c. Presence of emboli
T d. Relative afferent pupillary defect in the affected eye
F e. None of the above
172. Which of the following are indications to refer for pterygium excision?
T a. Motility restriction
T b. Cosmetic appearance
T c. Visual impairment
T d. Recurrent inflammation
T e. All of the above
173. Symptoms of optic neuritis include:
T a. Pain that worsens with eye movement
F b. Diplopia
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F c. Metamorphopsia
F d. Nausea
T e. Dychromatopsia
174. What is metamorphopsia?
F a. Floaters in the field of view
T b. Change in the shape of a fixated object
T c. Change in the size of a fixated object
F d. Blurring of vision
F e. All of the above
175. Symptoms of anterior uveitis include:
F a. Nausea
T b. Pain
T c. Photophobia
T d. Lacrimation
F e. Itching
176. Which is TRUE about photopsia?
T a. They are hallucinatory perceptions
T b. It can occur due to retinal disease
F c. They are associated with nystagmus
F d. They occur only in infants
T e. Pressure upon a closed eye can cause it
177. Which is true of polyopsia?
F a. A major symptom of primary open angle glaucoma
T b. Multiple images of a single object are perceived
T c. Can be caused by cataract
T d. Results from irregular ocular refraction
F e. None of the above
178. What alterations occur in the crystalline lens of a diabetic patient?
T a. Changes in lens curvature
T b. Changes in the thickness
F c. Increased transparency
T d. Changes in refractive index
T e. Changes in the fibrin matrix
179. The three MAJOR clinical signs (clinical triad) of retinitis pigmentosa are:
F a. Dot haemorrhages
T b. Anteriolar attenuation
T c. Waxy disc pallor
T d. Bone-spicule pigmentation
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F e. Cotton wool spots
180. Risk factors of glaucoma include:
T a. High myopia
F b. Repeated use of topical antihistamines
T c. Repeated use of topical corticosteroids
F d. Puberty
T e. Diabetes mellitus
181. Clinical features of proliferative diabetic retinopathy include:
T a. Neovascularization
T b. Vitreous detachment
F c. Cotton wool spots
T d. Haemorrhages
F e. Microaneurysms
182. Which of the following can be associated with ciliary injection‘?
T a. Iritis
T b. Keratitis
T c. Glaucoma
F d. Cataract
F e. Blepharitis
183. Which of the following is TRUE about conjunctival injection?
F a. Fades towards the conjunctiva
F b. More intense at the corneal limbus
T c. More intense at the fornix
T d. Derived from the posterior conjunctival vessels
T e. There can be mucopurulent discharges
184. Chemosis can result from:
F a. High myopia
T b. Trauma
F c. Diabetes
T d. Allergic reaction
F e. Amblyopia
185. The following are seen in trachoma EXCEPT:
F a. Papillae
F b. Follicles
T c. Conjunctival naevus
F d. Trichiasis
F e. Pannus
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186. Which of the following is TRUE about anterior uveitis?
T a. Iris is swollen
T b. It is often associated with sarcoidosis
F c. There is conjunctival injection
T d. Pupillary reaction is sluggish
T e. Pupil is miotic
187. Which of the following is a clinical feature of Third Nerve Palsy?
F a. Papilledema
T b. Ptosis
T c. Dilated pupil
F d. Constricted pupil
T e. Defective accommodation
188. Possible causes of Third Nerve Palsy include:
T a. Diabetes mellitus
F b. Glaucoma
T c. Trauma
T d. Hypertension
F e. Bacterial conjunctivitis
189. Which of the following muscles are affected by Third Nerve Palsy?
F a. Lateral Rectus
T b. Medial Rectus
F c. Superior Oblique
T d. lnferior Rectus
T e. Superior Rectus
190. Causes of retinal haemorrhages include:
T a. Retinal embolism
F b. Increased IOP
T c. Arteriosclerosis
F d. Optic neuritis
T e. Menstrual disturbances
191. The following are benign eyelid lesions:
F a. Ulcerative blepharitis
T b. Hordeolum
T c. Chalazion
T d. Molluscum contagiosum
F e. Kaposi’s sarcoma
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192. Causes of ocular tumors include:
F a. Bacterial infection
F b. Malaria
T c. Ultraviolet radiation
T d. Human papilloma virus infection
T e. Chemical injury
193. Consider the following about retinoblastoma:
F a. The risk of developing the disease increases with age
F b. It is not an age-related disease
T c. About one third of the cases are diagnosed before the age of 7 years
F d. Hereditary retinoblastoma is usually unilateral
T e. Nonhereditary retinoblastoma is caused by a sporadic mutation of the RB gene
194. Herpetic corneal infection is:
T a. Caused by herpes simplex virus
F b. Usually associated with staphylococcal infection
F c. Often caused by human papillomavirus
T d. A common cause of corneal ulceration
F e. Managed with topical antifungal agents
195. Uveal inflammation:
T a. May be secondary to systemic diseases
T b. May be auto immune mediated
F c. Has tuberculous leprosy as a causative factor
T d. Can secondarily involve the retina
T e. Can be due to cytomegalovirus
196. Pathological features of hypertensive retinopathy include the following:
T a. Focal narrowing of the retinal arterioles
T b. Generalised arteriolar spasm
F c. Cotton wool haemorrhages
T d. Optic nerve oedema
T e. Changes in the light reflex in the vessels
197. Retinal detachment is/has:
F a. A separation between the sclera and neurosensory retina
T b. A separation of the retinal pigment epithelium
T c. Often due to contraction of the vitreous collagen fibrils
T d. A rhegmatogenous type that is due to accumulation of fluid beneath sensory retina
T e. A complication of malignant melanoma
198. Grade II hypertensive retinopathy has the following features
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F a. Optic nerve oedema
F b. Fluid exudates in the retinal nerve
T c Microaneurysm
T d. Cotton wool spots
F e. Dot and blot haemorrhages
199. Morphological features of glaucoma include:
T a. Splinter haemorrhages within lDisc- diameter from the disc
F b. Swelling ofthe optic disc
T c. Thinning of the nerve fibre layer of the retina
T d. Excavation of the physiological cup
F e. Necrosis of the iris
200. ln glaucoma:
F a. Corneal oedema is seen in Open angle glaucoma
F b. Angle-closure type accounts for most cases of glaucoma
F c. Angle-closure type is often seen in large myopic eyes
F d. Raised intraocular pressure is a constant feature
T e. Destruction of ganglion cells is a constant feature
201. Acute fungal corneal infection is often associated with:
T a. Prolonged use of steroids
T b. Corneal injury with plant or vegetable matter
T c. Ulceration which can progress to corneal perforation
T d. Secondary bacterial infection
T e. Hypopyon ulcer
202. Consider the following statements about open-angle glaucoma
T a. It accounts for about 2/3 of all cases of glaucoma
F b. There is narrowing of anterior chamber angle
T c. There is poor transportation of the aqueous humour
T d. The angle opening is always normal
T e. It is characterized by loss of nerve fibres
203. Consider the following statements about background diabetic retinopathy
F a. About 50% of people with diabetes have signs of diabetic retinopathy
F b. Neurovascularisation is a feature
F c. Fibroplasia is often present
T d. There is ischaemia of the retina
F e. There is retinitis proliferans due to thickened basement membrane of capillaries
204. Grade III hypertensive retinopathy has the following features:
T a. Optic disc oedema
T b. Cotton wool spots
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F c. Optic nerve oedema
T d. Haemorrhages
F e. All of the above
205. Which of the following is a type of eye twitch?
T a. Minor
F b. Malignant
F c. Infective
F d. Degenerative
T e. Benign essential
206. Which of the following does NOT constitute a medical emergency in
blepharospasm?
F a. Duration of more than one week
F b. Complete closure of the eyelids
F c. Drooping of the upper eyelid
T d. Twitching without swelling
T e. Twitching with discharges
207. Which nerve is implicated in ptosis?
F a. Trochlear
F b. Abducens
T c. Oculomotor
F d. Trigeminal
F e. Levator palpebrae superioris
208. Which of the following is associated with blepharospasm?
T a. Fatigue
T b. Stress
T c. Insomnia
F d. Amblyopia
F e. Strabismus
209. This is a type ofKerato-conjunctivitis sicca:
F a. Epiphora
T b. Evaporative
F c. Blepharospam
F d. Allergic conjunctivitis
T e. Aqueous deficiency
210. In the management of acute bacterial conjunctivitis, the following steps should be
taken:
F a. Administer a topical anaesthetic to control pain
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T b. Start treatment with most appropriate antibiotic drug
F c. Administer a topical steroid drop to clear redness and control inflammation
T c. Send swab specimen to the laboratory for identification of pathogen
T e. Re-evaluate treatment after laboratory identification
211. Management of chronic conjunctivitis should include:
T a. Discontinue ineffective therapies
T b. Perform thorough case history and evaluation
T c. Consider trial with preservative free topical medications
T d. Laboratory culture of specimen
F e. None of the above
212. Marcus Gunn pupil is:
T a. An optic nerve dysfunction
F b. A central retinal disorder
T c. Associated with retrobulbar neuritis
F d. An efferent defect
T e. An afferent defect
213. Common age-related diseases may include:
T a. Macular degeneration
T b. Cataract
T c. Glaucoma
P d. Retinal detachment
F e. Albinisim
214. Ptosis
T a. Is abnormally low position of the upper lid
T b. Can be unilateral or bilateral
T c. Can be congenital or acquired
F d. Can be pseudoptosis, neurogenic but not myogenic
F e. Is generally inherited
215. Regarding dermatochalasis:
F a. It commences during puberty
T b. It may cause pseudoptosis
T c. Blepharoplasty can correct the disorder
T d. There is redundant skin around the eye lids
T e. Severe form may obstruct vision
216. Types of entropion include:
T a. Spastic entropion
T b. Congenital entropion
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F c. Paralytic entropion
T d. Cicatricial entropion
T e. Involutional entropion
217. Generally, the picture of hypertensive retinopathy is characterized by:
F a. Arteriosclerosis, detachment, superimposition
F b. Detachment, vasoconstriction, arteriosclerosis
T c. Leakages, superimposition, vasoconstriction
F d. Papilloedema, vessel narrowing, corneal opacity
F e. Vasoconstriction, arteriosclerosis, leakages
218. For a 15-year-old patient, referral should be made if his systolic blood pressure is
greater than:
F a. 85
F b. 90
T c. 125
F d. 135
F e. 145
219. Cogan’s dystrophy results from the degeneration of what part of the cornea?
F a. B0wman’s membrane
F b. Endothelial basement membrane
F c. Endothelium
T d. Epithelial basement membrane
F e. Stroma
220. A patient who presents with a deep-seated pain on one eye, deep peri-limbal
redness, constricted and sluggish pupil and complaints of seeing haloes around lights is
likely to have:
F a. Angle closure glaucoma
F b. Choroiditis
T c. Iritis
F d. Scleritis
T e. Commotio retinae
221. One of these will NOT present with a sharp ocular pain or foreign body sensation:
F a. Keratitis
F b. Trichiasis
F c. Trigeminal neuralgia
T d. Verruca
T e. Berlin’s disease
222. One condition that does NOT require referring a patient with corneal abrasion is if
the:
F a. Abrasion covers more than 50% of the cornea
F b. Abrasion involves the Bowman’s membrane
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F c. Abrasion penetrates the Descemet’s membrane
F d. Injury penetrates to the anterior segment
F e. Patient complains of extreme pain
223. In managing an abraded cornea with microcystic edema, one of the following will
NOT be beneficial:
F a. Gentamicin 0.3% eye drop
F b. Glycerin 50% eye drop
F c. Muro-128 2% eye drop
T d. Pilocarpine 2% eye drop
F e. Sochlor 5% eye drop
224. An afferent defect in the following list is:
F a. Argyll Robertson pupil
F b. Horner’s syndrome
T c. Marcus Gunn pupil
F d. Keyhole pupil
F e. White pupil
225. Classification of cataract according to age includes the following EXCEPT:
F a. Juvenile
F b. Pre-senile
F c. Senile
T d. Traumatic
T e. Intumescent
226. The common causes of vitreous floaters include the following EXCEPT:
F a. Hypopyon
F b. Muscae volitantes
F c. Vitritis
F d. Retinal tear
F e. Uveitis
227. ln a case of Uveitis, where pigmentary glaucoma is of concern; what test(s) is/are
MAJORLY required?
T a. Gonioscopy
F b. Ophthalmoscopy
F c. Slit lamp biomicroscopy
F d. Keratometry
F e. Autorefractometry
228. Symptoms of Acute Anterior Uveitis include the following EXCEPT:
F a. Lacrimation
T b. Keratic precipitates
T c. Mucus discharge
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F d. Photophobia
F e. Pain
229. Inflammation of the Optic nerve head due to raised intracranial pressure is called:
F a. Optic neuritis
F b. Optic atrophy
T c. Papilloedema
F d. Papillitis
F e. Retrobulbar neuritis
230. Which Optic neuropathy presents with a normal optic nerve head and nerve fibre
layer?
F a. Papillitis
F b. Pseudopapilloedema
F c. Pseudopapillitis
F d. Retrobulbar neuritis
T e. None of the above
231. The early stage of dry macular degeneration is characterized by:
F a. Choroidal neovascularization
T b. Drusens
F c. Geographic atrophy
F d. Prominence of the larger choroidal vessels
F e. Retinal pigment epithelium detachment
232. If a person with optic neuritis in the right eye (which causes that eye’s image to
appear dimmer) views a pendulum that is swinging in the fronto-parallel plane, it will
appear to:
T a. Come nearer when swinging from left to right and farther on the return swing.
F b. Come nearer when swinging from right to left and farther on the return swing.
F c. Come nearer when swinging in both directions
F d. Slow down when swinging from left to right but speed up on the return swing.
F e. None of the above
233. After suffering brain damage, some people find it difficult to recognize and/or orient
simple objects that they can easily “see.” This phenomenon is BEST described by the
term:
T a. Agnosia
F b. Past pointing
F c. anisometropia
F d. amblyopia
F e. Amaurosis fugax
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234. Using motion parallax, it is possible to determine the location of an ocular opacity
seen during direct ophthalmoscopy. If the doctor observes a small black dot in the pupil
reflex that appears to move in the same direction as his head, where is the opacity MOST
likely located?
F a. Retina
F b. Posterior lens
F c. Anterior epicapsule
T d. Corneal endothelium
F e. Corneal epithelium
235. According to Köller's rule, an acquired protan or deutan defect would MOST likely
indicate a disease of which of the following ocular structures‘?
F a. Cornea
F b. Lens
F c. Vitreous
T d. Optic nerve
F e. Choroid
236. Rate the following pathologies with respect to location from be anterior to posterior
eye:
I. Iritis,
II.Posterior subcapsular cataract
III.Koeppe’s nodules,
IV. Trantas’ dots
F a. II, III, I, V
T b. IV, III, I, II I
F c. IV, I, III, II
F d. III, IV, I, II
F e. I, II, IV, III
237. Predisposing causes of central retinal vein occlusion include:
T a. Raised intraocular pressure
T b. Diabetes
T c. Cardiovascular disease
T d. Systemic hypertension
F e. Choroiditis
238. Fifth nerve palsy could cause:
F a. Ptosis
F b. Proptosis
F c. Ophthalmoplegia
F d. Lagophthalmos
F e. Exophthalmos
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239. A third nerve palsy due to an underlying aneurysm of the posterior communicating
artery is:
F a. Pupil sparing
T b. Usually painful
F c. Not associated with ptosis
F d. Not a medical emergency
F e. All of the above
240. When considering temporal arteritis:
F a. A normal ESR excludes the diagnosis
F b. There is no systemic involvement
T c. Amaurosis fugax is a presenting feature
F d. Steroids are unhelpful
F e. None of the above
241. Tylosis refers to:
F a. Loss of lashes
F b. Misdirection of lashes
F c. Blocked meibomian orifices
F d. Inward turning of the eyelid
T e. Thickening of the tarsal border of the eyelid
242. Madarosis may be seen in:
T a. Eyelid neoplasm
T b. Chronic blepharitis
T c. Hansen's disease
T d. Alopecia
T e. All of the above
243. The following is TRUE about herpes zoster ophthalmicus:
F a. It is a bacterial infection of the orbit
T b. It affects the cornea
T c. It leaves disfiguring scars on one side of the head and face
T d. It affects the anterior uvea
F e. It is treated with anti-fungal drugs
244. Nerve palsy with pupil sparing is seen in the following conditions
T a. Hypertension
T b. Diabetes mellitus
F c. Aneurysm of the posterior communicating artery
F d. Internal carotid artery aneurysm within the cavernous sinus
F e. Uncal herniation
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CHAPTER THREE
PHARMACOLOGY
(GENERAL AND OCULAR)
1. Cholinergic agonists include:
T a. Parasympathomimetics: Carbachol
F b. Anticholinesterases: Pilocarpine
F c. Parasympatholytic: Cyclopentolate
F d. Sympathomimetic: Epinephrine
T e. Cholinomimetic: Metacholine
2. Adrenergic agents include:
T a. Syrnpathomimetics: Nonselective: Epinephrine
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T b. Selective (α-agonists): Brimonidine
T c. or; agonists: Apraclonidine
F d. Non-selective (B-antagonist): Betaxolol
F e. Selective (β₁ antagonists): Timolol
3. What is the mechanism of action of pilocarpine?
T a. It is a directly acting parasympathomimetic
F b. In POAG: Pilocarpine acts by causing relaxation of the longitudinal ciliary muscle.
T c. In PACG: Pilocarpine constricts the pupil and pulls the peripheral iris from the
trabecular meshwork
F d. Increases aqueous outflow through the uveoscleral pathway
F e. Decreases aqueous secretion by the ciliary processes
4. What are the ways to decrease systemic absorption of topically administered drug?
T a. Lacrimal occlusion following instillation
T b. Closing the eyes for 1 minute
F c. Blinking rapidly after instillation
T d. Instill only one drop
F e. Increase frequency of drug administration.
5. What is the mechanism of action of prostaglandin analogues?
T a. The relaxation of the ciliary muscle
T b. Remodeling the extracellular matrix of the ciliary muscle.
F c. Increase in outflow through the trabecular meshwork
F d. Increase aqueous production
T e. increase in uveoscleral outflow
6. What are the various prostaglandin analogues available?
F a. Latanoprost (0.05%)
F b. Travoprost (0.04%)
T c. Unoprostone (0.12%)
T d. Bimatoprost (0.03%)
F e. Dozoloprost (0.005%)
7. What Principles are to be adhered to in order to avoid resistance to topical antibiotics?
T a. Limit antibiotic use to diagnosed infections caused by susceptible organisms.
T b. Avoid chronic use of Antibiotics.
T c. Use newer generation antibiotics only when necessary for treatment of infections
resistant to traditional therapy.
T d. Completely treat all clinical infections and consider using a second therapeutic agent
to prevent emergence of resistant organisms.
F e. Stop antibiotic therapy immediately symptoms subside
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8. What will be the effect of the following on constitutively active receptors?
T a. Inverse agonists depress the basal activity of constitutively active receptors.
T b. Antagonists will only return these constitutively active receptors to their basal
activity.
F c. Agonists decrease the action of these receptors
T d. Antagonists can compete with constitutively active receptors
F e. All of the above
9. Two alpha-adrenergic antagonists (Drug A and B) decrease blood pressure by the
same amount following oral administration at the following doses:
DrugA: 120mg
Drug B:
15mg
This information implies that Drug A
F a. Has a higher therapeutic index than Drug B
F b. Has a lower bioavailability than Drug B
T c. Is less potent than Drug B
F d. Is less efficacious than Drug B
F e. None of the above
10. The following antimicrobial agents are inhibitors of metabolism:
T a. Sulfonamides
T b. Trimethoprim
F c. Fluoroquinolones
F d. Telavancin
F c. Penicillins
11. The following antimicrobial agents are inhibitors of cell wall synthesis:
T a. Penicillin:
T b. Cephalosporins
F c. Fluoroquinolones
T d. Lactams
F e. Chloramphenicol
12. The following antimicrobial agents are inhibitors of protein synthesis:
T a. Tetracyclines
T b. Aminoglyeosides
F c. Lactams
T d. Chloramphenicol
T e. Macrolides
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13. The following antimicrobial agents are Inhibitors of nucleic acid function or
synthesis:
T a. Fluoroquinolones
F b. Vancomycin
T c. Rifampicin
F d. Gentamycin
F e. Sulfonamide
14. Examples of Ophthalmic Drug Preservatives are:
T a. Benzalkonium chloride
T b. Thimerosal
F c. Silver Compounds
F d. Phenylmercuric citrate
F e. Sodium bicarbonate
15. Ocular antifungal agents broadly classified based on their chemical structure include:
T a. Polyene
F b. Sodium compounds
T c. lmidazole derivatives
T d. Pyrimidines
F e. Pyrimitamine
16. Factors affecting drug Penetration in the eye:
T a. Tear interaction
T b. Corneal interaction
F c. Eyelid interaction
T d. Blood-ocular barrier
T e. Presence of inflammation
17. Drugs entering the eye from any topical form such as solution, gel or ointment will
be distributed in different ways:
T a. The drug may be drained by the nasolacrimal apparatus
T b. It may be absorbed into the systemic circulation by the conjunctival and lid
vasculature
T c. It may penetrate the cornea.
F d. It is absorbed by the aqueous humor
F e. lt is evaporated from the ocular surface
18. Pharmacokinetic factors affecting topical drug administration include:
T a. Cell membrane
T b. Physicochemical properties of drug molecules.
F c. Anatomy of veins
T d. Anatomy of capillaries
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T e. Lacrimation
19. Ocular effects of alcohol include:
T a. Loss of smooth pursuits
T b. Loss of accommodation
T c. Eso @ distance, Exo @ near
T d. End point nystagmus
T e. Mild blue yellow colour defects
20. Types of pharmacological interventions for myopia control include:
T a. Atropine
T b. Levodopa
T c. Tropicamidc & Cyclopentolate
F d. Methyldopa
F e. Ranitidine
21. Route(s) of drug entry into the eye include(s):
T a. Transconjunctival/scleral routes
T b. Transcorneal routes
F c. Palpebral route
F d. Scleral route
F e. Punctal route
22. Heavily pigmented eyes require:
T a. More drop dosing for effective treatment
F b. Less drop dosing for effective treatment
F c. Same drop dosing for effective treatment
F d. No drop dosing for effective treatment
F e. Depot dosing for effective treatment
23. Ophthalmic drug removal is accomplished by:
T a. Nasal lacrimal system
T b. Episcleral vessels
T c. Scleral vessels
T d. Conjunctival vessels
F e. Cornea
24. Which route of drug administration gives 100% bioavailability?
T a. Intra venous
F b. Intramuscular
F c. Parenteral
F d. Topical
F e. Subcutaneous
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25. Ocular drug delivery may include:
T a. Instillation of drug into the eye
T b. Controlling and maximizing drug to the target tissue
T c. Injecting drug into the eye
T d. Ensuring that drugs introduced into the eye reach target tissues
F e. Injecting drugs into the lacrimal sac
26. Ocular topical drug administration includes:
T a. Ophthalmic suspensions
T b. Ophthalmic Solutions
T c. Ointments
F d. Sub-conjunctiva] injection
F e. Subcutaneous injection
27. Disadvantages of topical ocular drug administration include:
T a. Loss of drug via drainage and rapid tear fluid turnover
F b. Only about 60% of drug may eventually be absorbed
T c. Drainage loss may be high if formulation is irritating
T d. Loss of drug via evaporation and overflow over the lid
F e. Drainage loss may be low if formulation is irritating
28. The following are TRUE about topical ocular drug penetration:
T a. Corneal epithelium is a major barrier to drug penetration
T b. Corneal epithelium barrier is greater for hydrophobic than hydrophilic substances
T c. Corneal stroma allows relatively high diffusion because of its aqueous environment
T d. Lipid soluble substances penetrate cell membrane more easily than hydrophilic ones
T e. Biphasic substances are necessary for adequate penetration
29. Bioavailability of ophthalmic topical drugs can be improved by:
F a. Reducing contact time
T b. Subconjunctival injection
T c. Use of gel substances
T d. Use of muco-adhesive substances
F e. Use of solutions
30. Suitable drug for a causative organism is based on:
T a. Rate of infection
T b. Antimicrobial spectrum of the drug
F c. Rate of lymphatic absorption
T d. Previous history of drug allergies
T e. Hepatic and renal functions of the patient
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31. Indications for ocular antimicrobial therapy include:
T a. Bacteriologically and/ or clinically proven eye infection
T b. Internal or external nature of the infection
T c. Prophylaxis consideration
T d. Confirmation of suspected diagnosis of bacterial infection
T e. All of the above
32. Topical antibiotics may be used to treat the following:
T a. Conjunctivitis
F b. Choroiditis
T c. Keratoconjunctivitis
T d. Dacryocystitis
T e. Stye and chalazion
33. Indications for combined therapies include, to:
F a. Prevent drug interaction
T b. Delay emergence of microbial mutants on chronic use
T c. Treat mixed infections
T d. Achieve bactericidal synergies
T e. Provide prompt treatment
34. The following are beta-Lactam antibiotics:
T a. Penicillin
T b. Cephalosporin
F c. Ciprofloxacin
F d. Gentamicin
T e. Carbapenems
35. The following are CORRECT about gentamicin:
F a. It is an uncommonly used aminoglycoside
T b. Active against Gram ve bacteria such as E coli and Pseudomonas aerugmosa
F c. Available as drop or ointment, 3.0%
T d. Ideal for bacterial conjunctivitis
F e. Not toxic to the retina, therefore subconjunctival injection can be given
36. The following are CORRECT about corticosteroids:
T a. They are anti-inflammatory drugs
T b. Used to treat immunological diseases of the eye
F c. Their anti-inflammatory effects are specific
T d. Cause inhibition of inflammatory responses to inciting agents
F e. All of the above is correct
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37. Contraindications of corticosteroids include:
T a. Acute superficial herpes simplex keratitis
T b. Fungal diseases of the ocular structure
T c. Varicella diseases of the cornea and conjunctiva
T d. After deep-seated corneal foreign body removal
T e. All of the above
38. Anti-viral drugs are:
T a. Nucleoside analogs
F b. Not effective on bacterial infections
T c. Used to treat HIV, Herpes viruses and Hepatitis
F d. Able to destroy their pathogens
T e. Able to exhibit some anti-bacterial and anti-parasitic efficacy
39. The classifications of anti-viral drugs may include:
T a. Nucleoside reverse transcriptase inhibitors
F b. Influenza viruses
T c. Protease inhibitors
T d. Integrase inhibitors
F e. Herpes simplex and herpes zoster
40. Actions of atropine in the eyes include:
T a. Mydriasis
T b. Cycloplegia
F c. Miosis
F d. Chemosis
F e. Rubeosis
41. The following are non-steroidal anti-inflammatory drugs:
T a. Aspirin
F b. Prednisolone
T c. Flurbiprofen
F d. Flucytosine
T e. Indocid
42. The following drugs are used in the management of glaucoma:
T a. Latanoprost
T b. Betaxolol
F c. Atropine
T d. Timolol
F e. Beoptic-N
43. The following are ophthalmic dyes:
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T a. Fluorescein sodium
T b. Fluorex
T c. Rose bengal
T d. Lissamine
F e. Phenol red
44. Classes of medication for the treatment of glaucoma include:
T a. Beta-adrenergic antagonists
T b. Prostaglandin analogues
T c. Carbonic anhydrases Inhibitors
F d. Sympathomimetics
F e. Parasympatholytics
45. The following diagnostic agents are used in tear film integrity tests:
F a. Benzalkonium chloride
T b. Rose bengal
T c. Fluorescein sodium
F d. Cyclopentolate
F e. Pilocarpine
46. The following are routes of administration of ocular medications:
T a. Topical
F b. Intramuscular
F c. Intravenous
T d. Subconjunctival
F e. Subcutaneous
47. The following are anti-viral agents:
T a. Acyclovir
F b. Betamethasone
F c. Penicillin
F d. Vancomycin
T e. Idoxuridine
48. In pharmacologic terminology, sympathetic agents are also called:
F a. Parasympathomimetics
T b. Sympathomimetics
T c. Adrenoceptors
F d. Muscarinic agents
F e. Cholinomimetics
49. Parasympathetic agents produce the following effects:
T a. Contraction of the iris sphincter muscle
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F b. Mydriasis
T c. Bradycardia
T d. Miosis
T e. Stimulation of accommodation
50. What is the most common cycloplegic agent used in diagnosis of latent hyperopia?
F a. Atropine
F b. Tropicamide
T c. Cyclopentolate
F d. Homatropine
F e. Scopolamine
51. Three (3) topical treatments for dry eye are:
T a. Steroid
T b. Cyclosporine
T c. Antibiotic
F d. Antihistamine
F e. Contact lens
52. Which of the following is considered negative side effect of Atropine use in myopia
control?
T a. Photophobia
T b. Blurred vision
F c. Epiphora
T d. Tachycardia
F e. Bradycardia
53. Which type of medication is the gold standard for glaucoma treatment?
F a. Miotics
F b. Alpha adrenergic agonists
T c. Prostaglandins
F d. Beta blockers
F e. Carbonic anhydrase inhibitor
54. This agent has no reported adverse systemic effects; it’s extremely safe and can cause
a transient increase in IOP in POAG patients:
F a. Atropine ointment
F b. Cyclopentolate
T c. Tropicamide
F d. Scopolamine
F e. Homatropine
55. Which cycloplegic agent has the LONGEST duration of action?
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F a. Homatropine
F b. Cyclopentolate
F c. Tropicamide
F d. Scopolamine
T e. Atropine
56. Uses of fluorescein dye as it concerns the Optometrist include:
F a. To detect lesions of the eyelid
T b. In fitting and evaluating hard contact lenses
T c. In applanation tonometry
F d. In measuring corneal curvature with the keratometer
T e. To evaluate the patency of the lacrimal drainage system
57. Topical corticosteroids are contraindicated in:
T a. Corneal epithelial defect
F b. Episcleritis
T c. Acute fungal infection
T d. When unsure of the diagnosis
T e. Acute fungal infection
58. In the management of glaucoma, beta-blockers can be given to:
F a. People with asthma
F b. People with heart disease
T c. Post-menopausal women
T d. People With dental problems
T e. People with diabetes
59. Which of the following statements is TRUE about Bimatoprost
T a. It is a synthetic prostaglandin analog
T b. It is not recommended for use in patients below 16 years of age
F c. It is an anti-allergic drug
T d. It may contain the preservative benzalkonium chloride
F e. A common adverse reaction is eye pruritus
60. Which of the following is TRUE about Latanoprost
F a. Increases IOP
T b. Increases brown iris pigmentation
T c. Causes eyelid skin hyperpigmentation
T d. May exacerbate uveitis
T e. May cause macular edema
61. Which of the following may cause dry eyes?
T a. Oral contraceptives
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T b. Exposure to cigarette smoke
T c. Contact lens wear
T d. Thimerosal in eye drops
T e. Antihistamines
62. Topical treatments for dry eye include:
F a. Contact lens
F b. Antihistamine
T c. Antibiotic
T d. Cyclosporin
T e. Corticosteroid
64. Negative side effects of atropine use in myopia control include:
F a. Epiphora
T b. Photophobia
T c. Blurred vision
F d. Pain
T e. Increased heart rate
65. Medications for glaucoma management include:
T a. Beta blockers
F b. Antioxidants
T c. Prostaglandins
T d. Miotics
F e. Corticosteroids
66. Acceptable treatments for pterygium include:
F a. Topical anti-virals
T b. Artificial tears
T c. Topical NSAIDs
F d. Exenteration
F e. Photocoagulation
67. Which of the following is NOT a NSAID?
F a. Ibuprofen
T b. Pilocarpine
F c. Piroxicam
T d. Mannitol
F e. Diclofenac
68. Which of the following is a sympathomimetic?
T a. Dipivefrin
F b. Glycerol
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T c. Brimonidine
T d. Adrenaline
F e. Metachol
69. Sodium cromoglycate is:
F a. Antihistamine
F b. NSAID
F c. Antibiotic
T d. Mast cell stabilizer
T e. Anti-allergic
70. Which is TRUE about Ketotifen?
F a. Used to treat bacterial infections of the conjunctiva
T b. An antihistamine
T c. A Mast cell stabilizer
F d. Used to lower IOP
T e. Used to relieve itching
71. Which of the following is a vasoconstrictor?
T a. Naphazoline
F b. Aciclovir
T c. Phenylephrine
T d. Tetrahydrozoline
F e. Chloramphenicol
72. The following are indications for mydriasis:
T a. Contusion injury
T b. Vitreous opacity
T c. Sudden decrease in visual acuity
T d. Cloudiness of vision
F e. Superficial foreign body in the conjunctiva
73. Ocular complaints by a patient when atropine is instilled include:
F a. Double vision
T b. Photophobia
F c. Eyestrain
T d. Blurred vision
T e. Dry eye
74. Which of the following is a mast cell stabilizer?
F a. Antazoline
T b. Cromolyn sodium
F c. Naphazoline
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T d. Lodoxamide
T e. Ketotifen
75. Which of the following is a beta blocker?
T a. Carteolol
T b. Betaxolol
T c. Timolol
F d. Carbachol
F e. Pilocarpine
76. Which of the following is an anti-glaucoma drug?
T a. Adrenaline
F b. Atropine
T c. Bimatoprost
F d. Piroxicam
T e. Dorzolamide
77. The following are NASIDS EXCEPT:
T a. Prednisolone
F b. Flurbiprofen
F c. Naproxen
T d. Acetazolamide
F e. Ibuprofen
78. Which of the following is NOT a corticosteroid?
F a. Medrysone
T b. Ampicillin
T c. Phenylephrine
F d. Hydrocortisone
T e. Suprofen
79. These drugs act both as antihistamine and a mast cell stabilizer:
F a. Nedocromil sodium
T b. Olapatadine
T c. Ketotifen
F d. Antazoline
F e. Loratadine
80. Which of the following can be prescribed for itching?
F a. Aciclovir
T b. Astemizole
T c. Naphazoline
T d. Antazoline
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F e. Pilocarpine
81. Treatment of corneal ulcer involves the use of:
F a. Antihistamine
T b. Atropine
T c. Ant-inflammatory
F d. Pilocarpine
T e. Antibiotics
82. Which of the following is a carbonic anhydrase inhibitor?
T a. Brinzolamide
F b. Latanoprost
F c. Bromonidine
T d. Dorzolamide
T e. Acetazolamide
83. Which of the following is NOT an anti-bacterial?
F a. Amoxicillin
T b. Aciclovir
F c. Norfloxacin
F d. Ampicillin
F e. Neomycin
84. Systemic side effects of beta-blockers include:
T a. Bronchospasm
T b. Bradycardia
T c. Hypotension
F d. Kidney failure
F e. Anemia
85. Topical anti-fungal drugs include:
T a. Econazole
F b. Glycerol
T c. Clotrimazole
F d. Astemizole
F e. Epinastine
86. Which of the following is a diagnostic ophthalmic drug?
T a. Atropine
T b. Mydriacyl
F c. Timolol
F d. Ciprofloxacin
T e. Lidocaine
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87. Which of the following is NOT an antioxidant?
F a. Vitamin E
F b. Beta Carotene
T c. Paracetamol
F d. Vitamin C
T e. Dextracin
88. Adrenergic drugs cause:
F a. Constriction of pupil
T b. Dilation of pupil
T c. Inhibition of accommodation
F d. Stimulation of accommodation
T e. Constriction of blood vessels
89. Which of the following class of drugs is used in the treatment of glaucoma?
F a. Anti-inflammatory
F b. Sedatives
F c. Tranquilizers
T d. Carbonic anhydrase inhibitors
T e. Anticholinesterase
90. The following are cycloplegic drugs:
T a. Homatropine
T b. Tropicamide
T c. Cyclopentolate
F d. Botilinium
F e. Sodium cromoglycate
91. Antimuscarinic agents generally induce the following in the eye:
F a. Miosis
T b. Mydriasis
T c. Cycloplegia
T d. Photophobia
F e. Increased ability to read
92. Examples of Fluoroquinolones include:
T a. Ciprofloxacin
F b. Erythromycin
T c. Moxifloxacin
F d. Tobramycin
T. e. Ofloxacin
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93. Sympathomimetic drugs are used clinically for the following:
F a. Treat uveitis
F b. Induce cycloplegia
T c. Induce mydriasis
F d. Diagnosis of accommodative disorders
F e. For anaesthesia
94. The best route of drug administration for management of eyelid oedema is through:
F a. Topical application of drops
T b. Systemic application of drugs
F c. Subconjunctival injection of drugs
F d. Intracameral injection of drugs
T e. Intravenous application
95. Mast cell inhibitors have the following properties:
F a. Antihistaminic activity
T b. Inhibit type l immediate hypersensivity reactions
T c. Prevent mast cell degranulation
F d. Prevent bacterial growth
F e. Act as a wetting agent
96. Prostaglandin analogues are used in the management of:
F a. Uveitis
F b. Cataract
T c. Open angle glaucoma
F d. Blepharitis
F e. Conjunctivitis
97. The following is NOT required during a Goldmann applanation tonometry procedure:
F a. Procaine
T b. Mydriacyl
T c. Chloramphenicol
F d. Fluorescein dye
T e. Atropine
98. Which of these is NOT used to manage hypertension?
F a. Diuretics
T b. Parasympatholytics
T c. Sympathomimetics
F d. Vasodilators
F e. Beta blockers
99. The following are TRUE about fluorescein sodium:
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T a. It can exist in various ionic states
T b. It is excited by green light
T c. It is excreted mainly by the kidney
F d. It leaks out of the choriocapillaries readily
F e. It leaks out from the nose
CHAPTER FOUR
OPTICS
1. +1.75DC X 1000/ +1.25DC X 10₁ can be transposed to:
F a. +1.75DS/ -0.50DC X 100°
T b. +1.75DS/ -0.50DC X 10°
F c. +l.25DS/ +0.50DC X 10°
T d. +1.25DS/ +0.50DC X 100°
Fe. +l.75DS/ +0.50DC X 10°
2. By casual inspection, you can identify a minus spherical lens if:
T a. There is a “With” movement of the image of an object seen through the lens
F b. There is an “Against” movement of the image of an object seen through the lens
T c. The lens is thicker at the periphery than at the center
T d. Images seen through the lens are minified
F e. Images seen through the lens are magnified
3. +l.25DS/ -5.00DC X 045° can be transposed to
F a. +1.25DS/ +5.00DC X 135°
F b. -3.75DS/ -5.00DC X 135°
T c. -3.75DS/ +5.00DC X 135°
T d. -3.75DC X 045°/+1.25DC X 135°
F e. -3.75DC X 135°/+1.25DC X 045°
4. +2.50DS/ +3.25DC X 090° can be transposed
T a. +2.50DC X 180°/+5.75DC X 090°
F b. +2.50DC X 90°/+5.75DC X 180°
T c. +5.75DS/ -3.25DC X 180°
F d. +1.25DS/ -3.25D“C X 90°
F e. +5.75DS/ +3.25DC X 130°
5. Which of the following is TRUE?
T a. Plus lenses allow rays of light to converge, and move the focal points forward
F b. Minus lenses allow rays of light to converge. and move the focal points backward
F c. If the focal points lie in front of the retina, accommodation can occur
T d. If the focal points lie in front of the retina accommodation cannot occur
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T e. Minus lenses allow rays of light to diverge, and move the focal points backward
6. Which is TRUE about progressive lenses?
F a. These lenses have powers for viewing at only three distances
T b. These lenses are made without a line
T c. They are cosmetically superior to bifocals
T d. Provide a greater range of clear vision
F c. All of the above
7. Which of the following is TRUE about lenses?
F a. Plus lenses stimulate accommodation
F b. Plus lenses minify images
F c. Minus lenses make objects appear farther
F d. Minus lenses magnify images
T e. Minus lenses induce accommodative convergence
8.
Which of the following is TRUE about prisms?
F a. Base in prisms stimulate convergence
T b. Base out prisms make objects appear smaller
F c. Base in prisms make objects appear nearer
T d. Base out prisms make objects appear nearer
T e. Base out prisms stimulate convergence
9.
The following are purposes for decentration:
F a. To correct hyperopia
F b. To correct myopia
F c. To correct astigmatism
T d. To produce prismatic effect
T e. To eliminate prismatic effect
10. Polaroid lenses are specifically designed to:
F a. Improve distance vision
T b. Eliminate glare
F c. Improve colour perception
T d. Aid night driving
F e. Accentuate reflection
11. A ray of light passing through the centre of curvature of a spherical surface will:
F a. Be deviated towards the normal
F b. Be reflected back
T c. Emerge perpendicular and undeviated
F d. Be totally internally reflected
T e. Undergo no refraction
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12. For any given lens, the spectacle magnification depends on:
T a. Form or shape of the lens
F b. Illumination of the surrounding
T c. Power of the lens
F d. Age of the lens wearer
T e. Vertex distance
13. The following ocular conditions could result from exposure to harmful UV radiation:
F a. Myopia
T b. Retinal damage
T c. Photophthalmia
F d. Glaucoma
T e. Cataract
14. Qualities of a GOOD ophthalmic lens material include:
T a. Homogeneity of components
F b. Low refractive index
F c. High chemical instability
T d. Uniform physical state
T e. High scratch resistance
15. Qualities of a GOOD ophthalmic frame include:
T a. Durability
F b. Expensiveness
T c. Corrosion resistance
T d. Light weight
T e. Adjustability
16. The following are aberrations that could occur in lens design:
F a. Panthoscopic aberration
T b. Coma aberration
T c. Spherical aberration
F d. Retroscopic aberration
F e. Prismatic aberration
17. The number (n) of images formed of an object placed between two mirrors at an
angle
(a) apart can be represented by the formulae:
T a. 2(180)/a -1
F b. 360/a +1
T c. 4 (90)/a - 1
F d. 2 (90)/a -1
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F e. 2(180)/a +1
18. The following are CORRECT about spectacle lens materials:
T a. Plastic lenses are better than glass as aphakic lenses
T b. Plastic lenses scratch easily than glass lenses
F c. Crown glass has greater refractive index than flint glass
Td. Plastic lenses are preferable for children
T e. Crown glass has lesser refractive index than flint glass
19. Uses of prisms in Optometry include, for:
T a. Assessment of phorias and tropias
T b. Management of tropias
T c. Management of diplopia
T d. Management of visual field loss in low vision
F e. Management of accommodative problems
20. The following are CORRECT about Fresnel prisms:
F a. They are made of glass material
T b. They alter the direction of light thereby inducing prismatic effect
T c. One side has angular grooves the other is smooth
T d. Are useful in the management normal sighted patients
T e. Are useful in the management of low vision patients
21. The following are TRUE about astronomical (Keplerian) telescopes:
T a. They have 2 convex lenses
T b. Images produced are virtual
T c. Images produced are inverted
T d. The tube length is a sum of the focal lengths of the two lenses
T c. When looking through the objective lens, the image will be minified
22. Transpose the following prescription: + 2.00DS/ -1.00DC X 90°:
T a. +1.00DS/+1.00DC X 180
F b. -1.00DS/+1.00DC X 90
F c. +1.00DS/-1.00DC X 180
F d. +3.00DS/-1.00DC X 90
F e. +3.00DS/+1.00DC X 90
23. What is the spherical equivalent of -0.50DS/-0.50DC X 90₁:
F a. -0.50DS
F b. Plano
T c. – 0.75DS
F d. -1.00DS
F e. -1.25DS
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24. The dioptric equivalent of 60cm is:
T a. 1.67D
F b. 1.76D
F c. 2.56D
F d. 3.09D
F e. 3.50D
25. In spectacle bifocal, the vision that is easily achievable is:
T a. Alternating vision
F b. Simultaneous vision
F c. Neurological vision
F d. Rayleigh fraction vision
F e. Near vision
26. An ingredient used for the manufacturing of optical glass is called:
T a. Silica
F b. Silver
F c. Polish
F d. Blank
F e. Glazer
27. Which of the metallic oxides gives yellow colour to absorptive lenses?
F a. Silver oxide
T b. Uranium oxide
F c. Calcium oxide
F d. Sodium oxide
F e. None of the above
28. What type of lens is used to CORRECT astigmatism?
F a. Bifocal lenses
T b. Cylindrical lenses
T c. Sphero-cylindrical lenses
F d. Spherical lenses
T e. b and c
29. Concave spherical lenses are used to CORRECT a refractive error known as
F a. Presbyopia
F b. Hyperopia
T c. Myopia
F d. Astigmatism
F e. Anisometropia
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30. +0.50 DC x 90 / +0.50 DC x 180 =?
T a. +0.50DS
F b. + 1.00DS
F c. +0.5ODS x 180
F d. + 1.00DS x 90
F e. +0.50DS x 90
31. 1 prism dioptre is equal to
T a. 0.01 rad
T b. 1centrad
F c. 0.001 rad
T d. a and b
F e. b and c
32. 1 prism dioptre is equal to
F a. 0.0ldegree
T b. 0.5'7degree
F c. 0.86degree
F d. 0.67degree
F e. none of the above
33. Prism power at any point on a lens is defined by:
F a. Snell’s rule
F b. Prism’s rule
T c. Prentice’s rule
F d. Knapp’s rule
F e. Javal’s rule
34. An imaginary line that joins object of regard to the fovea is called:
T a. Visual axis
F b. Optical axis
F c. Principal axis
F d. Line of sight
F e. a and b
35. If a positive lens is shifted temporally, what prismatic effect will that produce?
T a. Base out
F b. Base in
F c. Base up
F d. Base down
F e. Base in and up
36. If a negative lens is shifted inward, what prismatic effect will that produce?
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T a. Base out
F b. Base in
F c. Base up
F d. Base down
F e. Base out and down
37. Dispersion is defined as the variation of refractive index with:
T a. Wavelength
F b. frequency
F c. thickness
F d. Power
F e. speed
38. Multifocal lenses are most commonly prescribed for:
F a. Hyperopia
T b. Presbyopia
F c. Astigmatism
F d. Compound myopic astigmatism
F e. Compound hyperopic astigmatism
39. Which ophthalmic glass has an index of refraction of 1.523?
T a. Crown glass
F b. Flint glass
F c. Barium glass
F d. Blast glass
F e. Fresnel glass
40. Dispersion is quantified by:
T a. Abbe number
T b. nu
F c. Dioptre
F d. Prism dioptre
F e. Degree
41. PMMA is an acronym for:
F a. Polymethenemethacrylate
F b. Polyethylmethacrylate
F c. Polymethacrylate
F d. Polymethymethalcrylate
T e. Polymethylmethacrylate
42. The separation between the lines of sight while fixating a distant object is known as:
T a. binocular interpupillary distance
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F b. monocular interpupillary distance
F c. binocular distance
F d. monocular distance
F e. Vertex distance
43. The process of moving the optical centre of the lens from geometric centre of the
lens aperture of the frame is known as:
T a. Decentration
F b. Recentration
F c. Shifting
F d. Centration
F e. Transposition
44. Which form of a lens always has 1.25 base curve?
F a. Corlon Lenses
T b. Periscopic
F c. Blank
F d. Pantoscopic
F e. Colombia resin
45. The special type of lenses that have a front layer of glass and a back layer of plastic
are:
T a. Corlon lenses
F b. Periscopic
F c. Blank
F d. Double lens
F e. CR-39
46. What component gives a photochromic lens dark colouration in sunlight?
T a. Silver halide
F b. Silver oxide
F c. Mercury halide
F d. Mercury oxide
F e. Silver nitrate
47. +0.50 DC X 180 / -0.50 DC X 90 =?
F a. +0.50 DC x 180
F b. +0.5 DS
F c. - 0.50 DS
F d. +0.50 DC X 90
T e. +0.50 DS / -1.00 DC x 90
48. Centre and edge thickness become important consideration for lens powers above:
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T a. ±4.00D
F b. ±2.00D
F c. ±6.00D
F d. ±1.00D
F e. ±3.00D
49. If the patient’s PD is 64mm, the frame eye wire is 50mm and the DBL is 20mm.
what is the amount of decentration required for this prescription?
T a. 0.5mm
F b. 0.7mm
F c. 0.8mm
F d. 0.85mm
F c. none of the above
50. The minus sphero-cyl form of +1.00 DC X 90 / +4.00 DC X 180 is:
T a. +4.00DS / -3.00DC X 90
F b. +3.00DS / -4.00DC X 90
F c. +1.00DS / -3.00DC X 90
F d. +4.00DS / -3.00DC X 180
F e. +1.00DS / -4.00DC X180
51. The human visual system can detect electromagnetic radiation wavelength ranging
from:
F a. 280 -780nm
F b. 300 - 850nm
F c. 300 - 500nm
F d. 790mm- 1000nm
T e. None
52. The science of measuring visible lights in units that are weighted according to the
sensitivity of the human eye is:
F a. Radiometry
F b. Holography
T c. Photometry
F d. Dichroism
F e. Calorimetry
53. Ultraviolent light was discovered by:
T a. Johann Ritter in 1801
F b. Johann Ritter in 1902
F c. Sir William Herschel in 1800
F d. Sir William Herschel in 1900
F e. Isaac Newton in I915
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54. .........is also referred to as an ideal diffuse emitter or reflector
T a. Lambertian surface
F b. Specular surface
F c. Fluorescent surface
F d. Coax surface
F e. None
55. An instrument which measures optical radiation is called:
F a. Optical refractometer
F b. Ophthalmoscope
F c. Spectrometer
T d. Radiometer
F e. Optoscope
56. The technique of using monochromatic light sources to produce 3D images on
photographic film is......
F a. Photometry
F b. Visual imaging
T c. Holography
F d. a and b
F e. a and c
57. An instrument that can spread light out into different colours is called
F a. Polaroid
T b. Spectrometer
F c. Laser
F d. Hologram
F e. Colorimeter
58. A lens is rotated in front of the eye and used to observe an optical cross if it is a:
F a. Spherical lens, there is an apparent break in the line
T b. Convex lens, it moves in against direction
F c. Convex lens, it moves in a with direction
T d. Concave lens, it moves in a with direction
F e. Concave lens, it moves in against direction
59. In lensometry:
T a. Power is measured in dioptre
F b. Front vertex power is measured
T c. Instrument used is called vertometer
T d. Optical centre of the lens can be marked
T e. Cylindrical axis can be marked
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60. Prisms can be used to:
T a. Compensate for binocular vision anomalies
T b. Decentre the optical centre
T c. Reduce thickness in progressive lenses
F d. Change vergence and direction of incident light.
F e. Increase thickness in progressive lenses
61. A frame has an eye size of 54mm, a bridge size of 16mm and is fit on a patient with a
64mm PD:
T a. The decentration is 3mm in for each eye
F b. Unwanted prism could be induced by correct lens centration
T c. Lenses that produce BI prismatic effect cause the eye to diverge out slightly in order
to
compensate for it
F d. Lenses that produce BO prismatic effect cause the eye to diverge out slightly in order
to compensate for it
F e. The decentration is 3mm out for each eye
62. In multifocal lens designs:
T a. As add power increases the range of clear vision through the segment decreases
F b. Higher add powers generally indicate higher amplitude of accommodation
T c. Trifocal lenses have an additional segment than bifocal
F d. Loss of intermediate vision occurs with higher add powers
F e. None of the above
63. Progressive additional lenses:
F a. Have visible lines of demarcation or segments
T b. Do not give unwanted differential image jump
F c. Have four different distinct visions
F d. Intermediate power is approximately 60% of add power
T e. Have no lines of demarcation or segments
64. In spectacle adjustment:
F a. When the spectacle lies on the nose, arc the nose bridge outwards
T b. When the spectacle lies on the nose, arc the nose bridge inwards
T c. Increase the temple tension by increasing the length to bend angle
F d. Increase the temple tension by decreasing the length to bend angle
F e. When the spectacle lies on the nose, arc the nose bridge upwards
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65. A patient’s prescription reads +1.00DCx 90 /-4.00DCx 180 in the distant portion and
+3.00DCx 90/ -2.00DCx I80 in the near portion of the lens. This prescription is spherocyl form could be written as:
T a. +1.0ODS /-5.00DC X 90 add +2.00D
F b. -4.00DS /+5.00DC x 180 add +2.50D
F c. -3.00DS /-4.00DC X 180 add +2.00D
F d. -2.00DS /-5.00DC x 90
F e. +1.00DS/-5.00DC x 90 add +2.50D
66. Toric lenses:
T a. Are cylindrical lenses
F b. Have the same curvature in all meridians
T c. Have maximum and minimum amounts of curvature
T d. Produce two different focal powers
F e. Are prism ballasted lenses
67. Which of the following statements is CORRECT?
T a. A ray of light incident on a higher index medium, is refracted towards the normal
F b. A ray of light incident on a higher index medium, is refracted away from the normal
F c. A ray of light incident on a rarer medium, is refracted towards the normal
T d. A ray of light incident on a rarer medium, is refracted away the normal
F e. When 21 ray is incident normally on a prism, the ray refracts (bends) only at the
second surface
68. +1.75DC X 090/-1.75DC X 090 can be replaced by what power of single lens?
F a. +3.50DC X 090
F b. -3.50DC X 090
F c. +1.75DCX090
T d. Plano
F e. -1.75DC X 090
69. +0.75DC X 180/+0.75DC X 090 can be replaced by what power of single lens?
F a. +0.75DC X 180
F b. +1.50DC X 090
F c. +1.50DS
F d. +0.75DS
F e. +1.5ODC X 180
70. Convert -2.50DC X 135 to its spherocylinder form:
T a. -2.5ODS/+2.50DC X O45
F b. -2.50DS/+2.50DC X 135
F c. +2.50DS/-2.50DC X 045
F d. -2.50DS/-5.00DC X O45
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F e. +2.50DS/+2.50DC X 135
71. Convert +2.00DC X 090 /-4.00DC X 180 to its spherocylinder form:
T a. +2.00DS/-6.00DC X 180
T b. -4.00DS/+6.00DC X 090
F c. +2.00DS/-2.00DC X 180
F d. +4.00DS/-2.00DC X 090
F e. -2.00DS/ -4.00DC X 180
72. Convert -3.75DC X 090 / -3.25DC X 180 into its minus spherocylinder form:
F a. -3.75DS/-0.50DC X 180
F b. -3.25DS/-0.50DC X 180
T c. -3.25DS/-0.50DC X 090
F d -3.75DS/-0.50DC X 090
F e. -3.75DS/-0.25DC X 180
73. Transpose +4.25DS/+1.75DC X 180 into cross cylinder form
F a. +4.25DC X 090/+6.00DC X 180
F b. +1.75DC X 180/+4.25DC X 090
F c. +6.00DC X 090/+4.25DC X 18O
F d. +4.25DS X 090/+l.75DC X 180
F c. +4.25DC X 180/-6.00DC X 090
74. Transpose Pl/-0.75DC X 45 into its alternate plus spherocylindrical form:
F a. Pl/+0.75DC X 135
T b. -0.75DS/+0.75DC X 135
F c. +0.75DS/+0.75DC X 45
F d. +0.75DS/+0.75DC X 135
F e. -0.75DS/+0.75DC X 45
75. +3.50DC X 180/-1.25DC X 180 can be replaced by what power of single lens?
F a. +1.25DC X 180
F b. -2.25DC X 180
F c. +4.75DC X 180
F d. -4.75DC X 180
T e. +2.25DC X 180
76. When a ray is incident normally on a prism i₁ equals:
F a. 0
T b. 1
F c. 2
F d. 3
F e. 4
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77. In refraction angle computations with Snell’s law, a computed sine greater than 1
indicates that:
F a. The ray was only refracted at the second surface
F b. The ray was incident normally on the prism
F c. The ray was an emergent ray
T d. The ray was totally internally reflected
F e. The ray angle was greater than the critical angle
78. Images formed by plane mirrors are:
T a. Same size as object
F b. Magnified
T c. Laterally inverted
F d. Upright and virtual
F e. Upright and real
79. The following are CORRECT:
T a. All images formed by concave lens are erect and minified
F b. All images formed by convex lens are real and erect
F c. All images formed by concave lens are erect and magnified
d. All images formed by convex lens are virtual and erect
F e. All images formed by convex lens are real and inverted
80.
The following statements about inverse square law for light intensity are
CORRECT:
F a. The intensity of illumination is proportional to the inverse square of the wavelength
of the monochromatic light
T b. The intensity of illumination is proportional to the inverse square of the distance
from the light source
F c. The law is applied to light energies only
T d. Large and diffuse light sources used at close ranges tend to diminish the effect of
inverse square law
F e. None of the above
81. The following statements are CORRECT about inverse square law:
T a. It can be used to predict the rate of light fight sources
T b. Intensity variation with a change in position is far more pronounced closer to the
source of light
T c. Light sources which use Fresnel lenses and grids as collimators will give brighter
luminosity despite their apparent distances from the patient
F d. The pupillary diameter of the human eye does not depend on the inverse square law
F e. All of the above
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82. The following statements are CORRECT about cosine law for plane surfaces:
F a. When the inclination angle between two plane surfaces is zero, the luminous
intensities at both surfaces become minima and also equal
F b. As the inclination angle between the two plane surfaces increases, the luminous
intensity at the inclined surface will increase
T c. When the inclination angle between the two plane surfaces is at right angle or 90
degrees, the luminous intensities at the inclined surface becomes zero
F d. To get the minimum luminous intensity at a surface, the source of light must be
directed at 90 degrees to the surface
F e. None of the above
83 The following illumination control techniques are applied in clinical optics to reduce
glare and enhance image visualization:
T a. The light from the ophthalmoscope/retinoscope shall be aligned co-linear with the
patient’s visual axis
T b. The viewing angle with the ophthalmoscope/retinoscope must be co-linear with the
examiner’s visual axis
T c. Pantoscopic tilts are built into ophthalmic frames
T d. All of the above
F e. None of the above
84. The following statements are correct about light reflectance:
T a. It is a measure of the proportion of light energy reflected from a given surface as
compared to original radiant energy that falls on the surface
F b. One of the ways to brighten the environment is to ensure that objects, wall, and
ceilings have low reflectance
T c. Objects with high reflectance values can be source of glare and dazzle
F d. All of the above
F e. None of the above
85. A prism typically can be identified by the following methods:
T a. Physical inspection
T b. Base-Apex marks
F c. Orientation test
T d. Transverse test
F e. Disjunction test
86. The power of a prism can be represented in the following units:
T a. Centrad
T b. Apical angle
T c. Deviation angle
T d. Meter angle
T e. Prism Dioptre
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87. The following statements are TRUE of lenses:
T a. A convex lens consists of prisms arranged Base-Base
F b. A convex lens consists of prisms arranged Apex-Base
T c. A concave lens consists of prisms arranged Apex-Apex
F d. A concave lens consists of prisms arranged Base-Apex
F e. None of the above
88. The following statements are TRUE of a prism:
F a. lt deviates light towards its Apex
T b. It displaces image towards its apex
T c. lt deviates light towards its base
F d. It displaces image towards its base
T e. The amount of deviation depends on its apical angle
CHAPTER FIVE
GENERAL OPTOMETRY
1.
Hyperopia could result from:
T a. Lateral displacement of crystalline lens
T b. Increased radius of curvature of one or more refractive surface(s)
T c. Presence of tumor within the eye
F d. Deep anterior chamber depth
F e. Axial length being too long
2.
Absolute hyperopia:
T a. Cannot be compensated for by accommodation
T b. Is total hyperopia. minus facultative hyperopia
F c. Is total hyperopia minus manifest hyperopia
F d. Is the portion of hyperopia that is within the amplitude of accommodation
T e. Leads to subnormal vision
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3.
Systemic diseases frequently associated with myopia include:
F a. Parkinson’s disease
T b. Microphthalmos
T c. Generalised albinism
F d. Paget’s disease
T e. Retinopathy of Prematurity
4. Non-spectacle treatment of myopia does NOT include:
F a. Diet control
F b. Surgical treatment
F c. Contact lens
F d. All of the above
T e. None of the above
5.
Causes of astigmatism include:
T a. Irregularity in the surface of the retina
T b. Variation in the index of the vitreous
T c. irregularity in the corneal curvature
F d. Centric position of the fovea in relation to the visual axis
T e. Tilted lenticular surface
6.
In compound hyperopic astigmatism:
F a. Principal meridians focus in front of the retina with accommodation relaxed
F b. Image of a point is vertical oval in with-the-rule
F c. Image of a point is horizontal oval in against-the-rule
T d. Image of a point is horizontal oval in with-the-rule
T e. Image of a point is vertical oval in against-the- rule
7. Factors that affect refractive error distribution include:
T a. Ethnicity
T b. Age
F c. Near Work
T d. Gender
F e. Intelligence
8. Information contained in social history include:
T a. Occupation
T b. Marital Status
F c. Hereditary conditions
T d. Avocational interest
F e. Recreational drugs
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9.
Classical model of migraine involves:
T a. Prodromal stage
F b. Headache before aura stage
T c. Fortification scotoma
T d. Scintillating scotoma
F e. Aura persists into the headache
10. Variants of migraine include:
T a. Ophthalmoplegic migraine
F b. Quadranopic migraine
F c. Hemianoplegic migraine
T d. Ophthalmic migraine
T e. Hemianopic migraine
11. Burning and tearing of eyes are:
T a. Related to dry eye
T b. Complaints that accompany seasonal allergy
T c. Associated with optic lagophthalmos
F d. Symptoms of optic neuritis
F e. Associated with acute angle closure glaucoma
12. Deep Ocular pain is associated with:
T a. Acute angle closure glaucoma
F b. Corneal abrasion
F c. Conjunctivitis
F d. Herpetic keratitis
T e. Posterior uveitis
13. Vision loss is longstanding or permanent in:
F a. Transient ischaemic attacks
F b. Migraine
F c. Multiple sclerosis
T d. Primary open angle glaucoma
T e. Central retinal vein occlusion
14. The effect of increased illumination on NPA includes:
F a. Increases NPA distance
T b. AA will be high
F c. AA will be low
T d. Increased depth of focus
F e. Decreased depth of focus
15. In facultative hyperopia:
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F a. VA is normal at far and reduced at near
T b. VA is normal at both far and near
F c. VA is normal at near and reduced at far
T d. Complaints of asthenopia after prolonged near work
F e. Complaints of double image at far
16. In high myopia:
F a. VA is reduced only at far
F b. VA is reduced only at near
T c. VA is reduced both at far and near
T d. There may be thinning of the retina
T e. VA can be improved through pin hole
17. Clinical symptoms of astigmatism include
T a. Smarting
F b. Narrowed palpebral fissure
T c. Tearing
F d. Constricted pupils
F e. Contracted brows
18. Ocular signs that could be probed in case history include:
F a. Floaters
F b. Photophobia
F c. Diplopia
T d. Chemosis
F e. Pain
19. A clinical sign of head tilt could be an indication of:
F a. Latent deviation
T b. Manifest deviation
T c. Aniseikonia
F d. Anisocoria
T e. Astigmatism
20. The amount of accommodation required at 6m and at 40cm, by an eye that has
1.00D of uncorrected hyperopia is:
F a. 1.00D at both distances
F b. 1.00D at 6m and 1.50D at 40cm
F c. 1.00D at 6m and 2.50D at 40cm
T d. 1.00D atom and 3.50D at 40cm
F e. 2.50D at both distances
21. A clinical test for the measurement of the accommodative response is:
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F a. Subjective refraction
T b. Dynamic retinoscopy
F c. Static retinoscopy
T d. Dissociated cross cylinder test
T e. Fused cross cylinder test
22. In the von Graefe technique of phoria measurement, if 5∆ B1 was used to achieve
alignment of the targets, state the condition and type of prisms required for visual
training:
F a. Esophoria, B1
F b. Exophoria, B1
F c. Esophoria, BO
T d. Exophoria, BO
F e. Orthophoria Nil
23. The phenomena whereby the amblyope reads one or two letters in each of several
lines is called:
T a. Contour interaction
T b. Crowding phenomenon
T c. Separation difficulty
F d. Optical illusion
F e. Entoptic phenomenon
24. Cycloplegic refraction is the MOST effective method of detecting:
F a. Muscle paresis
T b. Latent hyperopia
F c. Absolute hyperopia
F d. Facultative hyperopia
F e. Total hyperopia
25. These anomalies are often accompanied by symptoms of eye strain at far and at near:
T a. Simple hyperopic astigmatism
T b. Compound hyperopic astigmatism
T c. Divergence insufficiency
F d. Absolute hyperopia
F e. Convergence excess
26. The MOST effective treatment for convergence insufficiency is:
F a. Prescription of minus lenses
F b. Base-in visual training
T c. Base-out visual training
F d. Prescription of plus lenses
F e. Prescription of Base-in prisms
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27. In retinoscopy, with the working distance of 66cm and no retinoscopic lens in place,
no movement was noticed when both meridians were scoped: the magnitude of the
patient’s refractive error is:
F a. +1.5O0DS
T b. -1.500DS
F c. Plano
F d. +2.00DS
F e. -2.00D
28. In retinoscopy using the plane mirror, and with no retinoscopic lens in place, a ‘with’
movement is seen in:
T a. Emmetropia
T b. Hyperopia
T c. Myopia less than the working distance
F d. Myopia greater than the working distance
F e. Keratoconus
29. If subjective finding is -l.25DS and fused cross cylinder finding is +l.25DS, this
patient would require an Addition of:
F a. +1 .25D
F b. +2.00D
T c. +2.5OD
F d. Plano
F e. +1.50D
30. The response of a patient given a -l.00DS instead of a -1.25DS in the duochrome test
would be that the circles in the:
F a. Green are sharper
T b. Red are sharper
F c. Red are farther
F d. Green are nearer
F e. Green are farther
31. What is the ACA ratio of a patient whose near phoria of l eso changed to 4 exo with
the introduction of a +1 .00DS lens?
F a. 3/1
F b. 4/1
T c. 5/1
F d. 6/1
F e. 2/1
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32. How is the Maddox rod placed during lateral phoria and how is it seen by the
patient?
F a. Vertically, as horizontal
T b. Horizontally, as vertical
F c. Horizontally, as horizontal
F d. Vertically, as vertical
F e. Horizontally, as oblique
33. The Amplitude of Accommodation for the two eyes could differ in
F a. Isometropia
T b. Squint
T c. Anisocoria
T d. Anisometropia
T e. Antimetropia
34. Bright illumination:
F a. Decreases depth of focus
T b. Constricts the pupil
T c. Increases amplitude of accommodation
F d. Increases the near point of accommodation distance
T e. Increases depth of focus
35. Monocular amplitude of accommodation could be greater than the binocular
amplitude of accommodation in:
F a. lsometropia
T b. Amblyopia
F c. Heterophoria
T d. Vertical imbalance
T e. Tropia
36. Punctum remotum (PR), is:
T a. Closer than infinity point in myopes
T b. Located at a virtual infinity point in hyperopes
F c. Obtained by exertion of maximum accommodation
T d. The point conjugates with the retina in zero accommodation
T e. Also known as far point
37. A form of hyperopia which is within the range of patient’s amplitude of
accommodation is:
F a. Absolute hyperopia
T b. Facultative hyperopia
F c. Latent hyperopia
F d. Total hyperopia
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F e. Manifest hyperopia
38. The stimulus for convergence movement is:
F a. Blur circle
F b. Circle of least confusion
F c. Distorted image
T d. Retinal disparity
T e. Diplopia
39. Common clinical presentations of uncorrected astigmatism include:
T a. Furrowing and wrinkling of eyebrows
T b. Narrowing of the palpebral aperture
T c. Good vision in low degrees
F d. Poor accommodative ability in moderate degrees
T e. Head tilt
40. The following are components of the case history
T a. Patient’s history
T b. Eye health
T c. Binocular vision and coordination
T d. Vision and refractive status
T e. Parents ocular history
41. Demographic data include:
F a. Last eye examination
T b. Age
T c. Occupation
T d. Gender
F e. Previous medical history
42. In Family History, do you do Positive and Negative reporting‘?
T a. Yes
F b. No
F c. Sometimes
F d. Patient specific
T e. All the time
43. These are very important aspects of questioning:
T a. Support
T b. Reassurance
F c. Sympathy
T d. Probing
T e. Empathy
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44. A normal eye can distinguish:
F a. A point separated by an angle of 5min of arc
T b. 2 points separated by an angle of 1 min of arc
T c. 2 points separated by an angle of l/60 degree
F d. A point separated by an angle of 1 min of arc
F e. 2 lines separated by an angel of 5min of arc
45. A false idea of a visual acuity will be obtained:
F a. If a line of letters is presented instead of an isolated letter
F b. If a line of letters is too long
T c. If an isolated letter is presented instead of a line of letters
T d. If binocular VA is obtained before monocular VA
F e. If the VA chart is illuminated with tungsten bulb instead of LED
46. Colour vision deficiencies:
F a. Are also called colour blindness
F b. Are also called Daltonism
T c. Are sex linked
T d. Affect more males than females
F e. Affect more females than males
47. For a person with myopia, the following are CORRECT:
F a. Near vision is more affected than distant vision
F b. Use of appropriate biconvex lens corrects the defect
T c. Axial length tends to be longer than average
T d. Reading at distance is difficult without glasses
T e. Distance images focus in front of the retina
48. In a person with hyperopia:
F a. Distant vision is affected but near vision is normal
F b. Distant vision is normal but near vision is affected
F c. Light focuses in front of the retina
T d. Images focus behind the retina
F e. Correction is by biconcave lens
49. The following is/are feature(s) of a logMAR chart:
T a. Equal number of letters per row
T b. Equal inter-letter spaces in a row
F c. Each letter magnitude equals 0.25 logMAR for charts with 4 letters per row
F d. Each letter magnitude equals 0.2 logMAR for charts with 5 letters per row
F e. Letter sizes are graded by a ratio of 1.59
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50. A patient who read 6/40 acuity letters line at 2 meters. This VA could be written as:
F a. 6/80
T b. 6/120
T c. 4/80
F d. 6/140
F e. 6/60
51. The following are CORRECT about 6/60 visual acuity:
F a. Acuity letter size is 60 mm
T b. It is equivalent to 20/200
T c. It can be derived from 3/30 acuity
F d. LogMAR equivalent value is 0.1
T e. It may represent legal blindness
52. A patient read 4 rows and 4 letters in the next row of a standard logMAR chart with
5 letters per row. The VA (logMAR) of the patient is:
F a. 0.60
T b. 062
F c. 0.64
F d. 0.66
F e. 0.68
53. The spherical equivalent value of +2.00/-1.00 x 90 is:
F a. +1 .00DS
T b. +1.50DS
F c. +1.75DS
F d. +2.00DS
F e. +2.5ODS
54. The formula used to convert distance to diopters of accommodation is (d=distance in
cm):
F a. 1/d
F b. 10/d
T c. 100/d
F d. 1000/d
F e. 40/d
55. During Worth 4 dot test, a patient is considered to have diplopia when he reports
seeing:
F a. Two dots; both red
F b. Three dots; all green
F c. Four dots; two red and two green
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T d. Five dots; two red and three green
F e. Five dots; two green and three red
56. Factors that may influence intra-ocular pressure values include:
F a. Curvature of the cornea
T b. Thickness of the cornea
F c. Pupil size
T d. Time of the day
T e. Posture
57. What is latent hyperopia?
F a. Hyperopia, overcome by accommodation
T b. Hyperopia, not overcome by accommodation
T c. Hyperopia, shown in a wet refraction
F d. Hyperopia, shown in a dry refraction
F e. Hyperopia that is revealed by fogging
58. What are some possible symptoms of latent hyperopia?
T a. Asthenopia
F b. Exo deviations
T c. Headaches
F d. Diplopia
F e. Haloes
59. Which is NOT true regarding hyperopia?
F a. Cornea can be too flat
F b. Lens can be too weak
T c. Always a cause of reduced vision at near
F d. Can cause ocular discomfort
T e. Causes severe itching
60. Statistically, which group is the MOST hyperopic?
T a. Blacks
F b. Whites
F c. Asians
F d. Latinos
F e. Hispanics
61. Which of the following is NOT true regarding progressive myopia?
T a. Visual acuity is usually normal after correction
T b. It tends to increase slowly during adolescence
F c. The error usually exceeds -10.00D
F d. It may come as a secondary condition
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F e. It results from excessive elongation of the eye
62. Which of the following is NOT a symptom associated with progressive myopia?
F a. Blurred vision
F b. Haloes around light
F c. Difficulty adapting to darkness
F d. Headaches
T e. Itching
63. Adie's pupil may be due to:
T a. Disease of the ciliary ganglion
F b. Injury to the iris
F c. Inflammation in the anterior chamber
T d. Injury to the short ciliary nerve
T e. Syphilis
64. Which of the following is NOT a type of astigmatism?
F a. Simple Myopic
F b. Simple hypermetropic
T c. Complex myopic
T d. Complex hypermetropic
F e. Mixed
65. Signs of astigmatism include:
F a. Redness
F b. Swollen eyelids
T c. Constricted pupils
T d. Narrowed palpebral fissure
T e. Contracted brows
66. These are contributory factors to internal astigmatism:
F a. Colour of the iris
T b. Posterior surface of the cornea
T c. Anterior surface of the lens
F d. Rigidity of the cornea
T e. Posterior surface of the lens
67. The following are uses of IPD value:
T a. Centration of lenses in phorometry
T b. To abolish prismatic effect
T c. To induce prismatic effect
F d. Examination of pupils
F e. To perform ophthalmoscopy
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68. Fogging is utilized in the following
F a. Ophthalmoscopy
T b. Static retinoscopy
F c. Near Point of Convergence
T d. Subjective refraction
T e. Fused cross cylinder test
69. The conditions that are conducive for relaxation of accommodation while performing
cross cylinder test are:
T a. Presence of plus lenses
F b. Fixation at 6 meters
T c. Dim illumination
F d. The pupils are dilated with mydriacyl
T e. Presence of cross cylinder
70. Statistically, which group is the MOST hyperopic?
T a. Blacks
F b. Whites
F c. Asians
F d. Latinos
F e. Hispanics
71. Latent hyperopia is:
F a. Overcome by accommodation
T b. Not overcome by accommodation
T c. Shown in a wet refraction
F d. Shown in a dry refraction
F e. None of the above
72. Possible symptoms of latent hyperopia are:
F a. Myopia progression
F b. Eso deviations
T c. Headaches
F d. Ocular torticolis
T e. Asthenopia
73. Which of the following are TRUE regarding cluster headaches?
T a. More common in men than women
F b. More common in women than men
F c. Typically, bilateral
T d. They are concentrated in the retro-orbital and peri-orbital regions
F e. None of the above
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74. Symptoms associated with progressive myopia include:
T a. Decreased vision
T b. Photopsia
T c. Floaters
F d. Ambyopia
T e. Headaches
75. Secondary disorders associated with progressive myopia include:
F a. Amblyopia
F b. Retinoblastoma
T c. Posterior staphyloma
T d. Vitreous syneresis
F e. Rheumatoid Arthritis
76. Management options for progressive myopia include:
T a. Screenings and annual eye examinations
F b. Enucleation
T c. IOP control
F d. Pleoptics
T e. Pharmaceutical drugs
77. Regular astigmatism can take the following forms:
F a. Complex
T b. Simple
T c. Compound
F d. Dynamic
T e. Mixed
78. Which of the following is NOT a trial lens case accessory?
F a. Maddox rod
F b. Pinhole disc
T c. Hruby lens
T d. Fluorescein strips
F e. Stenopaic disc
79. Trial frames are used in:
T a. Refining prescription
T b. Measuring vertex distance
T c. Phoria test
F d. Visual field assessment
F e. Decentration
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80. The normal field of view of the eye of an individual are:
T a. 90° temporal
F b. 60° temporal
T c. 60° nasal
F d. 60° superior
T e. 70° inferior
81. Subjective refraction involves:
T a. Normal room illumination
F b. Testing at 40cm
F c. Use of prism bars
T d. Snellen visual acuity chart
F e. Maddox rod
82. Measurement of pupil size is useful in:
T a. Contact lens fitting
T b. Detecting anisocoria
F c. Retinoscopy
F d. Measuring tear break up time
F e. Tonometry
83. Which of these are optical solutions for aniseikonia?
F a. Prisms
T b. Contact lenses
F c. Contact lenses and prisms combination
T d. Spectacles
T e. Contact lenses and spectacles combination
84. Monocular AA can be greater than binocular AA in any of the following
T a. Anisometropia
T b. Amblyopia
T c. Vertical imbalance
T d. Pathology affecting one eye
F e. None of the above
85. Head tilting observed on a patient could be as a result of:
T a. Vertical imbalance
F b. Amblyopia
F c. Glaucoma
T d. Strabismus
T e. Aniseikonia
86. A tangent screen examination recorded as 3/1000 white means that:
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F a. The numerator 3 is the testing distance, 3 metres
T b. The denominator l000 is the testing distance, 1000mm
T c. White is the colour of the target
F d. White is the colour of the screen
F e. The numerator 3 is the target size, 3cm
87. Which is TRUE about latent hyperopia?
F a. The accommodation is relaxed in routine subjective refraction
T b. It is seen in wet retinoscopy
T c. The hyperopia is compensated by tonicity of the ciliary muscle
T d. The accommodation cannot be relaxed during subjective refraction
F e. Vision training is recommended for the patient
88. Which of the Following processes does NOT take place in accommodation?
T a. Pupil dilation
F b. Anterior surface of the lens becomes more convex
F c. The suspensory ligament relaxes
T d. The cornea becomes thicker
T e. Pupil size remains unchanged
89. What is the normal range of intraocular pressure?
T a. 10-20mmHg
F b. 25-30mmHg
F c. 35-40mmHg
F d. 2-5mmHg
T e. 11-21mmHg
90. Which part of the eye has the highest refractive power?
F a. Lens
T b. Comea
F c. Aqueous humour
F d. Sclera
F e. Vitreous
91. If 6/6 is equivalent to 20/20 in the English notation, convert 6/12 to the English
notation of visual acuity:
F a. 20/30
F b. 20/50
F c. 20/15
T d. 20/40
F e. 20/35
92. Which of the following is a method in case history?
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T a. Interview method
T b. Health questionnaire
T c. Combined method
F d. Electronic method
F e. Direct method
93. Why is the “E” optotype preferred to the “L” optotype in the measurement of visual
acuity?
T a. It has a gap
F b. It is darker
F c. It is common
T d. It satisfies the definition of visual acuity
F e. It has three bars
94. Which of the following is a determining factor in ACCURATE VA assessment?
T a. Pupil size
T b. Background luminance
T c. Type of optotype
F d. Room size
F e. Age of patient
95. What is the log of minimum angle of resolution value of 20/40 acuity?
F a. 0.1
F b. 0.2
T c. 0.3
F d. 0.4
F e. 0.5
96. The following are TRUE of pseudo myopia:
F a. It is a prolonged and uncorrected myopia
F b. It is an early stage of presbyopia
T c. It is a reversible form of myopia
T d. It is due to spasm of the ciliary muscles
F e. It is a form of axial myopia
97. In refraction, fogging is performed to ensure that:
T a. Any effort to accommodate will focus the image farther forward
F b. Any effort to accommodate will focus the image sharply on the retina
F c. A higher plus is prescribed
F d. A lower minus is prescribed
T e. Accommodation is eliminated to elicit the full error
98. The following is a measurement of IPD:
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T a. Distance between the centres of the two pupils
T b. Right temporal margin of one pupil to left nasal margin of the opposite pupil
T c. Right temporal margin of one limbus to left nasal margin of the opposite limbus
F d. Right temporal margin of one limbus to left temporal of the opposite limbus
F e. Distance between the centre of one pupil to the centre of the nose bridge
99. Ocular dominance is important in the following activities:
T a. IPD measurement
T b. Photography
T c. Shooting
F d. Ophthalmoscopy
F e. VDT Operation
100. When the conoid of Sturm is collapsed while using the clock dial, which of the
meridians will have equal clarity?
F a. 11 to 5 o’clock and 1 to 7 o’clock
T b. 12 to 6 O’clock and 9 to 3 o’clock
F c. 10 to 4 o’clock< and 2 to 8 o’clock
F d. 10 to 5 o’cl0ck and 2 to 8 o’clock
F e. 2 to 8 0’clock and 10 to 4 o’clock
101. Which of the following is a method in the determination of amplitude of
accommodation?
T a. Donders' method
F b. Krimsky method
F c. Percival’s method
F d. Hirschberg method
T e. Sheard’s method
102. What is the endpoint in the assessment of amplitude of accommodation?
F a. First blur point
T b. First sustained blur
F c. First break point
F d. First sustained break
F e. None of the above
103. Which of the following is an indication for tonometry?
T a. 40 years and above
T b. Family history of glaucoma
T c. Hypothyroidism
F d. Occupation
F e. Hypertelorism
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104. Which of the following figures represents the central visual field?
F a. 0 - 20°
T b. 0 - 30°
F c. 0 - 40°
F d. 0 - 50°
F e. 0 - 15°
105. The following terms are associated with perimetry:
T a. Threshold
T b. Sensitivity
T c. Isopter
F d. Graticule
F e. Optical infinity
106. Normal value of lag O
T a. +0.75D
F b. +1.00D
F c. +1.25D
F d. +1.5OD
F e. +0.25DS
107. Normal value of lead of accommodation is.
T a. +0.25D
F b. +0.50D
F c. +0.75D
F d. +1.00D
F e. +1.25DS
108. What is aniseikonia?
F a. Difference in the curvature of two corneas
F b. Difference in the diameter of the pupil
F c. Difference in the thickness of the corneas
T d. Difference in image size in both eyes
F e. Difference in the colours of both corneas
109. The relationship between NPA (cm) and AA is:
T a. AA=100/NPA
F b. AA=1/NPA
F c. AA= 10/NPA
F d. AA=1000/NPA
F e. AA=0.1/NPA
110. This is NOT a pupillary anomaly:
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F a. Adie’s tonic pupil
F b. Amaurotic pupil
F c. Marcus Gunn pupil
T d. Helmholtz pupil
T e. Heterochromia iridis
111. Ishihara test is used for:
F a. Accommodation
T b. Colour vision
F c. Amblyopia
F d. Suppression
F e. Near visual acuity
112. The presence of visual stimuli and brightness without regard to form is known as:
F a. Minimum resolvable
F b. Visual acuity
T c. Minimum visible
F d. Contrast
F e. Night vision
113. Which of these are known to be superior to the Snellen’s chart for visual acuity
assessment?
F a. Tumbling E
F b. Landolt rings
T c. Bailey-Lovie
T d. ETDRS
F e. Counting finger
114. In visual acuity testing, “the gap” is a width or space that subtends an angle of
____at the testing distance:
T a. 1’ of arc
F b. 5’ of arc
F c. 10’ of arc
F d. 30’ of arc
F e. 60’ of arc
115. Which of these is NOT a supplementary visual acuity test?
F a. Isolated VA
T b. Counting finger
F c. Pinhole acuity test
F d. Stenopaic slit VA
T e. Hand movement
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116. The point of clear vision, with the eye correctly focused and accommodation totally
relaxed is:
F a. Near point of accommodation
T b. Punctum remotum
F c. Punctum proximum
F d. Near point of convergence
F e. Accommodative range
117. During the Worth-4-dot test, which of the following outcomes suggest suppression?
F a. 2 green, 2 red dots
F b. 2 red, 3 green dots
T c. 2 red dots
T d. 3 green dots
F e. 2 white dots
118. The following are OEP tests that demonstrate limits of fusion EXCEPT:
T a. Test 9
F b. Test 10
F c. Test 11
F d. Test 16B
T e. Test 18
119. During ____, the crystalline lens adjusts in shape to facilitate focus at a given
distance
F a. Visual acuity testing
T b. Accommodation
F c. Fixation
F d. Depth of focus
F e. Field of focus
120. During pre-examination testing, NPA was identified at 18cm, what will the
accommodation amplitude be?
F a. 3.50D
F b. 2.50D
T c. 5.55D
F d. 4.55D
F e. 1.50D
121. The following factors negatively influence accommodation, EXCEPT:
F a. Myopia
F b. Presbyopia
T c. Hyperopia
F d. Increasing age
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F e. Convergence insufficiency
122. What ensues when the amplitude of accommodation is exceeded, and the limits of
accommodation are surpassed‘?
T a. Accommodation lag
F b. Accommodation excess
F c. Accommodation insufficiency
F d. Accommodative convergence
F e. Accommodative infacility
123. The angle between the line of sight and the pupillary axis is:
T a. Angle kappa
F b. Obtuse angle
F c. Angle lambda
F d. Angle phi
F e. Right angle
124. The corneal reflex test assesses;
F a. Phoria
F b. Purkinje
T c. Tropia
F d. Corneal sensitivity
F e. Reflex
125. Physiological blind spot is an example of:
T a. Absolute scotoma
T b. Negative scotoma
F c. Positive scotoma
F d. Relative Scotoma
F e. None of the above
126. The following are related to precautions taken during sphygmomanometer
T a. Ensuring that stethoscope head is placed on the arm of the patient and that its
position on the. arm is at the same level with the patient’s heart
F b. Ensuring that patient performs exercise before his/her blood pressure is measured
T c. Free forearm of patient’s clothing and ensure that rolled-up sleeve does not
excessively constrict the upper arm of patient
F d. Ensuring that patients are engaged in active talking during the procedure
T e. Palpating the systolic pressure before inflating
127. The following statements relate to sphygmomanometer generally:
F a. Hypertension is diagnosed on the basis of a single elevated in-office reading
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T b. With a severely elevated single BP reading (diastolic ≥ 115 or systolic ≥ 200) refer
the patient immediately for medical care
F c. There is no clinical relationship between hypertension and Papilledema
T d. Reinforcement of patient compliance with hypertension treatment regimens is one of
the indications for this procedure
F e. Systolic pressure corresponds with the arterial pressure during ventricular relaxation
between cardiac contractions.
128. The following statements relate to measurements of pupil size:
F a. Pupil diameter is measured in meters
F b. Pupil diameter measurement is only done in semi-darkened rooms
F c. A difference in pupil size of both eyes is called meiosis
F d. Pupillary diameter is usually estimated to the nearest nanometers
T e. Pupillary diameter may be measured with a millimeter rule
129. The following statements relate to pupillary tests:
T a. Normal pupils react consensually
F b. Normal pupils dilate during near reflexes
T c. Marcus Gunn pupil is detected during swinging flashlight test
F d. The ‘A’ in the acronym, PERRLA, stands for abduction
F e. The ‘E’ in the acronym, PERRLA, stands for extorsion
130. The following anomalies can be detected during pupillary tests:
T a. Horner’s syndrome _
T b. Argyll Robertson pupil
F c. Retinitis Pigmentosa
T d. Amaurotic pupil
F e. Protanopia
131. The following statements relate to accommodation:
T a. It can be presented as Range of accommodation
T b. It can be presented as Amplitude of accommodation
F c. Amplitude of accommodation is recorded in centimetres
F d. Amplitude of accommodation increases with age
T e. Range of accommodation is based on the positions of the far point and near point of
accommodation
132.The following statements relate to clinical assessment of accommodation:
T a. Near point of accommodation (NPA) is the distant at which a patient reports
sustained blur
F b. Near point of accommodation (NPA) is recorded in angular Seconds
F c. The reciprocal of NPA in millimetres will give the amplitude of accommodation of
the patient
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F d. NPC measurement is used to assess accommodation
F e. Punctum remotum is the same thing as NPA
133. The following statements relate to the Royal Air Force rule:
T a. It is used in measuring amplitude of accommodation
T b. It is used in measuring near point of convergence
T c. It consists of a graduated four-sided bar on which is mounted a movable target
holder
F d. It can be used to measure pupil diameter
T e. The bar is calibrated in centimetres and diopters
134. On Near Point of Convergence:
T a. It is the distance from the spectacle plane at which patient reports a break
F b. It is the distance from the spectacle plane at which patient reports a blur
T c. The examiner can as well note the distance at which the ‘suppressed’ eye turns
outward
T d. NPC value recedes with age
T e. NPC value is used in calculating amplitude of convergence
135. The following are anomalies that can be detected during penlight inspection‘
F a. Phoria
F b. Deuteranopia
T c. Trichiasis
F d. Presbyopia
T e. Chalazion
136. Indications for colour vision testing include:
T a. Age related macular degenerations i
T b. As a requirement
T c. Genetic counseling employment in certain occupations
T d. Glaucoma
T e. As part of pre-school screening tests
137. The following statements relate to colour vision:
T a. Achromatopsia refers to monochromatism
T b. Dyschromatopsia refers to dichromatism
T c. Achromatopsia is colour blindness state
F d. Aehromatopsia is colour deficiency state
F e. Tritanopia/Tritanomaly is a form of monochromatism
138. The progressive change in pupil size due to ageing is known as:
F a. Acute miosis
F b. Diffuse miosis
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F c. Late onset miosis
T d. Senile miosis
F e. Early miosis
139. Consider the following about the pupil:
F a. The pupil plays no role in the control of retinal illumination and determination of
retinal
image quality
F b. The lower limit of pupil size for optimal visual acuity is approximately 5mm
T c. The near triad response of accommodation, convergence, and miosis
F d. The near triad response of accommodation, adduction, and miosis
F e. Pupillary constriction reduces the pain associated with iris inflammation
140. Amplitude of Accommodation:
T a. Is a measure of accommodation from the far point to the near point
F b. Allows targets to be made clear over a large range of distance
F c. Is calculated by taking the inverse of the far point of accommodation
T d. Represents the amount of focusing power of the eye
T e. Decreases with increasing age
141. Direct (focal) illumination procedure includes:
T a. Narrow beam (optic section)
T b. Broad beam (parallelepiped)
F c. Sclerotic scatter
F d. Specular reflection
F e. Retroillumination
142. For diffuse slit lamp illumination, the following are correct:
T a. Used for observing eye and adnexia
F b. The slit should be narrow
T c. Magnification should be low
F d. Illumination should be focused at the limbus
F e. Magnification should be high
143. For direct/focal illumination, the following are CORRECT:
T a. Commonly used to view anterior ocular tissue
T b. Illuminated tissue area is viewed by the observer through the microscope
F c. Only wide beam illumination is used
F d. Only narrow beam illumination is used
F e. Only conical section is used
144. The following applies to sclerotic scatter illumination:
T a. Principle of total internal reflection applies
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F b. Wide beam is used
F c. Low level of room illumination is used
F d. Microscope is focused at limbus
T e. Illumination is directed to the limbus
145. The following information about retinoscopy are CORRECT:
F a. Working distance of 67cm requires +1.50 or +2.00D working lens
T b. Working distance of 25cm requires working lens of +4.00D
T c. Radical retinoscopy may be performed “off visual axis” of the patient
T d. Retinoscopic value may be prescribed if patient’s condition warrants that
T e. Radical retinoscopy may be performed at 20cm, if necessary
146. A patient with age-related macular degeneration could be examined with:
F a. Fluorescein dye
F b. Schirmer’s strip
T c. Amsler grid chart
T d. Ishihara colour vision plates
F e. Stereofly test
147. One of the following is a broad classification of headache:
F a. Extracranial
F b. Intracranial
T c. Cluster
T d. Vascular
T e. Tension
148. Which statement is CORRECT about the standard letter visual acuity?
F a. A luminance of l2 - 30Fc is required
F b. The standard letter size should subtend 1’ of arc at the reference distance the gap in
the
letter should be 5’ of arc
T c. The room illumination should be set to achieve at least 80% contrast
F d. The view angle is not important
F e. Working distances particularly the near vary widely
149. The condition in which the two ocular images are different in size and/or shape is
referred to as:
F a. Anisometropia
F b. Anisocoria
T c. Aniseikonia
F d. Anisophoria
Fe. None of the above
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150. The space eikonometer cannot be used to measure aniseikonia in patients with which
of the following conditions?
F a. Fixation disparity
T b. Suppression
F c. Heterophoria
F d. Anisometropia
F e. Myopia
151. Which of these is NOT an accommodative disorder?
T a. Ciliary injection
F b. Spasm
F c. Ill-sustained accommodation
F d. Paralysis of accommodation
T e. Corneal edema
152. Technique used to investigate development of V.A in neonates includes:
F a. Tumbling E
T b. Optokinetic nystagmus
F c. Landolt C
T d. Preferential looking
F e. Picture optotype
153. Prenatal factors to be probed during history taking include:
T a. Matemal age
T b. Therapeutic agents
T c. Infection/disease
F d. Apgar score
F e. Developmental milestone
154. Methods of diagnosing malingering include:
T a. Interrogation
F b. Pampering
F c. Measuring VA at same viewing distance
T d. Measuring VA on a vectographic chart
T e. Use lens combinations that add up to plano
155. Sudden onset of hyperopia in children could result from
T a. Drugs
T b. Subluxated lens
T c. Orbital tumor
F d. Hyperglyceamia
F e. Hysteria
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156. Which of the following is TRUE regarding refractive errors?
T a. Children who are regarded by their teachers as having a learning disability may have
an undiagnosed refractive error
T b. Children with myopia will sometimes have watery and swollen eyes
F c. Children with hyperopia may have to tilt or turn their head to get a clear image
F d. Children with high myopia have no problem seeing distant objects
T e. Children with astigmatism have headaches and tired eyes
157. The following visual functions may be affected by age EXCEPT:
F a. Contrast sensitivity
F b. Colour vision
F c. Visual acuity
T d. Stereopsis
F e. Visual field
158. The colours of rainbow include the following:
T a. Green
F b. Purple
T c. Blue
F d. Ultraviolet
F e. Infra-Red
159. The MOST commonly used treatment for convergence insufficiency is:
T a. Pencil pushup-to-blur test
F b. Synoptophore test
F c. Computer vision therapy
F d. Reading glasses with inbuilt prism
F e. None of the above
160. Characteristics of accommodative insufficiency include:
T a. Marked low amplitude of accommodation for age
T b. Alternate blurring and clearing of vision while testing for accommodative functions
T c. Low negative relative accommodation
T d. Low positive relative accommodation
T e. Reduced monocular flipper text rate
161. The refractive state of the eye is determined by the components which include:
T a. Corneal power
F b. Posterior chamber depth
T c. Lens power
T d. Anterior chamber depth
T e. Axial length of the eye
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162. The following statements about the axial length of the eye are CORRECT:
F a. Is expressed in centimetres
T b. Is expressed in millimetres
T c. Is longer in myopes than in hyperopes
T d. Is the distance between the anterior and posterior poles
T e. Each millimetre of change in axial length of the eye equals to approximately 2.5D
163. The symptoms of convergence insufficiency include:
T a. Eyestrain
T b. Blurry vision
T c. Double vision
T d. Headaches
T e. Reading related problems
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CHAPTER SIX
BINOCULAR VISION AND ORTHOPTICS
1. Oculomotor nerve innervates the following muscles
T a. Inferior rectus
T b. Inferior oblique
T c. Medial rectus
F d. Lateral rectus
F e. Superior oblique
2. The Trochlear nerve is/innervates:
F a. Designated as CN II
F b. Designated as CN III
T c. Designated as CN IV
T d. Superior oblique muscle
F e. Lateral rectus muscle
3. The Abducens nerve is/innervates:
F a. Designated as CN II
F b. Designated as CN III
T c. Designated as CN VI
F d. Medial rectus muscle
T e. Lateral rectus muscle
4. Synergists for elevation are:
T a. SR of the left and IO of the left
F b. SR of the left and IO of the right
F c. SR of the right and IO of the left
F d. LR of the right and MR of the left
T e. SR of the right and IO of the right
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5. Antagonists for vertical movements are
T a. SR of the right and IR of the right
F b. SR of the left and IR of the right
F c. IR of the left and SR of the right
F d. IR of the left and SR of the right
T e. SR of the left and IR of the left
6. These may be yoked muscles:
T a. SR of the left and IO of the right
T b. SR of the right and IO of the left
T c. IR of the left and S0 of the right
F d. MR of the left and MR of the right
T e. MR of the left and LR of the right
7. Hering’s law of ocular motility states that:
T a. Both eyes are equally innervated during ocular movements
T b. The two yoked muscles receive equal innervations
F c. Synergists receive equal but opposite innervations
F d. Concomitant deviation is equal in all directions of gaze
F e. Non-concomitant deviation is not equal in all directions of gaze
8. Suppression is:
T a. Usually manifested only in binocular vision
T b. To secure unconfused single vision
T c. To overcome slight disparity of images under normal circumstances
T d. A phenomenon used to avoid diplopia
F e. A phenomenon in monocular vision
9. Suppression:
T a. Involves the peripheral retina to avoid diplopia
T b. Involves the fovea to avoid confusion
T c. Unlike amblyopia is a phenomenon of binocular vision
T d. Like anomalous correspondence is a phenomenon of binocular vision
F e. ls present in monocular and binocular visions.
10. Amblyopia could be present in:
T a. Vision deprivation
F b. Presbyopia
T c. Strabismus
T d. Anisometropia
T e. Isometropia
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11. Anisometropic amblyopia frequently accompanies:
T a. Strabismic amblyopia
F b. Deprivational amblyopia
F c. Isometropic amblyopia
F d. Meridional amblyopia
F e. Nutritional amblyopia
12. Where H=objective angle, S=subjective angle and A=angle of anomaly; Harmonious
Anomalous Correspondence (HAC) is characterized as:
F a. S>H, A on the opposite side, A<O
F b. S is opposite, A>H
F c. H>S, S>0, H>A
T d. H>S, S=0, A=H
F e. H=S
13. Where H: objective angle, S: subjective angle and A=angle of anomaly;
unHarmonious
Anomalous Correspondence (uHAC) is characterized as:
F a. S>H, A on the opposite side, A<0
F b. S is opposite, A>H
T c. H>S, S>0, H>A
F d. H>S, S=0, A=H
F e. H=S
14. Where H=objective angle, S=subjective angle and A=angle of anomaly; Normal
Correspondence NC is characterized as:
F a. S>H, A on the opposite side, A<0
F b. S is opposite, A>H
F c. H>S, S>0, H>A
F d. H>S, S=O, A=H
T e. H=S
15. With the synoptophore, these are helpful in bringing about a fusion movement: 1
T a. Flashing lights
T b. Oscillating the targets
T c. Changing the relative level of illumination between the two eyes
T d. The introduction of lenses to stimulate accommodation
F e. Occluding one eye
16. Exercises to improve positive fusional vergence are:
T a. Push-up to break
T b. Convergence exercise with prism BO
T c. Convergence exercise using the synoptophore
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T d. Jump convergence exercise
F e. convergence exercise with prism BI
17. Exercises to improve negative fusional vergence are:
T a. Divergence exercise with prism BI
T b. Divergence exercise using the synoptophore
F c. Jump convergence exercise
F e. Convergence exercise with prism BI
F d. Convergence exercise with prism BO
18. Relative vergence exercises are performed with:
F a. Prism bar
T b. Stereograms
T c. Diploscope
T d. Remy separator
F e. Pencil push up
19. Accommodation facility is improved by the method of:
F a. Prism base-out exercise
F b. Push-up-to break
F c. Push-up-to blur
T d. Accommodation rocking
F e. Prism base-in training
20. The grades of binocular vision are:
T a. Flat fusion and fusion range, as 2nd grade
T b. Simultaneous perception even without superimposition, as 1st grade
T c. Stereopsis (depth perception), as 3rd grade
F d. Flat fusion and fusion range, as 1st grade
F e. Simultaneous perception even without superimposition, as 2nd grade
21. The binocular cues to depth perception are:
T a. Fixation disparity
T b. Binocular accommodation
F c. Aerial perspective
T d. Convergence
F e. Motion parallax
22. The fusion-free position of the eyes is:
T a. Phoria
T b. Heterophoria
F c. Primary position of gaze
F d. Tropia
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F e. Heterotropia
23. Tagging the macula in space in pleoptics is by:
T a. After image technique
F b. Base-in exercise
F c. Diplopia exercise
T d. Entoptic phenomenon
F e. Pencil push-up exercise
24. Pleoptics is/will:
T a. A training for amblyopia
T b. Restore the fovea as the principle seat of visual direction
T c. Restore central fixation
T d. Eliminate separation difficulties
T e. Improve visual acuity
25. ∆X =
T a. Sheard’s criterion
F b. Percival’s criterion
T c. A correction of lateral phoria
F d. A correction of vertical phoria
F e. A correction of hypertropia
. The formula represents:
26. ∆X=
F a. Sheard’s criterion
T b. Percival’s criterion
T c. ∆ correction of lateral phoria
F d. ∆ correction of vertical phoria
. This formula represents:
F e. ∆ correction of hypertropia
27. Vision therapy involves:
T a. Calisthenics
T b. Sneak occlusion
T c. Occlusion amblyopia
F d. Penalization of the amblyopic eye
T e. Penalization of the sound eye
28. The following are CORRECT about phoria:
T a. Most people are slightly exophoric at distance
F b. Most people are hyperphoric at distance
F c. Exophoria is usually higher at distance than near
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F d. In the von Graefe technique, target is vertically placed in vertical phoria
measurement
T e. In the von Graefe technique, target is vertically placed in horizontal phoria
29. Synoptophore slides:
T a. Include simultaneous perception targets
F b. Contain similar grades of pictures
T c. Are of different graded sizes
F d. Contain foveal slides that have larger pictures than macular perception slides
F e. D0 not include simultaneous paramacular perception slides
30. Suppression:
T a. Interrupts fusional reflex activity
T b. Can result from aniseikonia
T c. May eliminate diplopia
F d. May contribute to achieving binocularity
T e. Can be treated with synoptophores
31. The following statements are CORRECT:
T a. Visuoscope can detect fixation pattern of amblyopic eye
T b. Synoptophore can be used in the treatment of amblyopia
T c. Cycloplegic drugs can be used to treat ambylyopia
T d. Sneak occlusion method can be used to treat ambylopia
T e. After-images can be employed in the treatment of ambylopia
32. Anomalous Retinal Correspondence:
T a. Is a binocular vision problem
T b. Has an angle of deviation
F c. Can be treated with pleoptophore
T d. Can be treated using occlusion method
F e. Is a monocular phenomenon
33. Methods of treating amblyopia include:
T a. Occlusion
T b. Use of filters
T c. Drugs
F d. Prisms
T e. Pleoptics
34. Treatment for exophoria include:
T a. Jump convergence exercise
T b. Use of a diploscope
F c. Use of Remy separator
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T d. Relieving symptoms with BI prisms
F e. Divergence exercise using synoptophore
35. The effects of amblyopia on a patient include poor:
T a. Fusion
T b. Depth perception
T c. Stereopsis
T d. Retinal correspondence
T e. Colour perception
36. The following are advantages of binocular vision:
T a. Increase in visual field size
F b. Fixation disparity improvement
F c. Better monocular acuity
F d. Anomalous retinal correspondence improvement
T e. Improvement in stereopsis
37. Measured exophoria value may indicate:
T a. Amount and direction of demand
T b. Need for positive fusional convergence innervation
F c. Amount of negative fusional convergence to bring eyes to fixation point
F d. Amount of negative fusional innervation to bring eyes to fixation position
F e. Need for negative fusional convergence innervation
38. The following are CORRECT about positive and negative fusional vergence
innervations:
T a. Base-out-to-blur tests are the limits of PFVI
F b. Base-in-to-blur tests are the limits of PF VI
F c. Base-in-to-blur test at far is the limit of NF VI
F d. Base-out-to-blur tests are the limits of NFVI
T e. Base-in-to-blur test at near is the limit of NFVI
39. The following statements are CORRECT about phoria:
F a. Reserve for exophoria is measured with BI to blur or break.
F b. Reserve for esophoria is measured with BO to blur or break
F c. Positive fusional innervation is needed to overcome esophora
T d. Reserve for esophoria is measured with BI to blur or break
F e. In treating esophoria, BO prism power must be twice exophoria
40. The following are CORRECT about tonic (basal) vergence innervation:
T a. Responsible for muscle tone
T b. Influenced by sensory and motor inputs
T c. Acts on anatomical position of eyes
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T d. It is the only innervation present during distance phoria test
F e. It is initiated by awareness of nearness
41. The following are CORRECT about accommodative vergence innervation:
F a. Acts on anatomical position of eyes
F b. Initiated by retinal disparities
T c. Can be quantified by AC/A ratio
T d. Can influence the magnitude and direction of near phoria test results
T e. Can be initiated by any attempt to alter accommodative state of the eye
42. Tonic (basal) vergence innervation:
T a. Is continuously present and is responsible for muscle tone
T b. Is influenced by a number of sensory and motor inputs
T c. Acts on the anatomical position of rest
T d. Is the distance phoria position
T e. In an ideal distance phoria test, it is the only innervation in action
43. Accommodative vergence innervation:
T a. Is initiated by action that alters accommodation state of the eye
T b. Can be quantified by means of AC/A ratio
T c. Plays a major role in determining the magnitude and direction of near phoria
F d. Acts on the anatomical position of rest
F e. None of the above
44. Proximal innervation:
T a. Is known as voluntary vergence innervation
T b. Arises from the frontal cortex
T c. Is initiated by “awareness of nearness” ‘
T d. May increase vergence when distance phoria is measured with stereoscopes l
T e. Is psychic innervation v
45. Fusional vergence innervation:
T a. Is initiated by small retinal disparities that may result in diplopia
T b. Helps to establish bifoveal fixation at distance
T c. May help to establish bifoveal fixation at near
T d. Can compensate for phorias
T e. Contributes to the recovery to fusion movement seen during cover tests
46. Negative Relative Accommodation test:
T a. Is done at 40 cm only
T b. Is influenced by the reserves of positive and negative Fusional vergence
F c. Involves adding negative lenses binocularly
T d. Results in increased Exophoria
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T e. Results in decreased esophoria
47. In positive relative accommodation test:
F a. Plus lenses are added binocularly in front of the eyes at 40 cm
T b. Increase in accommodative innervation is accompanied by decrease in exophoria
T c. The decrease in exophoria is compensated for by Negative Fusional Vergence
T d. Patient may report blur due to over focus of retinal image
T e. Double target is reported when primary lines of sight assume dissociated position
48. Monocular cues for the perception of distance include:
T a. Size of target
T b. Overlay of the target
T c. Light and shadow around the target
T d. Prevailing geometric perspective
F e. Fixation disparity
49. Exophoria is commonly associated with:
T a. Convergence insufficiency
T b. Divergence excess
F c. Convergence excess
F d. Divergence insufficiency
F e. Accommodative excess
50. In concomitant squint:
F a. Primary deviation > Secondary deviation
F b. Primary deviation < Secondary deviation
T c. Primary deviation = Secondary deviation
F d. Primary deviation >Secondary deviation
F e. Primary deviation < Secondary deviation
51. In paralytic squint, the difference between primary and secondary deviation in the
gaze of direction of the paralytic muscle:
T a. Increases
F b. Decreases
F c. Remains the same
F d. Is unpredictable
F e. None of the above
52. In grades of binocular vision; grade 2 is:
F a. Simultaneous macular vision
T b. Fusion
F c. Stereopsis
F d. Fixation disparity
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F e. Simultaneous perception
53. Pick the CORRECT statements regarding Dyslexia:
T a. Dyslexia can be caused by a variety of conditions including trauma, visual, and
auditory problems
F b. Dyslexia is associated with mental retardation
F c. Optometrists can treat dyslexia with vision therapy and medications which is curative
of the disorder
T d. One common feature of dyslexia is unstable binocular vision
F e. None of the above
54. The goals of strabismus surgery include to:
T a. Develop or maintain binocular vision
T b. Improve visual acuity in nystagmus
T c. Increase the visual field in esotropia.
F d. Help improve monocular vision
F e. Make the patient more beautiful
55. What is the peak age of strabismus onset?
F a. Birth
T b. 3 years old
F c. 10 years old
F d. 18 years old
F e. 35 years old
56. Which of the following is NEVER an indication for strabismus surgery?
F a. Intermittent tropia
F b. Cosmesis (appearance)
F c. idiopathic congenital esotropia
T d. Accommodative esotropia
T e. Small angle of deviation
57. Amblyopia can have effects on the following:
T a. Spatial frequency
T b. Pursuits and saccades
T c. Pupils reaction to light
F d. Red green colour deficiency
T e. Blue yellow colour deficiency
58. The main problem with amblyopia is vision not developing normally. All the
following are reasons for this type of development EXCEPT:
F a. Severe ptosis
F b. Strabismus
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F c. Cataract
T d. Glaucoma
F e. Anisometropia
59. For which of the following Amblyopia is it critical to remove obstruction before
critical period?
F a. Anisometropic amblyopia
F b. lsoametropic amblyopia
T c. Deprivational amblyopia
F d. Strabismic amblyopia
F e. Meridional amblyopia
60. The following are treatment methods for amblyopia:
T a. Occlusion
F b. Plus lenses
T c. Atropine
T d. Pleoptics
F e. Base-In Prisms
61. Signs/symptoms of paralytic strabismus are:
T a. Limitation of movement
T b. Deviation
T c. False projection
T d. Diplopia
T e. Head tilting
62. What are the characteristics of convergence insufficiency?
F a. High AC/A ratio
T b. NPC recedes beyond 10cm
F c. High esophoria at near
T d. Low positive fusional vergence reserve
T e. Orthophoria or slight exophoria at far
63. What are the grades of binocular vision?
T a. Simultaneous perception
F b. Fixation disparity
T c. Stereopsis
T d. Fusion
F e. Physiological diplopia
64. Which muscles are responsible for moving the eyes up and to the left?
F a. Right inferior rectus
T b. Right inferior oblique
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T c. Left superior rectus
F d. Right superior rectus
F e. Left lateral rectus
65. Which muscles are involved in dextroversion?
T a. Right lateral rectus
T b. Left medial rectus
F c. Right medial rectus
F d. Right superior rectus
F e. Left lateral rectus
66. Crossed diplopia occurs:
T a. When the false image is seen in the opposite side with the deviating eye
F b. When the false image is seen in the same side with the deviating eye
F c. In esophoria
T d. In exophoria
F e. None of the above
67. The goals of strabismus surgery include:
T a. To improve visual acuity in nystagmus
T b. To develop or maintain binocular vision
T c. To increase the visual field in esotropia
F d. To help improve monocular vision
F e. All of the above
68. Which of the following is an indication for strabismus surgery‘?
T a. Intermittent tropia
F b. Redness
T c. Idiopathic congenital esotropia
T d. Cosmesis
F e. All of the above
69. Treatment for amblyopia include:
F a. Electrotherapy
T b. Occlusion
T c. Atropine
T d. Penalization
F e. Antibiotics
70. Which of these are requirements for orthoptic training for strabismus?
T a. Patient compliance
F b. Age above 40
T c. Normal motility of the eyes
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F d. Sudden mode of onset
F e. Age below 3
71. Orthoptic treatment for exophoria include use of:
F a. Henson perimeter
F b. Ishihara colour vision chart
F c. Snellen’s visual acuity chart
T d. Synoptophore
T e. Prisms
72. The synoptophore can be used to:
F a. Assess visual field
T b. Assess the grades of binocular vision
T c. Assess the presence of sensory and motor fusion
T d. Eliminate suppression
F e. Measure corneal rigidity
73. The following are treatment methods for eccentric fixation:
F a. Plus lenses
F b. Minus lenses
F c. Atropine
T d. Pleoptics
T e. Occlusion
74. Causes of heterotropia include:
F a. Increased IOP
T b. Paralysis of an extraocular muscle
T c. Ametropia
T d. Amblyopia
F e. Bacterial infection
75. Which cranial nerves are involved in squint?
T a. Oculomotor nerve
F b. Optic nerve
T c. Trochlear nerve
F d. Ophthalmic nerve
T e. Abducens nerve
76. Which of the following is TRUE about exophoria?
T a. There is crossed diplopia
F b. There is homonymous diplopia
T c. Visual training requires Base out prisms
T d. Base In prisms can be prescribed
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F e. Visual training requires Base In prisms
77. Which of the following is TRUE about esophoria?
F a. It is a vertical imbalance
F b. Prism correction is Base In
T c. Prism correction is Base Out
F d. There is crossed diplopia
T e. There is homonymous diplopia
78. Which of the following is TRUE about nystagmus?
F a. It presents with a homonymous hemaniopia
T b. It can result from corneal opacity
T c. It can be hereditary
F d. There are floaters in the field of view
T e. It can be neurological in origin
79. Some of the uses of a synoptophore include:
T a. Visual training for esophoria
T b. Assessment of the grades of binocular vision
T c. Treatment of suppression
T d. Treatment of amblyopia
F e. Treatment of myopia
80. On stereopsis:
F a. Stereopsis can be achieved monocularly
T b. Retinal disparity is the cue to stereopsis
T c. lt is considered to be an innate ability
F d. It is considered to be an acquired/learned ability
T e. It can be defined as the ability to perceive relative distance with both eyes
81. On Titmus Stereo test booklet:
T a. It can be used to assess gross stereopsis
T b. It can be used to assess fine stereopsis
F c. The test is done at 6 meters
T d. The test requires the use of cross-polarized
F e. Patients do not have to wear their refractive
82. On assessment of stereopsis:
T a. Bernel Stereo Reinder Test is used in assessing stereopsis
T b. American Optical Vectographic Project-O-C hart slide is used in assessing stereopsis
T c. Random Dot E Test is used in assessing stereopsis
F d. Slit-lamp can be used to assess stereopsis
F e. RAF rule can be used to assess stereopsis
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83. On strabismus:
T a. It can result in patients experiencing diplopia at the onset of it
F b. It is an anomaly of monocular vision
T c. It can result in patients experiencing confusion at the onset of it
F d. It has no relationship with amblyopia
F e. It is a latent deviation
84. Classification of strabismus can be based on:
T a. Age of onset
F b. Sex
F c. Race
T d. Etiology
T e. Deviation with position of gaze
85. The following terms can be used in describing a strabismuic case:
T a. Comitant
T b. Intermittent
F c. With the rule
F d. Organic
T e. Functional
86. The etiology of strabismus can be:
F a. Periodic
F b. Unilateral
F c. Alternating
T d. Paralytic
T e. Functional
87. The following tests are used in assessing strabismic cases:
T a. Corneal reflex test
F b. Edridge-Green Lantern test
T c. Cover test
F d. Ishihara test
F e. Schirmer’s test
88. Accommodative esotropia can be classified as:
T a. Refractive
F b. Genetic
T c. Nonrefractive
T d. Mixed.
F e. Paretic
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89. The following are treatment options for strabismus:
F a. Dieting '
T b. Orthoptic training
T c. Surgery
F d. Acupuncture
T e. Use of lenses and/or prisms
90. The following are occupations that require efficient binocular depth perception:
T a. Carpentry
T b. Crane lift operation
T c. Piloting
T d. Sailing
T e. Military
91. For a non-strabismic eye, the corneal reflex is located approximately:
F a. 0.5mm temporal to the centre of the pupil
T b. 0.5mm nasal to the centre of the pupil
F c. 0.5mm inferior to the centre of the pupil
F d. 0.5mm superior to the centre of the pupil
F e. 0.5mm inferio-nasal to the centre of the pupil
92. Cosmetic cure in strabismus is:
F a. Aimed at achieving bifoveal fixation
T b. Aimed only at enhancing the cosmetic appearance of the deviating eye
F c. Aimed at achieving stereopsis
T d. Achieved by means of surgical intervention
F e. Achieved by means of orthoptic training
93. Assessment of a strabismic case is aimed at providing information as regards:
T a. Age of onset
T b. Any previous surgical or orthoptic treatment
T c. Presence of adaptive conditions
T d. Unilateral or alternating status
T e. Comitant or incomitant status
94. The following terms are used in describing a Strabismic case:
F a. Age related strabismus
T b. Consecutive strabismus
F c. Dry strabismus
T d. Sensory strabismus
T e. Secondary strabismus
95. The confusion experienced by a strabismic patient is caused by the correspondence
between the following:
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F a. Fovea of the deviating eye and the optic disc of the non-deviating eye
F b. Fovea of the deviating eye and a non-foveal point of the non-deviating eye
T c. Fovea of the deviating eye and the fovea of the non-deviating eye
F d. Optic disc of the deviating eye and the optic disc of the non-deviating eye
F e. Optic disc of the deviating eye and the foyea of the non-deviating eye
96. The diplopia experienced by a strabismic patient is caused by the correspondence
between the following:
F a. Fovea of the deviating eye and the optic disc of the non-deviating eye
F b. Fovea of the deviating eye and a non-fovea point of the non-deviating eye
F c. Optic disc of the deviating eye and the optic disc of the non-deviating eye
F d. Optic disc of the deviating eye and the fovea of the non-deviating eye
T e. Non-foveal point of the deviating eye and the fovea of the non-deviating eye
97. The following are adaptive conditions in strabismus:
F a. Squinting
T b. Anomalous retinal correspondence
F c. Myopia
T d. Suppression
T e. Amblyopia
98. The following statements are TRUE:
T a. The Hirschberg test is a method of assessing the presence or absence of tropia
F b. When the eyes are uncovered, the corneal reflexes move away from their monocular
positions in the absence of a strabismus
T c. In esotropia, the corneal reflex for the deviating eye will be displaced temporally
compared with the fixing eye
T d. In exotropia, the corneal reflex for the deviating eye will be displaced nasally
T e. Each millimetre of displacement of the corneal reflex indicates approximately 22∆ of
strabismus
99. During Hirschberg test, the corneal reflex will be displaced:
Ta. Temporally relative to the position of the reflex in the fellow eye in the case of an
esotropia
F b. Nasally relative to the position of the reflex in the fellow eye in the case of an
esotropia
F c. Temporally relative to the position of the reflex in the fellow eye in the case of an
exotropia
T d. Nasally relative to the position of the reflex in the fellow eye in the case of an
exotropia
F e. Nasally relative to the position of the reflex in the fellow eye in the case of a
hypertropia
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100. Which of the following methods is useful in the assessment of ocular deviation?
T a. Hirschberg test
F b. Porta test
F c. Sheard’s method
F d. Donders’ test
T e. Krimsky’s test
101. The following is NOT a characteristic of convergence insufficiency:
F a. High exophoria at near
F b. Low AC/A ratio
F c. Reduced positive fusional vergence
F d. Receded NPC
T e. High AC/A ratio
102. Pencil push-up exercise is used in the management of:
F a. Convergence excess
T b. Convergence insufficiency
F c. Divergence insufficiency
F d. Accommodative excess
T e. Accommodative infacility
103. The following is a symptom of convergence excess:
T a. Asthenopia
T b. Headache
T c. Dizziness
F d. Gritty sensation
F e. Nausea
104. Which of the following is a vision therapy technique?
T a. Pencil spreading
T b. Thumb spreading
T c. Pen-to-nose
F d. Hole-in-the-card
F e. Dolman’s test
105. Which of the following is an adaptation to strabismus?
T a. Suppression
T b. Amblyopia
T c. Anomalous retinal correspondence
F d. Binocular rivalry
F e. Fixation disparity
106. Titmus fly test is used to test:
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F a. Colour vision
T b. Stereopsis
F c. Convergence insufficiency
F d. Dry eye
F e. Visual field
107. Stereopsis can be estimated using:
F a. Hole-in-the-card test
T b. Lang 2 pencil test
T c. Titmus stereo fly test
F d. Near point of convergence test
F e. Duochrome test
108. During the cover tests, binocular vision dissociation is achieved through:
F a. Prisms
F b. Maddox rod
F c. Eye movement
T d. Occlusion
F e. Hand movement
109. Tropia observed at 6m, but absent at 40cm is recorded as:
T a. Periodic
F b. Intermittent
F c. Alternating
F d. Unilateral
F e. Comitant
110. The following are tests to measure phoria EXCEPT:
F a. Maddox rod test
F b. von Graefe test
T c. Bruckner reflex test
F d. Howell card test
T e. Unilateral cover test
111. Stereopsis testing procedures are based on two principles:
F a. Contour stereotest and vectographic stereotests
F b. Titmus fly test and random dot stereotests
F c. Vectographic stereotests and titmus fly test
T d. Random dot stereotests and contour stereotests
F e. Stereotests and binocular vision
112. Lenses can be effective therapy if applied in binocular vision problems in cases
where:
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F a. Refractive error is very high
F b. AC/A is low & high exophoria present
F c. AC/A is low
T d. AC/A is high with esophoria present
F e. AC/A is low with exophoria
113. Calculate the AC/A ratio for Mr. GA with orthophoria at 6m and 10∆ esophoria at
40cm:
F a. 2 / 1
F b. 6 /l
T c. 10/ 1
F d. 4/ 1
F e. 8/ 1
114. With 10A exophoria at 40cm, BI test values of 18/28/12 and BO test results as 10/
16/8; how much prisms and in what direction will satisfy Sheard’s criterion?
T a. 3∆BI
F b. 3∆BO
F c. 2∆BI
F d. 2∆BO
F e. 4∆BO
115. During Von Graefe technique performance of OEP test 3, 2∆ BO was left after
testing.
The clinical conclusion is:
F a. Exophoria
F b. Exotropia
T c. Esophoria
F d. Esotropia
F e. Cyclophoria
116. Compensating vergence for exophoria is:
F a. Negative fusional vergence
T b. Positive fusional vergence
F c. Convergence excess
F d. Divergence excess
F c. Esotropia
117. Vergence is influenced by the following, EXCEPT:
F a. Fusion
F b. Fixation distance
F c. Accommodation
F d. Target size
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T e. None of the above
118. The rapid change in the Physiology of the visual cortex due to the imbalance visual
stimuli between the two eyes is referred to as:
F a. Binocular vision disorder
T b. Ocular dominance plasticity
F c. Deprivation
F d. Sensory plasticity
F e. Optic atrophy
119. If a patient’s phoria measures 2∆ exo @ distance and 5∆ eso @ near; and if the PD
is 68mm, what is the TRUE AC/A?
F a. 5.2/1
F b. 8.8/1
T c. 9.6/1
F d. 7.6/1
F e. 9.2/1
120. If a patient’s binocular data @ 6M yields: Phoria 8∆ eso; B1 to blur 14∆; BO to blur
10∆; what should be the correcting prism @ distance by Sheard criterion’?
F a. 1∆
T b. 2∆
F c. 4∆
F d. 5∆
F e. 8∆
121. A binocular data that has the eso at near greater than eso at distance is classified as:
T a. Basic eso
F b. Convergence excess
F c. Convergence insufficiency
F d. Divergence excess
F e. Divergence insufficiency
122. Ultimately, all conscious perceptions of visual direction are:
F a. Abathic
F b. Oculocentric
F c. The same as local sign
T d. Egocentric
F e. Unidirectional
123. When a patient bifoveally fixates a straight-ahead object through base-up yoked
prism, it appears to be lower than its true position. Based on the binocular sense of visual
direction, which of the following BEST explains this perception?
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F a. The prisms shift the retinal image to the superior retina and its sense of visual
direction is downward
F b. Prisms move the eyes downward. The retinal image falls on the inferior retina, so the
image moves down.
T c. Both eyes rotate downward to keep foveal fixation on the object. Extra ocular muscle
data tells the brain that the object is lower.
F d. Local sign says the object is down; proprioception says it’s straight ahead. The
combined perception is down.
F e. None of the above
124. Which of the following does NOT contribute to our explanation of the moon
illusion?
F a. When objects move further away, they normally decrease in angular size.
T b. The comparative size of trees, hills, etc., on the horizon make the moon appear larger
F c. The moon in the sky above (empty space) appears closer than the moon on the
horizon
F d. Because of size constancy, objects of constant angular size appear to grow when
their perceived distance increases.
F e. None of the above
125. Which of the following BEST describes microstrabismus, also known as
monofixation syndrome?
F a. It must usually be corrected surgically
F b. It is a common cause of eye strain and headaches
T c. It is a small residual deviation following strabismus surgery
F d. These patients are incapable of central or peripheral binocular fusion
F e. It is caused by high AC/A ratio
126. Which of the following is TRUE about amblyopia in humans?
F a. The magnocellular system is more severely affected by optical defocus than the
parvo system.
F b. Any strabismus should be surgically corrected before prescribing a refractive
correction.
F c. Treatment should include direct occlusion of the amblyopic eye to preserve superior
vision in the dominant eye
T d. A congenital cataract will cause severe irreversible amblyopia if not surgically
removed by about 3 months of age.
T e. Penalization of the good eye is a therapeutic option
127. If a laboratory technician suffers from eye strain and headaches when using a
binocular microscope and it is caused by excessive proximal convergence and proximal
accommodation, you could help him by prescribing:
F a. BI prism and plus lenses
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F b. BI prism and minus lenses
F c. BO prism and plus lenses
T d. BO prism and minus lenses
F e. Only BI prism
128. What is the approximate angular width of Panum’s area near the fixation point
(centre of the horopter)?
F a. ~10 arc seconds on either side of the horopter
T b. ~10 arc minutes on either side of the horopter
F c. ~10 degrees on either side of the horopter
F d. ~10 radians on either side of the horopter
F e. ~5 radians on either side of the horopter
129. A person with a 10-prism diopter right esotropia by the cover test is able to fuse, and
subjectively seems to have no strabismus. Which of the following conditions does this
patient MOST likely have?
F a. Suppression of one eye
F b. Altemating suppression
F c. Unharmonious anomalous correspondence
T d. Harmonious anomalous correspondence
F e. Alternating esotropia
130. A person with a 20-prism diopter right esotropia by the cover test is able to fuse, and
subjectively seems to have a l0-prism diopter strabismus. Which of the following
conditions does this patient MOST likely have?
F a. Suppression of one eye
F b. Alternating suppression
T c. Unharmonious anomalous correspondence
F d. Harmonious anomalous correspondence
F e. Alternating esotropia
131. Which of the following would MOST likely lead to binocular rivalry?
T a. Image of a house on the OD fovea and trees on the OS fovea
F b. High-quality, correlated images on the OD and OS retinas
F c. Alternating exotropia
F d. Fixation by OD and suppression of OS
F e. None of the above
132. Which of the following BEST describes diplopia (not confusion)?
F a. One image formed on the OD fovea and a different image on the OS fovea
F b. An image formed on the OD fovea and the same image on the OS fovea
T c. An image formed on the OD fovea and the same image on the OS peripheral retina
F d. Two different images formed on corresponding points on the two retinas.
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F e. One image formed on the OD fovea and a different image on the OS peripheral
133. Which of the following prismatic corrections would MOST likely make a patient
feel that he is taller than normal?
F a. Base up over one eye and base down over the other
F b. Base-in prism OU
T c. Base-out prism OU
F d. Horizontal yoked prism
F e. Base down OU
134. Stereocampimetry is a technique used to measure:
F a. Stereoacuity threshold
T b. The suppression field in one eye
F c. The empirical horopter
F d. The Hering-Hillebrand deviation
F e. Angle of deviation
135. Which of the following is CORRECT?
F a. Amblyopes can never see the Pulfrich effect
F b. Some amblyopes who cannot fuse can see the Pulfrich effect with a neutral density
(ND) filter
F c. Some amblyopes who cannot fuse can see the Pulfrich effect without an ND filter
T d. Some amblyopes who can fuse can see the Pulfrich effect without an ND filter
F e. None of the above
136. As target velocity increases, pursuits exhibit:
F a. Increased accuracy
T b. Increased frequency of saccades
F c. Increased latency
F d. Increased gain
F e. Smoother movement
137. Which one of the following is NOT part of normal fixation?
F a. Microsaccades
F b. Microdrifts
F c. Microtremors
T d. Square wave jerks
F e. Microstrabismus
138. Among the following symptoms, which would LEAST likely indicate a binocular
vision problem?
T a. Headache first thing in the morning
F b. Headache late in the day
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F c. Diplopia first thing in the morning
F d. Diplopia late in the day
F e. Transient blurred vision
139. Which of the following clinical procedures or considerations is MOST important for
a monocular patient (i.e. a patient who is blind in one eye)?
F a. Cover test
F b. von Graefe heterophoria test
F c. Testing for an afferent pupillary defect
F d. Balance using the red-green chart
T e. Prescribing polycarbonate or trivex lenses
140. During a cover test, the patient notices that the target appears to move from the
upper left to the lower right when you shift the occluder from OS to OD. What does the
patient have?
F a. Exophoria, OS hypophoria
T b. Exophoria, OS hyperphoria
F c. Esophoria, OS hypophoria
F d. Esophoria, OS hyperphoria
F e. None of the above
141. During the BI or BO to blur/break/recover test, you accidentally leave one side of
the phoropter closed. Which of the following BEST describes what the patient will notice
as you increase prism?
F a. The VA chart will be single and centered throughout the test.
T b. The VA chart will be single and will move to the side from the beginning.
F c. The VA chart will be single and centered at first but will begin to move a few
seconds later.
F d. The VA chart will be single and move to the side at first but stop moving a few
seconds later.
F e. The VA chart will be diplopic throughout the test
142. Which of the following sets of words are CORRECTLY correlated?
T a. Crossed disparity, crossed diplopia, object nearer than the fixation point
F b. Crossed disparity, uncrossed diplopia, object nearer than the fixation point
F c. Crossed disparity, crossed diplopia, object beyond the fixation point
F d. Uncrossed disparity, crossed diplopia, object nearer than the fixation point
T e. Uncrossed disparity, uncrossed diplopia, object beyond fixation point
143. Which of the following would MOST likely stimulate disparity vergence?
F a. Awareness that the object of interest is near
F b. Simply being awake and alert
F c. Retinal image blur
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F d. OD and OS retinal images centered on both foveas
T e. OD and OS retinal images slightly temporal to both foveas
144.
A medical laboratory technician experiences eyestrain and headaches when
examining specimens using a binocular microscope for a long time. Which of the
following might cause these symptoms?
F a. Haplopia
T b. Proximal vergence
F c. Presbyopia
F d. Tonic vergence
F e. Stereopsis
145. Which of the following statements BEST describes heterophoria and fixation
disparity?
F a. Heterophoria and fixation disparity are basically the same, except heterophoria is a
larger deviation
T b. Heterophoria is a deviation that exists when binocular fusion is interrupted, but a
fixation disparity is a deviation that exists during binocular fusion
F c. Heterophoria is a deviation that exists during binocular fusion, but a fixation
disparity is a deviation that exists when binocular fusion is interrupted
F d. Heterophoria describes the position of rest of the eyes, but a fixation disparity refers
to a mismatch in oculocentric visual directions for the two eyes
F e. None of the above
146. Which of the following statements BEST describes the Wesson Card and Sheedy
Disparometer when measuring a patient who has a fixation disparity?
T a. The Wesson Card lines will appear deviated to the patient and the Sheedy
disparometer lines will appear deviated to the doctor
F b. The Sheedy Disparometer lines will appear deviated to the patient and the Wesson
Card lines will appear deviated to the doctor
F c. The lines will appear aligned to the doctor for both the Sheedy Disparometer and the
Wesson Card
F d. The lines will appear aligned to the patient for both the Sheedy Disparometer and the
Wesson Card
F e. The lines will appear aligned to the patient for the Sheedy Disparometer and the
Wesson Card lines will appear deviated to the doctor
147. The MOST common cause of an acquired pendular nystagmus is:
F a. Alzheimer’s disease
T b. Multiple sclerosis
F c. AIDS dementia complex
F d. Huntington's disease
F e. Parkinson’s disease
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148. Which of the following BEST describes how binocular vision compares to
monocular vision in normal eyes?
F a. Binocular vision has more disadvantages than advantages
F b. Binocular and monocular vision are equally good for all virtual functions
F c. Most visual functions (except for stereopsis) are marginally better with binocular
vision
T d. Most visual functions (including stereopsis) are significantly better with binocular
vision
F e. Binocular vision has only advantages, and no disadvantages
149. A patient initially fixates the far bead of a Brock String, which has three beads. He
then shifts fixation to the middle bead. Which of the following BEST describes his
perception?
F a. Both the far and near beads will be seen in crossed diplopia
F b. Both the far and near beads will be seen in uncrossed diplopia
F c. The far bead will be seen in crossed and the near will be seen in uncrossed diplopia
T d. The far bead will be seen in uncrossed and the near will be seen in crossed diplopia
F e. No diplopia is seen
150. Which of the following could be a symptom of a vertical phoria?
T a. Skipping lines while reading
T b. Asthenopia
T c. Slow reading or difficulty in school
T d. Loosing place while reading
T e. Re-reading the same line
151. During the cover test, a patient notices that the target appears to move from the
upper left to the lower right when you shift the occluder from OS to OD. What is the
diagnosis?
F a. Orthophoria, OS hypophoria
F b. Esophoria, OS hypophoria
F c. Esophoria, OS hyperphoria
F d. Exophoria, OS hypophoria
T e. Exophoria, OS hyperphoria
152. The cover test is useful for diagnosing both:
T a. Strabismus and heterophoria
F b. Heterophoria and fixation disparity
F c. Strabismus and fixation disparity
F d. Strabismus and amblyopia
F e. Heterophoria and amblyopia
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153. The problems of the extra ocular muscle system can cause:
F a. Itching
F b. Burning
F c. Tearing
T d. Double vision
F e. Mucus discharge
154. Which of these tools help to diagnose and solve problem with the extra ocular
muscle system?
T a. Synoptophore
F b. Lenses
T c. Diploscope
F d. Keratometer
F e. Trial frame
155. What prisms will one use in training a convergence insufficiency and an overconvergence problem?
F a. BI & BO prism
F b. BO & BU prism
T c. BO & BI prism
F d. BI & BD prism
F e. BI & BU prism
156. Which of the following clinical tests can provide you with the MOST information
about the binocular development of a young pediatric patient?
T a. Random dot stereoacuity test
F b. Worth Four-Dot test
F c. Binocular visual acuity
F d. von Graffe phoria at far
F e. Maddox rod test
157. Which of the following kinds of developmental strabismus is MOST common at
about age 1?
T a. Infantile esotropia
F b. Refractive esotropia
F c. Intermittent exotropia
F d. Constant infantile exotropia
F e. Alternating exotropia
158. Which way do infants with infantile esotropia tend to rotate their heads?
F a. Toward the side with the strabismic eye
T b. Toward the side with the dominant eye
F c. Alternately toward the strabismic, then the dominant eye
F d. Downward
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F e. Upward
159. Which of the following would MOST likely be associated with an accommodative
esotropia in a young patient with less than 2 diopters of hyperopia in that eye?
F a. A similar angle of deviation at far and near
F b. Severe amblyopia
F c. High astigmatism
T d. An abnormally high AC/A ratio
F e. Muscle paresis
160. Which of the following usually causes the MOST severe disruption to normal
binocular development?
T a. Pattern deprivation
F b. Optical blur
F c. Strabismus
F d. High astigmatism
F e. High myopia
161. Which of the following BEST describes the normal course of stereopsis
development in humans?
T a. Rapid development to adult levels between 3 and 6 months of age
F b. Rapid development from birth to about 6 months of age and slower development
afterwards.
F c. Gradual development to about 8 months of age, then rapid development to adult
levels shortly after age 1 year
F d. Rapid development to age 3 months, then gradual development to about age 3 years
F e. Rapid development to age 3 months, then gradual development to about age 10 years
162. Which of the following kinds of strabismus is MOST frequently seen among
children about 6 months of age?
T a. Infantile esotropia
F b. Accommodative (refractive) esotropia
F c. Intermittent exotropia
F d. Constant infantile exotropia
F e. Refractive exotropia
163. Which of the following kinds of strabismus is MOST frequently seen among
children between 3 and 4 years of age?
F a. Infantile esotropia
T b. Accommodative (refractive) esotropia
F c. lntennittent exotropia
F d. Constant infantile exotropia
F e. Refractive
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CHAPTER SEVEN
INSTRUMENTATION/DIAGNOSTIC OPTOMETRY
1. The complete problem list:
T a. Includes every problem the patient has or has had
T b. Requires a diagnostic workup
F c. Contains clinical procedures
T d. Is a permanent list
F e. Is also known as the “SOAP” system
2. Blurred vision that occurs after prolonged close work in the young may be due to
F a. Night myopia
F b. Uncorrected hyperopia
T c. Poor accommodation facility
F d. Retinitis pigmentosa
F e. Temporal arteritis
3. In classic migraine:
F a. Nausea is a predominant symptom
T b. Nausea is due to stimulation of the CN X
F c. Aura is due to congestion of the meningeal arteries
F d. Headache is bilateral and throbbing
T e. Diagnosis is based mainly on history and symptoms
4. Tic douloureux:
T a. Most commonly occurs in the ophthalmic division of CN V
T b. Involves a trigger zone
F c. Affects mainly the young aged
F d. Occurs at the neck region
T e. Pain is extremely sharp and knife-like in character
5. Vernal conjunctivitis:
F a. Has watery discharge as a symptom
T b. Is a form of allergic conjunctivitis
F c. Most commonly affects aged males
T d. Has cobblestone papillae as a clinical sign.
F e. Causes mild to moderate itching
6.
Halos:
T a. Is one of the classical symptoms of angle closure glaucoma
F b. Will rotate if it is pathologic when the stenopaic disc is used
F c. Is often seen when the pupil is most constricted
T d. Is often seen at night
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F e. Occurs with excessive accommodation
7. Keratoconus is associated with:
T a. Munson’s sign
T b. Monocular diplopia
T c. Steep keratometric finding
F d. Ptosis
F e. Visual aura
8.
Keratoconjunctivitis sicca is associated with:
T a. Photophobia
T b. Mucus threads in the tear film
T c. Excessive debris in the tear film
F d. Marginal tear strip of 1mm
F e. Moderate tear production
9. Marcus Gunn pupil:
T a. Is due to condition affecting optic nerve
T b. Results in less constriction of both eyes with stimulation of affected pupil
T c. Results in less constriction of affected eye with stimulation of normal pupil
F d. Results in less constriction of the normal eye with stimulation of affected pupil
F e. Results in a marked decrease in visual acuity
10. Horner’s syndrome consists of:
T a. Ptosis
T b. Enophthalmos
T c. Miosis
F d. Decrease in facial sweating on the normal side
F e. Proptosis
11. Symptoms associated with exophoria include:
F a. Running together of letters
T b. Occasional diplopia
F c. Retrobulbar pain
F d. Desire for reading
F e. Constant headache
12. Preliminary examination includes:
T a. Cover test
T b. Sphygmomanometry
F c. Funduscopy
F d. Relative accommodation test
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T e. Visual field screening test
13. Initial treatment plan does NOT include:
F a. Therapy
F b. Education
F c. Contingency plans
T d. Family ocular history
T e. Preliminary examination
14. Blurred vision involving a transient loss of vision occurs in:
T a. Carotid artery occlusive disease
T b. Multiple sclerosis
T c. Migraine
F d. Nuclear sclerosis
F e. Night myopia
15. Latent hyperopia:
F a. Is mainly seen in the aged
T b. Is part of total hyperopia
F c. Can be partly corrected by patient’s accommodation
F d. Is always absolute
F e. Causes reduced vision
16. Clinical manifestations of hyperopia include:
T a. Shallow anterior chamber
T b. Small retinal images
T c. Miosis
F d. Short axial length
F e. Flat refractive surfaces
17. Cluster headache:
F a. Is unilateral headache occurring in the occipital lobe
T b. Affects mainly the middle-aged men
T c. ls often accompanied by nasal congestion
T d. Is also known as histamine cephalalgia
F e. Causes pain that is mostly tolerated by patient
18. Clinical features of congenital glaucoma include:
T a. Cupped optic nerve head
T b. Buphthalmos
F c. Mild photophobia
T d. Excessive tearing
F e. Muco-purulent discharge
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19. Tests for limits of accommodation include:
T a. Positive relative convergence
T b. True adduction
F c. Convergence at far
F d. Negative fusional reserve at near
T e. Negative relative convergence
20. Potential Acuity Meter (PAM) or Interferometer measures acuity for people with:
F a. Glaucoma
F b. Retinitis pigmentosa
F c. Macular degeneration
T d. Cataracts
F e. Amblyopia
21. Farnsworth 100 Hue test contains:
F a. 100 rainbow coloured caps that must be arranged in order of similar hues
F b. 15 rainbow coloured caps that must be arranged in order of similar hues
F c. 70 rainbow coloured caps that must be arranged in order of similar hues
T d. 85 rainbow coloured caps that must be arranged in order of similar hues
T e. 85 coloured tabs that must be arranged in order of similar hues
22. What colours can you see if you are missing L- and M- cones?
T a. Blues
T b. Yellows
F c. Reds
F d. Greens
F e. Cyan
23. The MAJOR cause of most colour deficiency involves patients having:
F a. Only one type of cones
F b. Only two types of cones
F c. Three types of cones
T d. Three types of cones but one cone is slightly different
T e. Abnormal peak sensitivity
24. Jones test evaluates:
F a. Patency of tear formation
F b. Patency of constituents of tears
T c. Patency of tear drainage
F d. Patency of the Lacrimal system
F e. Obstruction/stenosis of the lacrimal system
25. Seidel test is:
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F a. Observing the drainage of tears
T b. Also called percolation test
F c. Observing break up of tears
F d. For production of tears
T e. Observing aqueous leaking from the globe
26. These are a form of direct illumination:
F a. Sclerotic scatter
T b. Optic Section
T c. Broad beam
F d. Retro-illumination
T e. Parallelepiped
27. To study iris pathology, pseudo-exfoliation deposits, neovascularization etc use:
F a. Retro-illumination
F b. Optic section
F c. Sclerotic scatter
T d. Indirect illumination
F e. Broad beam
28. When performing direct retroF a. Optic section
F b. Broad beam
F c. Conical beam
T d. Parallelepiped
F e. Sclerotic scatter
29. When the biomicroscope is set so that the angle i = r is:
F a. Optic section
F b. Parallelepiped
T c. Specular reflection
F d. Conical beam
F e. Broad beam
30. Normal A/V ratio is:
T a. 2/3
T b. 3/4
F c. 1/4
F d. 1/3
F e. 1/1
31. The following reasons justify a dilated fundus examination
T a. Symptomatic patients: flashes/floaters
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T b. Blunt trauma
T c. Intraocular inflammation
T d. Known retinal disease
T e. Systemic conditions: hypertension/diabetes melts
32. The Image in the condensing lens of the binocular indirect Ophthalmoscope
compared to the retina is:
F a. Minified, inverted and laterally reversed
T b. Real, inverted and laterally reversed
F c. Real, upright and laterally reversed
F d. Real, upright and not reversed
F e. Minified, upright and laterally reversed
33. The equation for magnification of condensing lenses of the binocular indirect
ophthalmoscope is:
F a. M = F/2
F b. M = F
T c. M = F/4
F d. M = Fx2
F e. M=2/F
34. The following are normal background findings during dilated fundus examination:
T a. Uniform colour due to even distribution of melanocytes
T b. Tigroid/tessellated fundus due to uneven distribution of melanocytes
F c. Bone speckle/clumping of pigments
F d. White patches of sclera
F e. Uniform distribution of flaky white nerve fibres
35. The following are what you look out for when examining the optic nerve:
T a. Colour
T b. Elevation
T c. ISNT rule
T d. Spontaneous venous pulsation
T e. CD ratio
36. To increase the field of view in binocular indirect ophthalmoscopy:
F a. Increase the power of the condensing lens
F b. Close one eye intermittently
F c. Increase your IPD
F d. Increase the dilating agent
T e. Increase your working distance
37. What is the standard luminance for standard automated perimetry?
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F a. 15 cd/m2
F b. 20 cd/m2
T c. 10 cd/m2
T d. 13.5 asb
F e. 100 asb
38. The standard stimulus for the Goldmann Perimeter is:
F a. Stimulus Size I
F b. Stimulus Size II
T c. Stimulus Size III
T d. Stimulus Size IV
F e. Stimulus Size V
39. Subject is aware of the loss in sensitivity in:
F a. Scotoma
T b. Positive scotoma
F c. Negative scotoma
F d. No light perception
F e. Positive aberration
40. The subject is not aware of the loss in sensitivity:
F a. Scotoma
F b. Positive scotoma
T c. Negative scotoma
F d. No light perception
F e. Positive aberration
41. The Glaucoma hemifield test offers:
F a. High specificity only
F b. High sensitivity only
F c. Low sensitivity and high specificity
F d. Low specificity and high sensitivity
T e. High sensitivity and specificity
42. The ------- is becoming the standard glaucoma screener:
F a. Humphrey 24-2
F b. Humphrey 30-2
T c. Humphrey 10-2
F d. Humphrey 60-2
F e. Humphrey 32-4
43. The following are advantages of automated perimetry:
T a. Uniformity
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T b. Reproducibility
T c. Screening and threshold
T d. Tests central and peripheral visual field
T e. Random presentation
44. What group of people would you give their maximum addition?
T a. Aphakics
T b. Pseudophakics
T c. Absolute presbyopes
T d. Dilated patients
F e. High myopes
45. The reliability of the perimetry test is affected by:
T a. Fixation losses
T b. False positives
T c. False negatives
T d. Short term fluctuations
F e. Refractive errors
46. Indications for Amsler grid test include:
T a. Any unusual appearance of macula
F b. Unusual appearance of the fundus
F c. Inherited colour vision deficiency
T d. Corrected visual acuity is reduced
T e. Before pupillary dilation for an elderly
47. The following statement(s) about stereopsis is (are) CORRECT:
T a. It is largely learned
T b. It is the ability to perceive depth based on retinal disparity cues
F c. Stereopsis by monocular cues is innate
F d. Objects separated horizontally by over 6cm may not be seen stereoscopically
T e. It may be absent in patients with strabismus and amblyopia
48. Requirement for stereoscopic vision includes:
T a. A large binocular overlap of the visual field
F b. A large oblong Panum’s fusional area
T c. Partial decussation of the afferent visual fibres
T d. Coordinated conjugate eye movement
F e. Overlap of the efferent visual nerve fibres
49. The following statements are CORRECT about Maddox wing:
F a. Both the arrow and the scales, not seen together simultaneously suggests amblyopia
T b. Odd numbers are esophoria, while even numbers are exophoria
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F c. White arrow alignment on white numbers on white scale may suggest cyclophoria
T d. Maddox wing has a fixed test distance of 25cm
T e. Red arrow is used to measure vertical phoria
50. The following are CORRECT about contrast sensitivity (CS):
T a. It is visual ability to see objects that DO NOT stand out from their background
T b. It is ability of visual system to distinguish an object from its background
F c. Provides information that compliments stereopsis finding
T d. Poor CS may explain poor VA when optical aid is provided to low vision patient
T e. A patient may have normal VA and decreased CS at low spatial frequencies
51. The following are uses in slit lamp filters:
F a. Red filter is used to observed haemorrages and blood vessels
T b. Diffuser is used for overall observation of the eye and adnexae
F c. Neutral density filter is used with fluorescein to observe corneal staining
T d. Yellow filter enhances contrast when fluorescein and cobalt blue filter are used
T e. Grey filter reduces brightness for photosensitive patients
52. Corneal examination procedures include the following:
T a. Keratometry
T b. Topography
T c. Pachymetry
T d. Esthesiometry
T e. Placido disc
53. The following should be noted when evaluating visual acuity for a patient:
F a. Sitting posture
T b. Nystagmus
T c. Head and eye movement
T d. Frowning
F e. All of the above is correct
54. Indications for use of cycloplegic drugs include:
T a. Cases of strabismus
F b. Hyperopes above the age of 40
T c. Refraction of preschool children
T d. Unreliable subjective refraction
T e. Assessment of pseudomyopia
55. Functional integrity of 10° of visual field around fixation point can be evaluated with:
T a. Contrast sensitivity chart
F b. Ophthalmoscope
T c. Amsler grid
F d. Slit lamp
T e. Arc perimeter
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56. The following are CORRECT for performing ophthalmoscope:
T a. Low level illumination
F With +1 0.00D, the test distance can be 10-15cm to view anterior cornea
F c. Either eye may be used to examine the right eye
T d. The patient’s eyes may be slightly lower than that of the clinician
F e. The refractive error of the examiner must be corrected
57. In measuring inter-pupillary distance, the following are CORRECT:
F a. Illumination should be low
T b. Illumination should be high
T c. The reference point of the patient’s right eye should be the outer limbus
F d. The reference point of the patient’s left eye will be the outer limbus
F e. The reference point of the patient’s right e} e should be the inner limbus
58. Optic nerve function is BEST studied by:
F a. Direct Ophthalmoscopy
F b. Retinoscopy
T c. Perimetry
F d. Gonioscopy
F e. Slit lamp biomicroscopy
59. Which of the following is TRUE regarding cluster headaches‘?
T a. More common in men than women
F b. More common in women than men
F c. Typically bilateral
T d. They are concentrated in the retro-orbital and peri-orbital regions
F e. They are concentrated in the brow region
60. Antihistamines such as pseudoephedrine typically relieve which kind of headache
within 20-30 minutes?
F a. Hemiplegic migraine
T b. Vascular headache
F c. Tension headache
F d. Cluster headache
F e. Eyestrain headache
61. Which of the following is NOT true regarding the aura phase of classic migraines?
F a. The aura is also described as a scintillating scotoma
T b. The aura covers the whole visual field
T c. It is usually bilateral and lasts about 20mins
F d. The aura is caused by constriction of the branches of the internal carotid artery
T e. It typically precedes the headache by one hour or more
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62. Your patient. XY, came in complaining of boring pain around his right eye that
clusters together over days or weeks and they last 30 to 90 minutes. What would you
consider for your differential diagnoses?
T a. Cluster headache
F b. Frontal sinusitis
F c. Tension headache
T d. Acute angle closure glaucoma
T e. Migraine headache
63. What can help one distinguish patients that are responding to glaucoma treatment
from those that are not responding to treatment?
F a. Pupil size
F b. Asking their support system
F c. There is nothing that can be used to distinguish them
T d. Visual field changes
T e. Reduction in IOP
64. Of the following patients, who is the BEST candidate for refractive surgery?
F a. A patient with glaucoma
T b. A 19-year-old patient whose refractive error has remained stable for l year
F c. An uncontrolled diabetic patient
F d. A young lady who is 7 months pregnant
F e. None of the above
65. Which of the following conditions can present with anisocoria?
F a. Horner's syndrome
F b. CN V palsy
T c. Adie's syndrome
T ct. CN III palsy
T e. Antimetropia
66. According to the presentation, why is microperimetry an invaluable tool for clinician?
F a. it is an inexpensive equipment
F b. It is a quick test to perform
T c. It monitors reading speed by providing retinal sensitivity data
F d. It reflects retinal sensitivity expressed in decibel number
F e. It differentiates edema from hemangioma located in different retinal layers
67. Which of the following are differential diagnoses of CRAO?
T a. Acute ophthalmic artery occlusion
F b. Asteroid hyalosis
T c. Tay Sachs disease
F d. Branch retinal vein occlusion
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T e. Neimann Pick disease
68. What is "knocking out accommodation?"
F a. The process of over-minusing a patient and dropping them with 5% Proparacine in
order to find a patient’s true refractive error
T b. The use of agents to cause paralysis of the ciliary muscle in order to find a patient’s
true refractive error
F c. Using the fogging technique with plus lenses in order to rind a patient’s true
refractive
error
F d. Refraction in a dimly lit room to relax accommodation
F e. None of the above
69. Which of the following category of patients would benefit from a Cycloplegic
examination?
T a. A patient sitting in your chair wanting LASIK in the future
T b. Latent hyperopes
T c. Strabismic patients
T d. Hysterical amblyopic patients
T e. All of the above
70. Local anaesthetics are utilized in the Optometry clinic during:
F a. Dynamic retinoscopy
F b. Indirect ophthalmoscopy
F c. Colour vision test
T d. Removal of foreign body
T e. Contact tonometry
71 ln graphical analysis, validity and reliability of your test findings can be ascertained by
casual inspection of the graph if the:
T a. Graph has the shape of a parallelogram
T b. Phoria, blur and break values are slightly parallel
F c. Graph has the shape of a rectangle
F d. Phoria line is a vertical line
F e. Donder’s line is a horizontal line
72. A pseudomyope accepts/requires:
F a. More plus lenses in subjective refraction than retinoscopy
T b. More minus lenses in subjective refraction than retinoscopy
T c. More plus lenses in retinoscopy than subjective refraction
F d. More minus lenses in retinoscopy than subjective refraction
T e. Muscle relaxants
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73. A negative relative accommodation value above +2.50D could be due to:
T a. Overcorrected minus lens
T b. Uncorrected hyperopia
F c. Uncorrected myopia
F d. Astigmatism
T e. Latent hyperopia
74. Instruments used to view the retina include:
F a. Keratometer
T b. Fundus camera
F c. Tonometer
T d. Optical Coherence Tomography
T e. Slit lamp biomicroscope
75. Fundus photography requires taking pictures to document the health of:
T a. Optic disc
T b. Retinal blood vessels
T c. Macula
F d. Optic chiasm
F e. All of the above
76. Phorometry tests involving alteration of the stimulus to convergence are:
F a. Binocular cross cylinder test
T b. Lateral phoria at far
T c. Positive relative convergence
F d. Monocular cross cylinder test
F e. Positive relative accommodation
77. The following are methods of determining the near reading add:
T a. Fused cross cylinder
T b. Dynamic retinoscopy
T c. Amplitude of accommodation
F d. Near point of convergence
F e. Ocular motility
78. Inaccurate static retinoscopic findings can result from:
F a. The recognition of a scissors motion
T b. Failure to recognize scissors motion
F c. Dim illumination
F d. Patient fixation on distant target
T e. Incorrect working distance
79. Components of the illumination system of the ophthalmoscope are:
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T a. Condensing lens
T b. Aperture dial
T c. Reflecting mirror
F d. Red filter
F e. Viewing window
80. The following are apertures seen in the ophthalmoscope:
T a. Hemi-spot
T b. Red filter
T c. Slit
T d. Macular spot
T e. All of the above
81. Of what use is total fusional range in visual analysis?
F a. To determine the near point of convergence
T b. To determine the prism power
T c. To guide the practitioner in vision training
F d. To aid in contact lens fitting
F e. All of the above
82. The following are possibilities for a patient with a far entry VA of OD 6/6, OS 6/12:
T a. Facultative hyperopia in OD
F b. Moderate myopia in OD
T c. Manifest hyperopia in OS
T d. Pathology in OS
F e. Amblyopia in OD
83. Which test can be used to diagnose kerato-conjunctivitis sicca?
F a. Pachymetry
F b. Distometry
F c. Tonometry
T d. TBUT
T e. Schirmer’s test
84. Which of the following tests is used in the diagnosis of relative afferent pupillary
defect?
F a. Tonometry
F b. Distometry
T c. Swinging light test
F d. Perimetry
F e. Cover and uncover test
85. The following is a part of the direct ophthalmoscope:
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T a. Brow rest
T b. Lens wheel
T c. Lens viewing window
F d. Alignment marker
F e. Mires
86. The graticule is used in the measurement of:
T a. Cup-to-disc ratio
F b. Central corneal thickness
F c. Anterior chamber depth
T d. Fixation disparity
F e. A/V ratio
87. Which of the following does NOT explain the difference between direct and indirect
ophthalmoscopy?
F a. Test distance
F b. Stereoscopic vision
F c. Field of view
T d. Age of patient
F e. Condensing lens
88. Which of the following information are provided by keratometry?
T a. Corneal curvature
T b. Principal meridians
T c. Corneal distortions
F d. Corneal thickness
F e. Corneal ulcers
89. Which of the following procedures require K-reading‘?
T a. Contact lens fitting
T b. Monitoring keratoconus
T c. IOL power calculation
F d. Monitoring corneal staining
F e. Monitoring synechia
90. The following is a hindrance to ACCURATE K-reading:
T a. Dry eye
T b. Compromised cornea
T c. Meibomian gland dysfunction
F d. Room illumination
F e. Refractive error
91. The canthus adjustment knob on the keratometer is responsible for:
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F a. Aligning the canthus of the examiner
F b. Estimating the distance between the canthus of the examiner and the patient
T c. Aligning the patient’s outer canthus
F d. Aligning the examiner’s outer canthus
F e. Aligning the canthi of both patient and examiner
92. What is the function of the horizontal measuring drum in a B & L keratometer?
F a. To bring the minuses into alignment
F b. Adjust the canthus marker
F c. Cover the non-tested eye
T d. To bring the crosses into alignment
F e. To measure the horizontal meridian
93. In B & L keratometry, the non-alignment of the two plus signs is an indication of:
F a. Regular astigmatism
F b. Physiologic astigmatism
T c. Oblique astigmatism
T d. Irregular astigmatism
F e. With-the -rule astigmatism
94. Which of the following is a type of retinoscope?
F a. E-retinoscope
F b. Laser retinoscope
F c. Automated retinoscope
T d. Spot retinoscope
T e. Streak retinoscope
95. Which of the following is a type of ocular dominance test?
T a Mile’s test
T b. Porta’s test
T c. Dolman’s test
F d. Sheard’s test
F e. Maddox test
96. If a patient is not fogged in subjective refraction, which of the following can happen?
F a. Excess plus lens
T b. Insufficient plus lens
F c. Insufficient minus lens
T d. Excess minus lens
F e. Excess astigmatic correction
97. Why do we refine the axis of a cylinder before the power?
T a. The correct axis can be determined with inaccurate cylinder power
F b. The correct power can be determined with inaccurate axis
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F c. The correct power can be determined with correct axis
F d. The correct power can be determined with accurate axis
F e. The correct axis can be determined without a cylinder power
98. Which of the following techniques is used in binocular balancing?
F a. Hirschberg test
T b. Prism dissociation
F c. Hole-in-the-card test
F d. Krimsky test
T e. Bichrome test
99. Which of the following is a method in phoria test?
T a. Maddox rod method
T b. Thorington card method
T c. von Graefe method
F d. Krimsky method
F e. Hirschberg test
100. Which of the following formulae is applicable to Percival’s criteria?
F a. 1/3L42/3G
F b. 2/3G—1/3L
F c. 2/3G—1/2L
T d. 1/3G—2/3L
F e. 2/3 L---1/3G
101. Which of the following is a type of tonometry?
T a. Indentation
T b. Dynamic contour
T c. Non-contact
F d. Electronic tonometry
F e. Vapour tonometry
102. Amsler grid is used to assess:
F a. Retinitis pigmentosa
F b. Optic neuritis
T c. Maculopathy
F d. Colour defects
T e. Macular degeneration
103. The following test is required for the diagnosis of convergence insufficiency:
T a. Phoria
T b. NPC
T c. Positive fusional amplitude
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F d. AA
F e. Positive relative accommodation
104. What is Harmon’s distance?
F a. Distance between the patient and examiner
F b. Distance between the retinoscope and the patient
T c. Distance between the patient’s elbow and middle knuckle
F d. Distance between the examiner’s elbow and middle knuckle
F e. Distance between the ophthalmoscope and the patient’s cornea
105. Monocular estimation method is associated with:
F a. Tonometry
F b. Perimetry
T c. Retinoscopy
F d. Ophthalmoscopy
F e. Keratometry
106. Condition that can be treated with flipper lenses:
F a. Accommodative excess
F b. Accommodative insufficiency
T c. Accommodative infacility
F d. Accommodative paralysis
F e. Accommodative fatigue
107. What is the normal range of AC/A ratio?
T a. 4/ 1—6/ l
F b. 2/1---3/l
F c. 7/1—9/1
F d. 8/1—10/1
F e. 10/1----12/1
108. Which of the following is ASSOCIATED with pseudomyopia?
F a. Accommodative infacility
F b. Convergence excess
F c. Accommodative excess
T d. Ciliary spasm
F e. Divergence insufficiency
109. Types of illumination in the slit lamp include:
T a. Diffuse
T b. Sclerotic scatter
T c. Retro illumination
F d. Oblique illumination
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T e. Direct illumination
110. Disinfection guidelines for clinic instruments should include:
F a. Use of clean water only
T b. Exposure to fresh hydrogen peroxide
T c. Use of diluted common household bleach
T d. Use of 70% ethanol
F e. Use of acids
111. The following dyes may be used to stain the eye for evaluation:
T a. Lissamine green
T b. Rose bengal
F c. Phenol red thread
T d. Fluorescein
F e. Red green dyes
112. Cycloplegic refraction is indicated for the following conditions:
T a. Latent hyperopia
T b. Esotropia
T c. Pseudomyopia
T d. Hyperopia with esophoria
F e. Myopia
113. Red-green colour deficiency screening is COMMONLY done using:
T a. Pseudo-isochromatic plates
F b. Farnsworth D-15 test
F c. Anomaloscope
F d. City university test
T e. lshihara
114. During blood pressure assessment, with a sphygmomanometer, the stethoscope is
placed over:
T a. Brachial artery
F b. Central retinal artery
F c. Carotid artery
F d. Coronary artery
F e. Renal artery
115. During slit lamp biomicroscopy examination, the anterior chamber is BEST
assessed
using:
F a. Optic section
T b. Conical beam
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F c. Transillmnination
F d. Indirect illumination
F e. Diffuse beam
116. Dim illumination is recommended during direct ophthalmoscopy, because it relaxes:
T a. Accommodation
F b. The patient
T c. The pupil
F d. The examiner
F e. The instrument
117. The trial lens box has the following accessories EXCEPT:
F a. Pin hole disc
T b. PD rule
F c. Maddox rod
T d. Near chart
F e. Stenopaic disc
118. Using a stenopaic slit for diagnostic assessment of haloes, a physiologic halo will
present With __ when the slit is rotated
F a. No change in the appearance of the halo
F b. A halo that becomes dull
F c. A halo that becomes bigger and brighter
T d. A halo that breaks into segments and reconstitutes quickly
F e. A halo that becomes very thin and sharp
119. The following are some common errors associated with the anatomic PD
measurement, EXCEPT:
T a. Using test distance of 40cm
F b. Using test distance of 6m
F c. Very large difference between examiner PD and patient PD
F d. Examiner hand movement
T e. Eye movement
120. Entoptic Phakometry is very important for:
T a. Monitoring myopia progression
F b. Determining contact lens power
F c. Corneal topography assessment
T d. Determination of IOL power
F e. Making good frame choice
121. During near point of convergence test, the examiner observes:
T a. Purkinje image 1
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F b. Purkinje image 2
F c. Purkinje image 3
F d. Purkinje image 4
F e. Purkinje image 5
122. Fogging requires the use of ___ to relax accommodation:
F a. Cylindrical lenses
F b. Prisms
T c. Convex lenses
F d. Concave lenses
F e. Aspheric lenses
123. During lateral phoria test using von Graefe, the dissociating prism is:
F a. 12 prism BU
F b. 12 prism BD
F c. 12 prism Bl
F d. 12 prism BO
F e. 15 prism BU
124. A patient with 6∆ exophoria at near, has BO test values of 6/10/8 and BI test values
21/26/22. How much prisms and in which orientation is required for this patient, using
Sheard’s criterion?
F a. 3 ∆ BI
F b. 3 ∆ BO
T c. 2 ∆ BI
F d. 2 ∆ BO
F e. 5 ∆ BO
125. Pupillary distance is important to the Optometry clinician because it helps him to:
F a. Know the size of the pupil
T b. Set the trial lenses in proper position during tests
F c. Ascertain the power of the lens
F d. Measure the vertex distance
F e. Determine the effective power of the lens
126. Indications for perimetry include:
T a. Questionable appearance of the macular area during ophthalmoscopy
T b. Findings of large cupping during ophthalmoscopy
T c. Monitoring progression of retinal and optic nerve diseases
T d. Investigation of neurological disorders
T e. Patients with poor contrast sensitivity
127. Direct Gonioscopy procedure involves the use of:
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T a. Topical anaesthetic
T b. Coupling substance such as methyl cellulose
F c. Pilocarpine.
F d. Tropicamide.
F e. Cross-polarized lenses
128. The following are contra-indications for gonioscopy
F a. Myopia
T b. Corneal edema
F c. Astigmatism
T d. Recent intraocular surgery
T e. Corneal ulceration
129. Retinoscopy is:
F a. An automated method of objective refraction
F b. A manual method of subjective refraction
T c. A manual method of objective refraction
F d. An automated method of subjective refraction
F e. Used for both subjective and objective refraction
130. When the clinician encounters a hysterical patient during a routine optometric
examination, the best action to take is to:
F a. Immediately send for security to help curb any misbehavior
F b. Limit the examination to VA and detection of pathologies
F c. Perform tests to cover all segments of routine examination
T d. Refer the patient to a psychiatrist for expert management
F e. Stop the examination and book the patient for another day
131. Which out of the following is NOT regarded as visual-motor skill test‘?
F a. Cover test
T b. Ophthalmoscopy
F c. NPC test
T d. Shadow test
F e. Versions test
132. Which of the following is NOT one of the advantages of the problem oriented
optometric record (POOR) approach during routine optometric examination?
F a. Enables logical thinking
F b. Good problem definition
F c. Orderly record keeping
T d. Reduces examination time
F e. Teaches improved care
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133 The SOAP format is the type of record to be used for which case?
F a. Emergency
F b. Specialty
F c. Rebooked
F d. a & c
T e. None of the above
134. The definition of a problem, as regards analysis of patient’s clinical data are from
the:
F a. Complaints/concerns of the patient
T b. Clinical findings of the examiner
F c. Major pathological findings
F d. Refractive findings in the data
F e. a & c
135. Factors considered in formulating standard testing conditions are:
T a. Contrast
T b. Letter size
T c. Testing distance
T d. All of the above
F e. None of the above
136. The standard recommended test distances for distance and near acuity testing are:
Fa. 4M, 0.4M
T b. 6M, 0.4M
F c. 6M, 40M
F d. (a) and (b)
F e. (b) and (c)
137. Diagnostic tests for latent hyperopes include the following EXCEPT:
F a. Cycloplegic technique
F b. Latent hyperopic triad
F c. Retinoscopic comparism with subjective refraction
T d. PRA
T e. NFC
138. Which drug is used in the optometric management of tension headache?
T a. Carfegot
F b. Friorina
F c. Inderal
F d. Lithium
F e. Prednisone
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139. The following conditions simulate migraine EXCEPT:
F a. Aneurysm
T b. Retinitis pigmentosa
F c. Hypertension
F d. Intracranial tumours in occipital lobe
T e. Diabetes
140. Which Elschnig classification has characteristic features of cylindrical sharp distinct
borders with walls short and steep?
F a. E-I
F b. E-II
F c. E-III
F d. E-IV
T e. E-V
141. Among the following lenses, which one is used for fundus biomicroscopy and
provides the greatest amount of axial magnification? This would be particularly useful
when evaluating the depth of the optic cup in a glaucoma patient.
F a. 20 diopter lens
T b. 60 diopter lens
F c. 78 diopter lens
F d. 90 diopter lens
F e. 18 diopter lens
142. If a patient experiences asthenopia due to dissimilar image sizes, and A-scan
ultrasonography indicates that the more myopic eye is significantly longer, Knapp’s Law
says you should:
F a. Refer the patient to an ophthalmologist.
T b. Correct the refractive error with spectacles rather than contact lenses.
F c. Correct the refractive error with contact lenses rather than spectacles.
F d. Prescribe slab-off prism
F e. None of the above
143. How should you design a pseudo-isochromatic test plate so the figure is visible
against the background for normal colour vision, but invisible in protanopia?
F a. Make the background yellow and the figure blue, both with equal luminance
F b. Make the background blue and the figure yellow, both with equal luminance
T c. Make the background green and the figure red, both with equal luminance
T d. Make the background red and the figure green, both with equal luminance
T e. Either c or d would work
144. The following instruments are Contact tonometers:
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T a. Goldmann tonometer
T b. Perkins tonometer
F c. Reichert tonometer
F d. Pulsair tonometer
T e. Schiotz tonometer
CHAPTER EIGHT
CONTACT LENSES
1. The keratometer is calibrated for an index of refraction different from that of the
cornea so as to:
F a. Consider the refraction at the air-tear layer interface
F b. Consider the refraction at the tear layer-corneal interface
T c. Consider the refraction occurring at the back surface of the cornea
F d. Approximate for the index of refraction of the aqueous humour
F e. Approximate for the index 01° refraction of the vitreous humour
2. The total astigmatism for the keratometric readings 45.00D@H and 43.00D@V
F a. -1.00DC X 090
F b. -2.00DC X 090
F c. -2.00DC X 180
T d. -2.50DC X 090
F e. -3.00DC X 180
3. The corneal astigmatism and the type of astigmatism for the K-readings 43.00D@H
and 45.00D@V are:
F a. -2.00DC X 090, ATR
F b. -2.00DC X 090, WTR
F c. -2.00DC X 180, ATR
T d. -2.00DC X 180, WTR
F e. -1.50DC X 180, ATR
4. The radius of curvature of hard contact lens can be verified by:
F a. Slit lamp biomicroscope
T b. Radiuscope
F c. Keratoscope
F d. Keratometer
F e. Focimeter
5. The index of refraction for which the B & L keratometer is calibrated is:
F a. 1,000
F b. 1.336
T c. 1.3375
F d. 1.376
F e. 1.345
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6. The tear film can be evaluated during initial examination by:
T a. Presence of lacrimal lake
F b. Invasive TBUT
F c. Slit lamp biomicroscopy
F d. Non-invasive TBUT
F e. Rose bengal test
7. The contacted structure in contact lens wear is:
F a. Tear film
F b. Conjunctiva
T c. Cornea
F d. Lid
F e. All of the above
8. The most metabolic layer of the cornea is the:
F a. Epithelium
F b. Stroma
T c. Endothelium
F d. Bowman’s membrane
F e. Descemet membrane
9. The water content of soft contact lens material is synonymous with:
T a. Gas permeability
F b. Gas transmissibility
F c. Wettability
F d. Hydrophobicity
F e. Ionicity
10. This instrument is essential in assessing a contact lens patient:
T a. Keratometer
T b. Slit lamp biomicroscope
T c. Autorefractor
F d. Radiuscope
T e. Keratoscope
11. If a spectacle lens power of -l0.00D is worn at a vertex distance of 14mm, the
empirical contact lens power is:
F a. -10.00D
F b. -9.5OD
T c. -8.75D
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F d. -11.00D
F e. -9.75D
12. If a spectacle lens power of +l0.00D is worn at a vertex distance of 12mm, the
empirical contact lens power is:
F a. +I0.00D
F b. +9.50D
T c. +11.25D
F d. +8.75D
F e. +10.50D
13. This condition is a contraindication to contact lens wear:
T a. Corneal infection
T b Rheumatoid arthritis
T c Sarcoidosis
F d. Occasional itchy eyes
T e. Conjunctivitis
14. Replacing the contact lens frequently improves:
T a. Comfort level
T b. Visual acuity
T c. Corneal health of lens wearers
F d. Break-in period
F e. Deposit formation
15. Frequent replacement lenses are lenses worn on a daily basis and discarded after the
following period:
T a. Two weeks
T b. One month
T c. Three months
F d. Two years
F e. All of the above
16. Fitting a hard contact lens steeper than K creates:
F a. Less myopia
T b. Less hyperopia
T c. Tight fit
F d. Loose fit
F e. Optimum fit
17. Fitting a hard contact lens flatter than K creates:
F a. More myopia
T b. More hyperopia
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F c. Tight fit
F d. Less movement
T e. More movement
18. Tap water must not be used for soft contact lens storage because of possible risk of
infection by:
F a. Neisseria gonorrhoea
T b. Acanthamoeba hislolytica
F c. Chlamydia lrachomatis
F d. Mycobacterium tuberculosis
F e. Streptococcus pyogenes
19. This is likely to be a source of microbial re-infection in contact lens wearers:
T a. Contact lens solution
T b. Contact lens
T c. Contact lens case
T d. Comfort drop
F e. None of the above
20. Diabetes is a relative contraindication for contact lens wear because of:
F a. Fluctuating sugar level
F b. Fluctuating refractive error
T c. Fragile corneal epithelium
F d. Risk of ocular infection
F e. All of the above
21. These conditions can be managed with contact lenses:
T a. Keratoconus
T b. Corneal astigmatism
F c. Microbial keratitis
F d. Keratoglobus
F e. Keratomalacia
22. These are RELATIVE contraindications to contact lens wear:
T a. Menopause
T b. Pregnancy
F c. Trichiasis
F d. Urinary incontinence
F e. Very dry eyes
23. These are advantages of RGP over soft lenses:
T a. Stability and durability
T b. Ease of care
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F c. No foreign body sensation
T d. Corrects small amount of corneal astigmatism
T e. Less prone to deposit formation
24. Tear production is measured by:
F a. Keratometer mires
F b. Tear break-up-time test
T c. Schirmer test
T d. Phenol red cotton thread test
F e. Rose bengal test
25. The presence of a mucin deficiency can be determined by the use of:
F a. Schinner test I
F b. Schirmer test II
T c. Tear break-up-time test
F d. Lissamine green test
F e. Lacrimal lake
26. The corneal cylinder and the type of astigmatism for keratometric readings of
43.00@H
and 44.50@V is:
F a. -1.50DC X 90, WTR
T b. -1.50DC X 180, WTR
F c. -1.50DC X 90, ATR
F d. -1.50DC X 180, ATR
F e. -1.25DC X 90, ATR
27. These factors would make you prescribe soft contact lenses instead of rigid contact lenses:
T a. Intermittent wear
T b. Residual astigmatism
T c. Athletic activities
F d. Corneal astigmatism
T e. Pregnancy
28. The main contact lens prefitting measurement taken on a patient that would guide the
practitioner in the selection of the appropriate base curve for the contact lens
T a. K-reading
F b. Pupil size
F c. HVID
F d. Palpebral aperture
F e. Corneal thickness
29. The contact lens prefitting measurement(s) taken on a patient that would guide the
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practitioner in the selection of the appropriate diameter for the contact lens is:
F a. K-reading
F b. Pupil size
T c. HVID
T d. Palpebral aperture
F e. Lid tension
30. Soft contact lenses are:
F a. Flexible and move more
T b. Flexible and move less
T c. More wettable than silicone lenses
F d. Less deposit prone than RGP lenses
T e. Less durable than RGP lenses
31. A general method for fitting contact lenses where no trial fitting is performed is:
T a. Empirical fitting method
F b. Diagnostic fitting method
F c. Inventory fitting method
F d. Flatter than K method
F e. Steeper than K method
32. If lens fit is tight, a likely solution is to change to a lens with:
F a. Steeper base curve
T b. Smaller diameter
T c. Flatter base curve
F d. Larger diameter
F e. Less thickness
33. A general method for fitting contact lenses where trial fitting is performed is:
F a. Empirical fitting method
T b. Diagnostic fitting method
T c. Inventory fitting method
F d. Steeper than K method
F e. Flatter than K method
34. RGP is the lens of choice for a highly myopic student because:
T a. It is durable and requires less cleaning
F b. Corrects high myopia, less thickness and good sagittal depth
F c. High wettability
F d. Transparent and resilient
T e. High oxygen transmissibility
35. Advantages of contact lens over spectacles include:
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T a. Better acuity
T b. Wider field and stereopsis
T c. Safer in contact sports
F d. Wearing time and durability
F e. Safer in chemical industries
36. Contact lenses can be used in the following:
T a. Amblyopia
F b. Keratoglobus
T c. Myopia
T d. Low vision
T e. Cosmesis
37. Contact lenses:
T a. Suit certain lifestyle
T b. Correct refractive errors and vision problems
F c. Protect cornea from mechanical trauma
F d. Have optimum safety and efficacy
T e. Suit ocular and visual need of the patient
38. Orthokeratology is:
F a. RGP programmed application to reshape the sclera
T b. RGP programmed application to treat childhood myopia
F c. Keratometric measurement of the corneal front surface
F d. Abnormal topography of the cornea
T e. RGP programmed to reshape the cornea
39. Three specifications/parameters for rigid lens fitting are:
F a. Wettability, transparency, hardness
T b. Optic zone diameter, lens thickness, base curve
F c. Wettability, refractive index, humidity
F d. Optic zone diameter, tensile strength wettability
F e. Oxygen permeability, base curve, and refractive index
40. Which lens is suitable for poor dexterity patients?
T a. Scleral lenses, rigid lenses, visibility tinted soft lenses
F b. Reverse telescopics, bivisual lenses, scleral Lenses
F c. Scleral lenses, RGP, therapeutic lenses
F d. RGP, silicone elastomers, PMMA
F e. Silicone elastomers, bivisual lenses, scleral lenses
41. Which is NOT a contraindication to contact lens wear?
F a. Dry eyes and Infection
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F b. Reduced sensitivity of cornea and acute red eyes
F c. Diabetes and thyroid disease
T d. Keratoconus
T e. Aphakia
42. The first random dry spot after complete blink is indicated in:
F a. A Schinner’s l test
F b. Lacrimal lake
T c. TBUT
F d. Blink rate
F e. Rose bengal test
43. Advantages of PMMA lenses over soft hydrogel lenses include:
F a. Long adaptation time
T b. High resilience
T c. High tensile strength
F d. Better oxygen transmissibility
T e. Better optical quality
44. Cellulose Acetyl Butyrate is NOT used currently for Rigid Gas permeable lenses due
to:
F a. Low wettability
T b. Changes in its curvature while on the eyes
F c. High lens deposition
F d. High oxygen permeability
F e. Low modulus of elasticity
45. Fluorine has comparable oxygen permeability to silicone. However it is/has:
T a. More wettable
F b. Less prone to protein deposits ‘J
F c. Less wettable
F d. High tensile strength
T e. More prone to protein deposits
46. Compare DK/t and EOP:
T a. EOP is in vivo
F b. Both are in vitro
F c. Both are in vivo
F d. EOP is in vitro
F e. DK/t is in viva
47. Corneal topography can be measured with:
T a. Placido’s disk
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T b. Peripheral keratometry
T c. Plastic k-disk
F d. Topographic rule
F e. Slit lamp biomicroscope
48. Corneal transparency is compromised by:
F a. Avascularity
T b. Perpendicular corneal stromal fibrils
F c. Deturgenscence
F d. Thin and compact corneal epithelium
T e. Corneal oedema
49. The secretors of the pre-comeal tear film include:
T a. Goblet cells
T b. Gland of Manz
T c. Lacrimal glands
F d. Glands of Henle
T e. Zeis glands
50. The drawback of PMMA lenses includes:
T a. Hydrophobicity
F b. High oxygen permeability
F c. High wettability
F d. Low tensile strength
T e. Low oxygen transmissibility
51. Why is the mucin layer important to cornea for contact lens wear?
T a. Converts hydrophobic to hydrophilic surface
F b. It is the largest of the precorneal tear film
F c. It is antimicrobial in nature
F d. It is rich in protein
T e. Lowers surface tension
52. The importance of blinking includes:
T a. Adequate tear exchange
F b. Decreases CL wearing time
T c. Removes keratinized epithelial cells
T d. Keeps cornea and CL hydrated
T e. Helps to spread tears on the globe
53. Soft lenses are better for footballers because:
T a. They don’t dislodge
F b. They have high DK
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F c. They cause less deposits
F d. They have high modulus of elasticity
T e. They have wider diameter
54. Which of these statements are CORRECT?
T a. Oxygen permeability depends on lens material
F b. Oxygen transmissibility depends only on lens material
F c. Oxygen transmissibility is an in vivo technique
T d. Soft contact lenses have wider diameter than RGPs
T e. The water content of hydrogel contact lenses influences oxygen transmissibility
55. Which lens manufacturing type is BEST for RGP?
F a. Spin casting
T b. Cast moulding
F c. Lathe cutting
F d. Centrifugation
F e. Fatt method
56. Tear pump is highest in:
F a. Soft lenses
F b. Scleral lenses
F c. Monovision lenses
T d. Rigid lenses
F e. Hybrid lenses
57. RGP contact lenses are better than PMMA lenses EXCEPT for:
F a. Higher oxygen permeability
T b. More durability
T c. More optical clarity
F d. Short adaptation
F e. More comfort
58. Contact lens options in keratoconus do NOT include...
T a. Toric
F b. Piggy-back
F c. Hybrid
T d. Bitoric
F e. Multicurve
59. Contact lens options in astigmatism do NOT include:
T a. Monovision
F b. Spherical
F c. Aspherical
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T d. Reverse
F e. Front toric
60. Stabilization methods for Contact lenses in presbyopia include:
T a. Inferior truncation
T b. Inferior slab-off
F c. Concentric bifocals
F d. Piggy-back
T e. Prism ballast
61. Aphakic single-cut lenses are used for patients with:
T a. Large pupils
F b. Small pupils
F c. Large crystalline lens
F d. Small crystalline lens
F e. Small palpebral aperture
62. Bandage contact lenses are beneficial in:
F a. Keratoglobus
T b. Bullous keratopathy
F c. Comeal hypoesthesia
F d. Mooren’s ulcer
T e. Comeal erosion
63. Retinitis pigmentosa patients will benefit from:
T a. Reverse telescopic contact lens
F b. Bivisual contact lens
F c. Monovision lens
T d. Minus lens
F e. Hybrid lens
64. The interaction and cross-linking of monomeric contact lens materials is:
F a. Crosslinkage
T b. Polymerization
F c. Hybridization
F d. Keratinization
F e. Ionization
65. Wearing modalities do NOT include:
F a. Conventional
F b. Diposable
F c. Frequent replacement
T d. Displacement
T e. Cosmesis
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66. Globally, contact lenses are worn for:
T a. Aesthetics
T b. Therapeutics
T c. Occupational
F d. Preventive
T e. Cosmesis
67. The outcomes of immobile lenses include all EXCEPT:
T a. Optimum fit
F b. Corneal inflammation
T c. Refractive error
F d. Acute red eye
F e. Poor tear exchange
68. Variation of the apical curvature (radii of curvature) of the corneal meridians, due to
the aspheric nature of the anterior and posterior cornea is called:
F a. Meridonal curvature
T b. Corneal toricity
F c. Corneal flexure
F d. Residual astigmatism
F e. Corneal irregularity
69. Which of these statements is CORRECT?
T a. Lens flexure is determined by lens material and thickness
F b. Lens flexure is detennined by oxygen permeability and flux
F c. Thin lens with centre thickness of <0.l3mm rarely flex
F d. Lens flexure cannot be predicted from keratometric readings
F e. Lens flexure can be determined by the lens guage
70. Non-inflammatory progressive degeneration characterized by protrusion and thinning
of
the central cornea is:
F a. Progressive myopia
F b. Keratoglobus
T c. Keratoconus
F d. Corneal dystrophy
F e. Keratomalacia
71. In monovision contact lens option:
T a. The dominant eye wears the distant correction
F b. The dominant eye wears the near correction
T c. The non-dominant eye wears the near correction
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F d. The dominant eye is under-corrected
F e. The non-dominant eye wears the distant correction
72. Which of these statements is CORRECT?
F a. Contact lens flexure cannot induce astigmatism
T b. Physiologic astigmatism is caused by lens
F c. Lens flexure corrects lenticular astigmatism
F d. Corneal toricity corrects residual astigmatism
T e. Internal astigmatism is caused by macula
73. Which of these lenses can be used to correct residual astigmatism?
T a. Front-surface toric lenses
F b. Bi-visual contact lenses
F c. Multicurve lenses
T d. Bitoric lenses
F e. Pinhole lenses
74. Tear break up Time is considered normal after:
F a. 5 sec
T b. 10 sec
F c. 8 sec
F d. 40 sec
F e. 60 sec
75. The mean corneal power is:
F a. 38D
F b. 51D
F c. 49D
T d. 43D
F e. 47D
76. What does K-value measure?
F a. Astigmatism
F b. Degree of refractive error
T c. Curvature of the cornea
F d. Corneal Astigmatism
F e. Lenticular astigmatism
77. Contact lenses can be classified according to the following factors:
T a. Materials used to make contact lenses
T b. Wearing schedule
T c. Purpose for which the lens is used
T d. Design method
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F e. Values of the base curve
78. The following are types of contact lens materials:
T a. Hard
T b. Rigid gas permeable
T c. Hydrogel
F cl. Cosmetics
T e. Hybrid
79. Contact lenses classification based on wearing and replacement schedules include:
T a. Daily wear
T b. Continuous or extended wear
T c. Flexible wear
T d. Disposables
T e. Monthly wear
80. Contact lenses classified according to their uses may include:
T a. Optical
F b. Bifocal
T c. Cosmetic
F d. Progressive
T e. Therapeutic
81. These are contact lenses main classes according to their designs:
T a. Spherical
F b. Bitoric
F c. Back toric
T d. Toric
T e. Aspheric
82. Consideration for recommending contact lens use include:
T a. Keratoconus
T b. Irregular astigmatism
T c. N ystagmus
T d. Anisometropia
T e. Unilateral aphakia
83. Indication for rigid gas permeable (RGP) lenses include:
T a. Regular astigmatism greater than l.0D
T b. Irregular astigmatism
T c. Patient experiencing difficulty handling hydrogel lenses
F d. Lenticular opacification
F e. Old age
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84. Indications for hydrogel contact lenses include:
T a. Ametropia with minimum astigmatism
T b. Rigid gas permeable intolerance
T c. Athletics need
T d. Infant with aphakia
F e. Patient with nystagmus
85. Contraindications for contact lens wear may include:
T a. Any inflammation of anterior segment
T h. Acute or chronic ocular infection
F c. Advanced keratoconus
F d. Presence of cataract
F e. Psychological tolerance
86. The main parameters for selection of a trial contact lens are:
T a. Lens diameter
T h. Base curve
F c. Optic zone diameter
F d. Peripheral curve
T e. Lens power
87. Methods to investigate quality of tears may include:
T a. Tear beak-up-time with fluorescein
T b. Tearscope
T c. Xeroscope
T d. Keratometer mires
F e. Use of Keratoscope
88. The contact lens material most likely to develop surface deposits are:
F a. Hard
F b. Rigid gas permeable
T c. Hydrogel
F d. Hard and RGP
F e. RGP and hydrogel
89. Organic contact lens deposits include:
T a. Proteins
T b. Lipid
T c. Mucin
F d. Hydrophilic substances
F e. Sugar
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90. Inorganic contact lens deposits include:
T a. Calcium salts
T b. Iron oxide salts
F c. Potassium
F d. Lead
T e. Mercury
91. Parameters to be specified when prescribing a spherical rigid lens include:
T a. Lens type (material and design)
T b. Power
T c. Base curve
F d. Lens thickness
T e. Total diameter
92. Hydrophilic soft lenses can be classified based on:
T a. Method of manufacture
T b. Water content
T c. Ionicity
T d. Oxygen transmissibility
T e. Lens colour
93. Characteristics of well fitted contact lens include:
T a. Adequate lens centration with full limbal coverage
T b. Primary gaze lens movement 0.3 - 1.0 mm
T c. Upward gaze 0.3 - 0.7 mm
T d. Upward push test: Free movement
F e. Horizontal movement of 1.0 mm
94. A prospective contact lens patient should NOT be fitted with contact lenses if:
F a. Schirmer tear test value is only 10mm
F b. Astigmatism greater than -4.00DC axis 45°
T c. Tear break-up time is 8 seconds
F d. There is low vision caused by corneal opacities
F e. It is a case of juvenile macular degeneration
95. The following pathogens can cause contact lens-related keratitis:
T a. Pseudomonas aeruginosa
T b. Staphylococcus
T c. Acanthamoeba
T d. Fungi
F e. Influenza virus
96. Contact lenses are especially indicated in the following sports:
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T a. Boxing
T b. Bowling
T c. Wrestling
F d. Swimming
F e. Mountain climbing
97. Advanced keratoconus is LEAST to be corrected when treated by:
F a. Hard contact lens
F b. Rigid gas permeable (RGP) contact lens
T c. Spectacles
F d. Keratoplasty
F e. Piggy-back contact lens
98. How does contact lens (CL) wear result in dry eye?
T a. As the water from CL evaporates, it absorbs tears from the tear film dehydrating the
cornea
T b. CL damages corneal nerve sensitivity, which decreases lacrimal secretion
F c. Long-term CL wear results in hypotrophy of lacrimal gland which decreases lacrimal
secretion
T d. Continual rubbing of the lens could damage hair-like structures on the corneal layer
that stabilizes tear film
F e. None of the above
99. Which of the following is NOT a factor responsible for dry eyes?
F a. Soft CL vs. RGP
F b. Thimerosal in eye drops
F c. Oral contraceptives
F d. Exposure to cigarette smoking
T e. All the above are factors responsible for dry eyes
100. Which of the following is NOT correct about LOW WATER content of the Soft
Contact Lens?
F a. Greater durability
F b. Less surface deposition
T c. High oxygen transmissibility
F d. Better handling
T e. More flexibility
101. What is CORRECT about SiHy lenses?
F a. Greater dK (oxygen permeability) with more water content and less silicone
F b. Made up of hydrophilic polymers
F c. Usually contain 70-80% water
T d. Greater dK (oxygen permeability) with less water content and more silicone
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F e. None of the above
102. A patient walks into XYZ clinic complaining of dry eyes. Upon slit lamp
examination, you find that patient has fluorescein staining pattern at 3 and 9 o'clock
positions OU. Which of the following is the BEST management option for this patient?
F a. The patient is likely to be a soft contact lens (SCL) wearer and switching to Rigid
Gas
Permeable (RGP) may be helpful
T b. The patient is likely to be a RGP wearer and switching to SCL may be helpful
F c. 3 and 9 o'clock staining pattern is caused by thimerosal in CL cleaning solution, so
change patient’s lens care solution
F d. This patient has Vitamin A deficiency and Vitamin A supplements will definitely
resolve the issue
F e. Patient should permanently discontinue CL wear
103. Which of the following is an advantage of RGP lenses‘?
T a. Ability to reduce corneal aberrations
T b. High oxygen transmission
F c. Ability to change or enhance eye colour
F d. They are the recommended lenses for low ametropia
T e. They are cheaper on the long run
104. Which of the following sports is NOT ideal for soft contact lens wear?
F a. Football
F b. Golf
F c. Jogging
T d. Mountain climbing
F e. Basketball
105. Which of the following is an advantage of a Soft Contact Lens with low water
content‘?
T a. Greater durability
T b. Less surface deposition
F c. Greater flexibility
F d. Higher oxygen transmissibility
T e. Less dehydration
106. Which of the following is an ocular health benefit of wearing RGP lenses as
opposed to soft contact lenses?
T a. Good tear exchange
T b. Less likely to have infiltrates
T c. Does not compress the limbus
T d. Less likelihood of Giant Papillary Conjunctivitis
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T e. All of the above
107. What is the only method of treatment proven to slow/halt the progression of
keratoconus?
F a. Corneal ring inserts
F b. Penetrating keratoplasty
T c. Corneal cross linkage with riboflavin
F d. Photocoagulation
F e. Rigid gas permeable contact lenses
108. Which of the following are non-surgical options for patients with moderate to
advanced keratoconus who have a decentered cone?
F a Sunglasses
T b. Large diameter RGPS
T c. Scleral lenses
F d. Toric contact lenses
F e. Spectacles
109. Which of the following is a risk factor for microbial keratitis?
F a. Sun exposure
T b. Ocular trauma
T c. Contact lens wear
T d. Smoking
T e. Ocular surface disease
110. Contact Lens Induced Peripheral Ulcer (CLPU) is generally NOT managed in the
following way:
F a. Discontinue contact lens wear for at least one week
F b. Switch the patient from soft contact lens to RGP
T c. Switch the patient from RGP to soft contact lens
F d. Patient education
F e. Use of antibiotics
111. Which of the following is NOT a risk factor for developing Contact Lens Induced
Peripheral Ulcer (CLPU)?
F a. Poor contact lens disinfection
F b. Presence of mucin balls
F c. Low socio-economic class
F d. Smoking
T e. All of the above are risk factors for developing CLPU
112. Which of the following is an advantage of RGP contact lenses?
F a. Ability to change or enhance eye colour
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T b. Ability to reduce corneal aberrations
T c. High oxygen transmission
T d. They are cheaper in the long run
F e. They are the recommended lenses for low ametropia
113. Which of the following is a benefit to choosing a soft contact lens with low water
content?
F a. Higher oxygen permeability
T b. Greater durability
T c. Less surface deposition
F d. Greater flexibility
T e. Less dehydration
114. What are some environmental triggers for Keratoconus?
F a. Recurrent corneal erosions
T b. Eye rubbing
T c. Asthma
T d. Atopic disease
F e. Particulate matter
115. In contact lens fitting procedure, over refraction is the refraction done:
F a. When a trial spherical contact lens is worn with another toric contact lens
F b. When a trial spherical contact lens is worn with another larger spherical contact lens
T c. With a trial frame when a trial spherical contact lens is worn
F d. With a phoropter or trial frame over a final prescribed contact lens
T e. With a phoropter when a trial spherical contact lens is worn
116. In toric contact lens fitting, if the lens axis mislocates by 3° to the right, while
ordering for the lens:
F a. Add 3° to the lens axis
T b. Subtract 3° from the lens axis
F c. Divide by 3° of the lens axis
F d. Multiply by 3° of the lens axis
F c. Add the square root of the 3° of the lens axis
117. Due to normal lid force with blink a contact lens nasally rotates:
F a.± 4°
T b. ±5°
F c. ±3°
F d. ±2°
F e. ±1°
118. Generally soft contact lenses are:
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T a. Larger than RGPs
F b. Smaller than RGPs
F c. Initially less adaptable than RGPs
F d. Less water containing than RGPs
T e. Initially more adaptable than RGPs
119. Which of these statements are CORRECT?
T a. Spherical RGPs can be used to correct astigmatism
T b. Toric soft contact lenses can be used to correct astigmatism
T c. Bitoric contact lenses can be used to correct astigmatism
T d. Front toric soft contact lenses can be used to correct astigmatism
T e. Back toric soft contact lenses can be used to correct astigmatism
120. Presbyopia can be corrected with:
T a. Single vision soft contact lenses
T b. Radially asymmetric contact lenses
T c. Radially symmetric contact lenses
T d. Mono vision contact lenses
T e. Near centre concentric bifocal
121. Fused segment contact lens bifocal is available in:
T a. PMMA lenses
F b. Soft contact lenses
F c. RGP lenses
F d. Hydrogel lenses
F e. Piggy-back contact lenses
122. Which of these is a quality of radially symmetric bifocal contact lens:
F a. lt has rotational stability problem
F b. The upper segment of it is usually for far vision
T c. It has a central portion that can be used for far or near vision
F d. The power changes with rotation of the lens
T e. It is rotationally stable
123. Radially asymmetric bifocal contact lens is:
T a. Rotationally unstable
F b. A bifocal contact lens that has its refractive power in concentric iso-power
arrangement
F c. A bifocal contact lens with multiple refractive zones especially at the centre
T d. The lower segment of it is usually for near vision
T e. A bifocal contact lens that changes power when the lens rotates
124. In distance/centre concentric bifocal:
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F a. The central zone contains the eye’s near prescription.
T b. The central zone contains the eye’s distance prescription.
T c. The peripheral Zone contains the eye’s near prescription
F d. The peripheral Zone contains the eye’s distance prescription
F e. It is a type of radially asymmetric contact lens
125. Which of these is too uncomfortable for achieving proper rotational stability of flat
top bifocal?
F a. Inferior slab off
T b. Superior truncation
F c. Inferior truncation
F d. Prism ballast
F e. Inferior metal weight
126. The effect of truncation is more pronounced in:
T a. Plus lenses
F b. Minus lenses
F c. Prismatic lenses
F d. Pinhole lenses
F e. a & b only
127. In contact lens bifocal, the vision that is easily achievable is:
F a. Alternating vision
T b. Simultaneous vision
F c. Neurological vision
F d. Airy’s circles vision
F e. Monovision
128. Degradation of vision of the resultant retinal image in bifocal contact lenses occurs
in:
F a. Alternating vision
T b. Simultaneous vision
F c. Near vision
F d. Far vision
T e. Many bifocal contact lens wearers
129. In successful monovision:
T a. Alternating vision is achieved
F b. Simultaneous vision is achieved
F c. Single binocular vision is achieved
T d. Suppression is achieved
T e. There is no stereopsis
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130. The surface power of a contact lens is determined by the:
T a. Refractive index of the lens material
F b. Water content of the lens itself
T c. Radius of curvature of the contact lens
F d. The diffusivity of the contact lens
F e. The transmissibility of the contact lens
131. The following statements are CORRECT about contact lenses:
T a. The higher the water content of a soft contact lens, the higher the oxygen
transmissibility
F b. A soft contact lens that contains water of higher than 40% is high water content
T c. Oxygen permeability is not a contact lens property, but rather a material property
F d. A non-ionic soft contact lens is less deposit resistant
T e. Low oxygen transmissible contact lenses cause corneal oedema
132. The following statements relate to Placido disc:
T a. It is based on the principle of first Purkinje image
F b. Keratometer or Videokeratoscope cannot perform the functions of Placido disc
T c. It consists of equally spaced alternating black and white circular lines
T d. It is used in assessing corneal surface integrity
F e. It can also be used in assessing crystalline lens curvature
133. Which of the following tasks would be the MOST difficult to perform for a new
monovision contact lens wearer, compared to a person with normal binocular vision?
F a. Driving a car during the day l
F b. Landing an airplane during the day
T c. Threading a needle
F d. Reading a book
F e. Shooting from the free throw line in basketball
134. Prior to fitting a patient with monovision contact lenses, you perform a far sensory
dominance test. Binocular visual acuity is 20/ l 5- when +l.00D is placed over OD, but
20/20- when placed over OS. Which eye is dominant at that distance, and which should
be fitted with the far lens?
F a. OD, OD
F b. OD, OS
F c. OS, OS
F d. OS, OD
T e. Neither eye shows sensory dominance
135. Benzalkonium chloride:
F a. Does not cause a hypersensitivity response
T b. Can cause discomfort and redness on contact lens insertion
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T c. Is toxic to the epithelial surface in high concentration
T d. Is adsorbed onto the surface of soft contact lenses
T e. Causes punctate epithelial keratopathy
136. A female patient 18 years old, who has been wearing hydrogel contact lenses for
two years, has complaints of redness, lacrimation and foreign body sensation on both
eyes. On examination, visual acuity was 6/6 with negative fluorescein test. The expected
diagnosis can be:
F a. Acute anterior uveitis
T b. Giant papillary conjunctivitis
F c. Bacterial corneal ulcer
F d. Acute congestive glaucoma
F e. follicular conjunctivitis
137. Schirmer’s test is used for diagnosing:
T a. Dry eye
F b. Infective keratitis
F c. Watering eyes
F d. Horner’s syndrome
F e. Corneal ulcer
138. Giant Papillary Conjunctivitis usually presents with the following symptoms:
T a. Conjunctival redness, itching, increased mucous secretion
F b. Conjunctival redness, neovascularization, itching
F c. Increased mucous discharge, miosis, neovascularization
F d. Itching, conjunctival redness, mydriasis
F e. Itching, miosis, increased mucous secretion
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CHAPTER NINE
LOW VISION AND REHABILITATIVE OPTOMETRY
1. Treatment options to improve vision for ocular albinism are:
F a. Strabismus surgery
F b. Pleoptics
F c. Cataract surgery
T d. Prosthetic iris implant
T e. Contact lens
2. Which of the following statements are TRUE about telescopes?
F a. Telescopes can only be used for far vision enhancement
T b. Increased field of view
T c. Decrease in contrast and luminance
T d. Spectacle mounted telescopes leave hands free for use
F e. Decreased field of view
3. The following are CORRECT about WHO definitions of low vision:
F a. Best VA worse than 6/18
F b. Best VA better than 6/60
T c. Visual field greater than 10 degrees around fixation point
F d. The visual field better than 5 degrees
T e. Acuity worse than 6/18, but better than 3/60
4. MAJOR causes of visual impairment worldwide include:
F a. Diabetic retinopathy
T b. Glaucoma
F c. Hypertensive retinopathy
T d. Cataract
F e. Refractive errors
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5. Optometric low vision care services include:
T a. Training in eccentric viewing
T b. Advice on environmental modifications
T c. Advice on illumination control
T d. Recommendation of children to special education schools
T e. Education and training on the use of low vision devices
6. The following statements are CORRECT:
T a. A patient with best corrected 6/6 VA may be a low vision patient
F b. Best corrected VA of 6/20 in each eye constitutes low vision
T c. Cane for walking may be prescribed for low vision patient when indicated
F d. Children with low vision always need low magnifiers for reading
F e. Presbyopes need to use reading glasses with stand magnifiers
7. Referral to these professionals may be necessary before low vision devices are
provided:
T a. A Psychologist
T b. An Ear Nose and Throat (ENT) Surgeon
T c. An Ophthalmologist
F d. Occupational therapist
F e. Orientation and mobility (O&M) instructor
8. The following statements are CORRECT about low vision magnifiers:
T a. They are for near tasks only
T b. Stand magnifiers should preferably be used with reading glasses
T c. Hand magnifiers should preferably be used with distance glasses
F d. Spectacle magnifiers may require base-out prisms for comfort
T e. Minimum power that enables goal-task performance should be prescribed
9. Telescopes:
F a. Are for distance vision only
T b. Always have plus objective lenses
F c. Always have minus lenses as eye piece
F d. Should be used to see clearly while walking
T e. Have tube lengths that are sums of focal lengths of eye piece and objective lenses
10. The following is/are CORRECT about telescopes for low vision patients:
T a. There are of 2 types in terms of basic design
T b. Objective and eyepiece are plus lenses in Keplerain type
T c. Keplerian types have image-erecting prism
F d. Keplarian types are often prescribed as clip-ons
F e. Galilean telescopes have shorter tube lengths than Keplerains of the same power
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11. Disadvantages of binocular spectacle magnifiers include:
T a. Short working distance
T b. Fixed focus
T c. High power ones have restriction in visual field
F Need for hand manipulation
T Need for prisms in high power lenses
12. Advantages of near telescopes over magnifiers:
F a. Cheaper cost
F b. Good depth of focus
F c. Cosmetically acceptable to many patients
T d. Long working distance
P e. Wider visual field
13. The following statements are CORRECT:
F a. Typoscopes are used to reduce glare from overhead lights
F b. Visors reduce glare from reading materials
T c. Sunglasses with side shields reduce glare from overhead lights
T d. Pinholes spectacles are designed to reduce light entering the eye
T e. Low vision patients would benefit from talking wrist watches
14. The following formulae are CORRECT for determining the magnification:
F a. Denominator of estimated goal VA divided by denominator of best corrected VA
T b. Denominator of best corrected VA divided by denominator of estimated goal VA
F c. Denominator of best corrected VA multiplied by denominator of estimated goal VA
T d. Reciprocal of the patient’s best corrected distance VA
F e. Best corrected VA multiplied by minimum angle of resolution
15. A telescope with eyepiece of +40.0 D and objective power of +20.0D:
F a Is a Galilean telescope
T b. Will produce magnification of 2x
T c. Has tube length of 7.5 cm
T d. Can be used as a reversed telescope
F e. Is a focal telescope
16. A patient has best VA of 6/30 at 3 meters, if goal VA 6/15 at 6 meters is needed. The
magnification needed is:
F a. 2x
F b. 2.5x
F c. 3x
T d. 4x
F e. 5x
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17. A diabetic retinopathy patient with VA of 6/24 in each eye can be said to have
T a. Visual disorder
F b. Visual disability
T c. Visual impairment
F d. Visual handicap
F e. All of the above
18. Advantages of Closed-Circuit Television (CCTV) in low vision care include:
F a. Portability
F b. Affordability
T c. High magnifications and good resolution
T d. Variable and comfortable working distance
T e. May afford polarity
19. You want an Optician to provide a +10.0 D binocular spectacle magnifier for a
patient. The recommended prism (diopters) may be:
F a. 8 Base-In
F b. 10 Base-Out
F c. 15 Base-In
T d. 11 Base-In
F e. 9 Base-Out
20. For a patient with albinism, the following may be recommended as illumination
control:
T a. Reduce power of source of light
T b. Increase distance of source from reading area
F c. Reduce distance of source from reading area
T d. Increase angle between the source and perpendicular to the reading surface
F e. Need for greater illumination when reading
21. These will be recommended for a patient who complains of glare when walking in the
Sun:
T a. Visor
T b. Hat with wide brim
F c. Typoscope
T d. Side shield sunshade
T e. Need for dark shade with side shield outdoors
22. You prescribe a 2.5x hand-magnifier for a patient. Your advice to him will include"
F a. Hold the magnifier at approximately 8 cm from the reading surface
T b. Hold the magnifier at approximately 10cm from the reading surface
F c. Your eye-to-magnifier distance should be 40 cm
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T d. Your eye-to-magnifier distance may be any distance you feel is best for you
F e. Eye-to-reading material must be 40cm
23. A telescope has an eyepiece of -40.0D. If the magnification provided is 2x. The
following are correct about the telescope:
F a. It is a Keplerian telescope
T b. The tube length is 2.5cm
T c. The objective lens power is +20 D
F d. The telescope must have an image erecting prism
F e. The tube length is 7.5cm
24. Patients with the following conditions will benefit from reduced illumination when
reading:
T a. Albinism
F b. Achromatopsia
T c. Small central corneal opacity
F d. Age-related macular degeneration
F e. Advanced retinitis pigmentosa.
25. The following are CORRECT about use of contact lenses in low vision care:
T a. Can eliminate effects of corneal irregularities
F b. High plus power contact lenses may be used as magnifier
T c. May act as ocular component of a telescopic system
F d. May improve distance vision to normal level
F e. Useful for those whose vision loss is due to retinitis pigmentosa
26. The following is/ are low vision devices:
T a. Needle threader
T b. Talking calculator
T c. Reading stand
T d. Giant digit playing cards
T e. Giant print bible
27. A 6-year-old girl with low vision due to albinism, wishes to read her schoolbook. If
presenting VA is 6/36, she may benefit from:
T a. Relative distance magnification
T b. Dome magnifier
T c. Tinted spectacles and counselling
F d. Eccentric viewing
F e. Magnification device, even, if she has good amplitude of accommodation
28. Dome magnifier is also called:
T a. Bright field magnifier
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T b. Paper weight magnifier
F c. Monoface magnifier
F d. Telescope magnifier
F e. Typoscope magnifier
29. The following should be observed in low vision patients during the first visit:
T a. Mobility
T b. Facial cosmesis
T c. Psychological state
T d. Visual capacity
F e. None of the above
30. The following information may be relevant to a patient diagnosed with bitemporal
hemianopsia:
F a. May be a case of internal carotid arteries pressure on the retinocortical fibres
T b. May have problems with environmental navigation
F c. Base-In prisms may be helpful for the patient
T d. May need up to 10-15 prism dioptres for visual field enhancement
F e. May be assisted mainly with Base-Up prism
31. The following are TRUE about rod achromatopsia:
T a. Complete colour blindness
T b. Most common form of achromatopsia
T c. Transmitted as autosomal recessive
F d. An acquired colour blindness
T e. Usually associated with reduced vision
32. The following may NOT be considered when prescribing low vision devices for near
task:
F a. Working distance required for the task
F b. Field of view that can be provided by the device
F c. Cosmetic appearance of the device
T d. Appearance and weight of the device
T e. Weight and portability of the device
33. Angular magnification is provided when:
T a. A telescope is used for vision enhancement
F b. An object is moved closer to the observer
F c. An object size is increased
F d. A combination of devices are used
F e. Patient moved closer to an object of regard
34. Devices for training a patient how to use a spectacle magnifier may include:
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T a. Appropriate light source
T b. Felt pen
T c. Reading stand
T d. Typoscope
F e. A focal telescope
35. The following are CORRECT about both hand-held and standing magnifiers:
T a. The higher the power, the smaller the lens size
F b. The higher the power, the longer the eye-to-lens distance
T c. The shorter the eye-to-lens distance, the wider the field of view
T d. Round lenses permit vertical and horizontal magnification
F e. Low power magnifier lenses are usually round in shape
36. The first choice of device for reading, if there are no restrictions whatsoever, may be:
T a. Stand magnifier
T b. Spectacle magnifier
T c. Near telescope
T d. Electronic magnifier
F e. None of the above
37. Factors that may NOT be considered in prescribing a low vision device for a patient
include:
F a. Patient’s view of cosmetic aspect of device
F b. Cost and affordability of the device to the patient
F c. Availability of the device
F d. Stability of the disease entity causing the impairment
T e. The duration of the vision loss
38. Illumination control for a patient with macular degeneration may include:
T a. Illumination should be directly above the reading material surface
F b. Source of light should be relatively far from the reading material surface
F c. The higher the power of the source the better
F d. Dim light will be advisable for reading
F e. None of the above
39. Reserve visual acuity is necessary for:
F a. All low vision patients
T b. Fluent reading
F c. Spot reading
F d. Patients with visual field loss
F e. Children only
40. Magnitude of power to be prescribed for a patient may be influenced by
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T a. Severity of the ocular disorder
T b. Type of task to be performed
T c. Amplitude of accommodation of the patient
T d. Contrast of the material to be read
F c. Polarity of material to be read
41. Earliest visual rehabilitation occurs with:
T a. Phacoemulsification plus intraocular lens implantation
F b. Intracapsular cataract extraction plus intraocular lens implantation
F c. Extracapsular cataract extraction plus intraocular lens implantation
F d. Small incision cataract extraction
F e. Intracapsular cataract extraction
42. What is the main test for Albinism?
F a. Eye exam
T b. Hair test
F c. Urine analysis
F d. WBC count
F e. RBC count
43. Which of the following are treatments to improve vision for ocular albinism patients?
F a. Strabismus surgery
T b. Contact lens
T c. Prosthetic lens implants
F d. Cataract surgery
F e. Iridectomy
44. Reverse telescopes are MOST commonly used for:
T a. Late-stage retinitis pigmentosa
F b. ARMD
F c. Macular edema
T d. Late-stage glaucoma
F e. High myopia
45. How does a reverse telescope help a patient?
T a. It increases the field of view making movement safer and easier
F b. It magnifies images
F c. It is used purely for style; because, who wouldn't want two telescopes inserted into
their glasses
F d. It acts like a microscope so that small, up close objects can be analyzed
F e. None of the above
46. In which type of field defect is a reverse telescope used?
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F a. Small, unilateral scotoma
F b. Bitemporal hemianopsia
F c. No light perception
T d. Bilateral concentric field loss
T e. Tunnel vision
47. Which of the following statements is TRUE about telescopes?
F a. Telescopes can only be used for far vision enhancement
T b. Spectacle mounted telescopes leave hands free for use
F c. They increase field of view
T d. Cause decrease in contrast and luminance
T e. A concave mirror can be used as the objective in some types of telescopes
48. The following statements are CORRECT about artificial eye:
T a. It is a replacement for a lost natural eye
F b. Prosthetic eyes are currently made of glass
T c. Acts as cosmetic enhancement
F d. Children require less frequent replacement prosthetic eye
F e. Prosthetics are contraindicated for children
49. Prosthetic eye is fitted after these surgical procedures:
T a. Ocular enucleation
T b. Ocular evisceration
T c. Orbital exenteration
F d. Ocular laceration
F e. Ocular keratotomy
50. Materials used when making artificial eye include:
T a. Wax
T b. Plaster of Paris
T c. Alginate
T d. Paints and coloured threads
T e. Plastics
51. Advantages of a custom-made ocular prosthesis include:
T a. Retains the shape of the socket
T b. Prevents collapse of the eye lids
T c. Prevents accumulation of fluid in the ocular cavity
T d. Maintains palpebral opening similar to natural eye
F e. lt is relatively easier to make
52. The following are CORRECT about ocular prosthesis for babies
T a. Babies can be fitted with prosthesis
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T b. Psychological support for the parents is an important consideration for fitting
F c. Fitting children without anesthesia may cause serious pain
F d. Parents in denial of eye loss of their baby, will accept prosthesis easily
T e. Fitting children demands good knowledge of the anatomical development of eyes
53. Possible reasons for enucleation include:
T a. Blind and painful eyes
T b. Pathology threatening fellow eye
T c. Injuries to the eye causing eye loss
T d. Tropia with serious cosmetic implications
F e. Symptomatic tropia
54. Characteristics of well-fitted prosthesis include:
T a Comfort of the patient
T b. Exact matching of iris colours in the prosthetic and natural eye
T c. Equal size of palpebral features of both eyes
F d. Catoptric images not necessarily at the same point in artificial and natural eyes
T e. Steadiness of the eye in the socket
55. Reason why an enucleated eye may require prosthesis include:
T a. Cosmetic reasons
T b. Prevention of loss of shape of eyelid
T c. Re-establishment of lid movement
T d. Direction of tears and other secretions to proper channels
F e. Prevention of fluid accumulation in the ocular cavity
56. Consequences of too small prosthetic for the socket include:
T a. Orbicularis oculi muscle deprived of sufficient support
T b. Orbicularis oculi loses tonus
F c. Shallowing the groove where palpebral and orbital parts of orbicularis muscles are
located
T d. Alteration of eyebrow shape (may drop nasal-wards)
F e. Weakening of orbicularis oculi may cause entropion
57. Measurement taken on the normal eye for the prosthetic eye include:
T a Palpebral aperture
T b. Corneal diameter
T c. Pupil size
T d. Iris diameter
F e. Inter-pupillary distance
58. Evisceration is:
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F a. Excision of the entire eyeball
T b. Excision of all the inner contents of the eyeball including the uveal tissue
F c. Photocoagulation of the retina
F d. Removal of orbit contents
F e. Removal of a tumour
59. A sighted-blind child:
T a. Is sighted in some functions and blind to others
F b. Has the dorsal stream affected
T c. Does not bump into objects
F d. Always has poor orientation in space
F e. Learns to recognize visual forms
60. The following statements are CORRECT about ageing:
F a. Pupil size increases with age
T b. Crystalline lens loses transparency
T c. Density of photoreceptors decrease
T d. Increased need for light for reading
T e. There may be floaters in the vitreous
61. Traditional definition of low vision includes the following:
F a. Visual acuity only
F b. Visual field only
F c. Colour vision only
T d. Visual acuity and visual field
F e. Visual field and colour vision
62. Functional definition of low vision includes the following:
F a. Ocular motility
T b. Colour vision
T c. Contrast sensitivity
F d. State of the fundus
T e. Inability to perform activities of daily living
63. The Vision 2020/WHO ISCDICD-10 definition of low vision is based on the
following
premises:
T a. A person has a visual acuity of less than 6/ 18 or better than 3/60 in the better eye
T b. A person has visual field of less than 10 degrees in the better eye
T c. Visual acuity did not improve beyond 6/18 even with best possible optical correction
F d. a AND b
T e. a OR b
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64. The ICO/WHO/VISION 2020 classification of low vision and visual impairment
includes the following category of vision loss:
F a. Profound vision loss
T b. Moderate vision loss
F c. Total vision loss
T d. Severe vision loss
F e. Near total vision loss
65. The ICO/WHO/VISION 2020 classification of blindness includes the following
category of vision loss:
F a. Severe vision loss
T b. Near total vision loss
T c. Profound vision loss
F d. Count finger
T e. Total vision loss
66. Each statement below CORRECTLY describes visual disorder:
T a. It is anatomical deviation from normal ocular structure caused by pathologies,
injuries, acquired and congenital conditions
T b. It does not lead to visual impairments
T c. It does not necessarily affect a patient’s functional abilities
T d. All of the above
F e. None of the above
67. Each statement below CORRECTLY describes visual impairment:
T a. It is a limitation in one or more functions of the eye
F b. It is not due to the functional losses from a visual disorder
T c. It could be physiological or psychological
F d. All of the above
F e. None of the above
68. Each statement below CORRECTLY describes visual disability:
T a. It is a restriction or an inability to perform a visual task in a normal way
F b. The level of performance of the patient based on functional vision is not necessary
T c. An example of visual disability is cataract
F d. All of the above
F e. None of the above
69. Each statement below CORRECTLY describes visual handicap:
T a. The sufferer could experience some level of disadvantages in the society due to
associated visual impairment or disability
F b. It does not prevent or limit the fulfilment of visual tasks which are considered
normal to others
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T c. Crossing a high way by a blind man unguided is an instance of visual handicap
T d. It is synonymous with visual challenge
F e. None of the above
70. Illumination control is an important aspect of low vision management. Illumination
control could be achieved through the following:
T a. Modification of the environment
T b. Modification through optical devices
T c. Modification of the light sources
T d. All of the above
F e. None of the above
71. The following ocular conditions can be managed during low vision care with
appropriate illumination control as follows:
T a. Albinism: Use low illumination, Photochromic and or tinted lenses
F b. Aniridia and iris coloboma: Use high illumination, Photochromic and or tinted lenses
F c. Corneal scarring: Use low illumination, Photochomic, Tinted or Anti- reflex
F d. All of the above
F e. None of the above
72. The types of magnification encountered in low vision care include the following
T a. Spectral magnification
T b. Angular magnification
T c. Size magnification
T d. Proximal magnification
F e. All of the above
73. The following statements are CORRECT about bar magnifiers:
F a. lt is placed in between the eye and the near task
F b. It is placed directly on the eye at spectacle plane
F c. It can be adapted to view distant object
T d. It is placed on the reading material
F e. All of the above
74. The following statements are CORRECT about magnifiers:
T a. They are always used at near
T b. A mirror can be used as a magnifier
F c. They must be used binocularly
F d. A concave lens can be used as a magnifier
T e. Telescope can be modified to be used as a magnifier
75. The causes of low vision include the following:
T a. Glaucoma
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F b. Uveitis
F c. Operable cataract
T d. Uncorrected Refractive error
F e. Hyphema
76. The following telescopes can be used in low vision care:
T a. Keplerian telescope
F b. Radio telescope
T c.. Galilean telescope
F d. Infra-ray telescope
F e. X-ray-telescope
77 . The following telescopes exist in modern optics:
T a. Radio telescope
T b. Galilean telescope
T c. Infra-ray telescope
T d. Keplerian telescope
T e. X-ray-telescope
78. The following statements are CORRECT about telescopes as used in low vision
care:
F a. Galilean telescope is synonymous with astronomical telescope
T b. Keplerian telescope is built from plus lens objective and plus lens ocular
T c. Galilean telescope is built from plus lens objective and minus lens ocular
F d. Galilean telescope is built from minus lens objective and plus lens ocular
F e. Keplerian telescope is built from minus lens objective and plus lens ocular
79. Telescopes can be categorized according to their modus operandi as follows
T a. Refracting telescope
T b. Reflecting telescope
T c. Non-optical telescope
T d. All of the above
F e. None of the above
80. Telescope as Optical system can suffer from the following aberrations:
T a. Chromatic Aberration
T b. Coma
T c. Curvature of field
T d. Distortion
T e. Oblique astigmatism
81. The following statements are CORRECT about telescopes:
T a. Telescope can be used in reverse mode to create minification
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T b. The exit pupil represents the image of the objective lens at the ocular
F c. In Galilean telescope, the exit pupil lies outside the telescope
F d. In Keplarian telescope, the exit pupil lies within the telescope system
F e. None of the above
82. The following statements about membrane prism are CORRECT:
T a. It suffers from chromatic aberration for high power ranges
T b. It is light Weight
F c. A lens can be incorporated into it
T d. It is a modification and improvement of Fresnel prism
F e. All of the above
83. The following Rx are CORRECT for splitting and combination of prisms:
T a. OD: 4PD BI = OS: 4PD BI
F b. OD: 4PD BI = OD: 2PD BI / OS: 2PD BD
T c. OD: 4PD BU= OD: 4PD BD
T d. OD: 4PD BD = OD: 2PD BD / OS: 2PD BU
T e. OD: 4PD BD/ OS: 2PD BO = OD: 2PD BD, 1PD BO / OS: 2PD BU, 1PD BO
84. Reversed telescopy implies the following:
F a. Looking through the ocular to view a distant object
F b. Looking through the objective lens to view a near object
T c. Minification of object size
T d. Enlarging the visual field
F e. All of the above
85. The following statements about telescope are CORRECT:
T a. It is afocal
F b. It is composed of at least two lenses of opposite powers
P c. It places a demand on the accommodation of the user
T d. It can contain prism as a component
F e. None of the above
86. The following statements about bioptic telescope are CORRECT:
T a. It is a telescope with a special mounting on a frame
T b. It can be used for near tasks with help of reading cap
T c. It can be used for driving and other outdoor activities
F d. It is mostly binocular
T e. Patient’s glass prescription can be incorporated inside the telescope
87. The following statements about through the lens (TTL) telescope are CORRECT:
T a. The telescope is mounted over the patient’s habitual Rx
F b. It has superior optics than other types of telescope
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T c. it is a special variant of clip-on telescope
T d. It increases field size due to decreased vertex
F e. None of the above
38. A patient with total vision loss could be helped with the following low vision aids:
F a. Spectacle magnifier
F b. CCTV
T c. Scan reader
T d. Pedometer
T e. Talking clock
89. Non-bioptic telescopes are popular for the following reasons:
F a. Users can use them to walk around
T b. They are relatively cheaper
T c. They are available in various formats
F d. They are cosmetically appealing
F e. They do not suffer from distortions
90. Prisms are often incorporated binocularly with magnifiers for the following reasons:
F a. To balance the weight of the magnifier
T b. To compensate for induced base out effect
F c. To compensate for induced base in effect
F d. To reduce the effect of chromatic aberration
T e. To re-orientate the image seen through the magnifier
91. Some of the ways to make an environment friendly for a low vision patient include
the
following:
T a. improve overall illumination of the environment
F b. Use black colour to mark out potential danger zones
T c. Paint the walls to have moderate reflectance
T d. Use contrasting tiles on steps
F e. All of the above
92. A person living with low vision is expected by convention to use the following type
of mobility cane when necessary:
F a. White cane
F b. Red cane
F c. Black cane
T d. White cane with Red bottom
F e. White cane with Black bottom
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93. A person living with Deaf and Blindness is expected by convention to use the
following type of mobility cane:
F a. White cane
F b. Red cane
F c. Black cane
F d. Black cane and
94. The following professionals can be part of low vision team:
T a. Optometrist
T b. Optical engineer
T c. Clinical psychologist
T d. Special education instructor
T e. Orientation & mobility instructor
95. The mobile phone could be adapted to assist a person living with low vision as
follow;
T a. Increase the font size
F b. Decrease the contrast
T c. Enable monochrome mode
F d. Decrease background illumination
T e. Familiarise the location of key/button bumps
96. The following are low vision hi-tech devices:
F a. Bar magnifier
T b. Zoom text software reader
T c. CCTV
T d. Pedometer
T e. Artificial Silicone Retina
97. The Personal computers can be configured to assist a person living with low vision as
follows:
T a. Increase the font size
T b. Enable on-screen magnifier
F c. Increase the mouse speed
F d. Disable screen reader
T e. Enable voice recognition
98. The following statements are TRUE of a lens labelled +20.00DS:
T a. It can be used as a magnifier
F b. The working distance must be from 5cm - 10cm
T c. The working distance must fall below 5cm
F d. If placed on top of a reading material, maximum magnification is achieved
F e. None of the above
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99. The following statements are TRUE of combining +10.00DS and -20.00DS lenses:
T a. When both are placed in contact with each order it can form achromatic duplet
T b. When they are separated by 5 cm, it can form a Galilean telescope
F c. When they are separated by 10cm, it can form a Galilean telescope
F d. When they are separated by 5cm, it can form a Keplerian telescope
F e. None of the above
100. The following conditions are considered MAJOR causes of low vision:
T a. Diabetic retinopathy
T b. Glaucoma
T c. Uncorrected refractive error
T d. Age-related macular degeneration
T e. Retinopathy of prematurity
101. The following statements are TRUE about use of filters in low vision care:
F a. They are used in albinism only
Fb.They are not very often used in low vision care as they alter the contrast and spectral
hue
F c. Photochromic lenses are types of filters
F d. All of the above
T e. None of the above
102. Traditional definition of low vision includes the following:
F a. Visual acuity only
F b. Visual field only
F c. Colour vision only
T d. Visual acuity and visual field
F e. Visual field and colour vision
103. Functional definition of low vision includes the following:
F a. Ocular motility
T b. Colour vision
T c. Contrast sensitivity
F d. State of the fundus
T e. Inability to perform activities of daily living
104. The Vision 2020/WHO ISCDICD-l0 definition of low vision is based on the
following
premises:
T a. A person has a visual acuity of less than 6/18 or better than 3/60 in the better eye
T b. A person has visual field of less than 10 degrees in the better eye
T c. Visual acuity did not improve beyond 6/18 even with best possible optical correction
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F d. a AND b
T e. a OR b
105. The ICO/WHO/VISION 2020 classification of low vision and visual impairment
includes the following category of vision loss:
F a. Profound vision loss
T b. Moderate vision loss
F c. Total vision loss
T d. Severe vision loss
F e. Near total vision loss
106. The ICO/WHO/VISION 2020 classification of blindness includes the following
category of vision loss:
F a. Severe vision loss
T b. Near total vision loss
T c. Profound vision loss
F d. Count finger
T e. Total vision loss
107. Each statement below CORRECTLY describes visual disorder:
T a. It is anatomical deviation from normal ocular structure caused by pathologies,
injuries, acquired and congenital conditions
T b. It does not lead to visual impairments
T c. It does not necessarily affect a patient’s functional abilities
T d. All of the above
F e. None of the above
108. Each statement below CORRECTLY describes visual impairment:
T a. It is a limitation in one or more functions of the eye
F b. It is not due to the functional losses from a visual disorder
T c. It could be physiological or psychological
F d. All of the above
F e. None of the above
109. Each statement below CORRECTLY describes visual disability:
T a. It is a restriction or an inability to perform a visual task in a normal way
F b. The level of performance of the patient based on functional vision is not necessarily
T c. An example of visual disability is cataract
F d. All of the above
F e. None of the above
110. Each statement below CORRECTLY describes visual handicap:
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T a. The sufferer could experience some level of disadvantages in the society due to
associated visual impairment or disability
F b. It does not prevent or limit the fulfilment of visual tasks which are considered
normal to others
T c. Crossing a high way by a blind man unguided is an instance of visual handicap
T d. lt is synonymous with visual challenge
F e. None of the above
111. Illumination control is an important aspect of low vision management. Illumination
control could be achieved through the following:
T a. Modification of the environment
T b. Modification through optical devices
T c. Modification of the light sources
T d. All of the above
F e. None of the above
112. The following ocular conditions can be managed during low vision care with
appropriate illumination control as follows:
T a. Albinism: Use low illumination, Photochromic and or tinted lenses
F b. Aniridia and iris coloboma: Use high illumination, Photochromic and or tinted lenses
F c. Corneal scarring: Use low illumination, Photochomic, Tinted or Anti-reflex
F d. All of the above
F e. None of the above
113. The types of magnification encountered in low vision care include the following:
F a. Spectral magnification
T b. Angular magnification
T c. Size magnification
T d. Proximal magnification
F e. All of the above
114. The following statements are CORRECT about bar magnifiers:
F a. It is placed in between the eye and the near task
F b. lt is placed directly on the eye at spectacle plane
F c. lt can be adapted to view distant object
T d. lt is placed on the reading material
F e. All of the above
115. The following statements are CORRECT about magnifiers:
T a. They are always used at near
T b. A mirror can be used as a magnifier
F c. They must be used binocularly
F d. A concave lens can be used as a magnifier
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T e. Telescope can be modified to be used as a magnifier
116. The causes of low vision include the following:
T a. Glaucoma
F b. Uveitis
F c. Operable cataract
T d. Uncorrected Refractive error
F e. Hyphema
117. The following telescopes can be used in low vision care:
T a. Keplerian telescope
F b. Radio telescope
T c. Galilean telescope
F d. Infra-ray telescope
F e. X-ray-telescope
118. The following telescopes exist in modern optics:
T a. Radio telescope
T b. Galilean telescope
T c. Infra-ray telescope
T d. Keplerian telescope
T e. X- y-telescope
119. The following statements are CORRECT about telescopes as used in low vision
care:
F a. Galilean telescope is synonymous with astronomical telescope
T b. Keplerian telescope is built from plus lens objective and plus lens ocular
T c. Galilean telescope is built from plus lens objective and minus lens ocular
F d. Galilean telescope is built from minus lens objective and plus lens ocular
F e. Keplerian telescope is built from minus lens objective and plus lens ocular
120. Telescopes can be categorized according to their modus operandi as follows:
T a Refracting telescope
T b. Reflecting telescope
T c. Non-optical telescope
T d. All of the above
F e. None of the above
121. Telescope as Optical system can suffer from the following aberrations:
T a. Chromatic Aberration
T b. Coma
T c. Curvature of field
T d. Distortion
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T e. Oblique astigmatism
122. The following statements are CORRECT about telescopes:
T a. Telescope can be used in reverse mode to create minification
T b. The exit pupil represents the image of the objective lens at the ocular
F c. In Galilean telescope, the exit pupil lies outside the telescope
F d. In Keplarian telescope, the exit pupil lies within the telescope system
F e. None of the above
123. The following statements about membrane prism are CORRECT:
T a. It suffers from chromatic aberration for high power ranges
T b. It is light weight
F c. A lens can be incorporated into it
T d. It is a modification and improvement of Fresnel prism
F e. All of the above
124. The following Rx are CORRECT for splitting and combination of prisms:
T 21. OD: 4PD BI = OS: 4PD BI
F b. OD: 4PD BI I OD: 2PD BI / OS: 2PD BD
T C. OD: 4PD BU= OD: 4PD BD
T d. OD: 4PD BD = OD: 2PD BD / OS: 2PD BU
T e. OD: 4PD BD/ OS: 2PD BO = OD: 2PD BD, IPD BO / OS: 2PD BU, 1PD BO
125. Reversed telescopy implies the following:
F a. Looking through the ocular to view a distant object
F b. Looking through the objective lens to view a near object
T c. Minification of object size
T d. Enlarging the visual field
F e. All of the above
126. The following statements about telescope are CORRECT:
T a. It is afocal
F b. It is composed of at least two lenses of opposite powers
F c. It places a demand on the accommodation of the user
T d. It can contain prism as a component
F e. None of the above
127. The following statements about bioptic telescope are CORRECT:
T a. It is a telescope with a special mounting on a frame
T b. It can be used for near tasks with help of reading cap
T c. It can be used for driving and other outdoor activities
F d. It is mostly binocular
T e. Patient’s glass prescription can be incorporated inside the telescope
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128. The following statements about through the lens (TTL) telescope are CORRECT:
T a. The telescope is mounted over the patient’s habitual Rx
F b. It has superior optics than other types of telescope
T c. It is a special variant of clip-on telescope
T d. It increases field size due to decreased vertex
F e. None of the above
129. A patient with total vision loss could be helped with the following low vision aids:
F a. Speflatle magnifier ‘
F b. CCTV
T c. Scan reader
T d. Pedometer
T e. Talking clock
130. Non-bioptic telescopes are popular for the following reasons:
F a. Users can use them to walk around
T b. They are relatively cheaper
T c. They are available in various formats
F d. They are cosmetically appealing
F e. They do not suffer from distortions
131. Prisms are often incorporated binocularly with magnifiers for the following reasons:
F a. To balance the weight of the magnifier
T b. To compensate for induced base out effect
F c. To compensate for induced base in effect
F d. To reduce the effect of chromatic aberration
T e. To re-orientate the image seen through the magnifier
132. Some of the ways to make an environment friendly for a low vision patient include
the following:
T a. Improve overall illumination of the environment
F b. Use black colour to mark out potential danger zones
T c. Paint the walls to have moderate reflectance
T d. Use contrasting tiles on steps
F e. All of the above
133. A person living with low vision is expected by convention to use the following type
of mobility cane when necessary:
F a. White cane
F b. Red cane
F c. Black cane
T d. White cane with Red bottom
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F e. White cane with Black bottom
134. A person living with Deaf and Blindness is expected by convention to use the
following type of mobility cane:
F a. White cane
F b, Red cane
F c. Black cane
F d. Black cane and white stripe
T e. White cane with Red stripe
135. The following professionals can be part of low vision team:
T a. Optometrist
T b. Optical engineer
T c. Clinical psychologist
T d. Special education instructor
T e. Orientation & mobility instructor
136. The mobile phone could be adapted to assist a person living with low vision as
follow:
T a. Increase the font size
F b. Decrease the contrast
T c. Enable monochrome mode
F d. Decrease background illumination
T e. Familiarise the location of key/button bumps
137. The following are low vision hi-tech devices:
F a. Bar magnifier
T b. Zoom text software reader
T c. CCTV
T d. Pedometer
T e. Artificial Silicone Retina
138. The Personal computers can be configured to assist a person living with low vision
as
follows:
T a. Increase the font size
T b. Enable on-screen magnifier
F c. Increase the mouse speed
F d. Disable screen reader
T e. Enable voice recognition
139. The following statements are TRUE of a lens labelled +20.00DS:
T a. It can be used as a magnifier
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F b. The working distance must be from 5cm -10cm
T c. The working distance must fall below 5cm
F d. If placed on top of a reading material, maximum magnification is achieved
F e. None of the above
140. The following statements are TRUE of combining +10.00DS and -20.00DS lenses:
T a. When both are placed in contact with each order it can form achromatic duplet
T b. When they are separated by 5cm, it can form a Galilean telescope
F c. When they are separated by 10cm, it can form a Galilean telescope
F d. When they are separated by 5cm, it can form a Keplerian telescope
F e. None of the above
141. The following conditions are considered MAJOR causes of low vision:
T a. Diabetic retinopathy
T b. Glaucoma
T c. Uncorrected refractive error
T d. Age-related macular degeneration
T e. Retinopathy of prematurity
142. The following statements are TRUE about use of filter in low vision care:
F a. They are used in albinism only
Fb.They are not very often used in low vision care as they alter the contrast and spectral
hue
F c. Photochromic lenses are types of filters
F d. All of the above
T e. None of the above
143. The coloure of rainbow include the following
T a. Green
F b. Purple
T e. Blue
F d. Ultraviolet
F e. Infra-Red
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CHAPTER TEN
PAEDIATRIC OPTOMETRY
1. With regard to a normal infant eye:
F a. Poor pupil dilation is due to incomplete development of the sympathetic supply
T b. The normal axial length is around 16mm
F c. The anterior chamber is deeper than that of the adult
F d. The normal corneal diameter is 14mm
T e. Fovea maturation is completed post natally
2. At what month of gestation are the five layers of the cornea visible?
F a. 6
F b. 8
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F c. 9
T d. 5
F e. 7
3. Possible abnormalities of the eyelid tissues seen in children include:
T a. Poliosis
T b. Distichiasis
F c. Dacryoadenitis
F d. Symblepharon
T e. Madarosis
4. Congenital anomalies of the eyelids include:
T a. Coloboma of the lid
T b. Epicanthus
F c. Blepharitis
F d. Ecchymosis
F e. Emphysema
5. A 6-month-old child had large cloudy cornea and tearing, suspected diagnoses may
include:
F a. Cataract
T b. Glaucoma
F c. Keratoconus
F d. Conjunctivitis
F e. Scleritis
6. A one-year old child brought to your practice, with tearing, large cloudy cornea,
photophobia and blepharospasm. Your tentative diagnoses may be:
F a. Juvenile glaucoma
T b. Infantile glaucoma
F c. Keratitis
F d. Congenital cataract
F e. Megalocornea
7. Rubella’s syndrome may include:
T a. Cataract
T b. Glaucoma
T c. Pigmentary retinopathy
T d. High myopia
T e. Microphthalmia
8. Leucocoria is associated with:
T a. Cataract
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T b. Retinoblastoma
F c. Retinal detachment
F d. Sarcoidosis
F e. Buphthalmos
9. The following are CORRECT about childhood glaucoma:
T a. Developmental glaucoma is caused by underdevelopment of aqueous outflow system
T b. Congenital glaucoma exists at birth or sometime after birth
T c. Glaucoma occurring within one year of birth is infantile
T d. Infantile glaucoma is usually bilateral
F e. Congenital glaucoma exists after one year of birth
10. The following are CORRECT about secondary developmental glaucoma:
T a. Often associated with aniridia
T b. May be associated with ectopic lentis
T c. May be steroid induced
F d. May be associated with cryptophthalmos
F e. May be associated with Keratoconus
11. The following are CORRECT about ophthalmia neonatorum:
T a. It is contracted through the birth canal during delivery
T b. It is caused by Neisseria gonorrhoeae infection
T c. Differential diagnoses include chlamydial trachoma and bacterial conjunctivitis
F d. Common treatment include topical and systemic antibiotics and steroids
F e. It is congenital
12. The following are CORRECT about retinoblastoma:
F a. lt is a secondary intraocular malignant neoplasm
T b. Arises from immature retinal cells called retinoblasts in infants and children
T c. It is a consequence of gene abnormality
T d. Untreated retinoblastoma can destroy affected eye within a few months
T e. lt causes white pupil
13. A 12 years old boy receiving long term treatment for spring catarrh, developed
defective vision in both eyes. The likely cause is:
T a. Posterior subcapsular cataract
F b. Retinopathy of prematurity
F c. Optic neuritis
F d. Vitreous haemorrhage
F e. Open angle glaucoma
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14. A young child suffering from fever and sore throat began to complain of lacrimation.
On examination, follicles were found in the lower palpebral conjunctiva with tender
preauricular lymph nodes. The most probable diagnosis is:
F a. Trachoma
F b. Staphylococal conjunctivitis
T c. Adenoviral conjunctivitis
F d. Phlyctenular conjunctivitis
F e. Vernal conjunctivitis
15. A ten-year-old boy complains of itching. On examination, there are mucoid nodules
with smooth rounded surface on the limbus, and mucous white ropy mucopurulent
conjunctival discharge. He most probably suffers from:
F a. Trachoma
F b. Mucopurulent conjunctivitis
T c. Bulbar spring catarrh
F d. Purulent conjunctivitis
F e. Viral conjunctivitis
16. A 3 months old infant with watering lacrimal sac on pressing causes regurgitation of
mucopus material. What is the appropriate treatment?
F a. Dacryocystorhinostomy
F b. Probing
F c. Probing with syringing
T d. Massage with antibiotics up to age of 6 months
F e. Dacryocystectomy
17. A one-month old baby is brought with complaints of photophobia and watering.
Clinical examination shows normal tear passages and clear but large cornea. The MOST
likely diagnosis is:
F a. Congenital dacryocystitis
F b. Interstitial keratitis
F c. Keratoconus
T d. Buphthalmos
F e. Keratoglobus
18. Fibrin collarette around the base of the eyelashes in children is due to:
F a. Squamous blepharitis
F b. Blepharochalasis
T c. Ulcerative blepharitis
F d. Meibomianitis
F e. Vernal conjunctivitis
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19. If a baby is born with a dense cataract, he will have a low probability of developing
better than 20/50 visual acuity in that eye unless he has surgery before:
F a. 3 weeks of age
T b. 3 months of age
F c. 1 year of age
F d. 3 years of age
F e. 5 years of age
20. If the father carries the gene for deuteranopia but the mother does not carry the affect’
gene, what is the probability that, if their child is a boy, he will inherit deuteranopia?
T a. 0%
F b. 25%
F C. 50%
F d. 75%
F e. 100%
21. The parent of this 3-year-old child is concerned that the left eye appears partly close.
This has been present since birth. Which of the following tests is LEAST informative for
monitoring this condition? ‘
F a. Pupil function
F b. Ocular motility
F c. Visual acuity
T d. Lid eversion
F e. Near reflex test
22. Regarding refractive errors:
T a. Children who are regarded by their teachers as having a learning disability may
actually have an undiagnosed refractive error
T b. Children with myopia will sometimes have watery and swollen eyes
c. Children with astigmatism have headaches and tired eyes
F d. Children with hyperopia may have to tilt or turn their head to get a clear image
F e. None of the above
23. What vision problem would you suspect in a child who frequently skips lines or loses
his place when reading?
F a. Accommodative insufficiency
F b. Accommodative infacility
F c. Lateral phoria
T d. Vertical phoria
F e. Amblyopia
24. Which of the following is TRUE concerning childhood myopia?
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T a. A child with one myopic parent is twice more likely to develop high myopia than a
child with no myopic parents
T b. A child with two myopic parents is five times more likely to develop high myopia
than
a child with no myopic parents
F c. A child with one myopic parent is equally likely to develop high myopia as a child
with
no myopic parents
F d. A child with two myopic parents is equally likely to develop high myopia as a child
with no myopic parents
F e. Children within the same environment have equal likelihood to develop high myopia
25. Area of COMMON chief concerns in paedriatic case history includes:
T a. Child sits very close to the television
T b. Child squints
T c. Failed vision screening
F d. Glaucoma
F e. None of the above
26. Premature infants have:
T a. Higher incidence of myopia
T b. Higher incidence of retinopathy of prematurity
F c. Higher incidence of lens opacity
T d. Higher incidence of astigmatism
F e. Higher incidence of retinoschisis
27. The following health functions are NOT assessed at birth:
F a. Heart rate
F b. Colour
T c. Reproduction
F d. Muscle tone
T e. Excretory rate
28. Examination procedure for testing the integrity of the oculomotor system in children
include:
T a. Visual acuity
T b. Stereoacuity
T c. Visuscopy
F d. Accommodation test
F e. Worth-4-dot test
29. Near point test to measure stereoacuity in children:
F a. Howard-Dohlman test
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T b. Frisby stereo-test
T c. Lang stereo-test
T d. TNO stereo-test
T e. Random-dot E stereo-test
30. Ocular manifestations of child abuse:
F a. Malingering
T b. Subluxated lens
T c. Esotropia
F d. Ametropia
F e. Inadequate accommodative facilities
31. Apgar is:
F a. Rated on a 2-point scale
T b. An index of a newborn’s health status at the age of 1 minute
F c. An index of a newborn’s health status after 5 minutes
T d. A composite index based on five vital signs
F e. Flexion of extremeties is an assessment of reflex
32. The crystalline lens of a child is inspected for:
T a. Transparency
T b. Shape
F c. Vascular dilation
F d. Motilities
T e. Position
33. Names used in qualifying children with learning disability include:
T a. Perceptually handicapped
F b. Physically handicapped
T c. Neurologically handicapped
T d. Emotionally handicapped
F e. Educationally handicapped
34. What are the types of visual problems experienced by infants up to 18 months?
T a. Neurological disorders
F b. Changing refractive error
F c. Learning-related visual disorder
T d. Strabismus
T e. Amblyopia
35. Symptoms and signs experienced by a preschooler with vision problems include:
T a. Head tilt
T b. Excessive tearing
F c. Difficulty with handwriting
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F d. Frequent headaches
T e. Tendency to bump into objects
36. Symptoms and signs experienced by infants with vision problems include:
T a. Eyes appear to be unusual
F b. Avoid close work
F c. Double vision
T d. Light sensitivity
T e. White pupil
37. Landolt broken -ring test, E-game, Picture charts are more appropriate for measuring
visual acuity of the following:
F a. Illiterates
F b. School children
T c. Pre-school children
T d. Children with special needs
F e. Geriatrics
38. Children can usually:
T a. Fixate at 6 months
T b. Fixate and follow at 6 months
T c. Fixate and follow at 3 months
F d. See colours at 6 months
F e. Recognize siblings at 6 months
39. The following are relevant to learning in children:
T a. Depth perception
T b. Eye tracking
T c. Eye muscle teaming
T d. Peripheral awareness
T e. Colour perception
40. The following information are CORRECT about learning among children:
T a. About 80% of what a child learns are via vision
T b. From birth, a child uses vision for learning and development
T Vision guides motor and cognitive processes as a child begins to grab objects
T d. Poor vision can cause delay in development and learning
T e. All of the above is correct
41. Before examination, the child MUST:
T a. Be alert
T b. Not be hungry
T c. Relaxed
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F d. Seated
F e. Communicative
42. Identification acuity tests for children include:
T a. Landolt’s C
T b. Snellen’s E
T c. Sheridan’s letter test
T d. Optokinetic drum
T e. Lea symbols chart
43. As a practising optometrist that deals with amblyopia in children the MOST common
treatment methods you will be implementing are:
F a. Electrotherapy
T b. Occlusion therapy
T c. Penalization
F d. Synoptophore exercise
F e. Pleoptics
44. The following are methods you can use to measure the visual acuity of infants:
F a. Purkinje tree
T b. Preferential looking
T c. Visually evoked potential
T d. Optokinetic nystagmus
F e. Phosphenes
45. What vision problem would you suspect in a child who frequently skips lines or loses
their place when reading?
F a. Accommodative Insufficiency
F b. Accommodative Infacility
F c. Lateral Phoria
T d. Vertical Phoria
F e. Amblyopia
46. The following characteristics are true when determining the refractive error in
children:
F a. More on the hyperopic side during subjective refraction
T b. Inability to relax accommodation during retinoscopy
T c. Inconsistent answers during subjective refraction
F d. Ability to relax accommodation during retinoscopy
T e. Accommodation fluctuates greatly during testing
47. Methods of measuring the visual acuity of an infant include:
F a. Pinhole acuity
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F b. Illiterate E chart
T c. Optokinetic nystagmus
T d. Visually evoked potential
T e. Preferential looking
48. Which of the following is a characteristic of preschool visual acuity test?
T a. Isolated optotypes '
T b. Matching response
T c. Non-verbal response
F d. Brighter illumination
F e. Room size
49. Deficient visual acuity in neonates may be attributable to:
F a. Undeveloped structure for night vision
T b. Undeveloped structures for day vision
F c. Poor understanding
F d. Immature visual cortex
F e. Illiteracy
50. Most children are born
T a. Hyperopic
F b. Myopic
F c. Astigmatic
F d. Emmetropic
F e. Nystagmic
51. The axial length of the globe undergoes the MOST rapid growth phase during:
T a. 0 - 18 months
F b. 2 - 5 years
F c. 5 -13 years
F d. 13 - 15 years
F e. 6 - 7 years
52. The LEAST developed ocular structure at birth is:
F a. Cornea
F b. Lens
T c. Macula
F d. Optic disc
F e. Uvea
53. Dyslexia is a learning disability that is based on the ------ processing centre of the
brain:
F a. Visual
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T b. Auditory
F c. Olfactory
F d. Motor
F e. All of the above
54. A child’s eye-hand coordination is well developed by the age of:
F a. 5 - 8 months
F b. 9 - 12 months
T c. 1 - 2 years
F d. 3 - 4 years
F e. 5 years
55. Which of the following clinical tests provides the MOST information about the
binocular development of a young paediatric patient?
F a. Binocular visual acuity
F b. Alternate cover test
T c. Stereoacuity test
F d. Park’s three step
F e. Phoria test
CHAPTER ELEVEN
ETHICS AND JURISPRUDENCE
1.
A patient complained of pain and discomfort few months after contact lenses were
given. The lens was found to be too tight. It was discovered that patient went swimming
on the lens. What doctrine applies here?
F a. Doctrine of Vicarious liability
F b. Doctrine of Calculated risk
F c. Doctrine of Bad result
T d. Doctrine of Contributory Negligence
F e. None of the above
2. An optometrist will act as an expert witness in all EXCEPT:
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F a. Malpractice suit
F b. Enforcement of law
T c. Collection of loan
F d. Execution of will
F e. None of the above
3. The three conditions of termination of liability are the following EXCEPT:
F a. Patient fails to reappear for re-examination
F b. Patient was referred to another practitioner
F c. Practitioner has moved practice to another community
T d. Patient committed a crime
F e. None of the above
4.
Rules of etiquette adopted by the optometric profession to regulate professional
conduct is called:
F a. Laws of practice
T b. Ethics of practice
F c. Doctrines
F d. Legal codes
T e. Codes of conduct
5. Treatment in a manner contrary to accepted rules and results in injury is:
F a. Medical ethics
F b. Optometry ethics
T c. Optometry malpractice
F d. Jurisprudence
F e. All of the above
6. A divine healer is:
F a. Registered/qualified
F b. Involved in prescribing weak steroids
T c. Involved in prescribing ONLY diet/lifestyle
F d. A staff in a clinic
F e. An intern in the hospital
7. In mal-practice suits, these can help the optometrist financially
T a. Individual malpractice policy
F b. Expert witness
F c. Plaintiff
F d. Colleague
T e. Group practice policy
8.
When liability is assigned someone else due to legal relationship
T a. D. of Vicarious liability
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F b. D. of Calculated risk
F c. D. of Bad result
F d. D. of Contributory Negligence
F e. None of the above
9. A patient has diabetes insists on fitting contact lenses, it is:
F a. D. of Vicarious liability
T b. D. of assumption of risk
F c. D. of Bad result
F d. D. of Contributory Negligence
F e. None of the above
10. The following are ways for preparing for a testimony:
T a. Go through the case records
T b. Go to the court with the records
T c. Understand the case
F d. Don’t be confined to your licensed field
F e. All of the above
11. The purpose of a case report includes, to:
T a. Aid in the investigation of a patient’s health
T b. Aid in the investigation of the subject’s abilities
T c. Establish the possibility of the eyes, being a factor in eye strain
F d. Ensure adequate compliance to medication
F e. Establish a subject’s ability to pay
12. Determinants of office and practice efficiency include:
T a. Elimination and prevention of errors and oversights
T b. Efficiency of systems for sending patient’s elapse time
F c. High and moderate financial turnover
T d. The value of the service rather than speed of service
T e. Maintenance of patients’ confidence
13. Factors NOT considered before the purchase of a deceased optometrist s practice
include
F a. Eye examination method which is in vogue in the office
F b. Fee charging system
F c. Idea of the value of practice by close relations
T d. Non-consultation with previous patients
F e. Consultation with Bankers
14. MAJOR items filled in the account payable file will include;
T a. Purchase and delivery Slips
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T b. Invoices
T c. Monthly statements
T d. Cash discounts
F e. Cash borrowed
15. The following statements are CORRECT in practice management:
F a. Purchase and delivery slip contains name and address of the supplier
F b. Disbursement register includes the details of purchase or delivery of supplies
T c. Bill payment within a specified period may entitle the optometrist to a cash discount
T d. Monthly statement may be made by company showing amount owed it
T e. The Sole proprietor enjoys all profits and bears all loses
16. The following statements are CORRECT:
T a. A corporation is usually associated with filing fees and capital stock taxes
T b. Partnership and sole proprietorship have the advantage of freedom from government
control
F c. In purchase of the practice of a living Optometrist, announcements and publicity
should not be considered
F d. Income should be sufficient to enable the Optometrist to live comfortably
F e. The Optometrist is also a trader
17. The following statements are CORRECT:
F a. Practice “overhead” should not include depreciation of instruments
F b. Proprietorship is the most common but difficult form of practice
F c. Conventional announcement form for a practice will include equipment and tests
available
T d. For income analysis, accountant must have summary record of daily income and the
disbursement register
F e. For income analysis, the Bank must have summary record of daily income and the
disbursement register
18. The following statements are CORRECT:
T a. A profession is regulated by law, and provides training for skilled services delivery
T b. The public will be the loser, if optometry were to take the role of a trade
T c. Professions attract candidates of higher intellect and skill than do the traders
F d. Public always access the services of traders with ease and affordability
T e. A professional is guided by codes of ethics
19. Conditions for an Optometrist’s liability on a patient include:
T a. Patient’s failure to follow the optometrist’s recommendation
T b. Complete referral of a patient to another qualified practitioner
T c. Publicly known termination of an optometrist’s practice
F d. Direct dismissal of a patient with prejudice
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F e. Patient living with another optometrist in the same city
20. The following are CORRECT in practice management ethics:
T a. Doctrine of “common knowledge” means, nature of injury suggestive of negligence
F b. There is a need for expert medical testimony when the injury is due to negligence
T c. An Optometrist may be held liable, if he fails to investigate the cause of nonresponse of patient to a treatment over time
F d. A person who assents, and is injured, is referred to, in law as injured
F e. Employer can be held liable, if a servant is injured on account of negligence of
fellow servant
21. The following statements are CORRECT:
T a. Principle of “calculated risk” assumes that there is knowledge and consent
T b. Doctrine of Assumption of risk is implicated when there is knowledge and consent
T c. Violation of Code of Ethics results in the disfavour of colleagues
F d. Code of Ethics represents the interest of all elements of the society
T e. Treatment of a case, contrary to accepted guidelines, with injurious results is
malpractice
22. The following statements are CORRECT:
F a. A plaintiff may not recover damages, if his negligence was contributory and the
immediate and proximate cause of the injury being the defendant’s lack of due care
F b. Doctrine where an employer cannot be held liable if an employee is injured on
account
of the negligence of his fellow servant is called ‘good servant doctrine’
T c. Doctrine of Contributory Negligence can be antecedent and subsequent
F d. Doctrine of Vicarious Liability can be coincident and antecedent
F e. Doctrine of Vicarious Liability does not apply to optometry
23. An optometrist may be called to serve as an expert witness in the following
proceedings:
T a. Arising from the enforcement of optometry laws
T b. Involving the execution of the will of the deceased person allegedly blind or nearly
blind at the time of writing a will
F c. Involving the land space and environment where optical wares are produced
F d. Involving the execution of laws among other Allied Health Professional
F e. An Optometrist cannot be called upon as an expert
24. Acts which an optometrist may include in his practice, but not exclusive to Optometry
include:
P a. The dispensing of lenses and drugs
P b. The filling of prescription forms
F c. Use of drugs, surgery or the medical treatment of the eyes
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T d. The prescribing glasses and adapting the glasses to the patients face
F e. Referral of a patient to an ophthalmologist for ocular enucleation
25. The following apply to compensation] professional fees:
T a. Consideration is deemed unlawful, if contrary to law, morals, or public opinion
T b. Payment in kind for professional services
T c. Compensation or fee for services may be either in legal tender of currency or in-kind
T d. Payment in kind for professional services should not involve entering into a contract
with patient, that the patient shall submit to an illicit relationship
F e. Payment in kind is not professional
26. Express content of the professional oath of practice include, to:
F a. Always place the Welfare of my parents/guardians before all other considerations
F b. Show concern and compassion to patients at all times
T c. Reserve the confidentiality of all information revealed by or obtained from patients
F d. Behave in a proper manner towards my community
F e. Stay happy with my patients at all times
27. Modes of optometric practice include:
T a. Sole proprietorship
T b. Partnership
T c. Franchise
F d. Specialist practice
F e. Co- management practice
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CHAPTER TWELVE
COMMUNITY OPTOMETRY
1.
The MOST difficult access group for eye care services are:
F a. The rich
T b. The poor and destitute
T c. People disillusioned with existing services
T d. Many from slums and rural areas
F e. All of the above
2.
The EASY access group for eye care services are:
T a. Relatives of the rich
F b. Most of the blind and severely impaired
T c. The well educated
T d. More visually impaired than the blind
F e. None of the above
3.
The following are limitations of a mobile eye clinic:
F a. Inability to offer First Aid services
F b. Cannot provide care for minor eye infections
F c. Only good for detecting binocular vision anomalies
T d. Quality of care is not always guaranteed
T e. Quite often patients are seen superficially
4. The ability to CORRECTLY identify those having the disease is called:
F a. Accuracy
T b. Sensitivity
F c. Specificity
F d. Redundancy
F e. Diagnosis
5. The ability to CORRECTLY identify those not having the disease is called:
F a. Accuracy
F b. Sensitivity
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T c. Specificity
F d. Redundancy
F e. Diagnosis
6. What type of eyewear is considered INADEQUATE protection from sport injuries?
T a. Glass lenses
T b. CR-39
T c. Open Eye guards
T d. Hinge frames
F e. Polycarbonate
7. The MOST common ocular injury from a deployed air bag is:
F a. Vitreous haemorrhage
F b. Glaucoma
T c. Corneal abrasion
F d. Retinal detachment
F e. Angle recession
8. Vision changes in astronauts can be:
T a. Hyperopic shift
T b. Elevated Intra Cranial Pressure
T c. Optic disc edema
T d. Globe flattening
T e. Retinal changes
9. Ocular risks of long-term exposure to sunlight include:
T a. Pterygium
T b. Cataract
F c. Conjunctivitis
F d. Glaucoma
T e. Pinguecula
10. The MOST common cause of injury to the elderly is:
F a. Memory loss
T b. Slips and falls
F c. Blindness
F d. Urinary urgency
F e. Wrong prescription glasses
11. Elements of a comprehensive occupational examination include:
T a. Occupational history
T b. Task analysis
T c. Binocular assessment
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T d. External/internal eye health assessment
T e. Refraction
12. In selecting a proper safety eyewear, you would consider:
T a. Eye placement
T b. Vertex distance
T c. Lens size
T d. Lens thickness
T e. Field of view
13. Source(s) of disease epidemic include(s):
T a. Point transmission
T b. Person to person transmission
F c. Low immunity
T d. Continuous transmission
F e. Reversal transmission
14. _______detects the occurrence of health-related events or exposures in a target
population.
T a. Surveillance
F b. Prevalence
F c. Incidence
F d. Cases
F e. Rates
15.
! "#
$% !
! "&$%'%"&
'"' ( )")*( '%"&
x 100 at one point time is:
F a. Incidence
F b. Incidence rate
T c. Prevalence rate
F d. Cumulative incidence
F e. Rate
16. To find a difference between pre and post measurement in the same individual we
use:
F a. T - test
F b. P value
T c. Paired T test
F d. Z value
F e. Chi square
17. Disease frequency is important relative to:
T a. Patient
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T b. Time
T c. Place
F d. Disease
F e. Immunity
18. For rural outreach programme, the following equipment are recommended:
T a. Retinoscope
T b. Trial lens set
T c. Handheld keratometer
F d. Electronic non-contact tonometer
F e. Phoropter
19. The following are considered as special environmental driving conditions:
F a. Driving on highways
F b. Driving on multiple lanes road
T c. Driving during heavy snow
T d. Night driving
F e. Convoy driving
20. The following statements relate to glare:
T a. It is associated with a relatively bright source of light within the visual field
F b. It does not affect the visual performance of the subjects
T c. It causes discomfort to the subjects
T d. Disability glare is a type of glare experienced by subjects
T e. Certain visual conditions make subjects more prone to experiencing glare
21. Occupations that require efficient colour vision perception include:
T a. Graphic arts
T b. Paper making
T c. Transportation industries (railway, marine, or aviation)
T d. Textile dyeing
T e. Paint mixing
22. The following are sources of ocular hazard:
F a. Cataract
T b. Pollutants
T c. Radiations
F d. Pterygium
T e. Chemicals
23. Ocular protective devices used in sports include:
T a. Protective eye gear
T b. Helmets and face mask
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F c. Landolt ring
F d. Contact lenses
T e. Eyeglasses and goggles
24. The following are prevention strategies for xerophthalmia:
F a. Use of mosquito nets
T b. Nutritional education
T c. Measles vaccination
T d. Vitamin A supplementation
F e. Regular monitoring of blood pressure
25. The SAFE strategy for prevention of blinding trachoma include:
F a. Surgery for corneal opacity
T b. Environmental improvement
F c. Analgesics for pain
T d. Facial cleanliness
T e. Surgery for trichiasis
26. These are the people that can be infected with chlamydial conjunctivitis:
F a. Infants with low blood glucose
F b. Elderly people on dialysis
T c. Young adults who acquire the infection through sexual activity
T d. Children who develop trachoma
T e. New-born babies who acquire the infection during delivery
CHAPTER THIRTEEN
ALTERNATIVE TO CLINICAL QUESTIONS
CASE HISTORY, VISUAL ACUITY, PENLIGHT EXAMINATION,
PRELIMINARY TESTS
I. Give an insight into VA at far and at near in the following conditions, with examples
(i) Facultative hyperopia
(ii) Absolute hyperopia
(iii) High myopia
What effect does PH have on the VA in these conditions?
ANSWER:
i. Facultative hyperopia: VA is normal both at far and at near, but patient has
complaint of
asthenopia after prolonged near work e.g.
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Far VA
Near VA
OD}
OD}
OS} 6/5
OS} N.5
OU
OU
ii. Absolute hyperopia: Reduced VA at both far and near, and there is improvement
through PH e.g.
Far VA
Near VA
OD}
OD}
OS} 6/12
OS} N. 10
OU
OU
iii. High myopia: Reduced VA at both far and near which is improved though PH e.g.
Far VA
Near VA
OD
OD}
OS 6/60
OS} N.12
OU
OU
2. What symptom would your patient present with that may make you suspect
astigmatism?
ANSWER:
Asthenopic symptoms - headache (frontal and temporal)
Tearing
Smarting
Eyestrain
Blurred vision in higher degrees of astigmatism
3. What signs would your present that may make you suspect astigmatism?
ANSWER:
Constricted pupils
Narrowed palpebral fissures
Contracted brows
For patients who are already wearing lenses is the desire or tendency to wear the
lenses inclined to the plane of the eye at some odd angle
The tilting or carrying of the head on one side, resorted to by some patients with
oblique astigmatism
4. How would you measure the integrity of the macula in an elderly patient with lens
opacity, using the light projection test?
ANSWER:
*Light perception of the patient is checked as light is flashed at four quadrants of the
eye with the opacity. The quadrants where light is perceived are marked out on a cross.
*Light perception signifies that the macula is intact.
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5. What could a sign of head tilt noticed on your patient during case history indicate?
(State 4)
ANSWER:
Astigmatism
Vertical imbalance
Cyclophorias
Aniseikonia
Ocular paralysis
Torticolis of oblique muscle or vertical external muscle paralysis
6. State 3 ocular signs and 3 ocular symptoms you probe in case history; and 2
conditions, each could be indicative of.
ANSWER:
*Signs
Injections (ciliary Injection may indicate keratitis, iritis, cyclitis, and angle
closure glaucoma; while conjunctival injection may indicate conjunctivitis, presence of
foreign body, trauma etc)
Oedema (corneal oedema can be seen in eye diseases or contact lens wear with
low oxygen transmissibility; conjunctival oedema may be seen in inflammation, thyroid
ophthalmopathy etc.)
Hyperemia (conjunctival Hyperemia may be seen in the presence of foreign body
and conjunctivitis)
Ptosis (if acquired may indicate trauma or any affection of the nerve supply of
the upper eyelid musculature from a disease of the muscle themselves e.g. myasthenia
gravis, tumour or chronic tissue hypoxia e.g. diabetes)
Head tilt (may indicate astigmatism, vertical imbalance, strabismus,
Cyclophorias, Aniseikonia, ocular paralysis, torticolis of oblique muscle or vertical
external muscle paralysis)
Crust or flakes (may indicate blepharitis and conjunctivitis) etc.
*Symptoms
Blur at far (may indicate myopia, myopic astigmatism)
Blur at near (may indicate presbyopia)
Blur at both far and near (may indicate high myopia, absolute hyperopia, high
astigmatism, myopic presbyopia, hyperopic presbyopia, astigmatic presbyopia, any
ocular pathology that could affect visual acuity)
Headaches (may indicate uncorrected refractive error usually hyperopia and low
grade astigmatism, binocular vision anomaly, some eye diseases raised or low blood
pressure)
Diplopia (may indicate sclerosis, multiple sclerosis, binocular vision problem,
strabismus, myasthenia gravis, polyopia etc.)
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Monocular diplopia (may be caused by irregular refraction in one eye, e.g. in
elderly cataracts and corneal opacity), itchiness (may indicate any of the forms of
allergic conjunctivitis-vernal, atopic, giant papillary conjunctivitis, phlyctenular etc;
mild hypropia, mild astigmatism etc)
Burning (may indicate uncorrected refractive error, dry eyes, inflammation,
ocular irritation etc.)
Tearing (may indicate ocular surface diseases, inflammation, presence of foreign
body, corneal abrasion etc.)
Pain (may indicate ocular disease like inflammation, acute angle closure
glaucoma, corneal foreign body, abrasion etc.)
photophobia (may indicate ocular inflammation like iritis, conjunctivitis,
keratitis, etc. and refractive error)
Halos (may indicate corneal oedema, angle closure glaucoma, keratitis etc.)
Floaters (may be seen in posterior vitreous detachment, retinal detachment,
vitritis, and asteroid hyalosis)
Flashes of light (may indicate rhegmatogenous retinal detachment, posterior
vitreous detachment, proliferative diabetic retinopathy, papilloedema, retinal break or
migraine)
Secretion (may indicate ocular inflammation, ocular infection and ocular surface
disease etc.)
7. What does the acronym, PERRLA mean? Mention the tests involved here. Mention
three (3) pathologies where these tests could be significant and how they could be
significant?
ANSWER:
Pupil Equal, Round, Reactive to Light and Accommodation. The tests are direct,
consensual and near pupillary reflex tests.
*Adie's pupil (direct and consensual, almost abolished, near reflex, delayed and slow;
affected pupil is the larger of the two-anisocoria). May be due to injury or disease to
ciliary ganglion or to short ciliary nerves, temporal arteritis, syphilis or diabetes
*Amaurotic pupil (miotic pupil that does not react to direct and consensual ipsilateral
light stimulation, but does react consensually to contralateral stimulation). Noted in
cases of severe optic nerve dysfunction or retinal disease
*Argyll Robertson pupil (pupils with presence of near reflex and absence of direct and
consensual reflexes). Condition is bilateral; pupils are small and usually unequal.
Usually a sign of neurosyphilis.
*Horner's pupil (miosis seen in Horner's syndrome; as a result of interruption of the
sympathetic nerve supply to the dilator papillae muscle which may be caused by
tumour, carotid and aortic aneurysms etc).
*Hutchinson's pupil (pupil is directed and completely inactive to all stimuli. It is
associated with lesions of the central nervous system, as may occur in head injury) etc.
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8. Why do you record patient's name as part of demographic information in Case
History? (3 reason)
ANSWER:
-Communication between patient and examiner flows as the practitioner identifies the
patient by name (not as an inanimate object).
-Gives the patient a psychological lift, this makes the examination procedures smoother.
-Could be used in filing cards where the patient's surname is used to locate the card
during subsequent visits.
-Proper documentation of patient’s data, in terms of prescription (drugs and glasses),
laboratory tests, test results etc.
9. A patient has a far entry VA of OD 6/12 OS 6/5, considering the eyes separately and
together, give four possibilities.
ANSWER:
Refractive error - anisometropia, most probably myopia in OD.
-Pathology that affects VA in OD / amblyopia in OD.
-Pathology that does not affect VA may be present in OD and hence not the cause of the
reduce VA.
-Facultative hyperopia or emmetropia in OS.
-Pathology that does not affect VA may be present in OS, hence normal VA.
10. You got a far VA of OD 3/60 for a patient; what does this VA mean in simple
terms?
ANSWER:
What the normal eye sees at 60m, the right eye of the patient saw it at 3m.
11. What does a far VA of OU 6/4 mean in simple terms? What are the possible
implications if a patient has such a VA?
ANSWER:
*What the normal eye sees at 4m, both eyes of the patient saw it at 6m. *Emmetropia /
Facultative hyperopia / Mild pathology that does not affect VA.
12. A patient's chief complaint is blurred vision primarily in reduced illumination; give
two likely causes of this.
ANSWER:
*Retinitis pigmentosa
*Avitaminosis A (Vitamin A deficiency)
*Coronary Cataract.
13. How will you establish Marcus Gunn pupil in a patient?
ANSWER:
Perform the swinging flash light test, The Marcus Gunn pupil will dilate when the eye is
illuminated, as if the patient had "gone into a dark room", because of a lesion of the
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optic nerve of that eye. This is an afferent pupillary defect. Both pupils dilate when light
is directed into the affected eye, and Constrict when the light is directed into the normal
eye.
14. Why do you/we measure pupil size in the clinic? (3 reasons)
ANSWER:
-To detect anisocoria; this might be physiological, pathological or pharmacological.
-Mydriasis or miosis in both eyes is diagnostic (could be pathological - myopia or
hyperopia, pathological or pharmacological)
-Very useful in contact lens fitting to determine the optic zone diameter (OZD) of the
contact lens to be ordered for the patient.
15. How will you diagnose a patient with Argyll Robertson pupil in the pupillary reflex
tests? What does this kind of pupil indicate?
ANSWER:
*Check the size of the pupils and perform the pupillary reflex tests. Findings: Loss of
direct and consensual reflexes, but responds to accommodation (near reflex) / also
normal convergence and otherwise normal vision. Miosis may or may not be present.
*Usually indicates syphilis of the CNS (neurosyphilis).
16. A patient's chief complaint is photophobia, state four pathologies that would elicit
photophobia as a symptom.
ANSWER:
Acute angle closure glaucoma (AACG)/ Conjunctivitis/ Acute uveitis/ Keratitis etc
17. What symptoms (2) and signs (2) would a patient who has vernal conjunctivitis
present with?
ANSWER:
*Symptoms: Ropy discharge/ Severe itching.
*Signs: Cobblestones/ Limbal opacities/ Herbert's pits.
18. Is the near reflex intact in Argyll Robertson pupil? Give reason(s) for your answer.
ANSWER:
It is intact because the afferent pathways differ. The accommodation aspect- visual
cortex: the convergence aspect- 5th cranial nerve then synapse at Edinger-Westphal
nucleus.
19. How would you determine the dominant eye of your patient? Give 2 uses of it.
ANSWER:
*Hole in the card test (Dolman's test). The test consists of a card with about a 1cm
diameter hole in it, through which the patient views a spotlight (or a letter) on a distant
test chart, while holding the card with both hands. The eye that the patient uses to view
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the target is the dominant eye. This is easily detected by having the patient occlude each
eye in turn and when the dominant eye is covered the spotlight can no longer be seen
through the hole.
*Monovision contact lens fitting/Since it is the eye which is relied upon more in
binocular vision, it therefore guides in prescription (binocular balancing).
20. How is the diplopia test performed? When is the diplopia said to be uncrossed
(homonymous) and crossed (heteronymous)?
ANSWER:
*A pencil is held vertically a short distance in front of the eyes while a more distance
object is steadily fixated, the pencil will appear in crossed diplopia. When the pencil is
fixated the more distant object will be seen in uncrossed diplopia.
*Uncrossed Diplopia of the farther target when the nearer target is being fixated.
Crossed
Diplopia of the nearer when the farther target is being fixated.
21. How is trans-illumination performed using the pen torch? What do you want to
achieve with this procedure?
ANSWER:
*Press the bulb of the pen face down on thy part of the orbit to be examined, make sure
the bulb is Properly covered around it with the palm, so that the light is concentrated
on the area to be examined. This is performed in a dimly lit room.
*Opacities are looked out for on the reddish background.
22. How is the anterior chamber depth estimated in the absence of the slit lamp
biomicroscope? Explain the principle behind the test.
ANSWER:
*Shadow test is performed. Test is performed with the penlight directed from the
temporal side at a 90° angle to the line of sight (LOS) while the patient fixates the
examiner's eye from a distance of 30cm. If the cast fills the nasal side (3mm or more) of
the cornea, the anterior chamber is very shallow; if the shadow fills about a ¼ of the
nasal side, it is shallow; if little or no shadow is cast it is deep. In the normal patient
the shadow is 1-2mm wide.
*Principle of the rectilinear propagation of light. Iris protrusion will block anterior
chamber and cast a wider shadow implying shallow anterior chamber.
23. How do you proceed with the determination of the VA of your patient assuming
he/she is unable to read the 6/60 line? Of what relevance would PH be in a VA like
this?
ANSWER:
*Move chart closer, 4m, 3m, 1m/ Counting finger-CF/ Hand movement-HM/ Light
perception-LP.
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*Improvement of VA through PH shows that patient's VA may be improved with lenses.
24. How would you measure the IPD of a patient? Which four precautions are taking in
this exercise?
ANSWER:
*Measure from the temporal pupillary, limbal or corneo-scleral margin of one eye to
the nasal pupillary, limbal or corneo-scleral margin of the other.
*Same eye level with patient/ Proper alignment/ Ensure that instructions are adhered
to/ Face of the patient should be well illuminated/ For near PD, the distance from the
patient's eyes to the examiner's eye should approximate the patient's intended working
distance.
25. Give three (3) supplementary VA tests and indicate when they are used. Mention
three (3) instances when the Pinhole disc will not improve vision, three (3) instances
where it will lower the visual acuity and three (3) instances when PH will give a greater
improvement than lenses.
ANSWER:
*Pin hole - Reduced VA (to know whether the VA reduction is due to refractive or other
causes)
*Stenopaic disc- Astigmatism
*Isolated letters - Amblyopia and the elderly (to put crowding phenomenon in check)
*Opacities in the media/Edema of the retina/Dystrophy/Mature cataract/Vitreous haze
*Presence of macular lesion/ Amblyopia/Impaired light sense
*Punctate (discrete) opacities/ corneal dystrophy (e.g. conical cornea)/ irregular
astigmatism
26. Your patient's complaints include diplopia which disappears when either eye is
closed. How you would investigate further into the problem?
ANSWER:
One must ascertain if it exists when either eye is closed or when only one eye is closed
i.e. monocular or binocular diplopia. If it disappears when either eye is closed, it is
diplopia resulting from binocular in-coordination.
The clinician is directed towards investigation of the coordination of the extra ocular
muscles and the vergence system. Broad H test and the vergence test are done (Brief
description).
27. Your patient presents with red eyes. How would you get a clue to the etiology of the
redness?
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ANSWER:
From case history and external examination. Also pull the temporal canthus slightly to
see if the redness would move.
*Moving -------------conjunctival infection
*Not moving ------deeper infection
*Bright red---------possibly conjunctival
*Dull red------------possibly deep seated
*Unilateral red eye-----could be viral or bacterial infection
*Bilateral red eye------allergic, bacterial, Chlamydial or viral
28. During BP measurement of a subject, at what part of the arm is the stethoscope
placed?
ANSWER:
The chest piece of the stethoscope is placed in the antecubital space below the cuff
distal to the brachium.
29. Explain the absence of any sound beard during BP measurement when the cuff is
inflated.
ANSWER:
The pressure in the cuff is high enough such that it completely occludes the blood flow.
30. A student walks into the clinic with epiphora due to object that flew into his eye
during a short distance motorcycle ride. What preliminary test would you perform and
what are you looking out for?
ANSWER:
External assessment, upper and lower lid eversion- to check for foreign body. Check the
lacrimal excretory system for obstruction and stenosis.
31. An elderly Patient complains that his or her eyes run water and it feels like the eyes
are filled to the brim. What test would you do to diagnose his problem?
ANSWER:
This condition (pseudoepiphora) results from reflex tearing secondary to a dry eye. The
Schirmer 1 test is performed and interpreted.
32. Your patient walks in having difficulty around the corners and sitting down on the
examination chair. How would you uncover his visual field restrictions under
preliminary examination?
ANSWER:
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Visual field test using confrontation test (Brief description)
33. How would you assess if the anterior chamber angle of an uncooperative child is
open?
ANSWER:
Shadow test. The test is done under room illumination. A penlight is placed on the
temporal side of the eye at the level of the pupil and the beam of light is directed
horizontally towards the inner side of the eye. lf the iris lies in a flat plane, which
usually indicates a deep anterior chamber, the entire iris will be illuminated. If the iris
is directed anteriorly, which usually indicates a narrow anterior chamber, the iris on
the temporal side of the eye will be illuminated but the iris on the nasal side will be
shadowed to varying degrees depending on the narrowness of the anterior chamber.
Possible results include wide open, open angle, moderately narrow angle, and
extremely narrow angle.
34. Describe how you would measure the near and far IPD of your patient.
ANSWER:
IPD measurement at both distances using limbal margins, pupil margins, centres or
corneal reflexes (Brief description of IPD measurement)
35. Your patient comes back to the clinic complaining of his glasses. You notice that
the glasses are more comfortable tilting. How would you determine if the pupillary
centres of the patient aligned with the optical centres of the glasses?
ANSWER:
Compare patient's far IPD to the distance between centres of lenses (DBL) of the
glasses to ensure they coincide.
36. Assuming your patient has left eye esotropia, how would you measure his IPD at
both distances?
ANSWER:
Monocular IPD (Brief description).
*If a patient's strabismic eye will not fixate with both eyes open, cover the non
strabismic eye when it is desired to have the strabismic eye fixating.
*If the clinician has difficulty voluntarily closing an eye and cannot suppress, cover it
with the palm of your hand, making it seem like a normal part of the test.
37. Describe a test under preliminary examination which will give you useful
information on the integrity of the iris, optic nerve, the posterior visual pathway and the
third and sympathetic nerves to the eye
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ANSWER:
Pupillary tests. Pupil are equal, round, reactive to light and accommodation
(PERRLA).
38. How would you detect anisocoria in your patient?
ANSWER:
Measure the size of the pupils. In anisocoria, the pupils are unequal.
39. Measure the direct pupillary light response for your patient. Assuming they are
different for both eyes, show how you will record them.
ANSWER:
Pupils are equal, round; respond to light and accommodation (PERRLA)
*Static pupil size measurement (0-no change in size, 3- large change in size)
*Direct pupillary light response
*Speed (+ fast, - slow)
40. Describe how the pupillary near reflex (accommodative reflex) test is performed.
ANSWER:
This is the quantity and quality of change in the size of the pupil when fixation is
changed from distance to near or from near to distance
Method:
*Have the patient fixate a distant target in a room illuminated just enough to see the
pupil and observe the size of the pupil of the RE.
*Quickly place a target (small picture or letters) at about 25cm in front of the RE (to
avoid the convergence movement of the RE) and slightly lower than the distance target
and ask the patient to look at the near target.
*Record the change in the size of the right pupil (quantity) and the speed of the change
in the size of the pupil (quality). Repeat the same procedure for the LE pupil. It is easier
sometimes to see the change in the size of the pupil when the patient fixates the distant
target. This can be used to indirectly evaluate the near response.
41. Your patent experiences diplopia monocularly (diplopia seen by one eye only). How
would you investigate further into the problem?
ANSWER:
Find out which eye is experiencing the diplopia, then do a PH test. Monocular
disorders are usually optical in nature. Monocular diplopia is usually caused by
irregular refraction in one eye (e g. in early cataracts, corneal opacity) or two pupils in
one iris (dicoria) or multiple pupils in one iris (polycoria).
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42. A patient presents with sudden eye pain and complaints of blurred vision. How
would you determine the extent of blurred vision?
ANSWER:
VA at both distance; OD, OS & OU (Brief description)
43 How do you align the zero position in measurement of pupillary distance?
ANSWER:
The examiner closes his right eye and the patient is directed to look with his two eyes at
the examiner's left eye. The examiner places the PD rule at the patient's nose bridge. He
then aligns the zero point of the ruler with the temporal limbal margin of the patient's
right eye.
44. Use the pinhole disc to estimate the nature of the refractive state.
ANSWER:
The pinhole is held several inches before the eye monocularly and the line on the chart
is selected for fixation. The pinhole is moved up and down slightly while the target is
being observed through it for the direction of motion. If the chart moves opposite to the
movement of the disc, the error is hyperopia. If it moves with the disc, the error is
myopia.
45. How would you perform the corneal reflex test?
ANSWER:
The patient is instructed to look at the penlight introduced at 40cm. The light is directed
at the nose bridge of the patient while the examiner examines the corneal reflex in the
patient's eyes. If no tropia exists, the corneal reflex will be approximately 0.5mm nasal
to the centre of the pupil.
46. How will you convert a Snellen's visual acuity value to logMAR equivalent?
ANSWER:
By calculating the Minimum Angle of Resolution (MAR) and determining the logarithm
of the MAR. Example:
MAR of 6/60 is 60/6 = 10
Logarithm of 10 = 1
Therefore, logMAR equivalent of 6/60 is 1 logMAR
47. You are using a standard IogMAR chart (5 letters per row) to measure visual acuity,
a patient read only the first row (1 logMAR, 6/60 equivalent) and two letters in the
subjacent row. How will you record his VA?
ANSWER:
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The patient read 2 letters in the next row, and each latter is scored 0.02 because there
are five Ietters per row and each row has a value of 0.1logMAR. Value of letters read is
2 x 0.02 = 0.04. This should be subtracted from the value of the line read. 1.0 - 0.04 =
0.96 logMAR.
48. Describe the appearance of ciliary Injection.
ANSWER:
Ciliary Injection will have red eye effect that the bloody appearance will fade towards
the fornix, while the bloody area will be towards the limbal margin.
49. What will make you suspect your patient on external examination of having viral
and not bacterial infection, even when on laboratory result is available?
ANSWER:
Most bacterial injections are with copious film (mucous) discharges, while viral
infection came with only watery discharges.
50. Assess macular integrity in an elderly with cataract using +3.00D Add.
ANSWER:
Evaluation of VA at near through +3.00DS Add. A good acuity indicates good macula.
51. In Case History, under conditions of General Health, why do we enquire about
Dental Health?
ANSWER:
Pulpless teeth and foci of infection act as sources which produce reflex neuroses of the
eye and inflammatory changes. The motility of the eyes may often be impaired. This is
because of the nerve connection between the teeth and the eyes.
LENSOMETERRY AND OPTICS
1. Transpose + 1.75DS / -0.50DC x 10 to Cross cyl
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ANSWER:
+ 1.75DC x 100/+1.25DCx10
2. How is Prentice's rule applied?
ANSWER:
Prentice’s rule is used in decentration to determine the prismatic power (i.e. P = cF;
where P is the prismatic power, c is the decentration in cm, and F is the power of the
lens in dioptres).
3. Transpose +1.00DC x 110/ +0.50DC x 20 to Sph cyl
ANSWER:
+1.00DS/ -0.50DC x 20
4. Place this Rx on the optical cross -2.00DS/ -0.50DC x 055° (Also, supply the total
power on each meridian).
ANSWER:
55
−}-2.00
145
- 0.0}-2.25
5. Represent the prescription on the optical cross, also stating the total power on each
meridian +1.50DS/ -0.75DC x 30
ANSWER:
120
30
+1.50] +1.50
0.00
+1.50} +0.75
-0.75
6. What are the two (2) basic parts and the nine (9) essential parts of an eye glass
frame? Which dimensions do we usually measure? What is pantoscopic tilt as against
retroscopic tilt?
ANSWER:
*There are two (2) basic parts: the frame front that holds the lenses, and the temples
that hold the frame from falling off the face. The nine (9) essential parts are: rims,
endpieces, bridge, hinges, lenses, screws, nose pads, pad arms, and temple.
*We measure Temple/Temple to bend/span/Distance between lenses/Size of
eyewire/Bridge length etc.
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*Pantoscopic tilt is when the superior edge of the lense is farther away from the face
than the inferior edge, while retroscopic tilt is when the superior edge of the lens is
closer to the face than the inferior edge.
7. Transpose to cross cylinder and represent on the optical cross
-1.50DS/ -0.75DS x 90
-1.50
ANSWER:
-1.50DC x 180/ -2.25DC x 90
18
-
9
8. Transpose -5.25DC x 90/ -7.50DC x 180 to a sphero-cylinder (Give the answer in
plus cylinder).
ANSWER:
-5.25DS/-2.25DC x 180
Plus cylinder: -7.50DS/ +2.25DC x 90
9. Transpose to a sphero-cylinder and to a second sphero-cylinder.
+1.25DC x 30/ -0.50DC x120
ANSWER:
+1.25DS/ -1.75DC x 120
-0.50DS/ 1.75DS x 30
10. Transpose to a spherocylinder (Give your answer in plus cylinder)
+1.25DC x 90/-0.50DC x 180)
ANSWER:
+1.25DS/ -1.75DC x 180
Plus cylinder form: -0.50DS/ +1.75DC x 90
11. Calculate the prismatic effect induced and the base direction, if a +10.00DS lens is
to be decentred 4mm out.
ANSWER:
P = cF (c in cm)
P = 0.4 x 10 = 4∆BO
12. What is the prismatic effect induced and the prism base direction when a -6.00DS is
decentred 3mm in?
ANSWER:
= cF (c in cm) = 0.3x6 = 1.8∆BO
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13. How would you measure the spherical power of a lens using the lensometer?
ANSWER:
Turn the power drum towards you until the first mire comes into focus. If the triple lens
come into focus first, rotate the axis wheel by 90°, then try again. The single line should
come into focus first. This first reading is the spherical power.
14. How would you measure the cylinder power (if present) in lensometer? Give a
specific example.
ANSWER:
After getting the single line mire in focus (first reading) which is the sphere power, turn
the power drum until the triple lines come into focus (second reading). The cylinder
power is the difference between the first reading and the second reading. Example: If
the reading for the single line mire is -1.00D and the reading for the triple line mire is 2.50D, the cylinder power is -1.50D.
15. How would you measure the cylinder power (if present) and axis in lensometer?
Give specific example. Also give the power of the Rx.
ANSWER:
*After getting the single line mire in focus (first reading) which is the sphere power,
turn the power drum until the triple lines come into focus (second reading). The
cylinder power is the difference between the first reading and the second reading and
the axis is the triple lines' meridian.
*Example: If the reading for the single line mire is +0.50D and the reading for the
triple lines' mire is -1.50D on the 180 meridian; the cylinder power is -2.00DC x 180.
*The power of the Rx is: +0.50DS/ -2.00DC x 180.
SLIT LAMP BIOMICROSCOPY AND GONIOSCOPY
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1. How is the optic disc observed in slit lamp biomicroscopy?
ANSWER:
It is observed by attaching the Hruby lens which is a high minus lens.
2. A patient has anterior uveitis, what would you likely see in slit lamp biomicroscopy?
ANSWER:
Ciliary Injection/Exudation into the anterior chamber/Iris changes/Adhesion between
the iris and lens (posterior synechia)/Miosis/Keratic precipitates.
3. Differentiate between glaucomatous disc cupping and primary or simple optic disc
atrophy as seen with an ophthalmoscope. (Give 2)
ANSWER:
Glaucomatous Disc Cupping
Blurred disc margin
Nasal shift of vessels
1° Optic Disc Atrophy
Well defined disc margin
No nasal shift of vessels.
4. How will you use sclerotic scatter illumination of the slit lamp to examine corneal
edema or foreign body, or abrasion of the cornea?
ANSWER:
The patient should be comfortably seated at the instrument; such that his or her chin
could rest on the chin rest. Dim illumination could be used. Slit of medium width is
directed towards the limbus from a wide angle. A halo will be seen around the cornea
due to total internal light reflection. The corneal edema will be visible from the dark
background due to light scattering. The microscope will be focused on the cornea to
view the edema or other disorder
5. How would you perform Gonioscopy on a patient? What anatomical areas are seen?
ANSWER:
*With 4 Mirror Gonio-lens
i.
Patient lies supine with the examiner on the side of the eye to be examined (lf the
hand-held
i.
SLB is `used, otherwise the patient is seated infront of the SLB).
ii.
Topical anaesthetic is applied and the Gonio-lens is positioned on the cornea
using methylcellulose.
iii. Examiner holds the Gonio-lens in one hand and the slit lamp harbouring the light
source in the other. Using mid magnification 16x, scan the anterior chember angle by
turning the Gonio-lens until all the 360 degrees have been studied
*With 3 Mirror Gonio-lens
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i.
After anaesthetiizing the cornea, the coupling gel (methylcellulose) is inserted
into the cup of the gonio-lens.
ii.
Gonio-lens is placed and tipped onto the cornea.
iii. Slit lamp beam is focused on the mirror which shows the inverted angle image.
*The anatomical areas seen are:
i.
Iris
ii.
Ciliary body
iii. Scleral spur
iv.
Trabecular meshwork
v.
Schwalbe's line
6. Describe the procedure for slit lamp biomicroscopy.
ANSWER:
•
Before using the slit-lamp, it is important to ensure that the instrument is
correctly set up.
*The eyepieces should be focused for the observer for his/her own refractive error.
*Often a little more minus correction is required than the observer's actual refractive
error due to accommodation and proximal convergence.
*The pupillary distance (PD) is adjusted for the observer (perhaps the PD should be
slightly less than that usually measured to account for proximal convergence).
*Check that the observation and illumination systems are coupled, and the slit-beam is
of even illumination and has sharply demarcated edge (otherwise irregularity of the
bran: may be falsely interpreted as irregularity of the beam may be falsely interpreted
as irregularity of the tissues).
•
The slit-lamp examination is conducted in a semi-dark room.
*Patient is seated in front of the slit-lamp on an adjustable stool and his/her head is
steadied by placing chin an chin-rest and his forehead rests on the bar of head-rest.
*Adjust the chin-rest so that the patient's eyes are approximately level with the black
marker on the side of the head rest.
*Focus the slit-beam on the eye by moving the joystick either towards or away from the
patient.
*The examination should be commenced using the 10x eyepieces and the lower
powered objective to locate the pathology and higher magnification should then be used
to examine it.
*Use the lowest voltage setting on the transformer.
*Select the longest slit length by mean of the appropriate lever.
*The angulation between the observation arm and the illumination arm is adjusted.
7. Describe the Diffuse Illumination technique in SLB.
ANSWER:
I) Swing the microscope aside or keep it at 30- 40° of angle.
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2) Open the slit beam to full height and width.
3) Dial in the neutral density filter.
Beam is only 8-14mm diameter and therefore must be moved over the eyelids and
ocular surface.
8. What does Diffuse Illumination of SLB reveal?
ANSWER:
It can reveal location and general pattern of eyelid. It also reveals conjunctival and
corneal lesions.
9. Describe how you would check for aqueous flare and cells in SLB.
ANSWER:
•USING CONICAL BEAM: Conical beam is a small circular beam used to examine the
presence of cells and flare
*Beam: Small circular pattern.
*Light Source: 45-60° temporally and directed in to the pupil.
*Biomicroscope: Directly in front of the eye.
*Magnification: High
*Focusing: Beam is focused between cornea and anterior lens surface.
10.
Describe
Optic
section
procedure
size/Illumination/magnification and purpose.
in
SLB
in
terms
of
ANSWER:
*Slit width, 1mm or less
*Illumination angle, 45-60° or more
*High Illumination & magnification
• Purpose:
*Corneal depth, layers, scars, vessels, lens opacity
11. Describe direct Retro-illumination
illumination/size/magnification and purpose
in
SLB
in
terms
of
angle
of
ANSWER:
*Object of interest is illuminated by light reflected from the structures behind it.
*Vary angle of illumination (usually 45°)
*Moderately wide beam
*Slit beam is offset.
*Medium to high magnification (16x to 25x)
*Reflected light from iris (to view corneal pathology) or fundus depending on structure
of interest.
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12. Describe using SLB for indirect Ophthalmoscopy.
ANSWER:
Biomicroscopic Indirect Ophthalmoscopy.
*The patient's pupil may be dilated and background lights dimmed as for direct
ophthalmoscopy
*The patient is positioned comfortably at the slit lamp
*The slit lamp viewing piece and the light column are kept at an angle of 90° degrees.
*The intensity of the beam is kept to the minimum possible and the magnification
preferably set at 10x initially.
*The slit beam is set around 1.5-2.5mm wide and 5-10mm long.
*The beam is focused onto the patient's pupil and the condensing lens aligned at
around 1cm from the patient's eye.
*The slit lamp is then pulled backwards gradually towards the examiner until it comes
into focus with the aerial image of the fundus between the condensing lens and the slit
lamp.
*Alternatively, the slit lamp could be drawn back completely towards the examiner and
then gradually moved forwards until the image comes into focus.
*As with indirect Ophthalmoscopy, the image from a non- contact Volk Lens slit lamp
biomicroscopic examination is inverted and laterally reversed.
13. Describe diffuse type of illumination in SLB based on: a) Room Illumination b)
Beam size and Illumination angle c) Magnification d) Size of slit.
ANSWER:
a) Room Illumination is reduced.
b) A wide, unfocused beam of light is directed at the cornea from an angle of
approximately 45°
c) Magnification is low (6x)
d) Slit is opened completely for overall survey of the eye.
14. How do you produce the optic section?
ANSWER:
Narrow the slit to almost closed position less than 1mm wide.
15. How do you produce the parallelepiped section?
ANSWER:
The slit is wider than the optic section to give a 3-dimensional outlook.
16. After fluorescein staining of the cornea, how are areas of epithelial abrasion
identified using SLB?
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ANSWER:
Abrasions appear greener than the surrounding.
17. How do you produce the conical beam section?
ANSWER:
Both the height and width of the parallelepiped beam are reduced to obtain a circular
aperture, small enough to (go) through the pupil.
18. How do you produce the indirect type of illumination in SLB?
ANSWER:
Rotate the reflecting mirror or prism out of the click stop position to illuminate an area
adjacent to that under observation.
19. With a specific example, state what happens in Retro-illumination with the slit
lamp.
ANSWER:
To view the cornea; the parallelepiped beam is focused on the iris, while the
microscope is focused on the cornea (an anterior structure).
20. What happens in 'direct retro-illumination" with the slit lamp?
ANSWER:
An angle of 90° exists between the beam and the microscope, the beam focused on a
structure behind the structure to be viewed; and the structure is viewed in the direct
path of the reflected light.
21. What happens in 'indirect retro-Illumination'' with the slit lamp?
ANSWER:
The angle is not 90° between the beam and the microscope, and the structure under
view is seen against a dark background.
22. How do you produce the 'specular reflection' type of illumination with the slit lamp?
ANSWER:
A parallelepiped beam and the angle are varied until a catoptric image of the
precorneal fluid is seen. This is reflected to pass through one of the oculars.
23. How do you produce the ‘sclerotic scatter" type of illumination with the slit lamp?
ANSWER:
A broad beam of light is focused sharply at the limbus, while the microscope is at the
cornea at low magnification. A crescent halo of light will surround the cornea.
24. Which filter do you use to observe haemorrhages on the fundus?
ANSWER:
Use the green (red-free) filter of the ophthalmoscope or slit lamp.
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25. Which filter do you use to observe corneal abrasion when fluorescein has been
instilled?
ANSWER:
Use the blue filter of the Ophthalmoscope or slit lamp.
26. Which filter in the SLB do you use to assess contact lens fit?
ANSWER:
Use the blue filter of the slit lump.
27. How do you obtain a large field of view with diffuse illumination in SLB?
ANSWER:
Use a low magnification.
28. How do you obtain a direct illumination with the slit lamp?
ANSWER:
The microscope and the beam of light are sharply focused on the same area.
29. Which beam of the SLB do you use to study the anterior chember for the presence
of floaters, pigment granules, cells and proteins?
ANSWER:
Conical beam section is used
30. Which beam of the SLB do you use to examine the different layer of the cornea and
the depth of foreign body?
ANSWER:
Optic section is used.
31. Which illumination type is used for revealing iris freckles and tumours?
ANSWER:
Tangential illumination
32. Highlight the principle behind the SLB.
ANSWER:
The principle is the Tyndall phenomenon. The principle is that when an oblique beam
light is passed through a medium containing particles in suspension, the particles
become become visible by virtue of light scattered by these particles.
33. What phenomenon is employed in the assessment of the vitreous using the slit
lamp?
ANSWER:
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Tyndall phenomenon which deals with the scattering of light through the vitreous and
observed from an angle away from the axis and different from the angle of illumination.
34. What possible changes are seen in the aged vitreous using SLB?
ANSWER:
Liquefaction, Syneresis, Asteroid hyaloids, Synchysis scintillans,
degenerations.
Amyloid
35. Give three factors that influence onset or progression of cataract.
ANSWER:
Disease, drugs and sunlight.
36. Classify senile cataract based on location as seen in SLB.
ANSWER:
Anterior subcapsular, posterior subcapsular, nuclear and cortical.
37. What clinical characteristics do you watch for in assessing the aqueous layer of the
tear film layer using the slit lamp in the elderly?
ANSWER:
Dry eye features. Watch out for tear debris, tear meniscus and corneal compromise.
38. Describe the iris of an aphakic globe as seen using a slit lamp.
ANSWER:
The iris is flat and tremulous, and could occur in secondary cataract extraction or
subluxation of the lens.
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OPHTHALMOSCOPY
1. How would you determine the location of an opacity in the right eye of a patient
during
ophthalmoscopy?
ANSWER:
You may set the ophthalmoscopy power to +2 and move to a distance approximately
50cm from the patient's right eye. Further localization of position may be determined by
moving the Ophthalmoscope in an up-and-down direction. Any opacity located in front
of the lens of the eye will appear to move in the opposite direction as the
Ophthalmoscope, whereas any opacity posterior to the lens will appear to more in the
same direction as the Ophthalmoscope.
2. Describe Amsler Grid test.
ANSWER:
-Have the patient wear his or her glasses and occlude the left eye while an Amsler grid
is held approximately 12 inches in front of the right eye.
-The Patient is asked what is in the centre of the page. Failure to see the central dot
may indicate a central scotoma.
-Have the patient fixate on the central dot (or the centre of the page if s/he cannot see
the dot). Ask if all four corners of the diagram are visible and if any of the boxes are
missing.
-Again, while staring at the central dot, ask the patient if all of the lines are straight
and Continuous or if some are distorted and broken.
-The patient is asked to outline any missing or distorted areas on the grid with a pencil.
-Repeat the procedure, covering the right eye and testing the left.
3. A patient has posterior uveitis, what would you see during ophthalmoscopy?
ANSWER:
Vitreous opacities/Chorioretinitis (choroiditis)
4. How do you establish a fundus reflex in Ophthalmoscopy? Elucidate on the uses of
this reflex.
ANSWER:
*Fundus reflex is light reflected by the fundus of the eye, it appears as a red glow in the
plane of the pupil. With the lens through which the fundus was seen in Ophthalmoscopy,
move back about 10cm to see the red background of the fundus.
*Used to localize opacities in the media (seen as black opacities on the red fundus
background), as the patient looks up, or the examiner slowly moves the
Ophthalmoscope, a 'with or against' movement and the speed or nature of movement
gives an idea of the location of opacities. It is absent when the eye has a dense cataract.
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5. What do you understand by C/D ratio, and when is it significant?
ANSWER:
*The Ophthalmoscope is used to check the ratio of the horizontal diameter of the cup to
the horizontal diameter of the optic disc. It is recorded as decimal e.g. 0.2 (if the cup is
two parts out of 10 divided parts of the disc).
*It should be less than 0.5. If it exceeds that value or if there is a difference in ratio
between the two eyes, or if there is progressive enlargement of the cup, glaucoma may
be suspected.
6. How would ascertain the location of an opacity in the Vitreous when performing
direct
ophthalmoscopy?
ANSWER:
The Patient is asked to look up. If the object moves in the opposite direction of the eye
movement and then slowly floats back to the original position, it is located in the
vitreous.
7. Establish a focus of the fundus in binocular indirect Ophthalmoscopy.
ANSWER:
The patient is in a supine position facing the ceiling and the pupils are dilated with a
mydriatic. The examiner places the Ophthalmoscope on his head. The condensing lens
is held at 50cm with the convex surface facing the examiner. While examining the
fundus, the condensing lens is moved forward and backward slightly to get the fundus
of the patient in focus.
8. How would you examine the fundus of a patient, and what are the four (4) primary
features of interest in the fundus?
ANSWER:
*Following the use a the ophthalmoscope to view the anterior structures of the eye with
power +8.00D to +10.00D in the peep hole at a distance of 10 to 12cm, the power of
the
Ophthalmoscope will be gradually reduced, while the media and the posterior segment
structures will be examined until the retina is reached. A Plano power may be
necessary to view the retina clearly, if the examiner is emmetropic.
*On arrival at the fundus, structures of interest will include the optic disc, retinal
vessels, fundus-mid and peripheral areas as well as the macular area.
9. How will you use the direct Ophthalmoscope to determine that an opacity is located
at the anterior part of the crystalline lens?
ANSWER:
The opacity that is located on the anterior part of the lens will move slowly in the same
direction that the eye moves.
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10. How would you identify that a cupped disc is glaucomatous and not physiological?
ANSWER:
While seeing the optic disc of the patient, the arteries and veins pattern will be well
separated at the disc, to the superior area and inferior area. In addition, the cup-disc
(CD) ratio will no longer be 2:1 but type IV cupping or more would be in place.
11. State how you will identify the opacity in the lens using the Ophthalmoscope
ANSWER:
While performing ophthalmoscopy on the patient, s/he is asked to look up and the
floater is watched, if it displaced but seems to remain stationary, it is in the crystalline
lens.
12. Demonstrate how you will identify sub-hyaloid haemorrhage in the fundus and the
disease etiology.
ANSWER:
While performing direct ophthalmoscopy on a patient; at the background, it will be
seen as a half-moon slightly inferior to the equator between the disc and the macula,
sometimes on the macula. The half-moon will have a straight end cup and the curved
end below; with aggregate of blood collection on the curved end and the straight end
seen clearer, this is due to gravity that the weight of blood aggregates at the lower end.
The disease etiology is usually Diabetes Mellitus.
13. How would you proceed with Ophthalmoscope?
ANSWER:
-Lower the room lights.
-Remove your eyeglasses and the patient's eyeglasses (if wearing any), but not contact
lenses.
-Show the patient a spot directly ahead of her, on which to fix her gaze. An object or
picture 1m ahead is perfect.
-She will be able to fixate only with the eye that is not being examined (that is, not being
blocked and spotlighted by the examiner).
-Hold the Ophthalmoscope to your eye so that you can see well through it. Keep your
other eye open, but ignore its input for now.
-Begin with the light at two-thirds strength. Stand 15 degrees temporal to the patient's
optical axis, your eye 30cm from hers.
-Set the lens wheel at +10 diopters. Trans-illuminate the pupil and observe reflected
red light, the red reflex
-Place your contralateral palm on her forehead, with your abducted thumb on her
supraorbital ridge, to prevent accidentally bumping brow or eye with the instrument.
Slowly move toward the patient, slowly decreasing the diopters toward zero.
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-In this way you focus successively on cornea, lens, vitreous, and finally retina. The
appearance of black spots at any point tells you that opacities are in the path of the
light and will have to be accounted for or circumvented in inspecting the retina.
-You should wind up with the instrument only 3 to 5 cm from the patient's eye. When
you see the retina, look for the first distinct structure in the area. Sometimes this will be
the optic disc, more often a vessel.
-Bring the structure into sharp focus by rotating (changing) the lens wheel as needed, A
zero reading often works well.
-Myopic examiners need a negative or red number (unless the patient's refractive error
balances the examiner's). Aphakic patients require a high positive, often + 10D; by
contrast, the patient who has an intraocular lens implant after Cataract surgery has no
such special need.
-Now move along the vessel in the direction leading to larger calibre (i.e. toward
"junctures" of vessels). Soon you will reach the optic disc. Study its colour, its lateral
margins, the size of the optic cup, the disc elevation (if any), and the pattern of the
vessels emerging from it.
Record the details in a drawing of you wish to discuss abnormalities.
14. Describe how you would Perform Binocular Indirect Ophthalmoscope on a patient.
ANSWER:
•
Alignment of the head-band of the ophthalmoscope
-Place the Ophthalmoscope on the head and adjust the straps for maximum comfort.
-Face a wall approximately 40cm away, and adjust the illumination mirror such that
the illumination field is vertically centralized to the observation ports.
-Move the viewing ports horizontally by adjusting the interpupillary distance to align
with the illumination field.
-Adjust the illumination system to give the required field.
-Set the illumination at a medium intensity to start with. Use the yellow lens to relax
the amount of blue light on the retina.
•
Procedure Proper
-The practitioner should first Illuminate the patient's pupil area by pointing the head
and hence the illumination towards the patient's eye.
-Interpose the condenser lens close to the eye about 2cm, and centre the lens on to the
pupil.
The lens should be held with the more convex side towards the practitioner.
-Pull back the lens away from the patient's eye, at the same time taking care to keep the
illumination centered on the pupil. Whilst withdrawing the lens, the practitioner will
find a distance that provides an optimum field of view. This should be approximately at
the focus of the lens, i.e. 5cm from the pupil using a +20D lens.
-Having obtained an image filling the BIO lens, the fundus may then be examined by
moving around the patient if reclining, or by redirecting the patient's fixation if seated.
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15. Assuming your patient has glaucoma, what accessory in the ophthalmoscope would
you use in make a correct assessment of the optic disc or cup?
ANSWER:
The glaucoma beam graticule is used. It is projected on the retina to assess the optic
disc or cup as an aid to glaucoma diagnosis and monitoring.
16. What accessory in the ophthalmoscope would you use to assess the eccentric
fixation you have noticed in a child?
ANSWER:
The fixation cross graticule is projected onto the retina and is used for the assessment
of the degree and direction of eccentric fixation. This is particularly useful in
examination of children.
17. During Ophthalmoscopy, you notice that there might be elevation on the retina,
what accessory in the Ophthalmoscope would you use to assess it?
ANSWER:
This is primarily used to determine retinal elevations.
18. During ophthalmoscopy, you notice that there might be depression on the retina,
what accessory in the Ophthalmoscope would you use to assess it?
ANSWER:
This is primarily used to determine retinal depressions.
19. Which accessory in the Ophthalmoscope, would you use to assess the anterior
chamber depth?
ANSWER:
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This can be used to assess the anterior chamber depth.
20. Which accessory in the Ophthalmoscope would you use to comfortably examine a
wide-dilated pupil?
ANSWER:
A wide angle beam graticule is used; this illuminates the largest area of the fundus for
the best possible general diagnosis through a dilated pupil.
21. Which accessory in the Ophthalmoscope would you use to comfortably examine an
un-dilated pupil?
An intermediate round beam graticule is used; this permits easier access through an
un-dilated pupil in peripheral examination. This is particularly useful in paediatric
examination.
22. Which accessory in the Ophthalmoscope would you use to comfortably assess the
macular area of your patient?
ANSWER:
This tiniest beam (macular graticule beam) is used, which is designed specifically for
viewing the macular area of the fundus. This reduces pupillary reaction and improves
patient comfort.
23. Which accessory in the Ophthalmoscope would you use to examine in detail the
blood vessels of a patient with diabetic retinopathy (DR)?
ANSWER:
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The red free filter (green filter) is used to examine the blood vessels in fine details. The
green filter blocks red rays, showing blood vessels as black against a dark green
background. This filter is particularly useful in assessing DR.
24. Which accessory in the Ophthalmoscope would you use to assess the extent of
damage by a corneal scar or abrasion?
ANSWER:
This cobalt blue filter is used in conjunction with fluorescein dye for the detection and
assessment of corneal scars and abrasions.
25. How would you determine the position of a floater in the eye using the
ophthalmoscope?
ANSWER:
By slightly scoping the ophthalmoscope after establishing a fundus reflex;
*If in the aqueous- moves in a “with" direction
* If in the lens - no movement
*If in the vitreous - an ‘against' movement
26. How would you use the direct ophthalmoscope to determine the type of cataract
present in your patient’s eye?
ANSWER:
The refractive status of both the patient and examiner will determine the amount of +
lenses used to see the lens clearly.
"At an angle of 60°, a milky appearance shows probably the presence of a nuclear
cataract.
*If the opacities are seen at the periphery, inferior nasal quadrant of the anterior
cortex, cortical water clefts, spoking, wedges and lamellar separation which appear
black on bright field background illumination, probably shows the presence of cortical
cataract.
*A dark grainy shadow at near or centre of the posterior portion of the lens, probably
suggests posterior subcapsular cataract.
27. How will you differentiate between papillitis and papilloedema using the
ophthalmoscope, in terms of the elevation?
ANSWER:
In papillitis, the elevation seldom exceeds 3.00D; whereas in papilloedema, the
elevation may be as high as 9.00D.
28. How will you differentiate between papilloedema and pseudopapilloedema during
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ophthalmoscopy?
ANSWER:
Papilloedema is usually unilateral, while pseudopapilloedema is usually bilateral. In
papilloedema, there may be haemorrhages around the disc in advanced stages, while in
pseudopapilloedema, there is no haemorrhage. In papilloedema, the disc margins are
blurred; while in pseudopapilloedema, the margins of the disc are relatively sharp. In
papilloedema, there is nearly always a loss of induced venous pulsation; while in
pseudopapilloedema, spontaneous venous pulsation is usually present.
29. In the Elschnig classification of disc types, how many types are involved and which
type(s) is/are glaucomatous?
ANSWER:
The cups have types 1 - 5; with the 5th type being a glaucomatous cup.
30. What are possible Ophthalmoscopic findings in a case of long standing hypertensive
retinopathy?
ANSWER:
Local and/or generalized narrowing of the arterioles, changes at the arteriovenous
crossings, copper and silver wire arteriolar light reflexes, flame-shaped haemorrhages,
cotton wool exudates and oedema; depending on the advanced stage present.
31. Which accessory in the ophthalmoscope would you use to examine a patient whom
you suspect of having ARMD?
ANSWER:
The tiniest beam (macular graticule beam) is used, which is designed specifically for
viewing the macular area of fundus. This reduces pupillary reaction and improves
patient comfort.
32. Which accessory in the ophthalmoscope would you use to examine a patient with
suspected retinitis pigmentosa and what are your possible findings?
ANSWER:
*An intermediate round beam graticule is used; this permits easier access through an
un-dilated pupil in peripheral examination.
*The possible findings are; yellowish atrophy of the Optic nerve, severe arterial
attenuation and conspicuous pigment proliferation, which begins in the equatorial
region.
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33. In ophthalmoscopy which accessory would you use to confirm the presence of
haemorrhages in the retina and what are the possible types of haemorrhages?
ANSWER:
*The red free filter (green filter) is used to examine the blood vessels in fine details. The
green filter blocks red Ray's, showing blood vessels as black against a dark green
background. This filter is particularly useful in assessing DR.
*The possible types of retinal haemorrhages are; dot and blot haemorrhages, flameshaped haemorrhage, subhyaloid. haemorrhage.
34. Establish opacity in the lens in monocular direct ophthalmoscope.
ANSWER:
Starting with a high plus, say +10D, the ophthalmoscope is made to focus on the iris at
about 25cm, without changing the lens, the viewing is moved to the crystalline lens
where the red fundus can be seen. Any opacity in the lens will show up as black patches
against the red reflex.
35. Sum two clinical advantages of binocular indirect Ophthalmoscope.
ANSWER:
-The inbuilt illumination is strong and its intensity can be changed.
-It allows stereoscopic view of the image.
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TONOMETRY
1. Describe how you would perform Digital palpation Tonometry.
ANSWER:
Intraocular pressure (IOP) is estimated by response of eye to pressure applied by finger
pulp.
PROCEDURE:
-Patient looks down.
-Index fingers of both hands are used.
-One finger is kept stationary which feels the fluctuation produced by the indentation of
globe by the other finger
-If IOP is raised - fluctuation produced is feeble or absent and the eyeball feels firm to
hard.
-When the IOP is very low - eye feels soft like a partially filled balloon.
2. With specific example, document the IOP value once the inner edges of the two
semicircles coincide during Goldmann applanation tonometry.
ANSWER:
The scale reading is multiplied by 10 to get the IOP value. Example: if the scale raiding
is
1.9, the IOP is 19mmHg.
3. During Tonometric procedure on young patients using the Perkins applanation
tonometer, you could only observe small dot like pattern which flashes on and off. How
would you overcome this?
ANSWER:
Would move into working range and advance towards cornea.
4. What is the angle between the illumination and microscope system of the slit lamp
during
applanation tonometry for bright and clear images free of reflection?
ANSWER:
Approximately 60°
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5. Establish a major disadvantage of Schiotz indentation tonometer.
ANSWER:
The effects of both corneal and scleral rigidity resulting in Lower reading in the myopes
and higher values in hyperopes.
6. What instructions will you give your patient before measuring his IOP using
applanation
tonometer attached in a slit lamp?
ANSWER:
1) Place the chin and head firmly against the chin rest and forehead rest, respectively.
2) Look straight ahead
3) Keep eye wide open.
7. Briefly explain how you would measure intraocular pressure (IOP) for a patient using
a
Schiotz tonometer.
ANSWER:
Plunger of the tonometer is disinfected using cotton wool soaked in alcohol. Plunger is
inserted in the footplate, 5.5g weight screwed onto the plunger. If the 5.5g does not
indent the cornea, the 7.5g or 10g weight is inserted. Patient should be in supine
position for the measurement. Cornea is anaesthetized with a drop of a local
anaesthetic agent. Once the
anaesthetic takes effect, patient is instructed to raise his right hand up with his thumb
out, to act as the fixation target. Patient’s lids are held with the clinician‘s thumb and
index or middle finger of the left hand, no pressure should be exerted on the eyeball
when moving back the lids. Measurement is taken by placing the tonometer gently and
carefully in a vertical position at the centre of the cornea. Pressure value is read from
the scale when the pointer shows a pulse. The scale value of the measurement would be
got in millimeter of mercury (mmHg) from the conversion table included in the
tonometer pack.
8. How will you determine the diurnal variation in IOP measurement?
ANSWER:
Using any tonometer, we shall measure the morning IOP and later the evening IOP of
the same patient; the difference in the morning and evening IOP gives the diurnal
variation in mmHg.
9. Which instruments and materials are required for Applanation Tonometry.
ANSWER:
Instrument/Materials
-Tonometer, either Goldmann (used on slit lamps) or Perkins (hand-held}
-Applanation prism
-Local anaesthetic drops
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-Fluorescein strips
-Clean cotton wool or gauze swabs.
10. Describe the preparation made for Applanation Tonometry.
ANSWER:
-Ensure the prism has been disinfected with isopropyl alcohol, 70% (methylated spirit)
or sodium hypochlorite, 1%. The prism must be rinsed in sterile water and wiped dry
with a clean swab (residue of the disinfectant may cause a caustic burn on the cornea).
-Check that the graduation marked '0' on the measuring prism is aligned with the white
marker point on the tonometer head.
-Check that the calibrated dial of the tonometer is set at 10mmHg.
-Ensure that the patient is sitting comfortably at the slit lamp: at the right height, with
the chin on the rest and forehead against the headband (or in a chair with the head
supported, if using the Perkins tonometer)
-Set the magnification of the slit lamp at 10x.
11. Describe the method for Applanation Tonometry.
ANSWER:
-Instill the local anaesthetic drops and then the fluorescein. Only a very small amount
of
fluorescein is needed.
-For measuring the IOP in the right eye, make sure the slit beam is shining onto the
tonometer
head from the patient‘s right side; for the left eye, the beam should come from the
patient's left side.
-Move the filters so that the blue filter is used to produce a blue beam.
-Make sure the beam of light is as wide as possible, and that the light is as bright as
possible.
This makes visualizing the fluorescein rings easier (with the slit diaphragm fully open).
-Ask the patient to look straight ahead, open both eyes wide, fix his or her gaze and
keep perfectly still.
-With the thumb, gently hold up the patient’s top eyelid, taking care not to put any
pressure on the eye.
-Direct the blue light from the slit lamp or the Perkins tonometer onto the prism head.
-Make sure that the tonometer head is perpendicular to the eye.
-Move the tonometer forward slowly until the prism rests gently on the centre of the
patient's cornea.
-With the other hand, turn the calibrated dial on the tonometer clockwise until the two
fluorescein semi-circles in the prism head are seen to meet and form a horizontal 'S'
shape (Note: the correct end point is when the inner edges of the two fluorescein semicircle images are just touch)
294 | P a g e
-Note the reading on the dial and record it in the notes. Reading got is multiplied by 10
to get the IOP value.
-Withdraw the prism from the corneal surface and wipe its tip.
-Repeat the procedure for the other eye.
-Wipe the prism with a clean, dry swab and replace it in the receptacle containing the
disinfectant.
OCULAR ANATOMY, OCULAR PHYSIOLOGY,
OCULAR PHARMACOLOGY AND OCULAR PATHOLOGY
1. What is your diagnosis and treatment?
ANSWER:
•
Diagnosis:
Diabetic retinopathy
•
Treatment:
Control of systemic risk factors: Strict metabolic control of blood sugar and lipid
reduction
Photocoagulation: it remains the mainstay in the treatment of diabetic retinopathy.
Either argon or diode laser can be used.
2. What is the treatment plan for this patient?
ANSWER:
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Hot compresses 2-3 times a day are very useful in cellulitis stage.
•
When the pus point is formed it may be evacuated by epilating the involved cilia.
•
Surgical incision is required rarely for a large abscess.
•
Antibiotics eye drops (3-4 times a day) and eye ointment (at bed time) should be
applied to control the infection.
•
Anti-inflammatory and analgesics relieve pain and edema.
3. State is the diagnosis and treatment?
ANSWER:
Trichiasis
•
Epilation (mechanical removal with forceps)
•
Electrolysis
•
Cryoepilation
•
Surgical correction.
4. Make a diagnosis
ANSWER:
Hypertensive retinopathy
5. Make a diagnosis and justify your answer
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ANSWER:
•
Diagnosis: Optic disc atrophy
•
Justification: Pallor of the disc and decrease in the number of small blood vessels
6. Write a prescription for this patient.
ANSWER:
Diagnosis: Primary open angle glaucoma
Rx: Either of the following
•
Gutt: Timolol 0.5%1gtt bid x 1/12
•
Gutt: Betaxalol 0.5% 1gtt bid x 1/12
•
Gutt: Latanoprost 0.005% 1gtt q24h x 1/12
•
Any other antiglaucoma drug or combination therapy
7. Write a prescription for this patient
ANSWER:
Local therapy for ocular lesion
i.
Topical steroid eye drops 4 times a day.
ii.
Cycloplegics such as Cyclopentolate eyedrops bid or atropine eye ointment bid.
iii.
Topical acyclovir 3 percent eye ointment 5 times a day for about 2 weeks
8. Estimate the cup to disc ratio of this patient.
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ANSWER:
C/D Ratio 0.6 or 0.7
9. What is the diagnosis and treatment?
ANSWER:
Diagnosis is Hypopyon & corneal ulcer
Treatment:
•
Topical antibiotics
•
It is preferable to start with fortified gentamicin (14mg/ml) or
•
Fortified tobramycin (14mg/ml) eyedrops
Once a favourable response is obtained, the Fortified drops can be substituted by more
diluted commercially available eye-drops, e.g.: Ciprofloxacin (0.3%) eye drops, or
Ofloxacin (0.3%) eye drops, or Gatifloxacin eyedrops.
10. What is the diagnosis and how would you manage this case?
ANSWER:
Diagnosis: Subconjunctival haemorrhage
Treatment:
•
Treat the cause when discovered.
•
Placebo therapy with astringent eye drops.
•
Psychotherapy and assurance to the patient is most important part of treatment.
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•
Cold compresses to check the bleeding in the initial stage hot compresses may
help in absorption of blood in late stages.
11. Which instrument is used when lid immobilization is necessary in order to carry out
a foreign body removal?
ANSWER:
Use of Speculum
12. Which segment of the eye is not affected in the ocular manifestation of leprosy?
ANSWER:
The posterior segment.
13. Which of the refractive errors could cause glaucoma?
ANSWER:
Hyperopia
14. What are the possible implications of paralysis of the orbicularis muscle?
ANSWER:
Exposure Keratitis and Epiphora
15. In which of the glaucomas do genetic factors play a role?
ANSWER:
Primary open angle glaucoma (POAG)
16. What aspects of vision contribute to falls in the elderly?
ANSWER:
Decreased acuity
Poor night vision
Poor depth perception
Infused sensitivity to glare
Increased field defects
17. Give the clinical features of diabetic retinopathy.
ANSWER:
Presence of microaneurysms
Hard exudates
Cotton wool spots
lntraretinal hemorrhages
Macular oedema
Neovascularisation
18. Establish presence of a Marcus Gunn pupil.
ANSWER:
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Perform swinging flash light test. Patient fixates on a distant object in a semi-darkened
room; examiner illuminates the OD, then OS for about a second for each eye, swinging
the flash light from one eye to another. Pupil of both eyes will dilate when the affected
eye is illuminated.
19. Briefly describe how you would perform the photostress Recovery Time (PSRT)
test.
ANSWER:
Photo-stress recovery time (PSRT) is the time taken for visual acuity in return to
normal levels after the retina has been bleached by light source. It it a test of retinal
function and is independent of ocular disease that affects other parts of the visual
system. Distance VA of both eyes is measured. The patient is instructed to remove his or
her spectacles, but keep them on the lap, so that they can be quickly put on again.
The eye with poorer VA is occluded. A source of bright light e. g. pen light or other
bright
light source is held at about 2-3cm away from the patient‘s eye with better VA. The light
is switched on, and patient asked to look directly at the light for 10 seconds. After 10
seconds,
the light source is removed and the patient asked to put his or her glasses back on and
directed to the letters one line larger than the patient's original visual acuity. The
patient is to read those letters as quickly as possible, after the after-image has
disappeared. The time taken after the removal of the bleaching light for the patient to
read at least 2/3 of the letters on the line is noted. The same measurement procedure is
repeated for the eye with poorer
VA. The time taken in seconds to read the letter is noted. Findings are reported as
example:
PSRT: RE 35 seconds and LE 40 Seconds.
20. Establish a diagnosis during colour vision measurement; red is missing while blue
and green are present.
ANSWER:
Protanopia
21. What is the principle of the Ishihara colour plates?
ANSWER:
To identify a coloured symbol made up of coloured dots of varying sizes embedded in a
background of differently coloured dots.
22. During colour vision test, what is the time range for a patient to identify figures on a
plate using Ishihara plate?
ANSWER:
3 - 5 seconds
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23. Describe the Farnsworth D-15 panel test.
ANSWER:
A set of 16 different coloured papers fixed in numbered caps contained in a tray.
24. Mention four resultant ocular effects senile miosis.
ANSWER:
Decreased retinal illumination
Increased light scatter
Decreased dark adaptation
Decreased contrast sensitivity
25. Mention the ocular implications of rheumatoid arthritis.
ANSWER:
Dry eye (Sjogren's syndrome), can induce uveitis, episcleritis or scleritis.
26. Mention signs of hyperthyroidism.
ANSWER:
Eyelid retraction
Proptosis
Chemosis
Periorbital oedema
Altered ocular motility
27. Make differential diagnosis (3) of papilloedema from papillitis
ANSWER:
Signs
Definition
Papilloedema
A non-inflammatory oedema
of the optic nerve head
produced
by
raised
intraocular pressure and due
most commonly to a central
tumour. Could also result
from cerebral abscesses,
meningitis,
encephalitis,
subarachnoid
haemorrhages, head injury,
hydrocephalus etc.
Papillitis
Inflammatory of the optic
nerve head. Primary cause
is multiple sclerosis, but it
may also be associated with
severe
inflammation of the retina
or choroid, vitamin B
deficiency,
diabetes
Mellitus, thyroid disease,
lactation,
toxicity
or
syphilis.
Optic
disc
elevation
Pupil light reflex
Venous pulsation
Raised
Slightly raised
Normal
Absent
Impaired
Present
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Symptoms
Visual acuity
Visual field
Diplopia
Colour vision
Pain
Headache
Papilloedema
Normal except in late stage
Enlarged blind spot
Present
Normal
Absent
Present
Condition
is
usually
bilateral
Papillitis
Reduced
Central scotoma
Absent
Impaired
Present on moving the eye
Absent
Usually unilateral, although the
second eye may become involved
later.
28. Make differential diagnosis (3) of internal hordeolum from chalazion.
ANSWER:
Internal Hordeolum
Chalazion
An acute purulent infection (usually
caused by staphylococci) of the
meibomian glands.
A chronic inflammatory lipogranuloma due
to retention of the secretion (such as
blocked ducts) of the meibomian gland in
the tarsus of an eyelid.
Located on the conjunctival side of
the eyelid.
Characterized by much discomfort.
Located on the tarsus.
Characterized by a gradual painless
swelling of the gland without marked
inflammatory
signs
and
sometimes
astigmatism which is induced by the cyst
pressing on the cornea.
29. Make differential diagnosis (3) of POAG (Primary open angle glaucoma) from
AACG (Acute angle closure glaucoma or acute congestive glaucoma).
ANSWER:
POAG
Insidious in nature and difficult to detect.
Characterized
by
almost
complete
AACG
Rapid increase in IOP due to blockage of
the trabecular meshwork.
Intense pain / redness.
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absence of symptoms.
Halos, only in some patients.
Nausea, blurred vision etc. - In some
patients when disease is advanced, or
when there has been a sudden increase in
IOP.
Halos around light.
Nausea, blurred vision, corneal epithelial
oedema, semi-dilated and fixed pupil,
shallow anterior chamber, mild aqueous
cell and flare.
30. Make differential diagnosis (3) of anterior uveitis from acute angle closure
glaucoma (AACG).
ANSWER:
__
Anterior uveitis
AACG
Pain
Moderate to severe
Severe, prostrating.
Pupil
Miotic, reaction to light delayed Semi-dilated, does not react to light.
or absent.
Cornea
Usually clear, with deposits on Steamy, iris details not visible.
posterior surface sometimes
visible.
Onset
Gradual
Sudden
Vision
Slightly reduced
Markedly reduced
IOP
Normal or soft
Increased
31. Make differential diagnosis (3) of acute anterior uveitis from acute conjunctivitis.
ANSWER:
Acute anterior uveitis
Acute conjunctivitis
Pain
Injection
Moderate to severe.
Intense, near the corneoscleral
limbus and fades towards the
fornices. Not constricted with
1:1000 epinephrine, vessels do not
move with conjunctiva, are Violet
in colour, individual vessels not
distinguishable.
Burning, itching.
Conjunctival type that is most
intense near the fornices and fades
towards the limbus. Eye whitened
with 1:1000 epinephrine, vessels
superficial, move with conjunctiva,
and are bright red individual
vessels, are evident.
Pupil
Miotic reaction delayed or absent.
Normal
Cornea
Usually clear, with deposits on
posterior surface, sometimes
visible.
Watery
Slightly reduced
Clear and normal
Secretion
Vision
Stringy pus
Normal
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IOP
Normal or soft
Normal
32. What would prompt you to dilate the eye of a patient?
ANSWER:
Contusion injury
Vitreous opacity
Sudden decrease in VA
Unexplained loss of VA
Unexplained ocular pain
Redness of no known cause
Cloudiness of vision
33. Write the drug prescription for a patient who is supposed to instill a drop of a named
antibiotic eye drop three times daily for one week.
ANSWER:
Gutt: Chloramphenicol: 1gtt tid x 1/52
34. When would you use atropine in refraction, pathology, and orthoptics?
ANSWER:
Refraction: To reveal latent hypropia (Cycloplegic or Wet refraction).
Pathology: (acute) anterior uveitis to break synechiae / to immobilize the iris.
Orthoptics: Instilled into the good eye in amblyopia (Penalization) to stimulate
the bad eye to see.
35. As a clinician starting a practice, give three classes of diagnostic drugs you can
stock in the clinic, with an example each, and their uses.
ANSWER:
Cycloplegics e.g. atropine — reveal hyperopia
Mydriatic e.g. Phenylephrine, dilates the pupil for clearer visualization of the
fundus
Anaesthetic
e.g.
lignocaine,
contact
tonometry
(indentation
tonometry/applanation
tonometry), foreign body removal.
Dyes e.g. fluorescein strip, detection of laceration/TBUT/Applanation tonometry
etc
Miotics e.g. pilocarpine, differential diagnosis of fixed-dilated pupil
Decongestant, (Adrencrgic agonists) e.g. epinepherine, to differentiate between
conjunctival and ciliary injection (blanching)
36. What role (if any) does pilocarpine play as a diagnostic drug?
ANSWER:
It is used in the differential diagnosis of fixed-dilated pupil
304 | P a g e
Mydriasis of neurologic origin (3rd nerve palsy) responds readily to normal
concentrations (0.5% - I%) of pilocarpine, whereas there is no response when the
etiology
is anticholinergic-induced
37. What role (if any) does epinepherine play as a diagnostic drug?
ANSWER:
Epinepherine (1:1000) is used in the differential diagnosis of ciliary injection and
conjunctival injection, as it would constrict (blanch/whiten) the latter and not constriet
the former.
38. What would you tell a patient, you have good reason to instill atropine into his eye
that he will experience?
ANSWER:
Blurred vision
Dry eyes
Photophobia
Inability to do near work
Ocular irritation
39. You have reason to perform both the tear break up time (TBUT) and indentation
tonometric tests on a patient, which one should be performed first and why?
ANSWER:
TBUT test is performed before indentation tonometry, because topical anaesthetics used
in
tonometry cause dryness of the eyes and thus would affect TBUT adversely if tonometry
were performed first.
40. What uses (4) are fluorescein dye to you as a practicing Optometrist?
ANSWER:
To detect lesions of the corneal epithelium
In the fitting and evaluation of rigid contact lenses
Assessing the integrity of the cornea in contact lens wearers.
To evaluate the integrity af the precorncal tear film (invasive TBUT)
To evaluate the patency of the lacrimal drainage system (Jones test 1 & 2)
Applanotion tonometry
Make a diagnosis of corneal perforation using Seidel's text, for possible referral.
41. As an Optometrist, highlight the roles of three classes of drugs you can use in the
management of glaucoma, with examples.
ANSWER:
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Beta blockers (Timolol/Betaxolol): Reduce aqueous halnoar (AH) production
Carbonic anhydrase inhibitors (Acetazolamide): Reduce AH production
Alpha adrenergic agonists (Brimonidine): Reduce AH production and enhance
AH outflow
Chalinergic agonists (Pilocarpine): Increase AH outflow
Prostaglandin analogues (Latanoprost): Enhance outflow
42. As a practicing Optometrist, give two instances when you will utilize local
anaesthetics. Give two examples local anaesthetics.
ANSWER:
Removal of foreign body/Contact tonometry
*Examples; Tetracaine / Lignocaine/ Amithocaine etc.
43. State two ophthalmic uses and two examples of antimuscarinic agent.
ANSWER:
Uses:
Treatment of anterior uveitis
For cycloplegic refraction
For dilated fundus examination
Examples:
Atropine
Tropicamide
Homatropine
Cyclopentolate
44. Why will you use steroids with caution in your practice? Give three reasons.
ANSWER:
Because of the adverse effects of steroids
Increase IOP
Cataract formation
Slow clown healing process.
Suppress Immunity thus lead to increase susceptibility to infection
45. What would be the effect of (i) Adrenergic drug and (ii) Anticholinergic drug on
IOP?
Give one example of each drug.
ANSWER:
Adrenergic: Would lower IOP e.g. Phenylephrine
Anticholinergic: Would elevate IOP e.g. Atropine, Tropicamide
46. Establish a case of Marcus Gunn pupil.
ANSWER:
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Stimulation of the affected eye during swinging flash light test, results in small bilateral
dilatation
47. Chlaramphenicol eye drop was instilled into the lower conjunctival sac of a patient
and the patient tasted its bitter taste in the mouth. Trace the lacrimal pathway.
ANSWER:
Lacrimal punta →Canaliculi →Common Canaliculi → lacrimal sac →nasolacrimal
duct →inferior meatus (under the inferior turbinate)
48. Identify the meningeal sheaths that cover the optic nerve.
ANSWER:
Pia, dura and arachnoid.
49. The compositions of the brain stem include:
ANSWER:
Midbrain
Pons
Medulla Oblongata
50. Which nerve has the longest intracranial course and what is the consequence of this
characteristic?
ANSWER:
Abducens nerve (CN VI)
This makes it vulnerable to trauma and intracranial pressure
51. When a clinician lightly touches a wisp of cotton on the patient's cornea during
corneal reflex test which nerve(s) are stimulated?
ANSWER:
Trigeminal nerve (CN-V)
Facial nerve (CN VII)
52. Briefly describe how you will clinically differentiate between bacterial
conjunctivitis and viral conjunctivitis in the eyes of patients who visit your clinic.
ANSWER:
Bacterial Conjunctivitis usually starts in one eye and spreads to the other. It is often
accompanied by mild systemic symptoms such as sore throat or mild cold. Viral
conjunctivitis typically presents with irritation, profuse watery discharge and
photophobia. May be associated with follicles.
53. Outline the procedures for administering eye drops.
ANSWER:
1. Tilt patient's head backward.
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2. Instruct patient to direct gaze toward ceiling.
3. Gently grasp lower outer eyelid below lashes and pull eyelid away from the globe.
4. without touching lashes or eyelids, instill one drop of solution into conjunctival sac.
5. Continue to hold eyelid in this position a few seconds to allow solution to gravitate
into deepest portion of lower fornix.
6. Instruct patient to gaze downward while lifting the eyelid upward until it contacts the
globe.
7. Instruct patient to gently close eyes.
8. Patient should keep eyes closed for 2 to 3 minutes.
54. How will you remove a superficial ocular FB?
ANSWER:
Put a drop of 4%
lignocaine
↓
Put a speculum
↓
Remove the FB with sterile
hypodermic needle /FB
spud
↓
Wash the conjunctival sac
with
normal
saline
thoroughly
↓
Antibiotic
drop/ointment
↓
Eye pad for a
day
55. How will you treat chemical injury in emergency set up?
ANSWER:
Instillation of topical anaesthetic-4%
lignocaine
↓
Eye
speculum/retractor
↓
Irrigation of ocular surface with
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normal saline/water for 1/2 an
hour
↓
Removal
of
particulate
matters/debris
↓
Topical antibiotics, cycloplegic and
corticosteroids drops/ointment are
given
↓
(Depending upon the severity of the
injury patient may be admitted).
56. How will you treat internal hordeolum?
ANSWER:
Hot compress
Systemic analgesics
Local antibiotic drops and ointment
Systemic antibiotic
Once the acute condition subside —Incision and curettage
57. How will you treat blepharitis?
ANSWER:
To maintain hygienic status
Use of medicated shampoo
Correction of refractive errors
Treatment of louse infestations
Local- 3% sodium-bicarbonate lotion is applied with cotton buds to lid margin to
soak the crust or scales 2-3 times daily or baby shampoo may be used
Antibiotic/steroid ointment combination to be applied by rubbing the lid margin 3
times daily
Stop using oil on scalp
An antibiotic eye drop- if secondary infection is suspected
Systemic antibiotic; a course of tetracycline or doxycycline orally for 2-3 times is
useful in severe ulcerative blepharitis
In complicated cases, corticosteroids will also be used
58. Describe any diagnostic test for dry eye.
ANSWER:
Schirmer-1 test
Whatman-41 filter paper which is folded 5mm from one end and kept in the lower fornix
at the junction of lateral one-third and medial two-thirds. The patient is asked to look
up and not to blink or close the eyes.
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After 5 minutes, wetting of the filter paper strip from the bent end is measured. Normal
values of Schirmer-1 test are more than 15mm. Values of 5-10mm are suggestive of
moderate to mild keratoconjunctivitis sicca (KCS) and less than 5mm of severe KCS.
Tear film break-up (BUT) test
The first randomly distributed dry spot on the cornea is noted after instilling a drop of
fluorescein and examining in a cobalt-blue light of a slit-lamp. Its normal values range
from 15 to 35 seconds. Values less than 10 seconds imply an unstable tear film.
59. How will you manage a case of dry eye?
ANSWER:
Supplementation with tear substitute e.g. Methylcellulose
Preservation of existing tears
Reducing evaporation (decreasing room temperature, protective glasses)
Punctal occlusion with collagen implant
60. How will you test for corneal sensation?
ANSWER:
Ask the patient to look straight
- Wisp of cotton is brought from side (to avoid blinking response)
- Touch it 2mm inside the limbus
- Look for blink reflex
61. How will you differentiate between the rainbow halo of acute angle closure
glaucoma and that of immature senile cataract?
ANSWER:
Fincham's stenopaeic slit test
If a stenopaeic slit is passed across the pupil, glaucomatous halo remains intact, while
a halo due to cataract is broken up into segments.
62. Describe the technique of ointment instillation.
ANSWER:
With the globe elevated and the lower lid retracted, ointment is Instilled into the
inferior conjunctival sac in a sweeping fashion from lateral canthus to medial canthus.
RETINOSCOPY
1. Describe the Monocular Estimation Method of Dynamic Retinoscopy.
ANSWER:
With the patient's distance spectacle refraction in place in the phoropter, or in a trial
frame, have the patient view small letters mounted on the retinoscope head, which is
held at the near viewing distance.
Observe the direction of the reflex in one eye, "With" motion, which indicates a positive
accommodative lag, requires that a plus spherical lens be placed before the eye.
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"Against" motion, which indicates a negative accommodative lag, requires that a minus
spherical lens be placed before the eye.
Repeat the procedure with stronger lens powers until you observe neutrality.
2. How would you determine the two principal meridians of the eye when performing
static Retinoscopy?
ANSWER:
After scanning the various meridians, the principal meridians are determined by
aligning the light streak within the pupil with red reflex and disregarding any meridian
that produces an oblique motion when scanned.
3. Describe the elementary clinical procedures in static retinoscopy.
ANSWER:
1.
Apply convex lens when 'with ' motion is present.
2.
Apply concave lens when the motion is ‘against'.
3.
Correct the meridian of strongest plus or weakest minus with spheres so that one
meridian will be neutralized, leaving the other meridian with 'against' motion. Then
apply minus cylinders in the axis of the neutralizing cylinder until the motion ceases in
the opposite direction.
4. What do you do when you encounter a confused reflex (scissors motion) when
performing retinoscopy?
ANSWER:
When a confused reflex is encountered, it is best to neutralize the portion of the fundus
reflex that is projected against the central pupillary area and to relay on bracketing to
further reduce error in determining the point of neutrality.
5. In cases of large-angle strabismus (particularly exotropia or esotropia), how would
you perform static retinoscopy?
ANSWER:
The examiner should alter the gaze position of the fixating (opposing) eye so as to allow
the non-fixating eye to be more properly directed forward, then move to a position such
that the
retinoscopy is aligned with the line of sight of the deviating eye, or both.
6. During retinoscopy, you worked at 66cm and had no working distance lens in place.
Using the sphere-sphere method (and removing the first lens prior to neutralizing the
second meridian), you find it takes a +1.50D lens to neutralize with the streak on
vertical orientation and -2.00D to neutralize with the streak on horizontal orientation.
What is the patient‘s refractive error?
ANSWER:
Plano/-3.50DCX 180
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7. lf you are working at a distance of 66cm (and no working distance lens in place), you
find that with the streak at vertical orientation, -2.00 D sphere neutralized the reflex;
and with the at horizontal orientation (with the sphere still in place) a -1.50D cylinder
neutralizes the reflex. What is the patient's final refraction?
ANSWER:
-3.50DS/-1.50DC x 180
8. During retinoscopy you worked at 50cm and had no working distance lenses in place.
Using the minus cylinder method, you neutralized with a -2.00DS lens with the streak
vertically oriented and -3.00 DC with the streak horizontally oriented. What is the
patient's refractive error?
ANSWER:
-4.00DS/-3.00DC x 180
9. During retinoscopy, you worked at 50cm and had the working lens in place. Using
the sphere-sphere method (NOT removing the first lens prior to neutralizing the second
meridian), you neutralized with a -2.00DS lens with the streak vertically oriented and
+1.00DS with the streak horizontally oriented. What is the patient's refractive error?
ANSWER:
-1.00DS/-1.00DC X 090
10. During retinoscopy, you worked at 66cm and had no working distance lens in place.
Using the sphere-sphere method (and removing the first lens prior to neutralizing the
second meridian), you used a +1.00DS lens to neutralize the motion seen when
neutralizing the 180th meridian and -2.00D to neutralize 090th meridian. What is the
patient's refractive error?
ANSWER:
-0.50DS/-3.50DC x180
11. Describe what you will see for each step of the minus cylinder retinoscopy
procedure (with working distance lenses in place at 66cm working distance) to arrive at
this prescription: +2.00DS/-1.00DC X 30.
ANSWER:
1. With the working distance lens in place, a with motion will be seen at both 30th and
120th meridians.
2. Application of +2.00DS lens achieved neutrality at the 30th meridian and an
‘against' motion was observed at the 120th meridian.
3. With the +2.00DS lens still in place, -1.00DC with the axis at 030° changed the
'against' motion of the 120th meridian to neutral motion while the 30th meridian
remained neutral
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12. Without using a working distance lens, you neutralized the apparent motion for your
patient with a -2.00DS while you were sitting at 66cm. What lens will neutralize the eye
at infinity?
ANSWER:
Lens power= -2.00-100/67 = -2.00-1.50 = -3.50DS
13. Describe the thickness, brightness and width of a reflex in which the far point is a
great distance away from the examiner.
ANSWER:
A reflex will be slow, dim and narrow when the far point is far away.
14. Describe the thickness, brightness and width of a reflex in which the far point is
close to the examiner.
ANSWER:
A reflex will be bright, wide and fast when the far point is near the examiner
15. What two ways can be used to bracket for neutrality during retinoscopy?
ANSWER:
1. Optically bracket using lenses (plus should induce 'against' motion, minus should
induce 'with' motion).
2. Working distance (moving back should induce 'against', moving forward should
induce 'with').
16. What must you always do prior to neutralizing a reflex?
ANSWER:
1. You control accurately determine cylinder power using incorrect principal
meridians.
2. You must first find the principal meridians by evaluating break, width or size,
brightness and relative speed of motion.
17. Describe the orientation of the cylinder axis in relation to that of the retinoscope
streak.
ANSWER:
The streak assesses the power of the meridian that it sweeps (a horizontally oriented
streak assesses the vertical meridian, while a vertically oriented streak assesses the
horizontal meridian). When you are done neutralizing the first meridian, when using
cylinders; the axis must be set appropriately to put power in the meridian being scoped.
The streak and cylinder axis must always have the same orientation.
18. How do you neutralize a scissoring reflex?
ANSWER:
You keep your attention to the centre of the pupil, keep the motion of the retinoscopy
quick and try your best to bracket the prescription.
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19. If you are working at a distance of 66cm and without the working distance lens in
place, you find that with the streak oriented at 90 degrees, +2.50D sphere neutralized
the reflex; with the streak oriented at 180 degrees (With the sphere in place), a -2.000
cylinder neutralizes the reflex. What is the patient's final refraction?
ANSWER:
+1.00DS/-2.00DC x 180
20. How will you determine the refractive error of a patient with small pupils in
retinoscopy?
ANSWER:
This is done using the radical retinoscopy method which is done by the examiner
moving closer to the patient until an observable reflex is obtained. Working distance
(WD) may be as close as 20cm. In such a case, the WD is still appropriately subtracted
to get the final Prescription. Example: If WD is 20cm and neutrality is obtained with 6.00D in place, the retinoscopic finding will be, Gross retinoscopic finding-Dioptric
equivalence of WD: (+6. 00-[+5.00]) = +1.00D.
21. How will you determine the refractive error of patient with cataract or media
opacity?
ANSWER:
This is done by using the radical retinoscopy method which is done by the examiner
moving closer to the patient until an observable reflex is obtained. Working distance
(WD) may be as close as 20cm. In such cases, the WD will still be appropriately
subtracted to get the final Prescription. Final Rx = Gross retinoscopic finding Dioptric equivalence of Working
Distance (+6.00-[+5.00]) = +1.00.
22. How will you neutralise a dim slow-moving against movement noticed during
retinoscopy using plane mirror effect?
ANSWER:
This is seen in the presence of a high myopic refractive error. The examiner needs to
start with a high minus lens and gradually the reflex becomes brighter and then s/he
will continue till neutrality is achieved. Alternatively, the examiner can use the concave
mirror effect by pushing up the sleeve of the retinoscope; this will produce a narrower
slit that will give a ‘with' movement which is then appropriately neutralized using minus
lenses.
23. How will you neutralise a dim slow-moving ‘with’ movement noticed during
retinoscopy using plane mirror effect?
ANSWER:
314 | P a g e
This is seen in the presence of a high hyperopic refractive error. The examiner needs to
start with a high plus lens and gradually the reflex becomes brighter and then s/he will
continue till neutrality is achieved.
24. If scissors movement is observed in retinoscopy, how would you determine the
neutral point?
ANSWER:
The scissors movement can be due to oblique astigmatism, keratoconus or irregular
cornea.
Depending on what it is, focus on the central corneal reflex and neutralize. If due to
astigmatism, orientate the streak towards the axis and scope to neutralize
appropriately.
25. How would you check for accuracy of your neutral point? (2 ways)
ANSWER:
1) By reversing the sleeve i.e. pushing it from a plane mirror to a concave mirror or
from a concave mirror to a plane mirror. The neutrality should be maintained.
2) By bracketing i.e. moving forward (should become a ‘with' movement) and backward
(should become an ‘against ' movement).
3) The addition of a + or - 0.50 more over the neutral lens in place should reverse the
movement.
26. Assuming your patient is a presbyope, how will you determine the presbyopic add
objectively?
ANSWER:
Dynamic retinoscopy is performed. The addition over the static prescription is the
presbyopic add with a 1.00D subtracted from the final prescription to account for the
lag of accommodation at near
27. How will you use the Monocular Estimation Method (MEM) of retinoscopy to
determine the refractive error of your patient?
ANSWER:
In MEM, the target is usually placed at the patient's customary reading distance rather
than at an arbitrary distance. It might be a card containing pictures or word which is
clipped to the retinoscope and there is a hole made so that light from the retinoscope
can pass through for the examiner to use and examine.
28. Why is it suggested that approximate lenses be added to establish a definite against
motion in the retinoscopic test (Using plane mirror)?
ANSWER:
To ensure relaxation of accommodation, plus lenses are added to relax accommodation
hence the definite against motion.
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29. How is dynamic retinoscopy performed? Differentiate it from static retinoscopy (3
differences).
ANSWER:
Procedure:
Test distance-50cm or 100m
Normal illumination
Patient fixates at retinoscopic head
Both eyes are scoped simultaneously
The lens power that gave neutrality is the dynamic retinoscopic finding
Differences:
Accommodation is active in dynamic and relaxed in static
Fixation is at 50cm or 100cm in dynamic and at 6m in static
Illumination is normal in dynamic and dim in static
Eyes are scoped simultaneously in dynamic and sequentially in Static
No allowance is made for working distance in dynamic, while allowance is made
for working distance in static
Dynamic retinoscopy is for near correction, while static retinoscopy is for
distance correction etc.
30. In static retinoscopy, with a working distance of 66cm (and no retinoscopic lens in
place); neutrality was obtained at the vertical meridian through a +0.50DS and at the
horizontal meridian through a -1.00DC, what is the patient's static retinoscopic finding?
ANSWER:
-1.00DS/-1.00DC x 90
31. In retinoscopy, with a working distance of 50cm and without any retinoscopic lens
in place, no movement was noticed when both meridian were scoped. What is the
magnitude of the patient's refractive error?
ANSWER:
-2.00DS
32. In static Retinoscopy; with a working distance of 66cm and no retinoscopic lens in
place, you got neutrality on the two principal meridians through +3.00DS. What is the
retinoscopic finding? Show working.
ANSWER:
Static retinoscopic finding = +3.00 - (dioptric equivalence of working distance) =
+3.00 (100/67) = +3.00 -1.50 = +1.50DS
33. How would you achieve the retinoscopic plane mirror effect and concave mirror
effect from your retinoscope? Describe the beam got
ANSWER:
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For plane mirror effect, the retinoscopic sleeve is pushed down, while it is
pushed up to achieve the concave mirror effect.
The beam of plane mirror effect is broad, while that of concave mirror effect is
narrow.
34. In retinoscopy, with the plane mirror effect; interpret the different movements that
may be observed in determining a patent's refractive status.
ANSWER:
In plane mirror effect:
"With" movement would indicate emmetropia hypropia, or myopia less than the
dioptric equivalence of the working distance.
"Against" movement would indicate myopia greater than the dioptric equivalence
of the working distance.
35. In retinoscopy, with the concave mirror effect; interpret the different movements
that may be observed in determining a patient's refractive status.
ANSWER:
In concave mirror effect.
“With" movement would indicate myopia greater than the dioptric equivalence of
the working distance
“Against " movement would indicate emmetropia, hyperopia or myopia less the
dioptric equivalence of the working distance
36. Locate the principal meridians in static retinoscopy.
ANSWER:
Working under dim illumination and patient's fixation at 6m, start with the plane mirror
in the retinoscope. With the right eye on the retinoscope, drive the light across the pupil
of the patient's right eye along the horizontal meridian with a vertical streak, then along
the vertical meridian with a horizontal streak. lf the reflex movement is seen along these
meridians, they are the principal meridians. lf the reflex is seen to move at an angle to
the direction along which the retinoscope light is driven, change the meridian of the
streak to be in alignment with the direction of the reflex. These are the principal
meridians.
37. How and why do you perform radical retinoscopy on the elderly?
ANSWER:
Done by shortening working distance. This is done to get a better view of the reflex as
the pupil will be effectively larger and reflex brighter.
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SUBJECTIVE
REFRACTION,
CROSS
CYLINDER
TESTS,
ACCOMMODATIVE TESTS
1. How is the AA determined without using lenses? Give three (3) factors that could
affect AA.
ANSWER:
Procedure:
Donders' method (Push-up-to blur method). Illumination is normal. The Royal Air
Force (RAF) rule is appropriately positioned before the patient. The patient is directed
to his best visual acuity (BVA) on the reduced Snellen chart. The chart is pushed from
about 50cm towards the patient and the patient is asked to keep reading the print until
it blurs. The reading is taken when the patient reports a blur he cannot clear (first
sustained blur). Test is performed on OD, OS and OU. Whatever is read off the RAF
rule in diopters is the AA. If the reading is in cm, it is converted to diopters, e.g. 8cm =
100/8 = 12.5D
Factors
Age
Previous activity
Size of letters
Intellectual ability
Illumination
Contrast
Pupil size etc.
2. What is fogging? Mention three tests in which fogging is utilized.
ANSWER:
318 | P a g e
*Fogging is a method of relaxing accommodation by placing enough plus lens power in
front of an eye to form an image in front of the retina. In this condition, any effort to
accommodate will produce a poorer image and relaxation of accommodation is
achieved.
Tests:
Static retinoscopy
Subjective refraction
Infused cross cylinder
Fused cross cylinder test
3. A patient has the following test results: Subjective refraction OU +1.25DS, Unfused
cross cylinder OU +2.75DS, Phoria through Infused cross cylinder 3exo, Fused cross
cylinder OU +2.25DS, Phoria through fused cross cylinder Ortho, AA 3.00D. Calculate
the Add of this patient using 2 methods. (Show working).
ANSWER:
1. Add = Fused cross cylinder - Subjective refraction (+2.25 - +1.25) = +1.00D
2. Add = WD Dioptric equivalence - 1/2 AA (2.50 - 1/2 [3.00]) = +1.00D
4. In AA test, the Subjective finding was -0.50DC x180, and minus lenses in the
phoropter when the patient reported sustained blur was -10.00D, what is the Amplitude
of accommodation of this patient? (Show working).
ANSWER:
12.50D (10.00D of minus lenses were added over and above Subjective finding, we
consider only sphere not cylinder AA = 2.50 - (-10.00) = 2.50 + 10.00 = 12.50D.
5. Highlight three methods of determining the AA of a patient.
ANSWER:
Subtract Subjective finding from fused cross cylinder finding, e.g. Subjective
finding = 1.50DS, Fused cross cylinder = +3.00DS.
Add = +3.00 - (+1.50) = +1.50D
Dioptric equivalence of working distance - 1/2 AA, e.g. At 40cm, dioptric
equivalence of Working distance = 2.50D. If AA is 2.00D. 1/2AA = 1.00D. Therefore
Add = 2.50 - 1.00 = +1.50D.
TRA/2, i.e. NRA- Example NRA = +1.50D, PRA
PRA
= -1.50D
The absolute values (ignoring the signs) of NRA or PRA can also be summed up to get
TRA (i.e. 1.50 + 1.50).
Add = +1.50 - (-1.50)/2 = +3.00/2 = +1.50D
6. How would the AA be affected in the myope and hyperope if measured without
correcting the errors and why?
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ANSWER:
Overestimated in the myope (as the lens power that should have been the patient's
correction gets added into the AA value) and under estimated in the hyperope (as the
patient's start-point is behind the retina).
7. Give three advantages of the trial frame over the phoropter.
ANSWER:
A better vertex distance or one closer to that of the finished spectacles is
obtained
A better Rx in situations in which torticolis may exit can be obtained
Low phorias, particularly vertical ones, can be better measured with the trial
frame than through the refractor
Where a low VA exists, it is easier to demonstrate high additions and the close
working range necessary for such additions
It is easier to cylinders, or demonstrate orientation, by either reducing the power
or altering the axis position to eliminate tilts and other disturbances that sudden
introductions of cylindrical powers may produce
It is easier to demonstrate the effects of changes in the Rx and/or orientation
which may occur with them to the patient
8 How is the fused cross cylinder test performed? What would you do if a patient
cannot report equality of target, but a reversal in this test? Give reason(s) for the action
taken.
ANSWER:
Procedure:
*Target-cross grid/ Lenses in place-Unfused cross cylinder finding/ Dim illumination/
Auxiliary cross cylinder in place/ Binocular. Adequate plus lenses are added to make
the vertical lines darker. With both eyes open, patient is directed to the cross grid target
and the plus lenses before both eyes are reduced till patient reports equality in the
sharpness, blackness or darkness of the vertical and horizontal lines. Where the patient
cannot report equality but reversal, he is left with the horizontal lines darker (the lower
plus) Lenses left in the phoropter are recorded as the fused cross cylinder findings for
OD and OS.
*Patient is left with the lenses that made the horizontal lines darker, blacker or clearer
i.e. lesser plus so as to leave some accommodation free of convergence, thus giving the
patient some latitude to Still accommodate at near.
9. In AA test using lenses, if subjective finding was -1.50DS, and minus lenses were
added up to -9.00D as lenses in place in the phoropter for the patient to report a
sustained blur, what is the AA of this patient? Show working.
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ANSWER:
AA = 10.00OD (minus lenses added over and above subjective = -7.50D, AA =
2.50(Dioptric equivalence of 40cm working distance) - (- 7.50) = 10.00D.
10. In refining sphere during subjective refraction; what would be the response of a
patient given a -1.50DS instead of a -1.25DS, in the duochrome test?
ANSWER:
The circles in the green are blacker or clearer or sharper than the circles in the red.
11. In refining sphere during subjective refraction; what would be the response of a
patient given a +2.50DS instead of a +2.25DS, in the duochrome test?
ANSWER:
The circles in the red are blacker or clearer or sharper than the circles in the green.
12. How would you describe me if I can do without my +1.50DS lens? Give reason(s)
for your answer.
ANSWER:
*Facultative hyperope *In Facultative hyperopia, the error can be compensated for by
the patient's amplitude of accommodation.
13. Is it possible for a myope and a hyperope to have photophobia as a symptom? Give
reasons for your answer.
ANSWER:
*It is possible.
Myope: Dilated pupils, hence admitting excessive rays of light into the eyes
Hyperope: Stimulation of axon reflex, because of constant accommodation which
would lead to photophobia.
14. What type of cylinder lenses do Optometrist usually use to correct astigmatism and
why?
ANSWER:
Minus cylinders, because in the process of using the fogging technique to determine the
patient's Rx in subjective refraction, the focal point of the astigmatic error would be in
front of the retina necessitating the need to correct with a minus cylinder. This will
prevent a minus over correction, because relaxation of accommodation is ensured with
this focal point in front of the retina.
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15. What is the spherical equivalent (SE) of +1.50DS/-1.50DC x 180 and when is
spherical equivalence indicated? (Show working).
ANSWER:
*SE = Sph +1/2Cyl = +1.50+ (-0.75) = +0. 75DS
*Cylindrical intolerance
16. How do you perform the unfused cross cylinder test? If a patient cannot report
equality in the target used, but only reversal what would you do and why?
ANSWER:
*Target is cross grid (4 vertical lines and horizontal lines)/ Dim illumination/
Subjective refraction finding in place/3∆BD before OS/ Cross cylinder found in
phoropter accessories in place. Adequate plus lenses are added to make the vertical
lines darker. Patient is directed to the upper target and the plus lenses before OD are
reduced till patient reports equality between the vertical and horizontal lines. Where the
patient cannot report equality but reversal, he is left with the vertical lines darker (the
higher plus). Patient is directed to the lower target and the procedure repeated for OS.
Lenses left in the phoropter recorded as unfused cross cylinder findings for OD and OS.
*If equality could not be reported, but a reversal, patient is left with the lenses that
made the vertical lines blacker or clearer or darker.
*These lenses are higher plus or less minus hence ensuring further relaxation of
accommodation as we proceed to the fused cross cylinder test.
17. Give four instances when this kind of AA can be got: OD 12.00D OS 10.00D.
ANSWER:
Unequal AA far the two eyes:
Anisometropia
Anisocoria
Incorrect static refraction
Squint
Pathological interference with one of the ciliaries
Increased ocular tension in one eye restraining the action of the lens capsule
Toxic or pathologic interference with the innervational supply of one eye
18. Give No instances when this kind of AA can be got: OD 12.00D, OS 12.00D, OU
10.00D.
ANSWER:
Monocular AA is greater than binocular AA:
* Anisometropia
* Amblyopia
* Any pathology affecting one eye
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* Vertical imbalance
19. Use a clinical example to explain Gradient ACA ratio.
ANSWER:
A patient has a subjective refraction finding of -1.50DS and an induced phoria at near
of
2exo.To get the Gradient AC/A ratio, a +1.00DS is added over and above the
Subjective finding and another induced phoria at near is got (that is this time through a
-0.50DS). If the second induced phoria got is 7exo, then the AC/A ratio is 5/1, that is a
change in phoria value from 2exo to 7exo through a +1.00D change in accommodation
(5units of change in phoria to a 1. 00D change in accommodation). There is an
increase in exophoria because the plus lens added will relax accommodation and
subsequently relax accommodative convergence A -1.00DS can also be added over and
above the subjective refraction finding for the same purpose.
20. After conducting refraction on your paint, you got the following: Subjective
refraction, -1.50DS, Fused cross cylinder, -0.75DS, Write out the bifocals Rx for this
patient.
ANSWER:
-1.50DS Add + 2.25D
21. Describe how you would use the fan/sunburst to detect and determine cylinderical
component.
ANSWER:
-Fog two lines above BVA on the Snellen's chart, direct the patient to the sunburst, ask
if any one single line or group of lines appears more distinct or clearer than others do.
If there is, then astigmatism is present (detection).
-Rotate the arrow head of the fan/sunburst, and instruct the patient to say stop when the
arrow head points at the single line or middle of group of lines that appear more
distinct or clearer than others. Note the cylinder axis. If the clearest single line or
group of lines lies on 180° meridian, then the axis of the cylinder will be at 180°.
-Set the cylinder axis according to your finding (i.e. 180°) and while the patient watches
the sunburst, introduce cylinder power in -0.25D steps before the patient's eye until the
patient reports when the spokes of the fan/sunburst appear equally clear or equally
blurred. This gives the magnitude of the cylinder.
22. Establish equality in the sharpness of the cross grid in monocular cross cylinder test.
ANSWER:
Occlude one eye or put 6∆ Base Up as a dissociating vertical prism before one eye. The
patient's attention is called to the target and the eye being examined is properly fogged.
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Ask the patient which set of lines is sharper or more distinct than the other, "those
going up, or those going across"? The expected reply is those going up and down
because of the fogging lens in place. Reduce the plus lenses until the patient reports
equality in the sharpness of the cross grid.
23. Using the "minus lens to blur" method, obtain the amplitude of accommodation of a
presbyope. Give a specific example.
ANSWER:
With subjective finding in place and in bright illumination, the patient focuses at the
best near VA line at 33cm. plus lens power is added in +0.25D step until the patient just
sees the letters. The amount of plus lenses is subtracted from +2.50D. Example, if the
plus lens power that enabled the patient to just see the letters is+1.00D, the AA is 2.50(+1.00)= 2.50 - 1.00 = 1.50D.
24. Obtain the range of Accommodation of a patient.
ANSWER:
Patient wears his near prescription and a near chart is presented at 40cm. The patient
is directed to look at the best VA line and the chart is moved toward the patient until he
reports a blur and then the chart is moved away until the patient reports a blur. The
distance between the two blur points represents the range of accommodation.
25. Detect the cylinder axis of a patient using the clock dial chart, give specific
example.
ANSWER:
The patient is fogged with plus lenses and fixates at the clock dial chart at 6m. He is to
indicate whether all the lines or sets of lines appear equally blurred or whether one line
(or set of lines) appears to be blacker or clearer than the rest. The axis of the correcting
cylinder is placed perpendicular to the direction of the clearest line applying the rule of
30 (use the lower o'clock on the clock dial chart to multiple 30). Example: If the report
is that the 12 o'clock, 6 o'clock line is blacker or clearer, the axis of the correcting
cylinder will be 180 i.e. 6 (the lower o'clock) x 30.
26. Obtain the monocular spherical end point using the duochrome test.
ANSWER:
The eye is fogged with +0.75DS with the other eye occluded. In a dim illumination, the
patient is asked to look at the circles on the red and green background of the
duochrome chart. The plus lens is reduced in +0.25D steps until the patient reports the
circles in the red and green backgrounds to be equally clear.
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27. How is the Jackson Cross Cylinder positioned when refining the correcting cylinder
axis?
ANSWER:
The Jackson Cross Cylinder is positioned such that the line 45° to the two axes of the
JCC is parallel to the axis of the correcting cylinder i.e. in 'straddling position'.
28. Determine the Positive Relative Accommodation of a patient.
ANSWER:
Minus Lenses are added binocularly before the patient's eyes till the first sustained blur
is reported, as the pattern focuses on his best VA line on the near card, with his
subjective finding in place (if the subjective finding is what is acceptable to the patient
at near, otherwise use the fused cross cylinder finding). The total minus Lenses added
above the Subjective finding or the fused cross cylinder finding, as the case may be, is
the positive accommodation.
29. Determine the cylinder power after obtaining the cylinder axis using a clock dial in
subjective refraction.
ANSWER:
Add minus cylinders in -0.25DC steps until the patient says that all the lines or sets of
lines are equally clear.
30. Refine the cylinder axis using the rotation to blur method.
ANSWER:
The patient is asked to look at the best VA line and instructed to tell when the letters
blur. The cylinder axis is slowly turned clockwise and counter-clockwise until the
patient reports a blur of the letters. The correct cylinder axis lies midway between the
two limits at which the patient first noted blur.
31. Obtain the spherical end point using the fogging method.
ANSWER:
Fog the patient with +1.00DS and then start reducing the fog in +.025D steps until the
patient reports that additional reduction in plus lens (or increase in minus lens) worsen
the vision. The highest plus power or lowest minus power is the spherical end point.
32. How will you use the Fan/Sunburst to determine the cylindrical component during
refraction?
ANSWER:
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Illumination level: Normal. Target: Spokes on the chart, Monocular test. Patient's eye
fogged e.g. 6/12 line on the chart. Patient directed to view the fan/sunburst, and asked if
a single line or group of lines appears more distinct or clearer than the others. If Yes,
Astigmatism is present. Arrow head of the fan/sunburst is rotated. Patient to report
'stop' when the arrow head points at the single line or middle of group of lines that
appear more distinct or clearer than the others. The clearest line or group of lines
represents the axis. With the cylinder axis set in the axis direction, a cylinder power is
introduced before the patient's eye in -0.25D steps. The magnitude of the cylinder is
then determined as the patient reports when the spokes of the fan/sunburst appear
equally blurred or equally clears.
33. Describe how you may determine a patient’s refractive status using a Stenopeic
Disc/Slit.
ANSWER:
The stenaopeic slit is used in cases low visual acuity or when the vision is poor because
of high and or mixed astigmatism. The patient is fogged and then unfogged, until the
best possible acuity is reached. Then plus lenses are added (about 0.50 or 0.75D) to
ensure that neither meridian is hyperopic. The stenaopeic slit is placed before the eye
and is rotated while the patient fixates on the Snellen chart. The two meridians in which
the best and the poorest vision are found are located. The best meridian represents the
axis of the correcting minus cylinder. The slit is then aligned with the meridian in which
the best vision was obtained; then fogged and unfogged to best visual acuity, using
simple spheres. This power is then recorded on the optical cross in the meridian
corresponding to the location of the slit. The slit is the rotated 90 degrees away to the
secondary meridian of poorest vision. Patient fogged and unfogged until best visual
acuity achieved. This power is then recorded on the optical cross for the secondary
meridian. The axis and powers are then determined from the optical cross.
34. How can you use Jackson Cross Cylinder (JCC) to refine a correcting cylinder
power?
ANSWER:
The white or red dots on JCC arc aligned to the axis of the correcting cylinder, then
JCC is flipped. Patient is asked which side of the flip is clearer. If the red side is
clearer, minus cylinder power is increased, but if the white (or black) side is clearer,
the correcting minus cylinder is decreased. End point is when the two sides are equally
clear. If two positions shown appear the same, the lower minus cylinder power is taken.
Bracketing technique may be used, in which case, additional -0.25 added will be
rejected by the patient. Some phoropter have black and red dots instead of white and
red dots. The same procedure will still follow.
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35. Briefly explain how you will perform Positive Relative Accommodation (PRA) test.
State what the patient will report and explain why?
ANSWER:
Procedure:
Test distance is 40cm. Minus lenses are added binocularly before the eyes. Patient is to
report when target is blurred but single. Or patient to report when target remains clear
but becomes DOUBLE.
Explanations
•
Minus lenses increase accommodative innervation.
•
As accommodative vergence innervation increases, exophoria decreases.
•
Negative Fusional Vergence (NFV) compensates for phoria decrease.
•
Eventually, all accommodation is exhausted (this causes blur that might be
reported by the patient). Limit of NFV reached, patient reports clear but DOUBLE
targets because of (Dissociated position).
36. Briefly explain how you will perform Negative Relative Accommodation (NRA)
test.
State what the patient will report and explain why?
ANSWER:
Procedure:
Test distance: 40cm. Plus lenses added binocularly
Responses:
Target will be blurred but SINGLE. Or patient will report clear but DOUBLE targets.
Explanations: Plus lenses decrease accommodative innervation. Accommodative
vergence innervation decreases. Exophoria increases. Positive Fusional Vergence
(PFV) compensates for phoria (PFV)
Eventually: All accommodation has been relaxed (Causes blur to be reported). Limit of
PFV reached. Reports clear but DOUBLE targets (Dissociated position).
37. A patient who was said to have had cataract surgery, on refraction accepted: 1.00DS/-1.00DC x 50 on that eye at distance. Describe the situation:
ANSWER:
Cataract surgery will mean removing opaque crystalline lens; hence, the lens power in
that eye will be high plus lens upon refraction. But in this circumstance, we only had 1.00DS/-1.00DC x 50. What it means is that an intraocular lens has been implanted in
that eye.
38. 'I had a cataract surgery', was patient's report, but upon examination you (doctor)
said it was pterygium scrapping. What caused you to make the pronouncement?
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ANSWER:
Upon examination of the patient's eye there was no irregular area or zone of surgery
seen on the superior cornea; rather a clear scrapped zone on the external nasal part
was seen. Furthermore, VA was 6/6 on that eye, no intraocular lens was seen upon
ophthalmoscopy, and refraction showed Plano.
39. What Add is required for a patient with 20/80 acuity to read 1.00M prints?
ANSWER:
+4.00DS.
0
10
=
2
3.00;
3
5
=
2
3
3
therefore, x = = 0.25m;
5
3
0. 7.
= +4.00D
40. What Add is required for a patient with AA of 2.50D and working distance of 16"?
ANSWER:
Add = dioptric equivalent of working distance - 1/2 of AA
1/ of AA = 1.25D, Dioptric equivalent of working distance = 40/16 = 2.50
2
Add = 2.50 - 125 = 1.25D
BINOCULAR VISION AND FUSION
1. Describe the Worth's 4-dot test.
ANSWER:
The patient wears red lens in front of the right eye and green lens in front of the left eye
and views a box with four lights - one red, two green and one white. The patient is
asked to report how many coloured light he is seeing
Interpretation:
If the patient sees all the four lights in the absence of manifest squint, he has
normal single binocular vision.
In abnormal retinal correspondence (ARC) patient sees four lights even in the
presence of a manifest squint.
If the patient sees only three green light, he has right eye suppression
If the patient sees only two red lights, indicates left eye suppression.
2. Describe the After image test.
ANSWER:
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The right fovea is stimulated with a vertical bright light and the left with a horizontal
bright light and the patient is asked to draw the position of after-images.
Interpretation:
A patient with normal retinal correspondence will draw a cross.
An esotropic patient with abnormal retinal correspondence (ARC) will draw
vertical image to the left of horizontal.
An exotropic patient with ARC will draw vertical image to the right of horizontal.
3. A patient presents with a receded NPC, ortho at distance, and 10 exophoria at near,
Predict what you would find with step Vergence, Vergence Facility, Negative Relative
Accommodation, Monocular Estimation Method, Binocular Accommodative Facility,
and Monocular Accommodative Facility.
ANSWER:
Vergence Amplitude: Low Base Out to blur finding
Vergence facility: Low Base Out
Negative Relative Accommodation: Low NRA
Monocular Estimation Method: Low
Binocular Accommodative Facility: Fails +
Monocular Accommodative Facility: Normal
4. A patient presents with a normal NPC, orthophoria at distance, and 10 esophoria at
near. Predict what you would find with step Vergence, Vergence Facility, Negative
Relative Accommodation, Positive Relative Accommodation, Monocular Estimation
Method, Binocular Accommodation Facility, and Monocular Accommodative Facility.
ANSWER:
Step Vergence: Low Base in to blur finding
Vergence Facility: Low Base in
Positive Relative Accommodation: Low
Monocular Estimation Method: High (more plus)
Binocular Accommodative Facility: Fails Monocular Accommodative Facility: Normal
5. A patient has a near phoria of 12 exophoria, PFV is 4/8/2 and NFV is 12/20/14. How
much prism would you prescribe based on Sheard's criterion?
ANSWER:
Prism needed (P) =
2/ Phoria - 1/ compensating fusional
=
3
3
=
2/ (12) - 1/ (4)
3
3
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=
=
5
5
-
5
5
=
20/3
=
6.67 ∆ BI
6. A patient has a near phoria of 12 exophoria, Base-out vergence of 6/9/6, and Base-in
vergence of 18/24/21. How much prism would you prescribe based on Percival's
premise?
ANSWER:
P = 1/3G - 2/3L
= 1/3(18) - 2/3(6)
=6-4
=2
∆
2 Base-In would be required in this case because the deviation is exophoria
7. If a patient is symptomatic and has normal VA, refraction, and eye health and no
significant phoria, what condition would you investigate?
ANSWER:
8. Describe how you would objectively measure the angle of deviation with a
synotophore.
ANSWER:
-Place the tube containing the fixation slide, for example a lion, at zero on the scale at
the base of the instrument.
-The other tuba containing the surround, for example a cage, is moved to the estimated
angle of deviation.
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-An alternate cover test is performed by extinguishing the light in front of each eye in
turn and the angle is adjusted until there is no movement as the eye fixates.
-The angle is registered on the instrument's scale and should be recorded in degrees.
9. A patient presents with Ortho at distance and 6 esophoria at near and has an AC/A
ratio of 8:1. Which of the following findings is inconsistent with this presentation? An
NRA of +2.50, a PRA of -2.50, Base-out (near) 18/28/16, and Base-in (near) 4/6/-2.
Explain your answer.
ANSWER:
A PRA of -2.50 is inconsistent with the diagnosis (convergence excess)
PRA evaluates Negative Fusional Vergence in an indirect manner
The PRA procedure is not only an indication of the patient's ability to stimulate
accommodation, but also a reflection of the status of NFV.
The endpoint of the procedure in this patient is either an inability to stimulate
additional accommodation or reduced NFV.
Therefore, PRA is supposed to be much lower than the value obtained from the
patient above.
10. Describe the Consideration for prescribing added plus lens in, the treatment of
accommodative and binocular disorders.
ANSWER:
Test
Consider the Use of Added
Plus
Not
Added Plus
Indicated
AC/A Ratio
High
Low
Refractive error
Hyperopia
Myopia
Near Phoria
Esophoria
Exophoria
NRA/PRA
Low PRA
Low NRA
Base-out at Near
Normal to high
Low
Monocular Estimation Method High
Low
Retinoscopy
Amplitude of Accommodation
Low
Normal
Accommodative Facility Testing
Fails minus
Fails plus
11. Describe the Considerations for prescribing added minus lens in the treatment of
accommodative and binocular disorders.
ANSWER:
Test
Consider Use of Added Added
Minus
Not
Minus
Indicated
AC/A
High
Low
CA/C
High
Low
Phoria
Exophoria
Esophoria
Base-in at Near
Normal to high
Low
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Amplitude of
Accommodation
Accommodative
Testing
Age
Facility
Normal
Low
Fails plus
Fails minus
Younger than 6 years
9 years or older
12. Give the conditions that respond favourably to added plus lenses.
ANSWER:
Convergence excess
Basic esophoria
Accommodative insufciency
Ill-sustained accommodation
13. Which conditions respond favourably to added minus lenses?
ANSWER:
High exophoria
Divergence excess
14. How do you carry out exercises to improve the near point of convergence?
ANSWER:
- Exercises to improve the near point of convergence are carried out simply by the
patient holding a target at arm's length and then gradually bringing it towards the eye,
all the time maintaining bifoveal fixation.
- These exercises should be carried out several times each day for a few minutes.
15. Describe two modifications to the traditional near point of convergence test that can
be used to detect subtler cases of convergence insufficiency.
ANSWER:
*The near point of convergence test should be repeated four to five times.
*Assess the near point of convergence with a penlight, and then a penlight and red
glass are held before the patient's right eye, the test becomes more sensitive.
16. In performing alternating cover test, the OD turned inwards as it was uncovered,
and there was no movement in unilateral cover test. What is the condition and give
reasons for your answer?
ANSWER:
*Exphoria.
*Reasons: Fusion is broken for the eye under cover in alternating cover test, so any
movement of such an eye is indicative of a phoria (latent deviation); and an eye that
moved 'in‘ when uncovered implied that it was 'out ' under cover (physiological position
of rest).
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17. How do you determine vertical phoria at near using Maddox rod? lf the patient
reports the spot above the streak with the Maddox rod conventionally placed, what type
of phoria is that and what type of prism may be required for correction?
ANSWER:
*Patient is comfortably seated. Maddox rod is positioned vertically before OD (seen in
horizontal orientation by patient) and penlight shone at 40cm. The right eye sees a
horizontal streak, while the left eye sees the spot. Patient should report the position of
the streak with respect to the spot. If the streak is above the spot, it indicates right
hypophoria which is reported as left hyperphoria; if the streak is below the spot, it
indicates right hyperphoria; if the streak is superimposed on the spot, it indicates
orthophoria.
*RT hyperphoria.
*Prism BD before OD and BU before OS.
18. How do you perform the unilateral cover test at far? Which eye is conventionally
watched in the unilateral cover test and why not the other eye?
ANSWER:
*Patient seated comfortably and directed to fixate at a distant target straight ahead.
Examiner is positioned such that the patient's view is not obstructed and that he can
clearly see the patient's eyes. Cover and uncover OD, watch OS/Cover and uncover OS,
watch OD. Any movement of the watched eye as the other eye is covered and uncovered
is noted. Example: Of OD moves in as OS is covered and moves out as it is uncovered,
it indicates right exophoria. If OD moves out as OS is covered and moves in as it is
uncovered, it indicates right esophoria. If there is no movement it indicates absence of
tropia.
*To elicit a tropia (manifest deviation) you close the fixing eye and check the movement
the initially non-fixating eye makes to establish fixation and also the movement it makes
when the fixing eye is opened (to go back to its non-fixing position)
19. What are the three different possibilities if right eye does not move when left eye is
covered or uncovered in unilateral cover test?
ANSWER:
Phoria/No right tropia/Left tropia/Alternating tropia (right eye fixating)
20. Which EOMs are involved in dextroversion, there synergists, and antagonists?
ANSWER:
*EOMs-RLR and LMR
*Synergists-RIO, RSO and LSR
*Antagonists-LIR, RMR and LLR
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21. What do you use red/green goggles for in the clinic?
ANSWER:
Used in the Worth-4-dot test (red and green targets) to determine 2nd degree of fusion
22. Your patient's induced phoria at far is high esophoria, which duction test would be
of
great importance to determine the prismatic correction using sheard‘s criteria and why?
ANSWER:
*Base in duction at far
*BI prism would move the eye towards the apex which is out, and thus compensate for
the eyes which are latently inwards.
23. Your patient's induced phoria at near is high exophoria, which duction test would be
of great importance to determine the prismatic correction using Sheard's criteria and
why?
ANSWER:
*Base out (BO) duction at near
*The BO-prism will move the eye towards the apex which is in and thus improve
Positive Fusional Vergence reserve.
24. What clinical features would you use to make a diagnosis of convergence
Insufficiency?
ANSWER:
Low ACA ratio
NPC recedes beyond 10cm
Likely to be low positive fusional vergence reserve
Near phoria is high exophoria and far phoria is ortho or near ortho.
25. In the absence of a tropia, what is the approximate location of the corneal reflex and
why?
ANSWER:
*The reflex is 0.5mm nasal to the centre of the pupil
*Because of angle lambda. Angle lambda is measured from the entrance pupil of the
eye, because the line of sight (LOS) does not pass through the centre of the pupil. Angle
lambda is the intersection of the pupillary axis and the LOS. The LOS makes a small
angle (about 5°) with the pupillary axis.
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26. How would you position the Maddox rod to perform lateral phoria test, how is it
seen by the patient and why?
ANSWER:
*Placed horizontally
*Patient sees it reoriented vertically
*Because of the presence of convex cylinder in the Maddox rod that re-orientate object
seen 90° away from former position.
27. If a patient has orthophoria at 6m and 8∆ esophoria at 40cm, and is given a +1.00DS
for constant wear, what would be the effect on the demand if the ACA ratio is 4/1? Give
reasons for you answer.
ANSWER:
*Phoria at far: 4exo; Phoria at near: 4eso.
*Since the AC/A ratio is 4/1, the +1.00DS would relax accommodation and thus relax
accommodative convergence by 4 units (increase exophoria and reduce esophoria by 4
units)
This is why the new phoria is now 4exo @far and 4eso) @ near.
28. If there was no movement in unilateral cover test, and the right eye turned inward as
it was uncovered in alternating covert test, what would you record, and what type of
prism would be required for correction and for training?
ANSWER: ’
*Exophoria
*BI prism for correction
*BO prism for training
29. Which cranial nerves are involved in squint?
ANSWER:
*Cranial nerve III (Oculomotor nerve)
*Cranial nerve IV (Trochlear nerve)
*Cranial nerve VI (Abducens nerve)
30. How would a patient see a target if 15 ∆ BI is before the left eye and 6 ∆ BD before
the right eye. Explain your answer.
ANSWER:
*UP to the right, down to the left.
*The 15 ∆ BI before OS displaces the left target to the left and the 6 ∆ BD displaces the
right target up.
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31. Highlight the uses of prisms in diagnosis, correction, and training (orthoptics), with
specific references to the base direction.
ANSWER:
*Diagnosis: Phorias and ductions/To detect malingering.
*Correction: Vertical and lateral muscular imbalances.
*Orthoptics (Training): To stimulate one or more EOMs to counteract the effects of
phoria and strabismus (to counteract diplopia).
32. With the Maddox rod conventionally positioned in the determination of lateral
phoria, if the patient reports the streak to the right and the spot of light to the left, what
is the phoria condition, what type of prism is needed to achieve superimposition, and
what type of prism would be required for training?
ANSWER:
*Esophoria
*BO for correction
*BI for training.
33. State the prism directions, illumination, target and auxiliary devices needed to
perform
phoria test through unfused cross cylinder finding. Compare this test to induced lateral
phoria at near (2 differences and 2 similarities).
ANSWER:
*Prism directions; 15 ∆ BI OD, 6 ∆ BU OS. Illumination; Normal illumination. Target;
Cross grid. Auxiliary device; Auxiliary cross cylinder lenses in place.
*Differences- Target for phoria through unfused cross cylinder finding is cross
grid/Target for induced lateral phoria is reduced Snellen chart or vertical straight line
of letters (BVA at near).
-In phoria through unfused cross cylinder, cross cylinders are in place/ In induced
lateral phoria, cross cylinders are not in place.
-In unfused cross cylinder phoria, lenses in place are unfused cross cylinder findings/
In induced lateral phoria at near, lenses in place are subjective findings.
*Similarities- Both are lateral phoria test-same types of prisms, BI for measurement,
and BU for dissociation
-Both are near tests. - Illumination is normal in both.
34. How would you perform the test that reveals the compensating duction for a patient
that is exophoric at near? Differentiate it from the compensating duction test for the
esophoric patient at far (3 difference).
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ANSWER:
*Lenses in place are subjective refraction findings or lenses acceptable to the patient at
Illumination is normal/ Target is reduced Snellen's chart at near (BVA)/Phoropter is
adjusted for near test. BO prisms are increased before both eyes at near for patient to
report blur and the prism readings on both eyes are added to get the finding.
*Difference between the test and the compensating duction tast for esophoria at far. BO
prisms are introduced in the first, BI prisms in the second.
-Report is blur in the 1st and break in the 2nd
-Convergence is stimulated in the 1st, inhibited in the 2nd.
35. How is right infravergence of a patient at far determined? OF what relevance is this
finding?
ANSWER:
*Target is patient's BVA at far. Illumination is normal and phoropter is adjusted for far
IPD.
Lenses in place are subjective findings. Prisms are positioned to be turned BU or BD.
Prism
is increased in the Base-up direction before the right eye for the patient to report break
and decreased for patient to report recovery. Finding is recorded as Break
value/recovery value e.g. 5/2. If recovery occurs say at 1prism BD, it is recorded as 5/1
*Prescribing prisms for vertical imbalance
36. Perform the test determine PFV at near. Of what Significance is this test?
ANSWER:
*Lenses in place are subjective refraction findings or lenses acceptable to the patient at
near/Illumination is normal/Target is reduced Shellen's chart at near (BVA)/phoropter
is adjusted for near test. BO prisms are increased before both eyes at near for patient to
report blur and the prism readings on both eyes are added to get the finding.
*To know if the compensating duction is adequate in a case of exophoria at near. Also
of significance in prismatic prescription, alteration of spherical component of a
prescription and visual training.
37. How do you determine lateral phoria at near using Maddox rod? If with the Maddox
rod customarily placed, the patient reports the spot of light to the right of the streak,
what is the condition?
ANSWER:
*Patient is comfortably seated Maddox rod is positioned horizontally before OD and
penlight flashed on the midline at 40cm. The right eye sees a vertical streak while the
left eye sees the spot. Patient should report the position of the streak with respect to the
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spot. If the streak is to the right of the spot (uncrossed diplopia), it indicates exophoria;
if the streak is to the left of the spot (crossed diplopia), it indicates exophoria; if the
streak is superimposed on the spot, it indicates orthophoria.
*Exophoria (Crossed diplopia).
38. How do you perform alternating cover test? What is it used for? (2 uses)
ANSWER:
*Direct the patient to a far or near target depending on the distance at which the text is
to be preformed. Cover OD, uncover and watch it as occluder is moved to OS; do same
for OS. If OD moves with the occluder as it is moved to OS (meaning that OD was 'out'
behind the
ocluder), it indicates exophoria; if it moves against the movement of the occlude
(meaning that OD was “in" behind the occluder), it indicates esophoria; if there is no
movement, it indicates orthophoria.
- Used to detect phoria
-To measure magnitude of phoria
-To measure magnitude of tropia
39. How is right supravergence of a patient at far determined? What is the relationship
between the vertical duction values of the two eyes?
ANSWER:
*Target is patient's BVA at far. Illumination is normal and phoropter is adjusted for far
IPD.
Lenses in place are subjective findings. Prisms are positioned to be turned BU or BD.
Prism
is increased in the Base-down direction before the right eye for the patient to report
break and decreased for patient to report recovery. Finding is recorded as Break
value/recovery value e.g. 4/1. If recovery occurs say at 1prism BU, it is recorded as 4/1.
*If the muscle tone remains the same, magnitude of right supravergence should be same
as left infravergence and magnitude of left supravergence should be same as right
infravergence.
: ; 5/3
> ; 7/
Example:
= 7/
= 5 /3
40. How is the NPC determined? When is the finding of the NPC test significant and
what is the implication?
ANSWER:
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*The RAF rule is used. Illumination is normal. A fine target (the tip of a pen, a black
line on a white background etc.) is brought in from about 25cm on the patient's midline.
The target is moved towards the patient's nose, while the patient's is instructed to fixate
on the target and keep it single. The patient is to report when the target doubles. The
patient's eyes should be watched for a deviation of any of the eyes. The point is noted
when the patient reports diplopia or when one of the patient's eyes turns out. The target
is again moved back till the patient reports seeing one or the eye that turned out aligns.
It is recorded as Break/Recovery.
Example: 8/11, OS out.
*The expected value of the NPC is 8 - 10cm or less, as measured from the spectacle
plane. If the NPC is 12 to 15cm on repeated testing, the examiner should suspect
convergence insufficiency syndrome.
41. Describe saccade eyes' movement.
ANSWER:
Eyes change fixation from one point quickly and in the same direction. It is voluntary.
42. Describe version eyes' movement.
ANSWER:
Eyes follow a moving target across the field. Eyes move in the same direction.
43. Describe vergence eyes’ movement.
ANSWER:
Eyes follow a moving target as it comes closer to the nose or moves farther from the
nose
Eyes move in opposite directions.
44. What is graded occlusion?
ANSWER:
a) Occlusion not permitting light.
b) Occlusion permitting light without formation of image.
45. How do you improve the negative fusional vergence of your patient using the
synoptophore?
ANSWER:
Examiner diverges the arms of the synoptophore and the patent maintains the target,
say the lion in the cage, with mental effort.
46. What is the formula for determining the amount of prism correction in lateral phoria
using the Sheard's criteria and Percival’s premise?
ANSWER:
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*Sheard's; Prism amount = 2/3(Demand) - 1/3(Reserve)
*Percival's; Prism amount = 1/3(Greater of the lateral range blur limit BI or BO) 2/3(Lesser of the lateral range blur limit BI or BO)
47. Record your possible findings after vertical phoria and duction test at far.
ANSWER:
The phoria vertical finding and the ductions;
2^ rt hyper
OD S 5/1 I 4/1
OS S 4/1 I 5/1
Where S is supravergence and I is infravergence.
48. What do you use to measure the amount of deviation in a strabismic using
Krimsky's method?
ANSWER:
The prism bar
49. What do you use to measure the amount of deviation in a strabismic using
Hirschberg's method?
ANSWER:
PD rule
50. Interpret your patient's response in the Worth-4-dot test
ANSWER:
Conventionally placed; with Red lens on the Right eye and Green lens on the Left. lf
patient reports:
5 dots = diplopia
4 dots (2green, 1red, 1yellow/white) = normal binocular observer or a strabismic
with Anomalous Retinal Correspondence
3 green dots = right eye suppressed
2 red dots = left eye suppressed
51. How do you test for the first degree of fusion in your patient using the
synoptophore?
ANSWER:
With dissimilar cards to be perceived at the same time (like lion in a cage).
52. How do you test for the 2nd degree of fusion in your patient using the synoptophore?
ANSWER:
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With similar or identical cards
53. How do you train your patient for simultaneous perception using the synoptophore?
ANSWER:
With dissimilar slides to be perceived at the same time (like lion in a cage).
54. How do you improve the positive fusionaI vergence of your patient using the
synoptophore?
ANSWER:
Examiner converges the arms of the synoptophore and the patient maintains the lion in
the cage with mental effort.
55. How do you improve the positive fusionaI vergence of your patient using any other
device other than the synoptophore?
ANSWER:
With prism bar; successively increasing the power in the base out direction.
56. State the yoked muscle in the 6 cardinal positions of gaze.
Answer:
Position
Up and to the right
Up and to the left
Down and to the right
Down and to the left
To the right
To the left
RE
SR
IO
IR
SO
LR
MR
LE
IO
SR
SO
IR
MR
LR
57. a) Which eye do you observe in unilateral cover test, when a strabismus is obvious?
b) What is your objective as an examiner? c) lnterpret your result.
ANSWER:
a) The examiner observes the fixating (open) eye
b) The objective is to know if the patient can pick up and hold fixation with the
deviating (tropic) eye.
c) The resulting interpretation is to classify patient as a unilateral or alternating
strabismic.
58. In alternating cover test; a).Which eye do you observe? b) What is your objective as
the examiner? c) Interpret your result.
ANSWER:
a) The examiner observes the just uncovered eye.
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b) The objective is to know the direction of the corrective movement made to pick up
fixation upon uncovering.
c) The resulting interpretation is that if an eye moves 'out' to pick up fixation upon
uncovering, it means it was 'in' under the cover and therefore case of esophoria (the
direction of deviation is opposite the correcting movement made to pick up fixation).
The examiner can then classify the phoria as exo or eso, hyper, excyclo or incyclo.
59. Detect anomalous correspondence in the strabismic using Worth-4-dot test.
ANSWER:
With Worth-4-dot and the response of the strabismic is 4 dot (2 green, 1red, and
1yellow), it means that there is anomalous retinal correspondence (ARC).
60. In measurement of vertical phoria using the von Graefe technique, how will you
conventionally position the prisms in the phoropter? Identify the measuring and
dissociating prisms,
ANSWER:
Place 12 ∆ (or 15 ∆ ) Base In (Dissociating prism) before the right eye and 6 ∆ Base Up
(measuring prism) before the left eye.
61. How would you use the Worth-4-dot test to diagnose normal binocular vision,
suppression and diplopia in a patient?
ANSWER:
Procedure: There are 4 illuminated discs (dots), one red, one white and two green on a
black background. Dim illumination level is required. Patient wears a red-green goggle
or filters, red in front of one eye (conventionally OD) and green in front of the other
(conventionally OS). The eye behind the red, will see the red disc and the white disc, but
will not see the green disc. The eye behind the green will see the green disc and the
white disc, but not red. Test distance is 6m or 33cm. Patient is requested to report how
many dots and colours seen.
Interpretation: Report of four (4) dots (1 red, 2 green and 1 mixed), Indicates normal
binocular vision (Normal Retinal Correspondence). two (2)
dots, both red, Indicates suppression of the image in the eye wearing the green filter
(OS), three dots, all green, indicates suppression of the image in the eye wearing the
red filter (OD), and five (5) dots, 2 red and 3 green, Indicates diplopia.
62. How will you determine Physiologic exophoria for a patient?
ANSWER:
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The physiologic exophoria is the difference between the near and far phorias. The
distance and near phorias may be measured using the von Graefe methods. To obtain
the physiologic exophoria value, the far phoria should be subtracted from the near
phoria algebraically. Exophoria is considered as a plus (positive) and esophoria as a
minus (negative) quantity.
63. Briefly describe how you will measure vertical phoria at 6m, using the von Graefe's
method.
ANSWER:
Procedure: The distance prescription should be in the phoropter, the plane of fixation
should be horizontal and eyes in the primary position of bifoveal fixation. Target is a
horizontal row of letters representing the best VA of the patient. Patient is to fixate the
letters. Six prism diopter (6 ∆ ) is introduced BU before the left eye. Patient is informed
that he or she will see two rows of letters. Ten to fifteen (10-15 ∆ ) prism BI is then
introduced before the right eye.
The patient is informed that he will see two targets, one up and to the right, the other
down and to the left. The patient is asked to watch how the lower row will more up, and
to report when they are at the same horizontal level like the headlamps of a car. The
prism in front of the left eye is gradually reduced until the patient reports alignment.
Interpretation:
Prism before the eye is zero: Vertical orthophoria
Prism base down: Left hyperphoria
Base-up: Right hyperphoria.
64. Briefly describe how you will measure Lateral phoria at 6m, using the von Graefe‘s
prism dissociation method.
ANSWER:
Distance prescription in the phoropter. Plane of the fixation is horizontal and eyes at
primary position of gaze. Target: Letter targets recommended to ensure control of
fixation and accommodation. A single letter or row of letters representing the best VA,
or larger, but not larger than two rows above of the patient's best VA line. Patient to
fixate the letter or read the letters, to ensure control of accommodation.
Six to eight prism diopters (6- 8∆ ) BU prism to be introduced before LE. Patient is
informed that two letters or two rows of letters will be seen. Ten to fifteen prism
diopters (10-15∆ ) BI is introduced before the RE. Patient is informed that there are two
targets, one up and to the right, the other down and to the Left. If the patient reports
that the targets are not displaced as stated, the phoria may be greater than 10prism
diopters of exophoria. In that case, Increase the strength of BI prism until patient
reports seeing two targets appropriately displaced. If patient still report not seeing two,
increase the strength of the BU prism or check the phoropter head to ensure it is
properly positioned.
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Cover the LE, tell the patient that lower line has disappeared, when you see it, is it to
the right or left of the top line. Patient should report the lower line to the left. Reduce
the BI by 1-2 diopters and repeat the cover/uncover procedure until the targets are at
the same level, like the buttons on a shirt. The endpoint is when the top and lower rows
are at the same level. Record prism power as amount of exo, eso, or ortho. The
direction of prism base is the direction of the lateral phoria BO = eso, BI = exophoria.
65. How can prism bars be used to measure vertical vergence at far?
ANSWER:
Prism bar (base-up) is placed before the right eye. The patient is informed that the lens
in front of his or her eye will be changed. He/she should focus on the best VA target at
far and report the point when the target breaks into two. The prism power at this point
should be noted. The prism power is then reduced and the patient is instructed to report
the point at which the target becomes single again. The same procedure is repeated in
the same eye with the prisms placed base down (BI). Findings to be recorded as: E.g.
OD Infravergence (BI) 5/2, Supravergence (BD) 3/1. The same procedure is repeated
for OS and appropriately recorded.
66. How will you determine Positive Relative Convergence (Base Out in blur)?
ANSWER:
This near point base-out to blur prism test is done at 40cm. Normal room illumination.
Target is 20/20 acuity line. If patient is a non-presbyope, hyperope or emmetrope, the
test is done through subjective finding. If the patient is a presbyopic hyperope or
emmetrope, the test is done through the net fused cross cylinder test lenses. If the
patient is a myope, test should be done with the habitual near correction in place.
Patient is instructed to fixate the target and to report when s/he is no longer able to
read a single 20/20 line. Both Risley prisms are positioned before the patient's eyes so
that they can be turned in base out directions simultaneously. Patient is encouraged to
continue to fixate the target, the amount of base-out is gradually increased binocularly
at the same time, until the blur point is reached. The total amount of base-out before
both eyes is recorded as the Positive Relative Convergence value.
66. How will you measure lateral phoria for a patient using a Maddox rod for 50-year
old patient at near?
ANSWER:
Procedure: Target is a hand-held fixation light. Reading glasses should be in place.
Maddox rod is placed before right eye, with grooves horizontal to create vertical streak.
Rotary prism should be kept at zero and placed on the left eye (hand-held prism could
be used). The patient's LE is covered for a moment and his or her attention is drawn to
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the vertical red light (It should be ensured that the light is not tilted). The occluder is
removed. Patient will see the fixation light and the vertical red light.
Right eye is covered and Indicate to the patient the red line has disappeared and when
it reappears, tell me if it is to the right or left of the light. The cover is then removed.
Interpretation: If the red line passes through the light, Orthophoria. If the light is to the
right of the streak, there is exophoria. One, two or more prism diopters (BI) is used to
move the prism until the red line passes through the light. If the light is to the left of the
streak → Eso (measure with BO prisms). If Maddox Rod is on the left eye,
interpretation is reversed; however conventionally the Maddox rod is placed on the
right.
67. Briefly describe how you will measure amplitude of accommodation for a 60-yearold patient.
ANSWER:
Push up method may be used. This is a monocular test. Distance prescription of the
patient, if any, is put in the trial frame. A +2.00D auxiliary lens is also put in the trial
frame. Illumination: Normal room illumination plus over-head light. Eye not been
tested should be occluded. A Royal Air Force (RAF) rule is placed on the patients face.
The target is a 0.37M print, located beyond the patient's near accommodation.
Instructions to the patient: Read the print loud, I am going to move the print close to
you, it may be blurry, keep on reading until the first blurring of the print you cannot
clear instantly. The print material is moved toward the patient's eye. Target is moved
until end point is reached. End point is the first noticeable blur that cannot be cleared
by the patient within few seconds.
The distance between the spectacle plane and the blur distance is measured. The
auxiliary lens power (+2.00D) is subtracted from the reciprocal of this value to get the
Amplitude of Accommodation (AOA) in diopters (D). This value may be read directly
from the RAF rule and the auxiliary lens power still subtracted from it.
VISUAL FIELD
1. What would a lesion at the right optic tract lead to?
ANSWER:
Left homonymous hemianopsia.
2. In Standard Automated Perimetry (SAP), what set of data is provided by the
analysis?
ANSWER:
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Reliability indices (test duration, fixation losses, false-positive and false-negative
error scores)
Pictorial grey scale plot of the visual field
Plot of Raw data sensitivities of each test spot
Global indices in dB showing shape and height if patient's Hill of vision deviates
from normal
Total deviation Plot, Probability map
Analysis of change in visual field sensitivity with time
Glaucoma Hemifield test
3. Two major types of Perimetry have been identified, differentiate between them.
ANSWER:
*The two types are Kinetic and Static Perimetry,
*-Kinetic Perimetry involves detection of moving targets, while Static Perimetry
involves the detection of a stationary target.
-Static testing is superior to kinetic perimetry in detecting slopes and scotoma, it is
more reliable and consistent in detecting glaucomatous visual field loss.
4. In Glaucomatous field defects, enumerate 8 possible field defects that can be
elucidated during standard automated perimetry.
ANSWER:
Nasal step
Temporal wedge
Superior arcuate defect
Superior paracentral defect 10°
Superior fixation threatening paracentral defect
Superior arcuate peripheral breakthrough and early inferior defect
Tunnel Vision
Complete field loss.
5. Briefly describe how you will evaluate the central visual field at near for a paint
suspected to have an early stage of maculopathy (age-related macular degeneration).
ANSWER:
Best corrected visual acuity (BCVA) required. Test chart, Amsler grid to be used at 2830cm.
Instruction: Focus on the central white spot. Can you see the four corners of the large
square? if yes: There is complete near field. If no, and one or more corners cut off:
Scotoma.
Further instruction: Are there interruptions in the network or are there some blur
areas? If no interruption is reported: No Scotoma. If interruption is reported: Scotoma.
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Location of scotoma to be established. If wavy lines are reported: There is
metamorphopsia.
6. How will you use Tangent Screen to evaluate the visual field of a 50-year old
patient?
ANSWER:
Test distance is one meter, and illumination is normal level, except the patient highly
photophobic such as in case of patients with albinism. Appropriate glasses should be
worn, if the patient has refractive error. If patient wears bifocal, appropriate trial lens
for the test distance can be worn improvised. (Spherical equivalent lens may be
employed). The blind spot of the patient should be mapped out first, using white test
object 5 to 10mm, preferably going from unseen to seen. The patient is to report when
he sees the target. Once the blind spot has been grossly mapped out, a similar test
object 2-3mm is used to determine the boundaries of blind spot. Patient should be
instructed to fixate on central fixation target. To detect Scotomas within the central
field, the test object is moved in a radial direction at interval of 5 degrees. The target
should be occasionally flipped over to make the patient report disappearance. Target
should be moved to the mid-line vertical for detection of hemianopia and horizontal for
detection of nasal step. Any scotoma should be mapped out and location reported.
7. Demonstrate location of central scotoma and in what situation will it be found?
ANSWER:
Central scotoma are located as pericoecal areas beside the macula and usually found
in visual field of patients with optic nerve disease.
8. What is the difference between arcuate scotoma and Bjerrum scotoma?
ANSWER:
*These two scotomas are of glaucoma outcome; but the arcuate is of the early outcome,
while the Bjerrum scotoma is a visual field outcome at the established stage of
glaucoma.
*The arcuate is just a small scotoma emanating from about 20-degree portion of the
field and stopping not more than 10mm space, while the Bjerrum scotoma, arises from
the 20° portion of the field and runs upwards up to 50mm space unto another quadrant.
9. What is Bitemporal Hemianopsia; and where in the visual pathway is affected?
ANSWER:
The two temporal halve of the visual field are lost and the effect (lesion) in the patient
will be on the chiasma.
10. What is the most frequent Visual Field defect in a patient with optic nerve disease?
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ANSWER:
A central scotoma
11. Establish a diagnosis of homonymous hemianopsia on your patient.
ANSWER:
Visual field plotting will reveal visual field loss on the left or right side of the vertical
line.
12. Establish the position of a lesion in a case of Bitemporal hemianopsia.
ANSWER:
Since vision is missing in the outer half of both the right and the left visual fields the
lesion is located on the optic chiasma.
13. During peripheral field determination using Bjerrum screen, on which part of the
screen does the patient fixate while the blind spot of the eye is mapped out?
ANSWER:
Centrally
14. Describe how you perform confrontation field testing with both eyes open (both
patient and examiner).
ANSWER:
Confrontations testing with both eyes open.
Ask the patient to stare directly and steadily into your eyes. Staring can cause
embarrassment or awkwardness, so allow the patient to rest and try again if he finds it
difficult to look at you so directly. Check that the patient can look steadily at your eyes
while you look steadily at his. Ask the patient whether any part of your face is missing
or indistinct.
Check the patient's left hemi-field by making a fist with your right hand and holding it
in his left hemi-field, at eye level, just to the right of your face. Making sure that the
patient is still holding your gaze, raise one to four fingers and ask how many fingers
can be seen. To test the upper and lower quadrants, move your hand up and to the
right, and down and to the right, repeating the test at various points. The simple fingercounting test is particularly useful for detecting visual field loss due to neurological
problems (such as strokes), but is only useful for patients with glaucoma when the
visual field loss is severe.
To test the patient's right hem-field and upper and lower quadrants, repeat the fingercounting test using your left hand, starting just to the left of your face and moving up
and left and then down and left.
A useful, additional test to perform in patients with a suspected homonymous
hemianopsia (i.e. loss of either the right or left field of vision in both eyes, often from a
stroke) is to test for sensory inattention. Hold both hands up and wiggle the fingers of
the right hand, followed by those of the left hand in each hemi-field. If the patient sees
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the moving fingers, then wiggle one finger of each hand at the same time — if the
patient can only see movement on one side then he may have a subtle hemianopia.
15. Describe how you will perform confrontation field testing with one eye open (both
patient and examiner).
ANSWER:
Ask the patient to cover his eye with the palm of his hand (not the fingers, as it is easy to
peep between fingers). Remember that you should class your eyes in turn too, so that
you are comparing the field in your right eye with the field of the patient's left eye, for
example,
Do the finger counting test first (static testing). Be sure to test on both the left and the
right for each eye tested.
Next, bring your target finger from the far periphery in towards the central region
(kinetic testing). Ask the patient to say when he first sees the target. Repeat from several
different directions, ensuring that the full 360° for each eye is tested. The examiner
should remember to perform kinetic testing at a speed appropriate for the patient's
response.
Next, test the peripheral field with a white-headed neurological pin (beyond a central
30° radius) and the central field with a red-headed neurological pin (within a 30°
radius). Testing with neurological pin targets gives much more accurate results than
testing with fingers, and can detect earlier visual field loss. Red-headed neurological
pin are also useful for assessing the size of the blind spot (e.g. with Papilloedema),
again by comparing the size of your blind spot with that of the patient's. In addition,
red-headed neurological pin can be used to test for red-desaturation in early optic
nerve disease.
16. Describe how you would conduct a test using the Amsler grid.
ANSWER:
Test one eye at a time, correcting for any near refractive errors. Patient should hold the
chart at a comfortable reading distance from the uncovered eye, and stare at the central
spot of the grid. Ask him to identify and then point out any areas where the grid is
missing or distorted. Missing areas may suggest paracentral glaucomatous visual field
loss, whereas distortion is more common with macular disorders.
17. How is Campimetry performed?
ANSWER:
Campimetry is a method (technique) for examining and assessing the central part of a
person's visual field.
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The subject (in an experiment) or a patient (in a clinical situation) concentrates one eye
on a target at the center of a black screen, two metres ahead. A small lighter-coloured
object (3mm in diameter) is then brought into his/her field of view and the subject
reports when he or she first sees it. This process is repeated with the object being
brought into the subject's field of view from many different directions in order to buildup a map of the subject's field of view using that eye alone.
The procedure may he repeated for the other eye as the size and shape of the subject's
visual
field may not be the same for each eye.
18. Establish macular defect in the elderly using the Amsler's grid.
ANSWER:
If on looking directly at the white dot on the grid positioned at 30cm, with the
appropriate correction for the distance, the vertical and horizontal lines appear wavy
or bent.
19. Establish optic nerve defect in the elderly using the Amsler's grid.
ANSWER:
If on looking directly at the white light on the grid positioned at 30cm, with the
appropriate correction for the distance, the small squares become blurry or missing.
20. What conditions could possibly lead to the expected slightly constricted visual field
seen in the elderly?
ANSWER:
Senile miosis, dermatochalasis, decreased retinal illumination and slower reaction
time.
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PAEDIATRIC OPTOMETRY
1. Determine the far VA of a 5 year old patient.
ANSWER:
Using the Landolt C or the Tumbling E set at 6m or 3m, the patient tells the orientation
of the “C" or "E". Performed monocularly, where the acuities in both eyes are
compared and then binocularly.
2. Assess for anterior chamber clarity in a 10 year old boy.
ANSWER:
Visually inspect the chamber with the naked eye, a hand-held magnifier, an
ophthalmoscope or a slit lamp. Chamber should be completely clear: transparent and
free from foreign matter.
3. Establish fixation stability in a child.
ANSWER:
a)
Direct visual inspection for the absence of nystagmus: Naked eye observation at
each of the diagnostic positions of gaze.
b)
Assess patient under monocular and binocular viewing conditions.
c)
Assess patient with fixation at near point and far point.
4. Evaluate a pre-schooler for strabismus with an ophthalmoscope.
ANSWER:
Bruckner's test. Both eyes are simultaneously Illuminated with the ophthalmoscope
beam at a distance of 100cm. Difference in the brightness of the pupil area is noted.
The brighter and whiter pupil area is considered the strabismic eye.
5. Determine the near refractive status of a preverbal child using Mohindra's technique.
ANSWER:
With the infant seated on the parent's lap and the room darkened as much as possible.
Retinoscopy is performed at 50cm (20 inches) in the two principal meridians of each
eye with patient fixating at the light of the retinoscope monocularly (the other eye being
occluded). Distance retinoscopic refraction is derived by adding -1.25D algebraically
(to take into account the working distance and the state of accommodation in the dark)
to the spherical component found by near retinoscopy. Other sources state that -0.75D
is a better value to use for infants and -1.00D should be used for children over the age
of two years.
6. What features are usually looked out for in the assessment of the crystalline lens of a
neonate?
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ANSWER:
Size, shape, position and transparency
7. How do you evaluate the anterior chamber depth of a preschooler using penlight?
ANSWER:
Shadow test. Hold a penlight at the temporal side of the eye, directing the beam across
the plane of the iris. Watch closely for any shadow and judge its size.
8. How would you fully uncover what you suspect to be a case of latent hyperopia in a
child?
ANSWER:
Wet refraction is done here using a cycloplegic drug (preferably cyclopentolate).
9. Determine the integrity of a child's extra ocular muscles for mobility.
ANSWER:
Perform any of the following tests:
a) Duction: Movement of one eye
b) Version: Conjugate movement of both eyes.
c) Near point of convergence: As a disjugate movement of both eyes.
10. Assess for stereopsis in young children without the use of supplementary spectacles.
ANSWER:
Lang test or Frisby test.
Patient is directed to the test card which is placed 40cm away. He is to show or tell the
picture that looks closer to him/her.
11. Assess for binocular vision in a school child using the Worth-4-dot test.
ANSWER:
Red green goggles are worn with red lens conventionally on OD and 4 dots on a black
background are viewed: one white, one red and two green.
*Four dots seen in original pattern indicates normal binocular vision.
*Five dots seen indicate binocular vision without fusion
*Two red dots indicate suppression of OS.
*Three green dots indicate suppression of OD.
12. Assess mobility pattern of the eyelid in a 4 year old.
ANSWER:
a)
Blinking rate: Engage patient in conversation and count her blinks.
b)
Lid-globe movement: Have patient shift gaze from straight ahead to up, down,
right etc
c)
Lid closure: Ask patient to close her eyes in a normal style of going to sleep, note
the completeness of the lid closure.
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13. What features are watched out for during fundus assessment of a child?
ANSWER:
Using an ophthalmoscope, look at the optic disc, blood vessels, peripheral regions and
the macula.
14. What possible abnormalities of the scleral vasculature that can be seen in a child?
ANSWER:
Scleritis
Episcleritis
15. What are the maternal risk factors to a child developing eye problems?
ANSWER:
Maternal age
Nutrition
Hereditary
Maternal health
Mother's habits
16. What congenital abnormalities pose a threat to the transparency of the crystalline
lens?
ANSWER:
Congenital cataract
Mittendorf's dot
17. Give five abnormalities of the cornea associated with its shape and size in children.
ANSWER:
Megalocornea (macrocornea)
Buphthalmos
Microcornea
Keratoconus
Karatoglobus.
18. What alternatives could be given to a one year old child who cannot understand the
rudiments of orthoptic exercises?
ANSWER:
a)
Constant wear of full correction
b)
Occlusion or penalization in a patient who cannot tolerate occlusion.
19. What four methods are employed to improve accuracy of monocular foveal
alignment in amblyopic children?
ANSWER:
a)
Occlusion
b)
Penalization
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c)
d)
Use of plus lenses
Light filter
20. A baby is just 3 days old and has purulent, copious film discharge, bilaterally. What
candid advice will you give to the parent?
ANSWER:
This must be a case of ophthalmia neonatorum being a birth canal infection from
mother to child. Antibiotic used depends on the cause (systemic erythromycin and
topical tetracycline for Chlamydia infection, ceftriaxone or cefotaxime for gonococcal
infection) and eye irrigation with saline solution. Traditional therapy involved silver
nitrate or povidine iodine for at least 2 weeks, combined with antibiotics and copious
irrigation with bland lotion.
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KERATOMETRY, PACHYMETRY, CORNEA AND CONTACT LENSES
1. What steps would you take to determine the right eye K-reading of a patient with the
Bausch and Lomb keratometer?
ANSWER:
*Set occluder on the left eye
*Focus eyepiece
*Level keratometer with respect to outer canthus of the right eye
*Align keratometer with centre of cornea of the right eye
*Focus the mires, and refine level and alignment as needed
*Find K reading, using axis scale and measuring drums
2. How will you calibrate a manual keratometer?
ANSWER:
*Place a sheet of white paper over the back of the keratometer
*Turn on the instrument
*Rotate the eyepiece fully counter clockwise
*While keeping both eyes open, turn the eyepiece in the clockwise (plus) direction until
the crosshairs came into sharp focus, then stop
3. How are keratometry findings recorded?
ANSWER:
*Horizontal meridian is recorded first then the Vertical meridian
*Recorded as power (not radius) found @ the measured meridian (not axis)
*Recorded to the nearest 12D using three digits for the meridian e.g. 45.00 @ 180,
43,50D @ 090
*Comment on mire quality if not clear and regular
4. What are the sources of error in keratometry that an examiner should avoid?
ANSWER:
*Improper calibration
*Improperly focused eye piece
*Faulty positioning of patient
*Lack of proper fixation by patient
*Reduced VA of examiner
*Accommodative fluctuations of examiner
*Localized corneal distortions
*Improper focusing of mires (especially vertical)
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5. How would you determine the total astigmatism of an oblique astigmat from the
keratometric findings?
ANSWER:
*Calculate the corneal cylinder dK (the difference in corneal principal meridians'
reading)
*Multiply that with 1.25. In other words, physiological astigmatism is not put into
consideration. Example: 45.00D @ 045, 43.00D @ 135.
Formula: Astₜ = 1.25(Ac).
Ac = -2.00DC x 135. Astₜ = 1.25(-2 00) = -2.50DC x 135.
6. Why is the dK (corneal cylinder) not the same as total astigmatism?
ANSWER:
*Spectacle lens effectivity of 13mm is not considered in dK
*K’s only measure the anterior corneal surface
*The back of the cornea can also be toric leading to internal astigmatism
*Does not figure in lenticular astigmatism due to natural tilting of lens
7. Identify the parts of the Bausch and Lomb keratometer.
ANSWER:
8. Draw the mires when there is alignment in Bausch and Lomb keratometer
ANSWER:
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9.
Fig. 1: A, B, C are different presentations of mires in some position keratometer
(Bausch and Lomb). What adjustment will you make in 'A' before taking readings?
ANSWER:
*There is no horizontal alignment
*Refine the horizontal drum
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10. What adjustment will you make in 'B' before taking readings (Fig 1)?
ANSWER:
*There is no vertical alignment
*Refine the vertical measuring drum
11. What adjustment(s) will you make in 'C' before taking readings (Fig 1)?
ANSWER:
*Refine the axis scale
*Then refine the measuring drums
12. Give your possible K-findings which is with-the-rule and also put in an optical
cross.
ANSWER:
*The steeper power is along 90: 42.00@ 180, 43.50D@ 090
*
43.50
42.00
13. Give your possible K-findings which is against-the- rule and also put in an optical
cross.
ANSWER:
*The steeper power is along 180: 43.50 @ 180, 42.00D@ 090
*
42.00
43.50
14. Determine the corneal astigmatism for the following keratometric readings and the
type of astigmatism. 45.00D @ 180, 43.00D @ 90
ANSWER:
-2.00DC x 90 /Against-the-rule astigmatism
15. Determine the corneal cylinder for keratometric readings of 44.00D @ H and
45.00D V. What type of astigmatism is this?
ANSWER:
-1.00DC x 180 / WTR astigmatism
16. What is the total astigmatism, if the keratometric readings are 45.00D @ H and
44.00D @ V? (Show working)
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ANSWER:
Formula: Aₜ = p (Ac) + k, where Aₜ is total astigmatism, p is change in effective
power, Ac is corneal astigmatism (-1.00DC x 90) and K is physiological astigmatism (0.50DC x 90). Note that Ac is < -2.00D, so P is taken as 1. At = 1(-1.00) + (-0.50) = 1.00 - 0.50 = -1.50DC x 90.
17. What is the total astigmatism, if the keratometric readings are 42.00D @ H and
45.00D @ V? (Show working)
ANSWER:
Formula: Aₜ = p (Ac) + k where Aₜ is total astigmatism, p is change in effective
power, Ac is corneal astigmatism (-3.00DC x 180) and k is physiological astigmatism (0.50DC X 90).
Note that Ac is > -2.00D, so p is taken as 1.25. The axis of Ac is 180, while that of k is
90; so the sign of k will change to + for it to become axis 180. At = 1.25(-3.00) +
(+0.50) =-3.75 + 0.50 = -3.25DC x 180.
18. What do you understand by the doubling principle in keratometry?
ANSWER:
The size of the mire image on the cornea is only 3.0mm (as the keratometry only
measures that diameter). Since small eye movements cause constant motion of the
image, a telescope and doubling system is provided. The image of the mire is treated as
a new object and is imaged in the telescope system, which in the keratometer, magnifies
it 1.304times. The eyepiece lens magnifies it further to 6.197times. By doubling the
image, the question of minute eye movements is neutralized since both images move
together.
19. Using the Bausch and Lomb keratometer, what is the equivalent radius of curvature
for a corneal curvature of 44.00D? (Show working)
ANSWER:
7.67mm (r = n-1/D where n= 1.3375, D= 44.00D)
20. For a spectacle lens power of +8.50D, and a vertex distance or 12mm, give the
contact lens power (Show working).
Answer: +9.00D Fcl =
A
3
B
B
C
21. How would you use the contact lens to manage amblyopia?
ANSWER:
Fit the good eye with opaque tinted contact lens, hence stimulating the bad eye to see
(eliminating the cosmetic disadvantage of wearing an eye patch).
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22. What factors would make you prescribe soft contact lenses instead of rigid lenses
for your patient? (Give five)
ANSWER:
When initial comfort is desired
When rapid adaptation is desired
Inability to wear rigid lenses
Intermittent wear
Residual astigmatism
Low refractive error
Athletic activities etc.
23. What would be the contact lens power, if the spectacle lens power is +3.25D and
vertex distance is 12mm (Show working). Give reasons for your answer.
ANSWER:
Same (+3.25D), because lens power is < 4.00D so no vertex distance adjustment is
made.
24. If the diagnostic contact lens power was -3.00D, and the power over refraction was
+1.00D; what would be the final contact lens power given to the patient (show
working).
ANSWER:
-2.00D (Add algebraically: -3+ [+]).
25. What clinical issues would you consider before prescribing contact lenses for the
aged patient? (5)
ANSWER:
Diminished retinal function
Decreased tearing
Flaccid eyelids
Corneal and conjunctival degeneration (pterygium and pinguecula)
Reduced manual dexterity
Cognitive problems
Reduced corneal sensitivity
General apprehension.
26. Why is tear exchange important in contact lens wear? Give three (3) reasons.
ANSWER:
Oxygenation
Nutrition
Water removal
Lubrication
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27. What is the final contact lens power if the spectacle Iens power is -7.00DS and
vertex distance is 12mm? (Show working).
ANSWER:
D
E
-6.50DS
Fcl =
=
3 $D
=
3 0.03
3
E
E
0.015
E
3.15
= -6.46DS
27. What type(s) of contact lenses would you prescribe for patients with aniridia,
polycoria and albinism?
ANSWER:
*Pinhole contact lenses which are opaque contact lenses having a small pupil opening
to limit the amount of light entering the eye. They are often tinted or painted to
resemble a normal iris and pupil, dramatically improving the wearer's appearance as
well as visual function.
28. What would be the likely complaints of your patient who is using soft hydrogel
contact lenses and spend long hours under the air-conditioner and why?
ANSWER:
*Patient will complain of dry eyes and ocular irritation.
*Under the air conditioner, water will evaporate from hydrophilic lenses, causing
dehydration and resulting in ocular irritation with decreased contact lens comfort.
29. What are three (3) general indications for (reasons to use) bandage contact lenses?
ANSWER:
Provide mechanical protection to the cornea from the eyelids
Act as splint or cover over lacerations, perforation and wound leaks
Provide comfort protecting exposed corneal nerves
Improve vision by creating a more regular optical surface and / or providing
optical power
Act as a drug reservoir
Reduce corneal pain following photorefractive keratotomy (PRK), often in
conjunction with a non-steroidal anti-inflammatory drug (NSAID)
30. State five (5) contact lens preliminary prefitting tests or measurements. Why do we
perform these tests or measure the parameters?
ANSWER:
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*Measurement of Palpebral aperture/Corneal diameter (HVID and VVID)/ Pupil
diameter/ Keratometry/ Slit lamp biomicroscope/ TBUT/ Blink rate/ Schirmer test, etc.
*Will guide in selection of suitable contact lens patients and also in selecting the
desired contact lens parameters like base curve, diameter etc
31. Why do we measure the HVID instead of the corneal diameter in Contact lens
practice? Which contact lens parameters will this ocular parameter help us select?
ANSWER:
*The actual corneal diameter cannot be measured, because of the opaque scleral tissue
which overlies the limbus; so we measure the diameter of the visible iris, instead. The
external corneal diameter is actually greater than the diameter of the visible iris used.
*Helps us select the contact lens diameter.
32. Describe how the invasive TBUT test is performed. When is the finding of this test
significant?
ANSWER:
*Diffuse illumination, low magnification and cobalt blue light of the slit lamp
biomicroscope (SLB). Eye stained with fluorescein (paper strip preferable to solution).
Both parent and examiner comfortably seated and looking through the SLB. Patient
asked to blink several times after which he stops blinking and stares straight ahead and
the stop clock simultaneously switched on. The time the first randomly distributed dry
spot appears is noted.
*Patients with TBUT of as low as 10secs make poor contact lens patients as it shows
mucin deficient eyes.
33. Describe how Schirmer's test 1 is performed. When is the finding of this test
significant?
ANSWER:
*Patient is seated in a dimly lit room facing away from reflex stimulation. The Schirmer
test strip (35 x 5mm strip of Whatman filter paper that is folded 5mm from one end) is
inserted with the folded end at the mid-portion (or lateral portion) of the lower eyelid.
Patient is asked to blink normally and the paper strip is removed after 5minutes. The
length of wetting is read off and recorded.
*Poor tear formation, if <10mm of wetting occurs. Excessive tear formation, if >25mm.
34. How would you determine the blink rate of a patient? Which two (2) factors
augment (increase) blink rate, and which two (2) factors reduce blink rate? What is the
normal blink rate?
ANSWER:
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*The number of blinks per minute is counted using a watch/clock that shows the
seconds' hand or a stop watch clock, without the knowledge of the patient and recorded.
* Extremely dry air, glare, wind, emotional stress, surprise, anger, frights, would
increase blink rate.
*Concentrated visual tasks, like computer works, fatigue, reading, attention, etc, reduce
blink rate
* Normal blink rate is 10-20 times/minute.
35. What inspection do you carry out on a contact lens before inserting it into the eye?
ANSWER:
*Visual inspection to ensure there is no defects (i.e. chips, tears and debris)
*Make sure the lens is right-side-out.
36. Which ocular parameter would guide you in the selection of the contact lens base
curve for your contact lens patient?
ANSWER:
Corneal radius of curvature in mm (obtained from keratometry)
37. Which ocular parameter would guide you in the selection of the optic zone diameter
of the contact lens?
ANSWER:
Pupil size and for some lens types, also Corneal diameter
38. Which two (2) pre-fitting ocular parameters would guide you in the selection of the
overall diameter of the contact lens?
ANSWER:
Corneal diameter
Palpebral aperture size (vertical)
39. Which pre-fitting (5) would help you determine if your patient is contraindicated for
contact lens wear?
ANSWER:
Case history
External examination (penlight examination and slit lamp biomicroscope)
Ophthalmoscopy
Tests for tear quality (Tear break-up-time test)
Tests for tear quantity (Schirmer's test)
Blink rate etc.
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40. Which two (2) major ocular parameters will you need for a patient you want to fit
full iris tinted contact lenses?
ANSWER:
Pupil diameter
Iris diameter (HVID and VVID)
41. Which two (2) major ocular parameters will you need for a patient you want to fit
concentric iris tinted contact lenses?
ANSWER:
Pupil diameter
Iris diameter (HVID, VVID)
42. Why would Pachymetry be done on a patient?
ANSWER:
i.
To determine if the patient's corneal thickness is approprate for LASIK
ii.
To determine if there is any corneal abnormality
iii. Essential part of Glaucoma examination
iv.
To manage/treat various corneal diseases e.g. Fuch's dystrophy, bullous
keratopathy and keratoconus
v.
Assessing corneal thinness in corneal disorders like Terrien's and pellucid
degenerations, keratoglobus, post LASIK, ectasia.
43. What is the implication of corneal thickness in IOP reading?
ANSWER:
The thickness of the cornea significantly affects intraocular pressure reading. Thin
corneas will give a falsely low IOP, while a thick cornea would register an abnormally
high pressure.
44. What is the use of corneal thickness measurement in contact lenses?
ANSWER:
To assess corneal diameter edema
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LOW VISION
1. How would the VA of a low vision subject who cannot see any letter on the VA chart
at 6m be taken?
ANSWER:
*Reduce the test distance until subject can read
* Use the Berkeley Rudimentary Vision Testing chart for distance less than 1m
*Possibly do counting fingers and hand movement
*Perform light projection
2. Give the possible optical options for managing the reading difficulty of a myopic low
vision subject
ANSWER:
Use of unaided vision when request magnification is same with amount of
refractive error.
Use of magnifiers including, handheld, stand or dome magnifiers.
3. Give two (2) non optical options available in enhancing home management tasks by
low vision subjects.
ANSWER:
Use of needle threader for sewing
Use of high contrast surfaces, towels, cutting boards and respective dishes
Use large prints and touchable indicators to label vessels.
4. Which three (3) devices can help a low vision subject for distant tasks?
ANSWER:
Monocular telescope
Spectacle mounted telescopes
Binocular telescopes
Telemicroscopes
Reverse telescopes
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5. What kind of patients can Reverse telescopes be prescribed for and why?
ANSWER:
Patients who have visual field loss but with relatively good visual acuity, because of the
minification of images by reverse telescopes. Examples are patients with glaucoma
(tunnel vision) and retinitis pigmentosa.
6. In training a patient on the use of a hand held magnifier, what two (2) highlights are
very important?
ANSWER:
*Magnifier to be held at its focal length before reading material for optimum and clear
magnification
*To keep the surface of the magnifier away from scratches.
7. Give vital instructions on the use of a 4x cut-away stand magnifier.
ANSWER:
To use device with full near correction, because emergent rays from magnifier are
divergent due to length of magnifier being shorter than focal length of lens.
8. Give four (4) Non-optical options for aiding a teenager with moderate vision
impairment with school work.
ANSWER.
Use of bold line notebooks for contrast
Use of reading and writing guides
Employing relative distance magnification in reading and board work
Use of large print books where applicable
Use of felt tip pens in writing
9. Give three (3) options used in aiding a child with profound vision loss with school
work.
ANSWER:
The use of Braille
Use of audio books
Use of a scribe
10. In performing retinosoopy on a low vision subject with poor reflex due to a cataract
that cannot be readily operated upon, what procedure can be adopted?
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ANSWER:
Move closer to the patient until a better reflex is found. Then neutralize reflex and put
into account the distance from which test was done in reporting retinoscopic finding.
11. What should be the relevant contents of a full case history of an individual with
visual impairment?
ANSWER:
Chief complaint
Self reported visual status
Ocular and vision history
Visual needs and expectations
General health history
Previous interventions and access to services.
12. In what way would you position a hand held magnifier to obtain the best
magnification?
ANSWER:
Position the object of regard in the focal plane of the lens.
13. Give three (3) indicators of advanced field loss in an individual as seen during
clinical observation.
Tentative gait
Postural stiffness
Maintaining closeness to wall
Using tactile information.
14. Give three (3) options that are available for aiding low vision subjects with glare
control.
ANSWER:
Filters
Adjustable lamps
Orientation on controlled and indirect lighting
Use of peaked caps
15. Give three (3) mobility techniques that are available to individuals with blindness or
low vision.
ANSWER:
The use of sighted guide
The use of mobility cane
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The use of guide dogs
The use of electronic aid
16. What factors would inform the preference for a Keplerian or Galilean telescope,
over the other?
The nature of refractive error- Keplerian telescopes enhance magnification in
uncorrected hyperopes
The amount of magnification required- Galilean telescopes are in lower
magnification options
Portability-Galilean telescopes are light weight
17. In choosing a magnifier, when would a spectacle magnifier be preferred to a handheld magnifier? (Give 3 instances)
ANSWER:
*When free hands are required, in dexterity concerns
*When required magnification is relatively low
*When binocularity is still possible and necessary
18. What would be your choice of management for near tasks when high magnification
is required?
ANSWER:
*Combination magnification
*Electronic magnification with video magnifier or CCTV mouse magnifier
19. Why would you opt against prescribing stand magnifiers?
ANSWER:
*Possibilities of glare from lens surface
*Restricted field of view with higher magnification
*Extra demand on accommodation
*Cost in comparison to other magnifier
20. When would prisms be indicated in low vision management?
ANSWER:
When there is constricted visual field or quadrant field defect, so objects can be moved
away from scotoma.
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