Ophthalmology Board Exam Review Quiz

HLA-B27 is most likely to be positive in an American patient with acute non-granulomatous uveitis. This is because HLA-B27 is strongly associated with certain autoimmune diseases, including uveitis. Studies have shown that a significant percentage of patients with acute non-granulomatous uveitis, particularly in the American population, are positive for HLA-B27. Therefore, HLA-B27 is the most likely positive result in this scenario.

Trabeculotomy or goniotomy is the preferred therapy for infantile glaucoma because these surgical procedures directly target the underlying cause of the condition, which is the abnormality in the drainage system of the eye. Topical beta blockers and topical bromonidine may be used as adjunctive therapies to lower intraocular pressure, but they do not address the underlying issue. Oral acetazolamide may also be used to lower intraocular pressure, but it is not the preferred therapy for infantile glaucoma.

The Joint Statement of the American Academy of Pediatrics, Section on Ophthalmology; the American Association for Pediatric Ophthalmology and Strabismus; and the American Academy of Ophthalmology recommends at least 2 dilated funduscopic examinations using binocular indirect ophthalmoscopy for all infants with a birth weight less than 1500 grams, a gestational age of 28 weeks or less, or a birth weight between 1500 and 2000 grams and an unstable clinical course. This means that all infants who meet any of these criteria should undergo the recommended examinations to assess their eye health.

Magnetic resonance imaging (MRI) is not useful in evaluating a patient with a retained magnetic intraocular foreign body because it uses a strong magnetic field, which can cause movement or displacement of the foreign body and potentially lead to further complications. The other diagnostic tests mentioned, such as indirect ophthalmoscopy, computed tomography, electrophysiology, and echography, are all useful in evaluating a patient with a retained magnetic intraocular foreign body as they provide valuable information about the location, size, and potential damage caused by the foreign body.

Eosinophils are commonly associated with host defenses against parasitic infections. These white blood cells play a crucial role in the immune response against parasites by releasing toxic granules that can kill or immobilize the parasites. Eosinophils are particularly effective against helminth (worm) infections and are often found in higher numbers in areas of the body where parasites are more likely to invade, such as the gastrointestinal tract and respiratory system. Their ability to release toxic substances and regulate inflammation makes eosinophils an important component of the immune system's defense against parasitic infections.

Goldmann tonometry measures intraocular pressure (IOP) by flattening the cornea and measuring the force required to do so. Increased central corneal thickness can cause an artificially high IOP measurement because the thicker cornea requires more force to be flattened. Therefore, Goldmann tonometry may give an artificially high IOP measurement with increased central corneal thickness.

Polarity is not clinically important in ophthalmic applications because it refers to the direction of the electric field oscillation of the laser beam, which does not significantly affect the laser's interaction with eye tissues. The other properties listed, such as energy level, power level, pulse duration, and focal spot size, are all important factors that can impact the effectiveness and safety of laser treatments in ophthalmology.

MRI scanning provides a better view of the orbital apex and orbitocranial junction compared to CT scanning. This is because MRI uses magnetic fields and radio waves to create detailed images of soft tissues, while CT scanning uses X-rays to create images of bones and calcium. The ability of MRI to visualize soft tissues in high resolution makes it a preferred imaging modality for evaluating structures in the orbital apex and orbitocranial junction.

The medial rectus muscle inserts closest to the limbus. The rectus muscles are a group of muscles that control eye movement. The medial rectus muscle is responsible for inward or adduction movement of the eye. It originates from the common tendinous ring and inserts on the medial surface of the eyeball. The limbus is the border between the cornea and sclera of the eye. Therefore, the medial rectus muscle inserts closest to the limbus compared to the other rectus muscles.

Patients with sarcoidosis are most likely to present with granulomatous uveitis. Sarcoidosis is a systemic inflammatory disease that can affect multiple organs, including the eyes. Granulomatous uveitis is a specific type of uveitis characterized by the formation of granulomas, which are small inflammatory nodules. In sarcoidosis, these granulomas can develop in the eyes, leading to symptoms such as redness, pain, blurred vision, and sensitivity to light. Therefore, patients with sarcoidosis are more likely to present with granulomatous uveitis compared to those with Behcet syndrome, juvenile rheumatoid arthritis, or Reiter syndrome.

In this scenario, the best course of action is to undertake neuroimaging, preferably an MRI. Monocular vertical nystagmus in a 1-year-old child is a concerning symptom that may indicate an underlying neurological problem. Neuroimaging can help identify any structural abnormalities or lesions in the brain that may be causing the nystagmus. This can aid in making an accurate diagnosis and determining the appropriate treatment plan for the child.

The aqueous layer of the tear film is produced by the glands of Krause. These glands are located in the conjunctiva, which is the thin membrane that covers the front surface of the eye and the inner surface of the eyelids. The glands of Krause secrete a watery fluid that helps to keep the eye lubricated and moist. This fluid is an important component of the tear film, which helps to protect the eye from dryness and foreign particles.

Sickle cell disease is a genetic disorder that affects the shape of red blood cells, causing them to become crescent-shaped. This condition primarily affects the red blood cells and does not typically involve any abnormalities in the anterior segment of the eye. In contrast, Marfan syndrome is associated with lens dislocation, Galactosemia can cause cataracts, and Wilson disease can lead to Kayser-Fleischer rings in the cornea.

All of the above infectious agents can be linked to interstitial keratitis. Interstitial keratitis is an inflammation of the cornea that can be caused by various infectious agents. Herpes simplex virus and herpes zoster virus are both known to cause interstitial keratitis, while Chlamydia trachomatis, a bacterium, can also lead to this condition. Therefore, all three options listed in the question are correct.

Migraine is the most common cause of binocular transient visual loss lasting 30 minutes in a 29-year-old woman. Migraine is a neurological condition characterized by recurring headaches, often accompanied by visual disturbances such as flashing lights or blind spots. These visual disturbances, known as auras, can last for a short period of time and affect both eyes. Migraine-related visual loss is typically temporary and resolves on its own. Other potential causes such as thromboembolism, pseudotumor cerebri, and giant cell arteritis are less likely in this age group and presentation.

Reiter syndrome is a condition characterized by the triad of urethritis, arthritis, and conjunctivitis. It is also commonly associated with other symptoms such as skin lesions and inflammation of the joints and tendons. Ankylosing spondylitis, on the other hand, is a separate condition that primarily affects the spine and can lead to fusion of the vertebrae. While both Reiter syndrome and ankylosing spondylitis are related to inflammation and joint problems, they are distinct conditions. Therefore, ankylosing spondylitis is not associated with Reiter syndrome.

PAX6 is the correct answer because it is a well-known gene associated with aniridia, a genetic disorder that affects the development of the eye. Mutations in the PAX6 gene can lead to the absence or malformation of the iris, which is a characteristic feature of aniridia. PAX6 is responsible for regulating the development of various eye structures, including the iris, lens, and retina.

Current smokers should avoid beta carotene because it has been found to increase the risk of lung cancer in this population. Studies have shown that high doses of beta carotene, typically found in supplements, can actually have harmful effects on smokers. Therefore, it is recommended that smokers avoid beta carotene supplementation.

The correct answer is the medial portion of CN III. Parasympathetic fibers that control the pupil are located in the medial portion of the third cranial nerve (CN III). CN III, also known as the oculomotor nerve, is responsible for controlling the movement of the eye muscles and also carries parasympathetic fibers that regulate the size of the pupil. Therefore, the parasympathetic fibers destined for the pupil reside in the medial portion of CN III.

During the effector phase of the primary immune response to antigens, IgM antibodies are produced. IgM is the first antibody class to be produced by B cells in response to an infection or antigen. It is a pentameric antibody that is effective in neutralizing pathogens and activating the complement system. IgM antibodies are primarily involved in the early stages of an immune response, while IgG antibodies, for example, are produced later in the secondary immune response and provide long-term immunity. IgD antibodies are mainly found on the surface of B cells and are involved in the activation of B cells, while IgE antibodies are associated with allergic reactions and parasitic infections.

Descemet's membrane is a true basement membrane because it is a thin, acellular layer located between the corneal endothelium and the stroma of the cornea. It provides structural support and acts as a barrier between the cornea and the aqueous humor. Bowman's layer is a component of the cornea, but it is not considered a basement membrane. Zonules of Zinn are fibers that hold the lens of the eye in place and are not a basement membrane. The anterior border layer of the iris is also not a basement membrane but rather a part of the iris structure.

The most likely diagnosis in this case is a dermoid cyst. Dermoid cysts are typically present at birth and are well-demarcated masses. They can occur in various locations, including the superotemporal rim. Dermoid cysts are benign and are composed of tissue from the ectoderm, which can include hair follicles, sebaceous glands, and sweat glands. They are usually slow-growing and painless. Rhabdomyosarcoma, neurofibroma, capillary hemangioma, and metastatic Ewing sarcoma are less likely in this case because they do not typically present as well-demarcated masses present since birth.

Epidemiological studies have identified several risk factors for nuclear pacification. Current smoking is a known risk factor, as it increases the likelihood of developing nuclear pacification. Additionally, being of white race has been associated with a higher risk of nuclear pacification. Lower education levels have also been identified as a risk factor for this condition. Therefore, all of the above factors have been found to contribute to the risk of nuclear pacification based on epidemiological studies.

Flexible open-loop anterior chamber IOL implantation is not a risk factor for cystoid macular edema after cataract surgery. Cystoid macular edema is a condition where there is swelling in the macula, the central part of the retina, after surgery. Risk factors for this condition include diabetes mellitus, ruptured posterior capsule, marked postoperative inflammation, and vitreous loss. However, the type of IOL implantation does not contribute to the development of cystoid macular edema.

The correct answer is "Zygomatic" because it is one of the five major branches of the facial nerve. The facial nerve is responsible for controlling the muscles of the face and is divided into several branches that innervate different regions. The zygomatic branch specifically innervates the muscles around the cheekbone area, including the zygomaticus major and minor muscles.

Hypopyon is most likely to be seen in Behcet syndrome. Behcet syndrome is a chronic autoimmune disorder that causes inflammation in blood vessels throughout the body. It commonly affects the eyes, causing uveitis which is inflammation of the uvea, the middle layer of the eye. Hypopyon is the accumulation of white blood cells in the anterior chamber of the eye, and it is a characteristic feature of uveitis in Behcet syndrome. Sarcoidosis, rheumatoid arthritis, and Reiter syndrome can also cause uveitis, but hypopyon is most commonly associated with Behcet syndrome.

Periocular depot corticosteroid injections should not be used in toxoplasmosis uveitic syndrome. This is because corticosteroids can suppress the immune system, which may worsen the infection caused by toxoplasmosis. In contrast, corticosteroids are often used in the other uveitic syndromes mentioned, such as pars planitis with cystoid macular edema, sarcoidosis, and Reiter syndrome, to reduce inflammation and manage symptoms.

The average normal corneal thickness in the general population is typically around 540 um. This measurement is important as it helps to assess the health of the cornea and can be used to diagnose conditions such as glaucoma and keratoconus. A cornea that is thicker or thinner than the average range may indicate an underlying issue that requires further evaluation and treatment.

Based on the given information, a 65-year-old woman with a progressively enlarging mass in the right inferior orbit and a "salmon patch" appearance to the fornix, the most likely diagnosis is lymphoma. Lymphoma is a type of cancer that affects the lymphatic system and can present as a mass or swelling in various parts of the body, including the orbit. The "salmon patch" appearance refers to the reddish coloration often seen in lymphoma. Therefore, considering the symptoms and characteristics described, lymphoma is the most likely diagnosis.

The presence of ipsilateral facial numbness along with isolated eye pain suggests that there may be an underlying condition causing these symptoms. This combination of symptoms could be indicative of a neurological issue, such as trigeminal neuralgia or a tumor affecting the trigeminal nerve. The normal neuroimaging of the brain and orbits rules out any structural abnormalities, while the poor response to tricyclic antidepressants suggests that the pain is not related to a psychiatric condition. Therefore, the most likely explanation for the given symptoms is an underlying condition that is causing both the eye pain and facial numbness.

Bupivacaine has the longest duration of effect among the given local/regional anesthetic agents. This is because it is a long-acting amide-type anesthetic that is highly protein-bound, allowing it to stay at the site of action for a longer period of time. It has a slower onset but provides prolonged anesthesia, making it suitable for procedures requiring longer-lasting pain relief. Lidocaine, procaine, and mepivacaine, on the other hand, have shorter durations of effect compared to bupivacaine.

Pleomorphic adenoma of the lacrimal gland is a benign tumor that arises from the epithelial cells of the gland. It is known to have a tendency to recur, and in some cases, these recurrences can transform into malignancy. However, it is not known to resolve spontaneously. Therefore, the statement that it can resolve spontaneously is false.

CN II, also known as the optic nerve, does not enter the orbit through the superior orbital fissure. Instead, it enters the orbit through the optic canal. The superior orbital fissure is a passage in the skull that allows several nerves and blood vessels to enter the orbit, including CN III (oculomotor nerve), CN IV (trochlear nerve), and CN VI (abducens nerve).

The modified Callender classification of ocular melanoma applies to melanomas of the choroid. This classification system is used to categorize and stage melanomas based on their size, location, and extent of invasion. The choroid is a layer of tissue in the eye that contains blood vessels and provides nourishment to the retina. Melanomas that develop in the choroid can be particularly dangerous as they can grow and spread to other parts of the eye and body. Therefore, it is important to accurately classify and stage these melanomas to determine the appropriate treatment and prognosis.

In the CNTG study, it was found that a reduction in intraocular pressure (IOP) by 30% resulted in a significant reduction in the progression of Collaborative Normal-Tension glaucoma. This implies that lowering IOP by 30% was effective in slowing down the advancement of the disease. The study suggests that a 30% reduction in IOP is an optimal target for treatment in order to achieve positive outcomes in patients with this condition.

Cocaine 10% is most useful in distinguishing the cause of anisocoria that is greater in dark than in light. Cocaine is a potent sympathomimetic drug that blocks the reuptake of norepinephrine, leading to dilation of the pupil. In cases where anisocoria is greater in the dark, it suggests a sympathetic denervation of the dilator muscle in the affected eye. By instilling cocaine 10% into the eye, if the anisocoria resolves or decreases, it confirms that the cause of anisocoria is related to sympathetic dysfunction.

Optic disc drusen is a condition characterized by the presence of small calcium deposits in the optic disc. These deposits can cause various symptoms and features, such as optic disc elevation and blurred margins, high reflective signal on b-scan ultrasonography, and arcuate visual field defects. However, visual acuity loss is not typically associated with optic disc drusen. Therefore, the correct answer is visual acuity loss.

HLA-B27-associated acute anterior uveitis is associated with Reiter syndrome, psoriatic arthritis, and ankylosing spondylitis. Behcet syndrome, however, is not typically associated with HLA-B27.

The superior transverse ligament is commonly known as Whitnall's ligament. This ligament is located in the eye socket and helps to support the upper eyelid. It plays a crucial role in maintaining the proper position and function of the eyelid, ensuring that it opens and closes smoothly. Whitnall's ligament is named after the British ophthalmologist Charles Whitnall, who first described its anatomy and function.

Xerophthalmia is a condition characterized by dryness of the eyes due to vitamin A deficiency. Chronic alcoholism, cystic fibrosis, and bowel resection are all conditions that can potentially lead to malabsorption of nutrients, including vitamin A, and therefore increase the risk of xerophthalmia. On the other hand, glomerulonephritis is a kidney disease that does not directly affect the absorption or utilization of vitamin A, making it the exception among the given conditions.

Patients with diabetes and high risk proliferative changes visible through their cataract should have scatter laser 1 to 2 months prior to cataract extraction. This statement suggests that patients with diabetes and high risk proliferative changes should undergo scatter laser treatment before cataract surgery. This is done to reduce the risk of complications and improve the outcome of the surgery. The scatter laser treatment helps to stabilize the proliferative changes and reduce the risk of bleeding during the cataract surgery. By performing the scatter laser treatment prior to cataract extraction, the surgeon can ensure a safer and more successful surgery for these patients.

Fuchs heterochromic iridocyclitis is least likely to require topical corticosteroid management because it is a chronic, low-grade inflammation of the eye that typically does not respond well to corticosteroids. Unlike the other uveitic syndromes listed, Fuchs heterochromic iridocyclitis is often managed with other treatments such as nonsteroidal anti-inflammatory drugs (NSAIDs) or immunomodulatory agents.

Eyelid retraction is most likely to be present in a patient with Graves ophthalmopathy. Graves ophthalmopathy is an autoimmune condition that affects the eyes, commonly seen in patients with Graves' disease. It is characterized by inflammation and swelling of the tissues around the eyes, causing various eye symptoms. Eyelid retraction refers to the abnormal elevation of the upper eyelid, which is a classic sign of Graves ophthalmopathy. This condition is caused by the accumulation of glycosaminoglycans and inflammation in the tissues behind the eyes, leading to the protrusion of the eyeballs and retraction of the eyelids.

Adenovirus is the correct answer because it is known to be resistant to alcohol-based disinfectants. This means that even after medical instruments are cleaned with alcohol, adenovirus can still remain viable and transmissible. Unlike other viruses listed, such as herpes simplex virus, human immunodeficiency virus (HIV), and Epstein-Barr virus, adenovirus has the ability to survive and persist on surfaces even after alcohol disinfection.

Multifocal IOLs offer a trade-off between decreased image quality and increased depth of focus. This means that while these lenses can provide a wider range of focus, allowing for better near and far vision, the overall image quality may not be as sharp as with other types of lenses. However, the increased depth of focus can still be beneficial for patients who prioritize convenience and reduced dependence on spectacles.

Behcet syndrome is a chronic, multisystem inflammatory disorder that primarily affects blood vessels. The characteristic symptoms of Behcet syndrome include aphthous stomatitis (recurrent mouth ulcers), genital ulceration, and retinal vasculitis (inflammation of the blood vessels in the retina). Arthritis, however, is not typically associated with Behcet syndrome. Therefore, the correct answer is arthritis.

Myotonic dystrophy is not associated with ectopia lentis. Ectopia lentis is a condition where the lens of the eye is abnormally positioned. It is commonly seen in individuals with homocystinuria, Ehlers-Danlos syndrome, Marfan syndrome, and sulfite oxidase deficiency. However, myotonic dystrophy is a genetic disorder that primarily affects the muscles and other systems of the body, but it is not typically associated with ectopia lentis.

Simultaneous bilateral facial palsy, where both sides of the face are affected, is most likely to prompt additional evaluation in a patient with facial palsy. This is because bilateral facial palsy is a rare condition and can be associated with more serious underlying causes such as Lyme disease, Guillain-Barré syndrome, or certain viral infections. Therefore, it is important to further investigate and determine the underlying cause of simultaneous bilateral facial palsy in order to provide appropriate treatment and management.

Opsoclonus is a type of eye movement disorder that is commonly seen in patients with paraneoplastic syndromes. Paraneoplastic syndromes are a group of rare disorders that occur due to an abnormal immune response to a cancerous tumor. Opsoclonus is characterized by rapid, involuntary, and unpredictable eye movements in multiple directions. It is often accompanied by other neurological symptoms such as ataxia, myoclonus, and behavioral changes. Opsoclonus is believed to result from an autoimmune response against the tumor, leading to inflammation in the brain and affecting the control of eye movements.

The best choice for a reading add for a cataract surgery patient with macular degeneration and 20/70 best-corrected vision is +3.50 D. Macular degeneration affects the central vision, making it difficult to see fine details and small print. A reading add of +3.50 D would provide the patient with the necessary magnification to improve their near vision and make reading easier. A higher add power, such as +7.00 D, may be too strong and cause the patient to have difficulty focusing or adapting to the new prescription. A 3.5x magnifier is not a suitable option for a spectacle prescription.