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[DOMAIN 1: OPHTHALMOLOGY (EENT) - 35 Questions]
## **Question 1**
#
A 45-year-old patient presents with crusty, irritated eyelid margins and redness. with debris
buildup near the eyelash roots. They also report dry eye sensation. What is the first-line
treatment?
) Oral doxycycline 100 mg BID
A
B) Topical erythromycin ointment
C) Lid scrub with baby shampoo
D) Warm compresses only
E) Topical steroid drops
**[CORRECT: C]**
* *Rationale:** This presentation describes **blepharitis** (inflammation of the eyelid margins).
First-line treatment is lid hygiene using diluted baby shampoo or commercial lid scrubs. which
mechanically removes debris and improves meibomian gland function. Antibiotics (A) are
reserved for resistant cases. Erythromycin (B) treats bacterial conjunctivitis. Warm compresses
(D) alone are insufficient, and steroids (E) are contraindicated without addressing underlying
obstruction.
---
## **Question 2**
#
Which finding distinguishes a **pinguecula** from a **pterygium**?
) Presence of a fibrovascular growth
A
B) Whether the lesion crosses the limbus onto the cornea
C) Yellowish color of the lesion
D) Location on the nasal conjunctiva
E) Associated foreign body sensation
**[CORRECT: B]**
,* *Rationale:** The critical distinguishing feature is **corneal involvement**. A pinguecula is a
yellowish raised lesion on the nasal conjunctiva that does NOT cross the limbus (corneal
border). A pterygium is a wing-shaped growth of fibrovascular tissue that **extends onto the
cornea** and may impair vision. Both can appear yellowish and on nasal conjunctiva.
---
## **Question 3**
#
A patient has a painful, erythematous nodule on the eyelid margin with purulent drainage.
Another patient has a painless, firm nodule within the tarsal plate. What conditions are
represented?
) Both are chalazia
A
B) Hordeolum and then chalazion
C) Chalazion, then hordeolum
D) Both are hordeola
E) Conjunctivitis and blepharitis
**[CORRECT: B]**
* *Rationale:** The first description is a **hordeolum (stye)**—painful, superficial infection of
eyelash follicle or gland. The second is a **chalazion**—painless, deeper nodule within tarsal
plate from blocked meibomian gland. Location and pain characteristics distinguish these
entities.
---
## **Question 4**
#
A 6-year-old child presents with ear pain, fever, and a bulging, erythematous tympanic
membrane with decreased mobility. What is the most likely causative organism?
) Moraxella catarrhalis
A
B) Streptococcus pneumoniae
C) Staphylococcus aureus
C) Haemophilus influenzae
D) Pseudomonas aeruginosa
E) Group A Streptococcus
**[CORRECT: B]**
* *Rationale:** This is **acute otitis media (AOM)**. In pediatric patients, the most common
bacterial pathogen is **Streptococcus pneumoniae**, followed by Haemophilus influenzae and
, oraxella catarrhalis. The bulging TM and systemic symptoms (fever) distinguish AOM from
M
otitis externa.
---
## **Question 5**
#
A patient presents with sudden onset unilateral leg swelling, calf pain, and warmth. What is the
priority concern?
) Cellulitis
A
B) Deep vein thrombosis
C) Baker's cyst rupture
C) Muscle strain
D) Superficial thrombophlebitis
E) Lymphedema
**[CORRECT: B]**
* *Rationale:** **Sudden unilateral leg swelling with calf pain** is the classic presentation for
**deep vein thrombosis (DVT)**. This requires immediate evaluation due to risk of pulmonary
embolism. While cellulitis (A) causes erythema and warmth, it typically lacks the sudden onset
and degree of swelling seen in DVT.
---
## **Question 6**
#
Which medication is indicated for a patient with episodic migraine experiencing 6 headache
days per month with moderate disability?
) Sumatriptan acute therapy only
A
B) Propranolol preventive therapy
C) Aspirin 325 mg daily
D) Metoclopramide daily
E) Verapamil acute therapy
**[CORRECT: B]**
* *Rationale:** Indications for **preventive therapy** include: 4+ headache days with some
disability, or 6+ days with no disability. This patient qualifies. **Propranolol** (beta-blocker) is
first-line preventive therapy. Sumatriptan (A) is for acute treatment. The others are not standard
preventive agents.
---
, ## **Question 7**
#
A patient with diabetes presents with sweating, confusion, tremor, and palpitations. What is the
most likely condition?
) Hyperglycemic hyperosmolar state
A
B) Diabetic ketoacidosis
C) Hypoglycemia
D) Thyroid storm
E) Pheochromocytoma
**[CORRECT: C]**
* *Rationale:** **Hypoglycemia** presents with **sympathetic activation**: sweating, tremor,
palpitations, confusion, and weakness. This contrasts with hyperglycemic states (A, B) which
present with dehydration and altered mental without sweating.
---
## **Question 8**
#
What is the diagnostic criterion for diabetes mellitus?
) Fasting plasma glucose ≥126 mg/dL on one occasion with symptoms
A
B) Fasting plasma glucose ≥126 mg/dL on two separate tests
C) Random glucose >200 mg/dL with classic symptoms
D) HbA1c ≥7.0%
E) Two-hour OGTT ≥140 mg/dL
**[CORRECT: B]**
* *Rationale:** Diabetes diagnosis requires **fasting plasma glucose ≥126 mg/dL on two
separate tests** OR random glucose >200 mg/dL with classic symptoms (polyuria, polydipsia,
polyphagia), OR HbA1c ≥6.5%. Option B is the most specific standalone criterion.
---
## **Question 9**
#
Which finding is most concerning for gastrointestinal bleeding in a patient on warfarin therapy?
) INR 4.5
A
B) Minor bruising on arms
C) Black tarry stools (melena)
D) INR 1.8
E) Headache