Ophthalmology Exam Master Questions With Already
Passed Solutions.
A client comes into the clinic with a complaint of flaking and scaling around her
lashes, along with itching and burning sensation, occurring over the past year.
She has also noted her lid margins are red, and some of her lashes are missing.
Her history is significant for seborrheic dermatitis of the scalp, eyebrows, and
external ears, and diabetes.
What is the most likely diagnosis?
Blepharitis
Chalazion
Conjunctivitis
Ectropion
Foreign Body
Blepharitis
Blepharitis may be seborrheic or ulcerative. Seborrheic (non-ulcerative) blepharitis is
commonly associated with seborrhea of the face, eyebrows, external ears, and scalp.
Inflammation of the eyelid margins occurs, with redness, thickening, and often the
formation of scales and crusts or shallow marginal ulcers. Ulcerative blepharitis is
caused by bacterial infection (usually staphylococcal) of the lash follicles and the
meibomian glands. Removal of crusts, topical antibiotics, and /or oral antibiotics
remains the mainstay of treatment.
A 64-year-old African-American man presents to the emergency department after
he went blind in his right eye "out of the blue" 20 minutes ago. There is no pain
associated with his symptoms and he is not nauseated. Past medical history is
positive for DMII for the past ten years. The pupil reaction on the left side is
normal with pressure of 17mmHg. Right pupil evaluation reveals no reaction to
light or accommodation with pressure of 20mmHg. Right eye ophthalmoscopy
reveals arteriolar narrowing, vascular stasis, and "boxcar" pattern.
What is the most likely diagnosis?
Occlusion of the central retinal artery
Acute glaucoma attack
Subconjunctival hemorrhage
Retinal detachment
Macular degeneration
Occlusion of the central retinal artery
The symptoms described above are typical for occlusion of the central retinal artery,
which is a branch of the ophthalmic artery, in turn a branch of the internal carotid artery.
The "boxcar" pattern is segmentation of the venous blood column, bilateral boxcar ring
, is a useful sign of circulatory arrest and death. Acute central artery occlusion is an
emergency, since it results in permanent blindness if circulation is not restored within
30-60 minutes.
A 36-year-old woman presents with a small and irregular right pupil. On exam,
you note that the pupil does not respond to direct or consensual light stimuli;
however, it becomes smaller during an accommodation testing.
What is the most likely diagnosis?
Transient ischemic attack (TIA)
Retinal artery occlusion
Retinal vein occlusion
Tertiary syphilis
Herpes simplex keratitis
Tertiary syphilis
The clinical picture is suggestive of tertiary syphilis; more specifically, it is likely tabes
dorsalis. The pupil describe here is the Argyll Robertson pupil. The pupil reacts poorly to
light, but it reacts well to accommodation.
A 27-year-old woman presents with a 3-day history of left eye pain. The patient
notes sensitivity to light, and she comments that her eye throbs in pain at night.
On physical examination, you note a redness and loss of visual acuity.
What would be an appropriate treatment for this patient?
Cool compresses and artificial tears
Cortisporin ointment
Dexamethasone and homatropine ophthalmic drops
Oral acyclovir
IV acetazolamide
Dexamethasone and homatropine ophthalmic drops
The clinical picture is suggestive of uveitis. Patients with uveitis usually note redness,
pain, photophobia, and visual loss. Treatment is with topical steroids and a dilating
agent to relieve the discomfort. There are multiple causes of uveitis, but it is primarily
immunogenic.
A 1.5-year-old boy presents with a squint in the left eye. His mother informed you
that the child's eyes were quite normal until about 2 months ago, when she
noticed asymmetric movements of her son's eyes. She also felt that the child
could not see properly with his left eye. There is no history of trauma to the eye.
Child was born at full term and his growth and development were within normal
limits. Eye examination showed both eyeballs were equal in size. There was loss
of vision in the left eye and a convergent squint in the same eye. Fundus
examination showed absence of red reflex in the left eye, and instead a white
pupillary reflex (leukocoria) was seen. X-ray of the skull showed calcification
within the globe.
Passed Solutions.
A client comes into the clinic with a complaint of flaking and scaling around her
lashes, along with itching and burning sensation, occurring over the past year.
She has also noted her lid margins are red, and some of her lashes are missing.
Her history is significant for seborrheic dermatitis of the scalp, eyebrows, and
external ears, and diabetes.
What is the most likely diagnosis?
Blepharitis
Chalazion
Conjunctivitis
Ectropion
Foreign Body
Blepharitis
Blepharitis may be seborrheic or ulcerative. Seborrheic (non-ulcerative) blepharitis is
commonly associated with seborrhea of the face, eyebrows, external ears, and scalp.
Inflammation of the eyelid margins occurs, with redness, thickening, and often the
formation of scales and crusts or shallow marginal ulcers. Ulcerative blepharitis is
caused by bacterial infection (usually staphylococcal) of the lash follicles and the
meibomian glands. Removal of crusts, topical antibiotics, and /or oral antibiotics
remains the mainstay of treatment.
A 64-year-old African-American man presents to the emergency department after
he went blind in his right eye "out of the blue" 20 minutes ago. There is no pain
associated with his symptoms and he is not nauseated. Past medical history is
positive for DMII for the past ten years. The pupil reaction on the left side is
normal with pressure of 17mmHg. Right pupil evaluation reveals no reaction to
light or accommodation with pressure of 20mmHg. Right eye ophthalmoscopy
reveals arteriolar narrowing, vascular stasis, and "boxcar" pattern.
What is the most likely diagnosis?
Occlusion of the central retinal artery
Acute glaucoma attack
Subconjunctival hemorrhage
Retinal detachment
Macular degeneration
Occlusion of the central retinal artery
The symptoms described above are typical for occlusion of the central retinal artery,
which is a branch of the ophthalmic artery, in turn a branch of the internal carotid artery.
The "boxcar" pattern is segmentation of the venous blood column, bilateral boxcar ring
, is a useful sign of circulatory arrest and death. Acute central artery occlusion is an
emergency, since it results in permanent blindness if circulation is not restored within
30-60 minutes.
A 36-year-old woman presents with a small and irregular right pupil. On exam,
you note that the pupil does not respond to direct or consensual light stimuli;
however, it becomes smaller during an accommodation testing.
What is the most likely diagnosis?
Transient ischemic attack (TIA)
Retinal artery occlusion
Retinal vein occlusion
Tertiary syphilis
Herpes simplex keratitis
Tertiary syphilis
The clinical picture is suggestive of tertiary syphilis; more specifically, it is likely tabes
dorsalis. The pupil describe here is the Argyll Robertson pupil. The pupil reacts poorly to
light, but it reacts well to accommodation.
A 27-year-old woman presents with a 3-day history of left eye pain. The patient
notes sensitivity to light, and she comments that her eye throbs in pain at night.
On physical examination, you note a redness and loss of visual acuity.
What would be an appropriate treatment for this patient?
Cool compresses and artificial tears
Cortisporin ointment
Dexamethasone and homatropine ophthalmic drops
Oral acyclovir
IV acetazolamide
Dexamethasone and homatropine ophthalmic drops
The clinical picture is suggestive of uveitis. Patients with uveitis usually note redness,
pain, photophobia, and visual loss. Treatment is with topical steroids and a dilating
agent to relieve the discomfort. There are multiple causes of uveitis, but it is primarily
immunogenic.
A 1.5-year-old boy presents with a squint in the left eye. His mother informed you
that the child's eyes were quite normal until about 2 months ago, when she
noticed asymmetric movements of her son's eyes. She also felt that the child
could not see properly with his left eye. There is no history of trauma to the eye.
Child was born at full term and his growth and development were within normal
limits. Eye examination showed both eyeballs were equal in size. There was loss
of vision in the left eye and a convergent squint in the same eye. Fundus
examination showed absence of red reflex in the left eye, and instead a white
pupillary reflex (leukocoria) was seen. X-ray of the skull showed calcification
within the globe.
