Retina and Vitreous

1. A 32-year-old woman presents for a routine eye examination with no

complaints but an elevated choroidal lesion. Ultrasonography reveals an
8-mm-thick lesion with 6 x IO -mm basal dimensions and low internal
reflectivity on A-scan. Which of the following statements is most?
Correct?
a. Complete dermatologic evaluation should be scheduled to look for other
areas of metastatic malignant melanoma.
b. Chest radiographs and liver function tests should be ordered to evaluate
for metastasis.
c. The ultrasound findings are most consistent with a choroidal hemangioma.
d. Immediate enucleation should be considered.

2. A 75-year-old woman presents with sudden visual loss, with intraretinal

hemorrhages in all 4 quadrants; macular edema; and dilated, tortuous
retinal veins. Which of the following statements is most correct?
a. If the patient develops iris neovascularization, panretinal photocoagulation
should be performed immediately.
b. Grid photocoagulation would significantly reduce the macular edema and
improve her vision.
c. Panretinal photocoagulation should be performed immediately to prevent
neovascularization.
d. Younger patients with this diagnosis should receive grid
photocoagulation.

3. A 82-year-old man presents with signs and symptoms of acute,

exudative age-related macular degeneration, and fluorescein angiography
shows predominantly classic, subfoveal choroidal neovascularization
(CNV). 'What treatment option has been shown in controlled clinical trials
to yield the best visual acuity outcomes?
a. photodynamic therapy (PDT)
b. photodynamic therapy in combination with intravitreal triamcinolone
c. intravitreal injections of the anti-VEGF agent ranibizumab
d. laser photocoagulation with krypton red laser to cover the entire CNV

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4. A 64-year-old man presents 3 days after cataract surgery with severe eye
pain. Decreased vision, and photophobia that started 5 hours previously.
On examination, the vision is hand motions at 6 in and the intraocular
pressure is 27. There is 3+ conjunctival injections, 4+ anterior chamber
cell, a 3-mm layered hypopyon, a well-centered pCIOL, and a small
section of retained cortex in the inferior trabecular meshwork. Which of
the following statements is most correct?
a. The retained lens fragments have induced phacoanaphylactic glaucoma.
b. The cause of the hypopyon is aggressive postoperative inflammation.
c. A culture of the capsule in this patient would reveal Propionibacterium
acnes organisms.
d. The most likely organism involved is coagulase-negative staphylococci.

5. For the patient in question 4, what would be the best treatment option?
a. aggressive topical corticosteroids to decrease the intraocular inflammation
b. immediate vitrectomy to remove the retained lens fragments
c. tap of the anterior chamber andlor vitreous cavity and injection of
intravitreal antibiotics
d. immediate vitrectomy and injection of intravitreal antibiotics

6. All of the following are true about central serous chorioretinopathy

except:
a. Fluorescein angiography typically reveals a pinpoint, deep "expanding
dot" of hyper fluorescence during the active phase of the disease.
b. The condition is usually self-limited, with the subretinal fluid in the
macula resolving over several months.
c. The condition is often made better with periocular or oral corticosteroids.
d. Recurrent attacks can occur in the same or contralateral eye.

7. A 42-year-old woman was recently diagnosed with non-insulin-

dependent diabetes. Which statement is most correct?
a. Immediate focal laser photocoagulation should be performed if she has
clinically significant macular edema and her vision is 20/20.
h. According to the Diabetes Control and Complications Trial (DCCT), tight
control of the patient's blood sugar would decrease her risk of developing
diabetic retinopathy.
c. Immediate scatter photocoagulation should be applied if neovascularizat
ion of the disc and vitreous hemorrhage are present.

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d. Focal laser photocoagulation should be performed if fluorescein leakage is
present in the center of the fovea, even if the clinical examination does not
show retinal thickening.

8. A 52-year-old man presents with a small visual field defect in his left
eye. On examination, his vision is 20140, and he has a segmental,
triangular-shaped distribution of intraretinal hemorrhages extending from
an arteriovenous crossing along the superotemporal vascular arcade.
Given the patient's clinical presentation, which statement is most correct?
a. If macular edema has been present for more than 3 months and no retinal
hemorrhages would prevent laser treatment, grid photocoagulation can be
beneficial.
b. If he has more than 5 disc diameters of capillary nonperfusion on
fluorescein angiography, he should receive immediate photocoagulation.
c. If macular nonperfusion 'causes visual loss. then no treatment is indicated.
d. A complete embolic workup should be performed. especially evaluation
of the carotid arteries.

9. Fundus albipunctatus is characterized by all of the following except:

a. nyctalopia
b. a reduced scotopic ERG that normalizes after several hours of dark adapta
tion
c. normal visual acuity
d. progressive visual fi eld loss
e. yellow-white dots in the posterior pole

10. A reduced and delayed cone b-wave is consistent with all of the
following diagnoses except:
a. retinitis pigmentosa
b. central retinal vein occlusion
c. cone dystrophy
d. syphilitic chorioretinit is
e. sectoral retinitis pigmentosa

11. An individual born without red-sensitive cone pigment function (p

rotanopia) is likely to
a. have poor visual acuity
b. confuse blue and yellow
c. perceive the long-wavelength portion of the spectrum as being darker than
normal

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d. man ifest photophobia
e. be hypersensitive to green

12. A subnormal EOG in the setting of a normal ERG can be seen in the
following condition(s}:
a. retinitis pigmentosa
b. Best disease
c. rubella retinopathy
d. pattern dyst rophies
e. b and d

13. Progressive cone dystrophies are characterized by all of the following

except:
a. progressive loss of visual acuity
b. photoaversion (light intolerance)
c. better visual function during the day than at dusk
d. loss of color disc rimination
e. bull's-eye pattern of macular atrophy

14. Which of following macular dystrophies is typically inherited as an

autosomal recessive trait?
a. Best vitelliform dystrophy
b. Stargardt disease
c. familial drusen
d. pattern macular dystrophies
e. Sorsby macular dystrophy

15. A constant diagnostic feature of congenital X -linked retinoschisis is

a. peripheral retinoschis is
b. reduced ERG a-wave amplitudes
c. macular fluorescein leakage
d. peripheral pigmentary changes
e. foveal schisis

16. Which of the following systemic drugs can result in a toxic

maculopathy characterized by crystalline deposits, macular edema, and
decreased visual acuity?
a. thioridazine
b. chloroquine
c. tamoxifen

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d. canthaxanthine
e. sildenafil

17. The most critical and constant finding in retinitis pigmentosa is

a. dense bone-spicule pigmentation in the retinal periphery
b. an abnormality in the rhodopsin gene
c. acquired red-green color deficiency
d. a significantly reduced electroretinogram (ERG)
e. small tubular visual fields

18. Which of the following statements is false in relation to X -linked

ocular albinism?
a. The iris is translucent.
b. Carrier females cannot be detected.
c. Macromelanosomes are found in the retinal pigment epithelium.
d. Nystagmus and reduced vision are features of the disorder.

19. A normal electroretinogram is usually found in all of the following

diseases affecting the retina except:
a. vitelliform dystrophy
b. dominant drusen
c. juvenile retinoschisis
d. X-linked ocular albinism
e. pattern dystrophy

20. Fifty percent of rhegmatogenous retinal detachments associated with

blunt trauma in young eyes are found
a. immediately
b. within 1 month
c. within 8 months
d. within 24 months

21. 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. a birth weight less than 1500 grams
b. a gestational age of 30 weeks or less

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c. a birth weight between 1500 and 2000 grams and an unstable clinical
course
d. all of the above
22. Which of the following statements about cataract surgery in patients
with diabetes is correct?
a. Patients with diabetes enrolled in the ETDRS who underwent cataract
surgery did not show an immediate improvement in visual acuity.
b. Patients with diabetes with clinically significant macular edema should
have cataract surgery performed prior to focal laser.
c. Patients with diabetes and high-risk proliferative changes visible through
their cataract should ideally have scatter laser immediately before cataract
extraction.
d. Patients with diabetes and high-risk proliferative changes visible through
their cataract should have scatter laser 1- 2 months prior to cataract
extraction.
e. Preoperative phenylephrine drops for dilation are contraindicated in
patients with diabetes undergoing cataract surgery.

23. Which of the following statements about punctate inner choroidopathy

(PIC) is correct?
a. The condition affects males and females with equal frequency.
b. Punctate inner choroidopathy is more commonly seen in patients 'with the
ocular histoplasmosis syndrome.
c. Disease involvement is associated with HLA-DR2 antigen.
d. The condition is differentiated from multiple evanescent white dot
syndrome (MEWDS) in that choroidal neovascularization is rarely seen in
PIC.
e. The condition is usually bilateral.

24. The following statement about diffuse unilateral subacute

neuroretinitis (DUSN) is correct:
a. The disease never occurs bilaterally.
b. DUSN is a common cause of incorrectly diagnosed "unilateral retinitis
pigmentosa."
c. Eradication of the subretinal nematode often results in an intense
inflammatory reaction.
d. Visual loss typically continues after successful eradication of the
subretinal nematode.
e. The condition is seen only in individuals with a history of travel to
endemic areas.

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25. The following statement is correct about pneumatic retinopexy:
a. Pneumatic retinopexy works by mechanically reattaching the detached
retina.
b. Pneumatic retinopexy is contraindicated in patients with total retinal
detachments.
c. Pseudophakia is an absolute contraindication to pneumatic retinopexy.
d. Chronic detachments are a relative contraindication for pneumatic
retinopexy.
e. Pneumatic retinopexy is contraindicated in failed scleral buckles.

26. Features that may help distinguish CRVO from carotid artery
occlusive disease include all of the following except:
a. dilated retinal veins
h. tortuosity of retinal veins
c. ophthalmodynamometry
d. retinal artery pressure

27. Multiple evanescent white dot syndrome (MEWDS) is characterized by

each of the following clinical features except:
a. enlargement of the physiologic blind spot on visual field testing
b. individual hyperfluorescent spots on fluorescein angiography arranged in
a wreathlike pattern around the fovea
c. unilateral photopsias and loss of vision in young females with myopia
d. absence of cell in the anterior chamber
e. granular appearance of the fovea

28. In a randomized, controlled clinical trial, pneumatic retinopexy

a. was superior to scleral buckle in the anatomical success rate of repairing
macula-sparing rhegmatogenous retinal detachments in pseudophakic
patients
b. provided slightly better visual outcome than scleral buckle in patients with
macula-involving rhegmatogenous retinal detachments of less than 14-day
duration
c. included patients with causative breaks in the inferior 90° of the retina
d. led to a worse outcome in pat ients who required an additional scleral
buckle procedure for persistent or recurrent retinal detachment than if a
scleral buckle procedure had been performed primarily

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29. Patients with acute posterior multifocal placoid pigment epitheliopathy
(APMPPE) may have all of the following clinical features except:
a. unilateral or asymmetric fundus involvement
b. recurrent or relentless progression of fundus lesions leading to permanent
loss of central
vision
c. associated cerebral vasculitis
d. prompt response to oral corticosteroids

30. All of these diagnostic tests are useful in evaluating a patient with a
retained magnetic intraocular foreign body except:
a. indirect ophthalmoscopy
b. computed tomography (CT)
c. electrophysiology
d. magnetic resonance imaging (MRI)
e. echography

31. In phakic asymptomatic patients, which of the following types of

retinal break is almost always treated, whereas the others are rarely
treated?
a. operculated tears
b. lattice degeneration with or without hole
c. retinal dialysis
d. atrophic holes

32. Which of the following statements describing eyes with retained lens
fragments after phacoemulsificaton is false?
a. Marked intraocular inflammation is common.
b. Secondary glaucoma is caused by lens particles and proteins obstructing
the trabecular
meshwork.
c. The cumulative rate of retinal detachment is approximately 15% in these
eyes during follow-up.
d. The visual prognosis is generally poor in spite of treatment.

33. Which of the following is least likely to be present in an eye with a

purely tractional retinal detachment?
a. concave surface
b. sickle cell retinopathy
c. smooth retinal surface

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d. extension of detachment of the midperiphery
e. tobacco dust
34. Which of the following is most characteristic of exudative retinal
detachment?
a. shifting fluid
b. tobacco dust
c. fixed folds
d. equatorial traction folds
e. demarcation lines

35. Based on ETDRS reports, which of the following statements regarding

the use of aspirin is false?
a. It has no effect on visual acuity.
b. It has no effect on progression of retinopathy.
c. It has no effect on rates of vitreous hemorrhage.
d. It has no effect on rates of progression to high- risk PDR.
e. It significantly increases the rate of vitrectomy for nonclearing vitreous
hemorrhage.

36. In treating extrafoveal choroidal neovascularization (CNV) associated

with ocular histoplasmosis, the ophthalmologist can decrease the risk of
recurrent CNV by
a. using a red laser rather than a green laser
b. using durations of 0.5 second
c. covering the entire lesion with laser treatment
d. attaining a uniform white intensity of the area of photocoagulation at least
as great as the minimal intensity standard published by the Macular
Photocoagulation Study (MPS)
e. c and d

37. All of the following are signs of shaken baby syndrome except:
a. intraretinal hemorrhages
b. retinoschisis cavities
c. lethargy, irritability, seizures, and hypotonia
d. optic nerve hypoplasia

38. Sympathetic ophthalmia

a. occurs in approximately 1 in 1500 penetrating injuries
b. never causes permanent loss of sight
c. may be avoided by early enucleation of un salvageable eyes

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d. does not cause exudative detachment

39. Diffuse and circumscribed choroidal hemangiomas

a. are really the same thing
b. may both cause serous detachments
c. are both commonly associated with glaucoma
d. are not associated with visual problems
e. are not associated with systemic disease

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