3.1 Questions

Easy

Medium

Hard

1. (Easy) A medical student is preparing to travel with you on a medical mission and asks you what is the most likely cause of blindness in the patients you encounter. You answer as follows:

1. 
   

   Glaucoma

   
   
2. 
   

   Cataract

   
   
3. 
   

   Macular degeneration

   
   
4. 
   

   Trachoma

2. (Easy) Which of the following was the first known risk factor for the development of cataracts?

1. 
   

   Smoking

   
   
2. 
   

   UV light exposure

   
   
3. 
   

   High myopia

   
   
4. 
   

   Topical corticosteroid use

3. (Easy) The adult crystalline lens normally lacks a blood supply and innervation after fetal development. Where does it derive nutrients required for metabolic function?

1. 
   

   Lens capsule

   
   
2. 
   

   Zonules of Zinn

   
   
3. 
   

   Aqueous humor

   
   
4. 
   

   Vitreous humor

4. (Medium) You have followed a patient over the past 20 years for routine eye care. The patient brings up the topic of cataract surgery—“my friend’s having it”— and wants to know how his lens has changed with time. Which of the following would you not expect with aging of the crystalline lens?

1. 
   

   The relative thickness of the cortex increases.

   
   
2. 
   

   The lens adopts an increasingly curved shape.

   
   
3. 
   

   The index of refraction increases with age.

   
   
4. 
   

   The eye may become either more hyperopic or myopic as the lens ages.

5. (Easy) The lens capsule is comprised of _________ collagen, and is thinnest at the __________.

1. 
   

   Type I, anterior pole

   
   
2. 
   

   Type IV, anterior pole

   
   
3. 
   

   Type I, posterior pole

   
   
4. 
   

   Type IV, posterior pole

6. (Hard) As lens epithelial cells elongate to form lens fiber cells, which of the following is true?

1. 
   

   There is a significant increase in the mass of cellular proteins in the fiber cell membrane.

   
   
2. 
   

   Cells gain organelles including nuclei, mitochondria, and ribosomes.

   
   
3. 
   

   Metabolic functional capacity increases.

   
   
4. 
   

   Light passing through the cells is scattered at an increasing rate.

7. (Medium) The oldest layers of the lens, the embryonic and fetal lens nuclei, exist at which of the following?

1. 
   

   At the posterior pole of the lens

   
   
2. 
   

   At the center of the lens

   
   
3. 
   

   Toward the equator of the lens

   
   
4. 
   

   At the anterior pole of the lens

8. (Medium) The Y-shaped sutures of the lens appear as which of the following?

1. 
   

   Erect anteriorly and posteriorly

   
   
2. 
   

   Inverted anteriorly and posteriorly

   
   
3. 
   

   Erect anteriorly and inverted posteriorly

   
   
4. 
   

   Inverted anteriorly and erect posteriorly

9. (Medium) Which of the following is the largest group of lens proteins by molecular mass?

1. 
   

   α-Crystallins

   
   
2. 
   

   β-Crystallins

   
   
3. 
   

   βL-Crystallins

   
   
4. 
   

   γ-Crystallins

10. (Hard) You diagnose a 75-year-old woman with visually significant cataracts. She has read about this condition online and asks you if everything she has read is accurate. Which of the following is false?

1. 
   

   Proteins aggregate to form large particles which become water insoluble.

   
   
2. 
   

   An increase in water insoluble proteins correlates with the degree of lens opacification in advanced cataracts.

   
   
3. 
   

   Increased levels of glutathione and decreased levels of glutathione disulfide in the cytoplasm of nuclear fiber cells lead to increased protein aggregation.

   
   
4. 
   

   Nuclear proteins are highly cross-linked by disulfide and non-disulfide bonds.

11. (Medium) Which of the following is false regarding accommodation?

1. 
   

   Most of the accommodative change in lens shape occurs at the central anterior lens surface.

   
   
2. 
   

   The curvature of the posterior surface of the lens does not significantly change with accommodation.

   
   
3. 
   

   Zonular tension increases with accommodation.

   
   
4. 
   

   Lens equatorial diameter decreases with accommodation.

12. (Easy) The majority of adenosine triphosphate (ATP) responsible for metabolic function in the lens is generated by which of the following?

1. 
   

   Citric acid cycle

   
   
2. 
   

   Anaerobic glycolysis

   
   
3. 
   

   Hexose monophosphate shunt

   
   
4. 
   

   Sorbitol pathway

13. (Easy) Which of the following is the key enzyme in the sorbitol pathway responsible for the conversion of glucose to sorbitol?

1. 
   

   Phosphofructokinase

   
   
2. 
   

   Aldose reductase

   
   
3. 
   

   Hexokinase

   
   
4. 
   

   Polyol dehydrogenase

14. (Hard) You are asked to see an inpatient admitted for diabetic ketoacidosis, now complaining of decreased vision. Which of the following is likely true of his lens metabolism upon admission?

1. 
   

   Sorbitol is metabolized to fructose by the enzyme polyol dehydrogenase, which has a low affinity for sorbitol.

   
   
2. 
   

   In addition to sorbitol, fructose accumulates in the lens due to activation of the hexose monophosphate (HMP) and sorbitol pathway.

   
   
3. 
   

   Fructose and sorbitol increase the osmotic pressure in the lens, drawing in water.

   
   
4. 
   

   All of the above.

15. (Medium) A 45-year-old man is status post pars plana vitrectomy and membrane peel for an epiretinal membrane. He develops a nuclear sclerotic cataract shortly after his retinal surgery. What is the most likely mechanism of his cataract formation?

1. 
   

   Inadvertent trauma to the lens capsule during infusion cannula placement

   
   
2. 
   

   Inadvertent trauma to the lens capsule during vitrectomy

   
   
3. 
   

   Inadvertent trauma to the lens capsule during creation of sclerotomies

   
   
4. 
   

   Reduced protection from oxidative damage to the lens due to the removal of the vitreous

16. (Easy) The lens cells with the highest metabolic rates are found in which of the following?

1. 
   

   Epithelium and outer cortex

   
   
2. 
   

   Nucleus

   
   
3. 
   

   Inner cortex

   
   
4. 
   

   Posterior pole

17. (Medium) The lens vesicle, a single layer of cuboidal cells, forms at approximately _____ days of gestation.

1. 
   

   10

   
   
2. 
   

   20

   
   
3. 
   

   30

   
   
4. 
   

   40

18. (Easy) A fetal remnant of the tunica vasculosa lentis sometimes persists as a small opacity or strand on the posterior lens capsule called a _______.

1. 
   

   Mittendorf’s dot

   
   
2. 
   

   Lens coloboma

   
   
3. 
   

   Bergmeister’s papilla

   
   
4. 
   

   Posterior polar cataract

19. (Easy) A 2-year-old boy is brought by his parents after the pediatrician notes an abnormal light reflex OD. You find a unilateral cataract. Which of the following conditions is most commonly associated with this?

1. 
   

   Down’s syndrome

   
   
2. 
   

   Rubella

   
   
3. 
   

   Persistent fetal vasculature

   
   
4. 
   

   Aniridia

20. (Medium) The condition seen in the figure is most commonly associated with loss of one allele in the ______ gene.

1. 
   

   PITX2

   
   
2. 
   

   FOXC1

   
   
3. 
   

   CYP1B1

   
   
4. 
   

   PAX6

21. (Easy) The condition seen in the figure is associated with which of the following systemic features?

1. 
   

   Small stature

   
   
2. 
   

   Short and stubby fingers

   
   
3. 
   

   Reduced joint mobility

   
   
4. 
   

   Dilation of the aortic root

1. 
   

   1 and 2

   
   
2. 
   

   3 and 4

   
   
3. 
   

   1 and 3

   
   
4. 
   

   All of the above

22. (Hard) The condition seen in the figure is most classically associated with which of the following systemic features?

1. 
   

   Seizures

   
   
2. 
   

   Mitral valve prolapse

   
   
3. 
   

   Sensorineural deafness

   
   
4. 
   

   Cardiac conduction abnormalities

23. (Hard) The image shown is most commonly associated with which of the following?

1. 
   

   Diabetes

   
   
2. 
   

   Myotonic dystrophy

   
   
3. 
   

   No association

   
   
4. 
   

   Congenital cataract

24. (Easy) Bladder cells are associated with what type of cataract?

1. 
   

   Morgagnian cataract

   
   
2. 
   

   Cortical cataract

   
   
3. 
   

   Nuclear cataract

   
   
4. 
   

   Posterior subcapsular cataract

25. (Medium) A 60-year-old patient presents for a dilated examination and is found to have cortical cataracts. This is often associated with which of the following?

1. 
   

   Symmetric visual complaints

   
   
2. 
   

   A local disruption of lens fiber cells

   
   
3. 
   

   Increase in the refractive index of the lens leading to a myopic shift

   
   
4. 
   

   Greater disruption of visual symptoms at near

26. (Hard) When coupled with erythromycin, concomitant use of which of the following drugs may increase the risk of cataract?

1. 
   

   Simvastatin

   
   
2. 
   

   Prednisone

   
   
3. 
   

   Pilocarpine

   
   
4. 
   

   Chlorpromazine

27. (Medium) A 50-year-old patient has had type 2 diabetes for 10 years. Which of the following is true regarding cataracts for this specific patient?

1. 
   

   An increase in sorbitol in the lens may result in swelling of the lens fibers.

   
   
2. 
   

   Increased amplitude of accommodation.

   
   
3. 
   

   Given the swelling of the lens, presbyopia can occur later in patients with diabetes than those without diabetes.

   
   
4. 
   

   A sunflower cataract is a typical cataract of a diabetic patient.

28. (Hard) A 17-year-old male patient has periocular dermatitis. You notice lichenification on the flexural surface of his arms. Which of the following is the most likely associated lens change?

1. 
   

   Polychromatic iridescent crystals in the lens cortex

   
   
2. 
   

   Posterior synechiae and posterior subcapsular cataract

   
   
3. 
   

   Have an “oil droplet” appearance on retroillumination, which can progress to total opacification of the lens

   
   
4. 
   

   An anterior subcapsular shield-like cataract that typically develops in the early adult years

29. (Hard) A 3-week-old newborn has symptoms of jaundice, hepatomegaly, and mental deficiency has been found to have an inherited metabolic condition that may be treated by diet modifications. In this condition, the ocular examination may reveal which of the following lenses?

1. 
   

   Have inferior colobomas.

   
   
2. 
   

   Are dislocated into the anterior chamber due to their small size.

   
   
3. 
   

   Have an “oil droplet” appearance on retroillumination, which can progress to total opacification of the lens.

   
   
4. 
   

   Have been dislocated inferiorly and temporally given the zonular laxity.

30. (Easy) You are examining the patient with the condition shown. Her best corrected visual acuity of 20/80 and is interested in cataract surgery.

Which of the following may the patient be at higher risk for?

1. 
   

   Suprachoroidal hemorrhage

   
   
2. 
   

   Zonular dehiscence

   
   
3. 
   

   Aqueous misdirection

   
   
4. 
   

   Endophthalmitis

31. (Medium) A 27-year-old man presents in your office with visual loss in the left eye status post assault a few months prior. On examination, his best corrected visual acuity of 20/80, which you determine is due to a focal cortical cataract. You also notice which of the following signs of trauma?

1. 
   

   A fibrillogranular white material deposited on the lens and trabecular meshwork

   
   
2. 
   

   Polychromatic iridescent crystals in the lens cortex

   
   
3. 
   

   Vossius’ ring

   
   
4. 
   

   Soemmering’s ring

32. (Easy) A 30-year-old male construction worker presents to your office and on examination is found to have a small foreign body embedded in the lens. The cornea is Seidel negative, the anterior lens capsule appears to have sealed the perforation site, and the eye is quiet with no anterior chamber inflammation. Which of the following materials must be removed?

1. 
   

   Glass

   
   
2. 
   

   Titanium

   
   
3. 
   

   Iron

   
   
4. 
   

   Stone

33. (Medium) A 52-year-old woman comes to your office for a follow-up visit. On examination, her vision is 20/40, the eye is white and quiet, the cornea is clear, and intraocular pressure (IOP) is 18. On her lens, you note gray–white epithelial and anterior cortical lens opacities. These opacities are associated with which of her recent episodes?

1. 
   

   Phacoantigenic uveitis

   
   
2. 
   

   Phacolytic glaucoma

   
   
3. 
   

   Angle closure glaucoma

   
   
4. 
   

   Lens particle glaucoma

34. (Medium) Which of the following ocular treatments does not lead to the formation of cataract?

1. 
   

   Hyperbaric oxygen

   
   
2. 
   

   Scleral buckle

   
   
3. 
   

   Pars plana vitrectomy

   
   
4. 
   

   Topical steroids on the eyelids

35. (Medium) A 55-year-old man presents with complaint of difficulty reading. Which of the following indicates cataracts are unlikely to be a contributing factor?

1. 
   

   History of being on a college boxing team

   
   
2. 
   

   Diagnosis of a skin disorder, currently being treated by a dermatologist

   
   
3. 
   

   Complaint of glare and halos while driving at night

   
   
4. 
   

   History of never wearing glasses

36. (Hard) An 85-year-old man presents with pain and redness for the last few days. He has had decreased vision for over 10 years. Which of the following is the cause for his presenting complaint?

1. 
   

   Phacolytic glaucoma

   
   
2. 
   

   Primary angle closure glaucoma

   
   
3. 
   

   Lens particle glaucoma

   
   
4. 
   

   Phacomorphic glaucoma

37. (Easy) A 73-year-old woman with hypertension, hyperlipidemia, and thyroid eye disease presents decreased vision for 7 years. She has a previous 40-pack-year history of smoking and a remote history of IV drug abuse. Your examination is normal except for nuclear sclerotic cataracts and early age-related macular degeneration. Which of the following risk factors is most likely associated with the development of cataracts?

1. 
   

   Lack of age-related eye disease study (AREDS) multivitamin use

   
   
2. 
   

   Hyperlipidemia

   
   
3. 
   

   IV drug use

   
   
4. 
   

   Smoking

38. (Medium) A 28-year-old man presents to your office for recent decrease in vision. His previous ocular history is significant for high myopia, astigmatism, and a laser retinopexy for a retinal tear in his right eye. On examination, you see the following, which you suspect accounts for the decrease in vision. The rest of the ophthalmic examination is stable.

Which of the following is associated with this condition:

1. 
   

   Short stature

   
   
2. 
   

   Mental retardation

   
   
3. 
   

   Abnormal metabolites in the urine

   
   
4. 
   

   Aortic enlargement

39. (Hard) A 32-year-old man with mild mental retardation, ataxia, and tremor presents to your office with recent decrease in vision. On examination, vision is decreased to 20/30 but refracts to 20/25+2. Examination is significant for a cataract and the findings demonstrated.

Which of the following may not associated with this condition?

1. 
   

   Sunflower cataract

   
   
2. 
   

   Portal hypertension

   
   
3. 
   

   Hepatocellular carcinoma

   
   
4. 
   

   Hepatic encephalopathy

40. (Medium) A 72-year-old man has reduced visual acuity of 20/70. This has affected his ability to drive, read, and watch television. Upon review of his medical history, you find that he is currently taking tamsulosin for benign prostate hypertrophy. Prior to his cataract surgery, which of the following would you not consider?

1. 
   

   Review with the patient the associated risks of tamsulosin with cataract surgery

   
   
2. 
   

   Have the patient stop tamsulosin the day before surgery

   
   
3. 
   

   Use of pupil expansion devices during cataract surgery

   
   
4. 
   

   Utilize different parameters during phacoemulsification

41. (Hard) You are evaluating macular function in a patient with a limited view of the retina. Which of the following may not be helpful to determine macular function?

1. 
   

   Photostress recovery time

   
   
2. 
   

   The Maddox rod

   
   
3. 
   

   Blue-light entoptoscopy

   
   
4. 
   

   Humphrey visual field testing

42. (Medium) During the preoperative appointment prior to performing cataract surgery, you note that the patient has good dilation of the pupil and guttatA. Corneal edema after cataract surgery is associated with a central corneal thickness greater than which of the following?

1. 
   

   500 µm

   
   
2. 
   

   540 µm

   
   
3. 
   

   600 µm

   
   
4. 
   

   640 µm

43. (Medium) A patient with medical history significant for hypertension, diabetes, and coronary artery disease with a cardiac stent is brought to the operating room for cataract surgery. IV sedation and a retrobulbar block are given. Upon sterile draping, it is noted that the orbit is taut with ecchymosis of the eyelids and conjunctiva. The eye is extremely firm to palpation. What is the most appropriate course of action?

1. 
   

   Perform digital massage.

   
   
2. 
   

   Request the anesthesiologist to decrease sedation.

   
   
3. 
   

   Examine the fundus with indirect ophthalmoscopy to check for globe penetration.

   
   
4. 
   

   Perform a lateral canthotomy and cantholysis.

44. (Medium) During phacoemulsification of the lens nucleus, a tear is identified in the posterior lens capsule. Which of the following is the most appropriate next step?

1. 
   

   Remove the phacoemulsification probe from the eye immediately.

   
   
2. 
   

   Inject a dispersive ophthalmic viscosurgical device (OVD) over the tear.

   
   
3. 
   

   Proceed with anterior vitrectomy using a bimanual technique.

   
   
4. 
   

   Inject diluted triamcinolone to determine whether vitreous has prolapsed anteriorly.

45. (Hard) A 72-year-old woman presents for preoperative evaluation for cataract surgery in her right eye. Her refraction measures +0.50 −2.25 ×140 with 20/50 visual acuity. Biometry reveals an axial length of 24.10 mm and keratometry readings of 42.25 and 42.37 at 84 degrees. Which of the following is the most appropriate method for treating her astigmatism at the time of cataract surgery?

1. 
   

   Limbal relaxing incision

   
   
2. 
   

   Astigmatic keratotomy

   
   
3. 
   

   Toric intraocular lens implantation

   
   
4. 
   

   None of the above

46. (Hard) A colleague presents wondering which of four medications he should choose for his benign prostatic hyperplasia (BPH). You know that he will likely need cataract extraction in the upcoming year. Which of the following would be the worst choice?

1. 
   

   Alfuzosin

   
   
2. 
   

   Doxazosin

   
   
3. 
   

   Tamsulosin

   
   
4. 
   

   Terazosin

47. (Hard) Proposed methods for the management of intraoperative floppy iris syndrome include all of the following except which one?

1. 
   

   The use of iris retractors

   
   
2. 
   

   Injection of epinephrine into the anterior chamber

   
   
3. 
   

   Mechanical stretching of the pupil

   
   
4. 
   

   Lowering flow settings

48. (Hard) You are asked to perform cataract surgery on a veteran treated with prazosin for posttraumatic stress disorder (PTSD). What might his medication result in?

1. 
   

   Increased iris sphincter tone

   
   
2. 
   

   Iris stromal atrophy

   
   
3. 
   

   Pupillary mydriasis

   
   
4. 
   

   Decrease aqueous humor secretion

49. (Hard) A 61-year-old man undergoes cataract surgery of his left eye without complication. He is seen again 18 hours later complaining of mild pain, photosensitivity, and worsening vision. His visual acuity is 20/200 and shows diffuse corneal edema with dense cells in the anterior chamber and a small hypopyon. The therapy most likely to lead to resolution of this condition is which of the following?

1. 
   

   Intensive topical corticosteroid therapy in conjunction with a brief course of systemic corticosteroids

   
   
2. 
   

   Vitreous tap and injection of broad-spectrum antibiotic

   
   
3. 
   

   Fortified broad-spectrum antibiotic drops given every hour

   
   
4. 
   

   Broad-spectrum antibiotics given intravenously followed by an extended course of oral antibiotics

50. (Hard) A day after undergoing cataract surgery complicated by posterior capsular rupture and vitreous loss, a small strand of vitreous is observed extending through a paracentesis incision to the ocular surface. Which of the following is the most appropriate management for this?

1. 
   

   Nd:YAG laser vitreolysis.

   
   
2. 
   

   Return to the operating room for vitrectomy.

   
   
3. 
   

   Extended course of topical corticosteroid and nonsteroidal anti-inflammatory drug.

   
   
4. 
   

   Increase dosage frequency of broad-spectrum topical antibiotic until the wound has fully epithelialized.

51. (Medium) An angulated intraocular lens (IOL) is designed such that the optic is vaulted posteriorly relative to the haptics. Insertion of such a lens upside down in the capsular bag may result in which of the following?

1. 
   

   Hyperopic refractive surprise

   
   
2. 
   

   Zonular instability

   
   
3. 
   

   Corneal decompensation

   
   
4. 
   

   Pupillary block glaucoma

52. (Medium) A 53-year-old man with a visually significant cataract and history of rigid gas-permeable contact lens wear wishes to achieve spectacle independence with cataract surgery. His corneal topography is shown below.

Which of the following would be the best intraocular lens (IOL) option to achieve this goal?

1. 
   

   Single-piece monofocal intraocular lens (IOL)

   
   
2. 
   

   Toric IOL

   
   
3. 
   

   Multifocal IOL with limbal relaxing incisions

   
   
4. 
   

   Multifocal toric IOL

53. (Hard) A 65-year-old woman undergoes uncomplicated cataract surgery with insertion of a toric intraocular lens (IOL). At her 1-month postoperative visit, her uncorrected visual acuity is 20/80. Based on the information below, which of the following is the most likely cause?

Preoperative keratometry:

• 
  

  42.00 @ 180

  
  
• 
  

  45.00 @ 90

Postoperative refraction:

• 
  

  +1.50 −3.00 × 180

Postoperative keratometry:

• 
  

  42.00 @ 180

  
  
• 
  

  45.00 @ 90

  
  
• 
  

  The lens has rotated offaxis by approximately 30 degrees.

  
  
• 
  

  The lens has been implanted erroneously 90 degrees away from the correct axis.

  
  
• 
  

  The estimated surgically induced astigmatism of the main incision was too low.

  
  
• 
  

  The estimated surgically induced astigmatism of the main incision was too high.

54. (Hard) You are performing an uncomplicated cataract extraction, and have started hydrodissection. The globe suddenly becomes firm, and there is marked shallowing of the anterior chamber. Which of the following is the most appropriate course of action?

1. 
   

   Attempt to depressurize the globe by “burping” a paracentesis.

   
   
2. 
   

   Administer mannitol intravenously.

   
   
3. 
   

   Inject a cohesive ophthalmic viscosurgical device to reform the anterior chamber.

   
   
4. 
   

   Inject a dispersive ophthalmic viscosurgical device to reform the anterior chamber.

55. (Hard) A 71-year-old man with no significant past medical history presents 3 months after uneventful cataract surgery complaining of mildly reduced vision. Slit-lamp biomicroscopy reveals low-grade anterior chamber cell and flare, mild keratic precipitates, and normal fundoscopy except for trace vitreous cell. His best corrected visual acuity is 20/40.

Which of the following is the most definitive management for this condition?

1. 
   

   Injection of intravitreal antibiotics with capsulectomy

   
   
2. 
   

   Topical corticosteroids with slow tapering

   
   
3. 
   

   Nd:YAG laser capsulotomy

   
   
4. 
   

   Systemic evaluation for autoimmune disease with appropriate therapy for the underlying condition

56. (Medium) Cataract surgery with topical anesthesia would be most appropriate for which of the following patients?

1. 
   

   A 67-year-old man with severe hearing impairment and grade 2+ nuclear sclerosis cataract

   
   
2. 
   

   An 88-year-old man with a hypermature, brunescent nuclear sclerosis cataract, limiting visualization of the fundus

   
   
3. 
   

   A 75-year-old woman with pseudoexfoliation, grade 3+ nuclear sclerosis cataract, and mild subluxation

   
   
4. 
   

   A 45-year-old woman with trace nuclear sclerosis, dense cortical spokes, and 1 clock hour of posterior synechiaeobscuring the red reflex

57. (Medium) Compared to scleral tunnel incisions, which of the following regarding clear corneal incisions is not true?

1. 
   

   Has little to no effect on astigmatism.

   
   
2. 
   

   More efficient construction.

   
   
3. 
   

   Reduces the risk of endophthalmitis.

   
   
4. 
   

   Permits use of topical anesthesia.

58. (Easy) Compared to a cohesive ophthalmic viscosurgical device (OVD), advantages of a dispersive OVD include all of the following except which one?

1. 
   

   Protection of the corneal endothelium from phacoemulsification energy

   
   
2. 
   

   Partitioning of the eye during capsular rupture

   
   
3. 
   

   Minimal risk of postoperative ocular hypertension if retained in the eye

   
   
4. 
   

   Suppression of vitreous prolapse through a posterior capsular tear

59. (Hard) During phacoemulsification of a dense nuclear sclerotic cataract, the cornea at the main incision suddenly turns white and excessive egress of fluid is observed through this wound around the phaco probe.

Methods that could have prevented this complication include all of the following except which one?

1. 
   

   Using pulse or burst mode phacoemulsification

   
   
2. 
   

   Lowering the aspiration flow rate

   
   
3. 
   

   Ensuring the incision is constructed to the appropriate width

   
   
4. 
   

   Converting to a nuclear expression technique (e.g., extracapsular cataract extraction)

60. (Hard) A 37-year-old man has a history of traumatic injury resulting in angle recession glaucoma and lens dislocation, which required a complete lensectomy. Which of the following is the most appropriate intraocular lens (IOL) implant option to correct his aphakia?

1. 
   

   Anterior chamber IOL (ACIOL)

   
   
2. 
   

   Three-piece IOL secured to the iris with 9–0 nylon sutures

   
   
3. 
   

   One-piece acrylic IOL secured to the sclera with 9–0 polypropylene sutures

   
   
4. 
   

   Three-piece IOL with haptics externalized and secured via scleral tunnels

61. (Medium) Conditions associated with the finding shown in the image include all of the following except which one:

1. 
   

   Pseudoexfoliation syndrome

   
   
2. 
   

   Homocystinuria

   
   
3. 
   

   Axenfeld–Reiger syndrome

   
   
4. 
   

   Blunt force trauma

62. (Hard) Cataract surgery is performed on a subluxated lens and a radial tear develops in the anterior capsule during phacoemulsification. Which of the following should be avoided?

1. 
   

   Continue phacoemulsification in the capsular bag

   
   
2. 
   

   Insertion of capsule tension ring

   
   
3. 
   

   Use of iris hooks

   
   
4. 
   

   Insertion of anterior chamber intraocular lens (ACIOL)

63. (Hard) A 65-year-old patient with history of prior pars plana vitrectomy for nonclearing vitreous hemorrhage presents for cataract surgery. Which of the following should be avoided?

1. 
   

   Lowering the irrigating bottle before placing the phaco tip in the eye

   
   
2. 
   

   Filling the entire anterior chamber with ophthalmic viscosurgical device (OVD) to maintain positive pressure

   
   
3. 
   

   Placing a second instrument between the iris and the anterior capsule prior to turning on the infusion

   
   
4. 
   

   Creating a large capsulorrhexis to prolapse the lens nucleus

64. (Hard) During cataract surgery, severe zonular instability has resulted in posterior dislocation of the lens with presentation of vitreous into the anterior chamber. Prior to the insertion of an anterior chamber intraocular lens (ACIOL), which of the following is the most appropriate sequence of steps?

1. 
   

   Vitrectomy, inject acetylcholine, create peripheral iridectomy, inject ophthalmic viscosurgical device (OVD), enlarge wound.

   
   
2. 
   

   Enlarge wound, vitrectomy, create peripheral iridectomy, inject acetylcholine, inject OVD.

   
   
3. 
   

   Create peripheral iridectomy, vitrectomy, inject OVD, enlarge wound, inject acetylcholine.

   
   
4. 
   

   Inject OVD, enlarge wound, vitrectomy, inject acetylcholine, create peripheral iridectomy.

65. (Medium) During phacoemulsification, significant post-occlusion surge is detected. Modifications that help to reduce surge include any of the following except which one?

1. 
   

   Limiting the amount of vacuum applied with the foot pedal when on the linear setting

   
   
2. 
   

   Lowering the height of the irrigation bottle

   
   
3. 
   

   Use of rigid, low-compliance tubing

   
   
4. 
   

   Decreasing the vacuum setting

66. (Medium) After the cataractous lens has been divided into quadrants during cataract surgery, the surgeon struggles to attract nuclear fragments to the phaco tip for removal. Adjustments that may help to improve followability include all of the following except which one?

1. 
   

   Increase the aspiration flow rate on a peristatic pump machine.

   
   
2. 
   

   Increase the vacuum on a Venturi-based system.

   
   
3. 
   

   Decrease longitudinal phaco power.

   
   
4. 
   

   Switch from pulse mode to continuous phacoemulsification.

67. (Easy) A 72-year-old man with diabetes presents 8 weeks after uncomplicated phacoemulsification cataract surgery complaining of blurry vision. His visual acuity was previously 20/20 but has now decreased to 20/50. Examination reveals the following finding.

Which of the following is the most appropriate initial therapy?

1. 
   

   Subtenon injection of triamcinolone acetonide

   
   
2. 
   

   Intravitreal injection of triamcinolone acetonide and oral acetazolamide

   
   
3. 
   

   Intravitreal injection of antivascular endothelial growth factor (anti-VEGF) agent

   
   
4. 
   

   Topical ketorolac and topical prednisolone acetate

68. (Medium) An 80-year-old nondiabetic patient develops decreased vision and cystoid macular edema (CME) after cataract surgery. Which of the following is true?

1. 
   

   Most cases of uncomplicated CME resolve without treatment.

   
   
2. 
   

   The use of preoperative corticosteroids reduces the risk of CME.

   
   
3. 
   

   Anterior chamber (open-loop design) intraocular lenses (IOLs) increase the risk of persistent CME.

   
   
4. 
   

   There is a higher incidence of CME with acrylic IOLs than with silicone IOLs.

69. (Easy) Which of the following scenarios is least likely to result in a postoperative myopic refractive surprise?

1. 
   

   Placement of an intraocular lens (IOL) in the sulcus

   
   
2. 
   

   Inverted placement of an IOL

   
   
3. 
   

   Choroidal effusions

   
   
4. 
   

   History of myopia treated with laser in situ keratomileusis (LASIK)

70. (Easy) A 55-year-old man with uncontrolled diabetes and proliferative diabetic retinopathy with isolated areas of tractional retinal detachment presents with a dense posterior subcapsular cataract.

All of the following statements are true except which one?

1. 
   

   A silicone intraocular lens (IOL) is the preferred type of lens implant.

   
   
2. 
   

   The risk of postoperative cystoid macular edema is increased.

   
   
3. 
   

   Oral hypoglycemic medications should be withheld on the morning of surgery.

   
   
4. 
   

   Multifocal IOLs should be discouraged.