8.1 Questions

Easy

Medium

Hard

1. (Medium) A 48-year-old woman with diabetes presents to your office for examination. You order a high-definition swept-source optical coherence tomography (OCT) to assess for diabetic macular edema. What is the space in front of the optic nerve on her OCT called?

1. 
   

   Weigert’s ligament

   
   
2. 
   

   Vitreous base

   
   
3. 
   

   Area of Martegiani

   
   
4. 
   

   Cloquet’s canal

2. (Medium) You have just finished performing an optical coherence tomography (OCT) of the macula on a new patient. The patient asks you to describe the macula. Which one of the following best describes the anatomical macula?

1. 
   

   An area composed of only cones photoreceptors.

   
   
2. 
   

   An area where there are no capillaries.

   
   
3. 
   

   An area ~5.5 mm in diameter bordered by the disc and temporal vascular arcades.

   
   
4. 
   

   An area 3.0 mm temporal and 0.8 mm superior to the center of the optic disc.

3. (Hard) A 29-year-old woman with systemic lupus erythematosus presents for eye examination after her rheumatologist recently started her on hydroxychloroquine (HCQ). In HCQ toxicity, what retinal layer is initially affected?

1. 
   

   Retinal pigment epithelium (RPE)

   
   
2. 
   

   Choroid

   
   
3. 
   

   Outer plexiform layer

   
   
4. 
   

   Photoreceptor layer

4. (Medium) A 68-year-old man with diabetes and hypertension presents with blurry vision in his right eye and is found to have the dilated fundus as shown in figure. In patients with this entity, what imaging modality is most predictive of the likelihood of visual acuity recovery?

1. 
   

   Autofluorescence

   
   
2. 
   

   Optical coherence tomography (OCT)

   
   
3. 
   

   Fluorescein angiography (FA)

   
   
4. 
   

   Indocyanine green (ICG) angiography

5. (Easy) You decide to obtain fluorescein angiography on a patient with a branch retinal vein occlusion. What is the most common side effect of fluorescein angiography?

1. 
   

   Photosensitivity

   
   
2. 
   

   Hives

   
   
3. 
   

   Anaphylaxis

   
   
4. 
   

   Nausea

6. (Medium) A 30-year-old pregnant woman with a history of proliferative diabetic retinopathy presents with new onset blurry vision in her left eye and is found to have mild vitreous hemorrhage. An area suspicious for neovascularization is noted along the superotemporal arcade. What is the best way to confirm the presence of retinal neovascularization in this patient?

1. 
   

   Optical coherence tomography (OCT)

   
   
2. 
   

   OCT angiography

   
   
3. 
   

   Fluorescein angiography

   
   
4. 
   

   Indocyanine green (ICG) angiography

7. (Hard) A 72-year-old White woman with age-related macular degeneration presents for her routine follow-up. You obtain the following image to monitor progression. What layer of the retina does this imaging modality measure?

1. 
   

   Nerve fiber layer

   
   
2. 
   

   Inner nuclear layer

   
   
3. 
   

   Outer nuclear layer

   
   
4. 
   

   Retinal pigment epithelium (RPE) layer

8. (Medium) You order fluorescein angiography (FA) and indocyanine green (ICG) angiography on a patient with central serous chorioretinopathy. When comparing fluorescein to indocyanine green:

1. 
   

   Fluorescein optimally fluoresces at a shorter wavelength than ICG.

   
   
2. 
   

   ICG fluoresces brighter than fluorescein.

   
   
3. 
   

   Fluorescein is more protein-bound than ICG in the bloodstream.

   
   
4. 
   

   Fluorescein optimally fluoresces at a longer wavelength than ICG.

9. (Easy) An 80-year-old woman in your retina clinic asks how do you know that she does not have exudative age-related macular degeneration (AMD). Which of the following does she not demonstrate?

1. 
   

   Retinal pigment epithelium (RPE) pigmentary changes

   
   
2. 
   

   Drusenoid pigment epithelial detachments (PEDs)

   
   
3. 
   

   Thickening of Bruch’s membrane

   
   
4. 
   

   PED that exhibits leakage on fluorescein angiography

10. (Medium) Which of the following patients has been determined to benefit from Age-Related Eye Disease Study (AREDS) vitamin supplementation?

1. 
   

   40-year-old man with numerous large drusen

   
   
2. 
   

   14-year-old girl with Stargardt disease

   
   
3. 
   

   62-year-old man with geographic atrophy in one eye

   
   
4. 
   

   78-year-old patient with previous bilateral choroidal neovascularization

11. (Medium) A 90-year-old woman comes to your office for a routine eye exam. Normal retinal changes with age include all factors except:

1. 
   

   Photoreceptors are reduced in density.

   
   
2. 
   

   Lipofuscin accumulates in the retinal pigment epithelium (RPE).

   
   
3. 
   

   Deposits accumulate between Bruch’s membrane and the choriocapillaris.

   
   
4. 
   

   Involutional changes occur in the choriocapillaris.

12. (Easy) A 75-year-old woman presents to your clinic for evaluation of age-related macular degeneration (AMD). You obtain an optical coherence tomography (OCT) that shows the following findings shown in the figure. Which of the following findings are not part of the spectrum of disease in nonexudative AMD?

1. 
   

   Subretinal fluid

   
   
2. 
   

   Geographic retinal pigment epithelial atrophy

   
   
3. 
   

   Hard drusen

   
   
4. 
   

   Retinal pigment epithelium (RPE) pigmentary changes

13. (Medium) While examining a 77-year-old woman, you notice the presence of many intermediate, soft drusen. Which drusen carry the worst prognosis for visual loss from macular neovascular complications?

1. 
   

   Cuticular

   
   
2. 
   

   Hard

   
   
3. 
   

   Small

   
   
4. 
   

   Soft

14. (Easy) You have been asked to examine a patient known to have age-related macular degeneration (AMD). What aspect of evaluation is of primary importance?

1. 
   

   A complete fundus examination

   
   
2. 
   

   Fluorescein angiography

   
   
3. 
   

   Optical coherence tomography (OCT)

   
   
4. 
   

   Fundus photography

15. (Medium) An 82-year-old man with cardiovascular disease presents with an acute change in his vision. In the disease pictured, what is the material causing the pathology?

1. 
   

   Fibrin

   
   
2. 
   

   Cholesterol

   
   
3. 
   

   Calcium

   
   
4. 
   

   Parasite

16. (Medium) A 75-year-old man with a history of cardiovascular disease presents with 20/40 vision in the same eye as findings consistent with central retinal artery occlusion (CRAO). What is the most likely explanation?

1. 
   

   This is a nonischemic CRAO and so he has good central vision.

   
   
2. 
   

   The long anterior ciliary arteries maintain redundant circulation, thus there is good central vision.

   
   
3. 
   

   The cilioretinal arteries provide circulation to the fovea and are not affected.

   
   
4. 
   

   The occlusion has been detected early enough and with anti-VEGF therapy, he can maintain good vision.

17. (Easy) An 80-year-old woman had a central retinal artery occlusion (CRAO) in her left eye 4 days ago and now presents with sudden total loss of vision in her right eye. Which of the following tests should be considered immediately?

1. 
   

   Carotid ultrasound

   
   
2. 
   

   MRI of the brain

   
   
3. 
   

   CT of the orbits

   
   
4. 
   

   Erythrocyte sedimentation rate (ESR)/C-reactive protein (CRP)

18. (Medium) While examining a 68-year-old man with a history of stroke, you notice narrowed retinal arteries, dilated retinal veins, midperipheral intraretinal hemorrhages, and neovascularization of the iris in his right eye. The left eye fundus exam is unremarkable. What is the most important next step in the management of this patient?

1. 
   

   Panretinal photocoagulation

   
   
2. 
   

   Intravitreal anti-VEGF therapy

   
   
3. 
   

   Carotid ultrasound and referral to vascular surgery

   
   
4. 
   

   Cardiac stents

19. (Hard) You are examining a 2nd-year medical student who mentions to you that all pigmented structures in the body are derived from neural crest cells. You show him a swept-source optical coherence tomography (OCT) of his right eye. What is the origin of the cells that are part of the the bottom most hyperreflective layer on the OCT?

1. 
   

   Surface ectoderm

   
   
2. 
   

   Neural crest cells

   
   
3. 
   

   Mesoderm

   
   
4. 
   

   Neuroectoderm

20. (Medium) Your 60-year-old with severe nonproliferative diabetic retinopathy (NPDR) asks you if it is OK for him to take aspirin recommended by his cardiologist. Based on Early Treatment Diabetic Retinopathy Study (ETDRS) reports, which of the following statements regarding the use of aspirin is FALSE?

1. 
   

   It has no effect on progression of retinopathy.

   
   
2. 
   

   It has no effect on rates of progression to high-risk PDR.

   
   
3. 
   

   It has no effect on rates of vitreous hemorrhage.

   
   
4. 
   

   It significantly increases the rate of vitrectomy for nonclearing vitreous hemorrhage.

21. (Medium) After examining a diabetic patient with you, a rotating medical student asks you if the patient has clinically significant macular edema (CSME). According to the Early Treatment Diabetic Retinopathy Study (ETDRS), which of the following is defined as CSME?

1. 
   

   Retinal thickening anywhere within temporal arcades

   
   
2. 
   

   Hard exudate with 7500 µm of the center of the macula with adjacent thickening of the retina

   
   
3. 
   

   Extensive foveal and parafoveal nonperfusion on fluorescein angiography

   
   
4. 
   

   An area of retinal thickening <= one disc area, any part of which lies within one disc diameter of the center of the macula

22. (Medium) Which of the following statements regarding the Early Treatment Diabetic Retinopathy Study (ETDRS) is false?

1. 
   

   The ETDRS concluded that panretinal photocoagulation (PRP) reduces the risk of severe visual loss in patients with high-risk proliferative diabetic retinopathy (PDR).

   
   
2. 
   

   The ETDRS identified the risk factors for development of PDR.

   
   
3. 
   

   The ETDRS defined clinically significant macular edema (CSME).

   
   
4. 
   

   The ETDRS showed that aspirin does not affect disease progression.

23. (Hard) One of your patients with no significant ocular history was recently diagnosed with gestational diabetes and calls you to inquire when during her pregnancy should you screen her for diabetic retinopathy. Pregnant women with gestational diabetes mellitus should be examined:

1. 
   

   Only if symptomatic

   
   
2. 
   

   Every trimester

   
   
3. 
   

   Once during pregnancy

   
   
4. 
   

   During first trimester and after delivery

24. (Hard) A 23-year-old man presents to your office with blurry vision. His fundus findings are shown below in the ultra-widefield imaging. What is the genetic inheritance pattern of this disease?

1. 
   

   Autosomal recessive

   
   
2. 
   

   Autosomal dominant

   
   
3. 
   

   X-linked recessive

   
   
4. 
   

   None of the above

25. (Medium) A 68-year-old man with diabetes and hypertension presents with blurry vision in his right eye and is found to have an abnormal dilated fundus exam as shown in the color photograph below. Which one of the following is NOT a risk factor for this entity?

1. 
   

   Diabetes mellitus

   
   
2. 
   

   Hypertension

   
   
3. 
   

   Increased body mass index (BMI) at an age of 20

   
   
4. 
   

   Hyperlipidemia

26. (Medium) A 17-year-old girl with sickle cell SS disease presents for retinal evaluation and is found to have the following findings. Which proliferative sickle cell retinopathy feature is depicted in the color and fluorescein angiography images below?

1. 
   

   Iridescent spots

   
   
2. 
   

   Salmon patch

   
   
3. 
   

   Black sunburst lesions

   
   
4. 
   

   Sea fan

27. (Hard) A sickle cell patient is lost to follow-up and presents 2 years later with a retinal detachment. Which one the following cannot be listed as a reasonable precautionary action while planning retina detachment repair in a patient with SS disease?

1. 
   

   Avoiding sclera buckle

   
   
2. 
   

   Avoiding epinephrine in the local anesthetics

   
   
3. 
   

   Not removing extraocular muscles

   
   
4. 
   

   Applying cryopexy around the peripheral retina

28. (Medium) A 68-year-old man with diabetes and hypertension presents with blurry vision in his right eye and is found to have a branch retinal vein occlusion (BRVO). Which one of the following is an indication for laser photocoagulation in the setting of BRVO?

1. 
   

   Macular edema with central thickness more than 500 µm

   
   
2. 
   

   Macular edema for 3 months with vision 20/40

   
   
3. 
   

   Macular edema with vision 20/200 and central thickness more than 300 µm

   
   
4. 
   

   Patients with more than five disc areas of capillary drop out in fluorescein angiography

29. (Hard) A 41-year-old patient with “plucked chicken-skin” appearance presents with fundus and optical coherence tomography (OCT) findings shown below. Subretinal hemorrhages in this entity:

1. 
   

   May resolve spontaneously without evidence of choroidal neovascularization (CNV)

   
   
2. 
   

   Requires intravitreal dexamethasone

   
   
3. 
   

   Can be managed with photodynamic therapy if extrafoveal

   
   
4. 
   

   Can be managed with thermal laser if peripapillary

30. (Hard) A 45-year-old man presents with blurry vision in his right eye and is found to have the following finding on his fundus examination. Which one of the following clinical characteristics is typical of this finding?

1. 
   

   Serous detachment of the retinal pigment epithelium (RPE)

   
   
2. 
   

   Myopia

   
   
3. 
   

   Low internal reflectivity on A-scan

   
   
4. 
   

   Wash-out pattern on indocyanine green (ICG) angiography

31. (Medium) You notice the following finding while performing a dilated fundus examination on your patient. What is a potential complication of the condition shown below?

1. 
   

   Vitreous hemorrhage

   
   
2. 
   

   Branch retinal artery occlusion

   
   
3. 
   

   Branch retinal vein occlusion

   
   
4. 
   

   All of the above

32. (Medium) A 63-year-old woman presents to your office with acute onset of flashes and floaters. What is the chance of finding a retinal tear in a patient who has a symptomatic posterior vitreous detachment?

1. 
   

   > 1%

   
   
2. 
   

   3 to 5%

   
   
3. 
   

   8 to 15%

   
   
4. 
   

   20 to 25%

33. (Easy) During your routine dilated exam on a patient with age-related macular degeneration, you find a peripheral retinal break. The patient does not report any symptoms of flashes or floaters. Which of these may increase the risk of retinal detachment in a patient with an asymptomatic break?

1. 
   

   Family history

   
   
2. 
   

   Aphakia, pseudophakia

   
   
3. 
   

   History of retinal detachment (RD) in the fellow eye

   
   
4. 
   

   All of the above

34. (Hard) What is the correct order of the name of the pathologies shown below?

1. 
   

   Slit tear, lattice degeneration, peripheral retinal excavation, retinoschisis

   
   
2. 
   

   Meridional fold, lattice degeneration, cystic tuft with peripheral retinal excavation, white-without-pressure

   
   
3. 
   

   Dentate process, paving-stone, lattice degeneration, white-with-pressure

   
   
4. 
   

   Peripheral retinal excavation, lattice degeneration, cystic tuft with peripheral retinal excavation, reticular degeneration

35. (Medium) A 38-year-old investment banker under high stress presents to your office with blurry vision in his right eye. You obtain the imaging shown. What fluorescence patterns are demonstrated in the angiogram?

1. 
   

   Window defect

   
   
2. 
   

   Leakage

   
   
3. 
   

   Pooling

   
   
4. 
   

   B and C

36. (Medium) You obtain an optical coherence tomography (OCT) of the macula in a patient with decreased vision in the left eye. Which layer is affected in the OCT scan shown?

1. 
   

   Ganglion cell layer

   
   
2. 
   

   Inner nuclear layer

   
   
3. 
   

   Ellipsoid layer/interdigitation zone

   
   
4. 
   

   Outer plexiform layer

37. (Medium) You observe the optic nerve to be raised with edematous appearance in a young, asymptomatic woman. What kind of an imaging technique has been employed to obtain the fundus picture below and what is depicted in the image?

1. 
   

   Fluorescein angiography (FA): Neovascularization on or within one-disc diameter of the optic nerve head (NVD)

   
   
2. 
   

   FAF: Optic nerve drusen

   
   
3. 
   

   Near infrared: choroidal neovascularization (CNV)

   
   
4. 
   

   Indocyanine green (ICG) angiography: polypoidal choroidal vasculopathy

38. (Easy) A 70-year-old man presents with distorted vision in his left eye. An optical coherence tomography (OCT) of the macula is obtained. What condition is depicted in the OCT scan below?

1. 
   

   Vitreomacular traction (VMT)

   
   
2. 
   

   Wet age-related macular degeneration

   
   
3. 
   

   Acute posterior vitreous detachment

   
   
4. 
   

   Diabetic macular edema

39. (Medium) An 80-year-old Caucasian woman presents with acute decline in vision in her right eye and is found to have subretinal fluid in the macula. The differential diagnosis for neovascular age-related macular degeneration (AMD) includes which of the following pathologies?

1. 
   

   Idiopathic polypoidal choroidal vasculopathy (IPCV)

   
   
2. 
   

   Retinal arterial macroaneurysm

   
   
3. 
   

   Vogt–Koyanagi–Harada (VKH) disease

   
   
4. 
   

   All of the above

40. (Easy) A 70-year-old man with a history of stroke has narrowed retinal arteries, dilated retinal veins, mid-peripheral intraretinal hemorrhages, and neovascularization of the iris in his right eye suggestive of ocular ischemic syndrome. Which one the following fluorescein angiography pattern IS NOT typical for ocular ischemic syndrome?

1. 
   

   Delayed choroidal filling

   
   
2. 
   

   Increased transit time

   
   
3. 
   

   Vascular staining

   
   
4. 
   

   Pooling of dye under the retinal pigment epithelium (RPE)

41. (Medium) You diagnose a patient with ocular ischemic syndrome. Which statement is correct regarding ocular ischemic syndrome?

1. 
   

   Two-third of the eyes develop neovascularization of the iris (NVI)

   
   
2. 
   

   One-fifth of the eyes have flare and cells

   
   
3. 
   

   Half of the eyes develop neovascular glaucoma (NVG)

   
   
4. 
   

   All of the above

42. (Easy) A 76-year-old woman presents with a headache and acute vision loss in the left eye and is found to have a central retinal artery occlusion (CRAO) on dilated fundus exam in the emergency room. What test would you not consider?

1. 
   

   Erythrocyte sedimentation rate (ESR)

   
   
2. 
   

   C-reactive protein (CRP)

   
   
3. 
   

   Platelet count

   
   
4. 
   

   Interleukin 6 (IL-6)

43. (Hard) A 20-year-old patient who recently had brain surgery presents to you for a routine eye exam and is found to have the lesion shown below in his right eye. The left eye shows a similar but smaller lesion. What is the most common cause of death in these patients?

1. 
   

   Pheochromocytoma and cerebellar hemangioblastoma

   
   
2. 
   

   Cerebellar hemangioblastoma and renal cell carcinoma

   
   
3. 
   

   Liver cysts and meningiomas

   
   
4. 
   

   Spinal cord tumors and pheochromocytomas

44. (Easy) You see a patient in clinic who has cystoid macular edema. What structure comprises the inner blood–retinal barrier that is compromised in this condition?

1. 
   

   Inner nuclear layer–ganglion cell layer junction

   
   
2. 
   

   Tight junctional girdles of retinal pigment epithelium (RPE)

   
   
3. 
   

   External limiting membrane

   
   
4. 
   

   Endothelial cell tight junctions

45. (Medium) You order a fluorescein angiogram on a patient with diabetes. What are the excitation and emission wavelengths for sodium fluorescein, respectively?

1. 
   

   530 nm, 700 nm

   
   
2. 
   

   465 nm, 530 nm

   
   
3. 
   

   830 nm, 1000 nm

   
   
4. 
   

   700 nm, 530 nm

46. (Hard) While performing a dilated fundus exam on an asymptomatic patient, you notice a cystic retinal tuft in the right eye. Which of the following contributes the highest risk for a retinal tear?

1. 
   

   Noncystic retinal tufts

   
   
2. 
   

   Cystic retinal tufts

   
   
3. 
   

   Anteriorly located zonular traction tufts

   
   
4. 
   

   Posteriorly located zonular traction tufts

47. (Medium) A 65-year-old woman presents with acute flashes and floaters in her left eye and is diagnosed with a posterior vitreous detachment. Which one of the following is defined as the liquefaction of the vitreous?

1. 
   

   Syneresis

   
   
2. 
   

   Synchysis

   
   
3. 
   

   Posterior vitreous detachment

   
   
4. 
   

   Synchysis scintillans

48. (Medium) During your busy retina clinic, you diagnose four different patients with a giant retinal tear, horse-shoe tear, dialysis, and slit-tear in a single day. Which one may not result in an immediate retinal detachment?

1. 
   

   Giant tear in a 60-year-old

   
   
2. 
   

   Horse-shoe tear in a 25-year-old myopic patient

   
   
3. 
   

   Traumatic dialysis in a 35-year-old

   
   
4. 
   

   Slit-tear in a 50-year-old pseudophakic patient

49. (Easy) A 74-year-old man presents with acute vision loss and is found to have choroidal infarction on fluorescein angiography. Which one of the following symptoms/findings may give a hint as to the etiology of choroidal occlusion?

1. 
   

   Temporal scalp tenderness

   
   
2. 
   

   Glomerulonephritis

   
   
3. 
   

   History of YAG capsulotomy

   
   
4. 
   

   A and B

50. (Medium) You are seeing a 26-year-old man with blurry vision. His optical coherence tomography is shown below. You perform a fluorescein angiography (FA) that does not show any leakage. Which of the conditions below are these imaging findings most consistent with?

1. 
   

   Goldmann–Favre disease

   
   
2. 
   

   Irvine–Gass syndrome

   
   
3. 
   

   Choroidal hemangioma

   
   
4. 
   

   Cryopexy

51. (Medium) An 80-year-old male patient with headaches and sudden vision loss in the right eye presents with the fundus appearance as shown. Recently he had carotid Doppler ultrasonography which revealed > 20% steno-sis. His recent erythrocyte sedimentation rate (ESR) was 20 mm. What is the next best step in management?

1. 
   

   Anterior chamber paracentesis

   
   
2. 
   

   IV bolus steroids

   
   
3. 
   

   Temporal artery biopsy

   
   
4. 
   

   Carotid endarterectomy

52. (Medium) A 42-year-old woman was recently diagnosed with non-insulin-dependent diabetes. Which statement is most correct?

1. 
   

   Immediate focal laser photocoagulation should be performed if she has clinically significant macular edema (CSME) and her vision is 20/20.

   
   
2. 
   

   According to the DCCT, tight control of the patient’s blood sugar would decrease her risk of developing diabetic retinopathy.

   
   
3. 
   

   Immediate scatter photocoagulation should be applied if neovascularization of the disc and vitreous hemorrhage are present.

   
   
4. 
   

   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.

53. (Hard) Which of the following statements is most correct?

1. 
   

   In the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR) after 20 years of type 1 diabetes mellitus, half of patients had retinopathy.

   
   
2. 
   

   In the National Health and Nutrition Survey III among type 2 diabetics, non-Hispanic Caucasians had a higher frequency of retinopathy than those of African descent.

   
   
3. 
   

   In the WESDR, older onset diabetics after 20 years of DM were twice as likely to be legally blind than their counterparts who were >= 30 years old at DM onset.

   
   
4. 
   

   In the WESDR, 60% of patients had diabetic retinopathy after 20 years of type 2 diabetes.

54. (Medium) Which is false regarding peau d’orange?

1. 
   

   Represents stippled appearance at the interface between abnormal light colored and normal darker colored fundus.

   
   
2. 
   

   May be found along with optic nerve drusen and peripheral atrophic spots.

   
   
3. 
   

   Associated with ABCC6 mutations.

   
   
4. 
   

   Noted as orange color of skin after intravenous injection of fluorescein dye.

55. (Medium) Which one of these is true?

1. 
   

   SCORE study shows intravitreal steroids are five times more effective than sham in branch retinal vein occlusion (BRVO).

   
   
2. 
   

   GENEVA study shows steroids are less effective than laser photocoagulation in BRVO and central retinal vein occlusion (CRVO).

   
   
3. 
   

   SCORE study shows laser photocoagulation is better than intravitreal steroids for BRVO.

   
   
4. 
   

   BRAVO study showed similar efficacy of ranibizumab and laser photocoagulation in BRVO.

56. (Medium) Which one of these statements is incorrect?

1. 
   

   Grid laser treatment does not improve vision in patients with cystoid macular edema secondary to central retinal vein occlusion (CRVO).

   
   
2. 
   

   Grid laser treatment decreases angiographic macular edema in CRVO.

   
   
3. 
   

   Grid laser treatment may improve vision in younger individuals in CRVO.

   
   
4. 
   

   Panretinal photocoagulation (PRP) in CRVO should be done in patients with widespread ischemia.

57. (Hard) Which one of these medications can cause this condition?

1. 
   

   Latanoprost

   
   
2. 
   

   Niacin

   
   
3. 
   

   Rosiglitazone

   
   
4. 
   

   All of the above

58. (Medium) A 25-year-old male patient with renal hypertension is referred by the internist. Dilated fundus exam showed some hypertensive changes. What is the name of linear hyperpigmentations suggestive of hypertension?

1. 
   

   Focal intraretinal periarteriolar transudates

   
   
2. 
   

   Elschnig spots

   
   
3. 
   

   Vogt’s striae

   
   
4. 
   

   Siegrist streaks

59. (Medium) A 50-year-old male patient with no past medical history noticed sudden vision change in the left eye. Dilated fundus exam showed intraretinal hemorrhage and dilated tortuous retinal vasculature inferotemporally. Which one of the following indicates an inflammatory condition as the cause of this condition?

1. 
   

   Volcano-style macular edema

   
   
2. 
   

   Extensive hemorrhages

   
   
3. 
   

   Occlusion at a non-arteriovenous (AV) crossing site

   
   
4. 
   

   Presence of hard exudates

60. (Medium) A 77-year-old female patient with hypertension and hyperlipidemia noticed sudden vision loss in the right eye. There is an afferent pupillary defect. Dilated fundus exam showed dilation and tortuosity of all branches of the central retinal vein with cotton wool spots. Which one the following is the most important risk factor for prediction of iris neovascularization after this condition?

1. 
   

   Decreased electroretinogram bright flash/dark adapted b-wave

   
   
2. 
   

   Four quadrants of hemorrhage

   
   
3. 
   

   Prolonged retinovascular circulation times

   
   
4. 
   

   Poor visual acuity

61. (Medium) Which one the statements describe the genetic basis of the majority of the neuronal ceroid lipofuscinoses (NCLs)?

1. 
   

   They are a group of neurodegenerative disorders with autosomal recessive inheritance.

   
   
2. 
   

   They are a group of neurodegenerative disorders with autosomal dominant inheritance.

   
   
3. 
   

   They are a group of neurodegenerative disorders with X-linked inheritance.

   
   
4. 
   

   They are a group of sporadic neurodegenerative disorders.

62. (Medium) Which of the following statements for Fabry’s disease is correct?

1. 
   

   It is an autosomal dominant disorder.

   
   
2. 
   

   It is caused by a mutation in the gene encoding alpha-galactosidase A.

   
   
3. 
   

   It is associated with accumulation of ceramide trihexoside in joints.

   
   
4. 
   

   It is associated with whorls in the skin.

63. (Medium) What percent of the patients with type A Niemann–Pick disease manifest with a cherry-red spot in the fundus?

1. 
   

   100%

   
   
2. 
   

   75%

   
   
3. 
   

   50%

   
   
4. 
   

   25%

64. (Medium) A 26-year-old male patient presents with decreased and distorted vision of his left eye and on examination shows the following image. Which of the following is not consistent with his diagnosis?

1. 
   

   Visual prognosis may not be good for chronic, recurrent, and bullous cases.

   
   
2. 
   

   80–90% of the subretinal fluid undergoes spontaneous resorption in 6 weeks.

   
   
3. 
   

   Functional recovery follows anatomical recovery but can take up to 1 year.

   
   
4. 
   

   Contrast sensitivity and color vision defects may persist despite anatomical recovery.

65. (Medium) A 51-year-old male patient with uncontrolled diabetes has cataract in the right eye. Dilated fundus exam shows one-fourth area of NVD but not vitreous hemorrhage. You wish to plan cataract surgery. Which of the following is the most appropriate statement?

1. 
   

   Avoid cataract surgery.

   
   
2. 
   

   Ideally have scatter laser immediately after planned cataract extraction.

   
   
3. 
   

   Ideally have scatter laser 1 to 2 months before planned cataract extraction.

   
   
4. 
   

   Ideally have scatter laser immediately before planned cataract extraction.

66. (Hard) A 65-year-old male smoker with a history of hyperopia presents with drusen of both eyes. He is worried because his mother became blind from her age-related macular degeneration (AMD). Which of the following does not increase his risk of progressive vision loss from AMD?

1. 
   

   Hyperopia

   
   
2. 
   

   Smoking

   
   
3. 
   

   Male sex

   
   
4. 
   

   Family history of vision loss from AMD

67. (Medium) A 70-year-old male patient with gradual decrease in vision over 5 years in the left eye presents with the fundus appearance as shown in figure. The most common form of this lesion develops from which of the following?

1. 
   

   Choroidal neovascular membrane

   
   
2. 
   

   Retinal pigment epithelium (RPE) mottling

   
   
3. 
   

   Atrophic drusen

   
   
4. 
   

   RPE detachment

68. (Medium) A 35-year-old female patient presents with blurred vision and metamorphopsia in the left eye. Fundus exam shows small, round, discrete, and yellow-white spots in macula. Which of the following makes the diagnosis of multifocal choroiditis more likely than histoplasmosis?

1. 
   

   Punched out chorioretinal lesions

   
   
2. 
   

   Choroidal neovascularization (CNV)

   
   
3. 
   

   Vitritis

   
   
4. 
   

   Peripapillary pigmentary changes

69. (Medium) “Full panretinal photocoagulation (PRP)” as defined by the Diabetic Retinopathy Study (DRS) and Early Treatment Diabetic Retinopathy Study (ETDRS) includes at minimum

1. 
   

   800 laser burns

   
   
2. 
   

   1000 laser burns

   
   
3. 
   

   1200 laser burns

   
   
4. 
   

   1500 laser burns

70. (Medium) A 37-year-old male patient with sudden vision decrease in the left eye presents with fluorescein angiography (FA) as shown. Detachment of which one of the following structures can occur in this patient?

1. 
   

   Sensory retina

   
   
2. 
   

   Choroid

   
   
3. 
   

   Retinal pigment epithelium

   
   
4. 
   

   A and C

71. (Medium) Which of the conditions below may result in the changes demonstrated?

1. 
   

   Disseminated intravascular coagulation (DIC)

   
   
2. 
   

   Thrombotic thrombocytopenic purpura (TTP)

   
   
3. 
   

   Giant cell arteritis (GCA)

   
   
4. 
   

   All of the above

72. (Easy) A 77-year-old female inpatient hospitalized for a new diagnosis of ovarian cancer complains of severe loss of vision bilaterally over the past few weeks. On fundus exam, you notice large nevus-like regions of increased pigmentation and thickening of the choroid. Which of the following is correct regarding her most likely diagnosis?

1. 
   

   It is a benign condition.

   
   
2. 
   

   The associated gene is located on chromosome 4.

   
   
3. 
   

   It does not affect retina.

   
   
4. 
   

   Fifty percent of cases have a known malignancy at the time of diagnosis.

73. (Medium) A 10-year-old male patient followed by neurology for a diagnosis of Refsum disease is sent for consultation regarding visual prognosis. Which of the following clinical features is associated with his condition?

1. 
   

   Pigmentary retinopathy with decreased electroretinogram (ERG) signals

   
   
2. 
   

   Cataracts

   
   
3. 
   

   Enlarged corneal nerves

   
   
4. 
   

   All of the above

74. (Medium) A 74-year-old female patient previously diagnosed as neovascular age-related macular degeneration with monthly intravitreal anti-VEGF injection comes back to your clinic. What is featured in this optical coherence tomography (OCT) image?

1. 
   

   Subretinal fluid

   
   
2. 
   

   Pigment epithelial detachment

   
   
3. 
   

   Epiretinal membrane

   
   
4. 
   

   A and B

75. (Medium) The differential diagnosis for dry age-related macular degeneration (AMD) includes which of the following conditions?

1. 
   

   Late onset Stargardt disease

   
   
2. 
   

   Plaquenil or chloroquine toxicity

   
   
3. 
   

   Old central serous chorioretinopathy

   
   
4. 
   

   All of the above may be included

76. (Hard) A 54-year-old Caucasian male presents to your clinic with the finding shown after seeing flashes of light and floaters. Which genetic mutation is associated with the worst prognosis for this condition?

1. 
   

   Trisomy 21

   
   
2. 
   

   Monosomy 6

   
   
3. 
   

   Disomy 8

   
   
4. 
   

   Monosomy 3

77. (Medium) A 70-year-old African American female presents to your clinic with multifocal white creamy sub-retinal lesions in the macula of both eyes. Which is the most likely history associated with this finding?

1. 
   

   History of rheumatoid arthritis

   
   
2. 
   

   History of breast cancer in remission, treated 5 years ago with combination of chemotherapy and radiation

   
   
3. 
   

   History of ovarian cancer in sister

   
   
4. 
   

   Von Hippel’s disease

78. (Medium) A 55-year-old Asian female presents to your clinic after being treated for “chronic” vitritis for many months. She has been on topical steroids for several months with courses of both oral and sub-tenons steroids as well. She responds initially to treatment but then worsens each time her steroids are decreased. What is the next best step in management?

1. 
   

   Injection of intravitreal dexamethasone implant

   
   
2. 
   

   Vitreous biopsy with intravitreal injection of antibiotics

   
   
3. 
   

   Vitreous biopsy with culture and cytology

   
   
4. 
   

   Referral to rheumatologist for systemic evaluation

79. (Hard) A 90-year-old male is referred to your office due to uncontrolled glaucoma from his primary care physician. Anterior segment examination is shown in figure. What is the most likely primary malignancy in this patient?

1. 
   

   Prostate

   
   
2. 
   

   Lung

   
   
3. 
   

   Skin melanoma

   
   
4. 
   

   Brain

80. (Medium) Patient presents to your clinic with the finding shown in figure. What neurocutaneous disorder is this mass most commonly associated with?

1. 
   

   Bourneville’s disease

   
   
2. 
   

   Encephalotrigeminal angiomatosis

   
   
3. 
   

   Von Recklinghausen’s disease

   
   
4. 
   

   Wyburn-Mason syndrome

81. (Easy) A 6-year-old male comes to your clinic and has the following multiple fundus finding (capillary hemangioma hemangioblastoma). The causal gene is associated with which chromosome?

1. 
   

   17

   
   
2. 
   

   9

   
   
3. 
   

   22

   
   
4. 
   

   3

82. (Easy) Fundoscopy of a 15-year-old male revealed few pigmented lesions along the equator of the eye. Each of the lesions are flat, sharply demarcated, hyperpigmented, and have a surrounding halo and tail of depigmentation that is directed at the optic nerve. What is the most appropriate next step?

1. 
   

   External beam radiation

   
   
2. 
   

   Referral for colonoscopy

   
   
3. 
   

   Laser photocoagulation

   
   
4. 
   

   Serial photographs to assess for malignant change

83. (Easy) Parents bring their 2-year-old to your office after noticing that their child has a white pupil in one eye during their last family photograph. On examination, white creamy lesions are noted in the fundus with a dense nodular vitreous debris. Which chromosome carries the mutation leading to this condition?

1. 
   

   Chromosome 17

   
   
2. 
   

   Chromosome 13

   
   
3. 
   

   Chromosome 5

   
   
4. 
   

   Chromosome 3

84. (Medium) The parents of a 3-year-old successfully treated for retinoblastoma ask whether their child is at risk for any other malignancy. What is the most common secondary tumor in these patients after successful treatment of the primary tumor?

1. 
   

   Lymphoma

   
   
2. 
   

   Osteosarcoma

   
   
3. 
   

   Ewing’s sarcoma

   
   
4. 
   

   Lung

85. (Easy) A 70-year-old male is diagnosed with uveal melanoma. When ordering the imaging to evaluate for metastasis, where should you direct the radiologist to pay special attention?

1. 
   

   Brain

   
   
2. 
   

   Skin

   
   
3. 
   

   Liver

   
   
4. 
   

   Bone

86. (Easy) A 1-year-old is brought to your clinic for evaluation of strabismus. During exam, you notice a white pupil in the left eye and ultimately diagnose the child with retinoblastoma. The patient unfortunately has a germline mutation and is diagnosed with trilateral retinoblastoma. Which structure is involved in this rare condition?

1. 
   

   Sclera

   
   
2. 
   

   Long bones

   
   
3. 
   

   Frontal lobe

   
   
4. 
   

   Pineal gland

87. (Easy) A patient is referred to your office to rule out malignant melanoma of the right eye. The fundus photograph is shown in the given figure. What is the diagnosis?

1. 
   

   Choroidal melanoma

   
   
2. 
   

   Congenital hypertrophy of the retinal pigment epithelium

   
   
3. 
   

   Choroidal nevus

   
   
4. 
   

   Circumscribed choroidal hemangioma

88. (Medium) The Collaborative Ocular Melanoma Study (COMS) medium choroidal melanoma trial evaluated survival of standard enucleation versus I-125 brachytherapy. The study concluded which of the following?

1. 
   

   Survival rates were equivalent for both 5 and 10 years.

   
   
2. 
   

   Plaque brachytherapy was associated with better survival outcomes at both 5 and 10 years.

   
   
3. 
   

   Enucleation was associated with better survival outcomes at 5 and 10 years.

   
   
4. 
   

   Survival rate at 5 years was equivalent, but was better with enucleation at 10 years.

89. (Medium) A 48-year-old male is diagnosed with a small choroidal melanoma 2 mm from the optic nerve. Which of the following is not an accepted treatment for this condition?

1. 
   

   Transpupillary thermotherapy

   
   
2. 
   

   External beam radiotherapy

   
   
3. 
   

   Transscleral thermotherapy

   
   
4. 
   

   Observeration

90. (Easy) An 18-year-old male presents for routine examination. He has a diffusely red fundus of the right eye with normal fundus pigmentation of the left eye. He also has an associated port-wine stain of the right side of his face. Which inherited chromosome is this abnormality associated with?

1. 
   

   17

   
   
2. 
   

   9

   
   
3. 
   

   22

   
   
4. 
   

   No genetic inheritance is associated with this condition

91. (Hard) A 3-year-old male is diagnosed with endophytic retinoblastoma with vitreous seeding. In addition to intra-arterial chemotherapy, what other treatment is the best option for this patient?

1. 
   

   Intravitreal melphalan

   
   
2. 
   

   External beam radiation

   
   
3. 
   

   Intravenous chemotherapy

   
   
4. 
   

   Observation

92. (Medium) A patient is referred to your office for serous detachment of the right retina recalcitrant to repeated intravitreal anti-vascular endothelial growth factor injections. His vision is 20/80 in the right eye and 20/20 in the left eye without correction. Anterior segment examination reveals no abnormalities. You decide to perform ultrasonography and discover a subretinal mass that shows high internal reflectivity with focal diffuse choroidal thickening. The patient is asking you to please provide him with treatment as his vision is greatly affected. What is the best treatment for this patient’s condition?

1. 
   

   Laser photocoagulation

   
   
2. 
   

   Oral diamox

   
   
3. 
   

   Photodynamic therapy

   
   
4. 
   

   Intravitreal dexamethasone depot injection

93. (Easy) A patient is referred to your office by her primary ophthalmologist for a white, slightly elevated subretinal mass without overlying fluid in the left eye. She denies visual symptoms and vision is 20/20 on Snellen testing in both eyes. B-scan ultrasonography is performed and reveals a highly reflective mass replacing the normal choroid. A computed tomography (CT) scan shows calcification in the area of the lesion. What is best treatment?

1. 
   

   Biopsy of the lesion

   
   
2. 
   

   Observation

   
   
3. 
   

   Intravitreal injections of anti-vascular endothelial growth factor

   
   
4. 
   

   Thermal laser

94. (Hard) A 40-year-old female comes to you complaining of decreased vision and severe floaters in both eyes. Dilated fundus examination reveals creamy subretinal infiltrates, subellipsoid zone thickening in both eyes, and dense vitritis. Vitreous shows primary vitreoretinal lymphoma (VRL). Which is the most common subtype associated with this condition?

1. 
   

   Marginal zone lymphoma

   
   
2. 
   

   Mantle cell lymphoma

   
   
3. 
   

   T cell lymphoma

   
   
4. 
   

   Large B cell lymphoma

95. (Medium) A 70-year-old patient presents to your office with a pigmented lesion in the fundus of the right eye. Which of the following findings is associated with increased risk of malignant transformation?

1. 
   

   Orange pigment present on the tumor surface

   
   
2. 
   

   Tumor thickness of > 2 mm on ultrasonography

   
   
3. 
   

   Presence of drusen on the tumor surface

   
   
4. 
   

   Distance < 3 mm from optic nerve

96. (Easy) A 65-year-old male presents to your office complaining of decreased vision in his left eye. On slit lamp examination, you notice nuclear sclerosis of both lenses. However, upon careful examination you notice that a portion of the left cataract is more opaque than the rest of the lens. What is the next best step in management of this patient?

1. 
   

   Removal of cataract

   
   
2. 
   

   Visual field examination

   
   
3. 
   

   Ultrasound biomicroscopy

   
   
4. 
   

   Peripheral iridotomy over region of dense cataract

97. (Medium) What was the primary outcome of the Collaborative Ocular Melanoma Study (COMS) large choroidal melanoma trial?

1. 
   

   Standard enucleation and brachytherapy had equal survival outcomes.

   
   
2. 
   

   Pre-enucleation radiotherapy did not improve overall survival compared to primary enucleation alone.

   
   
3. 
   

   Brachytherapy should not be considered for large tumors.

   
   
4. 
   

   Melanoma specific mortality was 1% at 5 years.

98. (Hard) An 80-year-old male who recently died underwent autopsy and a glistening, white solid tumor was noted in the area of the ciliary body. What is the most likely lesion in this patient?

1. 
   

   Iris pigment epithelial cyst

   
   
2. 
   

   Ciliary body melanoma

   
   
3. 
   

   Fuch’s adenoma

   
   
4. 
   

   Pars plana cyst

99. (Easy) An 8-month-old male was referred to your office by his pediatrician after noticing a white pupil during well-child visit. Which of the following is not in the differential diagnosis for this child?

1. 
   

   Retinal capillary hemangioblastoma

   
   
2. 
   

   Coat’s disease

   
   
3. 
   

   Retinoblastoma

   
   
4. 
   

   Persistent fetal vasculature

100. (Medium) Patient undergoes computed tomography (CT) scan of the head after complaining of headache following vehicle collision. What is the incidental finding noted in the given image?

1. 
   

   Vitreous hemorrhage

   
   
2. 
   

   Disciform scar

   
   
3. 
   

   Choroidal osteoma

   
   
4. 
   

   Choroidal melanoma

101. (Medium) A 25-year-old male presents to your clinic with decreased vision in the right eye. He has a serous retinal detachment causing diminished visual acuity and visual distortion. He undergoes significant investigation and is diagnosed with a circumscribed choroidal hemangioma. What is the single best test to diagnose this lesion?

1. 
   

   Indirect ophthalmoscopy

   
   
2. 
   

   Indocyanine green angiography

   
   
3. 
   

   B-scan ultrasonography

   
   
4. 
   

   Fluorescein angiography

102. (Hard) You are seeing a patient referred to you with a retinal detachment in the right eye. As you finish examining him, the patient asks if he is a candidate for a “bubble” procedure. Which of the following is a contraindication for the procedure to which the patient is referring?

1. 
   

   A single break at 12 o’clock with PVR grade B

   
   
2. 
   

   Two breaks at 2:30 and 3:30 clock hours with mild nuclear sclerosis

   
   
3. 
   

   Pseudophakic patient with three breaks between 9:30 and 10:30 clock hours

   
   
4. 
   

   Single break at 12 o’clock with severe vitreous hemorrhage

103. (Easy) A 32-year-old man presents 6 months after sustaining a firecracker injury to his eye. Immediately after the injury, he was noted to have hyphema that later resolved. Which of the following retinal defects is least likely to be associated with the blunt traumatic injury?

1. 
   

   Image a

   
   
2. 
   

   Image b

   
   
3. 
   

   Image c

   
   
4. 
   

   Image d

104. (Medium) A 32-year-old male with a firecracker injury to his eye is wondering what his odds would have been for needing a retinal detachment surgery if a retinal issue were found. You tell him that retinal detachment surgery is most commonly necessary with:

1. 
   

   Penetrating scleral injury

   
   
2. 
   

   Retinal sclopetaria

   
   
3. 
   

   Choroidal rupture

   
   
4. 
   

   Traumatic macular hole

105. (Easy) A 30-year-old construction worker presents to your clinic for follow-up after being seen in the emergency department for an intraocular foreign body. When a coworker was using a jackhammer, a large, oddly shaped iron shard had penetrated through his safety glasses and globe into the vitreous cavity. Computed tomography (CT) of orbits was consistent with this history. Despite the recommendation for vitrectomy with foreign body removal, surgical repair was not elected by the patient, who instead opted for observation. Which of the following is best for long-term monitoring in this patient?

1. 
   

   CT scan

   
   
2. 
   

   Color plates

   
   
3. 
   

   Electroretinogram (ERG)

   
   
4. 
   

   Magnetic resonance imaging (MRI) scan

106. (Medium) A 30-year-old man with an intraocular foreign body is wondering about the chances of endophthalmitis with injuries like the one he sustained. Which one is correct regarding endophthalmitis after penetrating scleral trauma?

1. 
   

   Endophthalmitis occurs in about 25% of cases of penetrating scleral trauma.

   
   
2. 
   

   Bacillus cereus is the causative organisms 2 to 7% of the time.

   
   
3. 
   

   A rural location for the trauma is relatively protective.

   
   
4. 
   

   Loss of the eye is common with B. cereus endophthalmitis

107. (Medium) You are seeing a patient every 3 months for a condition, and he tells you that he is religious about using the “chart with the straight lines and black dot in the center” every day. The patient most likely has which of the following conditions?

1. 
   

   Scleral rupture

   
   
2. 
   

   Solar retinopathy

   
   
3. 
   

   Choroidal rupture

   
   
4. 
   

   Posttraumatic endophthalmitis

108. (Medium) A 37-year-old woman presents to your office for a “screening eye exam” after being referred by her primary care physician. The patient is not sure why she was specifically referred, does not endorse any visual complaints, and does not have any records with her or recall the names of the medications that she takes. On exam, you notice pigmentary changes in the macula and mid-periphery. Which drug is she most likely taking?

1. 
   

   Docetaxel

   
   
2. 
   

   Paclitaxel

   
   
3. 
   

   Niacin

   
   
4. 
   

   Thioridazine

109. (Hard) Intake of which compound can cause the following on spectral-domain optical coherence tomography imaging?

1. 
   

   Alkyl nitrate (“poppers”) inhalation

   
   
2. 
   

   Nitrofurantoin therapy

   
   
3. 
   

   Canthaxanthin ingestion

   
   
4. 
   

   Talc injection

110. (Easy) A 60-year-old patient with long-standing lupus nephritis presents for her regular eye examination. On medication review, she says that her rheumatologist finds that high-dose Plaquenil works best for her condition and she’s been well controlled. Which of the following would be most expected on spectral-domain optical coherence tomography (SDOCT) imaging?

1. 
   

   Figure

   
   
2. 
   

   Inner segment ellipsoid loss in a parafoveal location

   
   
3. 
   

   Thick choroid

   
   
4. 
   

   A and B

111. (Easy) A 36-year-old woman is new to your clinic and arrives for a retinal consultation. You notice yellow-orange crystalline macular deposits and ask the patient whether she might have been exposed to canthaxanthin. What is canthaxanthin used for?

1. 
   

   Tanning

   
   
2. 
   

   Antibiotics

   
   
3. 
   

   Anesthesia

   
   
4. 
   

   Breast cancer

112. (Medium) A 40-year-old man presents for an ophthalmologic evaluation at the county hospital. He is actively being treated for tuberculosis, but does not know his current medications. Your concern for rifabutin-related toxicity is increased given the presence of which finding?

1. 
   

   Choroidal folds

   
   
2. 
   

   Anterior and posterior uveitis with hypopyon

   
   
3. 
   

   Retinal pigment epithelium (RPE) loss

   
   
4. 
   

   Cataract

113. (Medium) You are examining a patient who asks you about possible effects to the eyes from exposure to different metals. He has been a metalworker for about 20 years. What can ocular argyrosis include?

1. 
   

   Gray or blue coloring of skin

   
   
2. 
   

   Black tears

   
   
3. 
   

   Dark choroid

   
   
4. 
   

   All of the above

114. (Easy) You are consulted in the emergency room for a 78-year-old man who noticed sudden yellowing of his vision since he started taking a medication newly prescribed by his primary care physician. He has dementia and cannot recall the name of the drug. Which of the following is the most likely culprit?

1. 
   

   Sildenafil

   
   
2. 
   

   Digitalis

   
   
3. 
   

   Topamax

   
   
4. 
   

   Nitrofurantoin

115. (Easy) A 57-year-old woman is referred to you from a local optometrist due to new floaters and flashes of light, followed by a shadow over her vision. On examination, you notice a break with subretinal fluid extending into the macula consistent with maculaoffretinal detachment, and decide to take her to the operating room for a primary, segmental, radial buckle with cryotherapy and no drainage the next day. Ultrasound from her postoperative day 1 visit is given in the figure, confirming support of the break by the buckle with resolving subretinal fluid. Which statement is correct regarding peripheral retinal lesions leading to retinal detachment?

1. 
   

   A hole is not a full-thickness break.

   
   
2. 
   

   A tear occurs due to atrophy of the inner retina.

   
   
3. 
   

   A horse-shoe retinal tear occurs if retina is pulled anteriorly.

   
   
4. 
   

   A tear covering 2 clock hours is termed as giant tear.

116. (Easy) A 30-year-old man at the county hospital emergency room was “minding his own business” when he was “jumped out of nowhere” and punched in his right eye. He has symptoms concerning for a retinal tear or detachment. At which locations should you have greatest suspicion for a traumatic retinal break?

1. 
   

   Inferotemporal and superonasal quadrants

   
   
2. 
   

   Superotemporal and superonasal quadrants

   
   
3. 
   

   Inferonasal and superonasal quadrants

   
   
4. 
   

   Superotemporal and inferonasal quadrants

117. (Medium) What is the definition of a “giant retinal tear”?

1. 
   

   A tear anterior to the base of the vitreous

   
   
2. 
   

   A tear that extends circumferentially more than 3 clock hours

   
   
3. 
   

   A large horse-shoe tear with a bridging blood vessel

   
   
4. 
   

   A tear that extends radially toward arcades or posterior pole

118. (Medium) You are seeing a patient on a Sunday night at 8 pm for new flashes and floaters, and notice a posterior vitreous detachment (PVD) on exam, but no retinal breaks. Which statement related to PVD is incorrect?

1. 
   

   During PVD vitreous gel starts separating 3 mm away from the ora serrata.

   
   
2. 
   

   Release of vitreous from the area of Martegiani causes a Weiss ring.

   
   
3. 
   

   Prevalence of PVD is higher among myopes.

   
   
4. 
   

   Syneresis is the collapse of the vitreous gel.

119. (Medium) It is 9 pm on Sunday night, and a patient calls with “tons of red spots” in her vision. On her exam, you notice not only a posterior vitreous detachment (PVD), but vitreous hemorrhage also. You then begin the scleral-depressed portion of the exam. What is the chance of finding a tear in a patient like this with vitreous hemorrhage and PVD?

1. 
   

   10%

   
   
2. 
   

   25%

   
   
3. 
   

   40%

   
   
4. 
   

   60%

120. (Medium) Which lesion, as per the given figure, requires immediate retinopexy to prevent retinal detachment in a symptomatic patient?

1. 
   

   Image a

   
   
2. 
   

   Image b

   
   
3. 
   

   Image c

   
   
4. 
   

   Image d

121. (Hard) Which statement is INCORRECT?

1. 
   

   Flap tears in fellow eyes of eyes with retinal detachment must be prophylactically treated.

   
   
2. 
   

   Laser retinopexy of the fellow eyes of retinal detachment with lattice degeneration can decrease retinal detachment rate.

   
   
3. 
   

   Lattice degeneration with a retinal hole does not require treatment unless there is a risk factor.

   
   
4. 
   

   Patients with demarcation line should be considered risk-free of further progression of a subclinical retinal detachment.

122. (Medium) If a patient presents with a left inferior retinal detachment extending between 3 and 11 o’clock, where is the most likely place you will find a retinal tear?

1. 
   

   3 o’clock

   
   
2. 
   

   4 o’clock

   
   
3. 
   

   5 o’clock

   
   
4. 
   

   10 o’clock

123. (Medium) A 65-year-old patient needs urgent surgery for a retinal detachment. He asks about his prognosis. Which statement about the functional and anatomical outcomes of retina reattachment surgery is incorrect?

1. 
   

   Success rate of retinal reattachment surgery is 80 to 90%.

   
   
2. 
   

   Eighty-seven percent of the eyes with macula-on retinal detachments recover vision equal to or better than 20/50.

   
   
3. 
   

   33 to 50% of the macula-off detachments can see equal to or better than 20/50.

   
   
4. 
   

   Delay in repair of macula-offdetachments does not affect the functional outcome.

124. (Medium) Which of the findings indicates the exudative nature of a retinal detachment?

1. 
   

   Shifting subretinal fluid

   
   
2. 
   

   Smooth retinal surface

   
   
3. 
   

   Lack of intravitreal pigment

   
   
4. 
   

   All of the above

125. (Medium) What is the cleavage plane in typical retinoschisis?

1. 
   

   Nerve fiber layer

   
   
2. 
   

   Inner plexiform layer

   
   
3. 
   

   Inner nuclear layer

   
   
4. 
   

   Outer plexiform layer

126. (Hard) A patient with + 3.00 hyperopic correction presents as a referral from another retina surgeon given concern for retinoschisis and possible retinal detachment. You notice a thin, transparent elevation involving the retina inferotemporally, but also the presence of demarcation line. Along with retinoschisis, what else do you suspect is present?

1. 
   

   Nothing, this is a normal finding.

   
   
2. 
   

   Presence of an inner hole.

   
   
3. 
   

   Presence of high myopia.

   
   
4. 
   

   Presence of an outer retinal hole.

127. (Medium) A 4-year-old boy presents to your clinic with nystagmus. Examination shows findings similar to the following image. What is true regarding this patient’s condition?

1. 
   

   Ocular albinism is usually autosomal recessive.

   
   
2. 
   

   Female carriers of ocular albinism have detectable ocular abnormalities.

   
   
3. 
   

   Patients with ocular albinism often have nystagmus but normal visual acuity.

   
   
4. 
   

   Chediak–Higashi syndrome is associated with fatal episodes of abnormal bleeding.

128. (Medium) You are consulted on a 58-year-old male hospitalized with a history of small-cell lung carcinoma. He complains of seeing lights he knows is not there, and decreased vision in dim light. These symptoms have been progressive. His acuity is 20/40 OU. On exam, he has minimal to trace cataracts. The arterioles are thin and his optic nerves appear mildly pale. Select the most correct statement about his most likely condition.

1. 
   

   The time course of visual loss progression is not distinguishable from retinitis pigmentosa.

   
   
2. 
   

   The condition never results in clinical visual loss without a known primary having been discovered.

   
   
3. 
   

   Steroids do not play a therapeutic role.

   
   
4. 
   

   Anti-recoverin antibodies are sometimes found.

129. (Hard) Upon returning to clinic from the operating room at the county hospital, your attending tells you to “go do this laser” for the right eye of a patient. Which of the following pigments is NOT considered a primary target for retinal laser photocoagulation?

1. 
   

   Oxidized reduced hemoglobin

   
   
2. 
   

   Xanthophyll

   
   
3. 
   

   Melanin

   
   
4. 
   

   Lipofuscin

130. (Easy) A patient present with proliferative diabetic retinopathy and is consented for panretinal photocoagulation (PRP). Which of the following is not a complication of laser photocoagulation?

1. 
   

   Permanent loss of corneal sensation

   
   
2. 
   

   Pupillary abnormalities

   
   
3. 
   

   Exudative retinal detachment

   
   
4. 
   

   Choroidal detachment

131. (Medium) A 42-year-old investment banker, recently divorced, is referred to your office from a local ophthalmologist due to new visual distortion and 20/30 vision. On exam, there is a pigment epithelial detachment at the fovea without any hemorrhage or evidence of neovascularization. Spectral-domain optical coherence tomography shows some focal thickening of the choroid. You discuss options with him including monitoring, and he would like a quick treatment now. Which statement is incorrect regarding photodynamic therapy (PDT)?

1. 
   

   Back pain and chest pain occur in 2.5% of the patients after PDT.

   
   
2. 
   

   Patients should avoid direct sunlight exposure for 48 hours after PDT.

   
   
3. 
   

   Pain is not related to infusion of verteporfin.

   
   
4. 
   

   0.7 to 2.2% of the patients may experience severe visual loss after PDT.

132. (Easy) A patient is referred for an epiretinal membrane and desires restoration of her vision as quickly as possible. She heard that you are “the BEST minimally-invasive, retinal surgeon.” After thoroughly explaining the risks, benefits, alternatives, and details of the surgery in layman’s terms, she wishes to proceed with a vitrectomy and membrane peel. Which of the following is a considered the most significant intraoperative advantage of small-gauge vitrectomy?

1. 
   

   Increased postoperative patient comfort

   
   
2. 
   

   Faster visual recovery

   
   
3. 
   

   Preserving conjunctiva for possible glaucoma surgeries

   
   
4. 
   

   Lower rate of retinal tears

133. (Medium) A 47-year-old patient at the county hospital has history of bilateral proliferative diabetic retinopathy and vitreous hemorrhages that are beginning to clear. Her HbA1c is 14.2%. In addition to intravitreal anti-VEGF therapy, she elects to proceed with pan-retinal photocoagulation (PRP). Which of the following lenses used for photocoagulation can result in a doubling of the laser spot?

1. 
   

   Volk Area Centralis lens

   
   
2. 
   

   Ocular Widefield lens

   
   
3. 
   

   Goldmann 3-mirror lens

   
   
4. 
   

   Ocular Mainster PRP 165 lens

134. (Medium) Which of the following is an indication for performing retinal laser photocoagulation?

1. 
   

   To ablate ischemic retina

   
   
2. 
   

   To create chorioretinal adhesion

   
   
3. 
   

   To destroy intraocular tumors

   
   
4. 
   

   All of the above

135. (Easy) Which of the statements is correct?

1. 
   

   Melanin poorly absorbs the visible spectrum of light.

   
   
2. 
   

   Xanthophyll absorbs infrared light best.

   
   
3. 
   

   Hemoglobin minimally absorbs red and infrared wavelengths.

   
   
4. 
   

   None of the above.

136. (Easy) A 54-year-old woman presents for follow-up with bilateral nonclearing vitreous hemorrhage (due to proliferative diabetic retinopathy) and moderate nuclear sclerosing cataracts. The view is beginning to improve and you think you can get adequate panretinal photocoagulation treatment. Which laser would be the best choice?

1. 
   

   Double-frequency YAG

   
   
2. 
   

   Argon green

   
   
3. 
   

   Argon red

   
   
4. 
   

   Diode infrared

137. (Medium) A 72-year-old woman presents a day early from her postoperative week 1 visit following cataract surgery because of excruciating eye pain, purulence, and worsening vision of her surgical eye. She had noticed her vision improve day 1 and then “all of a sudden” it became worse on day 5. Her external examination photo is shown in the figure. Which of the following is NOT a conclusion of the Endophthalmitis Vitrectomy Study (EVS)?

1. 
   

   Systemic antibiotic treatment with amikacin and ceftazidime does not improve final visual acuity.

   
   
2. 
   

   There is no difference in outcomes between vitrectomy and immediate tap/inject if visual acuity is better than light perception.

   
   
3. 
   

   Vitrectomy and intravitreal amikacin/ceftazidime injection results in better visual acuity if presenting vision is light perception or worse.

   
   
4. 
   

   Vitrectomy and intravitreal amikacin/ceftazidime injection results in better visual acuity regardless of the initial visual acuity.

138. (Medium) Your internal medicine colleague pages you at 11 pm on Sunday night regarding a 35-year-old immunocompromised patient at the local hospital with a new “white plaque in front of the pupil.” You immediately drive across the city to the hospital thinking it might be endophthalmitis. Examination of the patient reveals the findings in the above photograph. Which “endophthalmitis type” and “most common causative organism” pair below is INCORRECT?

1. 
   

   Chronic endophthalmitis–Propionibacterium acnes

   
   
2. 
   

   Traumatic exogeneous endophthalmitis–Candida species

   
   
3. 
   

   Bleb-associated endophthalmitis–Streptococcus and Haemophilus species

   
   
4. 
   

   Post-cataract surgery–coagulase-negative Staphylococci

139. (Hard) You are examining a 38-year-old man in your clinic who has a characteristic “port wine stain” on the side of his face. Which of the following is INCORRECT regarding his probable condition?

1. 
   

   Diffuse choroidal hemangioma is usually part of the condition and is usually found on the side ipsilateral to a facial nevus flammeus.

   
   
2. 
   

   Elevated intraocular pressure can be seen in eyes with circumscribed choroidal hemangiomas due to elevated episcleral venous pressure and/or angle malformation.

   
   
3. 
   

   B-scan ultrasound of a choroidal hemangioma typically shows a lesion with low internal reflectively.

   
   
4. 
   

   Photodynamic therapy is considered the treatment of choice for clinically symptomatic small- to medium-sized circumscribed choroidal hemangiomas.

140. (Easy) What is the most common source of choroidal metastasis in men and women, respectively?

1. 
   

   Prostate, kidney

   
   
2. 
   

   Prostate, lung

   
   
3. 
   

   Lung, breast

   
   
4. 
   

   Gastrointestinal tract, breast

141. (Medium) A 53-year-old male presents with decreased vision in the left eye. He has a poorly controlled vasculopathy. His examination reveals normal anterior segment findings but numerous retinal hemorrhages with mild vascular tortuosity. What is most helpful to differentiate ocular ischemic syndrome from central retinal vein occlusion (CRVO)?

1. 
   

   Location of the hemorrhages

   
   
2. 
   

   Ophthalmodynamometry

   
   
3. 
   

   Fluorescein angiography

   
   
4. 
   

   Optical coherence tomography

142. (Easy) A 54-year-old poorly controlled man with long-standing diabetes and hypertension presents for his regular screening examination. On dilated fundus examination, you notice the following lesions. What is the most common cause of these lesions?

1. 
   

   Diabetic retinopathy

   
   
2. 
   

   Hypertension

   
   
3. 
   

   HIV retinopathy

   
   
4. 
   

   Interferon retinopathy

143. (Medium) With regards to central artery occlusions, which statement is false?

1. 
   

   Thirty-two percent of the eyes have a cilioretinal artery.

   
   
2. 
   

   Cilioretinal artery occlusion mostly occurs with central retinal artery occlusion (CRAO).

   
   
3. 
   

   Giant cell arteritis (GCA) should be considered with isolated cilioretinal artery occlusion.

   
   
4. 
   

   Cilioretinal arteries arise from short posterior ciliary vessels.

144. (Hard) Your last patient of the day is a 79-year-old woman with sudden onset decrease vision in the left eye. She is a well-controlled hypertensive and diabetic. Her visual acuity is NLP on the affected side. The rest of her examination is normal except for the following. What does this clinical picture bring to mind?

1. 
   

   Likely malingering

   
   
2. 
   

   Cilioretinal artery occlusion

   
   
3. 
   

   The need for anti-VEGF treatment

   
   
4. 
   

   Involvement of the ophthalmic artery

145. (Easy) A new patient presents to your clinic for diabetic retinopathy screening after he was diagnosed with diabetes 2 months ago. Which statement regarding diabetic retinopathy (DR) is correct?

1. 
   

   It is present in 99% of type 2 diabetics at 20 years from time of diagnosis.

   
   
2. 
   

   It is the leading cause of blindness in adults aged 20 to 64 years in the United States.

   
   
3. 
   

   It is diagnosed primarily with fluorescein angiography.

   
   
4. 
   

   It can be classified as mild, moderate, or severe proliferative DR.

146. (Easy) Which of the following is not a finding of the Diabetes Control and Complications Trial (DCCT) trial?

1. 
   

   Sulfonylureas did not increase the risk of heart disease.

   
   
2. 
   

   Pregnancy can exacerbate diabetic retinopathy.

   
   
3. 
   

   Intensive blood sugar control reduces the progression of nonproliferative diabetic retinopathy (NPDR) to proliferative diabetic retinopathy (PDR).

   
   
4. 
   

   Intensive blood pressure control can slow progression of retinopathy.

147. (Medium) A 54-year-old patient presents to clinic for his diabetic screening test. His exam shows the following findings. Which study defined the characteristics of this entity?

1. 
   

   Diabetes Control and Complications Trial (DCCT)

   
   
2. 
   

   United Kingdom Prospective Diabetes Study (UKPDS)

   
   
3. 
   

   ETDRS

   
   
4. 
   

   RISE and RIDE

148. (Easy) A 56-year-old long-standing diabetic patient presents to clinic for his diabetic screening test. You look in the chart and find that a scribble was made to the side mentioning “4:2:1.” What does the 4:2:1 rule refer to in this case?

1. 
   

   A grading system for clinically significant macular edema (CSME)

   
   
2. 
   

   The definition of high-risk proliferative diabetic retinopathy (PDR)

   
   
3. 
   

   The risk of progression to high-risk PDR

   
   
4. 
   

   Criteria for diagnosing severe non-proliferative diabetic retinopathy (NPDR)

149. (Medium) Which of the following is a finding of the Early Treatment Diabetic Retinopathy Study (ETDRS)?

1. 
   

   Angiotensin-converting enzyme (ACE) inhibitors or beta blockers are effective in lowering blood pressure to reduce diabetic retinopathy.

   
   
2. 
   

   Panretinal photocoagulation is ineffective in type 2 diabetes.

   
   
3. 
   

   Anti-VEGF medications are effective in treatment of clinically significant macular edema.

   
   
4. 
   

   Focal laser therapy decreased the risk of moderate vision loss in diabetic macular edema.

150. (Medium) A 54-year-old long-standing diabetic patient presents to clinic for his diabetic screening test. You look in the chart and find that he was diagnosed with clinically significant diabetic macular edema (CSDME). You are about to perform focal laser therapy. Complications of focal laser therapy include which of the following?

1. 
   

   Choroidal neovascularization

   
   
2. 
   

   Enlarged blind spot

   
   
3. 
   

   Serous choroidal detachment

   
   
4. 
   

   Elevated intraocular pressure

151. (Hard) A patient has nonproliferative diabetic retinopathy (NPDR) with four quadrants of diffuse intraretinal hemorrhages and venous beading in two quadrants. This patient:

1. 
   

   Would benefit from panretinal photocoagulation according to the RISE and RIDE trials.

   
   
2. 
   

   Has a 45% chance of progression to proliferative diabetic retinopathy (PDR) in 1 year according to the Early Treatment Diabetic Retinopathy Study (ETDRS).

   
   
3. 
   

   Could experience improvement in diabetic retinopathy with intensive blood pressure and glucose control according to the Diabetic Retinopathy Clinical Research (DRCR) protocol I.

   
   
4. 
   

   Should receive a grid laser pattern of 50 to 100 µm spot size in the macular region.

152. (Medium) Which is not an option in the treatment of a patient who has type 2 diabetes with this fundus photo?

1. 
   

   Intravitreal anti-VEGF agents

   
   
2. 
   

   Intravitreal corticosteroid

   
   
3. 
   

   Focal laser therapy

   
   
4. 
   

   Photodynamic therapy

153. (Easy) A 56-year-old patient with decreased vision in the left eye tests positive for the histoplasmin skin test. Which of the following statements is false regarding the pathogen in question?

1. 
   

   It is endemic along the Mississippi and Ohio river valleys.

   
   
2. 
   

   The fungus is carried within the dropping of the infected bats.

   
   
3. 
   

   Humans are infected by direct skin contact.

   
   
4. 
   

   Systemic infection by the organism results in ocular scarring.

154. (Medium) A 40-year-old female presents for an annual check. She mentions that she was diagnosed with a subtle ocular finding and was advised to seek a dermatology evaluation. She never followed-up on that recommendation; however, now she complains of vision loss in her left eye and her fundus exam appears as shown below.

In what retinal layer were the initial ocular findings found?

1. 
   

   Internal limiting membrane

   
   
2. 
   

   Inner retina

   
   
3. 
   

   Outer plexiform layer

   
   
4. 
   

   Bruch’s membrane

155. (Hard) Which one of these statements is false regarding the disease this patient has?

1. 
   

   It is associated with the ABCC6 gene.

   
   
2. 
   

   Ocular findings of angioid streaks may also be seen in patients with thalassemia.

   
   
3. 
   

   It can be associated with optic nerve head drusen.

   
   
4. 
   

   Retinal findings may mimic Bietti crystalline dystrophy.

156. (Medium) What is the best course of action upon seeing a 33-year-old man with angioid streaks crossing the fovea with subretinal blood?

1. 
   

   Observation and use of safety glasses

   
   
2. 
   

   Perform laser photocoagulation

   
   
3. 
   

   Administer an anti-VEGF injection

   
   
4. 
   

   Order a fluorescein angiogram

157. (Easy) A patient with known reactivity to the histoplasmin skin test come in for an exam. Which one of the following is NOT part of the “4 signs of presumed ocular histoplasmosis syndrome (POHS)”?

1. 
   

   Punched-out chorioretinal lesions

   
   
2. 
   

   Juxtapapillary pigmented atrophic scars

   
   
3. 
   

   Choroidal neovascularization

   
   
4. 
   

   Vascular sheathing

158. (Medium) A patient with −9.00 spectacle prescription presents for his annual exam. He asks about the probability of complications associated with his refractive error. What is the prevalence of choroidal neovascularization (CNV) in pathologic/degeneration myopia?

1. 
   

   1 to 2%

   
   
2. 
   

   5 to 10%

   
   
3. 
   

   10 to 15%

   
   
4. 
   

   15 to 20%

159. (Hard) Which statement regarding the treatment of choroidal neovascularization (CNV) secondary to presumed ocular histoplasmosis syndrome (POHS) is false?

1. 
   

   Photocoagulation reduces the risk of severe vision loss (< 6 lines) compared to observation.

   
   
2. 
   

   Surgical removal of the neovascular complex is beneficial if visual acuity is worse than 20/100.

   
   
3. 
   

   Anti-VEGF agents are the mainstay of treatment for CNV secondary to POHS.

   
   
4. 
   

   POHS patients with subfoveal CNV cannot benefit from laser treatment.

160. (Easy) Which statement accurately describes pathologic myopia?

1. 
   

   It affects 25% of the US population.

   
   
2. 
   

   The incidence is higher in African Americans.

   
   
3. 
   

   The spherical equivalent is more than −6.0 D.

   
   
4. 
   

   The axial length greater than 32.5 mm.

161. (Hard) A 34-year-old man with previously diagnosed pathologic myopia presents for his regular follow-up. On exam, you find multiple isolated round deep hemorrhages. Which statement is true regarding these lesions in this patient?

1. 
   

   They indicate ingrowth of choroidal neovascularization.

   
   
2. 
   

   They need to be lasered immediately.

   
   
3. 
   

   Anti-VEGF treatment is required.

   
   
4. 
   

   They result from rupture of Bruch’s membrane and may require fluorescein angiography.

162. (Medium) You are consulted to perform a retinopathy of prematurity (ROP) screen on a baby born at 28 weeks with the following fundus findings.

Which of the following most accurately describes the zone of ROP in this patient?

1. 
   

   Zone 1

   
   
2. 
   

   Zone 2

   
   
3. 
   

   Zone 3

   
   
4. 
   

   Indeterminate

163. (Easy) Which of the following best describes stage 2 retinopathy of prematurity (ROP)?

1. 
   

   Retinal detachment, not involving the macula

   
   
2. 
   

   Neovascularization with fibrovascular tissue

   
   
3. 
   

   Tortuous arterioles and dilated venules

   
   
4. 
   

   Elevated ridge

164. (Easy) Which of the following is recognized as a risk factor for retinopathy of prematurity (ROP)?

1. 
   

   Birth weight > 2100 g

   
   
2. 
   

   Gestational age > 35 weeks

   
   
3. 
   

   High exposure to supplemental oxygen

   
   
4. 
   

   Maternal alcohol abuse

165. (Hard) Which of the following management options is most appropriate for this retinopathy of prematurity (ROP) baby?

1. 
   

   Laser treatment is indicated according to the early treatment ROP (ET-ROP) study.

   
   
2. 
   

   Cryotherapy is indicated according to the CRYOROP study.

   
   
3. 
   

   Anti-VEGF therapy is indicated according to the BEAT-ROP study.

   
   
4. 
   

   No treatment is indicated at this time.

166. (Hard) How would you follow a retinopathy of prematurity (ROP) baby with stage 2, zone II, no plus disease?

1. 
   

   Next day for laser therapy

   
   
2. 
   

   Two weeks

   
   
3. 
   

   Four weeks

   
   
4. 
   

   Six months

167. (Medium) The fundus photos of a prematurely born neonate are shown here. Which of the following is true regarding this patient’s future visual prognosis?

1. 
   

   Increased risk of hyperopia

   
   
2. 
   

   Increased risk of angle-closure glaucoma

   
   
3. 
   

   Decreased risk of cataract

   
   
4. 
   

   Decreased risk of retinal detachment

168. (Easy) You see a premature baby with retinopathy of prematurity and recommend laser treatment. When consenting the parents, you discuss risks of treatment. Which of these is not a potential complication of laser treatment for this condition?

1. 
   

   Vitreous hemorrhage

   
   
2. 
   

   Anterior segment ischemia

   
   
3. 
   

   Endophthalmitis

   
   
4. 
   

   Increased myopia

169. (Medium) Which of the following best describes type 2 retinopathy of prematurity (ROP)?

1. 
   

   Zone 1, stage 3 without plus disease

   
   
2. 
   

   Zone 1, stage 2 with plus disease

   
   
3. 
   

   Zone 2, stage 2 with plus disease

   
   
4. 
   

   Zone 2, stage 3 without plus disease

170. (Easy) A 32-year-old well-appearing female presents for long-standing bilateral photopsias. She was diagnosed with posterior uveitis by another specialist who mentioned that she has no inflammatory cells in her vitreous cavities. Which one of the below diagnoses fits her description?

1. 
   

   Acute posterior multifocal placoid pigment epitheliopathy (APMPPE)

   
   
2. 
   

   Serpiginous choroiditis

   
   
3. 
   

   Multiple evanescent white dot syndrome (MEWDS)

   
   
4. 
   

   Punctate inner choroidopathy (PIC)

171. (Medium) A 35-year-old well-appearing female presents for long-standing photopsia in her left eye. She was seen by another specialist who mentioned to her that the condition rarely affects both eyes. Which diagnosis is the specialist referring to?

1. 
   

   Acute zonal occult outer retinopathy (AZOOR)

   
   
2. 
   

   Multiple evanescent white dot syndrome (MEWDS)

   
   
3. 
   

   Acute posterior multifocal placoid pigment epitheliopathy (APMPPE)

   
   
4. 
   

   Punctate inner choroidopathy (PIC)

172. (Medium) What is the treatment of choice for the majority of patients with acute posterior multifocal placoid pigment epitheliopathy (APMPPE) in the acute phase?

1. 
   

   Observation

   
   
2. 
   

   Steroids

   
   
3. 
   

   Anti-VEGF agents

   
   
4. 
   

   Immunomodulators

173. (Hard) A 40-year-old man presents with geographic patch of grayish yellow placoid lesion in the peripapillary area, at the level of the choroid. He received a systemic work-up which was negative. What is the treatment for this patient’s inflammatory condition?

1. 
   

   Steroids

   
   
2. 
   

   Acyclovir

   
   
3. 
   

   Combination immunosuppressives and steroids

   
   
4. 
   

   Photodynamic therapy

174. (Hard) Subretinal choroidal neovascularization (CNV) is seen in 20% of which white dot syndrome?

1. 
   

   Punctate inner choroidopathy (PIC)

   
   
2. 
   

   Acute zonal occult outer retinopathy (AZOOR)

   
   
3. 
   

   Multifocal choroiditis (MFC)

   
   
4. 
   

   Multiple evanescent white dot syndrome (MEWDS)

175. (Easy) A 40-year-old patient of Mediterranean descent presents with the following finding, and has a positive cutaneous pathergy test as well as new skin lesions.

What is the classic triad found in the disease you suspect?

1. 
   

   Recurrent aphthous ulcers, genital ulcers, and iritis with hypopyon

   
   
2. 
   

   Arteritis of retinal vessels, retinal necrosis, and vitritis

   
   
3. 
   

   Arthritis, conjunctivitis, and urethritis

   
   
4. 
   

   Epiphora, photophobia, and blepharospasm

176. (Easy) Which human leukocyte antigen (HLA) type is associated with Behcet’s disease?

1. 
   

   HLA-B27

   
   
2. 
   

   HLA-A29

   
   
3. 
   

   HLA-DR2

   
   
4. 
   

   HLA-B5101

177. (Medium) Which laboratory test would confirm the diagnosis of Behcet’s disease?

1. 
   

   Human leukocyte antigen (HLA) testing

   
   
2. 
   

   Diagnostic paracentesis

   
   
3. 
   

   Kveim–Siltzbach test (KST)

   
   
4. 
   

   None

178. (Hard) You have been following a 78-year-old patient for idiopathic vitritis that has not responded to topical or systemic steroids and is now starting to become bilateral. Fundus picture shows the following:

What is the next step in this patient’s management?

1. 
   

   Start immunosuppressive treatment

   
   
2. 
   

   Obtain magnetic resonance imaging (MRI)

   
   
3. 
   

   Combine immunomodulators and steroids

   
   
4. 
   

   Vitreous biopsy

179. (Easy) Which of these uveitic conditions typically has the worst visual prognosis?

1. 
   

   Acute posterior multifocal placoid pigment epitheliopathy (APMPPE)

   
   
2. 
   

   Serpiginous choroiditis

   
   
3. 
   

   Multiple evanescent white dot syndrome (MEWDS)

   
   
4. 
   

   Punctate inner choroidopathy (PIC)

180. (Easy) A 50-year-old male presents with blurred vision in the left eye. He admits to macropsia and metamorphopsia in the same eye. His fundus photo, fluorescein angiogram, and optical coherence tomography (OCT) are shown. The thickness of choroid on OCT is 455 µm. What is the diagnosis?

1. 
   

   Central serous chorioretinopathy (CSR)

   
   
2. 
   

   Age-related macular degeneration (AMD)

   
   
3. 
   

   Vogt–Koyanagi–Harada (VKH) syndrome

   
   
4. 
   

   Idiopathic polypoidal choroidal vasculopathy (IPCV)

181. (Medium) A 56-year-old African American patient with lung-involving sarcoidosis has been referred to your clinic for an “ocular sarcoidosis rule-out exam.” He denies any recent ocular symptoms but thinks he may have had some mild photophobia 3 weeks prior. What percent of patients with sarcoidosis have ocular manifestations?

1. 
   

   10%

   
   
2. 
   

   20%

   
   
3. 
   

   50%

   
   
4. 
   

   60%

182. (Easy) Full-field electroretinography in a patient with MEWDS demonstrates reduced a-wave amplitudes. What part of the retina is assessed by the a-wave?

1. 
   

   Muller cells and bipolar cells

   
   
2. 
   

   Retinal pigment epithelium

   
   
3. 
   

   Rod and cone cells

   
   
4. 
   

   None of the above

183. (Easy) Which of these diseases manifest with granulomatous uveitis?

1. 
   

   Vogt–Koyanagi–Harada (VKH) syndrome

   
   
2. 
   

   Sarcoidosis

   
   
3. 
   

   Syphilis

   
   
4. 
   

   All of the above

184. (Medium) A 67-year-old woman with vitreomacular traction diagnosed by another specialist is referred to your clinic for surgical evaluation. Which statement is false regarding the management of this and similar pathologies?

1. 
   

   Macular hole closure rates with vitrectomy is at around 95%.

   
   
2. 
   

   After membrane peeling of macular pucker, 60 to 80% of the patients see two or more lines better.

   
   
3. 
   

   Vitrectomy must be offered to patients with vitreomacular adhesion.

   
   
4. 
   

   Vitrectomy should not be offered to patients with stage 1 macular hole.

185. (Medium) A poorly controlled diabetic is referred to your surgical clinic for vitrectomy evaluation. He has had multiple injections for recurrent non-clearing vitreous hemorrhages in the setting of proliferative diabetic retinopathy. Which of the following is NOT a strong indication for vitrectomy in diabetes?

1. 
   

   Tractional retinal detachment involving or threatening the macula

   
   
2. 
   

   Diabetic macular edema that does not respond to intravitreal anti-VEGF and dexamethasone treatment

   
   
3. 
   

   Vitreous hemorrhage that occurred a week ago

   
   
4. 
   

   Development of a peripheral tear within an extrafoveal tractional retinal detachment and increasing amounts of subretinal fluid

186. (Easy) Which “disease–most common causative agent” pairing is incorrect?

1. 
   

   Coagulase-negative staphylococci–post-cataract endophthalmitis

   
   
2. 
   

   Nocardia–post-intravitreal anti-VEGF injection endophthalmitis

   
   
3. 
   

   Bacillus cereus–post-traumatic endophthalmitis

   
   
4. 
   

   Streptococci and Hemophilus–Bleb-associated endophthalmitis

187. (Easy) You see a 70-year-old patient with longstanding inflammation in the left eye. He received cataract surgery 2 years ago. His most recent complaint is related to ongoing photophobia with new-onset floaters. His cataract surgeon noted thickened posterior capsule deposits. What is the most common causative organism for delayed-onset endophthalmitis?

1. 
   

   Propionibacterium acnes

   
   
2. 
   

   Streptococcus viridans

   
   
3. 
   

   Streptococcus mitis

   
   
4. 
   

   Haemophilus influenzae

188. (Medium) Which of the following is a risk factor for intraoperative suprachoroidal hemorrhage?

1. 
   

   Advanced age

   
   
2. 
   

   Glaucoma

   
   
3. 
   

   Aphakia

   
   
4. 
   

   All of the above