1.     a.T     b.T     c.F    d.F    e.F

Gorlin's syndrome (basal cell naevus syndrome)

• rare, autosomal dominant and multisystem disorder
• characterised by multiple basal cell carcinoma, jaw cysts, skeletal anomalies, ectopic calcification of the falx cerebri and pitting of the hand and feet
• ocular features also include hypertelorism, lateral displacement of the medial canthi and prominent supraorbital ridges

2.     a.T    b.T    c.F    d.F     e.F

Posterior polymorphous dystrophy:

•  a bilateral dominantly inherited dystrophy
• vesicular polymorphous deposits with clear halos in Descemet's membrane
• usually asymptomatic, rarely endothelium decompensation requiring penetrating corneal graft
• the abnormal endothelium may extend into the trabecular meshwork and iris
• glaucoma can occur as a result of trabecular meshwork involvement  iris involvement can lead to corectopia and ectopia simulating iridocorneal endothelial syndrome except that the later is unilateral

3.     a.T     b.T     c.T     d.F     e.T

Crystalline deposits occurs with:

• myloidosis as in multiple myeloma
• cystinosis
• treatment with gold
• uric acid from uraemia

4.     a.T     b.F     c.F     d.F     e.T

Pterygium:

•  fibrovascular overgrowth of the bulbar conjunctiva
•  the stroma shows basophilic degeneration (elastotic) of collagen
•  the epithelium is often thin but may show hyperplasia or dysplasia
•  it is not regarded as precancerous

5.     a.T     b.T     c.F     d.T     e.T

Keratoconjunctivitis sicca (dry eyes):

•  causes dysplasia of the epithelium which may eventually become keratinise
•  the goblet cells may increase due to chronic irritation from dry eyes
•  in Sjogren's syndrome, there is lymphocytic infiltration of the lacrimal and accessory glands

6.     a.F     b.F     c.T     d.F     e.F

Merkel cell carcinoma:

• an aggressive primary tumour of the skin, arising from papillary dermis
• usually presents as a firm non-tender solitary skin nodule on the face and neck
• early metastasis through the lymphatic channels
• contains APUD (amine precursor and uptake decarboxylation) cells

7.     a.F     b.T     c.F     d.F     e.T

Lens-induce uveitis:
- three types

• hacoanalphylactic endophthalmitis

- severe granulomatous inflammation when the lens protein is exposed
- zonal granulomatous reaction surrounding the exposed lens material. The inflammation include neutrophils, epihtelioid cells, macrophages and giant cells
• phacotoxic uveitis

- nongranulomatous inflammation when the lens protein is exposed.
- non-specific inflammation with lymphocytes, macrophages and occasional giant cells
• phacolytic glaucoma

- occurs when the hypermature cataract leaks out protein
- macrophages laden with eosinophilic lens materials are seen in the anterior chamber and the trabecular meshwork

8     a.F     b.F     c.T     d.T     e.T

Xeroderma pigmentosa:

• inheritance is autosomal recessive
• marked sensitive of skin to sunlight
• malignant skin tumours including squamous cell tumour, basal cell carcinoma and fibrosacorma
• main defect is due to the inability of the cells to repair damaged DNA following ultraviolet exposure

9.     a.T     b.F     c.T     d.T     e.T

Pathology of thyroid ophthalmopathy:

• there is enlargement and inflammation of orbital tissue especially the extraocular muscles
• histologically there is interstitial oedema and inflammatory cell infiltration (mainly lymphocytes, plasma cells and sometimes mast cells)
• thecondition tend to involve the nontendinous part of extraocular muscle
• the endomysial fibroblasts produces mucopolysaccharide especially hyaluronic acid
• the muscles are initially inflammed and at later stage undergoes fibrosis and shows fatty infiltrate

10.     a.T     b.T     c.T     d.F     e.F

Histological staining:

• Giemsa stain can demonstrate inclusion body such as chlamydia
• osmium tetroxide is used to fix and stain myelin for electron microscopy
• yeast and fungi can be stained with Fuelgin's stain, PAS, Luxol blue fast and Gomori methenamine silver
• eosin stains the cytoplasm pink whereas haematoxylin stains the nuclei blue

Sympathetic ophthalmitis

• a uncommon bilateral granulomatous panuveitis which occurs after penetrating ocular injury or intraocular surgery
• the inflammation usually begins 4 to 8 weeks after the injury
• Dellen-Fuch's nodules are seen at the level of Bruch's membrane and represent aggregates of epitheloid
• cells, it is not diagnostic as the nodules also occur in VKH syndrome
• may have systemic manifestation identical to Vogt-Koyanagi-Harada syndrome with cerebrospinal fluid
• pleocytosis, miningismus, alopecia, vitiligo and poliosis
• prevention is only useful if the injured eye were removed within the first 2 weeks after injury

12.     a.T     b.F     c.T     d.T     e.T

Abnormal material in the vitreous include:

• pseudoexfoliation in pseudoexfoliation syndrome
• haemosiderin from vitreous haemorrhage
• amyloidosis in familial amyloidosis
• calcium in asteroid hyalosis

13.     a.T    b .T     c.F     d.F     e.T

Giant cell arteritis:

• disease of the elderly
• sudden, painless and profound visual loss
• female more susceptible than male
• head ache, low grade fever, anorexia, weight loss, tenderness upon brushing hair and jaw claudication
• ESR and C-reactive proteins are always raised but not diagnostic of the condition
• diagnosis is base on biopsy which reveal fragmentation of the internal elastic lamina and giant cell infiltration of the tunica media of the artery. However, giant cells are not essential for diagnosis.

14.     a.F     b.T     c.T     d.F     e.T

The following conditions are pre-malignant:

• actinic keratosis is the result of metaplasia due to ultraviolet light
• Bowen's disease

15.     a.T     b.T     c.T     d.T     e.F

Hypoxic damage in diabetic mellitus is suggested by:

• cotton-wool spots
• extensive IRMA
• vascular beading
• extensive retinal haemorrhages
• iris neovascularization

16.     a.T    b .F     c.T     d.F     e.T

Biopsy report in rheumatoid arthritis include

• posterior scleritis
• episcleral necrotic tissue
• vasculitis

17.     a.T     b.F     c.F     d.F     e.F

The prognosis of retinoblastma is detemined by:

• evidence of external spread such as optic nerve involvement
• size of the tumours
• cell differentiation

18.     a.F     b.F     c.F     d.T     e.F

Microangiopathy in diabetes mellitus is characterised by:

• microvascular obstruction and non-perfusion of capilaries
• retinal capillary microaneurysms
• absent membrane thickening
• loss of pericytes
• intraretinal microvascular abnormality

19.     a.T     b.F     c.T     d.T     e.F

Optic nerve glioma:

• associated with type I neurofibromatosis
• most common type is pilocytic (hair-like) astrocytoma
• the age of onset is usually before the age of 10
• low-grade and rarely infiltrate the perineural tissue
• reactive meningeal hyperplasia
• good long-term survival

20    a.F     b.T     c.F     d.T     e.T

Mutton fat keratic precipitates:
- occurs in chronic granulomatous uveitis and seen in

• tuberculosis
• fungal
• leprosy
• syphilis
• sarcoidosis
• juvenile xanthogranuloma
• histiocytosis X
• sympathetic ophthalmia
• Vogt-Koyanagi-Harada syndrome
• toxoplasmosis

21.     a.F     b.T     c.F     d.F     e.T

Albinism:

• can be of oculocutaneous or ocular types
• oculocutaneous types can be divided into tyrosinase-positive and tyrosinase-negative types. Hair bulb
• test is useful to differentiate the two within the first three years of life
• is associated with abnormal platelet aggregation in Hermansky-Pudlak syndrome
• poor vision is usually due to macular hypoplasia

22.     a.T     b.T     c.F     d.T     e.F

Congenital glaucoma:
- may be primary
- secondary to:

• aniridia
• Sturge-Weber's syndrome
• anterior chamber angle cleavage syndrome such as Peter's anomaly or Axenfeld's syndrome

23.     a.F     bT     c.T     d.F     e.T

Nystagmus:

• see-saw nystagmus is seen with bitemporal hemianopia
• down-beat nystagmus occurs with lesion in the cervico-medullary junction at the foramen magnum
• manifest latent nystagmus is a type of horizontal jerk nystagmus which increases in amplitude when one eye is covered. It occurs in strabismus, amblyopia or uniocular pathology such as cataract
• gaze-evoked potential is not specific for cerebellar lesion, it occurs when the eyes are unable to maintain an eccentric gaze position through weakness of muscle tone in the agonist muscle
• convergence retraction nystagmus occurs with mid-brain tumours such as pinealoma

24.     a.T     b.F     c.F     d.F     e.F

Melanocytoma:

• benign, highly pigmented tumour arising from melanocytes
• most commonly found in optic nerve head
• histologically shows plump polyhedral cells
• equally sex incidence
• commoner in black population
• usually asymptomatic but may show enlargement of blind spots
• 50% have associated choroidal naevus
• rarely the tumour shows necrosis, vascular obstruction and optic nerve compression

25.     a.F     b.F     c.T     d.T     e.F

Retinoblastoma:

• most cases are due to new gene mutation only 10% is inherited
• caused by deletion of 13q14
• rosettese suggests cell differentiation and therefore better prognosis; however other factors such as size and optic nerve involvement may be more important
• has increased risk of osteosarcom (the oncogene of which is also located on chromosome 13)
• prognosis is generally good at around 90%

26.     a.T     b. T     c.T     d.F     e.F

Corneal dystrophy:
- inherited and bilateral conditions
- the following abnormal substance are documented:

• lycoaminoglycan (macular dystrophy, fleck dystrophy)
• yaline degeneration (granular dystrophy)
• amyloid (lattice dystrophy)
• lipid (fleck dystrophy)
• cholesterol (central crystalline dystrophy)

27.     a.T     b.F     c.T     d.T     e.T

Adenocystic carcinoma of the lacrimal gland:

• the most common malignant tumour of the lacrimal gland
• has no well-defined capsule
• invade perineural tissue causing pain and metastasise early to the brain
• 5 histologic patterns: cribriform (Swiss cheese and of lower grade), solid (basaloid), sclerosing,comedocarcinomatous and tubular (ductal)
• treatment is with orbital exenternation and removal of involved bone
• the prognosis is very poor

28.     a.F     b.T     c.T     d.F     e.T

Dissociated vertical deviation:

• refers to the phenomenon in which the eye elevates when the amount of light entering it is reduced
• usually begins between 2 to 3 years of age
• associated with infantile esotropia
• the binocular vision is usually poor
• surgery of choice is either superior rectus recession or Faden's procedure

29.     a.T     b.T     c.F     d.F     e.T

Duane type A:

• Brown's classification

    Type A: limited abduction and less marked adduction limitation
    Type B: limited abduction and normal adduction
    Type C: limitation of adduction exceeds the limitation of abduction
• widening of the palpebral fissure on abduction
• globe retraction and palpebral narrowing on adduction
• face turns to the affected side is common
• caused by innervation of the lateral rectus by a branch of third nerve in place of absent sixth nerve
• sixth nerve nucleus aplasia has been documented

30.     a.F     b.T     c.F     d.T     e.F

Retinoschisis:

•  presents in 5% of the population and is caused by the splitting of the neurosensory retinal in the outer plexiform layer
•  often bilateral
• arises from coalescence of peripheral cystoid degeneration
• associated with hypermetropia
• asymptomatic but can cause absolute scotoma (cf with retinal detachment which causes relative scotoma)
• does not cause water mark which is a feature of retinal detachment and is due to transformation of escaped retinal pigment epithelial cells
• renal breaks on the internal layer is common but if associated with breaks in the outer layer, there is a risk of retinal detachment

31.     a.F     b.F     c.T     d.T     e.T

Anti-glaucoma medications:

• beta-blocker causes slowing of heart rate but is not contra-indicated in primary heart block ( prolonged PR interval)
• beta-blocker should be avoided in patients taking centrally acting calcium channel blocker such as verapamil. Nifedipine acts peripherally
• acetazolide contains structure similar to sulphonamide and should be avoided in those who is allergic to it
• acetazolamide causes diuresis and loss of potassium, supplement may be needed  latanoprost is contraindicated in patients with intraocular inflammation

32.     a.F     b.T     c. T     d.T     e.F

Dendritic ulcer of the cornea can be treated with:

• iodination
• debridement
•  topical or systemic acyclovir

33.     a.T     b.F     c.F     d.F     e.F

Choroidaemia:

• X-linked recessive disorder characterised by progressive degeneration of the choriocapillaris and RPE
• typically affects male
• onset is in the first decade with night blindness
• central vision is affected late
• ERG shows reduced a and b waves female carriers may shows peripheral pigmentary changes

34.     a.T     b.T     c.T     d.T     e.F

Deafness occurs in:

• Cockayne's syndrome: premature ageing, dwarfism, bird like facies and retinal degeneration
• Altroem's syndrome: retinitis pigmentosa, deafness, obesity and diabetes mellitus
• Alport's syndrome: haematuria, sensorineural deafness, anterioir lenticonus
• Usher's syndrome: neurosensory deafness, retinitis pigmentosa

35.     a.T     b.T     c.T     d.F     e.T

Enlarged corneal nerves occur in:

• multiple endocrine adenomatosis
• keratoconus
• ichthyosis
• Refsum's disease
• Fuchs' corneal dystrophy
• neurofibromatosis
• leprosy
• trauma
• congenital glaucoma
• failed corneal graft
• keratoconjucntivitis sicca
• advanced age
• acanthoamoeba keratitis

36.     a.T     b.T     c.T     d.F     e.T

The following association are true:

• abetalipoproteinaemia with acanthocytosis
• Refsum's disease with cerebellar ataxia
• Friedrich'a ataxia with spinocerebellar degeneration
• Paget's disease and deafness

37.     a.T     b.T     c.T     d.F     e.T

Keratoconus occurs in:

• connective tissue disorders such as Ehlers-Danlos's syndrome and Marfan's syndrome
• atopic eye conditions such as atopic keratoconjunctivitis
• Down's syndrome

38.     a.F     b.F     c.T     d.T     e.F

Acquired syphilis:

• causes painless ulcer in the primary stage which is highly infectious
• in the secondary stage, the patient may develop a rash which is non-infectious
• uveitis can occur in the secondary stage
• treatment is with penicillin

39.     a.T     b.T     c.T     d.F     e.F

Reduced blinking occurs in:

•  Parkinson's disease
•  progressive supranuclear palsy
• alcohol intoxication
• neurotrophic keratitis
• contact lens wear

40.    a.F     b.F     c.F     d.T     e.T

Heterochromic cyclitis:

• chronic uveitis associated with cataract and glaucoma
• glaucoma develops in 20% of patients
• iris atrophy causes transillumination
• Amsler's sign occurs during cataract extraction and is due to wispy iris vessels which extends from the iris to the trabecular meshwork and do not cause anterior synechiae
• is resistant to steroid treatment

41     a. F     b.F     c.F     d.T     e.F

Retinal dialysis:

• caused by full hickness separation of the retina at the ora serrata
• traumatic dialysis is most often found in the superonasal quadrant
• idiopathic dialysis is most often in the inferotemporal quadrant
• can be closed with cryotherapy to the base of the dialysis followed by local scleral buckle

42.     a.T     b.F     c.T     d.T     e.F

Ocular bobbing:

• conjugate involuntary recurrent downward movement of the eyes
• rapid downward movement with a slower return to the neutral position
• absent horizontal movements
• occurs in patients with acute pontine lesion who are either comatose or locked-in state
• can occur with tumour in the pontine

43.     a.T     b.T     c.T     d.T     e.T

Investigation of sarcoidosis:

• chest X-ray typically shows bilateral hilar lymphadenopathy, there may also be interstitial infiltrate
• ACE concentration is increased
• conjunctival biopsy may show non-caseating granuloma
• serum calcium may be raised in sarcoidosis
• gallium scan shows increase in parts of body affected by sarcoidosis

44.     a.T     b.F     c.F     d.T     e.T

Holme-Adie's pupil:

• there is light-near dissociation however there may be delayed or absent pupil reaction to both
• the condition is usually unilateral
• women are affected more often than men
• due to paralysis of the ciliary muscle, the accommodation is impaired
• denervation hypersensitivity is demonstrated by constriction to 2.5% methacholine and 0.1% pilocarpine

45.     a.F     b.T     c.T     d.T     e.T

Absent of pupil response to direct and consensual light response:
- occur when the iris of the affected eye is paralysed and this occur in

• blunt trauma
• third nerve palsy
• atropine
• siderosis bulbi

46.     a.F     b.T     c.T     d.F     e.F

Leber's optic neuropathy:

• a mitochondrial inherited disease
• bilateral loss of central vision which is severe and painless
• typically in the second decade of life
• classic early picture shows a triad of circumpapillary telangiectatic microangiopathy, pseudoedema of the disc and absent fluorescein staining

47.     a.T     b.T     c.T     d.F     e.F

AMPPE:

• typically affects healthy young adults who presents with sudden onset central or paracentral visual loss after a flu like illness
• scattered, patchy creamy lesions at the level of the retinal pigment epithelium layers
• the lesions fade after one to two weeks leaving behind granular pigmentary changes
• fluorescein angiography shows early blockage of choroidal circulation by these lesions but in the late phase the lesions show late staining
• other findings: uveitis, serous retinal detachment, cerebral vasculitis, cerebrospinal fluid pleocytosis, headache, hearing loss and tinnitus
• spontaneous resolution is common and systemic steroid has not been shown to be useful

48.     a.F     b.T     c.F     d.F     e.F

Central serous retinopathy:

• the patient usually presents with distorted vision without significant central visual loss
• Amsler's chart testing usually shows distortion of lines or scotoma
• the image appears smaller than the unaffected eye

49.     a.T     b.T     c.T     d.T     e.F

Kayser-Fleishcer's ring:

• occurs in Wilson's disease and intraocular copper foreign body
• the ring is caused by copper deposited in Descemet's membrane which may be orange, brown, green- brown or grey in colour
•  it begins superiorly then inferiorly and finally circumferentially
• regresses with D-penicillamine treatment

50.     a.T     b.F     c.T     d.F     e.T

In corneal graft:

• the epithlium, keratocytes, nerves and epithelium will eventually be replaced by the host tissue
• the endothelium does not regenerate and therefore will remains that of donor.
• the descemet's membrane is produced by the endothelium and will therefore remains that of donor

51.     a.F     b.T     c.T     d.F     e.F

Vernal keratoconjunctivitis:

• affects mainly young people
• an allergic inflammatory condition characterised by giant papillae in the tarsal conjunctiva
• the limbal type is found commonly in black with typical Horner-Trantas' dots which are giant papillae containing eosinophils
• causes keratitis and corneal ulcer / scarring
• treatment is avoidance of allergens, mast cell stabilisers and short course of steroid in acute phase

52.     a.F     b.F     c.F     d.F     e.T

The following conditions are inherited as:

•  X-linked in protanopia (red-green colour blindness) and juvenile retinoschisis
• autosomal dominant in neurofibromatosis
• autosomal recessive in blue cone achromatopsia
• non-inherited in Sturge-Weber's syndrome

53.     a.F     b.F     c.F     d.F     e.T

Coat's disease:

• non-hereditary, unilateral congenital disorder characterised by abnormal telangiectatic and aneurysmal retinal vessels in the peripheral retina
• male outnumber female by 3 to 1
• presents with leukocoria and strabismus. Untreated can lead to exudative retinal detachment, glaucoma and pthisical eye
• laser is useful in destroying the abnormal blood vessels

54.     a.F     b.T     c.F     d.F     e.F
 
Laser:

• green light is not absorbed by xanthophyll and therefore it is theoretically more advantageous to use green laser in the macular area
• diode laser penetrate vitreous haemorrhage well and is therefore ideal in vitreous haemorrhage
• YAG laser is colourless and therefore require neodymium to give it red colour for targeting
• used in ophthalmic practice is classified as type IV laser

55.     a.T     b.T     c.F     d.T     e.F

Roth's spots:

• many causes including subacute bacterial endocarditis, leukaemia, anaemia etc
• contain white areas in the centre of retinal haemorrhage
• the white areas may contain immunocomplex, lymphoblasts or purulent exudates
• in subacute bacterial endocarditis, the white centres may contain organisms, although the majority are sterile and consists mainly of  white blood cells and fibrin thrombus at the site of extravasation of blood

56.     a.T     b.F     c.F     d.F     e.T

Breaks in Descemet's membrane occurs in:

• trauma as in forcep delivery
• keratoconus
• congenital glaucoma

57.     a.T     b.T     c.F     d.F     e.F

Stigma of acute angle closure glaucoma:

• iris atrophy
• sphincter paralysis due to ischaemia
• pigment dispersion
• glaukomflecken which is white opacities on the anterior surface of the lens caused by necrosis of the anterior lens capsule

58.     a.T     b.T     c.T     d.F     e.F

In blow-out fracture:

• the orbital rim may be fracture or intact. In the former a step can be felt
• occur only when the air sinuses have develop
• surgical emphysema is a feature
• although typically cause problem with upgaze, the horizontal recti have connective tissue that extends to
•  the orbital floor and therefore horizontal movement may be impaired to some extent
• the infraorbital nerve is involved but the nerve does not supply the tip of the nose which is by nasociliary nerve

Persistent hyperplastic primary vitreous:

• caused by abnormal regression of primitive hyaloid vascular system
• typically there is a fibrovascular stalk extending from optic disc and form a retrolental membrane
• the membrane extend to the ciliary process and if contract can lead to elongation of the ciliary processes
• causes shallow anterior chamber and acute glaucoma in untreated cases
• the prognosis is good if treated early especially if the retina were normal

Pars planitis:

• commonly affect young adult and children
• presents with folater or decreased visual acuity due to cystoid macular oedema
• 80% bilateral
• clinical examination shows inflammatory cells and snowball opacity in vitreous
• main complications are cataract and cystoid macular oedema. However, the visual prognosis is usually good
• rare complication include band keratopathy, glaucoma, vitreous organisation, tractional retinal detachment and vitreous haemorrhage.
• treatment is indicated only with decreased visual acuity from CMO and severe inflammation
• treatment include: periocular steroid, cryotherapy to vitreous base, par plana vitrectomy and use of immunosuppresive agents.