ophthalmopathology (Q1-18)

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Question 1 Neoplasms of the eyelid (basal cell carcinoma, squamous cell carcinoma, melanoma) are etiologically related most closely to:
A Use of mascara
B A hereditary condition
C Recurrent herpes infection
D Sunlight exposure
E Glaucoma
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Question 2 A 60 year old male has noted decreasing vision on the right for the past year. Funduscopic examination reveals a darkly pigmented uveal mass. These findings most strongly suggest a diagnosis of:
A Diabetic retinopathy
B Retinoblastoma
C Melanoma
D Tay-Sachs disease
E Cytomegalovirus retinopathy
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Question 3 A 56 year old female has noted increasingly frequent headaches for the past year. She recently had her vision checked, and her intraocular pressure was found to be increased. The most significant result of this condition, if not treated, is:
A Cataract formation
B Conjunctivitis
C Hypertensive retinopathy
D Optic nerve damage
E Strabismus
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Question 4 A 42 year old male notes a slowly enlarging nodule on his right upper eyelid over the past month. This nodule is firm. There is no ulceration. The conjunctiva and the cornea appear normal. This lesion can be characterized by all of the following findings EXCEPT:
A Resemblance to a sebaceous carcinoma on gross examination
B Recurrence
C Infection of eccrine sweat glands
D Granulomatous inflammation
E Relationship to sun exposure
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Question 5 A 3-year-old child, who had been born prematurely at 30 weeks gestation and then developed hyaline membrane disease at birth, is found to be visually impaired. Funduscopic examination reveals retinal detachment on the left. The most likely pathogenesis of this condition is:
A Retinal damage by oxygen species of free radicals
B Hereditary hexosaminidase A deficiency
C Germinal matrix hemorrhage at birth
D Alobar holoprosencephaly
E Absence of tumor suppressor gene on chromosome 13
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Question 6 A 70 year old female has noted the appearance of a "spot" discoloring the sclera of her right eye. Her physician notes a 0.3 cm raised yellowish-white lesion near the limbus. This lesion is LEAST likely to:
A Appear more often in older persons
B Decrease visual acuity
C Increase in size very slowly over time
D Show elastosis of collagen histologically
E Have an association with sunlight exposure
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Question 7 A 34-year-old female with recent onset of right eye pain and irritation is noted to have an irregular dendritic corneal ulcer with slit lamp examination. This lesion is probably due to infection with:
A Candida albicans
B Pseudomonas aeruginosa
C Hemophilus aegypticus
D Acanthameba
E Herpes simplex virus
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Question 8 A 17 year old female is 188 cm tall. She has long, thin fingers. Examination of her eyes reveals dislocated lenses. These findings are features of:
A Marfan's syndrome
B Osteogenesis imperfecta
C Glaucoma
D Aging
E Infection
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Question 9 A 4 year old boy has lost vision in the right eye. Other children in his family have had a similar problem, with many losing vision in both eyes. A presumptive diagnosis of an intraocular tumor is made. Which of the following statements is LEAST appropriate for this condition:
A Leukocoria is often noted on physical examination
B The patient may have inherited a faulty tumor suppressor gene
C The tumor is composed of small blue cells that form rosettes
D Dystrophic calcification is often seen histologically
E The tumor often spreads via scleral vascular channels
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Question 10 A 41 year old female with a history of intravenous drug abuse presents with a 1 day history of severe headache and high fever. She has marked nuchal rigidity. You suspect that her intracranial cerebrospinal fluid pressure is increased. Which of the following funduscopic examination findings is most likely to be present:
A Deepening of the optic cup with excavation
B Arteriolar narrowing
C Neovascularization of the optic nerve
D An elevation and swelling of the optic nerve
E Flame-shaped hemorrhages
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Question 11 An obese 50 year old male has a serum glucose of 171 mg/dL and a hemoglobin A1C that is increased. He has decreased visual acuity. A funduscopic examination reveals a proliferative retinopathy. Which of the following findings is most characteristic for this process:
A Capillary microaneurysms
B Dot and blot hemorrhages
C Neovascularization
D Flame-shaped hemorrhages
E Hard exudates
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Question 12 A firm 0.4 cm nodule is noted on examination of the upper eyelid of a 41 year old male. Biopsy of this lesion demonstrates inflammation consisting of lymphocytes admixed with epithelioid cells and giant cells. The diagnosis is most likely to be a(an):
A Pinguecula
B Hordeolum (stye)
C Pterygium
D Chalazion
E Actinic keratosis
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Question 13 A 62 year old female has decreasing vision as a consequence of deepening of the optic cup with excavation, as seen on funduscopic examination, with consequent atrophy of the optic nerve fibers. The disease that led to these findings should have been detected by screening for:
A Elevated serum glucose
B Hypercholesterolemia
C Homocystinuria
D Increased intraocular pressure
E Elevated blood pressure
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Question 14 A difficult to treat complication from wearing contact lenses that affects the cornea of a 30 year old male is:
A Band keratopathy
B Acanthameba infection
C Pterygium
D Staphylococcus aureus infection
E Herpes simplex infection
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Questions 15 and 16: Click on the checkbox first, then the lettered item: (15) A series of tissue samples for frozen section are sent to surgical pathology to make sure the lesion is completely excised. These samples are taken from the margin of a lesion of the medial lower eyelid of a 72 year old male. The lesion has been slowly enlarging for several years, and is now 0.4 cm in diameter, with slightly raised, pearly edges and an ulcerated center.
(16) Funduscopic examination in a 50 year old male with visual loss in the right eye reveals a pigmented uveal mass.
A Basal cell carcinoma
B Glioma
C Retinoblastoma
D Squamous cell carcinoma
E Malignant melanoma
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Question 17 A 62 year old obese male has received no medical care or check-ups for years. He now sees a physician who notes decreased visual acuity, as well as a non-healing ulcer on his left foot. His fasting blood glucose is found to be 175 mg/dL on two occasions. He is referred to an ophthalmologist, who on funduscopic examination observes a background retinopathy with:
A Neovascularization of the disc
B Vitreous hemorrhage
C Fibrous proliferation
D Dot and blot hemorrhage
E Papilledema
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Question 18 A 78 year old male is bothered by slightly decreased vision on the left, worsening over several years' time. He has no pain in the eye. You find a slightly raised, yellowish-white 0.2 x 0.4 cm lesion that encroaches from the conjunctiva onto the corneal surface of his left eye. The funduscopic examination is unremarkable. Which of the following conditions is most likely to explain these findings:
A Hordeolum
B Primary acquired melanosis
C Pterygium
D Herpes simplex keratitis
E Pinguecula
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