CLINICAL SCIENCES International Council of Ophthalmology International Ophthalmology Examinations Clinical Sciences Sample Questions Numbers of questions in each group Clinical Sciences i) General Medicine related to Ophthalmology ‘Community Medicine & Public Health Ophthalmic pathology and Ocular tumours iv) Neuro-ophthalmology v) Paediatric Ophthalmology & Strabismus vi) Orbit, eyelids and lacrimal disease Trauma, External disease and cornea viii) Ocular inflammation and uveitis ix) Glaucoma x) Lens and cataract xi) Retina and vitreous Number of Questions 20 8 12 20 20 20 20 20 20 20 20 On the answer sheet you have to put a BOLD HORIZONTAL line against the letter which you think correctly answers the question, thus:- ‘Answer Number a. b, Questionnumber 1) [1] [ 1 42 t) A Sal 4 1 01 NB. These are not necessarily the correct answers to the above questions Do not forget to mark your answers clearly with a HORIZONTAL line:-[-] Oblique [, even slightly oblique, or faint [- lines will not be marked. You do not HAVE to answer all the questions to pass the examination. Obviously, however, it helps! There are no “trick” questions. If you do not understand the question you may ask the invigilator who may {but cannot guarantee to} be able to help you:Question Formats The formats vary, here are some examples. It is VITAL to read the questions very carefully. Be especially careful with negative questions- those with Not, Least etc (see 4 below) 1. In microbial keratitis, which of the following is most likely to be true? > a. Perforation is common in Pseudomonas keratitis. b. Bacterial and fungal keratitis are clinically distinct. ¢ Fungal keratitis is more common than bacterial keratitis in temperate climates. d Acanthamoeba keratitis typically occurs in people who swim in public swimming baths. 2. A 9-year-old child is admitted for surgery for a penetrating eye injury. His maternal grandmother died under anaesthesia 20 years previously; his mother has never had an anaesthetic. How would an anaesthetist (anesthesiologist) best advise the family? @. To proceed with the normal anaesthetic immediately avoiding the use of Suxamethonium (succinyicholine, Scoline). b. To have a muscle biopsy under local anaesthetic. > ¢.To proceed, avoiding Halothane and having Dantrolene (Dantrolen, Dantrium) available. d. To send blood for urgent mutation analysis k ‘ , A Read carefully, mark True or False look up th tion on the web or in Kt Then check the answers! 3. Difficult question! Figure 3 In Figure 3 (Above), the 18 year old patient with Neurofibromatosis type (NF1) has been blind in the left eye for 3 years and the right eye has a temporal hemianopia with a visual acuity of Log MAR 0.1 (6/6, 20/20, 1.0). Which of these statements is most likely to be correct about the diagnosis? a. There is a bilateral optic nerve glioma. b. There is a tight optic nerve glioma and a left optic nerve meningioma, =@» There is a glioma involving the optic tract, chiasm and left optic nerve, d. The patient has had radiotherapy for a chiasmal gliomaNB the word most in the question implies that alfhough there may be more than one option that may be correct, only one is clearly correct. A value judgement is required. 4 A'NEGATIVE’ QUESTION During a difficult cataract operation, the posterior capsule ruptures and the nucleus completely dislocates into the posterior vitreous. Which of the following would be the LEAST safe next action? @. Sulcus fixation of an intraocular lens, if the anterior capsule is intact beRetrieval of the dislocated lens. cc. Suturing of the corneal wound. d. Anterior vitrectomy. 5. Concerning VISION 2020: The Right to Sight. Which of the following statements is most Correct? a. If successful, VISION 2020 will prevent 500 million people becoming blind. =b=The 5 major causes of avoidable blindness include Refractive Error. c. Men face a greater risk of vision loss than women. d. World Sight Day is observed on the second Thursday of March each year. 6 Which of the following tumours is LEAST likely to cause cellula a. Leukaemia. b. Retinoblastoma c. Large cell lymphoma. 2 Choroidal noemangioma. tration of the vitreous? 7 A patient who cannot voluntarily look upwards but has an intact Bell's phenomenon (an upward and movement of the eve when an attempt is made to close the eyes) most likely has a lesion that is located in which part of the oculomotor system? a. Internuclear. b. Intranuclear. Supranuclear. d. Infranuclear. 8. Which of the following are basement membranes? =e: Descemet's membrane. b. Lens capsule. c. Internal limiting membrane. d. Bowman's layer. % A predominantly papillary conjun @. Viral conjunctivitis. b. Allergic conjunctivitis. Floppy eyelid syndrome. d. Superior limbic conjunctivitis.10. Which of the following tests is the most rapid, sensitive and specific way of diagnosing herpes simplex keratitis? a. Gram stain of scraping. —L_DNA testing. c. Viral culture at 37°, d. Papanicolaou stain of cytology. u. Stage 3 retinopathy of prematurity is defined as which of the following? a. A ridge separating vascularized and avascular retina. -SeExtraretinal fibrovascular proliferation ¢. Localized retinal detachment. d. Dilatation and tortuousily of retinal vessels. 12. Acute, unilateral, visual loss associated with pain on eye movement in a 29-year-old woman is most likely to be optic neuritis i the affected eye has: a. -papilloedema with sightly reduced acuity and colour vision. Pa central scotoma. c.-exudates in Henle’s layer. d.-an inferior altitudinal visual field defect and reduced acuity 13. Where is the largest haemorrhage in figure 13 (above) located anatomically? a. Immediately anterior to the Retinal Pigment Epithelium. \der the internal limiting membrane of the retina. c. In the nerve fibre layer of the retina. d. In the Inner Plexiform layer of the retina.The mother of the 20-year-oldpatient whose fundus photograph is shown in Figure 14 (above) has had one eye blind since she was 18 years old and was treated for renal clear cell carcinoma, The patient was screened from birth for eye and systemic complications. The photograph shows the retinal vessels of the mid-periphery of one quadrant of the retina of one eye. wi h of the following conditions would the patient be most likely also to have? A cerebellar hemangioblastoma . A cavernous retinal hemangioma. c. An arteriovenous malformation in the midbrain. d. A blood Hyperviscosity syndrome. 15. ‘A70 year old man has had three identical episodes in which a blurred area appears in his vision, edged by shimmering, jagged lines, starting paracentrally and expanding to the periphery over 15 minutes. He does not develop a headache. Which is the most likely diagnosis? @. Cryptic arteriovenous malformation. b. Occipital seizure activity. 9 Migraine. Glioblastoma Multiforme. 16. Sturge-Weber Syndrome (encephalotrigeminal angiomatosis) is characterized which of the following? g, Astrocytic hamartomas. Retinal racemose haemangiomas. C. Linear calcification of the brain cortex. d. Haemangioma of the pia of the ventricles.17. Which of the following statements about choroideremia is true? The typical form progresses to blindness in young adult females. Crete are present from childhood, beginning with night blindness. he retinal vessel thinning is the earliest feature. d. The mode of inheritance is usually autosomal recessive. 18. The most common cause of visual loss in a patient with a choroidal osteoma is which of the following? a. Vascular occlusive disease. b. Direct macular involvement. Subretinal neovascularization. Optic atrophy. 19. A serous conjunctival discharge is most likely to be present in a patient with which of the following? a. Acute trachoma. b. Staphylococcus aureus conjunctivitis. c. Vernal conjunctivitis. EpeerP2s simplex conjunctivitis. 20. Which of the following conditions is commonly unilateral? a. Serpiginous choroiditis ("geographic helicoid peripapillary choroidopathy"). b. Best's Vitelliform Dystrophy. uitiple evanescent white dot syndrome ("MEWDS"). d. Acute multifocal posterior placoid pigment epitheliopathy ("AMPPE"). 21. The tight inferior rectus muscle is yoked with the left superior oblique muscle to produce a gaze that is which of the following? @. Up and left. b. Down and left. Down and right. d. Down and right. 22. Which of the following has mitochondrial inheritance? a. Leber’s congenital amaurosis. ‘earns-Sayre syndrome (oculocraniosomatic disease) &. Gyrate alrophy of the choroid and retina. d. Duchenne muscular dystrophy. 23. Regarding entropion, which of the following statements is true? @, Upper lid entropion is usually due to involutional changes. Upper lid entropion results in comeal epithelial damage. ¢. Congenital entropion is associated with orbicularis muscle atrophy. dd. Entropion occurs commonly in facial nerve play.24. Primary open-angle glaucoma is likely to be associated with which of the following? «a. Hypermetropia (hyperopia) b. Juvenile-onset diabetes melitus. ¢. Branch retinal artery occlusion. Increasing age. 25. Concerning tight suturing of incisions, enough to alter the comeal curvature, in extracapsular cataract extraction, which of the following statements is true? a. They steepen the curvature in the meridian of the incision. b. Stepped incisions are more prone to leak. ¢. They steepen the curvature at 90 degrees to the line of the incision. hey flatten the comea in the meridian of the incision. 26. ‘A compensatory head tilt toward the right shoulder is typical in which of the following conditions? @)ett superior oblique paresis. b. Right superior oblique paresis c. Left Duane’s syndrome. d. Right Brown's syndrome. 27. Regarding entropion, which of the following statements is true? @. Upper lid entropion is usually due to involutional changes. b. Upper lid entropion results in dystichiasis. & Congenital entropion is associated with hypertrophy of the orbicularis muscle. d. It Occurs in facial nerve play. 28. Comeal topographic abnormalities are more common and severe in patients who wear which of the following? gid contact lenses. Daily-wear soft contact lenses. c. Extended-wear soft contact lenses. dd. Aphakic soft contact lenses. 29. The Bec initial therapy of a patient with necrotizing scler is which of the following? ‘Oral immunosuppressive therapy. Oral nonsteroidal anti-inflammatory medications. c. Oral corticosteroids. d. Topical corticosteroids.30. The condition shown in Figure X4 may be associated with which of the following? a. -germ cell mosaicism. b. -autosomal recessive inheritance. (© choroidal haemangioma. d. -progression of the skin lesion and bony lesions during adolescence.ANSWERS: 1) 16) 2) 17) 3) oc 18) 4) b 19) 5) b 20) 6) d 21) nc 22) 8) a 23) 9) 24) 10) b 25) nN) b 26) 12) b 27) 13) b 28) 14) a 29) 15) oc 30) oeanecaccanense