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AOBOO Ophthalmology & Otolaryngology-HNS study materials
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AOBOO Ophthalmology & Otolaryngology-HNS practice questions

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Question 1Ophthalmology: Anterior Segment and Cornea

Which layer of the cornea is the primary barrier to infection and is regenerated by limbal stem cells?

  1. Bowman layer
  2. Descemet membrane
  3. Corneal epithelium Correct answer.
  4. Corneal endothelium

Explanation

The corneal epithelium is a stratified, non-keratinized squamous layer that resists pathogens and is continuously renewed by limbal stem cells. Its integrity is the first line of defense against microbial keratitis.

Question 2Ophthalmology: Anterior Segment and Cornea

A patient reports sudden pain and a foreign-body sensation after grinding metal without eye protection. Slit-lamp examination shows a small rust ring with surrounding tissue defect on the cornea. What is the most appropriate next step?

  1. Prescribe topical steroid alone and observe
  2. Remove the foreign body and rust ring under magnification, then treat with topical antibiotic Correct answer.
  3. Schedule routine follow-up in one week
  4. Apply a pressure patch without removal

Explanation

A metallic corneal foreign body with a rust ring should be removed under magnification to prevent corneal scarring and infection, followed by topical antibiotic prophylaxis. Steroids and patching alone do not address retained material.

Question 3Ophthalmology: Anterior Segment and Cornea

Which clinical finding is most characteristic of a dendritic ulcer from herpes simplex keratitis?

  1. Branching epithelial lesion with terminal bulbs that stains with fluorescein Correct answer.
  2. Diffuse punctate staining in a whorl pattern
  3. Raised gelatinous limbal nodule
  4. Circular stromal infiltrate with hypopyon

Explanation

HSV epithelial keratitis produces a branching dendritic ulcer with terminal bulbs, best seen with fluorescein and rose bengal staining. This reflects virus-mediated epithelial destruction.

Question 4Ophthalmology: Anterior Segment and Cornea

A 70-year-old presents with a painful red eye, decreased vision, and a hypopyon. Examination reveals a corneal epithelial defect with dense stromal infiltrate. What is the most important initial management step?

  1. Pressure patching and oral analgesia
  2. Topical antiviral therapy
  3. Topical steroid and observation
  4. Corneal scraping for culture and immediate topical fortified antibiotic therapy Correct answer.

Explanation

Bacterial keratitis with a hypopyon is a sight-threatening emergency; corneal scraping for culture guides therapy while fortified topical antibiotics are started immediately. This addresses the likely bacterial etiology and prevents progression.

Question 5Ophthalmology: Anterior Segment and Cornea

Which of the following best describes the function of the corneal endothelium?

  1. Production of the epithelial basement membrane
  2. Synthesis of stromal collagen
  3. Active fluid transport to maintain corneal deturgescence Correct answer.
  4. Secretion of the tear film lipid layer

Explanation

The endothelium uses Na+/K+-ATPase pumps to move fluid out of the stroma, keeping the cornea clear and dehydrated. Loss of endothelial cells leads to corneal edema.

Question 6Ophthalmology: Anterior Segment and Cornea

A patient with keratoconus is being evaluated for refractive surgery. Which finding on corneal topography most strongly suggests keratoconus?

  1. Diffuse symmetric steepening
  2. Superior flattening with regular astigmatism
  3. Central spherical flattening
  4. Inferior steepening with asymmetric astigmatism Correct answer.

Explanation

Keratoconus classically shows inferior corneal steepening with asymmetric astigmatism on topography. This pattern reflects localized thinning and protrusion.

Question 7Ophthalmology: Anterior Segment and Cornea

Which of the following is the most common cause of a corneal abrasion in children?

  1. Contact lens wear
  2. Fingernail scratch during play Correct answer.
  3. Ultraviolet radiation exposure
  4. Chemical burn

Explanation

In children, corneal abrasions most often result from accidental fingernail or object scratches during play. Chemical and radiation injuries are less common mechanisms in this age group.

Question 8Ophthalmology: Anterior Segment and Cornea

A patient presents with a painful, red eye and a fluorescein-stained epithelial defect. Which additional test is most useful to rule out a retained foreign body under the upper eyelid?

  1. Measuring intraocular pressure
  2. Testing color vision
  3. Performing gonioscopy
  4. Everting the upper eyelid and inspecting the tarsal conjunctiva Correct answer.

Explanation

Everting the upper eyelid allows inspection of the tarsal conjunctiva, where foreign bodies commonly lodge and cause linear abrasions. This is essential when a foreign body is suspected.

Question 9Ophthalmology: Anterior Segment and Cornea

Which of the following is a recognized risk factor for Acanthamoeba keratitis?

  1. Chronic topical steroid use without contact lenses
  2. Recent cataract surgery
  3. Contact lens wear with exposure to tap water Correct answer.
  4. Diabetes mellitus

Explanation

Acanthamoeba keratitis is strongly associated with contact lens wear, particularly exposure to contaminated water sources such as tap water or swimming pools. This protozoan adheres to lenses and causes a painful keratitis.

Question 10Ophthalmology: Anterior Segment and Cornea

A 60-year-old with long-standing rheumatoid arthritis presents with peripheral corneal thinning and an overhanging edge. Which condition is most likely?

  1. Mooren ulcer Correct answer.
  2. Pellucid marginal degeneration
  3. Terrien marginal degeneration
  4. Corneal ectasia after LASIK

Explanation

Mooren ulcer is a painful peripheral ulcerative keratitis with an overhanging edge, often associated with autoimmune disease. It results from immune-mediated destruction of peripheral corneal stroma.

Question 11Ophthalmology: Anterior Segment and Cornea

Which of the following is the treatment of choice for epithelial herpes simplex keratitis?

  1. Topical trifluridine or oral acyclovir Correct answer.
  2. Topical atropine alone
  3. Topical corticosteroid alone
  4. Topical antibiotic

Explanation

Epithelial HSV keratitis is treated with topical antivirals such as trifluridine or oral acyclovir to inhibit viral replication. Steroids are avoided in epithelial disease because they can worsen it.

Question 12Ophthalmology: Anterior Segment and Cornea

Which corneal dystrophy is characterized by bilateral, symmetric, granular deposits in the anterior stroma that stain with Masson trichrome?

  1. Macular corneal dystrophy
  2. Granular corneal dystrophy Correct answer.
  3. Lattice corneal dystrophy
  4. Fuchs endothelial dystrophy

Explanation

Granular corneal dystrophy features discrete hyaline deposits in the anterior stroma that stain red with Masson trichrome. The lesions are bilateral and symmetric.

Question 13Ophthalmology: Anterior Segment and Cornea

A patient with advanced Fuchs endothelial dystrophy develops corneal edema. Which surgical option is most appropriate when the stroma is still healthy?

  1. Radial keratotomy
  2. Descemet stripping endothelial keratoplasty Correct answer.
  3. Penetrating keratoplasty
  4. Phototherapeutic keratectomy

Explanation

Descemet stripping endothelial keratoplasty replaces only the diseased endothelium and preserves the healthy stroma, offering faster recovery. Penetrating keratoplasty is reserved for more extensive disease.

Question 14Ophthalmology: Anterior Segment and Cornea

Which of the following best describes the appearance of a pterygium?

  1. Diffuse corneal edema
  2. Cystic conjunctival swelling
  3. Raised pigmented limbal lesion
  4. Fibrovascular growth from the conjunctiva onto the cornea Correct answer.

Explanation

A pterygium is a fibrovascular wedge of conjunctiva that extends onto the cornea, typically from the nasal side. It is associated with ultraviolet exposure.

Question 15Ophthalmology: Anterior Segment and Cornea

A patient with a pterygium has significant astigmatism and recurrent inflammation. What is the most appropriate definitive management?

  1. Topical steroid indefinitely
  2. Topical antibiotic drops
  3. Surgical excision with conjunctival autograft Correct answer.
  4. Observation with sunglasses only

Explanation

Symptomatic pterygia causing astigmatism or recurrent inflammation are treated with excision and conjunctival autograft to reduce recurrence. This addresses the fibrovascular growth directly.

Question 16Ophthalmology: Anterior Segment and Cornea

Which of the following is a common cause of non-healing corneal epithelial defect in a patient with diabetes and chronic topical drop use?

  1. Epithelial toxicity from preservatives Correct answer.
  2. Endothelial pump failure
  3. Excess tear production
  4. Increased corneal sensitivity

Explanation

Preservatives such as benzalkonium chloride can cause epithelial toxicity and impair healing, especially with frequent drop use. This is a common cause of persistent epithelial defects.

Question 17Ophthalmology: Anterior Segment and Cornea

Which of the following findings is most consistent with a chemical burn to the eye?

  1. Dendritic epithelial lesion
  2. Limbal ischemia and conjunctival blanching Correct answer.
  3. Raised gelatinous limbal nodule
  4. Circular stromal infiltrate

Explanation

Chemical burns cause limbal ischemia and conjunctival blanching due to vascular damage, which is a key prognostic sign. Immediate irrigation is the priority.

Question 18Ophthalmology: Anterior Segment and Cornea

A patient presents after an alkali splash to the eye. What is the most important immediate step?

  1. Application of topical steroid before irrigation
  2. Referral for corneal transplant
  3. Copious irrigation with saline or balanced salt solution Correct answer.
  4. Pressure patching

Explanation

Immediate copious irrigation dilutes and removes the alkali, limiting tissue penetration and damage. This must precede other interventions.

Question 19Ophthalmology: Anterior Segment and Cornea

Which of the following is a feature of Terrien marginal degeneration?

  1. Painful central ulceration
  2. Diffuse punctate keratitis
  3. Painless superior peripheral corneal thinning with lipid deposition Correct answer.
  4. Inferior band-like thinning

Explanation

Terrien marginal degeneration is a painless, slowly progressive superior peripheral thinning with lipid deposition and vascularization. It is distinct from inflammatory ulcerative keratitis.

Question 20Ophthalmology: Anterior Segment and Cornea

Which of the following is the most appropriate treatment for a small, non-infected corneal abrasion?

  1. Topical antibiotic ointment and follow-up Correct answer.
  2. Immediate corneal transplant
  3. Systemic antibiotics
  4. Topical steroid

Explanation

Small, uncomplicated corneal abrasions are managed with topical antibiotic ointment to prevent infection and promote healing. Most heal within days.

Question 21Ophthalmology: Anterior Segment and Cornea

Which of the following conditions is most likely to cause a sterile corneal melt in a patient with severe dry eye?

  1. Bacterial keratitis
  2. Herpes zoster ophthalmicus
  3. Acanthamoeba keratitis
  4. Rheumatoid arthritis-associated keratoconjunctivitis sicca Correct answer.

Explanation

Severe dry eye associated with rheumatoid arthritis can lead to sterile corneal melting due to immune-mediated stromal destruction. This is a vision-threatening complication requiring systemic immunosuppression.

Question 22Ophthalmology: Anterior Segment and Cornea

Which of the following is the most common cause of infectious keratitis in contact lens wearers?

  1. Pseudomonas aeruginosa Correct answer.
  2. Herpes simplex virus
  3. Acanthamoeba
  4. Fusarium species

Explanation

Pseudomonas aeruginosa is the most common cause of contact lens-associated bacterial keratitis, often presenting rapidly with a corneal infiltrate. Prompt antibiotic therapy is essential.

Question 23Ophthalmology: Anterior Segment and Cornea

A patient with a history of herpes zoster ophthalmicus develops a persistent epithelial defect with reduced corneal sensation. What is the most likely diagnosis?

  1. Fungal keratitis
  2. Bacterial keratitis
  3. Neurotrophic keratitis Correct answer.
  4. Mooren ulcer

Explanation

Neurotrophic keratitis results from loss of corneal sensation, leading to impaired epithelial healing and persistent defects. Herpes zoster is a common cause.

Question 24Ophthalmology: Anterior Segment and Cornea

Which of the following is a characteristic finding in lattice corneal dystrophy?

  1. Amyloid deposits that stain with Congo red Correct answer.
  2. Hyaline deposits staining with Masson trichrome
  3. Glycosaminoglycan deposits staining with alcian blue
  4. Endothelial guttae

Explanation

Lattice corneal dystrophy is characterized by amyloid deposits that stain with Congo red and show birefringence. This distinguishes it from granular and macular dystrophies.

Question 25Ophthalmology: Anterior Segment and Cornea

A patient with a corneal ulcer and a history of contact lens wear is suspected of having fungal keratitis. Which feature most supports this diagnosis?

  1. Dendritic epithelial lesion
  2. Limbal ischemia
  3. Feathery infiltrate margins with satellite lesions Correct answer.
  4. Hypopyon with rapid onset

Explanation

Fungal keratitis often shows feathery infiltrate margins, satellite lesions, and a slower course. These features help distinguish it from bacterial keratitis.

Question 26Ophthalmology: Anterior Segment and Cornea

A healthy 24-year-old presents with a 2 mm central corneal abrasion after a fingernail injury. Which medication should be avoided during management of this injury?

  1. Preservative-free artificial tears
  2. Oral analgesics such as ibuprofen
  3. Topical erythromycin ointment
  4. Topical tetracaine for pain control Correct answer.

Explanation

Topical anesthetics are toxic to the corneal epithelium and inhibit healing; they are never used for ongoing pain control in corneal abrasion. They may be used briefly in the clinic to facilitate examination only.

Question 27Ophthalmology: Anterior Segment and Cornea

Which organism is the most frequent cause of bacterial corneal ulcer in a contact lens wearer?

  1. Haemophilus influenzae
  2. Pseudomonas aeruginosa Correct answer.
  3. Moraxella catarrhalis
  4. Streptococcus pneumoniae

Explanation

Pseudomonas aeruginosa is the classic and most common cause of contact lens-associated bacterial keratitis, favored by biofilm formation on lenses and cases. Gram-positive organisms such as staphylococci are more common in non-lens-related ulcers.

Question 28Ophthalmology: Anterior Segment and Cornea

A 45-year-old with long-standing atopic dermatitis presents with a non-healing peripheral corneal ulcer and a history of eye rubbing. Slit lamp shows a shield-shaped epithelial defect with a rolled leading edge. Which diagnosis is most likely?

  1. Marginal keratitis
  2. Herpes simplex keratitis
  3. Mooren ulcer Correct answer.
  4. Vernal keratoconjunctivitis

Explanation

Mooren ulcer is a painful, progressive peripheral corneal ulceration with a characteristic overhanging edge, often associated with eye rubbing and immune dysregulation. The shield-shaped defect and rolled edge distinguish it from limbal-adjacent hypersensitivity reactions.

Question 29Ophthalmology: Anterior Segment and Cornea

A 70-year-old presents with gradual painless visual loss and glare. Slit lamp shows central corneal epithelial edema with Descemet folds and endothelial guttata. Which finding best confirms the diagnosis of Fuchs endothelial dystrophy?

  1. Conjunctival injection with limbal follicles
  2. Anterior stromal granular opacities
  3. Specular microscopy showing reduced endothelial cell density Correct answer.
  4. Corneal pachymetry of 480 micrometers

Explanation

Fuchs dystrophy is characterized by accelerated endothelial cell loss and guttata, which is documented by specular microscopy showing reduced cell density with pleomorphism. Corneal edema and Descemet folds are downstream consequences of failing endothelial pump function.

Question 30Ophthalmology: Anterior Segment and Cornea

A patient with advanced keratoconus and prior hydrops develops a central corneal scar with severe irregular astigmatism and intolerance of rigid contact lenses. Which surgical option is most appropriate?

  1. Radial keratotomy
  2. Corneal collagen cross-linking alone
  3. Photorefractive keratectomy
  4. Penetrating keratoplasty Correct answer.

Explanation

When keratoconus is complicated by a central scar and contact lens intolerance, full-thickness penetrating keratoplasty is the definitive option because it replaces the scarred host tissue. Cross-linking stabilizes progression but cannot remove a scar or correct severe irregular astigmatism.

Question 31Ophthalmology: Posterior Segment, Retina, and Vitreous

Which retinal layer is responsible for the initial conversion of light into an electrical signal?

  1. Bipolar cell dendrites
  2. Retinal ganglion cells
  3. Retinal pigment epithelium
  4. Photoreceptor outer segments Correct answer.

Explanation

Photoreceptors (rods and cones) contain photopigment in their outer segments where photons trigger the phototransduction cascade. Ganglion cells and bipolar cells process and relay signals downstream rather than performing phototransduction.

Question 32Ophthalmology: Posterior Segment, Retina, and Vitreous

A patient reports a sudden shower of floaters with a curtain-like shadow across the temporal visual field. Which structure is most likely detached?

  1. Ciliary body
  2. Vitreous cortex
  3. Choroid
  4. Retina Correct answer.

Explanation

Photopsia, a sudden floater shower, and a peripheral visual field defect (curtain) are classic for rhegmatogenous retinal detachment. The visual field defect corresponds to the area of detached retina.

Question 33Ophthalmology: Posterior Segment, Retina, and Vitreous

What is the most common cause of exudative (serous) retinal detachment in older adults?

  1. Retinoschisis
  2. Rhegmatogenous retinal tear
  3. Choroidal neovascularization Correct answer.
  4. Ocular toxocariasis

Explanation

Exudative detachment results from fluid accumulation without a retinal break, most often from neovascular age-related macular degeneration with choroidal neovascularization. Rhegmatogenous detachment requires a full-thickness break.

Question 34Ophthalmology: Posterior Segment, Retina, and Vitreous

Which finding on fundoscopy is characteristic of a retinal vein occlusion?

  1. Cherry-red spot at the fovea
  2. Flame-shaped hemorrhages along the arcades Correct answer.
  3. Peripheral laser scars
  4. Retinal dialyses

Explanation

Retinal vein occlusion produces venous engorgement, cotton-wool spots, and flame-shaped hemorrhages following the distribution of the obstructed vein. The cherry-red spot is associated with central retinal artery occlusion.

Question 35Ophthalmology: Posterior Segment, Retina, and Vitreous

A patient with poorly controlled diabetes has microaneurysms, dot-blot hemorrhages, and hard exudates but no neovascularization. What stage of diabetic retinopathy is this?

  1. Diabetic macular edema with vitreous hemorrhage
  2. Nonproliferative diabetic retinopathy Correct answer.
  3. Advanced diabetic eye disease
  4. Proliferative diabetic retinopathy

Explanation

Microaneurysms, intraretinal hemorrhages, and hard exudates without neovascularization define nonproliferative diabetic retinopathy. Proliferative disease requires neovascularization of the disc or elsewhere.

Question 36Ophthalmology: Posterior Segment, Retina, and Vitreous

Which type of age-related macular degeneration is characterized by choroidal neovascular membranes?

  1. Macular hole
  2. Neovascular (wet) AMD Correct answer.
  3. Central serous chorioretinopathy
  4. Non-exudative (dry) AMD

Explanation

Neovascular or wet AMD is defined by choroidal neovascularization, which leaks and causes rapid central vision loss. Dry AMD features drusen and geographic atrophy without neovascular membranes.

Question 37Ophthalmology: Posterior Segment, Retina, and Vitreous

Which retinal finding is a classic sign of a retinal break in a patient with acute posterior vitreous detachment?

  1. Cherry-red macula
  2. Drusen
  3. Tobacco dust (pigmented cells) in the vitreous Correct answer.
  4. Retinal neovascularization

Explanation

Pigmented cells in the vitreous, termed tobacco dust, indicate a retinal break with release of RPE cells and warrant careful peripheral examination. Drusen and neovascularization are unrelated chronic findings.

Question 38Ophthalmology: Posterior Segment, Retina, and Vitreous

Which structure separates the vitreous body from the retina at the posterior pole?

  1. Descemet membrane
  2. Bruch membrane
  3. Internal limiting membrane Correct answer.
  4. Retinal pigment epithelium

Explanation

The internal limiting membrane is the innermost retinal layer bordering the vitreous and forms the posterior vitreous face interface. Posterior vitreous detachment occurs at this interface.

Question 39Ophthalmology: Posterior Segment, Retina, and Vitreous

A 68-year-old reports sudden painless loss of central vision with a normal peripheral field. Fundoscopy shows a cherry-red spot. Which diagnosis is most likely?

  1. Central retinal artery occlusion Correct answer.
  2. Central retinal vein occlusion
  3. Vitreous hemorrhage
  4. Retinal detachment

Explanation

Central retinal artery occlusion causes sudden painless central vision loss with a pale retina and cherry-red fovea due to preserved choroidal circulation. Retinal vein occlusion produces hemorrhages rather than a cherry-red spot.

Question 40Ophthalmology: Posterior Segment, Retina, and Vitreous

A patient with proliferative diabetic retinopathy develops sudden painless vision loss and a fundus obscured by blood. What is the most likely cause?

  1. Central serous chorioretinopathy
  2. Optic neuritis
  3. Retinal artery occlusion
  4. Vitreous hemorrhage Correct answer.

Explanation

Neovascularization in proliferative diabetic retinopathy is fragile and prone to bleed into the vitreous, causing sudden vision loss with a hazy or obscured fundus. Central serous chorioretinopathy causes localized serous detachment, not vitreous blood.

Question 41Ophthalmology: Posterior Segment, Retina, and Vitreous

Which imaging modality is most useful for detecting subretinal fluid and quantifying macular thickness in exudative retinal disease?

  1. Fluorescein angiography
  2. Indocyanine green angiography
  3. B-scan ultrasonography
  4. Optical coherence tomography Correct answer.

Explanation

Optical coherence tomography provides cross-sectional retinal imaging and is the standard for detecting and monitoring subretinal fluid and macular thickness. Fluorescein angiography shows leakage patterns but does not quantify thickness.

Question 42Ophthalmology: Posterior Segment, Retina, and Vitreous

A patient with a macula-sparing rhegmatogenous retinal detachment is evaluated. Why is macular involvement important prognostically?

  1. Macular detachment causes cataract
  2. Macular detachment prevents surgical repair
  3. Macular detachment markedly reduces final visual acuity Correct answer.
  4. Macular detachment increases intraocular pressure

Explanation

Final visual acuity after repair is strongly related to whether the macula was detached; macula-on detachments have better postoperative acuity. Surgery is still feasible regardless of macular status.

Question 43Ophthalmology: Posterior Segment, Retina, and Vitreous

Which finding distinguishes branch retinal vein occlusion from branch retinal artery occlusion?

  1. Sectoral hemorrhages and venous engorgement Correct answer.
  2. Vitreous hemorrhage
  3. Cherry-red spot at the fovea
  4. Sectoral retinal pallor with narrowed arterioles

Explanation

Branch retinal vein occlusion produces sectoral hemorrhages, venous engorgement, and edema in the affected quadrant. Branch retinal artery occlusion causes sectoral pallor with narrowed arterioles.

Question 44Ophthalmology: Posterior Segment, Retina, and Vitreous

A young patient with type A personality reports blurred central vision; OCT shows a serous macular detachment with no hemorrhage. What is the most likely diagnosis?

  1. Retinitis pigmentosa
  2. Proliferative diabetic retinopathy
  3. Neovascular AMD
  4. Central serous chorioretinopathy Correct answer.

Explanation

Central serous chorioretinopathy typically affects younger patients, often with stress or corticosteroid use, and causes serous macular detachment without hemorrhage. Neovascular AMD occurs in older patients with hemorrhage and exudation.

Question 45Ophthalmology: Posterior Segment, Retina, and Vitreous

Which medication class is a well-established risk factor for central serous chorioretinopathy?

  1. Corticosteroids Correct answer.
  2. Beta-blockers
  3. Proton pump inhibitors
  4. Statins

Explanation

Corticosteroid use, whether systemic, topical, or injected, is strongly associated with central serous chorioretinopathy. Other listed classes are not established risk factors.

Question 46Ophthalmology: Posterior Segment, Retina, and Vitreous

A patient with sickle cell disease presents with sudden vision loss and a fundus showing sea-fan neovascularization. Which process best explains this finding?

  1. Peripheral retinal ischemia driving VEGF release Correct answer.
  2. Vitreous traction alone
  3. Choroidal neovascularization
  4. Photoreceptor degeneration

Explanation

Sickle cell retinopathy causes peripheral ischemia, which upregulates VEGF and leads to sea-fan neovascularization. These fragile vessels can bleed, causing sudden vision loss.

Question 47Ophthalmology: Posterior Segment, Retina, and Vitreous

Which feature on optical coherence tomography suggests chronic rather than acute central serous chorioretinopathy?

  1. Subretinal fibrin
  2. Large serous detachment
  3. Spontaneous resolution
  4. RPE atrophy and irregularity Correct answer.

Explanation

Chronic central serous chorioretinopathy shows RPE atrophy and irregularity with persistent fluid, reflecting long-standing disease. Acute disease more often shows a simple serous detachment that may resolve spontaneously.

Question 48Ophthalmology: Posterior Segment, Retina, and Vitreous

A patient with a macular hole is most likely to report which symptom?

  1. Painful eye movements
  2. Central distortion and a small central scotoma Correct answer.
  3. Flashes of light only
  4. Peripheral curtain-like field loss

Explanation

A macular hole causes a central visual defect with metamorphopsia because the fovea is disrupted. Peripheral field loss and pain are not features of macular holes.

Question 49Ophthalmology: Posterior Segment, Retina, and Vitreous

Which condition is characterized by bilateral progressive night blindness, bone-spicule pigmentation, and a ring scotoma?

  1. Retinal vein occlusion
  2. Central serous chorioretinopathy
  3. Diabetic retinopathy
  4. Retinitis pigmentosa Correct answer.

Explanation

Retinitis pigmentosa is an inherited photoreceptor degeneration causing night blindness, bone-spicule pigmentation, and progressive peripheral field loss. The other conditions are acquired vascular or exudative disorders.

Question 50Ophthalmology: Posterior Segment, Retina, and Vitreous

A patient with a rhegmatogenous retinal detachment and a visible horseshoe tear at the superior periphery is treated. Which principle underlies scleral buckling?

  1. Reducing intraocular pressure permanently
  2. Destroying ischemic retina with laser
  3. Replacing the vitreous with silicone oil
  4. Approximating the retinal break to the RPE to promote adhesion Correct answer.

Explanation

Scleral buckling indents the eye wall to bring the retinal break into contact with the RPE, allowing a chorioretinal adhesion to form. Vitrectomy and laser serve different roles in detachment repair.