2008 Midterm Exam
65. What type of horizontal eye movement does not use the conjugate gaze center involving the PPRF and the MLF? Pursuit. Saccades. Vestibular. Convergence.
Convergence.
61. Duction and version testing is done on an adult patient with an apparent limitation to elevation of their left eye in abduction. The duction movement OS is found to be greater than the movement of the left eye on version testing. This finding is suggestive of a diagnosis from which of the following conditions? Left superior rectus palsy. Thyroid eye disease with involvement greater in the left eye than right eye. Floor fracture of the left eye. Left inferior rectus restriction.
Left superior rectus palsy.
5. Each of the following is true regarding accommodative esotropia EXCEPT: a. Always high AC/A ration. b. Usually intermittent at onset and becoming constant. c. Amblyopia is very common (>95%). d. Rarely develop diplopia.
a. Always high AC/A ration.
86. Bagolini lenses can be used to diagnose all of the following except: a. Amblyopia. b. Torsion. c. Anomalous retinal correspondence. d. Central suppression.
a. Amblyopia
7. What would be the best order of orthoptic treatment for the orthoptist to pursue? a. Amblyopia treatment, antisuppression therapy, diplopia training, amplitudes improvement. b. Amplitudes improvement, diplopia training, antisuppression therapy and amblyopia treatment. c. Amblyopia treatment, diplopia training, amplitude improvement, antisuppression therapy. d.Antisuppression therapy, amblyopia treatment, diplopia training, amplitude improvement
a. Amblyopia treatment, antisuppression therapy, diplopia training, amplitudes improvement.
2. Monocular nystagmus can be associated with: a. Mutation of the P-gene. b. Chiasmal glioma. c. Motor nystagmus. d. Equal vision.
b. Chiasmal glioma.
93. Manifest latent nystagmus can be associated with: a. Increasing exponential waveform. b. Ciancia syndrome. c. Excellent stereoacuity, typically 20 arc seconds. d. Face turn toward amblyopic eye.
b. Ciancia syndrome.
35. Medical treatment of congenital nystagmus can include: a. Base in prisms. b. Contact lenses. c. Divergence training to increase divergence amplitudes. d. Physical therapy to resolve torticollis.
b. Contact lenses.
62. A patient being evaluated for new onset vertical diplopia describes the image from the right eye to be tilted with the left side lower. What would you expect to see on Double Maddox Rod testing? a. Incyclotorsion right eye. b. Excyclotorsion right eye. c. Incyclotorsion left eye. d. Excyclotorsion both eyes.
b. Excyclotorsion right eye.
26. The basis for X-linked inheritance is: a. Females have two X chromosomes and males have one Y chromosome. b. Females have two X chromosomes and males have one X chromosome. c. Affected males transmit the genes to all sons and not to any of their daughters. d. Most of the family pedigree will have affected members who are female.
b. Females have two X chromosomes and males have one X chromosome.
56. To improve and stabilize divergence fusional amplitudes, one could employ: a. Base out prisms, stereograms and red/blue dot card. b. Framing, base in prisms, "notch" stereogram. c. Physiologic diplopia, split stereograms, framing. d. None of the above—you cannot improve divergence.
b. Framing, base in prisms, "notch" stereogram.
69. A 29 year-old-male was involved in a snowmobile-tree accident with loss of consciousness. He presents with the complaint of double vision that he can control with a head tilt. Which of the following would be an informative test to perform? a. Randot stereopsis testing in the distance. b. Maddox wing assessment. c. SBISA bar testing. d. 4Δ base out test.
b. Maddox wing assessment.
15. If the patient in question #14 was to have the same symptoms, but had a 10Δ X at near, a near point of convergence of 16 cm, and near point of accommodation of 20 cm, what would your recommendation be now? a. Convergence exercises. b. Reading glasses incorporating plus lenses. c. Surgery for the exodeviation. d. Anticholinesterase eye drops to stimulate the near reflex.
b. Reading glasses incorporating plus lenses.
100. What surgical procedure should be used to correct a V pattern XT? a. Recess both lateral recti and move them down. b. Recess both lateral recti and move them up. c. Recess both medial recti and move them down. d. Recess both medial recti and move them up.
b. Recess both lateral recti and move them up.
52. The 4Δ base out test is used to test a patient for the presence of: Peripheral fusion. A central area of suppression. Motor fusion ability. Whether the patient can produce a prism convergence response.
A central area of suppression.
54. Visual discomfort occurs in the strabismic patent when two different objects are seen occupying the same place in space. This symptom occurs in patients with: Anomalous retinal correspondence. Retinal rivalry. Eccentric fixation. Bifoveal awareness.
Bifoveal awareness.
57. Fusional amplitudes may be tested using a rotary prism, a prism bar or by a haploscopic instrument. When using the synoptophore to measure convergence ability the arms are moved to produce: Binasal retinal image disparity. Accommodative spasm. Bitemporal retinal image disparity. Homonymous diplopia.
Bitemporal retinal image disparity.
51. Which of the following is considered paradoxical diplopia? Crossed diplopia in an exotropia. Homonymous diplopia in an exotropia. Heteronymous diplopia in an exotropia. Uncrossed diplopia in an esotropia.
Homonymous diplopia in an exotropia.
63. When an object is moved slowly from primary position into left gaze what type of eye movement system is being tested? The vestibular. The saccadic system. The vergence system. Pursuit.
Pursuit.
47. The images of two different objects in free space fall on corresponding retinal elements. This defines: Visual confusion. Panum's area. The horopter. Diplopia.
Visual confusion.
81. Pseudoexotropia may be caused by all of the following except: a. Negative angle kappa. b. Hypertelorism. c. Wide interpupillary distance. d. Retinopathy of prematurity.
a. Negative angle kappa.
97. What is the usual type of surgery performed for the correction of a basic exotropia? a. Bilateral lateral rectus recessions. b. Bilateral medial rectus resections. c. Unilateral medial rectus resection on the dominant eye. d. Lateral rectus recession plus medial rectus resection on the non dominant eye.
a. Bilateral lateral rectus recessions.
21. In line with Mendel's theory of recessive inheritance: a. Both parents have a normal gene, a faulty recessive gene, and are unaffected by the faulty gene. b. There is a 50% chance that the offspring of carriers will be affected. c. There is no chance of children of carriers being carriers. d. The defect will be expressed in the second generation of offspring.
a. Both parents have a normal gene, a faulty recessive gene, and are unaffected by the faulty gene.
39. Your differential for limited upgaze in abduction should include all of the following EXCEPT: a. Brown syndrome. b. Monocular elevation deficiency. c. Superior rectus palsy. d. Congenital Fibrosis.
a. Brown syndrome.
9. Raised intracranial pressure from non-obstructive causes: a. Does not cause dilated ventricles. b. Is generally caused by a brain tumor. c. Often causes bilateral IV nerve weakness. d. May cause cupping of the optic nerve.
a. Does not cause dilated ventricles.
88. Which of these clinical features points to a long-standing superior oblique palsy? a. Facial asymmetry with the distance between orbital rim and jaw smaller on the contralateral side. b. Facial asymmetry with the distance between the orbital rim and jaw smaller on the ipsilateral side. c. Excyclotropia > 15°. d. Patient adopts an anomalous head posture.
a. Facial asymmetry with the distance between orbital rim and jaw smaller on the contralateral side.
49. The order in which the muscles are typically affected in Grave's disease are as follows: a. Inferior Rectus, Medial Rectus, Superior Rectus, Lateral Rectus. b. Superior Rectus, Inferior Rectus, Lateral Rectus, Medial Rectus. c. Inferior Rectus, Lateral Rectus, Superior Rectus, Medial Rectus. d. Inferior Rectus, Inferior Oblique, Superior Rectus, Superior Oblique.
a. Inferior Rectus, Medial Rectus, Superior Rectus, Lateral Rectus.
94. If a hyperopic patient wearing spectacles switches from glasses to contact lenses, how much accommodation is needed to see things clearly at near? a. Less accommodation. b. More accommodation. c. There is no accommodation change. d. The preferred eye will need to accommodate more and the non-preferred eye will need to accommodate less.
a. Less accommodation.
32. What is the common finding in all three types of Duane syndrome? a. Lid fissure narrowing on adduction, widening on abduction. b. Esodeviation. c. Head turn toward affected eye. d. Right eye most commonly affected.
a. Lid fissure narrowing on adduction, widening on abduction.
11. A 5-year-old is referred to your clinic for an opinion regarding his prognosis with surgery for the esotropia that has been present for one year. Findings include 20/20 acuity in each eye, 25Δ RET and 30Δ RET', suppression on W4D, no stereopsis, normal refractive error for age, normal fundus examination, and normal growth and development. Prior to surgery this patient would benefit from: a. P.A.T. test. b. Alternate occlusion for one month. c. Phospholine iodide. d. Patching of the left eye full time for one month.
a. P.A.T. test.
48. Passive antisuppression therapy includes: a. Patching. b. Red filter exercises. c. Synoptophore. d. Framing.
a. Patching.
28. Baclofen may be prescribed to treat patients that have: a. Periodic alternating nystagmus. b. Inferior Oblique myokymia. c. Opsoclonus. d. Square wave jerks.
a. Periodic alternating nystagmus.
75. After cycloplegic retinoscopy of a teenaged patient, what is the next step? a. Remove working distance and assess visual acuity. b. Document your findings and send the patient for exam with the doctor. c. Refine axis with Jackson cross cylinder. d. Refine axis with Risley prism.
a. Remove working distance and assess visual acuity.
80. In the scenario in question 79, after you place your findings in the phoropter, and checked visual acuity, what would be the next step? a. Roughly refine the sphere power. b. Refine the cylinder power with the Jackson cross cylinder. c. Refine the reading addition (bifocal power). d. Perform binocular balancing of the refraction.
a. Roughly refine the sphere power.
98. Comparison of treatment options for intermittent exotropia has shown which of the following to have the highest success rate? a. Surgery with preoperative orthoptic/occlusion therapy. b. Treatment with prisms alone. c. Horizontal muscle surgery alone. d. Preoperative use of minus lenses.
a. Surgery with preoperative orthoptic/occlusion therapy.
30. A patient has a variable strabismus and variable ptosis. Administration of which of the following helps make the diagnosis? a. Tensilon. b. Baclofen. c. Atropine IV. d. Topamax.
a. Tensilon.
25. Variable expressivity is demonstrated when: a. The parent of the affected child expressed the gene but in ways that are not readily recognized. b. The affected person is the result of a new mutation. c. The parent transmitting the gene did not show the trait, even though he or she carried the allele. d. One copy of an allele is sufficient for expression of a trait.
a. The parent of the affected child expressed the gene but in ways that are not readily recognized.
40. Brown syndrome can be differentiated from an isolated IO palsy by the presence of: a. V pattern tendency. b. A pattern tendency. c. Eso deviation in upgaze, and an exo deviation in downgaze. d. An exo deviation in downgaze.
a. V pattern tendency.
4. When performing retinoscopy at 0.67 m. the streak is oriented in the horizontal meridian (and the sweep is vertical), the reflex is neutralized with a +3.00 D lens. When the streak is oriented vertical (and the sweep is horizontal), the reflex is neutralized with a +4.00D lens. What lens would correct this refractive error? a. +3.00/+4.00 x 180º b. +1.50/+1.00 x 90º c. +3.00/+1.00 x 180º d. +1.50/+2.50 x 90º
b. +1.50/+1.00 x 90º
79. A 10 year old patient is seen for poor visual acuity in the left eye (20/50). Previous doctors have attributed this to amblyopia. The patient is wearing glasses with +2.00D sphere on the right and +3.00D sphere on the left. Your retinoscopy over the left lens reveals "with motion" at 90º and "against motion" at 180º. After neutralizing the reflex, you find this over the glasses after you remove your working distance: -1.00 +2.00 X 90º. What would you expect your retinoscopy to be without glasses? a. +3.00 +5.00 X90º. b. +2.00 +2.00 X 90º. c. +1.00 +2.00 X 180º. d. +3.00 -5.00 X 180º.
b. +2.00 +2.00 X 90º.
70. A patient presents with a chin up compensatory head posture to aid in achieving binocular single vision. The examiner find over acting inferior oblique muscles on examination. The patient most likely has: a. An "A" eso pattern. b. A "V" exo pattern. c. A "V" eso pattern. d. An "A" exo pattern.
b. A "V" exo pattern.
67. A surgeon performed bilateral lateral rectus recessions and lowered the insertions sites of the muscles. What was the pre operative deviation? a. V pattern exotropia. b. A pattern exotropia. c. A pattern esotropia. d. V pattern esotropia.
b. A pattern exotropia.
19. An anticholinesterase can be used in which of the following? a. X(T) easily dissociated. b. Accommodative ET. c. Penalization. d. High myopia with poor compliance with glasses.
b. Accommodative ET.
31. Barr Bodies are: a. Darkly staining bodies found in the buccal epithelial cells of human males. b. Always one number less than the number of X chromosomes of an individual. c. Highly condensed, active, X chromosomes. d. Formed when X-activation occurs in early development.
b. Always one number less than the number
53. Measurement of distance stereopsis can be performed using: a. 2 pencil test; Verhoff stereopter. b. American Optical CO. vectograph; M&S visual acuity system. c. Frisby stereo test; TNO stereo test. d. Duochrome test; astigmatic dial.
b. American Optical CO. vectograph; M&S visual acuity system.
41. Which of these conditions would most likely be included in the differential diagnosis of an acute vertical strabismus in a child? a. Accommodative spasm. b. Arthritis. c. Latent hyperopia. d. Pseudotumor cerebri.
b. Arthritis.
43. When used in the management of diplopia, prisms: a. Should always be placed on the preferred eye or eye with the best vision. b. Can be placed obliquely to correct for the horizontal and vertical diplopia. c. Can be used to shift the diplopic image out of the suppression scotoma. d. Are used in incomitant strabismus if they allow the patient to fuse in extreme right or left gaze only.
b. Can be placed obliquely to correct for the horizontal and vertical diplopia.
85. A patient with combined III and VI nerve palsy is likely to have a lesion in the: a. Midbrain. b. Cavernous sinus. c. Cerebral peduncle. d. Posterior cranial fossa.
b. Cavernous sinus.
38. A 6 year old with accommodative ET was well controlled in her +4.00D OU glasses. He returns for scheduled follow up in 3 months and now has 20∆ ET at distance and near through the same Rx. The next management step would be: a. Add bifocals to the glasses. b. Repeat cycloplegic refraction and prescribe full plus. c. Begin prism adaptation. d. Discontinue glasses and refer for strabismus surgery.
b. Repeat cycloplegic refraction and prescribe full plus.
36. Retinoscopy is performed at a distance of 50 cm. How do you modify the value obtained at neutralization to obtain the refraction at infinity? a. Add +2.00 to your streak result. b. Subtract +2.00 to your streak result. c. Add +1.50 to your streak result. d. Subtract +1.50 to your streak result.
b. Subtract +2.00 to your streak result.
12. Extraocular muscles may be distinguished from other skeletal muscles in that: a. They are smaller. b. They have a high nerve fiber to muscle fiber ratio. c. The individual fibers are larger than those found in other voluntary muscles. d. They are not as powerful.
b. They have a high nerve fiber to muscle fiber ratio.
14. A 10 year old male presents complaining of losing his place on the page when he reads and getting headaches after reading for just a few minutes. He hates to read and has difficulty paying attention in class. His grades have slipped significantly since the beginning of the school year. On examination there was no shift at distance and an exophoria of 6Δ at near. Convergence fusional amplitudes measured 8Δ /6Δ at distance and 20Δ /10Δ at near. Near point of convergence was 12 cm. Near point of accommodation was 7.5 cm. Cycloplegic refraction revealed +0.25D OU. Your recommendation would be: a. Refer him to a learning specialist for evaluation of ADHD. b. Give him -2.00D glasses to be used in school to stimulate accommodative convergence. c. Convergence exercises. d. +2.00D glasses for magnification when reading.
c. Convergence exercises.
16. Hering's Law refers to the action of: a. Adducting muscles. b. Yoke muscles. c. Antagonist muscles. d. Ipsilateral synergist muscles.
b. Yoke muscles.
24. Bifocals are appropriate for a patient with which one of the following measurements? a. cc 25Δ ET /cc40Δ ET' wearing full distance correction of +3.00D OU. b. cc ortho / cc 15Δ ET' wearing full distance correction of +1.00D OU. c. sc 20Δ ET first time visit, cycloplegic retinoscopy +3.00D OU. d. cc 10Δ ET / cc13Δ ET' wearing full cycloplegic correction of -2.50D OU.
b. cc ortho / cc 15Δ ET' wearing full distance correction of +1.00D OU.
77. What is the retinoscopy end point of the reflex described in question 76? a. Aim for most of the reflex to be "with motion". b. Aim for most of the reflex to be "against motion". c. Aim for equal motion from each side. d. This is an impossible reflex to neutralize.
c. Aim for equal motion from each side.
17. A three year-old child is found to have an esotropia (uncorrected) of 18Δ in the distance and 35Δ at near. There is a +2.00 refractive error in each eye. Re-measurement with +3.00 lenses at near reduced the deviation to 5Δ E. This problem can be described: a. As a weakness of the lateral rectus muscle that is responsible for the esodeviation. b. As the need to accommodate for clear vision in the distance triggering a spasm of the medial rectus muscles. c. As an excessive convergence response occurring with the accommodate effort needed in order to see clearly at all fixation distances. d. As the medial rectus muscles working more at near than for the distance.
c. As an excessive convergence response occurring with the accommodate effort needed in order to see clearly at all fixation distances.
59. A 4 year old patient is evaluated in the clinic and is found to have an intermittent esotropia of 15Δ in the distance and an intermittent esotropia of 20Δ at near. Visual acuity is equal and normal for age. Before dilation, the retinoscopy streak shows "with motion." What is the next step in devising a treatment plan? a. The retinoscopy indicates myopia, so you would hold up -2.00D sphere lenses and remeasure the patient. b. The retinoscopy indicates hyperopia, so you would hold up +2.00D sphere lenses and remeasure the patient. c. Dilate the patient with cycloplegic eye drops. d. Prescribe +3.00 bifocal lenses.
c. Dilate the patient with cycloplegic eye drops.
6. The Lyon Hypothesis explains that: a. All somatic cells will express both alleles of the female X chromosomes. b. Under normal conditions a male is a mosaic in each tissue derived from somatic cells. c. Dosage compensation is a random event in early human development, except where one of the X chromosomes is abnormal. d. Two gene products are produced in each cell of the female and only one gene product is expressed in each cell of the male.
c. Dosage compensation is a random event in early human development, except where one of the X chromosomes is abnormal.
34. In which patient should checking color vision be part of your examination? a. Brown syndrome. b. Duane syndrome. c. Grave's disease. d. Mobius syndrome.
c. Grave's disease.
92. The inferior division of the III cranial nerve supplies the following extraocular muscles: a. Medial rectus, superior rectus, inferior rectus. b. Medial rectus, lateral rectus, inferior rectus. c. Inferior oblique, medial rectus, inferior rectus. d. Medial rectus, inferior oblique, superior rectus.
c. Inferior oblique, medial rectus, inferior rectus.
89. A patient with a newly diagnosed epiretinal membrane is sent to the orthoptic clinic for evaluation of vertical diplopia. Cover testing does not bring out any strabismus. Which of the tests below would be most helpful? a. Prism cover test. b. Red glass test. c. Lights on/lights off test. d. Prism adaptation.
c. Lights on/lights off test.
55. Which medication is commonly used to treat myasthenia gravis? a. Baclofen. b. Tensilon. c. Mestinon. d. Physostigmine.
c. Mestinon.
95. A patient appears to have abducting nystagmus of the left eye on attempted left gaze. What can cause this? a. Chiasmal glioma. b. Increased intracranial pressure. c. Multiple sclerosis. d. Myasthenia gravis.
c. Multiple sclerosis.
64. A 3 month old boy has a small anterior polar cataract in the right eye. In order treat the resultant amblyopia, which of the following can be placed in the right eye? a. Phospholine iodide. b. Atropine. c. Neosynephrine. d. Viroptic.
c. Neosynephrine.
22. In line with Mendel's theory of autosomal dominant inheritance: a. One parent's sex determines expressivity. b. One parent has a single, faulty dominant gene, which does not affect that parent. c. One parent has a single, faulty dominant gene, which affects that parent. d.The offspring of that parent are almost always carriers
c. One parent has a single, faulty dominant gene, which affects that parent.
42. A patient comes in with a hypodeviation in primary, which of the following could make that deviation change to a hyperdeviation in down gaze? a. Brown syndrome. b. Congenital IV nerve palsy. c. Orbital floor fracture with entrapment of inferior rectus. d. Skew deviation.
c. Orbital floor fracture with entrapment of inferior rectus.
83. The brain's perception of white light is actually a mixture of approximately equal amounts of: a. Red and green light. b. Red, blue, and yellow light. c. Red, green, and blue light. d. Red, yellow, and green light.
c. Red, green, and blue light.
74. Uncorrected visual acuity of a patient is 20/100 in each eye, near and distance. The retinoscopy streak is very dim and you are unable to determine the direction of the streak motion. The next step would be to: a. Document "dim streak" on the chart and have the doctor examine the patient. b. Repeat retinoscopy using a loose cylinder lens from the trial set. c. Repeat retinoscopy using a +10.00D or a -10.00D lens . d. Add another set of cycloplegic eye drops.
c. Repeat retinoscopy using a +10.00D or a -10.00D lens .
44. A patient presents with a description of seeing a shimmering/ blurring of objects precipitated when looking down. What would you consider as a differential? a. Congenital nystagmus. b. Multiple Sclerosis. c. Superior oblique myokymia. d. Entrapment of a muscle.
c. Superior oblique myokymia.
66. During cycloplegic retinoscopy, the streak is "with motion" at axis 180º and "against motion" at axis 90º. What does this tell you about the patient's refractive status? a. The patient is not fully cyclopleged, as there should be "with motion" everywhere. b. The patient has astigmatism; + cylinder at 90º. c. The patient has astigmatism; + cylinder at 180º. d. The patient has astigmatism; + cylinder at 45º.
c. The patient has astigmatism; + cylinder at 180º.
84. A patient presents in the clinic with difficulty elevating one eye. Which of the tests below will help to determine if this is a paretic or restrictive process? a. Doll's head. b. Tensilon test. c. Tonometry in attempted upgaze. d. Double Maddox Rod.
c. Tonometry in attempted upgaze.
58. Patients with dorsal midbrain syndrome commonly demonstrate which following clinical features? a. Periodic alternating nystagmus, upgaze limitation, pupillary miosis. b. Abducting nystagmus, light/near dissociation, convergence weakness. c. Upgaze limitation, light/near dissociation, convergence retraction nystagmus. d. Convergence retraction nystagmus, normal pupillary responses, upgaze paresis.
c. Upgaze limitation, light/near dissociation, convergence retraction nystagmus.
60. A patient presents with an intermittent exotropia and an intermittent left hypotropia. He reports 40 seconds of arc stereopsis. A single Maddox rod is held horizontally over the left eye and the patient fixates on a distance light source. The patient will describe the: a. White light to the right and above the red line. b. Red line to the right and below the light. c. White light to the left and below the red line. d. Red line to the left and above the light.
c. White light to the left and below the red line.
29. X-linked dominant disorders are characterized as: a. Skipping every other generation. b. Affected mothers have carrier sons. c. 25% of daughters of affected mothers are affected. d. 50% of daughters of affected mothers are affected.
d. 50% of daughters of affected mothers are affected.
78. Diplopia awareness exercises have been considered a controversial non-surgical treatment of strabismus by some. An appropriate candidate for such treatment would be: a. A 40 year old accountant with a decompensating exotropia. b. A 20 year old college student with residual esotropia and ARC. c. A 2 year congenital esotrope. d. A 6 year old with a basic intermittent exotropia of 15Δ.
d. A 6 year old with a basic intermittent exotropia of 15Δ.
18. Which of the following would be a poor candidate for orthoptic treatment? a. A patient with divergence insufficiency with diplopia at distance only. b. CI of less than 15Δ exophoria. c. A consecutive esotropia of 5Δ. d. A patient who has no potential for single binocular vision.
d. A patient who has no potential for single binocular vision.
76. A retinoscopy streak has one reflex moving from the periphery to the center in "with motion" pattern and another reflex moving from the other side in "against motion" pattern; the two streaks moving in opposite directions, meeting in the center of the pupil. This describes: a. A cyclic reflex. b. A redundant reflex. c. An aphakic reflex. d. A scissors reflex.
d. A scissors reflex.
68. All of the following are characteristics of congenital esotropia EXCEPT: a. DVD. b. V pattern. c. Latent nystagmus. d. Angel of deviation is 20∆.
d. Angel of deviation is 20∆.
37. The 3 step tests will help in diagnosing the patient in all EXCEPT: a. Superior oblique palsy. b. Superior rectus palsy. c. Inferior oblique palsy. d. Brown syndrome.
d. Brown syndrome.
46. Which of the following is true of down beat nystagmus? a. Most common in infancy. b. Most likely congenital motor nystagmus. c. Localized to malformation near the central caudate nucleus. d. Can occur with herniation of the cerebellum.
d. Can occur with herniation of the cerebellum.
50. What is the most likely head position a patient with a bilateral superior oblique palsy would adopt? a. Chin up. b. Right tilt. c. Left tilt. d. Chin down.
d. Chin down.
33. A 2 year old is noted to have anisocoria. Administration of which of the following helps make the diagnosis? a. Atropine. b. Xalatan. c. Neosynephrine. d. Cocaine.
d. Cocaine.
13. Which of the following findings is most consistent with a typical refractive accommodative esotropia? a. Dissociated vertical deviation (DVD). b. Acquired onset from infancy to 4 years of age. c. Poor to no binocular potential. d. Cycloplegic refraction of +5.00D.
d. Cycloplegic refraction of +5.00D.
23. All of the following are tests that can aide in the diagnosis of Myasthenia Gravis EXCEPT: a. Administering Tensilon. b. Rest/ Ice test. c. Cogan's lid twitch. d. Forced Duction Test.
d. Forced Duction Test.
90. Reverse or occlusion amblyopia: a. Occurs after penalization therapy only. b. Is a result of patching therapy in children under the age of three years of age. c. Is never a result of treatment for anisometropic amblyopia. d. Is easily treated.
d. Is easily treated.
10. A 3 year old with refractive esotropia will not wear her glasses. Which of the following would NOT be helpful in getting her to wear her glasses? a. Atropine. b. Homatropine. c. Mydriacyl. d. Neosynephrine.
d. Neosynephrine.
3. Visual confusion: a. Is synonymous with diplopia. b. Results from treated strabismic amblyopia. c. Is a conflict between the retinae when two objects are superimposed in the presence of orthophoria. d. Occurs when dissimilar objects have the same visual direction in the presence of a manifest deviation.
d. Occurs when dissimilar objects have the same visual direction in the presence of a manifest deviation.
91. Clinical features of congenital nystagmus that may help differentiate it from other forms include: a. Onset only at birth. b. Dampens with divergence. c. Against the rule astigmatism. d. Oscillopsia absent.
d. Oscillopsia absent.
87. Double Maddox Rod testing of a hypertropic patient a reveals excyclotorsion of 5º degrees in primary gaze and 15º in downgaze. What would you expect to see when you assess versions? a. Under action in the field of gaze of both inferior obliques. b. Under action in the field of gaze of both medial rectus muscles. c. Over action in the field of gaze of both superior oblique muscles. d. Over action in the field of gaze of both inferior oblique muscles.
d. Over action in the field of gaze of both inferior oblique muscles.
72. Which of the following combinations of muscle problems would be likely to cause an X pattern? a. Underaction of both inferior obliques and overaction of the superior recti. b. Overaction of both inferior recti and underaction of both superior obliques. c. Overaction of both inferior obliques and underaction of both superior obliques. d. Overaction of both inferior obliques and overaction of both superior obliques.
d. Overaction of both inferior obliques and overaction of both superior obliques.
99. A 10 year old patient presents with a complaint of diplopia at near. Upon further questioning, the child explains that when he tries to see the board at school, the girl who sits in front of him has two heads. He is describing: a. Retinal rivalry and should be reassured that this is normal. b. Pathologic diplopia and needs further neurologic work-up is required. c. Unharmonious anomalous retinal correspondence and further sensory investigation is recommended. d. Physiologic diplopia and the patient should be instructed how to prevent its occurrence.
d. Physiologic diplopia and the patient should be instructed how to prevent its occurrence.
45. Prior to surgical correction of a long-standing esotropia in an adult patient, you are asked to evaluate his fovea-to-fovea correspondence. You do this using: a. Hess screen; Worth 4 lights. b. Bagolini lens; prism offset of the deviation. c. Amblyoscope with the arms set at zero; red filter and a light for distance fixation. d. Prism offset of the deviation in free space; after-image test.
d. Prism offset of the deviation in free space; after-image test.
27. The Bielschowsky head tilt test was advocated in order to differentiate a paresis of which of the pairs listed? a. RSO and RSR. b. RLL and LLR. c. LIR and LIO. d. RSO and LSR.
d. RSO and LSR.
1. A four-year old patient presents with a history of drifting of one eye for the past year. Prism alternate cover test reveals 25Δ X(T) in the distance and 4Δ X at near. In order to create an appropriate treatment plan, this patient should also have: a. A manifest refraction. b. Re-measurement of the near deviation through -3.00 lenses. c. Re-measurement of the distance deviation with +2.00 lenses. d. Re-measurement of the near deviation after 30 - 45 minutes of monocular occlusion.
d. Re-measurement of the near deviation after 30 - 45 minutes of monocular occlusion.
73. A patient with an exotropia and an A pattern requires surgery to correct the divergence and the pattern. The correct procedure would be: a. Recession/resection procedure of one eye with upward displacement of both muscle insertions. b. Recession/resection procedure of one eye with downward displacement of both muscles. c. Recession/resection procedure of one eye with upward displacement of medial rectus. d. Recessions of both lateral rectus with downward displacement of both.
d. Recessions of both lateral rectus with downward displacement of both.
96. Nystagmus that is pendular can be caused by: a. Midbrain lesion. b. Brun's nystagmus. c. Internuclear ophthalmoplegia. d. Septo optic dysplasia.
d. Septo optic dysplasia.
82. A patient presents with a new finding of a left hypertropia that increases in magnitude on right gaze and right tilt, associated with new headaches and fine down beating nystagmus. How would you describe these findings? a. Left superior oblique palsy. b. Right superior oblique palsy. c. Left inferior oblique palsy. d. Skew deviation.
d. Skew deviation.
8. Autosomal dominant inheritance is marked by: a. Two copies of the allele are required for expression of a trait. b. Males are more likely to be affected than are females. c. Two affected persons must have an affected child. d. The gene located on one of 22 autosomes is expressed in the heterozygous state.
d. The gene located on one of 22 autosomes is expressed in the heterozygous state.
71. Which of the following can cause a V pattern? a. Overaction of superior oblique. b. Underaction of inferior oblique. c. Underaction of the right and the left inferior rectus. d. Underaction of the right and the left superior rectus.
d. Underaction of the right and the left superior rectus.
20. Which of the following will NOT aid in the penetration of an eye drop? a. Disruption of the corneal epithelium. b. Placement of a topical anesthetic. c. Punctal occlusion. d.Use of a suspension as opposed to a solution
d.Use of a suspension as opposed to a solution
