Mixed Deck — All Board Certified Ophthalmologist Topics Flashcards
100 cards from real Board Certified Ophthalmologist practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 20 Mixed Deck — All Board Certified Ophthalmologist Topics flashcards as text
Which IOL material has the lowest rate of posterior capsule opacification (PCO)?
Answer: Hydrophobic acrylic
Hydrophobic acrylic IOLs have a sharp square edge design and material properties that create a strong barrier effect against lens epithelial cell migration, resulting in the lowest PCO rates.
A 65-year-old patient develops a peripheral corneal ulcer with an overlying epithelial defect adjacent to an area of limbal injection. Workup reveals elevated ESR and positive c-ANCA. What is the most likely systemic association?
Answer: Granulomatosis with polyangiitis
Peripheral ulcerative keratitis with positive c-ANCA is most strongly associated with granulomatosis with polyangiitis (formerly Wegener's granulomatosis).
A 26-year-old obese female presents with a 2-month history of daily headaches, pulsatile tinnitus, and transient visual obscurations. Fundus examination reveals bilateral optic disc edema. An MRI of the brain is normal. A lumbar puncture is performed, which shows an elevated opening pressure of 32 cm H2O with normal cerebrospinal fluid composition. What is the most likely diagnosis?
Answer: Idiopathic Intracranial Hypertension (IIH)
The patient's demographics (young, obese female), symptoms (headache, pulsatile tinnitus, transient visual obscurations), signs (bilateral papilledema), and diagnostic findings (normal neuroimaging with elevated opening pressure) are all classic for Idiopathic Intracranial Hypertension (IIH), formerly known as pseudotumor cerebri.
Which test is commonly used to evaluate tear production?
Answer: Schirmer test
Glaucoma is a group of eye conditions that damage the optic nerve, often linked to elevated intraocular pressure (IOP). The primary objective of glaucoma treatment is to lower and maintain a healthy IOP. This crucial step helps to prevent further damage to the optic nerve and preserve the patient's remaining vision.
Which aberration causes a point source of light to appear as a comet-shaped blur when imaged through a spherical lens peripherally?
Answer: Coma
Coma produces an asymmetric, comet-shaped image of off-axis point sources due to varying magnification across the lens aperture.
A 4-year-old boy presents with an intermittent exotropia that is well-controlled, occurring less than 50% of waking hours, primarily at distance when he is tired. His visual acuity is 20/20 in each eye, and stereopsis is excellent when his eyes are aligned. Refractive error is plano. Which of the following is the most appropriate initial management strategy?
Answer: Observation with follow-up in 6 months to monitor for progression.
For a well-controlled intermittent exotropia in a young child with good visual acuity and stereopsis, observation is a very reasonable initial approach. Surgery is typically reserved for deviations that are poorly controlled (manifest >50% of the time), increasing in frequency, or associated with a loss of stereopsis or development of a suppression scotoma. While occlusion and over-minus lenses are sometimes used, observation is the most common and appropriate first step when control is good.
In a patient with neovascular glaucoma secondary to proliferative diabetic retinopathy, what is the most critical initial treatment step?
Answer: Panretinal photocoagulation and/or intravitreal anti-VEGF injection
Treating the underlying retinal ischemia with panretinal photocoagulation and anti-VEGF therapy is essential to halt the neovascular drive before addressing IOP surgically.
A patient with a cycloplegic refraction of +5.00 D requires a spectacle lens at a vertex distance of 12 mm. What is the effective power at the corneal plane?
Answer: +5.31 D
Using the effectivity formula, the effective power at a shorter vertex distance increases for plus lenses: +5.00 / (1 - 0.012 x 5.00) = +5.31 D.
What does the Snellen chart primarily assess?
Answer: Visual acuity
Astigmatism is a refractive error caused by an irregularly shaped cornea or lens, leading to blurred or distorted vision at all distances. A cylindrical lens has different curvatures in different meridians, which precisely compensates for the eye's uneven focusing power. This specialized lens helps to converge light rays correctly onto the retina.
Which of the following systemic autoimmune diseases is most frequently associated with the development of necrotizing scleritis?
Answer: Rheumatoid Arthritis
Rheumatoid arthritis is the most common systemic autoimmune disease associated with scleritis, particularly the most severe form, necrotizing scleritis. While other conditions like granulomatosis with polyangiitis (GPA), systemic lupus erythematosus, and inflammatory bowel disease can also be associated with scleritis, rheumatoid arthritis is the most prevalent link found in large patient cohorts.
A 5-year-old child undergoes vision screening and is found to have visual acuity of 20/80 in the right eye and 20/20 in the left eye. The child has no manifest strabismus. Cycloplegic refraction is +6.00 D sphere in the right eye and +1.50 D sphere in the left eye. What is the most likely cause of the decreased vision in the right eye?
Answer: Anisometropic amblyopia
Anisometropic amblyopia occurs when there is a significant difference in refractive error between the two eyes (anisometropia). The brain favors the eye with the clearer image (the left eye in this case) and suppresses the input from the eye with the blurred image (the highly hyperopic right eye), leading to amblyopia. The +4.50 D difference between the eyes is a classic setup for this condition.
What is the first-line treatment for a small, localized sebaceous cell carcinoma of the eyelid with clear margins?
Answer: Mohs micrographic surgery or wide local excision with frozen section control
Sebaceous cell carcinoma requires complete excision with margin control (Mohs or frozen sections) due to its pagetoid spread and high recurrence risk.
Several months after cataract surgery, a patient has low-grade granulomatous inflammation and a white plaque on the posterior capsule. What is the most likely organism?
Answer: Cutibacterium acnes
C. acnes (formerly Propionibacterium) causes chronic, delayed-onset postoperative endophthalmitis with a capsular plaque.
What is the standard treatment regimen for active toxoplasmic retinochoroiditis threatening the macula?
Answer: Pyrimethamine + sulfadiazine + folinic acid (with adjunct corticosteroids)
The classic treatment for vision-threatening toxoplasmic retinochoroiditis is pyrimethamine + sulfadiazine + folinic acid (leucovorin to prevent bone marrow suppression), often combined with systemic corticosteroids.
A neonate presents with bilateral upper eyelid ptosis, inability to elevate either eye, and chin-up head posture. What is the most likely diagnosis?
Answer: Congenital fibrosis of the extraocular muscles
Congenital fibrosis of the extraocular muscles (CFEOM) presents with restrictive ophthalmoplegia, ptosis, and characteristic infraducted eye positions from birth.
During retinoscopy, the examiner sees 'against' motion. What does this mean?
Answer: The patient's far point is between the examiner and the patient; add minus
Against motion means the far point lies in front of the peephole, so minus lens power is needed to reach neutrality.
A 6-month-old with epiphora, photophobia, enlarged corneas, and horizontal Descemet breaks most likely requires which first-line treatment?
Answer: Angle surgery (goniotomy or trabeculotomy)
Primary congenital glaucoma is surgical, with angle surgery as first-line therapy.
Which diagnostic finding on optical coherence tomography (OCT) is most characteristic of early glaucomatous damage?
Answer: Thinning of the retinal nerve fiber layer in the inferior temporal sector
Early glaucomatous damage typically manifests as RNFL thinning, most commonly in the inferior temporal sector corresponding to the arcuate nerve fiber bundles.
About what pinhole diameter gives the best acuity when screening for uncorrected refractive error?
Answer: About 1.2 mm
A pinhole of about 1.2 mm balances a smaller blur circle against increasing diffraction and reduced light.
Which adverse effect is particularly characteristic of netarsudil?
Answer: Cornea verticillata
The Rho kinase inhibitor netarsudil commonly causes hyperemia and whorl-like corneal deposits (verticillata).