SPEX Exam Ophthalmology

Question 1

A 65-year-old man presents with sudden-onset severe right eye pain, headache, nausea, and blurred vision.
The eye appears red, the cornea is hazy, and the pupil is mid-dilated and non-reactive.
The most likely diagnosis is:

Accepted Answer

Acute angle-closure glaucoma

Answer

Acute anterior uveitis

Answer

Bacterial conjunctivitis

Answer

Corneal abrasion

Question 2

A 72-year-old hypertensive woman reports sudden, painless, complete loss of vision in her right eye. On fundoscopy, the retina appears pale and edematous with a 'cherry-red spot' at the fovea. The most likely diagnosis is:

Accepted Answer

Central retinal artery occlusion

Answer

Central retinal vein occlusion

Answer

Vitreous hemorrhage

Answer

Anterior ischemic optic neuropathy

Question 3

A 30-year-old woman presents with a painful red eye, photophobia, and excessive tearing. She wears contact lenses daily and reports sleeping in them. Slit-lamp examination reveals a central corneal ulcer with mucopurulent discharge. The most appropriate initial management is:

Accepted Answer

Immediate referral to ophthalmology and discontinuation of contact lens wear

Answer

Topical corticosteroids to reduce inflammation

Answer

Oral acyclovir empirically for presumed HSV keratitis

Answer

Saline irrigation and patching of the eye

Question 4

A 60-year-old man with poorly controlled diabetes reports gradually worsening vision in both eyes over 2 years. Fundoscopy shows microaneurysms, dot-blot hemorrhages, hard exudates near the macula, and new vessel proliferation on the optic disc. The stage of retinopathy is:

Accepted Answer

Proliferative diabetic retinopathy

Answer

Mild non-proliferative diabetic retinopathy

Answer

Moderate non-proliferative diabetic retinopathy

Answer

Severe non-proliferative diabetic retinopathy

Question 5

A 25-year-old construction worker presents with sudden eye pain after hammering metal. He reports a small object hitting his eye. Visual acuity is 20/40. The eye is injected, and there is a small, irregular pupil with a positive Seidel test on slit-lamp. The priority management is:

Accepted Answer

Immediate ophthalmology consultation for suspected open globe injury

Answer

Irrigate the eye copiously and patch it

Answer

Apply a topical anesthetic and foreign body removal at the bedside

Answer

Prescribe topical fluoroquinolone drops and follow up in 48 hours

Question 6

A 78-year-old woman reports gradual, painless loss of central vision over 3 years. She has difficulty recognizing faces but can navigate by peripheral vision. Fundoscopy shows drusen deposits and geographic atrophy in the macular region. Which form of macular degeneration does she have?

Accepted Answer

Dry (atrophic) AMD

Answer

Wet (exudative/neovascular) AMD

Answer

Central serous chorioretinopathy

Answer

Macular hole