BCSC 01, 2015-2020: Update on General Medicine (rev.

2015)

1. The risk of QT prolongation is associated with what medication?

- Azithromycin

2. What is a feature of a partial seizure?

- Automatisms

3. What class of oral hypoglycemic agents has been associated with worsening macular
edema?
- Thiazolidinediones
4. What is the most effective class of drugs for lowering low-density lipoprotein cholesterol
(LDL-C) levels and cardiovascular risk?
- HMG-CoA reductase inhibitors

5. What is the order of steps in the current American Heart Association guidelines for
performing cardiopulmonary resuscitation?
- Compressions, airway, breathing

6. Nocturnal hypotension may be a risk factor for which ocular condition?

- Low-tension glaucoma

7. What is the most common cause of stroke by cardioembolic origin?

- Atrial fibrillation

8. What is one of the earliest intraoperative signs of malignant hyperthermia?

- Unexplained tachycardia

9. The clinical picture of radiation retinopathy resembles that of which ocular condition?
- Diabetic retinopathy

10. What study design is thought to provide the strongest evidence for assessing an
intervention or treatment?
- Meta-analysis

2017 ONE Webinar Recording: Retina or Neuro-Ophthalmology? A Case-Based Discussion

1. <="">In the image, why do the dark spots look like clusters of round lesions?
Closure of choriocapillaris lobules
2. <="">In neuroretinitis, what finding is OCT most useful to detect?
Macular exudate/subretinal fluid
3. <="">Which visual field defect most likely represents an occult macular lesion?
Focal 5-degree fixation-centered
4. <="">In a patient with compressive optic neuropathy, what does a normal RNFL
thickness indicate?
Favorable prognosis after treatment
5. <="">What ancillary testing would you obtain first for a paracentral scotoma with no
visible fundus or optic nerve abnormality?
Macular OCT

BCSC 02, 2014-2017: Fundamentals and Principles

1. What characteristic most affects drug permeability across a cell layer?

- Drugs with higher lipid solubility have better penetration of cell membranes.

2. What statement best describes the anatomy of the greater wing of the sphenoid bone?
- It forms part of the lateral orbital wall.
3. What was a recommendation of the American Academy of Ophthalmology (AAO) Task
Force on Genetic Testing?
- Genetic testing should be offered to patients with clinical findings suggesting a mendelian
disorder for which the causative gene or genes is known.

4. What cells are responsible for maintaining retinal adhesion?

- Retinal pigment epithelial cells

5. What component of aqueous humor protects the eye from the damaging effects of
ultraviolet light?
- Ascorbate

6. What constitutes the outer blood–retina barrier?

- Tight junctions between adjacent retinal pigment epithelial cells

7. What structure–function relationship affects corneal hydration dynamics?

- Proteoglycans comprise approximately 10% of the dry weight of the cornea.
8. In what order do dilating drops rank in their relative duration of drug action?
- Atropine>scopolamine>homatropine>cyclopentolate>tropicamide
9. In embryology, the neural crest pertains to:
- The source of transient migratory stem cells that contribute to the formation of the cornea and
trabecular meshwork.

10. The air–tear-film interface at the surface of the cornea is responsible for approximately
what percentage of the refractive power of the human eye?
- 66%

BCSC 03, 2013-2016: Clinical Optics

1. In which type of astigmatism do the focal lines straddle the retina of the
nonaccommodated eye?
- Mixed astigmatism
2. If K measurements are 7.90 mm (horizontal) and 7.70 mm (vertical), the refractive error
is -3.25 +0.50 × 090, and the base curve of the rigid gas-permeable (RGP) contact lens is
chosen to be 7.80 mm, what is the anticipated (1) power needed by the contact lens and (2)
amount of residual astigmatism?
- (1) −3.25 D sphere and (2) −0.50 D × 090

3. Which of the following statements about the Brewster angle is true?

- It is always smaller than the critical angle.
4. Using a keratometer, you determine the radius of curvature of the central cornea to be
9.0 mm. Assuming an “averaged” corneal refractive index of 1.3375, what is the refractive
power of the central cornea?
- 37.50 D

5. Why is aiming for a slight residual myopia in IOL power selection usually desirable?
- An error in power calculation is less likely to produce a resultant hyperopia, which would result
in blurry vision at all distances.

6. A patient with a comitant 3.00–prism diopter (∆) right hyperphoria wears the following
spectacle correction: OD +3.00 +1.00 × 180 OS −1.00 +0.50 × 090 What is the vertical
imbalance in the reading position, 8 mm below the optical center of the lenses?
- 7.00∆ right hyperdeviation
7. Which of the following statements is true about contact lenses when compared with
spectacles?
- They increase the accommodative requirements of myopic eyes.

8. The spectacles of a patient with myopia are prescribed incorrectly and overminused by
1.00 D. With the correction, the near point of accommodation is 20 cm. What is the eye’s
refractive error and amplitude of accommodation?
- There is not enough information to solve this problem.
9. A patient with congenital nystagmus has a null point measured to be 10° to the left of
fixation. Which of the following prism prescriptions is appropriate to rectify the induced
head turn?
- OS 20∆ BI, OD 20∆ BO
10. What is the retinal magnification of an eye with a refractive error of +5.00 D when
viewed with a direct ophthalmoscope?
- 13.75×

BCSC 04, 2016-2019: Ophthalmic Pathology and Intraocular Tumors

1. What type of cataract is characteristically associated with a systemic disease?
- Bilateral anterior lenticonus (Alport syndrome)

2. A dermoid is an example of what type of tumor?

- Choristoma
3. A 68-year-old woman presents with a slightly elevated lesion on her left lower eyelid. She
states that the lesion has been present for over a year. Clinical examination reveals a pearly
lesion with some telangiectasias and ulceration, and histologic examination reveals nests of
tumor cells with peripheral palisading around the outer edge. What is the most likely
diagnosis?
- Basal cell carcinoma

4. Which organs should be monitored for related neoplasia in a patient with retinal
hemangioblastoma?
- Brain and kidney
5. A 68-year-old woman presents with a slightly elevated lesion on her left lower eyelid. She
states that the lesion has been present for over a year. Clinical examination reveals a pearly
lesion with some telangiectasias and ulceration, and histologic examination reveals nests of
tumor cells with peripheral palisading around the outer edge. What is the most likely
diagnosis?
- Basal cell carcinoma

6. An 82-year-old woman reports vision loss in her left eye, recent weight loss, and
weakness. Examination reveals optic nerve swelling and an afferent pupillary defect.
Because erythrocyte sedimentation rate and C-reactive protein levels are elevated, a
temporal artery biopsy is performed. What is/are the most likely finding(s) of the biopsy?
- Inflammatory infiltrates surrounding the internal elastic lamina
7. A 65-year-old man presents with unilateral painless proptosis. A CT scan reveals an
orbital mass involving the lacrimal gland that molds around the globe and the orbital
bones. The differential diagnosis suggests lymphoma. What would be the best fixative to
use in preparing a tissue sample for flow cytometry?
- Tissue culture medium (eg, RPMI)

8. A biopsy is performed on a gelatinous vascularized limbal conjunctival and corneal mass

in a 70-year-old man. What are the expected histologic findings?
- Dysplastic epithelial cells

9. Iridocorneal endothelial syndrome is associated with what histologic finding(s)?

- Epithelial-like corneal endothelial metaplasia

10. Vitreous sampling is commonly used in the diagnostic confirmation of which

intraocular malignancy?
- Primary intraocular lymphoma

11. What is the most common route for retinoblastoma to spread from the eye?
- Infiltration of the optic nerve

BCSC 05, 2017-2020: Neuro-Ophthalmology

1. <="">Cerebral achromatopsia refers to the loss of color perception caused by a
bilateral lesion at what location?
lingual and fusiform gyrus

2. <="">Delayed photostress test recovery in one eye localizes the lesion to which
anatomical site?
macula

3. <="">Which condition classically presents with an enlarged blind spot as the initial
visual field defect?
papilledema

4. <="">Which of the following is located outside of the optic nerve?

Schwann cells

5. <="">Which spontaneous abnormal eye movement is a true form of nystagmus?

oculopalatal myoclonus

6. <="">An 80-year-old woman is seen in a clinic urgently after experiencing an episode

of sudden transient binocular visual disturbance that resolved spontaneously within 10
minutes on the day of the clinic visit. The patient’s vision was diffusely blurry in both
eyes, then returned to normal. She continues to feel dizzy and unstable. The results of
her ophthalmic examination, including perimetry, are normal. What is the most
appropriate immediate management for this patient?
immediate transfer to an emergency department affiliated with a stroke center

7. <="">Autofluorescence of the optic nerve is helpful in the diagnosis of what

condition?
optic nerve head drusen

8. <="">What special magnetic resonance imaging (MRI) sequence best identifies the
periventricular lesions seen in multiple sclerosis?
FLAIR (fluid-attenuated inversion recovery)

9. <="">The vestibular-ocular system performs what function?

maintains foveal fixation during angular head movements

10. <="">A lesion at which anatomical site can result in alexia without agraphia?
corpus callosum

BCSC 06, 2014-2017: Pediatric Ophthalmology and

Strabismus
1. <="">What is the most common mechanism of glaucoma in Sturge-Weber syndrome?
increased episcleral venous pressure

2. <="">What is the best method for testing monocular vision in a patient with latent
nystagmus (fusion maldevelopment nystagmus syndrome)?
- With a +5.00 D lens in front of the fellow eye

3. <="">What preoperative test is the most appropriate for quantifying torsion during a
strabismus evaluation?
double Maddox rod test

4. <="">What is the most common cause of vision loss in an eye with a unilateral anterior
polar cataract?
- Anisometropic Amblyopia

5. <="">What surgical procedure is preferred as the initial surgery for primary congenital
glaucoma?
goniotomy

6. <="">What sensory examination finding is a typical feature of monofixation syndrome?

peripheral sensory fusion without central fusion
7. <="">A 5-year-old has a V-pattern exotropia. What is the most likely abnormality that
will be found on testing of versions?
inferior oblique muscle overaction

8. <="">In a patient presenting with juvenile idiopathic arthritis, what risk factor is the
most significant for development of uveitis?
ANA positivity

9. <="">A 13-month-old has persistent symptoms of nasolacrimal obstruction following

probing. What is the most appropriate next step in management?
a second probing with placement of lacrimal stents

10. <="">What clinical feature is the most useful for differentiating Brown syndrome from
inferior oblique muscle paralysis?
elevation of the eye as determined by forced-duction testing

BCSC 07, 2015-2018: Orbit, Eyelids & Lacrimal System

1. <="">What bone contains the optic canal?
lesser wing of the sphenoid

2. <="">Within what time frame should a pediatric patient with a trapdoor fracture who has pain on
eye movement and nausea and exhibits a vagal response be taken to surgery?
on an urgent basis

3. <="">A 28-year-old woman presents with a vascular anomaly of the left lower eyelid that is
violaceous and soft, as well as compressible on palpation. Retraction of the lower eyelid reveals a
vermiform subconjunctival mass. There is a marked increase in the size of the lesion after a
Valsalva maneuver. The lesion has been present since the age of 2 and is slowly increasing in
size. What is the most likely diagnosis?
venous malformation (orbital varix)

4. <="">What is the most common complication of involutional blepharoptosis surgery?

undercorrection

5. <="">An 8-month-old infant presents with a palpable, smooth, painless mass in the lateral brow
that has enlarged slowly over the last 3 months. CT shows a well-defined oval mass with an
enhancing wall and nonenhancing lumen, as well as adjacent bony remodeling. What is the most
likely diagnosis?
dermoid cyst

6. <="">Conservative medical management without surgical intervention is the initial treatment of

choice for orbital cellulitis in which clinical setting?
6-year-old with medial subperiosteal abscess and adjacent ethmoid sinusitis

7. <="">For which situation does computed tomography (CT) offer advantages over magnetic
resonance imaging (MRI)?
evaluation of orbital fractures

8. <="">Reconstruction of the eyelid margin includes approximation of the gray line. What
anatomical structure does the gray line represent?
isolated section of pretarsal orbicularis just anterior to the tarsus

9. <="">An intraconal orbital lesion is identified between the optic nerve and the lateral rectus
muscle. What is the best surgical approach for this lesion?
lateral orbitotomy

10. <="">What must be ruled out prior to evisceration?

malignant intraocular tumor

BCSC 08, 2017-2020: External Disease and Cornea

1. <="">What finding is associated with meibomian gland dysfunction?

foam in the tear meniscus

2. <="">A 65-year-old woman presents with pain and decreased vision in the left eye.
Examination shows elevated intraocular pressure and hyphema with a poor view through
the anterior chamber. She has a history of cataract surgery in the left eye 6 months ago
and recurrent uveitis during the postoperative period. What imaging test would be most
helpful in making the diagnosis?
ultrasound biomicroscopy

3. <="">A patient with keratoconus requires surgery in the left eye. Surgery was
previously performed on the right eye. A history of what intraoperative complication in
the right eye would make deep anterior lamellar keratoplasty the preferred procedure for
the left eye rather than penetrating keratoplasty?
expulsive choroidal hemorrhage

4. <="">What is the best surgical option in a patient with a whitish gray corneal lesion
most consistent with Salzmann nodular degeneration?
superficial keratectomy

5. <="">What corneal dystrophy is unlikely to recur following penetrating keratoplasty?

macular
6. <="">What therapy applied in acute Stevens-Johnson syndrome has been
demonstrated to improve the long-term outcomes of ocular surface disease?
amniotic membrane

7. <="">What agent is most effective in treating a solitary flat, patchy, pigmented

conjunctival lesion in a white man?
topical mitomycin C

8. <="">What is the mechanism of dry eye in patients with Sjögren syndrome?

aqueous tear deficiency

9. <="">What details about the condition of the cornea can be evaluated with
Scheimpflug tomography but not Placido disk–based topography?
posterior corneal elevation in forme fruste keratoconus

10. <="">Epithelial-like changes of the corneal endothelium are typical of what corneal
dystrophy?
posterior polymorphous corneal dystrophy (PPCD)