Dr A Rajendraprasad MS DO

Professor of Ophthalmology

Coimbatore Medical College, Coimbatore

1. Gorlin's syndrome:a. Is an inherited condition b. Is associated with multiple basal cell carcinoma c. Increases the incidence of cataract d. Is associated with liver carcinoma e. Increases the risk of retinal detachment

1. a.T b.T c.F d.F e.F

GORLIN'S SYNDROME (BASAL CELL NAEVUS SYNDROME)

•Rare, autosomal dominant and multisystem disorder•Characterised by multiple basal cell carcinoma, jaw cysts,b skeletal anomalies, ectopic calcification of the falxcerebri and pitting of the hand and feet

•ocular features also include hypertelorism, lateral displacement of the medial canthi and prominent supraorbital ridges

2. Posterior polymorphous dystrophy :a. Is present at birth b. Causes corectopiac. Is inherited in an autosomal

recessive fashion d. Causes blindness in over 90% of

sufferers e. Can be treated with lamellar

corneal grafts

2. a.T b.T c.F d.F e.FPosterior polymorphous dystrophy:

•A bilateral dominantly inherited dystrophy•Vesicular polymorphous deposits with clear halos in Descemet'smembrane

•Usually asymptomatic, rarely endothelium decompensation requiring penetrating corneal graft

•The abnormal endothelium may extend into the trabecularmeshwork and iris

•Glaucoma can occur as a result of trabecular meshwork involvement iris involvement can lead to corectopia and ectopiasimulating iridocorneal endothelial syndrome except that the later is unilateral

3. Crystalline deposits in the conjunctiva may be found in:

a. Amyloidosisb. Cystinosisc. Gold treatment d. Contact lens wear e. Uraemia

3. a.T b.T c.T d.F e.TCrystalline deposits occurs with:

•Myloidosis as in multiple myeloma•Cystinosis•Treatment with gold•Uric acid from uraemia

4. The histology of pterygium includes:a. Myxoid degeneration b. Epithelial inclusion bodiesc. Precancerous changes d. Squamous metaplasia of the

epithleiume. Elastotic degeneration

4. a.T b.F c.F d.F e.TPterygium:

•Fibrovascular overgrowth of the bulbar conjunctiva

•The stroma shows basophilic degeneration (elastotic) of collagen

•The epithelium is often thin but may show hyperplasia or dysplasia

5. The following may be found in conjunctiva in keratoconjunctivitis sicca

a. Dysplasia of the epitheliumb. Keratinisationc. Eosinophilsd. Numerous goblet cells e. Lymphocytic infiltrates

5. a.T b.T c.F d.T e.TKeratoconjunctivitis sicca (dry eyes):

•Causes dysplasia of the epithelium which may eventually become keratinize

•The goblet cells may increase due to chronic irritation from dry eyes

•In Sjogren's syndrome, there is lymphocytic infiltration of the lacrimal and accessory glands

6. Merkel cell carcinoma:a. Is most common in the bulbar

conjunctiva

b. Is associated with good prognosis

c. Is an APUD cell tumour

d. Is associated with ultraviolet

exposure

e. Produces corneal pigmentation

6. a.F b.F c.T d.F e.FMerkel cell carcinoma:

•An aggressive primary tumour of the skin, arising from papillary dermis

•Usually presents as a firm non-tender solitary skin nodule on the face and neck

•Early metastasis through the lymphatic channels•Contains APUD (amine precursor and uptake decarboxylation) cells

7. Histological changes in lens induced uveitis include:

a. Ghost cells b. Giant cell reaction c. Amyloid in the cornea d. Vasculitise. Non-caseating granuloma

7. a.F b.T c.F d.F e.TLens-induce uveitis: - three types

•Phacoanalphylactic endophthalmitis•Severe granulomatous inflammation when the lens protein is exposed

•Zonal granulomatous reaction surrounding the exposed lens material. The inflammation include neutrophils, epihtelioid cells, macrophages and giant cells

•Phacotoxic uveitis•Nongranulomatous inflammation when the lens protein is exposed.

•Non-specific inflammation with lymphocytes, macrophages and occasional giant cells

•Phacolytic glaucoma•Occurs when the hypermature cataract leaks out protein•Macrophages laden with eosinophilic lens materials are seen in the anterior chamber and the trabecular meshwork

8. Xeroderma pigmentosa is associated with:a. Intraouclar tumoursb. Metabolic disorders c. Photosensitivity d. Autosomal recessive inheritance e. Squamous cell carcinoma

8 a.F b.F c.T d.T e.TXeroderma pigmentosa:

•Inheritance is autosomal recessive•Marked sensitive of skin to sunlight•Malignant skin tumours including squamous cell tumour, basal cell carcinoma and fibrosacorma

•Main defect is due to the inability of the cells to repair damaged DNA following ultraviolet exposure

9. Pathological changes in thyroid ophthalmopathy includes:

a. Lymphocytic infiltrates b. Giant cell reactionc. Mucopolysaccharidesd. Fat cells e. Fibroblast proliferation

9. a.T b.F c.T d.T e.TPathology of thyroid ophthalmopathy:

•There is enlargement and inflammation of orbital tissue especially the extraocular muscles

•Histologically there is interstitial oedema and inflammatory cell infiltration (mainly lymphocytes, plasma cells and sometimes mast cells)

•Thecondition tend to involve the nontendinous part of extraocularmuscle

•The endomysial fibroblasts produces mucopolysaccharide especially hyaluronic acid

•The muscles are initially inflammed and at later stage undergoes fibrosis and shows fatty infiltrate

10. In histological stains:a. Chlamydia inclusion bodies stain

with Giemsab. Osmium tetroxide is the stain used in

electron microscopy c. Fungi stain with Fuelgin's stain d. Eosin stains the nuclei bluee. Haematoxylin stains the nuclei pink

10. a.T b.T c.T d.F e.FHistological staining:

•Giemsa stain can demonstrate inclusion body such as Chlamydia•Osmium tetroxide is used to fix and stain myelin for electron microscopy

•Yeast and fungi can be stained with Fuelgin's stain, PAS, Luxol blue fast and Gomori methenamine silver

•Eosin stains the cytoplasm pink whereas haematoxylin stains the nuclei blue

11. Sympathetic ophthalmitisa. Is characterized by Dalen-Fuchs' nodule b. Prevented by removal of the exciting eye

within 6 weeks of injuryc. Pigment laden macrophages are

diagnostic d. Is associated with poliosis and vitiligo e. Is a common cause of visual loss in

traumatic eye injury

11. a.T b.F c.F d.T e.FSympathetic ophthalmitis

•A uncommon bilateral granulomatous panuveitis which occurs after penetrating ocular injury or intraocular surgery

•The inflammation usually begins 4 to 8 weeks after the injury•Dellen-Fuch's nodules are seen at the level of Bruch's membrane and represent aggregates of epitheloid

•Cells, it is not diagnostic as the nodules also occur in VKH syndrome•May have systemic manifestation identical to Vogt-Koyanagi-Harada syndrome with cerebrospinal fluid

•Pleocytosis, miningismus, alopecia, vitiligo and poliosis•Prevention is only useful if the injured eye were removed within the first 2 weeks after injury

12. Abnormal material which may be present in the vitreous include:

a. Exfoliation b. Lipofuscinc. Haemosiderind. Amyloidosis

e. Calcium

12. a.T b.F c.T d.T e.TAbnormal material in the vitreous include:

•Pseudoexfoliation in pseudoexfoliation syndrome•Haemosiderin from vitreous haemorrhage•Amyloidosis in familial amyloidosis•Calcium in asteroid hyalosis

13. In giant cell arteritis:a. Histological diagnosis is based on

fragmentation of the internal intimalb. C-reactive protein is always raised c. Giant cell is needed for diagnosis d. Anterior cerebral artery is often involved e. Anaemia is a feature

13. a.T b .T c.F d.F e.TGiant cell arteritis:

•Disease of the elderly•Sudden, painless and profound visual loss•Female more susceptible than male•Head ache, low grade fever, anorexia, weight loss, tenderness upon brushing hair and jaw claudication

•ESR and C-reactive proteins are always raised but not diagnostic of the condition

•Diagnosis is base on biopsy which reveal fragmentation of the internal elastic lamina and giant cell infiltration of the tunica media of the artery. However, giant cells are not essential for diagnosis.

14. The following conditions are pre-malignant:

a. Oncocytoma of the caruncleb. Actinic keratosisc. Bowen's disease d. Squamous papillomae. Syringoma

14. a.F b.T c.T d.F e.TThe following conditions are pre-malignant:

•Actinic keratosis is the result of metaplasia due to ultraviolet light

•Bowen's disease•Oncocytoma of the caruncle results from metaplasia of the accessory gland and is not thought to be pre-malignant

•Squamous papilloma is benign hyperplasia of the skin •Syringoma is benign tumour of the sweat glands

15. Hypoxic damage in diabetic mellitus is suggested by:a. Nerve fibre layers haemorrhageb. Iris neovascularisationc. Anterior uveitisd. Vascular loop e. Decreased hard exudate

15. a.T b.T c.T d.T e.FHypoxic damage in diabetic mellitus is

suggested by:•Cotton-wool spots•Extensive IRMA•Vascular beading•Extensive retinal haemorrhages•Iris neovascularization

16. The following biopsy report may be found with rheumatoid arthritis:

a. Posterior scleritisb. Loss of goblet cells in the conjunctivac. Episcleral necrotic tissue d. Giant cell reaction e. Vasculitis

16. a.T b .F c.T d.F e.T

Biopsy report in rheumatoid arthritis include

•Posterior scleritis

•Episcleral necrotic tissue

•Vasculitis

-The dry eye in rheumatoid arthritis is caused by aqueous

deficiency and not goblet cell dysfunction

17. The following report is associated with increased mortality in an enucleated eye with retinoblastoma:

a. Involvement of the optic nerve b. Presence of calcification within the tumoursc. Necrosis within the tumoursd. Exophytic retinoblastoma e. Presence of retinal detachment

17. a.T b.F c.F d.F e.FThe prognosis of retinoblastma is detemined by:

•Evidence of external spread such as optic nerve involvement

•Size of the tumours•Cell differentiation•Calcification and necrosis are common in retinoblastoma.

18. Diabetic microangiopathy include:a. Endothelial vascular proliferationb. Proliferation of pericytes associated with

microaneurysms c. Deposition of calcium in the intima d. Thickening of the basement membrane e. Necrosis of the endothelium

18. a.F b.F c.F d.T e.FMicroangiopathy in diabetes mellitus is

characterised by: •Microvascular obstruction and non-perfusion of capillaries

•Retinal capillary microaneurysms•Absent membrane thickening•Loss of pericytes• Intraretinal microvascular abnormality

19. Optic nerve glioma:a. Is associated with neurofibromatosis

type I b. Increased incidence after 30 years old c. Majority is of pilocytic astrocytomad. Rarely infiltrate the perineural tissue e. Mortality of 40%

19. a.T b.F c.T d.T e.FOptic nerve glioma:

•Associated with type I neurofibromatosis•Most common type is pilocytic (hair-like) astrocytoma

•The age of onset is usually before the age of 10•Low-grade and rarely infiltrate the perineuraltissue

•Reactive meningeal hyperplasia•Good long-term survival

20. Mutton fat keratic precipitates are seen in:a. Uveal effusion syndrome b. Tuberculosis c. Fuch's heterochromia cyclitisd. Sarcoidosise. Fungal infection

20 a.F b.T c.F d.T e.TMutton fat keratic precipitates:- occurs in chronic

granulomatous uveitis and seen in •Tuberculosis•Fungal•Leprosy•Syphilis•Sarcoidosis•Juvenile xanthogranuloma•Histiocytosis X•Sympathetic ophthalmia•Vogt-Koyanagi-Harada syndrome•Toxoplasmosis

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