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Anatomy and physiology of Lens, cataract,, Ophthalmology, L19, 20, 21, 22

Ophthalmology, L19,20

Part (1), lens anatomy and physiology

Part (2), cataract, congenital disorders

Data L19, 20

L21,22, senile cataract (lens disorders)

Data L21, 22

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MCQ

1 -The following is true regarding the lens capsule except:
a) Highly elastic
b) Semi permeable.
c) Protect lens fibers from aqueous enzymatic
d) Secreted by equatorial epithelium.
e) Thicker at the ant. Capsule.

2 -The crystalline lens is suspended from ciliary body processes by:
a) Sutures
b) zonules.
c) Lens fibres.
d) Lens capsule.

3- Regarding the anatomy of crystalline lens:
a) Posterior capsule is thinner than anterior capsule.
b) Anterior capsule is thinner than posterior capsule.
c) Anterior and posterior capsules are of the same thickness.
d) Anterior surface is more curved than posterior surface.

4- Embryological origin of the crystalline lens is:
a) Mesoderm
b) Endoderm.
c) Surface ectoderm
d) None of the above

5 -The oldest lens fiber is located at:
a) The center of the lens.
b) The periphery of the lens.
c) Anterior pole of the lens.
d) Posterior pole of the lens.

6- Which of the following best explains accommodation?
a) The lens decreases its anterior-posterior lens diameter therefore increasing its refractive power
b) Relaxation of the circular muscles of the ciliary body results in pupil constriction and therefore helps with accommodation
c) Relaxation of the circular muscles of the ciliary body results in the lens increasing its refractive power
d) Contraction of the circular muscles of the ciliary body results in the lens becoming more globular in shape

7 -Where does the lens receive its nourishment in the adult?
a) Hyaloid artery
b) Long posterior ciliary artery
c) Aqueous humor
d) Lens zonules

8- Which of the following is the most correct about the lens capsule
a) The thinnest part is the anterior lens capsule
b) The lens capsule becomes opaque with age
c) It is the basement membrane of the lens epithelium
d) The lens epithelial cells lie on the lens capsule and contact the aqueous

9. Which part of the lens capsule is thinnest
a) Equator
b) Posterior
c) Anterior peripherally
d) Anterior

10- What is the primary metabolism of the adult lens
a) Glycerol pathway
b) Anaerobic
c) Glucose monophosphate shunt
d) Ketogenesis

11- The commonest complication of aphakia after congenital cataract is
a) Development of nystagmus
b) Retinal detachment
c) Amblyopia
d) macular degeneration

12- Congenital cataract is characterized by:
a) Commonly unilateral.
b) Always unilateral.
c) Always bilateral.
d) Commonly progressive course.
e) Commonly associated with other congenital anomalies.

13- A 6-month infant presenting with a localized dot shaped anterior polar cataract with no other apparent ocular abnormality is best managed by:
a) Lensectorny with IOL.
b) Black pupil contact lens.
c) Extracapsular cataract extraction with IOL.pant
d) Follow up with visual acuity testing.

14- Which of the following types of congenital cataract can affect vision:
a) Anterior polar
b) Posterior polar
c) Coronary
d) Blue dotted

15- Which of the following types of congenital cataract is related to Vitamin D deficiency?
a) Sutural.
b) Blue dot.
c) Coronary.
d) Lamellar.

16- Posterior polar cataract markedly affects vision because p
a) Its shadow lies on the macula
b) Close to the nodal point
c) It matures early
d) It blocks the pupillary area

17- The term "mature cataract" means:
a) A nuclear cataract present more than 10 years
b) A posterior subcapsular cataract that reduces visual acuity to 6/60 or worse
c) A cortical cataract that involves the entire cortex
d) An anterior subcapsular cataract that causes capsular wrinkling.

18- Criteria of mature senile cataract:
a) Visual acuity HM
b) Absent RR
c) Absent iris shadow
d) All of the above

19- Which of the following sequence of the cortical senile cataract is wrong:
a) Immature, Mature, Intumescent
b) Immature, Mature, Hyper mature
c) Immature, Hyper mature
d) Immature, Intumescent
e) All of the above is wrong.

20- Hyper mature senile cataract Shows or presents with except:
a) Shrunken totally opaque lens.
b) Wrinkled capsule.
c) Iris shadow may be present.
d) Complication as sublaxation, phacomorphic glaucoma phacotoxic iritis
e) Morgagnian cataract.

21- Which of the following is not a magnification of nuclear Cataract?
a) Central lens opacity
b) Iris shadow is present.
c) Red reflex is seen..
d) Shallow anterior chamber.
e) Normal capsule.

22. Presenile cataract may occur in the following cases except:
a) Diabetes.
b) Myotonic dystrophy.
c) Atopic dermatitis.
d) Essential hypertension.

23- The field of vision in a patient with mature senile cataract is tested by:
a) Confrontation method.
b) Projection of light
c) Perception of light.
d) Perimetry.

24- A patient with right immature senile cataract recently suffered from redness of the affected eye, pain and fronto-temporal headache. The best curative treatment is:
a) cataract extraction
b) filtering operation
c) cataract and filtering operation
d) local and systemic therapy

25- The following is true about senile cataract except:
a) Morgagnian cataract is a form of hypermature cataract
b) An increase in the refractive index of a senile nuclear
c) Should be removed only when it has matured
d) In incipient stage, there may be polyopia, haloes or fixed muscae

26- A patient complaining of defective vision of left eye on examination, left eye is 6/60 with nuclear cataract. Right eye is 6/6. The best management is:
a) ICCE + glasses.
b) ICCE + contact lens
c) ECCE+IOL Implant.
d) I.C.C.E+ IOL implant

27- Marked diminution of vision in a mature senile cataract implant results from:
a) Retinal changes
b) Optic nerve changes
c) Refractive changes
d) Density of lens opacity

28- Positive iris shadow is a sign of:
a) Mature senile cataract.
b) Morgagnian cataract.
c) Congenital cataract.
d) Immature senile cataract.

29- Senile nuclear cataract is accompanied by:
a) Myopic shift of refraction.
b) Hyperopic shift of refraction.
c) Night blindness.
d) Ocular pain.

30- Which type of glaucoma is caused by intumescent cataract?
a) Phacolytic glaucoma.
b) Phacoanaphylactic glaucoma.
c) Pseudoexfoliation glaucoma.
d) Phacomorphic glaucoma.

31- Phacotoxic uveitis is a complication of:
a) Intumescent cataract.
b) Immature senile cataract.
c) Mature senile cataract.
d) Hypermature cataract.

32. The refractive change in early cortical cataract is:
a) Curvature hypermetropia.
b) Index hypermetropia.
c) Curvature myopia.
d) Index myopia.

33- The term "mature cataract" means
a) A nuclear cataract present more than 10 years
b) A posterior subcapsular cataract that reduces visual acuity to 6/60 or worse
c) A cortical cataract that involves the entire cortex
d) An anterior subcapsular cataract that causes capsular wrinkling

34- Criteria of mature senile cataract
a) Visual acuity HM
b) Absent RR
c) Absent iris shadow
d) All of the above

35- Nuclear cataract changes the refraction of the eye into
a) Myopia
b) Hypermetropia
c) Astigmatism
d) No change

36-Complicated cataract may result from the following ocular Diseases except
a) High myopia
b) Anterior uveitis
c) Acute congestive glaucoma.
d) Paralytic squint

37- A morgagnian cataract can cause one of the following Complication:
a) Retinal detachment.
b) Optic atrophy.
c) Rise of IOP
d) Rubeosis iridis

38- Complicated cataract is characterized by:
a) Polychromatic luster.
b) Water vacuoles.
c) ubluxation.
d) Dislocation.

39- Vossius ring is found on anterior lens capsule in:
a) Complicated cataract.
b) Congenital cataract.
c) Traumatic cataract.
d) Hypermature cataract.

40- Steroids typically induce what kind of cataract
a) Nuclear sclerotic
b) Posterior polar
c) Posterior subcapsular
d) Cortical

41. The deterioration of vision in an aphakic patient, 3 days after surgery together with the development of pain, ciliary injection, aqueous flare, hypopyon and a cloudy view of the fimdus would necessitate:
a) Mannitol and diamox.
b) Prompt systemic, local intraocular antibiotics.
c) Immediate removal of the IOL.
d) Systemic, local and intraocular corticosteroids.

42- Post-operative unilateral aphakia can be corrected by glasses in the following case:
a) If the patient is old age.
b) If the patient has Keratoconos.
c) If the patient was hypermetrope Preoperatively
d) If patient is high myope.

43- Unilateral aphakia is likely to be corrected by any of the following except:
a) Anterior chamber intraocular lens
b) posterior chamber intraocular lens
c) contact lens
d) glasses

44- Complications of lens subluxation include:
a) Cataract.
b) Glaucoma.
c) Dislocation.
d) All of the above.

45- In posterior dislocation, the pupil is:
a) Jet black.
b) Peaked.
c) Festooned.
d) Irregular.

46- Diminution of vision in lens subluxation is caused by:
a) Myopia.
b) Astigmatism.
c) Complications.
d) All of the above.

47- Correction of unilateral aphakia with glasses will result in:
a) Astigmatism.
b) Glaucoma.
c) Hypermetropia.
d) Anisokonia.

48- The treatment of unilateral aphakia is:
a) Glasses
b) Intraocular lens implantation
c) Epikeratophakia
d) LASIK

49- Severe lens subluxation may cause:
a) Binocular diplopia.
b) Uniocular diplopia.
c) Myopia.
d) Anisokonia.

50- Glaucoma caused by anterior lens dislocation is called:
a) Glaucoma inversus.
b) Pseudoexfoliation glaucoma.
c) Malignant glaucoma.
d) Phacolytic glaucoma.

51- In case of aphakia, there is:
a) Absence of one of Purkinje Sanson images.
b) Absence of two of Purkinje Sanson images.
c) Absence of three of Purkinje Sanson images.
d) Absence of all Purkinje Sanson images

52- Refractive error change in aphakia is:
a) Shift towards myopia
b) Shift towards hypermetropia
c) Shift towards astigmatism.
d) All of the above.

53. The direction of lens displacement in Marfan syndrome is:
a) Superior and temporal.
b) Inferior and temporal.
c) Superior and nasal
d) Inferior and nasal

54. All the following are signs of lens subluxation except:
a) Phakodenesis
b) Iridodenesis
c) Irregular anterior chamber
d) Intact all zonule

55- The measurement of intraocular lens power prior to IOL implantation entails:
a) Measuring the preoperative spectacle power
b) Measuring the axial length of the eye
c) Performing preoperative retinoscopy
d) Careful fundus examination

56- The abuse of steroid eye drops can lead to
a) Blue dot cataract.
b) Nuclear cataract.
c) Anterior polar cataract.
d) Posterior sub capsular cataract.

57-Intracapsular cataract extraction is a must only in
a) Mature senile cortical cataract
b) anteriorly dislocated lens
c) Immature senile cortical cataract
d) Nuclear cataract

58- Disadvantages of intracapsular cataract extraction do not include
a) High incidence of vitreous loss.
b) High incidence of retinal detachment.
c) Opacification of posterior capsule.
d) Not suitable for congenital cataract.

59- Before the decision of cataract extraction and intra ocular lens implantation the followings must be done expect:
a) Fundus examination
b) Ultrasonography
c) Electrophysiology test
d) Computerized tomography

60- In a patient of unilateral cataract has extra capsular cataract extraction without ICL implantation he used contact lenses for correction he is now intolerant to contact lenses what Is the best for him
a) Secondary implantation of IOL
b) Use of ordinary glasses
c) Chang type of contact lens
d) Lasik

61- Phacomorphic glaucoma means:
a) Papillary block by a swollen lens
b) Blockage of the trabecular meshwork by lens proteins
c) Closure of the A.C angle by peripheral anterior synechia
d) Papillary block by posterior synechia

62- Phacolytic glaucoma occurs in:
a) Congenital cataract.
b) Early cortical cataract.
c) Subluxation of the lens.
d) Hyper mature cortical cataract.

63- Which of the following is not a cause of leucocoria:
a) Leucoma adherent
b) Cataract.
c) Retinoblastoma.
d) Persistent hyper plastic primary vitreous

64- A scan ultrasonography of the eye is used to calculate the power of the intraocular lens by measuring:
a) Corneal curvature.
b) Refractive index.
c) Depth of the anterior chamber.
d) Axial length of the eye.

65- The type of cataract surgery which results in the least postoperative astigmatism:
a) Extra capsular cat. + IOL
b) Extra capsular cat with no IOL
c) Phacoemulsification +10L.
d) Intra capsular cataract extraction + IOL.

66- The following test is mandatory before cataract surgery for a patient with hand motion visual acuity:
a) Perimetry.
b) Electrophysiology.
c) Gonioscopy.
d) Fluorescein angiography.

67. Phacoemulsification is the preferred procedure in the following condition:
a) Cataract with a dislocated lens.
b) Black cataract.
c) Intumescent cataract.
d) Dense posterior subcapsular cataract.

68- The worst complication that may happen after cataract surgery is:
a) Corneal edema.
b) Iris prolapse.
c) Endophthalmitis.
d) Increased ocular tension.

69- After 48 hours of a cataract extraction operation, a patient complained of ocular pain and visual loss. On examination, this eye looked red with ciliary injection, corneal edema and absent red reflex. The first suspicion must be:
a) Secondary glaucoma.
b) Anterior uveitis.
c) Bacterial endophthalmitis
d) Acute conjunctivitis.

70. Intracapsular cataract extraction is a must only in:
a) Mature senile cortical cataract.
b) Immature senile cortical cataract.
c) Anteriorly dislocated lens.
d) Nuclear cataract.

71- The complications of anterior chamber intraocular lens do not include:
a) Comeal endothelial injury.
b) Posterior dislocation in the vitreous
c) Secondary glaucoma.
d) Anterior uveitis.

72-Phacoemulsification of the cataractous lens is indicated in the following conditions, except:
a) Mature senile cortical cataract.
b) Immature senile cortical cataract.
c) Early nuclear cataract.
d) Congenital cataract.

73- An emmetropic diabetic patient who is on medical control. He suffered lately from defective vision that did not improve using the pin hole test, what would you like to do?
a) Fit him with far glasses,
b) Fit him with near glasses
c) Fit him with contact lens.
d) Detailed fundus examination.

74- Extracapsular cataract extraction + IOL is the operation of choice in:
a) Anteriorly dislocated lens.
b) Hard nuclear cataract.
c) Posterior dislocated lens.
d) Anterior polar cataract.

75- Phacomorphic glaucoma means:
a) Pupillary block by a swollen lens.
b) Blockage of the trabecular meshwork by lens proteins.
c) Closure of the A.C. angle by peripheral anterior synechia,
d) block by posterior nechia

76- Phacolytic glaucoma occurs in:
a) Congenital cataract
b) Early cortical cataract.
c) Subluxation of the lens.
d) Hyper mature cortical cataract.

77- A bad prognosis for visual improvement is expected for cataract extraction if:
a) The patient is myopic.
b) The cataract is hypermature.
c) The ocular tension is slightly high.
d) The light projection is bad.

78- An old patient complains of colored haloes around light. On examination, the eyes were quite, and comeas were clear The probable diagnosis is:
a) Incipient cataract
b) acute angle closure glaucoma
c) acute conjunctivitis
d) open angle glaucoma

79- Phacolytic glaucoma is best treated by:
a) Fistulizing operation
b) Cataract extraction
c) Cyclo-destructive procedure
d) Miotics and Beta blockers

80-A driver complained of progressive defective vision of one eye. On examination, the lens showed central dense opacity matured and the lens is subluxated. The management is:
a) I.C.C.E + aphakic glasses
b) E.C.C.E.+ IOL.
c) I.C.C.E+contact lens fitting
d) I.C.C.E+IOL.

81-A traumatic subluxated cataractous lens in a child aged 6 years is best removed by:
a) Extra-capsular method
b) Intra-capsular method
c) Lensectomy
d) Phacoemulsification

82- Lens induced glaucoma least occur in:
a) Intumescent cataract.
b) Anterior lens dislocation.
c) Posterior sub-capsular cataract
d) Posterior lens dislocation

83- After cataract is treated by:
a) YAG laser.
b) Argon laser
c) Excimer laser
d) Diode laser

84- Sommering ring is a feature of:
a) Traumatic cataract.
b) Complicated cataract.
c) After cataract.
d) Congenital cataract.

85- Risk of retinal detachment increases with the following:
a) Phacoemulsification.
b) Intracapsular cataract extraction.
c) Extracapsular cataract extraction.
d) Phacolaser.

86- Risk of postoperative cystoid macular edema increases after the following
a) Phacoemulsification.
b) Intracapsular cataract extraction.
c) Extracapsular cataract extraction.
d) Phacolaser.

87- The Y sutures of crytalline lens are arranged:
a) Erect anteriorly and inverted posteriorly.
b) Radially.
c) Horizontally.
d) Haphazardly.

88- Causes of leucocoria
a) Retinoblastoma
b) Retrolental fibrosis
c) Congenital cataract
d) Persistant hyperplastic primary vitreous
e) All of the above

89- Most common cause of diminution of vision after ECCE is
a) Cystoid macular edema
b) Posterior capsule opacification
c) Comeal decompansation
d) Retinal detachment

90- Tremulous iris can be seen in
a) Aphakia
b) Subluxation of the lens
c) Hypermature cataract
d) Posterior dislocation of the lens
e) All of the above

91- Glaucoma inversus can occur in
a) Post-subluxated lens
b) Post-dislocated lens
c) Intumescent cataract
d) None of the above

Answers

1) D
2) B
3) A
4) C
5) A
6) D
7) C
8) C
9) B
10) B
11) C
12) E
13) D
14) B
15) D
16) B
17) C
18) D
19) C
20) D
21) D
22) D
23) B
24) A
25) C
26) C
27) D
28) D
29) A
30) D
31) D
32) B
33) C
34) D
35) A
36) D
37) C
38) A
39) C
40) C
41) B
42) D
43) D
44) D
45) A
46) D
47) D
48) B
49) B
50) A
51) B
52) B
53) A
54) D
55) B
56) D
57) B
58) C
59) D
60) A
61) A
62) D
63) A
64) D
65) C
66) B
67) D
68) C
69) C
70) C
71) B
72) D
73) D
74) B
75) A
76) D
77) D
78) A
79) B
80) D
81) C
82) C
83) A
84) C
85) B
86) B
87) A
88) E
89) B
90) E
91) D
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