Ophthalmology (Prometric)

A healthy 6-month-old infant has had a constant large-angle inward deviation since 2 months of age. Cycloplegic refraction shows only +0.75 D of hyperopia in each eye, and ductions are full. The ocular alignment is shown. Which management is most appropriate?

A 46-year-old man develops impaired upgaze, convergence-retraction nystagmus, and pupils that constrict better to near than to light. Horizontal gaze is preserved. Which neuroanatomic region should be investigated most urgently?

A 60-year-old patient presents two weeks after uncomplicated cataract surgery with significant monocular blur. Refraction fluctuates, and slit-lamp examination reveals retained viscoelastic trapped between the intraocular lens and posterior capsule, causing anterior displacement of the optic. Which management is most appropriate if the distension persists?

An 18-month-old child has bilateral multifocal retinoblastoma and no known family history of the disease. Ocular treatment has begun successfully. Which additional step is most important for long-term family and surveillance planning?

A competent 52-year-old patient with progressive retinal disease tells the ophthalmologist not to discuss the diagnosis with his employer. The employer later telephones the clinic requesting details because the patient's work involves prolonged computer use. There is no immediate threat to another person. Which response is most appropriate?

A 54-year-old patient with rheumatoid arthritis is taking hydroxychloroquine and requires retinal toxicity surveillance. Which pair of tests provides the most useful complementary structural and functional screening information?

A 31-year-old patient develops unilateral ptosis and miosis after neck surgery. The anisocoria is greater in darkness, and apraclonidine testing reverses the anisocoria. Which interpretation is most appropriate?

An 84-year-old patient has a blind painful eye from end-stage refractory glaucoma. Intraocular pressure remains 52 mmHg despite maximally tolerated topical medication, and further incisional surgery is considered inappropriate because of poor visual potential and extensive conjunctival scarring. Which pressure-lowering intervention is most appropriate?

A 65-year-old patient with biopsy-proven systemic sarcoidosis develops new photopsias and blurred vision after immunomodulatory therapy is withdrawn. The fundus photograph is shown. Which interpretation is most appropriate?

Immediately before an intravitreal procedure, the ophthalmologist notices particulate material inside a prefilled compounded medication syringe from a newly delivered batch. The package is intact and within its labeled expiry date. What is the safest response?