Trial test · Ophthalmology (Prometric)

Question 1 of 10

A full-term 2-month-old infant has unilateral leukocoria and a slightly microphthalmic eye. Ultrasound demonstrates a retrolental fibrovascular stalk extending toward the optic disc without intraocular calcification. Which diagnosis best fits these findings?

Congenital nuclear cataract

Persistent fetal vasculature

Coats disease

Retinoblastoma

Question 2 of 10

Clinical photograph showing focal swelling at the upper lacrimal punctum with visible purulent material.

A 63-year-old woman has chronic unilateral tearing and recurrent localized swelling near the upper punctum. Pressure over the canaliculus expresses granular material, and the clinical photograph is shown. Which definitive treatment is most appropriate?

Perform canaliculotomy with concretion curettage

Insert a punctal occlusion plug

Perform external dacryocystorhinostomy

Continue topical antibiotics alone

Question 3 of 10

A 68-year-old patient has an asymptomatic inferotemporal peripheral retinal elevation discovered during routine examination. The lesion is smooth and immobile, has a sharply demarcated posterior border, and contains an inner-layer hole without subretinal fluid extending beyond the lesion. Which management is most appropriate?

Observe with retinal-detachment precautions

Apply prophylactic laser around the entire lesion

Perform immediate pars plana vitrectomy

Begin intravitreal anti-VEGF therapy

Question 4 of 10

Color fundus photograph showing diffuse inner retinal whitening with a contrasting foveal appearance.

A 63-year-old man develops sudden painless monocular visual loss 70 minutes ago. Visual acuity is counting fingers. The fundus photograph is shown. There is no giant-cell-arteritis history or systemic instability. What is the most appropriate immediate management?

Refer for emergency stroke evaluation

Give intravitreal anti-VEGF therapy

Perform prolonged ocular massage

Arrange outpatient carotid ultrasound

Question 5 of 10

Macular OCT showing a broad neurosensory retinal elevation with optically clear subretinal fluid.

A 45-year-old man has persistent central distortion for seven months. Corticosteroid exposure has been eliminated, but subfoveal fluid remains on repeated OCT examinations. The OCT appearance is shown. There is no macular neovascularization. Which treatment is preferred for this chronic presentation?

Begin long-term oral eplerenone therapy

Continue observation without ocular treatment

Begin monthly intravitreal anti-VEGF therapy

Reduced-dose verteporfin photodynamic therapy

Question 6 of 10

OCT showing persistent posterior hyaloid attachment producing focal foveal elevation, distortion, and intraretinal cystic change.

A 71-year-old patient reports increasing metamorphopsia and reduced reading vision over eight months. Best-corrected acuity is 20/80, and serial OCT confirms progression. The current OCT is shown. Which management is most appropriate?

Continue observation with serial OCT

Perform focal macular laser treatment

Begin intravitreal anti-VEGF injections

Perform pars plana vitrectomy with peeling

Question 7 of 10

A patient scheduled for cataract surgery agrees to treatment but explicitly refuses the presence of medical students during the operation. The surgeon normally teaches students in every theatre list. What is the most appropriate response?

Allow students to attend because teaching is routine in the unit

Cancel the surgery because student participation is part of standard care

Respect the refusal without disadvantaging the patient's clinical care

Require the patient to provide a detailed reason for refusing observers

Question 8 of 10

Late fluorescein angiogram showing focal progressive leakage in the macular region.

A 39-year-old man reports six weeks of micropsia and central blur. He recently completed a course of oral prednisone for severe dermatitis. OCT demonstrates a shallow neurosensory macular detachment. The late-phase fluorescein angiogram is shown. Which diagnosis is most likely?

Optic disc pit maculopathy

Central serous chorioretinopathy

Neovascular age-related macular degeneration

Adult vitelliform macular dystrophy

Question 9 of 10

A 5-week-old infant has dense bilateral congenital cataracts that completely obstruct both red reflexes. The posterior segments appear structurally normal on ultrasonography. Which management best protects visual development?

Observe with serial ocular ultrasonography

Begin alternating patching without surgery

Arrange prompt bilateral cataract surgery and rehabilitation

Delay surgery until later infancy

Question 10 of 10

A 52-year-old woman previously underwent a patent laser peripheral iridotomy for primary angle closure. She still develops pressure elevation after pharmacologic dilation. Gonioscopy shows persistent appositional closure with a double-hump configuration and a deep central anterior chamber. Which procedure is most appropriate?

Perform transscleral cyclophotocoagulation

Repeat laser peripheral iridotomy

Perform selective laser trabeculoplasty

Perform peripheral laser iridoplasty