ICO ADVANCED 115 New MCQs October 2018 / April 2019

October 2018 Questions

1) Figure of fundus color photo of morning glory syndrome, associated with:

a. Cone dystrophy
b. Hepatic fibrosis.
c. Ocular flatter.
d. Renal failure.

Answer: (d)
2) The visual fields shown in this figure are most likely to be caused by which abnormality:

a. A falx meningioma compressing both inferior occipital lobes.

b. A large pituitary adenoma compressing the optic chiasm and both optic nerves.
c. A left occipital lobe infract.
d. A mass compressing the right optic radiation.

Answer: (a)
3) Regarding White Dot Syndromes (WDS):
a. Acute zonal occult outer retinopathy (AZOOR) is uncommon sequel of punctuate inner
choroidopathy (PIC).
b. Birdshot's choroiditis is characterized by abrupt onset.
c. Birdshot's choroiditis tends to affect younger than most of the other white dot syndrome.
d. Punctate inner choroiditis (PIC) predominantly affects young myopic men.

Answer: (a)

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 ICO ADVANCED 115 New MCQs October 2018 / April 2019
4) Regarding the etiology of uveitis, which would be the most common in European teenagers:
a. Juvenile idiopathic arthritis.
b. Human leukocyte (HLA) B27 related.
c. Lymphoma/masquerade syndrome.
d. Herpes simplex virus.

Answer: (b)
5) Which is the most likely reason for iris heterochromia, pseudophakia and a trabeculectomy
in a 41 year old female patient:
a. Congenital Horner’s syndrome.
b. Fuch’s heterochromic cyclitis.
c. Naevus of Ota.
d. Siderosis.

Answer: (b)
6) A 35 year old man has bilateral ptosis, frontal baldness and highly-colored, polychromatic
cataracts. Which additional feature is most likely to be present:
a. An abnormal pupillary light response.
b. Iris transillumination.
c. Nystagmus.
d. Optic atrophy.

Answer: (a)
7) After surgical removal of a squamous cell carcinoma of the upper eyelid margin, there is
40% defect. Which procedure is most appropriate to reconstruct the lid and close the defect:
a. Direct closure.
b. Full thickness cutaneo-conjunctival inferior eyelid advancement flap.
c. Lateral canthotomy and rotation of semicircular flap.
d. Modified Hughes procedure.

Answer: (c)
8) Regarding malignant melanoma of the choroid:
a. Enucleation has a better prognosis than iodine 125 plaque brachytherapy.
b. Histological cell type is the most significant prognostic indicator.
c. Monosomy of chromosome 3 carries a poor prognosis.
d. Survival rates have improved over 30 years.

Answer: (c)

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 ICO ADVANCED 115 New MCQs October 2018 / April 2019
9) Which of these glaucoma medications is most likely to precipitate aqueous misdirection:
a. Brimonidine.
b. Latanoprost.
c. Pilocarpine.
d. Timolol.

Answer: (c)
10) Regarding primary angle closure (PAC) glaucoma:
a. Any degree of iridotrabecular touch is sufficient to diagnose a patient as a primary angle
closure suspect.
b. PAC glaucoma accounts for nearly half of glaucoma blindness worldwide.
c. Plateau iris syndrome is more commonly seen in males.
d. The angle closes inferiorly to superiorly.

Answer: (b)
11) Regarding myasthenia gravis:
a. Congenital myasthenia gravis is an autoimmune disease.
b. Gaze paretic nystagmus may be seen in myasthenia gravis.
c. Internuclear ophthalmoplegia points away from a diagnosis of myasthenia gravis.
d. Symptomatic ptosis that worse at the end of the day is diagnostic of myasthenia gravis.

Answer: (b)

12) The World Health Organization (WHO) definition of low vision includes which criteria:
a. Presenting visual acuity of less than logMAR 0.5 (20/60, 6/18, 0.33) to perception of light.
b. Visual acuity of less than logMAR 0.3 (20/40, 6/12, 0.5) to perception of light.
c. Visual field of less than 10 degrees from the fixation point.
d. Unable to use vision for planning/executing a task.

Answer: (a)

13) The World Health Organization (WHO) criteria for screening for a disease include
a. The disease should be rare.
b. The disease should not be infectious.
c. The late stage of the disease should be untreatable.
d. There should be a recognized latent or early symptomatic stage.

Answer: (d)

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 ICO ADVANCED 115 New MCQs October 2018 / April 2019
14) Regarding a case control design for a study:
a. It would be suitable for comparing the effect of a new drug treatment with the existing
treatment.
b. It would be suitable for investigating the cause of a recent outbreak of post-operative
endophthalmitis.
c. Matching controls carefully can not mitigate against potential confounding variables.
d. The higher the ratio of controls to cases, the more powerful the study.

Answer: (b)
15) Which treatment is most likely to preserve sight in a 57 year old woman with a primary optic
nerve sheath (perioptic) meningioma:
a. Stereotactic radiotherapy.
b. Surgical debulking.
c. Tamoxifen.
d. …………….

Answer: (a)
16) Which pupil reaction is most likely to be associated with Holmes-Adie syndrome
a. Presence of -– response to light from a pen torch.
b. Slow miosis -– when the patient looks at a near target.
c. ------------------- instillation of 0.5% apraclonidine drops.
d. ------------------- complete darkness.

Answer: (b)

17) Figure: Which ophthalmic feature is most likely to be associated with this condition:
a. Exudative retinal detachment.
b. Glaucoma.
c. Persistent fetal vasculature.
d. Unilateral nystagmus.

Answer: (?)

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 ICO ADVANCED 115 New MCQs October 2018 / April 2019
Repeated Questions - Corrected Answers

18) Regarding this clinical photograph shown below:

a. A giant retinal tear is the most likely cause.

b. A superior retinal tear is the most likely cause.
c. It is likely to be exudative.
d. It shows proliferative vitreoretinopathy (PVR) grade 3.

Answer: (b)
19) Regarding pre-operative evaluation of cornea in cataract surgery:
a. Corneal pachymetry should be performed late in the day, after the cornea has had
longer exposure to the environment.
b. In the presence of guttae, cataract surgery should be combined with corneal transplant
for speedy visual rehabilitation.
c. Normal corneal pachymetry measurements obtained in the early morning suggest that
the cornea will probably remain clear following uncomplicated cataract.
d. Specular microscopy is the best means to predict how the cornea will fare post-
operatively.

Answer: (c)
20) Which is likely to affect the rate of refractive growth of an infant eye after cataract surgery:
a. Age at cataract surgery.
b. Controlled glaucoma.
c. Use of intra-ocular lens (IOL) versus contact lens (CL).
d. Visual acuity.

Answer: (d)
21) For uveitis, the systemic steroid sparing drug with the highest success rate at 1 year is:
a. Azathioprine.
b. Cyclosporine A.
c. Methotrexate.
d. Mycophenolate Mofetil.

Answer: (d)

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 ICO ADVANCED 115 New MCQs October 2018 / April 2019
22) Regarding intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF)
agents:
a. Evidence collected over the last 10 years suggests trends improved visual outcomes and
fewer treatments in age related macular degeneration.
b. Evidence suggests that in real life situations, patient are undertreated.
c. The risk of raised intraocular pressure is not related to dose frequency.
d. Treat and extend regimens usually start with 2 monthly intervals between treatments.

Answer: (b)

23) Regarding visual hallucinations in patient with low vision (visual release hallucinations):
a. 90% are associated with age related macular degeneration.
b. Hallucinations are more intense with the eyes open.
c. Hallucinations tend to occur once or twice per day.
d. There is usually psychological insight into the unreal nature of the hallucinations.

Answer: (d)
24) Regarding Myopia:
a. Incidence of high myopia is around 2% in Asia.
b. Incidence is increasing in Asia but not in Western countries.
c. Population studies show an association with glaucoma.
d. Worldwide prevalence is approximately 10%.

Answer: (c)

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 ICO ADVANCED 115 New MCQs October 2018 / April 2019
New Questions

25) A 35-year-old man presents with IOP of 42 mmHg. He has uveitis with macular oedema. The
trabecular meshwork is heavy pigmented and the angle is open. Which of the following is the
most appropriate first line treatment in this patient:
a. Peripheral iridotomies.
b. Right Bareveldt 250 aqueous shunt.
c. Topical drop therapy.
d. Trabeculectomy.

Answer: (c)
26) Regarding meta-analysis of outcome studies or modern laser in situ keratomilleusis (LASIK)
procedures:
a. Around 90% of patients report satisfaction.
b. If corneal sensation is affected in the early post-operative period, recovery is unlikely.
c. Incidence of seeing haloes post-operatively has not decreased despite changes in
technique over the years.
d. Spherical equivalent post-operative refraction is within +/- 1 D of target refraction in over
98% cases.

Answer: (d)
27) Leber’s hereditary optic neuropathy is usually caused by a mutation in the mitochondrial
genome. This is the most likely to be an explanation for which:
a. Acute onset of the disease.
b. Greater prevalence in males.
c. Greater prevalence in smokers.
d. Transmission only through the mother.

Answer: (b)
28) Regarding orbital rhabdomyosarcoma, which subtype is likely to be associated with poor
prognosis:
a. Alveolar.
b. Botryoid.
c. Embryonal.
d. Pleomorphic.

Answer: (a)

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 ICO ADVANCED 115 New MCQs October 2018 / April 2019
29) Which therapy has proven benefit for patients with visual field loss (cerebral):
a. Electromagnetic stimulation of visual cortex.
b. Repetitive visual field testing.
c. Saccadic scanning training.
d. Spectacle mounted base in prisms.

Answer: (c)
30) Which is the predominant cell type in idiopathic epiretinal membrane::
a. Erythrocyte.
b. Glial cell.
c. Lymphocyte.
d. Photoreceptor.

Answer: (b)
31) The ICO curriculum ethics guidance refers to:
a. Abide by the law unless you feel it is not in patient’s best interests.
b. Avoid innovative or research approaches unless they have been tried on animals first.
c. Ensure that colleagues are participating in clinical audit activities.
d. Support the transparent and equitable allocation of health care resources.

Answer: (d)
32) Regarding ethical issues around new genetic techniques in ophthalmology:
a. If you want a screen for a rare but serious disease which you feel is very unlikely to be
positive but is part of the differential diagnosis, you should not discuss with the patient
unless you get an unexpected positive result, to avoid unnecessary anxiety.
b. It is unethical to screen family members of a patient with an untreatable ocular disease
for the same disease.
c. It is unethical to screen for a serious genetic disease unless you will receive the results
within 3 months because of induced patient anxiety.
d. The age at which the patients should receive a new gene therapy technique may differ
for different diseases.

Answer: (d)

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 ICO ADVANCED 115 New MCQs October 2018 / April 2019
New Questions with Figures

33) A 30 year old man presents with the current lesion shown in this figure. It was excised 6
months ago and recurred within three months. After re-excising the lesion, the most
appropriate adjunctive medical treatment would be:

a. Intralesional bleomycin.
b. Oral propranolol.
c. Topical interferon αlpha 2 beta.
d. Topical prednisolone phosphate 0.5%.

Answer: (c)
34) Which is the condition in the left eye of this 25 years old patient:

a. Branch retinal occlusion.

b. Cilio-retinal artery occlusion and central retinal vein occlusion.
c. Retinal vasculitis.
d. Toxoplasma chorioretinitis.

Answer: (b)

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 ICO ADVANCED 115 New MCQs October 2018 / April 2019
35) Which is the likely primary diagnosis of this figure:

a. Congenital glaucoma.
b. Congenital hereditary endothelial dystrophy syndrome.
c. Corneal dermoid.
d. Peter’s anomaly.

Answer: (d)
36) Regarding the condition shown in the fundus photo below

a. It is a progressive condition.
b. It is associated with Nyctalopia.
c. It is associated with reduced visual acuity.
d. It is inherited in an autosomal dominant pattern.

Answer: (b)
37) This figure shows a child looking to the right (top) and left (bottom). Which is the diagnosis:

a. Left Brown’s syndrome.

b. Left Duane’s syndrome.
c. Left partial third nerve palsy.
d. Left sixth nerve palsy.

Answer: (b)
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 ICO ADVANCED 115 New MCQs October 2018 / April 2019
38) Regarding this figure, which is the most likely explanation for the clinical sign shown:

a. Penetrating injury of right eye was predisposed to by proptosis due to shallow orbits.
b. Penetrating injury to right eye predisposed to by proptosis due to thyroid orbitopathy.
c. Right sided enophthalmos due to orbital secondary breast carcinoma.
d. Right sided orbital cellulitis.

Answer: (a)
39) An 80 year old man fell an injured his face. He did not seek treatment at the time but
presents three months later with ectropion pictured in this figure. Which surgical procedure
would be the most appropriate management:

a. Lateral tarsal strip and full thickness skin graft.

b. Lateral tarsorrhaphy.
c. Lateral wedge excision with retractor plication.
d. Split thickness skin graft.

Answer: (a)

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 ICO ADVANCED 115 New MCQs October 2018 / April 2019
40) Regarding the histopathological specimen shown in this figure:

a. Acquiring this condition requires contact with the cystic form of the organism.
b. Poor contact lens hygiene is more strongly associated with bacterial keratitis than this
condition.
c. The most common strain causing disease is the subtype Castellani.
d. The organism is not cultured from any part of the body except the eye.

Answer: (c)

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 ICO ADVANCED 115 New MCQs October 2018 / April 2019
Repeated Questions With Figures

41) Regarding this figure:

a. A surgical peripheral iridotomy should be performed.

b. The lens implant has subluxed into the anterior chamber.
c. This type of lens should no longer be used.
d. The vision will be poor.

Answer: (a)
42) Regarding the condition illustrated in this figure.

a. Cataract surgery does not carry an increased risk with modern phacoemulsification
techniques.
b. During cataract surgery, iris hooks maybe helpful in fixating the capsular bag if there is
zonular instability.
c. In the absence of intra-operative complications during cataract surgery, there is no
increased risk of post-operative complications.
d. It is invariably unilateral.

Answer: (b)

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 ICO ADVANCED 115 New MCQs October 2018 / April 2019
43) Regarding the appearance shown in this figure:

a. The blind spot will be enlarged.

b. The patient has a swollen disc.
c. The patient has glaucoma.
d. There is a juxtapupillary disciform membrane.

Answer: (a)
44) The condition illustrated in this figure is mostly likely to be associated with:

a. Neurofibromatosis type 1.
b. Neurofibromatosis type 2.
c. Sturge-Weber syndrome.
d. Wyburn-Mason syndrome.

Answer: (c)

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 ICO ADVANCED 115 New MCQs October 2018 / April 2019
45) A 50 year old male complains of floaters and mild visual loss. The left fundus is very similar to
his right fundus photographed below. Which is the diagnosis:

a. Birdshot chorioretinopathy.
b. Disseminated cotton wool spots in a patient with hypertensive retinopathy.
c. Disseminated drusen.
d. Multiple evanescent white dot syndrome (MEWSDS)

Answer: (a)
46) This figure is a fundus photograph of the right eye of a 22 year old male with Acquired
Immune Deficiency Syndrome (AIDS) who is on Highly Active Anti-retroviral Treatment
(HAART):

a. Increased mortality occurs with detectable viral load at diagnosis.

b. Oral ganciclovir is the most effective treatment.
c. The CD4 count is 200 cells per microliter.
d. The condition is very resistant to treatment.

Answer: (a)

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 ICO ADVANCED 115 New MCQs October 2018 / April 2019
Repeated Clinical Questions

47) This 70 year old man noticed a sudden decrease of the vision of his right eye. The color
picture and fluorescein angiography are shown below. What is the diagnosis:

a. Choroidal hemangioma.
b. Choroidal melanoma.
c. Hyperplasia of the retinal pigment epithelium.
d. Retinal pigment epithelium tear.

Answer: (d)

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 ICO ADVANCED 115 New MCQs October 2018 / April 2019
Repeated Questions - Completed Choices

48) A cataract surgeon notices the anterior capsulorhexis is extending to the periphery. Which
option should be considered:
a. All of them below.
b. Check for positive vitreous pressure and try to release any external pressure on the globe.
c. Inject and refill the anterior chamber with viscoelastic.
d. Insert a second instrument from the paracentesis site to press posteriorly on the lens.

Answer: (a)
49) Regarding perfluorocarbon liquids used in retinal surgery:
a. They are associated with retinal toxicity and uveitis.
b. They are used for post-operative tamponade of superior breaks.
c. They have a high viscosity and so remain where injected.
d. They have a lower specific gravity than water.

Answer: (a)
50) Regarding tuberculous uveitis:
a. Anterior uveitis is usually acute.
b. It is extremely rare in the absence of pulmonary tuberculosis.
c. Multifocal choroiditis may respond to anti-tuberculous therapy without oral steroids.
d. Mycobacterium tuberculosis (MTB) is anaerobic and rarely found in highly oxygenated
tissues.

Answer: (c)
51) Regarding a child who has Stargardt disease and who had comprehensive genetic testing
for mutations in the ABCA4 gene:
a. A heterozygous known mutation and a whole gene deletion could explain the condition.
b. A heterozygous known mutation could explain the condition.
c. Homozygosity for a single known mutation would be more common in non-
consanguineous populations.
d. Two different heterozygous known mutations found in the child and their father could
explain the condition.

Answer: (a)

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 ICO ADVANCED 115 New MCQs October 2018 / April 2019
52) Regarding traumatic optic neuropathy:
a. It occurs in approximately 0.2% of head injuries.
b. Magnetic Resonance Imaging scan should be performed urgently if suspected.
c. Recovery occurs in 40-60% without treatment.
d. The optic nerve head is usually swollen acutely on fundoscopy.

Answer: (c)
53) Regarding orbital lymphoma:
a. Complete surgical excision is recommended as it has the best tumor survival.
b. Extra nodal marginal zone lymphoma is more aggressive than mantle cell lymphoma.
c. Radiotherapy is contraindicated in bilateral disease.
d. Thyroid eye disease and chronic dacryoadenitis may be predisposing factors.

Answer: (d)
54) Regarding the clinical condition of melanocytoma:
a. Melanocytoma is only found at the optic disc and not elsewhere on the uveal tract.
b. Melanocytoma of the optic disc does not cause a relative afferent pupil defect.
c. Melanocytoma of the optic disc does not cause visual field defects.
d. Melanocytoma of the optic disc has low risk for transformation into melanoma.

Answer: (d)
55) Regarding the histopathology of eyelid tumors:
a. Nodules of palisading basal cells extend into the dermis in morphoeic basal cell
carcinoma.
b. Perineural invasion and solar elastosis are common features of sebaceous carcinoma.
c. Pigmented basal cell carcinoma most commonly arise from pre-existing pigmented
naevi.
d. Sebocytes with clear vacuolated cytoplasm are characteristic of sebaceous carcinoma.

Answer: (d)
56) Pooled analysis of people with diabetes in the US, Australia, Europe and Asia (between 1980
and 2008) showed that the overall prevalence of any diabetic retinopathy in all cases of
diabetes (type 1 or type 2) was approximately:
a. 10% for any diabetic retinopathy and 1% sight threating retinopathy.
b. 35% for any diabetic retinopathy and 7% sight threating retinopathy.
c. 50% for any diabetic retinopathy and 15% sight threating retinopathy.
d. 70% for any diabetic retinopathy and 13% sight threating retinopathy.

Answer: (b)

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 ICO ADVANCED 115 New MCQs October 2018 / April 2019
57) Regarding trachoma:
a. Infection with Chlamydia trachomatis as a child conveys limited immunity and future
infection episodes are of shorter duration.
b. Infection with Chlamydia trachomatis as a child conveys lifelong immunity and
protection against reinfection.
c. Infection with Chlamydia trachomatis as a child conveys no immunity and recurrent
infection episodes are similar in duration.
d. Vaccination in now part of a multifaceted World Health Organization (WHO) trachoma
control programme.

Answer: (a)
58) Regarding onchocerciasis:
a. A bacteria, Wolbachia, which lives symbiotically with adult worms may be involve in the
pathogenesis.
b. It is sometimes called river blindness because onchocerca volvulus breeds near fast
flowing rivers.
c. Ocular disease is most commonly seen in women.
d. Once microfilariae enter the eye, ocular disease develops rapidly.

Answer: (a)

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 ICO ADVANCED 115 New MCQs October 2018 / April 2019
Repeated Questions (October 2015) - Confirmed Answers

59) Regarding the condition illustrated in this figure, systemic review of treatment trials suggest
which of the following:

a. Acyclovir is more effective than ganciclovir.

b. Acyclovir is more effective than idoxuridine.
c. Idoxuridine is more effective than trifluridine.
d. Trifluridine is more effective than acyclovir.

Answer: (b)
60) Regarding intraocular pressure (IOP):
a. An increase in corneal thickness of 100 microns increases IOP by 1 mmHg.
b. IOP is always lower when lying down than when standing.
c. IOP levels normally reduce gradually in people over 65 years old.
d. IOP variations are more marked in patients with primary open angle glaucoma than in
those without.

Answer: (d)
61) Regarding the use of cyclodiode laser for ciliary body ablation:
a. Audible pops suggest the need for lower power settings.
b. In uvetic glaucoma, higher power settings are used to fully ablate the ciliary processes.
c. There is a linear relationship between total power used and pressure lowering effect.
d. To be most effective, the laser is focused on the pars plana.

Answer: (a)
62) Regarding associations between following conditions and cataract morphology:
a. Amiodarone is associated with anterior subcapsular cataract.
b. Down’s syndrome is associated with lamellar cataract.
c. Myotonic dystrophy is associated with sunflower cataract.
d. Wilson's disease is associated with Christmas tree cataract.

Answer: (a)

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 ICO ADVANCED 115 New MCQs October 2018 / April 2019
63) Regarding microspherophakia:
a. Associated pupillary block glaucoma should be treated with miotics.
b. It can be autosomal recessive disorder.
c. It is associated with hyperopia.
d. It is associated with long stature and hyperextensible joints.

Answer: (b)

64) A recent large multicenter randomized controlled trial of contact lens versus primary
intraocular lens (IOL) implantation for unilateral congenital cataract (Infant aphakia
treatment study–IATS):
a. Glaucoma rates were lower in the IOL group.
b. Re-operation rates were higher in the IOL group during the first year.
c. Visual results were better in the IOL group at 1 year.
d. Visual results were better in the IOL group at 1 year.

Answer: (b)
65) Regarding Vogt-Koyangi-Harada (VKH) disease:
a. It is more common inn males.
b. The acute phase is invariably involves extra-ocular disease as well as ocular disease.
c. The chronic phase is invariably involves extra-ocular disease as well as ocular disease.
d. The prodromal phase may mimic a viral infection.

Answer: (d)
66) Regarding cytomegalovirus (CMV) anterior uveitis:
a. Anterior chamber (AC) tap for specific polymerase chain reaction (PCR) analysis has a
low diagnostic yield.
b. Posner-Schlossman syndrome is associated with CMV in an immunocompetent host.
c. Posterior synechiae are often present.
d. Uveitis is usually bilateral.

Answer: (b)
67) Regarding Vogt-Koyangi-Harada (VKH) disease, which of following imaging techniques is
most likely to identify choroidal inflammation:
a. Fluorescein angiography (FFA).
b. Indocyanine green (ICG) angiography.
c. Optical coherence tomography (OCT) scan of the retina.
d. Visual field (VF) analysis.

Answer: (b)

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 ICO ADVANCED 115 New MCQs October 2018 / April 2019
68) Regarding cystinosis:
a. End stage renal failure develops by the age of 50.
b. It is inherited in an autosomal dominant pattern.
c. Oral cysteamine inhibits accumulation of corneal deposits.
d. Topical cysteamine inhibits accumulation of corneal deposits.

Answer: (d)

69) Regarding the steroid for corneal ulcer trial (SCUT):

a. Steroids are associated with better visual acuities at 3 months.
b. Steroids are associated with greater benefit for severe corneal ulcers than less severe
corneal ulcers.
c. Steroids are associated with a higher rate of corneal perforation.
d. Steroids are associated with a rise in intraocular pressure.

Answer: (b)

70) Regarding trials comparing treatment of moderate to high myopia with phakic intra-ocular
implants (IOLs) versus excimer laser:
a. Contrast sensitivity was better with phakic IOL compared with excimer.
b. Patients prefer excimer laser over phakic IOL.
c. Phakic IOLs achieved significantly higher rates of unaided visual acuities of logMAR 0.0
(Senellen 6/6, 20/20, decimal 1.0).
d. Risk of loss of best spectacle corrected visual acuity at 12 months was higher with phakic
IOL than excimer.

Answer: (a)

71) Classic epidemic keratoconjunctivitis (EKC) is likely caused by which virus:

a. Adenovirus types 3 and 7.
b. Adenovirus types 8 and 19.
c. Herpes simplex type 1.
d. Herpes simplex type 2.

Answer: (b)

72) Which of the following is most likely to be asymmetrical retinitis pigmentosa (RP):
a. Autosomal dominant individual.
b. Autosomal recessive individual
c. Female carriers of X linked RP.
d. Male patients with sporadic inheritance.

Answer: (c)

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 ICO ADVANCED 115 New MCQs October 2018 / April 2019
73) Testing of versions in a case of 'A' Pattern exotropia will mostly likely reveal:
a. Inferior oblique over action.
b. Inferior rectus over action.
c. Superior oblique over action.
d. Superior rectus over action.

Answer: (c)

74) Increased Accommodative Convergence/Accommodation (AC/A) ratio in:

a. Accommodation insufficiency.
b. Accommodative spasm.
c. Convergence excess esotropia.
d. Fully accommodative.

Answer: (c)

75) Which differentiates a skew deviation from a 4th cranial nerve palsy:
a. Excyclotorsion of the hyperdeviated eye.
b. Incyclotorsion of the hyperdeviated eye.
c. Inferior oblique overaction.
d. Inferior oblique underaction.

Answer: (b)
76) Regarding a 4 year old child with infantile nystagmus syndrome (INS) or idiopathic infantile
nystagmus (IIN):
a. Nystagmus beating in the direction of gaze horizontally.
b. Nystagmus only present on monocular occlusion.
c. Predominantly downbeat nystagmus.
d. See-saw nystagmus.

Answer: (a)
77) Which ONE of the following endogenous auto-immune uveitis entities is MOST likely to be
associated with visual prognosis:
a. Behcet's disease.
b. HLA (Human Leucocyte Antigen) B27.
c. Idiopathic.
d. VKH (Vogt-Koyangi-Harada) disease.

Answer: (a)

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 ICO ADVANCED 115 New MCQs October 2018 / April 2019
78) Which feature on Magnetic Resonance Imaging (MRI) scan of the head is likely to be
consistent with a diagnosis of Idiopathic intracranial hypertension (IIH):
a. Arachnoid cyst.
b. Chiari malformation.
c. Empty sella tursica.
d. Ventricular enlargement.

Answer: (c)
79) Regarding anterior ischemic optic neuropathy (AION):
a. A large cup disc ratio is a risk factor for developing the disease.
b. Approximately 40% of patients experience spontaneous improvement in visual acuity.
c. Pain usually precedes the visual loss.
d. The risk of fellow eye involvement over 5 years is approximately 50%.

Answer: (b)
80) A 40 year old hypertensive man has a twelve month history of excruciatingly severe left
sided pain behind and around the eye. It occurred daily, 1 or 2 times per day. For a few
weeks at a time. The first attack always started before his morning break at 11 am and the
attacks lasted 15 to 60 minutes. His eye usually became red and his eye and nose watered
and a droopy left upper lid was occasionally noticed. Occasionally, a similar pain occurred
on the right side. Which ONE of the following is most likely to be TRUE:
a. Early stereotactic radiosurgery (gamma knife) of the trigeminal nerve root is indicated.
b. It is likely to be improved by dihydroergotamine taken before the attack.
c. Magnetic Resonance Imaging is likely to show ipsilateral hypothalamic activation.
d. Remissions are usually longer than six months.

Answer: (c)
81) Regarding internuclear ophthalmoplegia (INO):
a. Bilateral INO is usually associated with convergence weakness.
b. If the cause is ischaemia, prognosis for recovery is poor.
c. Reduced adducting saccadic velocity is a characteristic sign.
d. Unilateral INO is more likely to be associated with multiple sclerosis than with brainstem
infraction.

Answer: (c)

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 ICO ADVANCED 115 New MCQs October 2018 / April 2019
82) Oculosympathetic paresis (Horner’s syndrome) and ipsilateral sixth nerve palsy are most
likely to indicate pathology in which anatomical site:
a. Cavernous sinus.
b. Cerebellopontine angle.
c. Meckel’s cave.
d. Petrous apex.

Answer: (a)
83) In a 65 year old woman with low vertical saccade and difficulty opening her eyes. Which is
the diagnosis:
a. Hydrocephalus.
b. Pineal tumor.
c. Progressive supranuclear palsy
d. Wilson’s disease.

Answer: (c)
84) Regarding management of trachomatous trichiasis in endemic regions, which of the
following procedures is first line treatment:
a. Bilamellar tarsal rotation with absorbable sutures.
b. Bilamellar tarsal rotation with either absorbable or non-absorbable sutures.
c. Bilamellar tarsal rotation with non-absorbable sutures.
d. Mucous membrane graft to posterior lamella.

Answer: (b)
85) Regarding thyroid orbitopathy (TO):
a. Active disease is unlikely in patients who are euthyoid.
b. Insulin like growth factor receptor (IGF-1R) is expressed at higher levels in the orbital
connective tissue.
c. Rituximab is now the first line treatment of choice.
d. The active phase is self limiting usually lasting less than 6 months.

Answer: (b)
86) Regarding senile involutional ptosis:
a. Levator function is likely to be less than 5 mm.
b. Mulller muscle – conjunctival resection is contra-indicated.
c. Normal adult margin-to-reflex distance 1 (centre of pupil to upper lid margin) is
approximately 3 mm.
d. Ptosis (>4 mm) is associated with higher risk of surgical udercorrection.

Answer: (d)

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 ICO ADVANCED 115 New MCQs October 2018 / April 2019
87) Regarding the blepharochalasis syndrome:
a. It is characterized by repeated episodes of painless eyelid oedema with complete
recovery each time.
b. It mainly affects people over the age of 50.
c. The average duration of an attack is approximately 2 days.
d. The Presence of ptosis excludes the condition.

Answer: (c)
88) Which tissue is likely to be the site of metastatic disease from choroidal melanoma:
a. Bone.
b. Brain.
c. Liver.
d. Lung.

Answer: (c)

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 ICO ADVANCED 115 New MCQs October 2018 / April 2019
Repeated Questions (October 2019)

89) Regarding the management of an over-draining bleb:

a. A Plamberg (compression mattress) sutures.
b. Botulinum induced ptosis.
c. Pilocarpine drops.
d. Xen implant.

Answer: (a)
90) Regarding Neovascular glaucoma (NVG) , which is most likely to be associated:
a. Irido corneal endothelial (ICE) syndrome.
b. Ocular ischemic syndrome (OIS).
c. Uveitis glaucoma hyphema (UGH) syndrome.
d. Vitelliform maculopathy.

Answer: (b)
91) Which agent is most likely to have a causative role in Fuch's uveitis:
a. Adenovirus.
b. Herpes simplex virus type 1 (HSV1).
c. Rubella virus.
d. Varicella zoster virus.

Answer: (c)

Withdrawn Question

92) Regarding primary open angle glaucoma (POAG):

a. Age adjusted prevalence is less in men than women.
b. Around 25% of case are caused by specific gene mutation.
c. Reduction of intraocular pressure (IOP) reduces the risk of visual field loss in patients with
normal IOP.
d. Risk factors for development of paracentral versus peripheral field loss are identical.

Answer: (?)

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