[
  {
    "Id": 1,
    "Name": "Cataract surgery",
    "Body": "\u003Cp class=\u0022MsoListParagraphCxSpFirst\u0022 style=\u0022margin: 0cm 0cm 0cm 36pt; line-height: 15.6933px; text-indent: -18pt;\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003E\u003Cspan style=\u0022color: rgb(0, 0, 0); font-family: Calibri, sans-serif; letter-spacing: normal;\u0022\u003ERegarding intraoperative management of astigmatism during cataract surgery, which of the following statements is most\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022color: rgb(0, 0, 0); font-family: Calibri, sans-serif; letter-spacing: normal; text-indent: -18pt;\u0022\u003Elikely to be true?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\u003Cp class=\u0022MsoListParagraphCxSpFirst\u0022 style=\u0022margin: 0cm 0cm 0cm 36pt; line-height: 15.6933px; font-size: 11pt; font-family: Calibri, sans-serif; color: rgb(0, 0, 0); letter-spacing: normal; text-indent: -18pt;\u0022\u003E\u003Cspan lang=\u0022EN-US\u0022 style=\u0022font-family: Symbol;\u0022\u003E\u00B7\u003Cspan style=\u0022font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: \u0026quot;Times New Roman\u0026quot;;\u0022\u003E\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u003C/span\u003E\u003C/span\u003E\u003Cspan dir=\u0022LTR\u0022\u003E\u003C/span\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003Cspan lang=\u0022EN-US\u0022\u003EIt is prudent to make reference marks\u003C/span\u003E\u003C/span\u003E\u003Cspan lang=\u0022EN-US\u0022\u003E, using a surgical marking pen, with the patient sitting up, preferably at the slit lamp. Marking with the patient in this position avoids reference-mark error due to cyclotorsion of the eyes. Studies have demonstrated that up to 15\u00B0 of cyclotorsion can occur when patients move from an upright to a supine position.\u0026nbsp;\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022MsoListParagraphCxSpFirst\u0022 style=\u0022margin: 0cm 0cm 0cm 36pt; line-height: 15.6933px; font-size: 11pt; font-family: Calibri, sans-serif; color: rgb(0, 0, 0); letter-spacing: normal; text-indent: -18pt;\u0022\u003E\u003Cspan lang=\u0022EN-US\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022MsoListParagraphCxSpMiddle\u0022 style=\u0022margin: 0cm 0cm 0cm 36pt; line-height: 15.6933px; font-size: 11pt; font-family: Calibri, sans-serif; color: rgb(0, 0, 0); letter-spacing: normal; text-indent: -18pt;\u0022\u003E\u003Cspan lang=\u0022EN-US\u0022 style=\u0022font-family: Symbol;\u0022\u003E\u00B7\u003Cspan style=\u0022font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: \u0026quot;Times New Roman\u0026quot;;\u0022\u003E\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u003C/span\u003E\u003C/span\u003E\u003Cspan dir=\u0022LTR\u0022\u003E\u003C/span\u003E\u003Cspan lang=\u0022EN-US\u0022\u003EWith increased age the majority of the population develop ATR astigmatism. Hence, a temporally placed incision may reduce or neutralise this astigmatism.\u0026nbsp;\u0026nbsp;Although it is generally preferable to undercorrect pre-existing astigmatism and avoid large swings of axis, WTR astigmatism is considered normal in younger individuals and may confer some optical advantage\u003Co:p\u003E\u003C/o:p\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022MsoListParagraphCxSpMiddle\u0022 style=\u0022margin: 0cm 0cm 0cm 36pt; line-height: 15.6933px; font-size: 11pt; font-family: Calibri, sans-serif; color: rgb(0, 0, 0); letter-spacing: normal; text-indent: -18pt;\u0022\u003E\u003Cspan lang=\u0022EN-US\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022MsoListParagraphCxSpLast\u0022 style=\u0022margin: 0cm 0cm 0cm 36pt; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif; color: rgb(0, 0, 0); letter-spacing: normal; text-indent: -18pt;\u0022\u003E\u003Cspan lang=\u0022EN-US\u0022 style=\u0022font-family: Symbol;\u0022\u003E\u00B7\u003Cspan style=\u0022font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: \u0026quot;Times New Roman\u0026quot;;\u0022\u003E\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u003C/span\u003E\u003C/span\u003E\u003Cspan dir=\u0022LTR\u0022\u003E\u003C/span\u003E\u003Cspan lang=\u0022EN-US\u0022\u003EA toric IOL is appropriate for patients with regular corneal astigmatism,\u0026nbsp;\u003Cspan style=\u0022font-weight: 700;\u0022\u003Ecurrently up to 4.00 D\u003C/span\u003E\u0026nbsp;at the corneal plane (United States). Patients with astigmatism exceeding the upper correction limits require additional measures to obtain full correction\u003Co:p\u003E\u003C/o:p\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022MsoListParagraphCxSpLast\u0022 style=\u0022margin: 0cm 0cm 0cm 36pt; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif; color: rgb(0, 0, 0); letter-spacing: normal; text-indent: -18pt;\u0022\u003E\u003Cspan lang=\u0022EN-US\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022MsoListParagraphCxSpLast\u0022 style=\u0022margin: 0cm 0cm 0cm 36pt; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif; color: rgb(0, 0, 0); letter-spacing: normal; text-indent: -18pt;\u0022\u003E\u003Cspan lang=\u0022EN-US\u0022\u003E\u003Cimg src=\u0022http://blazorcss.somee.com/upload-2025-02-26-83b22e73-8a3c-4a68-9b5e-1a3db75ee6e5.png\u0022\u003E\u003Cbr\u003E\u003Cbr\u003E\u003Cimg src=\u0022/upload-2025-02-27-3c6debe9-4774-4b14-a62f-cc04808cda3d.png\u0022 width=\u00221000\u0022 height=\u0022500\u0022\u003E\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 1,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 2,
    "Name": "Cataract surgery",
    "Body": "\u003Cspan style=\u0022font-weight: bold; font-size: large;\u0022\u003ESystematic review of studies comparing mono-focal lens implants with multifocal lens implants showed:\u003C/span\u003E",
    "Explanation": "Patients with Multifocal IOLs are more likely to have significant glare, halos, and ghosting than those with monofocal, toric, or accommodating IOLs. These issues stem from various etiologies, including residual refractive error, ocular surface disease, or intrinsic IOL problems.\u003Cdiv\u003E\u003Cbr\u003E\u003Cdiv\u003EThe reports of halos intrinsically related to the IOL tend to subside over several months, perhaps from the patient\u0027s neural adaptation, but they may be persistent.\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003EBecause of a reduction in contrast sensitivity, the subjective quality of vision after MF-IOL insertion may not be as good as after monofocal IOL implantation.\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003EWith MF-IOLS, intermediate vision may be less clear than distance or near acuity.\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003EMF-IOLs compared to standard IOLs or monovision result in better uncorrected near vision and a higher proportion of patients who achieve spectacle independence, but a greater risk of unwanted visual phenomena.\u003C/div\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 1,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 3,
    "Name": "PXF",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022 style=\u0022margin: 0cm; font-size: 12pt; font-family: Calibri, sans-serif; color: rgb(0, 0, 0); letter-spacing: normal;\u0022\u003E\u003Cb\u003EWhich of the following is characteristic of pseudo-exfoliation?\u003Co:p\u003E\u003C/o:p\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "PXF has no clear inheritance pattern. It is more common in females and those of Scandinavian ancestry. It causes chronic open angle glaucoma in about 15% at 10 years.",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 1,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 4,
    "Name": "Rieger\u0027s syndrome",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022 style=\u0022margin: 0cm; font-size: 12pt; font-family: Calibri, sans-serif; color: rgb(0, 0, 0); letter-spacing: normal;\u0022\u003E\u003Cb\u003EA patient has short stature, aortic stenosis, and mental retardation. On examination, the optic discs show glaucomatous cupping. What is the most likely diagnosis?\u003Co:p\u003E\u003C/o:p\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\u003Cbr\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 1,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 5,
    "Name": "Diabetic Retinopathy",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022 style=\u0022margin: 0cm; font-size: 12pt; font-family: Aptos, sans-serif; color: rgb(0, 0, 0); letter-spacing: normal;\u0022\u003E\u003Cb\u003EWhich of the following is LEAST appropriate when performing focal argon laser for diabetic macular oedema?\u003C/b\u003E\u003Co:p\u003E\u003C/o:p\u003E\u003C/p\u003E",
    "Explanation": "When performing focal argon laser treatment for diabetic macular oedema, the general recommended parameters are:\u0026nbsp;\u003Cblockquote style=\u0022margin: 0 0 0 40px; border: none; padding: 0px;\u0022\u003E\u003Cdiv\u003E\u2022\t\u003Cspan style=\u0022font-weight: bold;\u0022\u003ESpot size:\u003C/span\u003E typically 50\u2013100 microns\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\t\u003Cspan style=\u0022font-weight: bold;\u0022\u003EExposure time:\u003C/span\u003E short burns around 0.05\u20130.1 seconds, certainly not exceeding 0.2 seconds, to avoid excessive thermal diffusion\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\t\u003Cspan style=\u0022font-weight: bold;\u0022\u003EInitial power:\u003C/span\u003E generally less than 200 mW is reasonable to titrate a barely visible burn\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\t\u003Cspan style=\u0022font-weight: bold;\u0022\u003ETreatment area:\u003C/span\u003E apply burns to leaking microaneurysms between 500 and 3000 microns from the centre of the fovea. Lesions as near as 300 microns to the fovea may be treated, provided this would not be within the foveal avascular zone\u0026nbsp;\u003C/div\u003E\u003C/blockquote\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;Using laser burns longer than 0.2 seconds would cause excessive heat diffusion, damaging surrounding retina and retinal pigment epithelium beyond the intended treatment area, making this the least appropriate choice.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 6,
    "Name": "Nyctalopia",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022 style=\u0022margin: 0cm; font-size: 12pt; font-family: Aptos, sans-serif; color: rgb(0, 0, 0); letter-spacing: normal;\u0022\u003E\u003Cb\u003EA 54 year old female underwent bariatric surgery two years previously to try and control her weight. She is now complaining of nyctalopia. Which of these vitamins is the MOST likely therapy the patient requires?\u003C/b\u003E\u003Co:p\u003E\u003C/o:p\u003E\u003C/p\u003E",
    "Explanation": "Nyctalopia (night blindness) is classically caused by \u003Cspan style=\u0022font-weight: bold;\u0022\u003Evitamin A deficiency\u003C/span\u003E, which can occur after bariatric surgery due to fat-soluble vitamin malabsorption. Vitamin A is essential for rhodopsin regeneration in the retina, critical for night vision.\u0026nbsp;\u003Cdiv\u003E\u0026nbsp;Therefore, vitamin A supplementation is the most appropriate therapy.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 7,
    "Name": "Immune-suppresives",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022 style=\u0022margin: 0cm; font-size: 12pt; font-family: Aptos, sans-serif; color: rgb(0, 0, 0); letter-spacing: normal;\u0022\u003E\u003Cb\u003EA 55 year old patient with granulomatosis polyangiitis is being prescribed cyclophosphamide. Which of these side effects are they MOST likely to experience?\u003C/b\u003E\u003Co:p\u003E\u003C/o:p\u003E\u003C/p\u003E",
    "Explanation": "Cyclophosphamide is an alkylating agent with significant myelotoxicity, making bone marrow suppression the most common and dose-limiting side effect.\u0026nbsp;\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;Other side effects (like hemorrhagic cystitis, due to acrolein metabolite) can also occur but are less frequent with proper feeding and hydration protocols. Hirsutism and osteoporosis are more associated with long-term steroid therapy, not cyclophosphamide.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u0026nbsp;\u003Cspan style=\u0022font-weight: bold;\u0022\u003EThe BNF Lists myelosuppression as the most common and dose-limiting toxicity of cyclophosphamide.\u003C/span\u003E\n\n\nTherefore, marrow suppression is the most likely side effect.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px; font-weight: bold;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px; font-weight: bold;\u0022\u003E\u0026nbsp;A similar question appeared in FRCOphth part 2 written exam in 2022.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 5,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 8,
    "Name": "Immune-suppresives",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022 style=\u0022margin: 0cm; font-size: 12pt; font-family: Aptos, sans-serif; color: rgb(0, 0, 0); letter-spacing: normal;\u0022\u003E\u003Cb\u003EWhich of the following statements is MOST likely to be correct concerning Adalimumab?\u003C/b\u003E\u003Co:p\u003E\u003C/o:p\u003E\u003C/p\u003E",
    "Explanation": "\u2022\tAdalimumab is a fully human monoclonal anti-TNF-\u03B1 antibody.\u0026nbsp;\u003Cdiv\u003E\u2022\tIt is typically used \u003Cspan style=\u0022font-weight: bold;\u0022\u003Esubcutaneously\u003C/span\u003E (so option D is incorrect).\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tIn JIA-associated uveitis (iridocyclitis), it is indicated as second-line treatment if methotrexate fails, in accordance with uveitis guidelines.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tIt is \u003Cspan style=\u0022font-weight: bold;\u0022\u003Enot\u003C/span\u003E first line in sarcoid uveitis (option B incorrect).\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tInfliximab (not adalimumab) is a chimeric antibody (option A incorrect).\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 5,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 9,
    "Name": "Peads Cataract",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022 style=\u0022margin: 0cm; font-size: 12pt; font-family: Aptos, sans-serif; color: rgb(0, 0, 0); letter-spacing: normal;\u0022\u003E\u003Cb\u003ECataracts are MOST commonly associated with which ONE of the following collections of systemic abnormalities?\u003C/b\u003E\u003Co:p\u003E\u003C/o:p\u003E\u003C/p\u003E",
    "Explanation": "This triad is characteristic of \u003Cspan style=\u0022font-weight: bold;\u0022\u003ELowe syndrome (oculocerebrorenal syndrome)\u003C/span\u003E, which is well known for causing congenital cataracts along with:\u0026nbsp;\u003Cblockquote style=\u0022margin: 0 0 0 40px; border: none; padding: 0px;\u0022\u003E\u003Cdiv\u003E\u2022\tlearning difficulties (cerebral involvement)\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\thypotonia\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tproximal renal tubular acidosis\u0026nbsp;\u003C/div\u003E\u003C/blockquote\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;\u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003ERegarding the other choices:\u003C/span\u003E\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003EA: Biliary cirrhosis, muscle rigidity, muscle weakness\n\u2192 These features point more toward primary biliary cirrhosis or mitochondrial disorders like primary biliary cholangitis with myopathy \u2014 but these do not classically associate with cataracts.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;B: Hypodontia, mandibular hypoplasia, hypertelorism\n\u2192 Suggestive of orofacial-digital syndromes or other craniofacial dysplasias, which are not strongly linked with congenital cataracts.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;D: Mid-facial hypoplasia, epiphyseal dysplasia, deafness\n\u2192 Points toward conditions like Stickler syndrome or Treacher Collins, involving skeletal and facial anomalies and hearing loss, but cataracts are not their hallmark (Stickler is more linked with high myopia and retinal detachment).\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 1,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 10,
    "Name": "Fuch\u2019s Endothelial dystrophy",
    "Body": "\u003Cp class=\u0022p1\u0022 style=\u0022margin-right: 0cm; margin-left: 0cm; font-size: 12pt; font-family: \u0026quot;Times New Roman\u0026quot;, serif; color: rgb(0, 0, 0); letter-spacing: normal;\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EIn patients with Stage 1 Fuch\u2019s endothelial corneal dystrophy, which of the following is MOST likely to be true?\u003C/span\u003E\u003Co:p\u003E\u003C/o:p\u003E\u003C/p\u003E",
    "Explanation": "Stages of Fuchs\u2019 Endothelial Dystrophy (clinical):\u0026nbsp;\u003Cdiv\u003E\u2705 Stage 1 (Early):\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tFormation of central corneal guttae\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tNo stromal or epithelial edema\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u2705 Stage 2 (Edematous):\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tProgressive endothelial decompensation\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tStromal edema visible on slit-lamp\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tDescemet\u2019s folds may appear\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u2705 Stage 3 (Bullous keratopathy):\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tEpithelial edema with microcystic bullae\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tPain from ruptured bullae\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u2705 Stage 4 (Late / Scarring):\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tSubepithelial fibrosis\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tStromal scarring\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tPersistent edema\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cimg src=\u0022https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1836/11034696/c80102a036d7/TJO-14-15-g002.jpg\u0022\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003EAlgorithms for treating FECD.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E(a) Currently, only few conservative therapies could be tried. Surgery is the only definitive treatment for FECD.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E(b) As more novel therapeutic approaches are becoming available, a stepwise algorithm for treating FECD will substitute current surgery-centred manner. For patients with mild FECD, pharmacology-associated treatments should be used as the first line. Cell therapy-associated treatments are minimally invasive, being good candidates as second-line treatments. Surgery is reserved for patients with severe, refractory FECD. In addition to single treatment, the combination of different therapeutic methods should also be considered*\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-style: italic; font-size: x-small;\u0022\u003E\u0026nbsp;*Liu, Jia-Xin \u0026amp; Chiang, Tung-Lin \u0026amp; Hung, Kai-Feng \u0026amp; Sun, Yi-Chen. (2024). Therapeutic future of Fuchs endothelial corneal dystrophy: An ongoing way to explore. Taiwan Journal of Ophthalmology. 14. 10.4103/tjo.TJO-D-23-00115.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold; font-style: italic; text-decoration-line: underline;\u0022\u003ESources:\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u2022\tKrachmer JH, Mannis MJ, Holland EJ. Cornea, 4th Edition. Elsevier; 2017.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tEye Bank Association of America Medical Standards (latest revision)\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tEghrari AO, Riazuddin SA, Gottsch JD. Fuchs Corneal Dystrophy. Ophthalmology. 2015;122(12):2341-2349. doi:10.1016/j.ophtha.2015.08.017\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tAmerican Academy of Ophthalmology (AAO) EyeWiki: Fuchs Endothelial Corneal Dystrophy\u0026nbsp;\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 11,
    "Name": "OHT",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022 style=\u0022margin: 0cm; font-size: 12pt; font-family: Aptos, sans-serif; color: rgb(0, 0, 0); letter-spacing: normal;\u0022\u003E\u003Cb\u003EIn the Ocular Hypertension Treatment Study (OHTS), which ONE of the following was found to be a risk factor for conversion to glaucoma?\u003C/b\u003E\u003Co:p\u003E\u003C/o:p\u003E\u003C/p\u003E",
    "Explanation": "The Ocular Hypertension Treatment Study (OHTS) identified several significant risk factors for progression from ocular hypertension to primary open-angle glaucoma, including:\u0026nbsp;\u003Cdiv\u003E\u2022\tLarge vertical cup-disc ratio\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tThin central corneal thickness (not increased)\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tHigher intraocular pressure\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tOlder age\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tAfrican ancestry\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;Large vertical cup-disc ratio suggests existing structural vulnerability of the optic nerve head, making it a strong predictor of conversion.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;\u003Cspan style=\u0022font-size: x-small;\u0022\u003ESource:\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-size: x-small;\u0022\u003E\u2022\tKass MA, Heuer DK, Higginbotham EJ, et al. The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol. 2002;120(6):701\u2013713.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline; color: rgb(255, 0, 0);\u0022\u003E\u0026nbsp;Remember: OHT outcomes:\u003C/span\u003E\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cul\u003E\u003Cli\u003EThe five-year risk of developing POAG from ocular hypertension was reduced ~50% with topical medications.\nHowever, the risk of conversion to glaucoma remained low in both groups at five years (4.4% treated vs. 9.5% untreated).\u003C/li\u003E\u003Cli\u003E66.4% of originally abnormal VFs were within normal limits on follow-up testing.\u0026nbsp;\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 12,
    "Name": "DVLA",
    "Body": "\u003Ch2 style=\u0022margin: 8pt 0cm 4pt; break-after: avoid; font-family: \u0026quot;Aptos Display\u0026quot;, sans-serif; font-weight: normal; letter-spacing: normal;\u0022\u003E\u003Cspan style=\u0022font-size: medium; color: rgb(6, 6, 6);\u0022\u003EAccording to UK law, which of these patients would NOT be legally able to drive within their category?\u003C/span\u003E\u003Cspan style=\u0022color: rgb(15, 71, 97); font-size: 16pt;\u0022\u003E\u003Co:p\u003E\u003C/o:p\u003E\u003C/span\u003E\u003C/h2\u003E",
    "Explanation": "According to DVLA (Driver and Vehicle Licensing Agency) guidance, anyone who has experienced \u003Cspan style=\u0022font-weight: bold;\u0022\u003Etransient monocular vision loss (amaurosis fugax) \u003C/span\u003Emust stop driving for \u003Cspan style=\u0022text-decoration-line: underline;\u0022\u003Eat least one month\u003C/span\u003E and notify the DVLA if there is a risk of recurrence, due to potential underlying vascular risk (e.g., carotid disease). Three weeks is insufficient to resume driving safely without further assessment.\u0026nbsp;\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cblockquote style=\u0022margin: 0 0 0 40px; border: none; padding: 0px;\u0022\u003E\u003Cdiv\u003E\u0026nbsp;\u2022\tDVLA rules allow Group 1 drivers to have minor defects as long as there are no significant defects within a 20\u00B0 radius around fixation.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;\u2022\tMonocular vision is acceptable for Group 1 driving as long as they meet the acuity standard and adapt to monocularity. Patching to control diplopia is permissible.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tGroup 2 (lorry/bus drivers) require at least 6/7.5 in their better eye and at least 6/12 in the other eye, with spectacle correction up to \u002B8.0D acceptable.\u0026nbsp;\u003C/div\u003E\u003C/blockquote\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 7,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 13,
    "Name": "Glaucoma treatment",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022 style=\u0022margin: 0cm; font-size: 12pt; font-family: Calibri, sans-serif; color: rgb(0, 0, 0); letter-spacing: normal;\u0022\u003E\u003Cb\u003E\u003Cspan lang=\u0022EN-US\u0022\u003EWhich of the following glaucoma drops decreases aqueous production AND increases aqueous outflow?\u003Co:p\u003E\u003C/o:p\u003E\u003C/span\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "Alpha-2-adrenergic agonists such as brimonidine work by dual mechanism, decreasing aqueous production and increasing outflow.\u0026nbsp;",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 14,
    "Name": "CPEO",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022 style=\u0022margin: 0cm; font-size: 12pt; font-family: Aptos, sans-serif; color: rgb(0, 0, 0); letter-spacing: normal;\u0022\u003E\u003Cb\u003EWhich of the following is the LEAST likely eye related manifestation associated with mitochondrial dysfunction?\u003Co:p\u003E\u003C/o:p\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "Mitochondrial diseases commonly affect high-energy-demand tissues like the optic nerve, retina, and extraocular muscles.\u0026nbsp;\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003ETypical ophthalmic manifestations include:\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u2022\tProgressive external ophthalmoplegia (eye movement limitation with or without ptosis)\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tPtosis\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tOptic neuropathy (e.g., Leber hereditary optic neuropathy)\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tPigmentary retinopathy\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003EIn Kearns-Sayre syndrome\u003C/span\u003E for example, Motility restrictions vary with the stage of the disease and worsen as disease progresses and can limit eye excursions to 10% of normal in advanced cases. Because of symmetric limitation of motility, diplopia is reported in only 1/3 to 2/3 of patients with CPEO. Most patients exhibit exotropias (seen in up to 90% of patients) and 50% of patients develop suppression scotomas and remain asymptomatic.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003EHowever, retro-chiasmal visual pathway lesions (causing visual field defects from cortical or retrochiasmal damage) are not typical features of mitochondrial disorders, since \u003Cspan style=\u0022font-weight: bold;\u0022\u003Emitochondria-related dysfunction tends to involve peripheral visual structures rather than the retrochiasmal visual pathways.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003ETherefore the least likely is:\u0026nbsp; Visual field defect from retrochiasmal visual pathway damage\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-style: italic; font-size: x-small;\u0022\u003E\u2022\tSource: Arnold AC, \u201CMitochondrial optic neuropathies.\u201D J Neuroophthalmol. 2003;23(4):271\u2013279.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-style: italic; font-size: x-small;\u0022\u003E\u2022\tSource: Sadun AA, \u201CMitochondrial optic neuropathies.\u201D Eye. 2003;17: 1003\u20131008.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 15,
    "Name": "Lid Tumors",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022 style=\u0022margin: 0cm; font-size: 12pt; font-family: Aptos, sans-serif; color: rgb(0, 0, 0); letter-spacing: normal;\u0022\u003E\u003Cb\u003EWhich of these is the LEAST likely mechanism of action of propranolol when prescribed for management of lid haemangiomas?\u003C/b\u003E\u003Co:p\u003E\u003C/o:p\u003E\u003C/p\u003E",
    "Explanation": "Propranolol\u2019s primary mechanisms in infantile hemangiomas include:\u0026nbsp;\u003Cblockquote style=\u0022margin: 0 0 0 40px; border: none; padding: 0px;\u0022\u003E\u003Cdiv\u003E\u2022\t\u03B2-receptor blockade \u2192 promotes vasoconstriction\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tdownregulates VEGF (vascular endothelial growth factor)\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tincreases apoptosis of capillary endothelial cells\u0026nbsp;\u003C/div\u003E\u003C/blockquote\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003EWhile propranolol can cause systemic bradycardia as a side effect, this is \u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003Enot\u003C/span\u003E the therapeutic mechanism responsible for hemangioma involution. \u003Cspan style=\u0022font-weight: bold;\u0022\u003EIts bradycardia does not selectively reduce tumor blood flow.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 16,
    "Name": "Esotropia",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022 style=\u0022margin: 0cm; font-size: 12pt; font-family: Aptos, sans-serif; color: rgb(0, 0, 0); letter-spacing: normal;\u0022\u003E\u003Cb\u003EA 2 year old child was seen by their GP out ouf hours and referred to your emergency clinic. The mother has recently noticed a large esotropia in the child. She reports a recent viral illness. The child is otherwise well. On examination the child will fix either eye but does prefer the right. Eye movements are difficult to ascertain but there is abduction in either eye past the midline. Fundus exam is completed under duress with no clear evidence of papilloedema. Which of the following is MOST likely to influence the management?\u003C/b\u003E\u003Co:p\u003E\u003C/o:p\u003E\u003C/p\u003E",
    "Explanation": "\u003Cspan style=\u0022text-decoration-line: underline;\u0022\u003EKey clues:\u0026nbsp;\u003C/span\u003E\u003Cdiv\u003E\u2022\tSudden-onset large esotropia in a 2-year-old\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tRecent viral illness\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tEye movements difficult to assess but some abduction preserved\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tFundoscopy not clearly showing papilloedema (but done under duress, so could miss subtle papilloedema)\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tOtherwise well\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;This scenario is highly suspicious for acquired sixth nerve palsy after a viral illness (post-viral cranial neuropathy). However, in a 2-year-old with acute-onset esotropia, you \u003Cspan style=\u0022font-weight: bold;\u0022\u003Emust exclude raised intracranial pressure\u003C/span\u003E (e.g., a posterior fossa tumor) as a cause of sixth nerve palsy, especially since fundoscopy was incomplete.\n\nTherefore, cranial imaging (usually MRI) is the investigation most likely to influence management, to rule out a serious intracranial lesion before assuming it is benign post-viral palsy.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 17,
    "Name": "Alphabet Patterns",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022 style=\u0022margin: 0cm; font-size: 12pt; font-family: Aptos, sans-serif; color: rgb(0, 0, 0); letter-spacing: normal;\u0022\u003E\u003Cb\u003EA 6 year old child presented to clinic with a complaint of intermittent left exotropia that is present 70% of daytime hours, according to his parents. Visual acuities are 6/6 in both eyes. Prism cover test shows an alternating exotropia of 40 prism dioptres base-in for distance and an exophoria of 25 prism dioptres for near, which does not change after half an hour of monocular patching in clinic. There is also a large \u2018V\u2019 pattern but no inferior oblique overaction. If you are considering surgery, which of these procedures would be the MOST appropriate?\u003C/b\u003E\u003Co:p\u003E\u003C/o:p\u003E\u003C/p\u003E",
    "Explanation": "For both A and V patterns, the acronym \u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003EMALE\u003C/span\u003E identifies the direction of vertical translation: \u003Cspan style=\u0022font-weight: bold;\u0022\u003EMR to Apex, LR to Ends\u0026nbsp;\u003C/span\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;\u2022\tA V-pattern exotropia means the exotropia is larger in upgaze than downgaze.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tThe appropriate surgery is to recess the \u003Cspan style=\u0022font-weight: bold;\u0022\u003Elateral rectus muscles \u003C/span\u003E(because it is an exotropia), with \u003Cspan style=\u0022font-weight: bold;\u0022\u003Edown-shift\u003C/span\u003E of the insertions to weaken their effect in upgaze, thereby collapsing the V pattern.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tUp-shifting the lateral rectus would be for an A-pattern exotropia (more exotropia in downgaze).\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003EV pattern is the most common type of pattern in strabismus. The V-pattern is considered to be significant if the difference in horizontal deviation between the up and down gazes is \u2265 15 prism diopters.\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cimg src=\u0022/upload-2025-08-10-f48fbae1-e302-465b-a100-96a36d960537.jpg\u0022\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-size: x-small;\u0022\u003EPhoto from: The American Academy Books: Paediatric Ophthalmology and Strabismus \u2013 Chapter 9 \u2013 Pattern Strabismus\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-size: x-small;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2021 and 2022.\u003C/span\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 18,
    "Name": "Sensitivity",
    "Body": "\u003Cp style=\u0022margin: 8pt 0cm 4pt; break-after: avoid; font-family: \u0026quot;Aptos Display\u0026quot;, sans-serif; letter-spacing: normal;\u0022\u003E\u003Cspan style=\u0022font-size: medium; font-weight: bold; color: rgb(9, 9, 9);\u0022\u003EAccording to research on Anterior Ischaemic Optic Neuropathy (AION), around 20% of AION patients were found to have Giant Cell Arteritis (GCA) confirmed through temporal artery biopsy (TAB). Of those with positive TAB results, 70% showed elevated ESR levels, whereas only 5% of patients with negative TAB findings had a raised ESR. Based on these figures, what would be the approximate sensitivity of ESR for detecting GCA?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "The question is asking for the \u003Cspan style=\u0022font-weight: bold;\u0022\u003Esensitivity\u003C/span\u003E of ESR to detect GCA in biopsy-positive patients.\u0026nbsp;\u003Cdiv\u003ESensitivity = proportion of true positives detected:\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tAmong patients with biopsy-proven GCA (the \u201Cdisease positives\u201D), 70% had a high ESR.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;Therefore, the sensitivity of ESR in this group is 70%.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cimg src=\u0022https://thosenerdygirls.org/wp-content/uploads/2022/05/Sarah-1.png\u0022\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-size: x-small;\u0022\u003EImage Source: https://thosenerdygirls.org/sensitivity-and-specificity/\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 11,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 19,
    "Name": "Glaucoma",
    "Body": "Primary congenital glaucoma is usually:",
    "Explanation": "Most cases of primary congenital glaucoma are sporadic. About 10% are inherited as autosomal recessive with incomplete penetrance.",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 20,
    "Name": "Infectious Uveitis",
    "Body": "\u003Cp style=\u0022margin: 8pt 0cm 4pt; break-after: avoid; font-family: \u0026quot;Aptos Display\u0026quot;, sans-serif; color: rgb(15, 71, 97); font-weight: normal; letter-spacing: normal;\u0022\u003E\u003Cstrong style=\u0022font-size: medium;\u0022\u003EIn patients who have recovered from infection with Ebola, and whose serological tests are negative, which ocular tissues / fluids are MOST likely to harbor active viral agents?\u003C/strong\u003E\u003C/p\u003E",
    "Explanation": "Studies have shown that Ebola virus can persist in immune-privileged sites such as the eye even after patients are serologically negative.\u0026nbsp;\u003Cdiv\u003EViral persistence has been demonstrated most notably in the aqueous humour, posing a risk of transmission during intraocular procedures.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u0026nbsp;Therefore, the aqueous humour is the most likely ocular site to harbor active viral particles in survivors.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-size: x-small;\u0022\u003E\u0026nbsp;Source: Varkey JB, Shantha JG, Crozier I, et al.\nPersistence of Ebola Virus in Ocular Fluid during Convalescence.\nNew England Journal of Medicine. 2015;372(25):2423\u20132427.\nDOI: 10.1056/NEJMoa1500306\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u0026nbsp;A similar question appeared in FRCOphth part 2 written exam in 2022.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 12,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 21,
    "Name": "Infectious Uveitis",
    "Body": "\u003Cp style=\u0022margin: 8pt 0cm 4pt; break-after: avoid; font-family: \u0026quot;Aptos Display\u0026quot;, sans-serif; color: rgb(15, 71, 97); letter-spacing: normal;\u0022\u003E\u003Cspan style=\u0022font-size: medium; font-weight: bold;\u0022\u003EA 45-year-old man is complaining of floaters and reduced vision in one eye. On examination, he has vitritis and a pale lesion near the optic disc. Which of these conditions is the MOST likely diagnosis?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\u2022\tToxoplasma retinochoroiditis is the \u003Cspan style=\u0022font-weight: bold;\u0022\u003Emost common cause of posterior uveitis worldwide.\u003C/span\u003E\u0026nbsp;\u003Cdiv\u003E\u2022\tIt typically presents with focal retinitis (pale lesion) adjacent to an old pigmented scar, and significant vitritis (\u201C\u003Cspan style=\u0022font-weight: bold;\u0022\u003Eheadlight in the fog\u003C/span\u003E\u201D appearance).\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tLesions often occur near the optic disc (juxtapapillary).\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;\u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003EOther choices are less typical:\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u2022\tAPMPPE usually presents bilaterally with multiple placoid lesions\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tAcute retinal necrosis has more peripheral retinal involvement with severe retinal vasculitis\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tBirdshot chorioretinopathy is bilateral, with cream-colored spots and little vitritis\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;Therefore, the most likely diagnosis is toxoplasmosis.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cimg src=\u0022https://webeye.ophth.uiowa.edu/eyeforum/atlas/photos/toxoplasmosis/toxoplasma-1-LRG.jpg\u0022\u003E\u003C/div\u003E\u003Cdiv\u003EActive lesions have a classic \u0022headlight in fog\u0022 appearance with a focal, white, fluffy lesion adjacent to an old scar visible through the associated granulomatous uveitis and vitritis\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 12,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 22,
    "Name": "Lid Tumors",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA 76 year old man presented to your clinic with a hyperkeratotic lesion on the right upper eyelid. The excisional biopsy histopathology report shows a papillomatous tumor with surface keratin arising from dysplastic epidermis. It has an irregular outline and invades the underlying dermis. Which one of the following is the MOST likely diagnosis?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\u2022\tHistology describes dysplastic epidermis with invasion into the dermis \u2192 hallmark of carcinoma (malignancy).\u0026nbsp;\u003Cdiv\u003E\u2022\tThe presence of surface keratin and papillomatous growth is consistent with squamous differentiation.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tBasal cell papilloma and squamous cell papilloma are benign lesions without dermal invasion.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tKeratoacanthoma can look similar but typically shows rapid growth, central keratin plug, and may spontaneously regress \u2014 histology would not typically describe persistent dermal invasion from dysplastic epidermis in the same way as SCC.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003ETherefore, squamous cell carcinoma is the most likely diagnosis.\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003ETreatment:\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003EWide local excision may be achieved by Mohs\u2019 micrographical technique or by excisional biopsy with histological (e.g. paraffin or frozen section) control. This is usually curative for early lesions. Orbital involvement may require exenteration. SCCs in situ may be treated surgically or with cryotherapy, imiquimod cream, fluorouracil (5-FU), mitomycin, or PDT.*\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003ESource: Oxford Handbook of Ophthalmology - Fourth Edition.\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 23,
    "Name": "Anti-TB",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EWhich of these ophthalmic abnormalities is MOST likely to present in a patient being treated for tuberculosis?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EEthambutol\u003C/b\u003E\u003C/span\u003E, a first-line drug in tuberculosis treatment, is well known for causing \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Etoxic optic neuropathy\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIt presents with decreased visual acuity, central or cecocentral scotomas, and red-green colour vision defects.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ERisk increases with high doses, prolonged use, and renal impairment.\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003EOther choices:\u003C/span\u003E\u003C/div\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EBull\u2019s eye maculopathy \u2192 classically linked to hydroxychloroquine toxicity\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPigmentary retinopathy \u2192 linked to drugs like phenothiazines\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EVortex keratopathy \u2192 linked to amiodarone, chloroquine, and some other drugs\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003ETherefore, optic neuropathy is the most likely ocular side effect in TB treatment.\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium; color: rgb(255, 0, 0); text-decoration-line: underline;\u0022\u003ERemember these common side effects:\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cimg src=\u0022/upload-2025-08-10-01b7aefd-0191-450c-90a2-4273dcd8ed32.png\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 5,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 24,
    "Name": "Visual Field",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EOn reading a Humphreys visual field printout, which of the following parameters is MOST likely to indicate an inaccurate visual field?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EFalse positive errors\u003C/b\u003E\u003C/span\u003E occur when the patient responds when no stimulus is given, often due to over-anticipation or poor test understanding. High false positive rates can make the field appear \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebetter than it really is\u003C/b\u003E\u003C/span\u003E, leading to unreliable results.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EFalse negatives\u003C/b\u003E\u003C/span\u003E (patient fails to respond to bright stimuli) can occur in true disease or fatigue, but are less indicative of an \u003Ci\u003Eunreliable\u003C/i\u003E field compared to high false positives.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EFixation losses\u003C/b\u003E\u003C/span\u003E of 2/11 are acceptable (\u0026lt;20%).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMean deviation\u003C/b\u003E\u003C/span\u003E of -2.82 dB is within mild loss range and does not itself indicate unreliability.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003Cb\u003EKey point:\u003C/b\u003E\u003C/span\u003E In reliability indices, \u003Cspan class=\u0022s2\u0022\u003E\u003Cb\u003Efalse positives are the biggest red flag\u003C/b\u003E\u003C/span\u003E for an inaccurate Humphrey visual field.\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 25,
    "Name": "Cross-linking",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ECollagen cross linking works by increasing cornea\u2019s rigidity with the release of oxygen free radical as a result of the combination of which of the following vitamins?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECorneal collagen cross-linking\u003C/b\u003E\u003C/span\u003E is used to strengthen the cornea, most often in keratoconus.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe standard (\u201CDresden\u201D) protocol uses \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eriboflavin (vitamin B2)\u003C/b\u003E\u003C/span\u003E applied to the cornea, followed by \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EUVA irradiation\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ERiboflavin absorbs UVA and generates reactive oxygen species, which induce covalent cross-links between collagen fibers, increasing corneal rigidity.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EUVB is not used because it is more harmful to the corneal endothelium and deeper ocular structures.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EVitamin B6 is not involved in this process.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 26,
    "Name": "Fourth Nerve Palsy",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EWhat abnormal head position (AHP) would you expect to see in the presence of a LEFT superior oblique palsy?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EA \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eleft superior oblique palsy\u003C/b\u003E\u003C/span\u003E causes vertical diplopia that worsens on looking down and in.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPatients tilt their head \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eaway from the affected side\u003C/b\u003E\u003C/span\u003E (right tilt in this case) to reduce the vertical deviation (Bielschowsky head tilt test).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThey may also turn their face \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Etowards the side of the affected muscle\u003C/b\u003E\u003C/span\u003E (left face turn) to optimise binocular single vision in primary gaze.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESo the typical abnormal head posture for left SO palsy is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eright head tilt with left face turn\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 27,
    "Name": "Field defect",
    "Body": "\u003Cbr\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EThis is the result of the neuro-imaging tests you ordered for your patient, What is the MOST likely visual field defect they were complaining of?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cimg src=\u0022/upload-2025-08-10-4bbd366f-f484-4deb-83b4-87026035c178.png\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003E\u003C/b\u003E\u003C/p\u003E\u003C/div\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EFrom the MRI brain (left) and MR angiogram (right), the key abnormality is an infarct in the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eleft occipital lobe\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe occipital lobe contains the primary visual cortex, which processes visual information from the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Econtralateral visual field\u003C/b\u003E\u003C/span\u003E of both eyes.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003ELesion Location and Effect\u003C/b\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ELeft occipital lobe\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E damage \u2192 affects \u003C/span\u003E\u003Cb\u003Eright visual fields\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E of both eyes.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThis produces a \u003C/span\u003E\u003Cb\u003Eright homonymous hemianopia\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 28,
    "Name": "CMO",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 62 year old gentleman, a known diabetic for 10 years, underwent phacoemulsification with intraoperative posterior capsular rupture, anterior vitrectomy with implantation of anterior chamber intraocular lens. At the one-month post-operative review, he had a best corrected visual acuity of 6/6 with a normal macular appearance. However, at 8 weeks postoperatively, he presented with blurring and deterioration of vision 6/18. His intraocular pressure was within normal limits.\u0026nbsp;\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EFundus examination was normal apart from a dull foveal reflex. Macular OCT scans showed cystoid macular oedema. Which of the following is the LEAST correct management option?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThe OCT shows \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecystoid macular oedema (CMO)\u003C/b\u003E\u003C/span\u003E \u2014 a common complication after cataract surgery, especially with intraoperative complications like posterior capsular rupture and anterior vitrectomy. This is most likely \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIrvine\u2013Gass syndrome\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003ETypical management options:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EFirst line:\u003C/b\u003E\u003C/span\u003E Topical NSAIDs (e.g., nepafenac) and topical corticosteroids (prednisolone)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESecond line:\u003C/b\u003E\u003C/span\u003E Periocular or intravitreal corticosteroids (triamcinolone, dexamethasone implant)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAnti-VEGF agents like \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebevacizumab\u003C/b\u003E\u003C/span\u003E are \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot\u003C/b\u003E\u003C/span\u003E standard for post-surgical CMO unless there is coexistent macular oedema due to diabetic retinopathy or vein occlusion.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003ETherefore:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eleast likely correct\u003C/b\u003E\u003C/span\u003E option here is:\u003Cb style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u0026nbsp;Intravitreal injection Avastin (Bevacizumab 1.25 mg/0.05 ml)\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003Cb style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 29,
    "Name": "OCT",
    "Body": "\u003Cimg src=\u0022https://www.eyedocs.co.uk/images/eyeq/spectral_OCT.jpg\u0022\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EIn the spectral domain OCT image above, what is the layer labelled A?\u003C/span\u003E\u003C/div\u003E",
    "Explanation": "\u003Cimg src=\u0022https://www.eyedocs.co.uk/images/eyeq/OCT_01a.jpg\u0022\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 30,
    "Name": "Congenital Glaucoma",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EA 38 year old man presents with raised intraocular pressure, posterior embryotoxon, corectopia and hypodontia. Which of the following genetic mutations is MOST likely to be associated with his condition?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThe features described \u2014 \u003C/span\u003E\u003Cb\u003Eposterior embryotoxon\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, \u003C/span\u003E\u003Cb\u003Ecorectopia\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, \u003C/span\u003E\u003Cb\u003Ehypodontia\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, and \u003C/span\u003E\u003Cb\u003Eraised IOP\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2014 are classic for \u003C/span\u003E\u003Cb\u003EAxenfeld\u2013Rieger syndrome\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAxenfeld\u2013Rieger syndrome is caused by mutations in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPITX2\u003C/b\u003E\u003C/span\u003E or \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EFOXC1\u003C/b\u003E\u003C/span\u003E genes.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EFOXC1 mutations are strongly associated with anterior segment dysgenesis, abnormal iris development, and systemic features like dental anomalies.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EOther options:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECYP450\u003C/b\u003E\u003C/span\u003E \u2014 unrelated to this syndrome; involved in drug metabolism.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMYOC\u003C/b\u003E\u003C/span\u003E \u2014 linked to juvenile open-angle glaucoma.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOPTN\u003C/b\u003E\u003C/span\u003E \u2014 linked to normal-tension glaucoma.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 31,
    "Name": "CSCR",
    "Body": "\u003Cimg src=\u0022https://www.eyedocs.co.uk/images/eyeq/OCT_001.jpg\u0022\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EBased on the OCT image shown, What is the most likely diagnosis?\u003C/span\u003E\u003C/div\u003E",
    "Explanation": "The OCT shows a localised neurosensory detachment of the retina at the fovea. These findings are most consistent with central serous chorioretinopathy.\u003Cdiv\u003EIn neovascular Age related macular degeneration, neurosensory detachment can occur but it is usually associated with cystic retinal changes, drusen, and RPE changes.\u003C/div\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 32,
    "Name": "OHT",
    "Body": "\n\n\n\n\n\n\n\n\u003Cblockquote style=\u0022margin-bottom: 0px; margin-left: 15px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; line-height: normal; color: rgb(14, 14, 14);\u0022\u003E\u003Cspan style=\u0022font-size: medium; font-weight: bold; font-family: Arial;\u0022\u003EBased on findings from the Ocular Hypertension Treatment Study (OHTS), which of the following options is the least accurate regarding baseline demographic and clinical factors that predict the likelihood of developing primary open-angle glaucoma (POAG)?\u003C/span\u003E\u003C/blockquote\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003Erom the \u003C/span\u003E\u003Cb\u003EOcular Hypertension Treatment Study (OHTS)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, the key baseline predictors for conversion to \u003C/span\u003E\u003Cb\u003Eprimary open-angle glaucoma (POAG)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E were:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOlder age\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAfrican American race\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ELarger vertical cup-to-disc ratio\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EHigher IOP\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThinner central corneal thickness\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EGreater pattern standard deviation on visual field testing\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003EMigraine\u003C/b\u003E\u003C/span\u003E was \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003Enot\u003C/b\u003E\u003C/span\u003E identified as a significant risk factor in OHTS, making option \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003EC\u003C/b\u003E\u003C/span\u003E the least correct.\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 33,
    "Name": "Retrobulbar Hemorrhage",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EAn elderly man presents to A\u0026amp;E in the afternoon after undergoing bilateral lower lid blepharoplasties in the morning. He reports pain and sudden loss of vision in his right eye. The resident doctor measures an intraocular pressure of 40 mmHg. Which of the following is MOST likely to be an appropriate part of the IMMEDIATE management?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThis presentation is classic for \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eretrobulbar haemorrhage\u003C/b\u003E\u003C/span\u003E after eyelid surgery, causing \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eorbital compartment syndrome\u003C/b\u003E\u003C/span\u003E with a dangerously high intraocular pressure and threat to optic nerve perfusion.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EImmediate sight-saving management\u003C/b\u003E\u003Cspan class=\u0022s2\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELateral canthotomy and cantholysis\u003C/b\u003E\u003C/span\u003E (disinsertion of lids from the lateral canthus) to rapidly decompress the orbit\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMedical therapy (acetazolamide, mannitol, etc.) may follow, but \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esurgical decompression should not be delayed\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EOther choices:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAcetazolamide\u003C/b\u003E\u003C/span\u003E (A) helps lower IOP but is too slow alone in this acute compartment syndrome.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EHigh-dose corticosteroids\u003C/b\u003E\u003C/span\u003E (C) are not first-line in this scenario.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOpening surgical wounds\u003C/b\u003E\u003C/span\u003E (D) does not adequately decompress the orbit.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 34,
    "Name": "Cellulitis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EWhich of the following is the MOST common organism in preseptal cellulitis associated with trauma in the majority of cases?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPreseptal cellulitis\u003C/b\u003E\u003C/span\u003E following trauma is most often caused by \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eskin flora\u003C/b\u003E\u003C/span\u003E entering through the wound.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe most common organism is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EStaphylococcus aureus\u003C/b\u003E\u003C/span\u003E, including MRSA in some regions.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBacillus cereus\u003C/b\u003E\u003C/span\u003E \u2014 more associated with penetrating ocular trauma involving organic material (e.g., soil, plant matter).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EHaemophilus influenzae\u003C/b\u003E\u003C/span\u003E \u2014 historically common in children before Hib vaccination.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EStreptococcus pneumoniae\u003C/b\u003E\u003C/span\u003E \u2014 can be a cause but is less common in trauma-related cases compared to S. aureus.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 35,
    "Name": "AMD",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EAll of the following carotenoids are important for macular function EXCEPT:\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe macular pigment is composed mainly of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elutein\u003C/b\u003E\u003C/span\u003E, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ezeaxanthin\u003C/b\u003E\u003C/span\u003E, and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emeso-zeaxanthin\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThese carotenoids act as antioxidants and filter harmful blue light, supporting macular health and visual function.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIonones\u003C/b\u003E\u003C/span\u003E are aromatic compounds derived from carotenoids but are \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot\u003C/b\u003E\u003C/span\u003E part of the macular pigment and do not contribute directly to macular function.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003ERemember:\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cul\u003E\u003Cli\u003Ein AREDS, vitamin supplements containing high-dose antioxidants and minerals (vitamins C and E, \u03B1-carotene, and zinc) delayed AMD progression from intermediate to advanced stages (particularly those in category 4 with neovascular AMD already in one eye).\u0026nbsp;\u003C/li\u003E\u003Cli\u003E\u03B2 -carotene may lead to an increased incidence of lung cancer in former smokers\u003C/li\u003E\u003Cli\u003Ethe results of AREDS2 suggest that lutein \u002B zeaxanthin may be an appropriate carotenoid substitute.\u0026nbsp;\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003ENumerous supplements are commercially available, including: Bausch \u0026amp; Lomb\u2019s PreserVision\u00AE  (AREDS and AREDS2 formulations) and Alcon\u2019s I-Caps\u00AE .\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 Written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 36,
    "Name": "Phakomatosis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EWhich ONE of the following statements is MOST likely to be correct in regards to Neurofibromatosis NF2?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ENF2\u003C/b\u003E\u003C/span\u003E is characterised by \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebilateral vestibular schwannomas\u003C/b\u003E\u003C/span\u003E, often leading to hearing loss, tinnitus, imbalance, and cranial nerve deficits.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ELoss of the corneal reflex can occur due to involvement of the trigeminal nerve (CN V) by tumours.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EKyphoscoliosis\u003C/b\u003E\u003C/span\u003E (A) and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELisch nodules\u003C/b\u003E\u003C/span\u003E (B) are features of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ENF1\u003C/b\u003E\u003C/span\u003E, not NF2.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ENF2\u003C/b\u003E\u003C/span\u003E is caused by mutations in the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ENF2 gene\u003C/b\u003E\u003C/span\u003E on \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Echromosome 22\u003C/b\u003E\u003C/span\u003E, not chromosome 17 (D). Chromosome 17 is linked to NF1.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 37,
    "Name": "DVLA",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EWhich one of the following conditions would be MOST LIKELY to cause a United Kingdom Group 1 driving licence to be revoked?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EDVLA standards for \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGroup 1 drivers\u003C/b\u003E\u003C/span\u003E require a horizontal visual field of at least \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E120 degrees\u003C/b\u003E\u003C/span\u003E with no significant defect within the central 20 degrees.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EComplete homonymous hemianopia\u003C/b\u003E\u003C/span\u003E causes a large central field defect, meaning the driver cannot meet visual field standards, leading to licence revocation.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EColour blindness\u003C/b\u003E\u003C/span\u003E (A) is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot\u003C/b\u003E\u003C/span\u003E a bar to driving in the UK.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGlaucoma\u003C/b\u003E\u003C/span\u003E (C) is only disqualifying if it causes field loss below standards \u2014 ocular hypertension alone does not.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EKeratoconus\u003C/b\u003E\u003C/span\u003E (D) is acceptable if vision with correction meets the required standard (6/12 or better in both eyes together).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 7,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 38,
    "Name": "Non-infectious Keratitis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EA 48 year old man with a history of recurrent red eyes for 15 years presented to your clinic. His red eyes were usually treated with topical lubricants and antibiotics. On examination, you noted that he has a peripheral corneal infiltrate with inferonasal corneal vascularisation in his right eye. Which of the following is the MOST likely diagnosis?\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERosacea keratitis\u003C/b\u003E\u003C/span\u003E is associated with chronic ocular surface inflammation, recurrent redness, and peripheral corneal vascularisation, often infero-nasal or inferior.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIt can cause peripheral corneal infiltrates, thinning, and vascularisation due to chronic eyelid margin disease and meibomian gland dysfunction linked to rosacea.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003EOther choices:\u003C/span\u003E\u003C/div\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EDisciform keratitis\u003C/b\u003E\u003C/span\u003E\u0026nbsp;is usually due to herpes simplex virus and presents as stromal oedema with an intact epithelium.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMarginal keratitis\u003C/b\u003E\u003C/span\u003E\u0026nbsp;is typically a hypersensitivity reaction to staphylococcal antigens, presenting with small peripheral infiltrates near the limbus.\u0026nbsp;A perilimbal clear zone of cornea is preserved.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPeripheral ulcerative keratitis\u003C/b\u003E\u003C/span\u003E\u0026nbsp;is often associated with systemic autoimmune diseases such as rheumatoid arthritis, presenting with peripheral stromal thinning and ulceration.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 39,
    "Name": "Physiology",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EWhich of the following BEST describes the sequence of changes in visual photopigments after light exposure?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIn the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Evisual cycle\u003C/b\u003E\u003C/span\u003E, light converts \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E11-cis retinal\u003C/b\u003E\u003C/span\u003E (bound to opsin in rhodopsin) into \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eall-trans retinal\u003C/b\u003E\u003C/span\u003E \u2192 triggers a conformational change in opsin and initiates phototransduction.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAll-trans retinal\u003C/b\u003E\u003C/span\u003E is then reduced to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eall-trans retinol\u003C/b\u003E\u003C/span\u003E in the photoreceptor.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThis is transported to the retinal pigment epithelium (RPE), where it is converted back to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E11-cis retinol\u003C/b\u003E\u003C/span\u003E, and then oxidised to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E11-cis retinal\u003C/b\u003E\u003C/span\u003E, ready to recombine with opsin.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EThis is a very common question in FRCOphth written exams.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 40,
    "Name": "Retrobulbar Hemorrhage",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EYou were called to see a 68 year old man in the emergency department. He gives a history of being on Warfarin, and had tripped over a step in his house. On examination, there is tense proptosis of the left eye with peri-orbital bruising, subconjunctival hemorrhage, restricted ocular motility, visual acuity of counting fingers, and a relative afferent pupillary defect. You could not examine the fundus. What is the MOST appropriate immediate management for this patient?\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThis presentation is classic for \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eorbital compartment syndrome\u003C/b\u003E\u003C/span\u003E due to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eretrobulbar haemorrhage\u003C/b\u003E\u003C/span\u003E, with sight-threatening optic nerve compression.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EKey signs: acute proptosis, tense orbit, severe vision drop, RAPD, restricted motility, and high-risk history (warfarin use, trauma).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EImmediate management\u003C/b\u003E\u003C/span\u003E: \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELateral canthotomy and cantholysis\u003C/b\u003E\u003C/span\u003E at the bedside to decompress the orbit and restore optic nerve perfusion \u2014 this is sight-saving.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003EOther options:\u003C/span\u003E\u003C/div\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAcetazolamide lowers intraocular pressure but is too slow as the primary intervention.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOrbital wall decompression is a surgical procedure for chronic proptosis, not acute haemorrhage.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EVitamin K addresses anticoagulation but does not relieve the immediate orbital pressure.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 41,
    "Name": "Infectious Keratitis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EWhich of these is the MOST appropriate prophylactic treatment for the prevention of recurrent herpes simplex keratitis?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EFor \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eprophylaxis\u003C/b\u003E\u003C/span\u003E against recurrent herpes simplex keratitis, the standard regimen is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eoral aciclovir 400 mg twice daily\u003C/b\u003E\u003C/span\u003E for at least 6\u201312 months, as shown in the Herpetic Eye Disease Study (HEDS).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EHigher doses\u003C/b\u003E\u003C/span\u003E (800 mg 5\u00D7 daily) are used for \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eactive treatment\u003C/b\u003E\u003C/span\u003E of herpes simplex infections, not prophylaxis.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELower doses\u003C/b\u003E\u003C/span\u003E (200 mg bd) are subtherapeutic for prevention.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E800 mg bd\u003C/b\u003E\u003C/span\u003E is not a standard prophylactic dose and increases side effect risk unnecessarily.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 42,
    "Name": "Keratoconus",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EWhich of the following is LEAST likely to be a sign suggestive of keratoconus?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EKeratoconus signs on corneal topography\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E include:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EInferior steepening relative to superior cornea\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESkewed radial axes (non-orthogonal bow tie)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAbnormal curvature progression (greater in downgaze/upgaze)\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EWavefront analysis\u003C/b\u003E\u003C/span\u003E: Vertical coma is the most characteristic higher-order aberration in keratoconus.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAsymmetrical bow tie pattern with high angle kappa\u003C/b\u003E\u003C/span\u003E may mimic keratoconus but is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot\u003C/b\u003E\u003C/span\u003E truly diagnostic or suggestive of keratoconus.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIn keratoconus, the cone is often \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Einferiorly displaced\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EWhen you measure the corneal curvature in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edowngaze\u003C/b\u003E\u003C/span\u003E, the cone comes into the measurement zone \u2192 readings become \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esteeper\u003C/b\u003E\u003C/span\u003E than in primary gaze.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThis is sometimes referred to as a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E\u201Cgaze-dependent keratometric change\u201D\u003C/b\u003E\u003C/span\u003E, and it helps distinguish keratoconus from normal corneas or regular astigmatism.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 43,
    "Name": "DR",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich of these drugs is LEAST likely to be helpful in the management of a patient with diabetic macular oedema?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EDapagliflozin\u003C/b\u003E\u003C/span\u003E \u2013 An SGLT2 inhibitor, improves glycaemic control, may reduce fluid overload, and has shown some promise in protecting against diabetic retinopathy progression.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EFenofibrate\u003C/b\u003E\u003C/span\u003E \u2013 Supported by \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EFIELD\u003C/b\u003E\u003C/span\u003E and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EACCORD-Eye\u003C/b\u003E\u003C/span\u003E trials: reduces progression of diabetic retinopathy independent of lipid-lowering effects.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPioglitazone\u003C/b\u003E\u003C/span\u003E \u2013 A thiazolidinedione. \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAdverse effect\u003C/b\u003E\u003C/span\u003E: fluid retention and increased risk of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eworsening macular oedema\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERosuvastatin\u003C/b\u003E\u003C/span\u003E \u2013 Statins help improve endothelial function, lower lipid leakage, and some studies suggest reduced risk of diabetic retinopathy progression.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 44,
    "Name": "Infectious Keratitis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich of the following is LEAST likely to be a manifestation of herpes zoster keratitis?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EHerpes Zoster Ophthalmicus (HZO)\u003C/b\u003E\u003C/span\u003E can present with a variety of corneal manifestations:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EEpithelial keratitis\u003C/b\u003E\u003C/span\u003E: Early lesions present as \u003Ci\u003Epunctate epithelial keratitis\u003C/i\u003E, which may progress to pseudodendrites (unlike the true dendrites of HSV).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EStromal keratitis\u003C/b\u003E\u003C/span\u003E: May be nummular or diffuse; occurs due to immune-mediated inflammation after viral reactivation.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EEndotheliitis\u003C/b\u003E\u003C/span\u003E: Inflammation of the corneal endothelium, often with keratic precipitates and stromal edema, is a recognized complication of HZO.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\uD83D\uDC49 \u003C/span\u003E\u003Cb\u003EThickened corneal nerves\u003C/b\u003E\u003Cspan class=\u0022s3\u0022\u003E, however, is \u003C/span\u003E\u003Cb\u003Enot a feature of herpes zoster keratitis\u003C/b\u003E\u003Cspan class=\u0022s3\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003EThis finding is more typically associated with \u003C/span\u003E\u003Cb\u003Eherpes simplex keratitis (HSK)\u003C/b\u003E\u003Cspan class=\u0022s3\u0022\u003E or systemic conditions such as \u003C/span\u003E\u003Cb\u003Emultiple endocrine neoplasia (MEN), leprosy, or neurofibromatosis\u003C/b\u003E\u003Cspan class=\u0022s3\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\u003Cimg src=\u0022https://eyewiki.org/w/images/a/ae/Corneal_Nerves.jpg?20221007230607\u0022 class=\u0022\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022 style=\u0022text-align: left;\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\u003Cspan style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal; font-weight: bold; font-style: italic;\u0022\u003ECorneal nerves visible on slit lamp photograph\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022 style=\u0022text-align: left;\u0022\u003E\u003Cspan style=\u0022font-size: x-small;\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\u003Cspan style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal; font-weight: bold; font-style: italic;\u0022\u003ESource:\u0026nbsp;\u003C/span\u003E\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003Ehttps://eyewiki.org/File:Corneal_Nerves.jpg\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022 style=\u0022text-align: left;\u0022\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022 style=\u0022text-align: left;\u0022\u003E\u003Cspan class=\u0022s3\u0022 style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/p\u003E",
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    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
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  },
  {
    "Id": 45,
    "Name": "Tests",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EIn Right Monofixation syndrome, what is the MOST likely response to Worth 4 dot test at near (33 cm)?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EMonofixation syndrome = small-angle deviation with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eperipheral fusion\u003C/b\u003E\u003C/span\u003E and a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecentral suppression scotoma\u003C/b\u003E\u003C/span\u003E in the non\u2011fixating eye (here, the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eright\u003C/b\u003E\u003C/span\u003E eye).\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOn \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EWorth 4\u2011dot at near (33 cm)\u003C/b\u003E\u003C/span\u003E the target subtends a larger visual angle, engaging \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eperipheral fusion\u003C/b\u003E\u003C/span\u003E and lying largely outside the small central scotoma \u2192 \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Efusion (4 dots)\u003C/b\u003E\u003C/span\u003E is the most typical response.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOn \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edistance Worth (6 m)\u003C/b\u003E\u003C/span\u003E the target is much smaller and falls within the central scotoma, so patients often \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esuppress the right eye\u003C/b\u003E\u003C/span\u003E and report \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ethree green dots\u003C/b\u003E\u003C/span\u003E (since the white dot is seen only by the left/green eye).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EHence the expected \u003Ci\u003Enear\u003C/i\u003E response is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Efour dots with fusion\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EReferences (standard texts):\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EVon Noorden \u0026amp; Campos. \u003Ci\u003EBinocular Vision and Ocular Motility\u003C/i\u003E, Monofixation syndrome and Worth 4\u2011dot testing.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EWright \u0026amp; Strube. \u003Ci\u003EPediatric Ophthalmology and Strabismus\u003C/i\u003E, Worth test interpretation in monofixation.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EHolmes JM et\u202Fal. Monofixation syndrome\u2014clinical characteristics and sensory findings.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
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    "HighYield": true,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 46,
    "Name": "Chemical injury",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-size: medium; font-weight: bold;\u0022\u003EWhich of the following statements is MOST likely to be correct regarding chemical eye injury?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EAlkaline injury\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAlkalis (e.g., ammonia, lye, lime) penetrate rapidly due to saponification of cell membrane lipids.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThey cause \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehydrophilic and lipophobic degeneration\u003C/b\u003E\u003C/span\u003E, allowing deep penetration into ocular tissues (stroma, anterior chamber).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMuch more severe than acid burns (which typically cause coagulative necrosis, forming a barrier).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EDiphoterine\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EDiphoterine is indeed a chelating amphoteric solution used in Europe for chemical burns, but its \u003Ci\u003Eproven\u003C/i\u003E superiority over copious water/normal saline irrigation is still debated in clinical practice.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EFirst-degree burn\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EIn dermatology, \u003C/span\u003E\u003Cb\u003Efirst-degree burns involve only the epidermis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (not dermis). Dermis is affected in \u003C/span\u003E\u003Cb\u003Esecond-degree burns\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EDua classification\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EDua classification\u003C/b\u003E\u003C/span\u003E (2001) has \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E6 grades\u003C/b\u003E\u003C/span\u003E, based on limbal involvement (clock hours) and conjunctival involvement (%).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESo, the statement of \u201C4 levels\u201D is incorrect.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb\u003E\uD83D\uDCDA Sources:\u003C/b\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EDua HS et al. \u003Ci\u003EA new classification of ocular surface burns\u003C/i\u003E. Br J Ophthalmol. 2001.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EKuckelkorn R et al. \u003Ci\u003EChemical and thermal eye burns: emergency and clinical management\u003C/i\u003E. Ophthalmologe. 2002.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAmerican Academy of Ophthalmology (AAO): \u003Ci\u003EOcular Trauma \u2013 Chemical Injuries\u003C/i\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
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  },
  {
    "Id": 47,
    "Name": "Trauma",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EA 28 year old man presented with blurred vision in both eyes after regaining consciousness following a head injury with a left fronto-parietal skull fracture. On examination, his vision was No Perception of Light\u0026nbsp; in the left eye and 6/9 in the right with a right temporal visual field defect. Ocular examination, and eye movements were normal with normal lids. The left pupil shows an afferent pupillary defect, and both optic discs appear atrophic; left more than right. From these signs, what is the MOST likely location of injury to the visual pathways?\u0026nbsp;\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EKey findings\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELeft eye\u003C/b\u003E\u003C/span\u003E: No perception of light (severe optic nerve damage).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERight eye\u003C/b\u003E\u003C/span\u003E: Visual acuity 6/9 but \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Etemporal field defect\u003C/b\u003E\u003C/span\u003E (indicating involvement of nasal retinal fibers crossing in the chiasm).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ERelative afferent pupillary defect (RAPD) in left eye\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E: confirms more severe left optic nerve damage.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EBilateral optic atrophy (left \u0026gt; right)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E: chronic optic nerve/chiasmal injury.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EWhy not the other options?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOccipital infarct\u003C/b\u003E\u003C/span\u003E \u2192 would cause homonymous hemianopia, not monocular blindness \u002B contralateral temporal field loss.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOptic nerve avulsion\u003C/b\u003E\u003C/span\u003E \u2192 usually unilateral, would not explain contralateral temporal hemianopia.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERetrobulbar haemorrhage\u003C/b\u003E\u003C/span\u003E \u2192 acute vision loss from orbital compartment syndrome, but would not selectively cause chiasmal field defects.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ED: Traumatic optic neuropathy with chiasmal involvement\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ETrauma can damage both the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eoptic nerve\u003C/b\u003E\u003C/span\u003E (left side severe) and the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eoptic chiasm\u003C/b\u003E\u003C/span\u003E (affecting crossing nasal fibers \u2192 temporal field loss in right eye).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThis explains the combination: unilateral blindness \u002B contralateral temporal field defect \u002B disc pallor.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb\u003E\uD83D\uDCDA Supporting sources:\u003C/b\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMiller NR, Newman NJ. \u003Ci\u003EWalsh \u0026amp; Hoyt\u2019s Clinical Neuro-ophthalmology\u003C/i\u003E, 6th ed.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAmerican Academy of Ophthalmology (AAO) \u2013 \u003Ci\u003ENeuro-ophthalmology: Optic Neuropathies after Trauma\u003C/i\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
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    "HighYield": true,
    "CategoryId": 13,
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  },
  {
    "Id": 48,
    "Name": "Intra-ocular tumors",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EA 63 year old woman presents with a pigmented lesion in the periphery of her right iris. Which of the following characteristics would make you MOST suspicious of a ciliary body melanoma?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECiliary body melanoma\u003C/b\u003E\u003C/span\u003E is a uveal melanoma, and often not visible on initial presentation because the ciliary body is posterior to the iris root.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EClues suggesting malignancy include\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EProminent sentinel episcleral vessel\u003C/b\u003E\u003C/span\u003E \u2192 a dilated, tortuous episcleral vessel in the same quadrant as the tumor. This is considered one of the most important clinical signs of an underlying ciliary body melanoma.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIris distortion or corectopia (irregular pupil) may occur, but are less specific.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u201CSatellite lesions\u201D are more suggestive of conjunctival melanoma rather than intraocular (ciliary body) melanoma.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EConjunctival vessels are not typically associated with ciliary body tumors, but episcleral \u201Csentinel\u201D vessels are.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb\u003E\uD83D\uDCDA Supporting sources:\u003C/b\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EShields JA, Shields CL. \u003Ci\u003EIntraocular Tumors: An Atlas and Textbook\u003C/i\u003E, 3rd ed.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAmerican Academy of Ophthalmology (AAO) \u2013 \u003Ci\u003EOcular Oncology and Pathology\u003C/i\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
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  },
  {
    "Id": 49,
    "Name": "Fourth Nerve Palsy",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich of the following is LEAST likely to be a feature of a bilateral IV nerve palsy?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBilateral trochlear (IV) nerve palsy\u003C/b\u003E\u003C/span\u003E \u2192 affects both superior oblique muscles.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003ETypical clinical features include:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EVertical diplopia\u003C/b\u003E\u003C/span\u003E (worse on downgaze, such as reading or going downstairs).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ESmall hypertropia in primary gaze.\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPositive Bielschowski head tilt test to both sides:\u003C/b\u003E\u003C/span\u003E\u0026nbsp;hypertropia increases when head tilts to either shoulder.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EReversing vertical diplopia with horizontal gaze:\u003C/b\u003E\u003C/span\u003E\u0026nbsp;the higher eye switches depending on the direction of gaze (right vs left).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EHead posture in bilateral IV palsy\u003C/b\u003E\u003Cspan class=\u0022s3\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPatients usually adopt a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Echin-down\u003C/b\u003E\u003C/span\u003E posture to reduce diplopia (to avoid using downgaze where diplopia is worst).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EChin-up posture\u003C/b\u003E\u003C/span\u003E\u0026nbsp;is not typical and therefore is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eleast likely\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 50,
    "Name": "Microbiology",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWith regard to routine media used in bacteriology, which statement is MOST likely to be correct?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EMacConkey agar\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESelective and differential medium.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EInhibits gram-positive organisms (due to bile salts and crystal violet).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ESpecifically supports growth of \u003C/span\u003E\u003Cb\u003Egram-negative rods (enteric bacteria, e.g., E. coli, Klebsiella)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EDifferentiates \u003C/span\u003E\u003Cb\u003Elactose fermenters (pink colonies)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E from \u003C/span\u003E\u003Cb\u003Enon-fermenters (colorless colonies)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EChocolate agar\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EEnriched medium (lysed blood cells release growth factors).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EUsed for \u003C/span\u003E\u003Cb\u003Efastidious organisms\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E like \u003Ci\u003ENeisseria\u003C/i\u003E and \u003Ci\u003EHaemophilus influenzae\u003C/i\u003E, \u003C/span\u003E\u003Cb\u003Enot anaerobes\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EMeat broth\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EEnrichment medium for cultivating \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eanaerobic bacteria\u003C/b\u003E\u003C/span\u003E, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot acanthamoeba\u003C/b\u003E\u003C/span\u003E (acanthamoeba is typically cultured on \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enon-nutrient agar with E. coli overlay\u003C/b\u003E\u003C/span\u003E).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ENutrient agar\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EGeneral-purpose medium for non-fastidious organisms.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ENot selective for \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Egram-negative cocci\u003C/b\u003E\u003C/span\u003E (which are fastidious and grow better on chocolate agar).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 7,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 51,
    "Name": "Microbiology",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003ERegarding the microscopic examination of a preparation suspected of containing Acanthamoeba, which of the following preparations would be LEAST likely to be useful?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAcanthamoeba\u003C/b\u003E\u003C/span\u003E is a free-living amoeba causing \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAcanthamoeba keratitis\u003C/b\u003E\u003C/span\u003E and granulomatous amoebic encephalitis.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EUseful diagnostic preparations\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E include:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECalcofluor white\u003C/b\u003E\u003C/span\u003E: Binds to cellulose and chitin in cyst walls \u2192 fluoresces under UV.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGiemsa stain\u003C/b\u003E\u003C/span\u003E: Demonstrates trophozoites and cysts.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EKOH wet mount\u003C/b\u003E\u003C/span\u003E: Dissolves keratinous tissue and debris, making cysts visible.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAcid-fast stain\u003C/b\u003E\u003C/span\u003E: Designed for organisms with mycolic acid in their cell wall (e.g., \u003Ci\u003EMycobacterium\u003C/i\u003E). \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAcanthamoeba does not stain acid-fast\u003C/b\u003E\u003C/span\u003E, so this is the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eleast useful preparation\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cimg src=\u0022/upload-2025-08-20-d3ef375a-8f1b-4f9a-ad9f-24423e033c67.png\u0022\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 7,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 52,
    "Name": "Vitrectomy",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EA 73-year-old woman is undergoing phacovitrectomy for a stage 4 macular hole with good vision in the fellow eye and problems with postoperative posturing. Which intravitreal gas is the MOST appropriate to use as a retinal tamponade in this situation?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERetinal tamponade gases\u003C/b\u003E\u003C/span\u003E are used to close macular holes by providing internal pressure.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThe choice depends on \u003C/span\u003E\u003Cb\u003Eduration of tamponade\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and \u003C/span\u003E\u003Cb\u003Epatient compliance with posturing\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EGas options:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESF6 (Sulphur hexafluoride):\u003C/b\u003E\u003C/span\u003E Short-acting (1\u20132 weeks). Expansion 2x. Used at 20% concentration.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EC3F8 (Perfluoropropane):\u003C/b\u003E\u003C/span\u003E Long-acting (up to 6\u20138 weeks). Expansion 4x. Used at 12\u201314% concentration.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAir:\u003C/b\u003E\u003C/span\u003E Lasts only a few days, sometimes used in compliant patients.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022color: rgb(88, 0, 255);\u0022\u003E\u003Cb\u003E\u201CShort Six, Prolonged Propane\u0022\u0026nbsp;\u003C/b\u003E\u003Cb style=\u0022letter-spacing: 0.14994px;\u0022\u003ESF6 \u2192 Short (1\u20132 weeks),\u0026nbsp;\u003C/b\u003E\u003Cb style=\u0022letter-spacing: 0.14994px;\u0022\u003EC3F8 \u2192 Prolonged (6\u20138 weeks)\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cb style=\u0022text-decoration-line: underline;\u0022\u003EWhy 12% C3F8 here?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPatient has difficulty posturing \u2192 requires a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elong-acting tamponade\u003C/b\u003E\u003C/span\u003E to keep the hole closed despite suboptimal compliance.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E12% C3F8\u003C/b\u003E\u003C/span\u003E provides prolonged support and is the standard choice for macular hole surgery in such cases.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EHigher concentrations (36% C3F8, 80% SF6) are dangerous because they expand excessively \u2192 risk of raised IOP and ischemia.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E5% SF6 is too low to be effective (wrong concentration).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 53,
    "Name": "Demyelinating diseases",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 21-year-old lady presents complaining of acute unilateral visual loss. Her visual acuity is OD 6/6 and OS 6/60. The right optic nerve appears pale and the left optic nerve is oedematous. Colour vision is reduced in both eyes. She had a brief febrile illness when she was 8 associated with cognitive changes and seizures but recovered fully and there is no other past medical history of note. Which of the following results would MOST likely be positive?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThis is a \u003C/span\u003E\u003Cb\u003Eclassic presentation of demyelinating optic neuritis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, commonly linked with \u003C/span\u003E\u003Cb\u003EMultiple Sclerosis (MS)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EFeatures supporting MS-related optic neuritis:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EYoung woman (20 years old)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192 typical age group.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EAcute unilateral visual loss\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E with \u003C/span\u003E\u003Cb\u003Ereduced colour vision\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOptic disc: one side pale (old optic neuritis), other swollen (acute episode).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EHistory of a prior \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eneurological episode\u003C/b\u003E\u003C/span\u003E (febrile illness with seizures/cognitive changes may have been a prior demyelinating attack).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EAnswer choices in context:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAQP4 antibody\u003C/b\u003E\u003C/span\u003E \u2192 suggests \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ENeuromyelitis Optica (NMO)\u003C/b\u003E\u003C/span\u003E. Typically more severe, bilateral simultaneous optic neuritis, associated with longitudinally extensive transverse myelitis. Not the best fit here.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBorrelia serology\u003C/b\u003E\u003C/span\u003E \u2192 would be relevant if Lyme disease suspected (tick bite, systemic features). Not consistent with this case.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECSF oligoclonal bands\u003C/b\u003E\u003C/span\u003E \u2192 Seen in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E85\u201395% of MS patients\u003C/b\u003E\u003C/span\u003E; the most likely positive test in this scenario.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMOG antibody\u003C/b\u003E\u003C/span\u003E \u2192 Associated with MOG-associated disease (MOGAD). Often presents in younger patients and children, more likely bilateral or recurrent optic neuritis with disc swelling. Less likely here.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 54,
    "Name": "Intra-ocular tumors",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003ELooking at the image below, which of the following groups of factors are MOST associated with an increased risk of lesion growth?\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cimg src=\u0022/upload-2025-08-20-25ee3753-4099-4ed7-b147-c3dec1565b37.png\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThe lesion in the fundus photo is suggestive of a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Echoroidal nevus\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003ERisk factors for transformation into \u003C/span\u003E\u003Cb\u003Echoroidal melanoma\u003C/b\u003E\u003Cspan class=\u0022s2\u0022\u003E have been well studied in the \u003C/span\u003E\u003Cb\u003ECOMS (Collaborative Ocular Melanoma Study)\u003C/b\u003E\u003Cspan class=\u0022s2\u0022\u003E and \u003C/span\u003E\u003Cb\u003EShields\u2019 mnemonic \u201CTo Find Small Ocular Melanoma Using Helpful Hints Daily\u201D\u003C/b\u003E\u003Cspan class=\u0022s2\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ET\u003C/b\u003E\u003C/span\u003E: Thickness \u0026gt; 2 mm\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EF\u003C/b\u003E\u003C/span\u003E: Subretinal Fluid\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ES\u003C/b\u003E\u003C/span\u003E: Symptoms (e.g., vision loss, photopsia)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EO\u003C/b\u003E\u003C/span\u003E: Orange pigment (lipofuscin)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EM\u003C/b\u003E\u003C/span\u003E: Margin within 3 mm of optic disc\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EUH\u003C/b\u003E\u003C/span\u003E: Ultrasonographic Hollowness\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EH\u003C/b\u003E\u003C/span\u003E: Absence of halo\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ED\u003C/b\u003E\u003C/span\u003E: Absence of drusen\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eabsence of drusen\u003C/b\u003E\u003C/span\u003E (which suggest chronic, stable lesion) increases the risk that the lesion is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eactive\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe presence of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esubretinal fluid\u003C/b\u003E\u003C/span\u003E and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ethickness \u0026gt; 2 mm\u003C/b\u003E\u003C/span\u003E are major risk factors for growth.\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cimg src=\u0022/upload-2025-08-20-cd528ecf-460c-4ed5-80bf-528d70d2c931.png\u0022\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 55,
    "Name": "Supra-nuclear palsy",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWith regard to ataxia telangiectasia, which of these statements is MOST likely to be correct?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAtaxia-telangiectasia (A-T)\u003C/b\u003E\u003C/span\u003E is a rare, autosomal recessive neurodegenerative disorder caused by mutations in the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EATM gene\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EKey features:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOnset:\u003C/b\u003E\u003C/span\u003E Early childhood (usually before age 5, not in teenage years).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOcular:\u003C/b\u003E\u003C/span\u003E Oculomotor apraxia (difficulty initiating voluntary eye movements), but \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Evertical eye movements are not specifically affected early\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EImmune system:\u003C/b\u003E\u003C/span\u003E Patients have \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eimmune deficiency\u003C/b\u003E\u003C/span\u003E (especially IgA and IgG2 deficiency), leading to recurrent sinopulmonary infections.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBiochemical marker:\u003C/b\u003E\u003C/span\u003E \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERaised alpha-fetoprotein (AFP)\u003C/b\u003E\u003C/span\u003E is a classic laboratory finding, seen in \u0026gt;90% of patients.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E----\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline; color: rgb(255, 0, 0);\u0022\u003ESupra-Nuclear Palsy:\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E1. Dorsal Midbrain Syndrome\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;2. Progressive Supranuclear palsy (PSP) - Steele Richardson Olszweski\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;3. Parkinsonism\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;4. Louis-Bar Syndrome (Ataxia Telangiectasia)\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold; color: rgb(255, 0, 0); text-decoration-line: underline;\u0022\u003EAtaxia Telangectasia:\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cul\u003E\u003Cli\u003EReduced volitional eye movements but intact oculocephalic manoeuvre\u0026nbsp;\u003C/li\u003E\u003Cli\u003ECutaneous and conjunctival telangiectasia (age of 3)\u0026nbsp;\u003C/li\u003E\u003Cli\u003EDiffuse cerebral atrophy\u0026nbsp;\u003C/li\u003E\u003Cli\u003EThymic aplasia = deficient T cell function (could have Thymic lymphoma)\u0026nbsp;\u003C/li\u003E\u003Cli\u003ER\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003Eecurrent sinopulmonary infection due to IgA deficiency\u003C/span\u003E\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 56,
    "Name": "Exotropia",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich of the following MOST accurately describes the general surgical aims of squint surgery for exotropia?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThe aim of strabismus surgery depends on whether \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Efusion potential\u003C/b\u003E\u003C/span\u003E exists:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Col start=\u00221\u0022\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EIf fusion is possible (good sensory potential, e.g., intermittent exotropia):\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAim for a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esmall overcorrection\u003C/b\u003E\u003C/span\u003E (slight esotropia postoperatively).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EReason: Exotropia has a natural tendency to drift back outward (exodrift). A small overcorrection initially often results in long-term alignment close to orthotropia.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EIf fusion is absent (e.g., long-standing sensory exotropia, no binocularity):\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ECosmetic alignment is the goal.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOvercorrection should be avoided, as patients without fusion cannot adapt to diplopia \u2192 aim for \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eorthotropia or small undercorrection\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003C/ol\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Col start=\u00221\u0022\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/ol\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 57,
    "Name": "Confidence",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich of the following is the MOST appropriate estimate of the reliability of the average final refractive outcome from the results of a study assessing the success of cataract surgery?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EStandard deviation (SD):\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMeasures variability of individual data points around the mean.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EDescribes \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Espread\u003C/b\u003E\u003C/span\u003E, not reliability of the mean.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EConfidence interval (CI):\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EGives a range within which the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Etrue population mean\u003C/b\u003E\u003C/span\u003E is likely to fall.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EReflects the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eprecision and reliability\u003C/b\u003E\u003C/span\u003E of the mean estimate.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ENarrow CI \u2192 higher reliability, Wide CI \u2192 lower reliability.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ETherefore, best answer for reliability of the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eaverage final refractive outcome\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EStudent\u2019s t test:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EUsed to compare means between two groups, not to measure reliability of one mean.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EAnalysis of variance (ANOVA):\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EUsed to compare means across more than two groups, not to estimate reliability of a mean.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb style=\u0022font-size: calc(1.3rem \u002B 0.6vw); letter-spacing: 0.14994px;\u0022\u003EKey Point:\u003C/b\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ETo judge \u003C/span\u003E\u003Cb\u003Evariability of data\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192 use \u003C/span\u003E\u003Cb\u003ESD\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ETo judge \u003C/span\u003E\u003Cb\u003Ereliability of the mean estimate\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192 use \u003C/span\u003E\u003Cb\u003EConfidence Interval (CI)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 11,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 58,
    "Name": "Dystrophies",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich of the following statements is MOST likely to be correct in Lattice Corneal Dystrophy Type II?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ELattice Corneal Dystrophy (LCD) Type II\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EAlso known as \u003C/span\u003E\u003Cb\u003EMeretoja syndrome\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ECaused by \u003C/span\u003E\u003Cb\u003Emutations in Gelsolin gene (GSN)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESystemic disease with corneal lattice lines, cranial neuropathies, and cutis laxa.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EHistology:\u003C/b\u003E\u003C/span\u003E Shows \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eamyloid deposits\u003C/b\u003E\u003C/span\u003E (not hyaline) in corneal stroma.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EInheritance:\u003C/b\u003E\u003C/span\u003E Autosomal \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edominant\u003C/b\u003E\u003C/span\u003E (not recessive).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOnset:\u003C/b\u003E\u003C/span\u003E Usually around the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ethird decade\u003C/b\u003E\u003C/span\u003E, not as late as the fifth.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb\u003EIncorrect options:\u003C/b\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EHyaline deposits with Masson trichrome \u2192 seen in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGranular corneal dystrophy\u003C/b\u003E\u003C/span\u003E, not lattice.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EInheritance is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eautosomal dominant\u003C/b\u003E\u003C/span\u003E, not recessive.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOnset is usually \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eearlier (3rd decade)\u003C/b\u003E\u003C/span\u003E, not typically delayed to the fifth.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 59,
    "Name": "DR",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich of the following are LEAST likely to be associated with Optociliary Collaterals?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOptociliary collaterals\u003C/b\u003E\u003C/span\u003E = dilated pre-existing venous channels on the optic disc that act as shunts between retinal and choroidal circulation when normal venous outflow is obstructed.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThey are classically associated with:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ECentral Retinal Vein Occlusion (CRVO)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192 most common cause.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOptic Nerve Glioma\u003C/b\u003E\u003C/span\u003E \u2192 causes venous outflow obstruction.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIdiopathic Intracranial Hypertension (IIH)\u003C/b\u003E\u003C/span\u003E \u2192 chronic papilledema can lead to collateral vessel formation.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003ENOT associated with:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EProliferative Diabetic Retinopathy (PDR):\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIn PDR, the hallmark is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eneovascularization\u003C/b\u003E\u003C/span\u003E (new abnormal vessels on disc or elsewhere), not collateral/shunt vessels.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPathogenesis: due to ischemia-induced VEGF release, not venous obstruction.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMnemonic\u003C/b\u003E\u003C/span\u003E to remember:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E\u201CCollaterals = Clean\u201D\u003C/b\u003E\u003C/span\u003E \u2192 mature, non-leaking, smooth.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E\u201CNeovascularization = New and Nasty\u201D\u003C/b\u003E\u003C/span\u003E \u2192 fragile, leaky, sight-threatening.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cimg src=\u0022/upload-2025-08-20-0a79cada-d93b-4bb6-9774-dfec25259708.png\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E\u003C/div\u003E\u003Cul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 60,
    "Name": "Anaesthetics",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EWhich local anaesthetic has the longest duration of action?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EBupivacaine\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EVery \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elong-acting\u003C/b\u003E\u003C/span\u003E amide local anaesthetic.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EDuration: \u003C/span\u003E\u003Cb\u003E4\u20138 hours (or longer with epinephrine)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ECommonly used where prolonged postoperative analgesia is desired (e.g., nerve blocks, epidurals).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ELidocaine (with epinephrine)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EIntermediate duration\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (90\u2013180 min).\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EEpinephrine prolongs effect by vasoconstriction, but still shorter than bupivacaine.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EMepivacaine\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EIntermediate acting\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (2\u20133 hrs).\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESlightly longer than plain lidocaine, but less than bupivacaine.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPrilocaine\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EAlso \u003C/span\u003E\u003Cb\u003Eintermediate acting\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (1.5\u20133 hrs).\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EShorter than bupivacaine.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\uD83D\uDCCC \u003C/span\u003E\u003Cb\u003EMnemonic to remember duration (short \u2192 long):\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003EL\u003C/b\u003E\u003C/span\u003Eidocaine \u2192 \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003EM\u003C/b\u003E\u003C/span\u003Eepivacaine \u2192 \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003EP\u003C/b\u003E\u003C/span\u003Erilocaine \u2192 \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003EB\u003C/b\u003E\u003C/span\u003Eupivacaine\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\uD83D\uDC49 \u201C\u003C/span\u003E\u003Cb\u003ELittle Mice Play Briefly\u003C/b\u003E\u003Cspan class=\u0022s2\u0022\u003E\u201D\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 5,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 61,
    "Name": "CCF",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EWhich of the following is LEAST likely to be associated with a Carotico-cavernous fistula?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EA \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecarotico-cavernous fistula (CCF)\u003C/b\u003E\u003C/span\u003E is an abnormal arteriovenous communication between the carotid artery and cavernous sinus. The high-pressure shunt causes \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Evenous congestion in the orbit\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003ETypical features include:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EEngorged conjunctival/episcleral vessels\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (\u201Cred eye with corkscrew vessels\u201D).\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EProptosis\u003C/b\u003E\u003C/span\u003E (due to venous engorgement).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERaised intraocular pressure\u003C/b\u003E\u003C/span\u003E (from impaired aqueous drainage via congested episcleral veins).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EOrbital bruit or pulsatile exophthalmos\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESecondary retinal venous stasis and venous engorgement\u003C/b\u003E\u003C/span\u003E \u2192 can lead to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emacular oedema\u003C/b\u003E\u003C/span\u003E, disc swelling, and retinal haemorrhages.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EAnterior segment ischemia in the direct CCF.\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EVitreous haemorrhage, however, is NOT a common feature\u003C/b\u003E\u003C/span\u003E of CCF. It is more typically seen in proliferative diabetic retinopathy, retinal vein occlusion, trauma, etc.\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; color: rgb(0, 165, 255); text-decoration-line: underline;\u0022\u003ERemember, The raised\u0026nbsp;\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003Eepiscleral venous pressure causing a secondary open-angle glaucoma, can also cause:\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cul\u003E\u003Cli\u003E80% of patients with CCF develop ocular hypertension\u0026nbsp;\u003C/li\u003E\u003Cli\u003E25% develop optic disc cupping\u0026nbsp;\u003C/li\u003E\u003Cli\u003E20% visual field defects.\u0026nbsp;\u003C/li\u003E\u003C/ul\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 62,
    "Name": "VMT",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EWhat is the MOST likely diagnosis accounting for the Optical Coherence Tomogram (OCT) appearance shown?\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cimg src=\u0022/upload-2025-08-20-8ff1f5f7-2753-4713-9555-7a2bbef30483.gif\u0022\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThe OCT image shows:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EFoveal elevation with cystic spaces\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E in the inner retina.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EA \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Efocal foveal detachment\u003C/b\u003E\u003C/span\u003E with vitreomacular traction.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThis is an \u003C/span\u003E\u003Cb\u003Eimpending (Stage 1) macular hole\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb style=\u0022letter-spacing: 0.14994px; font-size: medium;\u0022\u003EOther options:\u003C/b\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECystoid macular oedema\u003C/b\u003E\u003C/span\u003E \u2192 would show multiple cystic hyporeflective spaces in a petaloid pattern, often involving the parafovea (not just central foveal detachment).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EEpiretinal membrane\u003C/b\u003E\u003C/span\u003E \u2192 OCT would show a hyperreflective membrane on the inner retinal surface with surface wrinkling (not present here).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EWet AMD\u003C/b\u003E\u003C/span\u003E \u2192 would show subretinal/intraretinal fluid, pigment epithelial detachment, or subretinal neovascular membrane (not seen here).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003EAlthough a diagnosis of vitreomacular traction is the most suitable for this scan, among the choices provided, an impending macular hole is the most likely.\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 63,
    "Name": "Retinoschisis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EWhich of the following features are MOST likely to be associated with retinoschisis?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERetinoschisis\u003C/b\u003E\u003C/span\u003E is a splitting of the retinal layers, usually between the outer plexiform and inner nuclear layers.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EIt is typically \u003C/span\u003E\u003Cb\u003Ebilateral, inferotemporal, and seen in hypermetropic patients\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb style=\u0022letter-spacing: 0.14994px; font-size: large;\u0022\u003EWhy not the others?\u003C/b\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022font-size: large;\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EDemarcation line\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192 seen in \u003C/span\u003E\u003Cb\u003Elongstanding rhegmatogenous retinal detachment (RRD)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, not retinoschisis.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERetinal haemorrhage\u003C/b\u003E\u003C/span\u003E \u2192 uncommon in retinoschisis; haemorrhage is more linked to vascular disease (e.g., diabetic retinopathy, CRVO).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EShaffer\u2019s sign (tobacco dust in vitreous)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192 a hallmark of \u003C/span\u003E\u003Cb\u003Erhegmatogenous retinal detachment\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, not retinoschisis.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cb\u003EKey Points for Exams:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERetinoschisis\u003C/b\u003E\u003C/span\u003E = Hypermetropia \u002B Inferotemporal \u002B Smooth dome-shaped elevation \u002B Absolute scotoma.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERetinal detachment\u003C/b\u003E\u003C/span\u003E = Myopia \u002B Flashes/floaters \u002B Shaffer\u2019s sign \u002B Demarcation line.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 64,
    "Name": "Vitrectomy",
    "Body": "\u003Cspan style=\u0022font-weight: 700; letter-spacing: 0.14994px; font-size: medium;\u0022\u003EWhich of the following BEST describes the MOST common effect of intravitreal silicone oil on the refraction of a phakic eye?\u003C/span\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ESilicone oil\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E has a \u003C/span\u003E\u003Cb\u003Ehigher refractive index (\u22481.405)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E compared to the vitreous (\u22481.336).\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIn \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ephakic eyes\u003C/b\u003E\u003C/span\u003E, this change in refractive index alters the optics:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eposterior surface of the lens\u003C/b\u003E\u003C/span\u003E now interfaces with silicone oil rather than vitreous.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThis creates a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehigher converging power\u003C/b\u003E\u003C/span\u003E, shifting refraction toward \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emyopia\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe magnitude of induced myopia depends on lens thickness and curvature (often 3\u20135D).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb style=\u0022font-size: large;\u0022\u003EWhy not the others?\u003C/b\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAstigmatic power is reduced\u003C/b\u003E\u003C/span\u003E \u2192 Incorrect. Silicone oil induces \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Espherical change\u003C/b\u003E\u003C/span\u003E, not selective astigmatic changes.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EMyopic refractive error is reduced\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192 Opposite effect; oil \u003C/span\u003E\u003Cb\u003Einduces myopia\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E in phakic eyes.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ENo change in spherical refractive error\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192 Incorrect, as a \u003C/span\u003E\u003Cb\u003Esignificant myopic shift\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is clinically well-documented.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u0026nbsp;\u003C/span\u003E\u003Cb\u003EKey memory aid:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cb\u003E\u201CSilicone oil sinks eyes into myopia.\u201D\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p2\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p2\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
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    "HighYield": true,
    "CategoryId": 2,
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  },
  {
    "Id": 65,
    "Name": "Congenital optic disc anomalies",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EWhich ONE of the following is NOT a recognised association of optic nerve hypoplasia?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EOptic nerve hypoplasia (ONH) is a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Econgenital anomaly\u003C/b\u003E\u003C/span\u003E characterized by a small optic disc and reduced number of axons. It is often associated with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emidline brain abnormalities\u003C/b\u003E\u003C/span\u003E and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eendocrine dysfunctions\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003ERecognized associations of ONH:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ESepto-optic dysplasia (de Morsier syndrome):\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EHypoplasia of the corpus callosum\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAbsence of septum pellucidum\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPituitary hypoplasia \u2192 leads to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eendocrine dysfunctions\u003C/b\u003E\u003C/span\u003E (e.g., diabetes insipidus, growth hormone deficiency, hypopituitarism).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOcular features:\u003C/b\u003E\u003C/span\u003E Nystagmus, strabismus, reduced visual acuity.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMaternal associations:\u003C/b\u003E\u003C/span\u003E More common in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eyoung maternal age (\u0026lt;20 years)\u003C/b\u003E\u003C/span\u003E, especially teenage pregnancies, and maternal risk factors such as alcohol, drugs, and diabetes.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb\u003E\u0026nbsp;\u003Cspan style=\u0022font-size: large;\u0022\u003EThe options:\u003C/span\u003E\u003C/b\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EDiabetes Insipidus\u003C/b\u003E\u003C/span\u003E \u2192 True. ONH often involves pituitary dysfunction.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EHypoplasia of the corpus callosum\u003C/b\u003E\u003C/span\u003E \u2192 True. Seen in septo-optic dysplasia.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ENystagmus\u003C/b\u003E\u003C/span\u003E \u2192 True. Common presenting ocular feature.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMaternal age \u0026gt;30 years\u003C/b\u003E\u003C/span\u003E \u2192\u0026nbsp; Incorrect. The known risk is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eyoung maternal age (\u0026lt;20 years)\u003C/b\u003E\u003C/span\u003E, not advanced maternal age.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 66,
    "Name": "Artery Occlusion",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EIn the management of a patient with an acute Cilio-Retinal artery occlusion, which statement is LEAST likely to be correct?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECilio-retinal artery occlusion\u003C/b\u003E\u003C/span\u003E is a retinal vascular emergency.\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EManagement focuses on:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EExcluding \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Egiant cell arteritis (GCA)\u003C/b\u003E\u003C/span\u003E if over age 50 \u2192 check ESR, CRP, temporal artery biopsy.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIdentifying \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecardioembolic and carotid sources\u003C/b\u003E\u003C/span\u003E \u2192 echocardiography and carotid Doppler are standard.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EConsidering \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eocular ischaemic syndrome\u003C/b\u003E\u003C/span\u003E if widespread mid-peripheral hemorrhages are seen (due to severe carotid stenosis).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003ENote:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ELowering systemic blood pressure is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Econtraindicated in the acute setting\u003C/b\u003E\u003C/span\u003E, because ocular perfusion pressure may already be critically low.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EFurther lowering BP risks worsening retinal ischaemia and infarction.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EInstead, maintaining or even slightly supporting perfusion pressure is preferred.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb style=\u0022font-size: large;\u0022\u003EOther options:\u003C/b\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EB: Carotid Doppler \u002B Echocardiogram\u003C/b\u003E\u003C/span\u003E \u2192 True, essential to rule out embolic sources.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EC: Raised inflammatory markers \u2192 GCA\u003C/b\u003E\u003C/span\u003E \u2192 True, must be excluded urgently in elderly.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ED: Retinal haemorrhages \u2192 ocular ischaemic syndrome\u003C/b\u003E\u003C/span\u003E \u2192 True, classically seen with severe carotid stenosis.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
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    "HighYield": true,
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  },
  {
    "Id": 67,
    "Name": "Cataract Surgery",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA 69-year-old gentleman presents 12 hours after an uneventful cataract surgery. He is worried that his vision has dropped quite suddenly, but he does not report any pain. On examination, there is no lid swelling or discharge. On examination, Vision is 6/60 in the affected eye, and the cornea is diffusely oedematous. The intraocular pressure is 35 mmHg, and there is mild anterior chamber activity. The pupil is unreactive. On B scan, there is no vitritis. Which of the following statements is MOST likely to be correct?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThis patient most likely has \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eacute postoperative raised intraocular pressure (IOP)\u003C/b\u003E\u003C/span\u003E after cataract surgery (secondary acute glaucoma or early Toxic Anterior Segment Syndrome (TASS) vs. retained viscoelastic).\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EKey features here:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EEarly onset (12 hrs post-op)\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPainless loss of vision\u003C/b\u003E\u003C/span\u003E (endophthalmitis usually causes pain \u002B hypopyon \u002B vitritis, which are absent here)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EDiffuse corneal oedema\u003C/b\u003E\u003C/span\u003E due to endothelial pump failure from high IOP\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIOP 35 mmHg\u003C/b\u003E\u003C/span\u003E \u2192 elevated\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EUnreactive pupil\u003C/b\u003E\u003C/span\u003E (secondary to iris ischaemia from high IOP)\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003EIf untreated, \u003C/span\u003E\u003Cb\u003Esustained raised IOP\u003C/b\u003E\u003Cspan class=\u0022s3\u0022\u003E \u2192 \u003C/span\u003E\u003Cb\u003Eirreversible corneal endothelial decompensation\u003C/b\u003E\u003Cspan class=\u0022s3\u0022\u003E \u2192 permanent corneal oedema and vision loss.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb style=\u0022font-size: medium; text-decoration-line: underline;\u0022\u003EThe other options:\u003C/b\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAnterior chamber washout\u003C/b\u003E\u003C/span\u003E \u2192 This may be useful if viscoelastic retention is suspected, but the immediate issue is high IOP; medical management (acetazolamide, topical IOP-lowering agents) is first-line. Washout is not the most likely correct general statement.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EExplantation of IOL and capsular bag\u003C/b\u003E\u003C/span\u003E \u2192 This is a very late salvage option (e.g., chronic TASS, intractable inflammation). Not relevant in the acute 12-hour presentation.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ETopical steroids with caution\u003C/b\u003E\u003C/span\u003E \u2192 In fact, topical steroids are often \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eindicated\u003C/b\u003E\u003C/span\u003E in TASS to reduce inflammation. The caution applies in fungal keratitis, not here.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 1,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 68,
    "Name": "GCA",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EConcerning giant cell arteritis (GCA), which of these statements is LEAST likely to be correct?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECRP is raised\u003C/b\u003E\u003C/span\u003E \u2192 Correct. Both \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EESR and CRP are usually elevated\u003C/b\u003E\u003C/span\u003E in GCA and are highly sensitive markers for diagnosis.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EFemales are more susceptible\u003C/b\u003E\u003C/span\u003E \u2192 Correct. GCA occurs more commonly in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eelderly women\u003C/b\u003E\u003C/span\u003E, particularly of Northern European descent.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EHistological diagnosis is based on fragmentation of the internal elastic lamina\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192 Correct. The biopsy shows \u003C/span\u003E\u003Cb\u003Egranulomatous inflammation\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, typically with \u003C/span\u003E\u003Cb\u003Edisruption/fragmentation of the internal elastic lamina\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPresence of giant cells required for diagnosis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192 Incorrect. Despite the name, \u003C/span\u003E\u003Cb\u003Egiant cells are not always present\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E on biopsy. The key diagnostic feature is \u003C/span\u003E\u003Cb\u003Egranulomatous inflammation with disruption of the internal elastic lamina\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E. Absence of giant cells does \u003C/span\u003E\u003Cb\u003Enot\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E rule out GCA.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EMnemonic for biopsy features of GCA \u2192 \u201CFIGS\u201D:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EF\u003C/b\u003E\u003C/span\u003E: Fragmentation of internal elastic lamina\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EI\u003C/b\u003E\u003C/span\u003E: Inflammatory infiltrate (granulomatous, lymphocytes, macrophages)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EG\u003C/b\u003E\u003C/span\u003E: Giant cells (sometimes, but not always present)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ES\u003C/b\u003E\u003C/span\u003E: Skip lesions (patchy involvement)\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 69,
    "Name": "Hereditaty vitreoretinopathies",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EA 12-month-old developmentally delayed boy with hearing impairment is referred. Examination findings include hand movements vision and bilateral white retrolental masses. The child\u2019s skin is normal. Which of these is the MOST likely diagnosis?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ENorrie disease\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EX-linked recessive\u003C/b\u003E\u003C/span\u003E disorder caused by mutations in the \u003Ci\u003ENDP gene\u003C/i\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EClassic triad: \u003C/span\u003E\u003Cb\u003Econgenital/infantile blindness (retrolental masses, leukocoria)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, \u003C/span\u003E\u003Cb\u003Esensorineural deafness\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, and \u003C/span\u003E\u003Cb\u003Edevelopmental delay/mental retardation\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESkin is typically \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enormal\u003C/b\u003E\u003C/span\u003E, which helps differentiate it from other conditions.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EStrong match to the vignette.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ECongenital rubella infection\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAssociated with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Etriad\u003C/b\u003E\u003C/span\u003E: cataract, deafness, congenital heart disease (PDA).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ERetrolental \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ewhite masses\u003C/b\u003E\u003C/span\u003E are not typical; rather, cataracts are seen.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EIncontinentia pigmentii\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EX-linked dominant\u003C/b\u003E\u003C/span\u003E (lethal in males).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EFeatures: skin lesions (vesicular \u2192 verrucous \u2192 hyperpigmented \u2192 atrophic), dental anomalies, CNS issues, and retinal vascular disease.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ENormal skin\u003C/b\u003E\u003C/span\u003E here rules this out.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ERetinoblastoma\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ELeukocoria is typical, but usually \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eunilateral (can be bilateral)\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EDoes not usually present with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehearing loss or developmental delay\u003C/b\u003E\u003C/span\u003E, so not the best fit.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cbr\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ENorrie disease = Blindness \u002B Deafness \u002B Developmental delay (boys, X-linked) =\u0026nbsp;\u003C/b\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EDoesn\u2019t see, doesn\u2019t hear, doesn\u2019t understand\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThink of \u003C/span\u003E\u003Cb\u003ENDP gene mutation\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and \u003C/span\u003E\u003Cb\u003Ebilateral retrolental masses\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E as the hallmark.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 70,
    "Name": "Dystrophies",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EIn which ONE of the following dystrophies does the central cornea show grey-white, fine round and polygonal opacities in Bowman\u2019s layer?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EReis-Buckler dystrophy (RBCD)\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESite\u003C/b\u003E\u003C/span\u003E: Bowman\u2019s layer (primary pathology).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EFindings\u003C/b\u003E\u003C/span\u003E: Grey-white, fine round and polygonal opacities in the central cornea.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThese opacities coalesce over time, causing recurrent erosions and progressive visual loss.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAutosomal dominant, mutation in \u003Ci\u003ETGFBI gene\u003C/i\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA: Granular dystrophy\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EHyaline deposits in the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Estroma\u003C/b\u003E\u003C/span\u003E (bread-crumb like, discrete opacities).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ENot in Bowman\u2019s layer.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EB: Macular dystrophy\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAutosomal recessive\u003C/b\u003E\u003C/span\u003E, deposits of glycosaminoglycans.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EDiffuse stromal haze\u003C/b\u003E\u003C/span\u003E involving full thickness of cornea.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ENot restricted to Bowman\u2019s.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EC: Meesmann dystrophy\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ETiny intraepithelial vesicles (microcysts), especially in interpalpebral zone.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EEpithelial dystrophy\u003C/b\u003E\u003C/span\u003E, not Bowman\u2019s layer.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EIf \u003C/span\u003E\u003Cb\u003EBowman\u2019s layer\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is involved \u2192 think \u003C/span\u003E\u003Cb\u003EReis-Buckler dystrophy\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\n\n\n\n\n\n\n\n\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EReis-Buckler\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192 \u003C/span\u003E\u003Cb\u003E\u201CRB = Rigid Bowman\u201D\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192 opacities sit in \u003C/span\u003E\u003Cb\u003EBowman\u2019s layer\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 71,
    "Name": "MG",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA 47-year-old patient who has rheumatoid arthritis complains of variable double vision. On examination, you noted a mild ptosis with fatigueability and limited depression of the left eye. Which of the following drugs is MOST likely to be the cause?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThe patient has \u003C/span\u003E\u003Cb\u003Evariable diplopia, ptosis, and fatigability\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192 classical features of \u003C/span\u003E\u003Cb\u003Emyasthenia gravis (MG)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EDrug-induced myasthenia\u003C/b\u003E\u003C/span\u003E is a recognized phenomenon.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb style=\u0022text-decoration-line: underline;\u0022\u003EPenicillamine\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ECan induce a \u003C/span\u003E\u003Cb\u003Emyasthenia gravis-like syndrome\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E in \u003C/span\u003E\u003Cb\u003E0.1\u20131%\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E of patients.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMechanism: autoimmune cross-reaction leading to acetylcholine receptor (AChR) antibodies.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOnset: may occur \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eweeks to years\u003C/b\u003E\u003C/span\u003E after starting therapy.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EUsually \u003C/span\u003E\u003Cb\u003Eresolves after withdrawal\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E of the drug.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EOther options\u003C/b\u003E\u003Cspan class=\u0022s2\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMethotrexate\u003C/b\u003E\u003C/span\u003E \u2192 causes hepatotoxicity, cytopenias, lung fibrosis, but \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot MG\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPrednisolone\u003C/b\u003E\u003C/span\u003E \u2192 immunosuppressive, often used to treat MG, not cause it.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESodium aurothiomalate (gold therapy)\u003C/b\u003E\u003C/span\u003E \u2192 can cause dermatitis, nephropathy, cytopenias, but not MG.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 72,
    "Name": "Physiology",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EWhich of the following is MOST likely correct regarding the mechanism for the pathogenesis of Type 2 diabetes?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThe pathogenesis of \u003C/span\u003E\u003Cb\u003EType 2 Diabetes Mellitus (T2DM)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E involves:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Col start=\u00221\u0022\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EInsulin resistance\u003C/b\u003E\u003C/span\u003E \u2192 in skeletal muscle, liver, and adipose tissue.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMuscle: \u2193 glucose uptake.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ELiver: \u2191 hepatic glucose production (not decreased).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EFat: \u2191 lipolysis.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EProgressive Beta-cell dysfunction\u003C/b\u003E\u003C/span\u003E \u2192 the pancreas cannot compensate with enough insulin, leading to hyperglycemia.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EInitially, there may be \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehyperinsulinemia\u003C/b\u003E\u003C/span\u003E (not excessive insulin secretion long-term).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOver time, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebeta-cell failure\u003C/b\u003E\u003C/span\u003E is the hallmark of progression.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGlucose uptake\u003C/b\u003E\u003C/span\u003E \u2192 is decreased in skeletal muscle, not increased.\u003C/p\u003E\n\u003C/li\u003E\u003C/ol\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 7,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 73,
    "Name": "Secondary Glaucoma",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EA 29-year-old lady presents after being punched in her left eye. On examination, her visual acuity is 6/6 right and 6/18 left. The left eye has a deep anterior chamber with dispersed red blood cells, and fundus examination is normal. She is given no treatment.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003E5 months later, she presented with an intraocular pressure of 32 mmHg in the left eye. Her visual acuity is 6/9 with no refractive error and there is no anterior chamber activity. Which of the following is the MOST likely diagnosis?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBlunt trauma\u003C/b\u003E\u003C/span\u003E with early hyphema/RBCs followed by \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edelayed IOP rise months later\u003C/b\u003E\u003C/span\u003E is classic for \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eangle\u2011recession glaucoma\u003C/b\u003E\u003C/span\u003E (tear between longitudinal and circular fibers of the ciliary muscle \u2192 trabecular dysfunction).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EAqueous misdirection (malignant glaucoma)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E presents with \u003C/span\u003E\u003Cb\u003Eshallow AC\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and high IOP, typically \u003C/span\u003E\u003Cb\u003Epost\u2011intraocular surgery\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, not trauma.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGhost cell glaucoma\u003C/b\u003E\u003C/span\u003E occurs \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eweeks\u003C/b\u003E\u003C/span\u003E after a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Evitreous hemorrhage\u003C/b\u003E\u003C/span\u003E (or vitrectomy) when degenerated RBCs enter the AC; history here lacks VH and timing is longer.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELens dislocation\u003C/b\u003E\u003C/span\u003E would usually cause refractive shift/iridodonesis or lens decentration\u2014absent here.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003ESo the delayed ocular hypertension after blunt trauma fits \u003Cspan class=\u0022s2\u0022\u003E\u003Cb\u003Eangle recession\u003C/b\u003E\u003C/span\u003E best.\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 74,
    "Name": "Retinoschisis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich of these is the MOST likely retinal pathology in a patient presenting with an absolute peripheral field defect?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERetinoschisis\u003C/b\u003E\u003C/span\u003E = splitting of retinal layers \u2192 produces a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esmooth, immobile, dome-shaped elevation\u003C/b\u003E\u003C/span\u003E of retina.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOn visual fields, this corresponds to an \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eabsolute scotoma\u003C/b\u003E\u003C/span\u003E (no light perception in that area) because there is a disruption in the connections between the retinal layers, so the visual stimulus is not properly transmitted to the visual pathways.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThis is in contrast to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eretinal detachment\u003C/b\u003E\u003C/span\u003E, which produces a relative scotoma, as despite the presence of a separation between the photoreceptors and the RPE, the visual pathway connections remain intact.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EOther options:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGiant retinal tear\u003C/b\u003E\u003C/span\u003E \u2192 causes risk of retinal detachment and relative field loss, not usually absolute.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPavingstone degeneration\u003C/b\u003E\u003C/span\u003E \u2192 benign, asymptomatic, no field defects.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESnail track degeneration\u003C/b\u003E\u003C/span\u003E \u2192 predisposes to tears but does not itself cause absolute peripheral defects.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cimg src=\u0022/upload-2025-08-21-a645b406-1406-46d1-a02d-0d8f7ca04d06.png\u0022\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EThis table from Oxford Handbook is really important for both written and oral exams.\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 75,
    "Name": "Cataract surgery",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EA gentleman presenting to you for left cataract surgery has a corrected acuity of 6/18 and the following refractive error and keratometry readings in the same eye:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003E-0.75 / \u002B1.50 \u00D7 110 and keratometry 41.28 D @ 170 degrees and 44.54 D @ 80 degrees.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich of these options is MOST likely to give the best refractive outcome?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERefractive error given\u003C/b\u003E\u003C/span\u003E: -0.75 / \u002B1.50 \u00D7 110 \u2192 Indicates significant \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eastigmatism\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EKeratometry readings\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E41.28 D @ 170\u00B0 (flat meridian)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E44.54 D @ 80\u00B0 (steep meridian)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ECylinder \u2248 \u003C/span\u003E\u003Cb\u003E3.26 D corneal astigmatism\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003EThis is \u003C/span\u003E\u003Cb style=\u0022letter-spacing: 0.14994px;\u0022\u003Ecorneal (regular) astigmatism\u003C/b\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E, best corrected by a \u003C/span\u003E\u003Cb style=\u0022letter-spacing: 0.14994px;\u0022\u003Etoric IOL\u003C/b\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EWhy not the other options?\u003C/b\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003Estandard IOL with incision placement:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ECorneal incisions can induce only ~0.5\u20131.0 D of astigmatism correction.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EInsufficient for a patient with \u0026gt;3 D of astigmatism.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003Etoric correction based on refractive error:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ERefractive error includes both corneal and lenticular astigmatism.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOnce cataract (lens) is removed, the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Erefractive astigmatism changes\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ECorrect calculation must be \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebased on corneal keratometry\u003C/b\u003E\u003C/span\u003E, not spectacle refraction.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 1,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 76,
    "Name": "Cataract surgery",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EA 68-year-old gentleman presents with blurring of vision in his right eye specially when looking upwards for the past 1 month. His visual acuity was 6/9 in the right eye and 6/6 in the left eye. The refraction was right -2D Cylinder @ 90 which improved vision to 6/6 and left plano. Slit lamp examination reveals an in-the-bag subluxated intraocular lens displaced inferiorly and nasally. Dilated fundus examination was normal. What is the MOST appropriate next step in management?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EPatient has \u003C/span\u003E\u003Cb\u003Egood visual acuity (6/6 with refraction)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E despite IOL subluxation.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESubluxated IOL is stable and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot causing major visual disability or complications\u003C/b\u003E\u003C/span\u003E (e.g., corneal touch, glaucoma, CME).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EImmediate surgical intervention\u003C/b\u003E\u003C/span\u003E\u0026nbsp;is not necessary unless vision is poor, lens is unstable, or complications occur.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EDischarging to optician\u003C/b\u003E\u003C/span\u003E\u0026nbsp;is inappropriate \u2014 the patient needs ophthalmology follow-up.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EUltrasound biomicroscopy\u003C/b\u003E\u003C/span\u003E\u0026nbsp;may be useful in long-term monitoring, but the immediate next step is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Espectacle correction and review\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb\u003ERemember:\u003C/b\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EStable subluxated IOL \u002B good corrected vision \u2192 Conservative management with glasses and monitoring.\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ESurgery is indicated\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E if:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPoor visual outcome with correction\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ELens instability progressing\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESecondary complications (glaucoma, corneal decompensation, CME).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
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  },
  {
    "Id": 77,
    "Name": "Investigations",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhen doing a B-scan ultrasound of the eye using an ultrasound probe, which of the following is MOST likely to be correct?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe probe beam is usually directed \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eperpendicular\u003C/b\u003E\u003C/span\u003E to structures for optimal imaging, not oblique.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EToo high a gain causes excessive noise and reduces clarity. Gain should be adjusted appropriately to balance resolution and contrast.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ELowering gray scale reduces detail; instead, optimal contrast should be maintained.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ewhite marker (or notch)\u003C/b\u003E\u003C/span\u003E on the probe is a standard convention in ultrasonography. It denotes \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebeam orientation\u003C/b\u003E\u003C/span\u003E, allowing correlation between the patient\u2019s anatomy and the display (top of screen corresponds to marker side).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 7,
    "Category": null,
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  },
  {
    "Id": 78,
    "Name": "Cataract",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EThe most frequent ocular association in most of the affected males in Alport\u2019s Syndrome includes:\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAlport\u2019s syndrome\u003C/b\u003E\u003C/span\u003E = a genetic condition caused by \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emutations in type IV collagen\u003C/b\u003E\u003C/span\u003E \u2192 affects kidneys (hematuria, progressive renal failure), ears (sensorineural deafness), and eyes.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThe \u003C/span\u003E\u003Cb\u003Eclassic ocular finding\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is \u003C/span\u003E\u003Cb\u003EAnterior Lenticonus\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (pathognomonic).\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe lens bulges forward due to weak capsule \u2192 causes progressive myopia and irregular astigmatism.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EDot-and-fleck retinopathy\u003C/b\u003E\u003C/span\u003E is also common but \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eless frequent\u003C/b\u003E\u003C/span\u003E than anterior lenticonus.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPosterior lenticonus\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192 usually seen in \u003C/span\u003E\u003Cb\u003Econgenital cataracts\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, not Alport\u2019s.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPosterior polymorphous corneal dystrophy\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E can also happen in Alport\u0027s syndrome but not as pathognomonic/common as Anterior lenticonus.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 79,
    "Name": "Keratoconus",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich ONE of the following is LEAST likely to be correct for corneal cross linking in the treatment of keratoconus?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ECorneal cross-linking (CXL):\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMain aim = \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehalt progression\u003C/b\u003E\u003C/span\u003E of keratoconus by stiffening the cornea with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eriboflavin \u002B UV-A light\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ETraditionally thought \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot to improve VA\u003C/b\u003E\u003C/span\u003E, but studies show \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emany patients do gain lines of BCVA\u003C/b\u003E\u003C/span\u003E due to corneal regularisation.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EIndications (true):\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EDocumented progression of keratoconus.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIntolerance to rigid contact lenses.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThin corneas with risk of further ectasia.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EMore effective after epithelial removal (epi-off CXL):\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EBecause riboflavin penetrates deeper.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EEpi-on is less effective but safer.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ETakes about 1 hour:\u003C/b\u003E\u003C/span\u003E True \u2014 ~30 min riboflavin soak \u002B 30 min UV exposure.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 80,
    "Name": "Studies",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EA 53\u2011year\u2011old lady with hypermetropia is referred to your clinic with suspected glaucoma. Her IOP is 30\u202FmmHg in both eyes, with no cataract, C/D ratio 0.6 OD and 0.7 OS. Gonioscopy grading: Shaffer grade 1 OU with heavily pigmented trabecular meshwork and no PAS. Automated perimetry shows bilateral visual field defects.\u0026nbsp;\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhich of the following studies could best guide your management?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThe clinical findings (very narrow angles, IOP 30, VF loss) fit \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eprimary angle\u2011closure glaucoma (PACG)\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EEAGLE\u003C/b\u003E\u003C/span\u003E trial compared \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eclear\u2011lens extraction vs LPI/medical therapy\u003C/b\u003E\u003C/span\u003E in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPAC/PACG with IOP \u226530 mmHg\u003C/b\u003E\u003C/span\u003E and showed lens extraction had better IOP control, fewer procedures, and improved quality of life\u2014directly applicable.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECIGTS\u003C/b\u003E\u003C/span\u003E and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EEMGT\u003C/b\u003E\u003C/span\u003E address \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eopen\u2011angle glaucoma\u003C/b\u003E\u003C/span\u003E (surgery vs meds; treatment vs observation), not angle\u2011closure.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EZAP\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E studied \u003C/span\u003E\u003Cb\u003Eprophylactic LPI in angle\u2011closure suspects (PACS)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E without glaucoma\u2014doesn\u2019t match this case.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 81,
    "Name": "Surgery",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EOn examining patients in the post-operative trabeculectomy clinic, which of the following clinical signs is MOST suggestive of sub-optimal function of the surgery?\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EHealthy bleb\u003C/b\u003E\u003C/span\u003E: Usually diffuse, slightly elevated, with microcysts (indicating filtration).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAvascular/thin bleb\u003C/b\u003E\u003C/span\u003E: Risk of leaks/infection but not necessarily poor function.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMicrocysts\u003C/b\u003E\u003C/span\u003E: Sign of \u003Ci\u003Egood filtration\u003C/i\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECorkscrew/tortuous vessels\u003C/b\u003E\u003C/span\u003E: Classic early warning sign of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebleb failure\u003C/b\u003E\u003C/span\u003E due to subconjunctival fibrosis and vascularisation.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 82,
    "Name": "Thryoid",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich of the following is LEAST likely to be correct regarding Thyroid associated orbitopathy (TAO)?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMost cases of TAO\u003C/b\u003E\u003C/span\u003E: associated with hyperthyroidism, but ~5\u201310% are \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eeuthyroid\u003C/b\u003E\u003C/span\u003E\u0026nbsp;\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EDysthyroid optic neuropathy (DON)\u003C/b\u003E\u003C/span\u003E: occurs due to apical crowding by \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eenlarged extraocular muscles\u003C/b\u003E\u003C/span\u003E (muscle-predominant disease), \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot fat-predominant\u003C/b\u003E\u003C/span\u003E\u0026nbsp;\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ETeprotumumab\u003C/b\u003E\u003C/span\u003E: is a monoclonal antibody against \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIGF-1 receptor\u003C/b\u003E\u003C/span\u003E, used in active TAO.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EThy-1\u002B fibroblasts\u003C/b\u003E\u003C/span\u003E: differentiate into myofibroblasts, driving fibrosis in late/chronic TAO.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 83,
    "Name": "NNT",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EIn the Early Treatment Diabetic Retinopathy Study (ETDRS) for laser treatment of diabetic macular oedema, moderate visual loss occurred in 12% of treated eyes compared to 24% of untreated eyes in three years. Which of these is MOST likely to be the approximate value of numbers needed to treat in this study?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAbsolute risk reduction (ARR)\u003C/b\u003E\u003C/span\u003E = Control event rate \u2013 Treatment event rate\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E= 24% \u2013 12%\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E= \u003C/span\u003E\u003Cb\u003E12% (0.12)\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ENumber Needed to Treat (NNT)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E = 1 \u00F7 ARR\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E= 1 \u00F7 0.12\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u2248 \u003C/span\u003E\u003Cb\u003E8.3 \u2192 round up = 9\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003ESo about 9 patients need to be treated with laser to prevent 1 case of moderate visual loss over 3 years.\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 11,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 84,
    "Name": "MMP",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWith regards to mucous membrane pemphigoid, which of the following is MOST likely to be correct?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMucous membrane pemphigoid (MMP)\u003C/b\u003E\u003C/span\u003E = chronic autoimmune blistering disease mainly affecting mucous membranes (conjunctiva, oral cavity, pharynx, larynx, genital mucosa).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESkin involvement\u003C/b\u003E\u003C/span\u003E: possible but \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eunusual\u003C/b\u003E\u003C/span\u003E, seen in \u0026lt;30% of cases.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPathology\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESubepithelial blistering (not intra-epithelial bullae).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIgG and C3 most commonly implicated (not IgA/IgM ).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EDiagnosis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EDirect immunofluorescence (DIF)\u003C/b\u003E\u003C/span\u003E of conjunctival/skin biopsy is gold standard, showing linear deposition of IgG and C3 at basement membrane.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIndirect immunofluorescence (IIF) is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eless sensitive\u003C/b\u003E\u003C/span\u003E \u2192 not definitive.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 85,
    "Name": "MH",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EIn idiopathic full-thickness macular holes, which preoperative factor is MOST likely to indicate a post-operative better visual prognosis?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPrognosis in macular hole surgery\u003C/b\u003E\u003C/span\u003E depends mainly on \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esize\u003C/b\u003E\u003C/span\u003E and associated findings.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ESmall holes (\u0026lt;250\u2013300 \u00B5m)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E have \u003C/span\u003E\u003Cb\u003Emuch better surgical and visual outcomes\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ELarger holes (\u0026gt;400 \u00B5m) have poorer prognosis.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPersistent vitreomacular traction (VMT)\u003C/b\u003E\u003C/span\u003E in small holes may be beneficial \u2192 once released surgically, the hole can close more effectively.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ENegative prognostic factors:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ELarge size (\u0026gt;400\u2013500 \u00B5m).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPresence of operculum.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIntraretinal cystic changes.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EChronicity and RPE changes/deposits.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 86,
    "Name": "Surgery",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003ERegarding Mitomycin C used in glaucoma drainage surgery, which of of the following statements is MOST likely to be true?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EMitomycin C (MMC):\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPotent antimetabolite (DNA cross-linker).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EUsed intraoperatively in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Etrabeculectomy and glaucoma drainage devices\u003C/b\u003E\u003C/span\u003E to reduce fibroblast proliferation \u2192 prevents bleb scarring.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ESide effects:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELimbal stem cell deficiency\u003C/b\u003E\u003C/span\u003E \u2192 MMC can damage limbal stem cells when applied near the limbus \u2192 leads to persistent epithelial defects, corneal vascularization, and vision loss.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThin, avascular blebs \u2192 predisposition to leaks and infection.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EOther options explained:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMMC is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emore potent\u003C/b\u003E\u003C/span\u003E than 5-FU at therapeutic levels.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMMC is commonly used at \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E0.02% (0.2 mg/mL)\u003C/b\u003E\u003C/span\u003E, not 0.2% (which would be 10\u00D7 stronger and toxic).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003Eits main action is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Einhibition of fibroblast proliferation\u003C/b\u003E\u003C/span\u003E, not mast cells.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 87,
    "Name": "Lid Tumors",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich of the following is the MOST likely diagnosis in an elderly patient presenting with a rapidly growing and well-demarcated bluish-purple upper lid lesion?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EMerkel cell carcinoma (MCC):\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ERare, highly malignant neuroendocrine tumor of the skin.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EClassically affects \u003C/span\u003E\u003Cb\u003Eelderly, immunosuppressed, or sun-exposed individuals\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EAppears as a \u003C/span\u003E\u003Cb\u003Erapidly growing, painless, firm, red-to-violaceous nodule\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOn eyelid \u2192 often well-demarcated, bluish-purple, mimicking vascular or hematologic lesions.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAggressive \u2192 high risk of local recurrence and metastasis.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EOther options:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBasal cell carcinoma:\u003C/b\u003E\u003C/span\u003E Most common eyelid malignancy, but \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eslow-growing\u003C/b\u003E\u003C/span\u003E, pearly edges, telangiectasia, rarely bluish-purple.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELymphoma:\u003C/b\u003E\u003C/span\u003E Usually \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esalmon-pink patch\u003C/b\u003E\u003C/span\u003E in conjunctiva, not a purple nodule.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESebaceous carcinoma:\u003C/b\u003E\u003C/span\u003E Typically arises from \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emeibomian glands\u003C/b\u003E\u003C/span\u003E, masquerades as recurrent chalazion, yellowish not purple.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 88,
    "Name": "White Dot syndromes",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich of the following findings is LEAST likely to occur in multiple evanescent white dot syndrome (MEWDS)?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EMEWDS (Multiple Evanescent White Dot Syndrome):\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAcute, unilateral visual loss in young women.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ECharacterized by \u003C/span\u003E\u003Cb\u003Emultiple small white dots at the RPE/outer retina\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ETypically self-limiting.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EImaging findings:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOCT:\u003C/b\u003E\u003C/span\u003E Disruption of the ellipsoid zone (IS/OS junction).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EFFA:\u003C/b\u003E\u003C/span\u003E Early punctate hyperfluorescence in a \u201Cwreath-like pattern.\u201D\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAutofluorescence:\u003C/b\u003E\u003C/span\u003E Hyperautofluorescent lesions corresponding to white dots.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EICG:\u003C/b\u003E\u003C/span\u003E \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EHypo\u003C/b\u003E\u003C/span\u003Ecyanescence (not hyper) corresponding to lesions.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ETherefore, \u003C/span\u003E\u003Cb\u003Ehypercyanescence on ICG\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is \u003C/span\u003E\u003Cb\u003Enot a feature\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 12,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 89,
    "Name": "Pupil",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich of the following statements regarding idiopathic tonic pupil (Adie syndrome / pupil) is MOST likely to be true?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EAdie\u2019s tonic pupil\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EUsually \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eunilateral\u003C/b\u003E\u003C/span\u003E at presentation (can become bilateral later, ~20%).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMost often occurs in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eyoung women\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPupil is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edilated and poorly reactive to light\u003C/b\u003E\u003C/span\u003E, but better to near (light-near dissociation).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EOver years, the affected pupil \u003C/span\u003E\u003Cb\u003Egradually becomes smaller (miotic)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2014 called \u201C\u003C/span\u003E\u003Cb\u003Elittle old Adie\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u201D\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EOther Options:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EDiagnosis is confirmed with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edilute pilocarpine (0.125%)\u003C/b\u003E\u003C/span\u003E, not phenylephrine.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAssociated with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehyperopia\u003C/b\u003E\u003C/span\u003E, not myopia.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EUsually \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eunilateral\u003C/b\u003E\u003C/span\u003E at onset, not bilateral.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOver time, pupil becomes \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eprogressively more miotic\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 90,
    "Name": "Congenital optic disc anomalies",
    "Body": "\u003Cbr\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EA 23-year-old student is referred because of the incidental finding of an abnormal optic disc (see image). What is the abnormality shown?\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cimg src=\u0022https://imagebank.asrs.org/tmp/asrs-rib-image-26420.jpg/image-full;max$643,0.ImageHandler\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe image shows \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebright, autofluorescent deposits\u003C/b\u003E\u003C/span\u003E at the optic nerve head.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThese are \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eoptic disc drusen\u003C/b\u003E\u003C/span\u003E: calcified hyaline bodies within the optic nerve head.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EOn \u003C/span\u003E\u003Cb\u003Efundus autofluorescence (FAF)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E imaging \u2192 they appear \u003C/span\u003E\u003Cb\u003Ebright white due to their autofluorescence\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EOther options:\u003C/span\u003E\u003C/p\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPapilloedema:\u003C/b\u003E\u003C/span\u003E Causes disc swelling, but would not autofluoresce.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EHamartoma:\u003C/b\u003E\u003C/span\u003E Usually pigmented or irregular mass, not bright autoflurescent deposits.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERetinal emboli:\u003C/b\u003E\u003C/span\u003E Appear as refractile intravascular bodies, not disc-centered autofluorescence.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EThis is a very common question in the FRCOphth written exams.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 91,
    "Name": "Medicolegal",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EIn which of the following cases did the Supreme Court affirm that a doctor \u003Cspan style=\u0022font-style: italic;\u0022\u003E\u201Chas a duty to take reasonable care to ensure that the patient is aware of any material risks involved in any recommended treatment, and of any reasonable alternative or variant treatments\u201D\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EMontgomery v Lanarkshire (2015)\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ELandmark case in \u003C/span\u003E\u003Cb\u003Emedical consent law\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe UK Supreme Court ruled that doctors must:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EInform patients of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ematerial risks\u003C/b\u003E\u003C/span\u003E of treatment.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EDiscuss \u003C/span\u003E\u003Cb\u003Ereasonable alternatives\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EEnsure \u003C/span\u003E\u003Cb\u003Eshared decision-making\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EShifted standard from the \u003C/span\u003E\u003Cb\u003Edoctor-centred Bolam test\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192 to \u003C/span\u003E\u003Cb\u003Epatient-centred standard\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb style=\u0022font-size: large;\u0022\u003EOther cases in context:\u003C/b\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBolam v Friern (1957):\u003C/b\u003E\u003C/span\u003E Established the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBolam test\u003C/b\u003E\u003C/span\u003E \u2192 a doctor is not negligent if acting in accordance with a responsible body of medical opinion.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBarnett v Chelsea (1968):\u003C/b\u003E\u003C/span\u003E Case on \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecausation\u003C/b\u003E\u003C/span\u003E, not consent. (Failure to diagnose arsenic poisoning but death was unavoidable).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EWilsher v Essex (1988):\u003C/b\u003E\u003C/span\u003E Case on \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecausation\u003C/b\u003E\u003C/span\u003E in a premature infant with retinopathy of prematurity.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 7,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 92,
    "Name": "Laser",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EComparing Argon laser trabeculoplasty to selective laser trabeculoplasty, which of the following statements is LEAST likely to be true?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EArgon Laser Trabeculoplasty (ALT):\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EUses thermal energy \u2192 causes \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecoagulative burns\u003C/b\u003E\u003C/span\u003E and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Escarring\u003C/b\u003E\u003C/span\u003E in the trabecular meshwork.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EWorks by \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Etissue contraction\u003C/b\u003E\u003C/span\u003E and increasing aqueous outflow.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ECauses an \u003C/span\u003E\u003Cb\u003Einflammatory reaction\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ESelective Laser Trabeculoplasty (SLT):\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EUses a Q-switched, frequency-doubled Nd:YAG (532 nm).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EEnergy is selectively absorbed by pigmented trabecular cells.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ECauses \u003C/span\u003E\u003Cb\u003Ebiological stimulation (cellular and cytokine-mediated response)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E rather than thermal damage.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EMinimal inflammation\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E compared to ALT.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
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  },
  {
    "Id": 93,
    "Name": "Exotropia",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EConcerning consecutive exotropia, which of the following is MOST likely to be true?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIt may appear immediately post-op or years later.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb\u003EKey associations:\u003C/b\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ECommonly linked to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eovercorrection\u003C/b\u003E\u003C/span\u003E of esotropia.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOften associated with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elimitation of adduction\u003C/b\u003E\u003C/span\u003E due to scarring or slipped/over-recessed medial rectus.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMay also be linked with amblyopia, anisometropia, or poor binocular fusion.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb\u003EOption breakdown:\u003C/b\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EEven in amblyopic eyes, post-op diplopia can still occur (though suppression reduces risk).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMore commonly seen in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehypermetropes\u003C/b\u003E\u003C/span\u003E (due to accommodative esotropia surgery).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAdduction limitation is a classic feature due to medial rectus weakening.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u0026nbsp;Orthoptic exercises rarely help; surgical re-correction is often needed.\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 94,
    "Name": "Disc Oedema",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EAn asymptomatic 63-year-old lady is referred by her optician with a unilateral swollen optic disc and an arcuate field defect. Which of the following is the MOST appropriate initial investigation?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EA \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eunilateral swollen optic disc\u003C/b\u003E\u003C/span\u003E with a corresponding \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Efield defect\u003C/b\u003E\u003C/span\u003E raises suspicion for \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecompressive optic neuropathy\u003C/b\u003E\u003C/span\u003E (e.g., optic nerve sheath meningioma, orbital or intracranial mass).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe patient is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Easymptomatic\u003C/b\u003E\u003C/span\u003E (no acute pain or systemic signs), making causes like optic neuritis or papilloedema less likely.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb\u003EOption breakdown:\u003C/b\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EB-scan ultrasound\u003C/b\u003E\u003C/span\u003E \u2192 Useful for optic disc drusen, but less sensitive for ruling out compressive causes. Not appropriate as first-line here.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECT brain\u003C/b\u003E\u003C/span\u003E \u2192 Can detect large intracranial masses, but MRI with contrast is more sensitive for orbital/optic nerve pathology.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EFluorescein angiography\u003C/b\u003E\u003C/span\u003E \u2192 Helpful for vascular or retinal conditions, not for optic nerve compression.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMRI of orbit with gadolinium contrast\u003C/b\u003E\u003C/span\u003E \u2192 Best first-line test for unilateral disc swelling with field defect. Detects compressive, infiltrative, and demyelinating lesions.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 95,
    "Name": "Tests",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhen measuring stereopsis, which of the following is LEAST likely to be true?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ENormal stereoacuity\u003C/b\u003E\u003C/span\u003E in humans is far finer than 100 seconds of arc:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EBest stereoacuity \u2248 \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E20\u201340 seconds of arc\u003C/b\u003E\u003C/span\u003E (sometimes even 10 sec of arc in young adults with excellent binocular vision).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E100 seconds of arc indicates \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ereduced stereoacuity\u003C/b\u003E\u003C/span\u003E, not the physiological limit.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb\u003EOption breakdown:\u003C/b\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPanum\u2019s fusional area = small disparity range where fusion is possible.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ENormal stereoacuity is ~20\u201340 arc seconds, not 100.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ERandot uses random dot patterns, eliminating monocular cues.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EA stereoscope indeed measures convergence required to fuse dissimilar images.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 96,
    "Name": "Disc Oedema",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 54-year-old lady notices blurred vision in her left eye without any pain or discomfort. On examination:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022font-weight: bold;\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EVA: 6/12\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EIshihara: 8/17 correct\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003ELeft RAPD\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EVisual fields: central scotoma\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E5.5 mm axial proptosis, normal eyelids and motility\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EFundus: swollen left optic disc\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003ERight eye: normal\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EFour months later vision deteriorates to PL only, but fundus remains unchanged.\u0026nbsp;\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhat type of pathological process is MOST likely to be the problem?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EKey features pointing to compression:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EGradual onset \u0026amp; progression\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (over months).\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EProptosis\u003C/b\u003E\u003C/span\u003E (5.5 mm axial displacement suggests orbital mass/lesion).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOptic disc swelling without pain\u003C/b\u003E\u003C/span\u003E \u2192 typical for compression (not neuritis).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESteady deterioration to PL\u003C/b\u003E\u003C/span\u003E \u2192 compressive lesions cause progressive irreversible loss.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EFundus unchanged despite worsening vision\u003C/b\u003E\u003C/span\u003E \u2192 \u201Coptic atrophy\u201D lagging behind functional decline, seen in compressive causes.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EWhy not the others?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EDemyelinating optic neuritis\u003C/b\u003E\u003C/span\u003E \u2192 usually acute painful visual loss, recovers partially, common in younger patients.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGranulomatous optic neuritis\u003C/b\u003E\u003C/span\u003E (e.g., sarcoid, TB) \u2192 would cause inflammation, often painful, with systemic features.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPost-infective optic neuritis\u003C/b\u003E\u003C/span\u003E \u2192 acute/subacute, typically self-limiting, not progressive deterioration over months.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 97,
    "Name": "Tests",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EA four-prism diopter base-out test is used to evaluate which of the following?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EFour Prism Diopter Base Out (4\u0394 BO) Test\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EUsed to detect \u003C/span\u003E\u003Cb\u003Emicrostrabismus\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E or \u003C/span\u003E\u003Cb\u003Ecentral suppression scotoma\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EA 4\u0394 BO prism is placed in front of one eye.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIn a normal patient:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe eye under prism makes a refixation movement.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe fellow eye makes a fusional movement.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EIn a patient with \u003C/span\u003E\u003Cb\u003Ecentral suppression scotoma\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe refixation movement occurs, but \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ethe fellow eye does not move\u003C/b\u003E\u003C/span\u003E, because the image falls into the suppression scotoma.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch1\u003E\u003Cb style=\u0022letter-spacing: 0.14994px; font-size: large;\u0022\u003EWhy not the others?\u003C/b\u003E\u003C/h1\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EDistance stereoacuity\u003C/b\u003E\u003C/span\u003E \u2192 Tested with stereotests like Frisby, Randot, TNO.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMicrotropia without identity\u003C/b\u003E\u003C/span\u003E \u2192 Can be suspected with this test, but the 4\u0394 BO specifically targets \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecentral suppression\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPeripheral binocular vision\u003C/b\u003E\u003C/span\u003E \u2192 Assessed with synoptophore, Worth 4-dot, not this test.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 98,
    "Name": "GCA",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EA 79-year-old woman presents with right-sided unilateral headache and a complete right pupil-sparing third nerve palsy. Which of the following is the most important initial investigation to order?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EKey clinical features:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EElderly patient (78 years old)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ENew-onset \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eheadache\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EComplete third nerve palsy\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, but \u003C/span\u003E\u003Cb\u003Epupil-sparing\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EHigh suspicion for \u003C/span\u003E\u003Cb\u003Egiant cell arteritis (GCA)\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIn older patients, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epupil-sparing third nerve palsy\u003C/b\u003E\u003C/span\u003E is usually \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eischemic (microvascular)\u003C/b\u003E\u003C/span\u003E, but the presence of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eheadache\u003C/b\u003E\u003C/span\u003E raises concern for \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGCA\u003C/b\u003E\u003C/span\u003E, a medical emergency.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThe \u003C/span\u003E\u003Cb\u003Emost important initial test\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is \u003C/span\u003E\u003Cb\u003EESR (or CRP)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E to urgently check for GCA.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EDelay in diagnosis can lead to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eirreversible blindness\u003C/b\u003E\u003C/span\u003E due to anterior ischemic optic neuropathy.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIf ESR/CRP are raised \u2192 immediate high-dose corticosteroid therapy should be started.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch1\u003E\u003Cb style=\u0022font-size: large;\u0022\u003EOther Options:\u003C/b\u003E\u003C/h1\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECT head\u003C/b\u003E\u003C/span\u003E \u2192 May help rule out compressive causes, but \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGCA must be excluded first\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPlasma glucose\u003C/b\u003E\u003C/span\u003E \u2192 Relevant for vascular palsies (diabetes-related), but less urgent than excluding GCA.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMR/CT angiography\u003C/b\u003E\u003C/span\u003E \u2192 Needed if a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epupil-involving third nerve palsy\u003C/b\u003E\u003C/span\u003E is present (to exclude posterior communicating artery aneurysm). But here the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epupil is spared\u003C/b\u003E\u003C/span\u003E. Some clinicians advocate for ordering MRA for all 3rd nerve palsies, however, ESR seems like the more logical \u0022first\u0022 investigation in this case.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 99,
    "Name": "SO",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EIn a patient with sympathetic ophthalmia, which of the following is MOST likely to be correct?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ESympathetic ophthalmia (SO):\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ERare, \u003C/span\u003E\u003Cb\u003Ebilateral granulomatous panuveitis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E that follows \u003C/span\u003E\u003Cb\u003Epenetrating trauma or intraocular surgery\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E in one eye.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIt occurs due to an \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eautoimmune reaction\u003C/b\u003E\u003C/span\u003E against retinal antigens.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EKey features:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESymptoms usually appear \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eweeks to months\u003C/b\u003E\u003C/span\u003E after injury (not within 5 days \u2192 rules out option C).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EExudative retinal detachment is common\u003C/b\u003E\u003C/span\u003E because of severe choroidal inflammation.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EDalen-Fuchs nodules\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E are not polymorphonuclear \u2192 they are \u003C/span\u003E\u003Cb\u003Ecollections of epithelioid cells (macrophages) between RPE and Bruch\u2019s membrane\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (rules out option A).\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EEnucleation of the severely injured eye may be considered \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ewithin 10\u201314 days\u003C/b\u003E\u003C/span\u003E if there is no visual potential, to reduce risk of SO (so option D is misleading).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022font-size: medium;\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch1\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EOther options:\u003C/b\u003E\u003C/h1\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EDalen-Fuchs nodules are granulomatous (epithelioid histiocytes), not polymorphonuclear.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOnset usually \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E2 weeks to months\u003C/b\u003E\u003C/span\u003E after injury, not within 5 days.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe injured eye may need \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eenucleation\u003C/b\u003E\u003C/span\u003E if unsalvageable, to protect the sympathizing eye.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in FRCOphth part 2 written exam in 2022.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 12,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 100,
    "Name": "Sarcoidosis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EA 6-year-old boy with a history of an upper respiratory tract infection presented to you with a rash on his legs, that is lumpy. His ocular examination showed bilateral anterior uveitis, granulomatous keratic precipitates, with marked flare and 2\u002B cells. His posterior segment examination was normal. Which of the following diagnoses is MOST likely to be True?\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EKey clinical clues from the stem:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAge:\u003C/b\u003E\u003C/span\u003E child (5 years)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESystemic:\u003C/b\u003E\u003C/span\u003E recent URTI \u002B \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elumpy rash on legs\u003C/b\u003E\u003C/span\u003E (erythema nodosum is classic in sarcoidosis)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EOcular:\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u003C/span\u003E\u003Cb\u003Ebilateral granulomatous anterior uveitis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E with keratic precipitates and flare\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EFundus normal\u003C/b\u003E\u003C/span\u003E (so posterior involvement less likely at this stage)\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\n\u003Cp class=\u0022p4\u0022\u003EThis combination strongly suggests \u003Cspan class=\u0022s2\u0022\u003E\u003Cb\u003Esarcoidosis\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003EOther Options:\u003C/span\u003E\u003C/p\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EJuvenile idiopathic arthritis (JIA):\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ECauses \u003C/span\u003E\u003Cb\u003Echronic, non-granulomatous anterior uveitis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (fine KPs, not granulomatous).\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ERash is not typical.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ELymphoma:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ERare in this age, and usually involves \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eposterior segment masquerade syndromes\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EMetastatic endophthalmitis:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EWould cause a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epainful red eye\u003C/b\u003E\u003C/span\u003E with hypopyon, vitreous involvement and abnormal fundus.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThis child has \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Equiet fundi\u003C/b\u003E\u003C/span\u003E and granulomatous inflammation, so not endophthalmitis.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch1\u003E\u003Cb style=\u0022letter-spacing: 0.14994px; font-size: medium; color: rgb(64, 0, 255);\u0022\u003ESarcoidosis:\u003C/b\u003E\u003C/h1\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022font-size: medium; color: rgb(64, 0, 255);\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ERare in children but should be suspected when \u003C/span\u003E\u003Cb\u003Euveitis \u002B systemic features (rash, lymphadenopathy, arthritis, lung involvement)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EOcular involvement is often \u003C/span\u003E\u003Cb\u003Egranulomatous anterior uveitis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESkin manifestations like \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eerythema nodosum\u003C/b\u003E\u003C/span\u003E are common.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 12,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 101,
    "Name": "Anatomy",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich of the following nerves is a cranial nerve that supplies the contralateral side?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ECranial Nerve IV (Trochlear nerve):\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThe \u003C/span\u003E\u003Cb\u003Eonly cranial nerve that decussates (crosses) completely\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E in the brainstem (at the dorsal midbrain).\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EIt then innervates the \u003C/span\u003E\u003Cb\u003Econtralateral superior oblique muscle\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThis makes it unique: all other cranial nerves supply ipsilateral structures.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003ERemember:\u003C/div\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\uD83D\uDC49 \u201C\u003C/span\u003E\u003Cb\u003ETrochlear Turns\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E\u201D \u2192 Trochlear nerve \u003C/span\u003E\u003Cb\u003Ecrosses and turns\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E to supply the \u003C/span\u003E\u003Cb\u003Econtralateral superior oblique\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003Cul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 102,
    "Name": "Infectious Keratitis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EA 26-year-old gentleman presents to you with a hyperacute conjunctivitis in his right eye. On examination, the cornea has a 3 mm ulcer with significant thinning. You ordered a gram film. Which one of the following is MOST likely to be shown?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EA \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehyperacute conjunctivitis\u003C/b\u003E\u003C/span\u003E with rapid corneal involvement and ulceration strongly suggests \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ENeisseria gonorrhoeae\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ENeisseria gonorrhoeae\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and \u003C/span\u003E\u003Cb\u003ENeisseria meningitidis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E appear as \u003C/span\u003E\u003Cb\u003EGram-negative diplococci\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E on gram stain.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EGonococcal keratoconjunctivitis is an ophthalmic emergency as it can \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Erapidly cause corneal perforation\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003EOther options:\u003C/div\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGram negative rods\u003C/b\u003E\u003C/span\u003E \u2192 e.g., Pseudomonas \u2192 typically seen in contact lens\u2013related keratitis, not hyperacute conjunctivitis.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGram positive diplococci\u003C/b\u003E\u003C/span\u003E \u2192 e.g., Streptococcus pneumoniae \u2192 can cause keratitis but not this hyperacute picture.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGram positive rods\u003C/b\u003E\u003C/span\u003E \u2192 e.g., Listeria, Corynebacterium \u2192 rare ocular pathogens, not the likely cause here.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 103,
    "Name": "Torch",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EYou are asked to see an infant who has history of intrauterine growth retardation. The infant suffers from deafness, a patent ductus arteriosus, and bilateral cataract. Which of these diagnoses is MOST likely to be true?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EExplanation:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThis infant presents with the \u003C/span\u003E\u003Cb\u003Eclassic triad of congenital rubella syndrome\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Col start=\u00221\u0022\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ESensorineural deafness\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECongenital cataracts\u003C/b\u003E\u003C/span\u003E (or other ocular abnormalities such as pigmentary retinopathy)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECongenital heart disease\u003C/b\u003E\u003C/span\u003E (commonly patent ductus arteriosus or pulmonary artery stenosis).\u003C/p\u003E\n\u003C/li\u003E\u003C/ol\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECytomegalovirus\u003C/b\u003E\u003C/span\u003E: Causes microcephaly, periventricular calcifications, chorioretinitis \u2014 not classically PDA and cataracts.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGalactosaemia\u003C/b\u003E\u003C/span\u003E: Can cause cataracts, but usually associated with hepatomegaly, hypoglycaemia, jaundice \u2014 not PDA or deafness.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELowe syndrome\u003C/b\u003E\u003C/span\u003E: Presents with congenital cataracts, hypotonia, and renal tubular dysfunction \u2014 not PDA and deafness.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThus, the findings here are \u003C/span\u003E\u003Cb\u003Emost consistent with maternal rubella infection during pregnancy\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022letter-spacing: 0.14994px;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 104,
    "Name": "Nystagmus",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EWhich of the following statements\u0026nbsp;\u003C/b\u003E\u003Cspan style=\u0022font-size: medium; font-weight: 700; letter-spacing: 0.14994px;\u0022\u003Eis LEAST likely to be true\u0026nbsp;\u003C/span\u003E\u003Cb style=\u0022letter-spacing: 0.14994px; font-size: medium;\u0022\u003Eregarding Congenital Nystagmus (infantile nystagmus syndrome)?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECongenital/infantile nystagmus\u003C/b\u003E\u003C/span\u003E is usually \u003Ci\u003Enot associated with oscillopsia\u003C/i\u003E, because the visual cortex adapts.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPatients often adopt a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enull point\u003C/b\u003E\u003C/span\u003E (head turn/tilt) to reduce the amplitude of nystagmus.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EConvergence typically dampens\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E congenital nystagmus.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EUnlike acquired forms, \u003C/span\u003E\u003Cb\u003Efixation tends to increase nystagmus intensity\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, not decrease it\u0026nbsp;\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003ESo\u0026nbsp;\u003Cb\u003ECorrect Answer: It is typically decreased by attempted fixation\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p2\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p2\u0022\u003E\u003Cb style=\u0022color: rgb(255, 0, 0); text-decoration-line: underline;\u0022\u003EMnemonic for CONGENITAL Nystagmus:\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p2\u0022\u003E\u003Cul\u003E\u003Cli\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EC\u003C/span\u003Eonvergence and eye closure dampen the nystagmus\u0026nbsp;\u003C/span\u003E\u003C/li\u003E\u003Cli\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EO\u003C/span\u003Epen eyes\u003Cspan style=\u0022font-weight: bold;\u0022\u003E - \u003C/span\u003Eso absent during sleep\u003C/span\u003E\u003C/li\u003E\u003Cli\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EN\u003C/span\u003Eull zone is present\u0026nbsp;\u003C/span\u003E\u003C/li\u003E\u003Cli\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EG\u003C/span\u003Eaze position stable: so gaze position does \u003Cspan style=\u0022font-weight: bold;\u0022\u003Enot\u003C/span\u003E change the direction of nystagmus;\u0026nbsp;\u003C/span\u003E\u003C/li\u003E\u003Cli\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EE\u003C/span\u003Equal amplitude and frequency of nystagmus in each eye\u0026nbsp;\u003C/span\u003E\u003C/li\u003E\u003Cli\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EN\u003C/span\u003Eear acuity is good because convergence dampens the nystagmus\u003C/span\u003E\u003C/li\u003E\u003Cli\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EI\u003C/span\u003Enversion of optokinetic nystagmus occurs\u003C/span\u003E\u003C/li\u003E\u003Cli\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003ET\u003C/span\u003Eurning of head or abnormal head posture to allow eyes to enter a null zone leads to better visual acuity\u003C/span\u003E\u003C/li\u003E\u003Cli\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA\u003C/span\u003Ebsent Oscillopsia as the brain adapts at a young age.\u003C/span\u003E\u003C/li\u003E\u003Cli\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EL\u003C/span\u003Eatent nystagmus occurs.\u003C/span\u003E\u003C/li\u003E\u003C/ul\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 105,
    "Name": "Hereditaty vitreoretinopathies",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EA 53-year-old asymptomatic woman is referred by her optometrist after detection of peripheral retinal haemorrhages in both eyes. Visual acuity and anterior segment examination are normal, and there is no relevant family history. The fluorescein angiogram shown demonstrates the retinal findings. What is the MOST likely diagnosis?\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cimg src=\u0022/upload-2025-08-27-0b246267-5fbf-4fa8-9fc0-705b6ade4553.png\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThe fluorescein angiogram shows \u003C/span\u003E\u003Cb\u003Eperipheral avascular retina with neovascularisation at the junction between perfused and non-perfused retina\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThis is characteristic of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Efamilial exudative vitreoretinopathy (FEVR)\u003C/b\u003E\u003C/span\u003E, an inherited condition (often autosomal dominant) where retinal vascular development is incomplete.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EKey differentiators:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECoat\u2019s disease\u003C/b\u003E\u003C/span\u003E \u2192 usually unilateral, telangiectatic vessels with exudation (not seen here).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIncontinentia pigmenti\u003C/b\u003E\u003C/span\u003E \u2192 X-linked dominant, presents in infancy with skin changes, not in a healthy 53-year-old.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E\u201CRetinal angiogenesis\u201D\u003C/b\u003E\u003C/span\u003E is a process, not a diagnosis.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003EThus, the most likely diagnosis here is \u003Cspan class=\u0022s2\u0022\u003E\u003Cb\u003EFEVR\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 106,
    "Name": "Phakomatosis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EA 45-year-old woman is referred for retinal screening following successful removal of a cerebral tumour. Based on the retinal appearance and fluorescein angiography findings, what is the abnormality and its associated heredo-familial syndrome?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cimg src=\u0022/upload-2025-08-27-087a5655-c41d-4116-a582-a33df993bce6.png\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe image shows a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eretinal capillary haemangioblastoma (retinal angioma)\u003C/b\u003E\u003C/span\u003E \u2014 a vascular lesion with feeder vessels that demonstrates hyperfluorescence and leakage on fluorescein angiography.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThis lesion is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Echaracteristically associated with von Hippel\u2013Lindau (VHL) disease\u003C/b\u003E\u003C/span\u003E, an autosomal dominant condition due to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EVHL gene mutation\u003C/b\u003E\u003C/span\u003E (chromosome 3p25\u201326). Patients are predisposed to retinal angiomas, cerebellar and spinal haemangioblastomas, renal cell carcinoma, and pheochromocytoma.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EWhy not the others?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E(NF1):\u003C/b\u003E\u003C/span\u003E Associated with optic gliomas and Lisch nodules, not retinal angiomas.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003E(Tuberous sclerosis):\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E Associated with \u003C/span\u003E\u003Cb\u003Eastrocytic hamartomas\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, not vascular angiomas.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E(NF2):\u003C/b\u003E\u003C/span\u003E Associated with bilateral vestibular schwannomas and retinal hamartomas, not angiomas.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan style=\u0022font-size: x-small;\u0022\u003E\u003Cb\u003ESupporting Evidence:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022font-size: x-small;\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-size: x-small;\u0022\u003ESingh AD, Shields CL, Shields JA. \u003Ci\u003EVon Hippel\u2013Lindau disease.\u003C/i\u003E Surv Ophthalmol. 2001;46(2):117\u2013142.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-size: x-small;\u0022\u003EAmerican Academy of Ophthalmology, BCSC Retina section, VHL chapter.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cbr\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 107,
    "Name": "Non-infectious Keratitis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EWhich of the following dermatological conditions is most likely to be associated with marginal keratitis?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMarginal keratitis\u003C/b\u003E\u003C/span\u003E is a peripheral corneal inflammation classically associated with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Estaphylococcal lid disease\u003C/b\u003E\u003C/span\u003E and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eocular rosacea\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOcular rosacea\u003C/b\u003E\u003C/span\u003E is a chronic inflammatory condition that affects the meibomian glands and eyelids, leading to chronic blepharitis, meibomian gland dysfunction, and secondary marginal keratitis.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EWhy not the others?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E(Acne vulgaris):\u003C/b\u003E\u003C/span\u003E While acne can affect sebaceous glands, it is not associated with marginal keratitis.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E(Dermatitis herpetiformis):\u003C/b\u003E\u003C/span\u003E Linked with gluten sensitivity, not ocular keratitis.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E(Pompholyx):\u003C/b\u003E\u003C/span\u003E A vesicular hand eczema, no ocular link.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan style=\u0022font-size: x-small;\u0022\u003E\u003Cb\u003ESupporting Evidence:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022font-size: x-small;\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-size: x-small;\u0022\u003EAmerican Academy of Ophthalmology (AAO) BCSC: External Disease and Cornea (Ocular Rosacea section).\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-size: x-small;\u0022\u003EO\u2019Donnell B, Morrow GL. \u003Ci\u003EOcular rosacea: Epidemiology, pathogenesis and treatment.\u003C/i\u003E Am J Clin Dermatol. 2012;13(6):421\u2013430.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 108,
    "Name": "Cataract surgery",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\n\n\n\n\n\n\n\n\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\n\n\n\n\n\n\n\n\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003E\u003Cb\u003EA patient is reviewed after right-eye cataract surgery. Pre-operative refraction was R \u22125.00 D and L \u22121.00 D. The left eye remains phakic, and the operated right eye now sees 6/6 unaided. Since surgery the patient reports eyestrain (asthenopic symptoms), having had no pre-op symptoms apart from blur in the right eye. What is the MOST likely cause of these symptoms?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EUnilateral cataract surgery has converted a \u22125.00 D myopic eye to emmetropia while the fellow eye remains \u22121.00 D, creating \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epost-operative anisometropia\u003C/b\u003E\u003C/span\u003E. The resulting \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Einterocular image-size disparity (aniseikonia)\u003C/b\u003E\u003C/span\u003E commonly causes asthenopic symptoms (eyestrain, discomfort) even when acuity is excellent. Differences as small as ~2\u20133 D can be symptomatic; larger differences increase the likelihood of aniseikonia.\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EFaulty biometry or a wrong-power IOL would more likely reduce unaided acuity rather than produce isolated asthenopia with 6/6 vision. Induced astigmatism presents with blur/ghosting and isn\u2019t suggested by the data provided.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\uD83D\uDCD6 AAO BCSC: Refractive Management \u0026amp; Cataract Surgery\u2014anisometropia/aniseikonia after unilateral pseudophakia; Grosvenor T. \u003Ci\u003EPrimary Care Optometry\u003C/i\u003E, 5th ed.\u2014clinical effects and thresholds for symptomatic aniseikonia.\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 1,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 109,
    "Name": "Intra-ocular tumors",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EWith respect to choroidal osteoma, which of the following statements is LEAST accurate?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EChoroidal osteoma is a benign ossifying choristoma, typically located in the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eperipapillary or macular region\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EDecalcified areas\u003C/b\u003E\u003C/span\u003E are more prone to choroidal neovascularisation (CNV), which can threaten central vision.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPathologically, it is indeed a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Echoristoma\u003C/b\u003E\u003C/span\u003E (normal tissue in an abnormal location).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ELesions often occur near the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eoptic nerve or macula\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EImportantly, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eanti-VEGF agents are not contraindicated\u003C/b\u003E\u003C/span\u003E; instead, they are an established treatment for secondary CNV associated with choroidal osteoma, improving or stabilising vision.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-size: x-small;\u0022\u003E-Shields CL, Shields JA. \u003Ci\u003EChoroidal Osteoma: Clinical Features and Update on Diagnosis and Management\u003C/i\u003E. Int Ophthalmol Clin. 2006;46(1):171-179.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-size: x-small;\u0022\u003E-BCSC Retina \u0026amp; Vitreous (2022\u201323): management of CNV in choroidal osteoma includes intravitreal anti-VEGF therapy.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 110,
    "Name": "Study types",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EWhen evaluating a case\u2013control study, which factor is MOST likely to enhance the level of evidence?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThe strength of a case\u2013control study depends heavily on \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emethodological rigour\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EClearly \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edefined and objective outcomes\u003C/b\u003E\u003C/span\u003E reduce misclassification bias and improve internal validity.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EHistorical controls\u003C/b\u003E\u003C/span\u003E introduce recall and selection bias, lowering evidence strength.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EDifferent populations\u003C/b\u003E\u003C/span\u003E reduce comparability and increase confounding.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EProxies for outcome\u003C/b\u003E\u003C/span\u003E are less reliable than direct measures, reducing validity.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThus, the use of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eprecise and predefined outcomes\u003C/b\u003E\u003C/span\u003E enhances the credibility and evidence level of case\u2013control studies.\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-size: x-small;\u0022\u003E-Grimes DA, Schulz KF. \u003Ci\u003EBias and causal associations in observational research\u003C/i\u003E. Lancet. 2002;359(9302):248\u2013252.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-size: x-small;\u0022\u003E-BCSC Section on Fundamentals \u0026amp; Principles of Ophthalmology (2022\u201323): emphasis on outcome definition in study design.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022font-size: x-small;\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 11,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 111,
    "Name": "Trauma",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EAccording to the Ocular Trauma Score, which of the following specific clinical findings directly influences the patient\u2019s score and predicted visual outcome?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThe \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOcular Trauma Score (OTS)\u003C/b\u003E\u003C/span\u003E is a validated system used to predict final visual outcomes following ocular trauma. It is calculated from:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EInitial visual acuity, and\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EDeductions for the presence of specific severe ocular findings.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003EThe \u003C/span\u003E\u003Cb\u003Efive factors that reduce the OTS score\u003C/b\u003E\u003Cspan class=\u0022s3\u0022\u003E are:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Col start=\u00221\u0022\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EGlobe rupture\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EEndophthalmitis\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPerforating injury\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ERetinal detachment\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ERelative afferent pupillary defect (RAPD)\u003C/p\u003E\n\u003C/li\u003E\u003C/ol\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EOther findings, such as \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehigh intraocular pressure\u003C/b\u003E\u003C/span\u003E or \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eophthalmoplegia\u003C/b\u003E\u003C/span\u003E, are not included in the OTS calculation. A \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eretained intraocular foreign body\u003C/b\u003E\u003C/span\u003E affects prognosis but is not part of the OTS scoring system itself.\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-size: x-small;\u0022\u003EKuhn F, Maisiak R, Mann L, Mester V, Morris R, Witherspoon CD. \u003Ci\u003EThe Ocular Trauma Score (OTS)\u003C/i\u003E. Ophthalmol Clin North Am. 2002 Jun;15(2):163\u2013165.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-size: x-small;\u0022\u003EBCSC Section 5: Neuro-Ophthalmology and Ocular Trauma (2022\u201323).\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 13,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 112,
    "Name": "Non-infectious Keratitis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EA 23-year-old woman presents with recurrent ocular redness, episcleritis, a peripheral corneal ulcer, saddle-nose deformity, and aortic valve involvement. Based on these findings, what is the most likely diagnosis?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003ERelapsing polychondritis is a rare autoimmune disorder characterized by recurrent inflammation of cartilaginous and connective tissue structures.\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EKey diagnostic clues in this case include:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOcular involvement\u003C/b\u003E\u003C/span\u003E: episcleritis, scleritis, keratitis.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ENasal cartilage involvement\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E: saddle-nose deformity.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECardiovascular involvement\u003C/b\u003E\u003C/span\u003E: aortic valve disease (common complication).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESystemic inflammation\u003C/b\u003E\u003C/span\u003E: elevated ESR, anemia of chronic disease.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe combination of ocular, nasal, and cardiovascular features is \u003Cspan class=\u0022s2\u0022\u003E\u003Cb\u003Ehighly characteristic of relapsing polychondritis\u003C/b\u003E\u003C/span\u003E and not typical of dermatomyositis, Kawasaki disease, or rheumatoid arthritis.\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-size: x-small;\u0022\u003E-Kent A, Michet CJ. \u003Ci\u003ERelapsing Polychondritis: Clinical Features and Diagnosis\u003C/i\u003E. Rheumatology (Oxford). 2019.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-size: x-small;\u0022\u003E-BCSC Section 9: Uveitis and Ocular Inflammation (2022\u201323).\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 113,
    "Name": "DR",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EAccording to UK national diabetic retinopathy screening guidelines, if R3 (active proliferative) retinopathy is identified at screening, within what timeframe should the patient be referred to the Hospital Eye Service (HES)?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EUK diabetic eye screening guidelines state that \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esight-threatening diabetic retinopathy (R3, proliferative retinopathy)\u003C/b\u003E\u003C/span\u003E requires \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eurgent referral to the Hospital Eye Service (HES) within 2 weeks\u003C/b\u003E\u003C/span\u003E. This ensures that patients at high risk of severe visual loss are promptly assessed for treatment such as panretinal photocoagulation (PRP) or intravitreal therapy.\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\n\n\n\n\n\n\n\n\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 114,
    "Name": "Genetics",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EWhen considering colour vision deficiency, which of the following statements is MOST likely to be correct?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EMost common congenital red-green colour vision defects are \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EX-linked recessive\u003C/b\u003E\u003C/span\u003E. This means:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMales (XY) with the defective gene are affected.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EDaughters of affected males (who inherit the defective X) are \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eobligate heterozygous carriers\u003C/b\u003E\u003C/span\u003E, unless the mother also carries the gene.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESons of an affected male will not inherit the condition (since they receive the father\u2019s Y chromosome).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EOther points from the options:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EProtanomaly is not the most common defect\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E; the most frequent is \u003C/span\u003E\u003Cb\u003Edeuteranomaly\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPseudo-isochromatic plates (Ishihara)\u003C/b\u003E\u003C/span\u003E can detect red-green deficiency but cannot reliably distinguish protanomaly from deuteranomaly.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe prevalence of red-green colour deficiency in UK males is ~8%, not 2%.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E-Birch J. \u003Ci\u003EWorldwide prevalence of red-green colour deficiency\u003C/i\u003E. J Opt Soc Am A. 2012.\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E-NHS Genomics Education Programme \u2013 Colour Vision Deficiency Genetics.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 115,
    "Name": "Surgery",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EYou review a patient 1 week after left trabeculectomy with Mitomycin-C. They present with IOP 45 mmHg, a flat bleb with no leak, and a uniformly shallow anterior chamber. The retina is unremarkable. What is the most appropriate management plan?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThis presentation is classic for \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eaqueous misdirection (malignant glaucoma)\u003C/b\u003E\u003C/span\u003E after trabeculectomy:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EHigh IOP despite a flat bleb (so the bleb is not functioning).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EUniformly shallow anterior chamber in all quadrants (not peripheral shallowing as in pupillary block).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAbsence of choroidal effusion or suprachoroidal haemorrhage.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EInitial management\u003C/b\u003E\u003C/span\u003E is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecycloplegia (atropine) and aqueous suppression\u003C/b\u003E\u003C/span\u003E, to move the lens-iris diaphragm posteriorly and reduce aqueous misdirection. Hyperosmotic agents may also help.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EArgon laser suture lysis\u003C/b\u003E\u003C/span\u003E is inappropriate because the IOP is already high with a flat bleb (not under-filtration).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBleb massage\u003C/b\u003E\u003C/span\u003E will not help, as aqueous misdirection is the cause, not flap resistance.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERe-forming the anterior chamber with viscoelastic\u003C/b\u003E\u003C/span\u003E is temporary and does not address the pathophysiology.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 116,
    "Name": "Tests",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EInvestigators are comparing two independent groups of subjects for a continuous variable that is not normally distributed (skewed data). Which is the most appropriate statistical test?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EFor \u003C/span\u003E\u003Cb\u003Econtinuous variables with skewed distribution\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (non-parametric data):\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EMann-Whitney U test\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is used to compare \u003C/span\u003E\u003Cb\u003Etwo independent groups\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EUnpaired t test\u003C/b\u003E\u003C/span\u003E assumes normal distribution, so inappropriate here.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPaired t test\u003C/b\u003E\u003C/span\u003E is for matched/paired data, not independent groups.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EWilcoxon signed rank test\u003C/b\u003E\u003C/span\u003E is also for \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epaired data\u003C/b\u003E\u003C/span\u003E, not independent groups.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003EThus, \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003EMann-Whitney U test\u003C/b\u003E\u003C/span\u003E is the correct choice when comparing two separate groups with skewed data.\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cb style=\u0022letter-spacing: 0.14994px;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 11,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 117,
    "Name": "Physiology",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EWhich of the following statements about intraocular pressure is correct?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ENormal \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eaqueous humor production\u003C/b\u003E\u003C/span\u003E is about \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E2\u20133 \u03BCl/min\u003C/b\u003E\u003C/span\u003E, primarily by the ciliary body.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIntraocular pressure (IOP) is determined by the balance between aqueous humor \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eproduction and outflow\u003C/b\u003E\u003C/span\u003E (via trabecular meshwork and uveoscleral pathways).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIt is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot directly proportional to systemic blood pressure\u003C/b\u003E\u003C/span\u003E or cerebrospinal fluid pressure, though extreme systemic changes may have minor effects.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe statement about reforming anterior and posterior chambers in 1000 min is physiologically incorrect.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 118,
    "Name": "Consent",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EWith regard to disclosure of personal information without a patient\u2019s consent, which statement is the most accurate?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EDoctors \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eowe a duty of confidentiality\u003C/b\u003E\u003C/span\u003E to their patients, but this is not absolute.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EBoth the \u003C/span\u003E\u003Cb\u003EGMC (General Medical Council) guidance\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and the \u003C/span\u003E\u003Cb\u003EData Protection Act / GDPR framework\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E recognise exceptions.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EDisclosure \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ewithout consent\u003C/b\u003E\u003C/span\u003E is justified where there is a risk of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eserious harm or death\u003C/b\u003E\u003C/span\u003E to others, e.g. risk of violence, terrorism, or serious communicable disease.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EA multidisciplinary team discussion is good practice but \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot a legal prerequisite\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E- GMC Confidentiality Guidance (2020).\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E- NHS Digital \u2013 Data Protection and Confidentiality.\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E- UK GDPR Article 9(2)(i): \u201Cprocessing necessary for reasons of public interest in the area of public health.\u201D\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 7,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 119,
    "Name": "CSCR",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EWhich statement best reflects current understanding of central serous chorioretinopathy (CSR)?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\n\n\n\n\n\n\n\n\u003Cp\u003E\u003C/p\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ECSR is associated with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eincreased corticosteroid levels\u003C/b\u003E\u003C/span\u003E, whether exogenous (steroid therapy) or endogenous (stress, Cushing\u2019s syndrome, pregnancy).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPregnancy, especially in the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ethird trimester\u003C/b\u003E\u003C/span\u003E, is a recognised risk factor for CSR, and cases often resolve spontaneously after delivery.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPathogenesis is linked to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Echoroidal vascular hyperpermeability\u003C/b\u003E\u003C/span\u003E and RPE dysfunction, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot VEGF\u003C/b\u003E\u003C/span\u003E (unlike neovascular AMD).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe presence of fibrin within CSR is not a favourable prognostic sign; in fact, it can be associated with poorer outcomes.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 120,
    "Name": "Retinal dystrophies",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EA 25-year-old man with slowly progressive central visual difficulties undergoes fundus photography and fluorescein angiography. He has no relevant ocular family history. Based on the clinical and imaging findings, what is the most likely diagnosis?\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cimg src=\u0022/upload-2025-08-27-9e13dd07-fc60-4d6b-a3ef-3ea66ee1d4ca.png\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EStargardt disease is the most common inherited macular dystrophy, typically presenting in the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Efirst to third decade of life\u003C/b\u003E\u003C/span\u003E with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eprogressive central vision loss\u003C/b\u003E\u003C/span\u003E and difficulty with tasks such as reading fine print. Fundus findings show \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eyellow-white pisciform flecks\u003C/b\u003E\u003C/span\u003E and a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E\u201Cbeaten bronze\u201D macula\u003C/b\u003E\u003C/span\u003E. On fluorescein angiography, a characteristic \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E\u201Cdark choroid\u201D sign\u003C/b\u003E\u003C/span\u003E is often observed due to lipofuscin accumulation in the RPE blocking background choroidal fluorescence.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAcute multifocal placoid pigment epitheliopathy (APMPPE):\u003C/b\u003E\u003C/span\u003E presents acutely with multiple creamy placoid lesions post-viral illness, not gradual deterioration.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EDominant drusen:\u003C/b\u003E\u003C/span\u003E usually strong family history with drusen scattered at posterior pole, not pisciform flecks.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAdult Best disease:\u003C/b\u003E\u003C/span\u003E shows vitelliform lesions at the macula, usually with family history (autosomal dominant BEST1 mutations).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-size: x-small;\u0022\u003E-Lambertus S, et al. \u003Ci\u003EProg Retin Eye Res\u003C/i\u003E 2017 \u2014 Stargardt disease pathophysiology and clinical features.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-size: x-small;\u0022\u003E-BCSC Retina \u2014 description of flecks, dark choroid, and distinguishing features from Best disease and drusen.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022font-size: x-small;\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 121,
    "Name": "Nystagmus",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EWhich of the following conditions is least likely to cause downbeat nystagmus?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EDownbeat nystagmus is a \u003C/span\u003E\u003Cb\u003Epathological ocular motor sign\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E typically associated with lesions at the \u003C/span\u003E\u003Cb\u003Ecervicomedullary junction\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (such as Arnold\u2013Chiari malformation), \u003C/span\u003E\u003Cb\u003Ebrainstem stroke\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, or \u003C/span\u003E\u003Cb\u003Ecerebellar disease\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E. It may also be induced by certain \u003C/span\u003E\u003Cb\u003Emedications (e.g., anticonvulsants such as phenytoin or carbamazepine)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EBy contrast, \u003C/span\u003E\u003Cb\u003EParkinson\u2019s disease does not cause downbeat nystagmus\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E. Instead, Parkinson\u2019s is primarily associated with abnormalities of \u003C/span\u003E\u003Cb\u003Esaccades, smooth pursuit, and fixation instability (e.g., square wave jerks)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, but not vertical downbeat nystagmus.\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003ESo to summarise:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECommon causes\u003C/b\u003E\u003C/span\u003E \u2192 \u003Ci\u003EChiari malformation, brainstem stroke, cerebellar disease, anticonvulsants\u003C/i\u003E\u003Ci\u003E\u003C/i\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ENOT a cause\u003C/b\u003E\u003C/span\u003E \u2192 \u003Ci\u003EParkinson\u2019s disease\u003C/i\u003E (causes other eye movement problems, not downbeat nystagmus)\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\u003Cp class=\u0022p2\u0022\u003E\u003Cb style=\u0022letter-spacing: 0.14994px;\u0022\u003EMnemonic:\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p2\u0022\u003E\n\n\n\n\n\n\n\n\n\n\n\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003E\u201CDownbeat is CBA (Chiari, Brainstem, Anticonvulsants)\u201D\u003C/b\u003E\u003Cspan class=\u0022s2\u0022\u003E \u2013 not Parkinson\u2019s.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 122,
    "Name": "DR",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EWhat is the most accurate statement regarding HbA1C targets in adults with type 2 diabetes mellitus?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ENICE guidelines (NG17) recommend \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E53 mmol/mol (7.0%)\u003C/b\u003E\u003C/span\u003E as the general target.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThis applies especially when the treatment carries a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Erisk of hypoglycaemia\u003C/b\u003E\u003C/span\u003E, as tighter control (e.g. 48 mmol/mol / 6.5%) may not be safe.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EA slightly higher target (58 mmol/mol / 7.5%) can be considered if managed only with lifestyle/diet or if treatment burden is high.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EKey point for revision:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EHypo-risk drugs \u2192 HbA1c 53 (7.0%)\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ENo hypo-risk drug \u2192 can aim lower (48 / 6.5%)\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ELifestyle only \u2192 relax to 58 (7.5%)\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 123,
    "Name": "Hereditaty vitreoretinopathies",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EIn Stickler syndrome Type I, which genetic and inheritance pattern is correct?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EStickler syndrome Type I is due to \u003C/span\u003E\u003Cb\u003Emutations in type II collagen (COL2A1 gene)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and is inherited in an \u003C/span\u003E\u003Cb\u003Eautosomal dominant pattern with complete penetrance\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u0026nbsp;\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EStickler syndrome is a connective tissue disorder affecting the eye, joints, and face.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EType I Stickler\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192 caused by \u003C/span\u003E\u003Cb\u003ECOL2A1 gene mutation\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (type II collagen).\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIt is the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emost common subtype\u003C/b\u003E\u003C/span\u003E and is inherited in an \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eautosomal dominant\u003C/b\u003E\u003C/span\u003E fashion.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EComplete penetrance means that all individuals with the mutation will show clinical features, though severity may vary.\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 124,
    "Name": "Keratoconus",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhat is the MOST likely diagnosis based upon this topography image?\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cimg src=\u0022/upload-2025-08-28-d438413d-d022-43fb-9138-52de298786e4.jpg\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThe map shows \u003C/span\u003E\u003Cb\u003Einferior peripheral steepening with central/paracentral relative flattening\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, creating a \u003C/span\u003E\u003Cb\u003E\u201Ccrab-claw/kissing-dove\u201D\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E bow-tie pattern\u2014classic for \u003C/span\u003E\u003Cb\u003EPMD\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EPMD is a \u003C/span\u003E\u003Cb\u003Eperipheral inferior thinning disorder (typically 4\u20138 o\u2019clock, near the limbus)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E that produces \u003C/span\u003E\u003Cb\u003Ehigh against-the-rule astigmatism\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and the above topographic signature.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EKeratoconus\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E usually has a \u003C/span\u003E\u003Cb\u003Eparacentral cone with localized inferior steepening and skewed radial axes\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, not the peripheral band of steepening seen in PMD.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPost-LASIK\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E corneas for myopia show \u003C/span\u003E\u003Cb\u003Ecentral flattening with a peripheral ring of relative steepening\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, rather than an inferior claw.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPost-ECCE astigmatism\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E gives a \u003C/span\u003E\u003Cb\u003Eregular bow-tie aligned with the incision axis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, lacking the inferior claw appearance.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 125,
    "Name": "Visual Field",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-size: medium; font-weight: bold;\u0022\u003EWhich type of visual field defect is LEAST commonly linked to glaucoma?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cbr\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ETypical glaucomatous field defects\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E include:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ENasal step\u003C/b\u003E\u003C/span\u003E (due to arcuate bundle damage)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EParacentral scotoma\u003C/b\u003E\u003C/span\u003E (early damage near fixation)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EArcuate scotoma\u003C/b\u003E\u003C/span\u003E (Bjerrum scotoma, following RNFL loss)\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ETemporal wedge defects\u003C/b\u003E\u003C/span\u003E are \u003Ci\u003Enot characteristic of glaucoma\u003C/i\u003E. Instead, they are more commonly associated with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eoptic nerve or chiasmal disease\u003C/b\u003E\u003C/span\u003E (e.g., compressive lesions).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 126,
    "Name": "Infectious Keratitis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EYou\u0027re examining a 38-year-old man who presents with a 2-day history of pain and redness in his right eye. Slit-lamp examination reveals a dendritic corneal ulcer with terminal bulbs, but there is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eno evidence of stromal oedema, vascularisation, or keratic precipitates\u003C/b\u003E\u003C/span\u003E, and the anterior chamber remains deep and quiet. He reports having had \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Etwo previous similar episodes of herpetic epithelial keratitis in the past year\u003C/b\u003E\u003C/span\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EWhat is the most appropriate treatment plan for managing this current episode and reducing the risk of further recurrences?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThis patient has \u003C/span\u003E\u003Cb\u003Euncomplicated recurrent epithelial herpes simplex keratitis (HSK)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2014 presenting with a dendritic ulcer and \u003C/span\u003E\u003Cb\u003Eno stromal involvement or anterior uveitis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E. Therefore, the treatment is:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ETopical aciclovir 3% ointment\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E 5\u00D7/day for 10\u201314 days\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E\u00B1 epithelial debridement\u003C/b\u003E\u003C/span\u003E, which can reduce viral load and speed epithelial healing in some cases\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESteroids are contraindicated\u003C/b\u003E\u003C/span\u003E in epithelial disease alone\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOral prophylaxis (400 mg BD)\u003C/b\u003E\u003C/span\u003E is considered only \u003Ci\u003Eafter resolution\u003C/i\u003E in select recurrent cases, but is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot part of acute management\u003C/b\u003E\u003C/span\u003E for isolated epithelial disease\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb style=\u0022letter-spacing: 0.14994px; font-size: large;\u0022\u003EHEDS Trial \u2013 Key Findings (Epithelial Arm):\u003C/b\u003E\u003C/h3\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThe \u003C/span\u003E\u003Cb\u003EHEDS-Epithelial Keratitis Trial\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E showed that:\u003C/span\u003E\u003C/p\u003E\n\u003Cblockquote style=\u0022margin-bottom: 0px; margin-left: 15px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; line-height: normal; font-family: \u0026quot;Helvetica Neue\u0026quot;; color: rgb(14, 14, 14);\u0022\u003E\u003Cb\u003EAdding oral aciclovir to topical treatment\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E did \u003C/span\u003E\u003Cb\u003Enot significantly improve resolution or reduce recurrence\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E of epithelial HSK during an active episode.\u003C/span\u003E\u003C/blockquote\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ETherefore, topical antiviral alone remains first-line therapy for epithelial disease\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, even in recurrent cases.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p5\u0022\u003E-- Oral aciclovir \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003E400 mg twice daily for 12 months\u003C/b\u003E\u003C/span\u003E (from the HEDS-Acyclovir Prevention Trial) \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003Eis only for prophylaxis\u003C/b\u003E\u003C/span\u003E, not acute treatment \u2014 and is more relevant in stromal or uveitic disease or frequent recurrences.\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 127,
    "Name": "MMP",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich of the following statements regarding the diagnosis of \u003Cspan class=\u0022s1\u0022\u003Eocular cicatricial pemphigoid (OCP)\u003C/span\u003E is MOST accurate?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EOcular cicatricial pemphigoid (OCP) is a chronic autoimmune subepithelial blistering disorder affecting mucous membranes including the conjunctiva. Diagnosis relies heavily on \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edirect immunofluorescence (DIF)\u003C/b\u003E\u003C/span\u003E of a conjunctival biopsy.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\uD83D\uDD2C \u003C/span\u003E\u003Cb\u003EKey points based on evidence and clinical guidelines:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EFor best results, the biopsy should be taken from \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eless inflamed, non-ulcerated conjunctiva\u003C/b\u003E\u003C/span\u003E, ideally 2\u20133 mm from the limbus. Severely inflamed areas often yield false negatives due to immune complex degradation.\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-size: x-small;\u0022\u003E\u21B3 \u003Ci\u003EReference: Mondino BJ et al. Diagnosis and management of ocular cicatricial pemphigoid. Ophthalmology. 1992.\u003C/i\u003E\u003C/span\u003E\u003Ci\u003E\u003C/i\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe hallmark finding on DIF is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elinear deposition of IgG, IgA, or C3\u003C/b\u003E\u003C/span\u003E (not typically IgE) along the epithelial basement membrane. IgE is not a diagnostic feature.\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-size: x-small;\u0022\u003E\u21B3 \u003Ci\u003EReference: American Academy of Ophthalmology (AAO) Basic and Clinical Science Course; Cornea.\u003C/i\u003E\u003C/span\u003E\u003Ci\u003E\u003C/i\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EUp to \u003C/span\u003E\u003Cb\u003E40% of biopsy specimens may be negative\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, especially if taken from inflamed tissue. Therefore, a \u003C/span\u003E\u003Cb\u003Enegative DIF does not exclude\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E OCP.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan style=\u0022font-size: x-small;\u0022\u003E\u21B3 \u003Ci\u003EReference: Tauber J et al., 1992; Watson PG et al., 1986.\u003C/i\u003E\u003C/span\u003E\u003Ci\u003E\u003C/i\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EFormalin destroys antigenicity\u003C/b\u003E\u003C/span\u003E needed for immunofluorescence. The specimen must be transported in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMichel\u2019s transport medium\u003C/b\u003E\u003C/span\u003E or similar. Formalin is used for standard histopathology, not DIF.\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-size: x-small;\u0022\u003E\u21B3 \u003Ci\u003EReference: American Society for Clinical Pathology guidelines.\u003C/i\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb\u003E\uD83D\uDD11\u003Cspan class=\u0022Apple-converted-space\u0022\u003E\u0026nbsp;\u003C/span\u003E\u003C/b\u003E\u003Cb style=\u0022font-size: calc(1.3rem \u002B 0.6vw); letter-spacing: 0.14994px;\u0022\u003ENote for Revision:\u003C/b\u003E\u003C/h3\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EIn suspected OCP, conjunctival biopsy for direct immunofluorescence should be taken from minimally inflamed tissue and placed in Michel\u2019s medium\u2014not formalin. A negative DIF does not exclude the diagnosis.\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
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    "CategoryId": 6,
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  },
  {
    "Id": 128,
    "Name": "Dystrophies",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich histopathological stain is most useful for confirming the diagnosis of \u003Cspan class=\u0022s1\u0022\u003EAvellino corneal dystrophy\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EAvellino corneal dystrophy\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, also known as \u003C/span\u003E\u003Cb\u003Egranular-lattice corneal dystrophy (or granular corneal dystrophy type II)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, is characterised by a combination of:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EHyaline deposits\u003C/b\u003E\u003C/span\u003E (as seen in granular dystrophy type I)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAmyloid deposits\u003C/b\u003E\u003C/span\u003E (as seen in lattice dystrophy)\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\uD83E\uDDEA \u003C/span\u003E\u003Cb\u003EStaining characteristics:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EH\u0026amp;E stain\u003C/b\u003E\u003C/span\u003E is the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emost useful and practical\u003C/b\u003E\u003C/span\u003E routine stain for detecting both granular (hyaline) and lattice (amyloid-like) deposits. It shows:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EEosinophilic hyaline material in the anterior stroma (granular)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EFaint or refractile linear deposits (lattice component)\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EAlcian blue\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E: Highlights \u003C/span\u003E\u003Cb\u003Emucin\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E; useful in \u003C/span\u003E\u003Cb\u003Emacular corneal dystrophy\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, not Avellino.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECongo red\u003C/b\u003E\u003C/span\u003E: Used for \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eamyloid\u003C/b\u003E\u003C/span\u003E, but Avellino\u2019s amyloid deposits are usually minimal and not always Congo red-positive.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOil Red O\u003C/b\u003E\u003C/span\u003E: Stains \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elipids\u003C/b\u003E\u003C/span\u003E; useful in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elipid keratopathy\u003C/b\u003E\u003C/span\u003E, not relevant here.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\uD83D\uDD2C Although Congo red may detect amyloid in some lattice dystrophies, the \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003Ecombined features of Avellino dystrophy are best demonstrated with H\u0026amp;E\u003C/b\u003E\u003C/span\u003E, making it the \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003Emost useful single stain\u003C/b\u003E\u003C/span\u003E for diagnosis.\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003EUsually, the exams direct the questions to the common corneal dystrophies, as remembered by this mnemonic:\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u0022\u003Cspan style=\u0022font-weight: bolder; color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal;\u0022\u003EMarylin Monroe Always Gets Her Men in L. A. County\u0022\u003C/span\u003E\u003C/p\u003E\u003Cul style=\u0022margin-top: 0.3em; margin-bottom: 0px; margin-left: 1.6em; padding-left: 0px; list-style-position: outside; list-style-image: url(\u0026quot;data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAAYAAAAJCAYAAAARml2dAAAABHNCSVQICAgIfAhkiAAAAAlwSFlzAAAN1wAADdcBQiibeAAAABl0RVh0U29mdHdhcmUAd3d3Lmlua3NjYXBlLm9yZ5vuPBoAAABUSURBVAiZdY4xDsAgFELB2J0DdnbwQI5OHvDfgC62SY0yvhAetI1dWEq5JN0kKwDYbhEx8oT9a5JdEtLb/M2QNW0FAJLttkLbLUfEkIRVztPdo\u002BMBm8UkW9Zxc20AAAAASUVORK5CYII=\u0026quot;); color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal; border-radius: 0px !important;\u0022\u003E\u003Cli style=\u0022margin-bottom: 0.1em; border-radius: 0px !important;\u0022\u003E\u003Cspan style=\u0022font-weight: bolder; border-radius: 0px !important;\u0022\u003EM\u003C/span\u003Eacular dystrophy -\u0026nbsp;\u003Cspan style=\u0022font-weight: bolder; border-radius: 0px !important;\u0022\u003EM\u003C/span\u003Eucopolysaccharide -\u0026nbsp;\u003Cspan style=\u0022font-weight: bolder; border-radius: 0px !important;\u0022\u003EA\u003C/span\u003Elcian blue\u003C/li\u003E\u003Cli style=\u0022margin-bottom: 0.1em; border-radius: 0px !important;\u0022\u003E\u003Cspan style=\u0022font-weight: bolder; border-radius: 0px !important;\u0022\u003EG\u003C/span\u003Eranular dystrophy -\u0026nbsp;\u003Cspan style=\u0022font-weight: bolder; border-radius: 0px !important;\u0022\u003EH\u003C/span\u003Eyaline materials -\u0026nbsp;\u003Cspan style=\u0022font-weight: bolder; border-radius: 0px !important;\u0022\u003EM\u003C/span\u003Easson trichrome\u003C/li\u003E\u003Cli style=\u0022margin-bottom: 0.1em; border-radius: 0px !important;\u0022\u003E\u003Cspan style=\u0022font-weight: bolder; border-radius: 0px !important;\u0022\u003EL\u003C/span\u003Eattice dystrophy -\u0026nbsp;\u003Cspan style=\u0022font-weight: bolder; border-radius: 0px !important;\u0022\u003EA\u003C/span\u003Emyloid -\u0026nbsp;\u003Cspan style=\u0022font-weight: bolder; border-radius: 0px !important;\u0022\u003EC\u003C/span\u003Eongo red\u003C/li\u003E\u003C/ul\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 129,
    "Name": "Chemical injury",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EIn a patient with a chemical eye injury, which of the following features, in addition to limbal ischaemia, is associated with a \u003Cspan class=\u0022s1\u0022\u003Epoor visual prognosis\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch4\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cul\u003E\u003Cli\u003E\u003Cspan style=\u0022font-size: small; font-weight: normal;\u0022\u003EThe key difference between Dua\u2019s classification and the Roper-Hall classification is that Dua\u2019s includes limbal epithelial involvement (rather than limbal ischaemia) and conjunctival involvement. These support the clinical relevance of conjunctival tissue in contributing to corneal re-epithelialisation in cases of limbal stem cell deficiency.\u0026nbsp;\u003C/span\u003E\u003C/li\u003E\u003Cli\u003E\u003Cspan style=\u0022font-size: small; font-weight: normal;\u0022\u003ELimbal involvement, assessed via fluorescein staining, offers a more objective and reproducible measure compared to limbal ischaemia, which can be highly subjective.\u0026nbsp;\u003C/span\u003E\u003C/li\u003E\u003Cli\u003E\u003Cspan style=\u0022font-size: small; font-weight: normal;\u0022\u003EThe degree of conjunctival involvement serves as an important indicator of conjunctival stem cell loss, which is critical in severe injuries where limbal stem cells are compromised.\u003C/span\u003E\u003C/li\u003E\u003C/ul\u003E\u003C/p\u003E\u003C/h4\u003E\u003Ch4\u003E\u003Cb\u003E\uD83D\uDD2C\u003Cspan style=\u0022font-size: medium;\u0022\u003EKey prognostic indicators (per\u003Cspan class=\u0022Apple-converted-space\u0022\u003E\u0026nbsp;\u003C/span\u003E\u003C/span\u003E\u003C/b\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003E\u003Cb style=\u0022letter-spacing: 0.14994px;\u0022\u003EDua Classification\u0026nbsp;\u003C/b\u003E\u003Cb style=\u0022letter-spacing: 0.14994px;\u0022\u003Eand literature):\u003C/b\u003E\u003C/span\u003E\u003C/h4\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELimbal ischaemia\u003C/b\u003E\u003C/span\u003E is the most important predictor of long-term epithelial healing and stem cell deficiency.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESevere conjunctival involvement\u003C/b\u003E\u003C/span\u003E (\u0026gt;80%) is also associated with a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epoor prognosis\u003C/b\u003E\u003C/span\u003E due to its impact on mucin-producing goblet cells and overall ocular surface healing.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EAnterior chamber cells \u0026gt;2\u002B\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E indicate inflammation but are \u003C/span\u003E\u003Cb\u003Enot independently predictive\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E of poor outcome.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIOP of 28 mmHg\u003C/b\u003E\u003C/span\u003E is not itself prognostic unless \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epersistent\u003C/b\u003E\u003C/span\u003E, and is more of a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecomplication to manage\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELarge epithelial defects\u003C/b\u003E\u003C/span\u003E are expected in early phases but \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecorneal opacification and stromal haze\u003C/b\u003E\u003C/span\u003E are more prognostic than the size of the epithelial defect alone.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\uD83D\uDCD6 \u003C/span\u003E\u003Cb\u003EReferences:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EDua HS et al. \u003Ci\u003EA new classification of ocular surface burns\u003C/i\u003E. Br J Ophthalmol. 2001;85(11):1379-1383.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EHolland EJ et al. \u003Ci\u003EManagement of ocular surface chemical injuries\u003C/i\u003E. Int Ophthalmol Clin. 1997;37(4):105-122.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cimg src=\u0022https://eyewiki.org/w/images/1/1b/Burnlegend2.JPG?20121201015301\u0022\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 13,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 130,
    "Name": "OSSN",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich of the following statements about \u003Cspan class=\u0022s1\u0022\u003Eocular surface squamous neoplasia (OSSN)\u003C/span\u003E is MOST likely to be correct?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOcular surface squamous neoplasia (OSSN)\u003C/b\u003E\u003C/span\u003E includes a spectrum of dysplastic lesions of the conjunctival and corneal epithelium, from \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Econjunctival intraepithelial neoplasia (CIN)\u003C/b\u003E\u003C/span\u003E to invasive \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esquamous cell carcinoma\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EThere is a strong and well-documented association between OSSN and HIV infection.\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIn regions with high HIV prevalence (especially sub-Saharan Africa), OSSN is significantly more common and more aggressive.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EAs a result, \u003C/span\u003E\u003Cb\u003Escreening for HIV/AIDS is recommended in all newly diagnosed OSSN patients\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, especially in younger or atypical presentations.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cblockquote style=\u0022margin-bottom: 0px; margin-left: 15px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; line-height: normal; font-family: \u0026quot;.AppleSystemUIFont\u0026quot;; color: rgb(14, 14, 14);\u0022\u003E\uD83D\uDD17 \u003Ci\u003EReference: Shields CL et al. Ocular surface squamous neoplasia: review of epidemiology and pathophysiology. Surv Ophthalmol. 2002;47(6):481\u2013502.\u003C/i\u003E\u003Ci\u003E\u003C/i\u003E\u003C/blockquote\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch4\u003E\u003Cb\u003EOther options:\u003C/b\u003E\u003C/h4\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe incidence of OSSN in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECaucasian populations\u003C/b\u003E\u003C/span\u003E is much \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elower\u003C/b\u003E\u003C/span\u003E, estimated at \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E0.03\u20130.2 per 100,000/year\u003C/b\u003E\u003C/span\u003E, not per 10,000.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOSSN usually presents at the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elimbus\u003C/b\u003E\u003C/span\u003E, particularly the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Einterpalpebral nasal conjunctiva\u003C/b\u003E\u003C/span\u003E, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot\u003C/b\u003E\u003C/span\u003E the inferior fornix.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EBowen\u2019s disease (a term used in skin pathology) is \u003C/span\u003E\u003Cb\u003Eequivalent to conjunctival intraepithelial neoplasia (CIN)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2014 a \u003C/span\u003E\u003Cb\u003Enon-invasive lesion\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E. It \u003C/span\u003E\u003Cb\u003Edoes not breach the basement membrane\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb\u003E\uD83D\uDD11\u003Cspan class=\u0022Apple-converted-space\u0022\u003E\u0026nbsp;Remember:\u003C/span\u003E\u003C/b\u003E\u003C/h3\u003E\n\u003Cp class=\u0022p5\u0022\u003E\u003Cb\u003EAll patients with OSSN should undergo HIV screening, as\u0026nbsp;\u003C/b\u003E\u003Cb style=\u0022letter-spacing: 0.14994px;\u0022\u003Eimmunosuppression is a major risk factor and may influence the lesion\u2019s behaviour and management.\u003C/b\u003E\u003C/p\u003E\n\n\n\n\n\n\n\n",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 131,
    "Name": "Infectious Keratitis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich of the following organisms is capable of penetrating an \u003Cspan class=\u0022s1\u0022\u003Eintact corneal epithelium and is more common in current Ophthalmic practice?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EOnly a select group of organisms are known to have the ability to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Einvade the cornea through an intact epithelial surface\u003C/b\u003E\u003C/span\u003E, bypassing the usual epithelial barrier.\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThese include:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Ci\u003ENeisseria gonorrhoeae\u003C/i\u003E\u003Ci\u003E\u003C/i\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Ci\u003ENeisseria meningitidis\u003C/i\u003E\u003Ci\u003E\u003C/i\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Ci style=\u0022font-weight: bold;\u0022\u003ECorynebacterium diphtheriae\u003C/i\u003E\u003Ci\u003E\u003C/i\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Ci\u003EListeria monocytogenes\u003C/i\u003E\u003Ci\u003E\u003C/i\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Ci\u003EHaemophilus influenzae\u003C/i\u003E\u003Ci\u003E\u003C/i\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003E\u003Ci\u003EPseudomonas aeruginosa\u003C/i\u003E\u003C/b\u003E\u003Cb\u003E\u003Ci\u003E\u003C/i\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Ci\u003EShigella\u003C/i\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u2705 \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPseudomonas aeruginosa\u003C/b\u003E\u003C/span\u003E is a highly virulent, opportunistic gram-negative organism. It can adhere to intact epithelium, secrete proteases, and cause \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Erapid corneal ulceration\u003C/b\u003E\u003C/span\u003E, especially in contact lens wearers.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch4\u003E\u003Cb\u003EOther options:\u003C/b\u003E\u003C/h4\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECorynebacterium diphtheriae\u003C/b\u003E\u003C/span\u003E: Can penetrate intact epithelium \u2014 but \u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003Enot \u003Cspan class=\u0022s1\u0022\u003Ecommonly\u003C/span\u003E seen in modern ophthalmic infections due to vaccination\u003C/span\u003E. Still a correct choice in other contexts, but not the best answer here.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGroup A Streptococcus\u003C/b\u003E\u003C/span\u003E: Requires \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecompromised epithelium\u003C/b\u003E\u003C/span\u003E (e.g., trauma) to infect the cornea.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMoraxella lacunata\u003C/b\u003E\u003C/span\u003E: Low virulence, typically affects \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecompromised\u003C/b\u003E\u003C/span\u003E ocular surfaces, not intact epithelium.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\uD83D\uDD17 \u003Ci\u003EReference: Krachmer JH, Mannis MJ, Holland EJ. Cornea (4th ed). Elsevier.\u003C/i\u003E\u003Ci\u003E\u003C/i\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\uD83D\uDD17 \u003Ci\u003EAAO BCSC Cornea, Section 8 (latest edition)\u003C/i\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 132,
    "Name": "Surgery",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EA 32-year-old lady presents with a 6-month history of photophobia and reduced vision in the right eye following a chemical injury. Her visual acuity is 6/36. Slit-lamp examination reveals \u003Cspan class=\u0022s1\u0022\u003E3 clock hours of peripheral corneal conjunctivalisation\u003C/span\u003E extending centrally towards the visual axis, along with \u003Cspan class=\u0022s1\u0022\u003Estippled fluorescein staining\u003C/span\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EWhat is the MOST appropriate initial management for this case?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThis patient has \u003C/span\u003E\u003Cb\u003Epartial limbal stem cell deficiency (LSCD)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2014 evidenced by:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPrior chemical injury (a common cause)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EConjunctivalisation of the cornea\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (3 clock hours)\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EInvolvement of the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Evisual axis\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EStippled fluorescein staining\u003C/b\u003E\u003C/span\u003E, indicating abnormal, unstable epithelium\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESuboptimal vision (6/36)\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003EIn \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003Epartial LSCD\u003C/b\u003E\u003C/span\u003E, especially with limited involvement (e.g., \u22643 clock hours), the preferred first-line approach is \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003Esequential sector conjunctival epitheliectomy (SSCE) \u002B amniotic membrane graft\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\uD83D\uDD0D \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003ESSCE\u003C/b\u003E\u003C/span\u003E involves:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMechanical removal of conjunctivalised epithelium from the corneal surface\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAllowing the remaining healthy limbus to repopulate the cornea with normal epithelium\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOften performed under topical anaesthesia as a minor outpatient procedure\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EHas good outcomes in \u003C/span\u003E\u003Cb\u003Eearly or localised disease\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch4\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/h4\u003E\u003Ch4\u003E\u003Cb\u003EOther options:\u003C/b\u003E\u003C/h4\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAmniotic membrane transplant\u003C/b\u003E\u003C/span\u003E: Helpful for promoting epithelial healing in acute injuries or non-healing epithelial defects, but \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot sufficient alone\u003C/b\u003E\u003C/span\u003E for LSCD with central visual axis involvement.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAnterior lamellar keratoplasty\u003C/b\u003E\u003C/span\u003E: Addresses \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Estromal scarring\u003C/b\u003E\u003C/span\u003E, but does \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot correct the epithelial abnormality\u003C/b\u003E\u003C/span\u003E or LSCD \u2014 not suitable unless the epithelium has first been restored.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAutologous limbal stem cell transplant\u003C/b\u003E\u003C/span\u003E: This is reserved for \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Etotal or bilateral LSCD\u003C/b\u003E\u003C/span\u003E or when SSCE fails. Not first-line in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epartial\u003C/b\u003E\u003C/span\u003E LSCD with remaining healthy limbal tissue.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb\u003E\uD83D\uDD11\u003Cspan class=\u0022Apple-converted-space\u0022\u003E\u0026nbsp;Remember:\u003C/span\u003E\u003C/b\u003E\u003C/h3\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EThis table from Oxford Handbook - Fourth Edition:\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cimg src=\u0022/upload-2025-08-29-8716bb6d-d923-4366-a858-03a893647132.png\u0022\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 133,
    "Name": "Dystrophies",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich of the following corneal dystrophies is caused by a mutation in a gene \u003Cspan class=\u0022s1\u0022\u003Edifferent\u003C/span\u003E from the others?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EMost corneal dystrophies are classified by the affected \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elayer of the cornea\u003C/b\u003E\u003C/span\u003E and their \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emolecular genetics\u003C/b\u003E\u003C/span\u003E.\u0026nbsp;\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\n\n\n\n\n\n\n\n\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMeesmann corneal dystrophy\u003C/b\u003E\u003C/span\u003E is genetically distinct, it involves \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ekeratin gene mutations\u003C/b\u003E\u003C/span\u003E (\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EKRT3/KRT12\u003C/b\u003E\u003C/span\u003E) affecting \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecorneal epithelium\u003C/b\u003E\u003C/span\u003E, whereas the others\u0026nbsp;\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003Eare all caused by mutations in the BIGH3 gene, or known as transforming growth factor \u03B2-induced\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u0026nbsp;\u003C/span\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cb\u003ETGFBI\u003C/b\u003E\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E mutations affecting \u003C/span\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cb\u003EBowman\u2019s layer and/or stroma\u003C/b\u003E\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E.\u0026nbsp;\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal; font-weight: bolder; color: rgb(255, 0, 0); border-radius: 0px !important; text-decoration-line: underline;\u0022\u003ERemember:\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal; font-weight: bolder; border-radius: 0px !important;\u0022\u003EBIG is LARGE:\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal;\u0022\u003EBIGH3gene defect in\u003C/span\u003E\u003C/p\u003E\u003Cul style=\u0022margin-top: 0.3em; margin-bottom: 0px; margin-left: 1.6em; padding-left: 0px; list-style-position: outside; list-style-image: url(\u0026quot;data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAAYAAAAJCAYAAAARml2dAAAABHNCSVQICAgIfAhkiAAAAAlwSFlzAAAN1wAADdcBQiibeAAAABl0RVh0U29mdHdhcmUAd3d3Lmlua3NjYXBlLm9yZ5vuPBoAAABUSURBVAiZdY4xDsAgFELB2J0DdnbwQI5OHvDfgC62SY0yvhAetI1dWEq5JN0kKwDYbhEx8oT9a5JdEtLb/M2QNW0FAJLttkLbLUfEkIRVztPdo\u002BMBm8UkW9Zxc20AAAAASUVORK5CYII=\u0026quot;); color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal; border-radius: 0px !important;\u0022\u003E\u003Cli style=\u0022margin-bottom: 0.1em; border-radius: 0px !important;\u0022\u003E\u003Cspan style=\u0022font-weight: bolder; border-radius: 0px !important;\u0022\u003EL\u003C/span\u003Eattice\u003C/li\u003E\u003Cli style=\u0022margin-bottom: 0.1em; border-radius: 0px !important;\u0022\u003E\u003Cspan style=\u0022font-weight: bolder; border-radius: 0px !important;\u0022\u003EA\u003C/span\u003Evellino\u003C/li\u003E\u003Cli style=\u0022margin-bottom: 0.1em; border-radius: 0px !important;\u0022\u003E\u003Cspan style=\u0022font-weight: bolder; border-radius: 0px !important;\u0022\u003ER\u003C/span\u003Eeis-Buckler\u0027s\u003C/li\u003E\u003Cli style=\u0022margin-bottom: 0.1em; border-radius: 0px !important;\u0022\u003E\u003Cspan style=\u0022font-weight: bolder; border-radius: 0px !important;\u0022\u003EG\u003C/span\u003Eranular\u003C/li\u003E\u003Cli style=\u0022margin-bottom: 0.1em; border-radius: 0px !important;\u0022\u003E\u003Cspan style=\u0022font-weight: bolder; border-radius: 0px !important;\u0022\u003EE\u003C/span\u003Empty\u003C/li\u003E\u003C/ul\u003E\u003Cp class=\u0022p1\u0022\u003E\n\n\n\n\n\n\n\n\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EMeesmann corneal dystrophy is caused by mutations in keratin genes (KRT3 or KRT12), making it genetically distinct from granular, Thiel\u2013Behnke, and many EBMD cases, which involve TGFBI mutations.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 134,
    "Name": "LSCD",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-size: medium; font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EWhich of the following findings on \u003C/span\u003Ecorneal impression cytology\u003Cspan class=\u0022s1\u0022\u003E is \u003C/span\u003Emost suggestive of limbal stem cell deficiency (LSCD)?\u003C/span\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECorneal impression cytology\u003C/b\u003E\u003C/span\u003E is a non-invasive diagnostic tool used to evaluate the cellular composition of the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecorneal surface\u003C/b\u003E\u003C/span\u003E \u2014 particularly useful in diagnosing \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elimbal stem cell deficiency (LSCD)\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EIn LSCD, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Econjunctival epithelial cells\u003C/b\u003E\u003C/span\u003E migrate onto the corneal surface, replacing the normal corneal epithelium. This results in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Econjunctivalisation\u003C/b\u003E\u003C/span\u003E of the cornea, including:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPresence of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Egoblet cells\u003C/b\u003E\u003C/span\u003E (normally absent on the cornea)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EExpression of \u003C/span\u003E\u003Cb\u003Econjunctival markers\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E like \u003C/span\u003E\u003Cb\u003ECK19\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and \u003C/span\u003E\u003Cb\u003ECK13\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ELoss of normal \u003C/span\u003E\u003Cb\u003Ecorneal epithelial markers\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, including \u003C/span\u003E\u003Cb\u003ECK3\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and \u003C/span\u003E\u003Cb\u003ECK12\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cimg src=\u0022/upload-2025-08-29-44d86f34-6ab1-413e-8527-0039634088c1.png\u0022\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 135,
    "Name": "Surgery",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-size: medium; font-weight: bold;\u0022\u003EA 28-year-old gentleman undergoes an uncomplicated penetrating keratoplasty for keratoconus. On the first post-operative day, they complain of a \u003Cspan class=\u0022s1\u0022\u003Eheadache\u003C/span\u003E and have a \u003Cspan class=\u0022s1\u0022\u003Efixed dilated pupil\u003C/span\u003E in the operated eye. The anterior chamber is deep and quiet. The dilated pupil \u003Cspan class=\u0022s1\u0022\u003Edoes not constrict with 2% pilocarpine\u003C/span\u003E, and \u003Cspan class=\u0022s1\u0022\u003Eptosis is absent\u003C/span\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EWhat is the most appropriate next step in management?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThis is a classic presentation of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EUrrets-Zavalia syndrome\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb style=\u0022letter-spacing: 0.14994px; font-size: large;\u0022\u003EDiagnosis: Urrets-Zavalia Syndrome\u003C/b\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022font-size: large;\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb style=\u0022letter-spacing: 0.14994px; font-size: large;\u0022\u003EKey Clinical Features Recap:\u003C/b\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOccurs \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eafter penetrating keratoplasty\u003C/b\u003E\u003C/span\u003E (especially in keratoconus patients)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPresents with a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Efixed dilated pupil\u003C/b\u003E\u003C/span\u003E postoperatively\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EDeep and quiet anterior chamber\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMay be associated with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eheadache or discomfort\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ENo response to pilocarpine 2%\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, due to \u003C/span\u003E\u003Cb\u003Eiris sphincter ischaemia\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ENo ptosis or ocular motility deficit \u2192 rules out 3rd nerve palsy\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EOften associated with a \u003C/span\u003E\u003Cb\u003Esignificant rise in intraocular pressure (IOP)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E early post-op\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EUrrets-Zavalia syndrome is thought to result from:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EAcute postoperative IOP spike\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ELeading to \u003C/span\u003E\u003Cb\u003Eiris ischemia\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and subsequent \u003C/span\u003E\u003Cb\u003Esphincter paralysis\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThe result is a \u003C/span\u003E\u003Cb\u003Epermanent, non-reactive mydriasis\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThe condition is more likely in \u003C/span\u003E\u003Cb\u003Eyoung keratoconus patients\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E with \u003C/span\u003E\u003Cb\u003Etight peripheral iridectomy\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E or when \u003C/span\u003E\u003Cb\u003Eair/gas is used in the anterior chamber\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb\u003EManagement Approach:\u003C/b\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Col start=\u00221\u0022\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EMeasure and control IOP\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E immediately\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EInitiate \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIOP-lowering therapy\u003C/b\u003E\u003C/span\u003E if pressure is elevated\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMonitor for resolution \u2014 but pupil often remains \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epermanently dilated\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ELater, if symptomatic (e.g. glare, photophobia), options include:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPhotochromic lenses\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ECosmetic contact lenses\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESurgical options\u003C/b\u003E\u003C/span\u003E (e.g., artificial iris or pupiloplasty in select cases)\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003C/ol\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003ESo c\u003Cb style=\u0022color: rgb(14, 14, 14); font-family: \u0026quot;Helvetica Neue\u0026quot;; letter-spacing: 0.14994px;\u0022\u003Ehecking the patient\u2019s IOP\u0026nbsp;\u003C/b\u003E\u003Cspan style=\u0022color: rgb(14, 14, 14); font-family: \u0026quot;.AppleSystemUIFont\u0026quot;; letter-spacing: 0.14994px;\u0022\u003Eis the best \u003C/span\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022color: rgb(14, 14, 14); font-family: \u0026quot;.AppleSystemUIFont\u0026quot;; letter-spacing: 0.14994px;\u0022\u003E\u003Cb\u003Einitial\u003C/b\u003E\u003C/span\u003E\u003Cspan style=\u0022color: rgb(14, 14, 14); font-family: \u0026quot;.AppleSystemUIFont\u0026quot;; letter-spacing: 0.14994px;\u0022\u003E next step \u2014 because elevated IOP is \u003C/span\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022color: rgb(14, 14, 14); font-family: \u0026quot;.AppleSystemUIFont\u0026quot;; letter-spacing: 0.14994px;\u0022\u003E\u003Cb\u003Ecausal and potentially reversible\u003C/b\u003E\u003C/span\u003E\u003Cspan style=\u0022color: rgb(14, 14, 14); font-family: \u0026quot;.AppleSystemUIFont\u0026quot;; letter-spacing: 0.14994px;\u0022\u003E if treated early.\u003C/span\u003E\u003C/div\u003E\u003Col start=\u00221\u0022\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/ol\u003E\u003Cp\u003E\u003C/p\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 136,
    "Name": "Infectious Keratitis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EA 79-year-old patient presents with a \u003Cspan class=\u0022s1\u0022\u003Evesicular rash\u003C/span\u003E affecting the \u003Cspan class=\u0022s1\u0022\u003Eright forehead, scalp, and nasal tip\u003C/span\u003E, respecting the facial midline. On examination, there are \u003Cspan class=\u0022s1\u0022\u003Epseudodendritic lesions\u003C/span\u003E on the cornea and \u003Cspan class=\u0022s1\u0022\u003Emild anterior chamber inflammation\u003C/span\u003E.\u0026nbsp;\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhich of the following statements is most accurate regarding this presentation?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThis patient has \u003C/span\u003E\u003Cb\u003Eherpes zoster ophthalmicus (HZO)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, given:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EDermatomal rash in \u003C/span\u003E\u003Cb\u003Eophthalmic division of trigeminal nerve (V1)\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EInvolvement of the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enasociliary branch\u003C/b\u003E\u003C/span\u003E (Hutchinson\u2019s sign \u2014 tip of nose)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EAssociated \u003C/span\u003E\u003Cb\u003Epseudodendritic keratitis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and \u003C/span\u003E\u003Cb\u003Eanterior uveitis\u003C/b\u003E\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003EHZO:\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EHZO affects the \u003C/span\u003E\u003Cb\u003Enasociliary nerve\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, which innervates the \u003C/span\u003E\u003Cb\u003Ecornea, ciliary body, and iris\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EPatients are at \u003C/span\u003E\u003Cb\u003Ehigh risk of corneal denervation\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, leading to:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ENeurotrophic keratopathy\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPersistent epithelial defects\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ECorneal melt or perforation in severe cases\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ECorneal sensation must be monitored regularly\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EOther options:\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003EAntivirals such as \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eoral aciclovir are still beneficial\u003C/b\u003E\u003C/span\u003E even if started \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eafter 72 hours\u003C/b\u003E\u003C/span\u003E, especially if new vesicles or ocular involvement are present\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u21B3 Starting antivirals up to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E7 days\u003C/b\u003E\u003C/span\u003E after onset may reduce complications\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ETopical aciclovir is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot routinely indicated\u003C/b\u003E\u003C/span\u003E in HZO keratitis; systemic treatment is preferred unless epithelial disease is severe\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u21B3 Most HZO pseudodendrites respond well to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eoral antivirals\u003C/b\u003E\u003C/span\u003E and supportive therapy\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EBilateral periorbital swelling is caused by\ngravitational oedema instead of spreading of infection; therefore, antibiotic is not warranted.\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 137,
    "Name": "Surgery",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EA 49-year-old man presents with a 3-day history of photophobia and mildly reduced vision in the right eye, one year after undergoing penetrating keratoplasty. He recently recovered from a viral illness. On slit-lamp examination, the eye is minimally injected, with mild papillary conjunctival reaction and \u003Cspan class=\u0022s1\u0022\u003Emultiple subepithelial infiltrates within the graft\u003C/span\u003E. There is \u003Cspan class=\u0022s1\u0022\u003Eno epithelial defect, stromal oedema, keratic precipitates, or anterior chamber inflammation\u003C/span\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EWhat is the most appropriate management in this case?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EDiagnosis: Subepithelial Rejection\u003C/b\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EFollowing penetrating keratoplasty, this patient has developed \u003C/span\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cb\u003Emultiple subepithelial opacities\u003C/b\u003E\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E within the graft after a \u003C/span\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cb\u003Eviral illness\u003C/b\u003E\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E, with:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ENo epithelial defect\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ENo stromal oedema\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ENo keratic precipitates\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ENo AC activity\u003C/p\u003E\u003C/li\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003EThe incidence of this type of stromal rejection ranges between 2% and 5%.\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\n\u003Cp class=\u0022p3\u0022\u003EThis is consistent with \u003Cspan class=\u0022s2\u0022\u003E\u003Cb\u003Esubepithelial immune rejection\u003C/b\u003E\u003C/span\u003E, sometimes an early or isolated manifestation.\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch4\u003E\u003Cb\u003ETreatment:\u003C/b\u003E\u003C/h4\u003E\u003Cp\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\n\n\n\n\n\n\n\n\n\u003Cp\u003E\u003C/p\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESubepithelial rejection can precede or co-exist with more severe endothelial rejection.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EPrompt use of \u003C/span\u003E\u003Cb\u003Efrequent topical corticosteroids\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E can \u003C/span\u003E\u003Cb\u003Ereverse inflammation and prevent progression\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EDexamethasone 0.1%\u003C/b\u003E\u003C/span\u003E QID\u20136\u00D7/day is an appropriate and standard regimen.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EA short follow-up interval (within 2\u20133 days) is critical to assess treatment response and detect progression.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EOther options:\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELubricants\u003C/b\u003E\u003C/span\u003E \u2013 Not sufficient for immune-mediated inflammation.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EChloramphenicol\u003C/b\u003E\u003C/span\u003E \u2013 There is no infection.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPrednisolone 0.5% BID\u003C/b\u003E\u003C/span\u003E \u2013 Too mild a dose and frequency for subepithelial rejection. Also, weaker than dexamethasone 0.1%.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 138,
    "Name": "Degenerations",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich of the following statements about \u003Cspan class=\u0022s1\u0022\u003Ecorneal arcus\u003C/span\u003E is most accurate?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\u003Cdiv style=\u0022letter-spacing: 0.14994px;\u0022\u003EArcus is a common bilateral degeneration, 2\u00B0 to progressive deposition of lipid in the peripheral stroma. It is usually age-related but may be associated with hyperlipidaemia.\u003C/div\u003E\u003Cdiv style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003ECauses:\u003C/span\u003E\u003C/div\u003E\u003Cdiv style=\u0022letter-spacing: 0.14994px;\u0022\u003EMost bilateral cases have no systemic association, but hyperlipidaemia (notably type II) should be ruled out in those presenting at a young age (arcus juvenilis).\u0026nbsp;\u003C/div\u003E\u003Cdiv style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cspan style=\u0022color: rgb(255, 0, 0);\u0022\u003EUnilateral\u003C/span\u003E\u0026nbsp;arcus is rare and may signify\u0026nbsp;\u003Cspan style=\u0022color: rgb(255, 0, 0);\u0022\u003Econtralateral carotid\u003C/span\u003E\u0026nbsp;compromise or previous ocular hypotony.\u003C/div\u003E\u003Cdiv style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003EClinical features:\u003C/span\u003E\u003C/div\u003E\u003Cdiv style=\u0022letter-spacing: 0.14994px;\u0022\u003EProgressive peripheral opacity starts (and remains thickest) superiorly and inferiorly but spreads circumferentially to form a complete ring of around 1mm thickness\u003C/div\u003E\u003Cdiv style=\u0022letter-spacing: 0.14994px;\u0022\u003Etypically, the central margin is blurred, but the peripheral margin is sharp, leaving a zone of clear perilimbal cornea (which may show thinning).\u003C/div\u003E\u003Cdiv style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022letter-spacing: 0.14994px;\u0022\u003ESource: Oxford Handbook of Ophthalmology - Fourth Edition\u003C/div\u003E\u003Cdiv style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 139,
    "Name": "Degenerations",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-size: medium; font-weight: bold;\u0022\u003EIn \u003Cspan class=\u0022s1\u0022\u003EWilson\u2019s disease\u003C/span\u003E, copper deposition in the cornea leads to the formation of a \u003Cspan class=\u0022s1\u0022\u003EKayser\u2013Fleischer ring\u003C/span\u003E.\u0026nbsp;\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhich corneal layer is primarily involved in this deposition?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThe \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EKayser\u2013Fleischer ring\u003C/b\u003E\u003C/span\u003E seen in Wilson\u2019s disease is caused by \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecopper accumulation\u003C/b\u003E\u003C/span\u003E at the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eperipheral cornea\u003C/b\u003E\u003C/span\u003E, visible as a golden-brown or greenish ring.\u003C/p\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ECopper is deposited at the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elevel of Descemet\u2019s membrane\u003C/b\u003E\u003C/span\u003E, typically beginning at \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E12 and 6 o\u2019clock\u003C/b\u003E\u003C/span\u003E, then progressing circumferentially.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe deposition occurs due to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eimpaired hepatic copper metabolism\u003C/b\u003E\u003C/span\u003E, resulting in systemic copper overload.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003EWilson\u0027s disease:\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cul\u003E\u003Cli\u003EThe diagnosis can be made by increased serum and urinary copper levels, reduced serum caeruloplasmin\u003C/li\u003E\u003Cli\u003EMRI brain of the basal ganglia showing increased intensity on T2 scan (\u2018face of giant panda\u2019)\u003C/li\u003E\u003Cli\u003Eliver biopsy is the gold standard.\u003C/li\u003E\u003Cli\u003ESerum ceruloplasmin \u0026lt; 20mg/dL in 90% of all patients with Wilson disease.\u0026nbsp;\u003C/li\u003E\u003Cli\u003ESystemic Treatment with Penicillamine can lead to the disappearance of the ring.\u003C/li\u003E\u003C/ul\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003Ekayser-fleischer rings DD:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cul\u003E\u003Cli\u003EPrimary biliary cirrhosis\u003C/li\u003E\u003Cli\u003ECholestasis\u003C/li\u003E\u003Cli\u003ECirrhosis\u003C/li\u003E\u003Cli\u003EChronic copper poisoning\u003Cspan class=\u0022Apple-converted-space\u0022\u003E\u0026nbsp;\u003C/span\u003E\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cimg src=\u0022https://eyewiki.org/w/images/thumb/7/7e/Kayser_Fleischer_ring_seen_on_parallelopiped_slitlamp_illumination.jpg/900px-Kayser_Fleischer_ring_seen_on_parallelopiped_slitlamp_illumination.jpg?20250531112658\u0022\u003E\u003C/div\u003E\u003C/p\u003E\n\n\n\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 140,
    "Name": "Dystrophies",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich of the following corneal conditions is associated with \u003Cspan class=\u0022s1\u0022\u003E\u2018curly fibres\u2019 in Bowman\u2019s layer\u003C/span\u003E on histopathologic examination?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EThiel\u2013Behnke corneal dystrophy\u003C/b\u003E\u003C/span\u003E is a type of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBowman\u2019s layer dystrophy\u003C/b\u003E\u003C/span\u003E and is often confused clinically with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EReis\u2013Bucklers dystrophy\u003C/b\u003E\u003C/span\u003E \u2014 both present with recurrent corneal erosions and subepithelial opacities.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cb style=\u0022letter-spacing: 0.14994px; font-size: large;\u0022\u003EKey Histopathological Feature:\u003C/b\u003E\u003C/p\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThiel\u2013Behnke dystrophy shows \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E\u201Ccurly fibres\u201D\u003C/b\u003E\u003C/span\u003E or \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E\u201Csaw-tooth\u201D pattern\u003C/b\u003E\u003C/span\u003E within a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edisrupted Bowman\u2019s layer\u003C/b\u003E\u003C/span\u003E, which is pathognomonic for this dystrophy.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThese curly fibres consist of abnormal collagen fibrils on electron microscopy.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003EOther options:\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMeesmann dystrophy\u003C/b\u003E\u003C/span\u003E: Intraepithelial cysts; mutation in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EKRT12/KRT3\u003C/b\u003E\u003C/span\u003E, not Bowman\u2019s layer.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EReis\u2013Bucklers\u003C/b\u003E\u003C/span\u003E: Bowman\u2019s layer is replaced by fibrous connective tissue, but \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eno curly fibres\u003C/b\u003E\u003C/span\u003E \u2014 instead, dense, rod-shaped bodies are seen.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESchnyder dystrophy\u003C/b\u003E\u003C/span\u003E: Characterised by \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elipid/crystal deposits in the stroma\u003C/b\u003E\u003C/span\u003E, not Bowman\u2019s layer, and no curly fibres.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 141,
    "Name": "Keratoconus",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich of the following statements regarding \u003Cspan class=\u0022s1\u0022\u003Ekeratoconus\u003C/span\u003E is \u003Cspan class=\u0022s1\u0022\u003ELEAST likely to be correct\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cbr\u003E\u003C/h3\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EHistopathologically, keratoconus is characterised by:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThinning of the corneal stroma\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EBreaks in Bowman\u2019s layer\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIron deposition (Fleischer ring)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIrregular epithelial thickening\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cblockquote style=\u0022margin-bottom: 0px; margin-left: 15px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; line-height: normal; font-family: \u0026quot;.AppleSystemUIFont\u0026quot;; color: rgb(14, 14, 14);\u0022\u003E\u003Cbr\u003E\u003C/blockquote\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPosterior keratoconus\u003C/b\u003E\u003C/span\u003E is a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Erare\u003C/b\u003E\u003C/span\u003E entity, distinct from keratoconus:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EOften \u003C/span\u003E\u003Cb\u003Econgenital\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EFrequently \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eunilateral\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ELocalised thinning of the posterior corneal surface with no ectasia anteriorly\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cblockquote style=\u0022margin-bottom: 0px; margin-left: 15px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; line-height: normal; font-family: \u0026quot;.AppleSystemUIFont\u0026quot;; color: rgb(14, 14, 14);\u0022\u003E\u003Cbr\u003E\u003C/blockquote\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPosterior corneal steepening\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is often \u003C/span\u003E\u003Cb\u003Eone of the earliest detectable changes\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E in keratoconus.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAdvanced corneal imaging (e.g., Scheimpflug tomography) detects early \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eposterior elevation\u003C/b\u003E\u003C/span\u003E and steepening \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebefore anterior surface changes are obvious\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cblockquote style=\u0022margin-bottom: 0px; margin-left: 15px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; line-height: normal; font-family: \u0026quot;Helvetica Neue\u0026quot;; color: rgb(14, 14, 14);\u0022\u003E\u003Cb\u003EBelin Ambrosio Enhanced Ectasia Display\u003C/b\u003E\u003Cspan class=\u0022s2\u0022\u003E (see below) \u003C/span\u003E\u003Cb\u003Erelies heavily on posterior curvature changes\u003C/b\u003E\u003Cspan class=\u0022s2\u0022\u003E to detect subclinical keratoconus.\u003C/span\u003E\u003C/blockquote\u003E\n\u003Cblockquote style=\u0022margin-bottom: 0px; margin-left: 15px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; line-height: normal; font-family: \u0026quot;.AppleSystemUIFont\u0026quot;; color: rgb(14, 14, 14);\u0022\u003E\u003Cbr\u003E\u003C/blockquote\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBelin Ambrosio Display\u003C/b\u003E\u003C/span\u003E (on Pentacam) integrates:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EAnterior \u0026amp; posterior elevation\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPachymetric progression\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ECorneal thickness profile\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u2192 To detect \u003C/span\u003E\u003Cb\u003Eforme fruste\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E or \u003C/span\u003E\u003Cb\u003Esubclinical keratoconus\u003C/b\u003E\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\u003C/li\u003E\u003C/ul\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 142,
    "Name": "Anterior segment",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich of the following statements regarding\u0026nbsp;\u003Cspan class=\u0022s1\u0022\u003EPeters anomaly\u003C/span\u003E is MOST likely to be\u0026nbsp;\u003Cspan class=\u0022s1\u0022\u003Ecorrect\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EPeters anomaly is a type of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eanterior segment dysgenesis\u003C/b\u003E\u003C/span\u003E, often presenting at birth with:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ECentral corneal opacity\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPosterior corneal defect (absence of Descemet\u2019s membrane and endothelium)\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EIris\u2013cornea adhesions\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (Type I)\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ELens\u2013cornea adhesions\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (Type II)\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cbr\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPeters anomaly may be \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eisolated\u003C/b\u003E\u003C/span\u003E, but it can also be part of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esyndromic conditions\u003C/b\u003E\u003C/span\u003E such as:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPeters Plus Syndrome\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EWhich includes:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ECardiac defects\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ECNS abnormalities (e.g., hydrocephalus)\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EDevelopmental delay\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EShort stature and craniofacial abnormalities\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cblockquote style=\u0022margin-bottom: 0px; margin-left: 15px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; line-height: normal; font-family: \u0026quot;Helvetica Neue\u0026quot;; color: rgb(14, 14, 14);\u0022\u003E\u003Cbr\u003E\u003C/blockquote\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ETIMP3 gene\u003C/b\u003E\u003C/span\u003E mutations are associated with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESorsby fundus dystrophy\u003C/b\u003E\u003C/span\u003E, not Peters anomaly.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPeters anomaly has been associated with mutations in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPAX6\u003C/b\u003E\u003C/span\u003E, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPITX2\u003C/b\u003E\u003C/span\u003E, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EFOXC1\u003C/b\u003E\u003C/span\u003E, and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EB3GALTL\u003C/b\u003E\u003C/span\u003E (especially in Peters Plus syndrome).\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGlaucoma develops in up to 50\u201370% of patients\u003C/b\u003E\u003C/span\u003E with Peters anomaly, particularly in more severe forms (Type II).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESo the stated figure of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E20%\u003C/b\u003E\u003C/span\u003E significantly \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eunderestimates the true prevalence\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cbr\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThe \u003C/span\u003E\u003Cb\u003Eprimary defect is in the posterior cornea\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (i.e., \u003C/span\u003E\u003Cb\u003EDescemet\u2019s membrane and endothelium\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E)\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIt is not primarily a stromal developmental defect.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 143,
    "Name": "Conjunctival lesions",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EA 14-year-old girl presents with a slowly enlarging lesion on the white of her eye. On examination, there is a \u003Cspan class=\u0022s1\u0022\u003Eminimally elevated pigmented conjunctival lesion\u003C/span\u003E near the \u003Cspan class=\u0022s1\u0022\u003Elimbus\u003C/span\u003E, showing \u003Cspan class=\u0022s1\u0022\u003Ecystic changes\u003C/span\u003E, \u003Cspan class=\u0022s1\u0022\u003Eno vascularisation\u003C/span\u003E, and \u003Cspan class=\u0022s1\u0022\u003Eno epithelial defect\u003C/span\u003E. Her mother states the lesion has been present for \u003Cspan class=\u0022s1\u0022\u003Emany years\u003C/span\u003E.\u0026nbsp;\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhat is the most likely diagnosis?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch4\u003E\u003Cb style=\u0022font-size: medium; text-decoration-line: underline;\u0022\u003EConjunctival naevus:\u003C/b\u003E\u003C/h4\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EMost common\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E conjunctival tumour in \u003C/span\u003E\u003Cb\u003Echildren and adolescents\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ETypically located near the \u003C/span\u003E\u003Cb\u003Elimbus\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E or in the \u003C/span\u003E\u003Cb\u003Einterpalpebral bulbar conjunctiva\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPigmented\u003C/b\u003E\u003C/span\u003E, but may be amelanotic\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECystic spaces\u003C/b\u003E\u003C/span\u003E within the lesion are common (and helpful in diagnosis)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ELesion is usually \u003C/span\u003E\u003Cb\u003Estable\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, but \u003C/span\u003E\u003Cb\u003Ecan enlarge slightly during puberty\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ENo feeder vessels\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, no epithelial defect, and \u003C/span\u003E\u003Cb\u003Eno signs of malignancy\u003C/b\u003E\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\u003Cb style=\u0022letter-spacing: 0.14994px; text-decoration-line: underline;\u0022\u003EConjunctival melanoma\u003C/b\u003E\u003Cbr\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ERare in this age group (more common in middle-aged or older adults)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EOften arises \u003C/span\u003E\u003Cb\u003Ede novo or from primary acquired melanosis (PAM)\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ETypically \u003C/span\u003E\u003Cb\u003Erapidly growing\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, may be \u003C/span\u003E\u003Cb\u003Enon-cystic\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, and often shows \u003C/span\u003E\u003Cb\u003Efeeder vessels or nodularity\u003C/b\u003E\u003C/p\u003E\u003C/li\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\u003C/li\u003E\u003C/ul\u003E\u003Cb style=\u0022letter-spacing: 0.14994px; text-decoration-line: underline;\u0022\u003EConjunctival melanosis\u003C/b\u003E\u003Cbr\u003E\u003Cul style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cli\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EUsually refers to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPAM\u003C/b\u003E\u003C/span\u003E or \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eracial melanosis\u003C/b\u003E\u003C/span\u003E, which presents as \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eflat\u003C/b\u003E\u003C/span\u003E pigmentation with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eno elevation or cysts\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ENot typically described as a \u201Clesion\u201D enlarging with time\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\u003C/li\u003E\u003Cli\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cb style=\u0022letter-spacing: 0.14994px; text-decoration-line: underline;\u0022\u003EConjunctival papilloma\u003C/b\u003E\u003Cbr\u003E\u003Cul style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EOften \u003C/span\u003E\u003Cb\u003Enon-pigmented\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, \u003C/span\u003E\u003Cb\u003Efleshy\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, and has a \u003C/span\u003E\u003Cb\u003Evascularised, lobulated or frond-like\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E appearance\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EMay be \u003C/span\u003E\u003Cb\u003Eassociated with HPV\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\u003C/li\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003ETypically lacks cystic features\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cimg src=\u0022https://www.aao.org/image.axd?id=30a703a5-291a-4f0e-9aed-fb6c767d4877\u0026amp;t=635565060124270000\u0022\u003E\u003C/div\u003E\u003Cp class=\u0022p2\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 144,
    "Name": "Infectious Keratitis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EWhich of the following statements regarding the \u003C/span\u003Euse of topical corticosteroids in bacterial keratitis\u003Cspan class=\u0022s1\u0022\u003E is MOST likely to be\u0026nbsp;\u003C/span\u003Etrue\u003Cspan class=\u0022s1\u0022\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThis question is based on data from the landmark \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESteroids for Corneal Ulcers Trial (SCUT)\u003C/b\u003E\u003C/span\u003E \u2014 a large, NIH-funded, randomized controlled trial designed to evaluate the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esafety and efficacy of adjunctive topical corticosteroids in bacterial keratitis\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb style=\u0022letter-spacing: 0.14994px; font-size: large; text-decoration-line: underline;\u0022\u003EKey SCUT Trial Findings (2004\u20132011):\u003C/b\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPrimary outcome\u003C/b\u003E\u003C/span\u003E: Best spectacle-corrected visual acuity (BSCVA) at 3 months\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EResult\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E: \u003C/span\u003E\u003Cb\u003ENo significant difference overall\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E between steroid and placebo groups\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EHowever, in subgroup analysis:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EPatients with \u003C/span\u003E\u003Cb\u003Eworse vision at presentation (\u22646/60)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E had a \u003C/span\u003E\u003Cb\u003Estatistically significant improvement in visual outcomes\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E with the use of \u003C/span\u003E\u003Cb\u003Eadjunctive topical steroids\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ESteroids hasten healing time\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192 \u003C/span\u003E\u003Cb\u003EIncorrect\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESCUT showed \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eno difference in epithelial healing time\u003C/b\u003E\u003C/span\u003E between steroid and placebo groups\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ESteroids increase perforation risk\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192 \u003C/span\u003E\u003Cb\u003EIncorrect\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESCUT showed no increased risk\u003C/b\u003E\u003C/span\u003E of corneal perforation in the steroid group\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EWhen used appropriately (i.e., after organism sensitivity confirmed), steroids are \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esafe\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ESteroids improve outcomes in Nocardia keratitis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192 \u003C/span\u003E\u003Cb\u003EIncorrect\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESCUT subgroup data showed that patients with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ENocardia keratitis had worse outcomes\u003C/b\u003E\u003C/span\u003E when treated with topical steroids\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EHence, steroids are \u003C/span\u003E\u003Cb\u003Econtraindicated\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E in \u003C/span\u003E\u003Cb\u003ENocardia infections\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 145,
    "Name": "Dystrophies",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich statement about Schnyder corneal dystrophy is least likely to be accurate?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ESchnyder corneal dystrophy is a \u003C/span\u003E\u003Cb\u003Erare autosomal dominant disorder\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E characterized by \u003C/span\u003E\u003Cb\u003Eprogressive corneal opacification due to lipid deposition\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EKey features:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOften associated with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Earcus lipoides\u003C/b\u003E\u003C/span\u003E (correct).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EUsually begins in the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Efirst or second decade\u003C/b\u003E\u003C/span\u003E (correct).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPrimarily affects the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Estroma and epithelium\u003C/b\u003E\u003C/span\u003E, but \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot the endothelium\u0026nbsp;\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cb\u003EMost important point:\u003C/b\u003E\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E \u003C/span\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cb\u003ECorneal crystals are not universal\u003C/b\u003E\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E \u2014 only about \u003C/span\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cb\u003E50% of patients\u003C/b\u003E\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E show visible crystals. The rest show haze without crystals.\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\u003C/li\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-family: Arial; font-size: small;\u0022\u003E\u003Cspan style=\u0022color: rgb(0, 29, 53); letter-spacing: normal;\u0022\u003EThe condition was reclassified from \u0022Schnyder crystalline corneal dystrophy\u0022 to \u0022Schnyder corneal dystrophy\u0022 to reflect this variable presentation, which can delay diagnosis in affected individuals.\u003C/span\u003E\u003Cspan jscontroller=\u0022JHnpme\u0022 class=\u0022pjBG2e\u0022 data-cid=\u0022c840db4c-8fce-4994-abbc-9b347044b8cf\u0022 jsaction=\u0022rcuQ6b:npT2md\u0022 style=\u0022color: rgb(0, 29, 53); letter-spacing: normal;\u0022\u003E\u003Cspan class=\u0022UV3uM\u0022 style=\u0022text-wrap-mode: nowrap;\u0022\u003E\u0026nbsp;\u003C/span\u003E\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal;\u0022\u003EAnterior segment OCT has \u0022shown diffuse high reflectivity in the epithelium, anterior, mid, and posterior stroma, which correspond to the hyperreflective deposits observed with IVCM and FF-OCT at the same level. Presence of epithelial hyperreflectivity was consistent with the presence of areas of thick and irregular epithelium on epithelial mapping.\u0022\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 146,
    "Name": "Patterns",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhat is the correct definition of A-pattern and V-pattern ocular deviations?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPattern strabismus\u003C/b\u003E\u003C/span\u003E describes changes in the horizontal deviation between upgaze and downgaze.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EA-pattern\u003C/b\u003E\u003C/span\u003E: more \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eesotropia in downgaze\u003C/b\u003E\u003C/span\u003E (resembles the shape of the letter \u201CA\u201D).\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EDefined when difference is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E\u0026gt;10 prism diopters\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EV-pattern\u003C/b\u003E\u003C/span\u003E: more \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eesotropia in upgaze\u003C/b\u003E\u003C/span\u003E (resembles the shape of \u201CV\u201D).\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EDefined when difference is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E\u0026gt;15 prism diopters\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThese definitions are based on \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Estandard strabismus diagnostic criteria\u003C/b\u003E\u003C/span\u003E (Burian \u0026amp; Miller classification).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\uD83E\uDDE0 \u003Cspan class=\u0022s2\u0022\u003E\u003Cb\u003EMemory aid:\u003C/b\u003E\u003C/span\u003E \u003Ci\u003EA = 10, V = 15\u003C/i\u003E \u2192 \u201CA comes before V, so the cut-off is smaller.\u201D\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 147,
    "Name": "Posterior Uveitis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EA 29-year-old man presents with a painful, photophobic, red right eye with reduced vision. On examination, he has both anterior chamber and vitreous cells as well as an extensive white patch in the peripheral retina. What is the MOST likely diagnosis?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAcute retinal necrosis (ARN):\u003C/b\u003E\u003C/span\u003E Caused by herpes viruses (VZV, HSV).\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EFeatures: painful red eye, anterior uveitis \u002B vitritis, peripheral necrotising retinitis (white patch).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ERapid progression, high risk of retinal detachment.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPars planitis:\u003C/b\u003E\u003C/span\u003E Chronic, painless, usually bilateral with snowbanking, not acute.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPosterior scleritis:\u003C/b\u003E\u003C/span\u003E Causes pain, thickened sclera, T-sign on ultrasound, but not necrotising retinitis.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERecurrent toxoplasma:\u003C/b\u003E\u003C/span\u003E Classically causes focal retinochoroiditis adjacent to an old scar, not widespread peripheral white patches.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022 style=\u0022text-align: center; \u0022\u003E\u003Cimg src=\u0022https://journal.opted.org/wp-content/uploads/2020/10/F20.P3.Fig1_.png\u0022 class=\u0022rz-state-selected\u0022\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 12,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 148,
    "Name": "Cataract surgery",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich statement about preoperative cataract surgery biometry is the most accurate?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAfter myopic LASIK/PRK:\u003C/b\u003E\u003C/span\u003E The cornea is flattened, but keratometry still assumes a normal anterior/posterior corneal curvature ratio.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThis leads to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eunderestimation of corneal power\u003C/b\u003E\u003C/span\u003E \u2192 IOL power calculation error \u2192 patient ends up \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emore hypermetropic than planned\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESpecial formulae\u003C/b\u003E\u003C/span\u003E (e.g. Barrett True-K, Haigis-L) or historical refractive data should be used.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EOther options:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E1D keratometry error \u2248 1D IOL error, not 1.25D.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-style: italic;\u0022\u003EO\u003C/span\u003Eptical biometry is actually more accurate than ultrasound unless dense cataract blocks signal.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESRK/T tends to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eunderestimate\u003C/b\u003E\u003C/span\u003E IOL power in short eyes, not overestimate.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\uD83E\uDDE0 \u003Cspan class=\u0022s2\u0022\u003E\u003Cb\u003EMemory hook:\u003C/b\u003E\u003C/span\u003E \u003Ci\u003EPost-myopic LASIK = \u201Cflat cornea trap\u201D \u2192 routine K underestimates power \u2192 hyperopic surprise.\u003C/i\u003E\u003Ci\u003E\u003C/i\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 1,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 149,
    "Name": "Nystagmus",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhat is the most important initial step when managing a child with nystagmus?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Efirst step in childhood nystagmus\u003C/b\u003E\u003C/span\u003E is always a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecomprehensive clinical exam\u003C/b\u003E\u003C/span\u003E (history, refraction, anterior and posterior segment assessment, ocular motility).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThis identifies treatable causes like \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eunrecognised refractive error, media opacity, or ocular pathology\u003C/b\u003E\u003C/span\u003E (albinism, aniridia, achromatopsia, retinal dystrophies).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAdditional tests (ERG, VEP, MRI, genetics) are important but \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eguided by clinical findings\u003C/b\u003E\u003C/span\u003E \u2014 not the first step.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 150,
    "Name": "RD",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EA 26-year-old emmetropic male with a history of blunt trauma presents with superior visual field loss. He is found to have an inferior retinal detachment caused by a large retinal dialysis spanning 3 clock hours. What is the most appropriate treatment?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ERetinal dialysis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is a common cause of \u003C/span\u003E\u003Cb\u003Etraumatic retinal detachment\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, usually in \u003C/span\u003E\u003Cb\u003Eyoung phakic patients\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe standard treatment is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Escleral buckling with cryotherapy\u003C/b\u003E\u003C/span\u003E, often combined with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edrainage of subretinal fluid\u003C/b\u003E\u003C/span\u003E for large dialyses.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERadial buckles\u003C/b\u003E\u003C/span\u003E may be used for small anterior dialyses, but \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecircumferential or segmental buckles with drainage\u003C/b\u003E\u003C/span\u003E are preferred for large ones.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EVitrectomy\u003C/b\u003E\u003C/span\u003E is generally reserved for more complex detachments (e.g., posterior breaks, vitreous haemorrhage, proliferative vitreoretinopathy).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 151,
    "Name": "Entropion",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EA 79-year-old patient presents with discomfort from involutional entropion. On examination, there is moderate lid laxity. Which surgical treatment is most likely to have the lowest recurrence rate?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EInvolutional entropion\u003C/b\u003E\u003C/span\u003E is usually due to a combination of:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EHorizontal lid laxity\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOverriding of preseptal orbicularis\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EDisinsertion/weakness of lower lid retractors\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EEverting sutures\u003C/b\u003E\u003C/span\u003E (Quickert sutures) are simple but have a high recurrence rate, especially with lid laxity.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAdding \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elateral lid tightening\u003C/b\u003E\u003C/span\u003E reduces recurrence but does not address orbicularis override.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELid tightening \u002B excision of overriding preseptal orbicularis\u003C/b\u003E\u003C/span\u003E is the most comprehensive approach \u2192 it corrects all the key mechanisms and therefore has the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elowest recurrence rate\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EInferior retractor plication\u003C/b\u003E\u003C/span\u003E can help but is less effective if orbicularis override is not corrected.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 152,
    "Name": "VKC",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhen distinguishing between Atopic Keratoconjunctivitis (AKC) and Vernal Keratoconjunctivitis (VKC), which statement is most accurate?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EAKC\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EChronic, affects young adults (often late teens to 30s).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAssociated with atopic dermatitis, asthma, eczema.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EAffects \u003C/span\u003E\u003Cb\u003Eboth sexes equally\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EMore risk of \u003C/span\u003E\u003Cb\u003Econjunctival and corneal scarring\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E than VKC.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EVKC\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ETypically begins in \u003C/span\u003E\u003Cb\u003Echildhood (first decade of life)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EStrong male predominance.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESeasonal, self-limiting by late teens.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ECharacterised by \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Egiant papillae and thick ropy discharge\u003C/b\u003E\u003C/span\u003E, but less risk of scarring compared to AKC.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 153,
    "Name": "AMD",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EAccording to the latest NICE guidelines for age-related macular degeneration (AMD), which of the following is \u003Cspan class=\u0022s1\u0022\u003ENOT\u003C/span\u003E considered a treatment eligibility criterion?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ENICE criteria for \u003C/span\u003E\u003Cb\u003Eanti-VEGF treatment in wet AMD\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E include:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EBest-corrected vision \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebetween 6/12 and 6/96\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ENo permanent structural damage\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E to the fovea\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESigns of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edisease progression\u003C/b\u003E\u003C/span\u003E (e.g., recent visual deterioration or leakage on imaging)\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECentral macular thickness\u003C/b\u003E\u003C/span\u003E is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot\u003C/b\u003E\u003C/span\u003E part of the NICE eligibility requirements (it is used in diabetic macular oedema, not AMD).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 154,
    "Name": "GPA",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich of the following statements most accurately describes the clinical features of granulomatosis with polyangiitis (Wegener\u2019s granulomatosis)?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOcular involvement in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Egranulomatosis with polyangiitis (GPA)\u003C/b\u003E\u003C/span\u003E occurs in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E~50% of cases\u003C/b\u003E\u003C/span\u003E, not \u0026lt;10% , and orbital involvement in up to 22%.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EOrbital inflammation with adjacent bony destruction\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is a well-recognised manifestation.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOrbital involvement \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecan occur independently\u003C/b\u003E\u003C/span\u003E of sinus disease.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ERenal disease is common, often \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esubclinical in the early stages\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003C/p\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 155,
    "Name": "Anterior uveitis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EIn an eye affected by Fuch\u2019s heterochromic uveitis, which of the following signs is least likely to be present?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EFuch\u2019s heterochromic uveitis (FHU)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is a \u003C/span\u003E\u003Cb\u003Echronic, low-grade anterior uveitis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EClassic signs include:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EFine, diffuse \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Estellate KPs\u003C/b\u003E\u003C/span\u003E across the cornea.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIris atrophy\u003C/b\u003E\u003C/span\u003E leading to heterochromia and transillumination defects.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ELow-grade \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Evitritis\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPosterior synechiae are characteristically absent\u003C/b\u003E\u003C/span\u003E because the inflammation is mild and not sticky, unlike in other uveitides (e.g., HLA-B27).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003C/p\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 12,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 156,
    "Name": "Surgery",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich of the following statements is least accurate regarding Descemet Membrane Endothelial Keratoplasty (DMEK)?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EDMEK\u003C/b\u003E\u003C/span\u003E is the most selective endothelial keratoplasty \u2014 only Descemet\u2019s membrane and endothelium are transplanted.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EIt \u003C/span\u003E\u003Cb\u003Ecan be performed after failed PKP\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E due to endothelial failure.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIt also has the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elowest risk of immunological rejection\u003C/b\u003E\u003C/span\u003E among endothelial keratoplasties.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EGlaucoma drainage tubes make surgery technically more challenging but are \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot an absolute contraindication\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EDonor selection:\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E Studies show that \u003C/span\u003E\u003Cb\u003Eolder donor corneas (up to 75 years)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E perform equally well as younger ones in DMEK, so \u003C/span\u003E\u003Cb\u003Epreferring \u0026lt;40 years is incorrect\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003C/p\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 157,
    "Name": "LSCD",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EIn a \u003Cspan class=\u0022s1\u0022\u003Eunilateral\u003C/span\u003E severe chemical injury with clinical and cytological evidence of \u003Cspan class=\u0022s1\u0022\u003Elimbal stem cell deficiency (LSCD)\u003C/span\u003E (loss of palisades, conjunctivalization with goblet cells), which intervention is the best next step?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EFindings (loss of palisades of Vogt, vascularized scar, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Egoblet cells on impression cytology\u003C/b\u003E\u003C/span\u003E) = \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Econjunctivalization \u2192 LSCD\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIn \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eunilateral LSCD\u003C/b\u003E\u003C/span\u003E, the treatment of choice is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eautologous limbal stem cell transplantation\u003C/b\u003E\u003C/span\u003E from the fellow eye (e.g., CLAU/SLET), often preceded by \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esuperficial keratectomy\u003C/b\u003E\u003C/span\u003E to remove fibrovascular pannus. This restores the corneal epithelial stem cell population so the surface can re-epithelialize normally.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EAmniotic membrane \u002B serum\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E\u0026nbsp;can support healing but \u003C/span\u003E\u003Cb\u003Edoes not replace missing limbal stem cells\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E\u2014insufficient for established LSCD.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPenetrating keratoplasty\u003C/b\u003E\u003C/span\u003E\u0026nbsp;fails without prior restoration of limbal stem cells (the graft epithelium will conjunctivalize).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EKeratoprosthesis\u003C/b\u003E\u003C/span\u003E\u0026nbsp;is a salvage option, typically reserved for \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebilateral\u003C/b\u003E\u003C/span\u003E severe disease or multiple graft failures.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 158,
    "Name": "NNT",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EA study reports a number needed to treat (NNT) of 3.13 for intravitreal ranibizumab (IVR) versus sham to prevent vision loss in neovascular AMD. Which statement best fits that result?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ENNT = 3.13\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E means \u003C/span\u003E\u003Cb\u003Eabout 3 patients must be treated with IVR (instead of sham) for one additional patient to retain vision\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E who otherwise would not have.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOptions \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EC\u003C/b\u003E\u003C/span\u003E and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ED\u003C/b\u003E\u003C/span\u003E incorrectly interpret NNT as a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Erisk ratio/odds ratio\u003C/b\u003E\u003C/span\u003E (they are not).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOption \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EA\u003C/b\u003E\u003C/span\u003E is about \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Etreatment allocation\u003C/b\u003E\u003C/span\u003E, not outcome.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EWhile option \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EB\u003C/b\u003E\u003C/span\u003E is phrased loosely, it most closely reflects the NNT concept (\u22483 treated \u2192 1 extra patient benefits compared with sham).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 11,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 159,
    "Name": "Pupil",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EIn a patient with anisocoria that is more pronounced in bright light, which drug would be most helpful for assessment?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAnisocoria \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eworse in bright light\u003C/b\u003E\u003C/span\u003E suggests the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elarger pupil is abnormal\u003C/b\u003E\u003C/span\u003E (likely due to parasympathetic denervation \u2192 possible Adie\u2019s pupil).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003E0.1% pilocarpine\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (dilute) is used as a \u003C/span\u003E\u003Cb\u003Ediagnostic test\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIn \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAdie\u2019s tonic pupil\u003C/b\u003E\u003C/span\u003E (denervation hypersensitivity), the pupil \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Econstricts\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EA normal pupil does \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot constrict\u003C/b\u003E\u003C/span\u003E with this dilute strength.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E1% pilocarpine\u003C/b\u003E\u003C/span\u003E would constrict both normal and abnormal pupils, so it\u2019s not diagnostic.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPhenylephrine 2.5%\u003C/b\u003E\u003C/span\u003E and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eapraclonidine\u003C/b\u003E\u003C/span\u003E are used for sympathetic pathway disorders (e.g., Horner\u2019s syndrome), not for this situation.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 160,
    "Name": "Anti-histamines",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ENedocromil sodium belongs to which class of drugs?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ENedocromil sodium\u003C/b\u003E\u003C/span\u003E is a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emast cell stabiliser\u003C/b\u003E\u003C/span\u003E, preventing degranulation and release of histamine and other mediators of allergy.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EUsed in \u003C/span\u003E\u003Cb\u003Eallergic conjunctivitis and asthma prophylaxis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIt is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot\u003C/b\u003E\u003C/span\u003E an antihistamine (which blocks histamine receptors), an NSAID (which inhibits cyclooxygenase), or a vasoconstrictor (which reduces redness via vascular action).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 5,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 161,
    "Name": "Investigations",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EWhich of the following statements about optical coherence tomography (OCT) is MOST likely to be true?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EOCT\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is excellent for detecting \u003C/span\u003E\u003Cb\u003Estructural changes\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E such as \u003C/span\u003E\u003Cb\u003Eintraretinal cysts, vitreomacular traction, macular holes, and subretinal fluid\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIn \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Evitreomacular traction\u003C/b\u003E\u003C/span\u003E, cystic spaces can appear on OCT, even though fluorescein angiography may show \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eno leakage\u003C/b\u003E\u003C/span\u003E \u2014 a key diagnostic distinction.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOCT \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecannot reliably differentiate\u003C/b\u003E\u003C/span\u003E between active CNV and fibrosis (angiography or OCTA is required).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIt is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot used alone\u003C/b\u003E\u003C/span\u003E to decide on laser for DMO \u2014 clinical context and angiography are essential.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOCT \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecannot distinguish rhegmatogenous vs exudative RD\u003C/b\u003E\u003C/span\u003E \u2014 that requires clinical exam and other imaging.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 7,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 162,
    "Name": "Drops",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EWhich of the following is the MOST appropriate choice?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBrimonidine\u003C/b\u003E\u003C/span\u003E is contraindicated with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ETCAs\u003C/b\u003E\u003C/span\u003E \u2192 risk of reduced efficacy \u0026amp; systemic side effects.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EDorzolamide\u003C/b\u003E\u003C/span\u003E is contraindicated in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esevere renal impairment\u003C/b\u003E\u003C/span\u003E (CrCl \u0026lt;30 ml/min).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ETimolol\u003C/b\u003E\u003C/span\u003E contraindicated in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Easthma\u003C/b\u003E\u003C/span\u003E \u2192 risk of bronchospasm.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELatanoprost\u003C/b\u003E\u003C/span\u003E is generally safe in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Econtact lens users\u003C/b\u003E\u003C/span\u003E, provided lenses are removed before instillation and reinserted after 15 minutes (to avoid preservative absorption).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 163,
    "Name": "Anti-biotics",
    "Body": "\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EA 25-year-old woman was prescribed oral antibiotics for an infection after attending the eye casualty 2 weeks earlier. She now presents with a skin rash after the use of a sunbed, and she attributes it to the drug. What is the most likely infection for which the patient was prescribed that drug?\u003C/span\u003E",
    "Explanation": "\u003Cdiv\u003E\u003Cul\u003E\u003Cli\u003E\u003Cul\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ECommon ocular reason for doxycycline\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E: \u003Ci\u003EChlamydia trachomatis\u003C/i\u003E conjunctivitis.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBorrelia burgdorferi\u003C/b\u003E\u003C/span\u003E \u2192 Lyme disease, ocular involvement rare, not routine in UK ophthalmology clinics.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPropionibacterium (Cutibacterium) acnes\u003C/b\u003E\u003C/span\u003E \u2192 causes \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Echronic post-cataract endophthalmitis\u003C/b\u003E\u003C/span\u003E, but that would be intraocular, not superficial; managed with intravitreal antibiotics/pars plana vitrectomy, not oral antibiotics.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ETreponema pallidum\u003C/b\u003E\u003C/span\u003E \u2192 syphilis can involve the eye (uveitis, interstitial keratitis, scleritis), and is treated with systemic antibiotics (penicillin, doxycycline if allergic).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EPhotosensitivity rash is \u003C/span\u003E\u003Cb\u003Eclassically associated with doxycycline\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EDoxycycline is used for:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EChlamydia trachomatis (adult inclusion conjunctivitis)\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EOcular rosacea / meibomianitis\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ESyphilis (if penicillin allergic)\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003EBut only \u003Cspan class=\u0022s2\u0022\u003E\u003Cb\u003EChlamydia trachomatis\u003C/b\u003E\u003C/span\u003E is a common reason in an ophthalmology clinic to give oral tetracyclines (especially doxycycline).\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\n\n\n\n\n\n\n\n\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 5,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 164,
    "Name": "Pupil",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA 6-month-old baby is referred with anisocoria. The mother has noticed this for 3 months but is unsure if it was present before then. She comments that the pupils appear unequal most of the time but not always. Which factor would MOST strongly influence the decision to investigate further?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAnisocoria in infants can often be \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ephysiological\u003C/b\u003E\u003C/span\u003E, especially if mild and stable.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ered flag\u003C/b\u003E\u003C/span\u003E is when anisocoria is associated with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eptosis\u003C/b\u003E\u003C/span\u003E, which raises suspicion for \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EHorner\u2019s syndrome\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EHorner\u2019s syndrome in infants may be linked to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eserious underlying causes\u003C/b\u003E\u003C/span\u003E such as \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eneuroblastoma or birth trauma\u003C/b\u003E\u003C/span\u003E \u2192 requires further urgent investigation.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EFamily history, pupil size alone, or variable history are less concerning compared to ptosis.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 165,
    "Name": "General",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EPatients with Body Dysmorphic Disorder (BDD) usually present with several characteristic features. Which of the following is the exception?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBDD is a psychiatric disorder\u003C/b\u003E\u003C/span\u003E, not a disorder of real cosmetic deformity.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPatients are preoccupied with an \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eimagined or minimal flaw\u003C/b\u003E\u003C/span\u003E, often perceived as much worse than reality.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThey often have \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emultiple cosmetic procedures\u003C/b\u003E\u003C/span\u003E but remain dissatisfied.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EFeatures such as \u003C/span\u003E\u003Cb\u003Etype-A personality traits\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and \u003C/span\u003E\u003Cb\u003Eunrealistic expectations\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E are common.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe key point: \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EThe defect is perceived, not real\u003C/b\u003E\u003C/span\u003E \u2192 therefore \u201Ccosmetic body defect\u201D is the exception.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 7,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 166,
    "Name": "Cataract surgery",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EWhich of these drugs is the most effective for inducing miosis during cataract surgery?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EIntracameral acetylcholine (Miochol-E)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is routinely used in cataract surgery to \u003C/span\u003E\u003Cb\u003Eproduce rapid and complete miosis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIt acts \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edirectly on muscarinic receptors\u003C/b\u003E\u003C/span\u003E of the iris sphincter muscle.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMethacholine is not commonly used in surgery.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPhysostigmine is an acetylcholinesterase inhibitor, not a direct surgical miotic.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESuccinylcholine is a neuromuscular blocker for muscle relaxation, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot for intraocular miosis\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003ETherefore, acetylcholine is the drug of choice.\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 1,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 167,
    "Name": "RVO",
    "Body": "\u003Cdiv\u003E\u003Cp class=\u0022MsoNormal\u0022 style=\u0022margin: 0cm; font-size: 12pt; font-family: Aptos, sans-serif; color: rgb(0, 0, 0); letter-spacing: normal;\u0022\u003E\u003Cb\u003EA \u0026nbsp;68 yr old asian woman presented with decreased vision in her right eye that had occurred about 2 weeks previously on waking up. Examination shows relative afferent pupillary defect and a visual acuity of 4/60. After revieweing her macular scans, what would your management be as per the most recent RCOphth guidelines?\u003C/b\u003E\u003Co:p\u003E\u003C/o:p\u003E\u003C/p\u003E\u003C/div\u003E\u003Cimg src=\u0022https://www.mdpi.com/jcm/jcm-12-06710/article_deploy/html/images/jcm-12-06710-g005-550.jpg\u0022\u003E",
    "Explanation": "These features together fit ischemic central retinal vein occlusion (CRVO) with macular oedema.\u0026nbsp;\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003E\u0026nbsp;According to RCOphth guidelines:\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cblockquote style=\u0022margin: 0 0 0 40px; border: none; padding: 0px;\u0022\u003E\u003Cdiv\u003E\u003Cdiv\u003E\u2022\tFirst-line is an anti-VEGF trial (3 injections) for macular oedema secondary to CRVO,\u0026nbsp;\u003C/div\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cdiv\u003E\u2022\tWith close monitoring for neovascular complications, including neovascular glaucoma, since the ischemic CRVO variant has high risk of anterior segment neovascularisation.\u0026nbsp;\u003C/div\u003E\u003C/div\u003E\u003C/blockquote\u003E\u003Cdiv\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-size: x-small;\u0022\u003E\u0026nbsp;Image source:\nKurobe, R.; Hirano, Y.; Yuguchi, T.; Suzuki, N.; Yasukawa, T. Severe Macular Ischemia Is Associated with a Poor Visual Prognosis and Serious Complications in Eyes with Central Retinal Vein Occlusion. J. Clin. Med. 2023, 12, 6710. https://doi.org/10.3390/jcm12216710\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 168,
    "Name": "CIN",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EWhich of the following is the least appropriate treatment option for conjunctival intraepithelial neoplasia (CIN)?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EStandard treatments for CIN include \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esurgical excision with cryotherapy\u003C/b\u003E\u003C/span\u003E and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Etopical chemotherapy\u003C/b\u003E\u003C/span\u003E (e.g., mitomycin C, 5-fluorouracil, or interferon \u03B12b).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThese methods achieve good control and have fewer complications.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EExternal beam radiotherapy is not routinely used\u003C/b\u003E\u003C/span\u003E due to significant risks (limbal stem cell failure, dry eye, secondary malignancy).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003ETherefore, external beam radiotherapy is the least appropriate option.\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 169,
    "Name": "DR",
    "Body": "\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EYou are reviewing a 42-year-old Type I diabetic patient. His visual acuity in both eyes is 6/6. His latest HbA1c was 12% (107 mmol/mol). His OCT scan showed the following findings. Which of the following is the most appropriate treatment?\u003C/span\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cimg src=\u0022/upload-2025-08-31-d9125af9-851d-4dfb-912b-336828384533.png\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003E\u003C/span\u003E\u003C/div\u003E",
    "Explanation": "\u003Cp\u003E\u003Cspan style=\u0022font-family: Arial;\u0022\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003E\u003Cspan style=\u0022color: rgb(51, 51, 51); letter-spacing: normal;\u0022\u003EThe structural OCT shows NVEs presenting as homogenous hyperreflective loops breaching the ILM and protruding into the vitreous with posterior retinal shadowing.\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022color: rgb(51, 51, 51); letter-spacing: normal;\u0022\u003EUsing SD-OCT, NVEs have been proposed to develop in 3 stages:\u0026nbsp;\u003Cbr\u003E\u003C/span\u003E\u003C/span\u003E\u003Cspan style=\u0022color: rgb(51, 51, 51); letter-spacing: normal; font-size: medium;\u0022\u003EI\u2014disruption of ILM\u003Cbr\u003E\u003C/span\u003E\u003Cspan style=\u0022color: rgb(51, 51, 51); letter-spacing: normal; font-size: medium;\u0022\u003EII\u2014horizontal growth along ILM\u003Cbr\u003E\u003C/span\u003E\u003Cspan style=\u0022color: rgb(51, 51, 51); letter-spacing: normal; font-size: medium;\u0022\u003EIII\u2014multiple breach of PH and linear growth\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-family: Arial;\u0022\u003E\u003Cspan style=\u0022color: rgb(51, 51, 51); letter-spacing: normal; font-size: medium;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003E\u003Cspan style=\u0022color: rgb(51, 51, 51); letter-spacing: normal;\u0022\u003ENVEs were also classified according to location\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022color: rgb(51, 51, 51); letter-spacing: normal;\u0022\u003Ebased on their intraretinal component\u003C/span\u003E\u003Cspan style=\u0022color: rgb(51, 51, 51); letter-spacing: normal;\u0022\u003E:\u003Cbr\u003E\u003C/span\u003E\u003C/span\u003E\u003Cspan style=\u0022color: rgb(51, 51, 51); letter-spacing: normal; font-size: medium;\u0022\u003E(1) above the ILM\u003Cbr\u003E\u003C/span\u003E\u003Cspan style=\u0022color: rgb(51, 51, 51); letter-spacing: normal; font-size: medium;\u0022\u003E(2) below the ILM types\u0026nbsp;\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-family: Arial;\u0022\u003E\u003Cspan style=\u0022color: rgb(51, 51, 51); letter-spacing: normal; font-size: medium;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003Cspan style=\u0022color: rgb(51, 51, 51); letter-spacing: normal; font-size: medium;\u0022\u003ENonetheless, most use the histopathology definition of NVE, where a breach of the ILM is a requisite.\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp\u003EOf course, the presence of NVE indicates that this is active proliferative diabetic retinopathy requiring Argon PRP laser treatment.\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA Similar question appeared in a previous FRCOphth written exam.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 170,
    "Name": "AMD",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EAccording to NICE guidance (2008, updated 2012) for wet AMD treatment, which of the following is least likely to be a valid criterion for anti-VEGF therapy?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cbr\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ENICE treatment criteria for wet AMD (anti-VEGF eligibility) include:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EBCVA 6/12\u20136/96\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EAbsence of permanent foveal damage\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EEvidence of recent progression\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELesion size restriction is no longer a criterion\u003C/b\u003E\u003C/span\u003E in NICE guidance, making it the least valid option here.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003ETherefore, the correct answer is: lesion size \u2264 4 disc areas.\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 171,
    "Name": "Surgery",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EWhich clinical finding is most consistent with aqueous misdirection one week after trabeculectomy with a patent peripheral iridotomy?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EAqueous misdirection (malignant glaucoma)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E occurs when aqueous is misdirected posteriorly into/behind the vitreous, causing \u003C/span\u003E\u003Cb\u003Eforward displacement of the lens\u2013iris diaphragm\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EKey clinical triad:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Col start=\u00221\u0022\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EShallow or flat anterior chamber (generalized, not peripheral only)\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ENormal or mildly raised IOP (often ~15\u201320 mmHg, not severely high)\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPatent iridotomy (rules out pupillary block)\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ol\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThis differentiates it from:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPupillary block\u003C/b\u003E\u003C/span\u003E \u2192 high IOP \u002B shallow peripheral AC \u002B closed angle\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EChoroidal detachment\u003C/b\u003E\u003C/span\u003E \u2192 shallow AC \u002B choroidal elevation\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ESimple trabeculectomy failure\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192 raised IOP \u002B deep AC\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003ETherefore, the scenario with shallow anterior chamber and IOP of 18 mmHg best fits aqueous misdirection.\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003ENote:\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EIn \u003C/span\u003E\u003Cb\u003Eaqueous misdirection (malignant glaucoma)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIOP is not always severely raised\u003C/b\u003E\u003C/span\u003E. Multiple authoritative sources (textbooks and reviews) describe it as \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enormal to moderately elevated\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\uD83D\uDD39 \u003C/span\u003E\u003Cb\u003EAAO BCSC: Glaucoma (2023\u201324 edition)\u003C/b\u003E\u003C/p\u003E\u003Cblockquote style=\u0022margin: 0.0px 0.0px 0.0px 15.0px; font: 14.0px \u0027.AppleSystemUIFont\u0027; color: #0e0e0e\u0022\u003E\u201CAqueous misdirection is characterized by a uniformly shallow or flat anterior chamber, a patent iridotomy, and an IOP that may be normal or moderately elevated.\u201D\u003C/blockquote\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\uD83D\uDD39 \u003C/span\u003E\u003Cb\u003EYanoff \u0026amp; Duker, Ophthalmology (5th edition)\u003C/b\u003E\u003C/p\u003E\u003Cblockquote style=\u0022margin: 0.0px 0.0px 0.0px 15.0px; font: 14.0px \u0027.AppleSystemUIFont\u0027; color: #0e0e0e\u0022\u003E\u201CThe intraocular pressure is usually mildly elevated, though it may be normal in some cases. Marked elevation is not typical at presentation.\u201D\u003C/blockquote\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\uD83D\uDD39 \u003C/span\u003E\u003Cb\u003EReview: Malignant Glaucoma: A Review (Eye, 2012)\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\u003C/p\u003E\u003Cblockquote style=\u0022margin-bottom: 0px; margin-left: 15px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; line-height: normal; font-family: \u0026quot;.AppleSystemUIFont\u0026quot;; color: rgb(14, 14, 14);\u0022\u003E\u201CAlthough originally described as \u2018malignant\u2019 because of severe and refractory IOP rise, current descriptions emphasize that the pressure may be normal or only modestly raised, with the predominant sign being uniform shallowing of the anterior chamber.\u201D\u003C/blockquote\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 172,
    "Name": "Consent",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EA 15-year-old girl attends alone requesting squint surgery for a cosmetically troubling consecutive exotropia. According to GMC guidance, what is the most accurate statement regarding the consent process in this case?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIn the UK, patients under 16 can legally consent to treatment if they are assessed as \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGillick competent\u003C/b\u003E\u003C/span\u003E (able to understand the nature, purpose, risks, and benefits of the treatment).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EGMC guidance emphasizes that even if a child is competent, it is good practice to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Einvolve parents or carers\u003C/b\u003E\u003C/span\u003E, unless the young person objects and confidentiality needs to be respected.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EBeing under 18 does \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot\u003C/b\u003E\u003C/span\u003E automatically remove the right to consent if competence is established.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 7,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 173,
    "Name": "Lid Tumors",
    "Body": "\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EA 5 month old boy is brought to your clinic by his parents who noticed a \u0022lump on his eye\u0022. On examination, you see the lesion shown in the photo. What is the MOST likely diagnosis?\u003C/span\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cimg src=\u0022https://d31g6oeq0bzej7.cloudfront.net/Assets/ResizeImages/image/webp/__detail/3c6f257b-d1b3-4245-a6d0-ab07302561d5.webp\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003E\u003C/span\u003E\u003C/div\u003E",
    "Explanation": "\u003Cspan style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal;\u0022\u003ECorneal dermoids are solid (not cystic) choristomas with surface epithelium resembling epidermis and dermis, often containing collagenous connective tissue, hair, skin, fat, and sebaceous glands on histology. Grossly, they are elevated, opaque, yellow-white masses often localized to the corneal limbus.\u003C/span\u003E\u003Cdiv\u003E\u003Cspan style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal;\u0022\u003EThe diagnosis of a corneal dermoid is largely clinical. Biopsy is generally not necessary. However, if surgical removal of the lesion is pursued, histopathology can confirm the diagnosis.\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Ch2 style=\u0022color: rgb(0, 0, 0); padding-top: 0.5em; padding-bottom: 0.17em; overflow: hidden; font-size: calc(1.2625rem \u002B 0.15vw); font-family: \u0026quot;Gotham SSm A\u0026quot;; letter-spacing: -0.5px; margin-bottom: 0px !important; border-style: initial !important; border-color: initial !important; border-image: initial !important; border-radius: 0px !important;\u0022\u003E\u003Cspan class=\u0022mw-headline\u0022 id=\u0022Risk_Factors_\u0026amp;_Associated_Conditions\u0022 style=\u0022border-radius: 0px !important;\u0022\u003EAssociated Conditions:\u003C/span\u003E\u003C/h2\u003E\u003Cp style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal; border-radius: 0px !important;\u0022\u003E\u003Cul\u003E\u003Cli\u003E\u003Cspan style=\u0022color: rgb(0, 0, 0); font-family: \u0026quot;Gotham SSm A\u0026quot;; font-size: 1.125rem; letter-spacing: -0.5px;\u0022\u003EGoldenhar syndrome\u003C/span\u003E\u003C/li\u003E\u003Cli\u003E\u003Cspan style=\u0022color: rgb(0, 0, 0); font-family: \u0026quot;Gotham SSm A\u0026quot;; font-size: 1.125rem; letter-spacing: -0.5px;\u0022\u003ERing dermoid syndrome\u003C/span\u003E\u003C/li\u003E\u003Cli\u003E\u003Cspan style=\u0022color: rgb(0, 0, 0); font-family: \u0026quot;Gotham SSm A\u0026quot;; font-size: 1.125rem; letter-spacing: -0.5px;\u0022\u003EEpidermal nevus syndromes\u003C/span\u003E\u003C/li\u003E\u003C/ul\u003E\u003C/p\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal;\u0022\u003EIn the case of\u0026nbsp;\u003C/span\u003E\u003Ca href=\u0022https://eyewiki.org/Goldenhar_Syndrome\u0022 title=\u0022Goldenhar Syndrome\u0022 style=\u0022color: rgb(62, 135, 203); background-image: none; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial; font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal; border-radius: 0px !important;\u0022\u003EGoldenhar syndrome\u003C/a\u003E\u003Cspan style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal;\u0022\u003E, head and neck examination may reveal periauricular tragi, microtia or anotia of external ear, hearing loss, low implantation of the auricular pavilion, micrognathia, or mandibular hypoplasia. Vertebral anomalies are also common, such as scoliosis and hemivertebrae. Congenital heart disease and central nervous system abnormalities have also been reported.\u003C/span\u003E\u003Cspan style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal;\u0022\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal; font-weight: bold; text-decoration-line: underline;\u0022\u003ECorneal dermoids have been traditionally classified into three grades:\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal;\u0022\u003EGrade I : superficial lesions \u0026lt;5mm and localized to the limbus.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal;\u0022\u003EGrade II: larger lesions covering most of the cornea and extending deep into the stroma down to Descemet membrane without involving it.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal;\u0022\u003EGrade III: large lesions covering the whole cornea and extending through the structures between the anterior surface of the eye and the pigmented epithelium of the iris.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cp style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal; border-radius: 0px !important;\u0022\u003E\u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003EA comprehensive review of the literature by Pirouzian generated the following management recommendations:\u003C/span\u003E\u003C/p\u003E\u003Cul style=\u0022margin-top: 0.3em; margin-bottom: 0px; margin-left: 1.6em; padding-left: 0px; list-style-position: outside; list-style-image: url(\u0026quot;data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAAYAAAAJCAYAAAARml2dAAAABHNCSVQICAgIfAhkiAAAAAlwSFlzAAAN1wAADdcBQiibeAAAABl0RVh0U29mdHdhcmUAd3d3Lmlua3NjYXBlLm9yZ5vuPBoAAABUSURBVAiZdY4xDsAgFELB2J0DdnbwQI5OHvDfgC62SY0yvhAetI1dWEq5JN0kKwDYbhEx8oT9a5JdEtLb/M2QNW0FAJLttkLbLUfEkIRVztPdo\u002BMBm8UkW9Zxc20AAAAASUVORK5CYII=\u0026quot;); color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal; border-radius: 0px !important;\u0022\u003E\u003Cli style=\u0022margin-bottom: 0.1em; border-radius: 0px !important;\u0022\u003EGrade I, \u0026lt;50 \u03BCm thickness and \u0026lt;1 mm diameter*: simple excision\u003C/li\u003E\u003Cli style=\u0022margin-bottom: 0.1em; border-radius: 0px !important;\u0022\u003EGrade I, \u0026lt;100 \u03BCm thickness and \u0026lt;1 mm diameter*: keratectomy \u002B amniotic membrane transplantation \u002B autologous limbal stem cell allograft\u003C/li\u003E\u003Cli style=\u0022margin-bottom: 0.1em; border-radius: 0px !important;\u0022\u003EGrade II and deeper Grade I: keratectomy \u002B amniotic membrane transplantation \u002B limbal stem cell allograft \u002B pericardial patch graft versus anterior or deep anterior lamellar keratoplasty \u00B1 amniotic membrane transplantation\u003C/li\u003E\u003Cli style=\u0022margin-bottom: 0.1em; border-radius: 0px !important;\u0022\u003EGrade III: total anterior segment reconstruction\u003C/li\u003E\u003C/ul\u003E\u003Cp style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal; border-radius: 0px !important;\u0022\u003E*Corneal dermoids of such small size were rarely observed in our clinical practice.\u003C/p\u003E\u003Cp style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal; border-radius: 0px !important;\u0022\u003EAdditionally, optical iridectomy is frequently needed in staged surgical management to permit visual development in the absence of clear cornea.\u003C/p\u003E\u003Cp style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal; border-radius: 0px !important;\u0022\u003ESource:\u0026nbsp;\u003Ca href=\u0022https://eyewiki.org/Corneal_Dermoid\u0022 style=\u0022font-family: Roboto, Helvetica, Arial, \u0026quot;sans-serif\u0026quot;; letter-spacing: 0.14994px;\u0022\u003EEyeWiki\u003C/a\u003E\u003C/p\u003E\u003Cp style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal; border-radius: 0px !important;\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 174,
    "Name": "Intermediate uveitis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EA 41-year-old woman with known sarcoidosis presents with vision of 6/24 in her right eye and clinical signs of intermediate uveitis. The left eye has normal vision (6/6) and appears normal on examination. What is the most likely cause of visual loss in her right eye?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EIn \u003C/span\u003E\u003Cb\u003Esarcoid-related intermediate uveitis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, the \u003C/span\u003E\u003Cb\u003Emost common cause of vision loss is cystoid macular oedema (CMO)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ELess common causes include choroidal granulomas or CNV, but these are not the primary mechanisms of visual loss.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMacular ischaemia is also less typical in sarcoid compared to diabetic or vascular uveitis.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ETherefore, macular oedema is the key complication to suspect when visual acuity drops.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 12,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 175,
    "Name": "Sarcoidosis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EA 42-year-old woman with erythema nodosum, interstitial nephritis, bilateral lung nodules, and bilateral hilar lymphadenopathy presents with gradual visual loss and mild ocular pain for 2 months. Visual acuity is LogMAR 0.48 in the right eye and 0.30 in the left. Which of the following is \u003Cspan class=\u0022s1\u0022\u003Eleast likely\u003C/span\u003E to be an ocular feature of her systemic condition?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThis case describes \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esarcoidosis\u003C/b\u003E\u003C/span\u003E, which can affect multiple organs and cause ocular inflammation.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ETypical ocular features include \u003C/span\u003E\u003Cb\u003Egranulomatous anterior uveitis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, \u003C/span\u003E\u003Cb\u003Echorioretinal lesions\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, and \u003C/span\u003E\u003Cb\u003Eoptic nerve or choroidal granulomas\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ERetinal vasculitis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E can occur in sarcoid, but it is usually \u003C/span\u003E\u003Cb\u003Evenous (phlebitis)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E rather than \u003C/span\u003E\u003Cb\u003Esevere retinal arteritis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESevere retinal arteritis is more characteristic of conditions like \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBeh\u00E7et\u2019s disease\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 12,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 176,
    "Name": "Scleritis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EA 64-year-old woman with rheumatoid arthritis on methotrexate presents to the Eye ED with severe pain and redness in her left eye for three days. She had a similar episode in the right eye 10 years ago. Examination reveals diffuse anterior scleritis in the left eye. Which is the most appropriate next step?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThe patient already has a \u003C/span\u003E\u003Cb\u003Econfirmed diagnosis of rheumatoid arthritis (RA)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EHer current presentation (scleritis) is a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eknown complication of RA\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAdditional autoimmune screening (ANCA, anti-dsDNA, RF) is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot necessary\u003C/b\u003E\u003C/span\u003E because the systemic cause is already established.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EManagement should focus on \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Etreating the scleritis\u003C/b\u003E\u003C/span\u003E (e.g., systemic immunosuppression if needed) rather than repeating investigations.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 12,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 177,
    "Name": "Anti-epileptics",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich of the following medications is most commonly associated with binasal concentric visual field loss as a side effect?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EVigabatrin (used in epilepsy, especially infantile spasms) can cause \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eirreversible concentric visual field constriction\u003C/b\u003E\u003C/span\u003E, often \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebinasal in distribution\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe mechanism involves \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGABA toxicity to retinal cells\u003C/b\u003E\u003C/span\u003E, particularly affecting the nasal retina.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EOther options:\u003C/span\u003E\u003C/div\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EChloroquine \u2192 macular \u201Cbull\u2019s eye\u201D retinopathy.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EChlorpromazine \u2192 pigmentary retinopathy, corneal deposits.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ETamoxifen \u2192 crystalline retinopathy, macular changes.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 5,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 178,
    "Name": "Esotropia",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EA 4-year-old boy has a 4-month history of a convergent squint. His unaided visual acuity is 0.00 LogMAR in the right eye and 0.12 in the left eye. Examination shows \u003Cspan class=\u0022s1\u0022\u003E40 prism dioptres of esotropia at near\u003C/span\u003E and \u003Cspan class=\u0022s1\u0022\u003E20 prism dioptres at distance\u003C/span\u003E. Worth lights demonstrate left eye suppression. Cycloplegic refraction is \u002B4.75D in the right eye and \u002B5.00D in the left eye. Fundus is normal.\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022font-size: medium; font-weight: bold; letter-spacing: 0.14994px;\u0022\u003EWhat is the MOST likely diagnosis?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EChild is hypermetropic (\u002B4.75D, \u002B5.00D) \u2192 strong accommodative drive.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ESquint is \u003C/span\u003E\u003Cb\u003Egreater at near (40\u0394) than distance (20\u0394)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192 typical of \u003C/span\u003E\u003Cb\u003Econvergence excess type\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESuppression in the left eye confirms reduced binocular control.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ENot non-accommodative esotropia (since refractive error explains it).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ENot nystagmus blockage (no nystagmus mentioned).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 179,
    "Name": "Albinism",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EIn which way is oculocutaneous albinism MOST likely to be inherited?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOculocutaneous albinism (OCA)\u003C/b\u003E\u003C/span\u003E is caused by mutations in genes affecting melanin biosynthesis (e.g., TYR, OCA2, TYRP1, SLC45A2).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EIt is \u003C/span\u003E\u003Cb\u003Emost commonly inherited in an autosomal recessive manner\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ECarriers are asymptomatic, but when both parents pass on the defective gene, the child manifests OCA.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EX-linked inheritance patterns are associated with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eocular albinism\u003C/b\u003E\u003C/span\u003E, not oculocutaneous albinism.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 180,
    "Name": "Contracts",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EAt your first job plan as a consultant, the manager asks you to do 15 lists per year to cover colleagues\u2019 holidays on a flexible annual basis. What PA allocation should you receive in your contract?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EIn NHS consultant contracts, \u003C/span\u003E\u003Cb\u003E1 PA (Programmed Activity) = 4 hours of work per week\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, across the year.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EA typical year has \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E42 working weeks\u003C/b\u003E\u003C/span\u003E (allowing for leave).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ETherefore, \u003C/span\u003E\u003Cb\u003E1 list/week = 42 lists/year = 1 PA\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EFor \u003C/span\u003E\u003Cb\u003E15 lists/year \u2192 15 \u00F7 42 = 0.36 PA\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 7,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 181,
    "Name": "Fourth Nerve Palsy",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich of the following surgical techniques would be MOST appropriate when aiming to correct the torsional component of a bilateral IV (trochlear) nerve paresis?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esuperior oblique muscle\u003C/b\u003E\u003C/span\u003E provides \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eintorsion\u003C/b\u003E\u003C/span\u003E, especially through its anterior fibres.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIn \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebilateral trochlear nerve palsy\u003C/b\u003E\u003C/span\u003E, patients often develop \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Etorsional diplopia\u003C/b\u003E\u003C/span\u003E due to loss of intorsion.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESurgical correction aims to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Erestore intorsional action\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAdvancing the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eanterior fibres\u003C/b\u003E\u003C/span\u003E of the superior oblique tendon specifically \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eenhances intorsion\u003C/b\u003E\u003C/span\u003E without excessively affecting vertical action.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOther listed procedures either weaken the wrong muscles or address vertical deviations rather than torsion.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 182,
    "Name": "Dystonias",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EIn patients with hemifacial spasm, which artery is the most common site of an aneurysm causing compression of the facial nerve root entry zone?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EHemifacial spasm is most often due to \u003C/span\u003E\u003Cb\u003Evascular compression at the root entry zone of the facial nerve\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eposterior inferior cerebellar artery (PICA)\u003C/b\u003E\u003C/span\u003E is the vessel most frequently responsible.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe anterior inferior cerebellar artery (AICA) can occasionally be involved, but other arteries such as the carotid or basilar tip are not typical causes.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 183,
    "Name": "Dystonias",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich of the following statements about hemifacial spasm (HFS) is true?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EHemifacial spasm is usually due to \u003C/span\u003E\u003Cb\u003Evascular compression of the facial nerve root entry zone\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThe most frequent culprit is the \u003C/span\u003E\u003Cb\u003Eposterior inferior cerebellar artery (PICA)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIt is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emore common in women\u003C/b\u003E\u003C/span\u003E (so option \u201Cmore common in men\u201D is incorrect).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIt affects the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eipsilateral facial nerve\u003C/b\u003E\u003C/span\u003E, not the contralateral.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIt often presents in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emiddle age\u003C/b\u003E\u003C/span\u003E, not just in the 70\u201380 age group.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 184,
    "Name": "RD",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EIn the context of a giant retinal break, which statement is most accurate?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EGiant retinal tears are \u003C/span\u003E\u003Cb\u003Efull-thickness circumferential retinal breaks\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E extending \u0026gt;90\u00B0.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe key feature is that the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Evitreous is still attached to the posterior edge\u003C/b\u003E\u003C/span\u003E \u2192 this causes the retina to roll over and invert.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ESatellite breaks are common\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (so \u201Cuncommon\u201D is wrong).\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPVR develops but not always rapidly\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ETrauma is a risk factor, but many are \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Espontaneous (e.g., in myopes, lattice degeneration)\u003C/b\u003E\u003C/span\u003E, so trauma is not the main cause.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 185,
    "Name": "Trauma",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EA 40-year-old man sustained a right upper lid injury which was surgically repaired. Six weeks later, he presents with right-sided ptosis. His marginal reflex distance (MRD1) is 1 mm on the right (compared to 4 mm on the left). Levator function in the right eye is measured at 5 mm. What is the most appropriate next step in management?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThis patient has \u003C/span\u003E\u003Cb\u003Etraumatic ptosis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E with \u003C/span\u003E\u003Cb\u003Efair levator function (5 mm)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESix weeks is still \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Etoo early for definitive surgery\u003C/b\u003E\u003C/span\u003E \u2014 levator function may recover spontaneously over a few months.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOrbital imaging is not indicated unless there are atypical features (e.g., suspicion of fracture or foreign body).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ELevator resection or brow suspension are surgical interventions, but only considered if the ptosis is persistent after a sufficient recovery period (usually \u22656 months).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 13,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 186,
    "Name": "White Dot syndromes",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EA 23-year-old myopic woman has 4 weeks of photopsia and 1 week of metamorphopsia in the right eye. Fundus shows multiple small round lesions (~\u2153 disc diameter) in the posterior pole. Fluorescein angiography reveals a choroidal neovascular membrane next to one lesion. What is the MOST likely diagnosis?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPIC\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E classically affects \u003C/span\u003E\u003Cb\u003Eyoung myopic women\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E with \u003C/span\u003E\u003Cb\u003Emultiple small (100\u2013300 \u03BCm) yellow-white lesions in the posterior pole\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and has a \u003C/span\u003E\u003Cb\u003Ehigh risk of CNV\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E\u2014fits the vignette.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBirdshot\u003C/b\u003E\u003C/span\u003E: middle-aged, HLA-A29\u002B, numerous cream spots in mid-periphery, not tiny posterior-pole dots.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAPMPPE\u003C/b\u003E\u003C/span\u003E: larger placoid RPE lesions, often after viral prodrome; CNV is uncommon.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EToxoplasma\u003C/b\u003E\u003C/span\u003E: focal retinochoroiditis with vitritis (\u201Cheadlight in fog\u201D) and old scars.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 12,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 187,
    "Name": "Hereditaty vitreoretinopathies",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EAn 11-year-old boy presents with vision of 6/6 in the right eye and 6/18 in the left, plus intermittent left exotropia. On examination:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022font-weight: bold; font-size: medium;\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003ESubtle peripheral vascular changes in the right eye\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003ELeft eye: macula dragged inferotemporally, associated retinal fold, mild neovascularisation, and subretinal exudates\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003ERest of ocular exam normal\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EWhat is the MOST likely diagnosis?\u003C/b\u003E\u003C/p\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EFEVR\u003C/b\u003E\u003C/span\u003E: Bilateral (though asymmetric) peripheral avascular retina, macular dragging, retinal folds, neovascularisation, and exudation in children/teens.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECoats disease\u003C/b\u003E\u003C/span\u003E: Usually unilateral, marked telangiectasia, heavy exudation, no macular dragging.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ENorrie disease\u003C/b\u003E\u003C/span\u003E: Presents in infancy with congenital blindness, not at age 11 with useful vision.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPersistent fetal vasculature\u003C/b\u003E\u003C/span\u003E: Unilateral, microphthalmia, retrolental membrane\u2014present early in life.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 188,
    "Name": "Retinoschisis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich of the following pathologic conditions is \u003Cspan class=\u0022s1\u0022\u003ELEAST likely\u003C/span\u003E to be associated with pathologic axial myopia?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPathologic myopia often leads to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emyopic foveoschisis\u003C/b\u003E\u003C/span\u003E, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emacular holes\u003C/b\u003E\u003C/span\u003E, and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Evitreomacular traction\u003C/b\u003E\u003C/span\u003E due to progressive posterior staphyloma and vitreoretinal interface abnormalities.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPeripheral retinoschisis\u003C/b\u003E\u003C/span\u003E, however, is usually related to age-related vitreoretinal degeneration (common in older hyperopes), not high/pathologic myopia.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 189,
    "Name": "Cataract surgery",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich one of the following statements in regards to phacoemulsification machines is \u003Cspan class=\u0022s1\u0022\u003EMOST likely\u003C/span\u003E to be correct?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPeristaltic system\u003C/b\u003E\u003C/span\u003E: Flow depends on pump speed, not infusion pressure.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EVenturi system\u003C/b\u003E\u003C/span\u003E: Vacuum is present immediately (not only after occlusion).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPiezoelectric crystals\u003C/b\u003E\u003C/span\u003E: Vibrate with alternating current (AC), not DC.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPulse/burst mode\u003C/b\u003E\u003C/span\u003E: Reduces cumulative ultrasound energy, limiting \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eheat generation\u003C/b\u003E\u003C/span\u003E in the anterior chamber and decreasing risk of corneal endothelial damage.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 1,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 190,
    "Name": "Congenital Glaucoma",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich of the following statements \u003Cspan class=\u0022s1\u0022\u003EBEST\u003C/span\u003E describes the inheritance of primary congenital glaucoma in the UK?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIn the UK, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eprimary congenital glaucoma\u003C/b\u003E\u003C/span\u003E is usually \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esporadic\u003C/b\u003E\u003C/span\u003E, without a clear family history.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESome cases are inherited in an \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eautosomal recessive\u003C/b\u003E\u003C/span\u003E pattern, often linked to CYP1B1 mutations, but this is more common in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Econsanguineous populations\u003C/b\u003E\u003C/span\u003E (e.g., Middle East, South Asia).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAutosomal dominant inheritance is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Erare\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EMost UK cases are sporadic.\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 191,
    "Name": "Intra-ocular tumors",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EA tumour is reported histologically as being comprised of tubules and acini formed by proliferating multilayered small cells. The cells form a lace-like network within a mucoid stroma. Occasional rosette-like structures are also seen. What is the MOST likely histological diagnosis?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMedulloepithelioma\u003C/b\u003E\u003C/span\u003E is a rare intraocular tumour (usually ciliary body) that shows:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ETubules and acini lined by multilayered neuroepithelial cells\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EA \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elace-like network\u003C/b\u003E\u003C/span\u003E in a mucoid stroma\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPresence of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Erosette-like structures\u003C/b\u003E\u003C/span\u003E, which are neuroectodermal features\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ERetinoblastoma also shows rosettes (Flexner-Wintersteiner, Homer Wright), but the description of tubules, acini, and mucoid stroma is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eclassic for medulloepithelioma\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EBasal cell carcinoma and sebaceous carcinoma do not show this histological pattern.\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 192,
    "Name": "Studies",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-size: medium; font-weight: bold;\u0022\u003EWhich of the following statements is\u0026nbsp;\u003Cspan class=\u0022s1\u0022\u003ENOT\u003C/span\u003E a finding from the LIGHT study?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELIGHT trial\u003C/b\u003E\u003C/span\u003E (Laser in Glaucoma and Ocular Hypertension Trial) compared selective laser trabeculoplasty (SLT) with eye drops as first-line treatment for open-angle glaucoma and ocular hypertension.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EKey findings:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESLT was \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eas effective as drops\u003C/b\u003E\u003C/span\u003E in controlling IOP at 36 months (\u224895% laser vs \u224893% drops).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EQuality of life (EQ-5D)\u003C/b\u003E\u003C/span\u003E scores were similar between groups.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EEvent rates\u003C/b\u003E\u003C/span\u003E (e.g., need for surgery, disease progression) were lower in the SLT group (4.19 vs 7.97 per 1000 eye-years).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EHerpes simplex keratitis and uveitis\u003C/b\u003E\u003C/span\u003E were not reported outcomes in the LiGHT study \u2014 making this statement incorrect.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 193,
    "Name": "Endophthalmitis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EA 67-year-old man with no other medical problems presents to the eye casualty with \u003Cspan class=\u0022s1\u0022\u003Eacute endophthalmitis. He underwent cataract surgery\u003C/span\u003E\u0026nbsp;four days ago, which was uneventful. His visual acuity on presentation is counting fingers. Which of these statements is \u003Cspan class=\u0022s1\u0022\u003EMOST likely to be correct\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EEndophthalmitis Vitrectomy Study (EVS)\u003C/b\u003E\u003C/span\u003E is the landmark trial guiding management of postoperative acute endophthalmitis.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EEVS found:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EFor patients with presenting VA of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehand movements or better\u003C/b\u003E\u003C/span\u003E, outcomes with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Evitreous tap/inject\u003C/b\u003E\u003C/span\u003E were comparable to immediate vitrectomy.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EVitrectomy only showed benefit when presenting VA was \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elight perception\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EIn LP vision, vitrectomy produced a 3x increase in achieving 6/12 or better (33% vs 11%) \u0026amp; 50% decrease in severe visual loss (20% vs 47%) over TAP.\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E\u03B2-haemolytic streptococci\u003C/b\u003E\u003C/span\u003E \u2192 poor prognosis, not good.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIntravitreal steroids\u003C/b\u003E\u003C/span\u003E are \u003Ci\u003Enot\u003C/i\u003E routinely recommended.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPropionibacterium acnes (Cutibacterium acnes)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is linked to \u003C/span\u003E\u003Cb\u003Echronic delayed-onset endophthalmitis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, not acute cases.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 1,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 194,
    "Name": "Pupil",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich of the following features is \u003Cspan class=\u0022s1\u0022\u003EMOST likely to be true\u003C/span\u003E regarding a pupil affected by \u003Cspan class=\u0022s1\u0022\u003EHorner\u2019s syndrome\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EHorner\u2019s syndrome \u2192 disruption of the sympathetic pathway \u2192 affected pupil is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esmaller\u003C/b\u003E\u003C/span\u003E (miosis), especially in dim light.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EWith chronic denervation, the iris dilator muscle develops \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edenervation hypersensitivity\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EApraclonidine\u003C/b\u003E\u003C/span\u003E (a weak alpha-1 agonist) usually has minimal effect in a normal pupil, but in Horner\u2019s it causes \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edilation\u003C/b\u003E\u003C/span\u003E due to upregulated alpha-1 receptors.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOther options are incorrect:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EAnisocoria is greater in darkness\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, not unchanged.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EApraclonidine causes \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edilation\u003C/b\u003E\u003C/span\u003E, not constriction.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPhenylephrine 1% may dilate a Horner\u2019s pupil (denervation hypersensitivity), but this is not paradoxical.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 195,
    "Name": "AMD",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EA 60-year-old diabetic female patient presents with 6/18 BCVA in her left eye. Fundus exam shows fine crystalline deposits and retinal pigment epithelium hyperplasia temporal to the fovea. A macular OCT is shown. Which of the following is \u003Cspan class=\u0022s1\u0022\u003Eyour next step in her management\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cimg src=\u0022/upload-2025-09-06-bdcc809e-8e16-4b7f-aefb-6ca7920f174e.png\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EClassic MacTel features include:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EBilateral parafoveal involvement (often asymmetric at presentation)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECrystalline deposits\u003C/b\u003E\u003C/span\u003E at the inner retina\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPigment hyperplasia temporal to the fovea\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOCT showing \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehyporeflective spaces (\u201Cpseudo-cysts\u201D)\u003C/b\u003E\u003C/span\u003E without true retinal thickening or leakage (unlike diabetic macular edema).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EVisual acuity is often reduced (like 6/18 in this case).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe key giveaway is the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecrystalline deposits \u002B temporal pigment changes\u003C/b\u003E\u003C/span\u003E \u2192 highly characteristic of MacTel.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EManagement:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EObservation\u003C/b\u003E\u003C/span\u003E if no neovascular proliferation\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAnti-VEGF\u003C/b\u003E\u003C/span\u003E only if subretinal neovascularization develops\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\n\n\n\n\n\n\n\n\n\n\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\uD83D\uDC49 In this vignette: The correct next step is \u003Cspan class=\u0022s2\u0022\u003E\u003Cb\u003EObservation\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\n\n\n\n\n\n\n\n\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 196,
    "Name": "Visual pathway",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EIn a right-handed individual with a glioma in the \u003Cspan class=\u0022s1\u0022\u003Eleft occipito-temporal region\u003C/span\u003E, which clinical feature would be most expected?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eleft occipito-temporal region\u003C/b\u003E\u003C/span\u003E in a right-handed person corresponds to the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elanguage-dominant hemisphere\u003C/b\u003E\u003C/span\u003E (left hemisphere).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ELesions here can disrupt the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Evisual word form area\u003C/b\u003E\u003C/span\u003E \u2192 causing \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehemianopic alexia\u003C/b\u003E\u003C/span\u003E (also known as \u201Cpure alexia\u201D).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022color: rgb(71, 71, 71); font-family: Arial, sans-serif; letter-spacing: normal;\u0022\u003EThe visual word form area (VWFA) is\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022font-weight: bold; color: rgb(118, 118, 118); font-family: Arial, sans-serif; letter-spacing: normal;\u0022\u003Ea functional region of the left fusiform gyrus and surrounding cortex\u003C/span\u003E\u003Cspan style=\u0022color: rgb(71, 71, 71); font-family: Arial, sans-serif; letter-spacing: normal;\u0022\u003E\u0026nbsp;(right-hand side being part of the fusiform face area)\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe patient typically has a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eright homonymous hemianopia\u003C/b\u003E\u003C/span\u003E but with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Especific inability to read\u003C/b\u003E\u003C/span\u003E, while other language functions remain intact.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOther options explained:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EFixed dilated pupil\u003C/b\u003E\u003C/span\u003E \u2192 suggests CN III palsy, not occipito-temporal lesion.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELeft homonymous hemianopia\u003C/b\u003E\u003C/span\u003E \u2192 incorrect side; lesion in left occipital lobe causes \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eright homonymous hemianopia\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESee-saw nystagmus\u003C/b\u003E\u003C/span\u003E \u2192 associated with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ediencephalic/chiasmal lesions\u003C/b\u003E\u003C/span\u003E, not occipito-temporal gliomas.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p2\u0022\u003E\u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003ENotes about hemianopic alexia:\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p2\u0022\u003E\u003Cul\u003E\u003Cli\u003EHemianopic alexia is the most peripheral of the alexias and also the most common. It particularly affects patients with macular-splitting hemianopias.\u0026nbsp;\u003C/li\u003E\u003Cli\u003E\u0026nbsp;It is caused by a hemianopia that mildly interferes with single-word reading but has its main impact on upon text reading.\u0026nbsp;\u003C/li\u003E\u003Cli\u003EThis is because the visuomotor system is robbed of visual information away from the point of fixation that it requires in order to plan efficient reading eye movements.\u0026nbsp;\u003C/li\u003E\u003Cli\u003Ereaders of left-to-right scripts, a right-sided hemianopia is more disabling than a left-sided one\u0026nbsp;\u003C/li\u003E\u003Cli\u003E\u0026nbsp;The Read-Right therapy consisted of reading laterally scrolling text (from right-to-left), to induce small-field OKN.\u0026nbsp;\u003C/li\u003E\u003Cli\u003EMost cases of alexia without agraphia are due to cerebrovascular accidents from thromobotic or thromboembolic disease involving the left posterior cerebral artery (PCA), which results in an infarct of the left occipital cortex and the splenium of the corpus callosum\u003C/li\u003E\u003C/ul\u003E\u003C/p\u003E\u003Cp class=\u0022p2\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 197,
    "Name": "Side effects",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following is \u003Cspan class=\u0022s1\u0022\u003ENOT\u003C/span\u003E a recognised ocular side effect of systemic drug use?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBisphosphonates\u003C/b\u003E\u003C/span\u003E \u2192 can cause ocular inflammation (episcleritis, scleritis, uveitis).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ETopiramate\u003C/b\u003E\u003C/span\u003E \u2192 known to cause \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Euveal effusion\u003C/b\u003E\u003C/span\u003E, angle closure glaucoma.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EVitamin A\u003C/b\u003E\u003C/span\u003E (in excess) \u2192 can lead to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ekeratopathy\u003C/b\u003E\u003C/span\u003E and even papilloedema due to toxicity.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMinocycline\u003C/b\u003E\u003C/span\u003E \u2192 associated with pigmentation (skin, sclera, conjunctiva), not papilloedema. Papilloedema is linked more to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Etetracyclines like doxycycline\u003C/b\u003E\u003C/span\u003E and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Evitamin A derivatives (isotretinoin)\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p2\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p2\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 5,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 198,
    "Name": "Anti-viral",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EA 73-year-old man with \u003Cspan class=\u0022s1\u0022\u003Eacute retinal necrosis\u003C/span\u003E is started on \u003Cspan class=\u0022s1\u0022\u003Ehigh-dose acyclovir\u003C/span\u003E. He is NPO and dehydrated before surgery, then quickly becomes unwell. \u003C/span\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EWhich renal complication is most likely?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EHigh-dose IV acyclovir \u002B dehydration\u003C/b\u003E\u003C/span\u003E \u2192 intratubular precipitation of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eacyclovir crystals\u003C/b\u003E\u003C/span\u003E \u2192 \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eacute kidney injury\u003C/b\u003E\u003C/span\u003E within 24\u201348 h (crystal-induced acute tubular obstruction).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ERisk is highest with \u003C/span\u003E\u003Cb\u003Erapid infusion, inadequate hydration, pre-existing renal impairment\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EManifests with a rapid rise in creatinine and reduced urine output; prevention is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eslow infusion and vigorous IV hydration\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMesangiocapillary nephritis and nephrotic syndrome are \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot typical\u003C/b\u003E\u003C/span\u003E acute toxicities of acyclovir; UTI does not explain the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esudden\u003C/b\u003E\u003C/span\u003E decline immediately after high-dose therapy.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 5,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 199,
    "Name": "Conjunctival lesions",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EA 40-year-old woman from Ethiopia presents with small (\u0026lt;1 mm) depressions at the peripheral cornea near the limbus, consistent with \u003Cspan class=\u0022s1\u0022\u003EHerbert\u2019s pits\u003C/span\u003E. Which microbiological description of the causative organism is most likely linked to this finding?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EHerbert\u2019s pits are a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epathognomonic sign of trachoma\u003C/b\u003E\u003C/span\u003E, seen after resolution of limbal follicles.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ETrachoma is caused by \u003C/span\u003E\u003Cb\u003EChlamydia trachomatis (serotypes A\u2013C)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOn histology, the hallmark is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebasophilic intra-cytoplasmic epithelial inclusion bodies\u003C/b\u003E\u003C/span\u003E (seen in conjunctival epithelial cells).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EGram staining would not reveal typical cocci or rods because \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EC. trachomatis is an obligate intracellular bacterium\u003C/b\u003E\u003C/span\u003E, not detectable by routine Gram stain.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 200,
    "Name": "Refractive",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-size: medium; font-weight: bold;\u0022\u003EA 28-year-old female patient, hours after a \u003Cspan class=\u0022s1\u0022\u003Ephakic IOL\u003C/span\u003E procedure for high myopia, presents with severe left-eye pain, CF vision, and \u003Cspan class=\u0022s1\u0022\u003EIOP 61 mmHg\u003C/span\u003E. What is the \u003Cspan class=\u0022s1\u0022\u003Ebest immediate\u003C/span\u003E treatment?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPhakic IOLs (e.g., ICL) can cause \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epupillary-block acute angle closure\u003C/b\u003E\u003C/span\u003E soon after surgery.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EHallmarks: sudden pain/blur, very \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehigh IOP\u003C/b\u003E\u003C/span\u003E, usually within hours.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ENd:YAG peripheral iridotomy (PI)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E promptly bypasses the block and is the \u003C/span\u003E\u003Cb\u003Edefinitive immediate\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E step.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPilocarpine\u003C/b\u003E\u003C/span\u003E can worsen block or be ineffective in very high IOP.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECycloplegia\u003C/b\u003E\u003C/span\u003E is for aqueous misdirection, not pupillary block.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAC paracentesis\u003C/b\u003E\u003C/span\u003E only gives transient IOP reduction and does not treat the underlying block.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 1,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 201,
    "Name": "Ptosis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich feature is \u003Cspan class=\u0022s1\u0022\u003Eleast commonly associated\u003C/span\u003E with congenital ptosis?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ECongenital ptosis is due to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elevator palpebrae superioris dysgenesis\u003C/b\u003E\u003C/span\u003E, not orbicularis weakness.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ECommon associations:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAbsent lid crease\u003C/b\u003E\u003C/span\u003E (poor levator development).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAstigmatism\u003C/b\u003E\u003C/span\u003E (from lid pressure).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAmblyopia\u003C/b\u003E\u003C/span\u003E (from visual axis obstruction or astigmatism).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOrbicularis oculi weakness\u003C/b\u003E\u003C/span\u003E is a feature of facial nerve palsy, not congenital ptosis.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 202,
    "Name": "Lacrimal",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EIn an external dacryocystorhinostomy (DCR), what is the correct anterior-to-posterior order of bones encountered?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIn DCR, the bony pathway to the lacrimal sac follows a consistent order:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMaxilla\u003C/b\u003E\u003C/span\u003E (anterior wall of the lacrimal sac fossa).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELacrimal bone\u003C/b\u003E\u003C/span\u003E (thin bone, main surgical target to access sac).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EEthmoid bone\u003C/b\u003E\u003C/span\u003E (posterior limit, sometimes exposed).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EFrontal and nasal bones are not encountered in the routine anterior-posterior sequence.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 203,
    "Name": "Retinal dystrophies",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EOn OCT, which condition is most likely to show large intraretinal cystic spaces without evidence of leakage on fluorescein angiography (FFA)?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EX-linked juvenile retinoschisis shows \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esplitting of the retinal layers (schisis cavities)\u003C/b\u003E\u003C/span\u003E that appear cystic on OCT. These spaces are \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot caused by vascular leakage\u003C/b\u003E\u003C/span\u003E, so FFA typically shows \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eno leakage\u003C/b\u003E\u003C/span\u003E, unlike cystoid macular edema.\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cimg src=\u0022https://eyewiki.org/w/images/8/8c/Optical_coherence_tomography_in_X-linked_retinoschisis.jpg?20220120222055\u0022\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 204,
    "Name": "Cataract surgery",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EA 68-year-old woman develops ocular discomfort and blurred vision in her right eye two months after uncomplicated cataract surgery. Examination shows corneal edema with keratic precipitates, anterior chamber and vitreous inflammation, elevated IOP, and a posterior capsular plaque. What is the most likely diagnosis?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022font-size: medium; text-decoration-line: underline;\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb style=\u0022font-size: medium; text-decoration-line: underline;\u0022\u003EPropionibacterium acnes endophthalmitis\u003C/b\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\u003C/div\u003E\u003Cul\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cb\u003ETiming:\u003C/b\u003E\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E Appears \u003C/span\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cb\u003Eweeks to months\u003C/b\u003E\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E after cataract surgery (vs. acute bacterial endophthalmitis which occurs within days).\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESigns:\u003C/b\u003E\u003C/span\u003E Mild-to-moderate anterior uveitis, keratic precipitates, vitritis, and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eclassic posterior capsular plaque\u003C/b\u003E\u003C/span\u003E (organism embedded in lens capsule).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECausative organism:\u003C/b\u003E\u003C/span\u003E \u003Ci\u003ECutibacterium (Propionibacterium) acnes\u003C/i\u003E \u2013 a slow-growing, low virulence organism.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EDifferentiation:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ETASS\u003C/b\u003E\u003C/span\u003E: Presents within \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E24\u201348 hrs\u003C/b\u003E\u003C/span\u003E post-op, sterile inflammation, no vitreous involvement, no posterior capsular plaque.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ETB uveitis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E: Possible given her history, but would not cause a \u003C/span\u003E\u003Cb\u003Elocalized posterior capsular plaque after cataract surgery\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAcute post-op endophthalmitis\u003C/b\u003E\u003C/span\u003E: Rapid onset (within 1\u20132 weeks), pain, hypopyon, severe vision loss.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb style=\u0022letter-spacing: 0.14994px;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 1,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 205,
    "Name": "Physiology",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-size: medium;\u0022\u003EWhich vitamin supplement has the strongest evidence for providing neuroprotection in patients with glaucoma?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EVitamin B3 (Niacinamide):\u003C/b\u003E\u003C/span\u003E Animal and early clinical studies show it supports \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emitochondrial function\u003C/b\u003E\u003C/span\u003E and protects \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eretinal ganglion cells\u003C/b\u003E\u003C/span\u003E against glaucomatous damage. Considered the most promising neuroprotective supplement.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EVitamin B2 (Riboflavin):\u003C/b\u003E\u003C/span\u003E Important for corneal collagen cross-linking (keratoconus) but not proven as neuroprotective in glaucoma.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EVitamin B1 \u0026amp; B6:\u003C/b\u003E\u003C/span\u003E Essential vitamins, but no strong evidence for glaucoma neuroprotection.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EFurther information:\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Col start=\u00221\u0022\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ENicotinamide \u002B Pyruvate Phase 2 Trial (De Moraes et al.)\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ERandomized, double-blind, placebo-controlled trial in open-angle glaucoma patients.\u003Cspan class=\u0022Apple-converted-space\u0022\u003E\u0026nbsp; \u003C/span\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EShort-term visual field gains: the number of improving test points was higher in the treatment arm vs placebo.\u003Cspan class=\u0022Apple-converted-space\u0022\u003E\u0026nbsp; \u003C/span\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESuggests nicotinamide may \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esupport inner retinal function\u003C/b\u003E\u003C/span\u003E when combined with IOP-lowering therapy.\u003Cspan class=\u0022Apple-converted-space\u0022\u003E\u0026nbsp; \u003C/span\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EThe Glaucoma Nicotinamide Trial (TGNT, NCT05275738)\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOngoing prospective, double-masked, placebo-controlled trial of nicotinamide in open-angle glaucoma.\u003Cspan class=\u0022Apple-converted-space\u0022\u003E\u0026nbsp; \u003C/span\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAims to test whether nicotinamide slows progression when added to standard IOP-lowering therapy.\u003Cspan class=\u0022Apple-converted-space\u0022\u003E\u0026nbsp; \u003C/span\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EOther Nicotinamide Trials\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EA crossover randomized trial showed improvement in inner retinal electrophysiology (photopic negative response) with nicotinamide supplementation.\u003Cspan class=\u0022Apple-converted-space\u0022\u003E\u0026nbsp; \u003C/span\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESeveral clinical trial listings exist investigating nicotinamide\u2019s neuroprotective role in glaucoma (e.g. NCT05405868).\u003Cspan class=\u0022Apple-converted-space\u0022\u003E\u0026nbsp; \u003C/span\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EConcerns \u0026amp; Position Statements\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe American Glaucoma Society and AAO are developing a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eposition statement on nicotinamide\u003C/b\u003E\u003C/span\u003E use in glaucoma, noting that it has promise but is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot yet approved therapy\u003C/b\u003E\u003C/span\u003E.\u003Cspan class=\u0022Apple-converted-space\u0022\u003E\u0026nbsp; \u003C/span\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESafety considerations include \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epossible liver toxicity\u003C/b\u003E\u003C/span\u003E, especially at high doses.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ol\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 206,
    "Name": "Pseudoexfoliation",
    "Body": "\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following statements is correct regarding Pseudoexfoliation?\u003C/span\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EPseudo-exfoliation (PXF)\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px; font-weight: 700;\u0022\u003Edoes have genetic associations with\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u0026nbsp;\u003C/span\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003ELOXL1 gene variants\u003C/span\u003E\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u0026nbsp;(G153D, R141L), but these polymorphisms have\u0026nbsp;\u003C/span\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003Ehigh prevalence in the general population\u003C/span\u003E\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E, so the inheritance is\u0026nbsp;\u003C/span\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003Ecomplex, multifactorial\u003C/span\u003E\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E, and influenced by environmental factors.\u0026nbsp;\u003C/span\u003ETherefore, it is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot considered a clearly inherited disease\u003C/b\u003E\u003C/span\u003E, despite known genetic risk alleles.\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMost large epidemiological studies show \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eequal or slightly increased prevalence in females\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\u003C/li\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EPXF prevalence is highest in \u003C/span\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cb\u003EScandinavian countries\u003C/b\u003E\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E (up to 20\u201330% in individuals over 60).\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003ELong-term cohort studies show\u0026nbsp;\u003Cb style=\u0022letter-spacing: 0.14994px;\u0022\u003E~15% of patients with pseudo-exfoliation develop glaucoma over a 10-year period.\u003C/b\u003E\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003EA similar question appeared in multiple previous FRCOphth exams.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
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    "Category": null,
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  },
  {
    "Id": 207,
    "Name": "Rieger\u0027s syndrome",
    "Body": "\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 22-year-old patient was referred to you from the optician as they suspected glaucoma. You notice that the patient has a short stature and has a history of aortic stenosis and intellectual disability. On ocular examination, you do find glaucomatous cupping. What is the most likely diagnosis?\u003C/span\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EAxenfeld\u2013Rieger syndrome (ARS)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is a \u003C/span\u003E\u003Cb\u003Edevelopmental disorder of the anterior segment\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, characterised by abnormalities of the \u003C/span\u003E\u003Cb\u003ESchwalbe\u2019s line\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, \u003C/span\u003E\u003Cb\u003Eiris\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, and various \u003C/span\u003E\u003Cb\u003Esystemic defects\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E. It represents the spectrum of \u003C/span\u003E\u003Cb\u003EAxenfeld anomaly\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, \u003C/span\u003E\u003Cb\u003ERieger anomaly\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, and associated systemic features.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb\u003EOcular Features\u003C/b\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPosterior embryotoxon\u003C/b\u003E\u003C/span\u003E: anteriorly displaced and prominent Schwalbe\u2019s line.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EOften accompanied by \u003C/span\u003E\u003Cb\u003Eiridocorneal adhesions\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and \u003C/span\u003E\u003Cb\u003Eiris stromal hypoplasia\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EGlaucoma develops in approximately 50% of patients\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, typically during childhood or early adulthood.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb\u003ESystemic Features\u003C/b\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003ESystemic anomalies occur mainly when the condition is due to \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003EPITX2\u003C/b\u003E\u003C/span\u003E or \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003EFOXC1\u003C/b\u003E\u003C/span\u003E mutations (true Axenfeld\u2013Rieger \u003Ci\u003Esyndrome\u003C/i\u003E). They include:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch4\u003E\u003Cb\u003ECraniofacial anomalies\u003C/b\u003E\u003C/h4\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EHypertelorism\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ETelecanthus\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMaxillary hypoplasia\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EBroad, flat nasal bridge\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch4\u003E\u003Cb\u003EDental abnormalities\u003C/b\u003E\u003C/h4\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EHypodontia or oligodontia (most characteristic)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMicrodontia\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EConical teeth\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch4\u003E\u003Cb\u003EOther systemic manifestations\u003C/b\u003E\u003C/h4\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EHypospadias\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAnal stenosis\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EUmbilical abnormalities\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPituitary dysfunction or growth retardation\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ECongenital heart defects (e.g., valvular anomalies)\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cimg src=\u0022https://www.frontiersin.org/files/Articles/732170/fgene-12-732170-HTML/image_m/fgene-12-732170-g003.jpg\u0022\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022color: rgb(40, 40, 40); font-family: ThinSpaceFallback, InftyFallback, MuseoSans, Helvetica, Arial, sans-serif; font-size: 16px; letter-spacing: normal;\u0022\u003EOcular features and systemic manifestations in our patients with ARS.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cstrong style=\u0022color: rgb(40, 40, 40); font-family: ThinSpaceFallback, InftyFallback, MuseoSans, Helvetica, Arial, sans-serif; font-size: 16px; letter-spacing: normal;\u0022\u003E(A)\u003C/strong\u003E\u003Cspan style=\u0022color: rgb(40, 40, 40); font-family: ThinSpaceFallback, InftyFallback, MuseoSans, Helvetica, Arial, sans-serif; font-size: 16px; letter-spacing: normal;\u0022\u003E\u0026nbsp;posterior embryotoxon indicated by white arrowheads.\u0026nbsp;\u003C/span\u003E\u003Cstrong style=\u0022color: rgb(40, 40, 40); font-family: ThinSpaceFallback, InftyFallback, MuseoSans, Helvetica, Arial, sans-serif; font-size: 16px; letter-spacing: normal;\u0022\u003E(B)\u003C/strong\u003E\u003Cspan style=\u0022color: rgb(40, 40, 40); font-family: ThinSpaceFallback, InftyFallback, MuseoSans, Helvetica, Arial, sans-serif; font-size: 16px; letter-spacing: normal;\u0022\u003E\u0026nbsp;iris stromal hypoplasia and polycoria.\u0026nbsp;\u003C/span\u003E\u003Cstrong style=\u0022color: rgb(40, 40, 40); font-family: ThinSpaceFallback, InftyFallback, MuseoSans, Helvetica, Arial, sans-serif; font-size: 16px; letter-spacing: normal;\u0022\u003E(C)\u003C/strong\u003E\u003Cspan style=\u0022color: rgb(40, 40, 40); font-family: ThinSpaceFallback, InftyFallback, MuseoSans, Helvetica, Arial, sans-serif; font-size: 16px; letter-spacing: normal;\u0022\u003E\u0026nbsp;irregular pupil and corectopia.\u0026nbsp;\u003C/span\u003E\u003Cstrong style=\u0022color: rgb(40, 40, 40); font-family: ThinSpaceFallback, InftyFallback, MuseoSans, Helvetica, Arial, sans-serif; font-size: 16px; letter-spacing: normal;\u0022\u003E(D)\u003C/strong\u003E\u003Cspan style=\u0022color: rgb(40, 40, 40); font-family: ThinSpaceFallback, InftyFallback, MuseoSans, Helvetica, Arial, sans-serif; font-size: 16px; letter-spacing: normal;\u0022\u003E\u0026nbsp;iridocorneal adhesions across the anterior chamber angle indicated by white arrowheads.\u0026nbsp;\u003C/span\u003E\u003Cstrong style=\u0022color: rgb(40, 40, 40); font-family: ThinSpaceFallback, InftyFallback, MuseoSans, Helvetica, Arial, sans-serif; font-size: 16px; letter-spacing: normal;\u0022\u003E(E)\u003C/strong\u003E\u003Cspan style=\u0022color: rgb(40, 40, 40); font-family: ThinSpaceFallback, InftyFallback, MuseoSans, Helvetica, Arial, sans-serif; font-size: 16px; letter-spacing: normal;\u0022\u003E\u0026nbsp;The ultrasound biomicroscopy (UBM) image\u0026nbsp; shows the iris strands bridging the iris to the posterior embryotoxon indicated by a white arrowhead.\u0026nbsp;\u003C/span\u003E\u003Cstrong style=\u0022color: rgb(40, 40, 40); font-family: ThinSpaceFallback, InftyFallback, MuseoSans, Helvetica, Arial, sans-serif; font-size: 16px; letter-spacing: normal;\u0022\u003E(F\u2013H)\u003C/strong\u003E\u003Cspan style=\u0022color: rgb(40, 40, 40); font-family: ThinSpaceFallback, InftyFallback, MuseoSans, Helvetica, Arial, sans-serif; font-size: 16px; letter-spacing: normal;\u0022\u003E. craniofacial abnormalities (a broad flat nasal root, maxillary hypoplasia, thin upper lip and everted lower lip)\u0026nbsp;\u003C/span\u003E\u003Cstrong style=\u0022color: rgb(40, 40, 40); font-family: ThinSpaceFallback, InftyFallback, MuseoSans, Helvetica, Arial, sans-serif; font-size: 16px; letter-spacing: normal;\u0022\u003E(F,G)\u003C/strong\u003E\u003Cspan style=\u0022color: rgb(40, 40, 40); font-family: ThinSpaceFallback, InftyFallback, MuseoSans, Helvetica, Arial, sans-serif; font-size: 16px; letter-spacing: normal;\u0022\u003E\u0026nbsp;and redundant periumbilical skin\u0026nbsp;\u003C/span\u003E\u003Cstrong style=\u0022color: rgb(40, 40, 40); font-family: ThinSpaceFallback, InftyFallback, MuseoSans, Helvetica, Arial, sans-serif; font-size: 16px; letter-spacing: normal;\u0022\u003E(H)\u003C/strong\u003E\u003Cspan style=\u0022color: rgb(40, 40, 40); font-family: ThinSpaceFallback, InftyFallback, MuseoSans, Helvetica, Arial, sans-serif; font-size: 16px; letter-spacing: normal;\u0022\u003E.\u0026nbsp;\u003C/span\u003E\u003Cstrong style=\u0022color: rgb(40, 40, 40); font-family: ThinSpaceFallback, InftyFallback, MuseoSans, Helvetica, Arial, sans-serif; font-size: 16px; letter-spacing: normal;\u0022\u003E(I)\u003C/strong\u003E\u003Cspan style=\u0022color: rgb(40, 40, 40); font-family: ThinSpaceFallback, InftyFallback, MuseoSans, Helvetica, Arial, sans-serif; font-size: 16px; letter-spacing: normal;\u0022\u003E\u0026nbsp;dental anomalies (hypodontia and microdontia).\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022color: rgb(40, 40, 40); font-family: ThinSpaceFallback, InftyFallback, MuseoSans, Helvetica, Arial, sans-serif; font-size: 16px; letter-spacing: normal;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022color: rgb(40, 40, 40); font-family: ThinSpaceFallback, InftyFallback, MuseoSans, Helvetica, Arial, sans-serif; font-size: 16px; letter-spacing: normal;\u0022\u003ESource:\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EHeterogeneity of Axenfeld\u2013Rieger Syndrome: Molecular and Clinical Findings in Chinese Patients; Youjia Zhang et al\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022display: revert; color: rgb(40, 40, 40); font-family: ThinSpaceFallback, InftyFallback, MuseoSans, Helvetica, Arial, sans-serif; font-size: 12px; letter-spacing: normal; background-color: rgb(247, 247, 247);\u0022\u003E\u0026nbsp;\u003C/span\u003E\u003Ca class=\u0022ArticleLayoutHeader__info__doi\u0022 href=\u0022https://doi.org/10.3389/fgene.2021.732170\u0022 style=\u0022display: inline-block; cursor: revert; vertical-align: middle; text-wrap-mode: nowrap; font-family: ThinSpaceFallback, InftyFallback, MuseoSans, Helvetica, Arial, sans-serif; font-size: 12px; letter-spacing: normal; background-color: rgb(247, 247, 247);\u0022\u003Ehttps://doi.org/10.3389/fgene.2021.732170\u003C/a\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
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    "Category": null,
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  },
  {
    "Id": 208,
    "Name": "ICE syndrome",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EIn Iridocorneal Endothelial (ICE) syndrome, which statement is FALSE?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EGlaucoma in ICE syndrome arises from \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eprogressive synechial angle closure\u003C/b\u003E\u003C/span\u003E caused by contraction of the abnormal, proliferative corneal endothelium. These eyes have a high risk of surgical failure because the aggressive endothelial membrane often obstructs or scars filtering pathways.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EEven with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emitomycin C\u003C/b\u003E\u003C/span\u003E,\u0026nbsp;\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EICE glaucoma is notoriously surgical-resistant and\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003Etrabeculectomy frequently fails over time, with high rates of \u003C/span\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cb\u003Ebleb fibrosis\u003C/b\u003E\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E and \u003C/span\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cb\u003Eprogressive peripheral anterior synechiae\u003C/b\u003E\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E. Modern data show that many patients ultimately require a \u003C/span\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cb\u003Eglaucoma drainage device\u003C/b\u003E\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E for long-term IOP control.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EBroad PAS, corneal endothelial abnormalities (especially in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EChandler syndrome\u003C/b\u003E\u003C/span\u003E), and a suspected \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eviral (HSV) association\u003C/b\u003E\u003C/span\u003E are all well-supported features of ICE syndrome.\u0026nbsp;\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003EChandler subtype features the most marked endothelial dysfunction, leading to corneal oedema and the \u201Cbeaten metal\u201D endothelium.\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a recent FRCOphth written exam.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 209,
    "Name": "Drops",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EWhich glaucoma medication both reduces aqueous humour production and enhances aqueous outflow?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBrimonidine\u003C/b\u003E\u003C/span\u003E, an \u03B12-adrenergic agonist, lowers intraocular pressure through a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edual mechanism\u003C/b\u003E\u003C/span\u003E:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Col start=\u00221\u0022\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EReduces aqueous production\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E at the ciliary body\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EIncreases uveoscleral outflow\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ol\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EOther listed agents have single dominant actions:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EBimatoprost\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (prostaglandin analogue): \u003C/span\u003E\u003Cb\u003E\u2191 uveoscleral outflow\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EBetaxolol\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (\u03B21-selective blocker): \u003C/span\u003E\u003Cb\u003E\u2193 aqueous production\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EDorzolamide\u003C/b\u003E\u003C/span\u003E (carbonic anhydrase inhibitor): \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E\u2193 aqueous production\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThus, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebrimonidine\u003C/b\u003E\u003C/span\u003E is the only option that provides both reduced aqueous formation and enhanced outflow.\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 210,
    "Name": "Drops",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EWhich medication is a direct cholinergic agonist that lowers intraocular pressure by enhancing conventional (trabecular meshwork) outflow?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPilocarpine\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is a \u003C/span\u003E\u003Cb\u003Edirect-acting muscarinic agonist\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E that contracts the ciliary muscle, opening the trabecular meshwork and \u003C/span\u003E\u003Cb\u003Eincreasing conventional aqueous outflow\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003EThe other options work via different mechanisms:\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELatanoprost\u003C/b\u003E\u003C/span\u003E (prostaglandin analogue): \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E\u2191 uveoscleral outflow\u003C/b\u003E\u003C/span\u003E (the non-conventional pathway).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EApraclonidine\u003C/b\u003E\u003C/span\u003E (\u03B12 \u0026gt; \u03B11 adrenergic agonist): \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E\u2193 aqueous production\u003C/b\u003E\u003C/span\u003E, with minimal effect on outflow.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EEchothiophate\u003C/b\u003E\u003C/span\u003E: an \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eindirect\u003C/b\u003E\u003C/span\u003E cholinergic agonist that \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eirreversibly inhibits acetylcholinesterase\u003C/b\u003E\u003C/span\u003E, thereby raising acetylcholine levels; it is not a direct receptor agonist.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 211,
    "Name": "Secondary Glaucoma",
    "Body": "\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 52-year-old lady with COPD attends a routine optician appointment. She is asymptomatic but is found to have bilateral IOPs of 32 mmHg on pneumatic tonometry. Which of his inhaled treatments is most likely responsible for this raised IOP?\u003C/span\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EInhaled corticosteroids such as \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Efluticasone\u003C/b\u003E\u003C/span\u003E can trigger a significant IOP rise in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esteroid responders;\u003C/b\u003E\u003C/span\u003E\u0026nbsp;a group that constitutes roughly \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E5% of the general population\u003C/b\u003E\u003C/span\u003E, and a higher proportion of glaucoma patients. A typical response is an IOP increase of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E\u0026gt;15 mmHg from baseline\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003ESalbutamol (\u03B2-agonist) and ipratropium (anticholinergic) can occasionally precipitate \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eacute angle closure\u003C/b\u003E\u003C/span\u003E through mild mydriasis, but such episodes are \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Erare\u003C/b\u003E\u003C/span\u003E, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eunilateral\u003C/b\u003E\u003C/span\u003E, and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehighly symptomatic\u003C/b\u003E\u003C/span\u003E (pain, blurred vision, halos).\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EA saline nebuliser has no effect on IOP.\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003ERemember:\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\n\n\n\n\n\n\n\n\u003Cp\u003E\u003C/p\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EChronic IOP rise \u2192 think STEROIDS first (any route).\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EAcute, painful, red eye \u2192 angle closure from anticholinergics, sympathomimetics, or sulfa-induced choroidal effusion.\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ETopiramate = bilateral, acute myopic shift \u002B angle closure (classical exam favourite).\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cimg src=\u0022/upload-2025-12-02-31525531-d209-4633-a339-b76d89f4462c.png\u0022\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003C/span\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 212,
    "Name": "Inflammatory Glaucoma",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 31-year-old myopic man presents with blurred vision and moderate photophobia. His intraocular pressure is 50 mmHg. What is the most likely diagnosis?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPosner-Schlossman syndrome\u003C/b\u003E\u003C/span\u003E is the most likely diagnosis:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EUnilateral, recurrent episodes\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EDisproportionately high IOP\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (often 40\u201360 mmHg)\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EOnly \u003C/span\u003E\u003Cb\u003Emild anterior chamber inflammation\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EBlurred vision due to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emild corneal oedema\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMinimal pain and no systemic symptoms\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003EThis pattern:\u0026nbsp;\u003C/span\u003E\u003Cb\u003Eyoung adult, very high IOP, mild photophobia, minimal inflammation =\u0026nbsp;\u003C/b\u003E\u003Cspan class=\u0022s3\u0022\u003Eis classic for \u003C/span\u003E\u003Cb\u003Eglaucomatocyclitic crisis\u003C/b\u003E\u003Cspan class=\u0022s3\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003EAcute angle-closure glaucoma is very uncommon in a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eyoung myope\u003C/b\u003E\u003C/span\u003E\u0026nbsp;and typically presents with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esevere ocular pain\u003C/b\u003E\u003C/span\u003E, headache, nausea, and a mid-dilated pupil; features not seen here.\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\n\n\n\n\n\n\n\n\n\n\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003EHerpetic keratitis and toxoplasma uveitis can elevate IOP, but they are usually associated with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esignificant anterior chamber inflammation\u003C/b\u003E\u003C/span\u003E, corneal epithelial disease (in HSV), keratic precipitates, or vitritis. It is unusual for either to produce an IOP of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E50 mmHg\u003C/b\u003E\u003C/span\u003E at first presentation without marked inflammation.\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline; font-size: large;\u0022\u003ENote:\u003C/span\u003E\u003Cspan style=\u0022font-weight: bold; font-size: large;\u0022\u003E\u0026nbsp;\u003C/span\u003E\u003Cb style=\u0022letter-spacing: 0.14994px; font-size: large;\u0022\u003E\u003Cspan style=\u0022color: rgb(0, 126, 255);\u0022\u003EHLA-Bw54\u003C/span\u003E in Posner\u2013Schlossman Syndrome (PSS)\u003C/b\u003E\u003C/p\u003E\u003Cp\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\n\n\n\n\n\n\n\n\n\u003Cp\u003E\u003C/p\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESeveral Japanese studies (e.g., Yamamoto et al., 1993; Shimizu et al., 1982) reported that \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E~40\u201350% of Japanese patients with PSS\u003C/b\u003E\u003C/span\u003E are HLA-Bw54 positive.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThis association is \u003C/span\u003E\u003Cb\u003Epopulation-specific\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and \u003C/span\u003E\u003Cb\u003Enot seen in Western cohorts\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ENo causal relationship has been proven; it is considered a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Egenetic susceptibility marker\u003C/b\u003E\u003C/span\u003E rather than a diagnostic feature.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
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  },
  {
    "Id": 213,
    "Name": "Surgery",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003ETwo days after trabeculectomy, a patient presents with a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eshallow anterior chamber\u003C/b\u003E\u003C/span\u003E and an \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIOP of 18 mmHg\u003C/b\u003E\u003C/span\u003E. What is the most likely diagnosis?\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EA \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eshallow anterior chamber with a normal or elevated IOP\u003C/b\u003E\u003C/span\u003E early after trabeculectomy is most characteristic of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eaqueous misdirection\u003C/b\u003E\u003C/span\u003E (malignant glaucoma). In this condition, aqueous humour is diverted posteriorly into or behind the vitreous, pushing the lens-iris diaphragm forward. Typical features include:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EShallow or flat anterior chamber\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERelatively high or \u201Cnormal\u201D IOP\u003C/b\u003E\u003C/span\u003E despite recent filtration surgery\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPoor/flat bleb\u003C/b\u003E\u003C/span\u003E due to lack of anterior aqueous flow\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EIn contrast:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EBleb leak\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192 \u003C/span\u003E\u003Cb\u003Eshallow AC \u002B hypotony\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (low IOP)\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ECiliary body shutdown\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192 \u003C/span\u003E\u003Cb\u003Eshallow AC \u002B hypotony\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E due to reduced aqueous production\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EUveitis alone\u003C/b\u003E\u003C/span\u003E does not typically cause significant chamber shallowing and would not explain an IOP of 18 mmHg soon after filtration surgery\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThus, the clinical picture strongly favours \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eaqueous misdirection\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cimg src=\u0022/upload-2025-12-02-803b6fe4-5d1a-4722-a852-333dda21ea55.png\u0022\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch1\u003E\u003Cb\u003ETop Exam Pearls\u003C/b\u003E\u003C/h1\u003E\u003Cp\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\n\n\n\n\n\n\n\n\n\u003Cp\u003E\u003C/p\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EShallow AC \u002B normal/high IOP = think malignant glaucoma first\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E unless iris bombe suggests pupillary block.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EShallow AC \u002B low IOP = leak or ciliary body shutdown.\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EDeep AC \u002B high IOP = blocked ostium or encapsulated bleb.\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPainful, sudden deterioration post-op = rule out suprachoroidal haemorrhage.\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003C/span\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 214,
    "Name": "Allergy",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EAcetazolamide is contraindicated in a patient with which drug allergy?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EAcetazolamide is a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecarbonic anhydrase inhibitor\u003C/b\u003E\u003C/span\u003E and belongs to the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enon-antibiotic sulfonamide\u003C/b\u003E\u003C/span\u003E class. Although cross-reactivity between sulfonamide antibiotics and non-antibiotic sulfonamides is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eless common than once believed\u003C/b\u003E\u003C/span\u003E, patients with a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Etrue, severe sulfonamide antibiotic allergy\u003C/b\u003E\u003C/span\u003E (e.g., Stevens\u2013Johnson syndrome, anaphylaxis) are generally considered at \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehigher risk\u003C/b\u003E\u003C/span\u003E and acetazolamide should be \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eavoided\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003ESulfamethoxazole is a classic \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esulfonamide antibiotic\u003C/b\u003E\u003C/span\u003E, so a confirmed allergy to it is a contraindication.\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\n\n\n\n\n\n\n\n\u003Cp\u003E\u003C/p\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EIf the exam says \u201Csevere sulfa allergy\u201D \u2192 avoid acetazolamide.\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EIf the exam says \u201Cpenicillin / aminoglycoside / quinolone allergy\u201D \u2192 acetazolamide is safe.\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ETopical CAIs (dorzolamide, brinzolamide)\u003C/b\u003E\u003C/span\u003E can also be avoided if the allergy was severe (SJS/TEN).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 5,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 215,
    "Name": "Laser",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EWhich of the following represents the most appropriate initial laser settings for argon laser trabeculoplasty (ALT)?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EALT uses a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esmall spot size and short pulse duration\u003C/b\u003E\u003C/span\u003E to deliver relatively \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehigh-energy bursts\u003C/b\u003E\u003C/span\u003E to the trabecular meshwork. The goal is a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emechanical (disruptive) effect\u003C/b\u003E\u003C/span\u003E, producing localized thermal expansion and tightening of the trabecular beams.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003ETypical starting parameters for ALT are:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ESpot size:\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u003C/span\u003E\u003Cb\u003E50 \u00B5m\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EDuration:\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u003C/span\u003E\u003Cb\u003E0.1 seconds\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EEnergy:\u003C/b\u003E\u003C/span\u003E\u0026nbsp;3\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E00\u20131000 mW\u003C/b\u003E\u003C/span\u003E, titrated to achieve \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emild blanching\u003C/b\u003E\u003C/span\u003E of the trabecular meshwork\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EWrong combinations include:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\n\n\n\n\n\n\n\n\n\u003Cp\u003E\u003C/p\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E500 \u00B5m spot sizes\u003C/b\u003E\u003C/span\u003E \u2192 used in SLT or MicroPulse, never in ALT.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E0.5 second duration\u003C/b\u003E\u003C/span\u003E \u2192 too long; would cause excessive coagulative damage.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EEnergy too low (200 mW)\u003C/b\u003E\u003C/span\u003E \u2192 insufficient for ALT endpoints.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 216,
    "Name": "Cataract",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EWhich of the following statements about posterior polar cataracts is TRUE?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EPosterior polar cataract is a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edistinct congenital cataract subtype\u003C/b\u003E\u003C/span\u003E, not to be confused with posterior subcapsular cataract (a common \u003Ci\u003Eacquired\u003C/i\u003E opacity). Posterior polar cataracts arise from \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edysplastic posterior lens fibres\u003C/b\u003E\u003C/span\u003E that form a characteristic central plaque \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eadherent to an extremely thin and fragile posterior capsule\u003C/b\u003E\u003C/span\u003E. This anatomical arrangement explains the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehigh risk of posterior capsule rupture\u003C/b\u003E\u003C/span\u003E during surgery.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EInheritance is most commonly \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eautosomal dominant\u003C/b\u003E\u003C/span\u003E (not recessive), though sporadic cases occur.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EMyotonic dystrophy is associated with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eposterior cortical cataracts\u003C/b\u003E\u003C/span\u003E and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EChristmas-tree cataracts\u003C/b\u003E\u003C/span\u003E, not posterior polar cataracts.\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cimg src=\u0022https://eyewiki.org/w/images/9/92/Central_posterior_polar_cataract.jpeg?20170711035407\u0022\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003ESource of image: Eyewiki\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 1,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 217,
    "Name": "Secondary Cataract",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EWhich statement about cataracts is most likely to be TRUE?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EWilson\u2019s disease leads to the classic \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esunflower cataract\u003C/b\u003E\u003C/span\u003E, caused by \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecopper deposition beneath the anterior lens capsule\u003C/b\u003E\u003C/span\u003E. It is highly distinctive and often highlighted in exams.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cimg src=\u0022https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/qjmed/114/11/10.1093_qjmed_hcab226/1/m_hcab226f1.jpeg?Expires=1766033277\u0026amp;Signature=cmhtfQw7cpJdroKrlmUlrYLXBYCVefvJBUpGdvjn7h8sgbtx0bh03-pszcAMwajnjkfN5h8RZgDytbe0xX2Yj8hGburtt6y~Qn6F1x5Gu6ZN3TkYzAf6VLendL5DaNjKipFU8PoCbA7IeTfwavtkphqY6zODe-xjJQ7pWZvX72NDrOTv-GqQDt8TFNHgZiczSP1hwYHXqEn8Rx5zDLLKwGYnc-Ji4sahmVy8SAUkrHTMq120Cpztvo9VOr0ymPZDHv3G9fg4DDbatos-HFtTN6rWxFpPkPbflgCIe-1UHF~q7X0cpXVzT63xnHT1HFOjIBf7pLTzdgHWvgBOHlf08w__\u0026amp;Key-Pair-Id=APKAIE5G5CRDK6RD3PGA\u0022\u003E\u003C/p\u003E\u003Cp class=\u0022p2\u0022\u003E\u003Cspan style=\u0022color: rgb(42, 42, 42); font-family: \u0026quot;Source Sans Pro\u0026quot;, Helvetica, Arial, sans-serif; font-size: 15px; letter-spacing: normal; font-weight: bold;\u0022\u003EKayser\u2013Fleischer ring and sunflower cataract (arrows and arrowheads, respectively)\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p2\u0022\u003E\u003Cspan style=\u0022color: rgb(42, 42, 42); font-family: \u0026quot;Source Sans Pro\u0026quot;, Helvetica, Arial, sans-serif; font-size: 15px; letter-spacing: normal;\u0022\u003ESource:\u0026nbsp;\u003C/span\u003E\u003Ca href=\u0022https://doi.org/10.1093/qjmed/hcab226\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003ET -Y Lin, I -C Liang, Y -H Chang, Kayser\u2013Fleischer ring and sunflower cataract in a patient with Wilson\u2019s disease, QJM: An International Journal of Medicine, Volume 114, Issue 11, November 2021, Pages 822\u2013823\u003C/a\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003EThe other statements are incorrect:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOil-droplet cataracts\u003C/b\u003E\u003C/span\u003E occur in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Egalactosaemia\u003C/b\u003E\u003C/span\u003E, which is characterised by the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epresence\u003C/b\u003E\u003C/span\u003E of reducing substances in the urine (galactose), not their absence.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EMyotonic dystrophy\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E typically causes a \u003C/span\u003E\u003Cb\u003EChristmas tree cataract\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, and later a \u003C/span\u003E\u003Cb\u003Eposterior subcapsular cataract\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, not an anterior cortical opacity.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESteroids\u003C/b\u003E\u003C/span\u003E are strongly associated with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eposterior subcapsular cataracts\u003C/b\u003E\u003C/span\u003E, not anterior subcapsular cataracts.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
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    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 218,
    "Name": "Refractive",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA phakic patient develops a retinal detachment with PVR [proliferative vitreoretinopathy] and undergoes vitrectomy with silicone oil fill, but \u003Cspan class=\u0022s1\u0022\u003Eno lens surgery\u003C/span\u003E is done. What postoperative refractive change is expected?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003ESilicone oil changes the effective refractive index of the vitreous cavity.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIn a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ephakic\u003C/b\u003E\u003C/span\u003E eye, silicone oil has a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elower refractive index than the natural vitreous\u003C/b\u003E\u003C/span\u003E, which effectively \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ereduces the converging power\u003C/b\u003E\u003C/span\u003E of the posterior segment \u2192 \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehyperopic shift\u003C/b\u003E\u003C/span\u003E (typically \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E\u002B5 to \u002B9D\u003C/b\u003E\u003C/span\u003E depending on axial length and oil viscosity).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EIn an \u003C/span\u003E\u003Cb\u003Eaphakic\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E eye, silicone oil acts as a \u003C/span\u003E\u003Cb\u003Erefractive medium compensating for the missing lens\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, producing a \u003C/span\u003E\u003Cb\u003Emyopic shift\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 1,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 219,
    "Name": "Refractive",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA mildly myopic patient undergoes routine phacoemulsification with in-the-bag posterior chamber IOL implantation. Biometry was accurate and reproducible with a target of emmetropia. Postoperatively, the patient is \u22121.50 D.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cb\u003EWhat is the most likely cause of this myopic refractive surprise?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EA postoperative \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emyopic shift\u003C/b\u003E\u003C/span\u003E in an eye with accurate biometry and standard in-the-bag IOL placement is most commonly due to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eretained viscoelastic trapped behind the IOL optic\u003C/b\u003E\u003C/span\u003E, producing \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecapsular bag distension syndrome\u003C/b\u003E\u003C/span\u003E. The viscoelastic pushes the IOL \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eanteriorly\u003C/b\u003E\u003C/span\u003E, reducing the effective lens position and increasing its refractive power \u2192 \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emyopia\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe other options are less likely:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECystoid macular oedema\u003C/b\u003E\u003C/span\u003E typically causes a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehyperopic shift\u003C/b\u003E\u003C/span\u003E due to macular thickening and flattening of the posterior pole.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPosterior IOL dislocation\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E moves the lens \u003Ci\u003Ebackward\u003C/i\u003E, reducing power \u2192 \u003C/span\u003E\u003Cb\u003Ehyperopic shift\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAnterior IOL dislocation\u003C/b\u003E\u003C/span\u003E causing \u22121.50 D is very unlikely with an intact capsular bag and stable zonules.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch1\u003E\u003Cb style=\u0022font-size: x-large; color: rgb(0, 50, 255);\u0022\u003ETOP EXAM PEARLS\u003C/b\u003E\u003C/h1\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022font-size: x-large; color: rgb(0, 50, 255);\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EEarly myopia post-phaco = think retained viscoelastic (CBDS).\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EHyperopia after stable surgery = suspect IOL sitting posteriorly.\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPosterior segment causes (CME) \u2192 hyperopic shift.\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EIncorrect biometry \u2192 direction depends on whether AL or K is wrong.\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EToric IOL: every 30\u00B0 off = zero effect.\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 1,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 220,
    "Name": "Neuropathy",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 69-year-old woman undergoes routine right cataract surgery. Her pre-operative VA was 6/18 (right) and 6/6 (left). At her 2-week post-operative review, her right VA remains 6/18. OCT macula is normal, but the right optic disc appears slightly pale.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cb\u003EWhat is the most appropriate next investigation?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EPersistent reduced visual acuity after uncomplicated cataract surgery with a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enormal OCT\u003C/b\u003E\u003C/span\u003E and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eoptic disc pallor\u003C/b\u003E\u003C/span\u003E strongly suggests \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eoptic neuropathy\u003C/b\u003E\u003C/span\u003E, not macular disease. The priority is to rule out \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecompressive or inflammatory optic nerve pathology\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EWhile visual fields can help document functional loss, they are \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot the definitive next step\u003C/b\u003E\u003C/span\u003E when optic disc pallor is noted early post-operatively.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMRI of the brain and orbits with contrast\u003C/b\u003E\u003C/span\u003E is the most appropriate test because it can identify:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOptic nerve compression (meningioma, pituitary disease, orbital mass)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOptic neuritis\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIschaemic or infiltrative optic neuropathies\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EFA is unnecessary with a normal OCT, and serum electrophoresis is for systemic paraproteinaemias, not acute optic disc pallor.\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/p\u003E",
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    "HighYield": true,
    "CategoryId": 8,
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  },
  {
    "Id": 221,
    "Name": "Ectopia Lentis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EWhich of the following is NOT typically associated with homocystinuria?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EHomocystinuria (usually due to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecystathionine \u03B2-synthase deficiency\u003C/b\u003E\u003C/span\u003E) is an \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eautosomal recessive\u003C/b\u003E\u003C/span\u003E metabolic disorder characterised by:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EInferonasal lens dislocation\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (downward displacement)\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EMarfanoid habitus\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EHigh risk of thromboembolic events\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMitral valve prolapse\u003C/b\u003E\u003C/span\u003E and other connective-tissue cardiac findings\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EFair, lightly pigmented hair\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (often reddish or blonde)\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe key distinguishing feature from Marfan syndrome is the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edirection of lens displacement\u003C/b\u003E\u003C/span\u003E:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EHomocystinuria \u2192 lens moves inferonasally\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EMarfan syndrome \u2192 lens moves superotemporally\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003ETherefore, \u003C/span\u003E\u003Cb\u003Esuperior lens dislocation is NOT typical\u003C/b\u003E\u003Cspan class=\u0022s3\u0022\u003E of homocystinuria.\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022 style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/p\u003E",
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    "Category": null,
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  },
  {
    "Id": 222,
    "Name": "Lenticonus",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA patient with \u003Cspan class=\u0022s1\u0022\u003E\u221214.00 D\u003C/span\u003E myopia in the right eye undergoes biometry before cataract surgery. Keratometry shows \u003Cspan class=\u0022s1\u0022\u003EK1 44.1 D\u003C/span\u003E and \u003Cspan class=\u0022s1\u0022\u003EK2 44.5 D\u003C/span\u003E, and the axial length is \u003Cspan class=\u0022s1\u0022\u003E23.8 mm\u003C/span\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cb\u003EWhat is the most likely diagnosis?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EA refractive error of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E\u221214.00 D\u003C/b\u003E\u003C/span\u003E is very high, yet this patient\u2019s biometry shows:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ENormal keratometry\u003C/b\u003E\u003C/span\u003E (\u224844 D \u2192 excludes keratoconus or steep cornea\u2013induced myopia)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ENormal axial length\u003C/b\u003E\u003C/span\u003E (\u224823.8 mm \u2192 excludes axial myopia)\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EWhen refractive error is disproportionately myopic \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edespite normal axial length and corneal power\u003C/b\u003E\u003C/span\u003E, the remaining location of excess refractive power is the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elens\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EPosterior lenticonus causes:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ELocalised posterior bulging of the lens\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIncreased lenticular power \u2192 \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emarked myopia\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOften disproportionate to AL and K readings\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EA classic \u201Cbiometry\u2013refraction mismatch\u201D\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EIndex myopia from nuclear sclerosis can induce a myopic shift, but \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E\u221214 D is far too large\u003C/b\u003E\u003C/span\u003E to be explained purely by nuclear change\u2014especially if the patient was highly myopic even before cataract formation.\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003ESurgeons must be cautious during cataract extraction because posterior lenticonus is associated with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eposterior capsule thinning or pre-existing dehiscence\u003C/b\u003E\u003C/span\u003E, increasing the risk of rupture.\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/p\u003E",
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    "HighYield": true,
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    "Category": null,
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  },
  {
    "Id": 223,
    "Name": "Secondary Glaucoma",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EIn uveitis\u2013glaucoma\u2013hyphaema (UGH) syndrome, which of the following statements is most likely to be TRUE?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EUGH syndrome occurs when an intraocular lens, typically \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emalpositioned\u003C/b\u003E\u003C/span\u003E, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Erotated\u003C/b\u003E\u003C/span\u003E, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eloose\u003C/b\u003E\u003C/span\u003E, or with an exposed \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehaptic,\u0026nbsp;\u003C/b\u003E\u003C/span\u003Emechanically irritates the iris or ciliary body. This leads to:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003Erecurrent \u003C/span\u003E\u003Cb\u003Eanterior uveitis\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003Ehyphaema\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003Esecondary \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eglaucoma\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003Echronic pain, photophobia, and fluctuating vision\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003EAlthough \u003C/span\u003E\u003Cb\u003Emost classically associated with rigid anterior chamber IOLs\u003C/b\u003E\u003Cspan class=\u0022s3\u0022\u003E, UGH can \u003C/span\u003E\u003Cb\u003Ealso\u003C/b\u003E\u003Cspan class=\u0022s3\u0022\u003E occur with:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003Eposterior chamber IOLs (especially if a haptic protrudes into the sulcus or ciliary body)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003Escleral- or iris-fixated lenses\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003Esubluxed/dialysed in-the-bag lenses\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe condition is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eunilateral\u003C/b\u003E\u003C/span\u003E, painful, and symptomatic; not bilateral or silent!\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EUGH has \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eno association with dermatologic depigmentation\u003C/b\u003E\u003C/span\u003E (this distractor echoes Vogt\u2013Koyanagi\u2013Harada disease).\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 224,
    "Name": "Secondary Glaucoma",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA patient has cataract surgery complicated by a posterior capsule rupture, and a posterior chamber IOL is placed in the \u003Cspan class=\u0022s1\u0022\u003Esulcus\u003C/span\u003E. 10 weeks later, the intraocular pressure was found to be 29 mmHg.\u0026nbsp;\u003C/span\u003E\u003Cb style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhat is the most likely cause of this raised IOP?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EA sulcus-placed IOL, especially if its haptics or optic edge rub against the posterior iris, can cause \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emechanical pigment release\u003C/b\u003E\u003C/span\u003E. This leads to trabecular meshwork obstruction and a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edelayed rise in IOP\u003C/b\u003E\u003C/span\u003E, typically weeks to months post-operatively.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EKey points supporting pigment dispersion:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOccurs \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eweeks to months\u003C/b\u003E\u003C/span\u003E after surgery (not immediately)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ERelated to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eiris chafing\u003C/b\u003E\u003C/span\u003E from sulcus-fixated IOLs\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ECauses gradual IOP elevation (often in the high 20s)\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Ca href=\u0022https://www.linkedin.com/posts/ahmed-omara-20713484_iris-chafing-syndrome-single-piece-iol-was-activity-7069029508959346688-Y_ck?utm_source=social_share_send\u0026amp;utm_medium=member_desktop_web\u0026amp;rcm=ACoAABwQJJsBaZhptdwPAib-jtOYs5OOIRqsr4w\u0022 style=\u0022color: rgb(0, 212, 255);\u0022\u003ESlit Lamp video showing Iris Chafing by Dr Ahmed Omara\u003C/a\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003EThe other options are less likely:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EUGH syndrome\u003C/b\u003E\u003C/span\u003E can occur in sulcus IOLs but is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emuch less common with modern designs\u003C/b\u003E\u003C/span\u003E, and typically presents with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehyphaema, pain, inflammation\u003C/b\u003E\u003C/span\u003E, \u003Cspan style=\u0022text-decoration-line: underline;\u0022\u003Enot isolated IOP rise.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAngle recession\u003C/b\u003E\u003C/span\u003E is associated with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Etrauma\u003C/b\u003E\u003C/span\u003E, not cataract surgery.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAqueous misdirection\u003C/b\u003E\u003C/span\u003E occurs \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eearly\u003C/b\u003E\u003C/span\u003E post-op and produces \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ea shallow anterior chamber\u003C/b\u003E\u003C/span\u003E, not a normal AC with late-onset pressure rise.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003EThus, \u003C/span\u003E\u003Cb\u003Eiris pigment chafing from the sulcus IOL\u003C/b\u003E\u003Cspan class=\u0022s3\u0022\u003E is the most likely explanation.\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022 style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/p\u003E",
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  },
  {
    "Id": 225,
    "Name": "Cataract surgery",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA hypermetropic patient with an axial length of \u003Cspan class=\u0022s1\u0022\u003E21 mm\u003C/span\u003E undergoes routine cataract surgery. Four weeks later, he reports deteriorating vision to his optician, measured at \u003Cspan class=\u0022s1\u0022\u003E6/36\u003C/span\u003E. The optician notes \u003Ci\u003E\u201Cretinal swelling.\u201D\u0026nbsp;\u003C/i\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhat is the most likely diagnosis?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECystoid macular oedema\u003C/b\u003E\u003C/span\u003E (Irvine Gass syndrome) is the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emost common retinal cause of reduced vision\u003C/b\u003E\u003C/span\u003E in the weeks following uncomplicated cataract surgery. It typically presents between \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E4 - 6 weeks post-operatively\u003C/b\u003E\u003C/span\u003E and appears as blurred or reduced central vision; OCT confirms the diagnosis.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe alternative diagnoses are much less likely:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EUveal effusion syndrome\u003C/b\u003E\u003C/span\u003E is strongly associated with \u003Ci\u003Enanophthalmos\u003C/i\u003E (axial length \u2248 \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E\u2264 16 mm\u003C/b\u003E\u003C/span\u003E). An axial length of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E21 mm\u003C/b\u003E\u003C/span\u003E is short but \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot nanophthalmic\u003C/b\u003E\u003C/span\u003E, and uveal effusion after routine cataract surgery remains \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Erare\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECiliary body detachment\u003C/b\u003E\u003C/span\u003E causes \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehypotony\u003C/b\u003E\u003C/span\u003E and often a shallow anterior chamber, not isolated \u201Cretinal swelling.\u201D\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERhegmatogenous retinal detachment\u003C/b\u003E\u003C/span\u003E reduces vision but typically presents with flashes, floaters, or a field defect rather than optician-described \u201Cretinal swelling.\u201D\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EGiven the timing, symptoms, and findings, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECMO is by far the most likely diagnosis.\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003Cb\u003E\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 1,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 226,
    "Name": "Glaucoma suspect",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA patient is referred by their community optometrist for possible glaucoma. On examination, the intraocular pressure (IOP) is \u003Cspan class=\u0022s1\u0022\u003E24 mmHg\u003C/span\u003E, the optic discs appear \u003Cspan class=\u0022s1\u0022\u003Enormal\u003C/span\u003E, and the\u0026nbsp;\u003Cspan class=\u0022s1\u0022\u003Evisual fields are normal\u003C/span\u003E.\u0026nbsp;\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhat is the most appropriate management plan?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EAn IOP of \u003C/span\u003E\u003Cb\u003E24 mmHg\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E with \u003C/span\u003E\u003Cb\u003Enormal discs\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and \u003C/span\u003E\u003Cb\u003Enormal visual fields\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E meets criteria for \u003C/span\u003E\u003Cb\u003Eocular hypertension only\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, not glaucoma.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003EAccording to NICE NG81 (Glaucoma: Diagnosis and Management):\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ETreatment is NOT recommended\u003C/b\u003E\u003C/span\u003E for IOP \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E\u0026lt; 25 mmHg\u003C/b\u003E\u003C/span\u003E unless there is evidence of structural or functional damage.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIndividuals with IOP \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E22\u201324 mmHg\u003C/b\u003E\u003C/span\u003E, normal discs, and normal fields should be \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ereturned to community optometry\u003C/b\u003E\u003C/span\u003E for routine \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eannual surveillance\u003C/b\u003E\u003C/span\u003E, not hospital follow-up.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThere is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eno indication\u003C/b\u003E\u003C/span\u003E for medication, as the risk of conversion to glaucoma at this IOP level is low.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cimg src=\u0022/upload-2025-12-03-34424722-55ba-48aa-98fe-ccf9caae8916.png\u0022\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThus, the correct management is \u003C/span\u003E\u003Cb\u003Esafe discharge to community monitoring\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared recently in FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003EIt is a very high-yield topic as it represents a recent [2022] change to the guidelines:\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Ca href=\u0022https://www.nice.org.uk/guidance/ng81/resources/glaucoma-diagnosis-and-management-pdf-1837689655237\u0022 style=\u0022color: rgb(0, 136, 255); text-decoration-line: underline;\u0022\u003EGlaucoma Management and Diagnosis - NICE guidelines\u003C/a\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 227,
    "Name": "CIN",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EWhich of the following statements about conjunctival intraepithelial neoplasia (CIN) is TRUE?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ECIN represents \u003C/span\u003E\u003Cb\u003Ecarcinoma in situ\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E on the spectrum of \u003C/span\u003E\u003Cb\u003Eocular surface squamous neoplasia (OSSN)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E. It typically presents as a \u003C/span\u003E\u003Cb\u003Emobile, gelatinous, leukoplakic, or papilliform limbal lesion\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E with \u003C/span\u003E\u003Cb\u003Eprominent feeder vessels\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E. Important risk factors include:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EUltraviolet light exposure\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EFair complexion\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EImmunosuppression\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, especially \u003C/span\u003E\u003Cb\u003EHIV infection\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EHPV infection (particularly HPV-16/18)\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ECIN \u003C/span\u003E\u003Cb\u003Eresponds well to topical chemotherapeutic agents\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, including:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EMitomycin C (MMC)\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003E5-fluorouracil (5-FU)\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EInterferon \u03B1-2b\u003C/b\u003E\u003C/span\u003E (excellent efficacy with best tolerability)\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003EThe tumour is \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003Enot fixed\u003C/b\u003E\u003C/span\u003E to the sclera; mobility helps distinguish it from invasive disease. CIN progresses to \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003Esquamous cell carcinoma\u003C/b\u003E\u003C/span\u003E, \u003Ci\u003Enot\u003C/i\u003E basal cell carcinoma.\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cimg src=\u0022https://eyerounds.org/atlas/pages/imgs/R_1cuBEeE9NvHsmvK_Screenshot2025.png\u0022\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cspan style=\u0022color: rgb(108, 117, 125); font-family: Roboto, sans-serif; font-size: 14.4px; letter-spacing: normal;\u0022\u003ESlit lamp photograph of the left eye in lateral gaze demonstrates a nasal, elevated, gelatinous, flesh-colored conjunctival lesion with leukoplakic areas extending approximately 1 mm onto the cornea, along with prominent nasal vessels.\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003ESource:\u0026nbsp;\u003Ca href=\u0022https://eyerounds.org/atlas/pages/CIN-Conjunctival-intraepithelial-neoplasia.htm#gsc.tab=0\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003EEyerounds - CIN\u003C/a\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003ENotes on OSSN:\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cul\u003E\u003Cli\u003EThe prevalence of OSSN is estimated to range from \u0026lt;0.2 cases/million/year (UK, 1996) to 35 cases/million/year (Uganda, 1992).\u0026nbsp;\u003C/li\u003E\u003Cli\u003E\u0026nbsp;In several series, CIN has been reported to be the most common conjunctival neoplasia, whereas SCC has been found to be the most common conjunctival malignancy.\u0026nbsp;\u003C/li\u003E\u003Cli\u003EIn the western hemisphere, OSSN afflicts mainly Caucasian men in their 60s to 70s who live close to the equator.\nHowever in Africa and certain parts of Asia, OSSN afflicts younger patients and tends to be more clinically aggressive.\nA similar pattern has been observed in patients with the human immunodeficiency virus (HIV) and xeroderma pigmentosum.\u003C/li\u003E\u003Cli\u003EPunctal occlusion is recommended during topical cytotoxic therapy to minimise systemic absorption.\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 228,
    "Name": "Dystrophies",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EYou receive a histopathology of an excised corneal button that shows the following findings:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022font-weight: bold;\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EThickened epithelial basement membrane\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EDuplication of the basement membrane\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EFibrillar/granular material between the basement membrane and Bowman\u2019s layer\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EWhat is the most likely diagnosis?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThe described histology is classic for \u003C/span\u003E\u003Cb\u003EMap\u2013dot\u2013fingerprint dystrophy (epithelial basement membrane dystrophy, EBMD)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E. Key features include:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EThickened and reduplicated epithelial basement membrane\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ETrapped fibrillar and fibrogranular material\u003C/b\u003E\u003C/span\u003E between the basement membrane and Bowman\u2019s layer\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPoor epithelial adhesion due to abnormal hemidesmosomes\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003EThese structural abnormalities create the characteristic \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003Emap\u003C/b\u003E\u003C/span\u003E, \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003Edot\u003C/b\u003E\u003C/span\u003E, and \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003Efingerprint lines\u003C/b\u003E\u003C/span\u003E seen clinically.\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cimg src=\u0022/upload-2025-12-03-893295d9-04d7-475e-9277-f3c1521d3371.png\u0022\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003EThe other options have distinct pathology:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EFuchs dystrophy\u003C/b\u003E\u003C/span\u003E \u2192 endothelial guttae, Descemet\u2019s membrane thickening\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EReis\u2013B\u00FCcklers dystrophy\u003C/b\u003E\u003C/span\u003E \u2192 replacement of Bowman\u2019s layer with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Efibrous scar tissue\u003C/b\u003E\u003C/span\u003E; \u201Choneycomb\u201D opacities\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EMeesmann\u2019s dystrophy\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192 intraepithelial cysts filled with \u003C/span\u003E\u003Cb\u003EPAS-positive material\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThus, the histology described is \u003C/span\u003E\u003Cb\u003Etypical of EBMD / map\u2013dot\u2013fingerprint dystrophy\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 229,
    "Name": "Rosacea Keratitis",
    "Body": "\u003Cspan style=\u0022font-size:11.0pt;line-height:115%;\nfont-family:\u0026quot;Cambria\u0026quot;,serif;mso-ascii-theme-font:minor-latin;mso-fareast-font-family:\n\u0026quot;MS Mincho\u0026quot;;mso-fareast-theme-font:minor-fareast;mso-hansi-theme-font:minor-latin;\nmso-bidi-font-family:Arial;mso-bidi-theme-font:minor-bidi;mso-ansi-language:\nEN-US;mso-fareast-language:EN-US;mso-bidi-language:AR-SA\u0022\u003EYou are asked to see\na 50-year-old man with recurrent red eyes for 15\nyears, treated with topical lubricants and antibiotics. He has developed a\nperipheral corneal infiltrate with infero-nasal corneal vascularization. Which\nof these is the MOST likely diagnosis?\u003Cbr\u003E\n\u003Cbr\u003E\n\u003C!--[if !supportLineBreakNewLine]--\u003E\u003Cbr\u003E\n\u003C!--[endif]--\u003E\u003C/span\u003E",
    "Explanation": "Correct Answer: Rosacea keratitis.\u003Cdiv\u003E\u003Cbr\u003E\u003Cdiv\u003ERosacea keratitis typically affects middle-aged patients and presents with chronic ocular redness and peripheral corneal vascularization, often infero-nasal. It is associated with meibomian gland dysfunction and lid margin disease, and patients may have facial rosacea features such as telangiectasia.\u0026nbsp;\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EManagement includes lid hygiene, oral doxycycline, lubricants, and cautious use of topical steroids.\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EIncorrect options: Disciform keratitis is linked to HSV and affects the central cornea. Marginal keratitis is acute, associated with staphylococcal blepharitis, and lacks chronic vascularization. Peripheral ulcerative keratitis is severe, linked to systemic autoimmune disease, and presents with crescent-shaped ulceration and thinning.\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EMnemonic: Red, Rough, Rosacea \u2013 chronic red eyes, lid disease, peripheral corneal changes.\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cimg src=\u0022/upload-2025-12-03-4dc5d27b-f35a-4dc0-b59c-64cb8efaf6aa.jpg\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cimg src=\u0022/upload-2025-12-03-8fca96cf-f324-4eab-9f91-3ad9016d6fc2.jpg\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cimg src=\u0022/upload-2025-12-03-5ce2f594-cebd-48c9-a4bc-f2b366bb0f73.jpg\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cimg src=\u0022/upload-2025-12-03-3bbe550b-3d2a-464b-a577-1a8057025c7a.jpg\u0022\u003E\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;list of pictures:\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E1-Rosacea keratitis.(https://webeye.ophth.uiowa.edu/eyeforum/atlas/pages/rosacea/Rosacea-OD-LRG.jpg)\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E2-Marginal Keratitis.(\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003Ehttps://www.sciencedirect.com/science/article/pii/S2214250922001640)\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E3-Disciform keratitis. (https://webeye.ophth.uiowa.edu/eyeforum/atlas/pages/Disciform-keratitis/Disciform-keratitis.jpg)\u003C/div\u003E\u003C/div\u003E\u003Cdiv\u003E4- PUK.(https://webeye.ophth.uiowa.edu/eyeforum/cases-i/case194/Fig1A-LRG.jpg)\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 230,
    "Name": "Leber\u2019s Hereditary Optic Neuropathy (LHON)",
    "Body": "In Leber\u2019s Hereditary Optic Neuropathy (LHON), which of the following statements is MOST likely to be correct?",
    "Explanation": "Correct Answer: A: A pathogenic mutation of mitochondrial DNA can be identified in approximately 90% of cases.\u003Cdiv\u003E\u003Cbr\u003E\u003Cdiv\u003ELHON is a maternally inherited optic neuropathy caused by mutations in mitochondrial DNA, most commonly affecting genes encoding complex I of the respiratory chain. The three primary mutations are ND4 (11778), ND1 (3460), and ND6 (14484), which account for the majority of cases.Genetic testing confirms the diagnosis in most patients.\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003EIncorrect options: LHON is transmitted exclusively through maternal inheritance, so symptomatic males do not pass the condition to their offspring. Spontaneous recovery of vision is uncommon but can occur, particularly in patients with the ND6 mutation (14484). Visual loss does not usually present as a gradual, symmetrical onset; instead, it typically begins in one eye and involves the fellow eye within weeks.\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003EMnemonic: LHON = Leber\u2019s Hereditary Optic Neuropathy \u2192 Mitochondrial mutation, Maternal inheritance.\u0026nbsp;\u003C/div\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cimg src=\u0022/upload-2025-12-03-aaf7ddec-d21f-4d87-823b-a2d896f6abe5.jpg\u0022\u003E\u003C/div\u003E\u003Cdiv\u003Ehttps://eyewiki.org/Leber_Hereditary_Optic_Neuropathy\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 231,
    "Name": "Neonatal Retinal Haemorrhage",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022\u003EA baby born by spontaneous vaginal delivery at 33 weeks has\ndot and blot retinal hemorrhages found shortly after birth. Which of the\nfollowing is the MOST likely diagnosis?\u003Co:p\u003E\u003C/o:p\u003E\u003C/p\u003E",
    "Explanation": "Correct Answer: C: Normal finding.\u003Cdiv\u003E\u003Cbr\u003E\u003Cdiv\u003ERetinal hemorrhages detected shortly after birth in a premature infant delivered vaginally are considered a normal physiological occurrence. These hemorrhages result from mechanical compression and transient venous congestion during delivery and typically resolve within a few weeks without intervention. Their presence immediately after birth does not indicate pathology and should not be confused with conditions such as retinopathy of prematurity or trauma.\u003C/div\u003E\u003Cdiv\u003EThe other options are incorrect: An inherited disorder of coagulation would present with systemic bleeding tendencies and persistent hemorrhages rather than isolated retinal findings immediately after birth.\u003C/div\u003E\u003Cdiv\u003ENon-accidental injury is characterized by extensive, multilayered retinal hemorrhages often accompanied by other signs of trauma or neurological involvement, which are absent in this case.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003ERetinopathy of prematurity develops later in premature infants, particularly those exposed to supplemental oxygen, and does not manifest as dot and blot hemorrhages immediately after birth.\u0026nbsp;\u003Cimg src=\u0022/upload-2025-12-03-9b97bc91-98b1-4319-b6c2-4c4836e3bce8.jpg\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003C/div\u003E\u003C/div\u003E\u003Cdiv\u003Ehttps://webeye.ophth.uiowa.edu/eyeforum/atlas/pages/non-accidental-trauma.htm\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 232,
    "Name": "DVLA Driving Standards",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022\u003EAccording to UK law, which of these patients would NOT be\nlegally able to drive within their category?\u003Co:p\u003E\u003C/o:p\u003E\u003C/p\u003E",
    "Explanation": "Correct Answer: C: A Group 1 driver who experienced a single episode of amaurosis fugax three weeks ago with no recurrence.\u003Cdiv\u003E\u003Cbr\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003EDriving After a Cerebrovascular Event (DVLA Guidance)\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-style: italic;\u0022\u003EGroup 1 Drivers (Cars / Motorcycles\u003C/span\u003E)\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;\u2022\tMust stop driving for: 1 month [not 3 weeks] after a stroke or TIA.\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;\u2022\tMay resume driving if: Clinical recovery is satisfactory.\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;\u2022\tNotify DVLA?\no\tNot required unless neurological deficit persists beyond 1 month.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u0026nbsp;\u2022\tMultiple TIAs within a short period:\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u0026nbsp; \u0026nbsp; \u0026nbsp;o\tMust be attack-free for at least 3 months.\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u0026nbsp; \u0026nbsp; \u0026nbsp;o\tDVLA must be notified.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cspan style=\u0022font-style: italic;\u0022\u003E\u0026nbsp;Group 2 Drivers (Heavy goods vehicles / Buses)\u003C/span\u003E\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u2022\tLicense refused or revoked for: 1 year after stroke or TIA.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u2022\tRe-licensing possible if:\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u0026nbsp; \u0026nbsp; o\tNo residual deficits affecting safe driving.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u0026nbsp; \u0026nbsp; o\tNo other significant risk factors.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cspan style=\u0022text-decoration-line: underline; font-weight: bold;\u0022\u003EDefect affecting central area only (Esterman within 20 degree radius of fixation) for Group 1 car and motorcycle driving:\n\u003C/span\u003E\u003Cspan style=\u0022font-style: italic;\u0022\u003Ethe following are generally regarded as acceptable central loss\u003C/span\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u0026nbsp;\uF0A7\tscattered single missed points\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u0026nbsp;\uF0A7\ta single cluster of up to 3 adjoining points\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cspan style=\u0022font-style: italic;\u0022\u003E\u0026nbsp;the following are generally regarded as unacceptable (\u2018significant\u2019) central loss:\u003C/span\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u0026nbsp;\uF0A7\ta cluster of 4 or more adjoining points that is either wholly or partly within the central 20\u00B0 area\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u0026nbsp;\uF0A7\tloss consisting of both a single cluster of 3 adjoining missed points up to and including 20\u00B0 from fixation, and any additional separate missed points within the central 20\u00B0 area\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\uF0A7\t any central loss that is an extension of hemianopia or quadrantanopia of size greater than 3 missed points.\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhy Other Options Are Incorrect B: Controlled diplopia with a patch and good acuity is permitted for Group 1 driving.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EA: a cluster of 4 or more adjoining points that is either wholly or partly within the central 20\u00B0 area is considered unacceptable.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003ED: A Group 2 driver with \u002B6.00 D correction and acuity of 6/6 and 6/12 meets DVLA standards because the prescription is within \u002B8.00 D and acuity thresholds are satisfied.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EReference:\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003EDVLA Visual Disorders: Assessing Fitness to Drive \u2013 GOV.UK: https://www.gov.uk/guidance/visual-disorders-assessing-fitness-to-drive\u003C/div\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 7,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 233,
    "Name": "Stargardt Disease",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022\u003EA 10-year-old girl presents with a recent history of\nproblems seeing at distance. She has 6/18 vision in both eyes, a normal\nrefraction, and subtle scattered sub-macular deposits. What is the MOST likely\ndiagnosis?\u003Co:p\u003E\u003C/o:p\u003E\u003C/p\u003E",
    "Explanation": "Correct Answer: D: Stargardt disease.\u0026nbsp;\u003Cdiv\u003EStargardt disease is the most common juvenile macular dystrophy, typically presenting in childhood or adolescence with progressive bilateral central vision loss. The hallmark features include normal refraction despite reduced visual acuity and the presence of subtle yellowish-white flecks or deposits at the posterior pole, often described as fundus flavimaculatus. Visual acuity of 6/18 in both eyes with normal refraction strongly supports a macular pathology rather than a refractive error. Stargardt disease is caused by mutations in the ABCA4 gene, leading to accumulation of lipofuscin in the retinal pigment epithelium.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003EWhy Other Options Are Incorrect: A: Cone dystrophy: Usually presents with photophobia, color vision defects, and progressive loss of central vision, but the fundus changes differ and often include bull\u2019s-eye maculopathy rather than scattered flecks.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003EB:Dominant drusen: Typically occurs later in life and is associated with drusen deposits in the macula and peripapillary region, not subtle flecks in a child.\u003C/div\u003E\u003Cdiv\u003EC: Fundus albipunctatus: Characterized by numerous small white dots throughout the retina and associated with night blindness, not isolated macular deposits or central vision loss in a child.\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003EClinical Pearls:\nMnemonic: \u2018Stargardt = Star flecks in macula\u2019 \u2192 Think of yellowish flecks and central vision loss in children.\nVisual acuity reduction with normal refraction in a child should raise suspicion for macular dystrophy.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003EList of images:\u003C/div\u003E\u003Cdiv\u003E1-Stargard dystrophy.(https://webeye.ophth.uiowa.edu/eyeforum/atlas/photos/stargardt-13-OD.jpg )\u003C/div\u003E\u003Cdiv\u003E2-Cone dystrophy.(https://www.eyerounds.org/atlas/pages/cone-rod-dystrophy.htm)\u003C/div\u003E\u003Cdiv\u003E3-Dominant drusen (https://imagebank.asrs.org/file/26145/familial-dominant-drusen)\u003C/div\u003E\u003Cdiv\u003E4-Fundus albipunctatus. (https://endeavors.unc.edu/win2005/retina.php).\u003C/div\u003E\u003Cdiv\u003E\u003Cimg src=\u0022/upload-2025-12-03-db982fba-e53a-4843-97ab-f97d51f78433.jpg\u0022\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cimg src=\u0022/upload-2025-12-03-e34d7768-6e91-4c89-a33d-00df6e8bdbe2.jpg\u0022\u003E\u003Cimg src=\u0022/upload-2025-12-03-79eb382f-fa94-4d35-888a-8177771ead5e.jpg\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cimg src=\u0022/upload-2025-12-03-00e73f90-7e8e-443a-a8b2-6b6f5a2e66fb.jpg\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 234,
    "Name": "Dystrophies",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EHistological examination of a corneal button demonstrates \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECongo red\u2013positive deposits within the corneal stroma\u003C/b\u003E\u003C/span\u003E.\u0026nbsp;\u003Cb style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhat is the most likely diagnosis?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECongo red positivity\u003C/b\u003E\u003C/span\u003E indicates \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eamyloid deposition\u003C/b\u003E\u003C/span\u003E, which is the hallmark histopathological feature of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elattice corneal dystrophy\u003C/b\u003E\u003C/span\u003E. The amyloid accumulates within the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecorneal stroma\u003C/b\u003E\u003C/span\u003E, producing the characteristic branching, lattice-like lines seen clinically.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EBy contrast:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMacular corneal dystrophy\u003C/b\u003E\u003C/span\u003E \u2192 stromal deposition of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eglycosaminoglycans\u003C/b\u003E\u003C/span\u003E (alcian blue\u2013positive)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGranular corneal dystrophy\u003C/b\u003E\u003C/span\u003E \u2192 \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehyaline\u003C/b\u003E\u003C/span\u003E deposits (Masson trichrome\u2013positive)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EReis\u2013B\u00FCcklers dystrophy\u003C/b\u003E\u003C/span\u003E \u2192 fibrous replacement of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBowman\u2019s layer\u003C/b\u003E\u003C/span\u003E, not amyloid\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 235,
    "Name": "Infectious Keratitis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EWhich of the following statements about Acanthamoeba is TRUE?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Ci\u003EAcanthamoeba\u003C/i\u003E species are \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Efree-living protozoa\u003C/b\u003E\u003C/span\u003E widely distributed in the environment, including \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esoil, dust, air, freshwater, seawater, and swimming pools\u003C/b\u003E\u003C/span\u003E. Growth in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Egarden soil\u003C/b\u003E\u003C/span\u003E is well recognised and underpins environmental exposure risk.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe other statements are incorrect:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Ci\u003EAcanthamoeba\u003C/i\u003E is \u003C/span\u003E\u003Cb\u003Enot easy to culture\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E; it requires \u003C/span\u003E\u003Cb\u003Enon-nutrient agar seeded with E. coli\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Etrophozoite\u003C/b\u003E\u003C/span\u003E is the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eactive, replicating form\u003C/b\u003E\u003C/span\u003E, while the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecyst\u003C/b\u003E\u003C/span\u003E is the dormant, resistant stage.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe organism is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ereadily identifiable on microscopy\u003C/b\u003E\u003C/span\u003E (especially cysts with a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edouble-walled structure\u003C/b\u003E\u003C/span\u003E) using corneal scrapings, confocal microscopy, or histology.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 6,
    "Category": null,
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  },
  {
    "Id": 236,
    "Name": "Infectious Keratitis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EWhich of the following statements about Candida species is FALSE?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Ci\u003ECandida\u003C/i\u003E species are \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eyeasts\u003C/b\u003E\u003C/span\u003E that have well-defined staining and culture characteristics:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPAS and GMS positive\u003C/b\u003E\u003C/span\u003E \u2192 highlights fungal cell walls\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EGram-positive\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and \u003C/span\u003E\u003Cb\u003Ecalcofluor-white positive\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192 binds to chitin and cellulose\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EOptimal growth on Sabouraud dextrose agar\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, though growth also occurs on blood agar\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003EHowever, \u003C/span\u003E\u003Cb\u003Emacroscopic colonies of Candida are typically creamy white\u003C/b\u003E\u003Cspan class=\u0022s3\u0022\u003E on agar.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EYellow-green colonies\u003C/b\u003E\u003Cspan class=\u0022s3\u0022\u003E are characteristic of \u003C/span\u003E\u003Cb\u003EAspergillus flavus\u003C/b\u003E\u003Cspan class=\u0022s3\u0022\u003E, not \u003Ci\u003ECandida\u003C/i\u003E.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 237,
    "Name": "Conjunctival lesions",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA man from \u003Cspan class=\u0022s1\u0022\u003EBotswana\u003C/span\u003E presents with a \u003Cspan class=\u0022s1\u0022\u003Ehaemorrhagic conjunctival lesion\u003C/span\u003E in the right eye.\u0026nbsp;\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhat is the most likely diagnosis?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EKaposi sarcoma\u003C/b\u003E\u003C/span\u003E is strongly associated with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EHIV infection\u003C/b\u003E\u003C/span\u003E and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EHHV-8\u003C/b\u003E\u003C/span\u003E, and is particularly prevalent in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esub-Saharan Africa\u003C/b\u003E\u003C/span\u003E, including Botswana. Ocular involvement commonly presents as a:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ERed\u2013purple or haemorrhagic conjunctival mass\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EHighly \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Evascular\u003C/b\u003E\u003C/span\u003E, often mistaken for subconjunctival haemorrhage\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EFrequently involves the \u003C/span\u003E\u003Cb\u003Einferior fornix or bulbar conjunctiva\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EBy contrast:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EConjunctival melanoma\u003C/b\u003E\u003C/span\u003E typically appears as a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epigmented\u003C/b\u003E\u003C/span\u003E, non-haemorrhagic lesion.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EConjunctival squamous cell carcinoma\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E presents as a \u003C/span\u003E\u003Cb\u003Efleshy, leukoplakic limbal mass\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, often linked to UV exposure and HIV, but is \u003C/span\u003E\u003Cb\u003Enot typically haemorrhagic\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EIn a patient from an HIV-endemic region with a haemorrhagic conjunctival lesion, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EKaposi sarcoma is the most likely diagnosis\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 238,
    "Name": "Infectious Keratitis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EWhich of the following antibiotics is least effective against Pseudomonas aeruginosa keratitis?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Ci\u003EPseudomonas aeruginosa\u003C/i\u003E is a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGram-negative, aerobic organism\u003C/b\u003E\u003C/span\u003E with intrinsic resistance to several antibiotics.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EChloramphenicol\u003C/b\u003E\u003C/span\u003E has \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epoor activity against Pseudomonas\u003C/b\u003E\u003C/span\u003E and is therefore ineffective for pseudomonal keratitis.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGentamicin\u003C/b\u003E\u003C/span\u003E (aminoglycoside) has good anti-pseudomonal activity and is commonly used in severe keratitis.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOfloxacin\u003C/b\u003E\u003C/span\u003E (fluoroquinolone) provides effective Gram-negative coverage, including \u003Ci\u003EPseudomonas\u003C/i\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECefuroxime\u003C/b\u003E\u003C/span\u003E (a second-generation cephalosporin) has \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elimited activity\u003C/b\u003E\u003C/span\u003E against \u003Ci\u003EPseudomonas\u003C/i\u003E, but still offers \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emore coverage than chloramphenicol\u003C/b\u003E\u003C/span\u003E, which has essentially none.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003EThus, \u003C/span\u003E\u003Cb\u003Echloramphenicol\u003C/b\u003E\u003Cspan class=\u0022s3\u0022\u003E is the \u003C/span\u003E\u003Cb\u003Eleast effective\u003C/b\u003E\u003Cspan class=\u0022s3\u0022\u003E option.\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022 style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 239,
    "Name": "Infectious Keratitis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EWhat is the approximate \u003C/span\u003Epercentage reduction in recurrence of stromal herpes simplex keratitis (HSK)\u003Cspan class=\u0022s1\u0022\u003E with \u003C/span\u003E6 months of oral acyclovir prophylaxis\u003Cspan class=\u0022s1\u0022\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThe \u003C/span\u003E\u003Cb\u003EHerpetic Eye Disease Study II (HEDS II)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E demonstrated that \u003C/span\u003E\u003Cb\u003Eoral acyclovir 400 mg twice daily for 6 months\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E significantly reduces recurrences of ocular HSV disease.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003EKey findings:\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EOverall ocular HSV recurrence:\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E reduced by ~\u003C/span\u003E\u003Cb\u003E45%\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAcyclovir group: \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E18%\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPlacebo group: \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E30%\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EStromal keratitis recurrence:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E14%\u003C/b\u003E\u003C/span\u003E with acyclovir vs \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E28%\u003C/b\u003E\u003C/span\u003E with placebo \u2192 \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E~50% reduction\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EEpithelial keratitis recurrence:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E9% vs 14% (modest reduction)\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EGreatest benefit\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E seen in patients with \u003C/span\u003E\u003Cb\u003Emultiple prior episodes\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ENo additional benefit\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E when oral acyclovir was added to \u003C/span\u003E\u003Cb\u003Etopical trifluridine\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EEffect consistent across \u003C/span\u003E\u003Cb\u003Eage, sex, and time since last episode\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003EThus, for stromal HSK, oral acyclovir halves the recurrence risk, making \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003E~50% reduction\u003C/b\u003E\u003C/span\u003E the best answer.\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 240,
    "Name": "Retinal dystrophies",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EA 14-year-old boy is noted to have \u003C/span\u003Escattered punctate white flecks at the left fovea\u003Cspan class=\u0022s1\u0022\u003E and a \u003C/span\u003Esub-foveal elevation in the right eye\u003Cspan class=\u0022s1\u0022\u003E. His father has similar ocular findings.\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhat is the most likely diagnosis?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThe clinical picture is characteristic of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBest vitelliform macular dystrophy\u003C/b\u003E\u003C/span\u003E, an \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eautosomal dominant\u003C/b\u003E\u003C/span\u003E condition caused by mutations in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBEST1\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EKey supporting features:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EOnset in childhood or adolescence\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ESub-foveal vitelliform (\u201Cegg-yolk\u201D) lesion\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, which may fragment into \u003C/span\u003E\u003Cb\u003Epunctate white flecks\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E as it evolves\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPositive family history\u003C/b\u003E\u003C/span\u003E consistent with autosomal dominant inheritance\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EOften, there is\u0026nbsp;\u003C/span\u003E\u003Cb\u003Erelatively preserved visual acuity early on\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, despite striking fundus changes\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EEOG (reduced Arden ratio) is classically abnormal, even when VA is good.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EWhy the other options are less likely:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAutosomal dominant drusen\u003C/b\u003E\u003C/span\u003E \u2192 typically later onset, with radial drusen around the disc (\u201Choneycomb\u201D pattern)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EFundus flavimaculatus\u003C/b\u003E\u003C/span\u003E \u2192 a form of Stargardt disease, usually \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eautosomal recessive\u003C/b\u003E\u003C/span\u003E, with widespread pisciform flecks\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ENorth Carolina macular dystrophy\u003C/b\u003E\u003C/span\u003E \u2192 congenital, non-progressive, often present from birth rather than adolescence\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 241,
    "Name": "Retinal Detachment",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 64-year-old myopic woman presents with \u003Cspan class=\u0022s1\u0022\u003Esudden-onset flashes and floaters\u003C/span\u003E. The optician notes the presence of \u003Cspan class=\u0022s1\u0022\u003Etobacco dust\u003C/span\u003E in the vitreous.\u0026nbsp;\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhat is the most likely diagnosis?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ETobacco dust\u003C/b\u003E\u003C/span\u003E (Shafer\u2019s sign) represents \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epigment cells in the vitreous\u003C/b\u003E\u003C/span\u003E, released from the retinal pigment epithelium. In the context of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eacute flashes and floaters\u003C/b\u003E\u003C/span\u003E, this finding is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehighly predictive of a retinal break\u003C/b\u003E\u003C/span\u003E and should be considered a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eretinal tear until proven otherwise\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EKey points:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ERetinal tears commonly occur following \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eposterior vitreous detachment\u003C/b\u003E\u003C/span\u003E, especially in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emyopes\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EA \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Erhegmatogenous retinal detachment\u003C/b\u003E\u003C/span\u003E may develop subsequently, but in the absence of a peripheral field defect or curtain-like visual loss, a tear is more likely at presentation.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMigraine causes transient visual phenomena without vitreous pigment.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ERetinal vein occlusion presents with painless visual loss and fundoscopic haemorrhages, not flashes or tobacco dust.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EVideo showing Shafer\u0027s sign:\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Ca href=\u0022https://www.youtube.com/watch?v=JHZqmlyVLW4\u0022 style=\u0022color: rgb(0, 29, 255);\u0022\u003ESchaffer\u2019 sign / Tobacco dust sign - Pigments in anterior Vitreous\u003C/a\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 242,
    "Name": "Viral retinitis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EWhat is the most appropriate treatment for peripheral cytomegalovirus (CMV) retinitis?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOral ganciclovir,\u0026nbsp;\u003C/b\u003E\u003C/span\u003Emost commonly given as \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Evalganciclovir,\u0026nbsp;\u003C/b\u003E\u003C/span\u003Eis the preferred \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esystemic oral therapy\u003C/b\u003E\u003C/span\u003E for CMV retinitis, particularly when disease is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eperipheral and non-sight-threatening\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EKey points:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGanciclovir/valganciclovir\u003C/b\u003E\u003C/span\u003E are active against CMV and achieve adequate intraocular levels.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EFoscarnet\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E has anti-CMV activity but is \u003C/span\u003E\u003Cb\u003Enot available orally\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E; it is given \u003C/span\u003E\u003Cb\u003Eintravenously or intravitreally\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EValacyclovir\u003C/b\u003E\u003C/span\u003E and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eacyclovir\u003C/b\u003E\u003C/span\u003E are ineffective against CMV due to lack of viral thymidine kinase activity.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 12,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 243,
    "Name": "PCV",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ERegarding \u003C/span\u003Eidiopathic polypoidal choroidal vasculopathy (PCV)\u003Cspan class=\u0022s1\u0022\u003E, which of the following statements is \u003C/span\u003ETRUE\u003Cspan class=\u0022s1\u0022\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EPCV is an idiopathic choroidal vasculopathy characterised clinically by \u003C/span\u003E\u003Cb\u003Eserous pigment epithelial detachments (PEDs)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, often associated with \u003C/span\u003E\u003Cb\u003Esubretinal fluid and recurrent subretinal or sub-RPE haemorrhage\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EIndocyanine green angiography (ICG)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is diagnostic and shows:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EA \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebranching vascular network\u003C/b\u003E\u003C/span\u003E at the level of the choriocapillaris\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPolypoidal (aneurysmal) dilatations\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E at terminal vessels\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ELesions that \u003C/span\u003E\u003Cb\u003Efill slowly and then leak intensely\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003EThe other statements are incorrect:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ERisk is increased in Asian populations\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, not Scandinavian ancestry.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EICG does \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot\u003C/b\u003E\u003C/span\u003E show occluded vessels; it demonstrates abnormal \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eaneurysmal choroidal vasculature\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMacular involvement is most common\u003C/b\u003E\u003C/span\u003E; peripapillary lesions occur but account for only \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E~20%\u003C/b\u003E\u003C/span\u003E of cases.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 244,
    "Name": "Stickler Syndrome",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EWhich of the following statements regarding Stickler syndrome is FALSE?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EStickler syndrome is a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Econnective tissue disorder\u003C/b\u003E\u003C/span\u003E most commonly inherited in an \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eautosomal dominant\u003C/b\u003E\u003C/span\u003E pattern. It is typically caused by mutations in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECOL2A1\u003C/b\u003E\u003C/span\u003E (type II collagen), though other collagen genes may also be involved.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EKey ophthalmic features include:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EHigh congenital myopia\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EVitreoretinal degeneration\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EHigh risk of retinal detachment\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EStickler syndrome demonstrates \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecomplete penetrance\u003C/b\u003E\u003C/span\u003E, meaning affected individuals will show some features of the condition, but with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Evariable expressivity\u003C/b\u003E\u003C/span\u003E, so the severity and combination of ocular, craniofacial, and musculoskeletal features can vary widely between individuals.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003ETherefore, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eincomplete penetrance\u003C/b\u003E\u003C/span\u003E is the false statement.\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 245,
    "Name": "White Dot syndromes",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EWhich of the following statements regarding punctate inner choroidopathy (PIC) is FALSE?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EPunctate inner choroidopathy is an inflammatory chorioretinal disorder that typically affects \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eyoung myopic women\u003C/b\u003E\u003C/span\u003E. It presents with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emultiple small yellow-white lesions\u003C/b\u003E\u003C/span\u003E at the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eposterior pole\u003C/b\u003E\u003C/span\u003E, usually without significant anterior segment or vitreous inflammation.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EA key complication of PIC is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Echoroidal neovascularisation (CNV)\u003C/b\u003E\u003C/span\u003E, which develops in a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esubstantial proportion of patients up to 30-40%\u003C/b\u003E\u003C/span\u003E in published series. CNV is a major cause of visual loss in PIC and often requires anti-VEGF therapy.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003ETherefore, the statement that CNV develops in only \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E5%\u003C/b\u003E\u003C/span\u003E of patients is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Efalse\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 12,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 246,
    "Name": "Retinal dystrophies",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EA patient presents with \u003C/span\u003Epigmentary retinopathy\u003Cspan class=\u0022s1\u0022\u003E, \u003C/span\u003Eanosmia\u003Cspan class=\u0022s1\u0022\u003E, and \u003C/span\u003Eataxia\u003Cspan class=\u0022s1\u0022\u003E.\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhich dietary component is most likely responsible for this clinical picture?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThis constellation of features is characteristic of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERefsum disease\u003C/b\u003E\u003C/span\u003E, a rare \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eautosomal recessive inborn error of metabolism\u003C/b\u003E\u003C/span\u003E caused by deficiency of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ephytanic acid \u03B1-hydroxylase (PHYH)\u003C/b\u003E\u003C/span\u003E. The defect leads to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eaccumulation of phytanic acid\u003C/b\u003E\u003C/span\u003E, a branched-chain fatty acid derived from the diet.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003ETypical features include:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPigmentary retinopathy\u003C/b\u003E\u003C/span\u003E (often presenting like retinitis pigmentosa)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPeripheral neuropathy and cerebellar ataxia\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EAnosmia\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ESensorineural deafness\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ECardiomyopathy\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EIchthyosis\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EManagement includes \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eplasmapheresis\u003C/b\u003E\u003C/span\u003E in acute settings and long-term adherence to a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ephytanic-acid-restricted diet\u003C/b\u003E\u003C/span\u003E (avoiding dairy fat, ruminant meat, and certain fish).\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe other options are incorrect:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBeta-lipoprotein deficiency\u003C/b\u003E\u003C/span\u003E \u2192 abetalipoproteinaemia (acanthocytosis, fat malabsorption)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECopper\u003C/b\u003E\u003C/span\u003E \u2192 Wilson disease (Kayser-Fleischer rings, hepatic and neurological disease)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EZinc\u003C/b\u003E\u003C/span\u003E \u2192 no such retinoneurological syndrome\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 247,
    "Name": "Retinal dystrophies",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhat is the pattern of inheritance of \u003Cspan class=\u0022s1\u0022\u003ELeber\u2019s congenital amaurosis (LCA)\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELeber\u2019s congenital amaurosis\u003C/b\u003E\u003C/span\u003E is a group of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esevere, early-onset retinal dystrophies\u003C/b\u003E\u003C/span\u003E presenting in infancy with profound visual impairment, nystagmus, and markedly reduced or absent ERG responses. The condition is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emost commonly inherited in an autosomal recessive pattern\u003C/b\u003E\u003C/span\u003E, with mutations identified in multiple genes (e.g. \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERPE65, CEP290, GUCY2D\u003C/b\u003E\u003C/span\u003E).\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EIt is important not to confuse this with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELeber hereditary optic neuropathy (LHON)\u003C/b\u003E\u003C/span\u003E, which affects young adults and is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emitochondrially inherited\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003ERemember:\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ELCA \u2192 autosomal recessive retinal dystrophy (infancy)\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ELHON \u2192 mitochondrial optic neuropathy (young adults)\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 248,
    "Name": "White Dot syndromes",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EIn \u003C/span\u003Ebirdshot chorioretinopathy\u003Cspan class=\u0022s1\u0022\u003E, which of the following \u003C/span\u003EERG findings is LEAST likely\u003Cspan class=\u0022s1\u0022\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EERG abnormalities in \u003C/span\u003E\u003Cb\u003Ebirdshot chorioretinopathy\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E closely \u003C/span\u003E\u003Cb\u003Ecorrelate with disease severity\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and are central to both \u003C/span\u003E\u003Cb\u003Emonitoring progression\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and \u003C/span\u003E\u003Cb\u003Eguiding immunosuppressive therapy\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003ETypical ERG features include:\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EReduced b-wave amplitude\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EReduced oscillatory potentials\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EProlonged implicit time of 30-Hz flicker;\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E\u0026nbsp;the \u003C/span\u003E\u003Cb\u003Emost sensitive and earliest abnormality\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EIn \u003C/span\u003E\u003Cb\u003Eearly disease\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, the ERG may be \u003C/span\u003E\u003Cb\u003Enormal or only subtly abnormal\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003EHowever, in \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003Esevere disease\u003C/b\u003E\u003C/span\u003E, the ERG is \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003Eclearly abnormal\u003C/b\u003E\u003C/span\u003E, not equivocal.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003ETherefore, an \u003Ci\u003Eequivocal ERG in severe disease\u003C/i\u003E is \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003Eleast likely\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003ERemember:\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EBirdshot = HLA-A29 \u002B ERG-driven management\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003E30-Hz flicker implicit time delay is the earliest and most sensitive ERG change\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 12,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 249,
    "Name": "Birdshot Chorioretinopathy",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich description best fits the fundus appearance of \u003Cspan class=\u0022s1\u0022\u003Ebirdshot chorioretinopathy\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EBirdshot chorioretinopathy is characterised by \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emultiple, cream-coloured or hypopigmented choroidal lesions\u003C/b\u003E\u003C/span\u003E, classically described as \u003Ci\u003E\u201Cbirdshot from a shotgun.\u201D\u003C/i\u003E These lesions:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EAre \u003C/span\u003E\u003Cb\u003Eoval and ill-defined\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EAre distributed \u003C/span\u003E\u003Cb\u003Ebetween the equator and mid-periphery\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ETypically \u003C/span\u003E\u003Cb\u003Espare the fovea early\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EBecome more visible over time as inflammation evolves\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cimg src=\u0022https://img1.wsimg.com/isteam/ip/d4b6c44c-e4e5-4e6a-b1c1-812b3ccb5a4d/c7805637-42f3-403d-a1ef-44ff4102b0ae.jpg/:/cr=t:0%25,l:0%25,w:100%25,h:100%25/rs=w:400,cg:true\u0022\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe other options are incorrect:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EFoveal atrophic spots\u003C/b\u003E\u003C/span\u003E suggest macular dystrophies or advanced inflammatory disease\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPigmented mid-peripheral lesions\u003C/b\u003E\u003C/span\u003E are more typical of healed chorioretinitis (e.g. toxoplasmosis)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPeripapillary atrophy\u003C/b\u003E\u003C/span\u003E is non-specific and not diagnostic of birdshot\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003ERemember:\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EBirdshot = cream-coloured hypopigmented lesions in the mid-peripheral fundus \u002B HLA-A29 \u002B ERG abnormalities.\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 12,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 250,
    "Name": "Lattice retinal degeneration",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 60-year-old moderate myope presents with a \u003Cspan class=\u0022s1\u0022\u003E1-week history of flashes and floaters\u003C/span\u003E. Examination reveals a \u003Cspan class=\u0022s1\u0022\u003Epartial posterior vitreous detachment\u003C/span\u003E. The retina is flat with \u003Cspan class=\u0022s1\u0022\u003Eno retinal breaks\u003C/span\u003E, but an area of \u003Cspan class=\u0022s1\u0022\u003Elattice degeneration\u003C/span\u003E is noted in the superotemporal periphery.\u0026nbsp;\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhat is the most appropriate management?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELattice degeneration\u003C/b\u003E\u003C/span\u003E is a recognised \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Erisk factor\u003C/b\u003E\u003C/span\u003E for rhegmatogenous retinal detachment, particularly in myopic eyes. However, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ein the absence of an associated retinal tear or hole\u003C/b\u003E\u003C/span\u003E, prophylactic treatment is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot indicated\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EKey points:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMost patients with lattice degeneration \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enever develop retinal detachment\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EEvidence does \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot support prophylactic laser or cryotherapy\u003C/b\u003E\u003C/span\u003E for asymptomatic lattice without breaks.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EUnnecessary treatment carries risks, including iatrogenic breaks and scarring.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EAppropriate management is:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EReassurance and education\u003C/b\u003E\u003C/span\u003E about warning symptoms (new flashes, floaters, curtain-like vision loss)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPrompt re-examination\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E if symptoms worsen\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThus, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eobservation alone\u003C/b\u003E\u003C/span\u003E is the correct approach.\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 251,
    "Name": "Electrophysiology",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EWhich condition is most likely to produce an inverted (negative) ERG on electrophysiological testing?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EA \u003C/span\u003E\u003Cb\u003Enegative (inverted) ERG\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is characterised by a \u003C/span\u003E\u003Cb\u003Erelatively preserved a-wave\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E with a \u003C/span\u003E\u003Cb\u003Emarkedly reduced b-wave\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, indicating dysfunction \u003C/span\u003E\u003Cb\u003Epost-photoreceptor\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, most commonly at the \u003C/span\u003E\u003Cb\u003Ebipolar cell level\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003EThis pattern is classically seen in conditions that disrupt signal transmission between \u003Cspan class=\u0022s2\u0022\u003E\u003Cb\u003Ephotoreceptors and bipolar cells\u003C/b\u003E\u003C/span\u003E, including:\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ECongenital stationary night blindness (CSNB)\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EX-linked retinoschisis\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ECentral retinal artery or vein occlusion\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (acute setting)\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EMelanoma Associated Retinopathy\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EQuinine toxicity\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EBirdshot Chorioretinopathy\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003EThe other options are less likely:\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERetinitis pigmentosa\u003C/b\u003E\u003C/span\u003E \u2192 both a- and b-waves are reduced\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELeber\u2019s congenital amaurosis\u003C/b\u003E\u003C/span\u003E \u2192 severely reduced or absent ERG overall\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBest disease\u003C/b\u003E\u003C/span\u003E \u2192 full-field ERG is typically normal (EOG is abnormal)\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cimg src=\u0022/upload-2025-12-14-e059aed0-41ab-46da-8b81-ddb164577cf0.png\u0022\u003E\u003C/h3\u003E\u003Cdiv\u003E*Table from Oxford Handbook for Ophthalmology\u003C/div\u003E\u003Ch3\u003E\u003Cbr\u003E\u003C/h3\u003E\u003Ch3\u003ERemember:\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ENegative ERG = intact photoreceptors, impaired bipolar cell function [inner retina]\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 252,
    "Name": "Retinal dystrophies",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EA patient is found to have \u003C/span\u003Einferotemporal retinoschisis\u003Cspan class=\u0022s1\u0022\u003E with associated \u003C/span\u003Emacular pigmentary changes\u003Cspan class=\u0022s1\u0022\u003E.\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhat is the \u003C/span\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003Emode of inheritance\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E of this condition?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThis clinical picture is characteristic of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EX-linked retinoschisis (XLRS)\u003C/b\u003E\u003C/span\u003E, caused by mutations in the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERS1 gene\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EKey features supporting the diagnosis:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EInferotemporal peripheral retinoschisis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (classical location)\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMacular involvement\u003C/b\u003E\u003C/span\u003E with pigmentary change or spoke-wheel pattern\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPredominantly affects \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emales\u003C/b\u003E\u003C/span\u003E, with female carriers usually asymptomatic\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOften associated with a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enegative ERG\u003C/b\u003E\u003C/span\u003E (reduced b-wave)\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EXLRS is therefore inherited in an \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EX-linked recessive\u003C/b\u003E\u003C/span\u003E pattern.\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cimg src=\u0022/upload-2025-12-14-0c38da5a-cf8f-4a93-8400-e328c2699143.png\u0022\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-size: small; font-style: italic;\u0022\u003E\u003Cspan style=\u0022color: rgb(0, 0, 0); font-family: Montserrat, Arial, sans-serif; letter-spacing: normal;\u0022\u003ECXLRS remains a clinical diagnosis. Affected males typically have characteristic foveal schisis (\u003C/span\u003E\u003Ca class=\u0022figure-link\u0022 href=\u0022https://www.asrs.org/content/images/cms/congenital_x_linked_retinoschisis_fig_1.png\u0022 title=\u0022\nFigure 1.\n\u0022 style=\u0022border-style: initial; border-color: initial; border-image: initial; font-family: Montserrat, Arial, sans-serif; outline: 0px; vertical-align: baseline; color: rgba(0, 69, 170, 0.5); transition: 0.1s ease-in-out; letter-spacing: normal;\u0022\u003EFigure 1\u003C/a\u003E\u003Cspan style=\u0022color: rgb(0, 0, 0); font-family: Montserrat, Arial, sans-serif; letter-spacing: normal;\u0022\u003E). The peripheral retina also may be involved (\u003C/span\u003E\u003Ca class=\u0022figure-link\u0022 href=\u0022https://www.asrs.org/content/images/cms/congenital_x_linked_retinoschisis_fig_2.png\u0022 title=\u0022\nFigure 2.\n\u0022 style=\u0022border-style: initial; border-color: initial; border-image: initial; font-family: Montserrat, Arial, sans-serif; outline: 0px; vertical-align: baseline; color: rgba(0, 69, 170, 0.5); transition: 0.1s ease-in-out; letter-spacing: normal;\u0022\u003EFigure 2\u003C/a\u003E\u003Cspan style=\u0022color: rgb(0, 0, 0); font-family: Montserrat, Arial, sans-serif; letter-spacing: normal;\u0022\u003E), with splitting of the retinal layers resulting in a blister-like elevation of the lower part of the retina. In severe cases retinal detachment may occur. CXLRS typically affects both eyes, although often not to the same degree.\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003EImage and comment source:\u0026nbsp;\u003Ca href=\u0022https://www.asrs.org/patients/retinal-diseases/14/congenital-x-linked-retinoschisis\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003ECongenital X-Linked Retinoschisis\u003C/a\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
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    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 253,
    "Name": "Retinal Detachment",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EIn which situation is \u003C/span\u003Edegenerative retinoschisis\u003Cspan class=\u0022s1\u0022\u003E most likely to progress to a \u003C/span\u003Erhegmatogenous retinal detachment\u003Cspan class=\u0022s1\u0022\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EDegenerative retinoschisis is usually a \u003C/span\u003E\u003Cb\u003Ebenign and stable condition\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E. Progression to a true \u003C/span\u003E\u003Cb\u003Eretinal detachment\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E occurs \u003C/span\u003E\u003Cb\u003Eonly when there is a pathway for vitreous fluid to access the subretinal space\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003EThis requires:\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EA \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebreak in the inner leaf\u003C/b\u003E\u003C/span\u003E \u2192 allows vitreous to enter the schisis cavity\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EA \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebreak in the outer leaf\u003C/b\u003E\u003C/span\u003E \u2192 allows fluid to pass into the subretinal space\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003EWhen \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003Eboth layers are breached\u003C/b\u003E\u003C/span\u003E, fluid can move from the vitreous cavity to the subretinal space, producing a \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003Erhegmatogenous retinal detachment\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003EIsolated inner- or outer-leaf breaks \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003Ealone\u003C/b\u003E\u003C/span\u003E are insufficient to cause detachment.\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cimg src=\u0022/upload-2025-12-14-f460f1a2-87ae-48cd-aa6b-0c342f880908.jpg\u0022\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Ca href=\u0022https://www.vrsurgeryonline.com/13-rhegmatogenous-retinal-detachment-special-scenarios/03-retinoschisis-retinal-detachment/\u0022\u003EA Large Outer Retinal Hole Leading to a Detachment in an Underlying Retinoschisis\u003C/a\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cimg src=\u0022/upload-2025-12-14-3ba5bae5-4df5-4058-a408-357d70e10c2c.jpeg\u0022\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Ca href=\u0022https://www.vrsurgeryonline.com/13-rhegmatogenous-retinal-detachment-special-scenarios/03-retinoschisis-retinal-detachment/\u0022\u003EAn OCT image of the Tear with Underlying Schisis\u003C/a\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003EImages source:\u0026nbsp;\u003Ca href=\u0022https://www.vrsurgeryonline.com/13-rhegmatogenous-retinal-detachment-special-scenarios/03-retinoschisis-retinal-detachment/\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003EVitreoretinal Surgery Online\u003C/a\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003ERemember:\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ERetinoschisis \u002B inner \u0026amp; outer leaf breaks = true retinal detachment risk.\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EEither break alone = usually stable, observe.\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 254,
    "Name": "Macular Hole",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following factors is \u003Cspan class=\u0022s1\u0022\u003ELEAST important\u003C/span\u003E for successful \u003Cspan class=\u0022s1\u0022\u003Emacular hole surgery\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThe key determinants of macular hole closure are \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esurgical\u003C/b\u003E\u003C/span\u003E, not positional:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EVitrectomy\u003C/b\u003E\u003C/span\u003E removes anteroposterior vitreomacular traction.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EILM peeling\u003C/b\u003E\u003C/span\u003E eliminates tangential traction and reduces reopening rates.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGas tamponade\u003C/b\u003E\u003C/span\u003E provides a temporary scaffold promoting hole apposition and closure.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe role of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eposturing\u003C/b\u003E\u003C/span\u003E (face-down positioning) is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emuch less critical\u003C/b\u003E\u003C/span\u003E. Multiple randomised trials and meta-analyses show \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehigh closure rates even with limited or no posturing\u003C/b\u003E\u003C/span\u003E, particularly for small-to-medium full-thickness macular holes.\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EWhile some surgeons still recommend short-term posturing in selected cases (e.g. large holes), it is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ethe least important factor\u003C/b\u003E\u003C/span\u003E among those listed.\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003EFurther reading:\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Ca href=\u0022https://pmc.ncbi.nlm.nih.gov/articles/PMC7852599/\u0022\u003EFactors affecting anatomical and visual outcome after macular hole surgery: findings from a large prospective UK cohort\u003C/a\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003ED H Steel 1,2,, P H J Donachie 3, G W Aylward 4, D A Laidlaw 5, T H Williamson 5, D Yorston 6; the BEAVRS Macular hole outcome group\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
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  },
  {
    "Id": 255,
    "Name": "Optic disc anomalies",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EA patient \u003C/span\u003E\u003Cspan class=\u0022s1\u0022\u003Epresents with \u003C/span\u003Egradual visual deterioration\u003Cspan class=\u0022s1\u0022\u003E in the right eye. On examination, Visual acuity is \u003C/span\u003ELogMAR 0.3 (right)\u003Cspan class=\u0022s1\u0022\u003E and \u003C/span\u003ELogMAR 0.0 (left)\u003Cspan class=\u0022s1\u0022\u003E. Fundus examination shows bilateral optic disc pits. OCT shows \u003C/span\u003Efoveal schisis with associated subretinal fluid\u003Cspan class=\u0022s1\u0022\u003E in the right eye, while the left eye is normal.\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhat is the most appropriate initial treatment?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThis presentation is typical of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eoptic disc pit maculopathy\u003C/b\u003E\u003C/span\u003E, where fluid from the optic pit tracks into the inner retina, causing \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eretinoschisis and/or serous macular detachment\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EInitial management\u003C/b\u003E\u003C/span\u003E is generally \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Econservative or minimally invasive\u003C/b\u003E\u003C/span\u003E, particularly when visual acuity is relatively preserved. \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELaser photocoagulation\u003C/b\u003E\u003C/span\u003E applied in one or more light rows \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebetween the optic disc and the macular detachment\u003C/b\u003E\u003C/span\u003E aims to create a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Echorioretinal adhesion\u003C/b\u003E\u003C/span\u003E, forming a barrier that limits further fluid migration from the pit into the macula.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EUnfortunately, Laser photocoagulation therapy has not had much success in most studies, patients treated did not notice improvement, in fact some reported more visual disturbance after the treatment\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p2\u0022\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p2\u0022\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px; font-weight: bold; text-decoration-line: underline;\u0022\u003EMore invasive options:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EVitrectomy with gas tamponade\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (\u00B1 ILM peel) is reserved for \u003C/span\u003E\u003Cb\u003Epersistent or progressive cases\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EStudies have shown promising long-term results in both retinal re-attachments (50-95% of patients) and visual improvement(\u0026gt;50% of patients).\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cspan style=\u0022font-weight: 400; letter-spacing: 0.14994px;\u0022\u003ESeveral studies have demonstrated high success rates using \u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003Eintravitreal gas tamponade\u003C/span\u003E\u003Cspan style=\u0022font-weight: 400; letter-spacing: 0.14994px;\u0022\u003E, with or without barrier laser applied to the temporal disc margin. These approaches achieved fluid resolution in approximately 50\u201375% of cases, with corresponding significant visual improvement. However, recurrence is common, and repeat gas injections are frequently required to maintain anatomical success\u003C/span\u003E\u003C/b\u003E\u003C/p\u003E\u003C/li\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022letter-spacing: 0.14994px;\u0022\u003EPDT\u003C/b\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E and \u003C/span\u003E\u003Cb style=\u0022letter-spacing: 0.14994px;\u0022\u003Eintravitreal steroids\u003C/b\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E have \u003C/span\u003E\u003Cb style=\u0022letter-spacing: 0.14994px;\u0022\u003Eno established role\u003C/b\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E in optic disc pit maculopathy.\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p2\u0022\u003E\u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003EIn Summary:\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p2\u0022\u003EGiven that this patient has optic disc pit-associated maculopathy with schisis and subretinal fluid, laser photocoagulation at the temporal disc edge remains the least invasive and most appropriate initial treatment, with escalation to vitrectomy or gas tamponade if needed.\u003C/p\u003E\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p2\u0022\u003E\u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003EPrognosis:\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p2\u0022\u003E\u003Cul\u003E\u003Cli\u003EIf optic disc pit maculopathy develops, approximately 80% of patients progress to a visual acuity of LogMAR 1.00 or worse.\u0026nbsp;\u003C/li\u003E\u003Cli\u003EIn the absence of treatment, visual decline typically occurs within six months.\u0026nbsp;\u003C/li\u003E\u003Cli\u003EIn contrast, surgical intervention has been associated with favourable anatomical and functional outcomes, with recent studies reporting success rates of up to 87%.\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003ESource:\u003C/div\u003E\u003Cdiv\u003E\u003Ca href=\u0022https://eyewiki.org/Optic_Pits\u0022\u003EEyeWiki - Optic disc pits\u003C/a\u003E\u003C/div\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 256,
    "Name": "AMD",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EWhich of the following genes is associated with an \u003C/span\u003Eincreased risk of age related macular degeneration (AMD)\u003Cspan class=\u0022s1\u0022\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EAge-related macular degeneration has a strong \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Egenetic component\u003C/b\u003E\u003C/span\u003E, with many risk variants involving the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecomplement pathway\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECFH (Complement Factor H) gene\u003C/b\u003E\u003C/span\u003E, particularly the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EY402H polymorphism\u003C/b\u003E\u003C/span\u003E, is one of the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Estrongest and most consistently replicated genetic risk factors\u003C/b\u003E\u003C/span\u003E for AMD. CFH plays a regulatory role in the alternative complement pathway, and dysfunction leads to chronic inflammation at the level of the retinal pigment epithelium and Bruch\u2019s membrane.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px; text-decoration-line: underline;\u0022\u003EOther important AMD-associated loci include:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022text-decoration-line: underline;\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EARMS2/HTRA1\u003C/b\u003E\u003C/span\u003E on chromosome 10\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EC3, CFB, CFI\u003C/b\u003E\u003C/span\u003E (additional complement pathway genes)\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cspan style=\u0022font-family: Arial; text-decoration-line: underline;\u0022\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022\u0022\u003EThe \u003C/span\u003E\u003Cb style=\u0022\u0022\u003EBCSC\u003C/b\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022\u0022\u003E identifies two key \u003C/span\u003E\u003Cb style=\u0022\u0022\u003Egenetic susceptibility loci\u003C/b\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022\u0022\u003E associated with the development of \u003C/span\u003E\u003Cb style=\u0022\u0022\u003Eage-related macular degeneration (AMD)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022\u0022\u003E:\u003C/span\u003E\u003C/span\u003E\u003Cspan style=\u0022font-family: Arial;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003Cbr\u003E\u003Cul\u003E\u003Cul\u003E\u003Cli\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022letter-spacing: 0.14994px; font-family: Arial; color: rgb(14, 14, 14);\u0022\u003E\u003Cb\u003ECFH (chromosome 1q31)\u003C/b\u003E\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px; font-family: Arial; color: rgb(14, 14, 14);\u0022\u003E encodes \u003C/span\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022letter-spacing: 0.14994px; font-family: Arial; color: rgb(14, 14, 14);\u0022\u003E\u003Cb\u003Ecomplement factor H\u003C/b\u003E\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px; font-family: Arial; color: rgb(14, 14, 14);\u0022\u003E, a regulator of the alternative complement pathway. The \u003C/span\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022letter-spacing: 0.14994px; font-family: Arial; color: rgb(14, 14, 14);\u0022\u003E\u003Cb\u003EY402H variant\u003C/b\u003E\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px; font-family: Arial; color: rgb(14, 14, 14);\u0022\u003E increases AMD risk by approximately \u003C/span\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022letter-spacing: 0.14994px; font-family: Arial; color: rgb(14, 14, 14);\u0022\u003E\u003Cb\u003E4.6-fold in heterozygotes\u003C/b\u003E\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px; font-family: Arial; color: rgb(14, 14, 14);\u0022\u003E and \u003C/span\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022letter-spacing: 0.14994px; font-family: Arial; color: rgb(14, 14, 14);\u0022\u003E\u003Cb\u003E7.4-fold in homozygotes\u003C/b\u003E\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px; font-family: Arial; color: rgb(14, 14, 14);\u0022\u003E.\u003C/span\u003E\u003C/li\u003E\u003Cli\u003E\u003Cb style=\u0022letter-spacing: 0.14994px; font-family: Arial; color: rgb(14, 14, 14);\u0022\u003EARMS2 (chromosome 10q26)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px; font-family: Arial; color: rgb(14, 14, 14);\u0022\u003E, short for \u003Ci\u003EAge-Related Maculopathy Susceptibility 2\u003C/i\u003E, has a gene product with incompletely understood function. The \u003C/span\u003E\u003Cb style=\u0022letter-spacing: 0.14994px; font-family: Arial; color: rgb(14, 14, 14);\u0022\u003EA69S variant\u003C/b\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px; font-family: Arial; color: rgb(14, 14, 14);\u0022\u003E is associated with a \u003C/span\u003E\u003Cb style=\u0022letter-spacing: 0.14994px; font-family: Arial; color: rgb(14, 14, 14);\u0022\u003E2.7-fold increase in AMD risk in heterozygotes\u003C/b\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px; font-family: Arial; color: rgb(14, 14, 14);\u0022\u003E and an \u003C/span\u003E\u003Cb style=\u0022letter-spacing: 0.14994px; font-family: Arial; color: rgb(14, 14, 14);\u0022\u003E8.2-fold increase in homozygotes\u003C/b\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px; font-family: Arial; color: rgb(14, 14, 14);\u0022\u003E.\u003C/span\u003E\u003C/li\u003E\u003C/ul\u003E\u003C/ul\u003E\u003Cp class=\u0022p2\u0022\u003E\n\n\n\n\n\n\n\n\n\n\n\n\n\n\u003C/p\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022font-family: Arial; letter-spacing: 0.14994px; color: rgb(14, 14, 14);\u0022\u003EIndividuals who are \u003C/span\u003E\u003Cb style=\u0022font-family: Arial; letter-spacing: 0.14994px; color: rgb(14, 14, 14);\u0022\u003Ehomozygous for risk variants in both CFH and ARMS2\u003C/b\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022font-family: Arial; letter-spacing: 0.14994px; color: rgb(14, 14, 14);\u0022\u003E have a \u003C/span\u003E\u003Cb style=\u0022font-family: Arial; letter-spacing: 0.14994px; color: rgb(14, 14, 14);\u0022\u003Emarkedly elevated risk\u003C/b\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022font-family: Arial; letter-spacing: 0.14994px; color: rgb(14, 14, 14);\u0022\u003E, estimated to be \u003C/span\u003E\u003Cb style=\u0022font-family: Arial; letter-spacing: 0.14994px; color: rgb(255, 0, 0);\u0022\u003Eup to 50-fold higher\u003C/b\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022font-family: Arial; letter-spacing: 0.14994px; color: rgb(14, 14, 14);\u0022\u003E than the general population.\u003C/span\u003E\u003Cbr\u003E\u003Cblockquote style=\u0022margin-bottom: 0px; margin-left: 15px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; line-height: normal;\u0022\u003E\u003Cspan style=\u0022font-family: Arial;\u0022\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022color: rgb(14, 14, 14);\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/span\u003E\u003C/blockquote\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003EThe other options are incorrect:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPAX6\u003C/b\u003E\u003C/span\u003E \u2192 ocular development (aniridia)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECHM\u003C/b\u003E\u003C/span\u003E \u2192 choroideremia\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ETIGR (MYOC)\u003C/b\u003E\u003C/span\u003E \u2192 primary open-angle glaucoma\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 257,
    "Name": "Macular Hole",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 74-year-old woman undergoes vitrectomy for a \u003Cspan class=\u0022s1\u0022\u003Emacular hole\u003C/span\u003E but is unable to maintain prolonged postoperative posturing due to \u003Cspan class=\u0022s1\u0022\u003Eosteoarthritis\u003C/span\u003E.\u0026nbsp;\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhat concentration of C3F8 gas is most appropriate to use?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPerfluoropropane (C3F8)\u003C/b\u003E\u003C/span\u003E is a long-acting intraocular gas that expands to approximately \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Efour times its injected volume\u003C/b\u003E\u003C/span\u003E when used at 100% concentration and can persist in the eye for \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eup to 8 weeks\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EFor vitrectomy, a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enon-expansile concentration\u003C/b\u003E\u003C/span\u003E is required to avoid excessive postoperative IOP rise. The accepted non-expansile range for C3F8 is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E12-16% mixed with air\u003C/b\u003E\u003C/span\u003E, making \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E14%\u003C/b\u003E\u003C/span\u003E the appropriate choice.\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EIn patients who struggle with posturing, a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elonger-acting gas\u003C/b\u003E\u003C/span\u003E such as C3F8 is preferred over SF6, as it provides \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eprolonged tamponade\u003C/b\u003E\u003C/span\u003E despite limited positioning.\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EFor comparison:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESF6\u003C/b\u003E\u003C/span\u003E doubles its volume within ~2 days, lasts ~2 weeks, and has a non-expansile concentration of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E20-30%\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003ERemember:\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;\u2022\tMacular hole \u002B poor posturing \u2192 choose long-acting gas (C3F8 12-16%).\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;\u2022\tC3F8 = long duration; SF6 = shorter duration.\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 258,
    "Name": "Retinal dystrophies",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EWhich investigation most reliably establishes the diagnosis of Best vitelliform macular dystrophy?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBest vitelliform macular dystrophy\u003C/b\u003E\u003C/span\u003E is most reliably diagnosed using \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eelectro-oculography (EOG)\u003C/b\u003E\u003C/span\u003E. The hallmark finding is a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ereduced light peak-to-dark trough ratio (Arden ratio)\u003C/b\u003E\u003C/span\u003E, reflecting dysfunction of the retinal pigment epithelium.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EKey points:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EEOG is abnormal even when visual acuity and fundus appearance are relatively preserved\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, especially early in the disease.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EFull-field ERG is typically normal\u003C/b\u003E\u003C/span\u003E, as photoreceptor function is largely intact.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EDark adaptation\u003C/b\u003E\u003C/span\u003E and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EVEP\u003C/b\u003E\u003C/span\u003E are not diagnostic for Best disease.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 259,
    "Name": "Retinal dystrophies",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003ERegarding \u003Cspan class=\u0022s1\u0022\u003Efamilial exudative vitreoretinopathy (FEVR)\u003C/span\u003E, which of the following statements is \u003Cspan class=\u0022s1\u0022\u003EFALSE\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EFEVR is a \u003C/span\u003E\u003Cb\u003Egenetically heterogeneous retinal vascular disorder\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E characterised by \u003C/span\u003E\u003Cb\u003Eincomplete peripheral retinal vascularisation\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, most commonly affecting the \u003C/span\u003E\u003Cb\u003Etemporal retina\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E. Recognised clinical features include \u003C/span\u003E\u003Cb\u003Eperipheral avascular retina\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, \u003C/span\u003E\u003Cb\u003Eneovascularisation\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, \u003C/span\u003E\u003Cb\u003Eexudation\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, \u003C/span\u003E\u003Cb\u003Etractional retinal detachment\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, and \u003C/span\u003E\u003Cb\u003Edisc dragging\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003EInheritance patterns in FEVR include:\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EAutosomal dominant\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (most common)\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EX-linked recessive\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EAutosomal recessive\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (less common)\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003ETherefore, describing FEVR as \u003Ci\u003Etypically autosomal recessive\u003C/i\u003E is incorrect.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003EAdvanced disease often requires \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003Evitreoretinal surgery\u003C/b\u003E\u003C/span\u003E, but outcomes are frequently limited due to severe tractional changes and chronic pathology, supporting the truth of the other statements.\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/p\u003E",
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    "CategoryId": 2,
    "Category": null,
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  },
  {
    "Id": 260,
    "Name": "Retinal dystrophies",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EA 12-year-old boy presents to clinic with \u003C/span\u003Ebilateral RPE mottling at the maculae\u003Cspan class=\u0022s1\u0022\u003E and \u003C/span\u003Emoderate reduction in visual acuity to 6/12\u003Cspan class=\u0022s1\u0022\u003E in both eyes. Fluorescein angiography is shown below\u003C/span\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhat is the most likely diagnosis?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cimg src=\u0022/upload-2025-12-14-02af7953-6b65-4905-8319-c7cf19056e61.png\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EStargardt disease\u003C/b\u003E\u003C/span\u003E (ABCA4-related macular dystrophy) classically presents in childhood or adolescence with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebilateral central visual loss\u003C/b\u003E\u003C/span\u003E and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERPE mottling\u003C/b\u003E\u003C/span\u003E at the macula.\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe hallmark fluorescein angiographic finding is the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E\u201Cdark choroid\u201D\u003C/b\u003E\u003C/span\u003E, caused by \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eexcess lipofuscin accumulation within the RPE\u003C/b\u003E\u003C/span\u003E, which \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eblocks background choroidal fluorescence\u003C/b\u003E\u003C/span\u003E from the choriocapillaris.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cimg src=\u0022https://www.researchgate.net/profile/Rehan-Hussain-2/publication/327148232/figure/fig2/AS:717320766894080@1548034006397/Fluorescein-angiography-demonstrates-classic-dark-or-silent-choroid-due-to-masking-of.png\u0022\u003E\u003C/p\u003E\u003Cp class=\u0022p2\u0022\u003E\u003Cspan style=\u0022font-style: italic;\u0022\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EFluorescein angiography demonstrates classic dark or \u0027silent\u0027 choroid due to masking of choroidal fluorescence, with staining of the pisciform flecks.\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p2\u0022\u003E\u003Cspan style=\u0022font-style: italic;\u0022\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EImage source:\u0026nbsp;\u003C/span\u003E\u003C/span\u003E\u003Ca href=\u0022https://www.tandfonline.com/doi/full/10.1080/14712598.2018.1513486?utm_source=researchgate.net\u0026amp;utm_medium=article\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003EStargardt macular dystrophy and evolving therapies\u003C/a\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003EThe other options are less likely:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EBest disease\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192 subfoveal lipofuscin deposition, but \u003C/span\u003E\u003Cb\u003Eno generalised loss of choroidal fluorescence\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E on FFA\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EChoroideraemia\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and \u003C/span\u003E\u003Cb\u003Egyrate atrophy\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192 show \u003C/span\u003E\u003Cb\u003Etrue chorioretinal and choriocapillaris atrophy\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, usually with \u003C/span\u003E\u003Cb\u003Eobvious mid-peripheral fundus changes\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E on examination, not isolated macular involvement at presentation\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 261,
    "Name": "Retinoschisis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following features is \u003Cspan class=\u0022s1\u0022\u003ELEAST consistent\u003C/span\u003E with \u003Cspan class=\u0022s1\u0022\u003Eretinoschisis\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EDegenerative (senile) retinoschisis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E typically occurs in \u003C/span\u003E\u003Cb\u003Eolder, emmetropic or mildly hypermetropic\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E individuals and is \u003C/span\u003E\u003Cb\u003Enot strongly associated with high myopia\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E. High myopia is much more closely linked to \u003C/span\u003E\u003Cb\u003Erhegmatogenous retinal detachment\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, not retinoschisis.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003EThe other features are characteristic of retinoschisis:\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBeaten-metal appearance\u003C/b\u003E\u003C/span\u003E reflects splitting of the inner retinal layers.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ELesions are often \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebilateral\u003C/b\u003E\u003C/span\u003E and classically occur in the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Einferotemporal quadrant\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\u003C/li\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003EAbsolute field defect\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
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  },
  {
    "Id": 262,
    "Name": "FFA",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EWhich of the following statements about \u003C/span\u003Efundus fluorescein angiography (FFA)\u003Cspan class=\u0022s1\u0022\u003E is \u003C/span\u003ELEAST true\u003Cspan class=\u0022s1\u0022\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EIn \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EFFA\u003C/b\u003E\u003C/span\u003E, the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Echoroidal circulation fills first\u003C/b\u003E\u003C/span\u003E, followed shortly by the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eretinal arterial phase\u003C/b\u003E\u003C/span\u003E. This occurs because the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Echoriocapillaris is fenestrated\u003C/b\u003E\u003C/span\u003E, allowing rapid dye leakage and producing the characteristic \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Echoroidal flush\u003C/b\u003E\u003C/span\u003E.\u0026nbsp;\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003ERegarding the other options:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EClassic CNV\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E typically shows \u003C/span\u003E\u003Cb\u003Eearly, well-defined hyperfluorescence\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E with progressive leakage.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EOccult CNV\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E generally demonstrates \u003C/span\u003E\u003Cb\u003Epoorly defined early fluorescence\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E with \u003C/span\u003E\u003Cb\u003Elate leakage\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\n\u003Cul\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIndocyanine green (ICG)\u003C/b\u003E\u003C/span\u003E is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E~98% protein-bound\u003C/b\u003E\u003C/span\u003E, far more than fluorescein (~80%), making statement \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ED true\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
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    "HighYield": true,
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  },
  {
    "Id": 263,
    "Name": "Retinoschisis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following conditions is associated with an \u003Cspan class=\u0022s1\u0022\u003Eabsolute peripheral visual field defect\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ERetinoschisis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E causes a \u003C/span\u003E\u003Cb\u003Etrue splitting of the neurosensory retina\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, resulting in \u003C/span\u003E\u003Cb\u003Eloss of functioning retinal tissue\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E in the affected area. This produces an \u003C/span\u003E\u003Cb\u003Eabsolute scotoma\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E on peripheral visual field testing.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003EIn contrast:\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGiant retinal tear\u003C/b\u003E\u003C/span\u003E may cause a field defect, but this depends on whether a retinal detachment is present and its extent; it is not intrinsically associated with a fixed absolute defect.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPaving stone degeneration\u003C/b\u003E\u003C/span\u003E involves outer retinal and choriocapillaris atrophy but typically \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edoes not produce visual field loss\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESnail track degeneration\u003C/b\u003E\u003C/span\u003E is a peripheral vitreoretinal degeneration associated with retinal breaks, but \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edoes not itself cause an absolute field defect\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/h3\u003E\u003Ch3\u003E\u003Cb\u003ERemember:\u003C/b\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ERetinoschisis \u2192 absolute scotoma\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ERetinal detachment \u2192 relative scotoma (unless chronic and extensive)\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 264,
    "Name": "Vitreous",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\n\n\n\n\n\n\n\n\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EPatients are most likely to be \u003Cspan class=\u0022s1\u0022\u003Esymptomatic from vitreous floaters\u003C/span\u003E under which of the following conditions?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EFloaters are perceived when \u003C/span\u003E\u003Cb\u003Evitreous opacities cast shadows on the retina\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E. The degree of symptomatology depends on both the \u003C/span\u003E\u003Cb\u003Edistance of the opacity from the retina\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and the \u003C/span\u003E\u003Cb\u003Eeffective pupil size\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ECloser opacities\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E produce \u003C/span\u003E\u003Cb\u003Esharper, more distinct shadows\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, making them more noticeable.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EA \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esmaller pupil\u003C/b\u003E\u003C/span\u003E increases depth of focus and reduces light scatter, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eenhancing the contrast\u003C/b\u003E\u003C/span\u003E of the shadow cast by the opacity.\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\n\u003Cp class=\u0022p4\u0022\u003EIn contrast, opacities that are \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003Efarther from the retina\u003C/b\u003E\u003C/span\u003E or viewed through a \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003Elarger pupil\u003C/b\u003E\u003C/span\u003E cast blurrier, less distinct shadows and are therefore less symptomatic.\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cspan style=\u0022font-size: 25.054px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cspan style=\u0022font-size: 25.054px;\u0022\u003ERemember:\u003C/span\u003E\u003C/b\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ECloser floater \u002B smaller pupil = more symptomatic.\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThis explains why floaters are often more noticeable in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebright light\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 265,
    "Name": "Retinal dystrophies",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EWhich statement about \u003C/span\u003Efamilial exudative vitreoretinopathy (FEVR)\u003Cspan class=\u0022s1\u0022\u003E is \u003C/span\u003ELEAST true\u003Cspan class=\u0022s1\u0022\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EFEVR is a \u003C/span\u003E\u003Cb\u003Egenetically heterogeneous disorder\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E of retinal vascular development. While \u003C/span\u003E\u003Cb\u003Eautosomal recessive inheritance can occur\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, the \u003C/span\u003E\u003Cb\u003Emost common inheritance pattern is autosomal dominant\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003ESupporting points for the other options:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EFEVR is an important cause of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eretinal detachment in children and infants\u003C/b\u003E\u003C/span\u003E, particularly tractional or exudative RD.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EGenetic linkage has been described on \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Echromosome 11\u003C/b\u003E\u003C/span\u003E (e.g. \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EFZD4\u003C/b\u003E\u003C/span\u003E), among other loci involved in the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EWnt signalling pathway\u003C/b\u003E\u003C/span\u003E (LRP5, TSPAN12, NDP).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESubretinal exudation\u003C/b\u003E\u003C/span\u003E is a recognised feature due to peripheral retinal non-perfusion and neovascular leakage.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 266,
    "Name": "Uveal Effusion syndrome",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EWhat is the most appropriate management for \u003C/span\u003Eidiopathic uveal effusion syndrome without nanophthalmos\u003Cspan class=\u0022s1\u0022\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EIdiopathic uveal effusion syndrome (UES) without nanophthalmos\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E differs fundamentally from nanophthalmic UES in both \u003C/span\u003E\u003Cb\u003Epathophysiology and management\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIn \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enanophthalmos\u003C/b\u003E\u003C/span\u003E, thickened sclera and impaired trans-scleral outflow are central \u2192 \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esclerectomy/sclerostomy\u003C/b\u003E\u003C/span\u003E is effective. [\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003Enanophthalmos and the presence of clinically detectable thickened/rigid sclera are a good predictor both for histologically abnormal sclera and of a good response to surgery.]\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003EIn \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enon-nanophthalmic (idiopathic) UES\u003C/b\u003E\u003C/span\u003E, scleral thickness is normal, and scleral surgery is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eusually ineffective\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003ENote: Nanophthalmic eyes axial length: 16 mm or less\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003EFor idiopathic UES:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPars plana vitrectomy\u003C/b\u003E\u003C/span\u003E is the preferred treatment, as it reduces vitreous traction and facilitates resolution of choroidal effusions and associated serous retinal detachment.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EAcetazolamide\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and \u003C/span\u003E\u003Cb\u003Esystemic steroids\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E may be tried but have \u003C/span\u003E\u003Cb\u003Eunreliable and often transient benefit\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EFull-thickness sclerectomy\u003C/b\u003E\u003C/span\u003E is not indicated without scleral thickening.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
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  },
  {
    "Id": 267,
    "Name": "Retinal tears",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EIn which of the following conditions is a \u003Cspan class=\u0022s1\u0022\u003Eposterior vitreous detachment (PVD)\u003C/span\u003E most typically present?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EA \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Egiant retinal tear (GRT)\u003C/b\u003E\u003C/span\u003E is classically associated with a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eposterior vitreous detachment\u003C/b\u003E\u003C/span\u003E. The acute separation of the posterior hyaloid generates strong \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecircumferential vitreoretinal traction\u003C/b\u003E\u003C/span\u003E, predisposing to the formation of a large (\u0026gt;90\u00B0) full-thickness retinal tear.\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe other options are less likely to be associated with PVD:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERetinal dialysis\u003C/b\u003E\u003C/span\u003E \u2192 typically traumatic and occurs at the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eora serrata\u003C/b\u003E\u003C/span\u003E, often \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ewithout PVD\u003C/b\u003E\u003C/span\u003E, especially in younger patients.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ETraumatic macular hole\u003C/b\u003E\u003C/span\u003E \u2192 results from \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eanteroposterior compression\u003C/b\u003E\u003C/span\u003E of the globe rather than vitreous separation.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAtrophic round hole retinal detachment\u003C/b\u003E\u003C/span\u003E \u2192 usually occurs \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ewithout PVD\u003C/b\u003E\u003C/span\u003E, particularly in young myopes, and is due to retinal thinning rather than traction.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 268,
    "Name": "Pupil",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EWhat is the \u003C/span\u003Emost likely mechanism\u003Cspan class=\u0022s1\u0022\u003E underlying a \u003C/span\u003Eparadoxical pupil response\u003Cspan class=\u0022s1\u0022\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EA \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eparadoxical pupil response\u003C/b\u003E\u003C/span\u003E refers to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epupillary constriction in darkness\u003C/b\u003E\u003C/span\u003E or dilation in response to light offset, most classically described in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Econe dysfunction syndromes\u003C/b\u003E\u003C/span\u003E (e.g. cone dystrophies, achromatopsia).\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe prevailing explanation is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Erelative preservation of S-cone (blue cone) function\u003C/b\u003E\u003C/span\u003E, with loss of L- and M-cone input. This results in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eunopposed S-cone signalling\u003C/b\u003E\u003C/span\u003E, which abnormally drives the pupillary light reflex pathway, producing a paradoxical response.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe other options are incorrect:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EConvergence in the dark\u003C/b\u003E\u003C/span\u003E does not account for a true paradoxical light response.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EDenervation hypersensitivity\u003C/b\u003E\u003C/span\u003E explains tonic pupils, not paradoxical reactions.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe phenomenon is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eclinically detectable\u003C/b\u003E\u003C/span\u003E and not restricted to laboratory testing.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 269,
    "Name": "Retinal dystrophies",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EA child presents with \u003C/span\u003Ereduced visual acuity (6/36)\u003Cspan class=\u0022s1\u0022\u003E, \u003C/span\u003Ebull\u2019s-eye maculopathy\u003Cspan class=\u0022s1\u0022\u003E, a \u003C/span\u003Ereduced b-wave on ERG\u003Cspan class=\u0022s1\u0022\u003E, and a \u003C/span\u003Ereduced EOG\u003Cspan class=\u0022s1\u0022\u003E.\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhat is the most likely diagnosis?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBatten disease\u003C/b\u003E\u003C/span\u003E (juvenile neuronal ceroid lipofuscinosis) is characterised by early-onset \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eprogressive visual loss\u003C/b\u003E\u003C/span\u003E, often presenting with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebull\u2019s-eye maculopathy\u003C/b\u003E\u003C/span\u003E. Retinal electrophysiology typically shows:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EReduced ERG b-wave\u003C/b\u003E\u003C/span\u003E \u2192 inner retinal dysfunction\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAbnormal EOG\u003C/b\u003E\u003C/span\u003E \u2192 retinal pigment epithelium involvement\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\n\u003Cp class=\u0022p1\u0022\u003EThis combination reflects \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ewidespread retinal degeneration\u003C/b\u003E\u003C/span\u003E, which is typical of Batten disease.\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003ERemember:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EHomocystinuria\u003C/b\u003E\u003C/span\u003E \u2192 ectopia lentis (inferonasal), thromboembolic disease, intellectual disability; not a bull\u2019s-eye maculopathy with characteristic ERG/EOG findings.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EZellweger syndrome\u003C/b\u003E\u003C/span\u003E \u2192 severe neonatal presentation with hypotonia, craniofacial abnormalities, and early death; ocular findings are present but the clinical context here fits poorly.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 270,
    "Name": "Vitrectomy",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich type of cataract is most commonly associated with a \u003Cspan class=\u0022s1\u0022\u003Egas-filled eye\u003C/span\u003E (e.g. after vitreoretinal surgery)?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPosterior subcapsular cataract\u003C/b\u003E\u003C/span\u003E is the cataract type most commonly associated with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eintraocular gas tamponade\u003C/b\u003E\u003C/span\u003E following vitrectomy.\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EContributing mechanisms include:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EDirect contact\u003C/b\u003E\u003C/span\u003E between gas and the posterior lens capsule\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EAltered lens metabolism and oxygen tension\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAccelerated epithelial cell migration beneath the posterior capsule\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EPSC formation is therefore frequent after vitreoretinal surgery, particularly in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ephakic patients\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px; font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 271,
    "Name": "PCV",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhat is the most appropriate management option for \u003Cspan class=\u0022s1\u0022\u003Epolypoidal choroidal vasculopathy (PCV)\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p2\u0022\u003E\n\n\n\n\n\n\n\n\u003C/p\u003E\u003Cblockquote style=\u0022margin-bottom: 0px; margin-left: 15px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; line-height: normal; font-family: \u0026quot;.AppleSystemUIFont\u0026quot;; color: rgb(14, 14, 14);\u0022\u003E\u003Cul\u003E\u003Cli\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPCV is less responsive to anti-VEGF monotherapy\u003C/b\u003E\u003C/span\u003E than other forms of CNV.\u0026nbsp;\u003C/span\u003E\u003C/li\u003E\u003Cli\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EThe \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EEVEREST trials\u003C/b\u003E\u003C/span\u003E showed that \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Everteporfin photodynamic therapy (PDT)\u003C/b\u003E\u003C/span\u003E, alone or combined with ranibizumab, achieves \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esuperior polyp regression\u003C/b\u003E\u003C/span\u003E compared with ranibizumab alone.\u0026nbsp;\u003C/span\u003E\u003C/li\u003E\u003Cli\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EThe \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPLANET study\u003C/b\u003E\u003C/span\u003E demonstrated that \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eaflibercept monotherapy\u003C/b\u003E\u003C/span\u003E produced visual acuity gains \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecomparable to aflibercept plus deferred PDT\u003C/b\u003E\u003C/span\u003E (\u224810.7 ETDRS letters), with most patients not requiring PDT.\u0026nbsp;\u003C/span\u003E\u003C/li\u003E\u003Cli\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EOverall, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPDT remains central for polyp closure\u003C/b\u003E\u003C/span\u003E, while anti-VEGF -particularly aflibercept- provides good functional outcomes.\u003C/span\u003E\u003C/li\u003E\u003C/ul\u003E\u003C/blockquote\u003E\u003Cblockquote style=\u0022margin-bottom: 0px; margin-left: 15px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; line-height: normal; font-family: \u0026quot;.AppleSystemUIFont\u0026quot;; color: rgb(14, 14, 14);\u0022\u003E\u003Cbr\u003E\u003C/blockquote\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 272,
    "Name": "Argyrosis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following conditions is associated with a \u003Cspan class=\u0022s1\u0022\u003Edark choroid\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOcular argyrosis\u003C/b\u003E\u003C/span\u003E results from \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Echronic silver deposition\u003C/b\u003E\u003C/span\u003E, typically after prolonged ingestion or exposure to colloidal silver. It is characterised by \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ediffuse brown-black granular deposits in Bruch\u2019s membrane\u003C/b\u003E\u003C/span\u003E, which block choroidal fluorescence on angiography and produce the classic \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E\u201Cdark choroid\u201D\u003C/b\u003E\u003C/span\u003E appearance.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EClinically, we can remember it as a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E\u201Cdark sky with silver stars\u201D\u003C/b\u003E\u003C/span\u003E, reflecting:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EGeneralised choroidal darkening\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ELeopard-spotting or drusen-like changes\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe other options do \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot\u003C/b\u003E\u003C/span\u003E cause a dark choroid:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EChalcosis\u003C/b\u003E\u003C/span\u003E \u2192 sunflower cataract, Kayser-Fleischer-like changes\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EHydroxychloroquine\u003C/b\u003E\u003C/span\u003E \u2192 parafoveal/bull\u2019s-eye maculopathy\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ETamoxifen\u003C/b\u003E\u003C/span\u003E \u2192 crystalline maculopathy\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 273,
    "Name": "Macular Hole",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following types of \u003Cspan class=\u0022s1\u0022\u003Emacular hole\u003C/span\u003E has the \u003Cspan class=\u0022s1\u0022\u003Ebest prognosis\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EA \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGrade 3 macular hole with an operculum\u003C/b\u003E\u003C/span\u003E indicates that \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eanteroposterior vitreomacular traction has been released\u003C/b\u003E\u003C/span\u003E, as the operculum represents avulsed retinal tissue attached to the posterior hyaloid. This release of traction is associated with:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EHigher rates of \u003C/span\u003E\u003Cb\u003Eanatomical closure\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EBetter \u003C/span\u003E\u003Cb\u003Evisual prognosis\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EReduced ongoing tractional forces\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EBy contrast:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EA \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Efull-thickness macular hole with PVD\u003C/b\u003E\u003C/span\u003E (Grade 4) lacks the operculum and often represents a more advanced stage.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ESurrounding subretinal fluid and intraretinal cystic changes\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E reflect \u003C/span\u003E\u003Cb\u003Echronicity and retinal damage\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, which are associated with poorer functional outcomes.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp\u003E\u003Cb style=\u0022font-size: medium; text-decoration-line: underline;\u0022\u003EGood Preoperative Prognostic Factors in Macular Hole Surgery\u003C/b\u003E\u003C/p\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIdiopathic macular holes\u003C/b\u003E\u003C/span\u003E have a better prognosis than \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Etraumatic macular holes\u003C/b\u003E\u003C/span\u003E that have not resolved spontaneously and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emyopic macular holes\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EShorter duration of symptoms\u003C/b\u003E\u003C/span\u003E is associated with better outcomes.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBetter preoperative visual acuity\u003C/b\u003E\u003C/span\u003E predicts improved postoperative vision.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EEarlier stage macular holes\u003C/b\u003E\u003C/span\u003E have a more favourable prognosis.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESmaller macular hole size\u003C/b\u003E\u003C/span\u003E is associated with higher closure rates and better visual outcomes.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOCT-based indices\u003C/b\u003E\u003C/span\u003E (e.g. hole size parameters and configuration metrics) can be used preoperatively to help predict prognosis.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 274,
    "Name": "Retinal Detachment",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EA patient presents following \u003C/span\u003Eocular trauma\u003Cspan class=\u0022s1\u0022\u003E with an \u003C/span\u003Einferior rhegmatogenous retinal detachment\u003Cspan class=\u0022s1\u0022\u003E, associated with \u003C/span\u003Eflashes and floaters\u003Cspan class=\u0022s1\u0022\u003E.\u0026nbsp;\u003C/span\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhat is the \u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003Emost appropriate next management step\u003C/span\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EIn \u003C/span\u003E\u003Cb\u003Etraumatic retinal detachment\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, particularly when there are \u003C/span\u003E\u003Cb\u003Einferior breaks\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, \u003C/span\u003E\u003Cb\u003Emultiple small retinal breaks near the ora serrata\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, or \u003C/span\u003E\u003Cb\u003Edialyses\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, a \u003C/span\u003E\u003Cb\u003Escleral buckle\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is a key component of management.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003EKey principles:\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EInferior retinal breaks\u003C/b\u003E\u003C/span\u003E are less effectively supported by intraocular gas alone due to buoyancy limitations.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ETraumatic RDs\u003C/b\u003E\u003C/span\u003E often involve \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eperipheral pathology\u003C/b\u003E\u003C/span\u003E (e.g. dialysis, multiple small tears) best addressed externally.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EA \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Escleral buckle provides permanent support\u003C/b\u003E\u003C/span\u003E to the vitreous base and inferior retina.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThe \u003C/span\u003E\u003Cb\u003Eoptimal approach is often a combined pars plana vitrectomy with scleral buckle.\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003EWhy the other options are less suitable:\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAir or gas alone\u003C/b\u003E\u003C/span\u003E \u2192 inadequate tamponade for inferior breaks\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESilicone oil\u003C/b\u003E\u003C/span\u003E \u2192 reserved for complex PVR, giant tears, or when posturing is not possible\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 275,
    "Name": "DR",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EWhat is the approximate risk of blindness at 5 years after new vessels at the disc (NVD) are detected in a patient with type 1 diabetes if left untreated?\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ENVD = high-risk proliferative diabetic retinopathy (PDR)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EData from the \u003C/span\u003E\u003Cb\u003EDiabetic Retinopathy Study (DRS)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E showed that \u003C/span\u003E\u003Cb\u003Euntreated high-risk PDR\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E carries a risk of \u003C/span\u003E\u003Cb\u003Esevere visual loss (\u22645/200)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E of approximately:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003E~25-30% at 2 years\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003E~40-50% by 5 years\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003ERemember:\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EType 1 diabetes\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EHigher risk of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPDR\u003C/b\u003E\u003C/span\u003E than type 2\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ESevere NPDR\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E~\u003C/span\u003E\u003Cb\u003E50% risk of PDR within 1 year\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EVery severe NPDR\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E~\u003C/span\u003E\u003Cb\u003E45% risk of high-risk PDR within 1 year\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EMacular oedema\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMore common in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Etype 2 diabetes\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPrevalence after ~15 years: \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EType 1 \u2248 15%\u003C/b\u003E\u003C/span\u003E, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EType 2 \u2248 25%\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003C/span\u003E\u003C/div\u003E\u003Cul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\u003C/div\u003E\u003Cul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 276,
    "Name": "Macular Hole",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following conditions is \u003Cspan class=\u0022s1\u0022\u003ELEAST likely\u003C/span\u003E to cause a \u003Cspan class=\u0022s1\u0022\u003Emacular hole\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EMacular holes typically result from \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emechanical or tractional forces\u003C/b\u003E\u003C/span\u003E acting on the fovea.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOcular trauma\u003C/b\u003E\u003C/span\u003E \u2192 well-recognised cause due to sudden anteroposterior compression.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EHigh myopia\u003C/b\u003E\u003C/span\u003E \u2192 predisposes to foveal thinning, traction, and myopic macular holes.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELong-standing retinal detachment\u003C/b\u003E\u003C/span\u003E \u2192 chronic retinal changes and traction may lead to macular hole formation.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003EIn contrast, \u003C/span\u003E\u003Cb\u003Econe dystrophy\u003C/b\u003E\u003Cspan class=\u0022s3\u0022\u003E is a \u003C/span\u003E\u003Cb\u003Eprimary photoreceptor degenerative disorder\u003C/b\u003E\u003Cspan class=\u0022s3\u0022\u003E and does \u003C/span\u003E\u003Cb\u003Enot cause structural foveal defects such as macular holes\u003C/b\u003E\u003Cspan class=\u0022s3\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022 style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 277,
    "Name": "Retinal Dialysis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following retinal lesions \u003Cspan class=\u0022s1\u0022\u003Erequires treatment\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ERetinal dialysis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is a circumferential retinal break at the \u003C/span\u003E\u003Cb\u003Eora serrata\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, commonly traumatic, and carries a \u003C/span\u003E\u003Cb\u003Ehigh risk of progressive rhegmatogenous retinal detachment\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E. \u003C/span\u003E\u003Cb\u003EProphylactic treatment (e.g., laser or cryotherapy)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is therefore indicated.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003EBy contrast:\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELattice degeneration with holes\u003C/b\u003E\u003C/span\u003E: prophylactic treatment is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot routinely indicated\u003C/b\u003E\u003C/span\u003E in asymptomatic patients without detachment.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAtrophic round holes\u003C/b\u003E\u003C/span\u003E: usually \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebenign\u003C/b\u003E\u003C/span\u003E, often without vitreoretinal traction, and typically \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eobserved\u003C/b\u003E\u003C/span\u003E unless associated with subretinal fluid or symptoms.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 278,
    "Name": "Retinal dystrophies",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EIn \u003Cspan class=\u0022s1\u0022\u003Eend-stage retinitis pigmentosa\u003C/span\u003E, which electrophysiological finding is most likely to be found?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EIn \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eretinitis pigmentosa (RP)\u003C/b\u003E\u003C/span\u003E, progressive degeneration of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ephotoreceptors\u003C/b\u003E\u003C/span\u003E leads to marked reduction or extinction of both \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EERG a and b waves\u003C/b\u003E\u003C/span\u003E. As the disease advances, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eretinal pigment epithelium (RPE) dysfunction\u003C/b\u003E\u003C/span\u003E also develops, resulting in an \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eabnormal electro-oculogram (EOG)\u003C/b\u003E\u003C/span\u003E with a reduced Arden ratio.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EIn early RP, EOG may be relatively preserved, but in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eend-stage disease\u003C/b\u003E\u003C/span\u003E, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eboth ERG and EOG are abnormal\u003C/b\u003E\u003C/span\u003E, reflecting widespread photoreceptor and RPE involvement.\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 279,
    "Name": "White Dot syndromes",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EWhich \u003C/span\u003Ewhite dot syndrome\u003Cspan class=\u0022s1\u0022\u003E is \u003C/span\u003Emost likely to develop choroidal neovascularisation (CNV)\u003Cspan class=\u0022s1\u0022\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPIC\u003C/b\u003E\u003C/span\u003E carries the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehighest risk of CNV\u003C/b\u003E\u003C/span\u003E among the white dot syndromes, with reported rates ranging from \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E~20% up to 70%\u003C/b\u003E\u003C/span\u003E in different series. CNV is the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emajor cause of visual loss\u003C/b\u003E\u003C/span\u003E in PIC and often requires \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eanti-VEGF therapy\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EBy contrast:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBirdshot chorioretinopathy\u003C/b\u003E\u003C/span\u003E \u2192 CNV is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Euncommon\u003C/b\u003E\u003C/span\u003E; vision loss is more often due to chronic inflammation and retinal dysfunction.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAPMPPE\u003C/b\u003E\u003C/span\u003E \u2192 CNV is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Erare\u003C/b\u003E\u003C/span\u003E, with most cases resolving without neovascular complications.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 280,
    "Name": "DVLA",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EAccording to \u003C/span\u003EDVLA Group 1 (car/motorcycle) guidance (2014)\u003Cspan class=\u0022s1\u0022\u003E, which of the following conditions \u003C/span\u003Emust be reported immediately to the DVLA\u003Cspan class=\u0022s1\u0022\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EBlepharospasm\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E must be \u003C/span\u003E\u003Cb\u003Ereported to the DVLA\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, even if mild or treated. Driving may continue \u003C/span\u003E\u003Cb\u003Eonly if supported by satisfactory medical reports\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E. If severe, \u003C/span\u003E\u003Cb\u003Edriving is not normally permitted\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, even with treatment.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ETemporary visual impairment\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E after surgery (e.g., patching) \u003C/span\u003E\u003Cb\u003Edoes not require notification\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E unless it \u003C/span\u003E\u003Cb\u003Epersists beyond 3 months\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EGlaucoma\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E requires notification \u003C/span\u003E\u003Cb\u003Eonly if visual field defects are bilateral\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EMonocularity\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E must be reported \u003C/span\u003E\u003Cb\u003Eonly if one eye has no light perception (NPL)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E. If there is \u003C/span\u003E\u003Cb\u003Eany light perception\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, notification is \u003C/span\u003E\u003Cb\u003Enot required\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth Part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 7,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 281,
    "Name": "Bacteriology Media",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWith regard to routine media used in bacteriology, which\nstatement is MOST likely to be correct?\u003C/span\u003E\u003Co:p\u003E\u003C/o:p\u003E\u003C/p\u003E",
    "Explanation": "\u003Cspan style=\u0022text-decoration-line: underline; font-style: italic;\u0022\u003ECorrect Answer:\u003C/span\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E MacConkey\u2019s agar is an appropriate medium to culture gram-negative rods.\u003C/span\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003Cdiv\u003EMacConkey\u2019s agar is a selective and differential medium designed to isolate and differentiate gram-negative rods, particularly members of the Enterobacteriaceae family. It contains bile salts and crystal violet, which inhibit gram-positive organisms, and lactose with a pH indicator to differentiate lactose fermenters (pink colonies) from non-fermenters (colorless colonies). This makes it ideal for culturing gram-negative rods such as E. coli and Klebsiella.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003EWhy Other Options Are Incorrect:\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u2022\tChocolate agar: Used for fastidious organisms like Haemophilus influenzae and Neisseria species, not anaerobic rods.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tMeat broth: A nutrient-rich medium but not specific for acanthamoeba; acanthamoeba requires non-nutrient agar with an overlay of E. coli for growth.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022\tNutrient agar: A general-purpose medium that supports many non-fastidious organisms but does not specifically select for gram-negative cocci.\u003C/div\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 7,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 282,
    "Name": "Herpes Simplex Keratitis",
    "Body": "\u003Cspan style=\u0022font-size: 11pt; line-height: 115%;\u0022\u003E\u003Cspan style=\u0022font-family: Arial; font-weight: bold;\u0022\u003EWith regard to Herpes\nsimplex infections of the anterior segment of the eye, which of the following\nstatements is MOST likely to be correct?\u003Cbr\u003E\u003C/span\u003E\u003Cbr\u003E\n\u003C!--[endif]--\u003E\u003C/span\u003E",
    "Explanation": "\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003ECorrect Answer:\u003C/span\u003E \u003Cspan style=\u0022font-weight: bold;\u0022\u003ELocalised debridement is recommended to remove viral load as a treatment option for dendritic ulcers.\u003C/span\u003E\u0026nbsp;\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003EExplanation\u003C/span\u003E:\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003EHerpes simplex epithelial keratitis, typically presenting as a dendritic ulcer, is caused by active viral replication within corneal epithelial cells. The cornerstone of treatment is antiviral therapy, either topical (such as trifluridine or ganciclovir) or systemic (oral acyclovir or valacyclovir). Mechanical debridement of the ulcer is a recognized adjunctive measure that reduces viral load and promotes epithelial healing when combined with antiviral therapy. This approach is particularly useful in resource-limited settings or when rapid reduction of viral burden is desired.\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022text-decoration-line: underline; font-style: italic;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022text-decoration-line: underline; font-style: italic;\u0022\u003EWhy Other Options Are Incorrect:\u003C/span\u003E\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003EA dendritic ulcer does contain live virus within infected epithelial cells.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003EDisciform keratitis represents an immune-mediated stromal reaction associated with underlying endotheliitis. It does not occur without endothelial involvement, making this statement false.\u003C/div\u003E\u003Cdiv\u003ERecurrent HSV keratitis typically leads to decreased corneal sensation due to trigeminal nerve involvement. Normal corneal sensitivity is not characteristic of recurrent disease.\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;\u003Cimg src=\u0022/upload-2026-01-19-26ee9710-cca8-4088-a2ad-e3da89937b1a.jpg\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 283,
    "Name": "ETDRS and Number Needed to Treat",
    "Body": "\u003Cspan style=\u0022font-size: 11pt; line-height: 115%; font-family: Arial; font-weight: bold;\u0022\u003EIn the Early\nTreatment Diabetic Retinopathy Study (ETDRS) for laser treatment of diabetic\nmacular oedema, moderate visual loss occurred in 12% of treated eyes compared\nto 24% of untreated eyes in three years. Which of these is MOST likely to be\nthe approximate value of numbers needed to treat in this study?\u003C/span\u003E",
    "Explanation": "\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003ECorrect Answer:\u003C/span\u003E \u003Cspan style=\u0022font-weight: bold;\u0022\u003E9\u0026nbsp;\u003C/span\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003EExplanation:\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003ENumber Needed to Treat (NNT) is the number of patients (or eyes) that need to be treated to prevent one additional adverse outcome: NNT = 1 \u00F7 ARR. The number needed to treat (NNT) is calculated as the inverse of the absolute risk reduction (ARR)\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\nAbsolute Risk Reduction (ARR) is the difference in event rates between control and treatment groups: ARR = Control Event Rate \u2212 Treatment Event Rate.\u003C/div\u003E\u003Cdiv\u003EIn this study, the risk of moderate visual loss was 24% in untreated eyes and 12% in treated eyes.\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;ARR = 24% \u2212 12% = 12% (or 0.12).\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;NNT = 1 \u00F7 ARR = 1 \u00F7 0.12 \u2248 8.3, which rounds to approximately 9.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;This means that for every 9 eyes treated with laser, one case of moderate visual loss is prevented over three years.\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EThe ETDRS study historically reported this benefit per eye, not per patient.\u003C/span\u003E\u003C/div\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 11,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 284,
    "Name": " MRI Sequence Identification",
    "Body": "\u003Cspan style=\u0022font-size:11.0pt;line-height:115%;\nfont-family:\u0026quot;Cambria\u0026quot;,serif;mso-ascii-theme-font:minor-latin;mso-fareast-font-family:\n\u0026quot;MS Mincho\u0026quot;;mso-fareast-theme-font:minor-fareast;mso-hansi-theme-font:minor-latin;\nmso-bidi-font-family:Arial;mso-bidi-theme-font:minor-bidi;mso-ansi-language:\nEN-US;mso-fareast-language:EN-US;mso-bidi-language:AR-SA\u0022\u003EWhat is the MOST\nlikely type of MRI sequence seen in this image?\u003C/span\u003E\u003Cimg src=\u0022/upload-2026-01-19-c6678adf-0388-41a1-aa8b-354c2b0e17d0.png\u0022\u003E",
    "Explanation": "\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003ECorrect Answer:\u003C/span\u003E\u0026nbsp;\u0026nbsp;\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u0026nbsp;Fluid-attenuated inversion recovery (FLAIR)\u003C/span\u003E\u0026nbsp;\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003EExplanation\u003C/span\u003E\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003EThe MRI image shows a brain scan with high signal intensity in white matter and cerebrospinal fluid (CSF) appearing dark, which is characteristic of a FLAIR sequence. FLAIR is a modified T2-weighted sequence where the CSF signal is suppressed, making it particularly useful for detecting lesions adjacent to CSF spaces, such as periventricular plaques in multiple sclerosis or subarachnoid pathology.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003EWhy Other Options Are Incorrect:\u003C/span\u003E\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E(DWI):\u003C/span\u003E Diffusion-weighted imaging highlights acute ischemia with bright restricted diffusion areas, but the overall appearance here is not typical for DWI.\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E(T1 with contrast):\u003C/span\u003E T1-weighted images show CSF as dark and gray matter lighter than white matter; contrast enhancement highlights lesions, which is not evident here.\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px; font-weight: bold;\u0022\u003E(T2 with contrast):\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E T2-weighted images show CSF as bright, unlike this image where CSF is dark due to inversion recovery suppression.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cimg src=\u0022/upload-2026-01-20-de334ce8-ef9f-489a-a467-431f4a0c7d17.jpg\u0022\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003C/span\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 285,
    "Name": "Thygeson\u0027s Keratitis",
    "Body": "\u003Cspan style=\u0022font-size:11.0pt;line-height:115%;\nfont-family:\u0026quot;Cambria\u0026quot;,serif;mso-ascii-theme-font:minor-latin;mso-fareast-font-family:\n\u0026quot;MS Mincho\u0026quot;;mso-fareast-theme-font:minor-fareast;mso-hansi-theme-font:minor-latin;\nmso-bidi-font-family:Arial;mso-bidi-theme-font:minor-bidi;mso-ansi-language:\nEN-US;mso-fareast-language:EN-US;mso-bidi-language:AR-SA\u0022\u003EYou are asked to see\na woman aged between 25 and 30 years who gives a history of recurrent episodes\nof tearing, foreign body sensation, photophobia, and mild reduction in vision\naffecting both eyes. During an acute attack she has mild conjunctival hyperaemia\nand numerous small coarse corneal epithelial opacities, which are clustered in\nthe central cornea and stain with fluorescein. Which is the MOST likely\ndiagnosis?\u003Cbr\u003E\n\u003C!--[if !supportLineBreakNewLine]--\u003E\u003Cbr\u003E\n\u003C!--[endif]--\u003E\u003C/span\u003E",
    "Explanation": "\u003Cspan style=\u0022text-decoration-line: underline; font-style: italic;\u0022\u003ECorrect Answer:\u003C/span\u003E \u003Cspan style=\u0022font-weight: bold;\u0022\u003EThygeson\u0027s keratitis\u003C/span\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003E\u0026nbsp;Explanation:\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;Thygeson\u0027s superficial punctate keratitis is a chronic, recurrent corneal condition that typically affects young adults. It is characterized by small, coarse, gray-white epithelial opacities clustered in the central cornea, which stain with fluorescein. Patients often present with tearing, photophobia, foreign body sensation, and mild visual disturbance during episodes. The conjunctival involvement is minimal, with only mild hyperaemia, and the condition follows a relapsing-remitting course over several years. The hallmark feature is the presence of discrete epithelial lesions without significant stromal involvement, distinguishing it from other conditions.\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003EWhy Other Options Are Incorrect:\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E Adenovirus keratitis usually follows epidemic keratoconjunctivitis and presents with subepithelial infiltrates rather than discrete epithelial opacities. Keratoconjunctivitis sicca is associated with dry eye and diffuse punctate erosions, not clustered coarse lesions. Superior limbic keratitis primarily affects the superior bulbar conjunctiva and limbus, not the central cornea.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cimg src=\u0022/upload-2026-01-20-ad489677-e742-44ab-92da-a0478709475d.jpg\u0022\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cimg src=\u0022/upload-2026-01-20-761fd80c-8794-4c4a-8731-420dbc207b34.jpg\u0022\u003E\u003C/div\u003E\u003C/div\u003E\u003Cdiv\u003EThgryson\u0027s punctate keratitis\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 286,
    "Name": " Orbital Floor Fracture with Inferior Rectus Entrapment",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022 style=\u0022mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;\nline-height:normal\u0022\u003E\u003Cspan style=\u0022font-size:12.0pt;font-family:\u0026quot;Times New Roman\u0026quot;,serif;\nmso-fareast-font-family:\u0026quot;Times New Roman\u0026quot;\u0022\u003EA 4-year-old boy presents having\nfallen off his bicycle and having hit his face on the handlebar. Which of these\nis \u003Cb\u003ELEAST consistent\u003C/b\u003E with a fracture of the orbital floor with entrapment\nof the inferior rectus muscle on the injured side?\u003Co:p\u003E\u003C/o:p\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003ECorrect Answer:\n\u003C/span\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EAfferent pupil defect.\u003C/span\u003E\u0026nbsp;\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003EExplanation:\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003EOrbital floor fractures with inferior rectus entrapment typically present with restricted ocular motility, especially in elevation and depression, due to mechanical tethering of the muscle. Associated features include nausea, vomiting, and bradycardia (oculocardiac reflex), particularly in children, and a white-eyed blowout fracture appearance with minimal external signs of trauma. The anterior segment usually remains quiet.\nAn afferent pupillary defect (APD), however, suggests optic nerve involvement or severe globe injury, which is not characteristic of isolated orbital floor fracture with muscle entrapment. Therefore, APD is the least consistent finding.\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 287,
    "Name": "Depth of Focus After Cataract Surgery",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022 style=\u0022mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;\nline-height:normal\u0022\u003E\u003Cspan style=\u0022font-size:12.0pt;font-family:\u0026quot;Times New Roman\u0026quot;,serif;\nmso-fareast-font-family:\u0026quot;Times New Roman\u0026quot;\u0022\u003EWhich of the following patients are\nMOST likely to have increased depth of focus following cataract surgery with a\nmonofocal lens?\u003Co:p\u003E\u003C/o:p\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\u003Cbr\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 1,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 288,
    "Name": "Sensitivity of ESR for Diagnosing GCA",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022 style=\u0022mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;\nline-height:normal\u0022\u003E\u003Cspan style=\u0022font-size:12.0pt;font-family:\u0026quot;Times New Roman\u0026quot;,serif;\nmso-fareast-font-family:\u0026quot;Times New Roman\u0026quot;\u0022\u003EData from a study of Anterior\nIschaemic Optic Neuropathy (AION) identifies that 20% of patients with AION\nhave Giant Cell Arteritis (GCA) confirmed by temporal artery biopsy (TAB).\nAssume \u003Cb\u003E80% of TAB-positive patients have a high ESR\u003C/b\u003E, and \u003Cb\u003E10% of\nTAB-negative patients have a high ESR\u003C/b\u003E. Using the data from this study, what\nis the approximate sensitivity of the ESR for diagnosing GCA?\u003Co:p\u003E\u003C/o:p\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003ECorrect Answer:\u003C/span\u003E\n\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u0026nbsp;80%\u0026nbsp;\u003C/span\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003EExplanation:\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;Sensitivity measures the proportion of true positives correctly identified by the test:\u0026nbsp; \u0026nbsp; \u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0022Sensitivity\u0022= (True Positives / All Patients with Disease) \u00D7100\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003EAssume 100 AION patients:\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; TAB positive = 20% \u2192 20 patients\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;High ESR among TAB positive = 80% \u2192 16 patients\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0022Sensitivity\u0022=16/20\u00D7100=80%\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;Specificity measures the proportion of true negatives correctly identified.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003EHere, 10% of TAB-negative patients have high ESR, which reduces specificity because of false positives.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;\u003Cspan style=\u0022font-weight: bold;\u0022\u003ESPIN \u0026amp; SNOUT Mnemonics:\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;SPIN = Specificity Positive rules IN disease \u2192 A highly specific test, when positive, confirms disease.\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;SNOUT = Sensitivity Negative rules OUT disease \u2192 A highly sensitive test, when negative, excludes disease.\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 11,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 289,
    "Name": "B-scan Signs of Raised Intracranial Pressure",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022 style=\u0022mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;\nline-height:normal\u0022\u003E\u003Cspan style=\u0022font-size:12.0pt;font-family:\u0026quot;Times New Roman\u0026quot;,serif;\nmso-fareast-font-family:\u0026quot;Times New Roman\u0026quot;\u0022\u003EWhich one of the following signs on\nB scan ultrasound is MOST likely to suggest raised intracranial pressure?\u003Co:p\u003E\u003C/o:p\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003ECorrect Answer:\n\u003C/span\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u0026nbsp;Fusiform swelling of the optic nerve with low-to-medium, regular, internal reflectivity\u003C/span\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022text-decoration-line: underline; font-style: italic;\u0022\u003EExplanation:\u003C/span\u003E\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003ERaised intracranial pressure often leads to papilledema, which can be detected on B-scan ultrasound as fusiform (spindle-shaped) swelling of the optic nerve. The swelling appears with low-to-medium internal reflectivity and a regular pattern because the nerve sheath is distended by cerebrospinal fluid. This finding correlates with optic nerve sheath diameter enlargement, a recognized indirect sign of increased intracranial pressure.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003EOther options are incorrect: An echolucent circle suggests optic nerve sheath fluid but is not the classic description for papilledema; medium-to-high, irregular reflectivity indicates optic nerve drusen rather than raised ICP; highly reflective areas also correspond to calcified drusen, not papilledema.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003EClinical Pearls:\u003C/span\u003E\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u2022\tOptic nerve sheath diameter \u0026gt;5 mm on B-scan is a strong indicator of raised ICP.\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u2022\tB-scan is useful when fundus view is obscured (e.g., media opacity).\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u2022\tDifferentiate papilledema from optic nerve head drusen by reflectivity pattern: drusen = highly reflective, irregular; papilledema = low-to-medium, regular.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cimg src=\u0022/upload-2026-01-22-b02bedb0-5686-4a6f-86bd-cad3f022d365.jpg\u0022 class=\u0022\u0022\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003Ean ocular US image shows papilledema\u003C/div\u003E\u003Cdiv\u003E\u003Cimg src=\u0022/upload-2026-01-22-97db03ac-bc98-46a3-876e-c64a1cfad4bf.jpg\u0022\u003E\u003C/div\u003E\u003Cdiv\u003Ean ocular US image shows optic disc drusen\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 290,
    "Name": "Mitomycin C and Glaucoma Drainage surgery ",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022\u003E\u003Cspan lang=\u0022EN\u0022\u003EWith regard to Mitomycin C used in glaucoma\ndrainage surgery, which of these statements is MOST likely to be correct?\u003Co:p\u003E\u003C/o:p\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003EAnswer:\u003C/span\u003E \u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u0026nbsp;It can cause limbal stem cell deficiency\u003C/span\u003E\u0026nbsp;\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003EExplanation:\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003EMitomycin C is a potent antimetabolite commonly used during glaucoma drainage surgeries (like trabeculectomy) to reduce postoperative scarring by inhibiting fibroblast proliferation. Its mechanism targets DNA synthesis, making it more effective than 5-Fluorouracil (5FU) at equivalent concentrations. One significant side effect is cytotoxicity to the ocular surface, particularly the limbus, which harbors corneal epithelial stem cells. Damage to these stem cells can result in limbal stem cell deficiency, leading to poor epithelial healing, persistent epithelial defects, and vision-threatening surface complications.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EOther options:\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003EMitomycin C is, in fact, more potent than 5FU\u003C/div\u003E\u003Cdiv\u003Ethe typical concentration used is 0.2 mg/mL (which equals 0.02%, not 0.2%).\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003EMitomycin C broadly inhibits cell proliferation, not specifically mast cell migration.\u0026nbsp;\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 291,
    "Name": "Drug induced papilledema",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022\u003E\u003Cspan lang=\u0022EN\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EDrug induced papilledema is MOST likely to be\ndue to which one of the following?\u003C/span\u003E\u003Co:p\u003E\u003C/o:p\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003EAnswer:\u003C/span\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u0026nbsp;Isotretinoin\u003C/span\u003E\u0026nbsp;\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022text-decoration-line: underline; font-style: italic;\u0022\u003EExplanation:\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\nPapilledema refers to optic disc swelling secondary to raised intracranial pressure (ICP). Drug-induced papilledema typically results from medications that can cause idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri. Among the options listed, isotretinoin is the most established culprit for this condition.\n\nIsotretinoin, a retinoid used primarily for severe acne, is well-documented to cause raised intracranial pressure, particularly in young patients. The mechanism is thought to involve altered cerebrospinal fluid (CSF) dynamics and reduced CSF absorption.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E(Pamidronate): Bisphosphonates have been associated with orbital inflammation and uveitis but not typically papilledema.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E(Sildenafil): PDE5 inhibitors can cause non-arteritic anterior ischemic optic neuropathy (NAION) and transient visual disturbances, but not papilledema from raised ICP.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E(Tamoxifen): This selective estrogen receptor modulator can cause crystalline retinopathy and rarely optic neuropathy, but not papilledema.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 292,
    "Name": "Apraclonidine usage",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022\u003E\u003Cspan lang=\u0022EN\u0022\u003EWhich of the following statements is MOST\nlikely to be correct?\u003Co:p\u003E\u003C/o:p\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003EAnswer:\u003C/span\u003E\u0026nbsp;\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u0026nbsp;Apraclonidine may cross the Blood brain barrier of children under one year of age, resulting in respiratory depression\u003C/span\u003E\u003Cdiv\u003E\u003Cspan style=\u0022text-decoration-line: underline; font-style: italic;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022text-decoration-line: underline; font-style: italic;\u0022\u003E\u0026nbsp;Explanation:\u003C/span\u003E\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;Apraclonidine is an alpha-adrenergic agonist used pharmacologically to diagnose Horner\u0027s syndrome through the reversal of ptosis and miosis in the affected eye due to denervation supersensitivity. However, it carries important safety considerations, particularly in pediatric populations.\n\nIn children under one year of age, the blood-brain barrier is incompletely developed and more permeable. Apraclonidine can cross this immature barrier and exert central nervous system effects, including sedation, bradycardia, hypotension, and potentially life-threatening respiratory depression. For this reason, apraclonidine is contraindicated in infants and young children.\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px; font-weight: bold; text-decoration-line: underline;\u0022\u003EWhy the other options are incorrect?\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cul\u003E\u003Cli\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EIn acute Horner\u0027s syndrome (especially within 48 hours of onset, such as from carotid dissection), denervation supersensitivity has not yet developed. Apraclonidine testing is unreliable in this timeframe and may yield false-negative results. The test is most reliable in chronic Horner\u0027s syndrome (typically after 2-3 days to weeks).\u0026nbsp;\u003C/span\u003E\u003C/li\u003E\u003Cli\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EApraclonidine works primarily as a weak alpha-1 agonist and alpha-2 agonist. The diagnostic effect in Horner\u0027s syndrome relies on alpha-1 receptor denervation supersensitivity in the dilator pupillae muscle of the affected eye, not alpha-2 supersensitivity.\u0026nbsp;\u003C/span\u003E\u003C/li\u003E\u003Cli\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EBrimonidine is not used for diagnosing Horner\u0027s syndrome. It is a potent alpha-2 agonist used to lower intraocular pressure in glaucoma. Like apraclonidine, brimonidine can also cross the blood-brain barrier in children and cause severe CNS and respiratory depression, making it contraindicated in young children.\u003C/span\u003E\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 293,
    "Name": "Blood supply of the optic nerve",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhich of the following statements is MOST\nlikely to be true with respect to the blood supply of the optic nerve?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\u003Cspan style=\u0022text-decoration-line: underline; font-style: italic;\u0022\u003EAnswer:\u003C/span\u003E \u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u0026nbsp;The retrolaminar optic nerve is supplied by branches of the pia vessels and central retinal artery\u003C/span\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003EExplanation:\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\n\nThe optic nerve has a complex, segmental blood supply that is clinically important for understanding various optic neuropathies. The nerve is anatomically divided into four portions: intraocular (optic nerve head), intraorbital, intracanalicular, and intracranial segments, each with distinct vascular supply.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003EThe retrolaminar optic nerve (the portion immediately posterior to the lamina cribrosa within the scleral canal and extending approximately 1-2 mm behind the globe) receives dual blood supply from both pial vessels (derived from the ophthalmic artery and its branches) and centrifugal branches of the central retinal artery. This dual supply creates a watershed zone that is particularly vulnerable to ischemia.\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003EOption A is incorrect: The ophthalmic artery is a branch of the internal carotid artery, not the external carotid artery. It typically arises from the internal carotid just after it exits the cavernous sinus.\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003EOption B is incorrect: The lamina cribrosa is primarily supplied by branches of the short posterior ciliary arteries (SPCAs), specifically the Para optic branches, and the circle of Zinn-Haller (an anastomotic circle formed by SPCAs). While short ciliary arteries do contribute, they are not the sole or primary supply; the more accurate terminology emphasizes posterior ciliary circulation.\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003EOption C is incorrect: The optic disc (optic nerve head) is predominantly supplied by the short posterior ciliary arteries via the circle of Zinn-Haller and paraoptic branches. The central retinal artery supplies primarily the nerve fiber layer on the disc surface, not the bulk of the optic disc tissue. A cilioretinal artery (present in 15-30% of individuals) supplies part of the retina, not the optic disc itself.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003ETo Sum Up:\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u2022 The ophthalmic artery arises from the internal carotid artery (medial to the anterior clinoid process).\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022 The optic nerve head has segmental blood supply: prelaminar (SPCAs), laminar (circle of Zinn-Haller from SPCAs), retrolaminar (pial vessels \u002B CRA branches).\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022 Non-arteritic anterior ischemic optic neuropathy (NAION) affects the optic nerve head supplied by posterior ciliary arteries.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022 Posterior ischemic optic neuropathy affects the retrolaminar and orbital portions supplied by pial vessels.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u2022 The watershed zone between different vascular territories makes certain optic nerve regions vulnerable to ischemic damage.\u0026nbsp;\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 294,
    "Name": "ROP",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EAccording to the 2008 RCOphth guidelines, when should a baby born at 26 weeks gestational age be screened for ROP?\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EROP screening in infants born \u0026lt;27 weeks GA should start at 30\u201331 weeks postmenstrual age, regardless of postnatal age.\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ENotes:\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb style=\u0022font-size: medium; text-decoration-line: underline;\u0022\u003EROP screening \u2013 timing of first examination\u003C/b\u003E\u003C/h3\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EInfants born \u0026lt;31\u002B0 weeks\u2019 gestation\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\u003Cblockquote style=\u0022margin: 0 0 0 40px; border: none; padding: 0px;\u0022\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u2192 First ROP screen at \u003C/span\u003E\u003Cb\u003E31\u201332 weeks postmenstrual age\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EOR\u003C/b\u003E\u003Cspan class=\u0022s2\u0022\u003E at \u003C/span\u003E\u003Cb\u003E4 weeks postnatal age\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u2192 \u003C/span\u003EUse whichever is\u003Cb\u003E later\u003C/b\u003E\u003C/p\u003E\u003C/blockquote\u003E\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EInfants born \u226531\u002B0 weeks\u2019 gestation\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\u003Cblockquote style=\u0022margin: 0 0 0 40px; border: none; padding: 0px;\u0022\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u2192 First ROP screen at \u003C/span\u003E\u003Cb\u003E36\u201337 weeks postmenstrual age\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EOR\u003C/b\u003E\u003Cspan class=\u0022s2\u0022\u003E at \u003C/span\u003E\u003Cb\u003E4 weeks postnatal age\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u2192 \u003C/span\u003EUse whichever is \u003Cb\u003Esooner\u003C/b\u003E\u003C/p\u003E\u003C/blockquote\u003E\u003Cp class=\u0022p1\u0022\u003E\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003EThe full guidelines:\u0026nbsp;\u003C/span\u003E\u003Ca href=\u0022https://www.rcpch.ac.uk/sites/default/files/2024-10/rop-screening-guideline-full-2022_updated-2024.pdf\u0022 target=\u0022_blank\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003EUK screening of retinopathy of prematurity guideline - 2024\u003C/a\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 295,
    "Name": "DR",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 53-year-old woman with \u003Cspan class=\u0022s1\u0022\u003Etype 1 diabetes\u003C/span\u003E and \u003Cspan class=\u0022s1\u0022\u003Eprimary open angle glaucoma\u003C/span\u003E presents with progressive visual loss in her \u003Cspan class=\u0022s1\u0022\u003Eright eye\u003C/span\u003E. Her visual acuity is \u003Cspan class=\u0022s1\u0022\u003E6/18\u003C/span\u003E, and OCT reveals \u003Cspan class=\u0022s1\u0022\u003Ecentral macular thickness of 500\u202F\u00B5m\u003C/span\u003E. Fundus fluorescein angiography shows a \u003Cspan class=\u0022s1\u0022\u003Emixed ischaemic-exudative pattern\u003C/span\u003E.\u0026nbsp;\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhat is the most appropriate management?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003EKey considerations for this patient:\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Col start=\u00221\u0022\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cb style=\u0022letter-spacing: 0.14994px;\u0022\u003EOCT shows central macular thickening \u2265500 \u03BCm\u003C/b\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E \u2192 qualifies for anti-VEGF under \u003C/span\u003E\u003Cb style=\u0022letter-spacing: 0.14994px;\u0022\u003ENICE guidelines\u003C/b\u003E\u003C/p\u003E\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EFFA shows mixed ischaemic and exudative maculopathy\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAnti-VEGF is still appropriate, even if macula is ischaemic.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EResponse may be reduced, but treatment is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot contraindicated\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ECoexisting glaucoma\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESteroids (e.g., triamcinolone)\u003C/b\u003E\u003C/span\u003E risk raising IOP - not ideal here.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EEvidence from key studies:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EDRCR.net Protocol I\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and \u003C/span\u003E\u003Cb\u003ERESTORE\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E trial:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\uD83D\uDC49 \u003Ci\u003ERanibizumab is superior to laser monotherapy.\u003C/i\u003E\u003Ci\u003E\u003C/i\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\uD83D\uDC49 \u003Ci\u003EIn patients with good glycaemic control, anti-VEGF leads to better functional outcomes.\u003C/i\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003C/ol\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-style: italic;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003C/div\u003E\u003Col start=\u00221\u0022\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/ol\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 296,
    "Name": "OHT",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 72-year-old woman is referred by her optometrist with an intraocular pressure (IOP) of \u003Cspan class=\u0022s1\u0022\u003E23 mmHg\u003C/span\u003E. Gonioscopy confirms \u003Cspan class=\u0022s1\u0022\u003Eopen angles\u003C/span\u003E, and her \u003Cspan class=\u0022s1\u0022\u003Ecentral corneal thickness (CCT) is 535 \u00B5m\u003C/span\u003E. Optic discs are healthy and visual fields are full.\u0026nbsp;\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EAccording to the \u003C/span\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E2022 NICE NG81 guidelines\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E, what is the most appropriate management for this patient?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EAccording to the \u003C/span\u003E\u003Cb\u003E2022 NICE NG81 guidelines\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, the decision to \u003C/span\u003E\u003Cb\u003Etreat or monitor ocular hypertension (OHT)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E depends on:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EIOP level\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EAge\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ECentral corneal thickness (CCT)\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPresence of optic nerve damage or visual field defects\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch4\u003E\u003Cb\u003EIn this patient:\u003C/b\u003E\u003C/h4\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EIOP = 23 mmHg\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192 \u003C/span\u003E\u003Cb\u003EBelow treatment threshold\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ECCT = 535 \u00B5m\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192 \u003C/span\u003E\u003Cb\u003ENormal\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ENo disc or field changes\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EAge = 72 years\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cblockquote style=\u0022margin-bottom: 0px; margin-left: 15px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-language-override: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; line-height: normal; font-family: \u0026quot;.AppleSystemUIFont\u0026quot;; color: rgb(14, 14, 14);\u0022\u003EFor patients \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003Eaged 60\u002B\u003C/b\u003E\u003C/span\u003E with:\u003C/blockquote\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cblockquote style=\u0022margin-bottom: 0px; margin-left: 15px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-language-override: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; line-height: normal; font-family: \u0026quot;Helvetica Neue\u0026quot;; color: rgb(14, 14, 14);\u0022\u003E\u003Cb\u003EIOP between 22\u201325 mmHg\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/blockquote\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cblockquote style=\u0022margin-bottom: 0px; margin-left: 15px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-language-override: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; line-height: normal; font-family: \u0026quot;Helvetica Neue\u0026quot;; color: rgb(14, 14, 14);\u0022\u003E\u003Cb\u003ENormal CCT\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/blockquote\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cblockquote style=\u0022margin-bottom: 0px; margin-left: 15px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-language-override: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; line-height: normal; font-family: \u0026quot;Helvetica Neue\u0026quot;; color: rgb(14, 14, 14);\u0022\u003E\u003Cb\u003ENo glaucomatous damage\u003C/b\u003E\u003C/blockquote\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cblockquote style=\u0022margin-bottom: 0px; margin-left: 15px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-language-override: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; line-height: normal; font-family: \u0026quot;.AppleSystemUIFont\u0026quot;; color: rgb(14, 14, 14); min-height: 19.4px;\u0022\u003E\u003Cbr\u003E\u003C/blockquote\u003E\n\u003Cblockquote style=\u0022margin-bottom: 0px; margin-left: 15px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-language-override: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; line-height: normal; color: rgb(14, 14, 14);\u0022\u003E\u003Cspan style=\u0022font-family: Arial; font-size: large;\u0022\u003E\u2705 NICE 2022 \u003Cspan class=\u0022s3\u0022 style=\u0022\u0022\u003E\u003Cb\u003Erecommends discharge from care\u003C/b\u003E\u003C/span\u003E, with advice to attend regular sight tests.\u003C/span\u003E\u003C/blockquote\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cimg src=\u0022/upload-2026-01-24-014e7828-b4c2-48d7-a856-edd8168b1d7d.png\u0022\u003E\u003C/p\u003E\n\u003Cblockquote style=\u0022margin-bottom: 0px; margin-left: 15px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-language-override: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; line-height: normal; font-family: \u0026quot;.AppleSystemUIFont\u0026quot;; color: rgb(14, 14, 14);\u0022\u003E\u003Cbr\u003E\u003C/blockquote\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EUnder the 2022 NICE guidelines, patients over 60 with IOP \u0026lt;26 mmHg, normal CCT, and no disc or field changes can be safely discharged.\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 297,
    "Name": "OHT",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EA 58-year-old man is referred by his optician with \u003C/span\u003Ebilateral raised intraocular pressure (IOP)\u003Cspan class=\u0022s1\u0022\u003E. Goldmann tonometry confirms \u003C/span\u003EIOP of 26 mmHg in both eyes\u003Cspan class=\u0022s1\u0022\u003E, with \u003C/span\u003Ecentral corneal thickness (CCT) of 567 \u00B5m\u003Cspan class=\u0022s1\u0022\u003E. There is \u003C/span\u003Eno evidence of glaucomatous optic neuropathy or visual field loss\u003Cspan class=\u0022s1\u0022\u003E.\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EAccording to the \u003C/span\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E2022 NICE Glaucoma Guideline (NG81)\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E, what is the most appropriate management?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThe \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E2022 NICE NG81\u003C/b\u003E\u003C/span\u003E guideline reflects updated evidence, including data from the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELiGHT Trial\u003C/b\u003E\u003C/span\u003E, which demonstrated that \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESLT is at least as effective as topical medications\u003C/b\u003E\u003C/span\u003E in lowering IOP and delaying disease progression in ocular hypertension (OHT) and early primary open-angle glaucoma (POAG).\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch4\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003E\uD83D\uDD0D This patient:\u003C/b\u003E\u003C/h4\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022font-size: medium;\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIOP = 26 mmHg\u003C/b\u003E\u003C/span\u003E \u2192 exceeds the treatment threshold\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ECCT = 567 \u03BCm\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192 not thin, but does \u003C/span\u003E\u003Cb\u003Enot alter decision to treat\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E at this IOP\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAge = 58 years\u003C/b\u003E\u003C/span\u003E \u2192 not suitable for discharge\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ENo glaucoma yet \u2192 diagnosis = ocular hypertension\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb style=\u0022font-size: 1.75rem; letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/h3\u003E\u003Ch3\u003E\u003Cb style=\u0022letter-spacing: 0.14994px; font-size: large;\u0022\u003ENICE NG81 (2022) Recommendation:\u003C/b\u003E\u003C/h3\u003E\n\u003Cblockquote style=\u0022margin-bottom: 0px; margin-left: 15px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-language-override: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; line-height: normal; font-family: \u0026quot;.AppleSystemUIFont\u0026quot;; color: rgb(14, 14, 14);\u0022\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003E\u201C\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOffer SLT as first-line treatment\u003C/b\u003E\u003C/span\u003E to people with ocular hypertension or chronic open-angle glaucoma if they are suitable for treatment.\u201D\u003C/span\u003E\u003C/blockquote\u003E\n\u003Cblockquote style=\u0022margin-bottom: 0px; margin-left: 15px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-language-override: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; line-height: normal; font-family: \u0026quot;Helvetica Neue\u0026quot;; color: rgb(14, 14, 14);\u0022\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\u2013 If SLT is \u003C/span\u003E\u003Cb\u003Enot suitable\u003C/b\u003E\u003Cspan class=\u0022s3\u0022\u003E, offer a \u003C/span\u003E\u003Cb\u003Egeneric prostaglandin analogue\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/span\u003E\u003C/blockquote\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003ETherefore, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESLT is the preferred first-line intervention\u003C/b\u003E\u003C/span\u003E in eligible patients, as in this case.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb style=\u0022font-size: medium;\u0022\u003EOther options are incorrect:\u003C/b\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022font-size: medium;\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EB. Beta-blocker\u003C/b\u003E\u003C/span\u003E\u0026nbsp;: Used if prostaglandins and SLT are not suitable or tolerated\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EC. Discharge:\u003C/b\u003E\u003C/span\u003E\u0026nbsp;Not appropriate with IOP \u226526 mmHg\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ED. Prostaglandin analogue:\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E\u0026nbsp;Acceptable \u003C/span\u003E\u003Cb\u003Eif SLT is not suitable\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, but not the first-line per NG81\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p6\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p6\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p6\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p6\u0022\u003E\u003Cimg src=\u0022/upload-2026-01-24-5d1374eb-5b97-4da9-89ff-90c979d27837.png\u0022\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 298,
    "Name": "ROP",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EAccording to the \u003C/span\u003Emost recent Royal College of Ophthalmologists guidelines\u003Cspan class=\u0022s1\u0022\u003E for the treatment of \u003C/span\u003Eretinopathy of prematurity (ROP)\u003Cspan class=\u0022s1\u0022\u003E, which of the following clinical scenarios \u003C/span\u003Emeets the treatment threshold\u003Cspan class=\u0022s1\u0022\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThe \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecurrent RCOphth guidance\u003C/b\u003E\u003C/span\u003E for ROP treatment thresholds aligns with the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EETROP (Early Treatment for ROP) study\u003C/b\u003E\u003C/span\u003E and international consensus. Treatment is recommended for \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EType 1 ROP\u003C/b\u003E\u003C/span\u003E, defined as:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EZone I\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, any stage \u003C/span\u003E\u003Cb\u003Ewith plus disease\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EZone I\u003C/b\u003E\u003C/span\u003E, Stage 3 (even \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ewithout\u003C/b\u003E\u003C/span\u003E plus disease)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EZone II\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, Stage 2 or 3 \u003C/span\u003E\u003Cb\u003Ewith plus disease\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003EZone II Stage 2 with plus disease \u003C/span\u003E\u003Cb\u003Eclearly meets the threshold for treatment\u003C/b\u003E\u003Cspan class=\u0022s3\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch4\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/h4\u003E\u003Ch4\u003E\u003Cb style=\u0022font-size: large;\u0022\u003EWhy the other options are incorrect:\u003C/b\u003E\u003C/h4\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022font-size: large;\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EA. Zone III, Stage 3 with plus\u003C/b\u003E\u003C/span\u003E \u2192 Treatment is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot indicated\u003C/b\u003E\u003C/span\u003E; zone III is peripheral, and stage 3 alone doesn\u2019t meet criteria\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EB. Zone I, Stage 1 with plus\u003C/b\u003E\u003C/span\u003E \u2192 Stage 1 in Zone I even with plus is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot sufficient\u003C/b\u003E\u003C/span\u003E unless progression is evident\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ED. Zone II, Stage 3 without plus\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192 \u003C/span\u003E\u003Cb\u003EPlus disease is essential\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E for treatment indication in Zone II\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EAccess the full guidelines:\u0026nbsp;\u003C/b\u003E\u003Ca href=\u0022https://www.rcophth.ac.uk/wp-content/uploads/2022/03/Treating-Retinopathy-of-Prematurity-in-the-UK.pdf\u0022 target=\u0022_blank\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003ETreating ROP - 2025 RCOphth guidelines\u003C/a\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cimg src=\u0022/upload-2026-01-24-907ec723-bada-4672-b0ed-4138d2297d2e.png\u0022\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 299,
    "Name": "MRI",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following is a \u003Cspan class=\u0022s1\u0022\u003Econtraindication to MRI\u003C/span\u003E scanning?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECochlear implants\u003C/b\u003E\u003C/span\u003E are generally considered a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Econtraindication to MRI\u003C/b\u003E\u003C/span\u003E, particularly \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eolder models\u003C/b\u003E\u003C/span\u003E that are not MRI-compatible. Some modern cochlear implants may be conditionally safe at specific field strengths, but \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emany still pose risks\u003C/b\u003E\u003C/span\u003E of heating, movement, or malfunction due to the magnetic field.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch4\u003E\u003Cb style=\u0022font-size: large; text-decoration-line: underline;\u0022\u003EOther options:\u003C/b\u003E\u003C/h4\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022font-size: large; text-decoration-line: underline;\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAllergy to gadolinium\u003C/b\u003E\u003C/span\u003E \u2192 Not a contraindication to MRI itself; only to contrast-enhanced studies. Non-contrast MRI can still be performed safely.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EFirst trimester pregnancy\u003C/b\u003E\u003C/span\u003E \u2192 MRI is not absolutely contraindicated. Although caution is advised due to theoretical risks, it may still be justified if essential and without contrast.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ETitanium ocular implant\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192 Titanium is \u003C/span\u003E\u003Cb\u003Enon-ferromagnetic\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and MRI-safe.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 300,
    "Name": "Pellucid marginal degeneration",
    "Body": "\u003Cdiv\u003E\u003Cimg src=\u0022/upload-2026-01-24-c06c471f-7bf9-417a-8399-0f3c4e12bff2.jpg\u0022\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EBased on the corneal topography image provided, which of the following is the \u003Cspan class=\u0022s1\u0022\u003Emost likely diagnosis\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThe image shows \u003C/span\u003E\u003Cb\u003Eclassic features of Pellucid Marginal Degeneration (PMD)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EInferior peripheral corneal steepening\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003E\u201CCrab claw\u201D or kissing dove appearance\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E on the topographic map\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThe area of steepening is \u003C/span\u003E\u003Cb\u003Ebelow the visual axis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, with \u003C/span\u003E\u003Cb\u003Ecentral corneal thinning absent\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe central cornea remains relatively flat, and astigmatism is typically \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eagainst-the-rule\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch4\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/h4\u003E\u003Ch4\u003E\u003Cb style=\u0022font-size: large;\u0022\u003EWhy other options are incorrect:\u003C/b\u003E\u003C/h4\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022font-size: large;\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMooren\u2019s ulcer\u003C/b\u003E\u003C/span\u003E \u2192 Presents as a peripheral, crescent-shaped stromal ulcer with overhanging edges, but \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot associated with this topographic pattern\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EKeratoconus\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192 Typically shows \u003C/span\u003E\u003Cb\u003Ecentral or paracentral steepening\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and thinning, not the \u003C/span\u003E\u003Cb\u003Einferior band pattern\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPost-LASIK ectasia\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192 Would show \u003C/span\u003E\u003Cb\u003Ecentral or paracentral irregularity\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and often \u003C/span\u003E\u003Cb\u003Ecentral thinning\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, not peripheral steepening\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb style=\u0022font-size: 14px; letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/h3\u003E\u003Ch3\u003E\u003Cb style=\u0022font-size: 14px; letter-spacing: 0.14994px;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/h3\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 301,
    "Name": "Thryoid Investigations",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following \u003Cspan class=\u0022s1\u0022\u003Eimaging modalities\u003C/span\u003E is most useful in assessing \u003Cspan class=\u0022s1\u0022\u003Edisease activity\u003C/span\u003E in a patient with thyroid eye disease?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThe \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESTIR sequence in MRI\u003C/b\u003E\u003C/span\u003E is the most helpful imaging modality for evaluating \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eactive orbital inflammation\u003C/b\u003E\u003C/span\u003E in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ethyroid eye disease (TED)\u003C/b\u003E\u003C/span\u003E. STIR is a fat-suppressed sequence that enhances the visibility of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esoft tissue oedema\u003C/b\u003E\u003C/span\u003E, including within the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eextraocular muscles\u003C/b\u003E\u003C/span\u003E, and correlates well with:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EClinical activity score (CAS)\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EDisease activity phase\u003C/b\u003E\u003C/span\u003E (active vs quiescent)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EResponse to immunosuppression\u003C/b\u003E\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\n\u003Cp class=\u0022p1\u0022\u003EThis makes it superior to standard MRI sequences or CT for evaluating \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edisease activity\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch4\u003E\u003Cb style=\u0022font-size: large;\u0022\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/h4\u003E\u003Ch4\u003E\u003Cb style=\u0022font-size: large;\u0022\u003EOther options are incorrect:\u003C/b\u003E\u003C/h4\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022font-size: large;\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EContrast-enhanced CT scan\u003C/b\u003E\u003C/span\u003E \u2192 Useful for anatomy and surgical planning, but not for assessing inflammatory activity\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EFLAIR MRI\u003C/b\u003E\u003C/span\u003E \u2192 Used for neuroimaging (e.g., demyelination); not optimal for orbit\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ET1-weighted MRI\u003C/b\u003E\u003C/span\u003E \u2192 Good for structural definition, but not sensitive to inflammation or oedema\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb style=\u0022font-size: 14px; letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/h3\u003E\u003Ch3\u003E\u003Cb style=\u0022font-size: 14px; letter-spacing: 0.14994px;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/h3\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 302,
    "Name": "Diabetes",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EAccording to the \u003C/span\u003Emost recent WHO diagnostic criteria\u003Cspan class=\u0022s1\u0022\u003E, which of the following findings \u003C/span\u003Emeets the threshold for a diagnosis of diabetes mellitus\u003Cspan class=\u0022s1\u0022\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThe \u003C/span\u003E\u003Cb\u003Elatest WHO criteria\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (2019 and reaffirmed in 2022) state that \u003C/span\u003E\u003Cb\u003Ediabetes mellitus can be diagnosed\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E in any of the following situations \u003C/span\u003E\u003Cb\u003E(confirmed on repeat testing unless symptoms are present):\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Col start=\u00221\u0022\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EFasting plasma glucose \u2265 7.0 mmol/L\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003E2-hour plasma glucose \u2265 11.1 mmol/L\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E during an OGTT\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ERandom plasma glucose \u2265 11.1 mmol/L\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E in a patient with symptoms\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EHbA1c \u2265 6.5% (48 mmol/mol)\u003C/b\u003E\u003C/span\u003E using a standardised method\u003C/p\u003E\n\u003C/li\u003E\u003C/ol\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch4\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/h4\u003E\u003Ch4\u003E\u003Cb\u003EOther options are incorrect:\u003C/b\u003E\u003C/h4\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EHbA1c \u0026gt; 6.0%\u003C/b\u003E\u003C/span\u003E \u2192 Below diagnostic threshold (must be \u2265 6.5%)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EFasting plasma glucose \u0026gt; 6.5 mmol/L\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2192 \u003C/span\u003E\u003Cb\u003Ediagnostic threshold is \u2265 7.0 mmol/L\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ED. Glucosuria\u003C/b\u003E\u003C/span\u003E \u2192 Non-specific; not diagnostic without blood glucose confirmation\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb style=\u0022font-size: 14px; letter-spacing: 0.14994px;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/h3\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 7,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 303,
    "Name": "Consent",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EAn 84-year-old woman with dense bilateral cataracts and \u003Cspan class=\u0022s1\u0022\u003Eadvanced dementia\u003C/span\u003E attends clinic. She is \u003Cspan class=\u0022s1\u0022\u003Eunable to understand, retain, or weigh medical information\u003C/span\u003E, and therefore \u003Cspan class=\u0022s1\u0022\u003Elacks capacity\u003C/span\u003E to consent for surgery. Which of the following statements is \u003Cspan class=\u0022s1\u0022\u003Ecorrect\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EUnder the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMental Capacity Act (2005)\u003C/b\u003E\u003C/span\u003E, if an adult lacks capacity:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EA \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehealth and welfare LPA\u003C/b\u003E\u003C/span\u003E, registered and in effect, has legal authority to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emake decisions\u003C/b\u003E\u003C/span\u003E regarding medical treatment, including consent to or refusal of surgery.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIn \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eabsence\u003C/b\u003E\u003C/span\u003E of such an LPA, healthcare professionals must act in the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epatient\u2019s best interests\u003C/b\u003E\u003C/span\u003E, following a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebest interest meeting\u003C/b\u003E\u003C/span\u003E process involving the care team and family.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ENext of kin alone has no legal standing\u003C/b\u003E\u003C/span\u003E to consent unless they are the registered LPA.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIn most cases, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecapacity assessments are clinical\u003C/b\u003E\u003C/span\u003E and do \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot require a psychiatrist\u003C/b\u003E\u003C/span\u003E, unless the case is complex or contested.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb style=\u0022font-size: 14px; letter-spacing: 0.14994px;\u0022\u003EOnly a registered health and welfare LPA can legally provide consent for a patient who lacks capacity; next of kin cannot.\u003C/b\u003E\u003C/h3\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 7,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 304,
    "Name": "DVLA",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EA patient attends a cataract pre\u2011assessment clinic. His \u003C/span\u003Ebinocular visual acuity is 6/15\u003Cspan class=\u0022s1\u0022\u003E, but he is able to \u003C/span\u003Eread a vehicle number plate at 20\u202Fmetres in good daylight\u003Cspan class=\u0022s1\u0022\u003E. Slit\u2011lamp examination reveals \u003C/span\u003Ebilateral cortical cataracts\u003Cspan class=\u0022s1\u0022\u003E.\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhat advice regarding \u003C/span\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003Edriving\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E should be given to this patient?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EAccording to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EDVLA Group 1 (car and motorcycle) visual standards\u003C/b\u003E\u003C/span\u003E, a patient must meet \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eboth\u003C/b\u003E\u003C/span\u003E of the following criteria to drive legally:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Col start=\u00221\u0022\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ENumber plate test\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAbility to read a vehicle registration plate at \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E20 metres\u003C/b\u003E\u003C/span\u003E in good daylight (post\u2011September 2001 plates)\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\u003C/li\u003E\u003C/ol\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EAND\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Col start=\u00222\u0022\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EVisual acuity requirement\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EBinocular best\u2011corrected visual acuity of at least 6/12 (Snellen 0.5)\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOr 6/12 in the only eye if monocular\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003C/ol\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EBecause \u003C/span\u003E\u003Cb\u003Eboth criteria must be satisfied\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, this patient \u003C/span\u003E\u003Cb\u003Edoes not meet the DVLA legal standard for driving\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, regardless of lighting conditions.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EThere is \u003C/span\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cb\u003Eno provision\u003C/b\u003E\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E in DVLA guidance allowing patients to drive only in good light, and clinicians should not give conditional advice that contradicts DVLA rules.\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\n\n\n\n\n\n\n\n\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Col start=\u00222\u0022\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/ol\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 7,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 305,
    "Name": "Drug induced Optic neuropathy",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EWhich of the following medications is \u003C/span\u003Emost likely to cause an optic neuropathy\u003Cspan class=\u0022s1\u0022\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAmiodarone\u003C/b\u003E\u003C/span\u003E is a well-established cause of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edrug-induced optic neuropathy\u003C/b\u003E\u003C/span\u003E, typically presenting as:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPainless, bilateral or asymmetric vision loss\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESwollen or pale optic discs\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESlowly progressive course\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOften seen in patients on long-term therapy\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch4\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/h4\u003E\u003Ch4\u003E\u003Cb style=\u0022font-size: large;\u0022\u003EOther options are incorrect:\u003C/b\u003E\u003C/h4\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022font-size: large;\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ETamoxifen\u003C/b\u003E\u003C/span\u003E \u2192 Causes \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecrystalline maculopathy\u003C/b\u003E\u003C/span\u003E and retinal pigment epithelial changes, not optic neuropathy\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGold\u003C/b\u003E\u003C/span\u003E \u2192 Known to cause \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eocular chrysiasis\u003C/b\u003E\u003C/span\u003E (corneal and conjunctival gold deposits), but not optic neuropathy\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECidofovir\u003C/b\u003E\u003C/span\u003E \u2192 Associated with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eanterior uveitis\u003C/b\u003E\u003C/span\u003E and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehypotony\u003C/b\u003E\u003C/span\u003E, not optic nerve damage\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cbr\u003E\u003C/h3\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EAmiodarone is one of several drugs known to cause optic neuropathy, alongside ethambutol, isoniazid, vigabatrin, and chloramphenicol.\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 306,
    "Name": "Retinoschisis",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022\u003E\u003Cspan lang=\u0022EN\u0022\u003EWhich of the following is least consistent\nwith the diagnosis of retinoschisis?\u003Co:p\u003E\u003C/o:p\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003EAnswer:\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EHigh myopia\u003C/span\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: 700; font-style: italic; text-decoration-line: underline;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003E\u0026nbsp;Explanation:\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003ERetinoschisis is a splitting of the neurosensory retina into two layers, typically at the outer plexiform layer (between the outer nuclear layer and inner nuclear layer). It is most commonly degenerative (acquired) in nature and must be distinguished from rhegmatogenous retinal detachment.\u003C/div\u003E\u003Cdiv\u003EUnderstanding the clinical features helps differentiate these conditions and guide appropriate management.\n\nHigh myopia is actually a risk factor for retinal detachment, not retinoschisis. Degenerative retinoschisis typically occurs in hyperopic or emmetropic eyes, affecting 7% of the population over 40 years. The association with myopia is weak, making this the least consistent feature with retinoschisis diagnosis. In contrast, high myopia is strongly associated with posterior vitreous detachment and tractional retinal breaks leading to rhegmatogenous retinal detachment.\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003EThe remaining options are characteristic features of retinoschisis: The beaten metal or \u0022frosted\u0022 appearance on the inner retinal surface is a pathognomonic sign of retinoschisis. This results from the splitting of retinal layers creating a shimmering, reflective quality on the inner leaf of the schisis cavity. This appearance is highly specific for retinoschisis and helps distinguish it from retinal detachment.\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003EDegenerative retinoschisis has a characteristic bilateral distribution, most commonly affecting the inferotemporal quadrant (60-70% of cases), followed by the superotemporal quadrant. This bilateral, symmetric presentation in the inferotemporal location is a classic feature. In contrast, rhegmatogenous retinal detachments are typically unilateral and more commonly occur in the superior quadrants due to gravity-dependent subretinal fluid accumulation.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003EWhen laser photocoagulation is applied to retinoschisis, there is typically no visible reaction or whitening because the inner leaf of the split retina lacks normal metabolic activity and the photoreceptors are separated from the RPE by the outer leaf. This absence of laser uptake is a key distinguishing feature. A visible laser reaction would suggest an intact retina, as seen in retinal detachment where the sensory retina remains as one layer (though detached from RPE). The question asks for \u0022least consistent,\u0022 so the presence of a visible reaction would actually argue against retinoschisis.\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003E\u0026nbsp;Mnemonic:\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E \u0022Retinoschisis - SPLIT\u0022\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\nS = Symmetric and bilateral\u003C/div\u003E\u003Cdiv\u003EP = Progresses slowly\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003EL = Lower (inferotemporal) location most common\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003EI = Inner leaf has beaten metal appearance\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003ET = Thin, immobile, no holes typically seen\u0026nbsp;\u003C/div\u003E\u003C/div\u003E",
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    "CategoryId": 2,
    "Category": null,
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  },
  {
    "Id": 307,
    "Name": "IOL Refractive Surprise - Hyperopic Shift",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022\u003E\u003Cspan lang=\u0022EN\u0022\u003EA patient undergoes routine cataract surgery\nwith a planned refractive outcome of -0.5DS. The axial length was 23.0 mm. When\nrefracted four weeks postoperatively they are found to be \u002B2.50DS. Of the\nfollowing, which is the MOST likely cause of this refractive surprise?\u003Co:p\u003E\u003C/o:p\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003EThe correct answer is\u003C/span\u003E: \u003Cspan style=\u0022font-weight: bold;\u0022\u003EThe A constant used in the biometry calculation was too low for the implanted IOL.\u003C/span\u003E\u0026nbsp;\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;The key to this question lies in understanding the relationship between IOL power and refractive outcome.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003EP = A \u2212 0.9K \u2212 2.5AL\u003C/div\u003E\u003Cdiv\u003EWhen an A constant is too low, the biometry formula systematically predicts a lower intraocular lens power than is optically required for that particular eye. Since a weaker IOL produces a hyperopic (positive) refractive shift, this mechanism directly explains the observed outcome: the patient targeted \u22120.5 DS but achieved \u002B2.50 DS, representing approximately a \u002B3.0 dioptre hyperopic surprise.\u003C/div\u003E\u003Cdiv\u003EThe axial length of 23.0 mm is normal, making formula selection differences between Hoffer Q and SRK/T irrelevant\u2014both would be concordant at this length.\u003C/div\u003E\u003Cdiv\u003ESulcus placement without power adjustment would position the IOL more anteriorly, making it effectively stronger and causing a myopic shift in the opposite direction from what was observed.\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EReversed implantation of an anteriorly angulated posterior-biconvex IOL typically produces a myopic shift of up to 0.9 dioptre, not the substantial hyperopic surprise documented here.\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003ETherefore, a systematic biometry error caused by an insufficiently low A constant represents the most parsimonious explanation for this refractive outcome in an otherwise normal-length eye.\u003C/span\u003E\u003C/div\u003E",
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    "CategoryId": 1,
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  },
  {
    "Id": 308,
    "Name": "Fundus Fluorescein Angiography - Protein Binding",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022\u003E\u003Cspan lang=\u0022EN\u0022\u003EWhich of the following statements regarding\nFundus Fluorescein Angiography (FFA) is LEAST likely to be true?\u003Co:p\u003E\u003C/o:p\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003EAnswer:\u003C/span\u003E\u0026nbsp;\u003Cspan style=\u0022font-weight: bold;\u0022\u003EThe dye used in FFA is more protein bound in the blood compared with ICG (Indocyanine Green)\u003C/span\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003EExplanation:\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EProtein Binding Facts:\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u0026nbsp;- Fluorescein (used in Fundus Fluorescein Angiography):\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E70-85% protein-bound to serum albumin\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E- Indocyanine Green: \u0026gt;98% protein-bound to albumin, alpha-1 lipoproteins, and globulins\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px; font-style: italic; text-decoration-line: underline;\u0022\u003E\u0026nbsp;Analysis of Other Options (Why They Are TRUE):\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px; font-style: italic; text-decoration-line: underline;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EClassic choroidal neovascularization shows a characteristic Fundus Fluorescein Angiography pattern. In the early phase (first 1-2 minutes), the choroidal neovascularization membrane appears hypo-fluorescent (dark) because the newly formed vessels have not yet filled with dye. As the angiogram progresses, classic choroidal neovascularization demonstrates progressive hyperfluorescence with well-demarcated lacy borders in a wheel-spoke pattern, followed by late leakage (5-10 minutes) that obscures the boundaries. This early hypo-fluorescence transitioning to hyperfluorescence is a defining characteristic of classic choroidal neovascularization according to the Macular Photocoagulation Study criteria.\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EOccult choroidal neovascularization includes two subtypes: fibrovascular pigment epithelial detachment and late leakage of undetermined source. Both subtypes demonstrate early hypo-fluorescence before late-phase changes become apparent. Fibrovascular pigment epithelial detachment shows irregular retinal pigment epithelium elevation with early hypo-fluorescence or stippled fluorescence, followed by late persistent fluorescence. Late leakage of undetermined source shows no hyperfluorescence in the early phase (remaining hypo-fluorescent), with speckled hyperfluorescence appearing only in the late phase (after 2-5 minutes). The key distinguishing feature from classic choroidal neovascularization is that occult lesions show late leakage without early well-demarcated hyperfluorescence.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhile the choroid receives 85-90% of ocular blood flow and blood reaches both circulations nearly simultaneously (around 10-15 seconds), clinically we visualize distinct retinal arterial filling at 10-12 seconds as clearly defined vascular structures, while the choroidal flush appears at 10-15 seconds as diffuse background fluorescence. The retinal vessels are the first clearly identifiable vascular structures that \u0022light up\u0022 individually during Fundus Fluorescein Angiography. The choroid fills as a diffuse \u0022flush\u0022 rather than as distinct individual vessels. From a clinical Fundus Fluorescein Angiography interpretation perspective, we identify and describe retinal arterial filling as a distinct phase, making this statement true in clinical practice.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E",
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    "CategoryId": 2,
    "Category": null,
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  },
  {
    "Id": 309,
    "Name": "Ocular Myasthenia Gravis - Clinical Signs",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022\u003E\u003Cspan lang=\u0022EN\u0022\u003EWhich of the following clinical signs is LEAST\nlikely to be of help in making the diagnosis of ocular myasthenia gravis?\u003Co:p\u003E\u003C/o:p\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003EAnswer:\u003C/span\u003E \u003Cspan style=\u0022font-weight: bold;\u0022\u003EBilateral symmetrical ptosis\u003C/span\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003EExplanation:\u003C/span\u003E\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;Ocular myasthenia gravis is an autoimmune disorder caused by antibodies against acetylcholine receptors at the neuromuscular junction. This leads to fatigable muscle weakness that worsens with sustained activity and improves with rest. The hallmark clinical feature is the development of asymmetric ocular muscle weakness that demonstrates clear fatigability.\u003C/div\u003E\u003Cdiv\u003EBilateral symmetrical ptosis is LEAST helpful because bilateral symmetrical ptosis is atypical for myasthenia gravis. The condition characteristically produces asymmetric or unilateral ptosis that may fluctuate throughout the day. When ptosis is bilateral in myasthenia, one eyelid is almost always more affected than the other, creating noticeable asymmetry. Finding perfectly symmetrical bilateral ptosis should prompt consideration of alternative diagnoses such as bilateral third nerve palsy, chronic progressive external ophthalmoplegia, mitochondrial myopathy, or oculopharyngeal muscular dystrophy. This sign would actually suggest against myasthenia gravis rather than support the diagnosis.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003ESustained closure of the eye lids giving rise to scleral show is helpful as it describes the orbicularis oculi fatigue phenomenon. When patients forcefully close their eyelids for a sustained period, the orbicularis muscles fatigue. Upon opening the eyes, there is incomplete relaxation and persistent contraction causing lid retraction, which reveals white sclera below the inferior limbus (scleral show). This fatigability of the orbicularis muscle is characteristic of myasthenia gravis and represents a useful bedside test.\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003ESustained upgaze producing bilateral ptosis is very helpful as sustained upgaze is one of the most valuable clinical tests for ocular myasthenia. Asking the patient to maintain upgaze for 30-60 seconds places sustained demand on the levator palpebrae superioris. In myasthenia gravis, progressive ptosis develops as the muscle fatigues, often becoming apparent within 30 seconds. The degree of ptosis typically worsens the longer upgaze is maintained and improves dramatically after a brief period of rest with eyes closed. This fatigue test has high sensitivity and specificity for ocular myasthenia.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EUpper lid twitching on return to primary position after prolonged downgaze is specifc to MG and it is called\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003ECogan\u0027s Lid Twitch Sign.\u003C/span\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
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  },
  {
    "Id": 310,
    "Name": "Cyclophosphamide Side Effects in Granulomatosis Polyangiitis",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022\u003E\u003Cspan lang=\u0022EN\u0022\u003EA 55 year old man with granulomatosis\npolyangiitis is being treated with cyclophosphamide. Which of these drug side\neffects is he MOST likely to experience?\u003Co:p\u003E\u003C/o:p\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003EAnswer:\u003C/span\u003E\u0026nbsp;\u003Cspan style=\u0022font-weight: bold;\u0022\u003EMarrow suppression\u003C/span\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022text-decoration-line: underline; font-style: italic;\u0022\u003EExplanation:\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;Cyclophosphamide is an alkylating agent commonly used to treat severe systemic vasculitis including granulomatosis polyangiitis (formerly Wegener\u0027s granulomatosis). While it has multiple potential side effects, bone marrow suppression (myelosuppression) is the most frequently encountered adverse effect, affecting nearly all patients to some degree.\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003ECyclophosphamide causes dose-dependent bone marrow toxicity that primarily affects rapidly dividing white blood cells (leukopenia/neutropenia), followed by platelets (thrombocytopenia), and less commonly red blood cells (anemia). The nadir of white blood cell count typically occurs 7-14 days after each dose. Regular monitoring with complete blood counts is essential, and doses must be reduced or delayed if white cell counts fall below safe thresholds (typically WCC \u0026lt; 4.0 x 10\u2079/L or neutrophils \u0026lt; 1.5 x 10\u2079/L). Severe myelosuppression increases infection risk and can be life-threatening, making this the most clinically significant side effect requiring constant vigilance.\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003ECyclophosphamide commonly causes - alopecia (hair loss) not Hirsutism. Hirsutism is more characteristic of corticosteroid therapy or medications with androgenic effects.\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhile hemorrhagic cystitis is indeed a serious and potentially life-threatening complication of cyclophosphamide therapy, it occurs less frequently than bone marrow suppression. Hemorrhagic cystitis develops in approximately 10-40% of patients (depending on cumulative dose and duration), whereas myelosuppression affects virtually all patients to some degree. The toxic metabolite acrolein causes direct bladder damage, and risk is reduced through adequate hydration, frequent voiding, and administration of mesna (which binds and neutralizes acrolein). However, in terms of frequency, marrow suppression remains more common.\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EOsteoporosis is NOT a direct side effect of cyclophosphamide.\u003C/span\u003E\u003C/div\u003E",
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    "CategoryId": 5,
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  },
  {
    "Id": 311,
    "Name": "Basilar artery syndrome",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EA man wakes from a coma with \u003C/span\u003Ebilateral complete ophthalmoplegia\u003Cspan class=\u0022s1\u0022\u003E, including \u003C/span\u003Epupil involvement\u003Cspan class=\u0022s1\u0022\u003E, and reports \u003C/span\u003Evisual disturbance\u003Cspan class=\u0022s1\u0022\u003E. Examination reveals \u003C/span\u003Enormal motor function in all limbs\u003Cspan class=\u0022s1\u0022\u003E.\u0026nbsp;\u003C/span\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhich vessel is the \u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003Emost likely site of embolic occlusion\u003C/span\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThis clinical picture is characteristic of \u003C/span\u003E\u003Cb\u003E\u201Ctop of the basilar syndrome\u201D\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, caused by an \u003C/span\u003E\u003Cb\u003Eembolic occlusion at the distal end of the basilar artery\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E. This territory includes:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERostral brainstem\u003C/b\u003E\u003C/span\u003E (midbrain and upper pons)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EThalami\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOccipital lobes\u003C/b\u003E\u003C/span\u003E (via posterior cerebral arteries)\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003EKey features include:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBilateral ophthalmoplegia\u003C/b\u003E\u003C/span\u003E (often involving all cranial nerves controlling eye movement)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPupil involvement\u003C/b\u003E\u003C/span\u003E due to oculomotor nerve and midbrain damage\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EVisual hallucinations or cortical blindness\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPreserved motor function in limbs\u003C/b\u003E\u003C/span\u003E, since corticospinal tracts are often spared\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch4\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/h4\u003E\u003Ch4\u003E\u003Cb\u003EOther options are incorrect:\u003C/b\u003E\u003C/h4\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EInternal carotid artery\u003C/b\u003E\u003C/span\u003E \u2192 Would likely affect anterior circulation (e.g. MCA/ACA territory), often with unilateral motor/sensory deficits\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPICA\u003C/b\u003E\u003C/span\u003E \u2192 Classically causes \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elateral medullary syndrome\u003C/b\u003E\u003C/span\u003E (Wallenberg), which includes vertigo, ataxia, and sensory deficits;\u0026nbsp;\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot complete ophthalmoplegia\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPCOM\u003C/b\u003E\u003C/span\u003E \u2192 Can compress the third nerve causing \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eisolated CN III palsy\u003C/b\u003E\u003C/span\u003E, but not bilateral ophthalmoplegia with visual cortex signs\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cbr\u003E\u003C/h3\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EBilateral ophthalmoplegia with pupil involvement and visual disturbance, but preserved motor function, strongly suggests top of the basilar artery syndrome.\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cimg src=\u0022/upload-2026-01-26-7750b5a2-1914-48e2-902c-8865687df9ef.png\u0022\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 312,
    "Name": "Facial nerve palsy",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA lesion in which of the following anatomical locations is most likely to cause \u003Cspan class=\u0022s1\u0022\u003Einability to fully close the eyelid\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThe \u003C/span\u003E\u003Cb\u003Eorbicularis oculi muscle\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, responsible for \u003C/span\u003E\u003Cb\u003Eeyelid closure\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, is innervated by the \u003C/span\u003E\u003Cb\u003Etemporal and zygomatic branches of the facial nerve (CN VII)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E. A lesion affecting the \u003C/span\u003E\u003Cb\u003Efacial nerve\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E therefore impairs eyelid closure.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003EThe \u003Cspan class=\u0022s2\u0022\u003E\u003Cb\u003Ecerebellopontine angle (CPA)\u003C/b\u003E\u003C/span\u003E is the most common site for lesions (e.g. acoustic neuroma/vestibular schwannoma, meningioma) that involve multiple cranial nerves\u2014especially:\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ECN V (trigeminal)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ECN VI (abducens)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ECN VII (facial)\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ECN VIII (vestibulocochlear)\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003EA CPA lesion affecting \u003Cspan class=\u0022s2\u0022\u003E\u003Cb\u003ECN VII\u003C/b\u003E\u003C/span\u003E results in \u003Cspan class=\u0022s2\u0022\u003E\u003Cb\u003Eipsilateral facial palsy\u003C/b\u003E\u003C/span\u003E, including \u003Cspan class=\u0022s2\u0022\u003E\u003Cb\u003Eincomplete eyelid closure\u003C/b\u003E\u003C/span\u003E (lagophthalmos).\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch4\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/h4\u003E\u003Ch4\u003E\u003Cb\u003EOther options are incorrect:\u003C/b\u003E\u003C/h4\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECavernous sinus\u003C/b\u003E\u003C/span\u003E \u2192 Affects CN III, IV, V1/V2, and VI\u2014but \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot CN VII\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EVentral midbrain\u003C/b\u003E\u003C/span\u003E \u2192 Typically involves ocular motor pathways (CN III, vertical gaze), not eyelid closure\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELateral medulla\u003C/b\u003E\u003C/span\u003E \u2192 Causes lateral medullary syndrome (e.g. dysphagia, vertigo, Horner\u2019s), but \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot CN VII dysfunction\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb style=\u0022font-size: 14px; letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/h3\u003E\u003Ch3\u003E\u003Cb style=\u0022font-size: 14px; letter-spacing: 0.14994px;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/h3\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 313,
    "Name": "Cerebellopontine angle tumour",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EWhich of the following conditions is \u003C/span\u003Emost likely\u003Cspan class=\u0022s1\u0022\u003E to present with \u003C/span\u003Efacial paralysis\u003Cspan class=\u0022s1\u0022\u003E and \u003C/span\u003Eipsilateral loss of corneal sensation\u003Cspan class=\u0022s1\u0022\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EA \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecerebellopontine angle tumour\u003C/b\u003E\u003C/span\u003E (e.g. vestibular schwannoma) typically affects cranial nerves:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECN V\u003C/b\u003E\u003C/span\u003E \u2013 sensory loss in the face and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ereduced corneal sensation\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECN VI\u003C/b\u003E\u003C/span\u003E \u2013 abduction weakness\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ECN VII\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2013 \u003C/span\u003E\u003Cb\u003Efacial weakness/paralysis\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECN VIII\u003C/b\u003E\u003C/span\u003E \u2013 sensorineural hearing loss and tinnitus\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003EThis makes it the \u003C/span\u003E\u003Cb\u003Eclassic lesion causing both facial nerve palsy and ipsilateral reduced corneal reflex\u003C/b\u003E\u003Cspan class=\u0022s3\u0022\u003E, due to simultaneous involvement of \u003C/span\u003E\u003Cb\u003ECN V and CN VII\u003C/b\u003E\u003Cspan class=\u0022s3\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch4\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/h4\u003E\u003Ch4\u003E\u003Cb\u003EOther options are incorrect:\u003C/b\u003E\u003C/h4\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMillard-Gubler syndrome\u003C/b\u003E\u003C/span\u003E \u2192 Lesion in the pons affecting \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECN VI and VII\u003C/b\u003E\u003C/span\u003E, but \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot CN V\u003C/b\u003E\u003C/span\u003E, so corneal sensation is preserved\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECavernous sinus meningioma\u003C/b\u003E\u003C/span\u003E \u2192 Affects CN III, IV, V1/V2, VI, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot CN VII\u003C/b\u003E\u003C/span\u003E (facial motor)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGradenigo\u2019s syndrome\u003C/b\u003E\u003C/span\u003E \u2192 Affects \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECN V and VI\u003C/b\u003E\u003C/span\u003E, due to petrous apicitis; facial paralysis is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot\u003C/b\u003E\u003C/span\u003E a feature\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb style=\u0022font-size: 14px; letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/h3\u003E\u003Ch3\u003E\u003Cb style=\u0022font-size: 14px; letter-spacing: 0.14994px;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/h3\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 314,
    "Name": "Pupil",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 26-year-old woman presents with \u003Cspan class=\u0022s1\u0022\u003Eanisocoria\u003C/span\u003E, first noted 3 days ago. Examination reveals a \u003Cspan class=\u0022s1\u0022\u003Edilated, non-reactive left pupil\u003C/span\u003E, while the right pupil shows normal direct and consensual light reflexes.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EPharmacologic testing of the left pupil shows:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022font-weight: bold;\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ECocaine 4%\u003C/span\u003E \u2192 no change\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EHydroxyamphetamine 1%\u003Cspan class=\u0022s1\u0022\u003E \u2192 no change\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EAdrenaline 1:1000\u003Cspan class=\u0022s1\u0022\u003E \u2192 no change\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EPilocarpine 1%\u003Cspan class=\u0022s1\u0022\u003E \u2192 no change\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhat is the most likely diagnosis?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThis is a classic presentation of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epharmacologic mydriasis\u003C/b\u003E\u003C/span\u003E, where the pupil is dilated due to exposure to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emydriatic agents\u003C/b\u003E\u003C/span\u003E (e.g. anticholinergics such as atropine or sympathomimetics).\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EKey diagnostic clue:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThe \u003C/span\u003E\u003Cb\u003Edilated pupil does not constrict with pilocarpine 1%\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, which is a \u003C/span\u003E\u003Cb\u003Edirect muscarinic agonist\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EEven Holmes-Adie or third nerve palsy pupils would constrict with pilocarpine 1%\u003C/b\u003E\u003C/span\u003E (due to denervation hypersensitivity or intact parasympathetic efferent pathway).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EA \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epharmacologically blocked iris sphincter\u003C/b\u003E\u003C/span\u003E will not respond to pilocarpine because receptors are blocked (e.g. atropine, tropicamide).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EAdditionally:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EHorner\u2019s syndrome presents with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emiosis\u003C/b\u003E\u003C/span\u003E, not mydriasis\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThird nerve palsy may cause mydriasis, but the pupil typically \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eresponds to pilocarpine\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EHolmes-Adie pupil is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Etonic\u003C/b\u003E\u003C/span\u003E and also \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eresponds to dilute pilocarpine (0.1%)\u003C/b\u003E\u003C/span\u003E due to cholinergic supersensitivity\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 315,
    "Name": "Midbrain syndromes",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA lesion results in \u003Cspan class=\u0022s1\u0022\u003Eipsilateral ophthalmoplegia\u003C/span\u003E (including ptosis and pupil involvement) and \u003Cspan class=\u0022s1\u0022\u003Econtralateral hemiplegia\u003C/span\u003E.\u0026nbsp;\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhere is the lesion most likely located?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThis clinical picture is classic for \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EWeber\u2019s syndrome\u003C/b\u003E\u003C/span\u003E, which is caused by a lesion in the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eventromedial midbrain\u003C/b\u003E\u003C/span\u003E, typically due to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eischaemia\u003C/b\u003E\u003C/span\u003E (e.g. from occlusion of penetrating branches of the posterior cerebral artery).\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EKey findings in Weber\u2019s syndrome:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIpsilateral third nerve palsy\u003C/b\u003E\u003C/span\u003E: ptosis, ophthalmoplegia, mydriasis\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EContralateral hemiparesis or hemiplegia\u003C/b\u003E\u003C/span\u003E: due to involvement of corticospinal tract in the cerebral peduncle\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch4\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/h4\u003E\u003Ch4\u003E\u003Cb\u003EOther options are incorrect:\u003C/b\u003E\u003C/h4\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EDorsal midbrain\u003C/b\u003E\u003C/span\u003E \u2192 Associated with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EParinaud\u2019s syndrome\u003C/b\u003E\u003C/span\u003E (upgaze palsy, light-near dissociation), not hemiplegia\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EDorsal pons\u003C/b\u003E\u003C/span\u003E \u2192 May affect horizontal gaze centres and facial nerve (e.g. Foville\u2019s syndrome)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EVentral pons\u003C/b\u003E\u003C/span\u003E \u2192 Classically associated with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMillard-Gubler\u003C/b\u003E\u003C/span\u003E or \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elocked-in syndrome\u003C/b\u003E\u003C/span\u003E, typically involving CN VI/VII and corticospinal tract, but not CN III\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb style=\u0022font-size: 14px; letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/h3\u003E\u003Ch3\u003E\u003Cb style=\u0022font-size: 14px; letter-spacing: 0.14994px;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/h3\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 316,
    "Name": "Parietal lobe lesions",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EA patient presents with a \u003C/span\u003Ecomplete left homonymous hemianopia\u003Cspan class=\u0022s1\u0022\u003E. On \u003C/span\u003Eoptokinetic nystagmus (OKN) testing\u003Cspan class=\u0022s1\u0022\u003E, they are \u003C/span\u003Eunable to follow the drum when rotated to the right\u003Cspan class=\u0022s1\u0022\u003E, but \u003C/span\u003Ecan follow it when rotated to the left\u003Cspan class=\u0022s1\u0022\u003E.\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhere is the most likely site of the lesion?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThis is a classic description of a \u003C/span\u003E\u003Cb\u003Eright parietal lobe lesion\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E affecting \u003C/span\u003E\u003Cb\u003Esmooth pursuit pathways\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E. The \u003C/span\u003E\u003Cb\u003Eparietal lobe\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is responsible for \u003C/span\u003E\u003Cb\u003Eipsilateral visual attention and pursuit\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, especially for OKN in the \u003C/span\u003E\u003Cb\u003Esame direction\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003EIn this case:\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThe \u003C/span\u003E\u003Cb\u003Eleft homonymous hemianopia\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E suggests a lesion \u003C/span\u003E\u003Cb\u003Eposterior to the optic chiasm\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, most likely in the \u003C/span\u003E\u003Cb\u003Eright hemisphere\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Easymmetric OKN\u003C/b\u003E\u003C/span\u003E, where the patient fails to follow rightward motion, is characteristic of a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eright parietal lesion\u003C/b\u003E\u003C/span\u003E, which impairs \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eipsilateral pursuit\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003EOccipital lobe lesions\u003C/b\u003E\u003C/span\u003E, even if they cause homonymous hemianopia, do \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003Enot impair OKN responses\u003C/b\u003E\u003C/span\u003E, since pursuit pathways are intact.\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch4\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/h4\u003E\u003Ch4\u003E\u003Cb\u003EOther options are incorrect:\u003C/b\u003E\u003C/h4\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERight frontal lobe\u003C/b\u003E\u003C/span\u003E \u2192 Affects saccades, not pursuit\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELeft occipital lobe\u003C/b\u003E\u003C/span\u003E \u2192 Would cause \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eright hemianopia\u003C/b\u003E\u003C/span\u003E, inconsistent with findings\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERight occipital lobe\u003C/b\u003E\u003C/span\u003E \u2192 Could cause left hemianopia, but would \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot impair OKN\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELeft parietal lobe\u003C/b\u003E\u003C/span\u003E \u2192 Would affect leftward OKN and right visual field\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb style=\u0022font-size: 14px; letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/h3\u003E\u003Ch3\u003E\u003Cb style=\u0022font-size: 14px; letter-spacing: 0.14994px;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/h3\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
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  },
  {
    "Id": 317,
    "Name": "Pupil",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA patient presents with \u003Cspan class=\u0022s1\u0022\u003Eright-sided miosis and mild ptosis\u003C/span\u003E. Pharmacological testing of the \u003Cspan class=\u0022s1\u0022\u003Eright pupil\u003C/span\u003E shows:\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003ECocaine 4%\u003Cspan class=\u0022Apple-converted-space\u0022\u003E\u0026nbsp; --\u0026gt;\u0026nbsp;\u003C/span\u003ENo dilatation\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EHydroxyamphetamine 1%\u003Cspan class=\u0022Apple-tab-span\u0022\u003E\u0026nbsp;--\u0026gt;\u0026nbsp;\u003C/span\u003ENo dilatation\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\n\n\n\n\n\n\n\n\n\n\n\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhere is the lesion MOST likely located?\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThe clinical features and pharmacological test results are \u003C/span\u003E\u003Cb\u003Ediagnostic of a post-ganglionic (third-order) Horner\u2019s syndrome\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECocaine 4%\u003C/b\u003E\u003C/span\u003E blocks norepinephrine reuptake and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Efails to dilate\u003C/b\u003E\u003C/span\u003E in Horner\u2019s (but does not localise the lesion).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EHydroxyamphetamine 1%\u003C/b\u003E\u003C/span\u003E stimulates norepinephrine release from the post-ganglionic neuron.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ENo dilation with hydroxyamphetamine\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E = \u003C/span\u003E\u003Cb\u003Epost-ganglionic lesion\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003ELesions affecting the \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003Einternal carotid artery\u003C/b\u003E\u003C/span\u003E (e.g. \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003Ecarotid dissection\u003C/b\u003E\u003C/span\u003E, aneurysm, or cavernous sinus pathology) disrupt \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003Ethird-order sympathetic fibres\u003C/b\u003E\u003C/span\u003E, which run with the artery into the skull.\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\n\n\n\n\n\n\n\n\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 318,
    "Name": "Non-Arteritic Anterior Ischaemic Optic Neuropathy (NAION)",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022\u003E\u003Cspan lang=\u0022EN\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 70 year old hypertensive woman wakes with\npainless loss of vision in the right eye. She has a visual acuity of 6/18 in\nthe right eye and 6/6 in the left eye. Her right visual field shows an\naltitudinal defect. Her right optic disc is swollen. She has a CRP of 5 mg/L\nand a blood sugar of 13.5 mmol/L. Which of the following is the MOST likely\ndiagnosis?\u003C/span\u003E\u003Co:p\u003E\u003C/o:p\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003EAnswer:\u003C/span\u003E\u0026nbsp;\u003Cspan style=\u0022font-weight: bold;\u0022\u003ENon-arteritic anterior ischaemic optic neuropathy\u003C/span\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-style: italic; text-decoration-line: underline;\u0022\u003E\u0026nbsp;Explanation:\u003C/span\u003E\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EThis presentation is most consistent with \u003C/span\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cb\u003Enon-arteritic anterior ischaemic optic neuropathy (NAION);\u0026nbsp;\u003C/b\u003E\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003Ethe most common acute optic neuropathy in individuals over 50. It is characterised by \u003C/span\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cb\u003Epainless, sudden vision loss\u003C/b\u003E\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E, often with an \u003C/span\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cb\u003Ealtitudinal visual field defect\u003C/b\u003E\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E, \u003C/span\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cb\u003Eoptic disc oedema\u003C/b\u003E\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E, and \u003C/span\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cb\u003Evascular risk factors\u003C/b\u003E\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E (e.g. diabetes, hypertension), in the absence of features suggestive of \u003C/span\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cb\u003Egiant cell arteritis (GCA)\u003C/b\u003E\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E.\u003C/span\u003E\u003C/div\u003E\n\n\n\n\n\n\n\n\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThis patient\u2019s \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECRP is 5 mg/L\u003C/b\u003E\u003C/span\u003E, within normal range (\u0026lt;10 mg/L), effectively \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eexcluding GCA\u003C/b\u003E\u003C/span\u003E, which typically shows \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emarkedly elevated inflammatory markers\u003C/b\u003E\u003C/span\u003E (CRP \u0026gt;50 mg/L, ESR \u0026gt;70 mm/hr). In contrast, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Earteritic AION\u003C/b\u003E\u003C/span\u003E (AAION) also presents with more profound vision loss and systemic symptoms such as \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eheadache, jaw claudication, or scalp tenderness\u003C/b\u003E\u003C/span\u003E, which are absent here.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe presence of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ediabetes (glucose 13.5 mmol/L)\u003C/b\u003E\u003C/span\u003E supports NAION, as microvascular compromise of the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eshort posterior ciliary arteries\u003C/b\u003E\u003C/span\u003E is the likely mechanism. The presence of a \u201Cdisc at risk\u201D (small cup-to-disc ratio) further predisposes to ischaemia.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EDiabetic papillopathy\u003C/b\u003E\u003C/span\u003E, although seen in diabetics, tends to occur in younger patients (\u0026lt;50), is often \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebilateral\u003C/b\u003E\u003C/span\u003E, causes \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emild vision loss\u003C/b\u003E\u003C/span\u003E, and features \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edifferent visual field defects\u003C/b\u003E\u003C/span\u003E (e.g. enlarged blind spot), making it unlikely in this 70-year-old patient with a unilateral altitudinal defect.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOptic neuritis\u003C/b\u003E\u003C/span\u003E is also improbable; it typically affects \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eyounger adults (20\u201340 years)\u003C/b\u003E\u003C/span\u003E, presents with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epain on eye movement\u003C/b\u003E\u003C/span\u003E, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecentral scotomas\u003C/b\u003E\u003C/span\u003E, and more pronounced \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecolor vision deficits\u003C/b\u003E\u003C/span\u003E. This patient\u2019s \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eage\u003C/b\u003E\u003C/span\u003E, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eabsence of pain\u003C/b\u003E\u003C/span\u003E, and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epattern of vision loss\u003C/b\u003E\u003C/span\u003E all argue against optic neuritis.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 319,
    "Name": "Painful red eye",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan lang=\u0022EN\u0022\u003EA low myope 36 year old was recently started\non a new drug for epilepsy. She presents with visual disturbance and a painful\nred eye. The pupil is not reacting to light, fixed and dilated.\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhich of the following treatment options would\nbe the LEAST likely treatment of choice in the initial management plan?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\u003Cbr\u003E\u003Cdiv\u003E\u003Cdiv\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThis is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eacute angle-closure glaucoma (AACG)\u003C/b\u003E\u003C/span\u003E likely triggered by medication-induced \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epupillary block\u003C/b\u003E\u003C/span\u003E (a recognised adverse effect of some antiepileptics with anticholinergic properties).\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EFirst-line treatment\u003C/b\u003E\u003C/span\u003E focuses on \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Erapid intraocular pressure (IOP) reduction\u003C/b\u003E\u003C/span\u003E to preserve optic nerve function and relieve symptoms.\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAcetazolamide\u003C/b\u003E\u003C/span\u003E (IV or PO, 500\u202Fmg) is the standard first-line agent, reducing aqueous humour production by \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecarbonic anhydrase inhibition\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIV mannitol\u003C/b\u003E\u003C/span\u003E is indicated when IOP is critically high (\u0026gt;50\u202FmmHg) or if corneal oedema limits other interventions.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPilocarpine\u003C/b\u003E\u003C/span\u003E is avoided initially when the IOP is very high, as the ischaemic iris may not respond, and it can paradoxically worsen pupillary block.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELaser peripheral iridotomy (LPI)\u003C/b\u003E\u003C/span\u003E is the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edefinitive treatment\u003C/b\u003E\u003C/span\u003E but should only be performed once IOP is controlled and the cornea is clear.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECyclodiode\u003C/b\u003E\u003C/span\u003E is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot appropriate\u003C/b\u003E\u003C/span\u003E here --\u0026gt; it is a cyclodestructive procedure reserved for \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Erefractory glaucoma\u003C/b\u003E\u003C/span\u003E, not acute AACG.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003C/div\u003E\u003C/div\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 320,
    "Name": "Paediatric Strabismus Diagnosis",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022 style=\u0022margin-top:12.0pt;margin-right:0in;margin-bottom:\n6.0pt;margin-left:0in\u0022\u003E\u003Cspan lang=\u0022EN\u0022 style=\u0022font-size:12.0pt;line-height:115%;\nfont-family:Roboto;mso-fareast-font-family:Roboto;mso-bidi-font-family:Roboto\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EAn\n18-month-old child is referred with a history from the parent of seeing the\neyes \u201Cnot move correctly.\u201D This is worse when tired or daydreaming. Examination\nis difficult as the child is tired and fractious. The vision is recorded as 6/9\nwith Kay\u2019s pictures with both eyes open, but it is not possible to record\nmonocular acuities. Orthoptic assessment has shown that the eyes are aligned\nfor near fixation but there is a deviation measuring 20 prism dioptres base in,\nat distance fixation. What is the MOST likely diagnosis?\u003C/span\u003E\u003Co:p\u003E\u003C/o:p\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\u003Cbr\u003E\u003Cdiv\u003E\u25CF\tIntermittent exotropia is the most likely diagnosis in a young child who presents with a history of periodic eye misalignment, especially when tired or inattentive, and who demonstrates a larger exodeviation at distance than near.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u25CF\tIn intermittent exotropia, parents often notice the eyes \u201Cgoing out\u201D when the child is daydreaming, tired, or not concentrating. The deviation is typically more apparent at distance fixation, as described here (20 prism dioptres base in at distance, aligned at near), which is characteristic of this type of strabismus.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u25CF\tAtypical Duane\u2019s syndrome would usually present with abnormal abduction/adduction movements and possible globe retraction, not typical distance-related exodeviation.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u25CF\tInfantile exotropia (congenital exotropia) is rare and usually presents in the first few months of life, not as an intermittent phenomenon at 18 months.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u25CF\tNormal eyes are very unlikely due to the clear evidence of distance exodeviation and parental concern.\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 321,
    "Name": "24-hour Intraocular Pressure (IOP) Measurement",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022 style=\u0022margin-top:6.0pt;margin-right:0in;margin-bottom:6.0pt;\nmargin-left:0in\u0022\u003E\u003Cspan lang=\u0022EN\u0022 style=\u0022font-size:12.0pt;line-height:115%;\nfont-family:Roboto;mso-fareast-font-family:Roboto;mso-bidi-font-family:Roboto\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003ERegarding\n24-hour intraocular pressure (IOP) measurement, which of the following\nstatements is most likely to be CORRECT?\u003C/span\u003E\u003Co:p\u003E\u003C/o:p\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cbr\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EThe Triggerfish contact lens sensor\u003C/b\u003E\u003C/span\u003E is a device that monitors \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Erelative changes\u003C/b\u003E\u003C/span\u003E in ocular volume or corneoscleral strain over 24 hours. It provides \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ea pattern of IOP-related fluctuations\u003C/b\u003E\u003C/span\u003E rather than absolute pressure values in mmHg. This makes it useful in identifying nocturnal peaks and circadian rhythms, which are increasingly recognised as risk factors in glaucoma progression.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EProstaglandin analogues\u003C/b\u003E\u003C/span\u003E (e.g., latanoprost) are superior to beta-blockers in maintaining IOP control during the night, as beta-blockers have \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ediminished nocturnal efficacy\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGAT\u003C/b\u003E\u003C/span\u003E, though the gold standard for IOP measurement, is unsuitable for overnight monitoring due to its reliance on upright positioning, corneal anaesthesia, and patient cooperation.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIOP increases in the supine position\u003C/b\u003E\u003C/span\u003E during sleep due to elevated episcleral venous pressure and changes in aqueous outflow, not in the upright position.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 322,
    "Name": "Light-Near Dissociation\u2014Pupillary Reflex Pathways",
    "Body": "\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following is LEAST likely to give rise to a phenomenon where the pupils do not respond to light, but where miosis on stimulating the near reflex is preserved?\u003C/span\u003E",
    "Explanation": "\u003Cbr\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\n\n\u25CF Light-near dissociation describes pupils that constrict with accommodation (near response) but not to direct light. This points to a disruption in the light reflex pathway, with the near reflex arc remaining intact.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u25CF Common causes include:\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;1-Ciliary ganglion lesion (e.g., Adie\u2019s tonic pupil): Light response typically lost or diminished, but the near response is relatively preserved.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;2- Pineal tumour (dorsal midbrain syndrome/Parinaud\u2019s): The lesion interrupts the fibers that mediate the light reflex in the pretectal area, while the near response pathway, which may bypass this region, is spared.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;3-Treponemal (syphilitic) infection: Argyll Robertson pupil is small, irregular, reacts to accommodation but not to light.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u25CF Lesion in the longitudinal fasciculus (i.e., medial longitudinal fasciculus/MLF): This structure coordinates horizontal eye movements (e.g., internuclear ophthalmoplegia) and is not part of the direct or indirect pupillary reflex pathways. It therefore does NOT cause light-near dissociation, making it the correct answer to the question.\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 323,
    "Name": "Mitochondrial Inheritance in Ophthalmic Diseases",
    "Body": "\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich ONE of the following exhibits mitochondrial inheritance?\u003C/span\u003E",
    "Explanation": "\u003Cbr\u003E\u003Cdiv\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;\u25CF Mitochondrial inheritance refers to the \u003Cspan style=\u0022font-weight: bold;\u0022\u003Eexclusive\u003C/span\u003E maternal transmission of genetic material contained within mitochondrial DNA (mtDNA).\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cul\u003E\u003Cli\u003EChronic progressive external ophthalmoplegia (CPEO) is a cardinal example of a disorder with mitochondrial inheritance.\u0026nbsp;\u003C/li\u003E\u003Cli\u003EClassical presentation is bilateral ptosis progressing to symmetric, painless, slowly progressive ophthalmoplegia, often accompanied by myopathy and, in syndromic cases, retinopathy, cardiac conduction defects, or other systemic features.\u0026nbsp;\u003C/li\u003E\u003Cli\u003EMuscle biopsy may show ragged-red fibers and demonstrate cytochrome c oxidase (COX)-negative fibers, supporting mitochondrial etiology.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003EOther options:\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;\u25CF Myotonic dystrophy: Autosomal dominant trinucleotide (CTG) repeat expansion in DMPK gene; shows multisystem involvement but not mitochondrial inheritance.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;\u25CF Refsum disease: Autosomal recessive peroxisomal disorder caused by mutations in the PHYH or PEX7 genes, leading to phytanic acid accumulation with retinal degeneration and neuropathy.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;\u25CF Vitamin D resistant rickets (X-linked hypophosphatemia): Caused by PHEX gene mutations (X-linked dominant); primarily affects phosphate handling in the kidney and does not involve mitochondrial genetics.\u0026nbsp;\u003C/div\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 324,
    "Name": "Management\u2014Persistent Epithelial Defect After Severe Chemical Burn",
    "Body": "The patient shown in the photograph below is recovering from a severe chemical burn and is exhibiting a large non-healing persistent corneal epithelial defect that has not changed over the course of 10 days. The eye is red, inflamed, with hazy corneal stroma but no corneal thinning. What would be the MOST appropriate next stage of management of this case?\u003Cdiv\u003E\u003Cimg src=\u0022/upload-2026-01-26-576d3ce9-460f-4a22-86c0-9d49fd60484b.png\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003Cbr\u003E\u003Cdiv\u003E\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u25CF\tPersistent epithelial defects after severe chemical burns reflect stromal inflammation, limbal stem cell dysfunction, and impaired corneal healing due to chronic surface toxicity and inflammation. With a large epithelial defect persisting 10 days post-injury and no corneal thinning or perforation, the primary goal is to promote re-epithelialization, protect the ocular surface, suppress inflammation, and prevent secondary complications.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold; text-decoration-line: underline;\u0022\u003E\u25CF\tMost appropriate next step:\u003C/span\u003E\u003C/div\u003E\u003Cblockquote style=\u0022margin: 0 0 0 40px; border: none; padding: 0px;\u0022\u003E\u003Cdiv\u003E1- Amniotic membrane graft provides a biological scaffold, anti-inflammatory, and anti-fibrotic effects conducive to epithelial healing.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E2-Autologous serum eye drops are rich in growth factors, vitamins, and anti-inflammatory mediators, mimicking natural tears and facilitating epithelialization.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E3-Tarsorrhaphy (partial or temporary) reduces exposure, encourages healing, and protects the defect from further desiccation and trauma.\u0026nbsp;\u003C/div\u003E\u003C/blockquote\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u25CF\tDefinitive stem cell transplantation is reserved for chronic or refractory cases where limbal stem cell deficiency is confirmed, and initial medical/surgical surface stabilization has failed; attempting such invasive grafts during acute inflammation raises the risk of graft failure.\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;\u25CF\tBotulinum toxin induced ptosis can be considered for exposure keratopathy but is less targeted than direct surface reconstruction and is generally reserved for cases where surgical closure is contraindicated.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u25CF\tTopical therapy alone (lubrication, steroids, antibiotics, potassium ascorbate) is foundational but insufficient when large epithelial defects fail to heal after 7-10 days despite appropriate conservative measures.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 325,
    "Name": "Paediatric Vitreoretinal Disease\u2014Syndromic Associations",
    "Body": "\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 12-month-old developmentally delayed boy with hearing impairment is referred. Examination findings include hand movements vision and bilateral white retrolental masses. The child\u0027s skin is normal. Which of these is the MOST likely diagnosis?\u003C/span\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ENorrie disease\u003C/b\u003E\u003C/span\u003E is a rare \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EX-linked recessive disorder\u003C/b\u003E\u003C/span\u003E caused by mutations in the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ENDP gene\u003C/b\u003E\u003C/span\u003E, affecting \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eretinal angiogenesis\u003C/b\u003E\u003C/span\u003E, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Einner ear\u003C/b\u003E\u003C/span\u003E, and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebrain development\u003C/b\u003E\u003C/span\u003E. The condition typically presents with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebilateral congenital blindness\u003C/b\u003E\u003C/span\u003E due to a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epseudoglioma;\u0026nbsp;\u003C/b\u003E\u003C/span\u003Ea white, fibrovascular mass behind the lens. Over time, this mass may calcify, mimicking retinoblastoma radiographically. However, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esyndromic features\u003C/b\u003E\u003C/span\u003E such as \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esensorineural hearing loss\u003C/b\u003E\u003C/span\u003E, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eintellectual disability\u003C/b\u003E\u003C/span\u003E, and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edevelopmental delay\u003C/b\u003E\u003C/span\u003E point strongly toward Norrie disease.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EOther options:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECongenital rubella\u003C/b\u003E\u003C/span\u003E: May cause cataracts and deafness, but the full triad (cardiac, ocular, auditory) is not described here, and pseudoglioma is not a classic feature.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIncontinentia pigmenti\u003C/b\u003E\u003C/span\u003E: X-linked dominant, usually fatal in males; survivors often show \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecutaneous findings\u003C/b\u003E\u003C/span\u003E (vesicular, verrucous, hyperpigmented stages), which are \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eabsent here\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ERetinoblastoma\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E: Bilateral cases do exist, and leukocoria is common, but it is \u003C/span\u003E\u003Cb\u003Enot associated with hearing loss or neurodevelopmental delay\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 326,
    "Name": "GCA",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following statements about \u003Cspan class=\u0022s1\u0022\u003Egiant cell arteritis (GCA)\u003C/span\u003E is \u003Cspan class=\u0022s1\u0022\u003Eincorrect\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EWhile \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EESR\u003C/b\u003E\u003C/span\u003E has historically been used to assess inflammation in GCA, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EC-reactive protein (CRP)\u003C/b\u003E\u003C/span\u003E has been shown to be \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emore sensitive and specific\u003C/b\u003E\u003C/span\u003E, and less influenced by age, gender, and haematological variations. CRP rises earlier than ESR in most inflammatory states and is now regarded as the superior acute-phase marker in suspected GCA.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGCA is indeed more common in females\u003C/b\u003E\u003C/span\u003E, and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Etongue claudication\u003C/b\u003E\u003C/span\u003E is a well-recognised but less common symptom due to ischaemia of the lingual artery.\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003EOn \u003C/span\u003E\u003Cb\u003Etemporal artery biopsy\u003C/b\u003E\u003Cspan class=\u0022s2\u0022\u003E, the characteristic finding includes \u003C/span\u003E\u003Cb\u003Efragmentation, reduplication, or disruption of the internal elastic lamina\u003C/b\u003E\u003Cspan class=\u0022s2\u0022\u003E, with a \u003C/span\u003E\u003Cb\u003Etransmural infiltrate of lymphocytes and macrophages\u003C/b\u003E\u003Cspan class=\u0022s2\u0022\u003E, often forming \u003C/span\u003E\u003Cb\u003Emultinucleated giant cells\u003C/b\u003E\u003Cspan class=\u0022s2\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 327,
    "Name": "Chiasmal lesions",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA patient with a chiasmal lesion undergoes Goldmann perimetry, which reveals a \u003Cspan class=\u0022s1\u0022\u003Eleft eye only \u201Cpie in the sky\u201D (superotemporal) field defect\u003C/span\u003E. Which of the following best describes the most likely lesion location?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThis visual field defect pattern is classic for a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ejunctional scotoma\u003C/b\u003E\u003C/span\u003E, caused by a lesion at the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ejunction of the optic nerve and chiasm\u003C/b\u003E\u003C/span\u003E. Specifically, it affects:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIpsilateral optic nerve fibers\u003C/b\u003E\u003C/span\u003E, leading to a central scotoma in that eye (not always reported by patients)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ECrossed inferonasal fibers\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E from the \u003C/span\u003E\u003Cb\u003Econtralateral eye\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (via \u003C/span\u003E\u003Cb\u003EWilbrand\u2019s knee\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E), causing a \u003C/span\u003E\u003Cb\u003Esuperotemporal defect\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E in the opposite eye\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EIn this case, the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eleft eye has a superotemporal (\u201Cpie in the sky\u201D) defect\u003C/b\u003E\u003C/span\u003E, indicating that the lesion is affecting:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eright inferonasal retinal fibers\u003C/b\u003E\u003C/span\u003E (which cross at the chiasm)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThus, the lesion is located at the \u003C/span\u003E\u003Cb\u003Eanterior junction of the right optic nerve and chiasm\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThis explains why the defect appears \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eunilaterally\u003C/b\u003E\u003C/span\u003E, and why the field loss is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esuperotemporal\u003C/b\u003E\u003C/span\u003E in one eye.\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cimg src=\u0022https://eyewiki-images.s3.us-east-va.perf.cloud.ovh.us/5/50/Junctional_Scotoma300.jpg\u0022\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cspan style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; font-size: 12.3704px; letter-spacing: normal; background-color: rgb(248, 249, 250);\u0022\u003EJunctional Scotoma\u0026nbsp;Humphrey visual 30-2 showing central depression in the left eye and superotemporal loss of field in the right eye.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 328,
    "Name": "Hydrocephalus",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following is the most frequent cause of \u003Cspan class=\u0022s1\u0022\u003Ecommunicating hydrocephalus\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECommunicating hydrocephalus\u003C/b\u003E\u003C/span\u003E arises when cerebrospinal fluid (CSF) \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecirculates freely through the ventricular system\u003C/b\u003E\u003C/span\u003E but is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot properly reabsorbed\u003C/b\u003E\u003C/span\u003E into the venous system via the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Earachnoid granulations\u003C/b\u003E\u003C/span\u003E. The most common cause of this condition is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esubarachnoid haemorrhage (SAH)\u003C/b\u003E\u003C/span\u003E. The blood products from SAH obstruct or damage the arachnoid villi, impairing CSF absorption.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EOther known causes include \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emeningitis\u003C/b\u003E\u003C/span\u003E and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Econgenital absence or dysfunction of arachnoid granulations\u003C/b\u003E\u003C/span\u003E, but SAH remains the most common acquired cause in clinical practice.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EBy contrast:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EColloid cysts\u003C/b\u003E\u003C/span\u003E and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EArnold\u2013Chiari malformations\u003C/b\u003E\u003C/span\u003E typically cause \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enon-communicating (obstructive) hydrocephalus\u003C/b\u003E\u003C/span\u003E due to physical obstruction within the ventricular system (e.g. at the foramen of Monro or fourth ventricle outflow tracts).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 329,
    "Name": "Medullary lesions",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA patient presents with sudden-onset vertigo. On examination, there is hoarseness of voice, dysmetria and dysdiadochokinesia on the right, loss of pin-prick and temperature sensation on the left side of the body, and similar sensory loss on the right side of the face. Where is the most likely site of the lesion?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThis clinical picture is characteristic of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elateral medullary syndrome\u003C/b\u003E\u003C/span\u003E (Wallenberg syndrome), typically caused by occlusion of the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eposterior inferior cerebellar artery (PICA)\u003C/b\u003E\u003C/span\u003E. The key features include:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EVertigo and nystagmus\u003C/b\u003E\u003C/span\u003E: from involvement of the vestibular nuclei\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIpsilateral cerebellar signs\u003C/b\u003E\u003C/span\u003E (dysmetria, dysdiadochokinesia): due to inferior cerebellar peduncle involvement\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EContralateral loss of pain and temperature on the body\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E: from damage to the \u003C/span\u003E\u003Cb\u003Elateral spinothalamic tract\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EIpsilateral facial sensory loss\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (pain and temperature): due to \u003C/span\u003E\u003Cb\u003Espinal trigeminal nucleus/tract\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E involvement\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EHoarseness and dysphagia\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E: from involvement of the \u003C/span\u003E\u003Cb\u003Enucleus ambiguus\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (CN IX, X)\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIpsilateral Horner\u2019s syndrome\u003C/b\u003E\u003C/span\u003E (not mentioned here, but commonly seen)\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EOther options are less consistent:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EC1-C2 spinal cord lesion\u003C/b\u003E\u003C/span\u003E would not produce crossed sensory findings or bulbar signs\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECerebellar vermis\u003C/b\u003E\u003C/span\u003E lesions primarily cause truncal ataxia\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPontine lesions\u003C/b\u003E\u003C/span\u003E typically involve facial weakness and horizontal gaze abnormalities\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cimg src=\u0022https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj53U_WM8ZYdjYmdHqpEQlnvwMFcKJ_-8BgPzgj7EpMBM2_cDQaES2GLZWShx-EctUPE5D75sB8WvLO6MFZ8pK6To-8K1udqT9hiRW1isNEqZs7dEjLKA3VwLrMDn1fmhhZzWeiIG1omw/s640/pica\u002Bcopy.jpg\u0022\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 330,
    "Name": "Myasthenia Gravis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following statements is \u003Cspan class=\u0022s1\u0022\u003Etrue\u003C/span\u003E regarding the treatment of myasthenia gravis?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAzathioprine\u003C/b\u003E\u003C/span\u003E is an immunosuppressant commonly used for long-term control of myasthenia gravis. It helps reduce the need for corticosteroids and maintains disease remission.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPlasmapheresis\u003C/b\u003E\u003C/span\u003E (plasma exchange) is effective for \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eshort-term improvement\u003C/b\u003E\u003C/span\u003E and is particularly used in acute exacerbations or pre-operatively, but it is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot suitable\u003C/b\u003E\u003C/span\u003E for chronic long-term control due to logistical burden and risks.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EThymectomy\u003C/b\u003E\u003C/span\u003E is most effective in antibody-positive (especially \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eacetylcholine receptor antibody-positive\u003C/b\u003E\u003C/span\u003E) patients, not in seronegative cases. It is most beneficial in younger patients with generalized MG and a hyperplastic thymus.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECorticosteroids\u003C/b\u003E\u003C/span\u003E are actually \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Erecommended\u003C/b\u003E\u003C/span\u003E in myasthenic crisis, but they should be used cautiously due to potential for transient worsening at initiation. They are \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot contraindicated\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 331,
    "Name": "Fetal alcohol syndrome",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following ocular abnormalities is \u003Cspan class=\u0022s1\u0022\u003Emost commonly\u003C/span\u003E associated with fetal alcohol syndrome?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EOptic nerve hypoplasia is the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emost frequently reported ocular anomaly\u003C/b\u003E\u003C/span\u003E in fetal alcohol syndrome, seen in up to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E50%\u003C/b\u003E\u003C/span\u003E of cases. It reflects the broader impact of alcohol on neurodevelopment during gestation. Other commonly associated ocular signs include:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ETortuous retinal vessels\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EShort palpebral fissures\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EEpicanthal folds, ptosis, and telecanthus\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMicrophthalmos\u003C/b\u003E\u003C/span\u003E (less frequent than ON hypoplasia)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPersistent fetal vasculature\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and \u003C/span\u003E\u003Cb\u003Erarely, cataract or coloboma\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EWhile microphthalmos, cataract, and coloboma can occur in FAS, they are \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eless consistent\u003C/b\u003E\u003C/span\u003E findings compared to optic nerve hypoplasia.\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cimg src=\u0022https://www.aafp.org/content/dam/brand/aafp/pubs/afp/issues/2005/0715/p279-f1.jpg\u0022\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cspan style=\u0022color: rgb(40, 40, 40); font-family: \u0026quot;Museo Sans\u0026quot;, Tahoma, sans-serif; letter-spacing: normal;\u0022\u003ECharacteristic facial features in a child with fetal alcohol spectrum disorders. Findings may include a smooth philtrum, thin upper lip, upturned nose, flat nasal bridge and midface, epicanthal folds, small palpebral fissures, and small head circumference.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
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    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 332,
    "Name": "Optic disc swelling",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EA patient with poorly controlled diabetes presents with \u003C/span\u003Ebilateral optic disc swelling\u003Cspan class=\u0022s1\u0022\u003E. A \u003C/span\u003ECT scan of the head is reported as normal\u003Cspan class=\u0022s1\u0022\u003E. What is the \u003C/span\u003Emost appropriate next investigation\u003Cspan class=\u0022s1\u0022\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EIn the setting of \u003C/span\u003E\u003Cb\u003Ebilateral optic disc swelling\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E with a \u003C/span\u003E\u003Cb\u003Enormal CT scan\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, the key concern is to rule out \u003C/span\u003E\u003Cb\u003Eraised intracranial pressure\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and \u003C/span\u003E\u003Cb\u003Esecondary causes of papilloedema or optic neuropathy\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, such as:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIntracranial mass lesions\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOptic nerve sheath meningioma or glioma\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EInflammatory/infective causes (e.g., optic neuritis, sarcoidosis)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIdiopathic intracranial hypertension (IIH)\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003EAn \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003EMRI with gadolinium\u003C/b\u003E\u003C/span\u003E offers superior soft tissue detail and is the preferred next step to assess:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThe \u003C/span\u003E\u003Cb\u003Eoptic nerves and chiasm\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EOrbital pathology\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EVenous sinus thrombosis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (especially with MRV)\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESigns of raised ICP\u003C/b\u003E\u003C/span\u003E, such as flattening of the posterior globe or empty sella\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ELumbar puncture (LP)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E should only be performed \u003C/span\u003E\u003Cb\u003Eafter serious structural pathology has been excluded\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E by MRI, due to the risk of brain herniation.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003EFFA\u003C/b\u003E\u003C/span\u003E may demonstrate leakage in true papilloedema but does not elucidate the underlying cause.\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003EOcular ultrasound\u003C/b\u003E\u003C/span\u003E is useful in cases of buried disc drusen but is \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003Enot the first-line\u003C/b\u003E\u003C/span\u003E test in this context.\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
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    "CategoryId": 8,
    "Category": null,
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  },
  {
    "Id": 333,
    "Name": "Squamous cell carcinoma",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following \u003Cspan class=\u0022s1\u0022\u003Ehistopathological findings\u003C/span\u003E is most consistent with a diagnosis of \u003Cspan class=\u0022s1\u0022\u003Esquamous cell carcinoma\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESquamous cell carcinoma (SCC)\u003C/b\u003E\u003C/span\u003E is a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emalignant tumour of keratinocytes\u003C/b\u003E\u003C/span\u003E, arising from the squamous layer of the epidermis. Key histological hallmarks include:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPleomorphic epithelial cells\u003C/b\u003E\u003C/span\u003E with hyperchromatic, prominent nuclei\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EAbundant eosinophilic cytoplasm\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EKeratin pearls\u003C/b\u003E\u003C/span\u003E: concentric whorls of keratinized cells \u2014 a hallmark of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ewell-differentiated SCC\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EIntercellular bridges\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E may also be visible\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EOther options represent different tumours:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E(vascular channel proliferation): typical of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eangiosarcoma\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E(palisading basal cells): classic for \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebasal cell carcinoma (BCC)\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E(foamy cytoplasm \u002B Oil Red O stain): characteristic of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esebaceous gland carcinoma\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cimg src=\u0022https://upload.wikimedia.org/wikipedia/commons/c/ca/Histopathology_of_squamous-cell_carcinoma.png\u0022\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
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  },
  {
    "Id": 334,
    "Name": "Rhabdomyosarcoma",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EA B-scan ultrasound is performed for a patient presenting with \u003C/span\u003Eunilateral proptosis\u003Cspan class=\u0022s1\u0022\u003E. It reveals a \u003C/span\u003Eheterogeneous, well-defined intra-conal mass\u003Cspan class=\u0022s1\u0022\u003E with \u003C/span\u003Eirregular borders\u003Cspan class=\u0022s1\u0022\u003E and \u003C/span\u003Elow internal reflectivity\u003Cspan class=\u0022s1\u0022\u003E.\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhich of the following is the most likely diagnosis?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThe B-scan features are \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehighly characteristic of orbital rhabdomyosarcoma\u003C/b\u003E\u003C/span\u003E, the most common primary orbital malignancy in children:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EHeterogeneous\u003C/b\u003E\u003C/span\u003E internal structure\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EIrregular margins\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELow internal reflectivity\u003C/b\u003E\u003C/span\u003E on ultrasound due to its cellular, poorly organized architecture\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERapid onset of proptosis\u003C/b\u003E\u003C/span\u003E, often with inflammatory signs\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EBy contrast:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ESchwannoma\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is a benign, encapsulated nerve sheath tumour, \u003C/span\u003E\u003Cb\u003Elow reflectivity\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, but \u003C/span\u003E\u003Cb\u003Ewell-circumscribed and homogeneous\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ECavernous haemangioma\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (most common benign orbital tumour in adults): \u003C/span\u003E\u003Cb\u003Emoderate to high reflectivity\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, \u003C/span\u003E\u003Cb\u003Esmooth borders\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, and \u003C/span\u003E\u003Cb\u003Eslow-growing\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECapillary haemangioma\u003C/b\u003E\u003C/span\u003E (seen in infants): \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehyperechoic\u003C/b\u003E\u003C/span\u003E, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecompressible\u003C/b\u003E\u003C/span\u003E, and often associated with skin discoloration\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cimg src=\u0022https://www.researchgate.net/profile/Luis-Gorospe/publication/10595168/figure/fig7/AS:337314590019603@1457433473958/a-c-Orbital-rhabdomyosarcoma-a-Ultrasound-scan-shows-a-solid-well-defined-hypoechoic.png\u0022\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\u003Ch1 class=\u0022nova-legacy-e-text nova-legacy-e-text--size-m nova-legacy-e-text--family-display nova-legacy-e-text--spacing-none nova-legacy-e-text--color-inherit\u0022 itemprop=\u0022caption\u0022 style=\u0022color: rgb(17, 17, 17); font-weight: 400; font-family: Roboto, Arial, sans-serif; font-size: 0.875rem; line-height: 1.3; margin-bottom: 0px; letter-spacing: normal;\u0022\u003Ea\u2013c Orbital rhabdomyosarcoma. a Ultrasound scan shows a solid, well-defined hypoechoic mass (arrows). b Axial T1-weight- ed and c coronal T1-weighted contrast-enhanced MR images show how the lesion (asterisk) displaces the muscular conus inferomedially (arrowheads). Note moderate and uniform contrast uptake by the tumor\u0026nbsp;\u0026nbsp;\u003C/h1\u003E",
    "Choices": [],
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  },
  {
    "Id": 335,
    "Name": "Rhabdomyosarcoma",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following statements about \u003Cspan class=\u0022s1\u0022\u003Erhabdomyosarcoma\u003C/span\u003E is \u003Cspan class=\u0022s1\u0022\u003Etrue\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ERhabdomyosarcoma is the \u003C/span\u003E\u003Cb\u003Emost frequent primary malignant orbital tumour in the paediatric population\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, typically presenting around the \u003C/span\u003E\u003Cb\u003Eage of 8\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E years and showing a \u003C/span\u003E\u003Cb\u003Eslight male predominance\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E. It accounts for approximately \u003C/span\u003E\u003Cb\u003E4% of all childhood cancers\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003EKey clinical features:\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ERapidly progressive \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eunilateral non-axial proptosis\u003C/b\u003E\u003C/span\u003E (not axial)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EOften associated with \u003C/span\u003E\u003Cb\u003Einflammatory signs and ptosis\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMay \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emimic orbital cellulitis\u003C/b\u003E\u003C/span\u003E, leading to diagnostic challenges\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003EAnatomical origin:\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E37% \u003C/span\u003E\u003Cb\u003Eextraconal\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E17% \u003C/span\u003E\u003Cb\u003Eintraconal\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E47% \u003C/span\u003E\u003Cb\u003Emixed\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EFrequently arises in the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esuperonasal quadrant\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 336,
    "Name": "Rhabdomyosarcoma",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EA 7-year-old girl presents with a 2-week history of \u003C/span\u003Esudden-onset painful unilateral axial proptosis\u003Cspan class=\u0022s1\u0022\u003E and overlying lid erythema. She is apyrexial. A \u003C/span\u003ECT scan shows a non-enhancing, poorly defined mass of homogenous tissue density\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003ERhabdomyosarcoma, though rare, is the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emost common primary malignant orbital tumour in children\u003C/b\u003E\u003C/span\u003E, typically presenting between ages \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E7-8 years\u003C/b\u003E\u003C/span\u003E. It often manifests as a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Erapidly progressive, painful, unilateral proptosis\u003C/b\u003E\u003C/span\u003E with inflammatory signs, mimicking \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eorbital cellulitis\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EImaging features on \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECT\u003C/b\u003E\u003C/span\u003E include:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EPoorly defined, \u003C/span\u003E\u003Cb\u003Ehomogeneous soft tissue mass\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ENon-enhancing\u003C/b\u003E\u003C/span\u003E or mildly enhancing\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMay show \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebone erosion\u003C/b\u003E\u003C/span\u003E in advanced cases\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EOther differential diagnoses:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECapillary haemangioma\u003C/b\u003E\u003C/span\u003E: common in infants \u0026lt;1 year, usually painless, and slow-growing\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELymphangioma\u003C/b\u003E\u003C/span\u003E: also presents earlier; may cause acute proptosis if haemorrhage occurs within the lesion\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOrbital varices\u003C/b\u003E\u003C/span\u003E: cause intermittent proptosis, worsened by Valsalva, not constant or painful\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 337,
    "Name": "Carotid Cavenrous Fistula",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EA patient presents with \u003C/span\u003Eunilateral proptosis\u003Cspan class=\u0022s1\u0022\u003E that has been \u003C/span\u003Eslowly progressing over several months\u003Cspan class=\u0022s1\u0022\u003E. He reports \u003C/span\u003Ereduced visual acuity\u003Cspan class=\u0022s1\u0022\u003E, particularly with \u003C/span\u003Eeye movement\u003Cspan class=\u0022s1\u0022\u003E. On examination, there is \u003C/span\u003Eengorgement of the conjunctiva\u003Cspan class=\u0022s1\u0022\u003E and \u003C/span\u003Eexaggerated ocular pulsation\u003Cspan class=\u0022s1\u0022\u003E noted on tonometry.\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhat is the most likely diagnosis?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThe constellation of \u003C/span\u003E\u003Cb\u003Eprogressive unilateral proptosis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, \u003C/span\u003E\u003Cb\u003Edilated conjunctival vessels\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, and \u003C/span\u003E\u003Cb\u003Eocular pulsation\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is characteristic of a \u003C/span\u003E\u003Cb\u003Ecarotid-cavernous fistula\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (CCF). In this case, the \u003C/span\u003E\u003Cb\u003Egradual onset\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and \u003C/span\u003E\u003Cb\u003Emild to moderate symptoms\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E suggest a \u003C/span\u003E\u003Cb\u003Elow-flow (indirect)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E CCF.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIndirect CCFs\u003C/b\u003E\u003C/span\u003E often arise \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Espontaneously\u003C/b\u003E\u003C/span\u003E, particularly in elderly hypertensive women. They cause \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Egradual symptoms\u003C/b\u003E\u003C/span\u003E, often with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edilated episcleral veins\u003C/b\u003E\u003C/span\u003E, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epulsatile IOP\u003C/b\u003E\u003C/span\u003E, and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ediplopia\u003C/b\u003E\u003C/span\u003E or \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Evisual loss\u003C/b\u003E\u003C/span\u003E from venous congestion or optic neuropathy.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIn contrast, a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edirect CCF\u003C/b\u003E\u003C/span\u003E is typically \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehigh-flow\u003C/b\u003E\u003C/span\u003E, usually following \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Etrauma\u003C/b\u003E\u003C/span\u003E, and presents \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eacutely\u003C/b\u003E\u003C/span\u003E with severe chemosis, bruit, and more dramatic proptosis.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003E- Orbital varices\u003C/b\u003E\u003C/span\u003E can cause intermittent proptosis exacerbated by Valsalva, not persistent pulsation.\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003E- Cavernous haemangiomas\u003C/b\u003E\u003C/span\u003E are benign, slow-growing masses and do not cause pulsation or conjunctival congestion.\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ENotes on CCF:\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cul\u003E\u003Cli\u003E80% of patients with CCF develop ocular hypertension\u0026nbsp;\u003C/li\u003E\u003Cli\u003E25% develop optic disc cupping\u0026nbsp;\u003C/li\u003E\u003Cli\u003E20% visual field defects.\u0026nbsp;\u003C/li\u003E\u003C/ul\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u0026nbsp;This is due to raised episcleral venous pressure causing a secondary open-angle glaucoma.\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cimg src=\u0022https://www.researchgate.net/publication/382769087/figure/fig1/AS:11431281264391645@1722558729763/Anatomical-Illustration-of-the-Carotid-Cavernous-Fistula-CCF-ICA-Internal-carotid.png\u0022\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\u003Ch1 class=\u0022nova-legacy-e-text nova-legacy-e-text--size-m nova-legacy-e-text--family-display nova-legacy-e-text--spacing-none nova-legacy-e-text--color-inherit\u0022 itemprop=\u0022caption\u0022 style=\u0022color: rgb(17, 17, 17); font-weight: 400; font-family: Roboto, Arial, sans-serif; font-size: 0.875rem; line-height: 1.3; margin-bottom: 0px; letter-spacing: normal;\u0022\u003EAnatomical Illustration of the Carotid Cavernous Fistula (CCF). ICA: Internal carotid artery Image Credit: Sura H. Talib\u003C/h1\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cimg src=\u0022/upload-2026-01-27-609ed8a7-7acf-45da-a8fc-7df5c0100659.png\u0022\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 338,
    "Name": "Hyperostosis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EWhich of the following is \u003C/span\u003Emost likely to cause orbital hyperostosis\u003Cspan class=\u0022s1\u0022\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EOrbital hyperostosis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E refers to \u003C/span\u003E\u003Cb\u003Ebony thickening of the orbital walls\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, typically due to \u003C/span\u003E\u003Cb\u003Ereactive bone formation\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E. It is \u003C/span\u003E\u003Cb\u003Emost classically associated with orbital meningioma\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, particularly \u003C/span\u003E\u003Cb\u003Eoptic nerve sheath meningiomas\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, where the tumour induces \u003C/span\u003E\u003Cb\u003Ereactive sclerosis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and \u003C/span\u003E\u003Cb\u003Ehyperostosis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E of adjacent bone.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMeningioma\u003C/b\u003E\u003C/span\u003E is the most common tumour associated with this feature, often presenting with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eprogressive visual loss\u003C/b\u003E\u003C/span\u003E, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eproptosis\u003C/b\u003E\u003C/span\u003E, and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eoptic canal narrowing\u003C/b\u003E\u003C/span\u003E due to bone overgrowth.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EFibrous dysplasia\u003C/b\u003E\u003C/span\u003E can cause orbital bone expansion and bony deformity, but it usually involves broader craniofacial changes and is not specific to the orbit or associated with hyperostosis in the same pattern.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERhabdomyosarcoma\u003C/b\u003E\u003C/span\u003E is a soft tissue malignancy with no association with bone sclerosis.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EVarices\u003C/b\u003E\u003C/span\u003E are venous malformations and do not affect orbital bone.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cimg src=\u0022https://www.researchgate.net/publication/332197503/figure/fig5/AS:963434137022476@1606712006238/Sphenoid-wing-meningioma-with-hyperostotic-lateral-orbital-bone-white-arrow-tumour.jpg\u0022\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\u003Ch1 class=\u0022nova-legacy-e-text nova-legacy-e-text--size-m nova-legacy-e-text--family-display nova-legacy-e-text--spacing-none nova-legacy-e-text--color-inherit\u0022 itemprop=\u0022caption\u0022 style=\u0022color: rgb(17, 17, 17); font-weight: 400; font-family: Roboto, Arial, sans-serif; font-size: 0.875rem; line-height: 1.3; margin-bottom: 0px; letter-spacing: normal;\u0022\u003ESphenoid wing meningioma with hyperostotic lateral orbital bone (white arrow), tumour within sphenoid sinus (red arrow) with compression of the optic nerve\u003C/h1\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 339,
    "Name": "Entropion",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EA 77-year-old woman presents with \u003C/span\u003Esenile lower lid entropion\u003Cspan class=\u0022s1\u0022\u003E. Examination reveals \u003C/span\u003Egeneralised horizontal lower lid laxity\u003Cspan class=\u0022s1\u0022\u003E.\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhich of the following procedures is \u003C/span\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003Emost appropriate\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThis is a classic presentation of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Einvolutional (senile) entropion\u003C/b\u003E\u003C/span\u003E, where the pathophysiology typically involves:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EHorizontal lid laxity\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EDehiscence or attenuation of lower lid retractors\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EOverriding of preseptal over pretarsal orbicularis oculi\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EEnophthalmos or poor orbital support\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E in elderly patients\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EQuickert procedure\u003C/b\u003E\u003C/span\u003E is designed to correct all of the above by:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EShortening the lower eyelid\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (horizontal tightening)\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPlacing everting sutures\u003C/b\u003E\u003C/span\u003E via a lid-splitting approach\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESometimes includes \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eretractor plication\u003C/b\u003E\u003C/span\u003E if needed\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch4\u003E\u003Cb style=\u0022font-size: medium; text-decoration-line: underline;\u0022\u003EWhy other options less appropriate:\u003C/b\u003E\u003C/h4\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022font-size: medium; text-decoration-line: underline;\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EJones procedure\u003C/b\u003E\u003C/span\u003E: Primarily targets retractor disinsertion (used for entropion without significant horizontal laxity).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EWies procedure\u003C/b\u003E\u003C/span\u003E: Combines everting sutures and lid-splitting but \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edoes not address lid laxity\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ETarsal fracture\u003C/b\u003E\u003C/span\u003E: Mainly used for \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecicatricial entropion\u003C/b\u003E\u003C/span\u003E, not the involutional type.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 340,
    "Name": "Facial nerve palsy",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EAn 81-year-old woman presents to the emergency department with a \u003Cspan class=\u0022s1\u0022\u003E2-day history of left hemiplegia\u003C/span\u003E, consistent with a stroke. Examination reveals a \u003Cspan class=\u0022s1\u0022\u003Eleft upper motor neuron 7th nerve palsy\u003C/span\u003E and a \u003Cspan class=\u0022s1\u0022\u003Epoor Bell\u2019s phenomenon\u003C/span\u003E.\u0026nbsp;\u003Cspan class=\u0022s2\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003EFrom an \u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003Eophthalmic management\u003C/span\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E perspective, what is the \u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003Emost appropriate initial approach\u003C/span\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThis patient has an \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eacute upper motor neuron facial palsy\u003C/b\u003E\u003C/span\u003E with a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epoor Bell\u2019s reflex\u003C/b\u003E\u003C/span\u003E, increasing the risk of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eexposure keratopathy\u003C/b\u003E\u003C/span\u003E. While UMN facial palsy typically spares the forehead, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eincomplete blink and orbicularis weakness\u003C/b\u003E\u003C/span\u003E may still result in lagophthalmos and corneal drying, especially if Bell\u2019s phenomenon is impaired.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe most appropriate \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Einitial conservative management\u003C/b\u003E\u003C/span\u003E includes:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIntensive lubrication\u003C/b\u003E\u003C/span\u003E during the day (e.g., preservative-free drops hourly)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ELubricating ointment and eye patch overnight\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EClose \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emonitoring for exposure signs\u003C/b\u003E\u003C/span\u003E (e.g., punctate keratopathy, epithelial defects)\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThis approach is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enon-invasive\u003C/b\u003E\u003C/span\u003E, suitable for the acute phase, and allows time for potential \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eneurological recovery\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch4\u003E\u003Cb\u003EOther options:\u003C/b\u003E\u003C/h4\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EChloramphenicol ointment\u003C/b\u003E\u003C/span\u003E: Not first-line unless there are signs of infection.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELevator recession\u003C/b\u003E\u003C/span\u003E: Reserved for chronic cases of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elagophthalmos or exposure\u003C/b\u003E\u003C/span\u003E due to upper lid retraction or poor closure, not indicated acutely.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELower lid traction suture\u003C/b\u003E\u003C/span\u003E: Used in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elower lid ectropion\u003C/b\u003E\u003C/span\u003E, not typically required in early UMN palsy with intact lid tone.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 341,
    "Name": "Mode of Action\u2014Propranolol in Lid Haemangiomas",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022 style=\u0022margin-top:12.0pt;margin-right:0in;margin-bottom:\n6.0pt;margin-left:0in\u0022\u003E\u003Cspan lang=\u0022EN\u0022 style=\u0022font-size:12.0pt;line-height:115%;\nfont-family:Roboto;mso-fareast-font-family:Roboto;mso-bidi-font-family:Roboto\u0022\u003EWhich\nof these is the LEAST likely mode of action of propranolol in the management of\nlid haemangiomas?\u003Co:p\u003E\u003C/o:p\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\u25CF\tPropranolol is a non-selective \u03B2-adrenergic antagonist and is the current standard of care for problematic infantile periocular haemangiomas. Its mechanisms include: \u03B2-receptor blockade promotes apoptosis and inhibits proliferation in endothelial cells of the haemangioma.\u0026nbsp;\u003Cdiv\u003E\u25CF\tVasoconstriction is mediated by inhibition of \u03B22-receptors, resulting in early blanching and regression.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u25CFPropranolol downregulates vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF), thereby inhibiting new vessel formation during the active growth phase.\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;\u25CF\tBradycardia is a systemic side effect of propranolol, not a therapeutic mechanism for the tumour. The local efficacy is independent of changes in systemic blood flow; reduction in haemangioma size is not due to cardiac effects but direct action on the lesion\u2019s endothelium.\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 342,
    "Name": "Post-Traumatic Secondary Glaucoma\u2014Anterior Segment Anatomy",
    "Body": "\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 35-year-old woman presents after being punched in her right eye. On examination her visual acuity is 6/18 right and 6/6 left. The right eye has a deep anterior chamber with dispersed red blood cells and fundus examination is normal. She is given no treatment. Six months later, the intraocular pressure is found to be 32 mmHg. Her right visual acuity is 6/9 with no refractive error and there is no anterior chamber activity. Which of the following is the MOST likely diagnosis?\u003C/span\u003E",
    "Explanation": "*Angle recession is the most likely diagnosis in this patient who developed delayed elevated intraocular pressure months after blunt trauma with initial findings of deep anterior chamber and microhyphaema.\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E* The pathophysiology involves a tear between the longitudinal and circular fibers of the ciliary muscle. Over time, this leads to trabecular meshwork dysfunction and increased IOP. Gonioscopic examination is essential- look for sectoral widening of the ciliary body band.\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E* Other listed diagnoses are less likely in this scenario:\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u0026nbsp;\u25CF\tAqueous misdirection (malignant glaucoma) typically presents with a shallow anterior chamber, often postoperatively.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u0026nbsp;\u25CF\tGhost cell glaucoma occurs soon after vitreous haemorrhage migrates into the anterior chamber, rarely delayed for months after minor anterior hemorrhage.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u0026nbsp;\u25CF\tLens dislocation (phacotopic/phacolytic glaucoma) usually causes refractive change, lens instability, or a shallow chamber.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003C/span\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 343,
    "Name": "Contraindications for Corneal Collagen Cross-Linking (CXL)",
    "Body": "\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px; font-weight: bold;\u0022\u003EWhich of the following conditions would be LEAST likely to be considered as a contra-indication for collagen cross linking?\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E",
    "Explanation": "\u25CF\tCorneal collagen cross-linking (CXL) is indicated for progressive keratoconus and other corneal ectasias. The main safety concern is adequate corneal thickness, as UV-A exposure can damage the endothelium if the stromal bed is too thin.\u0026nbsp;\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u25CF\tCorneal thickness of 450 \u00B5m is not a contraindication and safely allows standard (epi-off) CXL. The accepted threshold is generally \u2265400 \u00B5m after epithelial removal.\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;\u25CF\tOther options as contraindications:\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E1-\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003ESystemic lupus erythematosus: Increases risk of severe postoperative complications (melting, poor healing).\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E2- History of herpes simplex: Associated with risk of viral reactivation post-CXL.\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E3- Recurrent erosion syndrome: Indicates abnormal epithelial healing, increasing risk of persistent defect after CXL.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u25CF\tAbsolute contraindications include even thinner corneas, active infection, and some cases of severe ocular surface disease\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003C!--StartFragment--\u003E\u003Cspan style=\u0022white-space-collapse: preserve;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C!--EndFragment--\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003C/span\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 344,
    "Name": "Investigation\u2014Unilateral Optic Disc Swelling with Arcuate Visual Field Defect",
    "Body": "\u003Cspan lang=\u0022EN\u0022 style=\u0022font-size:12.0pt;line-height:\n115%;font-family:Roboto;mso-fareast-font-family:Roboto;mso-bidi-font-family:\nRoboto;mso-ansi-language:EN;mso-fareast-language:EN-US;mso-bidi-language:AR-SA\u0022\u003EAn\nasymptomatic 65-year-old woman is referred by her optometrist with a unilateral\nswollen optic disc and an arcuate field defect. Which of these is the MOST\nappropriate initial investigation?\u003C/span\u003E\u003Cdiv\u003E\u003Cspan lang=\u0022EN\u0022 style=\u0022font-size:12.0pt;line-height:\n115%;font-family:Roboto;mso-fareast-font-family:Roboto;mso-bidi-font-family:\nRoboto;mso-ansi-language:EN;mso-fareast-language:EN-US;mso-bidi-language:AR-SA\u0022\u003E\u003Cimg src=\u0022/upload-2026-01-27-9a3b8e00-2304-4e40-af5e-5bc83186ec6d.png\u0022\u003E\u003C/span\u003E\u003C/div\u003E",
    "Explanation": "In a 65-year-old with new unilateral optic disc swelling and a corresponding field defect, NAION is likely, but it is important that any optic neuropathy that cannot be confidently diagnosed clinically should be investigated with MRI of the orbits/brain with contrast as the first-line test.\u0026nbsp;\u003Cdiv\u003E\u003Cbr\u003E\u003Cdiv\u003E*MRI excludes compressive, infiltrative, inflammatory, or demyelinating causes that can mimic NAION and may be sight- or life-threatening.\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E*Fluorescein angiography can support a diagnosis of NAION (disc hypoperfusion and late leakage) but does not rule out retrobulbar or orbital pathology, so it is not the most appropriate initial investigation in this setting.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E*B scan ultrasound will only show elevated disc in the scan, which will not rule out intra-cranial lesions.\u003C/div\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003C!--StartFragment--\u003E\u003Cspan style=\u0022white-space-collapse: preserve;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C!--EndFragment--\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003C/span\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 345,
    "Name": "Peripheral visual field defects and peripheral retinal pathology",
    "Body": "\u003Cspan lang=\u0022EN\u0022 style=\u0022font-size: 12pt; line-height: 115%; font-family: Roboto; font-weight: bold;\u0022\u003EWhich\nof these is the MOST likely retinal pathology in a patient who presents with an\nabsolute peripheral field defect?\u003C/span\u003E",
    "Explanation": "\u25CF\tAn absolute peripheral field defect means complete loss of sensitivity in that area of the field, corresponding to full functional loss of the involved retina.\u0026nbsp;\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E*Degenerative peripheral retinoschisis causes splitting of the neurosensory retina, with the inner retinal layer functionally disconnected from the photoreceptors, producing a well-demarcated, stable, absolute scotoma on perimetry.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u25CF\tPeripheral lattice, snail track and pavingstone degenerations are usually asymptomatic and rarely produce a discrete absolute peripheral defect on their own, while giant retinal tears typically present with symptoms of acute rhegmatogenous retinal detachment (flashes, floaters, progressive \u201Ccurtain\u201D of field loss) rather than an isolated, localized absolute scotoma.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003C!--StartFragment--\u003E\u003Cspan style=\u0022white-space-collapse: preserve; font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C!--EndFragment--\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 346,
    "Name": "Vitreous floaters\u2014optics and symptomatology",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022 style=\u0022margin-top:12.0pt;margin-right:0in;margin-bottom:\n6.0pt;margin-left:0in\u0022\u003E\u003Cspan lang=\u0022EN\u0022 style=\u0022font-size:12.0pt;line-height:115%;\nfont-family:Roboto;mso-fareast-font-family:Roboto;mso-bidi-font-family:Roboto\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich\nof the following statements about symptoms of floaters caused by vitreous\nopacities is MOST likely to be correct?\u003C/span\u003E\u003Co:p\u003E\u003C/o:p\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\u25CF\tVitreous opacities cast shadows on the retina. The closer an opacity lies to the retina, the sharper and more distinct that shadow becomes on the photoreceptor layer, so the floater is perceived more clearly and is more symptomatic.\u003Cdiv\u003E\u003Cbr\u003E\u003Cdiv\u003E\u25CF\tWith a larger pupil, a wider cone of light enters the eye and a greater proportion of rays are intercepted by the opacity, producing a more extensive and noticeable disturbance in the retinal image. In contrast, a small pupil restricts the light bundle, so fewer rays interact with a given opacity and the symptoms can be less prominent. Therefore, the combination that maximizes symptoms is: opacities close to the retina with a large pupil.\u003C/div\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 347,
    "Name": "Pre\u2011operative allergy assessment for cataract surgery",
    "Body": "\u003Cspan lang=\u0022EN\u0022 style=\u0022font-size:12.0pt;line-height:\n115%;font-family:Roboto;mso-fareast-font-family:Roboto;mso-bidi-font-family:\nRoboto;mso-ansi-language:EN;mso-fareast-language:EN-US;mso-bidi-language:AR-SA\u0022\u003EA\n54\u2011year\u2011old patient is coming for cataract surgery. She is atopic and gives a\nhistory of allergy to chestnuts and kiwi fruit. Which of the following options\nwould you specifically ask about?\u003C/span\u003E",
    "Explanation": "\u25CF\tAllergy to chestnut and kiwi is strongly associated with the \u201Clatex\u2013fruit syndrome,\u201D in which IgE antibodies raised against natural rubber latex cross\u2011react with structurally similar proteins in certain fruits (classically banana, avocado, chestnut, and kiwi). In a patient with these food allergies, there is therefore a significantly increased risk of true latex hypersensitivity.\u0026nbsp;\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u25CF\tBefore cataract surgery, it is essential to specifically ask about and document any history of latex allergy, as perioperative exposure (gloves, tubing, syringe plungers, etc.) can provoke severe, even life\u2011threatening anaphylaxis.\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E*While chlorhexidine, fluorescein, and povidone\u2013iodine can all cause reactions, they are not specifically linked to chestnut/kiwi allergy; the key association here is with latex.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 1,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 348,
    "Name": "Sympathetic ophthalmia\u2014clinical features and management",
    "Body": "\u003Cspan lang=\u0022EN\u0022 style=\u0022font-size: 12pt; line-height: 115%; font-family: Roboto; font-weight: bold;\u0022\u003EWhich\nof the following statements regarding established sympathetic ophthalmia is\nLEAST likely to be correct?\u003C/span\u003E",
    "Explanation": "\u25CF\tSympathetic ophthalmia is a bilateral granulomatous panuveitis following penetrating trauma or intraocular surgery to one eye (the \u201Cexciting\u201D eye). Posterior segment findings commonly include multifocal choroiditis, Dalen-Fuchs nodules and serous/exudative retinal detachments.\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u25CF\tFundus fluorescein angiography typically demonstrates multiple pinpoint hyperfluorescent leaks in the early phases with progressive pooling and staining under the serous detachments.\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u25CF\tGranulomatous anterior uveitis with mutton\u2011fat keratic precipitates and nodules (granulomata) on the iris of one or both eyes is also a recognised feature.\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u25CF\tOnce sympathetic ophthalmia is established, treatment is based on high\u2011dose systemic corticosteroids and often additional systemic immunosuppressive therapy to control bilateral inflammation and preserve vision. Enucleation of the exciting eye is mainly a preventive measure if performed within about 10-14 days of the inciting injury and before the onset of disease; after sympathetic ophthalmia has developed, removing the traumatized eye rarely alters the course and is not considered primary treatment.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003C!--StartFragment--\u003E\u003Cspan style=\u0022white-space-collapse: preserve; font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C!--EndFragment--\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 12,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 349,
    "Name": "Evidence-based medicine\u2014ARR and NNT",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022 style=\u0022margin-top:12.0pt;margin-right:0in;margin-bottom:\n6.0pt;margin-left:0in\u0022\u003E\u003Cspan lang=\u0022EN\u0022 style=\u0022font-size:12.0pt;line-height:115%;\nfont-family:Roboto;mso-fareast-font-family:Roboto;mso-bidi-font-family:Roboto\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EIn\nthe ETDRS study for laser treatment of diabetic macular oedema, moderate visual\nloss occurred in 12% of treated eyes compared to 24% of untreated eyes in 3\nyears. What is the value of NNT (numbers needed to treat) in this study\napproximately?\u003C/span\u003E\u003Co:p\u003E\u003C/o:p\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\u25CF\tNNT is calculated as the inverse of the absolute risk reduction (ARR).\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E* Here, the event rate is 24% in untreated eyes and 12% in treated eyes.\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u0026nbsp;ARR = 24% \u2212 12% = 12%\u003C/span\u003E (0.12 as a proportion).\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003ETherefore,\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;\u25CF\tNNT=1/0.12\u22488.3\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u0026nbsp;\u003Cspan style=\u0022font-style: italic;\u0022\u003E\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; which is conventionally rounded up to 9 for NNT reporting\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u25CF\tInterpreting this clinically: approximately 9 eyes require ETDRS-style laser treatment over 3 years to prevent one additional case of moderate visual loss compared with no treatment.\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003C!--StartFragment--\u003E\u003Cspan style=\u0022white-space-collapse: preserve; font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C!--EndFragment--\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 11,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 350,
    "Name": "Diagnostic tests in aqueous\u2011deficient dry eye (ADDE)",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022 style=\u0022margin-top:12.0pt;margin-right:0in;margin-bottom:\n6.0pt;margin-left:0in\u0022\u003E\u003Cspan lang=\u0022EN\u0022 style=\u0022font-size:12.0pt;line-height:115%;\nfont-family:Roboto;mso-fareast-font-family:Roboto;mso-bidi-font-family:Roboto\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich\nof the following test results would be MOST likely to support a diagnosis of\naqueous\u2011deficient dry eye disease?\u003C/span\u003E\u003Co:p\u003E\u003C/o:p\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\u25CF\tADDE is defined by reduced lacrimal secretion leading to tear film hyperosmolarity, which is a core mechanism of dry eye disease.\u0026nbsp;\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u25CF\tSchirmer 15 mm/5 min: near\u2011normal; does not support significant aqueous deficiency.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u25CF\tTBUT 11 s: essentially normal; reduced TBUT (\u0026lt;10 s) is more typical of evaporative DED (e.g. MGD).\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u25CF\tOxford score 1: minimal staining; reflects mild surface damage and does not specifically indicate ADDE.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u25CF\tTear hyperosmolarity is the best single marker for dry eye pathophysiology and is particularly elevated in moderate\u2013severe ADDE, so among the options it most strongly supports the diagnosis.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003C!--StartFragment--\u003E\u003Cspan style=\u0022white-space-collapse: preserve; font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C!--EndFragment--\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 351,
    "Name": "Refractive surprise after uncomplicated cataract surgery",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022 style=\u0022margin-top:12.0pt;margin-right:0in;margin-bottom:\n6.0pt;margin-left:0in\u0022\u003E\u003Cspan lang=\u0022EN\u0022 style=\u0022font-size: 12pt; line-height: 115%; font-family: \u0026quot;Nova Mono\u0026quot;; font-weight: bold;\u0022\u003EA 63\u2011year\u2011old woman undergoes uncomplicated cataract surgery\naiming for emmetropia. On returning to the post\u2011operative clinic her vision is\n6/60 unaided and 6/18 with -3.5 DS. Which is the MOST likely diagnosis?\u003C/span\u003E\u003Cspan lang=\u0022EN\u0022 style=\u0022font-size:12.0pt;line-height:115%;font-family:Roboto;mso-fareast-font-family:\nRoboto;mso-bidi-font-family:Roboto\u0022\u003E\u003Co:p\u003E\u003C/o:p\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\u25CF\tShe was targeted for emmetropia but is now approximately -3.50 D myopic with good BCVA \u2192 this is a pure refractive (axial/ELP) issue, not primarily macular or corneal.\u0026nbsp;\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u25CF\tCapsular bag distension syndrome (CBDS): fluid trapped behind the IOL pushes it anteriorly, increasing its effective power and causing an unexpected myopic shift with otherwise good, corrected acuity.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u25CF\tCorneal oedema or CME would reduce BCVA and cause blur/distortion, with more hyperopic refraction.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u25CF\tIOL dislocation/tilt tends to cause decentration, irregular astigmatism, glare, not an isolated neat myopic shift.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003C!--StartFragment--\u003E\u003Cspan style=\u0022white-space-collapse: preserve; font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C!--EndFragment--\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 1,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 352,
    "Name": "Systemic drugs and diabetic macular oedema (DME)",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022 style=\u0022margin-top:12.0pt;margin-right:0in;margin-bottom:\n6.0pt;margin-left:0in\u0022\u003E\u003Cspan lang=\u0022EN\u0022 style=\u0022font-size:12.0pt;line-height:115%;\nfont-family:Roboto;mso-fareast-font-family:Roboto;mso-bidi-font-family:Roboto\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich\nof the following systemic drugs is LEAST likely to be helpful in the treatment\nof diabetic macular oedema?\u003C/span\u003E\u003Co:p\u003E\u003C/o:p\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E*Pioglitazone (a thiazolidinedione) is the drug among the options that is least likely to be helpful; in fact, it is known to cause or exacerbate diabetic macular oedema (DMO) due to systemic fluid retention. It is associated with an increased risk of DMO development compared to other diabetes medications.\u003C/span\u003E\u003Cdiv style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u0026nbsp;The other drugs listed have shown potential benefits in the management of diabetic retinopathy and DMO:\u0026nbsp;\u003C/div\u003E\u003Cdiv style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u0026nbsp; \u25CF Dapagliflozin (an SGLT2 inhibitor) has growing evidence suggesting it may have a beneficial effect on DMO by reducing retinal thickness and inflammation, and ongoing clinical trials are exploring its use as an adjunct therapy.\u0026nbsp;\u003C/div\u003E\u003Cdiv style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u0026nbsp; \u25CF Fenofibrate (a fibric acid derivative) significantly slows the progression of diabetic retinopathy and reduces the need for laser treatment for maculopathy and proliferative retinopathy, including the development of macular oedema.\u0026nbsp;\u003C/div\u003E\u003Cdiv style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u0026nbsp; \u25CF Rosuvastatin (a statin) has been shown in some studies to reduce DMO progression and improve the resolution of existing DMO, possibly due to its anti-inflammatory effects and ability to reduce lipid exudation.\u0026nbsp;\u003C/div\u003E\u003Cdiv style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cspan style=\u0022white-space-collapse: preserve; font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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  },
  {
    "Id": 353,
    "Name": " Treatment of intermediate uveitis with reduced vision",
    "Body": "\u003Cspan id=\u0022docs-internal-guid-c8d04b7c-7fff-607d-d570-42065bafd502\u0022\u003E\u003Cp dir=\u0022ltr\u0022 style=\u0022line-height:1.38;margin-top:12pt;margin-bottom:6pt;\u0022\u003E\u003Cspan style=\u0022font-size: 12pt; font-family: Roboto, sans-serif; color: rgb(0, 0, 0); background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-variant-position: normal; font-variant-emoji: normal; vertical-align: baseline; white-space-collapse: preserve; font-weight: bold;\u0022\u003EA 33\u2011year\u2011old woman presents with a 2\u2011year history of poor vision in her left eye. Eight years earlier she had been diagnosed with intermediate uveitis. On examination her vision is 6/12 in the left eye. What is the MOST appropriate treatment?\u003C/span\u003E\u003C/p\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-size: 12pt; font-family: Roboto, sans-serif; color: rgb(0, 0, 0); background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-variant-position: normal; font-variant-emoji: normal; vertical-align: baseline; white-space-collapse: preserve;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003C/span\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cspan id=\u0022docs-internal-guid-7b0c394d-7fff-ba2a-aea0-b2920c4b2a09\u0022\u003E\u003Cp dir=\u0022ltr\u0022 style=\u0022line-height:1.38;margin-top:12pt;margin-bottom:6pt;\u0022\u003E\u003Cspan style=\u0022font-size: 12pt; font-family: Roboto, sans-serif; color: rgb(0, 0, 0); background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-variant-position: normal; font-variant-emoji: normal; vertical-align: baseline; white-space-collapse: preserve;\u0022\u003EA young patient with known intermediate uveitis and chronic, unilateral reduced vision (6/12) is most likely to have uveitic cystoid macular oedema (CME) in that eye. For unilateral or clearly asymmetric intermediate uveitis with CME, the most appropriate first\u2011line therapy is a regional periocular corticosteroid injection (e.g. posterior sub\u2011Tenon/orbital floor triamcinolone), which delivers high drug levels to the macula with minimal systemic exposure.\u003C/span\u003E\u003C/p\u003E\u003Cp dir=\u0022ltr\u0022 style=\u0022line-height:1.38;margin-top:12pt;margin-bottom:6pt;\u0022\u003E\u003Cspan style=\u0022background-color: transparent; font-size: 12pt; white-space-collapse: preserve; color: rgb(0, 0, 0); font-family: Roboto, sans-serif; letter-spacing: 0.14994px;\u0022\u003E*Systemic steroid will work but exposes the whole body to steroid. It is p\u003C/span\u003E\u003Cspan style=\u0022background-color: transparent; font-size: 12pt; white-space-collapse: preserve; color: rgb(0, 0, 0); font-family: Roboto, sans-serif; letter-spacing: 0.14994px;\u0022\u003Ereferred when disease is bilateral, severe, or associated with systemic inflammatory disease, or when periocular therapy fails/relapses quickly.\u003C/span\u003E\u003C/p\u003E\u003Cp dir=\u0022ltr\u0022 style=\u0022line-height:1.38;margin-top:12pt;margin-bottom:6pt;\u0022\u003E\u003Cspan style=\u0022background-color: transparent; font-size: 12pt; white-space-collapse: preserve; color: rgb(0, 0, 0); font-family: Roboto, sans-serif; letter-spacing: 0.14994px;\u0022\u003E*A systemic steroid\u2011sparing immunosuppressant like oral Cyclosporin for long\u2011term control, not the first step for isolated unilateral CME.\u003C/span\u003E\u003C/p\u003E\u003Cp dir=\u0022ltr\u0022 style=\u0022line-height:1.38;margin-top:12pt;margin-bottom:6pt;\u0022\u003E\u003Cspan style=\u0022background-color: transparent; font-size: 12pt; white-space-collapse: preserve; color: rgb(0, 0, 0); font-family: Roboto, sans-serif; letter-spacing: 0.14994px;\u0022\u003E*Topical steroids have poor penetration to the vitreous and macula; adequate for anterior uveitis but not for intermediate uveitis with CME.\u003C/span\u003E\u003C/p\u003E\u003Cp dir=\u0022ltr\u0022 style=\u0022line-height:1.38;margin-top:12pt;margin-bottom:6pt;\u0022\u003E\u003Cspan style=\u0022background-color: transparent; font-size: 12pt; white-space-collapse: preserve; color: rgb(0, 0, 0); font-family: Roboto, sans-serif; letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp dir=\u0022ltr\u0022 style=\u0022line-height:1.38;margin-top:12pt;margin-bottom:6pt;\u0022\u003E\u003C!--StartFragment--\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan style=\u0022white-space-collapse: preserve;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C!--EndFragment--\u003E\u0026nbsp;\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022background-color: transparent; font-size: 12pt; white-space-collapse: preserve; color: rgb(0, 0, 0); font-family: Roboto, sans-serif; letter-spacing: 0.14994px;\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003C/span\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 12,
    "Category": null,
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  },
  {
    "Id": 354,
    "Name": "Unilateral Proptosis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 43-year-old woman who smokes and is taking \u003Cspan class=\u0022s1\u0022\u003Etamoxifen\u003C/span\u003E presents with \u003Cspan class=\u0022s1\u0022\u003Egradual onset of unilateral proptosis\u003C/span\u003E. What is the \u003Cspan class=\u0022s1\u0022\u003Emost likely underlying cause\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EThyroid eye disease (TED)\u003C/b\u003E\u003C/span\u003E is the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emost common cause of both unilateral and bilateral proptosis\u003C/b\u003E\u003C/span\u003E in adults. It classically affects \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emiddle-aged women\u003C/b\u003E\u003C/span\u003E, especially those who \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esmoke\u003C/b\u003E\u003C/span\u003E, which is a well-established risk factor for both \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eonset and severity\u003C/b\u003E\u003C/span\u003E of TED. While TED is more commonly bilateral, it can be \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eunilateral in up to 10-20%\u003C/b\u003E\u003C/span\u003E of cases, particularly in early or asymmetric disease.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EAlthough \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Etamoxifen use\u003C/b\u003E\u003C/span\u003E raises the possibility of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emetastatic breast cancer\u003C/b\u003E\u003C/span\u003E, orbital metastases are \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Efar less common\u003C/b\u003E\u003C/span\u003E than TED and typically present with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epain, diplopia, rapid progression\u003C/b\u003E\u003C/span\u003E, or signs of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Einfiltrative disease\u003C/b\u003E\u003C/span\u003E, which are not described here.\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ECavernous haemangiomas\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E are typically \u003C/span\u003E\u003Cb\u003Eslow-growing, benign intraconal tumours\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E presenting in middle age, but they are less common than TED and usually do \u003C/span\u003E\u003Cb\u003Enot occur in smokers with systemic autoimmune risk factors\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOrbital varices\u003C/b\u003E\u003C/span\u003E often cause \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eintermittent proptosis\u003C/b\u003E\u003C/span\u003E triggered by valsalva manoeuvres, not gradual persistent proptosis.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 355,
    "Name": "Basal cell carcinoma",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EWhat is the \u003C/span\u003Emost common route of spread\u003Cspan class=\u0022s1\u0022\u003E for \u003C/span\u003Ebasal cell carcinoma\u003Cspan class=\u0022s1\u0022\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EBasal cell carcinoma (BCC)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is the \u003C/span\u003E\u003Cb\u003Emost common malignant eyelid tumour\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, but it has \u003C/span\u003E\u003Cb\u003Every low metastatic potential\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E. The hallmark of BCC is \u003C/span\u003E\u003Cb\u003Eprogressive local tissue invasion\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, often with \u003C/span\u003E\u003Cb\u003Edestruction of adjacent structures\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, particularly if neglected or in high-risk locations (e.g. medial canthus, orbit).\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ELymphatic\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and \u003C/span\u003E\u003Cb\u003Ehaematogenous\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E spread are \u003C/span\u003E\u003Cb\u003Eextremely rare\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E in BCC.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECSF spread\u003C/b\u003E\u003C/span\u003E is irrelevant in this context as BCC does not involve the central nervous system.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ESquamous cell carcinoma\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, in contrast, has a \u003C/span\u003E\u003Cb\u003Ehigher risk of lymphatic spread\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and potential for metastasis.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ETherefore, \u003C/span\u003E\u003Cb\u003Elocal invasion\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E remains the \u003C/span\u003E\u003Cb\u003Eprimary and most clinically significant mode of spread\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E for BCC.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
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    "CategoryId": 9,
    "Category": null,
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  },
  {
    "Id": 356,
    "Name": "Orbit Anatomy",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following combinations of bones form the \u003Cspan class=\u0022s1\u0022\u003Emedial wall of the orbit\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThe \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emedial wall of the orbit\u003C/b\u003E\u003C/span\u003E is the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ethinnest\u003C/b\u003E\u003C/span\u003E and most \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Efragile\u003C/b\u003E\u003C/span\u003E orbital wall and comprises four bones:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMaxilla\u003C/b\u003E\u003C/span\u003E (specifically the frontal process)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ELacrimal bone\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EEthmoid bone\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (particularly the thin \u003C/span\u003E\u003Cb\u003Elamina papyracea\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E)\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EBody of sphenoid\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThis wall separates the orbit from the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eethmoid sinus\u003C/b\u003E\u003C/span\u003E, and trauma here may result in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eorbital emphysema\u003C/b\u003E\u003C/span\u003E or \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emedial wall blowout fractures\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cimg src=\u0022https://prod-images-static.radiopaedia.org/images/19311340/a2db73fd3be3c04a515e8998f1e6c5_big_gallery.jpeg\u0022\u003E\u003C/p\u003E\u003Cp style=\u0022margin-bottom: calc(1.16667em); color: rgb(61, 61, 61); font-family: \u0026quot;Open Sans\u0026quot;, sans-serif; letter-spacing: normal; background-color: rgb(238, 238, 238);\u0022\u003E\u003Cspan style=\u0022font-size: x-small;\u0022\u003ESkull and facial bone diagrams.\u0026nbsp;\u003C/span\u003E\u003C/p\u003E\u003Cp style=\u0022margin-bottom: 0px; color: rgb(61, 61, 61); font-family: \u0026quot;Open Sans\u0026quot;, sans-serif; letter-spacing: normal; background-color: rgb(238, 238, 238);\u0022\u003E\u003Cspan style=\u0022font-size: x-small;\u0022\u003ELicense: All image files licensed under Creative Commons BY 3.0 OpenStax College, cnx.org\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003EOther orbital walls include:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERoof\u003C/b\u003E\u003C/span\u003E: frontal bone and lesser wing of sphenoid\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELateral wall\u003C/b\u003E\u003C/span\u003E: zygomatic bone and greater wing of sphenoid\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EFloor\u003C/b\u003E\u003C/span\u003E: maxilla, zygomatic bone, and small part of palatine bone\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 357,
    "Name": "Orbital inflammation [IgG4 related]",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following ocular features is \u003Cspan class=\u0022s1\u0022\u003Emost commonly associated\u003C/span\u003E with IgG4-related ophthalmic disease?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIgG4-related ophthalmic disease (IgG4-ROD)\u003C/b\u003E\u003C/span\u003E is a systemic fibroinflammatory condition driven by IgG4-positive plasma cells. It \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecommonly affects the orbit\u003C/b\u003E\u003C/span\u003E, and less frequently intraocular tissues. The hallmark features include:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ELacrimal gland enlargement\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (dacryoadenitis)\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EOrbital mass lesions\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (often bilateral)\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EInfraorbital nerve enlargement\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EExtraocular muscle involvement\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ESclerosing inflammation\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E leading to fibrosis\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EUveitis is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Erare\u003C/b\u003E\u003C/span\u003E in IgG4-related disease and not a typical manifestation of IgG4-ROD.\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EHistopathology usually shows:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EDense lymphoplasmacytic infiltrate\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EStoriform fibrosis\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EObliterative phlebitis\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EElevated serum IgG4 levels may support the diagnosis\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EImaging (CT/MRI) typically shows \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ediffuse, homogenous enlargement\u003C/b\u003E\u003C/span\u003E of orbital structures with well-defined margins.\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 358,
    "Name": "Thyroid Eye disease",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EA 42-year-old woman with known Graves\u2019 disease presents with \u003C/span\u003Emild lid retraction (\u0026lt;2 mm)\u003Cspan class=\u0022s1\u0022\u003E, \u003C/span\u003Emild periorbital swelling\u003Cspan class=\u0022s1\u0022\u003E, \u003C/span\u003Eno diplopia\u003Cspan class=\u0022s1\u0022\u003E, and \u003C/span\u003Eintermittent foreign body sensation relieved by lubricants\u003Cspan class=\u0022s1\u0022\u003E. Examination confirms \u003C/span\u003Eexophthalmos \u0026lt;3 mm above normal\u003Cspan class=\u0022s1\u0022\u003E for her age and race.\u0026nbsp;\u003C/span\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003EThere is \u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003Eno evidence of optic neuropathy or corneal breakdown\u003C/span\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E.\u0026nbsp;\u003C/span\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhat is the \u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003Emost appropriate next step in management\u003C/span\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EIn \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emild thyroid eye disease (TED)\u003C/b\u003E\u003C/span\u003E, the emphasis is on \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Econservative, supportive care\u003C/b\u003E\u003C/span\u003E and controlling modifiable risk factors:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESmoking cessation\u003C/b\u003E\u003C/span\u003E is critical, as smoking worsens TED and reduces treatment efficacy.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ESelenium supplementation (100 mcg twice daily)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E has been shown to \u003C/span\u003E\u003Cb\u003Ereduce disease progression and improve quality of life\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E in patients with mild TED (as demonstrated in the EUGOGO study).\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOther measures include artificial tears, sunglasses, lifestyle advice, and achieving \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eeuthyroid status\u003C/b\u003E\u003C/span\u003E, but selenium and smoking cessation are considered \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecore interventions\u003C/b\u003E\u003C/span\u003E for mild active disease.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECarbimazole\u003C/b\u003E\u003C/span\u003E may be used to manage hyperthyroidism but is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot a direct treatment\u003C/b\u003E\u003C/span\u003E for eye disease unless required for systemic control.\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESteroids\u003C/b\u003E\u003C/span\u003E are reserved for \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emoderate-to-severe active TED\u003C/b\u003E\u003C/span\u003E, not for mild cases.\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cimg src=\u0022/upload-2026-01-28-b51521c7-d5e4-4a03-afd8-5df8106cc156.png\u0022\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cbr\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 359,
    "Name": "Sarcoidosis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EA young girl presents with a \u003C/span\u003Egeneralised rash\u003Cspan class=\u0022s1\u0022\u003E, \u003C/span\u003Ejoint pain\u003Cspan class=\u0022s1\u0022\u003E, and \u003C/span\u003Ebilateral lymphadenopathy\u003Cspan class=\u0022s1\u0022\u003E. Ocular examination reveals \u003C/span\u003Eband keratopathy\u003Cspan class=\u0022s1\u0022\u003E, \u003C/span\u003Eanterior uveitis\u003Cspan class=\u0022s1\u0022\u003E, and \u003C/span\u003Eretinal vasculitis\u003Cspan class=\u0022s1\u0022\u003E.\u0026nbsp;\u003C/span\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhat is the \u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003Emost likely diagnosis\u003C/span\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThis multisystem presentation involving \u003C/span\u003E\u003Cb\u003Erash, arthralgia, and lymphadenopathy\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, along with \u003C/span\u003E\u003Cb\u003Eocular findings of anterior uveitis, band keratopathy, and retinal vasculitis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, is \u003C/span\u003E\u003Cb\u003Emost characteristic of sarcoidosis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003EOcular sarcoidosis may present with:\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAnterior uveitis\u003C/b\u003E\u003C/span\u003E, often granulomatous\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBand keratopathy\u003C/b\u003E\u003C/span\u003E, from chronic inflammation\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERetinal periphlebitis\u003C/b\u003E\u003C/span\u003E or \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Evasculitis\u003C/b\u003E\u003C/span\u003E, classically with \u201Ccandle-wax drippings\u201D\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESystemic signs such as \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elymphadenopathy\u003C/b\u003E\u003C/span\u003E, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Erash\u003C/b\u003E\u003C/span\u003E, and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Earthropathy\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EWhile \u003C/span\u003E\u003Cb\u003EJIA\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is a common cause of uveitis in young girls, it \u003C/span\u003E\u003Cb\u003Etypically causes chronic, non-granulomatous anterior uveitis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and \u003C/span\u003E\u003Cb\u003Edoes not cause retinal vasculitis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E or generalized lymphadenopathy.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003EUlcerative colitis\u003C/b\u003E\u003C/span\u003E may rarely have uveitis, but retinal vasculitis is not typical, and lymphadenopathy would be unusual.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 12,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 360,
    "Name": "Functional visual loss",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 13-year-old girl presents with a \u003Cspan class=\u0022s1\u0022\u003E2-day history of sudden vision loss\u003C/span\u003E in her right eye. Visual acuity is \u003Cspan class=\u0022s1\u0022\u003Ehand movements\u003C/span\u003E in the right eye and \u003Cspan class=\u0022s1\u0022\u003E6/6\u003C/span\u003E in the left. \u003Cspan class=\u0022s1\u0022\u003EPupil responses are normal\u003C/span\u003E and there is \u003Cspan class=\u0022s1\u0022\u003Eno RAPD\u003C/span\u003E. \u003Cspan class=\u0022s1\u0022\u003ESlit-lamp, fundus, OCT, and FFA\u003C/span\u003E findings are all normal bilaterally.\u0026nbsp;\u003Cspan class=\u0022s2\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhat is the \u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003Emost likely response\u003C/span\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E when a \u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E20-dioptre base-out prism\u003C/span\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E is placed in front of the \u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003Eright eye\u003C/span\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThis presentation is classic for \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Efunctional visual loss (FVL)\u003C/b\u003E\u003C/span\u003E in a child, particularly in the context of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enormal ocular examination and imaging\u003C/b\u003E\u003C/span\u003E, no RAPD, and a disproportionate visual acuity reduction.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003EThe \u003C/span\u003E\u003Cb\u003E20-dioptre base-out prism test\u003C/b\u003E\u003Cspan class=\u0022s2\u0022\u003E is useful for detecting \u003C/span\u003E\u003Cb\u003Enon-organic visual loss\u003C/b\u003E\u003Cspan class=\u0022s2\u0022\u003E. When a base-out prism is placed in front of one eye, both eyes should \u003C/span\u003E\u003Cb\u003Emove toward the apex of the prism\u003C/b\u003E\u003Cspan class=\u0022s2\u0022\u003E (in this case, to the \u003C/span\u003E\u003Cb\u003Eleft\u003C/b\u003E\u003Cspan class=\u0022s2\u0022\u003E) and then the \u003C/span\u003E\u003Cb\u003Efellow eye makes a corrective movement to restore fixation\u003C/b\u003E\u003Cspan class=\u0022s2\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIn true monocular visual loss, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eno corrective movement occurs\u003C/b\u003E\u003C/span\u003E, because the brain does not detect displacement in the eye with no vision.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIn \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Efunctional (non-organic) loss\u003C/b\u003E\u003C/span\u003E, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eboth eyes respond normally\u003C/b\u003E\u003C/span\u003E, as seen in this case: \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eboth eyes move to the left\u003C/b\u003E\u003C/span\u003E, and the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eleft eye corrects fixation\u003C/b\u003E\u003C/span\u003E with adduction\u2014indicating that vision in the \u201Caffected\u201D eye is likely intact.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 361,
    "Name": "Cycloplegic refraction",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EWhat is the \u003C/span\u003Emost appropriate drop combination\u003Cspan class=\u0022s1\u0022\u003E for \u003C/span\u003Ecycloplegic refraction\u003Cspan class=\u0022s1\u0022\u003E in a \u003C/span\u003E6-month-old infant\u003Cspan class=\u0022s1\u0022\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EFor \u003C/span\u003E\u003Cb\u003Ecycloplegic refraction in infants under 12 months\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, the recommended agents are \u003C/span\u003E\u003Cb\u003Elow-dose cyclopentolate (0.5% or 0.25%)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and \u003C/span\u003E\u003Cb\u003Elow-dose phenylephrine (1% or 2.5%)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E. This combination provides adequate cycloplegia and mydriasis while \u003C/span\u003E\u003Cb\u003Eminimizing systemic side effects\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, particularly anticholinergic toxicity.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E1% cyclopentolate\u003C/b\u003E\u003C/span\u003E may be too strong and can cause systemic toxicity in young infants.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EAtropine\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is avoided in this age group due to its \u003C/span\u003E\u003Cb\u003Elong duration of action\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and \u003C/span\u003E\u003Cb\u003Ehigher risk of systemic effects\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003E10% phenylephrine\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is \u003C/span\u003E\u003Cb\u003Econtraindicated in infants\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E due to the risk of \u003C/span\u003E\u003Cb\u003Ehypertensive crises and cardiovascular complications\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 362,
    "Name": "Blepharitis - corneal vascularisation",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EA 5-year-old boy is \u003C/span\u003Easymptomatic\u003Cspan class=\u0022s1\u0022\u003E but noted to have \u003C/span\u003Ebilateral superficial inferior corneal vascularisation\u003Cspan class=\u0022s1\u0022\u003E. What is the \u003C/span\u003Emost likely underlying cause\u003Cspan class=\u0022s1\u0022\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EIn children, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Echronic blepharokeratoconjunctivitis (BKC)\u003C/b\u003E\u003C/span\u003E is the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emost common cause\u003C/b\u003E\u003C/span\u003E of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebilateral inferior superficial corneal vascularisation\u003C/b\u003E\u003C/span\u003E, often without significant symptoms. It may be subtle and under-recognized but can lead to long-term complications like corneal scarring and amblyopia if untreated.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAllergic eye disease\u003C/b\u003E\u003C/span\u003E, such as vernal keratoconjunctivitis, typically affects the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esuperior\u003C/b\u003E\u003C/span\u003E cornea and is associated with intense itching and photophobia.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAdenoviral keratitis\u003C/b\u003E\u003C/span\u003E causes \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esubepithelial infiltrates\u003C/b\u003E\u003C/span\u003E and is more central/paracentral in distribution.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERosacea\u003C/b\u003E\u003C/span\u003E is rare in young children and more common in older children/adults.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 363,
    "Name": "Shaken baby syndrome",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EThe retinal findings seen in \u003Cspan class=\u0022s1\u0022\u003Eshaken-baby syndrome\u003C/span\u003E are \u003Cspan class=\u0022s1\u0022\u003Eleast similar\u003C/span\u003E to which of the following conditions?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EShaken-baby syndrome (SBS) typically causes \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eextensive, multilayered retinal haemorrhages -\u0026nbsp;\u003C/b\u003E\u003C/span\u003Eincluding \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epreretinal\u003C/b\u003E\u003C/span\u003E, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eintraretinal\u003C/b\u003E\u003C/span\u003E, and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esubretinal-\u003C/b\u003E\u003C/span\u003E\u0026nbsp;often extending to the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eperipheral retina\u003C/b\u003E\u003C/span\u003E, and frequently too numerous to count. This pattern is most closely mimicked by other \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehaemorrhagic retinopathies\u003C/b\u003E\u003C/span\u003E:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ETerson\u2019s syndrome\u003C/b\u003E\u003C/span\u003E: intraocular haemorrhage due to raised intracranial pressure (e.g., subarachnoid haemorrhage).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPurtscher\u2019s retinopathy\u003C/b\u003E\u003C/span\u003E: associated with trauma or acute pancreatitis; presents with cotton-wool spots, retinal whitening, and retinal haemorrhages.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECRVO\u003C/b\u003E\u003C/span\u003E: causes widespread intraretinal haemorrhages in all quadrants.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cp class=\u0022p1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003EIn contrast,\u0026nbsp;\u003Cspan class=\u0022s1\u0022\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003Ecommotio retinae\u003C/span\u003E\u003C/span\u003E\u0026nbsp;presents with\u0026nbsp;\u003Cspan class=\u0022s1\u0022\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003Etransient retinal whitening\u003C/span\u003E\u003C/span\u003E\u0026nbsp;(particularly at the posterior pole), due to photoreceptor outer segment disruption after blunt trauma.\u0026nbsp;\u003Cspan class=\u0022s1\u0022\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003EIt typically lacks haemorrhages\u003C/span\u003E\u003C/span\u003E, making it least like SBS.\u003C/p\u003E\u003Cp class=\u0022p3\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cimg src=\u0022https://media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs12886-020-01666-9/MediaObjects/12886_2020_1666_Fig1_HTML.png?as=webp\u0022\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cspan style=\u0022font-size: x-small;\u0022\u003E\u003Cspan style=\u0022box-sizing: inherit; font-weight: bolder; color: rgb(34, 34, 34); font-family: Merriweather, serif; letter-spacing: normal;\u0022\u003Ea\u003C/span\u003E\u003Cspan style=\u0022color: rgb(34, 34, 34); font-family: Merriweather, serif; letter-spacing: normal;\u0022\u003E,\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022box-sizing: inherit; font-weight: bolder; color: rgb(34, 34, 34); font-family: Merriweather, serif; letter-spacing: normal;\u0022\u003Eb\u003C/span\u003E\u003Cspan style=\u0022color: rgb(34, 34, 34); font-family: Merriweather, serif; letter-spacing: normal;\u0022\u003E\u0026nbsp;Fundus photography showing bilateral intraretinal and preretinal hemorrhages, with a boat-shaped premacular hematoma, which is in the right eye larger in size and surrounded with an elevated ring-shaped white retinal fold (arrowheads).\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022box-sizing: inherit; font-weight: bolder; color: rgb(34, 34, 34); font-family: Merriweather, serif; letter-spacing: normal;\u0022\u003Ec\u003C/span\u003E\u003Cspan style=\u0022color: rgb(34, 34, 34); font-family: Merriweather, serif; letter-spacing: normal;\u0022\u003E\u0026nbsp;SS OCT scan through the macula of the right eye showing a dome-shaped highly reflective band corresponding to a detached internal limiting membrane (ILM) (orange arrow) with associated posterior shadowing from dense sub-ILM hemorrhage. Note the presence of retinal traction at the upper edge of the detached ILM corresponding to the perimacular elevated retinal fold seen clinically (asterix). Note also the fainter reflecting posterior hyaloid overlying the detached ILM superiorly (red arrows).\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022box-sizing: inherit; font-weight: bolder; color: rgb(34, 34, 34); font-family: Merriweather, serif; letter-spacing: normal;\u0022\u003Ed\u003C/span\u003E\u003Cspan style=\u0022color: rgb(34, 34, 34); font-family: Merriweather, serif; letter-spacing: normal;\u0022\u003E\u0026nbsp;SS OCT scan through nasal retina showing diffuse inner retinal hyperreflectivity (arrows) and multifocal serous retinal detachment.\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022box-sizing: inherit; font-weight: bolder; color: rgb(34, 34, 34); font-family: Merriweather, serif; letter-spacing: normal;\u0022\u003Ee\u003C/span\u003E\u003Cspan style=\u0022color: rgb(34, 34, 34); font-family: Merriweather, serif; letter-spacing: normal;\u0022\u003E,\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022box-sizing: inherit; font-weight: bolder; color: rgb(34, 34, 34); font-family: Merriweather, serif; letter-spacing: normal;\u0022\u003Ef\u003C/span\u003E\u003Cspan style=\u0022color: rgb(34, 34, 34); font-family: Merriweather, serif; letter-spacing: normal;\u0022\u003E\u0026nbsp;SS OCT scans of the left eye showing hyperreflective vitreous dots, a sub-ILM hemorrhage (arrow), wave-shaped retinal layers deformation, diffuse inner retinal hyperreflectivity, ellipsoid zone disruption, intraretinal hyperreflective dots, and serous retinal detachment\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003ESource of image:\u0026nbsp;\u003C/b\u003E\u003Ca href=\u0022https://link.springer.com/article/10.1186/s12886-020-01666-9\u0022 target=\u0022_blank\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003ESwept-source OCT findings in shaken baby syndrome: case report\u003C/a\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 364,
    "Name": "Visual acuity testing in children",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EWhat is the \u003C/span\u003Emost appropriate method\u003Cspan class=\u0022s1\u0022\u003E to assess \u003C/span\u003Evisual acuity\u003Cspan class=\u0022s1\u0022\u003E in an \u003C/span\u003E18-month-old child\u003Cspan class=\u0022s1\u0022\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EFor very young children, particularly under \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E2 years of age\u003C/b\u003E\u003C/span\u003E, conventional visual acuity testing methods (such as optotype or letter matching) are inappropriate due to limited cognitive and language development.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECardiff Cards\u003C/b\u003E\u003C/span\u003E use the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epreferential looking technique\u003C/b\u003E\u003C/span\u003E with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Evanishing optotypes\u003C/b\u003E\u003C/span\u003E, and are specifically designed for infants and toddlers aged \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E6 months to 2 years\u003C/b\u003E\u003C/span\u003E. They require no verbal response and are based on the child\u2019s instinctive tendency to look at patterns over blank spaces.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EKay pictures\u003C/b\u003E\u003C/span\u003E and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESonksen\u003C/b\u003E\u003C/span\u003E charts (crowded optotypes) are more suitable for children aged \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E2 to 3\u002B years\u003C/b\u003E\u003C/span\u003E, once picture matching and sustained attention are possible.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESheridan-Gardiner\u003C/b\u003E\u003C/span\u003E is a letter matching test suited to children \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eover 3 years\u003C/b\u003E\u003C/span\u003E, who can reliably match letters using a key card.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cimg src=\u0022/upload-2026-01-28-d29e8601-8d7b-4089-9e75-a08d034bd14c.png\u0022\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 365,
    "Name": "X-linked Retinoschisis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 5-year-old boy is referred by his optician due to difficulty with reading at school. Slit lamp biomicroscopy reveals \u003Cspan class=\u0022s1\u0022\u003Efoveal microcysts.\u0026nbsp;\u003C/span\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhat is the \u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003Emost likely diagnosis\u003C/span\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EX-linked retinoschisis (XLRS) is the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emost likely diagnosis\u003C/b\u003E\u003C/span\u003E in a young boy presenting with reduced central vision and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Efoveal microcystic changes\u003C/b\u003E\u003C/span\u003E. It typically presents \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebetween 3 and 6 years of age\u003C/b\u003E\u003C/span\u003E and is characterized by:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EFoveal schisis\u003C/b\u003E\u003C/span\u003E: Seen as cystic-appearing spaces or spoke-wheel striae confined to the macula\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EBilateral maculopathy\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E: Often symmetrical\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPeripheral schisis\u003C/b\u003E\u003C/span\u003E: Found in ~50% of cases, most commonly inferotemporal\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERetinoschisin gene mutation\u003C/b\u003E\u003C/span\u003E on the X chromosome (RS1 gene)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EElectroretinogram (ERG)\u003C/b\u003E\u003C/span\u003E: May be normal in isolated foveal disease, but \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Einverted waveform\u003C/b\u003E\u003C/span\u003E (reduced b-wave with preserved a-wave) is typical in peripheral schisis\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EIncorrect options:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERod monochromatism\u003C/b\u003E\u003C/span\u003E: Presents with nystagmus, photophobia, and reduced acuity from infancy; foveal cysts are not typical\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECongenital stationary night blindness (CSNB)\u003C/b\u003E\u003C/span\u003E: Presents with nyctalopia and sometimes high myopia; not usually associated with foveal microcysts\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBlue cone monochromatism\u003C/b\u003E\u003C/span\u003E: A rare cone dystrophy presenting with poor central vision and photophobia; fundus changes are less specific and usually show generalized cone dysfunction rather than foveal schisis\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cimg src=\u0022https://media.springernature.com/lw685/springer-static/image/art%3A10.1038%2Feye.2017.281/MediaObjects/41433_2018_Article_BFeye2017281_Fig1_HTML.jpg?as=webp\u0022\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\u003Cdiv class=\u0022c-article-section__figure-content\u0022 style=\u0022box-sizing: inherit; margin-bottom: 16px; color: rgb(34, 34, 34); font-family: -apple-system, \u0026quot;system-ui\u0026quot;, \u0026quot;Segoe UI\u0026quot;, Roboto, Oxygen-Sans, Ubuntu, Cantarell, \u0026quot;Helvetica Neue\u0026quot;, sans-serif; letter-spacing: normal;\u0022\u003E\u003Cdiv class=\u0022c-article-section__figure-description\u0022 data-test=\u0022bottom-caption\u0022 id=\u0022figure-1-desc\u0022 style=\u0022box-sizing: inherit;\u0022\u003E\u003Cp style=\u0022overflow-wrap: break-word; word-break: break-word; box-sizing: inherit; margin-bottom: 24px;\u0022\u003E\u003Cspan style=\u0022font-size: x-small;\u0022\u003E(a\u2013e) The images correspond to a 13-year-old male patient (case No. 2) with XLRS. (a) Fundus color photography of the OD showing hyporeflective cystic spaces in the foveal and parafoveal regions. (b) SS-OCT of the OD revealing schisis (thick blue arrows) at the level of the INL (thin blue arrow). These images also show a small defect at the ELM, the EPIS ellipsoid zone, and COST (yellow rectangle). The upper/left (retinal) and lower/right (choroidal) areas show the topographic map with nine subfields as defined by the ETDRS-style grid. (c, d) A 6 \u00D7 6\u2009mm OCT-A showing superficial and deep vascular plexus (more prominent) with irregularities due to schisis at INL. OCT angiograms showed petaloid non-reflective area located predominantly inside of the deep vascular plexus. (e) An en-face OCT image at the level of the INL showing a spoke-like pattern in the foveal region and a reticular pattern in the parafoveal region.\u003C/span\u003E\u003C/p\u003E\u003Cp style=\u0022overflow-wrap: break-word; word-break: break-word; box-sizing: inherit; margin-bottom: 24px;\u0022\u003E\u003Cspan style=\u0022font-size: x-small;\u0022\u003EImage source:\u0026nbsp;\u003C/span\u003E\u003Ca href=\u0022https://www.nature.com/articles/eye2017281\u0022 target=\u0022_blank\u0022\u003ESwept-source and optical coherence tomography angiography in patients with X-linked retinoschisis\u003C/a\u003E\u003C/p\u003E\u003C/div\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 366,
    "Name": "Orbital cellulitis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following statements is \u003Cspan class=\u0022s1\u0022\u003EFALSE\u003C/span\u003E regarding \u003Cspan class=\u0022s1\u0022\u003Echildhood orbital cellulitis\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOrbital cellulitis in children\u003C/b\u003E\u003C/span\u003E is most commonly due to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eextension of ethmoid sinusitis\u003C/b\u003E\u003C/span\u003E, not maxillary sinusitis. The \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elamina papyracea -\u0026nbsp;\u003C/b\u003E\u003C/span\u003Ea thin bony wall between the ethmoid sinus and the orbit- makes ethmoiditis the most frequent source of orbital spread.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIt is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emore common over the age of 5\u003C/b\u003E\u003C/span\u003E, with an average age of presentation around \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E7 years\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECT scanning\u003C/b\u003E\u003C/span\u003E with contrast is the initial imaging modality of choice due to its rapid acquisition and ability to delineate orbital abscesses, sinus disease, and subperiosteal collections. MRI is reserved for suspected intracranial spread or complications.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIntravenous antibiotics\u003C/b\u003E\u003C/span\u003E are the first-line treatment, and surgery (e.g., drainage of an abscess) is considered if there\u2019s no improvement or if there\u2019s a confirmed collection.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 367,
    "Name": "Rod monochromatism",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EAn 18-month-old hyperopic boy presents with nystagmus, photophobia, and difficulty seeing in bright light. Visual acuity using Cardiff cards is logMAR 1.0. What is the \u003Cspan class=\u0022s1\u0022\u003Emost likely diagnosis\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThis clinical picture is classic for \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Erod monochromatism\u003C/b\u003E\u003C/span\u003E (complete achromatopsia), a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Erare autosomal recessive disorder\u003C/b\u003E\u003C/span\u003E resulting from \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecomplete absence of cone function\u003C/b\u003E\u003C/span\u003E. It presents \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ein infancy\u003C/b\u003E\u003C/span\u003E with:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ENystagmus\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPhotophobia and hemeralopia\u003C/b\u003E\u003C/span\u003E (daylight visual impairment)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EReduced visual acuity\u003C/b\u003E\u003C/span\u003E (logMAR 1.0 \u2248 Snellen 6/60)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EHypermetropia\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThese children often appear uncomfortable in daylight and demonstrate \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epoor navigation under bright conditions\u003C/b\u003E\u003C/span\u003E due to reliance on rods, which are oversaturated in photopic conditions.\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EDifferential diagnoses:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBlue cone monochromatism\u003C/b\u003E\u003C/span\u003E is milder and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EX-linked\u003C/b\u003E\u003C/span\u003E, with partial cone function (S-cones retained); \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emyopia\u003C/b\u003E\u003C/span\u003E is common, not hyperopia.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EEnhanced S-cone syndrome (Goldmann-Favre)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E presents with \u003C/span\u003E\u003Cb\u003Enyctalopia (not photophobia)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and retinal degeneration, not evident here.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EDeuteranopia\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is an isolated red-green colour vision defect, \u003C/span\u003E\u003Cb\u003Enot associated with poor acuity or photophobia\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 368,
    "Name": "Rhabdomyosarcoma",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EA 7-year-old girl presents with a \u003C/span\u003E2-week history\u003Cspan class=\u0022s1\u0022\u003E of \u003C/span\u003Epainful, unilateral axial proptosis\u003Cspan class=\u0022s1\u0022\u003E and \u003C/span\u003Elid erythema\u003Cspan class=\u0022s1\u0022\u003E. She is \u003C/span\u003Eapyrexial\u003Cspan class=\u0022s1\u0022\u003E. CT imaging reveals a \u003C/span\u003Ehomogeneous, poorly defined, non-enhancing orbital mass\u003Cspan class=\u0022s1\u0022\u003E.\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhich diagnosis is \u003C/span\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003Emost likely\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERhabdomyosarcoma\u003C/b\u003E\u003C/span\u003E is the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emost common primary orbital malignancy in children\u003C/b\u003E\u003C/span\u003E, typically presenting between ages \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E7-8 years\u003C/b\u003E\u003C/span\u003E. It characteristically causes:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ESudden-onset\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, progressive \u003C/span\u003E\u003Cb\u003Epainful proptosis\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EAxial displacement\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EErythematous lids\u003C/b\u003E\u003C/span\u003E, mimicking inflammation\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECT scan\u003C/b\u003E\u003C/span\u003E: poorly defined, non-enhancing soft tissue mass\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EKey imaging clue: \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehomogeneous mass with no enhancement\u003C/b\u003E\u003C/span\u003E, often with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebone erosion\u003C/b\u003E\u003C/span\u003E in advanced stages.\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EOther options:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELymphangioma\u003C/b\u003E\u003C/span\u003E: Usually younger children (\u0026lt;4 years), \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enon-painful\u003C/b\u003E\u003C/span\u003E, and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enon-axial\u003C/b\u003E\u003C/span\u003E; may present acutely \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eif hemorrhage\u003C/b\u003E\u003C/span\u003E occurs.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECapillary haemangioma\u003C/b\u003E\u003C/span\u003E: Common in infants (\u0026lt;1 year), usually \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esuperior orbit\u003C/b\u003E\u003C/span\u003E, painless and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eslow-growing\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EOrbital varices\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E: Present with \u003C/span\u003E\u003Cb\u003Eintermittent proptosis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, worsened by Valsalva; \u003C/span\u003E\u003Cb\u003Enot painful\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, and imaging shows \u003C/span\u003E\u003Cb\u003Edistensible venous channels\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 369,
    "Name": "Fourth Nerve Palsy",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 30-year-old man presents with \u003Cspan class=\u0022s1\u0022\u003Etorsional diplopia\u003C/span\u003E following a \u003Cspan class=\u0022s1\u0022\u003Eclosed head injury\u003C/span\u003E sustained in a motorcycle accident \u003Cspan class=\u0022s1\u0022\u003E6 months ago\u003C/span\u003E. On examination, there is \u003Cspan class=\u0022s1\u0022\u003E12\u00B0 of excyclotorsion\u003C/span\u003E.\u0026nbsp;\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhich is the most appropriate surgical intervention?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThe patient has \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebilateral fourth nerve palsy\u003C/b\u003E\u003C/span\u003E, the most common cranial nerve injury following \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eclosed head trauma\u003C/b\u003E\u003C/span\u003E, particularly when \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eexcyclotorsion \u0026gt;10\u00B0\u003C/b\u003E\u003C/span\u003E is present. Other supportive signs include:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EMinimal vertical deviation in primary gaze\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ETorsional diplopia as primary complaint\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EChin-down posture\u003C/b\u003E\u003C/span\u003E, V-pattern esotropia\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EAlternating hypertropia on head tilt\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EHarada-Ito surgery\u003C/b\u003E\u003C/span\u003E selectively tightens the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eanterior fibers of the superior oblique\u003C/b\u003E\u003C/span\u003E, which are responsible for \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eintorsion\u003C/b\u003E\u003C/span\u003E. This corrects \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eexcyclotorsion\u003C/b\u003E\u003C/span\u003E while minimally affecting vertical movement; making it the procedure of choice for \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Etorsional diplopia\u003C/b\u003E\u003C/span\u003E in bilateral fourth nerve palsy.\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EOther options:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EObservation\u003C/b\u003E\u003C/span\u003E is inappropriate given persistent, symptomatic torsional diplopia.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESuperior oblique resection\u003C/b\u003E\u003C/span\u003E risks worsening vertical misalignment.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EInferior oblique myectomy\u003C/b\u003E\u003C/span\u003E would increase excyclotorsion; contraindicated here.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cimg src=\u0022https://childrenseye.org/wiki/lib/exe/fetch.php?w=512\u0026amp;tok=e3d9bb\u0026amp;media=harada-ito.png\u0022\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\u003Ch1 class=\u0022sectionedit1 page-header pb-3 mb-4 mt-5\u0022 id=\u0022harada-ito_procedure\u0022 style=\u0022font-size: 36px; font-family: \u0026quot;Open Sans\u0026quot;, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; font-weight: 500; line-height: 1.1; color: rgb(45, 45, 45); border-bottom-width: 1px; border-bottom-color: rgb(238, 238, 238); letter-spacing: normal; margin-top: 3rem !important; margin-bottom: 1.5rem !important; padding-bottom: 1rem !important;\u0022\u003EHarada-Ito Procedure\u003Ca class=\u0022anchorjs-link \u0022 href=\u0022https://childrenseye.org/wiki/doku.php?id=harada_ito#harada-ito_procedure\u0022 aria-label=\u0022Anchor link for: harada ito_procedure\u0022 data-anchorjs-icon=\u0022\uE9CB\u0022 style=\u0022background-color: transparent; color: rgb(51, 153, 243); opacity: 0; font-family: anchorjs-icons; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-variant-position: normal; font-variant-emoji: normal; font-weight: normal; line-height: 1; padding-left: 0.375em;\u0022\u003E\u003C/a\u003E\u003C/h1\u003E\u003Cdiv class=\u0022level1\u0022 style=\u0022color: rgb(102, 102, 102); font-family: \u0026quot;Open Sans\u0026quot;, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal;\u0022\u003E\u003C/div\u003E\u003Ch2 class=\u0022sectionedit2 page-header pb-3 mb-4 mt-5\u0022 id=\u0022purpose\u0022 style=\u0022font-family: \u0026quot;Open Sans\u0026quot;, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; font-weight: 500; line-height: 1.1; color: rgb(45, 45, 45); border-bottom-width: 1px; border-bottom-color: rgb(238, 238, 238); letter-spacing: normal; margin-top: 3rem !important; margin-bottom: 1.5rem !important; padding-bottom: 1rem !important;\u0022\u003E\u003Cspan style=\u0022font-size: large;\u0022\u003EPurpose\u003Cspan style=\u0022line-height: 1; padding-left: 0.375em;\u0022\u003E\u003Ca class=\u0022anchorjs-link \u0022 href=\u0022https://childrenseye.org/wiki/doku.php?id=harada_ito#purpose\u0022 aria-label=\u0022Anchor link for: purpose\u0022 data-anchorjs-icon=\u0022\uE9CB\u0022 style=\u0022background-color: transparent; color: rgb(51, 153, 243); opacity: 0; font-family: anchorjs-icons; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-variant-position: normal; font-variant-emoji: normal; font-weight: normal; line-height: 1; padding-left: 0.375em;\u0022\u003E\u003C/a\u003E\u003C/span\u003E\u003C/span\u003E\u003C/h2\u003E\u003Cdiv class=\u0022level2\u0022 style=\u0022color: rgb(102, 102, 102); font-family: \u0026quot;Open Sans\u0026quot;, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal;\u0022\u003E\u003Cul class=\u0022 fix-media-list-overlap\u0022 style=\u0022margin-bottom: 10px; overflow: hidden;\u0022\u003E\u003Cli class=\u0022level1\u0022\u003E\u003Cdiv class=\u0022li\u0022\u003EStrengthen Incylotorsion effect of the Superior Oblique without affecting vertical alignment\u003C/div\u003E\u003C/li\u003E\u003Cli class=\u0022level1\u0022\u003E\u003Cdiv class=\u0022li\u0022\u003EMost useful with a functioning superior oblique and excyclotorsion present\u003C/div\u003E\u003C/li\u003E\u003Cli class=\u0022level1\u0022\u003E\u003Cdiv class=\u0022li\u0022\u003ECan create 10-15 degrees of incyclotorsion\u003C/div\u003E\u003C/li\u003E\u003Cli class=\u0022level1\u0022\u003E\u003Cdiv class=\u0022li\u0022\u003EThe effect may wain 20-30% with time\u003C/div\u003E\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003Ch2 class=\u0022sectionedit3 page-header pb-3 mb-4 mt-5\u0022 id=\u0022description\u0022 style=\u0022font-family: \u0026quot;Open Sans\u0026quot;, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; font-weight: 500; line-height: 1.1; color: rgb(45, 45, 45); border-bottom-width: 1px; border-bottom-color: rgb(238, 238, 238); letter-spacing: normal; margin-top: 3rem !important; margin-bottom: 1.5rem !important; padding-bottom: 1rem !important;\u0022\u003E\u003Cspan style=\u0022font-size: large;\u0022\u003EDescription\u003C/span\u003E\u003C/h2\u003E\u003Ch2 class=\u0022sectionedit3 page-header pb-3 mb-4 mt-5\u0022 id=\u0022description\u0022 style=\u0022font-family: \u0026quot;Open Sans\u0026quot;, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; font-weight: 500; line-height: 1.1; color: rgb(45, 45, 45); border-bottom-width: 1px; border-bottom-color: rgb(238, 238, 238); letter-spacing: normal; margin-top: 3rem !important; margin-bottom: 1.5rem !important; padding-bottom: 1rem !important;\u0022\u003E\u003Cspan style=\u0022color: rgb(102, 102, 102); font-size: 14px; font-weight: 400;\u0022\u003ETranspose the anterior 1/3 to 1/2 of the superior oblique tendon fibers to the superior border of the lateral rectus muscle. Fixate the tendon 8 mm posterior to and 2 mm superior to the superior border of the lateral rectus muscle. Tightening only the radially oriented fibers will avoid a significant change in vertical deviation but there may be an exoshift in down-gaze.\u003C/span\u003E\u003C/h2\u003E\u003Cdiv class=\u0022level2\u0022 style=\u0022color: rgb(102, 102, 102); font-family: \u0026quot;Open Sans\u0026quot;, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal;\u0022\u003E\u003Cp style=\u0022margin-bottom: 10px;\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp style=\u0022margin-bottom: 10px;\u0022\u003ESource:\u0026nbsp;\u003Ca href=\u0022https://childrenseye.org/wiki/doku.php?id=harada_ito\u0022 target=\u0022_blank\u0022\u003EHarada Ito\u003C/a\u003E\u003C/p\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 370,
    "Name": "Intermittent exotropia",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EWhat is the \u003C/span\u003Emost common form of exotropia\u003Cspan class=\u0022s1\u0022\u003E seen in \u003C/span\u003Echildhood\u003Cspan class=\u0022s1\u0022\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIntermittent exotropia\u003C/b\u003E\u003C/span\u003E is the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emost frequent type of exotropia in children\u003C/b\u003E\u003C/span\u003E, typically presenting between \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E2 and 5 years of age\u003C/b\u003E\u003C/span\u003E. It is often noticed by parents when the child is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edaydreaming, tired, or fixating at distance\u003C/b\u003E\u003C/span\u003E. The deviation is not constant and may be well-controlled for near tasks in early stages.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EOver time, intermittent exotropia may \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eprogress to constant exotropia\u003C/b\u003E\u003C/span\u003E if untreated. Management depends on the frequency and severity of the deviation and may include \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eobservation, orthoptic exercises, or surgery\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EOther options:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EConsecutive exotropia\u003C/b\u003E\u003C/span\u003E occurs \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epostoperatively\u003C/b\u003E\u003C/span\u003E after overcorrection of esotropia.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EInfantile exotropia\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is rare and often associated with \u003C/span\u003E\u003Cb\u003Eneurological or syndromic disorders\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ESecondary exotropia\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E refers to exotropia from \u003C/span\u003E\u003Cb\u003Evision loss or disruption of fusion\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 371,
    "Name": "Consecutive exotropia",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following statements is \u003Cspan class=\u0022s1\u0022\u003ETRUE\u003C/span\u003E regarding \u003Cspan class=\u0022s1\u0022\u003Econsecutive exotropia\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EConsecutive exotropia\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E refers to an \u003C/span\u003E\u003Cb\u003Eexodeviation that develops following surgical correction of esotropia\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E. It is \u003C/span\u003E\u003Cb\u003Emore common in hyperopic children\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, especially if a reduction in hyperopic correction decreases the accommodative-convergence drive.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003EIncreasing \u003Cspan class=\u0022s2\u0022\u003E\u003Cb\u003Emyopic correction\u003C/b\u003E\u003C/span\u003E (or reducing hyperopic correction) can enhance accommodative effort and \u003Cspan class=\u0022s2\u0022\u003E\u003Cb\u003Estimulate convergence\u003C/b\u003E\u003C/span\u003E, thereby \u003Cspan class=\u0022s2\u0022\u003E\u003Cb\u003Ereducing the angle of exotropia\u003C/b\u003E\u003C/span\u003E. This approach can help manage small-angle deviations nonsurgically.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003EKey facts:\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOccurs after esotropia surgery\u003C/b\u003E\u003C/span\u003E, not exotropia.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAdduction is usually preserved\u003C/b\u003E\u003C/span\u003E, unless there\u2019s muscle slippage or scarring.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIt is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emore common in hyperopes\u003C/b\u003E\u003C/span\u003E, not myopes.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 372,
    "Name": "Brown Syndrome",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EAn 8-year-old girl is noted on routine examination to have limited elevation in adduction of the right eye. Elevation in abduction is full. There is overaction of the left superior rectus, with otherwise normal ocular motility. Bielschowsky head tilt test is negative.\u0026nbsp;\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhat is the most likely diagnosis?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBrown\u2019s syndrome\u003C/b\u003E\u003C/span\u003E is caused by a restriction of the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esuperior oblique tendon\u003C/b\u003E\u003C/span\u003E (typically at the trochlea), leading to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elimited elevation in adduction\u003C/b\u003E\u003C/span\u003E. Key features include:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ENormal elevation in abduction\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ENo muscle sequelae\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, apart from possible \u003C/span\u003E\u003Cb\u003Econtralateral superior rectus overaction\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (as seen here)\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ENegative Bielschowsky head tilt test\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ENo superior oblique overaction (which would suggest an IO palsy)\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003EThe \u003C/span\u003E\u003Cb\u003Emost important differential\u003C/b\u003E\u003Cspan class=\u0022s3\u0022\u003E is \u003C/span\u003E\u003Cb\u003Einferior oblique palsy\u003C/b\u003E\u003Cspan class=\u0022s3\u0022\u003E, but this would typically:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EShow \u003C/span\u003E\u003Cb\u003Epositive head tilt test\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EDemonstrate \u003C/span\u003E\u003Cb\u003Esuperior oblique overaction\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EShow \u003C/span\u003E\u003Cb\u003Efull muscle sequelae\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EOther options ruled out:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EDuane\u2019s syndrome\u003C/b\u003E\u003C/span\u003E (typically involves limited abduction/adduction and globe retraction, not vertical restriction)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESuperior rectus restriction\u003C/b\u003E\u003C/span\u003E would not spare elevation in abduction\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EClick on the link below to see a video of Brown syndrome:\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Ca href=\u0022https://youtu.be/EIFdiWftzsI?si=9AqrTolzQ9lBQ6Xk\u0022 target=\u0022_blank\u0022\u003EBrown Syndrome video\u003C/a\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 373,
    "Name": "Side effects of Immunosuppressive agent",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA patient is started on an immunosuppressive agent for retinal vasculitis. The patient develops gum hyperplasia. Which of the following drugs is MOST likely to cause this complication?\u003C/div\u003E",
    "Explanation": "The correct answer is Ciclosporin.\u003Cdiv\u003E\u003Cbr\u003E\u003Cdiv\u003EGingival hyperplasia is a well\u2011recognised adverse effect of ciclosporin therapy, caused by increased fibroblast proliferation and excessive extracellular matrix deposition within gingival tissues. This complication is classically associated with ciclosporin and is significantly less common with tacrolimus, despite both being calcineurin inhibitors.\u0026nbsp;\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003EMycophenolate mofetil does not cause gingival overgrowth; instead, it commonly produces gastrointestinal upset and bone\u2011marrow suppression.\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003EPrednisolone is also not associated with gum hyperplasia and typically causes Cushingoid features, hyperglycaemia, and osteoporosis.\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 5,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 374,
    "Name": "Interpretation of an anterior\u2011surface corneal topography map",
    "Body": "A patient undergoes corneal topography as part of the evaluation for reduced best\u2011corrected visual acuity. Based on the topography map shown, what is the most likely diagnosis?\u003Cdiv\u003E\u003Cimg src=\u0022/upload-2026-02-02-be6736f0-8497-44dd-ae4c-59b7d5863b05.png\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EThe most likely diagnosis is postoperative LASIK.\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EThe topography shows a large central flattened zone (blue) surrounded by a relatively normal or steeper mid\u2011periphery (green\u2013yellow\u2013red). This pattern reflects the typical myopic ablation profile seen after LASIK, where central corneal tissue is removed, producing central flattening rather than steepening. In contrast, keratoconus shows inferior steepening, not central flattening, with a pronounced warm\u2011coloured cone; this is clearly absent here.\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EPellucid marginal degeneration presents a characteristic \u201Ccrab\u2011claw\u201D or \u201Cbutterfly\u201D pattern with inferior band\u2011like thinning and peripheral steepening, which is also not present.\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003ECentral corneal scarring would yield irregular, non\u2011symmetric distortions rather than a smooth, symmetric ablation\u2011type flattening pattern.\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EThe simulated keratometry values in the mid\u201130s further support a post\u2011ablation cornea, as keratoconus typically shows increased K values ( \u0026gt;47 D ) from steepening, not reduced ones. Taken together, the round central blue zone, surrounding steeper periphery, low K values, and regular symmetric appearance strongly indicate a post\u2011LASIK corneal surface rather than ectasia or scarring.\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 375,
    "Name": "Most suitable mydriatic regimen for a 4\u2011month\u2011old baby",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhat is the MOST suitable mydriatic regime for dilating the pupils of a baby aged four months?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EThe correct answer is \u003Cstrong\u003Ephenylephrine 2.5% plus cyclopentolate 0.5%\u003C/strong\u003E.\u0026nbsp;\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EIn a 4\u2011month\u2011old, the key exam principle is to achieve reliable dilation while minimising systemic toxicity: infants are particularly susceptible to anticholinergic CNS and cardiopulmonary adverse effects from cyclopentolate, so \u003Cstrong\u003E0.5% is the preferred infant strength\u003C/strong\u003E rather than 1% (which increases the risk of agitation, feeding intolerance, tachycardia, and other systemic effects).\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EPhenylephrine is added to improve mydriasis by stimulating the dilator muscle, and \u003Cstrong\u003E2.5% is the standard paediatric concentration\u003C/strong\u003E used in infant examination protocols; higher concentrations increase the likelihood of systemic hypertension/tachycardia and are generally avoided when a lower strength is adequate.\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhen dilating babies, an important practical safety point that examiners like is to reduce systemic absorption by nasolacrimal occlusion and wiping excess drops, which is specifically recommended in neonatal/infant guidance.\u003C/span\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 14,
    "Category": null,
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  },
  {
    "Id": 376,
    "Name": "Familial Exudative Vitreoretinopathy (FEVR) \u2014 least likely to be true",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich of the following statements regarding Familial Exudative Vitreoretinopathy (FEVR) is LEAST likely to be true?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EThe correct answer \u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003Eis \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003EFEVR is most commonly inherited in an autosomal recessive pattern\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E.\u003C/span\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EMost individuals with FEVR have an \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Eautosomal dominant\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E form, especially in association with \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003EFZD4\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E or \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003ELRP5\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E, so autosomal recessive inheritance is not the predominant pattern.\u003C/span\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\n\u003Cstrong\u003ELinkage to chromosome 11\u003C/strong\u003E is well established, as several major FEVR\u2011related genes\u2014including \u003Cstrong\u003EFZD4\u003C/strong\u003E and \u003Cstrong\u003ELRP5\u003C/strong\u003E\u2014are located on this chromosome. \u003Cbr\u003E\n\u003Cstrong\u003ESubretinal exudates\u003C/strong\u003E are compatible with the disease, since abnormal peripheral vascularisation leads to leakage and exudation.\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u0026nbsp; \u003Cbr\u003EFEVR also contributes to \u003Cstrong\u003Eretinal detachments in infants and children\u003C/strong\u003E, as incomplete vascularisation and secondary traction can lead to detachment early in life.\u003C/div\u003E\u003C!--EndFragment--\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 377,
    "Name": "headaches, disc swelling, retinal haemorrhages and cotton\u2011wool spots",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 24\u2011year\u2011old man has been feeling slightly unwell for two weeks and complains of constant headaches. His visual acuity is 0.00 LogMAR each eye. His optic discs appear swollen. There are scattered retinal haemorrhages and cotton wool spots in both eyes. Which one of the following is the MOST likely diagnosis?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EThe most likely diagnosis is \u003Cstrong\u003Emalignant hypertension\u003C/strong\u003E. The combination of bilateral disc swelling, cotton\u2011wool spots, and widespread retinal haemorrhages strongly aligns with the retinal picture described in acute severe hypertension. Malignant hypertension produces end\u2011organ retinal damage with cotton\u2011wool spots, intraretinal haemorrhages, hard exudates, and papilloedema in severe cases, as documented in clinical series and reviews of hypertensive retinopathy.\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003EDiabetic retinopathy generally develops after years of hyperglycaemia and rarely presents acutely with disc oedema in an otherwise well young adult. Idiopathic intracranial hypertension can cause papilloedema but does not produce bilateral cotton\u2011wool spots and haemorrhages of this pattern. Optic nerve drusen causes pseudopapilloedema rather than true swelling and does not cause widespread ischaemic retinal signs. The acute retinal findings here\u2014cotton\u2011wool spots, haemorrhages, and swollen discs\u2014form the classic appearance of hypertensive crisis affecting the retina.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 378,
    "Name": "82\u2011year\u2011old with IOP 23\u202FmmHg",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich of these treatments is MOST likely to be appropriate for an 82\u2011year\u2011old with an intraocular pressure of 23\u202FmmHg and a cup\u2011to\u2011disc ratio of 0.7 with full visual fields and no family history of glaucoma?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EThe most appropriate option is \u003Cstrong\u003Ereview in six months\u003C/strong\u003E.\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EAn intraocular pressure of 23\u202FmmHg in an elderly patient, combined with a cup\u2013disc ratio of 0.7 but \u003Cstrong\u003Enormal visual fields\u003C/strong\u003E and \u003Cstrong\u003Eno family history\u003C/strong\u003E, is highly consistent with \u003Cstrong\u003Ephysiological cupping\u003C/strong\u003E rather than established glaucoma. Optic disc size increases with age, and larger discs can naturally display larger cups without corresponding neuroretinal rim loss.\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EIn this situation, initiating treatment with a beta\u2011blocker or a prostaglandin analogue is unnecessary without evidence of progressive structural or functional change.\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EDischarging the patient is also premature because the optic nerve appearance still warrants cautious observation. A planned re\u2011evaluation in six months allows monitoring for any early structural or pressure\u2011related progression while avoiding overtreatment.\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 379,
    "Name": "cataract surgery with new bradycardia",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EYou are about to start cataract surgery on a 78\u2011year\u2011old woman when you notice that the pulse oximeter is recording a pulse of 40\u202FBPM. At pre\u2011assessment her pulse rate was 65\u202FBPM. She is a type 2 diabetic on metformin and has glaucoma treated with timolol drops. She has no chest pain, breathlessness or palpitations. Which management is MOST appropriate?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EThe most appropriate management is \u003Cstrong\u003Eto defer surgery and undertake medical assessment\u003C/strong\u003E.\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA new bradycardia of 40\u202FBPM in an elderly patient represents a significant perioperative risk, even in the absence of symptoms. Topical timolol can cause systemic beta\u2011blockade with clinically relevant bradycardia, and older adults are particularly susceptible. Proceeding with surgery under local anaesthesia still carries cardiovascular risk if the cause of the bradycardia has not been evaluated.\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EContinuing with the operation or simply informing the GP fails to address a potentially unstable underlying cardiac issue, while immediate referral for assessment ensures safe optimisation and consideration of modifying or withholding timolol if needed.\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 1,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 380,
    "Name": "Blepharoplasty with IOP 40\u202FmmHg",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EAn elderly woman presents to A\u0026amp;E three hours after bilateral lower lid blepharoplasties. She reports pain and sudden loss of vision in her right eye. The casualty officer measures an intraocular pressure of 40\u202FmmHg. Which of the following is MOST likely to be an appropriate part of your IMMEDIATE management?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022line-height: 20px;\u0022\u003E\u003Cspan style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; letter-spacing: 0.14994px;\u0022\u003EThe most appropriate immediate step is \u003C/span\u003E\u003Cstrong style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; letter-spacing: 0.14994px;\u0022\u003Edisinsertion of the lids from the lateral canthus\u003C/strong\u003E\u003Cspan style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; letter-spacing: 0.14994px;\u0022\u003E.\u003C/span\u003E\u003Cbr\u003E\u003Cspan style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003Cspan style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; letter-spacing: 0.14994px;\u0022\u003ESudden vision loss, severe periocular pain, and a marked rise in intraocular pressure shortly after eyelid surgery strongly indicate an \u003C/span\u003E\u003Cstrong style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; letter-spacing: 0.14994px;\u0022\u003Eorbital compartment syndrome\u003C/strong\u003E\u003Cspan style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; letter-spacing: 0.14994px;\u0022\u003E caused by postoperative retrobulbar haemorrhage.\u003C/span\u003E\u003Cbr\u003E\u003Cspan style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003Cspan style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; letter-spacing: 0.14994px;\u0022\u003EVision depends on immediate decompression to restore perfusion to the optic nerve and retina. The most effective and time\u2011critical intervention is \u003C/span\u003E\u003Cstrong style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; letter-spacing: 0.14994px;\u0022\u003Eurgent lateral canthotomy and inferior cantholysis\u003C/strong\u003E\u003Cspan style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; letter-spacing: 0.14994px;\u0022\u003E, which rapidly relieves orbital pressure.\u003C/span\u003E\u003Cbr\u003E\u003Cspan style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003Cspan style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; letter-spacing: 0.14994px;\u0022\u003EMedical therapy such as intravenous acetazolamide or corticosteroids may be used as adjuncts but \u003C/span\u003E\u003Cstrong style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; letter-spacing: 0.14994px;\u0022\u003Emust not delay decompression\u003C/strong\u003E\u003Cspan style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; letter-spacing: 0.14994px;\u0022\u003E.\u003C/span\u003E\u003Cbr\u003E\u003Cspan style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003Cspan style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; letter-spacing: 0.14994px;\u0022\u003EOpening the surgical wound alone is insufficient to decompress the orbit effectively.\u003C/span\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 381,
    "Name": "Thyroid eye disease \u2013 muscle involvement sequence",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EIn thyroid eye disease, the MOST likely sequence of muscle involvement is:\u003C/span\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EThe correct sequence is \u003Cstrong\u003Einferior rectus \u2192 medial rectus \u2192 superior rectus \u2192 lateral rectus\u003C/strong\u003E.\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EThyroid eye disease classically follows the \u201CI\u2011M\u2011S\u2011L\u201D pattern, with the inferior rectus being the most commonly and most severely affected muscle due to its high glycosaminoglycan deposition and tight fascial constraints, leading to early restriction in upgaze. The medial rectus is generally involved next, producing esotropia and limited abduction. Superior rectus involvement follows, and the lateral rectus is typically the last muscle affected. This well\u2011recognised progression reflects the anatomical susceptibility and compartmental characteristics of each extraocular muscle within the orbit.\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E(A similar question appeared in a previous FRCOphth part 2 written exam)\u003C/span\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 382,
    "Name": "FAP\u2011associated retinal finding",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EFamilial adenomatous polyposis is MOST likely to be associated with which of the following?\u003C/span\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EThe correct association is \u003Cstrong\u003Emultiple atypical CHRPE\u003C/strong\u003E.\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EIn familial adenomatous polyposis, the retinal lesions are typically numerous, bilateral, and characteristically irregular in shape with scalloped or depigmented margins. They differ from solitary CHRPE and from grouped bear\u2011track pigmentation, both of which are benign, unrelated findings.\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EMultiple atypical lesions are highly specific and may appear years before gastrointestinal manifestations, making them a valuable ocular marker in affected families.\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E(A similar question appeared in a previous FRCOphth part 2 written exam)\u003C/span\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 383,
    "Name": "GCA second\u2011line therapy",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich second\u2011line agent is NOT recommended for Giant Cell Arteritis according to the British Society of Rheumatology Guidelines (2020)?\u003C/span\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EThe correct answer is Tumour Necrosis Factor inhibitor.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E The 2020 BSR guideline emphasises glucocorticoids with steroid\u2011sparing evidence only for \u003Cstrong\u003Etocilizumab\u003C/strong\u003E and, to a lesser extent, \u003Cstrong\u003Emethotrexate\u003C/strong\u003E, and it \u003Cstrong\u003Edoes not recommend anti\u2011TNF therapy\u003C/strong\u003E for GCA.\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EAzathioprine or ciclosporin\u003C/span\u003E may be considered only in selected cases with limited evidence, whereas \u003Cspan style=\u0022font-weight: bold;\u0022\u003Edapsone \u003C/span\u003Eis not a recommended therapy but the guideline\u2019s explicit \u201Cdo not use\u201D stance applies to anti\u2011TNF agents- hence this is the best \u201CNOT recommended\u201D choice.\u003C/p\u003E\n\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E(A similar question appeared in a previous FRCOphth part 2 written exam)\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 12,
    "Category": null,
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  },
  {
    "Id": 384,
    "Name": "Orthoptic tests",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following tests \u003Cspan class=\u0022s1\u0022\u003Edoes not require the use of glasses\u003C/span\u003E for completion?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThe \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EFrisby Test\u003C/b\u003E\u003C/span\u003E evaluates stereoacuity using real depth cues created by varying the thickness of transparent plates, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Erequiring no glasses\u003C/b\u003E\u003C/span\u003E. It\u2019s ideal for children and patients unable to tolerate or understand glasses-based tests.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EIn contrast:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ETitmus Fly\u003C/b\u003E\u003C/span\u003E test uses \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPolaroid glasses\u003C/b\u003E\u003C/span\u003E to present separate images to each eye for stereoacuity assessment.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ETNO Test\u003C/b\u003E\u003C/span\u003E uses \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ered-green anaglyph glasses\u003C/b\u003E\u003C/span\u003E for stereopsis testing with random dot patterns.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EWorth 4-Dot Test\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E requires \u003C/span\u003E\u003Cb\u003Ered-green glasses\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E to assess \u003C/span\u003E\u003Cb\u003Ebinocular vision, suppression\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, and \u003C/span\u003E\u003Cb\u003Eretinal correspondence\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-03-a082ae16-a58c-445c-b12e-0c29eb2a93bb.png\u0022\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 385,
    "Name": "Alphabet Patterns",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following surgical approaches is \u003Cspan class=\u0022s1\u0022\u003Emost appropriate\u003C/span\u003E for correcting an \u003Cspan class=\u0022s1\u0022\u003EA\u2011pattern strabismus\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EAn \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EA\u2011pattern deviation\u003C/b\u003E\u003C/span\u003E is characterized by \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Egreater esodeviation in upgaze\u003C/b\u003E\u003C/span\u003E and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Egreater exodeviation in downgaze\u003C/b\u003E\u003C/span\u003E. Surgical correction aims to weaken the pattern by altering the vertical position of the horizontal rectus muscles.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe useful mnemonic is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMALE\u003C/b\u003E\u003C/span\u003E:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EMedial recti \u2192 Apex\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E of the pattern\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ELateral recti \u2192 Ends\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E of the pattern\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EFor an \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EA\u2011pattern\u003C/b\u003E\u003C/span\u003E, the apex is in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eupgaze\u003C/b\u003E\u003C/span\u003E:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThe \u003C/span\u003E\u003Cb\u003Emedial recti are transposed superiorly\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThe \u003C/span\u003E\u003Cb\u003Elateral recti are transposed inferiorly\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThis repositions the muscles to reduce the vertical incomitance responsible for the pattern.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 386,
    "Name": "Chemical injury",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA patient presents with a chemical (alkali) injury to the left eye. Which of the following clinical signs is the \u003Cspan class=\u0022s1\u0022\u003Emost concerning\u003C/span\u003E indicator of severe ocular damage?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThe \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERoper-Hall classification\u003C/b\u003E\u003C/span\u003E is used to assess severity and prognosis in ocular chemical injuries. Among the features listed:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EStromal haze obscuring the iris\u003C/b\u003E\u003C/span\u003E suggests \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGrade IV injury\u003C/b\u003E\u003C/span\u003E, associated with a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epoor visual prognosis\u003C/b\u003E\u003C/span\u003E due to deep stromal damage and risk of limbal stem cell failure.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ELimbal ischaemia of 30%\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E falls within \u003C/span\u003E\u003Cb\u003EGrade II\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, with a relatively \u003C/span\u003E\u003Cb\u003Efavourable prognosis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELoss of epithelium\u003C/b\u003E\u003C/span\u003E is expected in chemical injuries and alone does not indicate poor prognosis.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAC flare\u003C/b\u003E\u003C/span\u003E reflects intraocular inflammation but is not a primary prognostic marker compared to corneal and limbal findings.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe degree of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecorneal transparency loss\u003C/b\u003E\u003C/span\u003E (as seen with stromal haze obscuring iris details) is a critical indicator of structural compromise and correlates with long-term visual outcomes.\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cimg src=\u0022https://eyewiki-images.s3.us-east-va.perf.cloud.ovh.us/1/1b/Burnlegend2.JPG\u0022\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 13,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 387,
    "Name": "Persistent epithelial defects",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA patient presents 10 days after a chemical injury to the right eye with a \u003Cspan class=\u0022s1\u0022\u003Epersistent, non-healing corneal epithelial defect\u003C/span\u003E measuring 6\u00D74\u202Fmm. There is \u003Cspan class=\u0022s1\u0022\u003Eno stromal scarring\u003C/span\u003E. What is the most appropriate next step in management?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EIn the subacute phase of a chemical injury, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epersistent epithelial defects\u003C/b\u003E\u003C/span\u003E that fail to heal by day 10 despite conservative therapy (e.g. lubrication, vitamin C, antibiotics) may benefit from \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eamniotic membrane grafting (AMT)\u003C/b\u003E\u003C/span\u003E. AMT promotes epithelialization, reduces inflammation, and provides a biological scaffold for healing.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ETopical steroids\u003C/b\u003E\u003C/span\u003E should be avoided at this stage as they \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eimpair epithelial healing\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELimbal stem cell transplantation\u003C/b\u003E\u003C/span\u003E is inappropriate in the presence of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eongoing inflammation\u003C/b\u003E\u003C/span\u003E and should be delayed until the ocular surface is stabilized.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPreservative-free lubricants\u003C/b\u003E\u003C/span\u003E are essential but alone insufficient for large, persistent epithelial defects.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-03-102b039c-d565-4e8d-a71c-9c82934348a9.jpg\u0022\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 388,
    "Name": "Soft CL wear \u0026 microbial keratitis",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich of the following is MOST likely to be true with respect to soft contact lens wear and microbial keratitis?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E \u003Cstrong\u003EThe correct answer is Removal of the contact lens is advised if the eye becomes red, even if the eye is comfortable.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\nStandard patient\u2011safety advice is to \u003Cstrong\u003Eremove lenses immediately and seek eye care if redness, pain, photophobia or blurred vision occur\u003C/strong\u003E, because these can herald microbial keratitis.  Sleeping in lenses \u003Cstrong\u003Edoes increase infection risk\u003C/strong\u003E, including with modern extended\u2011wear and silicone hydrogel designs.  Swimming \u003Cstrong\u003Eis not made safe by chlorination\u003C/strong\u003E; water exposure (pools, hot tubs, showers) is a recognised risk for \u003Cstrong\u003EAcanthamoeba\u003C/strong\u003E and other pathogens in contact lens wearers\u2014lenses should be removed before water activities.  Routine \u201Cweekly\u201D protein removal is \u003Cstrong\u003Enot a universal recommendation\u003C/strong\u003E with today\u2019s care systems; current guidance emphasises daily \u003Cstrong\u003Erub\u2011and\u2011rinse\u003C/strong\u003E and appropriate disinfection with multipurpose or peroxide systems rather than fixed weekly enzymatic cleaning for all users.\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E(A similar question appeared in a previous FRCOphth part 2 written exam)\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 389,
    "Name": "Iridodialysis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA patient presents one month after blunt ocular trauma from a golf ball to the right eye. At the time of injury, there was a 30% hyphaema and \u003Cspan class=\u0022s1\u0022\u003Evitreous prolapse into the anterior chamber\u003C/span\u003E. Current intraocular pressure is \u003Cspan class=\u0022s1\u0022\u003E30\u202FmmHg\u003C/span\u003E.\u0026nbsp;\u003Cspan class=\u0022s2\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhat is the \u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003Emost likely cause\u003C/span\u003E\u003Cspan class=\u0022s2\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EWhile \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eangle recession\u003C/b\u003E\u003C/span\u003E is a common long-term cause of raised IOP following blunt trauma, this scenario includes \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Evitreous prolapse into the anterior chamber\u003C/b\u003E\u003C/span\u003E, which is an important clue suggesting \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eiridodialysis\u003C/b\u003E\u003C/span\u003E with zonular dehiscence. Iridodialysis refers to the disinsertion of the iris root from the ciliary body, and if extensive enough, it may allow \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Evitreous to prolapse through a peripheral defect\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EKey findings pointing to iridodialysis:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EHyphaema\u003C/b\u003E\u003C/span\u003E: Occurs due to tearing at the iris root (common in iridodialysis).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EVitreous in anterior chamber\u003C/b\u003E\u003C/span\u003E: Suggests a structural defect at the iris root or angle, especially when associated with zonular dehiscence.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIOP elevation\u003C/b\u003E\u003C/span\u003E: Can occur if the prolapsed vitreous blocks the trabecular meshwork or due to associated trabecular trauma.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EBy contrast:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAngle recession\u003C/b\u003E\u003C/span\u003E is associated with IOP elevation and can occur alongside these signs, but does \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot explain\u003C/b\u003E\u003C/span\u003E anteriorly displaced vitreous unless zonular or iris root trauma coexists.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECyclodialysis cleft\u003C/b\u003E\u003C/span\u003E typically causes \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehypotony\u003C/b\u003E\u003C/span\u003E, not hypertension.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAqueous misdirection\u003C/b\u003E\u003C/span\u003E usually arises post-surgery and is rare post-trauma.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESummary\u003C/b\u003E\u003C/span\u003E: While both angle recession and iridodialysis are possible post-trauma, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eiridodialysis better explains all clinical features here\u003C/b\u003E\u003C/span\u003E, including hyphaema, vitreous prolapse, and raised IOP.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb style=\u0022text-decoration-line: underline;\u0022\u003EFurther Reading:\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cspan style=\u0022font-weight: bold; font-style: italic;\u0022\u003EAngle-recession glaucoma: long-term clinical outcomes over a 10-year period in traumatic microhyphema.\u003C/span\u003E\u0026nbsp;\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003ENg DS, Ching RH, Chan CW.\u0026nbsp;\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u2022\t62 out of 97 patients had microhyphema and 35 had gross hyphema.\u0026nbsp;\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u0026nbsp;\u2022\tAmong the traumatic microhyphema patients, 47 (75.8 %) had angle recession and 4 (6.5 %) had glaucoma with mean follow-up of 49 months (range 6-98 months).\u0026nbsp;\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u0026nbsp;\u2022\tA statistically significant association was found between angle recession greater than 180\u00B0 and the occurrence of glaucoma (p \u0026lt; 0.01).\u0026nbsp;\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u0026nbsp;\u2022\tNo statistically significant differences were found between groups of patients with microhyphema or gross hyphema regarding the incidence of angle recession and glaucoma.\u0026nbsp;\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u0026nbsp;\u2022\tThe complications of angle recession and glaucoma in patients after traumatic microhyphema appear similar to those found in patients after gross hyphema.\u0026nbsp;\u0026nbsp;\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 13,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 390,
    "Name": "Ciliary body melanoma sign",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 60\u2011year\u2011old woman presents with a pigmented lesion in the periphery of her left iris. Which of these characteristics would make you MOST suspicious of a ciliary body melanoma?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cstrong\u003EAnswer:\u003C/strong\u003E \u003Cstrong\u003EProminent episcleral vessel in the same quadrant.\u003C/strong\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\nA dilated, tortuous \u003Cstrong\u003Eepiscleral \u201Csentinel\u201D vessel\u003C/strong\u003E overlying the quadrant of a pigmented peripheral iris lesion is a classic warning sign of an underlying ciliary body melanoma because the tumour recruits deep scleral/episcleral blood supply. Conjunctival vessels are more superficial and less specific; an \u003Cstrong\u003Eirregular pupil\u003C/strong\u003E is nonspecific (can occur with benign iris lesions, synechiae or previous inflammation); and a \u003Cstrong\u003E\u201Csatellite\u201D lesion\u003C/strong\u003E implies conjunctival melanoma spread rather than a hidden ciliary body mass. In suspected cases, confirm with gonioscopy and anterior\u2011segment imaging (UBM/AS\u2011OCT), and look for secondary signs such as sectoral cataract or raised IOP.\u0026nbsp;\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E(A similar question appeared in a previous FRCOphth part 2 written exam)\u003C/span\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 391,
    "Name": "Ocular myasthenia \u2014 first\u2011line test",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cdiv style=\u0022line-height: 20px;\u0022\u003EA patient presents with right\u2011sided ptosis and intermittent binocular diplopia. They feel otherwise well and deny breathing or swallowing problems. Examination reveals normal eye movements and pupils, but the ptosis becomes worse following sustained up\u2011gaze. You also notice the right upper eyelid twitch when the patient takes up fixation after looking down.\u003Cbr\u003EWhat is the best first\u2011line investigation to confirm the diagnosis?\u003C/div\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cstrong\u003EAcetylcholine receptor antibodies\u003C/strong\u003E are the best first\u2011line investigation. The history of fatigable ptosis and intermittent diplopia with \u003Cstrong\u003ECogan\u2019s lid twitch\u003C/strong\u003E after downgaze is typical of ocular myasthenia. A serologic test is non\u2011invasive, widely available, and sufficiently specific to confirm the diagnosis when positive, even though sensitivity is lower in purely ocular disease.\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cstrong\u003ESingle\u2011fibre electromyography\u003C/strong\u003E is the most sensitive test but is resource\u2011intensive and not usually the first step.\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cstrong\u003ETensilon (edrophonium) testing\u003C/strong\u003E has largely fallen out of favour due to safety and availability issues.\u0026nbsp;\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cstrong\u003E\u003Cbr\u003E\u003C/strong\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cstrong\u003EMRI head\u003C/strong\u003E is not needed first when the clinical picture strongly suggests neuromuscular junction disease without localising neurological signs; imaging is reserved for atypical features or to exclude alternative pathology.\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E(A similar question appeared in a previous FRCOphth part 2 written exam)\u003C/span\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 392,
    "Name": "Orbital radiotherapy in thyroid eye disease",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich of the following statements relating to the administration of external beam orbital radiotherapy for thyroid\u2011associated ophthalmopathy is MOST likely to be correct?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cstrong\u003EIt is effective in patients with ocular motility problems\u003C/strong\u003E.\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EExternal beam orbital radiotherapy is particularly useful for active, moderate disease with restrictive myopathy, reducing EOM inflammation and improving diplopia (typical regimen ~20\u202FGy in 10 fractions).\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EIt is \u003Cstrong\u003Enot\u003C/strong\u003E usually repeatable because of cumulative orbital dose constraints, whereas iodine\u2011131 therapy for thyroid disease can be repeated.\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cstrong\u003EDiabetic retinopathy\u003C/strong\u003E is a relative contraindication due to risk of radiation retinopathy, so radiotherapy is not the treatment of choice in such patients.\u0026nbsp;\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EEfficacy is \u003Cstrong\u003Eenhanced when combined with systemic corticosteroids\u003C/strong\u003E, not with iodine\u2011131, which may actually exacerbate thyroid eye disease unless steroid\u2011covered.\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u0026nbsp;(A similar question appeared in a previous FRCOphth part 2 written exam)\u003C/span\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 393,
    "Name": "Nyctalopia after bariatric surgery",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 54\u2011year\u2011old female underwent bariatric surgery two years previously to try and control her weight. She is now complaining of nyctalopia. Which of these vitamins is the MOST likely therapy the patient requires?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer:\u003C/strong\u003E \u003Cstrong\u003EVitamin A.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\nBariatric (especially malabsorptive) procedures can lead to deficiency of fat\u2011soluble vitamins; vitamin A deficiency is a well\u2011documented cause of \u003Cstrong\u003Enyctalopia\u003C/strong\u003E due to impaired rhodopsin regeneration in rod photoreceptors, and vision typically improves with vitamin A repletion.  Thiamine, vitamin C, and vitamin D deficiencies have other systemic manifestations but are not primary causes of night blindness.\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E(A similar question appeared in a previous FRCOphth part 2 written exam)\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 394,
    "Name": "Aponeurotic ptosis",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 76\u2011year\u2011old pseudophakic Caucasian woman is referred to the general clinic with insidious onset ptosis. Examination reveals palpebral fissure measurements of 7\u202Fmm, an upper reflex distance of 2\u202Fmm, lid skin crease of 12\u202Fmm and good levator function in both lids. What is the MOST likely diagnosis?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cstrong\u003EAponeurotic ptosis\u003C/strong\u003E is most likely. The picture is classic for involutional/aponeurotic dehiscence: elderly patient with gradual onset, \u003Cstrong\u003Egood levator function\u003C/strong\u003E but \u003Cstrong\u003Ehigh lid crease (12\u202Fmm)\u003C/strong\u003E and reduced MRD1 (2\u202Fmm). Pseudophakia further supports a levator aponeurosis disinsertion after cataract surgery. \u003Cspan style=\u0022font-weight: bold;\u0022\u003EBlepharochalasis\u003C/span\u003E typically affects younger patients with recurrent eyelid edema and atrophic skin rather than isolated ptosis. \u003Cspan style=\u0022font-weight: bold;\u0022\u003EMyasthenia gravis\u003C/span\u003E would suggest variability, fatigability, and other neuromuscular signs. \u003Cspan style=\u0022font-weight: bold;\u0022\u003EMyotonic dystrophy\u003C/span\u003E causes bilateral ptosis with \u003Cstrong\u003Epoor\u003C/strong\u003E levator function and systemic myotonia, which are not present here.\u0026nbsp;\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam)\u003C/span\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 7,
    "Category": null,
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  },
  {
    "Id": 395,
    "Name": "Adie (tonic) pupil",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich of these statements regarding idiopathic tonic pupil (Adie syndrome/pupil) is MOST likely to be correct?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EThe affected pupil becomes progressively more miotic with time.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EAn Adie pupil typically starts enlarged with light\u2013near dissociation and segmental sphincter palsy; over years it often evolves into a smaller \u201Clittle old Adie,\u201D reflecting chronic denervation and aberrant re\u2011innervation.  Confirmation is by \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Esupersensitivity to dilute pilocarpine\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E (commonly 0.125% or even 0.0625%), not phenylephrine; constriction of the tonic pupil with these weak muscarinic concentrations supports the diagnosis.  Adie pupil is \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Eusually unilateral at presentation\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E and more common in women, though it may become bilateral over time.  There is \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Eno typical association with myopia\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E; instead, patients may have near blur from accommodative paresis.\u003C/span\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E(A similar question appeared in a previous FRCOphth part 2 written exam)\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 396,
    "Name": "Cyclodialysis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhat is the \u003Cspan class=\u0022s1\u0022\u003Emost common setting\u003C/span\u003E in which a cyclodialysis cleft occurs?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EA \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecyclodialysis cleft\u003C/b\u003E\u003C/span\u003E results from the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edisinsertion of the ciliary body from the scleral spur\u003C/b\u003E\u003C/span\u003E, creating an abnormal pathway for aqueous humour to flow into the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esuprachoroidal space\u003C/b\u003E\u003C/span\u003E, bypassing conventional outflow pathways. This typically leads to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eocular hypotony\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBlunt trauma\u003C/b\u003E\u003C/span\u003E is the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emost common cause\u003C/b\u003E\u003C/span\u003E, often due to rapid anterior-posterior compression of the globe.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIatrogenic causes\u003C/b\u003E\u003C/span\u003E (e.g. intraocular surgery, particularly glaucoma or anterior segment procedures) are also known but less frequent.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECongenital clefts\u003C/b\u003E\u003C/span\u003E are exceedingly rare.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EWhile \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehypotony\u003C/b\u003E\u003C/span\u003E is typical, secondary \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eelevated IOP\u003C/b\u003E\u003C/span\u003E can occur transiently if the cleft is partially blocked by inflammatory debris or blood, but this is not characteristic.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 13,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 397,
    "Name": "Suspected GCA work\u2011up",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 74\u2011year\u2011old woman presents with generalised fatigue and a history of transient horizontal diplopia. Ocular examination is normal except for an isolated cotton wool spot in the left fundus. Which ONE of the following tests would you be MOST likely to recommend to help establish the diagnosis?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003ETemporal artery biopsy\u003C/strong\u003E is the best next test. The age, systemic fatigue and \u003Cstrong\u003Etransient diplopia\u003C/strong\u003E point toward giant cell arteritis, in which diplopia is a recognised neuro\u2011ophthalmic manifestation and correlates with biopsy\u2011proven disease in a subset of patients.  The \u003Cstrong\u003Ecotton\u2011wool spot\u003C/strong\u003E adds weight by indicating retinal ischemia, which is reported among the ocular signs of GCA.  Current guidance recommends a \u003Cstrong\u003Econfirmatory test\u003C/strong\u003E when GCA is suspected, with \u003Cstrong\u003Etemporal artery biopsy\u003C/strong\u003E (or vascular ultrasound where available) used to establish the diagnosis.  An ice\u2011pack test targets myasthenia gravis, a brain MRI is not first\u2011line for this presentation, and a skeletal muscle biopsy would not help confirm a cranial large\u2011vessel vasculitis.\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E(A similar question appeared in a previous FRCOphth part 2 written exam)\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 398,
    "Name": "Mitochondrial replacement \u0026 who benefits least",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EIn vitro fertilisation has variations which include pro\u2011nuclear transfer and maternal spindle transfer. From a theoretical viewpoint, which of the following diseases would be LEAST likely to benefit from such techniques?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003ELeber congenital amaurosis\u003C/strong\u003E is least likely to benefit. Pro\u2011nuclear transfer and maternal spindle transfer are \u003Cstrong\u003Emitochondrial replacement therapy\u003C/strong\u003E techniques designed to prevent transmission of \u003Cem\u003Ematernally inherited mitochondrial DNA (mtDNA) mutations\u003C/em\u003E by moving the parents\u2019 nuclear DNA into a donor oocyte with healthy mitochondria; they target mtDNA disease, not disorders caused by \u003Cstrong\u003Enuclear\u003C/strong\u003E gene defects.\u003C/p\u003E\u003Cp\u003EMost forms of Leber congenital amaurosis arise from \u003Cstrong\u003Enuclear\u2011encoded retinal genes\u003C/strong\u003E (e.g., \u003Cem\u003ERPE65\u003C/em\u003E, \u003Cem\u003ECEP290\u003C/em\u003E, and \u0026gt;20 others), so avoiding maternal mtDNA does not address the underlying genetics.  In contrast, \u003Cstrong\u003EKearns\u2011Sayre syndrome\u003C/strong\u003E (mtDNA deletion), \u003Cstrong\u003ELeber hereditary optic neuropathy\u003C/strong\u003E (mtDNA point mutations in complex I genes), and \u003Cstrong\u003Emyoclonic epilepsy with ragged red fibres\u003C/strong\u003E (classically the mtDNA \u003Cem\u003EMT\u2011TK\u003C/em\u003E mutation) are \u003Cstrong\u003EmtDNA disorders\u003C/strong\u003E, which\u2014at least theoretically\u2014are the intended targets for mitochondrial replacement to reduce transmission risk.\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E(A similar question appeared in a previous FRCOphth part 2 written exam)\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 7,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 399,
    "Name": "ERG pattern \u2014 abnormal a\u2011wave \u0026 reduced b\u2011wave",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich of the following conditions is MOST likely to result in a abnormal A wave and reduced B Wave on ERG ?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003C!--StartFragment--\u003E\u003C!--EndFragment--\u003E\u003C/p\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; font-size: 14px; font-style: normal; line-height: 20px;\u0022\u003E\u003Cp style=\u0022font-weight: 400;\u0022\u003E\u003Cstrong\u003EAnswer:\u003C/strong\u003E \u003Cstrong\u003ECancer\u2011associated retinopathy.\u003C/strong\u003E\u003C/p\u003E\u003Cp style=\u0022\u0022\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\nAutoimmune attack against photoreceptor proteins (classically anti\u2011recoverin) in cancer\u2011associated retinopathy causes \u003Cstrong style=\u0022font-weight: 400;\u0022\u003Eprimary photoreceptor dysfunction\u003C/strong\u003E, so the full\u2011field ERG typically shows \u003Cstrong style=\u0022font-weight: 400;\u0022\u003Eabnormal (reduced) a\u2011waves with secondary reduction of b\u2011waves\u003C/strong\u003E under both scotopic and photopic conditions.\u0026nbsp;\u003C/p\u003E\n\u003Cp style=\u0022font-weight: 400;\u0022\u003EBy contrast, \u003Cstrong\u003Emelanoma\u2011associated retinopathy\u003C/strong\u003E and \u003Cstrong\u003Econgenital stationary night blindness\u003C/strong\u003E characteristically produce an \u003Cstrong\u003Eelectronegative ERG\u003C/strong\u003E (relatively preserved a\u2011wave with a disproportionately reduced b\u2011wave) reflecting ON\u2011bipolar pathway dysfunction. \u003Cstrong\u003EQuinine toxicity\u003C/strong\u003E can yield a negative ERG as well, but early changes often emphasize inner\u2011retinal/bipolar dysfunction and can be variable; this is less specific than the photoreceptor\u2011targeted pattern seen in cancer\u2011associated retinopathy.\u003C/p\u003E\n\u003Cp style=\u0022\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E(A similar question appeared in a previous FRCOphth part 2 written exam)\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 400,
    "Name": "NHS shingles vaccination",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich of these statements is MOST accurate with regard to the NHS Shingles vaccination service?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EThe most accurate statement is that \u003Cstrong\u003Evaccination is still beneficial even if a person has had shingles within the last two years\u003C/strong\u003E. People can develop shingles more than once, so UK advice is to vaccinate once the acute episode has resolved; there is no special waiting period beyond recovery.\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003EOther statements don\u2019t hold up to current guidance. Protection is not described as lifelong, and the \u003Cstrong\u003Eneed for any future boosters has not yet been determined\u003C/strong\u003E, so promising permanent immunity is inaccurate.  A previous \u003Cstrong\u003Echickenpox (varicella) vaccination is not a contraindication\u003C/strong\u003E; eligible adults should still receive Shingrix when they reach the qualifying age or risk group.  Finally, the programme is \u003Cstrong\u003Enot a blanket offer to everyone over 70\u003C/strong\u003E. In England it is offered to defined age cohorts (with a phased roll\u2011out starting at 65 and ongoing eligibility for 70\u201379 up to the 80th birthday) and to adults with severe immunosuppression, rather than to all comers above a single age cut\u2011off.\u003C/p\u003E\u003Cp\u003E\u003C!--StartFragment--\u003E\u003C!--EndFragment--\u003E\u003C/p\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; font-size: 14px; font-style: normal; line-height: 20px;\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E(A similar question appeared in a previous FRCOphth part 2 written exam)\u003C/span\u003E\u003C/div\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 7,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 401,
    "Name": "Systemic steroids with new metamorphopsia",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 24\u2011year\u2011old man who is taking systemic steroids for pulmonary sarcoidosis reports slight distortion of vision in his right eye for two weeks. His visual acuity in this eye is reduced to 6/9. Which one of the following is the MOST likely diagnosis?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cstrong\u003EThe correct answer is Central serous chorioretinopathy (CSCR).\u003C/strong\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E In a young male with recent\u2011onset metamorphopsia and mild reduction in acuity, concurrent \u003Cstrong\u003Esystemic corticosteroid use\u003C/strong\u003E is a hallmark risk factor that strongly points to CSCR, which typically presents in men in their 20s\u201350s with acute or subacute central distortion and a serous neurosensory detachment.  By contrast, \u003Cstrong\u003Ecystoid macular oedema\u003C/strong\u003E more often follows intraocular surgery, uveitis, or vascular disease,\u0026nbsp;making it less compatible with this vignette. \u003Cstrong\u003EJuxtafoveal (macular) telangiectasia type 2\u003C/strong\u003E is usually a \u003Cstrong\u003Ebilateral, middle\u2011aged\u003C/strong\u003E presentation with slow progression and temporal foveal telangiectasia/thinning on multimodal imaging, not an abrupt unilateral event in a 24\u2011year\u2011old.  Finally, an isolated \u003Cstrong\u003Epigment epithelial detachment\u003C/strong\u003E as a primary diagnosis is far more typical of \u003Cstrong\u003Eage\u2011related macular degeneration\u003C/strong\u003E in older adults; while small PEDs can accompany CSCR, they do not best explain this acute steroid\u2011related presentation.\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022line-height: 20px;\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E(A similar question appeared in a previous FRCOphth part 2 written exam)\u003C/span\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 402,
    "Name": "Ruptured globe repair",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA patient presents following an assault with a glass bottle. On examination of the left eye, vision is perception of light. There is a full-thickness corneal laceration extending across the limbus into the posterior sclera with vitreous prolapse and a total hyphaema. Anterior segment views are poor.\u0026nbsp;\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhat is the most appropriate surgical management?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThis case describes an \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eopen globe injury\u003C/b\u003E\u003C/span\u003E with:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EFull-thickness corneoscleral laceration\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EVitreous prolapse\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ENo view of posterior segment due to total hyphaema\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EVision reduced to perception of light\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EIn such cases:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPrimary repair\u003C/b\u003E\u003C/span\u003E is essential to restore globe integrity.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPars plana vitrectomy (PPV)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E may be warranted \u003C/span\u003E\u003Cb\u003Eat the time of primary repair\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E when:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThere is \u003C/span\u003E\u003Cb\u003Evitreous loss through the wound\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThere is a high risk of \u003C/span\u003E\u003Cb\u003Etractional complications\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, such as \u003C/span\u003E\u003Cb\u003Eretinal detachment\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThere is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epoor posterior view\u003C/b\u003E\u003C/span\u003E that prevents assessment, and immediate intervention is feasible in a specialist vitreoretinal setting\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EEnucleation or evisceration\u003C/b\u003E\u003C/span\u003E at this stage is not appropriate, even in eyes with poor vision, unless there is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eno visual potential and high risk of sympathetic ophthalmia\u003C/b\u003E\u003C/span\u003E (which should be assessed later, not acutely).\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 13,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 403,
    "Name": "Lyme disease",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA patient presents with intermediate and posterior uveitis. He reports a history of trekking in the United States and recalls developing a circinate rash on his leg during the trip.\u0026nbsp;\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhat is the most likely causative organism?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003Ehe clinical scenario is consistent with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELyme disease\u003C/b\u003E\u003C/span\u003E, caused by \u003Ci\u003EBorrelia burgdorferi\u003C/i\u003E, a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Espirochaete\u003C/b\u003E\u003C/span\u003E transmitted by the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIxodes tick\u003C/b\u003E\u003C/span\u003E, which is endemic in parts of the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ENortheast and upper Midwest USA\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EKey clues include:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ETrekking exposure\u003C/b\u003E\u003C/span\u003E (risk of tick bite)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EErythema migrans\u003C/b\u003E\u003C/span\u003E: classically a circinate or \u201Cbull\u2019s-eye\u201D rash\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOcular involvement\u003C/b\u003E\u003C/span\u003E (posterior/intermediate uveitis, retinal vasculitis) during late stages of systemic infection\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOcular Lyme disease\u003C/b\u003E\u003C/span\u003E can occur in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EStage II or III\u003C/b\u003E\u003C/span\u003E of infection and may present with:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIntermediate/posterior uveitis\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ENeuro-ophthalmic signs (cranial neuropathies, optic neuritis)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ERetinitis or vasculitis\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EOther options:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Ci\u003EBartonella henselae\u003C/i\u003E: Cat-scratch disease; typically causes neuroretinitis, not associated with trekking or rash\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Ci\u003ETreponema pallidum\u003C/i\u003E: Syphilis can mimic anything but rash and travel history more typical of Lyme\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Ci\u003EHistoplasma capsulatum\u003C/i\u003E: Linked with Presumed Ocular Histoplasmosis Syndrome (POHS), but not associated with rash or recent travel to tick-endemic areas\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 12,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 404,
    "Name": "Schistosomiasis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhat is the intermediate host involved in the life cycle of schistosomiasis?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESchistosomiasis\u003C/b\u003E\u003C/span\u003E, also known as bilharzia, is caused by parasitic flatworms called \u003Ci\u003Eschistosomes\u003C/i\u003E. It is transmitted through contact with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Efreshwater contaminated by larval forms (cercariae)\u003C/b\u003E\u003C/span\u003E released by specific \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Efreshwater snails\u003C/b\u003E\u003C/span\u003E, which act as the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eintermediate host\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EHumans\u003C/b\u003E\u003C/span\u003E serve as the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edefinitive host\u003C/b\u003E\u003C/span\u003E, where the adult worms reside in the venous system and lay eggs.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eeggs\u003C/b\u003E\u003C/span\u003E are passed in urine or feces into water, where they hatch into miracidia, which then \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Einfect freshwater snails\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EWithin the snail, the parasite undergoes \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Easexual multiplication\u003C/b\u003E\u003C/span\u003E before emerging as cercariae that infect humans through the skin.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThis snail-host stage is crucial in the transmission cycle and is a major target for public health control efforts.\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 12,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 405,
    "Name": "SLE investigations",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich is the most commonly found autoantibody in systemic lupus erythematosus (SLE)?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003ESystemic lupus erythematosus (SLE) is an autoimmune disease with a broad range of autoantibodies. \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAntinuclear antibodies (ANA)\u003C/b\u003E\u003C/span\u003E are present in over 95% of SLE cases and serve as a screening test. Among the ANA subtypes:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAnti-dsDNA\u003C/b\u003E\u003C/span\u003E is the most \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Especific\u003C/b\u003E\u003C/span\u003E for SLE and also the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emost commonly found\u003C/b\u003E\u003C/span\u003E subtype in these patients; present in ~70% of cases.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIts presence correlates with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edisease activity\u003C/b\u003E\u003C/span\u003E, particularly lupus nephritis.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAnti-Ro (SSA)\u003C/b\u003E\u003C/span\u003E can also occur in SLE, but it is more commonly associated with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esubacute cutaneous lupus\u003C/b\u003E\u003C/span\u003E and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eneonatal lupus\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ec-ANCA\u003C/b\u003E\u003C/span\u003E and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ep-ANCA\u003C/b\u003E\u003C/span\u003E are associated with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Evasculitides\u003C/b\u003E\u003C/span\u003E, such as granulomatosis with polyangiitis and microscopic polyangiitis, respectively, not SLE.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 12,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 406,
    "Name": "Granulomatosis with polyangiitis (Wegener\u2019s)",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA patient with a prior episode of peripheral ulcerative keratitis presents with new-onset right-sided proptosis due to an orbital mass. The history includes left elbow arthritis, and a recent chest X-ray reveals a pulmonary nodule.\u0026nbsp;\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EWhat is the most likely underlying diagnosis?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThe combination of:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPeripheral ulcerative keratitis (PUK)\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EArthritis\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPulmonary nodule\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EOrbital mass with proptosis\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u2026is highly characteristic of \u003Cspan class=\u0022s2\u0022\u003E\u003Cb\u003EGranulomatosis with polyangiitis (GPA, formerly Wegener\u2019s granulomatosis)\u003C/b\u003E\u003C/span\u003E. GPA is a necrotizing granulomatous vasculitis affecting small to medium vessels, commonly involving the \u003Cspan class=\u0022s2\u0022\u003E\u003Cb\u003Eupper and lower respiratory tracts, kidneys, joints, and eyes\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EKey distinguishing features:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOrbital mass\u003C/b\u003E\u003C/span\u003E is a well-recognised ophthalmic manifestation of GPA.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPUK\u003C/b\u003E\u003C/span\u003E is a classical ocular complication due to vasculitis of episcleral vessels.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPulmonary nodules\u003C/b\u003E\u003C/span\u003E (especially cavitating) are typical.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EArthritis\u003C/b\u003E\u003C/span\u003E is common.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EOther Options:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EChurg-Strauss (EGPA)\u003C/b\u003E\u003C/span\u003E: Typically associated with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Easthma\u003C/b\u003E\u003C/span\u003E and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eeosinophilia\u003C/b\u003E\u003C/span\u003E. PUK and orbital masses are less frequent.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESLE\u003C/b\u003E\u003C/span\u003E: Rarely causes orbital masses; PUK can occur but less commonly.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESarcoidosis\u003C/b\u003E\u003C/span\u003E: Can affect the orbit, but does \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot cause PUK\u003C/b\u003E\u003C/span\u003E. Lung involvement usually presents as \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehilar lymphadenopathy or interstitial disease\u003C/b\u003E\u003C/span\u003E, not nodules.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 407,
    "Name": "Hypoglycaemia in Diabetic patients",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA hospitalised patient with brittle type 1 diabetes mellitus collapses and is found to be unconscious due to hypoglycaemia. What is the most appropriate immediate treatment?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EIn an \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eunconscious hypoglycaemic patient\u003C/b\u003E\u003C/span\u003E who cannot safely tolerate oral carbohydrates, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eintravenous glucose\u003C/b\u003E\u003C/span\u003E is the treatment of choice. The most effective option is:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E50% dextrose IV\u003C/b\u003E\u003C/span\u003E, given as a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebolus (commonly 50 mL = 25 g glucose)\u003C/b\u003E\u003C/span\u003E, provides rapid correction of hypoglycaemia.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EAlternatives depend on context:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGlucagon 1 mg IM/SC\u003C/b\u003E\u003C/span\u003E is used if IV access is not immediately available.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E10% or 20% dextrose\u003C/b\u003E\u003C/span\u003E may be used for continuous infusion or maintenance after initial correction but are \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot first-line for acute correction\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E5% dextrose\u003C/b\u003E\u003C/span\u003E is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Etoo dilute\u003C/b\u003E\u003C/span\u003E for rapid reversal of severe hypoglycaemia.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003ERapid correction is essential to prevent \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eneurological damage\u003C/b\u003E\u003C/span\u003E in unconscious hypoglycaemia.\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 7,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 408,
    "Name": "Parinaud\u2019s oculoglandular syndrome",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA patient presents with unilateral granulomatous conjunctivitis and ipsilateral preauricular lymphadenopathy. What is the most likely causative organism?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EParinaud\u2019s oculoglandular syndrome\u003C/b\u003E\u003C/span\u003E is a rare ocular manifestation of systemic infection, typically presenting with:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EUnilateral granulomatous conjunctivitis\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EIpsilateral preauricular (or submandibular) lymphadenopathy\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emost common cause\u003C/b\u003E\u003C/span\u003E is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecat-scratch disease\u003C/b\u003E\u003C/span\u003E, which is due to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBartonella henselae\u003C/b\u003E\u003C/span\u003E, a gram-negative bacillus. It is transmitted via scratches, bites, or contact with infected cat saliva.\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EOther rare infectious causes include:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Ci\u003ETularemia\u003C/i\u003E\u003Ci\u003E\u003C/i\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Ci\u003ETuberculosis\u003C/i\u003E\u003Ci\u003E\u003C/i\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Ci\u003ESyphilis\u003C/i\u003E\u003Ci\u003E\u003C/i\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Ci\u003EHerpes simplex\u003C/i\u003E\u003Ci\u003E\u003C/i\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Ci\u003EChlamydia trachomatis\u003C/i\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EHowever, \u003Ci\u003EBartonella\u003C/i\u003E remains the most frequent and exam-relevant answer.\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 7,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 409,
    "Name": "Mucous membrane pemphigoid (MMP)",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following statements about mucous membrane pemphigoid (MMP) is TRUE?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMucous membrane pemphigoid (MMP)\u003C/b\u003E\u003C/span\u003E is a chronic autoimmune subepithelial blistering disease that primarily affects mucous membranes. The key features are:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EHistopathology\u003C/b\u003E\u003C/span\u003E: The hallmark finding is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elinear deposition of IgG\u003C/b\u003E\u003C/span\u003E, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EC3\u003C/b\u003E\u003C/span\u003E, and sometimes \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIgA\u003C/b\u003E\u003C/span\u003E along the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebasement membrane zone\u003C/b\u003E\u003C/span\u003E (BMZ) on direct immunofluorescence.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EEpidemiology\u003C/b\u003E\u003C/span\u003E: \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EFemales are more commonly affected\u003C/b\u003E\u003C/span\u003E than males, typically at a ratio of around 2:1.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOral mucosa\u003C/b\u003E\u003C/span\u003E is the most commonly involved site;\u0026nbsp;\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epresent in ~80%\u003C/b\u003E\u003C/span\u003E of cases.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESkin involvement\u003C/b\u003E\u003C/span\u003E occurs in only \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E~20-30%\u003C/b\u003E\u003C/span\u003E of cases, not 80%.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cimg src=\u0022https://images-provider.frontiersin.org/api/ipx/w=370\u0026amp;f=webp/https://www.frontiersin.org/files/Articles/437108/fimmu-10-00034-HTML-r1/image_m/fimmu-10-00034-g001.jpg\u0022\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cspan style=\u0022color: rgb(0, 0, 0); font-family: ThinSpaceFallback, InftyFallback, MuseoSans, Helvetica, Arial, sans-serif; letter-spacing: normal; font-size: small;\u0022\u003EDiagnostic strategy for MMP. The diagnosis of MMP is confirmed by clinical features and positive DIF results. In DIF-negative or DIF-unavailable cases, at least one serological or histological finding is needed.\u0026nbsp;\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cspan style=\u0022color: rgb(0, 0, 0); font-family: ThinSpaceFallback, InftyFallback, MuseoSans, Helvetica, Arial, sans-serif; letter-spacing: normal; font-size: small;\u0022\u003EDIF, direct immunofluorescence; IIF, indirect immunofluorescence; ELISA, enzyme-linked immunosorbent assay; H\u0026amp;E, hematoxylin and eosin staining.\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 410,
    "Name": "ESR levels",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following is a recognised cause of a \u003Ci\u003Elow\u003C/i\u003E erythrocyte sedimentation rate (ESR)?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EESR (erythrocyte sedimentation rate)\u003C/b\u003E\u003C/span\u003E is a nonspecific marker of inflammation that can be influenced by several physiological and pathological conditions. It is affected by plasma proteins (e.g., fibrinogen), red cell mass, and the properties of red cells (e.g., size, shape, and concentration).\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPolycythaemia\u003C/b\u003E\u003C/span\u003E leads to a low ESR because the increased red cell mass reduces the fall rate of erythrocytes due to increased blood viscosity and decreased plasma fibrinogen relative to red cells. Other causes include: Sickle cell disease, hypogammaglobulinemia, and hyperviscosity state.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPregnancy\u003C/b\u003E\u003C/span\u003E, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Efemale sex\u003C/b\u003E\u003C/span\u003E, and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eolder age\u003C/b\u003E\u003C/span\u003E are all associated with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eincreased\u003C/b\u003E\u003C/span\u003E ESR values, due to higher fibrinogen levels and alterations in plasma composition. Other causes include: malignancy, inflammation, and infection.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EEstimated Normal values [rough estimate]:\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cul\u003E\u003Cli\u003EMen: Age (in years) / 2\u003C/li\u003E\u003Cli\u003EWomen: ( [age in years]\u002B 10) / 2\u003C/li\u003E\u003C/ul\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 7,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 411,
    "Name": "Sarcoidosis Histology",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following histological features is most characteristic of \u003Cspan class=\u0022s1\u0022\u003Esarcoidosis\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESarcoidosis\u003C/b\u003E\u003C/span\u003E is a granulomatous inflammatory disease most commonly associated with:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ENon-caseating granulomas\u003C/b\u003E\u003C/span\u003E (i.e., lacking central necrosis, unlike tuberculosis)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EA core of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eepithelioid histiocytes\u003C/b\u003E\u003C/span\u003E and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELanghans-type multinucleated giant cells\u003C/b\u003E\u003C/span\u003E (not to be confused with Langerhans cells of the skin/immune system)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESurrounding \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECD4\u002B helper T lymphocytes\u003C/b\u003E\u003C/span\u003E, not cytotoxic T cells\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EIncorrect Options:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECaseating granulomas\u003C/b\u003E\u003C/span\u003E: Suggestive of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Etuberculosis\u003C/b\u003E\u003C/span\u003E or fungal infections.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELangerhans cells\u003C/b\u003E\u003C/span\u003E: Antigen-presenting dendritic cells seen in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELangerhans cell histiocytosis\u003C/b\u003E\u003C/span\u003E, not sarcoidosis.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPeripheral rim of killer T cells\u003C/b\u003E\u003C/span\u003E: Inconsistent with typical sarcoid granuloma, which is CD4\u002B dominant.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 12,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 412,
    "Name": "Tubulointerstitial nephritis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 12-year-old boy presents with bilateral non-granulomatous anterior uveitis. Which renal condition is \u003Cspan class=\u0022s1\u0022\u003Emost likely\u003C/span\u003E to be associated?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThe constellation of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebilateral non-granulomatous anterior uveitis\u003C/b\u003E\u003C/span\u003E in a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Echild or adolescent\u003C/b\u003E\u003C/span\u003E, especially if idiopathic, should raise strong suspicion for \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ETINU syndrome\u003C/b\u003E\u003C/span\u003E (Tubulointerstitial Nephritis and Uveitis). Key points:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMore common in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Echildren and adolescents\u003C/b\u003E\u003C/span\u003E, average age ~15\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EUveitis often \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eprecedes or follows\u003C/b\u003E\u003C/span\u003E renal symptoms by weeks\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ERenal impairment may be \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emild and subclinical\u003C/b\u003E\u003C/span\u003E, requiring urinalysis for detection\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EUveitis is typically \u003C/span\u003E\u003Cb\u003Ebilateral, non-granulomatous anterior\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EIncorrect options:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIgA nephropathy\u003C/b\u003E\u003C/span\u003E: Common in children but not associated with uveitis.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EFanconi syndrome\u003C/b\u003E\u003C/span\u003E: Involves proximal tubular dysfunction, rarely linked to uveitis.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGoodpasture\u2019s syndrome\u003C/b\u003E\u003C/span\u003E: Characterised by anti-GBM antibodies causing pulmonary-renal syndrome; not uveitis.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 12,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 413,
    "Name": "Endogenous endophthalmitis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EWhat is the \u003C/span\u003Emost common causative organism\u003Cspan class=\u0022s1\u0022\u003E of \u003Ci\u003Eendogenous endophthalmitis\u003C/i\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EEndogenous endophthalmitis\u003C/b\u003E\u003C/span\u003E results from hematogenous spread of organisms to the eye from a distant infectious focus. Unlike post-surgical or trauma-related (exogenous) cases, endogenous endophthalmitis is more often caused by \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Efungal pathogens\u003C/b\u003E\u003C/span\u003E, particularly in immunocompromised or hospitalised patients with indwelling catheters or IV drug use.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E\u003Ci\u003ECandida albicans\u003C/i\u003E\u003C/b\u003E\u003C/span\u003E is the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emost common\u003C/b\u003E\u003C/span\u003E cause overall, particularly in the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EWestern world\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E\u003Ci\u003EAspergillus fumigatus\u003C/i\u003E\u003C/b\u003E\u003C/span\u003E can cause endophthalmitis but is less frequent and more associated with immunosuppressed states.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EBacterial causes such as \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E\u003Ci\u003EStaphylococcus aureus\u003C/i\u003E\u003C/b\u003E\u003C/span\u003E and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E\u003Ci\u003EStreptococcus pneumoniae\u003C/i\u003E\u003C/b\u003E\u003C/span\u003E do occur, but less commonly than \u003Ci\u003ECandida\u003C/i\u003E, especially in high-risk patients.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERegional variation exists\u003C/b\u003E\u003C/span\u003E: Gram-negative organisms (e.g., \u003Ci\u003EKlebsiella\u003C/i\u003E) dominate in parts of Asia.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 12,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 414,
    "Name": "Ciliary body melanoma",
    "Body": "\u003Cp class=\u0022MsoNormal\u0022 style=\u0022margin: 0cm; font-size: 12pt; font-family: Calibri, sans-serif; color: rgb(0, 0, 0); letter-spacing: normal;\u0022\u003E\n\n\n\n\n\n\n\n\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich peripheral iris nodule feature is \u003Cspan class=\u0022s1\u0022\u003Emost suggestive of ciliary body melanoma\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EDilated sentinel episcleral vessels\u003C/b\u003E\u003C/span\u003E are a hallmark sign of underlying posterior segment pathology such as \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eciliary body melanoma\u003C/b\u003E\u003C/span\u003E. These vessels reflect increased vascular supply to a growing intraocular mass and are often the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Efirst external clue\u003C/b\u003E\u003C/span\u003E to a deeply seated tumor.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EOther key features suggestive of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eciliary body melanoma\u003C/b\u003E\u003C/span\u003E include:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ETumor extension anteriorly into the iris or posteriorly through the sclera\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ELocal iris displacement or sectoral cataract formation\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EInvolvement of trabecular meshwork causing secondary glaucoma\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ERing melanomas that encircle the ciliary body\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ELow intraocular pressure due to ciliary body shutdown\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EWhile features like an irregular pupil or pigmented iris lesions may occur in other iris pathologies, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eepiscleral hyperaemia with sentinel vessels\u003C/b\u003E\u003C/span\u003E is more specific for \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eposterior uveal melanoma\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 415,
    "Name": "Infectious scleritis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich ocular procedure carries the highest risk of \u003Cspan class=\u0022s1\u0022\u003Epost-operative infectious scleritis\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EInfectious scleritis\u003C/b\u003E\u003C/span\u003E is a rare but serious complication that accounts for approximately \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E5-10%\u003C/b\u003E\u003C/span\u003E of all scleritis cases. Unlike immune-mediated scleritis, it does \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot\u003C/b\u003E\u003C/span\u003E respond to steroids and may be \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eexacerbated\u003C/b\u003E\u003C/span\u003E by them. Clinical differentiation is crucial, as timely antimicrobial therapy is essential.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EAmong ophthalmic surgeries, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epterygium excision -\u003C/b\u003E\u003C/span\u003Eespecially when combined with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eadjuvants like mitomycin C or beta irradiation-\u003C/b\u003E\u003C/span\u003Eis the most frequently implicated procedure in post-operative infectious scleritis. These adjuvants impair wound healing and compromise scleral integrity, making it more susceptible to pathogens such as \u003Ci\u003EPseudomonas aeruginosa\u003C/i\u003E or fungal organisms.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EOther procedures (e.g., cataract, glaucoma, or strabismus surgeries) carry a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emuch lower\u003C/b\u003E\u003C/span\u003E risk in comparison.\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 416,
    "Name": "Presumed ocular histoplasmosis syndrome (POHS)",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EWhich of the following findings is \u003C/span\u003Emost consistent\u003Cspan class=\u0022s1\u0022\u003E with a diagnosis of \u003C/span\u003Epresumed ocular histoplasmosis syndrome (POHS)?\u003C/span\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPresumed ocular histoplasmosis syndrome (POHS)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is classically defined by the \u003C/span\u003E\u003Cb\u003Etriad\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E of:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPeripapillary atrophy\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E\u201CHisto spots\u201D\u003C/b\u003E\u003C/span\u003E: punched-out chorioretinal scars in the mid-periphery and posterior pole\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EMaculopathy due to CNVM\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ECritically, \u003C/span\u003E\u003Cb\u003Eintraocular inflammation is absent\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, and \u003C/span\u003E\u003Cb\u003Evitritis or anterior uveitis (e.g., iris nodules)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E would argue against the diagnosis.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003EPOHS has an epidemiological link to areas endemic for \u003Ci\u003EHistoplasma capsulatum\u003C/i\u003E, particularly in the Mississippi\u2013Ohio River Valley. There is \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003Eno association with HLA-DQ2\u003C/b\u003E\u003C/span\u003E, but increased prevalence has been reported for \u003Cspan class=\u0022s3\u0022\u003E\u003Cb\u003EHLA-B7 and HLA-DR2\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 12,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 417,
    "Name": "Steroid eye drops",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA steroid molecule bound to which of the following compounds is \u003Cspan class=\u0022s1\u0022\u003Emost likely\u003C/span\u003E to penetrate the cornea effectively and reach the anterior chamber?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EFor effective \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecorneal penetration\u003C/b\u003E\u003C/span\u003E, a drug must exhibit \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eboth lipophilic and hydrophilic properties\u003C/b\u003E\u003C/span\u003E to cross the epithelium and stroma. Steroid formulations are modified to enhance these properties:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAcetate esters\u003C/b\u003E\u003C/span\u003E (e.g. prednisolone acetate) are \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elipophilic\u003C/b\u003E\u003C/span\u003E, penetrate the cornea \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Every effectively\u003C/b\u003E\u003C/span\u003E, and reach therapeutic levels in the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eanterior chamber\u003C/b\u003E\u003C/span\u003E. These are typically formulated as \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esuspensions\u003C/b\u003E\u003C/span\u003E, so \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eshaking the bottle\u003C/b\u003E\u003C/span\u003E is necessary to ensure correct dosing.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAlcohol formulations\u003C/b\u003E\u003C/span\u003E also have good penetration but are \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eless effective\u003C/b\u003E\u003C/span\u003E than acetate esters.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPhosphate esters\u003C/b\u003E\u003C/span\u003E are \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehydrophilic\u003C/b\u003E\u003C/span\u003E, making them less effective for corneal penetration, though they are more stable and usually available as \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esolutions\u003C/b\u003E\u003C/span\u003E, which are easier to use.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESulphate-bound steroids\u003C/b\u003E\u003C/span\u003E are uncommon in ophthalmic formulations and are \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epoor penetrants\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 5,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 418,
    "Name": "Herpes Simplex Keratitis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhat is the \u003Cspan class=\u0022s1\u0022\u003Eprophylactic oral dose\u003C/span\u003E of acyclovir in patients with recurrent \u003Cspan class=\u0022s1\u0022\u003Eherpes simplex eye disease\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThe \u003C/span\u003E\u003Cb\u003EHerpetic Eye Disease Study (HEDS)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E demonstrated that \u003C/span\u003E\u003Cb\u003Eoral acyclovir 400\u202Fmg BD\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E significantly reduces the recurrence of \u003C/span\u003E\u003Cb\u003Eherpes simplex keratitis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, particularly \u003C/span\u003E\u003Cb\u003Estromal disease\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EProphylaxis\u003C/b\u003E\u003C/span\u003E is typically considered in cases with recurrent disease, post-keratoplasty, or during topical steroid use.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003E400\u202Fmg five times per day\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is used in \u003C/span\u003E\u003Cb\u003Eactive epithelial disease\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, not prophylaxis.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELower doses\u003C/b\u003E\u003C/span\u003E like 200\u202Fmg BD are insufficient for prophylaxis.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003E800\u202Fmg five times daily\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is reserved for \u003C/span\u003E\u003Cb\u003Eherpes zoster ophthalmicus\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, not HSV.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 419,
    "Name": " Ciclosporin A",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EA patient develops \u003C/span\u003Ehalitosis\u003Cspan class=\u0022s1\u0022\u003E and \u003C/span\u003Egingival hypertrophy around the molar region\u003Cspan class=\u0022s1\u0022\u003E. Which of the following medications is the \u003C/span\u003Emost likely cause\u003Cspan class=\u0022s1\u0022\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGingival hyperplasia\u003C/b\u003E\u003C/span\u003E (or gingival overgrowth) is a known adverse effect of several drugs. Among the options listed:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECiclosporin A\u003C/b\u003E\u003C/span\u003E is most strongly associated with gingival hypertrophy, particularly in the molar regions. It stimulates fibroblast proliferation and extracellular matrix production.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECalcium channel blockers\u003C/b\u003E\u003C/span\u003E (especially nifedipine) and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ephenytoin\u003C/b\u003E\u003C/span\u003E (an anti-convulsant) are also classic causes, but not listed here.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EAzathioprine\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, \u003C/span\u003E\u003Cb\u003Emethotrexate\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, and \u003C/span\u003E\u003Cb\u003Eanti-TNF agents\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E may cause oral ulcers or mucositis, but they do \u003C/span\u003E\u003Cb\u003Enot typically cause gingival overgrowth\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 5,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 420,
    "Name": "Rituximab",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following best describes the \u003Cspan class=\u0022s1\u0022\u003Emechanism of action\u003C/span\u003E of \u003Cspan class=\u0022s1\u0022\u003Erituximab\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERituximab\u003C/b\u003E\u003C/span\u003E is a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Echimeric monoclonal antibody\u003C/b\u003E\u003C/span\u003E that targets the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECD20 antigen\u003C/b\u003E\u003C/span\u003E, which is found on the surface of pre-B and mature B lymphocytes. Binding to CD20 leads to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EB-cell depletion\u003C/b\u003E\u003C/span\u003E via multiple mechanisms including antibody-dependent cytotoxicity, complement-mediated lysis, and apoptosis.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIt is used in conditions where pathogenic B cells play a role, such as \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Evasculitis\u003C/b\u003E\u003C/span\u003E, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enon-Hodgkin\u2019s lymphoma\u003C/b\u003E\u003C/span\u003E, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Erheumatoid arthritis\u003C/b\u003E\u003C/span\u003E, and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eorbital inflammatory disease\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIt \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edoes not inhibit IL-2 or TNF-\u03B1\u003C/b\u003E\u003C/span\u003E, and it is not an interferon agonist.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 5,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 421,
    "Name": "Iatrogenic Pigmentary retinopathy - Thioridazine",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA patient with a history of psychiatric illness develops signs of \u003Cspan class=\u0022s1\u0022\u003Epigmentary retinopathy\u003C/span\u003E. Which of the following medications is the \u003Cspan class=\u0022s1\u0022\u003Emost likely cause\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EThioridazine\u003C/b\u003E\u003C/span\u003E, a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ephenothiazine antipsychotic\u003C/b\u003E\u003C/span\u003E, is well known for causing a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edose-dependent pigmentary retinopathy\u003C/b\u003E\u003C/span\u003E, particularly at doses exceeding 800\u202Fmg/day.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003EKey features of \u003C/span\u003E\u003Cb\u003Ethioridazine-induced retinopathy\u003C/b\u003E\u003Cspan class=\u0022s2\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EEarly: Non-specific macular pigment changes\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAdvanced: Salt-and-pepper fundus, nyctalopia, decreased vision, optic atrophy\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EPathophysiology: Damage to \u003C/span\u003E\u003Cb\u003Eretinal pigment epithelium\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and \u003C/span\u003E\u003Cb\u003Echoriocapillaris\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIrreversible in many cases if not recognised early\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EOther options:\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELithium\u003C/b\u003E\u003C/span\u003E: Causes oculogyric crises and nystagmus, not pigmentary changes\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOlanzapine\u003C/b\u003E\u003C/span\u003E: May cause blurred vision or dry eye but not retinopathy\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECarbamazepine\u003C/b\u003E\u003C/span\u003E: Can cause diplopia and nystagmus, but no retinal toxicity\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Chr\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 422,
    "Name": "Vigabatrin",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EWhich \u003C/span\u003Emedication\u003Cspan class=\u0022s1\u0022\u003E is most likely to cause \u003C/span\u003Ebinasal visual field defects\u003Cspan class=\u0022s1\u0022\u003E?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EVigabatrin\u003C/b\u003E\u003C/span\u003E, an antiepileptic that inhibits GABA transaminase, is associated with a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Echaracteristic visual field defect\u003C/b\u003E\u003C/span\u003E:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EConcentric peripheral constriction\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, often with \u003C/span\u003E\u003Cb\u003Etemporal and macular sparing\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EManifests as \u003C/span\u003E\u003Cb\u003Ebinasal field defects\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIrreversible\u003C/b\u003E\u003C/span\u003E optic neuropathy\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ESigns: \u003C/span\u003E\u003Cb\u003EOptic disc pallor\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, RNFL atrophy, but \u003C/span\u003E\u003Cb\u003Epreserved central acuity\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EOther options:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EHydroxychloroquine\u003C/b\u003E\u003C/span\u003E: Central/paracentral visual loss due to maculopathy\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAmiodarone\u003C/b\u003E\u003C/span\u003E: May cause vortex keratopathy and optic neuropathy, but not binasal field loss\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ETamoxifen\u003C/b\u003E\u003C/span\u003E: Crystalline maculopathy and retinal deposits, not associated with nasal field loss\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EOphthalmic monitoring of patients on vigabatrin includes:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EBaseline and follow-up \u003C/span\u003E\u003Cb\u003Evisual fields (e.g., Humphrey 120)\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EFundus and \u003C/span\u003E\u003Cb\u003ERNFL imaging\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EMonitoring \u003C/span\u003E\u003Cb\u003Eevery 6 months for 5 years\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, then annually\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022text-decoration-line: underline;\u0022\u003EFurther reading:\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Ca href=\u0022https://pmc.ncbi.nlm.nih.gov/articles/PMC10947413/\u0022 target=\u0022_blank\u0022\u003EOcular examinations, findings, and toxicity in children taking vigabatrin\u003C/a\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Ca href=\u0022https://curriculum.rcophth.ac.uk/wp-content/uploads/2015/01/2008-SCI-020-The-Ocular-Side-Effects-of-Vigabatrin-Sabril.pdf\u0022 target=\u0022_blank\u0022\u003EThe Ocular Side-Effects of Vigabatrin (Sabril)\u003C/a\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Ca href=\u0022https://curriculum.rcophth.ac.uk/wp-content/uploads/2015/01/2008-SCI-020-The-Ocular-Side-Effects-of-Vigabatrin-Sabril.pdf\u0022 target=\u0022_blank\u0022\u003E\u0026nbsp;\u003C/a\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 423,
    "Name": "Cyclophosphamide",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following is the \u003Cspan class=\u0022s1\u0022\u003Emost common complication\u003C/span\u003E associated with \u003Cspan class=\u0022s1\u0022\u003Ecyclophosphamide\u003C/span\u003E therapy?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECyclophosphamide\u003C/b\u003E\u003C/span\u003E is a cytotoxic alkylating agent used in the management of severe inflammatory diseases (e.g., vasculitis) and some malignancies. Its \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edose-limiting and most frequent adverse effect\u003C/b\u003E\u003C/span\u003E is:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EBone marrow suppression\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, particularly affecting \u003C/span\u003E\u003Cb\u003Eneutrophils and lymphocytes\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMonitoring with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Efull blood count\u003C/b\u003E\u003C/span\u003E is mandatory during treatment\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EOther notable adverse effects:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EHaemorrhagic cystitis\u003C/b\u003E\u003C/span\u003E: Caused by the toxic metabolite \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eacrolein\u003C/b\u003E\u003C/span\u003E; reduced by ensuring adequate hydration or using \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emesna\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EBladder carcinoma\u003C/b\u003E\u003C/span\u003E: A \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elong-term risk\u003C/b\u003E\u003C/span\u003E, more likely with cumulative exposure\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EHepatitis\u003C/b\u003E\u003C/span\u003E: Rare but possible\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGonadal toxicity\u003C/b\u003E\u003C/span\u003E: Can cause infertility, particularly in higher doses\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 5,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 424,
    "Name": "Tamoxifen retinopathy",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following statements about \u003Cspan class=\u0022s1\u0022\u003Etamoxifen\u003C/span\u003E is \u003Cspan class=\u0022s1\u0022\u003Etrue\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ETamoxifen\u003C/b\u003E\u003C/span\u003E is a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eselective oestrogen receptor modulator (SERM)\u003C/b\u003E\u003C/span\u003E, not an anti-progesterone agent. It is primarily used in hormone receptor-positive breast cancer.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOcular toxicity is dose-related\u003C/b\u003E\u003C/span\u003E, not idiosyncratic. Risk increases with cumulative doses \u0026gt;100\u202Fg.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ETamoxifen retinopathy\u003C/b\u003E\u003C/span\u003E is characterised by:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERefractile crystalline deposits\u003C/b\u003E\u003C/span\u003E in the inner retina (typically \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ewhite\u003C/b\u003E\u003C/span\u003E, not black)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ECystoid macular oedema (CMO)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, which may lead to \u003C/span\u003E\u003Cb\u003Evisual impairment\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ERarely, optic neuritis or pseudocystic foveal cavitation\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003ERoutine OCT monitoring may detect early subclinical changes.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 425,
    "Name": "MEK inhibitors",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following is \u003Cspan class=\u0022s1\u0022\u003Eleast likely\u003C/span\u003E to occur as a side effect of MEK inhibitor therapy?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMEK inhibitors\u003C/b\u003E\u003C/span\u003E, used in oncology (notably for metastatic melanoma), are known to cause a wide range of ophthalmic adverse effects (OAEs), often grouped under \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMEK-associated retinopathy (MEKAR)\u003C/b\u003E\u003C/span\u003E. These include:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ESerous retinal detachments\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EVisual disturbances\u003C/b\u003E\u003C/span\u003E and transient VA reduction\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EUveitis\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPunctate epithelial erosions (PEE)\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ECentral retinal vein occlusion\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (rare but reported)\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003E\u003Cspan class=\u0022s3\u0022\u003EHowever, \u003C/span\u003E\u003Cb\u003Eraised intraocular pressure (IOP)\u003C/b\u003E\u003Cspan class=\u0022s3\u0022\u003E is \u003C/span\u003E\u003Cb\u003Enot a recognised or common adverse effect\u003C/b\u003E\u003Cspan class=\u0022s3\u0022\u003E of MEK inhibitors, making it the \u003C/span\u003E\u003Cb\u003Eleast likely\u003C/b\u003E\u003Cspan class=\u0022s3\u0022\u003E of the options listed.\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 5,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 426,
    "Name": "Methotrexate",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following is the \u003Cspan class=\u0022s1\u0022\u003Emost commonly occurring\u003C/span\u003E side effect of methotrexate?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EMethotrexate is an anti-metabolite and folate antagonist widely used in inflammatory diseases and oncology. Its adverse effect profile includes:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EMost common side effects\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EGastrointestinal upset\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EElevated liver enzymes and hepatotoxicity\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EMucocutaneous effects (e.g., stomatitis, ulcers)\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ELess common but serious side effects\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EInterstitial pneumonitis\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EBone marrow suppression\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ENephrotoxicity (rare)\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EIn clinical studies, \u003Cspan class=\u0022s2\u0022\u003E\u003Cb\u003Ehepatotoxicity\u003C/b\u003E\u003C/span\u003E (elevated transaminases) has consistently been one of the \u003Cspan class=\u0022s2\u0022\u003E\u003Cb\u003Emost frequently observed adverse effects\u003C/b\u003E\u003C/span\u003E, occurring in up to \u003Cspan class=\u0022s2\u0022\u003E\u003Cb\u003E18%\u003C/b\u003E\u003C/span\u003E of patients. While bone marrow suppression and pneumonitis are serious, they occur \u003Cspan class=\u0022s2\u0022\u003E\u003Cb\u003Eless frequently\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/p\u003E\u003Cp class=\u0022p4\u0022\u003E\u003Cb\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/b\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 5,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 427,
    "Name": "LASIK",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following statements best reflects LASIK outcomes?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EA major LASIK meta-analysis, synthesising outcomes across thousands of patients and multiple platforms, demonstrated the following key findings:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPatient satisfaction\u003C/b\u003E\u003C/span\u003E was extremely high: \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E92%-98%\u003C/b\u003E\u003C/span\u003E, with an average of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E96.3%\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E96%\u003C/b\u003E\u003C/span\u003E of patients achieved a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epostoperative spherical equivalent within \u00B11.00 D\u003C/b\u003E\u003C/span\u003E, a benchmark of refractive precision.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EDry eye symptoms\u003C/b\u003E\u003C/span\u003E and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehalos/glare\u003C/b\u003E\u003C/span\u003E tend to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eresolve or improve\u003C/b\u003E\u003C/span\u003E over time, not persist.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EWhile \u003C/span\u003E\u003Cb\u003ELASIK initially reduces corneal sensation\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, re-innervation does occur.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 428,
    "Name": "Neovascular glaucoma",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following conditions is associated with the development of neovascular glaucoma?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ENeovascular glaucoma (NVG)\u003C/b\u003E\u003C/span\u003E is a severe secondary glaucoma caused by retinal ischemia leading to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Erelease of VEGF\u003C/b\u003E\u003C/span\u003E, which stimulates neovascularisation of the iris and angle.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cul\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EUGH syndrome\u003C/b\u003E\u003C/span\u003E: Caused by mechanical trauma from IOL malposition. It leads to anterior segment inflammation, hyphema, and IOP elevation; but \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot retinal ischemia\u003C/b\u003E\u003C/span\u003E, so \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot typically associated with NVG\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EICE syndrome\u003C/b\u003E\u003C/span\u003E: Characterised by endothelial cell proliferation and membrane formation over the angle, leading to peripheral anterior synechiae and secondary angle-closure. \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ENeovascularisation is not a feature\u003C/b\u003E\u003C/span\u003E, hence \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot a usual cause of NVG\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EOcular Ischaemic Syndrome\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E: Results from \u003C/span\u003E\u003Cb\u003Esevere carotid artery stenosis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E. The resultant \u003C/span\u003E\u003Cb\u003Echronic retinal hypoperfusion\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is a classic cause of \u003C/span\u003E\u003Cb\u003Eneovascularisation of the iris (rubeosis iridis)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and \u003C/span\u003E\u003Cb\u003ENVG\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, especially in late stages.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 429,
    "Name": "Retinal Astrocytoma",
    "Body": "\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhat is the most likely diagnosis for the fundus finding shown below?\u003C/span\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cimg src=\u0022/upload-2026-02-05-126b3913-bc97-410e-8030-a0bb0e5caadc.webp\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003Cp style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal; border-radius: 0px !important;\u0022\u003ERetinal astrocytic hamartomas (sometimes called retinal astrocytoma) are benign glial cell tumors. They are often encountered as an asymptomatic lesion in screening of patients with tuberous sclerosis complex, but may be sporadic. Diagnosis is largely clinical and may be supported by ancillary tests. In tuberous sclerosis, retinal findings are significantly associated with concurrent neurological and renal disease. Growth or complications of RAH requiring treatment are rare.\u003C/p\u003E\u003Cdiv\u003ESource:\u0026nbsp;\u003Ca href=\u0022https://eyewiki.org/Retinal_Astrocytic_Hamartoma\u0022 target=\u0022_blank\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003ERetinal Astrocytoma\u003C/a\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cimg src=\u0022/upload-2026-02-05-2f7ce6fd-6fc8-4ffa-8b94-4c0f2d2f9461.png\u0022\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 430,
    "Name": "Microspherophakia",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following statements about microspherophakia is \u003Cspan class=\u0022s1\u0022\u003Etrue\u003C/span\u003E?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EMicrospherophakia is a congenital condition in which the crystalline lens is abnormally small and spherical. This increases the lens curvature and refractive power, resulting in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehigh lenticular myopia\u003C/b\u003E\u003C/span\u003E, lens instability, and a significant risk of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epupillary block glaucoma\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EPupillary block in this condition is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eworsened by miotics\u003C/b\u003E\u003C/span\u003E, as these increase contact between the lens and iris. Instead, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecycloplegic agents\u003C/b\u003E\u003C/span\u003E are used to move the lens posteriorly and relieve the block.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EMicrospherophakia is classically associated with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EWeill\u2013Marchesani syndrome\u003C/b\u003E\u003C/span\u003E, which follows an \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eautosomal recessive inheritance pattern\u003C/b\u003E\u003C/span\u003E and is characterised by short stature, brachydactyly, and reduced joint mobility. It can also be seen in other systemic conditions such as Marfan syndrome, Alport syndrome, congenital rubella, and hyperlysinaemia.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003ECardiac involvement in associated syndromes is typically \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emitral valve prolapse\u003C/b\u003E\u003C/span\u003E (as seen in Marfan syndrome), not mitral stenosis.\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 431,
    "Name": "Cataract in Systemic conditions",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following systemic conditions is correctly matched with its associated cataract morphology?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003ESystemic conditions often present with characteristic cataract morphologies:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EDown syndrome\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E: commonly associated with \u003C/span\u003E\u003Cb\u003Ebilateral lamellar cataracts\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EMyotonic dystrophy\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E: classically presents with \u003C/span\u003E\u003Cb\u003EChristmas tree (polychromatic)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E cataracts.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EWilson\u2019s disease\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E: shows \u003C/span\u003E\u003Cb\u003Esunflower cataracts\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E due to copper deposition.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAmiodarone\u003C/b\u003E\u003C/span\u003E is linked to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecorneal verticillata\u003C/b\u003E\u003C/span\u003E, not anterior capsular cataracts.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 1,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 432,
    "Name": "Cataract surgery - Corneal guttata",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EIn a patient with corneal guttata being assessed for cataract surgery, which statement best reflects current understanding of preoperative risk assessment?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003ESpecular microscopy is the most reliable method for evaluating \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eendothelial cell count and morphology\u003C/b\u003E\u003C/span\u003E, making it the best tool for predicting \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecorneal decompensation risk\u003C/b\u003E\u003C/span\u003E after cataract surgery in patients with guttata. A low endothelial cell count (especially \u0026lt;1000 cells/mm\u00B2), polymegathism, or pleomorphism on specular microscopy are all red flags.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EWhile central corneal thickness (CCT) via pachymetry may provide indirect evidence of endothelial health, it remains \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eless sensitive\u003C/b\u003E\u003C/span\u003E, as significant endothelial damage can be present even with normal thickness; especially early in the disease course. Also, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ea normal morning pachymetry doesn\u2019t rule out endothelial compromise\u003C/b\u003E\u003C/span\u003E, as corneal hydration may normalize overnight.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003ERoutine combined phaco \u002B endothelial keratoplasty is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot indicated\u003C/b\u003E\u003C/span\u003E for every patient with guttat; only those with advanced Fuchs\u2019 dystrophy or clear signs of decompensation.\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 1,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 433,
    "Name": "Blepharochalasis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following statements is most accurate regarding blepharochalasis syndrome?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EBlepharochalasis is a rare condition typically affecting children and adolescents, often young females around puberty. It presents with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Erecurrent, painless, transient eyelid oedema\u003C/b\u003E\u003C/span\u003E, usually affecting the upper lids. Although early episodes resolve completely, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eeach attack tends to last about 2 days\u003C/b\u003E\u003C/span\u003E, and with repeated inflammation, patients may develop \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eptosis, atrophic and wrinkled skin, and prolapse of orbital fat or lacrimal gland\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EIt is \u003C/span\u003E\u003Cb\u003Enot limited to people over 50;\u0026nbsp;\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003Equite the opposite.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epresence of ptosis does not exclude\u003C/b\u003E\u003C/span\u003E the diagnosis; in fact, it\u2019s often part of the clinical picture.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EEpisodes are typically \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enon-tender\u003C/b\u003E\u003C/span\u003E, and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eresolve within 48 hours\u003C/b\u003E\u003C/span\u003E on average.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 434,
    "Name": "Internuclear ophthalmoplegia (INO)",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich statement most accurately describes internuclear ophthalmoplegia (INO)?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThe defining feature of INO is impaired adduction of the affected eye with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eslowed saccadic velocity\u003C/b\u003E\u003C/span\u003E, and \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eabducting nystagmus\u003C/b\u003E\u003C/span\u003E in the contralateral eye. This results from damage to the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emedial longitudinal fasciculus (MLF)\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIschaemic INO\u003C/b\u003E\u003C/span\u003E often recovers well, similar to other ischaemic cranial nerve palsies.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EConvergence may be spared or impaired\u003C/b\u003E\u003C/span\u003E, especially in bilateral INO, and is not a reliable discriminator.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EUnilateral INO\u003C/b\u003E\u003C/span\u003E is more commonly associated with infarction than with multiple sclerosis, while \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebilateral INO\u003C/b\u003E\u003C/span\u003E is more characteristic of MS.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 435,
    "Name": "Progressive supranuclear palsy (PSP)",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 65-year-old woman presents with new-onset difficulty initiating eye opening after voluntary or involuntary lid closure, particularly associated with impaired vertical saccades. What is the most likely diagnosis?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThis presentation\u2014\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edifficulty opening the eyes (apraxia of lid opening)\u003C/b\u003E\u003C/span\u003E with impaired \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Evertical saccades,\u0026nbsp;\u003C/b\u003E\u003C/span\u003Eis classic for \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EProgressive Supranuclear Palsy (PSP)\u003C/b\u003E\u003C/span\u003E, a neurodegenerative tauopathy that affects the brainstem and basal ganglia.\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EKey clinical pointers include:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EImpaired \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Evoluntary vertical eye movements\u003C/b\u003E\u003C/span\u003E (especially downgaze early on)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EApraxia of lid opening\u003C/b\u003E\u003C/span\u003E, often mistaken for ptosis or blepharospasm\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EFrontalis overaction on attempted eye opening\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMidbrain atrophy (\u201Chummingbird sign\u201D on MRI)\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPineal tumours\u003C/b\u003E\u003C/span\u003E may affect vertical gaze (via dorsal midbrain syndrome) but are rare in elderly adults.\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EWilson disease\u003C/b\u003E\u003C/span\u003E is more typical in younger patients.\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EHydrocephalus\u003C/b\u003E\u003C/span\u003E is unlikely to present with isolated vertical saccade impairment or lid apraxia.\u003C/p\u003E",
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    "HighYield": false,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 436,
    "Name": "anterior ischaemic optic neuropathy (AION)",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following statements about \u003Cspan class=\u0022s1\u0022\u003Eanterior ischaemic optic neuropathy (AION)\u003C/span\u003E is most accurate?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EIn \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enon-arteritic AION (NAION)\u003C/b\u003E\u003C/span\u003E, approximately \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E40% of patients\u003C/b\u003E\u003C/span\u003E experience some degree of spontaneous visual improvement, particularly if initial acuity was moderately affected. This is in contrast to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Earteritic AION (AAION)\u003C/b\u003E\u003C/span\u003E, where profound and permanent vision loss is more common.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EA \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esmall, crowded disc\u003C/b\u003E\u003C/span\u003E (a \u201Cdisc at risk\u201D) is the anatomical risk factor; not a large cup-to-disc ratio.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ENAION typically presents \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epainlessly\u003C/b\u003E\u003C/span\u003E, unlike AAION which may involve periocular pain.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EFellow eye involvement in NAION is about \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E15% over 5 years\u003C/b\u003E\u003C/span\u003E, not 50%.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003E\n\n\n\n\n\n\n\n\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003EIn AAION, involvement of fellow eye occurs in 25% of patients in 6 days (and in 95% of untreated patients).\u003C/p\u003E\u003C/li\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003E\n\n\n\n\n\n\n\n\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003EIn NAION, 50% achieve 6/9 or better, while in AAION, 40% are associated with permanent visual loss.\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 437,
    "Name": "Cluster Headache",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 40-year-old hypertensive man reports a 12-month history of severe, strictly left-sided periorbital pain occurring once or twice daily in clusters lasting weeks at a time. The attacks consistently begin in the late morning, last 15-60 minutes, and are associated with ipsilateral red eye, lacrimation, ptosis, and nasal congestion. Occasional episodes have occurred on the right side. Which of the following statements is most likely true about this condition?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThe clinical description fits \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecluster headache\u003C/b\u003E\u003C/span\u003E, a subtype of trigeminal autonomic cephalalgia. Key features include:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EStrictly unilateral\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, \u003C/span\u003E\u003Cb\u003Eexcruciating periorbital pain\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAutonomic signs\u003C/b\u003E\u003C/span\u003E on the affected side (conjunctival injection, lacrimation, ptosis, nasal congestion)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAttacks occur in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eclusters\u003C/b\u003E\u003C/span\u003E (over weeks), often with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecircadian patterning\u003C/b\u003E\u003C/span\u003E (suggesting hypothalamic involvement)\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EFunctional imaging (e.g. fMRI, PET)\u003C/b\u003E\u003C/span\u003E in patients during cluster attacks has shown \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eipsilateral posterior hypothalamic activation\u003C/b\u003E\u003C/span\u003E, a characteristic feature of the condition.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGamma knife radiosurgery\u003C/b\u003E\u003C/span\u003E is not a standard treatment for cluster headache; it is used in trigeminal neuralgia.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EDihydroergotamine\u003C/b\u003E\u003C/span\u003E is less effective than \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Etriptans\u003C/b\u003E\u003C/span\u003E or \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehigh-flow oxygen\u003C/b\u003E\u003C/span\u003E, and timing is critical.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ERemissions\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E can vary, but in \u003C/span\u003E\u003Cb\u003Echronic cluster headache\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, remission may be absent or brief;\u0026nbsp;\u003C/span\u003E\u003Cb style=\u0022letter-spacing: 0.14994px;\u0022\u003Eless than six months\u003C/b\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cimg src=\u0022/upload-2026-02-05-2fc457db-4f05-4523-ab14-c083a4d846d9.png\u0022\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
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    "CategoryId": 8,
    "Category": null,
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  },
  {
    "Id": 438,
    "Name": "Trachoma",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EIn the context of endemic regions, what is the first-line surgical procedure for managing trachomatous trichiasis?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThe \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebilamellar tarsal rotation (BLTR)\u003C/b\u003E\u003C/span\u003E procedure is the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Erecommended first-line treatment\u003C/b\u003E\u003C/span\u003E for trachomatous trichiasis in endemic regions. It is a straightforward, effective technique that can be performed by ophthalmologists or trained ophthalmic assistants in community settings.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe choice of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eabsorbable vs non-absorbable sutures\u003C/b\u003E\u003C/span\u003E (e.g., silk, vicryl) \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edoes not significantly alter surgical outcomes\u003C/b\u003E\u003C/span\u003E. Both are considered acceptable by WHO and community eye health programs, making the use of either type of suture appropriate in first-line management.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EAdvanced procedures like \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emucous membrane grafting\u003C/b\u003E\u003C/span\u003E are reserved for complex or recurrent cases and not recommended as initial treatment in endemic settings.\u003C/p\u003E",
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    "CategoryId": 6,
    "Category": null,
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  },
  {
    "Id": 439,
    "Name": "Senile involutional ptosis",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich statement is most accurate regarding senile involutional ptosis?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003ESenile involutional ptosis, or aponeurotic ptosis, results from disinsertion or attenuation of the levator aponeurosis. In these patients:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELevator function is typically normal\u003C/b\u003E\u003C/span\u003E (usually \u226512 mm), distinguishing it from myogenic or neurogenic ptosis.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EM\u00FCller muscle-conjunctival resection is effective\u003C/b\u003E\u003C/span\u003E for mild ptosis (1-2 mm) in patients with good levator function and a positive phenylephrine test;\u0026nbsp;\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot contraindicated\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThe \u003C/span\u003E\u003Cb\u003Enormal MRD1 is approximately 4 mm\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, not 3 mm.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESevere ptosis (\u0026gt;4 mm)\u003C/b\u003E\u003C/span\u003E has a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehigher risk of surgical undercorrection\u003C/b\u003E\u003C/span\u003E, as greater amounts of lifting are required and levator adjustment becomes technically more challenging.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
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    "HighYield": false,
    "CategoryId": 9,
    "Category": null,
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  },
  {
    "Id": 440,
    "Name": "Orbital Lymphoma",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich statement is most accurate regarding orbital lymphoma?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EOrbital lymphoma, particularly extranodal marginal zone B-cell lymphoma (ENMZL), is the most common type of primary orbital lymphoma. It:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOften presents as \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epainless proptosis or mass effect\u003C/b\u003E\u003C/span\u003E, typically without inflammatory signs.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIs \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot treated by excision\u003C/b\u003E\u003C/span\u003E; instead, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebiopsy followed by radiotherapy\u003C/b\u003E\u003C/span\u003E (even in bilateral cases) is the mainstay.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EENMZL is indolent\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, whereas \u003C/span\u003E\u003Cb\u003Emantle cell lymphoma is more aggressive\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, often systemic and with poorer prognosis.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EHas been reported with increased incidence in patients with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elongstanding thyroid eye disease\u003C/b\u003E\u003C/span\u003E, possibly due to chronic orbital inflammation providing a pro-lymphomatous environment.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 441,
    "Name": "Choroidal Melanoma",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhat is the most common site of metastasis from choroidal melanoma?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EChoroidal melanoma is the most common primary intraocular malignancy in adults. Despite effective local control through radiotherapy or enucleation, metastatic spread can occur; often \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eyears or even decades later\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EThe liver is by far the most frequent site of metastasis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, involved in up to 90% of metastatic cases.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOther less common sites include the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elungs, bones, and brain\u003C/b\u003E\u003C/span\u003E, but these typically follow hepatic spread.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe Collaborative Ocular Melanoma Study (COMS) reports 5- and 10-year metastasis rates of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E25% and 34%\u003C/b\u003E\u003C/span\u003E, respectively, even after successful local therapy.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 442,
    "Name": "Melanocytoma",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following statements regarding melanocytoma is MOST likely to be true?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EMelanocytoma is a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebenign, pigmented tumour\u003C/b\u003E\u003C/span\u003E that most frequently arises on the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eoptic disc\u003C/b\u003E\u003C/span\u003E, though it may also involve adjacent \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eretina, choroid, or sclera;\u0026nbsp;\u003C/b\u003E\u003C/span\u003Eso it is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot exclusive to the uvea\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EDespite often being asymptomatic, up to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E90% of patients\u003C/b\u003E\u003C/span\u003E may show \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Evisual field defects\u003C/b\u003E\u003C/span\u003E, including blind spot enlargement or arcuate defects due to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecompression of optic nerve fibres\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EAn \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERAPD may be present\u003C/b\u003E\u003C/span\u003E even when visual acuity is preserved, indicating subtle optic nerve dysfunction.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003EAlthough \u003C/span\u003E\u003Cb\u003Eoptic disc melanocytomas can grow\u003C/b\u003E\u003Cspan class=\u0022s2\u0022\u003E slowly over time, \u003C/span\u003E\u003Cb\u003Emalignant transformation is rare\u003C/b\u003E\u003Cspan class=\u0022s2\u0022\u003E, estimated at \u003C/span\u003E\u003Cb\u003E1-2%\u003C/b\u003E\u003Cspan class=\u0022s2\u0022\u003E, making the \u003C/span\u003E\u003Cb\u003Elow risk of conversion to melanoma\u003C/b\u003E\u003Cspan class=\u0022s2\u0022\u003E the most accurate and relevant statement here.\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-05-8f8c18fd-d988-439d-b1ee-9e71133d1cca.png\u0022\u003E\u003C/span\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 443,
    "Name": "Charles Bonnet Syndrome",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EIn patients with low vision, which statement best describes visual release hallucinations (Charles Bonnet syndrome)?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EVisual release hallucinations\u003C/b\u003E\u003C/span\u003E, also known as \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECharles Bonnet syndrome\u003C/b\u003E\u003C/span\u003E, are complex visual hallucinations experienced by individuals with significant visual impairment, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emost often in the elderly\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThese hallucinations occur \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ewith the eyes open\u003C/b\u003E\u003C/span\u003E, unlike those in sleep disorders or psychosis.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThey are \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot psychiatric\u003C/b\u003E\u003C/span\u003E in origin and are \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot influenced by psychological illness;\u0026nbsp;\u003C/b\u003E\u003C/span\u003Epatients are fully aware the images are not real.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EARMD is a common underlying cause\u003C/b\u003E\u003C/span\u003E, but the syndrome does \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot affect 90%\u003C/b\u003E\u003C/span\u003E of ARMD patients; the estimated prevalence in ARMD is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E10-40%\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Efrequency varies\u003C/b\u003E\u003C/span\u003E significantly; some report multiple daily episodes, others have them less frequently. It is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot characteristically 1-2 times per day\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003ETherefore, the most consistently accurate and defining feature is that the hallucinations occur \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ewhile the eyes are open\u003C/b\u003E\u003C/span\u003E, reflecting \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edeafferentation of visual cortex\u003C/b\u003E\u003C/span\u003E due to visual loss.\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 444,
    "Name": "Primary Open angle glaucoma",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EIn relation to intraocular pressure (IOP) measurement, which statement is most accurate?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EDiurnal variation in IOP\u003C/b\u003E\u003C/span\u003E is a key consideration in glaucoma management, especially in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eprimary open-angle glaucoma (POAG)\u003C/b\u003E\u003C/span\u003E. These patients often show \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elarger fluctuations\u003C/b\u003E\u003C/span\u003E, sometimes up to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E10\u202FmmHg\u003C/b\u003E\u003C/span\u003E in a 24-hour period.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EIOP is actually higher when lying down\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E compared to standing, due to elevated \u003C/span\u003E\u003Cb\u003Eepiscleral venous pressure (EVP)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E in the supine position.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECentral corneal thickness (CCT)\u003C/b\u003E\u003C/span\u003E does affect IOP readings, especially with Goldmann applanation tonometry. However, the effect is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot linear;\u0026nbsp;\u003C/b\u003E\u003C/span\u003Ea 100\u202F\u03BCm increase does \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot always equal a 1\u202FmmHg rise\u003C/b\u003E\u003C/span\u003E, and correction formulas are only \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Erough approximations\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIOP does not typically reduce\u003C/b\u003E\u003C/span\u003E with age in healthy individuals, though \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eolder age increases glaucoma risk\u003C/b\u003E\u003C/span\u003E and may be associated with IOP elevation in some cases.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
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    "HighYield": false,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 445,
    "Name": "Acanthamoeba",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich statement about \u003Cspan class=\u0022s1\u0022\u003EAcanthamoeba\u003C/span\u003E is most accurate?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EAcanthamoeba castellanii\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and \u003C/span\u003E\u003Cb\u003EA. polyphaga\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E are the two most common species causing human infections, particularly \u003C/span\u003E\u003Cb\u003Ekeratitis\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and \u003C/span\u003E\u003Cb\u003Egranulomatous amoebic encephalitis (GAE)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAlthough \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Econtact lens wear\u003C/b\u003E\u003C/span\u003E is the major risk factor, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAcanthamoeba\u003C/b\u003E\u003C/span\u003E is \u003Ci\u003Enot\u003C/i\u003E the most common cause of lens-related infections;\u0026nbsp;\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebacterial keratitis\u003C/b\u003E\u003C/span\u003E (e.g., \u003Ci\u003EPseudomonas\u003C/i\u003E) is more frequent.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EThe trophozoite form\u003C/b\u003E\u003C/span\u003E is the \u003Ci\u003Epathogenic\u003C/i\u003E and \u003Ci\u003Eactive\u003C/i\u003E feeding stage, while the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecystic form\u003C/b\u003E\u003C/span\u003E is the \u003Ci\u003Eresistant\u003C/i\u003E, dormant stage that contributes to treatment challenges.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAcanthamoeba\u003C/b\u003E\u003C/span\u003E is found in many body sites and environments, and can cause \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esystemic disease\u003C/b\u003E\u003C/span\u003E (e.g., encephalitis), not just ocular infections.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EOver 80% of Acanthamoeba keratitis appears in contact lens wearers\u003C/span\u003E.\u003Cspan class=\u0022Apple-converted-space\u0022\u003E\u0026nbsp; \u003C/span\u003EIn one study, 75% of the patients were contact lens wearers; 40% wore daily soft lenses, 22% wore rigid gas permeable lenses, and 38% wore extended wear or other lenses. \u003Cspan class=\u0022Apple-converted-space\u0022\u003E\u0026nbsp;\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u2022\u003Cspan class=\u0022Apple-tab-span\u0022\u003E\t\u003C/span\u003EAcanthamoeba exist in two forms: trophozoites and cysts.\u003Cspan class=\u0022Apple-converted-space\u0022\u003E\u0026nbsp; \u003C/span\u003EThe trophozoites are mobile and consume bacteria (which allows for the diagnosis on E. coli plates).\u003Cspan class=\u0022Apple-converted-space\u0022\u003E\u0026nbsp; \u003C/span\u003EThe trophozoites form double walled cysts which are incredibly resistant to methods of eradication (including freezing, heating, and irradiation).\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u2022\u003Cspan class=\u0022Apple-tab-span\u0022\u003E\t\u003C/span\u003EAcanthamoeba trophozoites and cysts can also be identified with the help of Gram, Giemsa-Wright, hematoxylin and eosin, periodic acid-Schiff, calcoflour white, or other stains. Confocal microscopy has also been used to diagnose Acanthamoeba cysts with some success.\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\n\n\n\n\n\n\n\n\n\n\n\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u2022\u003Cspan class=\u0022Apple-tab-span\u0022\u003E\t\u003C/span\u003EAcanthamoeba is ubiquitous.\u003Cspan class=\u0022Apple-converted-space\u0022\u003E\u0026nbsp; \u003C/span\u003ECorneal trauma, followed by exposure to the parasite (often through a water supply or contact lens solution) in a patient with low tear levels of anti-Acanthamoeba IgA leads to infection. \u003Cspan class=\u0022Apple-converted-space\u0022\u003E\u0026nbsp;\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 446,
    "Name": "Myopia",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich statement regarding \u003Cspan class=\u0022s1\u0022\u003Emyopia\u003C/span\u003E is most likely to be true?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMyopia is significantly \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emore prevalent in Asia\u003C/b\u003E\u003C/span\u003E, particularly East and Southeast Asia, compared to Western countries. In places like Taiwan and Singapore, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eup to 84%\u003C/b\u003E\u003C/span\u003E of high school students are myopic.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EGlobal prevalence is much higher than 10%; projections suggest \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehalf the world\u2019s population\u003C/b\u003E\u003C/span\u003E may be myopic by 2050.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIncidence rates in Asia are \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Efar higher than 2%\u003C/b\u003E\u003C/span\u003E, particularly in children and adolescents.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAlthough \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emyopia is a risk factor for glaucoma\u003C/b\u003E\u003C/span\u003E, especially normal tension glaucoma, the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eassociation is not firmly established\u003C/b\u003E\u003C/span\u003E through large-scale population studies to the extent that it would be considered a proven clinical link.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003EA meta-analysis showed that more time spent on outdoor activities was associated with lower odds of myopia. The odds of myopia decreased by 2% for every additional hour of time spent outdoors per week\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\n\n\n\n\n\n\n\n\n\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u2022\u003Cspan class=\u0022Apple-tab-span\u0022\u003E\t\u003C/span\u003EThere may be a threshold of 10 to 14 hours spent outdoors per week to prevent myopia onset\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 447,
    "Name": "Traumatic Hyphema",
    "Body": "\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhat is the risk of developing glaucoma in a patient who presents with total hyphaema following trauma?\u003C/span\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb style=\u0022font-size: medium; text-decoration-line: underline;\u0022\u003E\uD83D\uDD34 Traumatic Hyphema \u2013 Key Facts\u003C/b\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EEpidemiology:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E75% male predominance\u003C/b\u003E\u003C/span\u003E, male:female ratio 3:1\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003E77% of cases occur in patients \u0026lt;30 years\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, especially ages 10\u201320\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EAetiology:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMost common site of bleeding: \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eanterior ciliary body tear\u003C/b\u003E\u003C/span\u003E (\u224871%)\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003ENatural History:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EUncomplicated duration\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E: 5\u20136 days\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EMean duration of elevated IOP\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E: ~6 days\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERebleeding\u003C/b\u003E\u003C/span\u003E increases risk of raised IOP:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ENo rebleed: ~5% develop high IOP\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EWith rebleed: ~52%\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EIntraocular Pressure:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003E50% overall incidence\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E of raised IOP\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIOP \u0026gt;22 mmHg\u003C/b\u003E\u003C/span\u003E seen in \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E32%\u003C/b\u003E\u003C/span\u003E at some point\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EHigher risk in patients with sickle cell hemoglobinopathy\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, particularly African descent \u2192 risk of \u003C/span\u003E\u003Cb\u003Ecentral retinal artery occlusion\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EClinical Grading of Hyphema:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGrade 1\u003C/b\u003E\u003C/span\u003E: \u0026lt;\u2153 of anterior chamber\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EGrade 2\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E: \u2153\u2013\u00BD\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGrade 3\u003C/b\u003E\u003C/span\u003E: \u0026gt;\u00BD but not total\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EGrade 4\u003C/b\u003E\u003C/span\u003E: total (\u201C8-ball\u201D or \u201Cblackball\u201D hyphema)\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EGlaucoma Risk:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EOverall relative risk\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E after hyphema: \u003C/span\u003E\u003Cb\u003E6.9\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EIf \u003C/span\u003E\u003Cb\u003E360\u00B0 angle recession\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E: risk \u2191 to \u003C/span\u003E\u003Cb\u003E7.5\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ERisk stratified by blood level:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u0026lt; 1/2 chamber: \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E13.5%\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px; font-weight: 700;\u0022\u003E1/2\u003C/span\u003E\u003Cspan style=\u0022color: rgb(14, 14, 14); font-family: \u0026quot;.AppleSystemUIFont\u0026quot;; letter-spacing: 0.14994px;\u0022\u003E chamber: \u003C/span\u003E\u003Cspan class=\u0022s1\u0022 style=\u0022color: rgb(14, 14, 14); font-family: \u0026quot;.AppleSystemUIFont\u0026quot;; letter-spacing: 0.14994px;\u0022\u003E\u003Cb\u003E27%\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ETotal: \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E52%\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 13,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 448,
    "Name": "Peripheral ulcerative keratitis (PUK)",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EIn peripheral ulcerative keratitis (PUK), which oral medication helps prevent corneal melting and complications?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EPUK is driven by immune\u2011mediated collagenolysis and stromal melt due to upregulated matrix metalloproteinases (collagenases). Tetracyclines (e.g., doxycycline 100\u202Fmg BD or tetracycline 250\u202Fmg QID) have a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enon\u2011antibiotic anti\u2011collagenase effect\u003C/b\u003E\u003C/span\u003E by inhibiting matrix metalloproteinases and neutrophil activity. This slows stromal degradation and reduces the risk of perforation.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EAdjuncts commonly used for the same purpose include:\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOral vitamin C\u003C/b\u003E\u003C/span\u003E (500\u202Fmg QID) to support collagen synthesis\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ETopical N\u2011acetylcysteine 20%\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E (collagenase inhibitor)\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ETopical medroxyprogesterone 1%\u003C/b\u003E\u003C/span\u003E (reduces collagenase production)\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003ECephalosporins and fluoroquinolones treat infection but \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edo not inhibit collagenase activity\u003C/b\u003E\u003C/span\u003E, so they do not prevent corneal melt in immune\u2011mediated PUK.\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 449,
    "Name": "Iatrogenic macular hole - Post PPV",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 63-year-old male, two weeks after vitrectomy with ERM and ILM peeling for an epiretinal membrane, presents with mildly reduced visual acuity. His preoperative BCVA was \u003Cspan class=\u0022s1\u0022\u003E0.4 LogMAR (20/50)\u003C/span\u003E and is now \u003Cspan class=\u0022s1\u0022\u003E0.48 LogMAR (20/60)\u003C/span\u003E in the left eye. Imaging shows an eccentric full-thickness hole in the temporal macular area. What is the most appropriate next step in management?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Ci\u003EEccentric full-thickness macular hole (FTMH):\u0026nbsp;\u003C/i\u003Ea rare complication seen in about 2% of eyes after ERM and ILM peeling. Proposed mechanisms include trauma to M\u00FCller cells, de-roofing of intraretinal cysts, ILM contraction, ILM-staining dye toxicity, or direct surgical injury.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EObservation is appropriate. These eccentric FTMHs typically do not affect central visual function unless they involve the fovea or papillomacular bundle. In this case, the hole is located \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Etemporally\u003C/b\u003E\u003C/span\u003E, so not central. It poses minimal visual threat and rarely leads to subretinal fluid or retinal detachment, except in highly myopic eyes.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe current visual acuity of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E0.48 LogMAR (20/60)\u003C/b\u003E\u003C/span\u003E is acceptable and expected at this early postoperative stage. There is no need for re-intervention, especially since both ERM and ILM have been adequately peeled centrally.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EOcriplasmin is ineffective because the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eposterior hyaloid has already been detached\u003C/b\u003E\u003C/span\u003E, as evidenced by imaging.\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 450,
    "Name": "DR",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich retinal sign most strongly indicates a high risk of progression from severe non-proliferative diabetic retinopathy (NPDR) to proliferative diabetic retinopathy (PDR)?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EAccording to the ETDRS, cotton-wool spots are poor predictors of progression to proliferative disease. In contrast, IRMA and venous beading are strong indicators of progression. The presence of IRMA in just one quadrant is sufficient to classify retinopathy as severe NPDR under the \u201C4:2:1 rule.\u201D This rule underpins much of the grading system used in diabetic eye screening and risk stratification.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EData from large-scale studies (ETDRS, WESDR) show that when IRMA is present in severe NPDR, the eye has a 17% risk of progressing to high-risk PDR within 1 year and around 40% within 3 years.\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 451,
    "Name": "Retinitis Pigmentosa",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following is \u003Ci\u003Eincorrect\u003C/i\u003E regarding retinitis pigmentosa (RP)?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EBone spicules are a classic but not universal feature of retinitis pigmentosa. Some patients present without this hallmark finding, a variant referred to as \u003Ci style=\u0022font-weight: bold;\u0022\u003Eretinitis pigmentosa sine pigmento\u003C/i\u003E.\u0026nbsp;\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003EThese patients still exhibit other characteristic signs of RP, such as optic disc pallor and narrowed retinal arterioles.\u0026nbsp;\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003EBone spicules form due to dispersion of pigment from the retinal pigment epithelium (RPE), accumulating in perivascular areas. However, their absence does not exclude the diagnosis.\u0026nbsp;\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003EMoreover, similar pigmentation patterns may appear in other retinal pathologies like post-traumatic scarring or infectious retinopathies (e.g., syphilis, diffuse unilateral subacute neuroretinitis).\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 452,
    "Name": "Tay-Sachs disease",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following best explains the child\u2019s condition, with this finding in the fundus examination and neurodevelopmental regression?\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-05-025d9d94-c702-4a1f-90b7-3664af4245b9.png\u0022\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThe clinical presentation and fundus photograph showing a cherry red spot are characteristic of \u003Cspan style=\u0022font-weight: bold;\u0022\u003ETay-Sachs disease.\u0026nbsp;\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003EThis neurodegenerative lysosomal storage disorder is caused by a deficiency of the enzyme hexosaminidase A, leading to the accumulation of GM2 ganglioside within neuronal lysosomes.\u0026nbsp;\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003ERetinal involvement manifests as a cherry-red spot at the macula; due to a pale surrounding retina from ganglion cell accumulation, contrasting with the fovea, which is devoid of these cells.\u0026nbsp;\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003ENeurological signs like seizures, hypotonia, increased startle reflex, and developmental regression support the diagnosis.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EIn contrast, Batten disease involves ceroid lipofuscin accumulation, Gaucher\u2019s disease is caused by glucocerebroside deposition, and amniotic fluid embolism is an acute maternal condition unrelated to the scenario.\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-05-35c2126e-8a7e-44a8-bc54-9e680abcc69a.png\u0022\u003E\u003C/p\u003E\u003Ch1 class=\u0022nova-legacy-e-text nova-legacy-e-text--size-m nova-legacy-e-text--family-display nova-legacy-e-text--spacing-none nova-legacy-e-text--color-inherit\u0022 itemprop=\u0022caption\u0022 style=\u0022color: rgb(17, 17, 17); font-family: Roboto, Arial, sans-serif; font-size: 0.875rem; line-height: 1.3; margin-bottom: 0px; letter-spacing: normal;\u0022\u003E\u003Cspan style=\u0022font-weight: normal;\u0022\u003ECherry-red spot in Tay-Sachs disease. The right frame shows normal retina. The circle surrounds the macula, lateral to the optic nerve. The left frame shows the macula of a child with Tay-Sachs disease. The cherry-red center is the normal retina of the fovea at the center of the macula.\u003C/span\u003E\u003C/h1\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: normal;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: normal;\u0022\u003EImage source:\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022color: rgb(85, 85, 85); font-family: Roboto, Arial, sans-serif; letter-spacing: normal;\u0022\u003EDOI:\u003C/span\u003E\u003Ca class=\u0022nova-legacy-e-link nova-legacy-e-link--color-inherit nova-legacy-e-link--theme-decorated\u0022 rel=\u0022noopener\u0022 target=\u0022_blank\u0022 href=\u0022https://doi.org/10.1016/j.ejmhg.2011.07.007?urlappend=%3Futm_source%3Dresearchgate.net%26utm_medium%3Darticle\u0022 style=\u0022text-decoration-line: underline; outline: none; font-family: Roboto, Arial, sans-serif; border-style: initial; border-color: initial; border-image: initial; background-image: none; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial; cursor: pointer; display: inline; letter-spacing: normal;\u0022\u003E10.1016/j.ejmhg.2011.07.007\u003C/a\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 453,
    "Name": "Cat-scratch disease",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 17-year-old male presents with two weeks of rapidly reduced vision in the left eye, which progressed over several days. Examination reveals left best-corrected visual acuity of 20/200 (LogMAR 1.0), a relative afferent pupillary defect, and impaired colour vision. Visual field testing shows global depression. Fundus photo shows left optic disc swelling with a macular star pattern. When an underlying cause is identified, what is the most likely aetiology of this presentation?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EThis patient has clinical features consistent with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eneuroretinitis\u003C/b\u003E\u003C/span\u003E, a condition marked by optic disc swelling and characteristic macular star formation. Though many cases are idiopathic, when an infectious etiology is found, the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emost common culprit is Bartonella henselae -\u003C/b\u003E\u003C/span\u003Ea \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Egram-negative rod-\u0026nbsp;\u003C/b\u003E\u003C/span\u003Eassociated with cat-scratch disease.\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003ENeuroretinitis may also be caused by other infectious agents (e.g., syphilis, Lyme, EBV, toxoplasmosis), but \u003Ci\u003EBartonella\u003C/i\u003E remains the most frequent identifiable cause.\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe condition is often self-limiting in immunocompetent individuals, but treatment with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edoxycycline \u00B1 rifampin\u003C/b\u003E\u003C/span\u003E is sometimes used, especially in confirmed Bartonella cases. Interestingly, many affected patients \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edo not recall a cat scratch or bite\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 454,
    "Name": "Vitreomacular traction (VMT)",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 53-year-old man presents with reduced vision in the right eye for several months. The OCT shows tenting of the retina consistent with vitreomacular traction (VMT). Which statement about this condition is accurate?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-05-d3d1e8aa-6796-4208-a9cd-e568d036312a.png\u0022\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\n\n\n\n\n\n\n\n\u003Cp\u003E\u003C/p\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe OCT shows vitreomacular traction (VMT) with characteristic tenting of the retina caused by incomplete separation of the posterior vitreous from the macula.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThis traction may lead to:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ECystoid macular edema\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EShallow retinal detachment\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EDecreased and distorted central vision\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ETypical examination findings:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAbnormal vitreous opacity over the macula\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMacular traction extending to the optic nerve\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EFluorescein angiography may demonstrate dye leakage from macular retinal vessels and the optic disc\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPathophysiology:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EVMT is considered a subset of epiretinal membrane pathology\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EGlial cells are the predominant cell type involved\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESurgical management:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPars plana vitrectomy for VMT has demonstrated visual improvement of \u22652 lines in 75% of eyes (McDonald et al., Ophthalmology 1994; 101:1397\u2013402)\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPharmacologic management:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOcriplasmin is a recombinant protease that targets fibronectin and laminin at the vitreoretinal interface\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIt is administered via intravitreal injection\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EDay 28 resolution rates:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E26% in ocriplasmin-treated eyes\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E10% in placebo-treated eyes\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003ESource:\u0026nbsp;\u003Ca href=\u0022https://iovs.arvojournals.org/article.aspx?articleid=2353949\u0022 target=\u0022_blank\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003EThe Phase III MIVI-TRUST Clinical Trial Data: Subgroup Responder Analysis of a Single Intravitreal Injection of Ocriplasmin in patients with Vitreomacular Traction\u003C/a\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 455,
    "Name": "Stickler Syndrome",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 40-year-old male\u003Cspan class=\u0022s1\u0022\u003E presents with \u003C/span\u003Ebilateral macula-off retinal detachments\u003Cspan class=\u0022s1\u0022\u003E. History reveals a \u003C/span\u003Edominant family inheritance\u003Cspan class=\u0022s1\u0022\u003E pattern (\u201Cfamily curse\u201D), \u003C/span\u003Ejoint hypermobility\u003Cspan class=\u0022s1\u0022\u003E, \u003C/span\u003Emidfacial hypoplasia\u003Cspan class=\u0022s1\u0022\u003E, \u003C/span\u003Emicrognathia\u003Cspan class=\u0022s1\u0022\u003E, and \u003C/span\u003Ehearing difficulty\u003Cspan class=\u0022s1\u0022\u003E. What is the most likely diagnosis?\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EStickler syndrome\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is the \u003C/span\u003E\u003Cb\u003Emost common hereditary vitreoretinopathy\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E with systemic manifestations.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIt is a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecollagen type II disorder\u003C/b\u003E\u003C/span\u003E, inherited in an \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eautosomal dominant\u003C/b\u003E\u003C/span\u003E pattern, typically due to mutations in the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECOL2A1 gene\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EPart of the group of \u003C/span\u003E\u003Cb\u003Ehereditary hyaloideoretinopathies with optically empty vitreous\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, which are divided into:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThose with only ocular signs: e.g., Jansen and Wagner diseases.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThose with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Esystemic signs\u003C/b\u003E\u003C/span\u003E: e.g., Stickler syndrome, Weill\u2013Marchesani, and dwarfism-related variants.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/h3\u003E\u003Ch3\u003E\u003Cb\u003EOcular Features:\u003C/b\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EUp to \u003C/span\u003E\u003Cb\u003E60% develop retinal detachment\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, often \u003C/span\u003E\u003Cb\u003Ebilateral and macula-off\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERetinal breaks\u003C/b\u003E\u003C/span\u003E in \u0026gt;90% due to:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPremature vitreous liquefaction\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EHigh myopia\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ERadial perivascular lattice degeneration\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003ESlit lamp shows \u003C/span\u003E\u003Cb\u003Eoptically empty\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and \u003C/span\u003E\u003Cb\u003Eliquefied vitreous\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ESubcapsular cataracts\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E may also be present.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/h3\u003E\u003Ch3\u003E\u003Cb\u003ESystemic Features:\u003C/b\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ECraniofacial abnormalities\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPierre-Robin sequence\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, \u003C/span\u003E\u003Cb\u003Ecleft palate\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, \u003C/span\u003E\u003Cb\u003Emidface flattening\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, \u003C/span\u003E\u003Cb\u003Emicrognathia\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EJoint hypermobility\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, \u003C/span\u003E\u003Cb\u003Eosteoarthritis\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ESensorineural hearing loss\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EJoint pain\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is common\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Ch3\u003E\u003Cb\u003E\u003Cbr\u003E\u003C/b\u003E\u003C/h3\u003E\u003Ch3\u003E\u003Cb\u003EManagement:\u003C/b\u003E\u003C/h3\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EConsider \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eprophylactic laser retinopexy\u003C/b\u003E\u003C/span\u003E for lattice degeneration, particularly in:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EHigh-risk patients\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPatients with prior RD in the fellow eye\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 456,
    "Name": "DR",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 45-year-old woman with poorly-controlled diabetes undergoes a routine dilated fundus exam. She is asymptomatic with visual acuity of LogMAR 0.10 in both eyes. On slit-lamp examination, there is contiguous neovascularisation of the pupil and iris, but not the angle. Fundoscopy shows four-quadrant intraretinal haemorrhages without retinal or vitreous neovascularisation. Macular contact lens examination reveals no thickening. Fluorescein angiography shows multiple hyperfluorescent foveal spots with one slow-leaking point. What is the most appropriate management for this patient?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThis patient has \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eneovascularization of the iris (NVI)\u003C/b\u003E\u003C/span\u003E, seen as contiguous neovascularization of the pupil and iris, without angle involvement.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EAccording to \u003C/span\u003E\u003Cb\u003EETDRS (Early Treatment Diabetic Retinopathy Study)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, this finding signifies \u003C/span\u003E\u003Cb\u003Eproliferative diabetic retinopathy (PDR)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E and requires prompt \u003C/span\u003E\u003Cb\u003Epanretinal photocoagulation (PRP)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EAlthough \u003C/span\u003E\u003Cb\u003Efluorescein angiography (FA)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E shows macular leakage, there is \u003C/span\u003E\u003Cb\u003Eno retinal thickening on slit-lamp contact lens exam\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, which means the patient does \u003C/span\u003E\u003Cb\u003Enot\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E meet the definition of \u003C/span\u003E\u003Cb\u003Eclinically significant macular edema (CSME)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ECSME is a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebiomicroscopic diagnosis\u003C/b\u003E\u003C/span\u003E, not made based solely on FA or OCT findings.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe vision is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ELogMAR 0.1\u003C/b\u003E\u003C/span\u003E, confirming that her central visual function is well-preserved, supporting the decision \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot\u003C/b\u003E\u003C/span\u003E to initiate focal laser at this time.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAnti-VEGF may be considered \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ein addition to\u003C/b\u003E\u003C/span\u003E PRP, especially in eyes with significant iris neovascularization, but \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPRP remains the standard of care\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EOCT-based \u003C/span\u003E\u003Cb\u003Ecentral subfield thickness\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E may guide macular edema management, but \u003C/span\u003E\u003Cb\u003Eleakage alone on FA is not an indication for treatment\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1424,
    "Name": "Central Serous Chorioretinopathy CSCR",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 26-year-old asymptomatic male presents for routine eye examination. His visual acuity is 0.0 LogMAR (20/20) in both eyes without correction. Fundus examination shows RPE mottling in the macula bilaterally. His fluorescein angiography (FA) is shown below. What is the most appropriate management for this patient?\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-06-62874d20-5a57-47e2-b897-89dce11bb0f7.jpg\u0022\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Ca id=\u0022sp0020\u0022 style=\u0022background-image: none; background-position: 0px 0px; background-size: initial; background-repeat: repeat; background-attachment: scroll; background-origin: initial; background-clip: initial; border-style: none; border-color: initial; border-image: initial; outline: none 0px; vertical-align: baseline; font-family: Arial, Helvetica, sans-serif; letter-spacing: normal; text-align: justify; font-size: small; color: rgb(14, 13, 13);\u0022\u003EFluorescein angiogram shows leakage with an ink blot appearance. The hyperfluorescence starts as a pinpoint and then enlarges concentrically similar to the appearance of dropping ink onto a piece of paper.\u003C/a\u003E\u003C/p\u003E\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe clinical picture and FA findings are consistent with \u003Ci\u003Ecentral serous chorioretinopathy (CSCR)\u003C/i\u003E, a condition typically affecting young to middle-aged males and often discovered incidentally in asymptomatic patients.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ECSCR involves idiopathic serous detachment of the subfoveal neurosensory retina, often associated with RPE changes and pigment epithelial detachment (PED). FA typically shows an expansile dot pattern of hyperfluorescence, as seen here.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAnti-VEGF therapy\u003C/b\u003E\u003C/span\u003E: Not indicated here. It is ineffective in CSCR unless a secondary choroidal neovascular membrane is present. The underlying mechanism of CSCR is related to choroidal hyperpermeability and congestion, not VEGF-driven neovascularisation.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPhotodynamic therapy\u003C/b\u003E\u003C/span\u003E: Effective in chronic symptomatic cases where subretinal fluid persists \u0026gt;3-4 months and involves the central macula. This patient is asymptomatic with no central involvement, so PDT is inappropriate.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EFocal laser\u003C/b\u003E\u003C/span\u003E: Reserved for persistent subretinal fluid \u0026gt;3-4 months, especially if leakage is within 500 microns of the central macula. In this case, there is no vision reduction or central leakage; so laser is not justified.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EObservation\u003C/b\u003E\u003C/span\u003E: The most appropriate first-line approach. In asymptomatic CSCR with 0.0 LogMAR vision, spontaneous resolution occurs in ~90% of cases within 3-4 months. Observation is also suitable in mildly symptomatic patients as long as central vision is preserved and the duration is \u0026lt;4 months.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003EImage source:\u003Ca href=\u0022https://entokey.com/central-serous-chorioretinopathy-2/\u0022 target=\u0022_blank\u0022 style=\u0022letter-spacing: 0.14994px;\u0022\u003ECentral Serous Chorioretinopathy\u003C/a\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cimg src=\u0022https://entokey.com/wp-content/uploads/2017/03/B9781455707379000722_f072-004-9781455707379.jpg\u0022\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Ca id=\u0022sp0025\u0022 style=\u0022color: rgb(74, 197, 167); background-image: none; background-position: 0px 0px; background-size: initial; background-repeat: repeat; background-attachment: scroll; background-origin: initial; background-clip: initial; border-style: none; border-color: initial; border-image: initial; font-size: 11.7px; outline: none 0px; vertical-align: baseline; font-family: Arial, Helvetica, sans-serif; letter-spacing: normal; text-align: justify;\u0022\u003EFluorescein angiogram shows leakage with a smoke stack appearance. The hyperfluorescence starts as a pinpoint and then migrates upward and subsequently diffuses laterally, leading to a mushroom cloud or umbrella-like appearance.\u003C/a\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1425,
    "Name": "Rhegmatogenous retinal detachment (RRD)",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 69-year-old African American phakic male with a known history of sickle cell disease presents with a macula-off rhegmatogenous retinal detachment (RRD), with multiple retinal breaks located both superiorly and inferiorly. What is the most appropriate surgical management option?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPars plana vitrectomy (PPV) is preferred in this patient due to:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMultiple breaks in both inferior and superior quadrants.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe macula being detached (macula-off status).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAvoiding the risks associated with scleral buckle in sickle cell disease.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EScleral buckling is contraindicated in patients with sickle cell disease due to increased risk of anterior segment ischemia.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAnterior segment ischemia in these patients can result from:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EDetachment of extraocular muscles.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EUse of local anaesthetic with epinephrine.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOverzealous photocoagulation or cryopexy.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EInadequate hydration or oxygenation.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EObservation is not appropriate as this is a surgical emergency requiring prompt intervention.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cbr\u003E\u003C/p\u003E\n\u003Cp class=\u0022p3\u0022\u003E\u003Cb\u003EReference:\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003Cp class=\u0022p4\u0022\u003ECartwright MJ, Blair CJ, Combs JL, Stratford TP. \u003Ci\u003EAnterior segment ischemia: a complication of retinal detachment repair in a patient with sickle cell trait.\u003C/i\u003E Ann Ophthalmol. 1990;22:333-4.\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1426,
    "Name": "Ocular toxoplasmosis",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 40\u2011year\u2011old man presents with floaters and reduced vision in one eye. On examination he has vitritis and a pale lesion adjacent to the optic disc. Which of these is the MOST likely diagnosis?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cstrong\u003EAnswer:\u003C/strong\u003E \u003Cstrong\u003EToxoplasmosis.\u003C/strong\u003E\u003Cbr\u003E\nThe combination of \u003Cstrong\u003Eunilateral floaters/reduced vision\u003C/strong\u003E, \u003Cstrong\u003Edense vitritis\u003C/strong\u003E, and a \u003Cstrong\u003Esolitary pale focus by the disc\u003C/strong\u003E is classic for ocular toxoplasmosis retinochoroiditis\u2014typically a \u003Cstrong\u003Efluffy white, focal necrotizing retinitis with overlying vitreous haze\u003C/strong\u003E (\u201Cheadlight in the fog\u201D), often \u003Cstrong\u003Eadjacent to an old chorioretinal scar\u003C/strong\u003E and sometimes juxtapapillary.\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EIn contrast, \u003Cstrong\u003Eacute posterior multifocal placoid pigment epitheliopathy\u003C/strong\u003E presents with \u003Cstrong\u003Ebilateral multiple creamy placoid RPE\u2011level lesions\u003C/strong\u003E and usually \u003Cstrong\u003Elittle vitritis\u003C/strong\u003E, not a single vitritis\u2011obscured focus. \u003Cstrong\u003EAcute retinal necrosis\u003C/strong\u003E characteristically shows \u003Cstrong\u003Erapidly progressive, peripheral confluent necrotizing retinitis with occlusive arteriolar vasculitis and prominent intraocular inflammation\u003C/strong\u003E, rather than an isolated juxtapapillary lesion. \u003Cstrong\u003EBirdshot chorioretinopathy\u003C/strong\u003E is a \u003Cstrong\u003Ebilateral, HLA\u2011A29\u2013associated\u003C/strong\u003E posterior uveitis with \u003Cstrong\u003Enumerous cream choroidal spots\u003C/strong\u003E in middle\u2011aged patients; vitritis may occur but the pattern is diffuse, not a single focal retinitis.\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022line-height: 20px;\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 12,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1427,
    "Name": "Estimating squint size from corneal light reflex",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhen assessing corneal reflexes in a squinting child, displacement of the corneal light reflex to the pupil margin (2\u202Fmm) suggests a squint of what size?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer:\u003C/strong\u003E \u003Cstrong\u003E30 prism dioptres.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\nOn the Hirschberg (corneal light\u2011reflex) estimate, a practical clinical rule is that \u003Cstrong\u003Eeach 1\u202Fmm of reflex decentration corresponds to ~15 prism dioptres\u003C/strong\u003E of deviation; when the reflex lies at the \u003Cstrong\u003Epupillary margin (\u22482\u202Fmm from the centre)\u003C/strong\u003E, the implied angle is therefore \u003Cstrong\u003Eabout 2\u202F\u00D7\u202F15\u202F=\u202F30\u202F\u2206\u003C/strong\u003E.\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003E\u003Cem style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/em\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1428,
    "Name": "Gene target for voretigene neparvovec (NICE)",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003ENICE has recommended voretigene neparvovec to treat inherited retinal disorders with which gene mutation?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003C!--StartFragment--\u003E\u003C!--EndFragment--\u003E\u003C/p\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; font-size: 14px; line-height: 20px;\u0022\u003E\u003Cp style=\u0022font-style: normal; font-weight: 400;\u0022\u003E\u003C!--StartFragment--\u003E\u003C!--EndFragment--\u003E\u003C/p\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; font-size: 14px; line-height: 20px;\u0022\u003E\u003Cp style=\u0022font-style: normal; font-weight: 400;\u0022\u003E\u003Cstrong\u003EAnswer:\u003C/strong\u003E \u003Cstrong\u003ERPE65.\u003C/strong\u003E\u003Cbr\u003E\nNICE Highly Specialised Technologies guidance \u003Cstrong\u003EHST11\u003C/strong\u003E recommends voretigene neparvovec (Luxturna) for \u003Cstrong\u003ERPE65\u2011mediated inherited retinal dystrophies\u003C/strong\u003E in patients with \u003Cstrong\u003Ebiallelic RPE65 mutations\u003C/strong\u003E and sufficient viable retinal cells.\u003C/p\u003E\n\u003Cp style=\u0022font-style: normal; font-weight: 400;\u0022\u003E\u003Cstrong\u003EAssociated diseases for each gene in the options (for quick recall):\u003C/strong\u003E\u003C/p\u003E\n\u003Cul style=\u0022font-style: normal; font-weight: 400;\u0022\u003E\n\u003Cli\u003E\u003Cstrong\u003EUSH2A\u003C/strong\u003E \u2192 \u003Cstrong\u003EUsher syndrome type IIA\u003C/strong\u003E (hearing loss with retinitis pigmentosa) \u003Cstrong\u003Eand\u003C/strong\u003E \u003Cstrong\u003Eautosomal\u2011recessive nonsyndromic retinitis pigmentosa\u003C/strong\u003E.\u0026nbsp;\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ERPE65\u003C/strong\u003E \u2192 \u003Cstrong\u003ELeber congenital amaurosis / early\u2011onset severe retinal dystrophy.\u003C/strong\u003E\u0026nbsp;\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EABCA4\u003C/strong\u003E \u2192 \u003Cstrong\u003EStargardt disease (STGD1/ABCA4 retinopathy)\u003C/strong\u003E; ABCA4 variants can also cause \u003Cstrong\u003Econe\u2011rod dystrophy\u003C/strong\u003E.\u0026nbsp;\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ECNGA1\u003C/strong\u003E \u2192 \u003Cstrong\u003EAutosomal\u2011recessive retinitis pigmentosa\u003C/strong\u003E (rod CNG\u2011channel\u2013related RP).\u003C/li\u003E\n\u003C/ul\u003E\n\u003Cp style=\u0022\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C/div\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1429,
    "Name": "Bitemporal field loss",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 27\u2011year\u2011old patient was found to have a bitemporal field loss on perimetry. Which of the following is LEAST likely to be the cause?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer:\u003C/strong\u003E \u003Cstrong\u003EParietal meningioma.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\nTrue bitemporal hemianopia localizes to the \u003Cstrong\u003Eoptic chiasm\u003C/strong\u003E, most classically from \u003Cstrong\u003Epituitary adenomas\u003C/strong\u003E and occasionally from \u003Cstrong\u003Eintracranial aneurysms\u003C/strong\u003E (e.g., anterior communicating/internal carotid territory) compressing the chiasm. \u003Cstrong\u003ETilted optic discs\u003C/strong\u003E can also produce a \u003Cstrong\u003Ebitemporal hemianopia\u2011like (pseudo) defect\u003C/strong\u003E that may cross the vertical meridian, mimicking chiasmal disease.  By contrast, \u003Cstrong\u003Eparietal lobe lesions\u003C/strong\u003E (including parietal meningioma or parietal involvement by other tumours) affect the \u003Cstrong\u003Edorsal optic radiations\u003C/strong\u003E and typically cause a \u003Cstrong\u003Econtralateral inferior homonymous quadrantanopia/hemianopia\u003C/strong\u003E, not a heteronymous bitemporal defect\u2014hence this is the least likely cause in this scenario.\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1430,
    "Name": "Seasonal allergic conjunctivitis in children",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003ERegarding seasonal allergic conjunctivitis in children which of the following statements is MOST likely to be true?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer:\u003C/strong\u003E \u003Cstrong\u003EThe allergic response is predominantly mediated by Th2\u2011lymphocytes.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\nSeasonal allergic conjunctivitis is a classic \u003Cstrong\u003EIgE\u2011mediated type\u2011I hypersensitivity\u003C/strong\u003E in which \u003Cstrong\u003ETh2\u2011polarized immunity\u003C/strong\u003E (notably IL\u20114/IL\u20115/IL\u201113) drives mast\u2011cell sensitization/degranulation and eosinophilic inflammation; blocking Th2 signaling reduces conjunctival inflammation, underscoring this mechanism.  Although many children are affected\u2014population syntheses estimate \u003Cstrong\u003E\u22656\u201330%\u003C/strong\u003E for allergic conjunctivitis overall, often higher in pediatric cohorts\u2014diagnostic \u003Cstrong\u003Especific IgE is not positive in \u201Calmost all\u201D cases\u003C/strong\u003E and test performance varies; thus that claim is overstated.  The \u003Cstrong\u003Eearly (immediate) phase\u003C/strong\u003E of ocular allergy peaks at \u003Cstrong\u003E~20\u201330 minutes and typically subsides within about an hour\u003C/strong\u003E, with a separate late phase several hours later\u2014so an early phase \u201Clasting up to 2 hours\u201D is not the usual pattern.\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1431,
    "Name": "Granulomatosis with polyangiitis (Wegener\u2019s)",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 51\u2011year\u2011old man presents with proptosis associated with a destructive orbital mass. Six months previously he had a peripheral ulcerative keratitis. Which of the following is the MOST likely diagnosis?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cstrong\u003EAnswer:\u003C/strong\u003E \u003Cstrong\u003EGranulomatosis with polyangiitis.\u003C/strong\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\nA prior \u003Cstrong\u003Eperipheral ulcerative keratitis (PUK)\u003C/strong\u003E strongly points to an underlying systemic vasculitis; PUK is classically associated with \u003Cstrong\u003EANCA\u2011associated disease, including GPA\u003C/strong\u003E, and can even be a presenting feature.  The current finding of \u003Cstrong\u003Eproptosis from a destructive orbital mass\u003C/strong\u003E fits orbital GPA, which frequently causes \u003Cstrong\u003Econtiguous sinonasal\u2013orbital granulomatous inflammation with paranasal bone erosion\u003C/strong\u003E on imaging; orbital involvement is common and may be the initial manifestation.\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EBy contrast, \u003Cstrong\u003Emucormycosis\u003C/strong\u003E usually occurs in \u003Cstrong\u003Eimmunocompromised or acidotic diabetics\u003C/strong\u003E, presents acutely with necrosis/\u201Cblack eschar,\u201D and is an aggressive \u003Cstrong\u003Erhino\u2011orbital\u2013cerebral\u003C/strong\u003E infection rather than a subacute granulomatous mass.\u0026nbsp;\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cstrong\u003EOrbital aspergillosis\u003C/strong\u003E is another invasive fungal sinus\u2011origin disease\u2014often in the immunocompromised\u2014and would not explain the antecedent PUK.\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cstrong\u003ENecrobiotic xanthogranuloma\u003C/strong\u003E typically produces \u003Cstrong\u003Eyellow\u2011orange periorbital plaques\u003C/strong\u003E with a strong paraproteinaemia association, not a destructive orbital mass with prior vasculitic keratitis.\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022line-height: 20px;\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1432,
    "Name": "Neuromyelitis optica spectrum disorder",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich of the following is LEAST likely to be a core clinical characteristic described in the diagnostic criteria for Neuromyelitis Optica Spectrum Disorder?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cstrong\u003EAnswer:\u003C/strong\u003E \u003Cstrong\u003EMononeuritis multiplex.\u003C/strong\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\nModern NMOSD criteria (IPND 2015) define six \u003Cstrong\u003Ecore clinical characteristics\u003C/strong\u003E:\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Col\u003E\u003Cli\u003E\u003Cstrong\u003EOptic neuritis \u003C/strong\u003E(Acute inflammation of the optic nerve causing painful vision loss; in NMOSD it is often \u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Esevere\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E, may be \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Ebilateral\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E or involve long segments/chiasm, and is one of the most common core presentations)\u003C/span\u003E\u003C!--EndFragment--\u003E\u003C/li\u003E\u003Cli\u003E\u0026nbsp;\u003Cstrong\u003EAcute myelitis\u003C/strong\u003E (\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EAn inflammatory spinal cord attack that in NMOSD typically presents as \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Elongitudinally extensive transverse myelitis (LETM)\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E: an intramedullary lesion spanning \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u22653 vertebral segments\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E, causing acute paraparesis/quadriparesis, a sensory level, and sphincter dysfunction),\u003C/span\u003E\u0026nbsp;\u003C/li\u003E\u003Cli\u003E\u003Cstrong\u003EArea postrema syndrome\u003C/strong\u003E (\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003ERecurrent, otherwise unexplained \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Eintractable hiccups, nausea, and vomiting\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E due to involvement of the \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Edorsal medulla/area postrema\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E; MRI often shows a lesion in this region\u003C/span\u003E).\u003C/li\u003E\u003Cli\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA\u003C/span\u003E\u003Cstrong\u003Ecute brainstem syndrome\u003C/strong\u003E,\u003C/li\u003E\u003Cli\u003E\u003Cstrong\u003ESymptomatic diencephalic syndrome\u003C/strong\u003E (e.g., narcolepsy) with typical MRI, and\u0026nbsp;\u003C/li\u003E\u003Cli\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003ESymptomatic cerebral syndrome\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E with NMOSD\u2011typical lesions; these features underpin diagnosis in both AQP4\u2011IgG\u2013positive and seronegative patients.\u0026nbsp;\u003C/span\u003E\u003C/li\u003E\u003C/ol\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003EMononeuritis multiplex\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E is a \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Eperipheral nerve vasculitic neuropathy\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E pattern (asymmetric, painful, multifocal nerve deficits) and is \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Enot part of the NMOSD core criteria\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E, making it the least likely option here.\u003C/span\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022line-height: 20px;\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1433,
    "Name": "Acute profound monocular vision loss in an 82\u2011year\u2011old",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EAn 82\u2011year\u2011old man presents with profound loss of vision in his right eye this morning (to PL). He has no previous ophthalmic history, no headache and denies jaw claudication and proximal myalgia. Apart from a dense right RAPD, ocular examination is normal. Which of these is the MOST appropriate immediate action?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cstrong\u003EAnswer:\u003C/strong\u003E \u003Cstrong\u003EPrescribe high\u2011dose prednisolone once daily and arrange a temporal artery biopsy.\u003C/strong\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cstrong\u003E\u003Cbr\u003E\u003C/strong\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022line-height: 20px;\u0022\u003EIn an 82\u2011year\u2011old with sudden, profound, painless monocular vision loss, a dense RAPD, and a normal fundus, the most likely emergency is \u003Cstrong\u003Earteritic posterior ischemic optic neuropathy from giant cell arteritis (GCA)\u003C/strong\u003E; PION is characteristically retrobulbar with an initially normal disc, and in older adults GCA is a key cause that can rapidly involve the fellow eye.  Because prevention of further visual loss is time\u2011critical, \u003Cstrong\u003Ehigh\u2011dose glucocorticoids must be started immediately\u003C/strong\u003E and \u003Cstrong\u003Etemporal artery biopsy arranged urgently\u003C/strong\u003E, rather than delaying treatment for investigations; biopsy remains diagnostic if performed within the first 1\u20132 weeks after steroids are started.  Typical initial regimens are oral prednisone 40\u201360\u202Fmg/day (up to 60\u201380\u202Fmg/day in visual involvement) or intravenous methylprednisolone in those with acute visual symptoms, with the aim of protecting the fellow eye even though vision already lost is unlikely to recover.  By contrast, prioritizing carotid imaging and aspirin aligns more with \u003Cstrong\u003Ecentral retinal artery occlusion\u003C/strong\u003E pathways and does not address the immediate GCA threat in this presentation.  Likewise, urgent CT or MRI of the optic pathway is not the initial priority when GCA is suspected; neuroimaging can follow, but steroid therapy should not be delayed while arranging it.\u003C/div\u003E\u003Cdiv style=\u0022line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022line-height: 20px;\u0022\u003E\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022line-height: 20px;\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam\u003C/span\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1434,
    "Name": "Uveal Effusion Syndrome",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EIn a patient with idiopathic uveal effusion syndrome without nanophthalmos which of the following is the MOST appropriate management?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer:\u003C/strong\u003E \u003Cstrong\u003EFull\u2011thickness sclerectomy (scleral windows).\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\nIdiopathic uveal effusion syndrome in a non\u2011nanophthalmic eye is still most often approached as a problem of impaired uveoscleral/trans\u2011scleral outflow related to scleral factors and/or vortex\u2011vein congestion, so the management that most directly addresses the mechanism is \u003Cstrong\u003Escleral decompression with scleral windows/sclerectomy\u003C/strong\u003E. Surgical series and reviews describe medical therapy (including systemic steroids) as historically disappointing in true uveal effusion syndrome, while scleral surgery (sclerectomies and/or vortex\u2011vein decompression) can lead to resolution of the choroidal and serous retinal detachments.  Oral acetazolamide does not treat the underlying scleral resistance problem, and pars plana vitrectomy is not a mechanism\u2011based treatment for idiopathic uveal effusion.  (Although there are modern reports showing that some patients can improve with corticosteroids and avoid surgery, that benefit is variable and does not replace scleral windows as the classic \u201Cbest answer\u201D for idiopathic non\u2011nanophthalmic UES.)\u003C/p\u003E\n\u003Cp\u003E\u003Cem style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/em\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1435,
    "Name": "Biometry Pitfall After Refractive Surgery",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWith regard to pre\u2011cataract surgery biometry, which of these statements is MOST likely to be correct?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer:\u003C/strong\u003E \u003Cstrong\u003EPrevious myopic excimer laser refractive surgery is likely to cause under\u2011estimation of the IOL power required if routine biometry is used without any correction factor.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EAfter myopic LASIK/PRK the anterior corneal curvature is flattened but the posterior surface is relatively unchanged, so standard keratometers (and many biometers) applying a fixed keratometric index and assumptions about anterior\u2013posterior curvature relationships tend to \u003Cstrong\u003Eoverestimate true corneal power\u003C/strong\u003E; when this inflated corneal power is fed into routine IOL formulas, the calculated IOL power is often \u003Cstrong\u003Etoo low\u003C/strong\u003E, \u2014which is exactly the same as saying routine biometry \u003Cstrong\u003Eunderestimates the IOL power required\u003C/strong\u003E unless a post\u2011refractive correction method is used.\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003EThe other statements are less likely as written. Keratometry error generally translates roughly \u003Cstrong\u003E1:1\u003C/strong\u003E into postoperative refractive surprise at the spectacle plane, so a 0.75 D K error would be expected to cause about a 0.75 D refractive error rather than 1.25 D.  Optical biometry (partial coherence interferometry) in silicone\u2011oil\u2013filled eyes is not intrinsically \u201Clow reliability\u201D; published work shows \u003Cstrong\u003Eacceptable accuracy/signal quality\u003C/strong\u003E, sometimes with device settings or adjustments, rather than being broadly unreliable.  Finally, short eyes remain difficult and some studies show systematic shifts depending on formula/constants, but the direction is not as universally exam\u2011stable as the post\u2011myopic excimer underestimation problem.\u003C/p\u003E\u003Cp\u003E\u003C!--StartFragment--\u003E\u003C!--EndFragment--\u003E\u003C/p\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; font-size: 14px; font-style: normal; line-height: 20px;\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 1,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1436,
    "Name": "Post\u2011operative Diplopia Test",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 45\u2011year\u2011old woman presents with a divergent left eye. She had surgery as a small child although she is unclear which eye. Her vision is 6/6 in the right eye and 6/60 in the left eye. With the angle corrected whilst viewing through a prism she is aware of double vision. Which one of the following is NOT used as a post\u2011operative diplopia test?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cp style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; letter-spacing: 0.14994px;\u0022\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003EAnswer:\u003C/span\u003E\u0026nbsp;\u003Cspan style=\u0022font-weight: 700;\u0022\u003EHess chart.\u003C/span\u003E\u003C/p\u003E\u003Cp style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; letter-spacing: 0.14994px;\u0022\u003EA post\u2011operative diplopia test is essentially a\u0026nbsp;\u003Cspan style=\u0022font-weight: 700;\u0022\u003Eprism simulation\u003C/span\u003E\u0026nbsp;of the intended surgical alignment to see whether diplopia emerges when the deviation is neutralised, and this can be done using\u0026nbsp;\u003Cspan style=\u0022font-weight: 700;\u0022\u003Eloose prisms or a prism bar\u003C/span\u003E, or by giving a\u0026nbsp;\u003Cspan style=\u0022font-weight: 700;\u0022\u003Eprolonged trial with a Fresnel prism\u003C/span\u003E\u0026nbsp;to mimic the planned correction. A synoptophore can also be used in orthoptic practice to explore sensory status and alignment under dissociation and is part of the prism\u2011based toolkit used in strabismus assessment.\u0026nbsp;\u003C/p\u003E\u003Cp style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; letter-spacing: 0.14994px;\u0022\u003EBy contrast, a Hess chart is a\u0026nbsp;\u003Cspan style=\u0022font-weight: 700;\u0022\u003Emapping tool for incomitant strabismus\u003C/span\u003E\u0026nbsp;(underaction/overaction across gaze positions) used to document and monitor motility patterns, not a prism\u2011simulation \u201Cwill you see double if we straighten you\u201D test, so it is not considered a post\u2011operative diplopia test.\u0026nbsp;\u003C/p\u003E\u003Cp style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; letter-spacing: 0.14994px;\u0022\u003E\u003Cem style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/em\u003E\u003C/p\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1437,
    "Name": "Choroidal melanoma",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhat is the MOST likely mechanism by which tumour cells spread in a 70\u2011year\u2011old man with malignant melanoma of the choroid?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer:\u003C/strong\u003E \u003Cstrong\u003EHaematological spread.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\nChoroidal (uveal) melanoma classically metastasizes via the bloodstream because the uveal tract lacks true lymphatics, so lymphatic spread is not the dominant route in the way it is for many surface/epithelial malignancies.  This hematogenous tendency aligns with the well\u2011known metastatic pattern of uveal melanoma, where distant spread occurs predominantly to the liver, supporting blood\u2011borne dissemination rather than perineural or \u201Cnatural plane\u201D extension as the primary mechanism.\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003E\u003Cem style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/em\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1438,
    "Name": "Glaucoma visual field patterns",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich of these scotomata is LEAST likely to be associated with glaucoma?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer:\u003C/strong\u003E \u003Cstrong\u003ETemporal wedge defect.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EArcuate scotomata, nasal steps, and paracentral scotomata are the classic nerve\u2011fibre\u2011bundle patterns of glaucomatous loss on standard automated perimetry, reflecting damage that respects the horizontal raphe and commonly presents as arcuate defects and nasal step changes, often with early paracentral involvement.  A temporal wedge defect can occur in glaucoma, but it is a less \u201Cclassic\u201D pattern on routine central field testing and is typically described as a far\u2011peripheral inferotemporal sector/wedge defect that may be missed unless the periphery is specifically tested, so it is the least likely option compared with the hallmark arcuate/nasal step/paracentral defects.\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003E\u003Cem\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/em\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1439,
    "Name": "Systemic drugs reaching high intraocular levels",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003ESystemically administered drugs achieve high intraocular concentrations if they have which ONE of the following?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer:\u003C/strong\u003E \u003Cstrong\u003EHigh lipid solubility.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003ESystemically administered drugs must cross the blood\u2013ocular barriers (blood\u2013aqueous and blood\u2013retinal barriers), which markedly restrict diffusion of many agents into the eye, so drugs that are more able to partition into and traverse lipid membranes are more likely to achieve higher intraocular levels.\u003C/p\u003E\u003Cp\u003E\u0026nbsp;High protein binding works in the opposite direction because only the unbound fraction is available to diffuse across barriers, so strong protein affinity generally reduces the amount of free drug that can enter ocular tissues.\u003C/p\u003E\u003Cp\u003EHigh molecular weight also tends to limit penetration across biological barriers, making high intraocular concentrations less likely.\u003C/p\u003E\u003Cp\u003E\u201CLow pH\u201D by itself is not a useful determinant in this context; what matters more is the degree of ionisation at physiological pH (and membrane permeability/transport), not simply having an intrinsically low pH.\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003E\u003Cem\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/em\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 5,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1440,
    "Name": "optic nerve sheath meningioma",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 40\u2011year\u2011old female in good general health presents with gradual painless loss of vision in her right eye over two months. Her acuity is 6/36 in the right eye and 6/6 in the left. She has a right relative afferent pupillary defect (RAPD) and fundus appearance is as shown. Which statement concerning radiological investigation is MOST likely to be correct?\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-07-ff344038-e2b7-44c2-aaa4-0e0fbcfb7f1a.png\u0022 style=\u0022color: rgb(66, 66, 66); font-family: Roboto, Helvetica, Arial, \u0026quot;sans-serif\u0026quot;; letter-spacing: 0.14994px;\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer:\u003C/strong\u003E \u003Cstrong\u003ECT scan with contrast may show a \u201Ctram\u2011track\u201D sign within the orbit.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThe fundus photo shows a swollen/abnormal optic disc with prominent dilated vessels on and around the disc that are typical of \u003Cstrong\u003Eoptociliary (retinochoroidal) shunt vessels\u003C/strong\u003E, a classic clue in compressive optic neuropathies and particularly optic nerve sheath meningioma in the right clinical context of painless progressive unilateral visual loss and RAPD.  Optic nerve sheath meningioma characteristically enhances \u003Cstrong\u003Earound\u003C/strong\u003E the optic nerve rather than within it, so with contrast imaging the enhancing sheath/tumor flanks the non\u2011enhancing optic nerve, creating the well\u2011known \u003Cstrong\u003E\u201Ctram\u2011track\u201D sign\u003C/strong\u003E on axial views (and a \u201Cdot/target\u201D sign on coronal views).  This is why the \u201CCT with contrast\u201D statement is the most likely correct option here; MRI is also excellent, but the option given is \u003Cstrong\u003EMRI without contrast\u003C/strong\u003E, which is specifically less suited to demonstrating the key enhancement pattern.  MRA is aimed at vascular disease (aneurysm/AVM) rather than a sheath tumor, and B\u2011scan ultrasound is not usually the defining diagnostic test compared with cross\u2011sectional orbital imaging that demonstrates the peri\u2011optic enhancement pattern.\u003C/p\u003E\u003Cp\u003E\u003C!--StartFragment--\u003E\u003C!--EndFragment--\u003E\u003C/p\u003E\u003Cdiv style=\u0022font-family:\u0027Segoe UI\u0027;font-size:14px;font-style:normal;font-weight:400;line-height:20px\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/div\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1441,
    "Name": "Left occipito\u2011temporal glioma in a right\u2011handed patient ",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EIn a right\u2011handed patient with a left occipito\u2011temporal glioma which of these features is MOST likely to be found?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer:\u003C/strong\u003E \u003Cstrong\u003EHemianopic alexia.\u003C/strong\u003E\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003EIn a right\u2011handed person, language is most commonly left\u2011hemisphere dominant, and a lesion in the \u003Cstrong\u003Eleft occipito\u2011temporal region\u003C/strong\u003E is a classic setup for a reading disorder in which visual word information cannot be effectively processed by the dominant language network. Lesions involving the dominant occipital/occipito\u2011temporal region produce the syndrome of \u003Cstrong\u003Ealexia without agraphia (\u201Cpure alexia\u201D)\u003C/strong\u003E, typically accompanied by a \u003Cstrong\u003Eright homonymous hemianopia\u003C/strong\u003E, and clinically this often presents as marked difficulty reading despite preserved writing\u2014hence the expected finding is a form of alexia linked to the hemianopia.  A left homonymous hemianopia would imply a right retrochiasmal lesion, not a left occipito\u2011temporal one, so the hemianopia direction in that statement does not fit the lesion side.  See\u2011saw nystagmus is more characteristically associated with chiasmal/parasellar or related central lesions rather than a focal occipito\u2011temporal glioma, and a fixed dilated pupil suggests third nerve compression/uncal herniation rather than a localized occipito\u2011temporal cortical tumor presentation.\u003C/p\u003E\n\u003Cp\u003E\u003Cem style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/em\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1442,
    "Name": "Dysphotopsia after cataract surgery",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003ERegarding dysphotopsia after cataract surgery which of the following statements is LEAST likely to be correct?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer:\u003C/strong\u003E \u003Cstrong\u003ENegative dysphotopsia is relieved by pupillary constriction.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003ENegative dysphotopsia is classically perceived as a \u003Cstrong\u003Etemporal (often frontotemporal) crescent/arc-shaped shadow\u003C/strong\u003E, so that description is consistent with the usual symptom profile.  What makes the statement wrong is that negative dysphotopsia is typically \u003Cstrong\u003Eworse with a small pupil (pupillary constriction)\u003C/strong\u003E and \u003Cstrong\u003Eless noticeable when the pupil dilates\u003C/strong\u003E, which is why bright conditions (small pupil) often aggravate it.\u003C/p\u003E\u003Cp\u003EPositive dysphotopsia, in contrast, is described as \u003Cstrong\u003Ebright phenomena\u003C/strong\u003E such as streaks/arcs/rays (often triggered by \u003Cstrong\u003Eoblique or side light sources\u003C/strong\u003E) and is widely linked to \u003Cstrong\u003Eedge-related light effects\u003C/strong\u003E, particularly with \u003Cstrong\u003Esquare-edge IOL designs\u003C/strong\u003E that can promote internal reflections/glare.\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003E\u003Cem style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/em\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 1,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1443,
    "Name": "Marfan syndrome inheritance risk",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA patient has Marfan\u2019s syndrome and would like to know how likely it is that one of her children will inherit the condition. Her partner is not a member of her extended family. Which of the following options is the BEST estimate of the likelihood?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer:\u003C/strong\u003E \u003Cstrong\u003E0.5\u003C/strong\u003E\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003EMarfan syndrome is inherited in an \u003Cstrong\u003Eautosomal dominant\u003C/strong\u003E pattern, meaning an affected individual typically carries one altered copy of the relevant gene and one normal copy, so \u003Cstrong\u003Eeach pregnancy has a 50% (1 in 2) chance\u003C/strong\u003E of the child inheriting the pathogenic variant and therefore the condition.  The fact that her partner is not from her extended family simply reduces the chance that the partner also has the same familial variant; assuming the partner is unaffected, the risk to each child remains \u003Cstrong\u003E50%\u003C/strong\u003E.\u003C/p\u003E\n\u003Cp\u003E\u003Cem style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/em\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 7,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1444,
    "Name": "Penicillin allergy",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich ONE of the following drugs should NEVER be given to a patient with penicillin allergy?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer:\u003C/strong\u003E \u003Cstrong\u003ECo\u2011amoxiclav.\u003C/strong\u003E\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003ECo\u2011amoxiclav contains \u003Cstrong\u003Eamoxicillin\u003C/strong\u003E, which is a \u003Cstrong\u003Epenicillin (penicillin\u2011class / penicillin\u2011like \u03B2\u2011lactam)\u003C/strong\u003E, so in a patient labelled as penicillin\u2011allergic it is the one you should avoid.  In contrast, amikacin is an aminoglycoside (not a \u03B2\u2011lactam) and has no structural relationship to penicillin, so penicillin allergy does not automatically preclude its use.\u003C/p\u003E\u003Cp\u003ECefuroxime (a cephalosporin) and meropenem (a carbapenem) are \u03B2\u2011lactams but true cross\u2011reactivity with penicillin is generally \u003Cstrong\u003Elow\u003C/strong\u003E and depends mainly on side\u2011chain similarity rather than the \u03B2\u2011lactam ring itself; many guidelines therefore treat them as \u003Cem\u003Epotentially usable with appropriate clinical caution and history\u2011taking\u003C/em\u003E, rather than \u201Cnever.\u201D\u003C/p\u003E\n\u003Cp\u003E\u003Cem style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/em\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 5,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1445,
    "Name": "Immunological treatment of myasthenia gravis",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u201CWith regards to the immunological treatment of myasthenia gravis, which of the following is MOST likely to be correct?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer:\u003C/strong\u003E \u003Cstrong\u003EAzathioprine may be used as a steroid\u2011sparing agent for disease control.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EAzathioprine is a well\u2011established long\u2011term immunosuppressant in myasthenia gravis and is commonly used alongside corticosteroids to achieve disease control while allowing steroid reduction (a steroid\u2011sparing strategy).\u003C/p\u003E\u003Cp\u003EIntravenous immunoglobulin is not typically used for \u201Cmild\u201D disease; it is mainly a short\u2011term, rapid immunomodulatory treatment used for severe or rapidly worsening weakness, peri\u2011operative bridging, or crisis/exacerbations rather than routine mild presentations.\u003C/p\u003E\u003Cp\u003EPlasma exchange is also a rapid \u201Crescue/bridge\u201D therapy with benefits that are short\u2011lived (weeks), so it does not confer long\u2011term remission on its own without ongoing immunosuppression.\u003C/p\u003E\u003Cp\u003EThymectomy has the strongest evidence base in non\u2011thymomatous acetylcholine receptor antibody\u2013positive generalized disease (improving outcomes and reducing steroid requirement); in seronegative disease, benefit is less certain and it is not the clear \u201Cmost likely correct\u201D statement in this set.\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003E\u003Cem style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/em\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1446,
    "Name": "Effect of a single radial corneal suture on astigmatism",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EConsidering the effect of inserting or removing a single radial corneal suture upon refractive astigmatism, which of the following statements is MOST LIKELY to be correct?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer:\u003C/strong\u003E \u003Cstrong\u003EInsertion of a suture results in steepening of the corneal curvature in the meridian of the new suture.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EA single \u003Cstrong\u003Etight\u003C/strong\u003E radial corneal suture increases tensile force across that meridian, and the predictable topographic response is \u003Cstrong\u003Esteepening in the sutured meridian with coupling-related flattening 90 degrees away\u003C/strong\u003E, which is the principle surgeons exploit when adjusting or adding sutures to reduce post\u2011operative astigmatism.  By the same logic, removing (or significantly loosening) a previously tight suture tends to reduce that meridional steepening\u2014i.e., it \u003Cstrong\u003Eflattens the meridian of the removed suture\u003C/strong\u003E and causes a relative \u003Cstrong\u003Esteepening 90 degrees away\u003C/strong\u003E, so the \u201Cremoval causes steepening in the same meridian\u201D statement is the opposite of what is expected.\u003C/p\u003E\n\u003Cp\u003E\u003Cem style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/em\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 7,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1447,
    "Name": "Follicular conjunctivitis \u002B preauricular/submandibular lymphadenopathy",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 22\u2011year\u2011old female presents with a history of fever, and now has a follicular conjunctivitis. Examination reveals that the sub\u2011mandibular and the pre\u2011auricular lymph nodes are enlarged. Which of the following is least likely to be an association?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer:\u003C/strong\u003E \u003Cstrong\u003ESuccessful treatment with clindamycin.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThis presentation is most consistent with \u003Cstrong\u003EParinaud oculoglandular syndrome\u003C/strong\u003E, most commonly due to \u003Cstrong\u003Ecat\u2011scratch disease (Bartonella henselae)\u003C/strong\u003E, which characteristically causes \u003Cstrong\u003Eunilateral granulomatous/follicular conjunctivitis with ipsilateral regional lymphadenopathy\u003C/strong\u003E (often preauricular and/or submandibular) and systemic symptoms such as fever.  Ocular Bartonella infection is well known to be associated with \u003Cstrong\u003Euveitis\u003C/strong\u003E and with \u003Cstrong\u003Eoptic nerve swelling\u003C/strong\u003E in the form of \u003Cstrong\u003Eneuroretinitis\u003C/strong\u003E (optic disc edema with later macular star), and Bartonella can also cause \u003Cstrong\u003Evasculitis that may be occlusive\u003C/strong\u003E, with reported cases including \u003Cstrong\u003Ecentral retinal artery/vein occlusion\u003C/strong\u003E.\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003EBy contrast, \u003Cstrong\u003Eclindamycin is not a standard or typical effective therapy\u003C/strong\u003E for cat\u2011scratch disease/Parinaud oculoglandular syndrome; when antibiotics are used, guidance commonly cites \u003Cstrong\u003Eazithromycin\u003C/strong\u003E for uncomplicated CSD and other regimens (e.g., doxycycline \u00B1 rifampicin) for more significant ocular/systemic disease, making \u201Csuccessful treatment with clindamycin\u201D the least likely association in this context.\u003C/p\u003E\u003Cp\u003E\u003C!--StartFragment--\u003E\u003C!--EndFragment--\u003E\u003C/p\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; font-size: 14px; font-style: normal; line-height: 20px;\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1448,
    "Name": "PEDIG occlusion dose",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EAccording to Paediatric Eye Diseases Investigative Group guidelines, what patching regime would you MOST likely prescribe \u003Cstrong\u003Ewithout near tasks\u003C/strong\u003E for a 3\u2011year\u2011old child with the following VA: \u003Cstrong\u003ERVA LogMAR 0.1, LVA 0.7\u003C/strong\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer:\u003C/strong\u003E \u003Cstrong\u003ERight occlusion 6 hours per day.\u003C/strong\u003E\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003ELogMAR \u003Cstrong\u003E0.7\u003C/strong\u003E corresponds to approximately \u003Cstrong\u003E20/100\u003C/strong\u003E, while logMAR \u003Cstrong\u003E0.1\u003C/strong\u003E corresponds to ~\u003Cstrong\u003E20/25\u003C/strong\u003E, so this is \u003Cstrong\u003Esevere amblyopia\u003C/strong\u003E by the commonly used PEDIG severity bands (severe \u2248 20/100\u201320/400).  PEDIG\u2019s key randomized trial in severe amblyopia compared \u003Cstrong\u003E6 hours/day\u003C/strong\u003E with full\u2011time patching and showed similar visual improvement, which is why 6 hours/day is the standard evidence\u2011based \u201Cpart\u2011time\u201D prescription for severe cases in this age group.\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003EThe \u201Cwithout near tasks\u201D wording doesn\u2019t force you to reduce or increase the prescribed hours in the PEDIG framework, because PEDIG also tested whether \u201Cnear\u201D activities add benefit to patching and found no meaningful advantage of near over distance activities when patching is prescribed (so the dose recommendation is still driven mainly by baseline severity rather than the activity type).\u003C/p\u003E\u003Cp\u003E\u003C!--StartFragment--\u003E\u003C!--EndFragment--\u003E\u003C/p\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; font-size: 14px; font-style: normal; line-height: 20px;\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1449,
    "Name": "Hysteresis principle",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich of the following investigations utilises the principle of hysteresis?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer:\u003C/strong\u003E \u003Cstrong\u003EOcular response analyser.\u003C/strong\u003E\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003EHysteresis refers to a system showing different responses on \u201Cloading\u201D versus \u201Cunloading,\u201D and in the eye the classic clinical example is \u003Cstrong\u003Ecorneal hysteresis\u003C/strong\u003E, which reflects the cornea\u2019s viscoelastic damping.  The \u003Cstrong\u003EOcular Response Analyzer (ORA)\u003C/strong\u003E measures this by using an air\u2011puff to indent the cornea and recording two applanation events: one as the cornea moves \u003Cstrong\u003Einward\u003C/strong\u003E and one as it returns \u003Cstrong\u003Eoutward\u003C/strong\u003E; the \u003Cstrong\u003Edifference between the inward and outward applanation pressures\u003C/strong\u003E is the hysteresis value (corneal hysteresis).  In contrast, \u003Cstrong\u003EB\u2011scan ultrasonography\u003C/strong\u003E is based on acoustic reflection/echoes, \u003Cstrong\u003EERG\u003C/strong\u003E is based on retinal bioelectrical responses to light stimuli, and \u003Cstrong\u003ESD\u2011OCT\u003C/strong\u003E is based on optical interferometry\u2014none of which relies on a hysteresis loop phenomenon as the core measurement principle.\u003C/p\u003E\n\u003Cp\u003E\u003Cem style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/em\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 7,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1450,
    "Name": "Jackson Cross Cylinder",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich of the following statements MOST clearly describes a Jackson Cross Cylinder?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer:\u003C/strong\u003E \u003Cstrong\u003EA spherocylindrical lens in which the power of the sphere is half the power of the cylinder and of the opposite sign.\u003C/strong\u003E\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003EA Jackson cross cylinder is made from \u003Cstrong\u003Etwo equal but opposite cylinders oriented 90\u00B0 apart\u003C/strong\u003E, giving it \u003Cstrong\u003Ezero spherical equivalent\u003C/strong\u003E and allowing it to refine cylinder power/axis without shifting the circle of least confusion.  In spherocylindrical notation this is commonly written as \u003Cstrong\u003E\u002B0.25 / \u22120.50\u003C/strong\u003E or \u003Cstrong\u003E\u002B0.50 / \u22121.00\u003C/strong\u003E, which shows that the \u003Cstrong\u003Ecylinder magnitude is double the sphere magnitude\u003C/strong\u003E and the \u003Cstrong\u003Esigns are opposite\u003C/strong\u003E\u2014equivalently, the \u003Cstrong\u003Esphere is half the cylinder and of opposite sign\u003C/strong\u003E.\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003E\u003Cem style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/em\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 7,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1451,
    "Name": "pigmented conjunctival lesion",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EYou are asked to see a 30\u2011year\u2011old woman with a slowly enlarging pigmented conjunctival lesion as shown in the photograph below. What is the MOST likely diagnosis?\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-09-5a3256a0-f052-4739-92f9-7c7951f17409.png\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EThis is most consistent with \u003Cstrong\u003Econjunctival malignant melanoma\u003C/strong\u003E, because the lesion is \u003Cstrong\u003Ediscrete and nodular/elevated\u003C/strong\u003E with \u003Cstrong\u003Eprominent feeder vessels\u003C/strong\u003E and a history of \u003Cstrong\u003Eprogressive enlargement\u003C/strong\u003E, which are classic suspicious clinical features for conjunctival melanoma.  A conjunctival naevus is typically \u003Cstrong\u003Elong\u2011standing from childhood/early life\u003C/strong\u003E and often contains \u003Cstrong\u003Eintralesional cysts\u003C/strong\u003E, which supports a benign diagnosis rather than a newly enlarging nodular lesion.  Primary acquired melanosis is usually \u003Cstrong\u003Eflat, patchy pigmentation\u003C/strong\u003E rather than a raised mass (even though it can be a precursor lesion).  Lymphangioma/lymphangiectasia characteristically appears \u003Cstrong\u003Ecystic/transparent\u003C/strong\u003E (often \u201Cstring of pearls\u201D or cystic spaces), not as a solid pigmented nodule.\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022line-height: 20px;\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1452,
    "Name": "Posterior vitreous detachment",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EPosterior vitreous detachment is typically present in which one of the following:\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer:\u003C/strong\u003E \u003Cstrong\u003EGiant retinal tear.\u003C/strong\u003E\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003EA \u003Cstrong\u003Egiant retinal tear\u003C/strong\u003E is classically defined as a full\u2011thickness retinal break extending \u22653 clock hours \u003Cstrong\u003Ein the presence of a posteriorly detached vitreous\u003C/strong\u003E, so PVD is part of the typical setting rather than an incidental finding.  In \u003Cstrong\u003Eretinal dialysis\u003C/strong\u003E, the mechanism is different: the vitreous is typically still attached (including at the vitreous base), which is why these detachments can be slow and often demarcated, so a PVD is not the usual context. \u003Cstrong\u003ETraumatic macular holes\u003C/strong\u003E are also usually seen without a complete PVD\u2014EyeWiki notes that complete PVD is rare and the posterior vitreous remains adherent to the macula in the majority.  Finally, \u003Cstrong\u003Eatrophic round hole retinal detachments\u003C/strong\u003E (often in lattice) commonly occur in eyes with little vitreous degeneration and typically \u003Cstrong\u003Ewithout\u003C/strong\u003E PVD, reflecting their non\u2011tractional pathogenesis.\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003E\u003Cem style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/em\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1453,
    "Name": " nedocromil sodium",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich of these types of drug is nedocromil sodium?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer:\u003C/strong\u003E \u003Cstrong\u003EMast cell stabiliser.\u003C/strong\u003E\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003ENedocromil sodium acts by \u003Cstrong\u003Estabilising mast cells\u003C/strong\u003E and inhibiting mediator release (including histamine) involved in allergic reactions, which is why it is used for \u003Cstrong\u003Eitching associated with allergic conjunctivitis\u003C/strong\u003E as an ophthalmic preparation.\u003C/p\u003E\n\u003Cp\u003E\u003Cem style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/em\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 5,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1454,
    "Name": "Blunt ocular trauma",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich of the following statements is MOST likely to be true following blunt trauma to the eye?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer:\u003C/strong\u003E \u003Cstrong\u003ESclera is thinnest behind rectus muscle insertions.\u003C/strong\u003E\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003EIn blunt trauma, ocular tissues fail preferentially at anatomical weak points, and the sclera has a well\u2011described thickness profile: it is \u003Cstrong\u003Ethickest near the optic nerve\u003C/strong\u003E and \u003Cstrong\u003Ethinnest just posterior to the rectus muscle insertions\u003C/strong\u003E, which is why ruptures from blunt trauma are commonly described at or just behind these insertions as well as at the limbus.  Bruch\u2019s membrane is not \u201Chighly elastic\u0022, in traumatic choroidal rupture the globe deformation causes the RPE\u2013Bruch complex to stretch and \u003Cstrong\u003Ebreak\u003C/strong\u003E, reflecting its limited tensile strength/elasticity rather than resilience.  Retinal detachment associated with retinal dialysis often \u003Cstrong\u003Eprogresses slowly\u003C/strong\u003E and diagnosis is frequently \u003Cstrong\u003Edelayed\u003C/strong\u003E, rather than presenting immediately, consistent with vitreous being typically still attached in these eyes.\u003C/p\u003E\n\u003Cp\u003E\u003Cem style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/em\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 13,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1455,
    "Name": "Intermittent Exotropia Subtype ",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EAn 8\u2011year\u2011old child presents with strabismus. The findings are an exotropia, which measures 35 prism dioptres for distance and 15 prism dioptres for near. After 45 minutes of monocular occlusion the near deviation has increased to 30 prism dioptres. Which of the following is the MOST accurate diagnostic category?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer:\u003C/strong\u003E \u003Cstrong\u003ESimulated divergence excess exotropia.\u003C/strong\u003E\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003EA larger distance than near exodeviation initially suggests a divergence\u2011excess pattern, but the key step is reassessing the near angle after prolonged monocular occlusion to abolish tenacious proximal fusion. When the near deviation increases after occlusion so that the distance\u2013near difference becomes small (typically no longer meeting the \u226510 prism dioptre distance\u2011greater\u2011than\u2011near threshold), this fits the definition of pseudo/simulated divergence excess rather than true divergence excess. Here, the near angle rises from 15\u0394 to 30\u0394 after 45 minutes of occlusion, bringing it close to the distance angle of 35\u0394, which is exactly the pattern expected in simulated divergence excess.\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003E\u003Cem style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/em\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1456,
    "Name": "Best IOP\u2011lowering response to argon laser trabeculoplasty (ALT)",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich of the following types of glaucoma is MOST likely to have the best intraocular pressure lowering response to Argon laser trabeculoplasty (ALT)?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: \u003Cstrong\u003EPseudoexfoliative glaucoma\u003C/strong\u003E\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EALT tends to work best when the \u003Cstrong\u003Etrabecular meshwork is densely pigmented\u003C/strong\u003E, because pigment facilitates absorption of laser energy and enhances the biological response that increases outflow. Eyes with \u003Cstrong\u003Epseudoexfoliation\u003C/strong\u003E commonly have \u003Cstrong\u003Eheavier trabecular pigmentation\u003C/strong\u003E and are classically described as responding well to trabeculoplasty.\u003C/p\u003E\n\u003Cp\u003EBy comparison, \u003Cstrong\u003Euveitic glaucoma\u003C/strong\u003E is not an ideal candidate because trabeculoplasty is generally \u003Cstrong\u003Eavoided in active inflammation\u003C/strong\u003E (and can exacerbate intraocular inflammation), and secondary glaucomas such as \u003Cstrong\u003Eaphakic/traumatic mechanisms\u003C/strong\u003E are described as \u003Cstrong\u003Eless responsive\u003C/strong\u003E than primary open\u2011angle/pigmentary/PEX patterns.\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003E\u003Cem style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/em\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1457,
    "Name": "Contact lens\u2013related painful keratitis",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA patient, who wears contact lenses, has developed a painful keratitis. Which of the following MOST strongly supports a diagnosis of acanthamoeba keratitis?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: \u003Cstrong style=\u0022\u0022\u003ELinear intrastromal infiltrates\u003C/strong\u003E\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003ELinear intrastromal infiltrates represent \u003Cstrong\u003Eradial keratoneuritis / radial perineuritis\u003C/strong\u003E (perineural infiltrates tracking along corneal nerves), which is an \u003Cstrong\u003Eearly and characteristic\u003C/strong\u003E sign of Acanthamoeba keratitis and therefore the most supportive finding among the options.\u003C/p\u003E\n\u003Cp\u003EThe other findings listed are \u003Cstrong\u003Enon\u2011specific\u003C/strong\u003E and can occur with many causes of microbial keratitis or chronic inflammation. Corneal melting is more typical of severe bacterial/fungal disease and is not the key supportive clinical clue for Acanthamoeba, while neovascularisation and stromal haze/opacification can be secondary late sequelae of multiple keratitides rather than a distinguishing feature.\u003C/p\u003E\n\u003Cp\u003E\u003Cem style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/em\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1458,
    "Name": "CRVO \u002B raised ESR \u002B raised gamma region on SPEP",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 67\u2011year\u2011old man presents with a three\u2011day history of blurred vision due to a central retinal vein occlusion in the right eye. Acuity is 6/18 right and 6/6 left. ESR is elevated at 98 and the gamma zone is elevated on serum protein electrophoresis. What is the MOST likely diagnosis?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer:\u003C/strong\u003E \u003Cstrong\u003EMultiple myeloma.\u003C/strong\u003E\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003EAn elevated \u003Cstrong\u003Egamma region\u003C/strong\u003E on serum protein electrophoresis strongly points toward a \u003Cstrong\u003Emonoclonal gammopathy\u003C/strong\u003E, classically seen as a narrow spike in the gamma-globulin zone, and multiple myeloma is a key malignant cause of this pattern.  In the context of a retinal vein occlusion, paraproteinaemia can drive \u003Cstrong\u003Ehyperviscosity\u003C/strong\u003E and microvascular flow impairment, predisposing to venous stasis and retinal venous occlusion; CRVO has been reported in association with paraproteinaemias and multiple myeloma, including cases where electrophoresis demonstrates increased \u03B3\u2011globulins/paraprotein.  Although ESR can be markedly raised in many inflammatory and malignant states, the combination of a very high ESR with a raised gamma region on electrophoresis makes a plasma\u2011cell dyscrasia the most coherent single diagnosis from the list. \u0026nbsp;\u003C/p\u003E\n\u003Cp\u003E\u003Cem style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/em\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1459,
    "Name": "DVLA Group 2 driving standard",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EFor a Group 2 Driving license the minimum requirement in the better eye is 6/7.5. What does the DVLA specify should be the minimum visual acuity in the worse eye?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer:\u003C/strong\u003E \u003Cstrong\u003E6/60.\u003C/strong\u003E\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003EFor \u003Cstrong\u003EGroup 2 (bus and lorry)\u003C/strong\u003E licensing, DVLA guidance states the visual acuity must be \u003Cstrong\u003Eat least 6/7.5 in the better eye\u003C/strong\u003E and \u003Cstrong\u003Eat least 6/60 in the poorer (worse) eye\u003C/strong\u003E, with correction if required (and if spectacles are used, there is also a \u002B8 dioptre limit).\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003E\u003Cem style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/em\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 7,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1460,
    "Name": "Post\u2011blunt trauma hypotony with shallow AC and resolving hyphaema ",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA patient presents with blurred vision in one eye following blunt trauma one week previously. The visual acuity is 6/18 in that eye. The anterior chamber is shallow and there is a small resolving hyphaema. The intraocular pressure is recorded as 4 mmHg compared with 16 mmHg in the other eye. What is the MOST likely cause of the hypotony?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer:\u003C/strong\u003E \u003Cstrong\u003ECyclodialysis cleft.\u003C/strong\u003E\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003EA cyclodialysis cleft is a \u003Cstrong\u003Edisinsertion of the ciliary body from the scleral spur\u003C/strong\u003E, creating a direct pathway between the \u003Cstrong\u003Eanterior chamber and the suprachoroidal space\u003C/strong\u003E, which markedly increases uveoscleral outflow and produces \u003Cstrong\u003Eprofound hypotony\u003C/strong\u003E.  This fits the clinical picture of \u003Cstrong\u003Every low IOP (4 mmHg)\u003C/strong\u003E shortly after blunt trauma with associated anterior segment signs such as a resolving hyphaema, and it is specifically highlighted as an important diagnosis to consider in \u003Cstrong\u003Enew\u2011onset hypotony after trauma\u003C/strong\u003E, even when the peripheral chamber is shallow and gonioscopic visualization can be difficult.  In contrast, angle recession is classically important because it predisposes to \u003Cstrong\u003Elater elevated IOP and secondary open\u2011angle glaucoma\u003C/strong\u003E, not marked early hypotony.\u003C/p\u003E\n\u003Cp\u003E\u003Cem style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/em\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 13,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1461,
    "Name": "Oculocardiac reflex",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWith regard to the oculo\u2011cardiac reflex, which of these statements is MOST likely to be correct?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer:\u003C/strong\u003E \u003Cstrong\u003EIt can occur after peribulbar anaesthesia.\u003C/strong\u003E\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003EThe oculocardiac reflex is a \u003Cstrong\u003Etrigeminovagal\u003C/strong\u003E reflex: the \u003Cstrong\u003Eafferent limb is via the trigeminal nerve (predominantly V1/ophthalmic division)\u003C/strong\u003E and the \u003Cstrong\u003Eefferent limb is via the vagus nerve\u003C/strong\u003E, producing bradycardia when the globe, conjunctiva, or extraocular muscles are manipulated.  Because it can be triggered by orbital manipulation and even regional blocks, it has been reported during or despite \u003Cstrong\u003Eperibulbar/retrobulbar-type regional anaesthesia\u003C/strong\u003E, and peribulbar anaesthesia does \u003Cstrong\u003Enot reliably abolish\u003C/strong\u003E the reflex once it is provoked by extraocular muscle traction.\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003EThe other statements are less likely to be correct because the reflex \u003Cstrong\u003Edoes not require an intact globe\u003C/strong\u003E (it can be elicited by manipulation of orbital contents, including after enucleation), it is generally \u003Cstrong\u003Emore prominent in children and tends to decrease with age rather than increase\u003C/strong\u003E, and the afferent limb is \u003Cstrong\u003Enot\u003C/strong\u003E the facial nerve (that description fits the corneal blink reflex instead).\u003C/p\u003E\u003Cp\u003E\u003Cem style=\u0022letter-spacing: 0.14994px; font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/em\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 7,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1462,
    "Name": "TASS",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich of the following is LEAST likely to be a complication of toxic anterior segment syndrome (TASS)?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003ECorrect answer:\u0026nbsp;\u003C/span\u003E\u003Cstrong style=\u0022font-size: 14px; letter-spacing: 0.14994px;\u0022\u003EPeripheral corneal ulceration\u003C/strong\u003E\u003C/h3\u003E\n\u003Cp\u003EToxic anterior segment syndrome is a sterile, acute postoperative inflammatory reaction caused by exposure of intraocular tissues to toxic substances, so its complications are largely confined to the anterior segment and reflect intraocular damage rather than surface tissue necrosis. It can lead to marked anterior chamber inflammation with corneal oedema, secondary trabecular dysfunction with a significant rise in intraocular pressure, and iris injury that may result in atrophy with transillumination defects and an atonic, poorly reactive dilated pupil. Although macular oedema is not a defining feature, it can occur as a postoperative inflammatory sequela and is still more plausible than peripheral corneal ulceration, which typically implies corneal epithelial breakdown and stromal necrosis from infectious keratitis, exposure, neurotrophic disease, or immune-mediated peripheral ulcerative keratitis rather than a toxic intraocular anterior segment reaction.\u003C/p\u003E\u003Cp\u003E\u0026nbsp;A similar question appeared in a previous FRCOphth part 2 written exam.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 1,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1463,
    "Name": "Paradoxical pupil response",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWith regard to the paradoxical pupil response found in some inherited retinal conditions, which of the following statements is MOST likely to be correct?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: It is thought to be due to the unopposed effect of S cones in the retina\u003C/span\u003E\u003C/h3\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\n\u003Cp\u003EThe paradoxical pupil response described in some inherited retinal disorders is best explained by altered retinal photoreceptor signaling in which the usual balance of cone inputs is disrupted, leaving short-wavelength sensitive cone pathways relatively unopposed and capable of driving an atypical pupillary behavior. This is a retinal phenomenon rather than a near-response phenomenon, so attributing it to convergence in the dark does not fit the physiology of the pupillary light reflex pathway, and it is not primarily an iris autonomic problem such as denervation hypersensitivity, which would instead point toward post-ganglionic parasympathetic dysfunction and pharmacological supersensitivity rather than a stimulus-dependent paradoxical response. It is also not confined to laboratory-only detection, because the abnormality can be appreciated clinically with careful observation of pupillary behaviour to different light conditions and wavelengths in the appropriate retinal dystrophy context.\u003C/p\u003E\u003Cp\u003E\u0026nbsp;\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1464,
    "Name": "Number needed to treat",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA study comparing the use of Intravitreal ranibizumab (IVR) for the treatment of neovascular age-related macular degeneration (AMD), reports a number needed to treat of 3.13 when compared to sham treatment. Which of these statements is MOST likely to be justified based upon this information?\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cbr\u003E\u003C/h3\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-size: 14px; line-height: 20px;\u0022\u003E\u003Cp style=\u0022font-weight: 400;\u0022\u003EA number needed to treat is the inverse of the absolute risk reduction and represents the average number of patients who must receive the intervention instead of control for one additional patient to achieve the specified outcome (or avoid one additional bad outcome) over the study time frame.  An NNT of 3.13 therefore means that treating about three patients with intravitreal ranibizumab rather than sham results in one additional patient meeting the study endpoint (here framed as vision retention), so the statement that best matches the meaning of NNT is the one expressing \u201Cabout three treated for one additional beneficial outcome.\u201D  Statements that describe \u201C3.13 times more likely\u201D are describing a relative measure such as a risk ratio or odds ratio, not an NNT, and a statement about how many received sham versus IVR is about allocation ratio rather than treatment effect.\u0026nbsp;\u003C/p\u003E\n\u003Cp style=\u0022\u0022\u003E\u003Cem style=\u0022\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/em\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E\u003C/h3\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 11,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1465,
    "Name": "Abusive head trauma (RCOphth 2013)",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWith regard to the suggested documentation of retinal haemorrhages in children with suspected abusive head trauma within The Royal College of Ophthalmologists\u2019 guideline on abusive head trauma (2013), which of the following descriptions is LEAST likely to be correct?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: The depth of haemorrhages should be classified as either intraretinal or multilayered.\u003C/span\u003E\u003C/h3\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\n\u003Cp\u003EA key part of the 2013 RCOphth/RCPCH recommended proforma is to document retinal hemorrhages in a structured way that captures features with diagnostic value, including morphology, layer, location, and approximate burden; importantly, the \u201Cdepth/layer\u201D field is not restricted to only intraretinal versus multilayered, because the proforma explicitly prompts classification across preretinal, intraretinal, subretinal, and multilayered categories, so a statement limiting depth to just intraretinal or multilayered is incomplete and therefore least likely to be correct.  The other descriptions align with the same proforma: recording whether haemorrhages are white-centred is specifically prompted under morphology, location is explicitly separated into posterior pole defined in relation to zone 1 of ROP and the peripheral retina, and the number is categorised as few, many, or too numerous to count with indicative ranges, so these are consistent with the guideline\u2019s suggested documentation framework.\u0026nbsp;\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1466,
    "Name": "Drug toxicity: sudden bilateral central vision loss",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003ESudden loss of central vision in both eyes is MOST likely due to treatment with which of the following?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: Ethambutol.\u003C/span\u003E\u003C/h3\u003E\u003Ch3\u003E\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-size: 14px; line-height: 20px;\u0022\u003E\n\u003Cp style=\u0022font-weight: 400;\u0022\u003EEthambutol classically causes a \u003Cstrong\u003Etoxic optic neuropathy\u003C/strong\u003E that is \u003Cstrong\u003Ebilateral and fairly symmetric\u003C/strong\u003E, producing an \u003Cstrong\u003Eacute-to-subacute drop in central visual acuity\u003C/strong\u003E with \u003Cstrong\u003Ecentral or centrocaecal scotomas\u003C/strong\u003E and \u003Cstrong\u003Edyschromatopsia\u003C/strong\u003E (often red\u2013green), which fits the pattern of sudden bilateral central vision loss best. Tamoxifen toxicity is more typically a \u003Cstrong\u003Emaculopathy\u003C/strong\u003E with \u003Cstrong\u003Ecrystalline deposits\u003C/strong\u003E and foveal structural change that is usually \u003Cstrong\u003Emore insidious\u003C/strong\u003E rather than presenting as abrupt bilateral central acuity loss. Thioridazine is associated with a \u003Cstrong\u003Epigmentary retinopathy\u003C/strong\u003E and more \u003Cstrong\u003Egeneralised retinal dysfunction\u003C/strong\u003E, so symptoms and signs tend to reflect \u003Cstrong\u003Ediffuse retinal involvement\u003C/strong\u003E rather than a predominantly optic nerve pattern of central scotoma and dyschromatopsia. Vigabatrin toxicity characteristically causes \u003Cstrong\u003Ebilateral concentric peripheral field constriction\u003C/strong\u003E due to retinal toxicity, so the hallmark complaint is \u003Cstrong\u003Eprogressive \u201Ctunnel vision\u201D\u003C/strong\u003E rather than sudden central visual loss.\u003C/p\u003E\u003Cp style=\u0022\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E\u003C/h3\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 5,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1467,
    "Name": "Uveitic glaucoma",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EIn glaucoma associated with uveitis, which of the following is least likely to be the cause of raised intraocular pressure?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: Pigments deposit on the trabecular meshwork.\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EIn uveitis-associated glaucoma, \u003Cstrong\u003Eraised intraocular pressure is most commonly driven by impaired aqueous outflow due to inflammatory mechanisms\u003C/strong\u003E rather than primary pigmentary obstruction, so pigment deposition is the least likely explanation in this context. \u003Cstrong\u003EPeripheral anterior synechiae can permanently close the angle and reduce trabecular access\u003C/strong\u003E, producing a sustained outflow block and chronic pressure elevation, particularly in recurrent or severe anterior uveitis. \u003Cstrong\u003ETrabeculitis causes functional shutdown of the trabecular meshwork\u003C/strong\u003E through inflammatory oedema and cellular dysfunction, giving a potentially marked pressure rise even when the angle is anatomically open, and this is a well-recognised mechanism in several uveitic entities. \u003Cstrong\u003EProteinaceous flare, inflammatory cells, and fibrin can physically clog the trabecular meshwork\u003C/strong\u003E, forming trabecular precipitates and debris-related obstruction that elevates pressure, especially in acute anterior chamber inflammation. By contrast, while pigment liberation from the iris can occur during inflammation, \u003Cstrong\u003Epigment deposition as the dominant mechanism is more characteristic of pigment dispersion or pseudoexfoliation syndromes\u003C/strong\u003E, not the typical pathophysiology of uveitic glaucoma, making it the least likely cause among the listed options.\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 3,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1468,
    "Name": "Acute orbital inflammation with lid necrosis in a poorly controlled diabetic",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA poorly controlled diabetic patient develops acute orbital inflammation with proptosis. There is necrosis of the upper lid. Which of the following is the MOST likely diagnosis?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: Mucormycosis.\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EIn a poorly controlled diabetic, especially in the setting of ketoacidosis, \u003Cstrong\u003Erhino\u2011orbito\u2011cerebral mucormycosis is the classic cause of rapidly progressive orbital inflammation with proptosis and tissue necrosis\u003C/strong\u003E, because the organism is \u003Cstrong\u003Eangioinvasive\u003C/strong\u003E, causing \u003Cstrong\u003Evascular thrombosis, ischemia, and \u201Cblack eschar\u201D necrosis\u003C/strong\u003E that can involve the nasal mucosa, palate, eyelids, and orbit with alarming speed. \u003Cstrong\u003EUpper lid necrosis\u003C/strong\u003E is a major clue pointing to this angioinvasive necrotising process rather than a purely inflammatory orbital cellulitis pattern. Aspergillosis can also be invasive in immunocompromised patients and can involve the orbit, but the most exam\u2011typical pairing of \u003Cstrong\u003Euncontrolled diabetes with fulminant necrosis\u003C/strong\u003E is mucormycosis rather than aspergillus. Granulomatosis with polyangiitis can cause orbital inflammation and necrotising disease, but it is usually framed by \u003Cstrong\u003Esystemic vasculitis features\u003C/strong\u003E and tends to be less \u201Cexplosively\u201D necrotic at the eyelid as a presenting hallmark compared with the classic rapidly progressive fungal angioinvasion seen in mucormycosis. Necrobiotic xanthogranuloma is typically a \u003Cstrong\u003Echronic\u003C/strong\u003E periocular infiltrative condition with \u003Cstrong\u003Eyellowish plaques/nodules\u003C/strong\u003E and association with paraproteinaemia, not an acute fulminant orbital process with lid necrosis.\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1469,
    "Name": "Episcleritis with peripheral corneal ulcer, saddle nose, and valvular disease",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 23 year old woman presents to casualty with a history of recent episodes of redness of her eyes and some discomfort. On examination she has some episcleritis and one peripheral corneal ulcer. She has a saddle nose and is on the waiting list for an aortic valve replacement. She is taking prednisolone and etanercept. Her ESR is 72 mm/hr and her haemoglobin is 10.2 g/dl. What is the MOST likely diagnosis?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: Relapsing polychondritis.\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003ERelapsing polychondritis is the best fit because it is a \u003Cstrong\u003Esystemic, immune\u2011mediated inflammation targeting cartilaginous and proteoglycan\u2011rich tissues\u003C/strong\u003E, classically producing \u003Cstrong\u003Eauricular and nasal chondritis with collapse of the nasal bridge leading to a saddle\u2011nose deformity\u003C/strong\u003E, and it commonly causes ocular inflammation such as \u003Cstrong\u003Eepiscleritis and scleritis\u003C/strong\u003E, with the potential for \u003Cstrong\u003Eperipheral ulcerative keratitis\u003C/strong\u003E due to adjacent limbal vasculitis and collagenolysis. The history of \u003Cstrong\u003Esignificant cardiovascular involvement requiring aortic valve replacement\u003C/strong\u003E is also highly supportive, because relapsing polychondritis can involve the \u003Cstrong\u003Eaortic root and cardiac valves\u003C/strong\u003E, leading to regurgitation and progressive valvular disease in a subset of patients, and the raised inflammatory markers with anaemia fit a chronic systemic inflammatory process. Rheumatoid arthritis can certainly be associated with episcleritis and peripheral ulcerative keratitis, and biologic therapy such as etanercept is used in rheumatoid disease, but the combination of \u003Cstrong\u003Esaddle\u2011nose deformity from cartilage destruction\u003C/strong\u003E together with \u003Cstrong\u003Emajor valvular/aortic involvement at this young age\u003C/strong\u003E is much more characteristic of relapsing polychondritis than rheumatoid arthritis. Kawasaki disease is a childhood medium\u2011vessel vasculitis with mucocutaneous features and coronary artery involvement rather than destructive nasal cartilage disease and chronic episcleritis with peripheral corneal ulceration in adulthood. Dermatomyositis is primarily an inflammatory myopathy with characteristic skin findings and does not explain the hallmark combination of \u003Cstrong\u003Ecartilage collapse\u003C/strong\u003E and \u003Cstrong\u003Evalvular/aortic disease\u003C/strong\u003E alongside these ocular signs.\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1470,
    "Name": "Acute red, photophobic eye with anterior and vitreous cells and a peripheral white patch",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 32 year old man presents with a sore, photophobic, red left eye with reduced vision. On examination he has both anterior chamber and vitreous cells and an extensive white patch in the peripheral retina. What is the MOST likely diagnosis?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: Acute retinal necrosis.\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003E\u003Cstrong\u003EAcute retinal necrosis\u003C/strong\u003E is the best fit because the key pattern is \u003Cstrong\u003Ea painful red photophobic eye with both anterior uveitis and vitritis plus a confluent, pale-white area of peripheral necrotising retinitis\u003C/strong\u003E, which is the classic clinical constellation for this diagnosis and explains the reduced vision through intense intraocular inflammation and retinal involvement. This differs from \u003Cstrong\u003Epars planitis\u003C/strong\u003E, which is an intermediate uveitis characterised by \u003Cstrong\u003Evitreous cells with \u201Csnowballs/snowbanking\u201D\u003C/strong\u003E and often relatively less pain and photophobia, and it does not typically produce an \u003Cstrong\u003Eextensive, sharply abnormal white necrotic retinal patch\u003C/strong\u003E in the periphery. It also differs from \u003Cstrong\u003Eposterior scleritis\u003C/strong\u003E, where the dominant feature is usually \u003Cstrong\u003Esevere deep ocular pain\u003C/strong\u003E with posterior segment signs such as choroidal folds or exudative retinal detachment, and while some spill-over inflammation can occur, the hallmark is not a large peripheral necrotising retinal whitening. \u003Cstrong\u003ERecurrent toxoplasma chorioretinitis\u003C/strong\u003E can present with vitritis and a white retinitis focus, but it is classically a \u003Cstrong\u003Efocal necrotising retinochoroiditis often adjacent to an old pigmented scar\u003C/strong\u003E and more often posterior, rather than an \u003Cstrong\u003Eextensive peripheral confluent necrotic patch\u003C/strong\u003E accompanied by the intense pan-uveitic picture that strongly points to acute retinal necrosis.\u0026nbsp;\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 12,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1471,
    "Name": "Haemorrhagic retinal pigment epithelial detachment in a 35-year-old",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 35 year old man presents with a haemorrhagic retinal pigment epithelial detachment and an acuity of 6/60. An image of his fundus is shown. Which ONE of the following is the MOST likely diagnosis?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: Sorsby\u2019s macular dystrophy.\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EA haemorrhagic retinal pigment epithelial detachment with marked central vision loss in a relatively young adult is most consistent with \u003Cstrong\u003Eearly-onset choroidal neovascularisation on a background of an inherited macular dystrophy\u003C/strong\u003E, and \u003Cstrong\u003ESorsby\u2019s macular dystrophy is classically a third-to-fifth decade condition in which choroidal neovascular membranes recur and are associated with haemorrhage and rapid central visual loss\u003C/strong\u003E.  This presentation is less consistent with acute posterior multifocal placoid pigment epitheliopathy because that disorder is characterised by \u003Cstrong\u003Emultiple creamy placoid lesions at the level of the retinal pigment epithelium in the posterior pole\u003C/strong\u003E, usually with a self-limited inflammatory course, and haemorrhagic pigment epithelial detachment would be an atypical framing for the primary diagnosis rather than the expected core finding.  It is also less consistent with birdshot retinopathy, which is a chronic posterior uveitis with \u003Cstrong\u003Emultiple cream-coloured choroidal lesions and vitritis\u003C/strong\u003E rather than an isolated haemorrhagic pigment epithelial detachment picture causing abrupt central acuity drop.  Punctate inner choroidopathy can certainly be complicated by \u003Cstrong\u003Echoroidal neovascularisation and pigment epithelial detachment with haemorrhage\u003C/strong\u003E, but it predominantly affects \u003Cstrong\u003Eyoung myopic women\u003C/strong\u003E and is typically described with multiple small punched-out yellow-white lesions in the posterior pole; therefore, in an exam stem emphasising a haemorrhagic pigment epithelial detachment in a 35-year-old man, the more characteristic \u201Cfit\u201D is Sorsby\u2019s macular dystrophy.\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1472,
    "Name": "Episodic blurred vision with pain and tearing on waking in a hypermetropic 65-year-old",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 65 year old hypermetropic woman (\u002B3.50 DS both eyes) gives a six month history of episodic blurred vision associated with ocular pain and epiphora. She has difficulty opening her eyes in the morning on awakening. On examination she has bilateral corneal guttata, anterior chamber depths of 3.0mm right and left eye and central corneal thickness of 530 microns right and left eye. The eyelids and conjunctiva appear normal. What is the MOST likely cause of her symptoms?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: Recurrent corneal erosion syndrome.\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003ERecurrent corneal erosion syndrome best explains this presentation because the defining clinical clue is \u003Cstrong\u003Edifficulty opening the eyes on awakening\u003C/strong\u003E, which reflects \u003Cstrong\u003Elid\u2013epithelium adhesion overnight followed by epithelial shear on first opening\u003C/strong\u003E, producing \u003Cstrong\u003Esudden pain, reflex tearing, and transient blur\u003C/strong\u003E from an irregular corneal surface. The episodic nature over months with \u003Cstrong\u003Epain and epiphora that are worst on waking\u003C/strong\u003E is far more characteristic of recurrent erosions than endothelial or glaucomatous mechanisms.\u0026nbsp;\u003C/p\u003E\u003Cp\u003EFuchs endothelial dystrophy can cause \u003Cstrong\u003Emorning blurred vision\u003C/strong\u003E due to overnight corneal hydration, and guttata may be present, but it typically produces \u003Cstrong\u003Ehaze/blur that improves as the day progresses\u003C/strong\u003E rather than the very specific \u003Cstrong\u003Emechanical \u201Ccan\u2019t open the eye on waking\u201D pain pattern\u003C/strong\u003E, and the \u003Cstrong\u003Enormal central corneal thickness\u003C/strong\u003E with no mention of stromal/epithelial edema makes decompensation less likely as the main driver.\u003C/p\u003E\u003Cp\u003EIntermittent angle closure glaucoma is suggested by hypermetropia, but it classically causes \u003Cstrong\u003Ehaloes, headache, nausea, and an attack pattern often precipitated by dim light\u003C/strong\u003E, and it does not explain \u003Cstrong\u003Erecurrent morning lid-opening pain\u003C/strong\u003E; in addition, the anterior chamber depth given is not markedly shallow and the external eye is described as normal, which is less consistent with symptomatic angle-closure episodes.\u003C/p\u003E\u003Cp\u003EStaphylococcal hypersensitivity would usually be accompanied by \u003Cstrong\u003Eblepharitis/meibomian disease and conjunctival hyperaemia\u003C/strong\u003E with peripheral corneal infiltrates, and the stem explicitly notes that \u003Cstrong\u003Eeyelids and conjunctiva appear normal\u003C/strong\u003E, making this the least fitting explanation for the symptom pattern.\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
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  },
  {
    "Id": 1473,
    "Name": "NICE (Aug 2008; updated later) wet AMD",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWith regard to the National Institute for Health and Care Excellence (NICE) guidance issued in August 2008 (and updated in 2012) for treatment of wet age-related macular degeneration (AMD), which of these is LEAST likely to be a valid criterion for treatment with anti-VEGF agents?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: Lesion size is less or equal to 4 disc areas in greatest linear dimension.\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EThe NICE technology appraisal criteria for initiating anti\u2011VEGF therapy in wet AMD specify \u003Cstrong\u003Ea best\u2011corrected visual acuity between 6/12 and 6/96\u003C/strong\u003E, \u003Cstrong\u003Eno permanent structural damage to the central fovea\u003C/strong\u003E, \u003Cstrong\u003Eevidence of recent presumed disease progression\u003C/strong\u003E, and a \u003Cstrong\u003Emaximum lesion size of 12 disc areas in greatest linear dimension\u003C/strong\u003E, so a threshold of 4 disc areas is not the NICE anti\u2011VEGF cut\u2011off and is therefore the least likely to be valid.  The reason the 4 disc area figure appears as a distractor is that smaller lesion size limits have historically been used in other treatment contexts (classically photodynamic therapy eligibility discussions), whereas NICE\u2019s anti\u2011VEGF recommendation explicitly allows treatment up to 12 disc areas provided the other clinical criteria are met.\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
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  },
  {
    "Id": 1474,
    "Name": "Reverse pupil block during phaco",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EDuring a phaco-emulsification procedure a patient develops \u201Creverse pupil block\u201D. Which of the following manoeuvres is MOST likely to be effective at preventing excessive depth of the anterior chamber?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: Using a second instrument to lift the iris forward.\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003E\u201CReverse pupil block\u201D during phaco is essentially the iris being \u003Cstrong\u003Epushed posteriorly\u003C/strong\u003E because fluid/pressure in the anterior chamber cannot readily equilibrate across the pupil into the posterior chamber, producing a \u003Cstrong\u003Every deep anterior chamber\u003C/strong\u003E with a \u003Cstrong\u003Eback-bowed iris\u003C/strong\u003E and a tendency toward iris\u2013lens diaphragm retropulsion; therefore, the most effective immediate manoeuvre is to \u003Cstrong\u003Ebreak the block mechanically\u003C/strong\u003E by \u003Cstrong\u003Elifting the iris forward at the pupillary margin\u003C/strong\u003E, allowing pressure equalisation and rapid shallowing to a safer, more stable chamber.\u003C/p\u003E\u003Cp\u003EIntravenous mannitol is least relevant because it reduces vitreous volume and posterior segment pressure over time rather than correcting an acute intraoperative iris\u2013pupil pressure differential that is being maintained by the fluidics of the surgery.\u003C/p\u003E\u003Cp\u003EReducing the bottle height can lessen infusion pressure and may reduce the degree of deepening, but it does not directly relieve the fundamental \u201Cvalve\u201D effect at the pupil and is therefore less reliably effective as a single manoeuvre when the syndrome is established.\u0026nbsp;\u003C/p\u003E\u003Cp\u003EA surgical iridotomy can prevent or treat certain pupil block mechanisms in other settings, but in the acute phaco setting it is not the most practical or immediate solution compared with simply lifting the iris to equalise pressures and restore normal iris configuration.\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 1,
    "Category": null,
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  },
  {
    "Id": 1475,
    "Name": "Intracameral agents",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EIntracameral use of which of the following is MOST likely to result in ocular toxicity?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: Gentamicin.\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EIntracameral gentamicin is the most likely to cause ocular toxicity because \u003Cstrong\u003Eaminoglycosides are well recognized to be directly toxic to intraocular tissues\u003C/strong\u003E, particularly the \u003Cstrong\u003Ecorneal endothelium\u003C/strong\u003E and, if they reach the posterior segment, the \u003Cstrong\u003Eretina\u003C/strong\u003E, with reported severe complications after intraocular exposure.\u0026nbsp;\u003C/p\u003E\u003Cp\u003EIn contrast, ceftazidime is widely used intraocularly in endophthalmitis treatment with a comparatively safer ocular toxicity profile at appropriate doses, triamcinolone is commonly used intraocularly as an anti-inflammatory and to visualize vitreous with its main risks being \u003Cstrong\u003Esteroid-related pressure rise\u003C/strong\u003E and cataract rather than acute direct tissue toxicity, and trypan blue is routinely used for capsular staining in cataract surgery and is generally well tolerated when used at correct concentration and exposure time. \u003Cstrong\u003ETherefore, gentamicin is the option most associated with clinically significant ocular toxicity when placed intracamerally.\u003C/strong\u003E\u0026nbsp;\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 5,
    "Category": null,
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  },
  {
    "Id": 1476,
    "Name": "Aspirin and diabetic retinopathy progression",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich ONE of the following trials showed that aspirin has no clinically important effects on the progression of diabetic retinopathy?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: Early Treatment Diabetic Retinopathy Study (ETDRS).\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EThe key evidence comes from the \u003Cstrong\u003EEarly Treatment Diabetic Retinopathy Study\u003C/strong\u003E, in which \u003Cstrong\u003E3,711 patients\u003C/strong\u003E with mild-to-severe non\u2011proliferative or early proliferative diabetic retinopathy were randomized to \u003Cstrong\u003Easpirin 650 mg daily versus placebo\u003C/strong\u003E, and the study concluded that \u003Cstrong\u003Easpirin did not alter the course of diabetic retinopathy\u003C/strong\u003E, did \u003Cstrong\u003Enot prevent progression to high\u2011risk proliferative disease\u003C/strong\u003E, did \u003Cstrong\u003Enot reduce visual loss\u003C/strong\u003E, and did \u003Cstrong\u003Enot increase vitreous haemorrhage\u003C/strong\u003E, leading to the explicit conclusion that aspirin has \u003Cstrong\u003Eno clinically important beneficial (or harmful) effect\u003C/strong\u003E on retinopathy progression.\u003C/p\u003E\u003Cp\u003E\u0026nbsp;By contrast, the \u003Cstrong\u003EDiabetes Control and Complications Trial\u003C/strong\u003E was fundamentally a trial of \u003Cstrong\u003Eintensive glycaemic control\u003C/strong\u003E in type 1 diabetes aimed at testing whether near\u2011normal glucose reduces microvascular complications rather than a trial designed to answer the aspirin question.\u003C/p\u003E\u003Cp\u003EThe \u003Cstrong\u003EUnited Kingdom Prospective Diabetes Study\u003C/strong\u003E addressed type 2 diabetes outcomes with \u003Cstrong\u003Eglycaemic and blood pressure control strategies\u003C/strong\u003E, not aspirin as the primary intervention for retinopathy progression.\u003C/p\u003E\u003Cp\u003EThe \u003Cstrong\u003EDAMAD\u003C/strong\u003E study did investigate antiplatelet therapy in early diabetic retinopathy and reported small changes in microaneurysm evolution, but its findings were not framed as the definitive \u201Cno clinically important effect\u201D conclusion that is classically attributed to the ETDRS aspirin component.\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 4,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 1477,
    "Name": "Progressive central reading difficulty in a young adult",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 25 year old man with no family history of eye disease presents with slowly progressive difficulties reading fine print. His fundal appearance and fluorescein angiograms are shown in the photographs. What is the MOST likely diagnosis?\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-12-4a8e2d3f-1a51-4f4a-b4aa-4319b5070251.png\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: Stargardt disease.\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EA young adult with \u003Cstrong\u003Eslowly progressive loss of central reading ability\u003C/strong\u003E together with the typical appearance of \u003Cstrong\u003Eyellow-white macular/posterior pole flecks and silent choroid\u003C/strong\u003E\u0026nbsp;on colour imaging and a fluorescein angiogram pattern that is classically used to support this diagnosis is most consistent with Stargardt disease, which is the commonest inherited juvenile-onset macular dystrophy and often presents exactly with gradually worsening central vision and difficulty with fine print. This is much less consistent with acute multifocal placoid pigment epitheliopathy, which is an \u003Cstrong\u003Eacute inflammatory chorioretinopathy\u003C/strong\u003E presenting with \u003Cstrong\u003Esudden\u003C/strong\u003E visual disturbance and multiple placoid creamy lesions rather than an insidious course. It is also less consistent with dominant drusen, which typically has an \u003Cstrong\u003Eautosomal dominant\u003C/strong\u003E pattern with a suggestive family history and drusen configuration rather than a \u201Cflecked retina\u201D dystrophy presentation in a 25-year-old with progressive reading difficulty. Pseudo\u2011vitelliform degeneration tends to show a more \u003Cstrong\u003Efovea-centred vitelliform (\u2018egg-yolk\u2019) lesion\u003C/strong\u003E pattern and a different angiographic signature related to vitelliform material, rather than a flecked maculopathy phenotype typical of Stargardt disease.\u0026nbsp;\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
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  },
  {
    "Id": 1478,
    "Name": "Frisby stereotest",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003ERegarding the test of visual function shown, which of the following statements is MOST likely to be correct?\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-12-be3debd3-8fbe-4d20-8772-40a669b2b6a9.png\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: It can be affected by parallax cues.\u003C/span\u003E\u003C/h3\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\n\u003Cp\u003EThe device shown is a \u003Cstrong\u003EFrisby (real-depth) stereotest\u003C/strong\u003E, which presents stereoscopic disparity using \u003Cstrong\u003Ephysical separation of targets on different surfaces\u003C/strong\u003E and does \u003Cstrong\u003Enot\u003C/strong\u003E rely on polarizing spectacles; a key practical limitation is that if the plate or the patient\u2019s head is allowed to move, the target can become detectable through \u003Cstrong\u003Emotion parallax\u003C/strong\u003E, meaning the result can be contaminated by parallax cues rather than true binocular stereopsis.  This is why the statement about susceptibility to parallax is the most defensible. In contrast, the claim that it requires orthogonal polarizing lenses describes vectograph-based stereotests rather than Frisby, and the claim about testing only a small range is not a defining feature of this test compared with its well-known issue of monocular cue contamination if administered incorrectly.\u0026nbsp;\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1479,
    "Name": "PERG \u002B full-field VEP",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EUsing this investigation, what is the\u0026nbsp;\u003Cstrong\u003Emost likely clinical scenario\u003C/strong\u003E.\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-12-59913867-d2d8-4d4b-9103-a5b5cfee6cb7.png\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: A 30 year old female with acute left vision loss to 6/36 and a relative afferent pupillary defect (RAPD).\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003E\u003C!--StartFragment--\u003E\u003C!--EndFragment--\u003E\u003C/p\u003E\u003Cdiv style=\u0022font-family:\u0027Segoe UI\u0027;font-size:14px;font-style:normal;font-weight:400;line-height:20px\u0022\u003Ethis is a picture of\u0026nbsp;\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003Epattern ERG (PERG) and\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003Efull-field VEP.\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EThe VEP is abnormal because the \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Emajor positive peak is delayed (prolonged peak time/latency)\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E and the response appears \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Ereduced and temporally dispersed\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E compared with what is expected for a normal VEP and\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EThe PERG is abnormal because the N95 component is reduced, giving a reduced N95 amplitude (and therefore a reduced N95:P50 relationship).\u003C/span\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family:\u0027Segoe UI\u0027;font-size:14px;font-style:normal;font-weight:400;line-height:20px\u0022\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003C!--StartFragment--\u003E\u003C!--EndFragment--\u003E\u003Cdiv style=\u0022font-family:\u0027Segoe UI\u0027;font-size:14px;font-style:normal;font-weight:400;line-height:20px\u0022\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EThe key step is to interpret the \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003EVEP first\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E: a full-field VEP abnormality localises dysfunction \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Esomewhere along the retino\u2011cortical pathway\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E, but crucially \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Ea delayed or abnormal VEP is not specific for optic nerve disease because macular dysfunction can also produce VEP delay\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E, so the VEP alone cannot tell you whether the problem is retinal (macular) or post\u2011retinal (optic nerve/visual pathway).  That is exactly why the \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003EPERG is paired\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E with the VEP: PERG provides an objective measure of \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Emacular/retinal ganglion cell\u2013related function\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E, helping you decide whether the VEP abnormality is driven primarily by retinal (macular) dysfunction or by post\u2011retinal conduction abnormalities.\u003C/span\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family:\u0027Segoe UI\u0027;font-size:14px;font-style:normal;font-weight:400;line-height:20px\u0022\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family:\u0027Segoe UI\u0027;font-size:14px;font-style:normal;font-weight:400;line-height:20px\u0022\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EOnce you use that logic, the most coherent clinical scenario is an \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Eacute optic neuropathy\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E picture: an \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003ERAPD\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E is a strong clinical sign of asymmetric afferent pathway dysfunction and is typical of optic neuritis/optic neuropathy, whereas a simple refractive change does not produce an RAPD.  The refractive scenario is therefore unlikely because a VEP abnormality driven by optics would not match the physiology and the acuity improving with a small plus lens points to refractive/latent hyperopia rather than a primary afferent defect. The elderly subretinal neovascular membrane option is less likely because a CNV-driven maculopathy would be expected to show a primary macular functional deficit that can account for VEP changes, whereas the overall logic of using PERG alongside VEP is to demonstrate that the VEP abnormality is \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Enot\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E simply macular in origin.  A retained ferrous intraocular foreign body with siderosis is less likely because it classically causes progressive retinal toxicity detectable on retinal electrophysiology rather than a presentation anchored by an acute afferent defect with RAPD.\u003C/span\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family:\u0027Segoe UI\u0027;font-size:14px;font-style:normal;font-weight:400;line-height:20px\u0022\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; font-size: 14px; font-style: normal; line-height: 20px;\u0022\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px; font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam\u003C/span\u003E\u003C/div\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 7,
    "Category": null,
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  },
  {
    "Id": 1480,
    "Name": "Abnormal head posture in right superior oblique palsy",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhat abnormal head position (AHP) would you expect to see in the presence of a RIGHT superior oblique palsy?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: Left head tilt, left face turn.\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EA right superior oblique palsy typically produces a \u003Cstrong\u003Eright hypertropia that worsens on right head tilt\u003C/strong\u003E because the weak superior oblique cannot generate normal \u003Cstrong\u003Eintorsion\u003C/strong\u003E during ipsilateral head tilt, so the vertical deviation increases; the compensatory posture is therefore a \u003Cstrong\u003Ehead tilt to the opposite side\u003C/strong\u003E to minimise the hypertropia and torsional diplopia. In addition, the vertical deviation is usually least in the gaze position where the affected eye is relatively \u003Cstrong\u003Eabducted\u003C/strong\u003E, so the patient adopts a \u003Cstrong\u003Eface turn that places the eyes into that more comfortable gaze\u003C/strong\u003E, which in a right superior oblique palsy is most commonly achieved by a \u003Cstrong\u003Eleft face turn\u003C/strong\u003E (placing the eyes into right gaze). Taken together, the classic compensatory AHP is \u003Cstrong\u003Eleft head tilt with left face turn\u003C/strong\u003E, whereas postures involving right head tilt would tend to exacerbate the deviation and are therefore less likely.\u003C/p\u003E\u003Cp\u003E\u0026nbsp;\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "HighYield": true,
    "CategoryId": 10,
    "Category": null,
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  },
  {
    "Id": 1481,
    "Name": "Pharmacological localization of Horner syndrome",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 52 year old patient presents with a 2mm left ptosis and ipsilateral miosed pupil. An apraclonidine test is positive and the pupil dilates by 2mm with 1% phenylephrine to which the contralateral pupil is unresponsive. Of these diagnoses, which is the MOST likely?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: Carotid artery dissection.\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003E\u003C!--StartFragment--\u003E\u003C!--EndFragment--\u003E\u003C/p\u003E\u003Cdiv style=\u0022font-family:\u0027Segoe UI\u0027;font-size:14px;font-style:normal;font-weight:400;line-height:20px\u0022\u003EA \u003Cstrong\u003Epositive apraclonidine test\u003C/strong\u003E supports Horner syndrome because \u003Cstrong\u003Edenervation hypersensitivity\u003C/strong\u003E allows apraclonidine\u2019s weak alpha\u20111 activity to \u003Cstrong\u003Edilate the affected miotic pupil and partially elevate the ptosis\u003C/strong\u003E, but this step \u003Cstrong\u003Econfirms Horner rather than localising the lesion\u003C/strong\u003E.\u0026nbsp;\u003C/div\u003E\u003Cdiv style=\u0022font-family:\u0027Segoe UI\u0027;font-size:14px;font-style:normal;font-weight:400;line-height:20px\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family:\u0027Segoe UI\u0027;font-size:14px;font-style:normal;font-weight:400;line-height:20px\u0022\u003EThe crucial localising clue is that the affected pupil \u003Cstrong\u003Edilates markedly with dilute phenylephrine (1%) while the normal pupil does not\u003C/strong\u003E, which indicates \u003Cstrong\u003Epostganglionic (third\u2011order) sympathetic denervation\u003C/strong\u003E because the iris dilator has become \u003Cstrong\u003Esupersensitive to adrenergic agonists\u003C/strong\u003E. \u003Cstrong\u003EPostganglionic Horner syndrome classically arises from internal carotid artery pathology\u003C/strong\u003E because the oculosympathetic fibres travel with the \u003Cstrong\u003Einternal carotid artery\u003C/strong\u003E into the cavernous sinus and orbit, making \u003Cstrong\u003Ecarotid artery dissection\u003C/strong\u003E the most likely diagnosis here.\u0026nbsp;\u003C/div\u003E\u003Cdiv style=\u0022font-family:\u0027Segoe UI\u0027;font-size:14px;font-style:normal;font-weight:400;line-height:20px\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family:\u0027Segoe UI\u0027;font-size:14px;font-style:normal;font-weight:400;line-height:20px\u0022\u003EBy contrast, an \u003Cstrong\u003Eapical lung tumour\u003C/strong\u003E and a \u003Cstrong\u003Ecervical rib\u003C/strong\u003E most typically affect the \u003Cstrong\u003Epreganglionic (second\u2011order) fibres\u003C/strong\u003E at the thoracic outlet, and an \u003Cstrong\u003EArnold\u2013Chiari malformation\u003C/strong\u003E would be expected to cause a \u003Cstrong\u003Ecentral (first\u2011order) Horner syndrome\u003C/strong\u003E, so these do not match the \u003Cstrong\u003Epostganglionic hypersensitivity pattern\u003C/strong\u003E implied by the phenylephrine response.\u003C/div\u003E\u003Cdiv style=\u0022font-family:\u0027Segoe UI\u0027;font-size:14px;font-style:normal;font-weight:400;line-height:20px\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; font-size: 14px; font-style: normal; line-height: 20px;\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
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  },
  {
    "Id": 1482,
    "Name": "Child with bull\u2019s-eye maculopathy",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA seven year old boy is referred with reduced visual acuity by his optometrist. His teachers have also noted that he is falling behind at school. His visual acuity is 6/36 in each eye. Fundoscopy shows a bilateral bull\u2019s eye maculopathy. An electroretinogram (ERG) shows a reduced b-wave and electro-oculography (EOG) is normal. Which one of the following is the MOST likely diagnosis?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: large;\u0022\u003EAnswer: Juvenile neuronal ceroid lipofuscinosis (Batten\u2019s disease).\u003C/span\u003E\u003C/h3\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-size: large;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\n\u003Cp\u003EThe combination of \u003Cstrong\u003Eearly school-age bilateral visual loss\u003C/strong\u003E, a \u003Cstrong\u003Ebull\u2019s-eye maculopathy\u003C/strong\u003E, and evidence of \u003Cstrong\u003Einner retinal dysfunction on ERG\u003C/strong\u003E (classically an \u201Celectronegative\u201D pattern with a relatively reduced b-wave) strongly points to juvenile neuronal ceroid lipofuscinosis, and the fact that he is \u201Cfalling behind at school\u201D supports the expected \u003Cstrong\u003Eneurocognitive decline\u003C/strong\u003E that accompanies this disorder.  A \u003Cstrong\u003Enormal EOG\u003C/strong\u003E argues against a primary retinal pigment epithelium pump disorder as the dominant problem and is compatible with the retinal degeneration pattern described in CLN3-associated disease.\u003C/p\u003E\u003Cp\u003E\u0026nbsp;Fabry disease would more typically be associated with corneal verticillata and vascular changes rather than a bull\u2019s-eye maculopathy with this electrophysiology pattern and early cognitive decline.\u0026nbsp;\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EHomocystinuria more classically causes ectopia lentis and high myopia with systemic thrombotic risk rather than this retinal dystrophy phenotype.\u003C/span\u003E\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u0026nbsp;Zellweger syndrome is a severe peroxisomal disorder presenting in infancy with profound systemic features, making it very unlikely in a 7-year-old presenting primarily with school-age retinal degeneration.\u003C/span\u003E\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px; font-weight: bold;\u0022\u003E\u0026nbsp;A similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1483,
    "Name": "Myopic young woman with photopsias and posterior pole spots",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 35\u2011year\u2011old myopic woman presents with intermittent brief flashes of light in the central field of the left eye for three months (about once a week). Corrected VA is 6/9 with contact lenses; colour vision and visual fields are normal. Fundus shows multiple depigmented spots. Which is the MOST likely diagnosis?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: \u003Cstrong\u003EPunctate inner choroidopathy.\u003C/strong\u003E\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003E\u003Cstrong\u003EPunctate inner choroidopathy (PIC)\u003C/strong\u003E best fits because it classically affects \u003Cstrong\u003Eyoung myopic women\u003C/strong\u003E, presents with \u003Cstrong\u003Ephotopsias\u003C/strong\u003E and \u003Cstrong\u003Esmall yellow\u2011white depigmented lesions at the posterior pole\u003C/strong\u003E, and early on may show \u003Cstrong\u003Enear\u2011normal acuity, color vision, and fields\u003C/strong\u003E. The lesions are inflammatory at the level of the choroid/outer retina and carry a risk of later \u003Cstrong\u003Echoroidal neovascularisation\u003C/strong\u003E, but the initial exam can otherwise be unremarkable\u2014exactly as described.\u003C/p\u003E\u003Cp\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003EBig blind spot syndrome:\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E would give an \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Eenlarged blind spot on perimetry\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E and often MEWDS\u2011like signs; the stem states \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Enormal visual fields\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E, making this unlikely.\u003C/span\u003E\u003C/p\u003E\u003Cp\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003EOptic neuritis:\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E typically causes \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Epain on eye movements, reduced color vision (red desaturation), RAPD, and central visual loss\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E rather than photopsias with discrete chorioretinal spots; here \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Ecolor vision and fields are normal\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\u003Cp\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003EStargardt disease:\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E a \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Emacular dystrophy\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E with \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Episciform flecks\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E and progressive central loss, usually beginning in the teens/early adulthood; \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Ebrief intermittent photopsias\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E with otherwise normal colour vision/fields are not typical, and the \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Efundus description (depigmented punctate spots)\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E is not characteristic.\u003C/span\u003E\u003C/p\u003E\n\u003Cp\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 12,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1484,
    "Name": "Diabetic foot infection with shock features",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 45\u2011year\u2011old man with type 2 diabetes mellitus has developed an infected left foot ulcer after minor trauma. He attends the eye clinic with loss of appetite, nausea and vomiting, polyuria and weight loss. On examination he is hypotensive with a tachycardia, cold extremities and peripheral cyanosis. Which of the following is the MOST likely diagnosis?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: \u003Cstrong\u003ESepticaemia.\u003C/strong\u003E\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EThe presence of an \u003Cstrong\u003Eobvious infectious source (infected diabetic foot ulcer)\u003C/strong\u003E together with \u003Cstrong\u003Esystemic features of circulatory compromise\u2014hypotension, tachycardia, cold extremities and peripheral cyanosis\u2014most strongly indicates septicaemia (sepsis with shock)\u003C/strong\u003E as the unifying diagnosis.\u003C/p\u003E\u003Cp\u003E\u0026nbsp;While \u003Cstrong\u003Ehyperglycaemia\u003C/strong\u003E can explain polyuria and weight loss, it \u003Cstrong\u003Edoes not cause cold, cyanotic peripheries with hypotension\u003C/strong\u003E, which are hallmarks of shock.\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u0026nbsp;\u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003EDiabetic ketoacidosis\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E may complicate infection in type 2 diabetes, but the stem does not give typical pointers such as \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003EKussmaul respirations, fruity breath, marked dehydration with warm peripheries, or documented severe acidosis/ketonaemia\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E; instead, it emphasises \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Ehaemodynamic instability from infection\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E. \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003EHyponatraemia\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E might cause nausea or malaise, yet \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Ecannot account for the profound shock physiology\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E described. In short, \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Einfected diabetic foot \u002B shock signs = septicaemia/septic shock\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E as the most likely\u2014and most urgent\u2014diagnosis.\u0026nbsp;\u003C/span\u003E\u003C/p\u003E\u003Cp\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 7,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1485,
    "Name": "Acute corneal hydrops in keratoconus",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA twenty five year old patient who had previously refused treatment with collagen cross linking presents with an acutely painful left eye. The cornea is oedematous inferiorly although the upper part is clear. Which of the following treatment options is LEAST likely to play a role in treatment?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: \u003Cstrong\u003EDescemet stripping endothelial keratoplasty.\u003C/strong\u003E\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EThis presentation is most consistent with \u003Cstrong\u003Eacute corneal hydrops in keratoconus\u003C/strong\u003E, where a \u003Cstrong\u003Ebreak in Descemet membrane\u003C/strong\u003E\u0026nbsp;producing \u003Cstrong\u003Esectoral corneal oedema\u003C/strong\u003E and significant pain, often inferiorly. In that setting, measures that \u003Cstrong\u003Ereduce stromal oedema and promote reattachment/sealing of the Descemet break\u003C/strong\u003E can be helpful, so \u003Cstrong\u003Ehypertonic sodium chloride 5%\u003C/strong\u003E may reduce epithelial/stromal oedema symptomatically, and \u003Cstrong\u003Eanterior chamber gas (such as SF6)\u003C/strong\u003E can act as an internal tamponade to \u003Cstrong\u003Eoppose Descemet membrane and shorten the course of hydrops\u003C/strong\u003E in selected cases. If significant scarring, irregularity, or optical failure persists after resolution, \u003Cstrong\u003Epenetrating keratoplasty\u003C/strong\u003E can have a role as a definitive tectonic/optical rehabilitation option in advanced keratoconus.\u003C/p\u003E\u003Cp\u003EIn contrast, \u003Cstrong\u003EDescemet stripping endothelial keratoplasty is designed for primary endothelial failure\u003C/strong\u003E, and it is \u003Cstrong\u003Eleast relevant in acute hydrops\u003C/strong\u003E, because the fundamental problem is \u003Cstrong\u003Ea mechanical Descemet rupture in an ectatic cornea\u003C/strong\u003E, not isolated endothelial pump failure, so replacing endothelium alone would not address the underlying ectasia or the tear mechanism.\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1486,
    "Name": "Hemifacial spasm",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich of these is the MOST likely location of an aneurysm causing hemifacial spasm?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: \u003Cstrong\u003EAnterior inferior cerebellar artery\u003C/strong\u003E\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EHemifacial spasm is most commonly caused by \u003Cstrong\u003Eneurovascular compression of the facial nerve at its root exit zone\u003C/strong\u003E in the cerebellopontine angle, and the arteries most often implicated are branches of the vertebrobasilar system rather than anterior circulation vessels. In large series and reference summaries, the \u003Cstrong\u003Eanterior inferior cerebellar artery is the commonest offending vessel\u003C/strong\u003E, followed by the \u003Cstrong\u003Eposterior inferior cerebellar artery\u003C/strong\u003E and then the vertebral artery, which is why an aneurysm arising from the anterior inferior cerebellar artery is the most likely to produce hemifacial spasm by compressing the facial nerve in this region. \u003Cstrong\u003ESupraclinoid carotid\u003C/strong\u003E and \u003Cstrong\u003Ebasilar tip\u003C/strong\u003E aneurysms are anatomically remote from the facial nerve root exit zone and are therefore much less likely to present with hemifacial spasm as the primary mechanism.\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u0026nbsp;A similar question appeared in a previous FRCOphth part 2 written exam\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1487,
    "Name": "Proliferative vitreoretinopathy ",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhat is the MOST likely effect of proliferative vitreoretinopathy on a retinal break?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: \u003Cstrong\u003EEverting of the edge of the retinal break.\u003C/strong\u003E\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EIn PVR, \u003Cstrong\u003Ecellular proliferation on the retinal surfaces forms contractile epi\u2011 and subretinal membranes\u003C/strong\u003E that exert tangential traction on the retina; \u003Cstrong\u003Ethis traction \u201Crolls\u201D or everts the margins of a pre\u2011existing retinal break (fish\u2011mouth configuration)\u003C/strong\u003E, making it wider and more rigid and hampering successful re\u2011apposition with retinopexy and tamponade. \u003Cstrong\u003EBy contrast, operculation\u003C/strong\u003E\u0026nbsp;is an \u003Cstrong\u003Eacute vitreoretinal traction event\u003C/strong\u003E in which a plug of retina is avulsed and \u201Coperculated,\u201D typically \u003Cstrong\u003Ebefore\u003C/strong\u003E PVR develops; it is \u003Cstrong\u003Enot\u003C/strong\u003E a consequence of PVR scarring. \u003Cstrong\u003EA retinal pigmentary demarcation line\u003C/strong\u003E\u0026nbsp;indicates \u003Cstrong\u003Echronic rhegmatogenous retinal detachment\u003C/strong\u003E (the \u201Chigh\u2011water mark\u201D), \u003Cstrong\u003Enot\u003C/strong\u003E the contractile changes of PVR. \u003Cstrong\u003ETortuosity of surrounding vessels\u003C/strong\u003E\u0026nbsp;is \u003Cstrong\u003Enonspecific\u003C/strong\u003E and not the characteristic mechanical effect that PVR has on a break.\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u0026nbsp;A similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 1488,
    "Name": "Immunosuppressive \u201Cdisease\u2011modifying\u201D drugs",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich of the following disease modifying drugs is best described as an anti\u2011metabolite?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: \u003Cstrong\u003EMycophenolate mofetil.\u003C/strong\u003E\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EMycophenolate mofetil is best described as an \u003Cstrong\u003Eantimetabolite\u003C/strong\u003E because it inhibits \u003Cstrong\u003Einosine monophosphate dehydrogenase\u003C/strong\u003E, thereby blocking \u003Cstrong\u003Ede novo guanine nucleotide synthesis\u003C/strong\u003E and preferentially suppressing \u003Cstrong\u003ET\u2011 and B\u2011lymphocyte proliferation\u003C/strong\u003E, which rely heavily on this pathway. In contrast, ciclosporin and tacrolimus are \u003Cstrong\u003Ecalcineurin inhibitors\u003C/strong\u003E that reduce T\u2011cell activation by inhibiting calcineurin\u2011dependent transcription of cytokines such as IL\u20112, so they are not antimetabolites. Cyclophosphamide is an \u003Cstrong\u003Ealkylating agent\u003C/strong\u003E that crosslinks DNA and suppresses rapidly dividing immune cells, but it is mechanistically distinct from antimetabolites, which act by interfering with nucleotide synthesis pathways.\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 5,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1489,
    "Name": "Scintillating scotoma in a young adult",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 22 year old man referred by an optometrist describes a transient visual disturbance where a blank area develops near fixation blocking out print when reading. It gradually enlarges and moves out to the edge of his field of vision and seems to have shimmering silvery edges. It gradually fades over 15 to 20 minutes and his vision returns to normal. He has had two or three similar episodes in the last six months. What is the MOST appropriate management?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: \u003Cstrong\u003EReassurance\u003C/strong\u003E\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EThis history is most characteristic of a \u003Cstrong\u003Emigraine visual aura (scintillating scotoma/fortification-type phenomenon)\u003C/strong\u003E: a \u003Cstrong\u003Epositive visual symptom\u003C/strong\u003E with \u003Cstrong\u003Eshimmering edges\u003C/strong\u003E that \u003Cstrong\u003Egradually expands and marches across the visual field\u003C/strong\u003E, then \u003Cstrong\u003Eresolves completely over 15\u201320 minutes\u003C/strong\u003E, and recurs in stereotyped fashion in a young person with otherwise normal vision between attacks. That time course and \u201Cmoving, shimmering\u201D quality strongly favours aura rather than an ischaemic event, because transient ischaemic attacks and amaurosis fugax are more often described as \u003Cstrong\u003Esudden-onset negative loss\u003C/strong\u003E (a curtain/grey-out), typically without scintillation, and the management would then pivot toward vascular risk evaluation, which is not the best fit here. Carotid ultrasound and low-dose aspirin are therefore not the most appropriate first steps for a classic migrainous aura pattern in a 22-year-old with no red-flag neurological features given. MRI brain imaging is generally reserved for \u003Cstrong\u003Eatypical\u003C/strong\u003E presentations such as persistent deficit, first-ever severe/new neurological symptoms, abnormal neurological examination, or unusual features suggesting an alternative diagnosis; in a typical recurrent visual aura with complete recovery and a classic spreading pattern, \u003Cstrong\u003Ereassurance and migraine-style counselling\u003C/strong\u003E is the most appropriate management.\u0026nbsp;\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1490,
    "Name": "Acute recurrent alternating anterior uveitis",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich one of the following is MOST commonly associated with acute bilateral, recurrent, alternating anterior uveitis?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: \u003Cstrong\u003EHLA-B27 positivity\u003C/strong\u003E\u003C/span\u003E\u003C/h3\u003E\n\u003Ch3\u003E\u003Cbr\u003E\u003C/h3\u003E\n\u003Cp\u003EAcute recurrent alternating anterior uveitis is most classically the pattern seen with HLA-B27\u2013associated acute anterior uveitis, which typically presents with sudden onset pain, photophobia, marked anterior chamber activity, a tendency to recur, and a characteristic behavior of affecting one eye at a time but alternating between eyes across episodes; it can appear bilateral over time because successive attacks occur in either eye rather than through simultaneous bilateral inflammation. Anterior segment ischaemia is usually a postoperative or vascular-compromise phenomenon linked to surgery on multiple rectus muscles or severe carotid/ocular ischemia and does not produce a stereotyped recurrent alternating acute uveitis pattern. Glaucomatocyclitic crisis is characterized by mild anterior uveitis with disproportionately raised intraocular pressure and recurrent unilateral attacks rather than alternating bilateral episodes. Sarcoidosis more commonly causes a chronic, granulomatous anterior uveitis with mutton-fat keratic precipitates, iris nodules, and a more persistent course, often with posterior segment involvement, rather than the classic acute recurrent alternating phenotype.\u0026nbsp;\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 12,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1491,
    "Name": "SRK/T A\u2011constant change",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA patient presents for cataract surgery. Biometry has been performed using the SRK T formula for a lens with an A constant of 118.5 and suggests a 22.0 Dioptre lens to achieve a desired post-operative refraction of emmetropia. The lens you wish to use has an A constant of 118.0. What power intraocular lens would be the MOST likely to achieve the desired post-operative refraction?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: \u003Cstrong\u003E21.5 D\u003C/strong\u003E\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EThe key is what the \u003Cstrong\u003EA\u2011constant represents\u003C/strong\u003E: it is a lens-specific calibration term that primarily shifts the predicted \u003Cstrong\u003Eeffective lens position\u003C/strong\u003E, and changing it changes the IOL power needed to hit the same refractive target. A \u003Cstrong\u003Elower A\u2011constant\u003C/strong\u003E (118.0 instead of 118.5) corresponds to a prediction of a \u003Cstrong\u003Emore anterior effective lens position\u003C/strong\u003E, and for the same IOL power a more anterior lens position tends to produce a \u003Cstrong\u003Emore myopic outcome\u003C/strong\u003E, so to keep the target at \u003Cstrong\u003Eemmetropia\u003C/strong\u003E you typically choose a \u003Cstrong\u003Eslightly lower IOL power\u003C/strong\u003E. In practical exam terms, you adjust the IOL power by roughly the \u003Cstrong\u003Esame magnitude and direction\u003C/strong\u003E as the A\u2011constant change, so dropping the A\u2011constant by \u003Cstrong\u003E0.5\u003C/strong\u003E means dropping the IOL power by about \u003Cstrong\u003E0.5 D\u003C/strong\u003E, taking you from \u003Cstrong\u003E22.0 D to 21.5 D\u003C/strong\u003E.\u0026nbsp;\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 1,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1492,
    "Name": "Diabetic retinopathy screening",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWith regard to Diabetic Retinopathy Screening, which of these statements is MOST likely to be correct?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: \u003Cstrong\u003EThere is a recognisable latent or pre-symptomatic stage of the disease.\u003C/strong\u003E\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EDiabetic retinopathy is a classic example of a condition with a \u003Cstrong\u003Elong recognisable pre-symptomatic phase\u003C/strong\u003E, because patients can develop detectable microvascular retinal changes for years before they notice symptoms, and this is precisely what makes population screening clinically valuable. The statement that most screened patients require treatment is incorrect because screening programmes primarily identify many individuals with no retinopathy or mild non-proliferative changes who do not need immediate intervention, with only a minority meeting thresholds for laser or intravitreal therapy at any one screening round. The claim that there is little published evidence of cost-effectiveness is also unlikely to be correct, as diabetic retinopathy screening is widely regarded as one of the more established and economically justified screening programmes due to prevention of avoidable sight loss and downstream costs. Finally, the statement about a WHO definition in 1978 is less likely to be the best answer because the classic public health framework for screening principles is usually attributed to earlier WHO-linked work on screening criteria rather than being uniquely anchored to that specific year, making it a weaker \u201Cmost likely\u201D statement compared with the clearly true point about a latent pre-symptomatic stage.\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u0026nbsp;A similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1493,
    "Name": "Vertical diplopia with enophthalmos and restricted vertical movements",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 60 year old woman with vertical diplopia has a left hypertropia and reduced vertical movements of the left eye. She also has left enophthalmos. What is the MOST likely diagnosis?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: \u003Cstrong\u003EOrbital metastasis\u003C/strong\u003E\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EThe key discriminator here is the combination of vertical diplopia with a hypertropia plus genuinely reduced vertical movements of the same eye and ipsilateral enophthalmos, which points to a restrictive orbital process rather than an isolated cranial nerve palsy. Orbital metastases can infiltrate extraocular muscles and orbital fat, producing mechanical restriction of elevation and/or depression, and some metastases\u2014classically scirrhous-type infiltration such as from breast carcinoma\u2014can cause fibrosis and volume contraction leading to enophthalmos rather than proptosis, making this the best overall fit.\u0026nbsp;\u003C/p\u003E\u003Cp\u003EA fourth nerve palsy typically causes a hypertropia with pattern-dependent incomitance and compensatory head tilt, but it does not usually produce true mechanical restriction on ductions or enophthalmos. A partially recovered third nerve palsy would more often be associated with a history of trauma and additional features such as ptosis, anisocoria, or a larger horizontal deviation, and enophthalmos is not characteristic. Thyroid eye disease most commonly causes proptosis and restrictive myopathy (often affecting elevation), so the restriction could fit, but the presence of enophthalmos makes thyroid eye disease much less likely than an infiltrative metastatic process.\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1494,
    "Name": "Uveitis\u2013Glaucoma\u2013Hyphaema (UGH) syndrome",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWith regard to Uveitis Glaucoma Hyphaema (UGH) syndrome, which of the following statements is MOST likely to be correct?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: \u003Cstrong\u003EUGH syndrome can occur with posterior chamber intraocular lenses.\u003C/strong\u003E\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EUGH syndrome is a \u003Cstrong\u003Emechanical complication\u003C/strong\u003E caused by \u003Cstrong\u003Echafing of intraocular lens components against the iris/ciliary body or angle\u003C/strong\u003E, leading to \u003Cstrong\u003Erecurrent anterior uveitis, intermittent hyphaema (or microhyphaema), and secondary IOP spikes/glaucoma\u003C/strong\u003E, so it is \u003Cstrong\u003Enot confined to anterior chamber lenses\u003C/strong\u003E and can occur with \u003Cstrong\u003Eposterior chamber IOLs\u003C/strong\u003E when they are malpositioned, placed in the sulcus with poor fit, tilted/decentred, or when haptics or optic edge rub the uveal tissues.\u003C/p\u003E\u003Cp\u003EThe other statements are less likely because the syndrome is often \u003Cstrong\u003Esymptomatic\u003C/strong\u003E with episodes of blurred vision, pain, photophobia, and red eye rather than being an incidental finding, and it is not predominantly driven by autoimmune predisposition but by \u003Cstrong\u003Erepetitive mechanical trauma\u003C/strong\u003E. The comparison with amaurosis fugax is also unreliable as a defining discriminator, because transient vision loss duration varies widely by cause, whereas UGH is best understood and identified by its \u003Cstrong\u003Erecurrent triad and mechanical IOL\u2013uveal irritation mechanism\u003C/strong\u003E.\u0026nbsp;\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 1,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1495,
    "Name": "Opsoclonus\u2013myoclonus syndrome in infancy",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 14 month old child presents with ataxia and \u201Cchaotic\u201D eye movements. What is the MOST likely underlying diagnosis?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: \u003Cstrong\u003EOccult neuroblastoma.\u003C/strong\u003E\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003E\u201CChaotic\u201D multidirectional, high\u2011frequency saccadic eye movements in an infant strongly suggests \u003Cstrong\u003Eopsoclonus\u003C/strong\u003E, and when this is paired with \u003Cstrong\u003Eataxia\u003C/strong\u003E (often with myoclonus and irritability), the classic clinical constellation is \u003Cstrong\u003Eopsoclonus\u2013myoclonus syndrome\u003C/strong\u003E. In children, this syndrome is most commonly a \u003Cstrong\u003Eparaneoplastic autoimmune phenomenon\u003C/strong\u003E associated with \u003Cstrong\u003Eneuroblastoma\u003C/strong\u003E, which may be clinically occult at presentation, so the most appropriate underlying diagnosis among the options is occult neuroblastoma. The other choices are less likely because Aicardi syndrome is a congenital neurodevelopmental disorder classically associated with agenesis of the corpus callosum and chorioretinal lacunae rather than opsoclonus, Miller Fisher syndrome is typically an acute post\u2011infectious neuropathy with ophthalmoplegia, ataxia and areflexia rather than chaotic saccadic eye movements, and Wilms\u2019 tumour is not the characteristic neoplasm linked to opsoclonus\u2013myoclonus.\u0026nbsp;\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1496,
    "Name": "Gas-filled (post\u2011vitrectomy) eye",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich of the following types of cataract is MOST likely to form in a gas filled (post\u2011vitrectomy) eye?\u003Cbr\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: \u003Cstrong\u003EPosterior sub\u2011capsular\u003C/strong\u003E\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EA gas-filled post\u2011vitrectomy eye most characteristically develops a \u003Cstrong\u003Eposterior sub\u2011capsular cataract\u003C/strong\u003E because intraocular gas can promote \u003Cstrong\u003Eposterior lens changes\u003C/strong\u003E through \u003Cstrong\u003Ealtered lens metabolism and local dehydration/toxic effects at the posterior lens surface\u003C/strong\u003E, particularly when the gas bubble apposes the posterior lens region during postoperative positioning, leading to a \u003Cstrong\u003Erapidly symptomatic central posterior opacity\u003C/strong\u003E. \u003Cstrong\u003ENuclear sclerosis\u003C/strong\u003E is very common after vitrectomy in general due to increased intraocular oxygen exposure to the lens over time, but the question specifically highlights a \u003Cstrong\u003Egas-filled\u003C/strong\u003E eye, which classically points to \u003Cstrong\u003Eposterior sub\u2011capsular opacification\u003C/strong\u003E as the most likely pattern in that context. \u003Cstrong\u003EPosterior polar\u003C/strong\u003E cataract is a congenital/structural posterior capsular abnormality rather than an acquired post\u2011vitrectomy change, and \u003Cstrong\u003Ecortical\u003C/strong\u003E cataract is less characteristic of gas-related postoperative lens change.\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 1,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1497,
    "Name": "Exercise\u2011induced transient central dimming",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 30 year old woman reports dimming and greyness of central vision in her right eye each time she attends her aerobics class. Her optic disc is a little pale, but there are no other findings. What is the MOST likely diagnosis?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cstrong\u003EAnswer: Uhthoff phenomenon.\u003C/strong\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E Transient dimming or \u201Cgreying out\u201D of vision precipitated reproducibly by exercise is classic for Uhthoff phenomenon, in which a rise in core body temperature temporarily worsens conduction in previously demyelinated optic nerve fibres, producing brief visual deterioration; the subtly pale optic disc supports prior optic nerve injury, commonly from previous optic neuritis. Basilar migraine would more typically cause transient binocular visual symptoms with other brainstem features and does not characteristically recur only with exertion in one eye, while a carotico\u2011ophthalmic artery aneurysm would be expected to cause compressive neuro\u2011ophthalmic signs such as progressive field loss or ocular motor deficits rather than a temperature\u2011dependent reversible symptom. Visual obscurations from raised intracranial pressure are classically brief \u201Cgrey-outs\u201D triggered by posture or Valsalva and are associated with papilloedema rather than optic disc pallor, so that option is less fitting here.\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u0026nbsp;\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 1498,
    "Name": "Congo red staining in corneal dystrophies",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EIn which of the following conditions is positively stained with Congo red?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: \u003Cstrong\u003ELattice dystrophy type 1\u003C/strong\u003E\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003ECongo red is a histochemical stain that highlights \u003Cstrong\u003Eamyloid deposition\u003C/strong\u003E (classically showing \u003Cstrong\u003Eapple\u2011green birefringence under polarized light\u003C/strong\u003E), and among the listed corneal dystrophies the one defined by \u003Cstrong\u003Estromal amyloid\u003C/strong\u003E is \u003Cstrong\u003Elattice dystrophy type 1\u003C/strong\u003E, so it is the condition that would be \u003Cstrong\u003ECongo red positive\u003C/strong\u003E. Granular dystrophy is primarily a \u003Cstrong\u003Ehyaline (non\u2011amyloid) stromal deposition\u003C/strong\u003E disorder, macular dystrophy is a \u003Cstrong\u003Emucopolysaccharide/glycosaminoglycan stromal deposition\u003C/strong\u003E disorder, and Schnyder dystrophy is characterized by \u003Cstrong\u003Echolesterol/lipid deposition\u003C/strong\u003E within the cornea, so none of these would be expected to stain positively with Congo red in the way lattice dystrophy does.\u0026nbsp;\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E A similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1499,
    "Name": "Suspected intraocular foreign body after high\u2011velocity injury",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 20 year old mechanic feels something hit his right eye, and presents with 6/12 visual acuity, subconjunctival and vitreous haemorrhage, and low IOP. What is the MOST appropriate investigation?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: \u003Cstrong\u003ECT scan of the orbits\u003C/strong\u003E\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EThis presentation is highly suspicious for a \u003Cstrong\u003Ehigh\u2011velocity metallic intraocular foreign body and/or an open\u2011globe injury\u003C/strong\u003E, because\u0026nbsp;\u003Cstrong\u003Esubconjunctival haemorrhage\u003C/strong\u003E, \u003Cstrong\u003Evitreous haemorrhage\u003C/strong\u003E, and especially \u003Cstrong\u003Elow intraocular pressure\u003C/strong\u003E strongly suggest \u003Cstrong\u003Eglobe penetration/rupture with uveal wound leak\u003C/strong\u003E rather than an isolated superficial injury. In that setting, the most appropriate investigation is a \u003Cstrong\u003Enon\u2011contrast CT orbit\u003C/strong\u003E, as it is the best first\u2011line imaging test to detect and localise an \u003Cstrong\u003EIOFB\u003C/strong\u003E (particularly metallic) and associated orbital injury, while \u003Cstrong\u003EMRI is contraindicated\u003C/strong\u003E if a metallic foreign body is possible due to the risk of movement/heating. \u003Cstrong\u003EOcular ultrasound\u003C/strong\u003E can be helpful for vitreoretinal assessment when the globe is intact, but with suspected open globe and low IOP it is \u003Cstrong\u003Erelatively contraindicated\u003C/strong\u003E because probe pressure may worsen extrusion; \u003Cstrong\u003EOCT of the optic nerve\u003C/strong\u003E is not relevant to the acute trauma question and will not address the key diagnostic priority of excluding an IOFB/open globe.\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 13,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1500,
    "Name": "Recurrent submacular haemorrhage with ICG nodular hyperfluorescence",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 73 year old patient presents with recurrent acute sub-macular haemorrhage. Indocyanine Green Angiography (ICG) demonstrates sub-retinal nodular fluorescence appearing within five minutes and persisting to the late phase. What is the MOST appropriate treatment?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: \u003Cstrong\u003EPhotodynamic therapy (PDT) or verteporfin treatment\u003C/strong\u003E\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EThe ICG description of an early-appearing subretinal nodular hyperfluorescent lesion that persists into the late phases in an elderly patient with recurrent acute submacular haemorrhage is most typical of polypoidal choroidal vasculopathy, where ICG highlights the polypoidal aneurysmal dilatations and branching vascular network far better than fluorescein angiography.\u003C/p\u003E\u003Cp\u003EIn this setting, verteporfin photodynamic therapy is the most appropriate treatment because it directly targets and closes the polypoidal lesions responsible for recurrent bleeding, thereby reducing rebleeding risk and improving anatomical control, whereas observation risks further haemorrhagic episodes and irreversible macular damage. Focal thermal laser is generally avoided for macular/subfoveal lesions due to scarring and poor visual outcomes, and while intravitreal anti-VEGF can be helpful\u2014particularly for associated exudation or the branching vascular network\u2014it is less reliably effective at inducing complete polyp closure when used alone in the classic exam framing, making PDT the best single choice here.\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1501,
    "Name": "Visual acuity assessment in a 10\u2011month\u2011old",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich is MOST likely to be an appropriate test for visual acuity in a ten month old child?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: \u003Cstrong\u003EForced choice preferential looking (using a grating pattern).\u003C/strong\u003E\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EIn a 10\u2011month\u2011old infant, the most appropriate visual acuity assessment is one that does not require naming, matching, or reliable symbol recognition, and forced\u2011choice preferential looking with grating targets is designed exactly for this developmental stage by exploiting an infant\u2019s natural preference to look at a patterned stimulus rather than a blank field, allowing estimation of acuity without language or formal cooperation. Cardiff cards can also be used in infants and are a reasonable alternative because they use a preferential looking principle with vanishing optotypes, but forced\u2011choice grating methods are generally the most directly suitable and widely used approach at this age. In contrast, crowded Kay pictures and the Sheridan\u2013Gardiner test depend on picture/letter recognition or matching and typically require an older, more cooperative child, making them less appropriate for a 10\u2011month\u2011old.\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1502,
    "Name": "Orbital cellulitis",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich of the following is MOST likely to be the commonest cause of orbital cellulitis?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: \u003Cstrong\u003EInfection of the sinuses\u003C/strong\u003E\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EOrbital cellulitis most commonly arises by \u003Cstrong\u003Econtiguous spread from adjacent paranasal sinus infection\u003C/strong\u003E, particularly from the \u003Cstrong\u003Eethmoid sinuses\u003C/strong\u003E, because the \u003Cstrong\u003Elamina papyracea is thin\u003C/strong\u003E and valveless venous channels facilitate extension of infection into the orbit, making sinusitis the dominant aetiology in typical presentations. Dacryocystitis usually causes a more anterior, medial preseptal infection centred on the lacrimal sac and is less often the primary driver of true postseptal orbital cellulitis, while dental, otitic, and facial skin infections can certainly spread but are overall less frequent than sinus-derived disease. Orbital trauma with fracture or a retained foreign body is an important cause to consider\u2014especially in specific histories\u2014but it is not the commonest cause across the general population compared with sinus infection.\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1503,
    "Name": "Corneal topography pattern",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhat is the MOST likely diagnosis based upon this topography image?\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-14-5befa56a-1639-4f15-a367-282307fa4c0a.png\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: \u003Cstrong style=\u0022\u0022\u003EPellucid marginal degeneration\u003C/strong\u003E\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EThis topography is most characteristic of \u003Cstrong\u003Epellucid marginal degeneration\u003C/strong\u003E because it shows \u003Cstrong\u003Einferior peripheral corneal steepening\u003C/strong\u003E with a relatively \u003Cstrong\u003Eflatter central cornea\u003C/strong\u003E, producing the classic \u003Cstrong\u003E\u201Ccrab-claw/kissing-doves\u201D pattern\u003C/strong\u003E that reflects \u003Cstrong\u003Ehigh against-the-rule astigmatism\u003C/strong\u003E driven by a \u003Cstrong\u003Ethin band of inferior cornea\u003C/strong\u003E rather than a focal cone. In contrast, \u003Cstrong\u003Ekeratoconus\u003C/strong\u003E usually shows a more \u003Cstrong\u003Elocalized cone-like area of steepening\u003C/strong\u003E (often inferotemporal) with an \u003Cstrong\u003Easymmetric bow-tie and skewed axes\u003C/strong\u003E, rather than broad inferior peripheral \u201Cclaws.\u201D \u003Cstrong\u003EPost\u2013extracapsular cataract extraction astigmatism\u003C/strong\u003E is typically a \u003Cstrong\u003Emore regular, symmetric bow-tie\u003C/strong\u003E pattern consistent with surgically induced regular astigmatism, not the distinctive peripheral inferior steepening pattern seen here. \u003Cstrong\u003EPost-LASIK\u003C/strong\u003E topography most often demonstrates a \u003Cstrong\u003Ecentral flattening ablation zone\u003C/strong\u003E (often with a ring-like transition), rather than isolated \u003Cstrong\u003Einferior peripheral steepening\u003C/strong\u003E with central relative sparing.\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1504,
    "Name": "Retinal arteriovenous anastomosis",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich one of the following retinal vascular abnormalities is MOST likely to represent an arteriovenous anastomosis?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: \u003Cstrong\u003ERacemose haemangioma\u003C/strong\u003E\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EA retinal \u003Cstrong\u003Earteriovenous anastomosis\u003C/strong\u003E implies a \u003Cstrong\u003Edirect artery-to-vein communication without an intervening capillary bed\u003C/strong\u003E, and the classic retinal lesion that represents this is a \u003Cstrong\u003Eracemose haemangioma\u003C/strong\u003E, which is essentially a congenital \u003Cstrong\u003Eretinal arteriovenous malformation\u003C/strong\u003E with markedly dilated, tortuous vessels that shunt blood directly from artery to vein. By contrast, a \u003Cstrong\u003Ecapillary haemangioma\u003C/strong\u003E and an \u003Cstrong\u003Eoptic nerve haemangioblastoma\u003C/strong\u003E are vascular tumours characterized by a \u003Cstrong\u003Ecapillary-rich network\u003C/strong\u003E (typically with prominent feeder and draining vessels) rather than a direct AV shunt, and a \u003Cstrong\u003Ecavernous haemangioma\u003C/strong\u003E is composed of \u003Cstrong\u003Ethin-walled saccular venous \u201Ccaverns\u201D\u003C/strong\u003E with sluggish flow rather than an arteriovenous connection.\u0026nbsp;\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1505,
    "Name": "Uveitis investigations",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EPatients with uveitis are frequently investigated for underlying conditions. In the following scenarios which is MOST likely to have the greatest positive predictive value?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: \u003Cstrong\u003EANA in a child with uveitis and an inflamed knee\u003C/strong\u003E\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EPositive predictive value rises when the test is applied in a setting with a high pre-test probability, and the scenario that most strongly concentrates pre-test probability is a child with uveitis plus a clearly inflammatory large joint problem such as an inflamed knee, because that combination immediately makes juvenile idiopathic arthritis the leading systemic association and ANA positivity meaningfully supports that diagnostic pathway and risk phenotype.\u0026nbsp;\u003C/p\u003E\u003Cp\u003EBy contrast, ACE is an imperfect marker with limited specificity and is not made \u201Chigh PPV\u201D simply by a normal lung function test, anti-cardiolipin testing is not a typical high-yield discriminator for vitritis presentations, and HLA\u2011B27 can be associated with hypopyon anterior uveitis but the added history of recurrent mouth ulcers points more toward Beh\u00E7et disease (which is not defined by HLA\u2011B27), so that pairing is less coherent and therefore less predictive than the child-with-arthritis scenario.\u0026nbsp;\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 12,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1506,
    "Name": "Canaliculitis",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich of the following treatments is the Most effective treatment for canaliculitis:\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: \u003Cstrong\u003ESurgery to the canaliculus and irrigation with topical antibiotics\u003C/strong\u003E\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003ECanaliculitis most often persists because \u003Cstrong\u003Einfective concretions and debris within the canaliculus act as a protected nidus\u003C/strong\u003E, so purely medical therapy frequently fails to eradicate the source even if symptoms temporarily improve. The most effective approach is therefore \u003Cstrong\u003Eprocedural removal of canalicular contents (canaliculotomy with curettage/expression) followed by irrigation and topical antibiotics\u003C/strong\u003E, which directly clears the obstructing/infected material and reduces recurrence. Massage and warm compresses may help surface drainage but usually do not eliminate intraluminal concretions, oral antibiotics have limited penetration into the canalicular lumen and cannot reliably clear the debris-based nidus, and topical steroids risk masking infection and worsening persistence if used without definitive source control.\u0026nbsp;\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1507,
    "Name": "Incidental orbital cavernous haemangioma with stable longstanding visual loss",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 55 year old man with multiple sclerosis was referred to you after he was incidentally found to have a cavernous haemangioma in his left orbital apex from an MRI scan. He has had poor vision in his left eye for the past two years and had attributed it to his previous \u201Coptic neuritis\u201D. He does not complain of any recent change in his vision. What would be the MOST appropriate management in this case?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: \u003Cstrong\u003EObserve with frequent clinic review\u003C/strong\u003E\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EAn incidental orbital cavernous haemangioma at the orbital apex in a patient with \u003Cstrong\u003Eno recent visual change\u003C/strong\u003E and \u003Cstrong\u003Elongstanding stable poor vision already attributed to optic neuritis\u003C/strong\u003E is most appropriately managed conservatively, because many orbital cavernous haemangiomas are \u003Cstrong\u003Eslow-growing and benign\u003C/strong\u003E, and intervention is usually reserved for cases with \u003Cstrong\u003Eprogressive visual decline, increasing optic nerve compression, or symptomatic progression\u003C/strong\u003E.\u003C/p\u003E\u003Cp\u003E\u0026nbsp;In an orbital apex location, surgery carries \u003Cstrong\u003Ehigher risk\u003C/strong\u003E due to proximity to the optic nerve and extraocula muscles, so proceeding straight to excision without evidence of progression is unlikely to be justified. Medical therapy such as propranolol is not a standard effective treatment for adult orbital cavernous haemangioma, and stereotactic radiotherapy is typically considered only in selected situations where there is progressive compression and surgery is unsuitable, rather than for an incidental, stable lesion. \u003Cstrong\u003ETherefore, careful observation with regular clinical review is the best approach.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E A similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1508,
    "Name": "RCOphth hydroxychloroquine/chloroquine retinopathy monitoring",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003ERegarding the RCOphth clinical guidelines on Hydroxychloroquine and chloroquine monitoring, which is the MOST likely recommendation?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: \u003Cstrong\u003EAll patients who have been taking chloroquine should be monitored within 1 year of starting treatment\u003C/strong\u003E\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EThe RCOphth updated guidance recognises that \u003Cstrong\u003Echloroquine is more retinotoxic than hydroxychloroquine\u003C/strong\u003E and therefore recommends that \u003Cstrong\u003Emonitoring for all chloroquine users begins after one year of therapy\u003C/strong\u003E, using appropriate retinal imaging tests, which makes the one\u2011year chloroquine statement the best match.  The six\u2011month chloroquine statement is not the recommended threshold in the guideline, so it is less likely to be correct.  The hydroxychloroquine statements are also less likely because RCOphth recommends \u003Cstrong\u003Eannual monitoring after five years for most hydroxychloroquine users\u003C/strong\u003E, with earlier commencement around one year reserved for those with \u003Cstrong\u003Eadditional risk factors\u003C/strong\u003E (such as high dose, renal impairment, or tamoxifen use), so routine monitoring within one year or within three years for all hydroxychloroquine users does not reflect the guideline\u2019s main recommendation.\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 5,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1509,
    "Name": "Aberrant regeneration of the third nerve",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EThe following are features of Aberrant regeneration of third nerve except\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: \u003Cstrong\u003EAbduction on attempted upgaze\u003C/strong\u003E\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EAberrant regeneration (oculomotor synkinesis) is caused by \u003Cstrong\u003Emisdirection of regenerating third\u2011nerve fibres\u003C/strong\u003E, producing \u003Cstrong\u003Eparadoxical co\u2011contraction\u003C/strong\u003E and characteristic synkinetic signs: the pupil may \u003Cstrong\u003Econstrict on attempted adduction\u003C/strong\u003E (pseudo\u2013Argyll Robertson pattern), the upper lid may \u003Cstrong\u003Eelevate or retract on attempted downgaze or adduction\u003C/strong\u003E (pseudo\u2013von Graefe), and there can be \u003Cstrong\u003Eadduction during attempted vertical gaze\u003C/strong\u003E with co\u2011contraction that may even produce \u003Cstrong\u003Eglobe retraction on attempted upgaze/downgaze\u003C/strong\u003E.  In contrast, \u003Cstrong\u003Eabduction on attempted upgaze\u003C/strong\u003E does not fit the physiology of third\u2011nerve misdirection, because the classic horizontal synkinesis in this condition is \u003Cstrong\u003Einappropriate adduction\u003C/strong\u003E during vertical gaze rather than abduction.\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1510,
    "Name": "Infant \u201Cwhite lump\u201D at the limbus",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA six month old boy presents as his parents have noticed a \u201Clump on the eye\u201D. You observe the white, solid lesion shown in the photograph. What is the MOST likely diagnosis?\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-15-001f417e-b8d8-4ba1-a64c-daad47ea3fb6.png\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: \u003Cstrong\u003ELimbal dermoid (epibulbar choristoma)\u003C/strong\u003E\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EThis is most consistent with a \u003Cstrong\u003Elimbal dermoid\u003C/strong\u003E, because the lesion appears \u003Cstrong\u003Econgenital/early-onset\u003C/strong\u003E, \u003Cstrong\u003Ewhite and solid\u003C/strong\u003E, and sits at the \u003Cstrong\u003Einferior limbal/peripheral corneal region\u003C/strong\u003E, which is the classic location and look for an \u003Cstrong\u003Eepibulbar choristoma containing skin-like tissue\u003C/strong\u003E that can be noticed by parents as a \u201Clump\u201D in infancy; these lesions are typically \u003Cstrong\u003Ewell-circumscribed, non-infective, and non-fluctuant\u003C/strong\u003E, and may induce \u003Cstrong\u003Eastigmatism\u003C/strong\u003E if they encroach on the cornea.\u003C/p\u003E\u003Cp\u003EA conjunctival inclusion cyst is usually \u003Cstrong\u003Etranslucent and cystic\u003C/strong\u003E, often following trauma or surgery, rather than a solid white plaque-like mass in a 6\u2011month\u2011old. Phlyctenular disease is an \u003Cstrong\u003Einflammatory hypersensitivity reaction\u003C/strong\u003E that tends to be \u003Cstrong\u003Ered, irritated, photophobic\u003C/strong\u003E, and associated with \u003Cstrong\u003Elimbal injection\u003C/strong\u003E and episodic inflammation rather than a stable, solid congenital-appearing lump. Corneal keloid is an uncommon \u003Cstrong\u003Efibroproliferative scar mass\u003C/strong\u003E that usually follows \u003Cstrong\u003Etrauma, surgery, or significant inflammation\u003C/strong\u003E, and the history and age here fit far better with a \u003Cstrong\u003Edevelopmental choristoma\u003C/strong\u003E than an acquired scarring process.\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1511,
    "Name": "Vernal keratoconjunctivitis (Horner\u2013Trantas dots)",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EAn eight year old boy presents with this clinical appearance. If the white lesions were to be submitted for histological examination which of the following immune cells would be MOST likely to predominate?\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-15-2ca5f742-d355-43c6-b80d-ddd4d2af9642.png\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: \u003Cstrong\u003EEosinophils\u003C/strong\u003E\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EThe image shows multiple white limbal dots consistent with \u003Cstrong\u003EHorner\u2013Trantas dots\u003C/strong\u003E, a classic sign of \u003Cstrong\u003Evernal keratoconjunctivitis\u003C/strong\u003E, which is an allergic, Th2\u2011predominant ocular surface disease. These dots represent accumulations of inflammatory debris at the limbus in which \u003Cstrong\u003Eeosinophils\u003C/strong\u003E are prominent, reflecting the allergic/eosinophil\u2011driven nature of the condition; therefore, eosinophils would be the predominant immune cells on histology. Neutrophils would be more typical of acute bacterial infection, lymphocytes predominate in many chronic non\u2011allergic inflammatory processes, and plasma cells are seen in chronic conjunctival inflammation but are not the hallmark cell type for Horner\u2013Trantas dots in vernal disease.\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1512,
    "Name": "GMC social media guidance",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich of the following would NOT breach GMC guidance on appropriate use of social media?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: \u003Cstrong\u003EUsing a professional social media website (not open to the public) to discuss a patient\u2019s care (with no identifiable features)\u003C/strong\u003E\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EThe only scenario that can be compatible with GMC expectations is using a \u003Cstrong\u003Eprofessional, non\u2011public platform\u003C/strong\u003E to discuss care \u003Cstrong\u003Ewithout sharing any identifiable patient information\u003C/strong\u003E, because the guiding principles are to \u003Cstrong\u003Emaintain patient confidentiality\u003C/strong\u003E, \u003Cstrong\u003Erespect privacy\u003C/strong\u003E, and \u003Cstrong\u003Ebehave professionally online\u003C/strong\u003E; a closed professional environment with robust anonymization is the closest match to those requirements.  The other scenarios are more likely to breach guidance because giving advice publicly while identifying yourself as a doctor yet remaining anonymous undermines \u003Cstrong\u003Eaccountability and trust\u003C/strong\u003E expected in professional communications, failing to disclose a financial/employment interest when commenting on a procedure is a clear \u003Cstrong\u003Econflict\u2011of\u2011interest transparency\u003C/strong\u003E problem, and replying to a patient via a private profile risks \u003Cstrong\u003Eboundary blurring\u003C/strong\u003E and unstructured clinical advice outside appropriate professional channels.\u0026nbsp;\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 7,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1513,
    "Name": "Headache \u002B bilateral uveitis \u002B retinal periphlebitis",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 24 year old man presents with headache, bilateral uveitis and a periphlebitis. Which of the following is the MOST likely diagnosis?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: \u003Cstrong\u003EBeh\u00E7et\u2019s disease\u003C/strong\u003E\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EThis combination most strongly supports Beh\u00E7et\u2019s disease because it classically causes a \u003Cstrong\u003Ebilateral, relapsing panuveitis\u003C/strong\u003E with \u003Cstrong\u003Eretinal vasculitis\u003C/strong\u003E that commonly manifests as \u003Cstrong\u003Eperiphlebitis (venous sheathing and inflammation)\u003C/strong\u003E, and the associated \u003Cstrong\u003Eheadache\u003C/strong\u003E fits with systemic inflammatory activity and the possibility of neurological involvement in the Beh\u00E7et spectrum.\u003C/p\u003E\u003Cp\u003E\u0026nbsp;Acute retinal necrosis is usually dominated by a unilateral, rapidly progressive necrotising retinitis with intense vitritis rather than a primary picture of bilateral uveitis with periphlebitis. Sympathetic ophthalmia requires a preceding penetrating ocular injury or intraocular surgery to trigger bilateral granulomatous uveitis, which is not suggested by the stem. Vogt\u2013Koyanagi\u2013Harada syndrome can present with headache and bilateral granulomatous uveitis, but it is more characteristically associated with diffuse choroiditis and exudative retinal detachments rather than a retinal periphlebitis-led vasculitic phenotype, making Beh\u00E7et\u2019s disease the best single fit here.\u0026nbsp;\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 12,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1514,
    "Name": "HSV stromal keratitis with endotheliitis",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 30 year old man known to have recurrent herpes simplex keratitis presents with a 2 week history of reduced vision and a sore eye. He had been on prophylactic oral acyclovir but had discontinued this in error. On examination he has a moderate injection, an area of stromal thickening with localised endotheliitis and 1\u002B of anterior chamber cells. Which of the following is the most widely accepted combination of therapeutic agents in this case?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: \u003Cstrong\u003ESystemic acyclovir, topical steroid only\u003C/strong\u003E\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EThis presentation is most consistent with \u003Cstrong\u003EHSV immune stromal keratitis with associated endotheliitis and mild anterior uveitis\u003C/strong\u003E, where the key pathology is \u003Cstrong\u003Estromal and endothelial inflammation\u003C/strong\u003E rather than active epithelial viral replication, so the cornerstone of management is a \u003Cstrong\u003Etopical corticosteroid to suppress the immune-mediated corneal inflammation\u003C/strong\u003E, but it must be given with \u003Cstrong\u003Eantiviral cover\u003C/strong\u003E to prevent worsening or reactivation of HSV; in practice, that antiviral cover is very commonly provided as \u003Cstrong\u003Esystemic acyclovir\u003C/strong\u003E (especially here, given he stopped prophylaxis and now has a significant inflammatory recurrence).\u003C/p\u003E\u003Cp\u003EAdding topical acyclovir on top of adequate systemic antiviral therapy is generally not essential in a case without epithelial ulceration, while systemic steroids are not the standard first-line for localised HSV stromal/endothelial disease and would be reserved for selected severe uveitic/systemic situations under specialist guidance; finally, any regimen that omits topical steroid fails to address the main driver of the reduced vision and stromal thickening, and risks persistent scarring and decompensation.\u0026nbsp;\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 6,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1515,
    "Name": "Periocular keratoacanthoma",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWith regard to peri-ocular keratoacanthoma which of the following is LEAST likely to be correct?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: \u003Cstrong\u003ERapid growth suggests the lesion is more likely to be an SCC\u003C/strong\u003E\u003C/span\u003E\u003C/h3\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003E\u003Cstrong\u003E\u003Cbr\u003E\u003C/strong\u003E\u003C/span\u003E\u003C/div\u003E\n\u003Cp\u003EPeriocular keratoacanthoma is a crateriform lesion that characteristically undergoes a phase of \u003Cstrong\u003Erapid growth over weeks\u003C/strong\u003E, and this rapid growth history is actually one of the clinical clues that points toward keratoacanthoma rather than making squamous cell carcinoma more likely, even though the key practical problem is that keratoacanthoma and well\u2011differentiated squamous cell carcinoma can overlap clinically and histologically.  Because of this uncertainty and the clinically important risk that a lesion labelled \u201Ckeratoacanthoma\u201D may prove to be invasive squamous cell carcinoma, periocular lesions are generally managed with \u003Cstrong\u003Edefinitive excision and margin control\u003C/strong\u003E to secure diagnosis and treatment, and this approach is explicitly recommended in periocular series.  It is also plausible that a periocular keratoacanthoma may be mistaken clinically for other common lid tumours, including nodular basal cell carcinoma.\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u0026nbsp;A similar question appeared in a previous FRCOphth part 2 written exam.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1516,
    "Name": "Hypertropia in Adduction",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA child is brought in because the parent noticed that one eye occasionally \u201Cfloats upward.\u201D On examination you find a left hypertropia, and it becomes most noticeable when the child looks to the right. During an alternate cover test, when the left eye is uncovered it makes a corrective downward movement to re-fixate. When the left eye is covered, the right eye moves upward.\u003Cbr\u003EWhich diagnosis best accounts for this pattern?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cstrong\u003EAnswer: Left inferior oblique overaction .\u003C/strong\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\nThe \u003Cstrong\u003Eleft hypertropia is most evident in right gaze\u003C/strong\u003E, which places the \u003Cstrong\u003Eleft eye in adduction\u003C/strong\u003E\u2014the position where the \u003Cstrong\u003Einferior oblique acts as an elevator\u003C/strong\u003E\u2014so \u003Cstrong\u003Eoveraction makes the left eye drift upward\u003C/strong\u003E. On alternate cover testing, the \u003Cstrong\u003Edownward refixation of the left eye when uncovered\u003C/strong\u003E indicates it had \u003Cstrong\u003Eelevated under cover\u003C/strong\u003E, and the \u003Cstrong\u003Eupward shift of the right eye when the left is covered\u003C/strong\u003E reflects a \u003Cstrong\u003Eyoked, compensatory response consistent with Hering\u2019s law\u003C/strong\u003E. Therefore, the findings are best explained by \u003Cstrong\u003Eleft inferior oblique overaction\u003C/strong\u003E.\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1517,
    "Name": "Earliest sign of malignant hyperthermia",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EYou are preparing for strabismus surgery in a child who has a family history suggesting susceptibility to malignant hyperthermia. Which clinical/monitoring change is typically the first clue that malignant hyperthermia is developing during anesthesia?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: E\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px; font-weight: bold;\u0022\u003Elevation of end-tidal carbon dioxide concentration\u003C/span\u003E\u003C/p\u003E\n\u003Cp\u003EMalignant hyperthermia causes a \u003Cstrong\u003Esudden hypermetabolic state in skeletal muscle\u003C/strong\u003E, leading to \u003Cstrong\u003Erapid CO\u2082 overproduction\u003C/strong\u003E. In the operating room, the earliest and most reliable clue is often a \u003Cstrong\u003Eprogressive, unexplained increase in end\u2011tidal CO\u2082 despite adequate ventilation\u003C/strong\u003E (often accompanied by \u003Cstrong\u003Eearly tachycardia\u003C/strong\u003E).\u003C/p\u003E\n\u003Cp\u003EA rise in body temperature is a \u003Cstrong\u003Elate finding\u003C/strong\u003E, because the patient may generate excess heat early but \u003Cstrong\u003Emeasurable hyperthermia typically appears after CO\u2082 and cardiovascular changes\u003C/strong\u003E. Myoglobinuria is also \u003Cstrong\u003Elater\u003C/strong\u003E, reflecting \u003Cstrong\u003Erhabdomyolysis\u003C/strong\u003E after sustained muscle breakdown, so it is not usually the first sign. Muscle rigidity can occur early (classically \u003Cstrong\u003Emasseter spasm\u003C/strong\u003E or generalized rigidity), but \u003Cstrong\u003Eend\u2011tidal CO\u2082 elevation is usually detected first\u003C/strong\u003E because it is continuously monitored and reflects the earliest physiologic shift toward hypercarbia and increased metabolic demand.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 5,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1518,
    "Name": "Binocular diplopia: most affected EOM",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 42-year-old woman has had binocular double vision for several weeks, and an external photograph is provided. Which extraocular muscle is most likely involved in the underlying condition?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: Inferior rectus.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThe findings are most consistent with \u003Cstrong\u003Ethyroid eye disease\u003C/strong\u003E, a common cause of \u003Cstrong\u003Ebinocular diplopia in adults\u003C/strong\u003E due to \u003Cstrong\u003Erestrictive involvement of extraocular muscles\u003C/strong\u003E. The typical pattern of muscle involvement is: \u003Cstrong\u003Einferior rectus most commonly\u003C/strong\u003E, then \u003Cstrong\u003Emedial rectus\u003C/strong\u003E, followed by \u003Cstrong\u003Esuperior rectus\u003C/strong\u003E, and \u003Cstrong\u003Elateral rectus least often\u003C/strong\u003E. Because the \u003Cstrong\u003Einferior rectus\u003C/strong\u003E is frequently affected, patients often develop \u003Cstrong\u003Erestriction of elevation\u003C/strong\u003E and diplopia related to that limitation.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1519,
    "Name": "Pediatric CN VI palsy",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich statement about sixth cranial nerve palsy in children is not correct?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003ETrue sixth nerve palsy in childhood is \u003Cstrong\u003Eseen more often in older children than in newborns/infants\u003C/strong\u003E, so saying it is more frequent in infancy is incorrect. A compensatory head turn can help maintain \u003Cstrong\u003Esingle binocular vision\u003C/strong\u003E, which is \u003Cstrong\u003Eprotective against amblyopia\u003C/strong\u003E by reducing constant suppression. Also, a meaningful proportion of children with an apparent sixth nerve palsy can have an \u003Cstrong\u003Eintracranial cause\u003C/strong\u003E, so \u003Cstrong\u003Eneuroimaging is often warranted\u003C/strong\u003E depending on the clinical context. In infants especially, many \u201Ccongenital sixth nerve palsy\u201D presentations are actually \u003Cstrong\u003Einfantile (congenital) esotropia with cross-fixation\u003C/strong\u003E, which can \u003Cstrong\u003Emimic an abduction limitation\u003C/strong\u003E, so checking \u003Cstrong\u003Etrue ductions\u003C/strong\u003E is important.\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1520,
    "Name": "Amblyopia and crowding on HOTV testing",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 3-year-old has reduced acuity in one eye measured using matching single bracketed HOTV. Considering how this testing method influences amblyopic vision, does the measured acuity in the weaker eye tend to be accurate, underestimated, or overestimated?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAmblyopia is associated with \u003Cstrong\u003Ecrowding (contour interaction)\u003C/strong\u003E, meaning vision often looks \u003Cstrong\u003Ebetter when letters are presented alone\u003C/strong\u003E than when they are surrounded by other letters or \u201Ccrowding bars.\u201D If testing uses \u003Cstrong\u003Eisolated single optotypes without surrounding contours\u003C/strong\u003E, acuity can be \u003Cstrong\u003Eartificially better (overestimated)\u003C/strong\u003E in amblyopia. Here, the optotypes are \u003Cstrong\u003Esingle but bracketed\u003C/strong\u003E, which intentionally adds \u003Cstrong\u003Econtour bars to simulate crowding\u003C/strong\u003E, making the measurement \u003Cstrong\u003Ecloser to what line testing would reveal\u003C/strong\u003E.\u003C/p\u003E\n\u003Cp\u003EAlso, because the child is using a \u003Cstrong\u003Ematching method\u003C/strong\u003E, the result does not depend on \u003Cstrong\u003Eknowing or naming letters\u003C/strong\u003E, so poor letter knowledge is not the reason for reduced acuity.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1521,
    "Name": "Congenital glaucoma: risk to offspring",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA patient who has congenital glaucoma is considering having children. No other relatives are affected, and the partner has no history of congenital glaucoma. What is the estimated chance that a child will also have congenital glaucoma?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003E2%\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EWhen an individual has primary congenital glaucoma and there is \u003Cstrong\u003Eno additional family history\u003C/strong\u003E (and the partner is unaffected), the \u003Cstrong\u003Eempiric risk\u003C/strong\u003E for an affected child is \u003Cstrong\u003Eabout 2%\u003C/strong\u003E. This estimate comes from published observational data and is also summarized in the BCSC text, which states that \u003Cstrong\u003Eif no other family history of primary congenital glaucoma exists, the chance of an affected parent having an affected child is approximately 2%\u003C/strong\u003E.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1522,
    "Name": "Parks 3-step",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 55-year-old has a right hypertropia. On Parks\u2013Bielschowsky 3-step testing, the vertical deviation increases in left gaze and with a left head tilt. Which extraocular muscle weakness best fits this pattern?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003ELeft superior rectus weakness.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EA right hypertropia limits the possibilities to muscles that would normally \u003Cstrong\u003Edepress the right eye\u003C/strong\u003E or \u003Cstrong\u003Eelevate the left eye\u003C/strong\u003E. When the hypertropia becomes larger in \u003Cstrong\u003Eleft gaze\u003C/strong\u003E, the pattern narrows to two main candidates: a muscle that primarily acts in that gaze position. The added clue is the \u003Cstrong\u003Eleft head tilt\u003C/strong\u003E, which drives the left eye to \u003Cstrong\u003Eintort\u003C/strong\u003E; vertical deviations that worsen with head tilt point to a problem in the muscles responsible for torsional stabilization in that eye. Because \u003Cstrong\u003Esuperior rectus and superior oblique are intorters\u003C/strong\u003E, worsening with \u003Cstrong\u003Eleft tilt\u003C/strong\u003E indicates deficient \u003Cstrong\u003Eleft-eye intorsion/elevation control\u003C/strong\u003E, identifying the \u003Cstrong\u003Eleft superior rectus\u003C/strong\u003E as the paretic muscle.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1523,
    "Name": "Stage 3 ROP definition",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich description best matches stage 3 retinopathy of prematurity?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003ERidge with extraretinal fibrovascular proliferation.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EStage 3 ROP is defined by a \u003Cstrong\u003Eridge\u003C/strong\u003E at the junction of vascularized and avascular retina with \u003Cstrong\u003Efibrovascular tissue proliferating beyond the retina (extraretinal)\u003C/strong\u003E. This distinguishes it from earlier stages, where there is either a \u003Cstrong\u003Eflat demarcation line\u003C/strong\u003E (stage 1) or a \u003Cstrong\u003Eraised ridge with or without small tufts\u003C/strong\u003E but without true extraretinal proliferation (stage 2). Retinal detachment corresponds to later disease, with \u003Cstrong\u003Esubtotal detachment in stage 4\u003C/strong\u003E (and \u003Cstrong\u003Etotal detachment in stage 5\u003C/strong\u003E).\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1524,
    "Name": "Angle of vertical recti to visual axis",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhat angle do the superior and inferior rectus muscles make relative to the eye\u2019s visual axis?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003E23 degrees.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThe superior and inferior rectus muscles do not run exactly along the visual axis; instead, they travel from the \u003Cstrong\u003Eannulus of Zinn\u003C/strong\u003E in a slightly outward (lateral) direction, creating an angle of \u003Cstrong\u003Eabout 23\u00B0\u003C/strong\u003E with the visual axis. This is commonly contrasted with the oblique muscles, which have a larger relationship angle to the visual axis of \u003Cstrong\u003Eabout 51\u00B0\u003C/strong\u003E, helping explain differences in their secondary/tertiary actions.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1525,
    "Name": "IO palsy vs Brown syndrome: key differences",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA patient has a left hypertropia and the right eye shows limited elevation in adduction on left gaze. Which statement is wrong when trying to tell inferior oblique palsy apart from Brown syndrome?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EThe statement that a V\u2011pattern occurs in inferior oblique palsy is incorrect.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EBoth conditions can look similar because each can cause \u003Cstrong\u003Elimited elevation in adduction\u003C/strong\u003E. The separation point is whether the problem is \u003Cstrong\u003Erestrictive\u003C/strong\u003E (Brown syndrome) or \u003Cstrong\u003Eparetic\u003C/strong\u003E (inferior oblique palsy). Brown syndrome is due to \u003Cstrong\u003Erestriction at the trochlea\u2013superior oblique tendon complex\u003C/strong\u003E, so it typically shows \u003Cstrong\u003Epositive forced ductions\u003C/strong\u003E, \u003Cstrong\u003Eminimal/absent superior oblique overaction\u003C/strong\u003E, \u003Cstrong\u003Eno significant torsion\u003C/strong\u003E, and a \u003Cstrong\u003Enegative head\u2011tilt test\u003C/strong\u003E; it often produces a \u003Cstrong\u003EV\u2011pattern\u003C/strong\u003E because the restricted eye cannot elevate in adduction and tends to drift outward in upgaze.\u003C/p\u003E\n\u003Cp\u003EInferior oblique palsy is a true weakness, so forced ductions are \u003Cstrong\u003Enegative\u003C/strong\u003E, and secondary changes are common\u2014especially \u003Cstrong\u003Esuperior oblique overaction\u003C/strong\u003E, which produces \u003Cstrong\u003Eintorsion\u003C/strong\u003E and tends to create an \u003Cstrong\u003EA\u2011pattern\u003C/strong\u003E, with a \u003Cstrong\u003Epositive head\u2011tilt test\u003C/strong\u003E. Therefore, attributing a \u003Cstrong\u003EV\u2011pattern\u003C/strong\u003E to inferior oblique palsy is the incorrect distinguishing feature.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1526,
    "Name": "Intermittent exotropia vs \u201Clazy eye\u201D patching",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 12-year-old boy has a two-year history of intermittent exotropia that has become constant over the last six months. On exam his visual acuity is 20/20 in the right eye and 20/20\u22122 in the left eye, with a 30\u2011prism\u2011diopter exotropia in primary gaze and freely alternating fixation (refraction \u002B1.00 sphere in both eyes; stereoacuity 40 seconds of arc with prism correction). His father notices the small acuity difference and asks whether patching would help a \u201Clazy eye.\u201D What is the most appropriate response?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EPatching is not indicated here; management should focus on the manifest exotropia (surgical consideration).\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThis history fits a deviation that began around age 10, meaning binocular vision development during early childhood was likely \u003Cstrong\u003Enormal\u003C/strong\u003E, with the exotropia initially \u003Cstrong\u003Eintermittent/controlled\u003C/strong\u003E. A small inter-eye acuity difference such as 20/20 versus 20/20-2 typically \u003Cstrong\u003Edoes not meet common clinical thresholds for unilateral amblyopia\u003C/strong\u003E, which is usually defined as a \u003Cstrong\u003Edifference of at least two lines\u003C/strong\u003E on best-corrected acuity testing. Because the problem is now a \u003Cstrong\u003Emanifest exotropia\u003C/strong\u003E, the priority is restoring comfortable alignment and binocular function; \u003Cstrong\u003Estrabismus surgery can address the constant deviation\u003C/strong\u003E and reduce reliance on prisms.\u003C/p\u003E\n\u003Cp\u003EThe PEDIG patching data applies to children who truly have \u003Cstrong\u003Eamblyopia\u003C/strong\u003E; in this scenario, the child\u2019s findings are more consistent with \u003Cstrong\u003Estrabismus control failure\u003C/strong\u003E rather than amblyopia needing patch therapy.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1527,
    "Name": "Christmas tree cataract \u002B paresthesias",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 6-year-old is referred because of an abnormal red reflex in both eyes. Slit-lamp exam shows bilateral lens opacities like those pictured. The child frequently reports tingling in the hands, feet, and around the mouth, yet is doing very well academically. Which underlying disorder best explains this presentation?\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-19-bcbf324b-3f5a-431e-a8f8-c739d2460a22.png\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003C!--StartFragment--\u003E\u003C!--EndFragment--\u003E\u003C/p\u003E\u003Cdiv style=\u0022font-family:\u0027Segoe UI\u0027;font-size:14px;font-style:normal;font-weight:400;line-height:20px\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: Hypoparathyroidism.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThe slit-lamp photo shows a \u003Cstrong\u003E\u201CChristmas tree\u201D cataract\u003C/strong\u003E (multicolored, sparkling crystalline flecks). This cataract pattern is classically associated with \u003Cstrong\u003Ehypoparathyroidism\u003C/strong\u003E and can also be seen with \u003Cstrong\u003Emyotonic dystrophy\u003C/strong\u003E, so you must use the systemic clues to choose between them. The child\u2019s \u003Cstrong\u003Eperioral and distal tingling\u003C/strong\u003E strongly suggests \u003Cstrong\u003Ehypocalcemia\u003C/strong\u003E, which is a hallmark consequence of \u003Cstrong\u003Elow parathyroid hormone\u003C/strong\u003E. Hypocalcemia can also cause \u003Cstrong\u003Etetany\u003C/strong\u003E and classic bedside signs such as \u003Cstrong\u003EChvostek\u003C/strong\u003E (facial twitch with tapping) and \u003Cstrong\u003ETrousseau\u003C/strong\u003E (carpal spasm with BP cuff). Importantly, children with hypoparathyroidism typically have \u003Cstrong\u003Enormal intelligence\u003C/strong\u003E, matching the history.\u003C/p\u003E\n\u003Cp\u003EMyotonic dystrophy would be suggested instead by \u003Cstrong\u003Emyotonia (delayed relaxation, e.g., difficulty releasing a grip)\u003C/strong\u003E and other systemic/ocular features like \u003Cstrong\u003Eptosis, external ophthalmoplegia, pigmentary retinopathy, and cardiac conduction issues\u003C/strong\u003E, rather than prominent hypocalcemic paresthesias. Lowe syndrome has a different typical cataract morphology (often described as \u003Cstrong\u003Ethin discoform\u003C/strong\u003E), and sarcoidosis does not fit the combination of \u003Cstrong\u003EChristmas tree cataract \u002B hypocalcemic symptoms\u003C/strong\u003E.\u003C/p\u003E\u003C/div\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1528,
    "Name": "Failure of fetal fissure closure",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich condition results from incomplete closure of the embryonic (fetal) fissure during eye development?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003C!--StartFragment--\u003E\u003C!--EndFragment--\u003E\u003C/p\u003E\u003Cdiv style=\u0022font-family:\u0027Segoe UI\u0027;font-size:14px;font-style:normal;font-weight:400;line-height:20px\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: Microphthalmos with cyst.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThis is a \u003Cstrong\u003Ecoloboma-spectrum anomaly\u003C/strong\u003E caused by \u003Cstrong\u003Efailure of the embryonic (fetal) fissure to close\u003C/strong\u003E, which leaves a defect in the ocular wall. Through this defect, \u003Cstrong\u003Eneuroectoderm can herniate outward\u003C/strong\u003E, forming a \u003Cstrong\u003Ecolobomatous cyst\u003C/strong\u003E, and the globe is typically \u003Cstrong\u003Emicrophthalmic\u003C/strong\u003E. The cyst is usually \u003Cstrong\u003Einferonasal\u003C/strong\u003E, so it may present as a \u003Cstrong\u003Evisible/palpable mass under or behind the lower eyelid\u003C/strong\u003E, and the associated coloboma often involves the \u003Cstrong\u003Eoptic disc\u003C/strong\u003E with variable extension into the \u003Cstrong\u003Echoroid/retina\u003C/strong\u003E. Like other coloboma-related conditions, it can be associated with \u003Cstrong\u003Esystemic syndromes\u003C/strong\u003E (so a general/systemic evaluation may be warranted).\u003C/p\u003E\n\u003Cp\u003EThe other listed conditions are not due to fissure-closure failure: \u003Cstrong\u003EBergmeister papilla\u003C/strong\u003E and \u003Cstrong\u003Epersistent fetal vasculature\u003C/strong\u003E reflect \u003Cstrong\u003Epersistence of the fetal hyaloid system\u003C/strong\u003E, and \u003Cstrong\u003Enanophthalmos\u003C/strong\u003E is a \u003Cstrong\u003Esmall eye without a coloboma/cyst mechanism\u003C/strong\u003E.\u003C/p\u003E\u003C/div\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1529,
    "Name": "ARC and paradoxical diplopia after ET surgery",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 45-year-old with long-standing esotropia is found to have anomalous retinal correspondence on pre-op testing, and you plan bilateral medial rectus recessions. What postoperative visual symptom may occur soon after surgery?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003C!--StartFragment--\u003E\u003C!--EndFragment--\u003E\u003C/p\u003E\u003Cdiv style=\u0022font-family:\u0027Segoe UI\u0027;font-size:14px;font-style:normal;font-weight:400;line-height:20px\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: Crossed diplopia.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EIn long\u2011standing esotropia, the visual system may develop \u003Cstrong\u003Eanomalous retinal correspondence (ARC)\u003C/strong\u003E to \u003Cstrong\u003Emaintain single binocular vision despite misalignment\u003C/strong\u003E by \u201Cremapping\u201D which retinal points correspond between the two eyes. If surgery corrects the \u003Cstrong\u003Emeasured\u003C/strong\u003E esotropia to orthotropia, the \u003Cstrong\u003Esensory adaptation can persist temporarily\u003C/strong\u003E, so the patient may \u003Cem\u003Eperceive\u003C/em\u003E the eyes as now being \u003Cstrong\u003Eovercorrected toward exotropia\u003C/strong\u003E relative to their adapted straight-ahead. That mismatch between the new motor alignment and the old sensory map produces \u003Cstrong\u003Eparadoxical diplopia\u003C/strong\u003E, and because the perceived state is \u003Cstrong\u003Eexotropic\u003C/strong\u003E, the doubling pattern is \u003Cstrong\u003Ecrossed diplopia\u003C/strong\u003E.\u003C/p\u003E\u003C/div\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1530,
    "Name": "CN IV palsy",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 35-year-old develops diplopia after head trauma. He has a left hypertropia that increases in right gaze and with left head tilt; the primary-position hypertropia measures 10 prism diopters and torsion is minimal on double Maddox rod testing. What is the most appropriate initial surgical approach?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003ELeft inferior oblique weakening.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThis motility pattern localizes to a \u003Cstrong\u003Eleft superior oblique (CN IV) palsy\u003C/strong\u003E: the hypertropia worsens in \u003Cstrong\u003Econtralateral gaze (right gaze)\u003C/strong\u003E and with \u003Cstrong\u003Eipsilateral head tilt (left tilt)\u003C/strong\u003E, which is the classic Parks/Bielschowsky pattern. Surgical planning is guided mainly by the \u003Cstrong\u003Eprimary-position vertical deviation\u003C/strong\u003E. With a primary-position hypertropia of \u003Cstrong\u003E10 prism diopters (\u226415)\u003C/strong\u003E, the standard initial procedure is \u003Cstrong\u003Eweakening of the ipsilateral inferior oblique\u003C/strong\u003E, which reduces the hypertropia in adduction and improves the typical gaze/tilt incomitance.\u003C/p\u003E\n\u003Cp\u003EMore extensive surgery is generally reserved for larger deviations: when the primary-position hypertropia is \u003Cstrong\u003E\u0026gt;15 prism diopters\u003C/strong\u003E, a common strategy is combining \u003Cstrong\u003Eipsilateral inferior oblique weakening\u003C/strong\u003E with \u003Cstrong\u003Econtralateral inferior rectus recession\u003C/strong\u003E to address the larger vertical misalignment. \u003Cstrong\u003ESuperior oblique tendon tuck\u003C/strong\u003E is typically considered when there is \u003Cstrong\u003Edemonstrable tendon laxity\u003C/strong\u003E or when the clinical picture suggests underaction that is best addressed by tightening, rather than as the first step for a small primary deviation.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1531,
    "Name": "Infantile esotropia",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 7\u2011month\u2011old has had constant inward eye deviation for two months. Vision assessment shows CSM in the right eye and UC/US/UM in the left eye, and cycloplegic refraction is \u002B4.00 sphere in both eyes. What is the usual sequence of management?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EStart with spectacles and amblyopia therapy (patch the better-seeing eye), then proceed to medial rectus recessions.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThis child has \u003Cstrong\u003Esignificant hyperopia\u003C/strong\u003E and the left eye\u2019s fixation behavior (UC/US/UM) indicates \u003Cstrong\u003Ereduced visual function consistent with amblyopia risk\u003C/strong\u003E compared with the right eye (CSM). The standard approach is to optimize the sensory inputs before surgery: prescribe \u003Cstrong\u003Efull hyperopic correction\u003C/strong\u003E and treat amblyopia by \u003Cstrong\u003Epatching the better eye\u003C/strong\u003E to drive use of the weaker eye. Once vision is improved and more balanced, strabismus surgery is performed to align the eyes; operating before correcting \u003Cstrong\u003Erefractive error and amblyopia\u003C/strong\u003E increases the chance of an \u003Cstrong\u003Eunstable or suboptimal functional outcome\u003C/strong\u003E.\u003C/p\u003E\n\u003Cp\u003EQuick interpretation of the fixation notation: \u003Cstrong\u003ECSM\u003C/strong\u003E suggests \u003Cstrong\u003Ecentral, steady fixation that is maintained\u003C/strong\u003E, whereas \u003Cstrong\u003EUC/US/UM\u003C/strong\u003E suggests \u003Cstrong\u003Euncentered, unsteady fixation that is not maintained\u003C/strong\u003E, supporting the need for \u003Cstrong\u003Eamblyopia therapy\u003C/strong\u003E.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "CategoryId": 10,
    "Category": null,
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  },
  {
    "Id": 1532,
    "Name": "CN III palsy surgery",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EIn strabismus caused by a third cranial nerve palsy, several operations may be used to improve alignment. Which listed approach is not an appropriate corrective option?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003ELarge lateral rectus recession with fixation of the globe to the lateral orbital periosteum.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EIn third nerve palsy, the typical resting position is a large \u003Cstrong\u003Eexotropia\u003C/strong\u003E (often with vertical/torsional components) because \u003Cstrong\u003Emedial rectus and other third-nerve muscles are weak\u003C/strong\u003E while the \u003Cstrong\u003Elateral rectus remains unopposed\u003C/strong\u003E. Surgical strategies therefore aim to \u003Cstrong\u003Ereduce abducting force\u003C/strong\u003E (e.g., large lateral rectus weakening or disinsertion/anchoring) and, when needed, provide \u003Cstrong\u003Eadditional adducting support\u003C/strong\u003E (e.g., large medial rectus strengthening or globe fixation toward the nasal side).\u003C/p\u003E\n\u003Cp\u003EFixing the globe to the \u003Cstrong\u003Elateral\u003C/strong\u003E orbital periosteum would pull/hold the eye \u003Cstrong\u003Eoutward\u003C/strong\u003E, which would \u003Cstrong\u003Eworsen exotropia rather than correct it\u003C/strong\u003E. If periosteal fixation is used as part of management, it is directed \u003Cstrong\u003Enasally\u003C/strong\u003E to help counter the abducting tendency after lateral rectus weakening.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 1533,
    "Name": "Convergence insufficiency",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EAn 11-year-old has headaches with near work. Alignment is normal at distance, but there is a 15\u2206 exophoria at near and a remote near point of convergence (18 cm). Cycloplegic refraction shows minimal hyperopia (\u002B0.25 OU). Which listed option is not an appropriate treatment approach?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EPrescription of additional plus power beyond refractive error correction.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThis presentation is classic for \u003Cstrong\u003Econvergence insufficiency\u003C/strong\u003E: symptoms with near tasks, \u003Cstrong\u003Egreater exophoria at near than distance\u003C/strong\u003E, and a \u003Cstrong\u003Ereceded near point of convergence\u003C/strong\u003E. Appropriate treatments aim to \u003Cstrong\u003Eincrease fusional convergence ability\u003C/strong\u003E and \u003Cstrong\u003Ebring the near point of convergence closer\u003C/strong\u003E, which is why \u003Cstrong\u003Econvergence exercises/vision therapy\u003C/strong\u003E (e.g., pencil push-ups and stereograms) are used; base-out prism can also be used as a \u003Cstrong\u003Etraining tool to stimulate convergence demand\u003C/strong\u003E in selected therapy setups.\u003C/p\u003E\n\u003Cp\u003EIn contrast, giving extra plus power reduces the need to accommodate, and because \u003Cstrong\u003Eaccommodation normally drives accommodative convergence\u003C/strong\u003E, extra plus tends to \u003Cstrong\u003Edecrease convergence drive\u003C/strong\u003E, potentially \u003Cstrong\u003Eworsening near exophoria and symptoms\u003C/strong\u003E rather than improving them.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 1534,
    "Name": "Kestenbaum",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA child with congenital nystagmus has a longstanding right head turn and is planned for a Kestenbaum procedure. The planned amounts are right medial rectus recession 7.0 mm, left medial rectus resection 8.4 mm, left lateral rectus recession 9.8 mm, and the right lateral rectus resection is unknown. What should the missing right lateral rectus resection value be?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003E11.2 mm.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EIn the Kestenbaum (Kestenbaum\u2013Anderson) approach, the goal is to \u003Cstrong\u003Erotate the eyes toward the direction of the head turn\u003C/strong\u003E to bring the \u003Cstrong\u003Enull point closer to primary position\u003C/strong\u003E. A key planning rule is to keep the \u003Cstrong\u003Etotal surgical \u201Cdose\u201D balanced between the two eyes\u003C/strong\u003E so that both eyes rotate by a similar amount.\u003C/p\u003E\n\u003Cp\u003EHere, the left eye total is \u003Cstrong\u003E8.4 mm \u002B 9.8 mm = 18.2 mm\u003C/strong\u003E. The right eye must match this total, and it already has \u003Cstrong\u003E7.0 mm\u003C/strong\u003E assigned to the right medial rectus recession. Therefore, the remaining amount for the right lateral rectus resection is \u003Cstrong\u003E18.2 \u2212 7.0 = 11.2 mm\u003C/strong\u003E.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 1535,
    "Name": "Dissociated nystagmus",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich condition is most classically linked to dissociated nystagmus (nystagmus seen predominantly in the abducting eye)?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EInternuclear ophthalmoplegia.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EDissociated nystagmus\u003C/strong\u003E refers to an oscillation that is \u003Cstrong\u003Emost prominent in the abducting eye during attempted horizontal gaze\u003C/strong\u003E. This pattern is classically seen in \u003Cstrong\u003Einternuclear ophthalmoplegia (INO)\u003C/strong\u003E because INO results from a lesion in the \u003Cstrong\u003Emedial longitudinal fasciculus (MLF)\u003C/strong\u003E, disrupting the normal linkage between \u003Cstrong\u003Eabducens output in one eye and medial rectus activation in the fellow eye\u003C/strong\u003E. The consequence is \u003Cstrong\u003Eimpaired adduction in the affected eye\u003C/strong\u003E and \u003Cstrong\u003Eabducting \u201Cnystagmus\u201D of the fellow eye\u003C/strong\u003E, which may represent \u003Cstrong\u003Esaccadic intrusions rather than a true nystagmus\u003C/strong\u003E. INO is most often due to \u003Cstrong\u003Edemyelination\u003C/strong\u003E (especially in younger patients) or \u003Cstrong\u003Ebrainstem ischemia/stroke\u003C/strong\u003E (more common in older patients).\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 1536,
    "Name": "Uncooperative child: screening for misalignment",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 3-year-old will not fixate on a near target during your exam. Which test is not suitable for screening ocular misalignment in this situation?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003C!--StartFragment--\u003E\u003C!--EndFragment--\u003E\u003C/p\u003E\u003Cdiv style=\u0022font-family:\u0027Segoe UI\u0027;font-size:14px;font-style:normal;font-weight:400;line-height:20px\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: Cover\u2013uncover test.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EIn this scenario the limiting factor is \u003Cstrong\u003Epoor/unstable fixation\u003C/strong\u003E. The cover\u2013uncover test (and especially the alternate cover test) depends on the child \u003Cstrong\u003Econtinuously fixating a single target\u003C/strong\u003E so you can detect a \u003Cstrong\u003Etrue refixation movement\u003C/strong\u003E when the cover is placed and removed. If the child keeps looking away, you can\u2019t be sure whether any eye movement you see is due to \u003Cstrong\u003Estrabismus\u003C/strong\u003E, \u003Cstrong\u003Erandom searching/saccades\u003C/strong\u003E, or \u003Cstrong\u003Eattention shifts\u003C/strong\u003E, so the test becomes \u003Cstrong\u003Eunreliable\u003C/strong\u003E and can easily miss or falsely suggest a deviation.\u003C/p\u003E\n\u003Cp\u003EBy contrast, the other options are useful precisely because they \u003Cstrong\u003Edo not require sustained attention to an accommodative target\u003C/strong\u003E:\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\n\u003Cp\u003E\u003Cstrong\u003EHirschberg test\u003C/strong\u003E uses the \u003Cstrong\u003Ecorneal light reflex (first Purkinje image)\u003C/strong\u003E. You shine a penlight and simply observe whether the reflexes are \u003Cstrong\u003Esymmetric\u003C/strong\u003E and approximately centered in each pupil. Even if the child only looks toward the light briefly, you can still screen for misalignment. A common clinical estimate is that \u003Cstrong\u003E~1 mm of reflex decentration corresponds to ~15 prism diopters\u003C/strong\u003E. So a reflex near the pupillary margin (roughly 2 mm from center in a 4 mm pupil) suggests \u003Cstrong\u003E~30 PD\u003C/strong\u003E, mid-iris (~4 mm) suggests \u003Cstrong\u003E~60 PD\u003C/strong\u003E, and near the limbus (~6 mm) suggests \u003Cstrong\u003E~90 PD\u003C/strong\u003E. The key point is that Hirschberg is mainly a \u003Cstrong\u003Escreening/rough estimation\u003C/strong\u003E tool, not a precise measurement.\u003C/p\u003E\n\u003C/li\u003E\n\u003Cli\u003E\n\u003Cp\u003E\u003Cstrong\u003EKrimsky test\u003C/strong\u003E is essentially \u201CHirschberg plus prism.\u201D You still use the corneal light reflex, but you add a prism bar and adjust prism strength until the reflex becomes \u003Cstrong\u003Ecentered\u003C/strong\u003E in the deviating eye. This gives a \u003Cstrong\u003Ebetter quantification\u003C/strong\u003E than Hirschberg in a child who won\u2019t cooperate for cover testing. It\u2019s still imperfect (head turns, intermittent fixation, and variable attention can affect accuracy), but it is often the \u003Cstrong\u003Ebest practical way\u003C/strong\u003E to estimate the deviation in an uncooperative child.\u003C/p\u003E\n\u003C/li\u003E\n\u003Cli\u003E\n\u003Cp\u003E\u003Cstrong\u003EBruckner test\u003C/strong\u003E uses a direct ophthalmoscope to compare the \u003Cstrong\u003Ered reflex brightness\u003C/strong\u003E of both eyes simultaneously. If the eyes are misaligned (or if there is significant anisometropia/amblyopia risk), the reflexes become \u003Cstrong\u003Easymmetric\u003C/strong\u003E, and the deviating/non-fixating eye often shows a \u003Cstrong\u003Ebrighter, lighter reflex\u003C/strong\u003E. This makes Bruckner very helpful as a \u003Cstrong\u003Equick screen\u003C/strong\u003E in toddlers; however, it \u003Cstrong\u003Edoes not measure the angle\u003C/strong\u003E of deviation\u2014its strength is detection rather than quantification.\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "CategoryId": 10,
    "Category": null,
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  },
  {
    "Id": 1537,
    "Name": "Moebius syndrome",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 5-year-old has never shown facial smiling since birth. Examination shows bilateral failure of abduction with mild limitation of adduction in both eyes. Which diagnosis best fits this presentation?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EMoebius syndrome.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EMoebius syndrome is defined by congenital palsies of \u003Cstrong\u003Ecranial nerve VI\u003C/strong\u003E and \u003Cstrong\u003Ecranial nerve VII\u003C/strong\u003E. \u003Cstrong\u003EFacial nerve (VII) palsy\u003C/strong\u003E explains the history of a child who has \u003Cstrong\u003Enever smiled\u003C/strong\u003E and has a characteristic \u003Cstrong\u003E\u201Cmask-like\u201D facial expression\u003C/strong\u003E. \u003Cstrong\u003EAbducens (VI) palsy\u003C/strong\u003E explains the \u003Cstrong\u003Ebilateral loss of abduction\u003C/strong\u003E. Some patients also show \u003Cstrong\u003Emild adduction limitation\u003C/strong\u003E due to associated ocular motor dysinnervation or concomitant involvement of other cranial nerve pathways, and this can appear \u003Cstrong\u003Eless severe with convergence\u003C/strong\u003E. Moebius syndrome may also be accompanied by \u003Cstrong\u003Elimb anomalies (e.g., clubfoot), craniofacial/orofacial abnormalities, and chest-wall defects\u003C/strong\u003E, which can help support the diagnosis when present.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 1538,
    "Name": "Periocular dermatitis from cycloplegic drops",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 5-year-old with JIA-associated uveitis is using steroid and cycloplegic drops and develops marked periocular irritation with an eczematous allergic dermatitis around one eye. Which drop is the most likely culprit?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EAtropine 1%.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EPeriocular \u201Ceczema-like\u201D inflammation in a child on drops is most consistent with \u003Cstrong\u003Eallergic contact dermatitis\u003C/strong\u003E from a topical ophthalmic medication. \u003Cstrong\u003EAtropine is a well-recognized trigger of eyelid/periocular allergic contact dermatitis\u003C/strong\u003E, and it may be due to the active drug itself or to components/preservatives that contact the periocular skin.  A recent ophthalmic report also describes periocular dermatitis findings occurring after atropine exposure around the eye region, reinforcing that this reaction can occur clinically.\u003C/p\u003E\n\u003Cp\u003EScopolamine can cause systemic \u003Cstrong\u003ECNS effects such as drowsiness\u003C/strong\u003E (and other anticholinergic effects), but that profile does not specifically match \u201Csevere periocular allergic dermatitis\u201D as the key clue in this vignette.  Steroid drops (prednisolone or fluorometholone) are more often used to \u003Cstrong\u003Etreat\u003C/strong\u003E ocular surface inflammation rather than being the classic cause of this periocular allergic pattern.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 5,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 1539,
    "Name": "Ectopia lentis \u002B DVT",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cdiv style=\u0022line-height: 20px;\u0022\u003EA 17-year-old teenager presents to your clinic with the slit-lamp finding as shown in the photograph. He has a personal caregiver because of his intellectual disability and also has a history of deep vein thrombosis. Which of the following would be the most appropriate treatment of this patient\u0027s systemic disorder?\u003C/div\u003E\u003Cdiv style=\u0022line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-19-106752c7-d86c-4bfd-bc5c-cbb3f601098b.png\u0022\u003E\u003C/div\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cp style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; letter-spacing: 0.14994px;\u0022\u003E\u003C!--StartFragment--\u003E\u003C!--EndFragment--\u003E\u003C/p\u003E\u003Cdiv style=\u0022font-family:\u0027Segoe UI\u0027;font-size:14px;font-style:normal;font-weight:400;line-height:20px\u0022\u003E\u003Cp\u003EThe combination of \u003Cstrong\u003Eectopia lentis\u003C/strong\u003E, \u003Cstrong\u003Eintellectual disability\u003C/strong\u003E, and \u003Cstrong\u003Ethrombotic events (e.g., DVT)\u003C/strong\u003E is most consistent with \u003Cstrong\u003Ehomocystinuria\u003C/strong\u003E, classically due to \u003Cstrong\u003Ecystathionine \u03B2\u2011synthase deficiency\u003C/strong\u003E. The key management goal is to \u003Cstrong\u003Elower homocysteine levels\u003C/strong\u003E, because elevated homocysteine drives the \u003Cstrong\u003Ehypercoagulable risk\u003C/strong\u003E and contributes to systemic complications. Treatment therefore includes \u003Cstrong\u003Erestricting methionine intake\u003C/strong\u003E (to reduce precursor load) and giving \u003Cstrong\u003Epyridoxine (B6)\u003C/strong\u003E in patients who are responsive, often alongside \u003Cstrong\u003Efolate support\u003C/strong\u003E to optimize homocysteine metabolism. Early treatment can \u003Cstrong\u003Esubstantially reduce the risk of thrombosis\u003C/strong\u003E and improve long\u2011term outcomes, even though it is not a complete \u201Ccure.\u201D\u003C/p\u003E\n\u003Cp\u003EThe other options fit different disorders: \u003Cstrong\u003Eblood pressure/aortic management\u003C/strong\u003E aligns more with connective tissue aortopathy; \u003Cstrong\u003Ecysteamine\u003C/strong\u003E treats cystinosis; and a \u003Cstrong\u003Elow\u2011lysine diet\u003C/strong\u003E is used for conditions such as glutaric acidemia type I rather than this presentation.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
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  },
  {
    "Id": 1540,
    "Name": "OKN drum in horizontal nystagmus",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 1-year-old with congenital horizontal nystagmus needs an estimate of visual acuity using an OKN drum. Given the existing horizontal eye movements, what is the correct way to use the OKN drum to assess vision?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003ERotate the OKN drum vertically (up or down).\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThe OKN drum is meant to trigger an \u003Cstrong\u003Eoptokinetic response\u003C/strong\u003E\u2014a pattern of \u003Cstrong\u003Eslow tracking\u003C/strong\u003E in the direction of the moving stripes with \u003Cstrong\u003Efast corrective \u201Crefixation\u201D jerks\u003C/strong\u003E in the opposite direction. In a child who already has \u003Cstrong\u003Ehorizontal nystagmus\u003C/strong\u003E, rotating the drum horizontally can make the OKN response \u003Cstrong\u003Ehard to recognize\u003C/strong\u003E, because the induced movements can be \u003Cstrong\u003Emasked by the baseline horizontal oscillations\u003C/strong\u003E. Rotating the drum \u003Cstrong\u003Evertically\u003C/strong\u003E avoids that overlap and makes it easier to detect a \u003Cstrong\u003Eclear vertical OKN response\u003C/strong\u003E. If a vertical OKN response is present, it generally indicates that vision is \u003Cstrong\u003Eat least around 20/400 or better\u003C/strong\u003E (a coarse screening threshold rather than a precise acuity measurement).\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1541,
    "Name": "S1 hemangioma",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 3\u2011month\u2011old has a large facial capillary hemangioma in the segment 1 distribution causing significant ptosis (MRD \u22121). What is the most appropriate next step in management?\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-19-a2c28c57-0393-4295-8037-aaf523511f8a.png\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EMRI and MRA of the brain.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EA large segmental facial hemangioma in the \u003Cstrong\u003Esegment 1 (frontotemporal) distribution\u003C/strong\u003E raises concern for \u003Cstrong\u003EPHACE syndrome\u003C/strong\u003E, in which \u003Cstrong\u003Earterial cerebrovascular anomalies\u003C/strong\u003E can coexist with the cutaneous lesion. Because \u003Cstrong\u003Epropranolol can lower blood pressure\u003C/strong\u003E, starting it before defining the cerebral vasculature can be risky if the child has \u003Cstrong\u003Estenosis, hypoplasia, or other cerebrovascular abnormalities\u003C/strong\u003E, since reduced perfusion may precipitate ischemic complications. The safest \u201Cnext step\u201D is therefore \u003Cstrong\u003Eneurovascular imaging (MRI/MRA)\u003C/strong\u003E to evaluate for associated intracranial/arterial abnormalities; once this risk is assessed, hemangioma-directed therapy (often beta\u2011blocker treatment) can be pursued more safely.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1542,
    "Name": "Infected dacryocystocele",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EIn a 1-week-old with an infected congenital dacryocystocele, which management option should be avoided?\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-19-7cb7fb1e-5453-41c8-b33f-e6a7c6225d6c.png\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EExternal skin incision to decompress the sac.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EAn infected congenital dacryocystocele is typically due to \u003Cstrong\u003Eobstruction at the distal nasolacrimal duct with distention of the lacrimal sac\u003C/strong\u003E, often accompanied by an \u003Cstrong\u003Eintranasal cyst\u003C/strong\u003E under the inferior turbinate. When infection is present, treatment focuses on \u003Cstrong\u003Esystemic antibiotics\u003C/strong\u003E and \u003Cstrong\u003Erelieving the obstruction at its anatomic site\u003C/strong\u003E, most commonly with \u003Cstrong\u003Enasolacrimal duct probing\u003C/strong\u003E, sometimes combined with \u003Cstrong\u003Eendoscopic intranasal cyst management\u003C/strong\u003E when a nasal component contributes to persistent blockage or respiratory issues.\u003C/p\u003E\n\u003Cp\u003EAn external cut-down through the skin over the lacrimal sac is avoided because it does not address the underlying distal obstruction and carries a significant risk of creating a \u003Cstrong\u003Epersistent cutaneous lacrimal fistula\u003C/strong\u003E, which can become a chronic drainage problem.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1543,
    "Name": "Pediatric TED",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EIn children with thyroid eye disease, which clinical feature is much less common than it is in adults?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EExtraocular muscle fibrosis.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EPediatric thyroid eye disease is generally \u003Cstrong\u003Eless frequent and typically milder\u003C/strong\u003E than adult disease, so children more often show \u003Cstrong\u003Esoft-tissue signs\u003C/strong\u003E such as \u003Cstrong\u003Eproptosis\u003C/strong\u003E, \u003Cstrong\u003Eupper lid retraction\u003C/strong\u003E, \u003Cstrong\u003Elid lag\u003C/strong\u003E, and \u003Cstrong\u003Eperiorbital fullness/edema\u003C/strong\u003E. In contrast, the more advanced \u201Cburned-out\u201D manifestations seen in adults\u2014particularly \u003Cstrong\u003Erestrictive myopathy from extraocular muscle fibrosis\u003C/strong\u003E\u2014are \u003Cstrong\u003Euncommon in children\u003C/strong\u003E, which is why significant motility restriction is less typical in pediatric TED.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1544,
    "Name": "Upper eyelid coloboma",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA newborn has a congenital eyelid coloboma. In the syndrome most commonly linked to this type of eyelid defect, what additional eye finding would you expect?\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-19-ff784fd0-b830-457d-a84e-23683c045d33.png\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003ELimbal (epibulbar) dermoid.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EAn \u003Cstrong\u003Eupper eyelid coloboma\u003C/strong\u003E is classically associated with \u003Cstrong\u003EGoldenhar syndrome (oculo\u2011auriculo\u2011vertebral spectrum)\u003C/strong\u003E. One of the most typical accompanying ocular findings in this syndrome is an \u003Cstrong\u003Eepibulbar/limbal dermoid\u003C/strong\u003E, often located at the inferotemporal limbus. Goldenhar can also present with other ocular features such as \u003Cstrong\u003Emicrophthalmia, coloboma involving other ocular structures, strabismus, and refractive error\u003C/strong\u003E, but the \u201Cclassic\u201D paired finding tested most often is the \u003Cstrong\u003Elimbal dermoid\u003C/strong\u003E.\u003C/p\u003E\n\u003Cp\u003EA helpful distinction is that \u003Cstrong\u003Elower eyelid colobomas\u003C/strong\u003E are more classically associated with \u003Cstrong\u003ETreacher\u2011Collins syndrome\u003C/strong\u003E, whereas \u003Cstrong\u003Eupper eyelid colobomas\u003C/strong\u003E point you toward \u003Cstrong\u003EGoldenhar/OAV spectrum\u003C/strong\u003E\u2014and that is why the expected ocular association is the \u003Cstrong\u003Elimbal dermoid\u003C/strong\u003E.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1545,
    "Name": "Congenital ptosis: amblyopia mechanism",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 5-year-old has a longstanding droopy right upper eyelid consistent with congenital ptosis. Which type of amblyopia is most commonly responsible for reduced vision in this situation?\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-19-787b2683-280e-46e1-8cb6-fb4ac832b1db.png\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EAnisometropic amblyopia.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EIn congenital ptosis, reduced vision is most often due to \u003Cstrong\u003Erefractive causes\u003C/strong\u003E, particularly \u003Cstrong\u003Eanisometropia and associated astigmatism\u003C/strong\u003E, rather than true deprivation. \u003Cstrong\u003EOcclusion (deprivation) amblyopia is uncommon\u003C/strong\u003E unless the lid physically blocks the visual axis for a substantial portion of the time. Even when ptosis looks significant, many children adopt a \u003Cstrong\u003Ecompensatory chin-up posture\u003C/strong\u003E that helps maintain a usable visual axis and reduces the risk of deprivation amblyopia.\u003C/p\u003E\n\u003Cp\u003EAnother key point is that congenital ptosis is frequently associated with \u003Cstrong\u003Epersistent astigmatism\u003C/strong\u003E, and this refractive component can remain \u003Cstrong\u003Eeven after ptosis repair\u003C/strong\u003E. For that reason, management should not stop at surgery: \u003Cstrong\u003Eaccurate refraction with appropriate spectacle correction\u003C/strong\u003E and \u003Cstrong\u003Econtinued amblyopia treatment when indicated\u003C/strong\u003E are necessary to optimize visual outcomes.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1546,
    "Name": "Axenfeld\u2013Rieger syndrome gene association",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EAn 18-year-old has anterior segment findings consistent with the condition shown and is being treated for glaucoma in both eyes. Which gene mutation best explains this ocular syndrome?\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-19-54f41ea2-1285-4f38-8edf-9c9ff160c624.png\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-19-3e1917ea-78da-4a02-ae2b-1bf9e36b9031.png\u0022 style=\u0022color: rgb(66, 66, 66); font-family: Roboto, Helvetica, Arial, \u0026quot;sans-serif\u0026quot;; letter-spacing: 0.14994px;\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EPITX2.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThe ocular findings described are characteristic of \u003Cstrong\u003EAxenfeld\u2013Rieger syndrome\u003C/strong\u003E, which features \u003Cstrong\u003Eanterior segment dysgenesis\u003C/strong\u003E such as \u003Cstrong\u003Eposterior embryotoxon\u003C/strong\u003E, \u003Cstrong\u003Eiris strands bridging to the angle\u003C/strong\u003E, and \u003Cstrong\u003Epupillary displacement (corectopia)\u003C/strong\u003E, often accompanied by \u003Cstrong\u003Eearly-onset glaucoma\u003C/strong\u003E due to \u003Cstrong\u003Eangle abnormalities\u003C/strong\u003E. Axenfeld\u2013Rieger syndrome is most commonly \u003Cstrong\u003Eautosomal dominant\u003C/strong\u003E, and a major gene associated with this phenotype is \u003Cstrong\u003EPITX2\u003C/strong\u003E (with \u003Cstrong\u003EFOXC1\u003C/strong\u003E also classically implicated, though it is not one of the listed choices).\u003C/p\u003E\u003Cp\u003E\u003C!--StartFragment--\u003E\u003C!--EndFragment--\u003E\u003C/p\u003E\u003Cdiv style=\u0022font-family:\u0027Segoe UI\u0027;font-size:14px;font-style:normal;font-weight:400;line-height:20px\u0022\u003E\u003Cp\u003EHere are the conditions classically linked to the \u003Cem\u003Eother\u003C/em\u003E gene options:\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EMYOC (myocilin)\u003C/strong\u003E \u2192 most strongly associated with \u003Cstrong\u003Ejuvenile\u2011onset open\u2011angle glaucoma (JOAG)\u003C/strong\u003E and can also be seen in \u003Cstrong\u003Eadult primary open\u2011angle glaucoma\u003C/strong\u003E.\u0026nbsp;\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EOPTN (optineurin)\u003C/strong\u003E \u2192 associated with \u003Cstrong\u003Eopen\u2011angle glaucoma\u003C/strong\u003E, particularly forms described as \u003Cstrong\u003Enormal\u2011tension glaucoma susceptibility\u003C/strong\u003E, and certain pathogenic variants (e.g., E50K) are well known in inherited glaucoma literature.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EOPA1\u003C/strong\u003E \u2192 classically causes \u003Cstrong\u003Eautosomal dominant optic atrophy (DOA / \u201CKjer\u201D optic atrophy)\u003C/strong\u003E and can present as \u003Cstrong\u003EDOA\u2011plus\u003C/strong\u003E with extra\u2011ocular neurologic features in some carriers.\u0026nbsp;\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1547,
    "Name": "INO",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 33-year-old woman with neurologic symptoms has slow adduction of the right eye on exam, consistent with internuclear ophthalmoplegia. Which statement about this condition is true?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EThe abducting eye shows horizontal nystagmus.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EInternuclear ophthalmoplegia results from a \u003Cstrong\u003Emedial longitudinal fasciculus (MLF) lesion\u003C/strong\u003E, which disrupts the normal linkage between \u003Cstrong\u003Eabduction of one eye and adduction of the fellow eye\u003C/strong\u003E during horizontal gaze. This produces \u003Cstrong\u003Eslow or limited adduction\u003C/strong\u003E of the affected eye and a compensatory \u003Cstrong\u003Eabducting (dissociated) nystagmus\u003C/strong\u003E in the fellow eye when looking to the opposite side. The lesion localizes \u003Cstrong\u003Eto the same side as the adduction deficit\u003C/strong\u003E, and \u003Cstrong\u003Econvergence is typically preserved\u003C/strong\u003E, so adduction improves when the patient converges. Medial rectus fibrosis is not the usual mechanism here; the problem is \u003Cstrong\u003Ecentral internuclear signaling\u003C/strong\u003E, not primary extraocular muscle scarring.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1548,
    "Name": "Kestenbaum\u2013Anderson for nystagmus head turn",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 3-year-old with congenital nystagmus uses a large left head turn to reduce the nystagmus, and prism glasses were not tolerated. Which surgical option can be used to lessen this compensatory head turn?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EIn congenital nystagmus, a head turn usually reflects a \u003Cstrong\u003Enull zone\u003C/strong\u003E where the nystagmus intensity is lowest and vision is best. The purpose of the Kestenbaum\u2013Anderson procedure is to \u003Cstrong\u003Eshift the null zone toward primary position\u003C/strong\u003E, so the child no longer needs a large compensatory head posture to see clearly. For a \u003Cstrong\u003Eleft head turn\u003C/strong\u003E, the eyes are surgically rotated \u003Cstrong\u003Eto the left\u003C/strong\u003E, achieved by combining \u003Cstrong\u003Eweakening (recession) of the left medial rectus and right lateral rectus\u003C/strong\u003E with \u003Cstrong\u003Estrengthening (resection) of the left lateral rectus and right medial rectus\u003C/strong\u003E.\u003C/p\u003E\n\u003Cp\u003EA different strategy sometimes used is \u003Cstrong\u003Erecession of all four horizontal rectus muscles posterior to the equator\u003C/strong\u003E to dampen nystagmus, but placing them \u003Cstrong\u003Eanterior\u003C/strong\u003E to the equator is not the intended approach for that alternative technique.\u003C/p\u003E\n\u003Cp\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003ESo,\u003C/span\u003EThe appropriate operation is the \u003Cstrong\u003EKestenbaum\u2013Anderson pattern that rotates the eyes toward the left\u003C/strong\u003E to bring the \u003Cstrong\u003Enull zone\u003C/strong\u003E closer to primary position and reduce the head turn.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1549,
    "Name": "Marfan ectopia lentis",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EAn 8-year-old with Marfan syndrome has marked lens subluxation with minimal zonular support. Glasses or other refractive correction does not provide acceptable vision, and lensectomy is planned. Which option is the least suitable intraocular lens or visual rehabilitation approach in this child?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003ETraditional anterior chamber intraocular lens.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EIn a child with Marfan-related ectopia lentis, the capsule\u2013zonule complex is often \u003Cstrong\u003Etoo unstable to support a standard posterior chamber IOL\u003C/strong\u003E, so management frequently aims for the safest long-term optical plan. Many pediatric surgeons prefer to leave the child \u003Cstrong\u003Eaphakic initially\u003C/strong\u003E and achieve good vision with \u003Cstrong\u003Econtact lenses (often best quality)\u003C/strong\u003E or aphakic spectacles, because these options avoid implant-related risks while the eye is still growing and the child will need long-term follow-up.\u003C/p\u003E\n\u003Cp\u003EWhen an IOL is considered without capsular support, \u003Cstrong\u003Eiris-fixated\u003C/strong\u003E and \u003Cstrong\u003Escleral-fixated\u003C/strong\u003E lenses are possible, but in children there is ongoing concern about \u003Cstrong\u003Elong-term complications\u003C/strong\u003E such as \u003Cstrong\u003Ecorneal endothelial cell loss\u003C/strong\u003E, \u003Cstrong\u003Elens dis-enclavation (iris-claw)\u003C/strong\u003E, \u003Cstrong\u003Esuture-related failure/breakage\u003C/strong\u003E, and the need for reoperation over decades.\u003C/p\u003E\n\u003Cp\u003EA \u003Cstrong\u003Etraditional anterior chamber IOL\u003C/strong\u003E is generally viewed as the poorest choice in this age group because it sits close to the cornea and angle, increasing the risk of \u003Cstrong\u003Echronic endothelial trauma and progressive cell loss\u003C/strong\u003E, as well as other anterior segment complications over a long lifetime.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1550,
    "Name": "Intermittent exotropia: type of suppression",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 48-year-old has a recorded intermittent exotropia of 30 prism diopters, demonstrates good stereopsis (40 seconds of arc), and reports no history of diplopia. Which type of suppression is most likely present?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EFacultative suppression.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThis pattern fits an intermittent deviation where binocular function is still strong: \u003Cstrong\u003Egood stereoacuity implies the visual system can fuse when the eyes are aligned\u003C/strong\u003E. The lack of diplopia suggests that when the eye drifts out, the patient briefly uses \u003Cstrong\u003Ea suppression mechanism to avoid double vision\u003C/strong\u003E, but that suppression must \u003Cstrong\u003Eturn off when alignment is restored\u003C/strong\u003E, otherwise stereo would be consistently poor. That \u201Con only when misaligned\u201D behavior defines \u003Cstrong\u003Efacultative suppression\u003C/strong\u003E.\u003C/p\u003E\n\u003Cp\u003EIn contrast, \u003Cstrong\u003Eobligatory suppression is present all the time\u003C/strong\u003E (even when the eyes are straight), which would be expected to \u003Cstrong\u003Edegrade binocular vision\u003C/strong\u003E and is more in line with persistent sensory loss such as amblyopia. \u201CCentral\u201D and \u201Cperipheral\u201D describe \u003Cem\u003Ewhere\u003C/em\u003E suppression occurs (to prevent confusion versus diplopia), but the key clue here is the \u003Cem\u003Eintermittent\u003C/em\u003E nature with preserved stereo\u2014pointing to \u003Cstrong\u003Esuppression that is conditional, not constant\u003C/strong\u003E.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 1551,
    "Name": "One-eye surgery for 20\u0394 partially accommodative esotropia",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 3-year-old with partially accommodative esotropia has a residual 20 prism diopters of esotropia at distance despite full cycloplegic correction, and amblyopia has already been treated. The parent will only consent to surgery on one eye. Using the provided surgical dosage table, what is the most appropriate surgical plan?\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-19-c11978b8-605b-4a1d-9a57-619772deb8dc.png\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EA unilateral recess\u2013resect procedure: medial rectus recession 3.5 mm plus lateral rectus resection 5.0 mm in the same eye.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThe child has \u003Cstrong\u003Ea true residual 20\u0394 esotropia\u003C/strong\u003E even with full cycloplegic correction, so surgery should target \u003Cstrong\u003Ethe nonaccommodative (residual) component\u003C/strong\u003E. The dosage chart provided is for \u003Cstrong\u003Ebilateral\u003C/strong\u003E surgery: for 20\u0394, it shows \u003Cstrong\u003E3.5 mm recession of both medial recti\u003C/strong\u003E or \u003Cstrong\u003E5.0 mm resection of both lateral recti\u003C/strong\u003E. If you perform only one of those bilateral plans on a single eye, you would expect \u003Cstrong\u003Eroughly half the intended effect\u003C/strong\u003E, leaving a substantial residual deviation.\u003C/p\u003E\n\u003Cp\u003EWhen only one eye can be operated, the standard way to approximate the bilateral \u201Cdose\u201D is a \u003Cstrong\u003Eone-eye recess\u2013resect\u003C/strong\u003E: combine \u003Cstrong\u003Ea medial rectus recession\u003C/strong\u003E (to weaken the adducting pull) with \u003Cstrong\u003Ea lateral rectus resection\u003C/strong\u003E (to strengthen the abducting pull) in the same eye. Using the table values for a 20\u0394 target, pairing \u003Cstrong\u003E3.5 mm medial rectus recession\u003C/strong\u003E with \u003Cstrong\u003E5.0 mm lateral rectus resection\u003C/strong\u003E effectively \u201Cadds\u201D the corrective effect from each muscle so the combined result is designed to address \u003Cstrong\u003Ethe full 20\u0394\u003C/strong\u003E rather than half.\u003C/p\u003E\n\u003Cp\u003EAlso, simply \u201Csplitting the difference\u201D into equal recession and resection amounts is not ideal because \u003Cstrong\u003Erecessions and resections do not produce identical prism-diopter effects per millimeter\u003C/strong\u003E, and \u003Cstrong\u003Emedial vs lateral rectus dose\u2013response differs\u003C/strong\u003E, so averaging risks \u003Cstrong\u003Esystematic under- or overcorrection\u003C/strong\u003E.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "CategoryId": 10,
    "Category": null,
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  },
  {
    "Id": 1552,
    "Name": "Blood supply to extraocular muscles",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich option most accurately describes how the ophthalmic (and related) arterial branches supply the extraocular muscles?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EThe lateral muscular branch of the ophthalmic artery supplies the lateral rectus, superior rectus, superior oblique, and levator palpebrae.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThe ophthalmic artery gives off \u003Cstrong\u003Emuscular branches\u003C/strong\u003E that feed the extraocular muscles. A useful way to remember the split is: \u003Cstrong\u003Ethe lateral muscular branch supplies the \u201Clateral/superior\u201D group (lateral rectus, superior rectus, superior oblique, and levator)\u003C/strong\u003E, while \u003Cstrong\u003Ethe medial muscular branch supplies the \u201Cmedial/inferior\u201D group (medial rectus, inferior rectus, and inferior oblique)\u003C/strong\u003E.\u003C/p\u003E\n\u003Cp\u003EThis matters clinically because the rectus muscles also contribute \u003Cstrong\u003Eanterior ciliary arteries\u003C/strong\u003E, which are a major component of \u003Cstrong\u003Eanterior segment perfusion\u003C/strong\u003E. The \u003Cstrong\u003Esuperior and inferior recti\u003C/strong\u003E (not the medial and lateral recti as a pair) are typically emphasized as carrying a large share of this anterior segment contribution, which is why operating on multiple rectus muscles\u2014especially several in the same eye\u2014raises concern for anterior segment ischemia.\u003C/p\u003E\n\u003Cp\u003EFinally, the infraorbital artery contribution is more relevant to the \u003Cstrong\u003Einferior rectus and inferior oblique\u003C/strong\u003E, not the superior oblique and lateral rectus, making that pairing incorrect.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 1553,
    "Name": "Visual axis definition",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich statement correctly defines the eye\u2019s visual axis?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EAn imaginary line connecting the fixation point and the fovea.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThe \u003Cstrong\u003Evisual axis\u003C/strong\u003E represents the line of sight used for fixation: it links the \u003Cstrong\u003Eobject being looked at (fixation point)\u003C/strong\u003E to the \u003Cstrong\u003Efovea\u003C/strong\u003E, where the sharpest vision occurs. This is why it is the most relevant \u201Caxis\u201D for describing alignment and where the eye is actually aimed during viewing.\u003C/p\u003E\n\u003Cp\u003EBy contrast, the statement describing a line through the optical centers corresponds to the \u003Cstrong\u003Eoptical axis\u003C/strong\u003E, which is an anatomic/optical reference line through the eye\u2019s refracting elements rather than the line used for fixation. The statement describing a line perpendicular to the cornea through the pupil center defines the \u003Cstrong\u003Epupillary axis\u003C/strong\u003E. The remaining statement does not correspond to a standard ocular axis used in clinical optics.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
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  },
  {
    "Id": 1554,
    "Name": "Kawasaki disease",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA hospitalized 4-year-old has fever, bilateral red eyes with photophobia, fissured lips, and redness of the palms and soles, suggesting a systemic inflammatory syndrome. Which test is most crucial for guiding management?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EEchocardiography.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThis presentation is most consistent with \u003Cstrong\u003EKawasaki disease\u003C/strong\u003E, a \u003Cstrong\u003Emedium\u2011vessel vasculitis\u003C/strong\u003E in children. The management priority is evaluating for \u003Cstrong\u003Ecoronary artery involvement\u003C/strong\u003E, because the most serious complications are \u003Cstrong\u003Ecoronary artery dilation/aneurysms\u003C/strong\u003E and associated cardiac morbidity. A \u003Cstrong\u003E2\u2011D echocardiogram\u003C/strong\u003E is therefore essential early to assess the coronary arteries and guide urgency and follow\u2011up.\u003C/p\u003E\n\u003Cp\u003EOcular inflammation can occur (including \u003Cstrong\u003Econjunctival injection\u003C/strong\u003E and sometimes \u003Cstrong\u003Eanterior uveitis\u003C/strong\u003E), but these findings are typically \u003Cstrong\u003Enot the main determinant of systemic risk\u003C/strong\u003E. The life\u2011threatening concern is \u003Cstrong\u003Ecardiac\u003C/strong\u003E, so the most important test is \u003Cstrong\u003Eechocardiography\u003C/strong\u003E.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 1555,
    "Name": "CN III divisions: who innervates what?",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich statement correctly describes how the oculomotor nerve divides and which extraocular muscles each division supplies?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003ECN III splits into upper and lower divisions; the upper division supplies levator palpebrae and superior rectus, while the lower division supplies medial rectus, inferior rectus, and inferior oblique.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThe oculomotor nerve divides in the orbit into \u003Cstrong\u003Etwo branches\u003C/strong\u003E with a predictable pattern. The \u003Cstrong\u003Eupper division\u003C/strong\u003E supplies \u003Cstrong\u003Elevator palpebrae superioris\u003C/strong\u003E and \u003Cstrong\u003Esuperior rectus\u003C/strong\u003E. The \u003Cstrong\u003Elower division\u003C/strong\u003E supplies \u003Cstrong\u003Emedial rectus\u003C/strong\u003E, \u003Cstrong\u003Einferior rectus\u003C/strong\u003E, and \u003Cstrong\u003Einferior oblique\u003C/strong\u003E. A useful extra clinical detail is that the \u003Cstrong\u003Eparasympathetic fibers to the pupil (sphincter pupillae) and accommodation (ciliary muscle)\u003C/strong\u003E travel with the \u003Cstrong\u003Elower-division pathway\u003C/strong\u003E, classically alongside the branch going to the \u003Cstrong\u003Einferior oblique\u003C/strong\u003E via the ciliary ganglion.\u003C/p\u003E\u003Cp\u003E\u003Cimg src=\u0022/upload-2026-02-19-5ef25595-1aef-4c93-9e8d-929ebb0125da.png\u0022\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 1556,
    "Name": "Neonatal chlamydial conjunctivitis: treatment",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 7-day-old newborn has bilateral mucous discharge with papillary conjunctival inflammation and pseudomembranes, and there are strong maternal risk factors for sexually transmitted infection. What is the most appropriate treatment?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EOral macrolide antibiotic.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThis presentation is most consistent with \u003Cstrong\u003Eneonatal chlamydial conjunctivitis\u003C/strong\u003E (ophthalmia neonatorum due to \u003Cstrong\u003EChlamydia trachomatis\u003C/strong\u003E): onset around \u003Cstrong\u003Ethe first 1\u20132 weeks of life\u003C/strong\u003E, \u003Cstrong\u003Emucopurulent discharge\u003C/strong\u003E, and a \u003Cstrong\u003Epapillary\u003C/strong\u003E conjunctival response; \u003Cstrong\u003Epseudomembranes\u003C/strong\u003E can appear in more significant cases. \u003Cstrong\u003EPremature rupture of membranes\u003C/strong\u003E increases the chance of earlier exposure, so symptoms can show up sooner than the typical window.\u003C/p\u003E\n\u003Cp\u003EThe key management point is that treatment should be \u003Cstrong\u003Esystemic\u003C/strong\u003E, not just topical, because chlamydial infection in neonates can involve more than the eyes and is associated with \u003Cstrong\u003Epneumonia\u003C/strong\u003E and \u003Cstrong\u003Eotitis media\u003C/strong\u003E. Therefore, a \u003Cstrong\u003Esystemic macrolide (classically oral erythromycin)\u003C/strong\u003E is used rather than topical therapy alone.\u003C/p\u003E\n\u003Cp\u003EWhy the other options are not appropriate:\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003ETopical erythromycin alone may reduce surface bacterial load but \u003Cstrong\u003Edoes not adequately treat or prevent systemic disease\u003C/strong\u003E.\u003C/li\u003E\n\u003Cli\u003EObservation fits \u003Cstrong\u003Echemical conjunctivitis\u003C/strong\u003E, which typically occurs very early and resolves quickly, not at 7 days with this inflammatory picture.\u003C/li\u003E\n\u003Cli\u003ETrifluridine is an antiviral used for \u003Cstrong\u003Eherpetic\u003C/strong\u003E eye disease, which more often presents later and with different clues (e.g., vesicular skin lesions or corneal involvement).\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
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  },
  {
    "Id": 1557,
    "Name": "Sensory nystagmus patterns vs visual acuity",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EIn congenital sensory nystagmus, which sequence of nystagmus patterns generally corresponds to the lowest to highest visual acuity?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003ESearching nystagmus \u0026lt; pendular nystagmus \u0026lt; jerk nystagmus.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EIn congenital sensory nystagmus, the waveform often reflects how much usable foveal vision the child has. \u003Cstrong\u003ESearching nystagmus\u003C/strong\u003E tends to occur when vision is \u003Cstrong\u003Every poor\u003C/strong\u003E (often \u003Cstrong\u003Eworse than 20/200\u003C/strong\u003E), because fixation is unstable and the eyes appear to \u201Csearch\u201D for a target. \u003Cstrong\u003EPendular nystagmus\u003C/strong\u003E is common and is more typical when vision is \u003Cstrong\u003Eat least about 20/200 in one eye\u003C/strong\u003E, representing a middle range of acuity. \u003Cstrong\u003EJerk nystagmus\u003C/strong\u003E is generally linked with the \u003Cstrong\u003Ebest acuity\u003C/strong\u003E among these patterns (often around \u003Cstrong\u003E20/60\u201320/100\u003C/strong\u003E), because there is usually a more effective fixation strategy (including brief periods of better foveation).\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "CategoryId": 14,
    "Category": null,
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  },
  {
    "Id": 1558,
    "Name": "Orbital subperiosteal abscess with optic nerve compromise",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 10-year-old develops rapid unilateral eyelid swelling after recent dental work. Exam shows reduced vision in the affected eye, a clear afferent pupillary defect, proptosis, and restricted eye movements. CT confirms a large lateral orbital subperiosteal abscess. What is the most appropriate management?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EImmediate drainage of the subperiosteal abscess with intravenous antibiotics.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThis child has multiple high-risk features that indicate \u003Cstrong\u003Eurgent surgical drainage rather than observation\u003C/strong\u003E. The most important red flag is \u003Cstrong\u003Eoptic nerve compromise\u003C/strong\u003E demonstrated by \u003Cstrong\u003Ereduced visual acuity and a definite afferent pupillary defect\u003C/strong\u003E, meaning vision-threatening pressure/inflammation is already present. The abscess is also \u003Cstrong\u003Elarge\u003C/strong\u003E and located \u003Cstrong\u003Elaterally (nonmedial)\u003C/strong\u003E, which is less likely to resolve reliably with antibiotics alone. In addition, a \u003Cstrong\u003Erecent dental source\u003C/strong\u003E increases concern for \u003Cstrong\u003Eanaerobic and mixed flora\u003C/strong\u003E, making the infection more aggressive and less predictable with conservative therapy. Finally, his age (10 years) falls into the group with \u003Cstrong\u003Ehigher likelihood of refractory pathogens\u003C/strong\u003E and a lower threshold for operative management.\u003C/p\u003E\n\u003Cp\u003EOral antibiotics alone are inadequate for an orbital abscess. Delaying drainage for a trial period risks progression to \u003Cstrong\u003Eworsening optic neuropathy\u003C/strong\u003E and potential \u003Cstrong\u003Eintracranial extension\u003C/strong\u003E. Adding systemic corticosteroids up front is not the priority in an active abscess because the immediate goal is \u003Cstrong\u003Esource control\u003C/strong\u003E plus \u003Cstrong\u003Ebroad intravenous antimicrobial coverage\u003C/strong\u003E.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 1559,
    "Name": "Latent nystagmus: waveform \u002B head turn",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 4-year-old with congenital esotropia reads better binocularly (20/25) than with either eye covered (20/60). He develops horizontal jerk nystagmus only during monocular occlusion and makes compensatory head turns depending on which eye is covered. What waveform is typical for this nystagmus, and which direction does he turn his head when the right eye is occluded?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EExponential decrease in slow-phase velocity; head turn to the left.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThis pattern is classic for \u003Cstrong\u003Elatent nystagmus\u003C/strong\u003E: vision is \u003Cstrong\u003Ebetter with both eyes open\u003C/strong\u003E and the nystagmus \u003Cstrong\u003Eappears only when one eye is occluded\u003C/strong\u003E. The hallmark waveform is an \u003Cstrong\u003Eexponentially decreasing slow phase\u003C/strong\u003E, which contrasts with congenital motor nystagmus where the slow phase typically \u003Cstrong\u003Eincreases\u003C/strong\u003E over time.\u003C/p\u003E\n\u003Cp\u003EWhen one eye is covered in latent nystagmus, the \u003Cstrong\u003Efast phase beats toward the eye that is not occluded\u003C/strong\u003E. So with the \u003Cstrong\u003Eright eye occluded\u003C/strong\u003E, the \u003Cstrong\u003Eleft eye is the viewing eye\u003C/strong\u003E and the jerk beats \u003Cstrong\u003Eto the left\u003C/strong\u003E. To reduce the nystagmus (use the \u201Cnull\u201D), the child positions gaze so the viewing eye is in the more favorable direction; here that means he prefers to look \u003Cstrong\u003Eto the right\u003C/strong\u003E with the left eye (adducting it), which is achieved by turning the head \u003Cstrong\u003Eto the left\u003C/strong\u003E.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EFinal sentence:\u003C/strong\u003E The correct combination is \u003Cstrong\u003Eexponential decrease in slow-phase velocity\u003C/strong\u003E with a \u003Cstrong\u003Eleft head turn\u003C/strong\u003E when the \u003Cstrong\u003Eright eye is occluded\u003C/strong\u003E.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
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  },
  {
    "Id": 1560,
    "Name": "Superior segmental optic nerve hypoplasia: key maternal association",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 10-year-old frequently trips over objects on the ground. Examination shows bilaterally thin superior optic disc rims with prominent peripapillary atrophy, and visual field testing demonstrates inferior field loss in both eyes. Which maternal condition is most classically linked to this finding?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: Maternal diabetes.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThis presentation is most consistent with \u003Cstrong\u003Esuperior segmental optic nerve hypoplasia\u003C/strong\u003E, a variant of optic nerve hypoplasia where the \u003Cstrong\u003Esuperior neuroretinal rim is underdeveloped\u003C/strong\u003E, producing \u003Cstrong\u003Ecorresponding inferior visual field defects\u003C/strong\u003E\u2014which explains why the child bumps into objects at his feet. The finding of \u003Cstrong\u003Ethin superior rims with marked peripapillary changes\u003C/strong\u003E fits this pattern, and it is \u003Cstrong\u003Eclassically associated with children of diabetic mothers\u003C/strong\u003E, although sporadic cases can occur.\u003C/p\u003E\n\u003Cp\u003EOther maternal exposures (such as certain drugs/toxins) have been reported in association with optic nerve hypoplasia more broadly, but the \u003Cstrong\u003Emost characteristic association for superior segmental involvement\u003C/strong\u003E is \u003Cstrong\u003Ematernal diabetes\u003C/strong\u003E.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1561,
    "Name": "Dacryocystocele with feeding difficulty",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA newborn has a bluish swelling just nasal to the lower eyelid near the medial canthus, without fever or skin redness. The infant also has feeding difficulty with grunting. What is the best next management step?\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u0026nbsp;\u003Cimg src=\u0022/upload-2026-02-22-a4cc3aec-ddc4-4e5a-ad9d-ec580023d95d.png\u0022 style=\u0022color: rgb(66, 66, 66); font-family: Roboto, Helvetica, Arial, \u0026quot;sans-serif\u0026quot;; letter-spacing: 0.14994px;\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EImmediate lacrimal probing, with ENT endoscopic management if needed.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThis presentation most strongly fits a \u003Cstrong\u003Econgenital dacryocystocele\u003C/strong\u003E, caused by \u003Cstrong\u003Enasolacrimal duct obstruction with distention of the lacrimal sac\u003C/strong\u003E, often accompanied by a \u003Cstrong\u003Edistal intranasal cyst\u003C/strong\u003E. The key management-changing clue is the report of \u003Cstrong\u003Efeeding difficulty and grunting\u003C/strong\u003E, which raises concern for \u003Cstrong\u003Epartial nasal airway obstruction\u003C/strong\u003E from the intranasal component. Because newborns are \u003Cstrong\u003Eobligate nasal breathers\u003C/strong\u003E, even partial blockage can produce \u003Cstrong\u003Erespiratory distress during feeding\u003C/strong\u003E. In this setting, management should be \u003Cstrong\u003Eurgent decompression\u003C/strong\u003E: \u003Cstrong\u003Enasolacrimal probing\u003C/strong\u003E to relieve the obstruction, and if there is a significant nasal cyst or persistent obstruction, \u003Cstrong\u003Eendoscopic marsupialization by ENT\u003C/strong\u003E is added to definitively open the intranasal blockage.\u003C/p\u003E\n\u003Cp\u003EImaging can be helpful when the diagnosis is unclear or when alternative lesions are suspected, but here the priority is addressing \u003Cstrong\u003Efunctional airway compromise\u003C/strong\u003E. Conservative measures (massage \u00B1 antibiotics) are reasonable only when there is \u003Cstrong\u003Eno infection and no respiratory compromise\u003C/strong\u003E; delaying intervention in a symptomatic newborn risks worsening breathing/feeding issues. Routine incision/drainage as if all cases are occultly infected is not appropriate, especially when the exam suggests \u003Cstrong\u003Eno cellulitis\u003C/strong\u003E.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1562,
    "Name": "Medial rectus recession amount for 15\u0394 esotropia",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 1-year-old with esotropia has cross-fixation and measures 15 prism diopters at both distance and near. What is the typical average bilateral medial rectus recession amount per eye for this deviation?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003E3.0 mm in each eye (bilateral medial rectus recessions).\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EFor infantile or early-onset esotropia, surgical dosing is commonly guided by standard recession tables. A deviation of \u003Cstrong\u003E15 prism diopters\u003C/strong\u003E is considered a \u003Cstrong\u003Esmall-angle esotropia\u003C/strong\u003E, and the typical bilateral plan is \u003Cstrong\u003Eabout 3 mm recession of each medial rectus\u003C/strong\u003E. The logic is dose\u2013response: \u003Cstrong\u003Esmaller angles require smaller recessions\u003C/strong\u003E, while larger deviations progressively require \u003Cstrong\u003Elarger medial rectus recessions\u003C/strong\u003E (often exceeding \u003Cstrong\u003E5 mm\u003C/strong\u003E for large angles). Cross-fixation supports that the deviation is clinically meaningful, but it \u003Cstrong\u003Edoes not change the basic recession amount\u003C/strong\u003E for a measured 15\u0394 in a standard dosing approach.\u003C/p\u003E\u003Cp\u003E\u003Cimg src=\u0022/upload-2026-02-22-c27aa6eb-1ae7-4f84-a650-ff3105442325.png\u0022\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1563,
    "Name": "Refractive accommodative esotropia",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 2-year-old has progressively increasing inward deviation over 3 months. Exam shows about 20\u0394 esotropia at both distance and near, and cycloplegic refraction is \u002B4.00 sphere in each eye. What is the most appropriate initial management?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EPrescribe the full cycloplegic hyperopic correction (\u002B4.00 sphere OU).\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThis pattern fits \u003Cstrong\u003Erefractive accommodative esotropia\u003C/strong\u003E: onset in the typical age range, \u003Cstrong\u003Emoderate hyperopia\u003C/strong\u003E, and an esotropia that is \u003Cstrong\u003Esimilar at distance and near\u003C/strong\u003E. The key mechanism is that excessive accommodation needed to overcome hyperopia drives \u003Cstrong\u003Eaccommodative convergence\u003C/strong\u003E, pulling the eyes inward. Providing the \u003Cstrong\u003Efull cycloplegic refraction\u003C/strong\u003E reduces the accommodative demand and therefore \u003Cstrong\u003Ereduces the convergence trigger\u003C/strong\u003E, often improving or resolving the deviation.\u003C/p\u003E\n\u003Cp\u003EOver-plussing beyond the measured cycloplegic refraction is not routine because it can blur distance vision and is not necessary to address the mechanism when the cycloplegic measurement already captures the needed correction. Undercorrecting (\u201Cleaving some accommodation stimulus\u201D) risks \u003Cstrong\u003Epersistent esotropia\u003C/strong\u003E and may jeopardize binocular development.\u003C/p\u003E\n\u003Cp\u003EBifocals are mainly used when there is a \u003Cstrong\u003Enear\u2013distance disparity\u003C/strong\u003E consistent with a \u003Cstrong\u003Ehigh AC/A ratio\u003C/strong\u003E (near deviation much larger than distance). Here, the deviation is essentially the same at distance and near, so an executive bifocal is not the appropriate first step. Alongside glasses, the clinician should still watch for and treat \u003Cstrong\u003Eamblyopia\u003C/strong\u003E if present.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1564,
    "Name": "Optical penalization in amblyopia therapy",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich option describes optical penalization as a method used to treat amblyopia?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EPrescribing a high plus lens to the sound eye to intentionally blur it for amblyopia treatment.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EOptical penalization means \u003Cstrong\u003Ereducing the visual performance of the better-seeing (sound) eye using optics\u003C/strong\u003E, so the child is encouraged to \u003Cstrong\u003Euse the amblyopic eye\u003C/strong\u003E, especially for near tasks. A \u003Cstrong\u003Ehigh plus lens\u003C/strong\u003E placed over an emmetropic sound eye creates \u003Cstrong\u003Eintentional blur (most noticeably at near)\u003C/strong\u003E by shifting the focal point, which \u201Cpenalizes\u201D the sound eye without using an occlusive patch.\u003C/p\u003E\n\u003Cp\u003EPRK is a refractive surgical procedure and is not a penalization strategy. Over-minus lenses are used to stimulate accommodation and convergence in intermittent exotropia management, not to penalize the sound eye. A high minus contact lens over an emmetropic sound eye would tend to increase accommodative demand and does not serve the goal of \u003Cstrong\u003Eblurring the sound eye to promote amblyopic-eye use\u003C/strong\u003E.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1565,
    "Name": "Methotrexate in children",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 5-year-old with oligoarticular juvenile idiopathic arthritis is doing well on weekly oral methotrexate. What is the most common adverse effect of methotrexate in children?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EGastrointestinal disturbance.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EWith weekly \u003Cstrong\u003Eoral methotrexate\u003C/strong\u003E, the most frequent problem in children is \u003Cstrong\u003Egastrointestinal intolerance\u003C/strong\u003E\u2014typically \u003Cstrong\u003Enausea, abdominal discomfort, vomiting, or diarrhea\u003C/strong\u003E. This is common enough that clinicians often reduce symptoms by using \u003Cstrong\u003Efolic acid supplementation\u003C/strong\u003E and, if intolerance persists, switching from oral to \u003Cstrong\u003Esubcutaneous/intramuscular dosing\u003C/strong\u003E, which can be better tolerated in some patients.\u003C/p\u003E\n\u003Cp\u003EBy contrast, \u003Cstrong\u003Ehepatic toxicity\u003C/strong\u003E, \u003Cstrong\u003Einterstitial pneumonitis\u003C/strong\u003E, and \u003Cstrong\u003Emyelosuppression\u003C/strong\u003E are important but \u003Cstrong\u003Emuch less common\u003C/strong\u003E (though potentially serious), which is why routine monitoring is done even when the child feels well.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 5,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1566,
    "Name": "Parinaud (dorsal midbrain) syndrome",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 10-year-old has months of restricted eye movements. Exam shows impaired upgaze with \u201Csinking\u201D of the eyes on attempted upgaze, and pupils that respond better to near than to light. What is the most likely underlying cause?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EPinealoma.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThe findings point to \u003Cstrong\u003Edorsal midbrain (Parinaud) syndrome\u003C/strong\u003E, suggested by \u003Cstrong\u003Eupgaze limitation (especially saccades)\u003C/strong\u003E, \u003Cstrong\u003Elight\u2013near dissociation\u003C/strong\u003E, and \u003Cstrong\u003Econvergence\u2013retraction movements\u003C/strong\u003E on attempted upgaze (the \u201Ceyes sink in\u201D description). In children, the most characteristic structural cause is a \u003Cstrong\u003Epineal region mass\u003C/strong\u003E, which compresses the dorsal midbrain/pretectal area and produces this classic pattern.\u003C/p\u003E\n\u003Cp\u003EThe other listed causes are less typical for this age/presentation: \u003Cstrong\u003Emidbrain infarction\u003C/strong\u003E is more characteristic in older patients, \u003Cstrong\u003Emultiple sclerosis\u003C/strong\u003E is a more common cause in young adults, and \u003Cstrong\u003Ecraniopharyngioma\u003C/strong\u003E is a suprasellar tumor classically linked to optic chiasm/visual field endocrine issues rather than the classic dorsal midbrain gaze palsy pattern.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1567,
    "Name": "4\u2011PD base\u2011out test",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 4-year-old undergoes the 4\u2011prism\u2011diopter base\u2011out test. When the prism is placed in front of the right eye, the left eye abducts; when the same prism is placed in front of the left eye, neither eye moves. What diagnosis best explains this pattern?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EMonofixation syndrome.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThe 4\u2011PD base\u2011out test checks whether the visual system can detect a small induced disparity and then respond with \u003Cstrong\u003Ea version movement followed by a fusional vergence (refixation) movement\u003C/strong\u003E. In a normal binocular system, placing a 4\u2011PD base\u2011out prism before either eye triggers \u003Cstrong\u003Ea conjugate shift of the eyes\u003C/strong\u003E to pick up the displaced image, followed by \u003Cstrong\u003Ea corrective convergence movement\u003C/strong\u003E to re-establish single binocular fixation.\u003C/p\u003E\n\u003Cp\u003EThis child\u2019s asymmetric response suggests a \u003Cstrong\u003Esmall central suppression scotoma\u003C/strong\u003E in one eye with \u003Cstrong\u003Eperipheral fusion\u003C/strong\u003E preserved\u2014classic for monofixation. When the prism is placed before the eye with intact fixation, the fellow eye may show an initial movement (indicating the system detected image displacement), but when the prism is placed before the eye with the suppression scotoma, \u003Cstrong\u003Ethere is no drive to move\u003C/strong\u003E, because the displaced image falls into the suppressed central area and is effectively \u201Cignored.\u201D That is why you can see \u003Cstrong\u003Emovement in one testing position but no movement when the prism is switched to the other eye\u003C/strong\u003E.\u003C/p\u003E\n\u003Cp\u003EThis pattern is not explained by simple accommodative esotropia, and it is not a normal response. Isolated amblyopia can reduce responses, but the hallmark here is \u003Cstrong\u003Eselective non-response tied to one eye consistent with a suppression scotoma\u003C/strong\u003E, which is the defining sensory feature of monofixation.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1568,
    "Name": "Inferior oblique: tertiary action",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EDuring surgery to weaken an overacting inferior oblique muscle, which movement would be reduced that corresponds specifically to this muscle\u2019s tertiary action?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003ELess abduction.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThe inferior oblique has three actions: \u003Cstrong\u003Eprimary extorsion\u003C/strong\u003E, \u003Cstrong\u003Esecondary elevation\u003C/strong\u003E, and \u003Cstrong\u003Etertiary abduction\u003C/strong\u003E. When you weaken the inferior oblique to treat inferior oblique overaction, you reduce the muscle\u2019s overall effect, including its \u003Cstrong\u003Etertiary action\u003C/strong\u003E. Since the tertiary action of the inferior oblique is \u003Cstrong\u003Eabduction\u003C/strong\u003E, the expected effect on that specific action is \u003Cstrong\u003Ereduced abduction\u003C/strong\u003E.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1569,
    "Name": "Craniosynostosis (Apert): common strabismus pattern",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EIn craniosynostosis syndromes such as Apert syndrome, which A/V pattern deviation is seen most often?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: V-pattern exotropia.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EIn craniosynostosis syndromes (such as Apert), the strabismus pattern is strongly influenced by the \u003Cstrong\u003Eabnormal orbital anatomy\u003C/strong\u003E. These children often have \u003Cstrong\u003Ewide\u2011spaced orbits (hypertelorism)\u003C/strong\u003E and \u003Cstrong\u003Eshallow, dysmorphic orbits with abnormal orbital size/shape\u003C/strong\u003E. The shallow orbits can be associated with \u003Cstrong\u003Eproptosis\u003C/strong\u003E and, more importantly for motility, \u003Cstrong\u003Emalposition and altered pull directions of the extraocular muscles\u003C/strong\u003E. Because the bony orbit and muscle paths are distorted, the eyes frequently drift \u003Cstrong\u003Emore outward in upgaze\u003C/strong\u003E, producing a \u003Cstrong\u003EV\u2011pattern exotropia\u003C/strong\u003E, and this is commonly accompanied by \u003Cstrong\u003Einferior oblique overaction\u003C/strong\u003E (which further increases divergence in upgaze).\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1570,
    "Name": "Infantile esotropia: amblyopia likelihood",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EAn 8\u2011month\u2011old appears to have infantile (congenital) esotropia, and the deviation seems similar regardless of which eye is fixing. Which statement about amblyopia is most likely true?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EAmblyopia in neither eye.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EWhen the deviation is \u003Cstrong\u003Ecomitant and the child alternates fixation\u003C/strong\u003E, each eye gets used often enough that \u003Cstrong\u003Eone eye is not consistently suppressed\u003C/strong\u003E, so amblyopia is less likely. Amblyopia is more expected when there is \u003Cstrong\u003Efixation preference\u003C/strong\u003E\u2014for example, if one eye is consistently the deviating/non\u2011fixing eye over time.\u003C/p\u003E\n\u003Cp\u003EInfants with long\u2011standing esotropia may also show \u003Cstrong\u003Ecross\u2011fixation\u003C/strong\u003E, where the adducting eye is used to look into the opposite temporal field. This can \u003Cstrong\u003Emimic an abduction limitation\u003C/strong\u003E, but true abduction can usually be demonstrated using \u003Cstrong\u003Edoll\u2019s head (vestibulo\u2011ocular) maneuvers\u003C/strong\u003E or by \u003Cstrong\u003Ebriefly occluding one eye while checking ductions\u003C/strong\u003E.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1571,
    "Name": "Allergic conjunctivitis",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EAn 11-year-old with weeks of itchy eyes is started on lodoxamide 0.1% for allergic conjunctivitis. The parent calls the next day upset because there is no symptomatic relief. What is the most appropriate counseling/management response?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003ELodoxamide is primarily a \u003Cstrong\u003Emast\u2011cell stabilizer\u003C/strong\u003E, so it is \u003Cstrong\u003Enot expected to give immediate relief\u003C/strong\u003E\u2014its benefit builds over \u003Cstrong\u003Eseveral days\u003C/strong\u003E because it works by \u003Cstrong\u003Epreventing mediator release\u003C/strong\u003E rather than quickly blocking histamine that is already driving itching.\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003ESwitching from one pure mast\u2011cell stabilizer to another (e.g., cromolyn) doesn\u2019t solve the parent\u2019s \u201Cnext-day\u201D concern because it has a similar \u003Cstrong\u003Edelayed onset\u003C/strong\u003E profile. Jumping straight to a topical steroid (e.g., loteprednol) is generally unnecessary for a mild presentation and carries \u003Cstrong\u003Esteroid risks\u003C/strong\u003E (IOP rise, cataract, infection risk) that are not justified when a safer, effective anti-allergy drop can address symptoms.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1572,
    "Name": "Dominant optic atrophy (Kjer)",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 10-year-old girl is referred to your office after failing a school vision screening. Her best corrected visual acuity is 20/50 OD and 20/40 OS. Her mom states that her vision seems to have gotten slowly worse over the past couple of years. There is no afferent pupillary defect. She does not display any nystagmus. Her dilated fundus exam is seen in the photo above. You perform a neurological exam which is completely normal. Which of the following is true regarding this girl\u0027s most likely ocular condition?\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-23-ea117311-3fd5-48bc-a69d-76754a64965b.png\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EIt is associated with blue\u2013yellow (tritan) dyschromatopsia.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThe history and disc appearance fit \u003Cstrong\u003Edominant optic atrophy (Kjer optic atrophy)\u003C/strong\u003E: \u003Cstrong\u003Eslowly progressive bilateral vision loss\u003C/strong\u003E, typically \u003Cstrong\u003Emild to moderate\u003C/strong\u003E, often with \u003Cstrong\u003Etemporal disc pallor\u003C/strong\u003E and a characteristic excavation appearance, and usually \u003Cstrong\u003Eno nystagmus\u003C/strong\u003E. A classic functional clue is \u003Cstrong\u003Eblue\u2013yellow (tritan) color vision deficiency\u003C/strong\u003E, and long-term vision is often \u003Cstrong\u003Erelatively preserved\u003C/strong\u003E compared with more severe hereditary optic atrophies. This condition is commonly linked to \u003Cstrong\u003EOPA1 mutations\u003C/strong\u003E and follows an \u003Cstrong\u003Eautosomal dominant\u003C/strong\u003E inheritance pattern.\u003C/p\u003E\n\u003Cp\u003EThe other statements match different entities: an \u003Cstrong\u003Eautosomal recessive optic atrophy\u003C/strong\u003E tends to present \u003Cstrong\u003Eearlier\u003C/strong\u003E with \u003Cstrong\u003Emore severe vision loss\u003C/strong\u003E (often with nystagmus in a subset), and \u003Cstrong\u003Ematernal-only transmission\u003C/strong\u003E points toward \u003Cstrong\u003Emitochondrial inheritance\u003C/strong\u003E (as in Leber hereditary optic neuropathy), which more often affects \u003Cstrong\u003Eyoung males\u003C/strong\u003E rather than a girl with a long, gradual course.\u003C/p\u003E\u003Cp\u003E\u003C!--StartFragment--\u003E\u003C!--EndFragment--\u003E\u003C/p\u003E\u003Cdiv style=\u0022font-family:\u0027Segoe UI\u0027;font-size:14px;font-style:normal;font-weight:400;line-height:20px\u0022\u003EBehr optic atrophy is another hereditary optic atrophy which is much rarer than the above diseases. Its clinical features are: onset of vision loss in early childhood (i.e. \u0026lt;10 years old), ataxia, intellectual disability, and urinary incontinence.\u003C/div\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1573,
    "Name": "3\u2011step test: localizing a left hypertropia",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 33-year-old develops diplopia after head trauma. Motility measurements show a left hypertropia that becomes larger in left gaze and also increases with a left head tilt. Based on the Parks\u2013Bielschowsky three-step test, what is the most likely diagnosis?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003ERight inferior oblique palsy.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThe pattern localizes using the \u003Cstrong\u003EParks\u2013Bielschowsky 3\u2011step test\u003C/strong\u003E:\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003EStep 1: A \u003Cstrong\u003Eleft hypertropia\u003C/strong\u003E limits the possibilities to muscles that normally \u003Cstrong\u003Edepress the left eye\u003C/strong\u003E or \u003Cstrong\u003Eelevate the right eye\u003C/strong\u003E (because weakness in those actions allows the left eye to sit higher).\u003C/li\u003E\n\u003Cli\u003EStep 2: The hypertropia is \u003Cstrong\u003Eworse in left gaze\u003C/strong\u003E, which further narrows the problem to the pair of candidates whose vertical action is most relevant in that gaze position.\u003C/li\u003E\n\u003Cli\u003EStep 3: The hypertropia is \u003Cstrong\u003Eworse with left head tilt\u003C/strong\u003E, which identifies the muscle that fails when the eyes are challenged by the torsional demand produced by that head tilt. Putting these together points most strongly to \u003Cstrong\u003Eweakness of the right inferior oblique\u003C/strong\u003E.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1574,
    "Name": "High AC/A accommodative ET: traditional medication risk",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EA 3-year-old has intermittent esotropia that is larger at near than distance and has a high AC/A ratio. The parent refuses spectacles. Which medication has historically been used to reduce the convergence component, and what major serious adverse effect must be warned about?\u003C/p\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EEchothiophate iodide\u003C/strong\u003E, with the key serious risk being \u003Cstrong\u003Eprolonged paralysis during general anesthesia (especially with succinylcholine)\u003C/strong\u003E.\u003C/p\u003E\n\u003Cp\u003EEchothiophate is a \u003Cstrong\u003Elong\u2011acting anticholinesterase\u003C/strong\u003E that increases acetylcholine at the neuromuscular and muscarinic synapses. In this setting, it is used to create \u003Cstrong\u003Echronic miosis and increased ciliary muscle tone\u003C/strong\u003E, which can \u003Cstrong\u003Ereduce accommodative effort\u003C/strong\u003E and thereby \u003Cstrong\u003Ereduce accommodative convergence\u003C/strong\u003E, helping children whose esotropia is driven by a \u003Cstrong\u003Ehigh AC/A ratio\u003C/strong\u003E.\u003C/p\u003E\n\u003Cp\u003EThe most important safety issue is systemic cholinesterase inhibition: echothiophate can \u003Cstrong\u003Eprolong the action of depolarizing neuromuscular blockers\u003C/strong\u003E, so a child exposed to \u003Cstrong\u003Esuccinylcholine\u003C/strong\u003E may have \u003Cstrong\u003Eunexpectedly prolonged apnea/paralysis\u003C/strong\u003E. This is why families must be told to \u003Cstrong\u003Ealert anesthesiologists\u003C/strong\u003E if the child ever needs surgery. A notable additional adverse effect is \u003Cstrong\u003Eiris cyst formation\u003C/strong\u003E, which may be mitigated by \u003Cstrong\u003Ephenylephrine co\u2011administration\u003C/strong\u003E in some regimens.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1575,
    "Name": "Sturge\u2013Weber: red fundus and brain association",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 5-year-old has a unilateral port-wine\u2013type facial lesion and a fundus that looks noticeably redder in one eye, along with a stroke-like episode after minor head trauma. Which intracranial abnormality is most likely associated with this syndrome?\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-23-bf33205d-45a1-4454-8ad9-cf6ad714b64c.png\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003ELeptomeningeal vascular malformation.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThe unilateral \u201Credder/pinker\u201D fundus strongly suggests a \u003Cstrong\u003Ediffuse choroidal hemangioma\u003C/strong\u003E, and when this occurs together with a facial \u003Cstrong\u003Eport\u2011wine stain\u003C/strong\u003E (especially around the eyelid), the classic diagnosis is \u003Cstrong\u003ESturge\u2013Weber syndrome\u003C/strong\u003E. The neurological hallmark of this syndrome is a \u003Cstrong\u003Eleptomeningeal vascular malformation (leptomeningeal angioma)\u003C/strong\u003E, which can lead to \u003Cstrong\u003Eseizures, stroke\u2011like episodes, and progressive neurologic deficits\u003C/strong\u003E, and is often associated with \u003Cstrong\u003Ecortical/subcortical calcifications\u003C/strong\u003E on imaging. The history of a stroke\u2011like event after seemingly minor head trauma fits this pattern of fragile/abnormal vascular perfusion.\u003C/p\u003E\n\u003Cp\u003EA practical clinical implication is that these children can also develop \u003Cstrong\u003Eglaucoma on the same side as the facial lesion\u003C/strong\u003E, due to either \u003Cstrong\u003Eangle dysgenesis (earlier presentation)\u003C/strong\u003E or \u003Cstrong\u003Eelevated episcleral venous pressure (later presentation)\u003C/strong\u003E, so eye pressure monitoring is important in follow-up.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1576,
    "Name": "Longest extraocular muscle tendon",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EAmong the listed extraocular muscles, which one has the longest tendon?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003ELevator.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThe \u003Cstrong\u003Elevator palpebrae superioris\u003C/strong\u003E is one of the muscles with a notably long tendon; among the options provided, it has the \u003Cstrong\u003Elongest tendon\u003C/strong\u003E. In contrast, the rectus muscles listed have \u003Cstrong\u003Eshorter tendons\u003C/strong\u003E compared with the levator. A useful related fact is that the \u003Cstrong\u003Esuperior oblique\u003C/strong\u003E (not listed here) has an even longer tendon overall, which is why it is often cited as having the longest tendon among the extraocular muscles.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1577,
    "Name": "ROP screening: preferred dilating drop",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EDuring an ROP screening exam in the NICU, which dilating drop is most routinely recommended for this very young age group?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003ECyclopentolate 0.5%.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EFor ROP screening, many neonatal protocols use \u003Cstrong\u003Ecyclopentolate 0.5%\u003C/strong\u003E (often paired with \u003Cstrong\u003Ephenylephrine 2.5%\u003C/strong\u003E) because it achieves reliable dilation while aiming to limit systemic adverse effects in premature infants. \u003Cbr\u003E\nThis age group is especially vulnerable to systemic absorption from eye drops, so practice guidelines commonly prefer \u003Cstrong\u003Elower concentrations/regimens\u003C/strong\u003E and careful administration (e.g., minimizing excess drops, nasolacrimal occlusion) to reduce complications.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1578,
    "Name": "Blepharophimosis syndrome",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EAn 11-year-old girl has lifelong \u201Csleepy-looking\u201D eyelids, and her father appears to have the same inherited eyelid condition. Which systemic problem can be associated with this disorder?\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-23-cf8f42f8-0656-41f7-a22a-82f96405b5a4.png\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EPremature ovarian failure.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThis presentation is most consistent with \u003Cstrong\u003Eblepharophimosis\u2013ptosis\u2013epicanthus inversus syndrome (BPES)\u003C/strong\u003E, an \u003Cstrong\u003Eautosomal dominant\u003C/strong\u003E eyelid disorder characterized by \u003Cstrong\u003Enarrowed horizontal palpebral fissures (blepharophimosis)\u003C/strong\u003E, \u003Cstrong\u003Eptosis\u003C/strong\u003E, \u003Cstrong\u003Etelecanthus\u003C/strong\u003E, and \u003Cstrong\u003Eepicanthus inversus\u003C/strong\u003E. BPES has two clinical subtypes: \u003Cstrong\u003Eone form is associated with premature ovarian insufficiency\u003C/strong\u003E, which can lead to \u003Cstrong\u003Ereduced fertility/infertility\u003C/strong\u003E and earlier loss of ovarian function. Because the condition can be transmitted through an affected father, a clear family history like this supports an inherited BPES pattern, and the most important systemic association to remember is \u003Cstrong\u003Epremature ovarian failure\u003C/strong\u003E (in the subtype that includes ovarian involvement).\u003C/p\u003E\u003Cp\u003E\u003C!--StartFragment--\u003E\u003C!--EndFragment--\u003E\u003C/p\u003E\u003Cdiv style=\u0022font-family:\u0027Segoe UI\u0027;font-size:14px;font-style:normal;font-weight:400;line-height:20px\u0022\u003E\u003Cp\u003ETo connect the \u003Cem\u003Eother listed findings\u003C/em\u003E with their more typical syndromic associations:\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EPreauricular skin tags\u003C/strong\u003E \u2192 commonly seen in \u003Cstrong\u003EGoldenhar syndrome / oculo\u2011auriculo\u2011vertebral spectrum\u003C/strong\u003E, often along with epibulbar dermoids and vertebral anomalies.\u0026nbsp;\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EAtrioventricular septal defect\u003C/strong\u003E \u2192 strongly associated with \u003Cstrong\u003EDown syndrome (trisomy 21)\u003C/strong\u003E and is one of its most common congenital heart lesions.\u0026nbsp;\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EProximal muscle weakness\u003C/strong\u003E \u2192 classically points toward \u003Cstrong\u003Emyotonic dystrophy type 2 (proximal myotonic myopathy)\u003C/strong\u003E or other proximal myopathies; myotonic dystrophy is a multisystem muscular dystrophy family with characteristic muscle weakness patterns.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1579,
    "Name": "Apert syndrome: \u201CEXCEPT\u201D feature",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA child with a congenital skull deformity is suspected to have Apert syndrome. Which listed feature does not support this diagnosis?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EAbsence of syndactyly.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EApert syndrome is a craniosynostosis syndrome in which \u003Cstrong\u003Esyndactyly is a hallmark finding\u003C/strong\u003E, often severe enough to produce a \u003Cstrong\u003E\u201Cmitten hand\u201D\u003C/strong\u003E appearance when multiple digits are fused. Because \u003Cstrong\u003Edigit fusion is expected\u003C/strong\u003E, stating that syndactyly is absent argues against Apert and therefore is the \u201CEXCEPT\u201D feature.\u003C/p\u003E\n\u003Cp\u003EOther findings can occur in Apert and therefore support the diagnosis: \u003Cstrong\u003Eautosomal dominant inheritance\u003C/strong\u003E is typical for many craniosynostosis syndromes, \u003Cstrong\u003Edevelopmental delay/intellectual impairment\u003C/strong\u003E can be present, and \u003Cstrong\u003Einternal organ malformations (including cardiac defects)\u003C/strong\u003E may occur as part of the syndrome spectrum. A useful comparator is that \u003Cstrong\u003ECrouzon syndrome\u003C/strong\u003E classically has craniosynostosis \u003Cstrong\u003Ewithout limb anomalies\u003C/strong\u003E, which helps explain why lack of syndactyly points away from Apert.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1580,
    "Name": "Gonococcal conjunctivitis in a child",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 6-year-old has two days of severe bilateral purulent conjunctivitis with copious green discharge, and Gram stain shows gram-negative diplococci. What is the most appropriate management?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer:\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u0026nbsp;\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003Efrequent saline lavage, ceftriaxone, and referral to child protective services\u003C/span\u003E\u003C/span\u003E\u003C/p\u003E\u003C!--StartFragment--\u003E\u003C!--EndFragment--\u003E\n\u003Cp\u003EThis presentation strongly suggests \u003Cstrong\u003Egonococcal conjunctivitis\u003C/strong\u003E, which is an \u003Cstrong\u003Eocular emergency\u003C/strong\u003E because it can progress rapidly and become vision-threatening if corneal involvement develops. The cornerstone of management is \u003Cstrong\u003Esystemic therapy with ceftriaxone\u003C/strong\u003E plus \u003Cstrong\u003Ecopious saline irrigation\u003C/strong\u003E to reduce bacterial load and discharge.\u003C/p\u003E\n\u003Cp\u003EIn a prepubertal child, gonococcal infection is \u003Cstrong\u003Enot typical from casual contact\u003C/strong\u003E, so clinicians must treat this as a \u003Cstrong\u003Epossible sexually transmitted infection\u003C/strong\u003E and ensure \u003Cstrong\u003Eimmediate child-safety evaluation through the appropriate protection services and multidisciplinary team\u003C/strong\u003E.\u003C/p\u003E\n\u003Cp\u003ETopical-only regimens (such as erythromycin) are \u003Cstrong\u003Einsufficient\u003C/strong\u003E for gonococcal disease, and oral macrolides are aimed more at chlamydial infection rather than gonorrhea. Partner treatment language applies to sexually active patients, but in this scenario the priority is \u003Cstrong\u003Esystemic treatment, safety assessment, and reporting through the proper channels\u003C/strong\u003E. If corneal disease appears, \u003Cstrong\u003Eadd intensive topical therapy\u003C/strong\u003E guided by the treating team.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1581,
    "Name": "Emmetropization and childhood hyperopia trend",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA healthy 3-year-old has \u002B2.00 D hyperopia in both eyes, normal acuity, and straight eyes. The parents ask how this refractive error typically changes as the child grows. What is the best counseling statement?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EHyperopia often increases until about age 6\u20138, then gradually decreases toward emmetropia.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EChildren are typically \u003Cstrong\u003Ehyperopic early in life\u003C/strong\u003E because the eye starts with a \u003Cstrong\u003Eshorter axial length\u003C/strong\u003E and different optical proportions. As the eye grows through early childhood, hyperopia can \u003Cstrong\u003Eincrease and reach a peak around school age (roughly 6\u20138 years)\u003C/strong\u003E. After that, normal growth tends to produce a \u003Cstrong\u003Emyopic shift toward emmetropia\u003C/strong\u003E\u2014the process called \u003Cstrong\u003Eemmetropization\u003C/strong\u003E, where the refractive state moves closer to plano over time.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1582,
    "Name": "Post\u2011strabismus conjunctival granuloma",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA child is 9 months after bilateral medial rectus recession. A localized conjunctival \u201Clump\u201D has been present for about 8 weeks near the prior surgical site. What is the most appropriate management?\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-23-be331e83-81f9-4813-885d-d302a57123b8.png\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003ETopical steroids.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThis lesion is most consistent with a \u003Cstrong\u003Epost\u2011strabismus conjunctival granuloma\u003C/strong\u003E, commonly a \u003Cstrong\u003Eforeign\u2011body (suture) granuloma\u003C/strong\u003E arising at or near the muscle reattachment site. These appear as a \u003Cstrong\u003Elocalized, raised, mildly inflamed mass\u003C/strong\u003E and are often related to a chronic reaction to suture material. First\u2011line treatment is \u003Cstrong\u003Etopical anti\u2011inflammatory therapy\u003C/strong\u003E, because many cases \u003Cstrong\u003Eshrink or resolve with topical steroids\u003C/strong\u003E.\u003C/p\u003E\n\u003Cp\u003EExcision is generally reserved for lesions that \u003Cstrong\u003Efail to regress\u003C/strong\u003E, \u003Cstrong\u003Erecur\u003C/strong\u003E, or remain \u003Cstrong\u003Esymptomatic/persistent\u003C/strong\u003E despite adequate topical therapy. Mitomycin C is not a routine treatment for this postoperative granuloma, and simple observation risks prolonged irritation when a low\u2011risk medical option is usually effective.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1583,
    "Name": "Epiretinal membrane",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 65-year-old patient undergoes pars plana vitrectomy (PPV) for an epiretinal membrane. What is the approximate risk of developing a visually significant cataract within 2 years following surgery?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe most common complication after pars plana vitrectomy in phakic patients over 50 years is development of a visually significant \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enuclear sclerotic cataract\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAccording to the BCSC Retina text, \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emore than 90% of eyes\u003C/b\u003E\u003C/span\u003E in patients over 50 years will develop a visually significant cataract within \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E2 years\u003C/b\u003E\u003C/span\u003E of vitrectomy.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe mechanism is thought to relate to:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIncreased intraocular oxygen tension after removal of the vitreous gel\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOxidative damage to the crystalline lens nucleus\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAdditional long-term risk after vitrectomy includes \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eopen-angle glaucoma (~10-20%)\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EFurther reading:\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Ca href=\u0022https://www.ajo.com/article/S0002-9394(06)00254-6/fulltext\u0022 target=\u0022_blank\u0022\u003EOpen Angle Glaucoma After Vitrectomy by Stanley Chang\u003C/a\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EDr. Stanley Chang\u2019s work demonstrated:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EHigher mean IOP in vitrectomized eyes compared with fellow eyes (19.5 \u00B1 2.7 mmHg vs 14.3 \u00B1 3.0 mmHg; p = 0.0001).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIn eyes developing glaucoma post-vitrectomy, the interval to diagnosis was longer in phakic eyes (45.95 \u00B1 44.79 months) than in nonphakic eyes (18.39 \u00B1 13.76 months; p = 0.0115), suggesting the crystalline lens may be relatively protective.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EEyes already treated for glaucoma preoperatively required more medications post-vitrectomy (2.9 \u00B1 1.2 vs 2.00 \u00B1 1.4; p = 0.0215).\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1584,
    "Name": "ROP",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA pediatrician refers a newborn infant to the Ophthalmology clinic to rule out retinopathy of prematurity (ROP). The baby is currently 2 weeks old with a postconceptional age of 29 weeks. When should the first dilated fundus examination be performed?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EROP screening timing is based on:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPostnatal age\u003C/b\u003E\u003C/span\u003E (4-6 weeks after birth), OR\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003E31-33 weeks postmenstrual/postconceptional age\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E,\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EWhichever is later\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThis infant is:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E2 weeks postnatal age\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E29 weeks postconceptional age\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe first screening should therefore occur at:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E4-6 weeks postnatal age \u2192 which would be \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E2-4 weeks from now\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EImmediate screening is not indicated because:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ERetinal vascularization has not yet progressed sufficiently to detect clinically meaningful ROP at 29 weeks postconceptional age.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EFurther reading:\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Ca href=\u0022https://www.sciencedirect.com/science/article/pii/S0378378223000117\u0022 target=\u0022_blank\u0022\u003EUK screening and treatment of retinopathy of prematurity Updated 2022 Guidelines\u003C/a\u003E\u003C/div\u003E\u003Cul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1585,
    "Name": "Papilloedema investigations",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 5-year-old girl presents with bilateral blurry vision. Fundus examination in both eyes shows severe bilateral optic disc edema with associated retinal changes as illustrated. What is the most important next diagnostic step?\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-24-f6a3e388-7357-42c2-b5aa-42b5d67eaa5e.png\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe fundus photograph demonstrates \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ebilateral severe optic disc edema\u003C/b\u003E\u003C/span\u003E, consistent with possible \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Epapilledema\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EBilateral disc edema in a child must be assumed to represent raised intracranial pressure until proven otherwise.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EUrgent neuroimaging is required before any lumbar puncture.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EMRI brain\u003C/b\u003E\u003C/span\u003E is necessary to exclude:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EIntracranial mass lesions\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EHydrocephalus\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EMeningoencephalitis\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EMRV (magnetic resonance venography)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is essential to exclude:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ECerebral venous sinus thrombosis\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EAlthough infections (e.g., Bartonella, Toxoplasma) and inflammatory causes (e.g., sarcoidosis) can cause optic disc edema, they do not take priority over ruling out life-threatening intracranial pathology.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EERG is not helpful in evaluating optic disc edema or papilledema.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003EImage source:\u003C/div\u003E\u003Cdiv\u003E\u003Ca href=\u0022https://www.medlink.com/media/jrp4\u0022 target=\u0022_blank\u0022\u003EPapilledema with macular star figure\u003C/a\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1586,
    "Name": "Bilateral vs unilateral SO palsy",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich statement is not typical when comparing findings in bilateral versus unilateral superior oblique palsy?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EUnilateral cases usually have at least 15 degrees of excyclotorsion.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EIn superior oblique palsy, \u003Cstrong\u003Elarge excyclotorsion strongly suggests bilateral involvement\u003C/strong\u003E, not unilateral. \u003Cstrong\u003EUnilateral cases typically have minimal torsion\u003C/strong\u003E (often only a few degrees) and often show \u003Cstrong\u003Elittle or no V\u2011pattern\u003C/strong\u003E, whereas \u003Cstrong\u003Ebilateral palsy\u003C/strong\u003E is more likely to produce a \u003Cstrong\u003Esignificant V\u2011pattern\u003C/strong\u003E and \u003Cstrong\u003Egreater excyclotorsion (commonly \u0026gt;10\u00B0)\u003C/strong\u003E. A classic clue for bilateral disease is the \u201Calternating\u201D head\u2011tilt pattern: \u003Cstrong\u003Eright hypertropia on right head tilt and left hypertropia on left head tilt\u003C/strong\u003E, reflecting involvement of both superior obliques.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1587,
    "Name": "Maddox rod in esotropia",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA child has a large esotropia when not wearing glasses. A Maddox rod is placed in front of the left eye to measure the horizontal deviation. What relative position of the red line compared with the white light would the child report?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: The child would report a \u003Cstrong\u003Ered vertical line to the left of the white light\u003C/strong\u003E.\u003C/p\u003E\n\u003Cp\u003ETo measure a horizontal deviation with a Maddox rod, the rod is oriented horizontally so it produces a \u003Cstrong\u003Evertical red line\u003C/strong\u003E, allowing you to judge horizontal separation between the red line (seen by the eye behind the Maddox rod) and the white light (seen by the fellow eye). In an \u003Cstrong\u003Eesotropia\u003C/strong\u003E, the diplopia pattern is \u003Cstrong\u003Euncrossed\u003C/strong\u003E, meaning each eye\u2019s perceived image stays on its own side of space. Because the Maddox rod is over the \u003Cstrong\u003Eleft eye\u003C/strong\u003E, the red line corresponds to the left eye\u2019s perception, so it will be perceived \u003Cstrong\u003Eto the left\u003C/strong\u003E of the white light seen by the right eye.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1588,
    "Name": "Marcus Gunn jaw-winking: involved nerve",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 4-month-old has mild congenital ptosis with eyelid elevation triggered by jaw movements during bottle feeding. Which nerve is classically aberrantly connected with the superior division of CN III in this condition?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003ECranial nerve V3 (mandibular division of the trigeminal nerve).\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThis presentation is typical of \u003Cstrong\u003EMarcus\u2013Gunn jaw-winking (trigemino-oculomotor synkinesis)\u003C/strong\u003E, where \u003Cstrong\u003Ejaw movement triggers involuntary elevation of the ptotic eyelid\u003C/strong\u003E. The classic mechanism is an \u003Cstrong\u003Eaberrant connection between motor fibers of the mandibular division of CN V (V3)\u003C/strong\u003E and the \u003Cstrong\u003Elevator palpebrae superioris pathway carried by the superior division of CN III\u003C/strong\u003E, leading to \u003Cstrong\u003Eco-contraction during chewing/sucking\u003C/strong\u003E.\u003C/p\u003E\n\u003Cp\u003EThe other trigeminal divisions listed (V1 and V2) are \u003Cstrong\u003Epurely sensory\u003C/strong\u003E, so they are not the typical motor pathway responsible for the synkinetic eyelid movement. CN VII is the motor nerve to \u003Cstrong\u003Eorbicularis oculi\u003C/strong\u003E (eyelid closure), not levator elevation, so it does not match the characteristic \u201Cjaw-wink\u201D pattern.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1589,
    "Name": "Preferential looking card",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EA preverbal 1-year-old is being assessed for visual acuity using a preferential-looking method shown in the image. Which type of visual acuity card is being used?\u003C/p\u003E\u003Cp\u003E\u003Cimg src=\u0022/upload-2026-02-24-efee0630-ed39-4fc5-b843-804f32094c6f.png\u0022\u003E\u003C/p\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003ETeller card.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EA Teller preferential-looking card has \u003Cstrong\u003Etwo fields\u003C/strong\u003E\u2014one side contains \u003Cstrong\u003Ehigh-contrast grating stripes\u003C/strong\u003E and the other side is \u003Cstrong\u003Eblank/gray\u003C/strong\u003E. The examiner watches whether the child \u003Cstrong\u003Econsistently looks toward the grating side\u003C/strong\u003E, indicating the stripes are being detected. By presenting \u003Cstrong\u003Eprogressively finer gratings\u003C/strong\u003E, you identify the finest stripe width the child can reliably detect, which provides an \u003Cstrong\u003Eestimate of visual acuity\u003C/strong\u003E in a nonverbal child.\u003C/p\u003E\u003Cp\u003E\u003C!--StartFragment--\u003E\u003C!--EndFragment--\u003E\u003C/p\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; font-style: normal; font-weight: 400; line-height: 20px;\u0022\u003E\u003Cp style=\u0022font-size: 14px;\u0022\u003EHere\u2019s a quick summary of the \u003Cstrong\u003Eother choices\u003C/strong\u003E\u0026nbsp;):\u003C/p\u003E\n\u003Ch3 style=\u0022\u0022\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003E* Tumbling E\u003C/span\u003E\u003C/h3\u003E\n\u003Cul style=\u0022font-size: 14px;\u0022\u003E\n\u003Cli\u003EUses the letter \u003Cstrong\u003E\u201CE\u201D\u003C/strong\u003E shown in different orientations (up, down, left, right).\u003C/li\u003E\n\u003Cli\u003EThe child either \u003Cstrong\u003Epoints\u003C/strong\u003E to match the direction or \u003Cstrong\u003Estates\u003C/strong\u003E the direction.\u003C/li\u003E\n\u003Cli\u003EBest for children who \u003Cstrong\u003Ecan understand directions\u003C/strong\u003E but may not know letters (often older preschool age and above).\u003C/li\u003E\n\u003C/ul\u003E\n\u003Ch3 style=\u0022font-size: 14px;\u0022\u003E*Allen card\u003C/h3\u003E\n\u003Cul style=\u0022font-size: 14px;\u0022\u003E\n\u003Cli\u003EUses \u003Cstrong\u003Esimple picture optotypes\u003C/strong\u003E (common objects) to measure recognition acuity.\u003C/li\u003E\n\u003Cli\u003EDesigned for young children who can \u003Cstrong\u003Ename\u003C/strong\u003E or \u003Cstrong\u003Ematch\u003C/strong\u003E pictures.\u003C/li\u003E\n\u003Cli\u003ELess precise than standardized letter-based charts, but useful when the child can\u2019t do letters yet.\u003C/li\u003E\n\u003C/ul\u003E\n\u003Ch3 style=\u0022font-size: 14px;\u0022\u003E* HOTV card\u003C/h3\u003E\n\u003Cul style=\u0022font-size: 14px;\u0022\u003E\n\u003Cli\u003EUses only the letters \u003Cstrong\u003EH, O, T, V\u003C/strong\u003E.\u003C/li\u003E\n\u003Cli\u003ECan be done as \u003Cstrong\u003Ematching\u003C/strong\u003E (child points to the same letter on a handheld card) or \u003Cstrong\u003Enaming\u003C/strong\u003E.\u003C/li\u003E\n\u003Cli\u003EVery common for preschool children because it\u2019s \u003Cstrong\u003Emore standardized\u003C/strong\u003E than picture charts and doesn\u2019t require knowing the full alphabet.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1590,
    "Name": "Worth 4-dot in monofixation syndrome",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 5-year-old with prior strabismus surgery is tested with the Worth 4-dot. If the child has monofixation syndrome, what pattern of responses is expected at distance versus near?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EDistance: 2 or 3 lights; near: 4 lights.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EMonofixation syndrome is characterized by \u003Cstrong\u003Ea small central suppression scotoma\u003C/strong\u003E with \u003Cstrong\u003Epreserved peripheral fusion\u003C/strong\u003E. At \u003Cstrong\u003Edistance\u003C/strong\u003E, the Worth 4-dot image is more likely to fall \u003Cstrong\u003Ewithin the central suppression zone\u003C/strong\u003E, so the child may report \u003Cstrong\u003Esuppression\u003C/strong\u003E and see only \u003Cstrong\u003E2 or 3 lights\u003C/strong\u003E. At \u003Cstrong\u003Enear\u003C/strong\u003E, the target subtends a larger visual angle and is more likely to project \u003Cstrong\u003Eoutside the central scotoma\u003C/strong\u003E, allowing \u003Cstrong\u003Eperipheral fusion\u003C/strong\u003E, so the child typically reports seeing \u003Cstrong\u003Eall 4 lights\u003C/strong\u003E.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1591,
    "Name": "Accommodative esotropia",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 2-year-old with accommodative esotropia has moderate hyperopia on cycloplegic refraction and is prescribed the full correction. The parent asks whether the child will keep needing the same glasses strength over the next few years. What is the most accurate counseling statement?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EYour child\u0027s prescription will likely increase in power over the next 2 to 3 years.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EIn early childhood, hyperopia often \u003Cstrong\u003Eincreases until it peaks around school age (roughly 5\u20137 years)\u003C/strong\u003E as the eye continues its growth and refractive development. Because this child is only 2 years old, it is reasonable to counsel that the measured hyperopic prescription may \u003Cstrong\u003Eincrease over the next few years\u003C/strong\u003E, so the glasses strength may need to be updated. Later, as emmetropization progresses, the hyperopia may \u003Cstrong\u003Egradually decrease\u003C/strong\u003E, and some children can be carefully reduced (\u201Cweaned\u201D) from full plus over time, but this is typically considered \u003Cstrong\u003Eafter the peak years\u003C/strong\u003E and only if alignment remains stable.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1592,
    "Name": "Paralytic incomitant horizontal strabismus",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EFor an incomitant horizontal deviation caused by a weak horizontal muscle that still has some remaining function, what single surgical approach is most commonly chosen first?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EWeakening of the direct antagonist muscle.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EWhen a weak horizontal muscle still has \u003Cstrong\u003Esome residual function\u003C/strong\u003E, the main problem is often the \u003Cstrong\u003Eunopposed pull and secondary tightness/contracture of its antagonist\u003C/strong\u003E, which mechanically prevents the weak muscle from working effectively. \u003Cstrong\u003EWeakening the antagonist reduces this restraining force\u003C/strong\u003E, improves the eye\u2019s ability to rotate toward the weak muscle\u2019s field, and typically \u003Cstrong\u003Epreserves better motility\u003C/strong\u003E than trying to \u201Cforce\u201D alignment by strengthening the weak muscle alone.\u003C/p\u003E\n\u003Cp\u003EA pure strengthening procedure on the weak muscle may not truly restore lost innervation; instead it can act like a \u003Cstrong\u003Etight tether\u003C/strong\u003E, risking \u003Cstrong\u003Erestriction\u003C/strong\u003E and limiting versions without reliably correcting the incomitance. Transposition procedures are generally reserved for situations where the muscle is \u003Cstrong\u003Eessentially nonfunctional\u003C/strong\u003E (complete palsy) and you need to recruit other muscles to substitute for the lost action. Operating on the contralateral eye can help in selected incomitance patterns, but it is \u003Cstrong\u003Enot the usual first single move\u003C/strong\u003E when the key issue is an antagonist that is overpowering a partially functioning muscle.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1593,
    "Name": "Notation for intermittent near esotropia",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 2-year-old has an intermittent esotropia seen at near fixation. Which abbreviation correctly documents this deviation?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003Enswer: \u003Cstrong\u003EE\u0027(T)\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EE\u003C/strong\u003E denotes \u003Cstrong\u003Eesophoria/esotropia direction (eso)\u003C/strong\u003E, and \u003Cstrong\u003E(T)\u003C/strong\u003E indicates the deviation is \u003Cstrong\u003Eintermittent\u003C/strong\u003E (only manifest some of the time). The \u003Cstrong\u003Eprime symbol (\u0027)\u003C/strong\u003E specifies \u003Cstrong\u003Enear fixation\u003C/strong\u003E. Putting these together, \u003Cstrong\u003EE\u0027(T)\u003C/strong\u003E correctly communicates \u003Cstrong\u003Eintermittent esotropia at near\u003C/strong\u003E.\u003C/p\u003E\u003Cp\u003E\u003C!--StartFragment--\u003E\u003C!--EndFragment--\u003E\u003C/p\u003E\u003Cdiv style=\u0022font-family:\u0027Segoe UI\u0027;font-size:14px;font-style:normal;font-weight:400;line-height:20px\u0022\u003E\u003Cstrong\u003EE(T)\u003C/strong\u003E means an \u003Cstrong\u003Eintermittent esotropia\u003C/strong\u003E but doesn\u2019t specify whether it\u2019s at near or distance, \u003Cstrong\u003EE\u2032\u003C/strong\u003E indicates an \u003Cstrong\u003Eeso deviation at near\u003C/strong\u003E but doesn\u2019t convey intermittency (often interpreted as a near \u003Cstrong\u003Ephoria\u003C/strong\u003E), and \u003Cstrong\u003EET\u2032\u003C/strong\u003E specifies a \u003Cstrong\u003Econstant near esotropia\u003C/strong\u003E (a near tropia present all the time).\u003C/div\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1594,
    "Name": "Maximizing superior rectus primary action",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhen testing the superior rectus muscle, which eye position best isolates and maximizes its primary action?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EAbduct the eye about 23\u00B0 from primary position.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThe \u003Cstrong\u003Eprimary action of the superior rectus is elevation\u003C/strong\u003E. Because the superior rectus does not pull exactly along the visual axis in primary position (its line of pull is angled), placing the eye in about \u003Cstrong\u003E23\u00B0 of abduction\u003C/strong\u003E aligns the muscle\u2019s pull more directly with the visual axis. This makes the superior rectus act as the \u003Cstrong\u003Emost effective elevator\u003C/strong\u003E, allowing you to best assess its primary action.\u003C/p\u003E\n\u003Cp\u003EIn contrast, moving the eye far into adduction would increase the relative contribution of the muscle\u2019s \u003Cstrong\u003Etorsional component (intorsion)\u003C/strong\u003E rather than pure elevation, and \u201C67\u00B0 adduction\u201D is also not a practical physiologic position for standard clinical testing.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1595,
    "Name": "Head tilt test: primary IO overaction vs bilateral SO palsy",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich clinical exam finding best distinguishes bilateral primary oblique overaction from bilateral weakness of the opposing oblique muscle?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: Head tilt test.\u003C/p\u003E\n\u003Cp\u003EThe key discriminator is how the \u003Cstrong\u003Evertical deviation changes with head tilt\u003C/strong\u003E. In \u003Cstrong\u003Ebilateral superior oblique palsy\u003C/strong\u003E, the Bielschowsky head-tilt response typically shows \u003Cstrong\u003Ealternating hypertropias\u003C/strong\u003E: \u003Cstrong\u003Eright hypertropia on right tilt\u003C/strong\u003E and \u003Cstrong\u003Eleft hypertropia on left tilt\u003C/strong\u003E, because tilting recruits torsional demands that expose weakness of each superior oblique on its respective side. In contrast, \u003Cstrong\u003Eprimary inferior oblique overaction\u003C/strong\u003E is not driven by a superior oblique weakness, so the \u003Cstrong\u003Ehead-tilt\u2013induced hypertropia is usually small or negligible\u003C/strong\u003E (often without the classic alternating pattern).\u003C/p\u003E\n\u003Cp\u003EThe other options are less specific for this particular distinction: \u003Cstrong\u003Esubjective torsion\u003C/strong\u003E can be absent or unreliable due to \u003Cstrong\u003Esensory adaptation\u003C/strong\u003E; a \u003Cstrong\u003E\u0026gt;10\u0394 up/down gaze difference\u003C/strong\u003E can signal a pattern deviation but does not reliably tell you whether it is primary overaction versus secondary to antagonist palsy; and \u003Cstrong\u003Elarge vertical fusional amplitudes\u003C/strong\u003E are more helpful for separating long-standing/congenital from acute causes rather than distinguishing these two mechanisms.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1596,
    "Name": "Most common site of limbal dermoid",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhere on the limbus do limbal dermoids most commonly occur?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EInferotemporal limbus.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003ELimbal dermoids are congenital choristomas that most often arise at the \u003Cstrong\u003Einferotemporal limbus\u003C/strong\u003E, classically at the corneoscleral junction. This location is also clinically useful because limbal dermoids are commonly associated with \u003Cstrong\u003Eoculo\u2011auriculo\u2011vertebral spectrum (Goldenhar syndrome)\u003C/strong\u003E, where ocular surface dermoids may coexist with craniofacial/auricular anomalies. A simple way to remember the site is that \u003Cstrong\u003Einferotemporal\u003C/strong\u003E is the limbal quadrant closest to the ear region, which is frequently involved in Goldenhar-spectrum disorders.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1597,
    "Name": "Congenital CN IV palsy",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 12-year-old is being evaluated for a trochlear nerve palsy. Which finding would argue against a congenital (long-standing) trochlear nerve palsy?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003ESmall vertical fusional amplitudes.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003ECongenital trochlear nerve palsy is typically long-standing, so patients often develop \u003Cstrong\u003Ecompensatory mechanisms\u003C/strong\u003E over time. One common clue is a \u003Cstrong\u003Ehead tilt present in old photographs\u003C/strong\u003E, showing the abnormal posture existed for years. Long-term head tilt can also produce \u003Cstrong\u003Efacial asymmetry\u003C/strong\u003E from chronic posture during growth. Importantly, because the deviation has been present for a long time, these patients often develop \u003Cstrong\u003Elarge vertical fusional amplitudes\u003C/strong\u003E (they can \u201Cfuse through\u201D a larger vertical misalignment), which is a classic feature supporting a congenital palsy.\u003C/p\u003E\n\u003Cp\u003EBy contrast, \u003Cstrong\u003Esmall vertical fusional amplitudes\u003C/strong\u003E fit better with an \u003Cstrong\u003Eacquired\u003C/strong\u003E vertical deviation, where the patient has not had time to adapt and therefore cannot compensate well. Lack of recent head trauma may be reassuring, but it does not outweigh the key physiologic point that congenital cases usually show \u003Cstrong\u003Elarge\u003C/strong\u003E, not small, vertical fusional ranges.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1598,
    "Name": "Aniridia: characteristic corneal change",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 10-year-old with bilateral reduced vision and horizontal jerk nystagmus has minimal visible iris tissue on exam. Which corneal finding is most classically associated with this condition?\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-24-b0f06b84-3e89-473c-8440-90035166153e.png\u0022\u003E\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003ECorneal opacification.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThis presentation is most consistent with \u003Cstrong\u003Eaniridia\u003C/strong\u003E, where the iris is \u003Cstrong\u003Ehypoplastic rather than truly absent\u003C/strong\u003E and patients commonly have \u003Cstrong\u003Efoveal hypoplasia and nystagmus\u003C/strong\u003E, leading to reduced visual acuity. The corneal complication most characteristic of aniridia is a progressive \u003Cstrong\u003Eaniridia-associated keratopathy\u003C/strong\u003E, driven by \u003Cstrong\u003Elimbal stem cell deficiency\u003C/strong\u003E. Over time, this causes \u003Cstrong\u003Econjunctivalization, superficial vascularization, recurrent epithelial breakdown, and scarring\u003C/strong\u003E, which clinically appears as \u003Cstrong\u003Eprogressive corneal opacification\u003C/strong\u003E and can further reduce vision.\u003C/p\u003E\n\u003Cp\u003EThe other options fit different corneal disease patterns: \u003Cstrong\u003Eapical thinning with pain\u003C/strong\u003E suggests ectatic disease (e.g., keratoconus/hydrops), \u003Cstrong\u003Esevere corneal hypoesthesia\u003C/strong\u003E points toward neurotrophic causes, and \u003Cstrong\u003Ediffuse microcystic edema\u003C/strong\u003E is more typical of acute endothelial decompensation or acute IOP-related corneal edema rather than the classic long-term corneal problem in aniridia.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1599,
    "Name": "Over-elevation in adduction",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EIn an incomitant vertical deviation, which condition would not produce overelevation of the adducted eye?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EBrown syndrome.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EOverelevation in adduction\u003C/strong\u003E is most often linked to \u003Cstrong\u003Einferior oblique overaction\u003C/strong\u003E, commonly seen as a secondary finding when the \u003Cstrong\u003Esuperior oblique is weak\u003C/strong\u003E (so the eye elevates excessively in adduction). It can also be seen in settings where an apparent \u201Cupshoot\u201D in adduction becomes more noticeable, such as \u003Cstrong\u003Elarge-angle exotropia with a V-pattern tendency\u003C/strong\u003E, and craniofacial/orbital dysmorphism can predispose to \u003Cstrong\u003Eoblique dysfunction or pulley-related abnormalities\u003C/strong\u003E that mimic these patterns.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EBrown syndrome is the opposite problem\u003C/strong\u003E: it is a \u003Cstrong\u003Emechanical restriction of elevation in adduction\u003C/strong\u003E (classically involving the superior oblique tendon\u2013trochlea complex), so instead of an upshoot you expect a \u003Cstrong\u003Elimitation of upgaze in adduction\u003C/strong\u003E and often an appearance of \u003Cstrong\u003Erelative overdepression in adduction\u003C/strong\u003E, not overelevation.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1600,
    "Name": "Definition of a phoria",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich statement correctly defines a phoria?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EA latent deviation that becomes apparent when fusional control is disrupted.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EA \u003Cstrong\u003Ephoria\u003C/strong\u003E is a \u003Cstrong\u003Elatent (hidden) misalignment\u003C/strong\u003E that is normally \u003Cstrong\u003Ekept in check by binocular fusion\u003C/strong\u003E, so the eyes appear straight under ordinary binocular viewing. When fusion is \u003Cstrong\u003Ebroken\u003C/strong\u003E\u2014for example during \u003Cstrong\u003Ecover testing\u003C/strong\u003E\u2014the latent deviation \u003Cstrong\u003Eshows itself\u003C/strong\u003E, because the fusional mechanism is no longer holding the eyes aligned.\u003C/p\u003E\n\u003Cp\u003EBy contrast, a \u003Cstrong\u003Etropia\u003C/strong\u003E is a \u003Cstrong\u003Emanifest deviation\u003C/strong\u003E that is present even when both eyes are open, because fusion cannot fully control it. An intermittently manifest deviation under binocular conditions would be described as an \u003Cstrong\u003Eintermittent tropia\u003C/strong\u003E, not a phoria.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1601,
    "Name": "Lisch nodules and NF1",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA boy\u2019s slit-lamp exam shows multiple small iris lesions as shown in the photo. Which associated systemic/ocular statement is most likely true?\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-24-750192d5-a8c6-4992-a165-4fac0f1ffa9b.png\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EThis boy is at higher risk for pilocytic astrocytomas of the optic nerve.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThe photo shows \u003Cstrong\u003Emultiple iris melanocytic hamartomas (Lisch nodules)\u003C/strong\u003E, which are a classic ocular sign used in diagnosing \u003Cstrong\u003Eneurofibromatosis type 1 (NF1)\u003C/strong\u003E. \u003Cbr\u003E\nNF1 is strongly associated with \u003Cstrong\u003Eoptic pathway gliomas\u003C/strong\u003E, and these are most commonly \u003Cstrong\u003Epilocytic astrocytomas\u003C/strong\u003E occurring in childhood. \u003Cbr\u003E\nTherefore, the most likely true statement is that the child has increased risk of \u003Cstrong\u003Epilocytic astrocytoma involving the optic pathway/optic nerve\u003C/strong\u003E.\u0026nbsp;\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EPosterior subcapsular cataracts\u003C/strong\u003E are classically linked to \u003Cstrong\u003Eneurofibromatosis type 2 (NF2)\u003C/strong\u003E rather than NF1.\u0026nbsp;\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ESpontaneous hyphema\u003C/strong\u003E is a classic association of \u003Cstrong\u003Ejuvenile xanthogranuloma (JXG)\u003C/strong\u003E involving the iris, not Lisch nodules.\u0026nbsp;\u003C/li\u003E\n\u003Cli\u003ENF1 is typically \u003Cstrong\u003Eautosomal dominant\u003C/strong\u003E, not autosomal recessive.\u0026nbsp;\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1602,
    "Name": "Forceps Descemet tears",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EIn an infant with a Descemet membrane tear from forceps delivery, what is the most common reason for persistent long-term visual loss?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EAmblyopia.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EForceps-related \u003Cstrong\u003EDescemet membrane breaks\u003C/strong\u003E can cause \u003Cstrong\u003Eacute stromal/epithelial corneal edema\u003C/strong\u003E, but in many infants this corneal haze \u003Cstrong\u003Eimproves as endothelial function stabilizes\u003C/strong\u003E. The bigger long-term problem is that the scar/irregularity often induces \u003Cstrong\u003Esignificant astigmatism and anisometropia\u003C/strong\u003E, creating a chronic blur in one eye during the critical period of visual development. That sustained image degradation most commonly leads to \u003Cstrong\u003Erefractive amblyopia\u003C/strong\u003E, which becomes the main driver of lasting reduced vision unless it\u2019s detected early and treated with \u003Cstrong\u003Efull cycloplegic correction \u00B1 occlusion/penalization therapy\u003C/strong\u003E.\u003C/p\u003E\n\u003Cp\u003EWhy the other options are less likely as the \u003Cem\u003Emajor\u003C/em\u003E long-term cause:\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003ECorneal edema:\u003C/strong\u003E usually \u003Cstrong\u003Etransient\u003C/strong\u003E; persistent edema can occur if endothelial damage is severe, but it is not the typical main reason for long-term loss compared with amblyopia.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ESecondary glaucoma:\u003C/strong\u003E not a classic primary sequela of isolated Descemet tears from forceps; it can occur in other anterior segment/angle disorders but is not the usual outcome here.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EHyphema:\u003C/strong\u003E may occur with significant birth trauma but is typically \u003Cstrong\u003Eacute\u003C/strong\u003E and not the usual cause of permanent visual deficit in this scenario.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1603,
    "Name": "Monocular elevation deficiency (MED)",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA patient has monocular elevation deficiency of the left eye with a large hypotropia and chin-up posture. Forced duction testing shows no restriction. Which surgical procedure is most appropriate?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EKnapp procedure.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EMonocular elevation deficiency (formerly \u201Cdouble elevator palsy\u201D) has two main mechanisms:\u003C/p\u003E\n\u003Col\u003E\n\u003Cli\u003E\u003Cstrong\u003ERestrictive\u003C/strong\u003E: a \u003Cstrong\u003Etight inferior rectus\u003C/strong\u003E mechanically prevents elevation.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EParetic\u003C/strong\u003E: \u003Cstrong\u003Eweakness of the elevators\u003C/strong\u003E (superior rectus and/or inferior oblique) due to dysinnervation.\u003C/li\u003E\n\u003C/ol\u003E\n\u003Cp\u003E\u003Cstrong\u003EForced duction testing is the key fork in the road.\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EIf forced ductions are positive (restriction present)\u003C/strong\u003E \u2192 treat the restriction first, typically with \u003Cstrong\u003Einferior rectus recession\u003C/strong\u003E.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EIf forced ductions are negative (no restriction)\u003C/strong\u003E \u2192 the problem is most consistent with \u003Cstrong\u003Eelevator weakness\u003C/strong\u003E, and the preferred approach is a \u003Cstrong\u003Etransposition procedure\u003C/strong\u003E to \u201Cborrow\u201D vertical elevating force from functioning muscles.\u003C/li\u003E\n\u003C/ul\u003E\n\u003Cp\u003EThat is exactly what the \u003Cstrong\u003EKnapp procedure\u003C/strong\u003E does: it \u003Cstrong\u003Etransposes the medial and lateral rectus muscles superiorly\u003C/strong\u003E (toward the superior rectus insertion) to augment elevation and improve the hypotropia and chin-up posture in the \u003Cstrong\u003Enon-restrictive\u003C/strong\u003E form of MED.\u003C/p\u003E\n\u003Cp\u003EWhy the other options are wrong:\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EHarada\u2013Ito\u003C/strong\u003E: designed to treat \u003Cstrong\u003Etorsional diplopia/excyclotorsion\u003C/strong\u003E (selective anterior superior oblique tendon tightening), not a primary elevation deficit.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ESuperior oblique spacer\u003C/strong\u003E: used for \u003Cstrong\u003EBrown syndrome\u003C/strong\u003E (restriction of elevation in adduction due to tight SO tendon\u2013trochlea complex), not MED.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EInferior rectus recession\u003C/strong\u003E: correct \u003Cstrong\u003Eonly if the inferior rectus is tight\u003C/strong\u003E (positive forced ductions). Here forced ductions are negative, so IR recession is not the best match.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1604,
    "Name": "Cogan lid twitch",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 45-year-old with one week of diplopia has a characteristic upper lid \u201Ctwitch\u201D/overshoot when returning to primary gaze after looking down. Which test would confirm the suspected diagnosis?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EAnti\u2011MuSK antibody test.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThe \u201Covershoot\u201D of the upper lid when returning to primary gaze after sustained downgaze is \u003Cstrong\u003ECogan lid twitch\u003C/strong\u003E, a classic bedside sign of \u003Cstrong\u003Eocular myasthenia gravis (OMG)\u003C/strong\u003E. OMG causes \u003Cstrong\u003Efatigable weakness\u003C/strong\u003E of extraocular muscles (diplopia) and often eyelid muscles (ptosis), and confirmation is supported by \u003Cstrong\u003Emyasthenia autoantibody testing\u003C/strong\u003E. Among the options, \u003Cstrong\u003Eanti\u2011MuSK antibodies\u003C/strong\u003E are a recognized confirmatory serologic test for myasthenia.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other options are wrong:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003EMRI/MRA Circle of Willis: aimed at aneurysm/vascular lesions; that would fit a painful CN III palsy workup, not a \u003Cstrong\u003Efatigable ocular motility disorder with Cogan lid twitch\u003C/strong\u003E.\u003C/li\u003E\n\u003Cli\u003EAnti\u2011thyrotropin receptor antibodies: support \u003Cstrong\u003Ethyroid eye disease\u003C/strong\u003E, which is typically restrictive and non\u2011fatigable, and does not produce Cogan lid twitch.\u003C/li\u003E\n\u003Cli\u003EEKG: not a diagnostic test for the cause of this ocular sign (though systemic MG can have other evaluations, EKG is not confirmatory for OMG).\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 8,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1605,
    "Name": "CN VI palsy: why secondary deviation \u003E primary deviation",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA patient has a right abducens (CN VI) palsy. The deviation is smaller when the left (normal) eye fixates and larger when the right (paretic) eye fixates. What principle explains this?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EThe secondary deviation is larger than the primary deviation because of Hering\u2019s law.\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EPrimary deviation\u003C/strong\u003E is measured while the \u003Cstrong\u003Enormal (left) eye fixates\u003C/strong\u003E; the paretic right eye is allowed to assume its underacting position, so the deviation you measure is relatively smaller.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ESecondary deviation\u003C/strong\u003E is measured while the \u003Cstrong\u003Eparetic (right) eye fixates\u003C/strong\u003E. To force the weak right lateral rectus to abduct enough to fixate, the brain increases innervation to that muscle.\u003C/li\u003E\n\u003Cli\u003EBy \u003Cstrong\u003EHering\u2019s law of equal innervation\u003C/strong\u003E, the increased drive sent to the weak right lateral rectus is \u003Cstrong\u003Ealso sent to its yoke muscle\u003C/strong\u003E in the fellow eye (the \u003Cstrong\u003Eleft medial rectus\u003C/strong\u003E). That extra left medial rectus activation pulls the left eye further inward, making the measured misalignment \u003Cstrong\u003Elarger\u003C/strong\u003E.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "CategoryId": 10,
    "Category": null,
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  },
  {
    "Id": 1606,
    "Name": "Orbital rhabdomyosarcoma",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich finding is least likely to be a presenting feature of orbital rhabdomyosarcoma?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-size: 14px; font-weight: 400; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EPain.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EOrbital rhabdomyosarcoma most often presents with \u003Cstrong\u003Erapid-onset proptosis\u003C/strong\u003E and \u003Cstrong\u003Eglobe displacement\u003C/strong\u003E due to \u003Cstrong\u003Emass effect\u003C/strong\u003E, frequently accompanied by \u003Cstrong\u003Eeyelid edema and conjunctival chemosis\u003C/strong\u003E from orbital congestion. \u003Cstrong\u003EPain is comparatively uncommon\u003C/strong\u003E at presentation and tends to occur only in a minority of cases (for example, if there is secondary inflammation or significant pressure effects), making it the \u003Cstrong\u003Eleast likely\u003C/strong\u003E among the listed options.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E\u003C/h3\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1607,
    "Name": "Extraocular muscle innervation",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich statement about extraocular muscle innervation is incorrect?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003Ethe nerves to the recti and superior oblique enter at two\u2011thirds of the distance from origin to insertion.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EFor the \u003Cstrong\u003Erectus muscles and the superior oblique\u003C/strong\u003E, the motor nerves typically enter the muscle belly \u003Cstrong\u003Emuch closer to the origin\u2014about the posterior one\u2011third\u003C/strong\u003E, not two\u2011thirds of the way toward the insertion. This is why \u003Cstrong\u003Eanterior segment surgery near the insertion is unlikely to injure these motor nerves\u003C/strong\u003E, whereas a deep posterior instrument/needle can.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other choices are true:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003ECN IV lies outside the muscle cone\u003C/strong\u003E, so a standard retrobulbar block (within the cone) is \u003Cstrong\u003Eless likely\u003C/strong\u003E to affect superior oblique function. (Not impossible if the needle/volume tracks unusually, but the anatomic principle is correct.)\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EInferior oblique nerve injury can cause pupillary abnormalities\u003C/strong\u003E because the \u003Cstrong\u003Eparasympathetic fibers destined for the ciliary ganglion\u003C/strong\u003E travel with the \u003Cstrong\u003Einferior division of CN III\u003C/strong\u003E and run with the branch that supplies the \u003Cstrong\u003Einferior oblique\u003C/strong\u003E\u2014so injury can produce a \u003Cstrong\u003Epersistently dilated pupil\u003C/strong\u003E.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EThe nerve to the inferior oblique enters laterally\u003C/strong\u003E as it crosses near the inferior rectus region, making the \u201Clateral entry\u201D description correct.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1608,
    "Name": "Oculocardiac reflex: highest-risk muscle",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EDuring strabismus surgery, traction on which extraocular muscle most commonly triggers the oculocardiac reflex?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EMedial rectus.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThe \u003Cstrong\u003Eoculocardiac reflex\u003C/strong\u003E is a trigemino\u2011vagal reflex: \u003Cstrong\u003Etraction on an extraocular muscle\u003C/strong\u003E (or pressure on the globe) sends afferent signals via the \u003Cstrong\u003Etrigeminal nerve (V1)\u003C/strong\u003E to the brainstem, which then triggers increased \u003Cstrong\u003Evagal output\u003C/strong\u003E, producing \u003Cstrong\u003Ebradycardia\u003C/strong\u003E and in severe cases \u003Cstrong\u003Earrhythmias or asystole\u003C/strong\u003E. \u003Cstrong\u003EMedial rectus traction\u003C/strong\u003E is classically the most likely to provoke this reflex during strabismus surgery.\u003C/p\u003E\n\u003Cp\u003EIf bradycardia occurs, the immediate first step is to \u003Cstrong\u003Estop traction/release the muscle\u003C/strong\u003E, and if significant or persistent, treat with an anticholinergic such as \u003Cstrong\u003EIV atropine\u003C/strong\u003E (and optimize oxygenation/anesthetic depth).\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1609,
    "Name": "Phakomatoses: tumor suppressor gene \u201CNOT\u201D question",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich listed condition is not typically caused by a tumor suppressor gene mutation?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EEncephalotrigeminal angiomatosis (Sturge\u2013Weber syndrome).\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EVon Recklinghausen disease = Neurofibromatosis type 1 (NF1)\u003C/strong\u003E, which is caused by mutation of \u003Cstrong\u003ENF1\u003C/strong\u003E, a classic \u003Cstrong\u003Etumor suppressor\u003C/strong\u003E gene.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EVon Hippel\u2013Lindau disease\u003C/strong\u003E is due to mutation in \u003Cstrong\u003EVHL\u003C/strong\u003E, also a \u003Cstrong\u003Etumor suppressor\u003C/strong\u003E gene.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ERetinoblastoma\u003C/strong\u003E is the prototype \u003Cstrong\u003Etumor suppressor\u003C/strong\u003E disease (mutation in \u003Cstrong\u003ERB1\u003C/strong\u003E).\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EEncephalotrigeminal angiomatosis = Sturge\u2013Weber syndrome\u003C/strong\u003E is typically a \u003Cstrong\u003Esporadic vascular malformation syndrome\u003C/strong\u003E, not classically grouped with inherited tumor suppressor gene disorders.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1610,
    "Name": "TAO restrictive esotropia",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA patient with thyroid-associated orbitopathy has horizontal diplopia and a CT showing extraocular muscle enlargement. The motility grid shows esotropia that is largest in right gaze and smaller in primary and left gaze. Which strabismus surgery plan is most appropriate?\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-24-8d58201b-5e3e-4e79-b8db-b7f6e0f114a8.png\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-24-8cb4f6da-d2a1-4cbf-a8cd-e42bd69e218d.png\u0022 style=\u0022color: rgb(66, 66, 66); font-family: Roboto, Helvetica, Arial, \u0026quot;sans-serif\u0026quot;; letter-spacing: 0.14994px;\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003ERight medial rectus recession.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EIn thyroid-associated orbitopathy, the misalignment is typically \u003Cstrong\u003Erestrictive\u003C/strong\u003E, not paretic. The enlarged, fibrotic muscle \u003Cstrong\u003Etethers the globe toward its field of action\u003C/strong\u003E, and the deviation becomes worse when the patient tries to look \u003Cstrong\u003Eaway\u003C/strong\u003E from the restricted muscle.\u003C/p\u003E\n\u003Cp\u003EHere, the esotropia is \u003Cstrong\u003Emuch larger in right gaze\u003C/strong\u003E than in primary and left gaze. Right gaze requires \u003Cstrong\u003Eabduction of the right eye\u003C/strong\u003E. A tight \u003Cstrong\u003Eright medial rectus\u003C/strong\u003E limits right eye abduction, so when the patient attempts right gaze the right eye cannot abduct adequately and the measured \u003Cstrong\u003Eesotropia increases\u003C/strong\u003E, matching the grid pattern. Therefore, the correct surgical strategy is to \u003Cstrong\u003Erecess (weaken) the tight, restricted muscle\u003C/strong\u003E, which is the \u003Cstrong\u003Eright medial rectus\u003C/strong\u003E.\u003C/p\u003E\n\u003Cp\u003EWhy the other choices are wrong:\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003ERight lateral rectus resection\u003C/strong\u003E and \u003Cstrong\u003Ebilateral lateral rectus resection\u003C/strong\u003E are \u003Cstrong\u003Estrengthening\u003C/strong\u003E procedures. In restrictive TAO strabismus, \u003Cstrong\u003Eresection is generally avoided\u003C/strong\u003E because it can worsen restriction and create unpredictable outcomes; the main goal is to \u003Cstrong\u003Erelease restriction\u003C/strong\u003E, not \u201Cboost\u201D the antagonist.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ELeft medial rectus recession\u003C/strong\u003E would address a left medial rectus restriction pattern (typically making deviation worse in left gaze), which does \u003Cstrong\u003Enot\u003C/strong\u003E fit this grid where the deviation is worst in \u003Cstrong\u003Eright\u003C/strong\u003E gaze.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1611,
    "Name": "AKC vs VKC",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich clinical feature most helps tell atopic keratoconjunctivitis apart from vernal keratoconjunctivitis?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EAKC also involves the inferior palpebral conjunctiva.\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EAKC classically involves the lower lid (inferior palpebral/tarsal) conjunctiva\u003C/strong\u003E and can have more chronic, year\u2011round disease tied to atopic dermatitis. This lower-lid involvement is a useful \u201Cexam differentiator.\u201D\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EVKC more classically targets the upper tarsus (giant papillae) and/or limbus\u003C/strong\u003E, often in a seasonal pattern.\u003C/li\u003E\n\u003C/ul\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other choices are less helpful:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003ESeasonality\u003C/strong\u003E is more characteristic of \u003Cstrong\u003EVKC\u003C/strong\u003E, not AKC.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EIntense itching and redness\u003C/strong\u003E occur in \u003Cstrong\u003Eboth\u003C/strong\u003E AKC and VKC.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EMale predominance\u003C/strong\u003E is more typical of \u003Cstrong\u003EVKC\u003C/strong\u003E (often boys/young males).\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1612,
    "Name": "Avoiding anterior segment ischemia while correcting hypertropia",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EAn elderly diabetic patient will only allow surgery on one eye. You plan a lateral rectus recession and medial rectus resection for a large exotropia, and you also want to address a right hypertropia. Which additional procedure is least likely to cause anterior segment ischemia while also helping the hypertropia?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EInferior oblique myectomy.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EAnterior segment ischemia risk rises when multiple rectus muscles are operated in the same eye\u003C/strong\u003E, because the anterior segment circulation is largely supported by anterior ciliary arteries traveling with the rectus muscles. In an \u003Cstrong\u003Eelderly diabetic\u003C/strong\u003E (vascular risk), doing surgery on a third rectus muscle in the same sitting is particularly undesirable.\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003ESuperior rectus recession\u003C/strong\u003E and \u003Cstrong\u003Einferior rectus resection\u003C/strong\u003E can help a hypertropia, but each would make this a \u003Cstrong\u003Ethree-rectus operation\u003C/strong\u003E in one eye (lateral rectus \u002B medial rectus \u002B another rectus), \u003Cstrong\u003Eincreasing ischemia risk\u003C/strong\u003E.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ESuperior oblique tenotomy\u003C/strong\u003E weakens a depressor/intorter; weakening it would typically \u003Cstrong\u003Eworsen a hypertropia\u003C/strong\u003E rather than treat it.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EInferior oblique myectomy\u003C/strong\u003E is an \u003Cstrong\u003Eoblique muscle procedure\u003C/strong\u003E, so it \u003Cstrong\u003Edoes not add another rectus muscle\u003C/strong\u003E to the operation (therefore \u003Cstrong\u003Eminimizing anterior segment ischemia risk\u003C/strong\u003E) and it can \u003Cstrong\u003Ereduce a hypertropia\u003C/strong\u003E when the inferior oblique is contributing (e.g., overelevation in adduction).\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1613,
    "Name": "Post\u2011trauma depression deficit without entrapment",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 10-year-old has facial trauma with reduced depression of the right eye. Forced ductions are negative and CT shows no muscle entrapment. What is the best management approach?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EObservation.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EWith a depression deficit after trauma, the first task is to decide whether this is \u003Cstrong\u003Erestrictive entrapment\u003C/strong\u003E (which needs urgent release) or a \u003Cstrong\u003Eparetic/contusional weakness\u003C/strong\u003E (which often improves spontaneously). The key findings here are \u003Cstrong\u003Enegative forced ductions\u003C/strong\u003E and \u003Cstrong\u003Eno entrapment on CT\u003C/strong\u003E, which strongly support \u003Cstrong\u003Einferior rectus weakness/contusion\u003C/strong\u003E rather than mechanical tethering. In that setting, the most appropriate initial strategy is \u003Cstrong\u003Ewatchful waiting\u003C/strong\u003E, because post-traumatic muscle/nerve dysfunction frequently \u003Cstrong\u003Erecovers over time\u003C/strong\u003E as edema and neuropraxia resolve.\u003C/p\u003E\n\u003Cp\u003EImmediate exploration is reserved for scenarios suggesting \u003Cstrong\u003Etrue entrapment\u003C/strong\u003E (restriction on forced ductions, classic trapdoor fracture with oculocardiac symptoms, or imaging/clinical evidence of incarceration). Steroids are not the routine first-line solution when the primary issue is an isolated motility weakness without restriction. Definitive strabismus surgery (such as strengthening the depressed action or weakening the antagonist) is typically deferred until the deviation is \u003Cstrong\u003Estable\u003C/strong\u003E and \u003Cstrong\u003Espontaneous recovery has plateaued\u003C/strong\u003E, commonly over a period of months.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1614,
    "Name": "Facial angiofibromas",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA child has facial lesions as shown. Which retinal lesion is classically associated with the underlying syndrome?\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-25-35be0a37-00c9-4b93-99b5-5bdb4ebbcfa3.png\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003ERetinal astrocytoma.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThe facial lesion shown is most consistent with \u003Cstrong\u003Efacial angiofibromas (formerly \u201Cadenoma sebaceum\u201D)\u003C/strong\u003E, which are a classic cutaneous manifestation of \u003Cstrong\u003Etuberous sclerosis complex (TSC)\u003C/strong\u003E. TSC is a phakomatosis characterized by hamartomas in multiple organs, and the characteristic retinal lesion is the \u003Cstrong\u003Eretinal astrocytic hamartoma (retinal astrocytoma)\u003C/strong\u003E.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other choices are less fitting:\u003C/strong\u003E capillary hemangioma is more typical of infantile hemangioma syndromes; cavernous hemangioma can be sporadic or associated with cerebral cavernous malformations; and proliferative retinal vasculopathy is not the classic retinal hallmark of TSC.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1615,
    "Name": "A\u2011pattern XT",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EIn an A\u2011pattern exotropia (with mild excyclotorsion) managed using a recess\u2013resect procedure, how should the horizontal rectus muscles be vertically transposed?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EMedial rectus resection displaced superiorly \u002B lateral rectus recession displaced inferiorly.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EFor \u003Cstrong\u003EA\u2011pattern\u003C/strong\u003E deviations, the goal of vertical transposition of the horizontal recti is to shift the horizontal muscle vectors in a way that \u003Cstrong\u003Ereduces the greater deviation in upgaze\u003C/strong\u003E (the \u201CA\u201D opens superiorly). The classic rule is:\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003E\u201CMALE\u201D = Medials to the Apex, Laterals to the Empty space.\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003EIn an \u003Cstrong\u003EA\u2011pattern\u003C/strong\u003E, the \u003Cstrong\u003Eapex is superior\u003C/strong\u003E (the narrow part of the \u201CA\u201D is in downgaze and the wider part is in upgaze).\u003C/li\u003E\n\u003Cli\u003ETherefore, place the \u003Cstrong\u003Emedial rectus (strengthening/resection) superiorly\u003C/strong\u003E (toward the apex) and place the \u003Cstrong\u003Elateral rectus (weakening/recession) inferiorly\u003C/strong\u003E (toward the \u201Cempty/open\u201D part).\u003C/li\u003E\n\u003Cli\u003EThis combination both addresses the exotropia (recess\u2013resect) and collapses the A\u2011pattern by appropriate vertical offsets.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1616,
    "Name": "Partially accommodative ET",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 2-year-old with moderate hyperopia has an esotropia that improves but does not fully resolve with full cycloplegic correction (residual 25\u0394 at distance and near). Before bilateral medial rectus recessions, what is the best counseling about the goal of surgery?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EThe objective of this surgery is to produce straight eyes with glasses on.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThis child has \u003Cstrong\u003Epartially accommodative esotropia\u003C/strong\u003E: full hyperopic correction reduces the deviation (from 45\u0394 to 25\u0394), but a \u003Cstrong\u003Eresidual non-accommodative component\u003C/strong\u003E remains. \u003Cstrong\u003EStrabismus surgery in this setting targets that residual deviation while the child is wearing the full plus correction.\u003C/strong\u003E It is \u003Cstrong\u003Enot\u003C/strong\u003E intended to \u201Ccure\u201D the refractive error or eliminate the need for glasses. After surgery, the child typically \u003Cstrong\u003Estill needs the hyperopic spectacles\u003C/strong\u003E to keep the accommodative component controlled and to maintain alignment.\u003C/p\u003E\n\u003Cp\u003EWhy the other choices are wrong:\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003ESaying the child won\u2019t need glasses after surgery is incorrect because the underlying hyperopia and accommodative component persist.\u003C/li\u003E\n\u003Cli\u003EThe goal is not straight eyes with glasses off; removing glasses would reintroduce accommodative demand and likely bring back a larger esotropia.\u003C/li\u003E\n\u003Cli\u003EBifocals are used mainly for \u003Cstrong\u003Ehigh AC/A (near deviation \u0026gt; distance)\u003C/strong\u003E; here distance and near residual deviations are the same (25\u0394 and 25\u0394\u2032), so bifocals are not the expected next step.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1617,
    "Name": "PHACES (S1 hemangioma \u002B morning glory)",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 2\u2011month\u2011old has a large segment 1 facial hemangioma (\u0026gt;5 cm) and morning glory disc anomaly. What associated abnormality is most likely on further workup?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EIpsilateral cerebrovascular abnormalities.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\u003C!--StartFragment--\u003E\u003C!--EndFragment--\u003E\u003C/p\u003E\u003Cdiv style=\u0022font-family:\u0027Segoe UI\u0027;font-size:14px;font-style:normal;font-weight:400;line-height:20px\u0022\u003E\u003Cp\u003EA large \u003Cstrong\u003Esegment 1 (frontotemporal) facial hemangioma\u003C/strong\u003E in an infant strongly suggests \u003Cstrong\u003EPHACES syndrome\u003C/strong\u003E, a neurocutaneous association defined by:\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EP\u003C/strong\u003Eosterior fossa malformations\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EH\u003C/strong\u003Eemangioma (typically large, segmental facial)\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EA\u003C/strong\u003Erterial anomalies (especially cervicocerebral)\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EC\u003C/strong\u003Eardiac defects (and/or coarctation)\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EE\u003C/strong\u003Eye abnormalities\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ES\u003C/strong\u003Eternal clefting / supraumbilical raphe\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003Cp\u003Ethe \u201CA\u201D stands for \u003Cstrong\u003Earterial abnormalities\u003C/strong\u003E, and segment 1 hemangiomas are particularly linked to \u003Cstrong\u003Eipsilateral cerebrovascular anomalies\u003C/strong\u003E such as \u003Cstrong\u003Earterial hypoplasia, stenosis/occlusion, aberrant arterial origin, progressive vasculopathy, or aneurysms\u003C/strong\u003E. The added finding of \u003Cstrong\u003Emorning glory disc anomaly\u003C/strong\u003E is an important \u003Cstrong\u003Eeye abnormality\u003C/strong\u003E that further supports PHACES and increases the need for \u003Cstrong\u003Eneurovascular imaging\u003C/strong\u003E.\u003C/p\u003E\n\u003Cp\u003EWhy the other options are less likely:\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EDilated/tortuous episcleral vessels\u003C/strong\u003E is more suggestive of conditions with elevated episcleral venous pressure (e.g., certain glaucomas/vascular syndromes).\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EChoroidal hemangioma\u003C/strong\u003E is classically linked with \u003Cstrong\u003ESturge\u2013Weber syndrome.\u003C/strong\u003E\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EVentral/midline cleft\u003C/strong\u003E and cardiac defects can occur in PHACES, but \u003Cstrong\u003Esegment 1\u003C/strong\u003E hemangiomas most characteristically point to \u003Cstrong\u003Earterial/cerebrovascular abnormalities\u003C/strong\u003E on the same side.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1618,
    "Name": "Duane syndrome",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich statement is false about Duane syndrome?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EIn most anatomical and imaging studies, the nucleus of the third cranial nerve is absent.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EDuane syndrome is a congenital cranial dysinnervation disorder primarily involving the abducens system.\u003C/strong\u003E The classic neuroanatomy is \u003Cstrong\u003Eabsent or hypoplastic CN VI (abducens) nucleus/nerve\u003C/strong\u003E, with \u003Cstrong\u003Eaberrant innervation of the lateral rectus by branches of CN III\u003C/strong\u003E, leading to co-contraction of medial and lateral rectus on attempted adduction and the characteristic \u003Cstrong\u003Eglobe retraction and palpebral fissure narrowing\u003C/strong\u003E. Therefore, saying the \u003Cstrong\u003ECN III nucleus is absent\u003C/strong\u003E is the incorrect statement; it is the \u003Cstrong\u003ECN VI nucleus/nerve\u003C/strong\u003E that is typically absent/hypoplastic.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1619,
    "Name": "PEDIG ATS: what helps in stable residual amblyopia?",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EIn children with stable residual amblyopia despite standard treatment, which PEDIG Amblyopia Treatment Study strategy has been shown to produce a meaningful additional improvement in visual acuity?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EIncreased patching to 6 hours in patients previously patching 2 hours per day.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EStable residual amblyopia\u003C/strong\u003E means the child has already had an initial response to treatment (glasses \u00B1 patching/atropine) but then \u003Cstrong\u003Eplateaus\u003C/strong\u003E. In PEDIG\u2019s ATS work, the approach that consistently produced \u003Cstrong\u003Estatistically significant additional gain\u003C/strong\u003E was \u003Cstrong\u003Eescalating patching from 2 hours/day to 6 hours/day\u003C/strong\u003E in children who were still amblyopic despite 2-hour patching. This makes sense clinically: if the child is plateaued on a low \u201Cdose,\u201D increasing the \u201Cdose\u201D can recruit more improvement before considering more invasive or less proven add-ons.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other options don\u2019t best fit ATS evidence for improved acuity:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003ELevodopa \u002B carbidopa\u003C/strong\u003E was studied as an adjunct but did \u003Cstrong\u003Enot\u003C/strong\u003E show a clinically meaningful advantage over placebo in the relevant ATS trial population.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EAdding a plano lens to atropine penalization\u003C/strong\u003E may increase blur in the sound eye, but the study results did \u003Cstrong\u003Enot\u003C/strong\u003E demonstrate a clearly significant benefit over atropine alone for stable residual amblyopia.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1620,
    "Name": "Congenital (infantile) esotropia",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 6\u2011month\u2011old has congenital/infantile esotropia. Which associated finding is commonly seen with this condition?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: Latent nystagmus.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EInfantile (congenital) esotropia\u003C/strong\u003E is classically associated with the \u201Cinfantile strabismus complex,\u201D which commonly includes \u003Cstrong\u003Elatent nystagmus (fusion maldevelopment nystagmus), dissociated vertical deviation (DVD), and inferior oblique overaction\u003C/strong\u003E, along with cross-fixation. Because the deviation begins early (by ~6 months), binocular fusion development is disrupted, making \u003Cstrong\u003Elatent nystagmus\u003C/strong\u003E a frequent accompanying finding.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other choices are wrong:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EHigh refractive error (\u0026gt; \u002B4.00 D OU):\u003C/strong\u003E Infantile esotropia usually has \u003Cstrong\u003Elow to moderate hyperopia\u003C/strong\u003E; marked hyperopia with ET is more suggestive of \u003Cstrong\u003Erefractive accommodative esotropia\u003C/strong\u003E rather than true infantile ET.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EA-pattern:\u003C/strong\u003E When a pattern is present in infantile esotropia, it is more often a \u003Cstrong\u003EV-pattern\u003C/strong\u003E due to \u003Cstrong\u003Einferior oblique overaction\u003C/strong\u003E, not an A-pattern.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ESmall angle (\u0026lt;15 PD):\u003C/strong\u003E Infantile esotropia is typically a \u003Cstrong\u003Elarge-angle, constant deviation\u003C/strong\u003E (often ~35\u201350 PD or more), not a small-angle deviation.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1621,
    "Name": "Aphakic glaucoma risk",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich child has the greatest risk of developing aphakic glaucoma after pediatric cataract surgery?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003E10-year-old child with microcornea who underwent cataract surgery at age 1 year.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThe two strongest predictors for aphakic (post\u2013congenital cataract surgery) glaucoma are:\u003C/p\u003E\n\u003Col\u003E\n\u003Cli\u003E\u003Cstrong\u003EYounger age at surgery\u003C/strong\u003E, especially surgery performed in \u003Cstrong\u003Einfancy/first year of life\u003C/strong\u003E, and\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EAbnormal anterior segment anatomy\u003C/strong\u003E, with \u003Cstrong\u003Emicrocornea\u003C/strong\u003E being a classic high\u2011risk marker.\u003C/li\u003E\n\u003C/ol\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy this option is highest risk:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EInfant surgery\u003C/strong\u003E: The earlier the cataract is removed, the higher the long-term glaucoma risk\u2014often presenting \u003Cstrong\u003Eyears later\u003C/strong\u003E, so a 10\u2011year\u2011old who had surgery at \u003Cstrong\u003E1 year\u003C/strong\u003E is in the window where glaucoma can manifest.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EMicrocornea\u003C/strong\u003E: A smaller cornea often signals broader anterior segment dysgenesis/angle vulnerability, which increases the likelihood of later aqueous outflow problems and glaucoma.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1622,
    "Name": "40\u0394 basic exotropia",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA patient has a comitant, freely alternating exotropia measuring 40 prism diopters at both distance and near on repeat exams. Which surgical plan most appropriately corrects this deviation?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EBilateral lateral rectus recession of 8 mm.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EA 40\u0394 exotropia is a moderate-to-large deviation, and standard \u201Cvirgin muscle\u201D dosing typically requires a large bilateral weakening of the lateral recti (often around 8\u20139 mm each).\u003C/strong\u003E A bilateral plan is preferred because it is \u003Cstrong\u003Esymmetric\u003C/strong\u003E, tends to be \u003Cstrong\u003Emore predictable\u003C/strong\u003E for comitant deviations, and avoids creating excessive unilateral limitation in abduction that can happen with very large single-muscle surgery.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other plans are less appropriate:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EBilateral lateral rectus recession of 5 mm\u003C/strong\u003E is usually appropriate for smaller exotropias; for 40\u0394 it would be expected to \u003Cstrong\u003Eundercorrect\u003C/strong\u003E (insufficient weakening).\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EBilateral medial rectus resection of 5 mm\u003C/strong\u003E strengthens adduction bilaterally and can correct exotropia, but for a typical \u201Cbasic\u201D 40\u0394 deviation, surgeons more commonly start with \u003Cstrong\u003Ebilateral lateral rectus recessions\u003C/strong\u003E as the primary symmetric weakening approach; resections can be used in other strategies but this option is not the best \u201Cstandard\u201D match here.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EUnilateral lateral rectus recession of 12 mm\u003C/strong\u003E is an unusually large single-muscle recession and risks \u003Cstrong\u003Esignificant abduction limitation\u003C/strong\u003E and postoperative incomitance; large deviations are generally managed by operating on \u003Cstrong\u003Etwo horizontal muscles\u003C/strong\u003E rather than pushing one muscle to an extreme dose.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 1623,
    "Name": "Oblique muscles: anatomy \u201CEXCEPT\u201D question",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich statement about the superior and inferior oblique muscles is not correct?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EBoth the superior and inferior oblique muscles pass closer to the globe than their respective recti muscles.\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003ESuperior oblique:\u003C/strong\u003E its tendon passes through the trochlea and then courses \u003Cstrong\u003Eclose to the globe\u003C/strong\u003E, and clinically it\u2019s often described as passing closer to the globe than the \u003Cstrong\u003Esuperior rectus\u003C/strong\u003E.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EInferior oblique:\u003C/strong\u003E however, \u003Cstrong\u003Edoes not\u003C/strong\u003E pass closer to the globe than the \u003Cstrong\u003Einferior rectus\u003C/strong\u003E\u2014it runs \u003Cstrong\u003Emore inferiorly (farther from the globe) relative to the inferior rectus\u003C/strong\u003E.\u003Cbr\u003E\u003C/li\u003E\u003C/ul\u003E\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EOrigins:\u003C/strong\u003E the superior oblique originates near the sphenoid (not from the annulus of Zinn) and the inferior oblique originates from the anterior medial orbital floor (also not the annulus) .\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1624,
    "Name": "Skull base suture fusion ",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EPremature closure of sutures at the skull base leads to which craniofacial abnormality?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EMidface hypoplasia.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EPremature fusion of \u003Cstrong\u003Eskull base sutures\u003C/strong\u003E primarily affects \u003Cstrong\u003Efacial growth\u003C/strong\u003E, especially the \u003Cstrong\u003Emaxilla and midface\u003C/strong\u003E, producing \u003Cstrong\u003Emidface hypoplasia\u003C/strong\u003E (a retruded midface). In contrast, premature fusion of the \u003Cstrong\u003Ecalvarial sutures\u003C/strong\u003E (coronal, sagittal, metopic, lambdoid) alters the \u003Cstrong\u003Eshape of the cranial vault\u003C/strong\u003E, producing head-shape deformities such as \u003Cstrong\u003Eplagiocephaly\u003C/strong\u003E or \u003Cstrong\u003Escaphocephaly\u003C/strong\u003E.\u003C/p\u003E\n\u003Cp\u003EHypertelorism and telecanthus are \u003Cstrong\u003Edistance descriptors\u003C/strong\u003E rather than primary \u201Ccranial malformation names\u201D:\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EHypertelorism\u003C/strong\u003E = increased bony orbital separation / increased interpupillary distance.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ETelecanthus\u003C/strong\u003E = increased distance between the \u003Cstrong\u003Emedial canthi\u003C/strong\u003E (can be due to hypertelorism or soft-tissue causes).\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1625,
    "Name": "Monofixation syndrome",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich clinical finding would essentially exclude (rule out) monofixation syndrome?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003E60 seconds of arc of stereoacuity.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EMonofixation syndrome is a sensory adaptation characterized by \u003Cstrong\u003Eperipheral fusion with a central suppression scotoma\u003C/strong\u003E, meaning the patient generally lacks \u003Cstrong\u003Ebifoveal (bimacular) fusion\u003C/strong\u003E. As a result, stereoacuity is usually \u003Cstrong\u003Ereduced (coarse)\u003C/strong\u003E\u2014commonly in the \u003Cstrong\u003Ehundreds to thousands of seconds of arc\u003C/strong\u003E, not fine stereopsis. Therefore, \u003Cstrong\u003E60 arcsec\u003C/strong\u003E implies \u003Cstrong\u003Egood/fine stereopsis\u003C/strong\u003E, which essentially \u003Cstrong\u003Erules out monofixation syndrome\u003C/strong\u003E.\u003C/p\u003E\n\u003Cp\u003EWhy the other choices fit monofixation rather than exclude it:\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EPeripheral fusion\u003C/strong\u003E is actually a defining feature of monofixation.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EAbsence of bimacular fusion\u003C/strong\u003E is expected because of the central scotoma.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ESeeing only 2 lights at distance on Worth 4-dot\u003C/strong\u003E can occur because the distance target projects more centrally and falls within the suppression zone, leading to a non-fusion response; near testing often improves because the stimulus subtends a larger angle and can be fused peripherally.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1626,
    "Name": "Mechanical origin of the superior rectus",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich structure functions as the mechanical (functional) origin of the superior rectus muscle?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EDense collagen surrounding extraocular muscles.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003C!--StartFragment--\u003E\u003C!--EndFragment--\u003E\u003C/p\u003E\u003Cdiv style=\u0022font-family:\u0027Segoe UI\u0027;font-size:14px;font-style:normal;font-weight:400;line-height:20px\u0022\u003E\u003Cp\u003EThe \u003Cstrong\u003Esuperior rectus is a rectus muscle\u003C/strong\u003E, and the rectus muscles do not behave mechanically as if they \u201Cpull\u201D directly from their anatomic origin at the annulus of Zinn. Instead, their effective line of action is guided by a \u003Cstrong\u003Efibroelastic pulley system\u003C/strong\u003E\u2014rings/sleeves of \u003Cstrong\u003Edense connective tissue\u003C/strong\u003E surrounding each rectus muscle. These pulleys act as the \u003Cstrong\u003Efunctional (mechanical) origin\u003C/strong\u003E because they redirect and stabilize the muscle path, largely determining the direction of force applied to the globe during eye movements.\u003C/p\u003E\n\u003Cp\u003EWhy the other options are not correct:\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003ETrochlea\u003C/strong\u003E is the functional pulley/mechanical origin of the \u003Cstrong\u003Esuperior oblique\u003C/strong\u003E, not the superior rectus.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ELockwood\u2019s ligament\u003C/strong\u003E is the main suspensory ligament of the globe and is more relevant to the \u003Cstrong\u003Einferior rectus/inferior oblique complex\u003C/strong\u003E and lower lid support, not the superior rectus\u2019 mechanical origin.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EWhitnall\u2019s ligament\u003C/strong\u003E is a key support structure for the \u003Cstrong\u003Elevator palpebrae superioris\u003C/strong\u003E (acts as a sling/pulley for the levator), not for the superior rectus.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1627,
    "Name": "Longest extraocular muscle overall",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhen you include both the muscle belly and the tendon, which extraocular muscle is the longest overall?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003ESuperior oblique.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThe superior oblique has the \u003Cstrong\u003Elongest tendon\u003C/strong\u003E among the extraocular muscles, and when you add tendon length to the muscle belly, it becomes the \u003Cstrong\u003Elongest overall\u003C/strong\u003E. The \u003Cstrong\u003Elevator\u003C/strong\u003E also has a long tendon (aponeurosis), making it a close second, but the superior oblique still wins on total length.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1628,
    "Name": "Worth 4\u2011dot",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA child sees only 2 dots on Worth 4\u2011dot at distance but sees all 4 dots at near (red filter OD, green filter OS). What diagnosis does this pattern indicate, and which eye is amblyopic?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EMonofixation syndrome with OS being the amblyopic/suppressed eye.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EHere\u2019s the logic using the Worth\u20114\u2011Dot principles:\u003C/p\u003E\n\u003Col\u003E\n\u003Cli\u003E\u003Cstrong\u003EWhy this is monofixation syndrome\u003C/strong\u003E\u003C/li\u003E\n\u003C/ol\u003E\n\u003Cul\u003E\n\u003Cli\u003EIn \u003Cstrong\u003Emonofixation syndrome\u003C/strong\u003E, the patient has \u003Cstrong\u003Eperipheral fusion\u003C/strong\u003E but a \u003Cstrong\u003Esmall central suppression scotoma\u003C/strong\u003E (no true bifoveal fusion).\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EAt distance (10 ft)\u003C/strong\u003E, the 4\u2011dot target subtends a \u003Cstrong\u003Esmall visual angle\u003C/strong\u003E, so its image tends to fall \u003Cstrong\u003Ewithin the central suppression zone\u003C/strong\u003E \u2192 the child reports \u003Cstrong\u003Esuppression\u003C/strong\u003E (seeing fewer than 4 dots).\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EAt near (2 ft)\u003C/strong\u003E, the same target subtends a \u003Cstrong\u003Elarger visual angle\u003C/strong\u003E, so more of the stimulus falls \u003Cstrong\u003Eoutside\u003C/strong\u003E the central suppression scotoma \u2192 the child can use \u003Cstrong\u003Eperipheral fusion\u003C/strong\u003E and reports \u003Cstrong\u003E4 dots\u003C/strong\u003E.\u003C/li\u003E\n\u003C/ul\u003E\n\u003Col\u003E\n\u003Cli\u003E\u003Cstrong\u003EWhich eye is suppressed/amblyopic? (OS)\u003C/strong\u003E\u003Cbr\u003E\nWith \u003Cstrong\u003Ered over the right eye\u003C/strong\u003E and \u003Cstrong\u003Egreen over the left eye\u003C/strong\u003E:\u003C/li\u003E\n\u003C/ol\u003E\n\u003Cul\u003E\n\u003Cli\u003ESeeing \u003Cstrong\u003Eonly 2 dots\u003C/strong\u003E at distance implies the child is seeing \u003Cstrong\u003Eonly the red\u2011filter eye\u2019s perception\u003C/strong\u003E (the \u003Cstrong\u003Ewhite\u003C/strong\u003E dot appears red through the red lens, plus the red dot itself), meaning the \u003Cstrong\u003Eleft eye (green lens, OS)\u003C/strong\u003E is being suppressed at distance.\u003C/li\u003E\n\u003Cli\u003ETherefore, the \u003Cstrong\u003Esuppressed eye is OS\u003C/strong\u003E, which corresponds to the \u003Cstrong\u003Eamblyopic/suppressed eye\u003C/strong\u003E in the answer choices.\u003C/li\u003E\n\u003C/ul\u003E\n\u003Col\u003E\n\u003Cli\u003E\u003Cstrong\u003EWhy \u201Cnormal W4D with dense amblyopia\u201D is not the best fit\u003C/strong\u003E\u003Cbr\u003E\nA \u201Cnormal\u201D Worth\u20114\u2011Dot response is \u003Cstrong\u003E4 dots at both distance and near\u003C/strong\u003E (stable fusion). This child shows \u003Cstrong\u003Edistance suppression\u003C/strong\u003E but \u003Cstrong\u003Enear fusion\u003C/strong\u003E, which is the classic monofixation pattern rather than a normal response.\u003C/li\u003E\u003C/ol\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1629,
    "Name": "Septo\u2011optic dysplasia",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 1\u2011year\u2011old has unilateral poor vision with an optic nerve abnormality on fundus exam, and MRI shows absence of the septum pellucidum. Which pituitary hormone abnormality is most commonly seen in this condition?\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-26-12b6ba18-e80c-4346-9b3d-cb2047da83b0.png\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EGrowth hormone (GH).\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThis picture \u002B MRI clue points to \u003Cstrong\u003Esepto\u2011optic dysplasia (SOD / de Morsier syndrome)\u003C/strong\u003E, defined by \u003Cstrong\u003Eoptic nerve hypoplasia\u003C/strong\u003E with a \u003Cstrong\u003Emidline brain defect\u003C/strong\u003E (classically \u003Cstrong\u003Eabsent septum pellucidum\u003C/strong\u003E) and frequent \u003Cstrong\u003Ehypothalamic\u2011pituitary dysfunction\u003C/strong\u003E. In SOD, the \u003Cstrong\u003Emost common endocrine abnormality is growth hormone deficiency\u003C/strong\u003E, which can make a child appear \u201Csickly\u201D due to poor growth and broader hypopituitarism risk.\u003C/p\u003E\n\u003Cp\u003EWhy the other options are less likely as the \u003Cem\u003Emost common\u003C/em\u003E:\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003ETSH\u003C/strong\u003E and \u003Cstrong\u003EACTH\u003C/strong\u003E deficiencies can occur and are clinically important (especially ACTH because of hypoglycemia/adrenal crisis risk), but they are \u003Cstrong\u003Enot the most frequent\u003C/strong\u003E deficiency in SOD.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EADH\u003C/strong\u003E deficiency (central diabetes insipidus) can occur, but it is \u003Cstrong\u003Eless common\u003C/strong\u003E than GH deficiency.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1630,
    "Name": "Normal timing of infant eye contact",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA healthy full-term 2\u2011week\u2011old isn\u2019t making eye contact or reacting to facial expressions yet. What is the best reassurance/counseling response?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EDo not worry. Your baby will not make eye contact with you until she is at least 6 weeks old.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EAt \u003Cstrong\u003E2 weeks\u003C/strong\u003E, a full\u2011term newborn\u2019s vision and social engagement are still immature. Newborns can see \u003Cstrong\u003Elight, shapes, and faces\u003C/strong\u003E but their vision is \u003Cstrong\u003Eblurry\u003C/strong\u003E and their ability to sustain purposeful gaze is limited in the early weeks.  Intentional, consistent \u003Cstrong\u003Eeye contact\u003C/strong\u003E is commonly expected around \u003Cstrong\u003E6\u20138 weeks\u003C/strong\u003E of age, making reassurance the most appropriate response here.\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003EThe other options are inappropriate as first responses in an otherwise healthy 2\u2011week\u2011old: a routine dilated exam or neuroimaging is not the initial step when the timeline is still within normal developmental range, and waiting until \u003Cstrong\u003E4 months\u003C/strong\u003E is too late for this milestone.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1631,
    "Name": "Central vs peripheral fusion",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich statement correctly describes how receptive field size affects central (foveal) versus peripheral fusion?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EThe area in the peripheral retina has a large receptive field and thus objects can be dissimilar in size and shape and still be seen singly.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy this is true:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003ECentral (foveal) fusion\u003C/strong\u003E demands extremely precise matching because foveal receptive fields are \u003Cstrong\u003Esmall\u003C/strong\u003E and spatial resolution is high. That means the two eyes\u2019 images must be \u003Cstrong\u003Every similar\u003C/strong\u003E (fine detail, contour, size/shape) to be fused into one percept.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EPeripheral fusion\u003C/strong\u003E is more \u201Cforgiving\u201D because receptive fields in the peripheral retina are \u003Cstrong\u003Elarger\u003C/strong\u003E and spatial resolution is lower. With larger receptive fields, the visual system can tolerate \u003Cstrong\u003Emore mismatch\u003C/strong\u003E between the two eyes\u2019 images (differences in size/shape/position) and still maintain single vision.\u003C/li\u003E\n\u003C/ul\u003E\n\u003Cp\u003E\u003Cbr\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 1632,
    "Name": "JIA-associated uveitic glaucoma with band keratopathy",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 10-year-old with the corneal abnormality shown in the photo above and has a history of joint pains affecting both knees and wrists, has severe glaucoma (IOP ~40) despite maximal medical therapy including oral CAI. Which intervention best controls IOP?\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-02-26-b90d7379-9e18-45f1-88cf-c804bf9f9fab.png\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EBaerveldt glaucoma drainage implant.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EThe corneal photo is consistent with band keratopathy\u003C/strong\u003E, which in a 10-year-old plus knee/wrist arthralgias strongly points toward \u003Cstrong\u003EJIA-associated chronic anterior uveitis\u003C/strong\u003E. \u003Cstrong\u003EUveitic glaucoma\u003C/strong\u003E in children can be aggressive and may be due to \u003Cstrong\u003Etrabecular damage from chronic inflammation\u003C/strong\u003E, \u003Cstrong\u003Esteroid response\u003C/strong\u003E, and/or sequelae of repeated intraocular inflammation. An IOP of ~40 mmHg \u003Cstrong\u003Edespite maximal drops and oral CAI\u003C/strong\u003E indicates that medication escalation is unlikely to achieve safe long-term control.\u003C/p\u003E\n\u003Cp\u003EIn pediatric uveitic glaucoma, \u003Cstrong\u003Efiltering surgery (trabeculectomy or ExPress-type bleb surgery) has a high failure risk\u003C/strong\u003E because uveitic eyes\u2014especially in children\u2014tend to \u003Cstrong\u003Escar aggressively\u003C/strong\u003E, causing \u003Cstrong\u003Erapid bleb failure\u003C/strong\u003E and poor durability of pressure control. Similarly, \u003Cstrong\u003Eangle surgery (goniotomy/trabeculotomy)\u003C/strong\u003E can work in select pediatric glaucomas, but in established \u003Cstrong\u003Euveitic/secondary glaucomas\u003C/strong\u003E with marked IOP elevation on maximal meds, it is often \u003Cstrong\u003Eless predictable\u003C/strong\u003E as a definitive solution.\u003C/p\u003E\n\u003Cp\u003ETherefore, when the goal is \u003Cstrong\u003Ethe best chance of sustained IOP control\u003C/strong\u003E, many specialists favor a \u003Cstrong\u003Eglaucoma drainage device\u003C/strong\u003E (e.g., \u003Cstrong\u003EBaerveldt\u003C/strong\u003E, Ahmed, Molteno), and among the provided options the best match is the \u003Cstrong\u003EBaerveldt implant\u003C/strong\u003E.\u003C/p\u003E\n\u003Cp\u003EKey perioperative counseling/management point: \u003Cstrong\u003Einflammation control is critical\u003C/strong\u003E. \u003Cstrong\u003EActive uveitis increases postoperative complication risk\u003C/strong\u003E, especially hypotony and scarring, so surgery is ideally timed when inflammation is quiet and may be accompanied by \u003Cstrong\u003Eperioperative \u201Cstress-dose\u201D steroids/immunosuppression\u003C/strong\u003E to reduce postoperative inflammatory complications.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1633,
    "Name": "Wilson disease",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich test is best for diagnosing Wilson disease early in a child?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003ESerum copper and ceruloplasmin.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWilson disease is a disorder of copper handling, so the earliest reliable clue comes from abnormal copper/ceruloplasmin biochemistry rather than late physical signs.\u003C/strong\u003E In many children\u2014especially those presenting early\u2014\u003Cstrong\u003EKayser\u2013Fleischer rings may be absent\u003C/strong\u003E, and even when present they tend to correlate more with advanced copper deposition (classically neurologic involvement) rather than being the best \u003Cem\u003Eearly\u003C/em\u003E screening tool.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other options are not the best \u201Cearly\u201D method:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003ECT of the brain:\u003C/strong\u003E brain imaging may be normal early and is not a screening/confirmatory test for Wilson disease.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EKayser\u2013Fleischer ring detection:\u003C/strong\u003E helpful and classic, but \u003Cstrong\u003Enot sensitive for early pediatric disease\u003C/strong\u003E (can appear later or be absent in purely hepatic presentations).\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EUrinary copper excretion:\u003C/strong\u003E can be useful and is often part of the workup, but for the \u201Cbest early method\u201D, \u003Cstrong\u003Eserum ceruloplasmin (and copper studies) are the first-line biochemical screen\u003C/strong\u003E.\u003C/li\u003E\n\u003C/ul\u003E\n\u003Cp\u003E\u003Cbr\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1634,
    "Name": "Brown syndrome vs inferior rectus restriction",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA patient has limited elevation of the right eye in adduction, and forced ductions show restriction. Which maneuver best helps you tell Brown syndrome (superior oblique tendon restriction) apart from inferior rectus restriction?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EWorsened restriction on retropulsion.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EBoth inferior rectus restriction and Brown syndrome can cause \u201Cpoor elevation in adduction,\u201D so you need a maneuver that selectively stresses the suspected structure.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EBrown syndrome is essentially a mechanical problem of the superior oblique tendon\u2013trochlea complex\u003C/strong\u003E (a \u201Ctight\u201D tendon that won\u2019t glide). \u003Cstrong\u003EWhen you retropulse the globe (push it posteriorly), you effectively increase tension on the superior oblique tendon\u003C/strong\u003E, which \u003Cstrong\u003Eaccentuates the restriction\u003C/strong\u003E of elevation in adduction if Brown syndrome is the cause. That is why \u003Cstrong\u003Erestriction worsening with retropulsion\u003C/strong\u003E points toward \u003Cstrong\u003EBrown syndrome\u003C/strong\u003E.\u003C/p\u003E\n\u003Cp\u003EIn contrast, \u003Cstrong\u003Einferior rectus restriction is a rectus tightness problem\u003C/strong\u003E, and the classic way to stress the rectus muscles during forced duction is not retropulsion; it\u2019s maneuvers that alter the rectus \u201Ctethering\u201D mechanics (often evaluated by testing restriction patterns in the opposite direction of the suspected restriction and by assessing behavior with proptosis vs retropulsion). \u003Cstrong\u003ERetropulsion specifically is the discriminating stressor for the oblique tendon mechanism\u003C/strong\u003E, so it favors Brown syndrome over inferior rectus restriction.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1635,
    "Name": "Complete CN VI palsy (6 months)",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 56-year-old has a traumatic right CN VI palsy with complete loss of right lateral rectus function persisting for 6 months. What is the most appropriate management now?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EVertical muscle transposition surgery.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EIn a CN VI palsy, management depends on whether there is \u003Cstrong\u003Eresidual lateral rectus function\u003C/strong\u003E:\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EIf there is some residual function\u003C/strong\u003E, a common strategy is \u003Cstrong\u003Eweakening the antagonist medial rectus\u003C/strong\u003E (recession) and \u003Cstrong\u003Estrengthening the lateral rectus\u003C/strong\u003E (resection) to rebalance forces and improve alignment. That works because the lateral rectus can still contribute something when you \u201Chelp it\u201D mechanically.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EIf there is total paralysis (no meaningful lateral rectus function)\u003C/strong\u003E, then resecting the lateral rectus alone (or even doing a big MR recession \u002B LR resection) cannot reliably restore abduction, because you cannot \u201Cresect\u201D function into a completely denervated muscle. In that setting, the most effective approach is to \u003Cstrong\u003Erecruit other muscles to substitute for abduction\u003C/strong\u003E.\u003C/li\u003E\n\u003C/ul\u003E\n\u003Cp\u003EThat is exactly what \u003Cstrong\u003Evertical rectus transposition (VRT)\u003C/strong\u003E procedures do: they shift the vertical recti (superior and inferior rectus) toward the lateral rectus to create an \u003Cstrong\u003Eabducting vector\u003C/strong\u003E, improving primary position alignment and expanding the field of single binocular vision.\u003C/p\u003E\n\u003Cp\u003ECommon examples include:\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EHummelsheim\u003C/strong\u003E (split-tendon transposition of vertical recti toward LR)\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EJensen\u003C/strong\u003E (muscle union/suture technique)\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EFoster augmentation\u003C/strong\u003E (full-tendon transposition with posterior fixation/augmentation to increase abducting effect)\u003C/li\u003E\n\u003C/ul\u003E\n\u003Cp\u003EWhy the other choices are less appropriate here:\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EBotulinum toxin to the medial rectus\u003C/strong\u003E can be useful earlier (to reduce contracture and sometimes help alignment), but at \u003Cstrong\u003E6 months with persistent total palsy\u003C/strong\u003E, it is usually not definitive by itself.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ELarge MR recession \u002B LR resection\u003C/strong\u003E is best when some LR function remains; with \u003Cstrong\u003Etotal LR paralysis\u003C/strong\u003E, it\u2019s typically insufficient compared with transposition.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ELarge LR resection only\u003C/strong\u003E is the least effective in complete palsy for the same reason (no innervation \u2192 no true abducting force).\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1636,
    "Name": "Post-op nausea in a 2\u2011year\u2011old",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EAfter strabismus surgery, a nauseated 2\u2011year\u2011old needs an antiemetic. Which option is contraindicated due to a serious age-related safety risk?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EPromethazine.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EPromethazine (Phenergan) is \u003Cstrong\u003Econtraindicated in children under 2 years\u003C/strong\u003E because of the risk of \u003Cstrong\u003Epotentially fatal respiratory depression\u003C/strong\u003E\u2014a risk serious enough to warrant a \u003Cstrong\u003Eboxed warning\u003C/strong\u003E and explicit age-based contraindication in labeling.\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EOndansetron\u003C/strong\u003E is commonly used for pediatric postoperative nausea/vomiting and is widely recommended as first-line in many pediatric recovery protocols (with typical cautions like QT risk in susceptible patients).\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EMetoclopramide\u003C/strong\u003E can be used but carries risks like extrapyramidal symptoms; it is not the classic strict age-based \u201Cdo not use\u201D choice in this question stem.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EDiphenhydramine\u003C/strong\u003E is not a standard first-line antiemetic, but it is not the key contraindicated drug in a 2\u2011year\u2011old the way promethazine is.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 5,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1637,
    "Name": "Red-glass test: \u201Cpinkish\u201D single light",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EDuring the red-glass test in an adult with exotropia, the patient reports seeing one \u201Cpinkish\u201D light instead of two. What does this indicate?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EHarmonious ARC.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhat the red-glass test is checking:\u003C/strong\u003E It helps detect \u003Cstrong\u003Eanomalous retinal correspondence (ARC)\u003C/strong\u003E so you can anticipate \u003Cstrong\u003Epost\u2011operative diplopia risk\u003C/strong\u003E in long\u2011standing strabismus. You place the \u003Cstrong\u003Ered filter over the fixating (non-deviating) eye\u003C/strong\u003E, shine a white light, and ask what the patient sees.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EHow to interpret \u201Cpinkish single light\u201D:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003EIf the patient reports a \u003Cstrong\u003Esingle \u201Cpink\u201D light\u003C/strong\u003E, it means the \u003Cstrong\u003Ered-filter image and the white/green image are perceived as superimposed\u003C/strong\u003E\u2014the brain is matching the two eyes\u2019 images as if they correspond, \u003Cstrong\u003Edespite the measured exotropia\u003C/strong\u003E.\u003C/li\u003E\n\u003Cli\u003EThat pattern is classic for \u003Cstrong\u003Eharmonious ARC\u003C/strong\u003E, where the sensory adaptation fully compensates for the deviation so that the patient maintains \u003Cstrong\u003Esingle vision without separation\u003C/strong\u003E.\u003C/li\u003E\n\u003C/ul\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy it is not the other choices:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003ESuppression\u003C/strong\u003E would typically produce \u003Cstrong\u003Eone light\u003C/strong\u003E of the color corresponding to the \u003Cstrong\u003Enon-suppressed eye\u003C/strong\u003E (not a blended \u201Cpink\u201D superimposition), because one eye\u2019s input is being ignored.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EUnharmonious ARC\u003C/strong\u003E is when the patient sees \u003Cstrong\u003Etwo lights\u003C/strong\u003E, but the separation is \u003Cstrong\u003Eless than the measured deviation\u003C/strong\u003E (partial sensory adaptation).\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EPseudoharmonious ARC\u003C/strong\u003E is a special situation where the test result may appear \u201Charmonious\u201D due to testing conditions (e.g., certain prism/measurement setups), but it does not represent true harmonious correspondence in everyday viewing.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1638,
    "Name": "Corneal clouding",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich of the listed systemic diseases is most strongly associated with prominent corneal clouding?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EScheie syndrome.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EScheie syndrome is part of mucopolysaccharidosis type I (MPS I)\u003C/strong\u003E (\u03B1\u2011L\u2011iduronidase deficiency), a group in which \u003Cstrong\u003Eglycosaminoglycans (GAGs) accumulate in the cornea\u003C/strong\u003E, leading to \u003Cstrong\u003Eclassically significant corneal clouding\u003C/strong\u003E (often more consistently emphasized in MPS I than in many other metabolic disorders). \u003Cstrong\u003EThis makes Scheie the best choice in terms of both frequency and clinically meaningful corneal haze among the options.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other choices are wrong:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EHunter syndrome (MPS II)\u003C/strong\u003E: classically \u003Cstrong\u003Edoes not have corneal clouding\u003C/strong\u003E. Ocular findings are more often pigmentary retinopathy/optic nerve issues rather than prominent corneal haze.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EKrabbe disease\u003C/strong\u003E: a leukodystrophy (galactocerebrosidase deficiency) where major findings are neurologic (irritability, spasticity, developmental regression). \u003Cstrong\u003ECorneal clouding is not a classic hallmark.\u003C/strong\u003E\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EGaucher disease\u003C/strong\u003E: lipid storage disease (glucocerebrosidase deficiency) with hepatosplenomegaly, cytopenias, bone crises; ocular findings are not typically dominated by severe corneal clouding.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1639,
    "Name": "Type 1 Duane syndrome",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EIn type 1 Duane retraction syndrome with a significant compensatory face turn, what is the most commonly performed surgical procedure?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EMedial rectus recession on the involved side.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EType 1 Duane syndrome is characterized by abduction limitation (an \u201Cabduction deficit\u201D), often with esotropia in primary position and a face turn toward the involved side to place the eyes in a gaze position where alignment is better.\u003C/strong\u003E The surgical goal in a symptomatic patient is to \u003Cstrong\u003Ereduce the abnormal head posture\u003C/strong\u003E and \u003Cstrong\u003Eimprove primary position alignment\u003C/strong\u003E, while also minimizing the hallmark co\u2011contraction phenomenon that causes globe retraction.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003ERecessing the medial rectus on the involved side is the most commonly used first procedure\u003C/strong\u003E because it \u003Cstrong\u003Ereduces the esotropic pull\u003C/strong\u003E in primary position and \u003Cstrong\u003Ereduces the drive for adduction\u003C/strong\u003E, which can also lessen the degree of co\u2011contraction and retraction on attempted adduction. In practical terms, it\u2019s the most standard, broadly applicable operation for the typical \u201Cesotropic Duane\u201D presentation with a face turn.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other procedures are not preferred as the \u201Cmost often used\u201D option:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003ELateral rectus resection on the involved side\u003C/strong\u003E tends to be avoided because strengthening the lateral rectus in Duane can \u003Cstrong\u003Eexacerbate co\u2011contraction and globe retraction\u003C/strong\u003E and may worsen abnormal upshoots/downshoots.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EOperating on the uninvolved eye\u2019s horizontal muscles\u003C/strong\u003E is not the classic first-line approach for type 1 Duane with face turn; the main problem is usually the \u003Cstrong\u003Eprimary position eso/head posture driven by the involved side mechanics\u003C/strong\u003E, so treatment is typically directed to the involved side first.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1640,
    "Name": "Panum\u2019s fusional area:",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich statement correctly describes how Panum\u2019s fusional area relates to whether a 3\u2011D object is seen singly or double?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EA 3-dimensional object is seen as a double image if any part of it falls outside of Panum\u2019s area.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EPanum\u2019s fusional area\u003C/strong\u003E is the tolerance zone around corresponding retinal points where \u003Cstrong\u003Esmall retinal disparities can still be fused into single vision\u003C/strong\u003E. A \u003Cstrong\u003E3\u2011D object has depth\u003C/strong\u003E, so different parts of it project with different disparities. If \u003Cstrong\u003Eany portion\u003C/strong\u003E of that object produces a disparity \u003Cstrong\u003Ebeyond\u003C/strong\u003E Panum\u2019s fusional limits, that portion cannot be fused and is perceived as \u003Cstrong\u003Ediplopic\u003C/strong\u003E (even if other parts of the object remain fused).\u0026nbsp;\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1641,
    "Name": "Gaze-evoked nystagmus",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EA child has a right-beating jerk nystagmus that becomes stronger when she looks to the right and lessens when she looks to the left. Which named \u201Claw\u201D describes this pattern?\u003C/p\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EAlexander\u2019s law.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EAlexander\u2019s law states that jerk nystagmus increases in intensity when gaze is directed toward the fast phase (the direction of the jerk).\u003C/strong\u003E\u003Cbr\u003E\nHere, the nystagmus is \u003Cstrong\u003Eright-beating\u003C/strong\u003E (fast phase to the right), so it \u003Cstrong\u003Eworsens in right gaze\u003C/strong\u003E and \u003Cstrong\u003Eimproves in left gaze\u003C/strong\u003E\u2014a classic Alexander\u2019s law pattern.\u003C/p\u003E\n\u003Cp\u003EWhy the other options are not the best fit:\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EListing\u2019s law\u003C/strong\u003E and \u003Cstrong\u003EDonder\u2019s law\u003C/strong\u003E are rules about \u003Cstrong\u003Etorsion and eye orientation\u003C/strong\u003E in different gaze positions (how the eye \u201Cchooses\u201D a unique torsional position for a given direction of gaze), not about nystagmus intensity changing with gaze direction.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ESherrington\u2019s law\u003C/strong\u003E is \u003Cstrong\u003Ereciprocal innervation\u003C/strong\u003E (when an agonist contracts, its antagonist relaxes). It explains normal muscle coordination and is famously violated in some dysinnervation syndromes (e.g., co-contraction), but it does not describe gaze-dependent nystagmus intensity.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1642,
    "Name": "ROP screening: who qualifies when course is stable?",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EIn clinically stable newborns, which criterion best identifies those who should undergo ROP screening?\u003C/p\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EBorn at gestational age of 30 weeks or earlier.\u003C/strong\u003E\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EThe classic screening thresholds used in many guidelines are birth weight \u22641500 g or gestational age \u226430 weeks, plus selected higher\u2011GA/higher\u2011BW infants only if their clinical course is unstable or high risk.\u003C/strong\u003E \u003Cbr\u003E\nBecause the stem explicitly says \u003Cstrong\u003Eassume all newborns are clinically stable\u003C/strong\u003E, the \u201Cextra\u201D group (1500\u20132000 g or \u0026gt;30 weeks) does \u003Cstrong\u003Enot\u003C/strong\u003E apply, so the best match among the choices is the \u003Cstrong\u003Egestational age cutoff of \u226430 weeks\u003C/strong\u003E.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other choices are wrong:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EBirth weight \u22642000 g\u003C/strong\u003E: some guidelines include \u003Cstrong\u003Eselected\u003C/strong\u003E infants between 1500\u20132000 g only when they are \u003Cstrong\u003Ehigh risk/unstable\u003C/strong\u003E.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EBirth weight \u22642500 g\u003C/strong\u003E: this is \u003Cstrong\u003Etoo broad\u003C/strong\u003E and would greatly overscreen; it is not part of standard ROP screening criteria in settings with developed neonatal care\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EGestational age \u226432 weeks\u003C/strong\u003E: standard criteria emphasize \u003Cstrong\u003E\u226430 weeks\u003C/strong\u003E (with selective screening above that only if high risk).\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1643,
    "Name": "Spasmus nutans: expected associated finding",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 1-year-old has head nodding with fine, high-frequency, asymmetric horizontal nystagmus and otherwise normal ocular exam. What additional finding would you expect with the most likely diagnosis?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EStiff neck (torticollis).\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EThis presentation is most consistent with \u003Cstrong\u003Espasmus nutans\u003C/strong\u003E, which classically includes the triad of \u003Cstrong\u003Ehead nodding\u003C/strong\u003E, \u003Cstrong\u003Emonocular/asymmetric nystagmus\u003C/strong\u003E, and \u003Cstrong\u003Etorticollis (abnormal head posture that can look like a stiff neck)\u003C/strong\u003E. \u003Cstrong\u003EThe \u201Cshimmering,\u201D low-amplitude, high-frequency, asymmetric nystagmus with head nodding\u003C/strong\u003E is the key pattern that points to this diagnosis.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other findings are not expected:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EAlternating nystagmus with either eye occluded\u003C/strong\u003E points more toward \u003Cstrong\u003Elatent/manifest latent nystagmus\u003C/strong\u003E associated with early-onset strabismus, not the spasmus nutans triad.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EA null point in primary gaze\u003C/strong\u003E is more typical of \u003Cstrong\u003Einfantile nystagmus syndrome\u003C/strong\u003E (congenital motor nystagmus) with a gaze position that dampens the oscillation, often producing a consistent compensatory head posture rather than the classic spasmus nutans triad.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EPersistence until adolescence\u003C/strong\u003E is not typical for spasmus nutans, which is usually \u003Cstrong\u003Ebenign and self-limited\u003C/strong\u003E, commonly resolving in early childhood.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1644,
    "Name": "Craniosynostosis growth rule",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EIn craniosynostosis, which \u201Claw\u201D describes the principle that skull growth is restricted perpendicular to the fused suture and continues mainly parallel to it?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cstrong\u003EVirchow\u2019s law\u003C/strong\u003E explains the predictable head shapes seen in craniosynostosis: when a suture fuses early, skull growth is \u003Cstrong\u003Erestricted perpendicular\u003C/strong\u003E to that suture and compensates \u003Cstrong\u003Eparallel\u003C/strong\u003E to it, producing characteristic deformities\u2014e.g., \u003Cstrong\u003Esagittal synostosis \u2192 scaphocephaly (long, narrow head)\u003C/strong\u003E, \u003Cstrong\u003Eunicoronal synostosis \u2192 anterior plagiocephaly (asymmetric frontal/orbital shape)\u003C/strong\u003E, \u003Cstrong\u003Ebicoronal synostosis \u2192 brachycephaly (short, broad head)\u003C/strong\u003E, \u003Cstrong\u003Emetopic synostosis \u2192 trigonocephaly (triangular forehead)\u003C/strong\u003E, and \u003Cstrong\u003Elambdoid synostosis \u2192 posterior plagiocephaly.\u003C/strong\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cstrong\u003E\u003Cbr\u003E\u003C/strong\u003E\u003C/div\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EWhy the other choices are wrong:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003ESherrington\u2019s law\u003C/strong\u003E = reciprocal innervation of agonist/antagonist muscles (extraocular muscle physiology), not skull growth.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EHering\u2019s law\u003C/strong\u003E = equal innervation to yoke muscles, also extraocular muscle physiology.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EKestenbaum\u003C/strong\u003E refers to a \u003Cstrong\u003Estrabismus procedure\u003C/strong\u003E for nystagmus-related head posture, not a cranial growth law.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1645,
    "Name": "BoTox in extraocular muscle: duration \u002B effect",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EIn a patient with a CN VI palsy, if botulinum toxin A is injected into the medial rectus, how long does the paralysis typically last and what happens to the muscle?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003E5\u20138 weeks; will lengthen the muscle.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EBotulinum toxin A causes chemodenervation of the injected extraocular muscle\u003C/strong\u003E, with clinical onset usually within \u003Cstrong\u003E2\u20134 days\u003C/strong\u003E. \u003Cstrong\u003EDuring the period of paralysis, the medial rectus effectively \u201Crelaxes,\u201D allowing it to lengthen\u003C/strong\u003E, which helps reduce its restrictive pull in a sixth nerve palsy (i.e., helps counteract the esotropic tendency from an unopposed medial rectus). \u003Cstrong\u003EIn extraocular muscles, the typical functional duration is about 5\u20138 weeks\u003C/strong\u003E, which is \u003Cstrong\u003Eshorter\u003C/strong\u003E than the duration seen when BoTox is used in facial muscles such as the orbicularis (often \u003Cstrong\u003E~3 months or longer\u003C/strong\u003E).\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1646,
    "Name": "CN III palsy: primary goal of strabismus surgery",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA patient has a chronic pupil-involving third nerve palsy with significant hypotropia and marked loss of elevation/adduction. What is the main goal of strabismus surgery in this setting?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EBinocular function in primary position and in slight downgaze for reading.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EIn long-standing, complete or near-complete CN III palsy, surgery cannot truly \u201Crestore\u201D the missing muscle innervation\u003C/strong\u003E, so attempts to regain \u003Cstrong\u003Eall ductions\u003C/strong\u003E or recreate normal \u003Cstrong\u003Erotational forces\u003C/strong\u003E are unrealistic. \u003Cstrong\u003EThe practical surgical aim is to expand the patient\u2019s field of single binocular vision where it matters most functionally\u003C/strong\u003E\u2014straight ahead (\u003Cstrong\u003Eprimary position\u003C/strong\u003E) and the \u003Cstrong\u003Ereading position\u003C/strong\u003E (typically \u003Cstrong\u003Eslight downgaze\u003C/strong\u003E). This is why surgeons prioritize alignment that reduces diplopia in these key gaze positions rather than chasing full motility restoration.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1647,
    "Name": " Krimsky test",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA preverbal toddler with dense amblyopia in the left eye has poor fixation, so cover\u2013uncover testing cannot reliably measure the strabismus. You shine a penlight at both eyes and see the corneal light reflex is decentered. You want to quantify the deviation by placing prisms in front of one eye until the corneal reflex is centered and symmetric. Which test are you performing?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: Krimsky test.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EBruckner test:\u003C/strong\u003E \u003Cstrong\u003EUse a direct ophthalmoscope to view both red reflexes at the same time.\u003C/strong\u003E You are mainly judging \u003Cstrong\u003Esymmetry and brightness\u003C/strong\u003E of the reflexes to screen for problems such as \u003Cstrong\u003Estrabismus, anisometropia, or media opacity (e.g., cataract)\u003C/strong\u003E. A noticeably \u003Cstrong\u003Ebrighter reflex in one eye\u003C/strong\u003E can suggest \u003Cstrong\u003Estrabismus in that eye\u003C/strong\u003E (often because \u003Cstrong\u003Efoveation/angle changes alter the reflected light pattern\u003C/strong\u003E).\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EHirschberg test:\u003C/strong\u003E \u003Cstrong\u003EUse a penlight and observe where the corneal light reflex falls relative to the pupil.\u003C/strong\u003E This is a \u003Cstrong\u003Erough estimate\u003C/strong\u003E of ocular misalignment (not a precise measurement). \u003Cstrong\u003ECentered reflex \u2248 straight eyes; decentered reflex \u2248 strabismus\u003C/strong\u003E, and the farther the reflex is displaced, the larger the deviation.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EKrimsky test:\u003C/strong\u003E \u003Cstrong\u003EThis is the Hirschberg test plus prisms.\u003C/strong\u003E Instead of just estimating, you \u003Cstrong\u003Eplace prisms in front of one eye and increase prism power until the corneal light reflex becomes centered and symmetric\u003C/strong\u003E between the two eyes. The prism amount required to \u201Cre-center\u201D the reflex gives a \u003Cstrong\u003Equantified measurement\u003C/strong\u003E of the deviation. This is especially useful when the patient \u003Cstrong\u003Ecannot reliably fixate\u003C/strong\u003E (e.g., \u003Cstrong\u003Edense amblyopia, low vision, or very young children\u003C/strong\u003E), where cover testing is unreliable.\u003C/p\u003E\n\u003Cp\u003E\u003Cbr\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1648,
    "Name": "Dystopia canthorum",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA patient has dystopia canthorum (lateral displacement of the medial canthi). Which syndrome is this finding classically specific for?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EWaardenburg syndrome.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EDystopia canthorum\u003C/strong\u003E refers to \u003Cstrong\u003Elateral displacement of the medial canthi\u003C/strong\u003E (often with lateral displacement of the lacrimal puncta). Clinically, a helpful way to visualize it is that an imaginary line drawn between the \u003Cstrong\u003Eupper and lower puncta\u003C/strong\u003E may \u003Cstrong\u003Ecross the cornea\u003C/strong\u003E, reflecting that the medial canthal complex has shifted laterally. This finding is a classic hallmark of \u003Cstrong\u003EWaardenburg syndrome\u003C/strong\u003E, particularly the subtype that features dystopia canthorum.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other options are not correct:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EMarfan syndrome\u003C/strong\u003E is classically linked to \u003Cstrong\u003Eectopia lentis\u003C/strong\u003E and systemic connective tissue features, not dystopia canthorum.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EStickler syndrome\u003C/strong\u003E is associated with \u003Cstrong\u003Ehigh myopia, retinal detachment risk, and craniofacial anomalies\u003C/strong\u003E (e.g., Pierre Robin sequence), not a \u201Cspecific\u201D dystopia canthorum sign.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EHallermann\u2013Streiff syndrome\u003C/strong\u003E features \u003Cstrong\u003Ecraniofacial dysplasia with microphthalmia and dental anomalies\u003C/strong\u003E, but dystopia canthorum is not its defining specific marker.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1649,
    "Name": "Bangerter foils as amblyopia therapy",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich item is actually used to treat amblyopia rather than to test binocular function?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EBangerter foil.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EBangerter foils are a form of optical penalization.\u003C/strong\u003E They are \u003Cstrong\u003Egraded translucent filters\u003C/strong\u003E that stick onto the spectacle lens of the \u003Cstrong\u003Esound (non-amblyopic) eye\u003C/strong\u003E, creating a controlled amount of blur so the child is encouraged to use the amblyopic eye. The level of blur can be titrated by choosing different foil densities, making them useful when a child \u003Cstrong\u003Ecannot tolerate patching\u003C/strong\u003E or \u003Cstrong\u003Eatropine penalization\u003C/strong\u003E, especially in \u003Cstrong\u003Emild to moderate amblyopia\u003C/strong\u003E.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other choices are not amblyopia therapy:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003ESynoptophore\u003C/strong\u003E is primarily an \u003Cstrong\u003Eassessment/orthoptic training tool\u003C/strong\u003E for binocular vision (fusion, suppression, stereopsis) rather than a standard amblyopia \u201Cpenalization\u201D treatment.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EBagolini lenses\u003C/strong\u003E are used to \u003Cstrong\u003Eevaluate sensory fusion and suppression\u003C/strong\u003E under near-natural viewing conditions; they\u2019re a \u003Cstrong\u003Etest\u003C/strong\u003E, not a treatment.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EWorth 4-dot flashlight\u003C/strong\u003E is a \u003Cstrong\u003Efusion/suppression test\u003C/strong\u003E (near/distance responses), not an amblyopia treatment.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1650,
    "Name": "ROP look-alikes: IP and FEVR",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich two conditions most closely mimic the retinal appearance of retinopathy of prematurity?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EAnswer: \u003Cstrong\u003EIncontinentia pigmenti and familial exudative vitreoretinopathy (FEVR).\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EBoth \u003Cstrong\u003EIP\u003C/strong\u003E and \u003Cstrong\u003EFEVR\u003C/strong\u003E can produce a retinal picture that strongly resembles ROP because they share the key anatomic problem of \u003Cstrong\u003Eincomplete peripheral retinal vascularization\u003C/strong\u003E with subsequent \u003Cstrong\u003Eneovascularization\u003C/strong\u003E, \u003Cstrong\u003Efibrovascular proliferation\u003C/strong\u003E, \u003Cstrong\u003Etraction\u003C/strong\u003E, and potential \u003Cstrong\u003Eretinal detachment\u003C/strong\u003E\u2014the same pathway that drives severe ROP.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EHow to distinguish them from true ROP (high-yield clues):\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EFEVR\u003C/strong\u003E is a \u003Cstrong\u003Egenetic disorder of retinal vascular development\u003C/strong\u003E (often autosomal dominant) that can look very similar to ROP, but \u003Cstrong\u003Eprematurity is not required\u003C/strong\u003E. A full-term child (or a \u201Cnormal pregnancy\u201D history) with a ROP-like fundus should make you think of \u003Cstrong\u003EFEVR\u003C/strong\u003E; \u003Cstrong\u003Efamily screening\u003C/strong\u003E can be helpful because expressivity is variable and relatives may have subtle findings.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EIncontinentia pigmenti (Bloch\u2013Sulzberger)\u003C/strong\u003E is \u003Cstrong\u003EX-linked dominant\u003C/strong\u003E and classically has \u003Cstrong\u003Eskin findings\u003C/strong\u003E (staged lesions progressing to hyperpigmented streaks/whorls), plus possible \u003Cstrong\u003ECNS features\u003C/strong\u003E (e.g., seizures, developmental issues). The eye findings can mirror ROP because of peripheral nonperfusion and secondary neovascular changes.\u003C/li\u003E\n\u003C/ul\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other options are wrong:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EUsher syndrome\u003C/strong\u003E is primarily a \u003Cstrong\u003Eretinal dystrophy (retinitis pigmentosa) \u002B hearing loss\u003C/strong\u003E, not a peripheral avascular \u201CROP-like\u201D vasoproliferative retinopathy.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EPHPV (persistent fetal vasculature)\u003C/strong\u003E is a \u003Cstrong\u003Edevelopmental failure of hyaloid regression\u003C/strong\u003E causing leukocoria/microphthalmia and a fibrovascular stalk\u2014its anatomy and retinal appearance are \u003Cstrong\u003Enot the classic ROP pattern\u003C/strong\u003E of peripheral avascular retina with neovascular ridge/tractional changes.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1651,
    "Name": "Downbeat nystagmus in primary gaze ",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 13-year-old has had progressively noticeable abnormal eye movements for about six months. On straight-ahead fixation, there is a jerk nystagmus whose fast phase beats downward. The patient tends to hold the head with the chin lowered, which seems to reduce the oscillations. The remainder of the eye exam is unremarkable. What is the most likely underlying cause?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: Arnold\u2013Chiari malformation.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003EA jerk nystagmus with a downward fast phase in primary (straight-ahead) gaze is classic for downbeat nystagmus.\u003C/strong\u003E Downbeat nystagmus most strongly points to dysfunction at the \u003Cstrong\u003Ecervicomedullary junction\u003C/strong\u003E and/or the \u003Cstrong\u003Evestibulocerebellum (especially the cerebellar flocculus).\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EArnold\u2013Chiari (classically Chiari I) involves downward displacement of the cerebellar tonsils through the foramen magnum,\u003C/strong\u003E which can disrupt these pathways and produce \u003Cstrong\u003Edownbeat nystagmus.\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EA compensatory head posture (often chin-down) may lessen symptoms\u003C/strong\u003E by moving gaze into a position where the nystagmus is reduced (a \u201Cnull\u201D zone), so that behavioral clue supports a chronic central pattern rather than an isolated ocular problem.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other options are less likely\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003ENeuroblastoma\u003C/strong\u003E is classically linked to \u003Cstrong\u003Eopsoclonus\u003C/strong\u003E (chaotic, rapid, multidirectional saccades) rather than a steady downbeat jerk nystagmus in primary gaze.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EPinealoma\u003C/strong\u003E more commonly causes \u003Cstrong\u003Edorsal midbrain (Parinaud) syndrome\u003C/strong\u003E\u2014problems with upgaze and characteristic convergence\u2013retraction phenomena\u2014rather than primary-position downbeat nystagmus.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ECraniopharyngioma\u003C/strong\u003E is a parasellar/suprasellar lesion and is more often associated with \u003Cstrong\u003Esee-saw\u2013type ocular oscillations\u003C/strong\u003E or visual field/endocrine manifestations, not the typical downbeat pattern.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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  },
  {
    "Id": 1652,
    "Name": "Ectopia lentis et pupillae",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 5-year-old is evaluated for \u201Csmall pupils.\u201D Examination shows bilaterally small pupils that are decentered toward the superotemporal quadrant. Both crystalline lenses are also partially dislocated (subluxed). If ectopia lentis et pupillae is suspected, in which direction should the lens displacement occur?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: inferonasally.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003EIn ectopia lentis et pupillae, the lens and the pupil are typically displaced in opposite directions.\u003C/strong\u003E The pupil is eccentrically positioned because of developmental abnormalities of the iris and zonular apparatus, and the lens tends to shift away from the direction of the pupil decentration.\u0026nbsp;\u003Cspan style=\u0022letter-spacing: 0.14994px; font-weight: 700;\u0022\u003EReported inheritance is most often autosomal recessive, though autosomal dominant inheritance with reduced penetrance has also been described.\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u0026nbsp;Associated ocular findings can include\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px; font-weight: 700;\u0022\u003Epoor dilation, persistent pupillary membrane, iris transillumination defects, early cataract formation, secondary glaucoma, high myopia, and increased risk of retinal detachment.\u003C/span\u003E\u003C/p\u003E\u003C!--StartFragment--\u003E\u003C!--EndFragment--\u003E\u003Cp\u003E\n\u003Cstrong\u003EThe pupils are displaced superotemporally in both eyes, so the lenses should be displaced inferonasally\u003C/strong\u003E (the opposite quadrant).\u003C/p\u003E\u003Cp\u003E\u003Cbr\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1653,
    "Name": "Fresnel prisms to reduce a nystagmus-related head turn",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 4-year-old with congenital nystagmus is brought in because of a pronounced abnormal head posture. The caregiver prefers a non-surgical option. Examination shows the child consistently turns the head to the left to lessen the nystagmus. How should horizontal Fresnel prisms be oriented on each eye to help reduce the left head turn?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: base-in prism over the right eye; base-out prism over the left eye.\u003C/span\u003E\u003C/h3\u003E\n\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EExplanation:\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003E\u003Cstrong style=\u0022text-decoration-line: underline;\u0022\u003EStep 1: Identify the null zone from the head posture\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EA left face turn usually means the eyes are being placed in right gaze to reach the \u201Cnull zone\u201D (the gaze position where nystagmus intensity is lowest).\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003ESo, a left head turn \u2192 null zone in right gaze.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong style=\u0022text-decoration-line: underline;\u0022\u003EStep 2: How prisms help in congenital nystagmus\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EYoked prisms are used to shift the visual scene toward the null zone so the child can keep the head straighter while still benefiting from the reduced nystagmus.\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EA practical rule: orient the prisms so the prism apices point toward the null zone.\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EBecause a prism displaces the image toward its apex, placing the apex toward the null zone moves the target into that preferred gaze position.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong style=\u0022text-decoration-line: underline;\u0022\u003EStep 3: Apply this to a right-gaze null zone\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003ERight-gaze null zone means both prism apices must point to the patient\u2019s right (in real-world coordinates).\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003ERight eye:\u003C/strong\u003E the apex must point temporally (to the right) \u2192 \u003Cstrong\u003Ebase-in\u003C/strong\u003E.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ELeft eye:\u003C/strong\u003E the apex must point nasally (also to the right) \u2192 \u003Cstrong\u003Ebase-out\u003C/strong\u003E.\u003C/li\u003E\n\u003C/ul\u003E\n\u003Cp\u003E\u003Cstrong\u003ETherefore, the correct setup is base-in on the right eye and base-out on the left eye.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003EIf the head turn is large or prism management is insufficient, surgical approaches (e.g., Kestenbaum\u2013Anderson-type procedures) can rotate the eyes so primary gaze aligns closer to the null zone, reducing the need for an abnormal head posture.\u003C/strong\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "CategoryId": 10,
    "Category": null,
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  },
  {
    "Id": 1654,
    "Name": "Monocular oscillopsia",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 40-year-old has chronic diplopia and describes a sensation that the visual world \u201Cshimmers\u201D or \u201Cmoves,\u201D and this persists even when the left eye is covered. Which management option would NOT be an appropriate treatment for the problem described?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: Harada\u2013Ito procedure.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003EThe key clue is \u201Coscillation\u201D that continues when one eye is closed, which indicates monocular oscillopsia.\u003C/strong\u003E That strongly suggests an abnormal movement of a single eye rather than a purely binocular misalignment complaint. \u003Cstrong\u003EA classic cause is superior oblique myokymia\u003C/strong\u003E, where \u003Cstrong\u003Eintermittent, small-amplitude, high-frequency torsional (and sometimes vertical) micro-movements\u003C/strong\u003E occur in one eye, often in an otherwise neurologically normal person. These brief torsional bursts create the subjective sense that the environment is vibrating or moving.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy most listed treatments are appropriate\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003ETopical timolol\u003C/strong\u003E can reduce symptoms in some patients because \u003Cstrong\u003Ebeta-blockade may dampen the abnormal muscle activity\u003C/strong\u003E and lessen the frequency/intensity of the oscillations.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ESystemic anticonvulsants (for example carbamazepine or phenytoin)\u003C/strong\u003E are commonly used because \u003Cstrong\u003Esuperior oblique myokymia behaves like an episodic hyperexcitability phenomenon\u003C/strong\u003E, and membrane-stabilizing agents can suppress attacks.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ESuperior oblique tendon weakening (often tenotomy/tenectomy) with simultaneous inferior oblique weakening\u003C/strong\u003E is a recognized surgical strategy when medical therapy fails, aiming to \u003Cstrong\u003Ereduce the torsional oscillations and balance the vertical/torsional forces\u003C/strong\u003E.\u003C/li\u003E\n\u003C/ul\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy Harada\u2013Ito is the exception\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EHarada\u2013Ito is primarily a torsion-correcting procedure for symptomatic excyclotorsion, typically in a trochlear (fourth nerve) palsy scenario.\u003C/strong\u003E It works by \u003Cstrong\u003Eadvancing/strengthening the anterior fibers of the superior oblique tendon to address torsional misalignment\u003C/strong\u003E, and it has \u003Cstrong\u003Elimited impact on vertical deviation\u003C/strong\u003E.\u003Cbr\u003E\nIn contrast, \u003Cstrong\u003Esuperior oblique myokymia is not mainly a static torsional misalignment problem\u2014it is an episodic torsional \u201Ctremor-like\u201D movement disorder of the muscle.\u003C/strong\u003E Therefore, \u003Cstrong\u003EHarada\u2013Ito does not target the underlying mechanism and is not considered an appropriate intervention for the oscillopsia described.\u003C/strong\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "CategoryId": 8,
    "Category": null,
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  },
  {
    "Id": 1655,
    "Name": "CN VI palsy vs Duane syndrome",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich statement does not help differentiate an abducens (CN VI) palsy from Duane syndrome?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: The statement that CN VI palsy usually has little to no esotropia in primary gaze.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003ECN VI palsy weakens the lateral rectus, so abduction is limited and the affected eye drifts inward. As a result, a noticeable esotropia in primary position is expected, often roughly matching the severity of the abduction deficit.\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EDuane syndrome, in contrast, often has only a small primary-position deviation (sometimes none), with its hallmark findings appearing on attempted adduction due to co-contraction and misinnervation.\u003C/strong\u003E\u003Cbr\u003E\nSo, saying that \u003Cstrong\u003ECN VI palsy lacks significant primary-position esotropia\u003C/strong\u003E is \u003Cstrong\u003Enot\u003C/strong\u003E a feature of CN VI palsy and therefore \u003Cstrong\u003Edoes not\u003C/strong\u003E serve as a distinguishing sign\u2014making it the exception.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong style=\u0022text-decoration-line: underline;\u0022\u003EWhy the other statements DO distinguish CN VI palsy from Duane syndrome\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EAbsence of upshoots/downshoots:\u003C/strong\u003E \u003Cstrong\u003EIn CN VI palsy, the main issue is abduction weakness without the classic \u201Cslippage\u201D phenomena. Duane syndrome can show dramatic upshoots or downshoots on adduction from tight lateral rectus and co-contraction.\u003C/strong\u003E\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ENo globe retraction on adduction:\u003C/strong\u003E \u003Cstrong\u003EGlobe retraction is a signature clue for Duane syndrome (co-contraction of medial and lateral rectus on adduction), whereas CN VI palsy does not produce retraction.\u003C/strong\u003E\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ENo palpebral fissure narrowing with attempted adduction:\u003C/strong\u003E \u003Cstrong\u003EBecause the globe retracts in Duane syndrome, the eyelid fissure typically narrows on adduction; CN VI palsy lacks this finding.\u003C/strong\u003E\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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  },
  {
    "Id": 1656,
    "Name": "Earliest clinical sign of anterior segment ischemia",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 72-year-old with hypertension and diabetes undergoes a rectus transposition procedure to treat exotropia secondary to a third nerve palsy. When more than two rectus muscles are operated on, a sight-threatening complication can occur. What is the earliest clinical sign of that complication?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: anterior chamber cells and flare.\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003E\u003Cstrong\u003EThis scenario is most concerned with anterior segment ischemia (ASI).\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EASI becomes more likely when surgery involves multiple rectus muscles (classically three or more), especially in older patients or those with vascular risk factors such as diabetes and hypertension.\u003C/strong\u003E The key anatomic reason is that \u003Cstrong\u003Ea large portion of the anterior segment blood supply comes from the anterior ciliary arteries, which run with the rectus muscles; operating on several recti can reduce perfusion to the iris/ciliary body/anterior segment.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EEarliest sign:\u003C/strong\u003E \u003Cstrong\u003EAnterior chamber inflammation (cells and flare) is typically the first detectable finding\u003C/strong\u003E, reflecting early ischemic injury to the iris and ciliary body with breakdown of the blood\u2013aqueous barrier. This can appear before corneal changes or pupil abnormalities.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other options are not the earliest\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003ECorneal epithelial edema\u003C/strong\u003E is a later manifestation, generally occurring after ischemia has progressed enough to impair endothelial function and corneal clarity.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EDescemet membrane folds\u003C/strong\u003E also tend to appear after significant corneal edema develops, so they are usually a subsequent sign rather than the first clue.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EPupil irregularity\u003C/strong\u003E (from iris ischemia/atrophy and sphincter dysfunction) is classically associated with ASI but is typically a more advanced finding compared with early anterior chamber reaction.\u003C/li\u003E\n\u003C/ul\u003E\n\u003Cp\u003E\u003Cstrong\u003EClinical pearl:\u003C/strong\u003E In suspected ASI, clinicians also watch for \u003Cstrong\u003Epain, photophobia, decreased vision, sluggish pupil responses, hypotony, corneal edema, and progressive iris atrophy\u003C/strong\u003E, with risk rising as the number of operated rectus muscles increases and in patients with systemic vasculopathy.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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  },
  {
    "Id": 1657,
    "Name": "Cyclic esotropia",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich statement about cyclic esotropia is incorrect?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: The claim that extraocular muscle surgery is usually not curative.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003ECyclic esotropia is an uncommon type of intermittent strabismus in which patients alternate between \u201Cstraight\u201D periods and periods of manifest esotropia in a predictable cycle (classically every other day, i.e., about 48 hours).\u003C/strong\u003E Because of this alternating pattern, \u003Cstrong\u003Enon-surgical treatments often give inconsistent results.\u003C/strong\u003E However, \u003Cstrong\u003Estrabismus surgery directed at the measured deviation on the esotropic days is generally the most reliable and is often curative\u003C/strong\u003E, which is the opposite of what the incorrect statement suggests.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other statements are true\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003ETypical cycle ~48 hours:\u003C/strong\u003E \u003Cstrong\u003EMany cases follow an every-other-day pattern.\u003C/strong\u003E\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EBinocular function on straight days:\u003C/strong\u003E \u003Cstrong\u003EWhen alignment is orthotropic (or close to it), binocular single vision and fusion are often possible.\u003C/strong\u003E On esotropic days, \u003Cstrong\u003Efusion is frequently lost\u003C/strong\u003E, commonly due to \u003Cstrong\u003Esuppression\u003C/strong\u003E (especially in younger children).\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EPatching may convert it to constant esotropia:\u003C/strong\u003E \u003Cstrong\u003EOcclusion can disrupt sensory adaptation and may \u201Cbreak\u201D the cycle\u003C/strong\u003E, occasionally resulting in \u003Cstrong\u003Ea persistent, manifest esotropia\u003C/strong\u003E rather than alternating straight/strabismic days.\u003C/li\u003E\n\u003C/ul\u003E\n\u003Cp\u003E\u003Cstrong\u003EExtra clinical pearl (helps the concept stick)\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EOn strabismic days, younger children often suppress to avoid diplopia; older children who cannot suppress as easily may complain of diplopia during the esotropic phase.\u003C/strong\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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  },
  {
    "Id": 1658,
    "Name": "Botulinum toxin A",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EBotulinum toxin type A produces muscle weakness by preventing release of which neurotransmitter at the neuromuscular junction?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: acetylcholine.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EBoNT-A causes chemodenervation by blocking acetylcholine release at the neuromuscular junction.\u003C/strong\u003E Botulinum toxin A enters cholinergic nerve terminals and \u003Cstrong\u003Ecleaves SNARE proteins (classically SNAP-25), which are required for synaptic vesicles to fuse with the presynaptic membrane.\u003C/strong\u003E Without vesicle fusion, \u003Cstrong\u003Eacetylcholine cannot be released\u003C/strong\u003E, so the muscle fiber is not stimulated and becomes functionally weakened/paralyzed.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other neurotransmitters are incorrect\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003ENorepinephrine\u003C/strong\u003E is mainly used by \u003Cstrong\u003Epostganglionic sympathetic neurons\u003C/strong\u003E and is not the primary transmitter at skeletal muscle NMJs.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EDopamine\u003C/strong\u003E is primarily a \u003Cstrong\u003Ecentral nervous system\u003C/strong\u003E neurotransmitter (and a precursor to norepinephrine), not the key transmitter for skeletal NMJ transmission.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ESerotonin\u003C/strong\u003E is chiefly involved in \u003Cstrong\u003Ecentral neurotransmission\u003C/strong\u003E and enteric signaling; it is not the transmitter responsible for skeletal muscle activation at the NMJ.\u003C/li\u003E\n\u003C/ul\u003E\n\u003Cp\u003E\u003Cstrong\u003EClinical duration pearl (cleaned and clarified)\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EThe functional effect typically lasts longer in facial muscles like the orbicularis (often \u22653 months) and tends to be shorter in extraocular muscles (commonly ~5\u20138 weeks),\u003C/strong\u003E reflecting differences in muscle physiology, dosing, and reinnervation dynamics.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1659,
    "Name": "JIA subtypes",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EAmong common juvenile idiopathic arthritis (JIA) subtypes, arrange the following conditions from the highest to the lowest likelihood of developing uveitis:\u0026nbsp;\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003EAnswer\u003C/h3\u003E\n\u003Cp\u003E\u003Cstrong\u003EAnswer: Oligoarticular JIA \u0026gt; RF-negative polyarticular JIA \u0026gt; systemic JIA (Still disease).\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EJuvenile idiopathic arthritis is the leading systemic condition associated with pediatric uveitis, most often presenting as chronic anterior uveitis.\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EThe risk of uveitis is not equal across JIA subtypes\u2014oligoarticular disease carries the highest risk (between the mentioned types), RF-negative polyarticular disease has an intermediate risk, and systemic JIA has a very low risk.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003EOligoarticular JIA is classically the subtype most linked to chronic anterior uveitis, with reported rates often in the ~10\u201330% range.\u003C/strong\u003E This category is typically defined by \u003Cstrong\u003Earthritis lasting more than 6 weeks with involvement of four or fewer joints during the first 6 months.\u003C/strong\u003E Serologically, \u003Cstrong\u003Erheumatoid factor is usually negative\u003C/strong\u003E, and \u003Cstrong\u003EANA positivity is common\u003C/strong\u003E, which correlates with a higher uveitis risk in many children.\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003ERF-negative polyarticular JIA can also be associated with anterior uveitis, but overall less frequently than oligoarticular disease.\u003C/strong\u003E A commonly cited figure is \u003Cstrong\u003Earound ~10%\u003C/strong\u003E in some cohorts, making it a reasonable \u201Cmiddle\u201D option among the three listed conditions.\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003EUveitis is uncommon in systemic JIA compared with other subtypes.\u003C/strong\u003E Systemic JIA is characterized by systemic inflammation (fevers, rash, etc.), but \u003Cstrong\u003Eit rarely produces the classic chronic anterior uveitis pattern seen in oligoarticular/ANA-positive disease\u003C/strong\u003E, so it belongs at the bottom of the frequency list.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1660,
    "Name": "Orbital fat prolapse during strabismus surgery",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EDuring strabismus surgery for a 6-year-old with exotropia, an unintended rent occurs in Tenon\u2019s capsule and orbital fat herniates into the surgical field. What is the most appropriate management at this moment?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EOrbital fat appearing in a strabismus case usually means the posterior Tenon\u2019s barrier has been breached. If the fat is left prolapsed, it can heal to the sclera or extraocular muscles and form restrictive scar tissue.\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EThis postoperative restriction is known as fat adherence (adherence) syndrome and can lead to limited ductions and new or worsening motility problems.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EThe practical goal in the operating room is to remove the exposed fat that could scar to ocular tissues and then restore the tissue plane.\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003ETherefore, the preferred approach is to carefully trim/excise the prolapsed orbital fat (rather than leaving it exposed) and then close the Tenon\u2019s capsule tear using absorbable sutures to prevent further fat herniation and minimize future adhesions.\u003C/strong\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 1661,
    "Name": "Infant with enlarged corneas and corneal haze",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 2-month-old is brought in because the eyes appear unusually large. Penlight examination shows bilateral findings consistent with corneal clouding, and both corneas measure 13.5 mm horizontally. The irides look normal. There is a family history of a similar eye problem in a close relative. Which gene mutation is most consistent with the diagnosis in this infant?\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-03-05-82cb8047-c725-4783-858c-9e736c6392ef.png\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: GLC3B\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003E\u003Cstrong\u003EThe combination of \u201Cbig-looking eyes,\u201D very large corneal diameters (13.5 mm in a 2\u2011month-old), and a hazy/irregular corneal light reflex strongly indicates primary congenital glaucoma (PCG) with corneal edema.\u003C/strong\u003E \u003Cstrong\u003EIn infants, elevated intraocular pressure can stretch the cornea and globe (buphthalmos) and cause corneal edema, which is why the corneal reflex looks irregular and the cornea appears cloudy.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EPrimary congenital glaucoma is often sporadic, but familial cases occur and are linked to mutations in the \u201CGLC3\u201D group (classically including CYP1B1/GLC3A, and also GLC3B and GLC3C).\u003C/strong\u003E Since the listed choices include \u003Cstrong\u003EGLC3B\u003C/strong\u003E, that is the best match for PCG among the options provided.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other options are wrong :\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EPITX2\u003C/strong\u003E is classically associated with \u003Cstrong\u003EAxenfeld\u2013Rieger spectrum\u003C/strong\u003E, an anterior segment dysgenesis condition that can lead to secondary glaucoma, but it does not best explain the classic PCG picture of markedly enlarged infant corneas with diffuse corneal edema.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EGLC1A (MYOC)\u003C/strong\u003E is associated with \u003Cstrong\u003Ejuvenile-onset open-angle glaucoma\u003C/strong\u003E, typically presenting later (childhood/adolescence) and not with buphthalmos/corneal enlargement in early infancy.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ELOXL1\u003C/strong\u003E is strongly associated with \u003Cstrong\u003Epseudoexfoliation glaucoma\u003C/strong\u003E, a condition of older adults rather than infants.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 1662,
    "Name": "Familial aniridia: expected associated finding",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 2-year-old has had nystagmus since early infancy, reduced vision in both eyes, and very little visible iris tissue bilaterally. The same iris abnormality is present in the child\u2019s parent and two siblings. Which additional finding is most likely in this child?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: Photosensitivity.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003EThe clinical picture is most consistent with aniridia, which typically includes bilateral iris hypoplasia, foveal hypoplasia (driving reduced visual acuity), and early-onset nystagmus.\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EWhen aniridia is familial (multiple affected first-degree relatives), it most often reflects a heritable PAX6-related condition rather than a sporadic contiguous gene deletion.\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EWith little to no iris tissue, excessive light enters the eye, so photophobia/photosensitivity is a very common symptom.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\nWilms tumor and nephroblastoma refer to the same pediatric renal malignancy. The key discriminator is inheritance pattern: familial aniridia (typically isolated PAX6 mutation) is not associated with a substantially increased Wilms tumor risk compared with the general population.\u003Cbr\u003E\nIn contrast, sporadic aniridia can be due to larger deletions involving the WT1 region (classically the WAGR spectrum), and that subgroup carries a meaningful Wilms tumor risk\u2014hence the emphasis on genetic testing and tumor surveillance in apparently sporadic cases.\u003Cbr\u003E\nBecause this case is strongly familial, the \u201Ctumor risk\u201D association is less likely than a direct optical symptom such as photosensitivity.\u003C/p\u003E\u003Cp\u003E\nMyelinated retinal nerve fiber layer is an incidental fundus finding that can be linked to refractive amblyopia, but it is not a typical association of aniridia. Aniridia is more classically associated with glaucoma, cataract, optic nerve hypoplasia, and later corneal changes from limbal stem cell deficiency rather than myelinated nerve fibers.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1663,
    "Name": "Cerebral visual impairment (CVI)",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich statement about cerebral visual impairment is true?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: Optic nerve cupping may be seen in premature infants.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003ECerebral visual impairment refers to visual dysfunction caused by injury to the visual pathways behind the lateral geniculate nucleus (retrogeniculate), and the term \u201Ccerebral\u201D is preferred because both cortical and subcortical damage can produce the same functional visual problems.\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EIn premature infants, periventricular leukomalacia is a major cause of cerebral visual impairment and can be associated with optic nerve structural changes, including optic disc cupping that can resemble glaucomatous cupping.\u003C/strong\u003E Importantly, this cupping occurs from neurodevelopmental/white-matter injury effects on the optic pathways rather than from elevated intraocular pressure.\u003C/p\u003E\u003Cp\u003E\u003Cbr\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1664,
    "Name": "Planning a unilateral recess\u2013resect for a 40\u0394 alternating exotropia ",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EA 20-year-old has an untreated alternating exotropia measuring 40 prism diopters. You plan a unilateral recess\u2013resect procedure on the left eye. Using the general Parks dosing approach, which combination of medial rectus strengthening and lateral rectus weakening is most reasonable?\u003C/p\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: Left medial rectus resection 6 mm with left lateral rectus recession 8 mm.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong style=\u0022text-decoration-line: underline;\u0022\u003EThese problems usually assess three ideas rather than exact memorized millimeters:\u003C/strong\u003E\u003C/p\u003E\n\u003Col\u003E\n\u003Cli\u003E\u003Cstrong\u003EWhich muscles to target for an exotropia\u003C/strong\u003E,\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EWhich action to take on each muscle (strengthen vs weaken)\u003C/strong\u003E, and\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EWhether the deviation size calls for a small vs large dose.\u003C/strong\u003E\u003C/li\u003E\n\u003C/ol\u003E\n\u003Cp\u003E\u003Cstrong\u003EStep 1 \u2014 Pick the correct \u201Cdirection\u201D of surgery for exotropia\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EIn exotropia, the eye is deviated outward, so the standard recess\u2013resect strategy is:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EStrengthen the medial rectus (resection)\u003C/strong\u003E to increase adduction pull, and\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EWeaken the lateral rectus (recession)\u003C/strong\u003E to reduce abduction pull.\u003Cbr\u003E\nAll proposed plans follow this basic pairing, so the decision hinges on the amount.\u003C/li\u003E\n\u003C/ul\u003E\n\u003Cp\u003E\u003Cstrong\u003EStep 2 \u2014 Remember that the lateral rectus generally needs a larger millimeter dose\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EFor horizontal surgery, equal millimeter changes do not produce equal effects across muscles.\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EThe lateral rectus typically requires a larger recession than the medial rectus requires resection to achieve a comparable overall correction\u003C/strong\u003E, so a sensible plan usually shows a \u003Cstrong\u003Ebigger number on the lateral rectus\u003C/strong\u003E than on the medial rectus.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EStep 3 \u2014 Scale the dose to the deviation size (40\u0394 is \u201Clarge\u201D)\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EA 40\u0394 exotropia is well beyond a small-angle deviation, so a minimal recess\u2013resect (such as ~3\u20134 mm on each muscle) would be under-dosed.\u003C/strong\u003E\u003Cbr\u003E\nA more appropriate plan should reflect a \u003Cstrong\u003Esubstantial\u003C/strong\u003E lateral rectus recession paired with a \u003Cstrong\u003Emoderate-to-large\u003C/strong\u003E medial rectus resection\u2014commonly in the range of \u003Cstrong\u003Eabout 8 mm recession on the lateral rectus with about 6 mm resection on the medial rectus\u003C/strong\u003E for a unilateral approach.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong style=\u0022text-decoration-line: underline;\u0022\u003EWhy the other plans are not reasonable:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EPlans with very small amounts (around 3\u20134 mm)\u003C/strong\u003E are \u003Cstrong\u003Etoo conservative\u003C/strong\u003E for a 40\u0394 deviation and would be expected to leave a significant residual exotropia.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EA plan where the medial rectus resection exceeds the lateral rectus recession\u003C/strong\u003E is generally \u003Cstrong\u003Eless consistent with typical horizontal dose-response behavior\u003C/strong\u003E, where the lateral rectus often needs the larger millimeter change.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EA plan that reverses the \u201Cbigger LR, smaller MR\u201D relationship\u003C/strong\u003E tends to be less aligned with the usual Parks-style proportional thinking for unilateral recess\u2013resect in moderate-to-large exotropia.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
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  },
  {
    "Id": 1665,
    "Name": "Congenital NLDO at 18 months despite massage",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EAn 18\u2011month\u2011old has had tearing from presumed congenital nasolacrimal duct obstruction since early infancy. The family has performed consistent Crigler massage for about a year, but the child still has epiphora. What is the most appropriate next management step?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: Probing.\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003E\u003Cstrong\u003EPersistent tearing at 18 months despite adequate conservative care suggests that spontaneous resolution is less likely, so the next standard step is to mechanically open the obstruction.\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EPrimary probing of the nasolacrimal duct is typically the first interventional treatment\u003C/strong\u003E and can often be performed as an office procedure in select children (or under anesthesia depending on age/cooperation and local practice). \u003Cstrong\u003EWhen done properly, probing has a high success rate, commonly reported around the 80\u201390% range in uncomplicated cases\u003C/strong\u003E, which is why it is the preferred next step after massage fails.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EIf symptoms remain after initial probing, escalation options include a repeat probing, silicone intubation.\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EDacryocystorhinostomy (DCR) is generally reserved for refractory cases\u003C/strong\u003E because it is more invasive and usually considered only after less invasive procedures have not worked.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1666,
    "Name": "Congenital visual loss: which condition shows an early abnormal fundus?",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EIn an infant with reduced vision present since birth, which diagnosis is most likely to show an abnormal fundus examination when evaluated during the first few months of life?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: De Morsier syndrome (septo-optic dysplasia).\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003E\u003Cstrong\u003EKey idea:\u003C/strong\u003E \u003Cstrong\u003EAmong these conditions, septo\u2011optic dysplasia is the one in which the eye exam can reveal a structural abnormality immediately\u2014classically optic nerve hypoplasia\u2014so the fundus can look abnormal very early in life.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\u003Cspan style=\u0022font-weight: 700;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\n\u003Cstrong\u003ESepto\u2011optic dysplasia (De Morsier syndrome) is a congenital disorder involving midline brain development issues with unilateral or bilateral optic nerve hypoplasia.\u003C/strong\u003E Because the optic nerve is underdeveloped from birth, \u003Cstrong\u003Ethe optic discs may appear small and pale with a \u201Cdouble\u2011ring\u201D sign, making the fundus abnormal even in the first months.\u003C/strong\u003E \u003Cstrong\u003ENystagmus often becomes more obvious around 1\u20134 months as fixation pathways mature, but the optic nerve abnormality is present from the start.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other options are less likely to show an abnormal fundus in the first months\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EAchromatopsia:\u003C/strong\u003E \u003Cstrong\u003EThis is a cone dysfunction syndrome (often described as rod monochromatism) causing poor central vision, photophobia, reduced/absent color vision, and nystagmus.\u003C/strong\u003E However, \u003Cstrong\u003Ethe retinal appearance in early infancy is typically normal\u003C/strong\u003E, and diagnosis often relies on \u003Cstrong\u003EERG demonstrating absent or markedly reduced cone responses.\u003C/strong\u003E\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ELeber congenital amaurosis:\u003C/strong\u003E \u003Cstrong\u003EThis is a severe inherited retinal dystrophy affecting rods and cones.\u003C/strong\u003E Although visual behavior is markedly reduced and pupils may be sluggish, \u003Cstrong\u003Ethe fundus can look deceptively normal early on\u003C/strong\u003E, with more classic pigmentary/atrophic changes (vessel attenuation, optic disc pallor, pigment migration) developing later in many genotypes. \u003Cstrong\u003EERG is often crucial early.\u003C/strong\u003E\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ECortical visual impairment:\u003C/strong\u003E \u003Cstrong\u003EThe problem is retro\u2011geniculate (brain/visual pathway) rather than primary retinal disease, so the ocular structures and fundus are usually normal.\u003C/strong\u003E In some cases of very early severe injury, \u003Cstrong\u003Esecondary optic pallor can eventually occur via trans\u2011synaptic degeneration\u003C/strong\u003E, but \u003Cstrong\u003Ethat is not the typical early fundus finding within the first few months\u003C/strong\u003E, and many infants still have a normal-appearing fundus initially.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "CategoryId": 14,
    "Category": null,
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  },
  {
    "Id": 1667,
    "Name": "Infantile spasms \u002B chorioretinal lacunae: expected systemic finding",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 3-month-old infant is evaluated for infantile spasms. Fundus examination shows multiple oval, pale chorioretinal lesions consistent with the appearance in the image. Which additional abnormality is most likely to be found during further evaluation?\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-03-05-a5b55168-0cd2-443f-beba-1b8bb0927c04.png\u0022\u003E\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cbr\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: Absence (agenesis) of the corpus callosum on MRI.\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003E\u003Cstrong\u003EThe fundus photo shows characteristic chorioretinal lacunae\u2014well-known for Aicardi syndrome.\u003C/strong\u003E \u003Cstrong\u003EWhen chorioretinal lacunae occur in an infant with infantile spasms, Aicardi syndrome becomes the unifying diagnosis.\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EAicardi syndrome classically presents with a triad: chorioretinal lacunae, agenesis of the corpus callosum, and infantile spasms.\u003C/strong\u003E \u003Cstrong\u003EBecause corpus callosum agenesis is a core feature of the syndrome, brain MRI most often demonstrates partial or complete absence of the corpus callosum.\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EAdditional supportive findings can include optic nerve and retinal anomalies (for example colobomas) and small eyes, along with neurodevelopmental delay.\u003C/strong\u003E \u003Cstrong\u003EThe condition is typically described as X-linked dominant and usually not compatible with survival in most 46,XY individuals (rare exceptions such as XXY can occur).\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other options are less likely\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EPositive Toxocara ELISA\u003C/strong\u003E fits ocular toxocariasis, which more often produces a unilateral inflammatory mass-like picture (posterior pole granuloma or peripheral granuloma) and may cause leukocoria.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ENeuronal lipofuscin deposits\u003C/strong\u003E point toward neuronal ceroid lipofuscinosis (Batten disease). \u003Cstrong\u003EThat disorder can involve seizures and progressive neurodegeneration, but it typically presents later and is associated with retinal degeneration/optic atrophy and markedly abnormal ERG rather than classic chorioretinal lacunae in early infancy.\u003C/strong\u003E\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EA mutation on chromosome 22\u003C/strong\u003E is commonly tested in association with neurofibromatosis type 2. \u003Cstrong\u003ENF2 is characterized by bilateral vestibular schwannomas and other tumors/cataracts, not the distinctive lacunae-plus-infantile-spasms pattern.\u003C/strong\u003E\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "CategoryId": 14,
    "Category": null,
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  },
  {
    "Id": 1668,
    "Name": "Strabismus procedure with the highest vision threat if perforation happens",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EAmong the following strabismus operations, which one carries the greatest risk to central vision if an intraoperative complication (such as scleral perforation) occurs?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: Inferior oblique advancement.\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003E\u003Cstrong\u003EThe key complication being tested is scleral perforation and the potential for retinal injury.\u003C/strong\u003E \u003Cstrong\u003EThe procedure that becomes most dangerous to visual acuity is the one performed closest to the posterior pole\u2014because an accidental full-thickness pass risks damaging the macula, which is critical for central vision.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EInferior oblique advancement is a \u201Cstrengthening/anteriorization/advancement-type\u201D operation that requires reattaching the inferior oblique more posteriorly and/or in a location that brings the surgical field closer to the posterior segment than typical weakening procedures.\u003C/strong\u003E \u003Cstrong\u003EThat posterior (and relatively deep) working location increases the chance that an unintended perforation could involve the posterior retina, and therefore the macula, leading to a much greater threat to best-corrected visual acuity (for example macular hemorrhage, chorioretinal scar, or retinal detachment involving the posterior pole).\u003C/strong\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
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  },
  {
    "Id": 1669,
    "Name": "Oculocerebrorenal (Lowe) syndrome ",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 4\u2011month\u2011old has poor visual tracking since birth. The child had marked hypotonia at birth, severe growth failure, and urine studies showing renal tubular dysfunction (renal tubular acidosis, hypokalemia, hypercalciuria, and aminoaciduria). This constellation suggests a specific systemic syndrome. Which congenital cataract morphology is most characteristic of that syndrome?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: disciform (membranous) cataracts.\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003E\u003Cstrong\u003EThis presentation is most consistent with Lowe syndrome (oculocerebrorenal syndrome): a disorder combining ocular disease, neurodevelopmental hypotonia, and proximal renal tubular dysfunction (Fanconi-type features).\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EThe urinalysis pattern\u2014aminoaciduria, renal tubular acidosis, hypokalemia, and hypercalciuria\u2014strongly points to a proximal tubulopathy, which explains failure to thrive and can contribute to rickets/poor growth.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EIn Lowe syndrome, the classic ocular hallmark is dense congenital cataracts that are commonly described as disciform or \u201Cmembranous.\u201D\u003C/strong\u003E These cataracts are often present early and are a key reason infants have poor fixation/visual behavior from birth.\u003Cbr\u003E\n\u003Cstrong\u003EAdditional high-yield ocular associations include an increased risk of glaucoma in infancy and surface abnormalities (such as conjunctival/corneal scarring),\u003C/strong\u003E but the cataract type asked here is the disciform/membranous pattern.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other cataract types are less appropriate\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EAnterior subcapsular cataracts\u003C/strong\u003E are more classically linked to \u003Cstrong\u003Elens trauma or chronic inflammation and certain dermatologic associations (for example severe atopy).\u003C/strong\u003E\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ECerulean (\u201Cblue\u2011dot\u201D) cataracts\u003C/strong\u003E are typically \u003Cstrong\u003Esmall peripheral cortical opacities\u003C/strong\u003E that are often minimally symptomatic.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EPosterior subcapsular cataracts\u003C/strong\u003E are commonly associated with \u003Cstrong\u003Esteroid exposure, inflammation, radiation, and some retinal dystrophies.\u003C/strong\u003E\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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  },
  {
    "Id": 1670,
    "Name": "Microcornea: diagnostic size cutoff in newborns",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhat horizontal corneal diameter is commonly used as the cutoff to label a newborn as having microcornea?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: Horizontal corneal diameter less than 9 mm.\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003E\u003Cstrong\u003EMicrocornea refers to a cornea that is abnormally small in diameter but otherwise typically clear and of near-normal thickness.\u003C/strong\u003E In practice, the most commonly used definition is \u003Cstrong\u003Ea horizontal corneal diameter below 9 mm in a newborn.\u003C/strong\u003E As children grow, the threshold is sometimes expressed differently (for example, \u003Cstrong\u003Ebelow about 10 mm by around 2 years of age\u003C/strong\u003E), reflecting the expected increase in corneal diameter with age.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy this cutoff matters clinically\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EA small cornea often accompanies a smaller overall eye (short axial length), which frequently produces hyperopia.\u003C/strong\u003E The anterior segment can also be crowded, which increases susceptibility to \u003Cstrong\u003Eangle-closure mechanisms\u003C/strong\u003E. Even when angle closure is not present, \u003Cstrong\u003Eglaucoma risk can still be higher than in the general population\u003C/strong\u003E, so these children warrant careful long-term monitoring of intraocular pressure, optic nerves, and anterior chamber configuration.\u0026nbsp;\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EMicrocornea may be seen alongside other congenital ocular disorders such as \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Epersistent fetal vasculature (PFV/PHPV), coloboma, and nanophthalmos\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E, so it should prompt a broader anatomic evaluation (corneal clarity, anterior segment depth, lens status, axial length, and posterior segment assessment when possible).\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "CategoryId": 14,
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  },
  {
    "Id": 1671,
    "Name": " SUN grading of anterior chamber cells and flare (pediatric uveitis)",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 3-year-old has band keratopathy in both eyes. Anterior chamber assessment shows 30 cells in a 1 mm \u00D7 1 mm slit beam in the right eye, and the iris details look hazy. In the left eye there are 20 cells in the same field, and there is only a mild haze while iris details remain clearly visible. Using SUN terminology, how should the cell and flare grades be documented for each eye?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: Right eye: 3\u002B cell, 3\u002B flare | Left eye: 2\u002B cell, 1\u002B flare.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong style=\u0022text-decoration-line: underline;\u0022\u003EStep 1 \u2014 Grade the cells (SUN, 1 mm \u00D7 1 mm field):\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003ESUN cell grades are based on the number of cells per 1\u00D71 mm slit beam: 16\u201325 cells = 2\u002B, 26\u201350 cells = 3\u002B, and \u0026gt;50 = 4\u002B.\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003ERight eye has 30 cells \u2192 falls in 26\u201350 \u2192 3\u002B cells.\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003ELeft eye has 20 cells \u2192 falls in 16\u201325 \u2192 2\u002B cells.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong style=\u0022text-decoration-line: underline;\u0022\u003EStep 2 \u2014 Grade the flare (SUN):\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003ESUN flare grading is based on clarity of iris/lens details: 1\u002B = faint flare, 2\u002B = moderate (details still clear), 3\u002B = marked (details hazy), 4\u002B = intense with fibrin/plastic aqueous.\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003ERight eye: \u201Cview of the iris is hazy\u201D \u2192 marked flare \u2192 3\u002B flare.\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003ELeft eye: \u201Cfaint haze but iris details clearly visible\u201D \u2192 faint flare \u2192 1\u002B flare.\u003C/strong\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "CategoryId": 14,
    "Category": null,
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  },
  {
    "Id": 1672,
    "Name": "See-saw nystagmus in a child",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 14-year-old has had unusual rhythmic eye movements for three months. Examination shows a pendular pattern in which one eye moves upward with inward torsion while the other simultaneously moves downward with outward torsion. In children, which lesion most commonly explains this finding?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: Craniopharyngioma.\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003E\u003Cstrong\u003EThis eye movement pattern is classic for see-saw nystagmus.\u003C/strong\u003E \u003Cstrong\u003EIn see-saw nystagmus, the two eyes move in opposite vertical directions while torsion also occurs in opposite directions (one eye elevates and intorts while the other depresses and extorts), giving a \u201Cteeter-totter\u201D appearance.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EThe most typical neuroanatomic source is a lesion around the parasellar region and/or the midbrain.\u003C/strong\u003E \u003Cstrong\u003EIn pediatric patients, craniopharyngioma is a common parasellar mass and is therefore a classic association with see-saw nystagmus.\u003C/strong\u003E \u003Cstrong\u003EBecause craniopharyngiomas can compress the optic chiasm, they may also produce bitemporal hemianopic visual field loss.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EManagement focuses on treating the underlying cause.\u003C/strong\u003E \u003Cstrong\u003EDefinitive therapy is directed at the responsible lesion (often surgical removal/management).\u003C/strong\u003E \u003Cstrong\u003ESymptom-reducing medications such as baclofen or clonazepam may lessen the oscillations in some cases, but they do not replace lesion-directed treatment.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other options are wrong\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003ENeuroblastoma is most strongly linked to opsoclonus\u003C/strong\u003E (chaotic, rapid, multidirectional saccadic bursts).\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ECerebellar tumor or infarct more commonly produces other nystagmus patterns\u003C/strong\u003E (for example downbeat, upbeat, or periodic alternating nystagmus depending on the region involved).\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EWhipple disease is not a typical pediatric cause of see-saw nystagmus\u003C/strong\u003E and is classically associated with systemic infectious features; it is not the high-yield lesion-location match for this specific ocular motor finding.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "HighYield": true,
    "CategoryId": 8,
    "Category": null,
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  },
  {
    "Id": 1673,
    "Name": "Neonatal conjunctivitis prophylaxis",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EAcross different countries, several agents are used to prevent neonatal conjunctivitis (ophthalmia neonatorum). Which option is not used for prophylaxis?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: PHMB eye drops.\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003EPHMB (polyhexamethylene biguanide) is primarily an anti-amoebic medication used in the treatment of Acanthamoeba keratitis, not as routine newborn prophylaxis. Because its standard clinical role is therapeutic for corneal infection rather than preventive neonatal care, it is the \u201Cexception\u201D among the listed options.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other listed agents can be used for prophylaxis\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003EErythromycin ophthalmic ointment is the standard prophylactic medication used in many settings (notably in the United States) to reduce the risk of neonatal conjunctivitis, especially gonococcal disease.\u003C/li\u003E\n\u003Cli\u003ESilver nitrate was historically the classic prophylactic agent (\u201CCred\u00E9 prophylaxis\u201D). It is effective at preventing gonococcal ophthalmia, but it does not reliably prevent chlamydial conjunctivitis and can cause chemical conjunctivitis.\u003C/li\u003E\n\u003Cli\u003EPovidone\u2013iodine drops have been used as a low-cost prophylaxis option in resource-limited settings and have broad antimicrobial activity, making it a practical alternative in some regions.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "CategoryId": 14,
    "Category": null,
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  },
  {
    "Id": 1674,
    "Name": "Inferior oblique anatomy",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich statement about the inferior oblique extraocular muscle is incorrect?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer:\u0026nbsp;\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px; font-weight: bold;\u0022\u003EThe inferior oblique arises from the ethmoid bone.\u003C/span\u003E\u003C/p\u003E\u003C!--StartFragment--\u003E\u003C!--EndFragment--\u003E\u003Cp\u003E\n\u003Cstrong\u003EThe inferior oblique does not originate from the ethmoid.\u003C/strong\u003E \u003Cstrong\u003EIt originates anteriorly from the periosteum of the maxillary bone on the orbital floor, just lateral to the nasolacrimal fossa.\u003C/strong\u003E Because of this anterior\u2013inferomedial origin, the muscle then courses posterolaterally beneath the inferior rectus toward its scleral insertion.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other statements are true\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EThe course relative to the inferior rectus is a common point of confusion, but it is correct that the inferior oblique passes \u201Cinferior/external\u201D to the inferior rectus (farther from the globe).\u003C/strong\u003E In practical terms, the inferior oblique is in a more superficial plane than the inferior rectus as it sweeps laterally and posteriorly.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EIts insertion is also correctly described as being under the lateral rectus and relatively posterior on the globe, in the vicinity of the macular/posterior pole region.\u003C/strong\u003E This posterior insertion location is one reason posterior passes during certain inferior oblique procedures can carry a higher risk of visually significant complications if a scleral perforation occurs.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EInnervation is correctly stated as coming from the inferior division of cranial nerve III.\u003C/strong\u003E The inferior oblique shares this division with the medial rectus and inferior rectus (and the parasympathetic fibers to the pupil travel with the inferior division as well).\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EQuick memory anchor (high-yield)\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EInferior oblique: \u201Cmaxillary origin, under/behind IR plane, inserts posterolateral under LR, innervated by inferior division of III.\u201D\u003C/strong\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "CategoryId": 10,
    "Category": null,
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  },
  {
    "Id": 1675,
    "Name": "Brown syndrome surgery",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhen operating for Brown syndrome, surgeons may take steps to reduce the risk of causing a symptomatic superior oblique weakness afterward. Which option is not considered a preventive strategy?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: Complete tenectomy of the posterior portion of the superior oblique tendon.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003EThe concern in Brown syndrome surgery is \u201Cover-weakening\u201D the superior oblique tendon, which can convert a mechanical elevation limitation into a true symptomatic superior oblique palsy (with new vertical deviation, torsional symptoms, or diplopia).\u003C/strong\u003E Because of that, techniques that \u003Cstrong\u003Econtrol\u003C/strong\u003E how much the tendon is weakened are preferred.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EA key surgical principle is that a partial posterior tenectomy (often described as ~80% of the posterior fibers) can relieve the restrictive component while still preserving enough tendon function to reduce the chance of a clinically significant superior oblique weakness.\u003C/strong\u003E In contrast, \u003Cstrong\u003Ea complete posterior tenectomy removes too much tendon effect and therefore is the option most likely to precipitate symptomatic superior oblique palsy rather than prevent it.\u003C/strong\u003E That is why it is the \u201CEXCEPT\u201D choice.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other interventions can help reduce postoperative symptomatic superior oblique palsy:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003ECareful handling of the intermuscular septum during tenotomy\u003C/strong\u003E can reduce scarring or unintended traction effects that may worsen motility outcomes or destabilize tendon function after surgery.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ESimultaneous ipsilateral inferior oblique weakening\u003C/strong\u003E can be used in selected cases to balance vertical/torsional forces and reduce the likelihood that a surgically weakened superior oblique will become clinically symptomatic.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ESewing an inert spacer between the cut ends of the superior oblique tendon\u003C/strong\u003E is a \u201Ccontrolled weakening\u201D approach: \u003Cstrong\u003Eit lengthens the tendon rather than fully disrupting it, providing a more titratable effect and lowering the risk of an abrupt, excessive loss of superior oblique function.\u003C/strong\u003E\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "CategoryId": 10,
    "Category": null,
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  },
  {
    "Id": 1676,
    "Name": "Clinical significance thresholds for A- and V-pattern strabismus",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EFor pattern strabismus, what minimum difference between measurements in upgaze and downgaze is generally used to label an A-pattern as clinically meaningful?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: 10 prism diopters.\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003E\u003Cstrong\u003EAn A-pattern describes a horizontal deviation that changes with vertical gaze\u2014classically the deviation differs between upgaze and downgaze in a way that forms an \u201CA\u201D when plotted.\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EIn routine clinical practice, an A-pattern is typically considered significant when the upgaze\u2013downgaze difference reaches about 10 prism diopters or more.\u003C/strong\u003E This cutoff helps distinguish small measurement variability from a true pattern that may affect symptoms, head posture, or surgical planning.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EA helpful comparison is the V-pattern threshold: V-pattern strabismus is usually considered clinically significant at a larger difference\u2014around 15 prism diopters between upgaze and downgaze.\u003C/strong\u003E The higher cutoff reflects how these patterns are commonly categorized for decision-making.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1677,
    "Name": "Pediatric superotemporal eyelid mass with adnexal elements on histology",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 4-year-old is brought in with a firm, palpable lump near the lateral aspect of the upper eyelid. The caregiver noticed it incidentally during bathing and cannot say when it first appeared. The lesion is removed, and the accompanying histology images are provided. What is the most likely diagnosis?\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-03-12-15048d5a-2534-4086-8a65-efac5046436b.png\u0022\u003E\u003Cimg src=\u0022/upload-2026-03-12-a11b010d-dcf1-49a5-bc7b-a844b59a6e67.png\u0022 style=\u0022color: rgb(66, 66, 66); font-family: Roboto, Helvetica, Arial, \u0026quot;sans-serif\u0026quot;; letter-spacing: 0.14994px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-03-12-b493366d-f922-496b-986b-36cd78614d1c.png\u0022 style=\u0022color: rgb(66, 66, 66); font-family: Roboto, Helvetica, Arial, \u0026quot;sans-serif\u0026quot;; letter-spacing: 0.14994px;\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: Dermoid cyst.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003EThe location and pathology together strongly support a dermoid cyst.\u003C/strong\u003E \u003Cstrong\u003EClinically, dermoid cysts in children often present as a painless, slowly noticed mass near the superotemporal orbital rim, classically around the frontozygomatic suture.\u003C/strong\u003E \u003Cstrong\u003EOn histology, the defining feature is a cyst lined by keratinizing stratified squamous epithelium with keratin debris in the lumen, plus skin adnexal structures in the cyst wall (such as hair follicles and sebaceous/sweat glands).\u003C/strong\u003E \u003Cstrong\u003EThose adnexal elements are what separate a dermoid cyst from an epidermoid cyst.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EKey concept (high yield)\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EDermoid cyst =adnexal structures present.\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EEpidermoid cyst =adnexal structures absent.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other options are not the diagnosis\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EEpidermoid cyst:\u003C/strong\u003E \u003Cstrong\u003ECan look similar clinically, but histology lacks adnexal structures.\u003C/strong\u003E \u003Cstrong\u003EIf the specimen shows hair follicles or sebaceous glands within the cyst wall, that points away from epidermoid and toward dermoid.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EAdenoid cystic carcinoma:\u003C/strong\u003E \u003Cstrong\u003EThis is typically a painful lacrimal gland malignancy and would be very unusual as a painless incidental eyelid-margin mass in a young child.\u003C/strong\u003E \u003Cstrong\u003EPathology classically shows a cribriform (\u201CSwiss-cheese\u201D) pattern rather than a keratin-filled cyst with adnexal elements.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EPyogenic granuloma:\u003C/strong\u003E \u003Cstrong\u003EUsually appears as a bright red, friable, vascular lesion (often after surgery, trauma, or chronic irritation).\u003C/strong\u003E \u003Cstrong\u003EIt does not present as a well-encapsulated cystic lesion with keratin and adnexal structures on histology.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EClinical relevance/complication:\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EDermoid cysts can rupture spontaneously or during manipulation.\u003C/strong\u003E \u003Cstrong\u003EWhen the cyst contents (keratin) spill into surrounding tissues, an intense inflammatory reaction can occur and may mimic preseptal/orbital cellulitis.\u003C/strong\u003E \u003Cstrong\u003EDuring excision, careful removal without violating the cyst wall helps reduce postoperative inflammation.\u003C/strong\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
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  },
  {
    "Id": 1678,
    "Name": "Newborn retinal hemorrhages found incidentally on exam",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 3-day-old newborn is evaluated for suspected neonatal conjunctivitis. During a full eye examination with dilation, you notice a small amount of intraretinal hemorrhage in both eyes. The newborn otherwise looks well, interactive, and medically stable. What is the most appropriate next step in management?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: Observation only.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003ESmall, intraretinal hemorrhages detected in the first days of life are commonly related to the mechanical stresses of delivery (especially vaginal delivery) and are usually self-limited.\u003C/strong\u003E \u003Cstrong\u003EIn an otherwise well-appearing newborn with no neurologic symptoms and only mild hemorrhages, the safest and most appropriate approach is reassurance with follow-up rather than urgent systemic investigations.\u003C/strong\u003E\u003Cbr\u003E\u003Cstrong\u003EBirth-related retinal hemorrhages typically fade over days to weeks and usually resolve within about the first month.\u003C/strong\u003E \u003Cstrong\u003EBecause the finding is common and transient, immediate escalation (imaging, hematologic testing, or mandatory reporting) is not the default when the infant is clinically well and the hemorrhages are mild.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other options are not appropriate in this specific vignette\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EHematologic workup for a bleeding disorder\u003C/strong\u003E\u003Cbr\u003E\nA coagulation evaluation becomes more relevant when hemorrhages are unusually extensive, recurrent, occur without an obvious perinatal explanation, or are accompanied by systemic bleeding signs (bruising, bleeding from venipuncture sites, mucosal bleeding) or a concerning family history.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EImaging for non-accidental trauma\u003C/strong\u003E\u003Cbr\u003E\nRetinal hemorrhages from abusive head trauma are typically more severe and have a different \u201Cpattern \u002B context.\u201D They are often numerous, multilayered (intra-, pre-, and subretinal), can extend to the retinal periphery, and may be associated with retinal structural injury such as perimacular folds or traumatic retinoschisis. Importantly, affected infants are frequently clinically unwell (altered consciousness, seizures, vomiting, irritability, poor feeding) and may have evidence of intracranial injury.\u0026nbsp;\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EImmediate reporting to child protective services\u003C/strong\u003E\u003Cbr\u003E\nReporting is appropriate when there is reasonable suspicion of abuse based on the overall clinical picture (history inconsistencies, systemic/neurologic findings, or a hemorrhage pattern strongly suggestive of trauma).\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhat \u201Cobservation\u201D should include (practical documentation)\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EDocument the hemorrhage type and extent (intraretinal, mild, bilateral), overall infant wellness, and arrange follow-up to confirm resolution.\u003C/strong\u003E \u003Cstrong\u003EEscalate evaluation if hemorrhages are extensive, multilayered, associated with retinal splitting/folds, persist beyond the expected resolution window, or if any systemic/neurologic concerns emerge.\u003C/strong\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
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  },
  {
    "Id": 1679,
    "Name": "Iris coloboma: \u201Ctypical\u201D location, laterality, and posterior association",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003ERegarding to the lesion showed in the picture, If the defect is the typical type, which statement is correct regarding which eye is shown and whether deeper (posterior) ocular structures may also be involved?\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-03-12-d064ad31-87f2-4c0b-ae5a-125b071d6543.png\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: Typical coloboma \u2192 right eye, and posterior involvement may occur.\u003C/span\u003E\u003C/h3\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhat the photo represents\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EThe abnormality is an iris coloboma, which results from incomplete closure of the embryonic (choroidal) fissure during early gestation (classically around the 5th week).\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003ETypical vs atypical: the key distinction\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EA \u201Ctypical\u201D coloboma lies in the inferonasal quadrant because that is where the embryonic fissure closes.\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EBecause the same fissure relates to multiple ocular layers, a typical iris coloboma can be accompanied by colobomas of deeper structures such as the ciliary body, choroid, retina, and even the optic nerve.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy this is the right eye (when typical)\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EIn standard anterior segment photos, the inferonasal defect appears in the inferonasal part of the iris. The orientation in the pictured eye is consistent with a right eye when you assume a typical inferonasal defect.\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003ETherefore, \u201Cright eye \u002B may involve posterior structures\u201D is the correct combined statement.\u003C/strong\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
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  },
  {
    "Id": 1680,
    "Name": "Estimating visual acuity in a preverbal child",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA preverbal child needs an estimate of visual acuity. Which method is appropriate for measuring visual acuity in a child who cannot yet name letters or match symbols?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch2\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: Teller card\u003C/span\u003E\u003C/h2\u003E\n\u003Cp\u003E\u003Cstrong\u003ETeller preferential-looking cards are designed specifically for infants and other preverbal children.\u003C/strong\u003E \u003Cstrong\u003EThey rely on the principle that babies naturally look toward a patterned target (high-contrast stripes) rather than a blank field.\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EEach card has one blank side and one side with black-and-white gratings; the examiner watches the child\u2019s gaze through a small central viewing hole.\u003C/strong\u003E \u003Cstrong\u003EBy presenting progressively finer stripe widths, the examiner identifies the smallest grating that still attracts consistent looking\u2014this \u201Cthreshold\u201D provides an estimate of visual acuity.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EOther ways to estimate vision in preverbal children include objective/behavioral methods such as visual evoked potentials (VEP) and optokinetic nystagmus (OKN), but among the listed choices, Teller cards are the classic option for preverbal acuity estimation.\u003C/strong\u003E\u003C/p\u003E\n\u003Ch3\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EWhy the other options are not the best fit here\u003C/span\u003E\u003C/h3\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EAllen cards\u003C/strong\u003E use picture optotypes and generally require a level of recognition/communication that many young infants do not have.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EHOTV\u003C/strong\u003E is typically used once a child can match letters (often with a matching card), so it is better suited to slightly older, cooperative children.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ESnellen\u003C/strong\u003E requires letter identification and is intended for literate/verbal patients, not preverbal infants.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
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  },
  {
    "Id": 1681,
    "Name": "Mild eyelid cellulitis in a child: next step",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA child presents with redness and swelling of the left upper eyelid. Examination shows eyelid erythema and edema, but there is full, painless extraocular motility, no proptosis, no chemosis or conjunctival injection, normal visual acuity, and the child is afebrile and otherwise well-appearing. What is the most appropriate management?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: Treat as an outpatient with oral amoxicillin\u2013clavulanate and close follow-up.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003EThe findings described fit preseptal (periorbital) cellulitis rather than orbital cellulitis.\u003C/strong\u003E Preseptal cellulitis is limited to tissues \u003Cstrong\u003Eanterior to the orbital septum\u003C/strong\u003E, so it typically causes \u003Cstrong\u003Eeyelid erythema and edema\u003C/strong\u003E but \u003Cstrong\u003Edoes not\u003C/strong\u003E cause the \u201Cpostseptal red flags\u201D seen in orbital cellulitis. The most important features that argue against orbital involvement here are: \u003Cstrong\u003Efull, painless extraocular movements (no restriction or pain with eye movement), absence of proptosis, absence of conjunctival chemosis/injection suggestive of orbital congestion, and an afebrile, non-toxic overall appearance.\u003C/strong\u003E In a stable child with these reassuring features, \u003Cstrong\u003Eoutpatient therapy is appropriate\u003C/strong\u003E provided reliable follow-up is arranged.\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003EOral broad-spectrum coverage is standard for uncomplicated preseptal cellulitis\u003C/strong\u003E, and \u003Cstrong\u003Eamoxicillin\u2013clavulanate\u003C/strong\u003E provides coverage for common pathogens associated with skin/soft tissue and upper respiratory sources. \u003Cstrong\u003EClose follow-up is essential\u003C/strong\u003E to confirm improvement and to ensure that orbital signs do not develop.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other management approaches are less appropriate in this scenario:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EInpatient admission for IV antibiotics\u003C/strong\u003E is generally reserved for children who appear ill, have significant fever, cannot tolerate oral medication, are very young with unreliable observation, or show any signs concerning for orbital disease.\u0026nbsp;\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EUrgent orbital imaging\u003C/strong\u003E is most useful when the exam suggests orbital cellulitis or when the exam is unreliable (e.g., severe swelling preventing assessment) or when there is poor response to appropriate therapy.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EDoxycycline or ciprofloxacin are not preferred routine choices in a young child for this indication.\u003C/strong\u003E \u003Cstrong\u003ETetracyclines (like doxycycline) are generally avoided in developing children due to tooth discoloration concerns\u003C/strong\u003E, and \u003Cstrong\u003Efluoroquinolones (like ciprofloxacin) are used selectively because of musculoskeletal adverse-effect concerns\u003C/strong\u003E; neither is a typical first-line outpatient option for straightforward preseptal cellulitis when safer, effective alternatives exist.\u003C/li\u003E\n\u003C/ul\u003E\n\u003Cp\u003E\u003Cstrong\u003EPractical safety-net (what should be documented and advised):\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EProvide strict return precautions\u003C/strong\u003E for any development of \u003Cstrong\u003Efever, worsening swelling, decreased vision, new diplopia, proptosis, pain with eye movements, or restricted eye movements\u003C/strong\u003E, and reassess promptly if symptoms fail to improve within \u003Cstrong\u003E24\u201348 hours\u003C/strong\u003E.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "CategoryId": 14,
    "Category": null,
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  },
  {
    "Id": 1682,
    "Name": "Ophthalmia neonatorum with heavy purulent discharge at day 5",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 5-day-old infant has copious pus-like discharge from both eyes consistent with neonatal conjunctivitis. What is the most likely way the infection was acquired?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: Exposure during delivery while passing through the maternal genital tract (birth canal).\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003EConjunctivitis appearing within the first month of life is termed ophthalmia neonatorum, and the timing after birth is a practical clue to the underlying cause.\u003C/strong\u003E \u003Cstrong\u003EWhen an infant presents very early with profuse purulent discharge, a birth-acquired bacterial infection is most likely, because organisms in the maternal genital tract can directly inoculate the conjunctiva during delivery.\u003C/strong\u003E This is why \u003Cstrong\u003Ethe most typical route for infectious neonatal conjunctivitis is acquisition during passage through the birth canal.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EThe clinical timing pattern that supports this reasoning is:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EChemical conjunctivitis\u003C/strong\u003E tends to occur \u003Cstrong\u003Ewithin the first 24 hours\u003C/strong\u003E and usually improves quickly (often by \u003Cstrong\u003Eday 2\u003C/strong\u003E), so it would be less consistent with new, heavy purulence on day 5.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EGonococcal conjunctivitis\u003C/strong\u003E classically presents around \u003Cstrong\u003Edays 3\u20135\u003C/strong\u003E and is often \u003Cstrong\u003Ethe most dramatically purulent\u003C/strong\u003E and can be severe\u2014so day 5 with abundant discharge strongly fits a birth-acquired mechanism.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EChlamydial conjunctivitis\u003C/strong\u003E more often presents around \u003Cstrong\u003Edays 5\u201314\u003C/strong\u003E (commonly near \u003Cstrong\u003E1 week\u003C/strong\u003E), though it can appear earlier in certain circumstances; it is still typically \u003Cstrong\u003Eacquired intrapartum\u003C/strong\u003E, which again points to birth-canal exposure as the mechanism.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EHSV conjunctivitis\u003C/strong\u003E is uncommon and more typical around \u003Cstrong\u003E~2 weeks\u003C/strong\u003E, making it less likely in this specific day\u20115 scenario.\u003C/li\u003E\n\u003C/ul\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other mechanisms are less appropriate here:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003ETransplacental spread\u003C/strong\u003E is not the usual mechanism for neonatal conjunctivitis; it is more relevant for congenital infections that affect multiple systems rather than presenting primarily as isolated purulent conjunctivitis.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EHospital personnel/environment contamination\u003C/strong\u003E can cause neonatal eye infection, but the classic, high-yield etiologies of ophthalmia neonatorum (especially gonorrhea and chlamydia) are most strongly linked to \u003Cstrong\u003Eintrapartum exposure\u003C/strong\u003E rather than postnatal hospital contact.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EHematogenous spread from another infection site\u003C/strong\u003E would typically imply a systemically ill infant or signs of sepsis; the common neonatal conjunctivitis pathogens usually reach the eyes by \u003Cstrong\u003Edirect contact\u003C/strong\u003E, not via the bloodstream.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
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  },
  {
    "Id": 1683,
    "Name": "Mean normal intraocular pressure (IOP) in a newborn",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhat is the mean NORMAL intraocular pressure (IOP) of a newborn child?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: 10 to 12 mmHg.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003ENewborns have a lower average IOP than older children and adults.\u003C/strong\u003E The commonly quoted mean normal IOP range in a newborn is \u003Cstrong\u003Eabout 10\u201312 mmHg\u003C/strong\u003E, and \u003Cstrong\u003EIOP gradually increases with age\u003C/strong\u003E, reaching roughly \u003Cstrong\u003E~14 mmHg by around school age (about 8 years)\u003C/strong\u003E. This age-related rise reflects maturation of ocular rigidity and aqueous dynamics.\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003ECongenital glaucoma is not a subtle elevation.\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E When primary congenital glaucoma is present, IOP is often \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Emarkedly high (commonly in the 30\u201340 mmHg range)\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E. Also, \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003EIOP measurements taken under general anesthesia may read lower than awake measurements\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E, yet affected infants can still show elevated pressures (often remaining in the \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003E20s\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E), so exam context is important.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
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  },
  {
    "Id": 1684,
    "Name": "Eye movements that are typically not fully present at birth",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EIn newborns, which type of eye movement is commonly not yet fully developed?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: Conjugate vertical gaze.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003EAt birth, many ocular motor functions are present, especially basic horizontal conjugate movements and vestibular-driven eye movements (the vestibulo-ocular reflex), because these pathways are relatively mature early and are critical for stabilizing gaze.\u003C/strong\u003E In contrast, \u003Cstrong\u003Ecoordinated vertical gaze is often immature in newborns and may not appear fully developed until several months of age (commonly cited around ~6 months).\u003C/strong\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 1685,
    "Name": "Stargardt disease (fundus flavimaculatus)",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 17-year-old candidate for military aviation is found to have reduced best-corrected vision (20/40 in one eye and 20/70 in the other). His dilated fundus exam is seen below. Which feature is most characteristic of this condition?\u003Cbr\u003E\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-03-16-d07200c3-9fe6-474e-8182-8c2e160217a1.png\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: \u201CDark choroid\u201D sign on fluorescein angiography.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\nThe fundus appearance described (juvenile onset decreased central acuity with macular changes and yellow pisciform flecks) is most consistent with Stargardt disease, often discussed together with fundus flavimaculatus. This is a juvenile macular dystrophy in which lipofuscin accumulates within the retinal pigment epithelium (RPE), producing flecks and progressive macular dysfunction.\u003C/p\u003E\n\u003Cp\u003EThe hallmark fluorescein angiography clue is the \u201Cdark choroid\u201D sign. In early phases of FA, the choroid appears unusually hypofluorescent because excess lipofuscin in the RPE blocks normal background choroidal fluorescence (a masking effect). As a result, the retinal vessels can look relatively prominent against a darker-than-expected choroidal background.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong style=\u0022text-decoration-line: underline;\u0022\u003EWhy the other statements are wrong:\u003C/strong\u003E\u003Cbr\u003E\nA congenital color deficiency without progressive loss of acuity describes inherited color vision deficiency (such as protan/deutan defects). Those patients typically have a normal fundus and do not develop a bull\u2019s-eye maculopathy with flecks or progressive central retinal changes.\u003C/p\u003E\n\u003Cp\u003EProgressive color vision loss with \u201Chemeralopia\u201D (day-blindness) is more typical of cone dystrophies. Cone dystrophy can also produce a bull\u2019s-eye pattern, but it usually causes more prominent photophobia, dyschromatopsia, and often worse eventual acuity than typical Stargardt presentations, and the FA signature tested here is not \u201Cdark choroid\u201D as a defining feature.\u003C/p\u003E\n\u003Cp\u003E\u201CQuenching\u201D on fluorescein angiography is classically linked to certain white-dot chorioretinopathies (such as birdshot chorioretinopathy), not Stargardt disease. That phenomenon refers to characteristic angiographic behavior in those inflammatory choroidopathies rather than lipofuscin-related masking.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
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  },
  {
    "Id": 1686,
    "Name": "Quantifying a manifest deviation (heterotropia) in strabismus",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA patient has strabismus with a manifest deviation. Which clinical test is used to measure the size of the manifest deviation (heterotropia)?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: Simultaneous prism-and-cover test.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003EThe key concept is the difference between measuring only the manifest deviation (heterotropia) versus measuring the full deviation (heterotropia plus any latent component, heterophoria).\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003EThe simultaneous prism-and-cover test is designed to quantify the manifest component only.\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E It does this by \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Eplacing a prism in front of the deviating eye while the fixing eye is covered at the same time\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E, preventing fusion but \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Enot \u201Cdissociating\u201D the eyes enough to bring out the latent phoria.\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003EYou increase prism strength until the deviating eye no longer makes a refixation movement\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E, which gives the magnitude of the heterotropia.\u003C/span\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other options are wrong:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003ECover\u2013uncover test: This detects the presence of a tropia by observing a refixation movement when the cover is removed, but it does not provide a prism-neutralized measurement of the deviation by itself. It is primarily a detection test for manifest deviation.\u003C/li\u003E\n\u003Cli\u003EAlternate cover test with prism (prism alternate cover): This fully dissociates the eyes, so it measures the total deviation\u2014tropia plus phoria\u2014rather than isolating the heterotropia alone.\u003C/li\u003E\n\u003Cli\u003EHirschberg test: This uses the corneal light reflex position to estimate alignment, but it is only a rough, qualitative (or at best very approximate) estimate and is not the standard way to precisely quantify a manifest deviation in prism diopters.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
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  },
  {
    "Id": 1687,
    "Name": "Angle of the oblique muscles relative to the visual axis",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EHow many degrees do the superior oblique and inferior oblique muscles typically make with the eye\u2019s visual axis?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: 51 degrees.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003EThe oblique extraocular muscles have a characteristic course such that their line of pull is angled significantly relative to the visual axis.\u003C/strong\u003E The commonly cited value is that \u003Cstrong\u003Eboth the superior oblique and inferior oblique form an angle of about 51\u00B0 with the visual axis.\u003C/strong\u003E This relationship is clinically useful because \u003Cstrong\u003Ethe actions of the obliques (torsion plus vertical components) are highly position-dependent\u003C/strong\u003E, and understanding their geometry helps explain why their vertical actions are most evident in adduction.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EA high-yield contrast is the vertical rectus muscles.\u003C/strong\u003E \u003Cstrong\u003EThe superior and inferior rectus are oriented about 23\u00B0 from the visual axis\u003C/strong\u003E, which is why their actions include a combination of \u003Cstrong\u003Evertical movement and torsion\u003C/strong\u003E, with the torsional component depending on gaze position.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
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  },
  {
    "Id": 1688,
    "Name": "CPEO with pigmentary retinopathy",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 25-year-old has gradually worsening droopy eyelids and difficulty tracking moving objects, beginning in adolescence. Examination suggests a chronic progressive external ophthalmoplegia picture, and the fundus shows mild \u201Csalt-and-pepper\u201D pigmentary changes in both eyes. There is no delayed relaxation on handshake. Which additional test is most important to obtain as part of the workup?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: Electrocardiogram (EKG).\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003EThis presentation is most consistent with a mitochondrial ophthalmic syndrome in the chronic progressive external ophthalmoplegia spectrum, and the added finding of pigmentary retinopathy strongly points toward Kearns\u2013Sayre syndrome.\u003C/strong\u003E Kearns\u2013Sayre classically combines progressive ptosis/ophthalmoplegia with pigmentary retinopathy and can be associated with serious cardiac conduction abnormalities, including heart block. Because conduction disease can be silent until it becomes dangerous, an EKG is a key screening test and is the most urgent ancillary study among the listed options.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other options are wrong:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003ETensilon (edrophonium) test:\u003C/strong\u003E \u003Cstrong\u003EThis is used to support a diagnosis of myasthenia gravis.\u003C/strong\u003E Myasthenia typically causes fluctuating fatigable ptosis/ophthalmoparesis and does not explain a pigmentary retinopathy pattern; additionally, the vignette leans toward a slowly progressive mitochondrial process rather than fatigability.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ESingle-fiber EMG:\u003C/strong\u003E \u003Cstrong\u003EThis is most helpful for neuromuscular junction disorders (especially myasthenia) and may also be used in certain myopathic conditions, but the scenario specifically notes no handshake abnormality (arguing against myotonic dystrophy) and highlights pigmentary retinopathy, which pushes the diagnosis toward Kearns\u2013Sayre where cardiac screening is the priority.\u003C/strong\u003E\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EElectroretinography (ERG):\u003C/strong\u003E \u003Cstrong\u003EERG can help characterize retinal dystrophies, and it may be informative if the diagnosis is uncertain, but it does not address the major potentially life-threatening association of Kearns\u2013Sayre\u2014cardiac conduction block.\u003C/strong\u003E\u0026nbsp;\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "HighYield": false,
    "CategoryId": 8,
    "Category": null,
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  },
  {
    "Id": 1689,
    "Name": "Pediatric open-globe injury with \u201Cfluffy\u201D anterior chamber material",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 7-year-old sustains a knife injury to the eye. Slit-lamp exam reveals a 3 mm peripheral corneal laceration and a shallow anterior chamber. Wispy \u201Cfluffy\u201D material is seen floating in the anterior chamber, and the anterior lens capsule is difficult to assess through it. Orbital CT shows no intraocular foreign body. What is the most appropriate next management step?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: Globe exploration and repair in the operating room only.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003EThis presentation should be managed as a penetrating/open-globe injury, so the priority is urgent surgical exploration and watertight globe repair.\u003C/strong\u003E \u003Cstrong\u003EIn children, inflammatory fibrin can form rapidly after penetration and may look like \u201Clens material\u201D in the anterior chamber.\u003C/strong\u003E Because this appearance can be misleading, \u003Cstrong\u003Eperforming a lens removal at the time of primary repair is not recommended unless there is clear, definite evidence that the anterior lens capsule is violated (for example, obvious capsular rupture, lens matter extruding, or a traumatic cataract with unmistakable capsular disruption).\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EEven if capsular injury is suspected, it is often safer to stabilize the globe first and address the lens in a planned second stage once the eye is quieter and less inflamed.\u003C/strong\u003E \u003Cstrong\u003EImmediate lensectomy during the primary open-globe repair can increase surgical complexity and may worsen inflammation or compromise outcomes if the diagnosis is uncertain.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy conservative measures alone are not enough:\u003C/strong\u003E \u003Cstrong\u003EUsing glue or a bandage contact lens is appropriate for selected non-penetrating corneal problems or very small self-sealing injuries, but a knife-induced corneal laceration with a shallow anterior chamber raises strong concern for an open globe and needs operative repair rather than office-based temporizing measures.\u003C/strong\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1690,
    "Name": "Ophthalmia neonatorum",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003ENeonatal conjunctivitis in the first month is termed ophthalmia neonatorum. At what time after birth does chemical conjunctivitis most commonly appear?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: Within the first 24 hours.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003EChemical conjunctivitis is the earliest form of ophthalmia neonatorum and typically shows up in the first day after birth.\u003C/strong\u003E \u003Cstrong\u003EIt most often follows exposure to prophylactic eye medications (classically older silver nitrate preparations), leading to a transient irritative reaction rather than an active infection.\u003C/strong\u003E \u003Cstrong\u003EBecause it is an irritant response, it usually improves quickly\u2014often resolving by about the second day of life.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other time points are wrong:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003E3\u20134 days\u003C/strong\u003E is more typical of \u003Cstrong\u003Egonococcal conjunctivitis\u003C/strong\u003E, which often produces \u003Cstrong\u003Every copious purulent discharge\u003C/strong\u003E and is a more urgent infection to recognize.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003E~7 days\u003C/strong\u003E is a common timing for \u003Cstrong\u003Echlamydial conjunctivitis\u003C/strong\u003E (though it can present earlier in certain situations such as prolonged rupture of membranes).\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003E~14 days\u003C/strong\u003E fits better with \u003Cstrong\u003EHSV-related conjunctivitis\u003C/strong\u003E, which is uncommon but classically later than chemical causes.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1691,
    "Name": "Acute comitant esotropia after short-term patching",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 5-year-old develops a new inward eye deviation over one week. One week earlier, the child sustained blunt trauma to the left eye with a hyphema, and the family has kept that eye patched continuously for protection. There was no prior strabismus history. Alignment measures a 25 prism-diopter comitant esotropia at distance and near. Eye movements are full. Visual acuity is 20/20 in the right eye and 20/30 in the left eye. Cycloplegic refraction is \u002B0.50 D in both eyes. What is the most likely explanation for this esotropia?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: Acquired nonaccommodative esotropia.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003EThis is most consistent with a basic acquired nonaccommodative esotropia triggered by temporary disruption of binocularity.\u003C/strong\u003E The key clues are \u003Cstrong\u003E(1) the deviation began after a week of occluding one eye\u003C/strong\u003E, \u003Cstrong\u003E(2) the esotropia is comitant (same size in all gaze positions)\u003C/strong\u003E, and \u003Cstrong\u003E(3) there is minimal hyperopia (\u002B0.50 D), so accommodation is not driving the deviation.\u003C/strong\u003E Short-term patching can \u003Cstrong\u003Eremove fusional control\u003C/strong\u003E, allowing a previously compensated tendency to become manifest as a comitant esotropia.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy refractive accommodative esotropia is unlikely:\u003C/strong\u003E \u003Cstrong\u003ERefractive accommodative esotropia typically requires meaningful hyperopia and improves substantially with full hyperopic correction.\u003C/strong\u003E With \u003Cstrong\u003Eonly \u002B0.50 D OU\u003C/strong\u003E, there is \u003Cstrong\u003Enot enough accommodative demand\u003C/strong\u003E to explain a 25\u0394 esotropia.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy sensory esotropia is unlikely:\u003C/strong\u003E \u003Cstrong\u003ESensory esotropia occurs when there is significant unilateral visual impairment that disrupts fusion.\u003C/strong\u003E Here, the left eye is \u003Cstrong\u003Eonly mildly reduced (20/30)\u003C/strong\u003E and the vision loss is \u003Cstrong\u003Enot severe enough\u003C/strong\u003E to be the usual driver of a sensory deviation\u2014especially over such a short timeline.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy CN VI palsy is unlikely:\u003C/strong\u003E \u003Cstrong\u003EAn abducens palsy causes an incomitant esotropia with limited abduction\u003C/strong\u003E (often worse in the direction of action of the weak lateral rectus). This child has \u003Cstrong\u003Efull ductions\u003C/strong\u003E and a \u003Cstrong\u003Ecomitant\u003C/strong\u003E deviation, which argues strongly against CN VI palsy.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 1692,
    "Name": "Iris stromal cyst in an infant obstructing the visual axis",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 2-year-old is evaluated for an apparent iris mass. Examination under anesthesia with ultrasound biomicroscopy confirms a primary iris stromal cyst, and the lesion fully blocks the visual axis. What is the preferred management?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: Surgical excision.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003EA primary iris stromal cyst in infancy behaves differently from many benign iris pigment epithelial cysts.\u003C/strong\u003E \u003Cstrong\u003EStromal cysts can enlarge quickly and may cause clinically important complications, especially when the cyst blocks the pupil/visual axis.\u003C/strong\u003E These complications include \u003Cstrong\u003Edeprivation amblyopia from occluding the visual axis\u003C/strong\u003E, as well as \u003Cstrong\u003Ecorneal damage from intermittent or sustained corneal touch, secondary glaucoma, and anterior uveitis if cyst contents leak.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EBecause the visual axis is completely obstructed in this child, observation is not appropriate.\u003C/strong\u003E \u003Cstrong\u003ELeaving the axis blocked during the amblyogenic period can lead to permanent reduction in visual potential\u003C/strong\u003E, even if the cyst later regresses or is treated.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EAmong active treatment options, surgical excision is preferred because it offers the best chance of definitive control with lower recurrence compared with less definitive approaches.\u003C/strong\u003E \u003Cstrong\u003ESimple aspiration or laser-based methods often have higher recurrence\u003C/strong\u003E, since the cyst wall/lining may remain and can reaccumulate fluid.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1693,
    "Name": "Spasm of the near reflex",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cdiv style=\u0022line-height: 20px;\u0022\u003EA 21-year-old develops sudden diplopia and an inward deviation during a stressful exam period. Distance acuity is reduced, but near acuity is excellent in both eyes. Alignment shows a comitant esotropia of about 15 prism diopters at both distance and near. Monocular ductions are full, yet on binocular versions both eyes appear to have limited abduction. Pupils are small and respond poorly to light. Non-cycloplegic refraction shows moderate myopia, and the patient declines cycloplegia. Which diagnosis best explains this presentation?\u003C/div\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003C!--StartFragment--\u003E\u003C!--EndFragment--\u003E\u003C/p\u003E\u003Cdiv style=\u0022font-family:\u0027Segoe UI\u0027;font-size:14px;font-style:normal;font-weight:400;line-height:20px\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: Spasm of the near reflex.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003EThis presentation is classic for spasm of the near reflex (also called convergence spasm or ciliary spasm), which is characterized by an inappropriate, excessive activation of the near triad: convergence, accommodation, and miosis.\u003C/strong\u003E \u003Cstrong\u003EThe stress trigger, acute onset diplopia, small pupils, and a myopic-looking manifest refraction all strongly support this.\u003C/strong\u003E The apparent \u201Cabduction deficit\u201D on versions occurs because \u003Cstrong\u003Ewhen both eyes are open, excessive convergence makes the eyes look like they cannot abduct\u003C/strong\u003E, but \u003Cstrong\u003Etrue lateral rectus function is intact\u2014proved by full monocular ductions.\u003C/strong\u003E That \u201Cversions look limited, ductions are full\u201D pattern is a major clue that this is functional/convergence-driven rather than a cranial nerve palsy.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EThe visual acuity pattern also fits.\u003C/strong\u003E \u003Cstrong\u003ENear vision is excellent while distance acuity is reduced, which can happen when accommodation is inappropriately engaged at distance, producing pseudomyopia.\u003C/strong\u003E \u003Cstrong\u003EWithout cycloplegia, the refraction may look more myopic than the true baseline because accommodative spasm adds extra minus power.\u003C/strong\u003E Cycloplegic refraction often reveals much less myopia (or even minimal refractive error), and it can temporarily \u201Cbreak\u201D the spasm.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other diagnoses are wrong:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EAccommodative insufficiency:\u003C/strong\u003E \u003Cstrong\u003EThis primarily causes near blur, asthenopia, and difficulty sustaining near work.\u003C/strong\u003E It does not typically cause \u003Cstrong\u003Emiosis with acute comitant esotropia\u003C/strong\u003E or a binocular-only abduction limitation that disappears on monocular ductions.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EHorner syndrome:\u003C/strong\u003E \u003Cstrong\u003EHorner syndrome causes a small pupil with poor dilation in dim light (often with mild ptosis and dilation lag), but it does not cause episodic excessive convergence, pseudomyopia, or a binocular-only abduction limitation.\u003C/strong\u003E In addition, Horner pupils usually have a relatively preserved light reaction; the key issue is sympathetic denervation and impaired dilation rather than a near-triad spasm picture.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EDivergence insufficiency:\u003C/strong\u003E \u003Cstrong\u003EThis produces distance esotropia that is greater at distance than near\u003C/strong\u003E, typically in older patients, and it does not explain \u003Cstrong\u003Emiosis, pseudomyopia, or the mismatch of full ductions with limited abduction only on versions.\u003C/strong\u003E Here the deviation is the same at distance and near, which argues against divergence insufficiency.\u003C/li\u003E\n\u003C/ul\u003E\n\u003Cp\u003E\u003Cstrong\u003EClinical pearl (high-yield):\u003C/strong\u003E \u003Cstrong\u003ESpasm of the near reflex is often functional and associated with stress/anxiety.\u003C/strong\u003E \u003Cstrong\u003ETreatment focuses on breaking the accommodative component (cycloplegic drops such as atropine or cyclopentolate), reducing triggers, and sometimes using plus lenses/bifocals for near comfort.\u003C/strong\u003E Persistent cases may need orthoptic support; invasive treatments are rarely required.\u003C/p\u003E\u003C/div\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
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  },
  {
    "Id": 1694,
    "Name": "Shortest overall extraocular muscle",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhen you consider both the muscle belly and its tendon together, which extraocular muscle has the smallest total length?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: inferior oblique.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003EThis is an anatomy \u201Ctotal length\u201D question\u2014muscle belly length plus tendon length\u2014not simply which muscle has the shortest contractile portion.\u003C/strong\u003E Several rectus muscles have \u003Cstrong\u003Esimilar active (contractile) lengths\u003C/strong\u003E, so the \u003Cstrong\u003Etendon length\u003C/strong\u003E becomes the deciding factor.\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003EThe medial rectus, lateral rectus, and inferior rectus (and also the superior rectus) have active muscle bellies that are roughly similar in size (commonly cited around 40 mm).\u003C/strong\u003E The inferior oblique\u2019s active belly is \u003Cstrong\u003Eslightly shorter (around the high 30s mm)\u003C/strong\u003E, but what really matters is that \u003Cstrong\u003Ethe inferior oblique has an extremely short tendon\u2014often described as about 1 mm.\u003C/strong\u003E Because the tendon contributes very little additional length, \u003Cstrong\u003Ethe inferior oblique ends up being the shortest extraocular muscle overall when \u201Cmuscle \u002B tendon\u201D are added together.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003EThe superior oblique is often the longest overall because it has a long tendon (classically around the mid\u201120s mm),\u003C/strong\u003E so even if its contractile portion is not the longest, the tendon substantially increases its total length. This \u201Clong tendon vs very short tendon\u201D contrast explains why \u003Cstrong\u003Esuperior oblique tends toward the longest overall\u003C/strong\u003E, while \u003Cstrong\u003Einferior oblique tends toward the shortest overall.\u003C/strong\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
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  },
  {
    "Id": 1695,
    "Name": "Lisch nodules \u002B multiple caf\u00E9-au-lait macules",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA patient has multiple small, well-defined raised spots on the anterior iris consistent with the appearance in the photo. The patient also has numerous discrete hyperpigmented patches on the trunk. Which chromosome contains the gene locus most classically associated with this systemic diagnosis?\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-03-17-04bee7d9-1bfc-4fb4-a755-257f3788c690.png\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: Chromosome 17.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003EThe iris findings shown are most consistent with Lisch nodules, which are melanocytic iris hamartomas.\u003C/strong\u003E \u003Cstrong\u003EWhen Lisch nodules occur together with multiple caf\u00E9-au-lait macules, the unifying diagnosis is neurofibromatosis type 1 (NF1).\u003C/strong\u003E \u003Cstrong\u003ENF1 is caused by pathogenic variants in the NF1 gene, which is located on chromosome 17.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\nLisch nodules are highly characteristic of NF1 and become increasingly common with age, often appearing in childhood and being very common in adults. The presence of multiple caf\u00E9-au-lait macules strengthens the diagnosis because pigmentary skin findings are among the most frequent early clues to NF1. NF1 is a \u201Cphakomatosis\u201D (neurocutaneous syndrome), so ocular signs plus skin findings are a classic board-style pairing.\u003C/p\u003E\u003Cp\u003E\nNF1 is diagnosed clinically using a criteria-based approach, and meeting at least two of the standard features supports the diagnosis. Typical features include multiple caf\u00E9-au-lait macules, axillary/inguinal freckling, neurofibromas (including plexiform types), optic pathway glioma, characteristic bony lesions (such as sphenoid dysplasia), and Lisch nodules.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other chromosomes are not the best match:\u003C/strong\u003E\u003Cbr\u003E\nChromosome 22 is associated with neurofibromatosis type 2 (NF2), which is classically linked to bilateral vestibular schwannomas and different ocular findings (for example certain cataracts and retinal hamartomas), rather than Lisch nodules as the hallmark.\u003Cbr\u003E\nChromosomes 9 and 16 are commonly tested in tuberous sclerosis (TSC1 on 9 and TSC2 on 16), which has a different neurocutaneous pattern (e.g., facial angiofibromas, cortical tubers) and different ophthalmic associations than NF1.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
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  },
  {
    "Id": 1696,
    "Name": "Treatment of isoametropic (bilateral refractive) amblyopia",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhat is the standard first-line treatment for isoametropic amblyopia (amblyopia from high, symmetric refractive error in both eyes)?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: Optimal refractive correction alone.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003EIsoametropic amblyopia happens when both eyes are blurred during early visual development because of high, relatively equal refractive error (such as large hyperopia, myopia, significant astigmatism, or a combination) in both eyes.\u003C/strong\u003E Since the problem is \u003Cstrong\u003Ebilateral and symmetric\u003C/strong\u003E, the main issue is \u003Cstrong\u003Eglobal deprivation of a clear retinal image\u003C/strong\u003E, not one eye \u201Cwinning\u201D over the other.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003ETherefore, the primary treatment is simply to provide the best optical clarity with full, appropriate refractive correction (usually glasses).\u003C/strong\u003E \u003Cstrong\u003EMany children improve substantially with spectacles alone over weeks to months as the visual system receives a consistently focused image in both eyes.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy patching or atropine is usually not needed at the start:\u003C/strong\u003E\u003Cbr\u003E\nPenalization therapies (patching or atropine) are designed to force use of a weaker eye when there is competition between the eyes (most commonly anisometropic or strabismic amblyopia). In isoametropic amblyopia, both eyes are under-stimulated, so penalizing one eye does not address the root cause and can even be counterproductive if it reduces binocular input unnecessarily.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhen you would add penalization:\u003C/strong\u003E\u003Cbr\u003E\nIf vision does not improve adequately with consistent spectacle wear, or if an additional amblyogenic factor is present (like anisometropia or strabismus), then patching or other amblyopia therapy may be considered. But the best initial step remains glasses alone.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
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  },
  {
    "Id": 1697,
    "Name": "First follow-up after starting full-time patching",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EAfter prescribing full-time occlusion therapy for amblyopia in a 4-year-old, what is the usual timing for the first review visit?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: 4 weeks.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003EFull-time patching carries a real risk of \u201Creverse amblyopia\u201D (new reduction of vision in the patched, previously better eye), so the first follow-up is scheduled relatively early.\u003C/strong\u003E \u003Cstrong\u003EA practical, commonly taught approach is to review children on full-time occlusion at an interval roughly tied to age (about \u201Cone month\u201D for a 4-year-old), which balances early safety monitoring with allowing enough time to see a treatment response.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other timeframes are less appropriate:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003E2 weeks\u003C/strong\u003E is often used for \u003Cem\u003Eyounger\u003C/em\u003E children or when there is heightened concern about compliance or reverse amblyopia risk, but it is not the \u201Ctypical\u201D first interval for an otherwise stable 4-year-old starting full-time patching.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003E8 weeks\u003C/strong\u003E is usually too long for an initial check on \u003Cem\u003Efull-time\u003C/em\u003E occlusion because you could miss early reverse amblyopia or over-treatment.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003E12 weeks\u003C/strong\u003E is even longer and generally inappropriate as a first review interval for full-time patching.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1698,
    "Name": "V-pattern strabismus: clinically significant cutoff",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EIn pattern strabismus, what minimum difference between the measured horizontal deviation in upgaze versus downgaze is generally used to call a V-pattern clinically meaningful?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: 15 prism diopters.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003EA V-pattern is defined by a significant change in the horizontal deviation between upgaze and downgaze, and it becomes clinically relevant when that change is large enough to influence symptoms, abnormal head posture, or surgical planning.\u003C/strong\u003E The commonly used threshold is \u003Cstrong\u003Ea difference of at least 15 prism diopters\u003C/strong\u003E between measurements taken in upgaze and downgaze.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EA useful comparison is the A-pattern cutoff.\u003C/strong\u003E \u003Cstrong\u003EAn A-pattern is typically labeled clinically significant at a smaller change\u2014about 10 prism diopters or more between upgaze and downgaze\u2014whereas the V-pattern requires a larger difference to meet significance criteria.\u003C/strong\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1699,
    "Name": "Upper eyelid change after a large superior rectus recession",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA patient has a 30\u2011prism\u2011diopter right hypertropia. You plan a single\u2011muscle operation consisting of a right superior rectus recession. Which postoperative eyelid change is most likely?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: Widening of the palpebral fissure.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003EVertical rectus surgery often affects eyelid position because the vertical recti have anatomic/fascial relationships with the eyelid retractors.\u003C/strong\u003E This effect is usually more noticeable with inferior rectus surgery, but it can also occur with the superior rectus because of its association with the levator complex.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EA useful rule of thumb is that vertical rectus recession tends to produce lid retraction (a \u201Chigher\u201D lid position) and therefore widens the palpebral fissure, whereas vertical rectus resection tends to produce the opposite effect (relative lid lowering and narrowing).\u003C/strong\u003E In this vignette, the hypertropia is large (30 PD), so the superior rectus recession would also be relatively large; with larger recessions, the eyelid effect becomes more clinically apparent, making \u003Cstrong\u003Eupper lid retraction with fissure widening\u003C/strong\u003E the most expected change.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other choices are wrong:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003EUpper lid lowering: This is more consistent with an effect seen after a superior rectus resection (tightening/advancing) rather than recession, or with postoperative swelling mimicking ptosis\u2014not the typical direction of change for a large recession.\u003C/li\u003E\n\u003Cli\u003EPseudoptosis: Pseudoptosis usually reflects a smaller palpebral fissure because the eye is hypotropic (or the fellow eye is hypertropic) and the lid \u201Cappears\u201D lower; it is not the classic lid effect expected specifically from a superior rectus recession.\u003C/li\u003E\n\u003Cli\u003ENo changes in the upper lid: Eyelid changes are common enough with vertical rectus procedures that \u201Cno change\u201D is not the best answer\u2014especially when the recession is large, which increases the likelihood of a noticeable lid position shift.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1700,
    "Name": "Vernal keratoconjunctivitis",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 12-year-old has severe bilateral ocular itching that tends to recur seasonally and is worse this year. Slit-lamp exam of the upper tarsal conjunctiva shows the lesion showed in the picture. Which additional ocular finding would most likely be seen with the underlying diagnosis?\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-03-20-3dd98d68-df11-4b9c-b4e2-e92f521f51ce.png\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch2\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: epithelial defect of the superior cornea\u003C/span\u003E\u003C/h2\u003E\n\u003Cp\u003E\u003Cstrong\u003EThis presentation most strongly points to vernal keratoconjunctivitis (VKC).\u003C/strong\u003E \u003Cstrong\u003EThe key clues are intense itching, seasonal recurrence (often spring/fall), and the tarsal conjunctival appearance consistent with giant papillary conjunctivitis.\u003C/strong\u003E \u003Cstrong\u003EVKC is a chronic, allergic inflammation seen mainly in children and adolescents and is characterized by prominent tarsal papillae and/or limbal disease.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EA classic corneal complication of VKC is a \u201Cshield ulcer,\u201D which is essentially an epithelial defect that typically involves the superior cornea.\u003C/strong\u003E \u003Cstrong\u003EIt occurs because large papillae and inflammatory mediators (including eosinophil-derived proteins) mechanically and chemically injure the corneal epithelium.\u003C/strong\u003E \u003Cstrong\u003ESo a superior corneal epithelial defect fits perfectly with VKC.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other findings are wrong (and what they actually suggest):\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EMultiple circular subepithelial infiltrates\u003C/strong\u003E are more typical of \u003Cstrong\u003Eadenoviral epidemic keratoconjunctivitis\u003C/strong\u003E, where immune-mediated subepithelial infiltrates appear after the acute conjunctivitis (EKC pattern).\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ESmall gaps in pannus from healed limbal follicles\u003C/strong\u003E describes \u003Cstrong\u003EHerbert pits\u003C/strong\u003E, which are characteristic of \u003Cstrong\u003Etrachoma\u003C/strong\u003E (healed limbal follicles leaving depressed scars).\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ELinear subconjunctival scarring of the everted upper lid\u003C/strong\u003E describes \u003Cstrong\u003EArlt line\u003C/strong\u003E, also a classic scarring sign of \u003Cstrong\u003Etrachoma\u003C/strong\u003E.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1701,
    "Name": "Craniosynostosis syndrome most strongly linked to syndactyly",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich of the following craniosynostosis is most commonly associated with syndactyly?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: Apert syndrome.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003ESyndactyly is the key discriminator here.\u003C/strong\u003E \u003Cstrong\u003EApert syndrome is the craniosynostosis syndrome that classically includes marked syndactyly\u2014often severe \u201Cmitten-hand\u201D and \u201Csock-foot\u201D fusion\u2014alongside craniosynostosis and midface hypoplasia.\u003C/strong\u003E Because the question asks for the craniosynostosis condition most commonly linked to syndactyly, \u003Cstrong\u003EApert syndrome is the best match.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other options are wrong:\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003ECrouzon syndrome is a common craniosynostosis syndrome but typically does not have syndactyly.\u003C/strong\u003E The phenotype centers on craniofacial findings (e.g., proptosis/midface hypoplasia) rather than limb fusion.\u003Cbr\u003E\n\u003Cstrong\u003ESaethre\u2013Chotzen syndrome is usually milder and may show subtle limb changes (like brachydactyly or partial soft-tissue syndactyly), but it does not characteristically produce the dramatic, extensive syndactyly seen in Apert syndrome.\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EPierre Robin sequence is not a craniosynostosis syndrome and is not defined by syndactyly.\u003C/strong\u003E It is a sequence involving mandibular hypoplasia with airway/tongue position issues and is often discussed with connective tissue disorders (for example, Stickler syndrome), not craniosynostosis with limb fusion.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1702,
    "Name": "Megalocornea: key associated feature",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA question asks which clinical association is most characteristic of megalocornea. Which statement is most likely to be true?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: Female carriers may have mildly enlarged corneal diameters.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003EMegalocornea is classically an X-linked disorder, so it is seen predominantly in males, while heterozygous carriers (often mothers) can show subtle manifestations such as slightly larger-than-average corneal diameters.\u003C/strong\u003E \u003Cstrong\u003EThis inheritance pattern is the key reason the \u201Ccarrier mother with mild enlargement\u201D association is a high-yield clue.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003EClinically, megalocornea is typically a non-progressive enlargement of the cornea with a deep anterior chamber, and it is usually not accompanied by elevated intraocular pressure. That distinction matters because enlarged corneas in infancy can also be caused by primary congenital glaucoma, which \u003Cem style=\u0022\u0022\u003Edoes\u003C/em\u003E feature high IOP, corneal edema, Haab striae, and progressive globe enlargement. So, when you see large corneas without the glaucoma picture, megalocornea becomes a leading consideration.\u003C/p\u003E\n\u003Cp\u003EMegalocornea can coexist with lens and iris abnormalities (such as lens subluxation, iris hypoplasia, radial transillumination defects, or an ectopic pupil). Because the cornea is large and the anterior chamber is often deep, the angle structures may be visible without gonioscopy in some patients.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other statements are wrong:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EMegalocornea is generally stable rather than progressively enlarging.\u003C/strong\u003E\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EThe deep chamber can allow direct visualization in many cases.\u003C/strong\u003E\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EIris hyperplasia is not a classic association\u003C/strong\u003E; \u003Cstrong\u003Eif anything, iris underdevelopment or transillumination-type changes are more typical in the megalocornea spectrum.\u003C/strong\u003E\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1703,
    "Name": "Spiral of Tillaux",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EDuring scleral buckle surgery, you plan to hook the rectus muscles. Based on their normal insertion distances from the limbus, which rectus muscle ranks as the third closest insertion?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: lateral rectus.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003EThis is a \u201CSpiral of Tillaux\u201D anatomy question.\u003C/strong\u003E \u003Cstrong\u003EThe four rectus muscles do not insert at the same distance from the limbus; instead, they form a spiral where insertions become progressively farther posterior.\u003C/strong\u003E A high-yield order is: \u003Cstrong\u003Emedial rectus (closest) \u2192 inferior rectus \u2192 lateral rectus \u2192 superior rectus (farthest).\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003ETypical insertion distances (approximate) help lock in the ranking:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EMedial rectus ~5.5 mm\u003C/strong\u003E\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EInferior rectus ~6.5 mm\u003C/strong\u003E\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ELateral rectus ~6.9\u20137.0 mm\u003C/strong\u003E\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ESuperior rectus ~7.5\u20137.7 mm\u003C/strong\u003E\u003C/li\u003E\n\u003C/ul\u003E\n\u003Cp\u003E\u003Cstrong\u003ETherefore, the third closest rectus insertion is the lateral rectus.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EExtra surgical pearl:\u003C/strong\u003E \u003Cstrong\u003EThe vertical recti insert slightly obliquely, with the temporal edge sitting a bit more posterior than the nasal edge\u003C/strong\u003E, which can matter when judging the insertion during exposure.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1704,
    "Name": "Thyroid eye disease",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA patient with thyroid eye disease has prominent proptosis, eyelid retraction, and binocular diplopia. When surgery is required, which sequence best reflects the standard staging of surgical management?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch2\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer:\u0026nbsp;\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Eorbital decompression, strabismus surgery, lid surgery.\u003C/strong\u003E\u003C/span\u003E\u003C/h2\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/strong\u003E\u003C/span\u003E\u003C/div\u003E\n\u003Cp\u003E\u003Cstrong\u003EThe surgical plan in thyroid eye disease is staged because each operation can change measurements needed for the next step.\u003C/strong\u003E The goal is to correct \u003Cstrong\u003Eorbital volume/globe position first\u003C/strong\u003E, then \u003Cstrong\u003Eocular alignment\u003C/strong\u003E, and finally \u003Cstrong\u003Eeyelid position\u003C/strong\u003E.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EOrbital decompression is performed first\u003C/strong\u003E because \u003Cstrong\u003Eit can significantly alter ocular motility and alignment\u003C/strong\u003E by changing orbital anatomy and extraocular muscle mechanics. If alignment surgery is done before decompression, the deviation may shift afterward, creating a new or different diplopia problem.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EStrabismus surgery is performed after decompression\u003C/strong\u003E once motility has stabilized, allowing the surgeon to correct diplopia based on a more reliable deviation measurement.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EEyelid surgery is performed last\u003C/strong\u003E because \u003Cstrong\u003Elid position can change after strabismus surgery\u003C/strong\u003E, and it is also influenced by globe position and vertical alignment. Doing lid surgery earlier risks over- or under-correcting lid retraction once the alignment is later adjusted.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 9,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 1705,
    "Name": " unilateral congenital cataract",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003EA newborn has a dense, centrally located nuclear cataract in one eye, with the rest of the eye exam normal. What is the accepted timing window for cataract extraction to reduce the risk of deprivation amblyopia?\u003C/p\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch2\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer\u0026nbsp;\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Ebefore 6 weeks of age\u003C/strong\u003E\u003C/span\u003E\u003C/h2\u003E\u003Ch2\u003E\u003Cspan style=\u0022font-weight: normal; font-size: small;\u0022\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EA \u201Crelatively-dense\u201D and \u201Ccentral\u201D congenital cataract is very likely to be amblyogenic because it blocks the visual axis during the most sensitive period of visual development.\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E \u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EUnilateral visual deprivation is especially damaging because the brain strongly favors the clear fellow eye, accelerating deprivation amblyopia in the affected eye.\u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E For that reason, \u003C/span\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003Ea visually significant unilateral congenital cataract is treated urgently, with surgery typically targeted within the first several weeks of life\u2014classically by about 4\u20136 weeks, and certainly before 6 weeks.\u003C/span\u003E\u003C/span\u003E\u003C/h2\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: normal; font-size: small;\u0022\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/span\u003E\u003C/div\u003E\n\u003Cp\u003E\u003Cstrong style=\u0022text-decoration-line: underline;\u0022\u003EWhy the other answer choices are wrong:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\n\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003Ecataract surgery is not indicated at this time\u003C/span\u003E\u003Cbr\u003E\nThis is incorrect because a dense central cataract in a newborn obstructs the visual axis and is not something you \u201Cwatch\u201D if it is visually significant. Delaying intervention risks irreversible deprivation amblyopia.\u003C/p\u003E\n\u003C/li\u003E\n\u003Cli\u003E\n\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003Ebefore 4 weeks of age\u003C/span\u003E\u003Cbr\u003E\nThis can be \u201Ctoo aggressive\u201D as a universal rule. While some cases are operated very early, the commonly taught accepted window for unilateral visually significant congenital cataract is around 4\u20136 weeks to balance amblyopia prevention against perioperative considerations.\u0026nbsp;\u003C/p\u003E\n\u003C/li\u003E\n\u003Cli\u003E\n\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003Ebefore 10 weeks of age\u003C/span\u003E\u003Cbr\u003E\nThis timing is more consistent with bilateral congenital cataracts rather than unilateral disease. Bilateral cataracts can sometimes be removed slightly later (often before ~10 weeks) because both eyes are similarly deprived and there is less interocular competition, whereas unilateral cataracts must be addressed earlier.\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1706,
    "Name": "Infantile (congenital) esotropia",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 6-month-old has had constant inward deviation noted since 3 months of age. Examination shows a comitant esotropia measuring 50 prism diopters. Cycloplegic refraction reveals \u002B1.00 sphere in each eye, and fixation alternates without evidence of amblyopia. What is the next best management step?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch2\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: Surgery to correct the large angle esotropia\u003C/span\u003E\u003C/h2\u003E\n\u003Cp\u003E\u003Cstrong\u003EThis presentation is most consistent with infantile esotropia: an early-onset, large-angle, comitant esodeviation that begins within the first months of life and is not driven by significant hyperopia.\u003C/strong\u003E \u003Cstrong\u003EThe refractive error here is mild (\u002B1.00 OU), which makes a refractive accommodative mechanism very unlikely, so glasses alone will not meaningfully reduce a 50 prism-diopter deviation.\u003C/strong\u003E \u003Cstrong\u003EBecause large-angle infantile esotropia rarely resolves on its own once established, the definitive management is surgical alignment of the eyes.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EThe main reason to intervene early is sensory development.\u003C/strong\u003E \u003Cstrong\u003EBinocular pathways are most plastic in infancy, and aligning the eyes closer to orthotropia during this early period gives the best chance for developing some level of binocular function and stereopsis.\u003C/strong\u003E \u003Cstrong\u003EMany pediatric strabismus practices aim for early alignment in infancy (often within the first year, and sometimes as early as several months) when the deviation is large and stable, especially in otherwise healthy infants.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other answer choices are wrong:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\n\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EObservation until 2 years of age\u003C/span\u003E; since this condition may spontaneously improve by age 2.\u003Cbr\u003E\nA large, constant esotropia beginning in early infancy is unlikely to spontaneously \u201Cgrow out of it.\u201D Waiting risks missing the window for binocular development and increases the chance of persistent suppression and poor stereopsis, even if amblyopia is not yet evident.\u003C/p\u003E\n\u003C/li\u003E\n\u003Cli\u003E\n\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EAlternate patching of both eyes\u003C/span\u003E\u003Cbr\u003E\nAlternating occlusion can be used to treat or prevent fixation preference and amblyopia, but it does not correct a large, stable infantile esotropia. This child already alternates fixation (no clear amblyopia), so patching does not address the primary problem: the large constant misalignment requiring mechanical correction.\u003C/p\u003E\n\u003C/li\u003E\n\u003Cli\u003E\n\u003Cp\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA prescription for the \u002B1.00 with a prism ground into the glasses to correct for the deviation\u003C/span\u003E\u003Cbr\u003E\nPrism is not a practical primary solution for a 50 prism-diopter deviation. The amount of prism required would be optically and physically impractical (thick, heavy, distortion) and would not reliably restore stable binocular alignment in a large-angle infantile deviation. Mild hyperopia correction also will not collapse a deviation of this magnitude when accommodation is not the driver.\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1707,
    "Name": "Estimated visual acuity at birth",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA question asks for the approximate Snellen-equivalent visual acuity expected in a healthy newborn immediately after birth. Which value best matches typical newborn vision?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch2\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: 20/400\u003C/span\u003E\u003C/h2\u003E\n\u003Cp\u003E\u003Cstrong\u003ENewborn visual acuity is poor compared with older infants and adults because the central retina is structurally and functionally immature at birth.\u003C/strong\u003E \u003Cstrong\u003EThe fovea has not yet achieved adult-like cone packing and foveal specialization, and visual pathways (including myelination and cortical processing) are still developing.\u003C/strong\u003E \u003Cstrong\u003EAs a result, a typical estimate for term newborn acuity is around 20/400.\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EFoveal maturation continues through infancy, with major improvements over the first year as cone density and foveal architecture become more adult-like.\u003C/strong\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1708,
    "Name": "Ophthalmia neonatorum",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003ENeonatal conjunctivitis occurs during the first month of life. At what postnatal age does herpes simplex virus conjunctivitis most commonly present?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch2\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: 14 days\u003C/span\u003E\u003C/h2\u003E\n\u003Cp\u003E\u003Cstrong\u003EHSV-related ophthalmia neonatorum most commonly appears around 2 weeks of life, so the best answer is 14 days.\u003C/strong\u003E \u003Cstrong\u003EThe timing is clinically useful because different etiologies cluster at different postnatal ages, reflecting incubation periods and exposure patterns.\u003C/strong\u003E HSV infection in newborns is \u003Cstrong\u003Euncommon but important\u003C/strong\u003E because it can be associated with keratitis and systemic neonatal HSV disease.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other answer choices are wrong:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003Ewithin the first day\u003C/strong\u003E is most consistent with \u003Cstrong\u003Echemical conjunctivitis\u003C/strong\u003E (an irritative reaction to prophylaxis) and usually improves quickly.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003E3-4 days\u003C/strong\u003E is the classic timeframe for \u003Cstrong\u003ENeisseria gonorrhoeae\u003C/strong\u003E conjunctivitis, often with very copious purulent discharge.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003E7 days\u003C/strong\u003E aligns best with \u003Cstrong\u003EChlamydia trachomatis\u003C/strong\u003E conjunctivitis (often around 5\u201314 days, commonly near one week).\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1709,
    "Name": "Shortest overall extraocular muscle (muscle belly \u002B tendon)",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EIncluding both the active muscle belly and the tendon, which extraocular muscle is the shortest overall?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cp\u003E\u003Cstrong\u003EAnswer: inferior oblique.\u003C/strong\u003E\u003C/p\u003E\u003Cp\u003E\n\u003Cstrong\u003EThis question is asking about total length, meaning the active (contractile) muscle belly plus the tendon, not just the muscle belly alone.\u003C/strong\u003E Several extraocular muscles have similar belly lengths, so \u003Cstrong\u003Etendon length becomes the deciding factor\u003C/strong\u003E when comparing \u201Coverall\u201D size.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EKey anatomy numbers:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003ERectus muscles (medial rectus, lateral rectus, superior rectus, inferior rectus)\u003C/strong\u003E have \u003Cstrong\u003Eactive muscular portions of about 40 mm\u003C/strong\u003E.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ESuperior oblique\u003C/strong\u003E has a \u003Cstrong\u003Eshorter muscle belly (~32 mm)\u003C/strong\u003E but a \u003Cstrong\u003Every long tendon (~26 mm)\u003C/strong\u003E, making it \u003Cstrong\u003Ethe longest overall\u003C/strong\u003E when belly \u002B tendon are combined.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EInferior oblique\u003C/strong\u003E has an \u003Cstrong\u003Eactive muscle belly of ~37 mm\u003C/strong\u003E, and crucially it has an \u003Cstrong\u003Eextremely short tendon (~1 mm)\u003C/strong\u003E. \u003Cstrong\u003EThat tiny tendon adds almost nothing to its total length\u003C/strong\u003E, which is why the \u003Cstrong\u003Einferior oblique ends up being the shortest overall extraocular muscle\u003C/strong\u003E.\u003C/li\u003E\u003C/ul\u003E\u003Cul\u003E\n\u003C/ul\u003E\n\u003Cp\u003E\u003Cstrong\u003EMemory anchor:\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003ELongest overall = superior oblique (long tendon).\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EShortest overall = inferior oblique (almost no tendon).\u003C/strong\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1710,
    "Name": "Brushfield spots",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA child is noted to have multiple pale, speckled iris lesions consistent with Brushfield spots. Which statement correctly describes the most likely clinical association of this iris finding?\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-03-21-a913de63-9a72-4dfd-86a8-d7a57420c828.png\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch2\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer\u0026nbsp;\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003EIt is associated with trisomy 21\u003C/strong\u003E\u003C/span\u003E\u003C/h2\u003E\n\u003Cp\u003E\u003Cstrong\u003EThe described iris finding is most consistent with Brushfield spots, which are small, pale stromal iris speckles that are especially noticeable in lighter irides.\u003C/strong\u003E \u003Cstrong\u003EThese spots represent focal areas of iris stromal hyperplasia surrounded by relatively thinner stroma, creating a \u201Cspeckled\u201D appearance.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EBrushfield spots are strongly associated with Down syndrome (trisomy 21), occurring in a large proportion of affected individuals.\u003C/strong\u003E \u003Cstrong\u003EImportantly, Brushfield spots themselves do not typically affect vision and are usually an incidental finding.\u003C/strong\u003E A similar-appearing benign variant, \u003Cstrong\u003EW\u00F6lfflin nodules\u003C/strong\u003E, can also be seen in individuals without systemic disease.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other statements are incorrect (and what they refer to):\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EIt can result in secondary glaucoma and corectopia\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EThis describes the iris nodules and iris changes seen in ICE syndrome (especially Cogan\u2013Reese), which can lead to corectopia and secondary angle-closure glaucoma.\u003C/strong\u003E\u0026nbsp;\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EIt is associated with optic gliomas and hyperpigmented macules of the skin\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EThis points to neurofibromatosis type 1\u003C/strong\u003E, where \u003Cstrong\u003ELisch nodules\u003C/strong\u003E (iris hamartomas) are associated with caf\u00E9-au-lait macules and optic pathway gliomas\u2014different from Brushfield spots.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EIt can be associated with oculodermal melanocytosis\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EThis is more consistent with iris mammillations\u003C/strong\u003E, which can be seen with oculodermal melanocytosis, not Brushfield spots.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1711,
    "Name": "Acute Brown syndrome presentation",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 34-year-old develops recent diplopia that is worse in right gaze. Examination shows limited elevation of the left eye when the patient looks to the right, and forced ductions confirm a mechanical restriction in that position. Elevation is less restricted when the patient looks to the left. The patient recently had an upper respiratory-type illness. What should be done next?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch2\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer\u0026nbsp;\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003ECT of the orbits and paranasal sinuses\u003C/span\u003E\u003C/span\u003E\u003C/h2\u003E\n\u003Cp\u003E\u003Cstrong\u003EThis motility pattern is classic for Brown syndrome: a mechanical limitation of elevation in adduction.\u003C/strong\u003E The key supportive clues are \u003Cstrong\u003E(1) elevation restriction that is position-dependent (worst when the affected eye is adducted), and (2) a positive forced duction test\u003C/strong\u003E, which indicates a restrictive (mechanical) process rather than a neurogenic palsy.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EThe history of upper respiratory tract infection raises concern for inflammatory or infectious involvement near the trochlea/superior oblique tendon-trochlear complex (for example, sinus-related inflammation).\u003C/strong\u003E In an acute presentation like this, the appropriate next step is \u003Cstrong\u003Eorbital and paranasal sinus imaging\u003C/strong\u003E to identify or exclude an adjacent inflammatory process, structural abnormality, or other secondary cause that would change treatment.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EThe other options are not the best next step because treatment should be directed only after identifying the underlying cause.\u003C/strong\u003E A \u003Cstrong\u003Esuperior oblique spacer\u003C/strong\u003E is a surgical option for selected cases, but it is not the initial step in a new-onset, potentially secondary Brown syndrome. \u003Cstrong\u003ELocal steroid injection\u003C/strong\u003E can be considered in some inflammatory trochleitis/tendon-related cases, but imaging is a key next step first when sinus involvement is suspected. \u003Cstrong\u003EBotulinum toxin injection into the superior rectus\u003C/strong\u003E does not address the primary restrictive mechanism at the superior oblique tendon-trochlea interface.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EClinical pearl:\u003C/strong\u003E \u003Cstrong\u003EBrown syndrome is often associated with a V-pattern\u003C/strong\u003E, whereas \u003Cstrong\u003Einferior oblique palsy tends to produce an A-pattern\u003C/strong\u003E, which can help with pattern recognition in complex motility cases.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1712,
    "Name": "Yoke muscles for up-and-right gaze",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhen assessing cardinal gazes, you ask a patient to look up and to the right. Which pair of yoke muscles (one from each eye) produces this movement?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch2\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: right superior rectus and left inferior oblique\u003C/span\u003E\u003C/h2\u003E\n\u003Cp\u003E\u003Cstrong\u003EYoke muscles are the paired muscles\u2014one in each eye\u2014that contract together to move both eyes into the same direction of gaze (Hering\u2019s law of equal innervation).\u003C/strong\u003E For \u003Cstrong\u003Eup-and-right gaze\u003C/strong\u003E, the \u003Cstrong\u003Eright eye is abducted\u003C/strong\u003E, so its primary elevator in abduction is the \u003Cstrong\u003Eright superior rectus\u003C/strong\u003E. At the same time, the \u003Cstrong\u003Eleft eye is adducted\u003C/strong\u003E, and its primary elevator in adduction is the \u003Cstrong\u003Eleft inferior oblique\u003C/strong\u003E. \u003Cstrong\u003EThat is why the correct yoke pair is right superior rectus with left inferior oblique.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cimg src=\u0022/upload-2026-03-21-f0b187fb-1f99-42ff-993e-983785d13f63.png\u0022\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1713,
    "Name": "Periodic alternating nystagmus",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 3-year-old has had abnormal eye and head movements since infancy. Examination shows a horizontal jerk nystagmus beating to one side that stays horizontal even when looking up or down. After a brief absence, the nystagmus is now beating in the opposite direction. Based on the most likely diagnosis, about how much time passed?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch2\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: 60-120 seconds\u003C/span\u003E\u003C/h2\u003E\n\u003Cp\u003EThis pattern is most consistent with periodic alternating nystagmus (PAN), in which the direction of horizontal jerk nystagmus reverses in a regular cycle. In PAN, the nystagmus typically beats in one direction for about 60\u201390 seconds, then there is often a brief \u201Cquiet\u201D interval (commonly ~10\u201320 seconds) with minimal or no nystagmus, followed by nystagmus beating in the opposite direction for a similar duration. So a full \u201Cdirection-to-direction\u201D change generally occurs over roughly 1\u20132 minutes, making 60-120 seconds the best estimate for the time you were away.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EClinical pearl:\u003C/strong\u003E \u003Cstrong\u003EChildren with PAN may show alternating head turns to follow the shifting null zone as the fast phase changes direction, which can make the head posture seem inconsistent over short periods.\u003C/strong\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1714,
    "Name": "Primary action of inferior oblique and secondary action of superior rectus",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich option correctly pairs the primary action of the inferior oblique with the secondary action of the superior rectus?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch2\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: extorsion and intorsion\u003C/span\u003E\u003C/h2\u003E\n\u003Cp\u003E\u003Cstrong\u003EThe key is remembering what \u201Cprimary\u201D and \u201Csecondary\u201D actions mean and using a few high-yield rules.\u003C/strong\u003E \u003Cstrong\u003EPrimary action\u003C/strong\u003E refers to the main effect of a muscle when the eye is in primary position. \u003Cstrong\u003ESecondary\u003C/strong\u003E (and tertiary) actions are the additional rotational effects that occur because the muscle\u2019s pull is not perfectly aligned with a single axis of rotation.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EInferior oblique (IO): primary action = torsion, specifically extorsion.\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003EOblique muscles primarily produce torsion.\u003C/strong\u003E The inferior oblique\u2019s torsional effect is \u003Cstrong\u003Eextorsion\u003C/strong\u003E (top of the eye rotates away from the nose). Its other actions are \u003Cstrong\u003Eelevation\u003C/strong\u003E (secondary; opposite of \u201Cinferior\u201D) and \u003Cstrong\u003Eabduction\u003C/strong\u003E (tertiary).\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003ESuperior rectus (SR): primary action = elevation; secondary action = intorsion.\u003C/strong\u003E\u003Cbr\u003E\nThe superior rectus is a \u003Cstrong\u003Erectus muscle\u003C/strong\u003E, so in addition to its main vertical action (elevation), it also contributes to torsion and horizontal movement due to its angled insertion. A useful mnemonic is \u003Cstrong\u003E\u201CSIN\u2013RAD\u201D\u003C/strong\u003E:\u003Cbr\u003E\n\u003Cstrong\u003ESuperior muscles INtort\u003C/strong\u003E, and \u003Cstrong\u003ERecti ADduct\u003C/strong\u003E.\u003Cbr\u003E\nSo for the superior rectus, \u003Cstrong\u003Ethe secondary torsional action is intorsion\u003C/strong\u003E, and the horizontal (tertiary) action is \u003Cstrong\u003Eadduction\u003C/strong\u003E.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1715,
    "Name": "Congenital glaucoma suspicion in an infant",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 6-month-old has persistent tearing and frequent squeezing/shutting of both eyes since early infancy. The ocular appearance is consistent with corneal edema, raising concern for a pressure-related disorder. Which ancillary test is most useful for tracking treatment response over time?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch2\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer\u0026nbsp;\u003Cspan style=\u0022font-weight: 400; letter-spacing: 0.14994px;\u0022\u003EA-scan ultrasound\u003C/span\u003E\u003C/span\u003E\u003C/h2\u003E\n\u003Cp\u003E\u003Cstrong\u003EThe symptom cluster of tearing with frequent squeezing/shutting of the eyes in an infant is highly suggestive of primary congenital glaucoma, especially when the cornea appears edematous.\u003C/strong\u003E \u003Cstrong\u003EIn congenital glaucoma, elevated intraocular pressure can enlarge the eye (buphthalmos) and stretch the cornea, leading to edema and an abnormal light reflex.\u003C/strong\u003E Because the key threat is \u003Cstrong\u003Eongoing globe enlargement and optic nerve damage\u003C/strong\u003E, monitoring should focus on objective measures of disease control and progression.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EA-scan ultrasound is the best choice here because it allows reliable measurement of axial length over time, which is a practical way to monitor whether the eye is continuing to enlarge.\u003C/strong\u003E \u003Cstrong\u003EIf axial length is increasing faster than expected for age, that strongly suggests inadequate intraocular pressure control\u003C/strong\u003E, even if single IOP readings are variable (especially when measured under anesthesia). This makes A-scan ultrasound a high-yield tool for following response after treatment (most often surgical in primary congenital glaucoma).\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other answer choices are wrong:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003EMagnetic resonance imaging\u003Cbr\u003E\n\u003Cstrong\u003EMRI does not monitor glaucoma control and is not the routine way to track progression in suspected primary congenital glaucoma.\u003C/strong\u003E\u0026nbsp;\u003C/li\u003E\n\u003Cli\u003ECorneal pachymetry\u003Cbr\u003E\n\u003Cstrong\u003ECorneal thickness can be altered by edema and may affect interpretation of measured IOP, but pachymetry does not directly track progression or response as well as axial length monitoring does in infantile glaucoma.\u003C/strong\u003E\u003C/li\u003E\n\u003Cli\u003EVisual evoked potentials\u003Cbr\u003E\n\u003Cstrong\u003EVEP may estimate visual pathway function, but it is not the preferred method to monitor congenital glaucoma treatment response\u003C/strong\u003E, because it does not directly reflect pressure control or globe enlargement.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1716,
    "Name": "Posterior lenticonus in children",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich of the following statements is TRUE regarding cataracts associated with posterior lenticonus in children?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch2\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: These cataracts are not present at birth\u003C/span\u003E\u003C/h2\u003E\n\u003Cp\u003E\u003Cstrong\u003EPosterior lenticonus is a localized, cone-like protrusion of the central posterior lens capsule due to thinning/weakness of that capsule.\u003C/strong\u003E \u003Cstrong\u003EOn retroillumination it can create an \u201Coil droplet\u201D appearance.\u003C/strong\u003E Over time, \u003Cstrong\u003Ethe abnormal posterior bulge tends to induce progressive lens changes\u003C/strong\u003E, and \u003Cstrong\u003Eopacification may develop as the capsule continues to stretch and the overlying cortex becomes affected\u003C/strong\u003E. This clinical behavior is why posterior lenticonus\u2013associated cataract is commonly described as \u003Cstrong\u003Eacquired/diagnosed after birth rather than clearly present at birth\u003C/strong\u003E, making \u201CThese cataracts are not present at birth\u201D the correct statement.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other statements are wrong:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\n\u003Cp\u003E\u003Cstrong\u003EPosterior lenticonus cataracts are classically more often unilateral in children.\u003C/strong\u003E \u003Cstrong\u003EBilateral involvement can occur, but it is not the typical presentation\u003C/strong\u003E.\u003C/p\u003E\n\u003C/li\u003E\n\u003Cli\u003E\n\u003Cp\u003E\u003Cstrong\u003EAlport syndrome is classically associated with anterior lenticonus (and dot-and-fleck retinopathy), not posterior lenticonus.\u003C/strong\u003E \u003Cstrong\u003EPosterior lenticonus in Alport is rare and mainly reported as isolated case reports\u003C/strong\u003E.\u003C/p\u003E\n\u003C/li\u003E\n\u003Cli\u003E\n\u003Cp\u003E\u003Cstrong\u003EPosterior lenticonus is not characteristically linked to microphthalmos or a consistent inter-eye size discrepancy.\u003C/strong\u003E When microphthalmos is present, it usually points to other developmental lens/anterior segment disorders rather than posterior lenticonus as the typical association.\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
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  },
  {
    "Id": 1717,
    "Name": "Congenital motor nystagmus",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 3-year-old has congenital motor nystagmus with a left jerk pattern. Which abnormal head posture would most likely be adopted to reduce the nystagmus?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch2\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer\u0026nbsp;\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003Eleft head turn\u003C/span\u003E\u003C/span\u003E\u003C/h2\u003E\n\u003Cp\u003E\u003Cstrong\u003EA \u201Cleft jerk nystagmus\u201D is defined by a fast phase that beats to the left.\u003C/strong\u003E \u003Cstrong\u003EBy Alexander\u2019s law, jerk nystagmus typically becomes stronger when the eyes look toward the direction of the fast phase, and it becomes quieter when the eyes look away from that direction.\u003C/strong\u003E\u003Cbr\u003E\n\u003Cstrong\u003ESo, a left-beating (left jerk) nystagmus tends to worsen in left gaze and dampen in right gaze.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EChildren with congenital motor nystagmus often adopt a compensatory head posture to place their eyes in the gaze position where the nystagmus is minimal (the null zone).\u003C/strong\u003E \u003Cstrong\u003EIf the null zone is in right gaze, the child can keep the eyes in right gaze while still looking straight ahead by turning the face to the left.\u003C/strong\u003E That is why the expected posture is \u003Cstrong\u003Ea left head turn\u003C/strong\u003E.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 1718,
    "Name": "Congenital motor nystagmus",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA young child has had a horizontal nystagmus since early infancy and has relatively good visual function on age-appropriate testing. You are trying to distinguish congenital motor nystagmus from other congenital nystagmus entities. Which ancillary finding is considered specific for congenital motor nystagmus?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch2\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: paradoxical inversion of the OKN response\u003C/span\u003E\u003C/h2\u003E\n\u003Cp\u003E\u003Cstrong\u003EA horizontal nystagmus beginning in early infancy with relatively preserved vision most commonly fits congenital motor nystagmus (CMN).\u003C/strong\u003E CMN is a diagnosis of an ocular motor \u201Ccontrol\u201D problem rather than a primary retinal/optic nerve sensory deficit, so many children maintain better-than-expected visual behavior compared with sensory nystagmus causes.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EAlthough CMN is often described as uniplanar (remaining horizontal even in upgaze and downgaze), that feature is supportive but not mandatory.\u003C/strong\u003E The absence of strict uniplanar behavior does not rule CMN out, because congenital nystagmus phenotypes can vary and some overlap exists with other early-onset nystagmus categories.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003ECMN also does not have to be a classic jerk waveform.\u003C/strong\u003E CMN can present with jerk, pendular, or more complex oscillation patterns (including circular or elliptical-appearing movements). So waveform shape alone is not the best \u201Csingle discriminator.\u201D\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EThe key high-yield feature that occurs only in CMN is paradoxical inversion of the optokinetic nystagmus (OKN) response.\u003C/strong\u003E In typical jerk nystagmus, an OKN stimulus that drives pursuit in one direction tends to \u003Cstrong\u003Eincrease\u003C/strong\u003E the nystagmus in that same direction. In CMN, the opposite can happen: an OKN drum moving in a direction that would normally reinforce the existing jerk can instead \u003Cstrong\u003Edampen\u003C/strong\u003E the jerk nystagmus or even \u003Cstrong\u003Eflip\u003C/strong\u003E the beating direction. That counterintuitive (\u201Cparadoxical\u201D) behavior is the classic specific clue.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other choices are wrong:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003Emarkedly reduced ERG responses in both eyes\u003C/strong\u003E points toward a retinal dystrophy/sensory cause of nystagmus (for example, inherited retinal disease), not CMN.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003Enystagmus that becomes vertical in upgaze and downgaze\u003C/strong\u003E is not a defining or specific feature for CMN and would push you to consider other ocular motor or central causes depending on the full pattern.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003Ea relative afferent pupillary defect in one eye\u003C/strong\u003E suggests asymmetric optic nerve or severe retinal disease and is not expected in isolated CMN.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
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  },
  {
    "Id": 1719,
    "Name": "Congenital iris ectropion with pediatric glaucoma",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 6-year-old has a unilateral iris abnormality on slit-lamp exam, and the affected eye has markedly elevated intraocular pressure compared with the fellow eye. Based on the most likely ocular diagnosis suggested by the iris appearance and unilateral glaucoma, which additional finding could be present?\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-03-22-ec86b4db-f37b-4114-878d-1cb25789b0c1.png\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch2\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer\u0026nbsp;\u003Cspan style=\u0022font-weight: 400; letter-spacing: 0.14994px;\u0022\u003Ecaf\u00E9 au lait spot\u003C/span\u003E\u003C/span\u003E\u003C/h2\u003E\n\u003Cp\u003E\u003Cstrong\u003EThe iris photo is most consistent with ectropion uveae (also called iris ectropion), where the posterior iris pigment epithelium extends onto the anterior surface at the pupillary margin.\u003C/strong\u003E \u003Cstrong\u003EWhen this is congenital and unilateral and is accompanied by high iris insertion/cryptless iris and glaucoma (as suggested by the markedly elevated unilateral IOP), the picture fits congenital ectropion uveae syndrome.\u003C/strong\u003E \u003Cstrong\u003EThis syndrome is classically associated with neurofibromatosis type 1 (NF1), and caf\u00E9 au lait macules are a common cutaneous feature of NF1\u2014so caf\u00E9 au lait spot is the best associated abnormality.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other answer choices are wrong:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003Eadenoma sebaceum\u003C/strong\u003E \u003Cstrong\u003Eis a misnomer for facial angiofibromas, which are associated with tuberous sclerosis, not congenital ectropion uveae syndrome.\u003C/strong\u003E\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003ENevus of Ota\u003C/strong\u003E \u003Cstrong\u003Eis associated with oculodermal melanocytosis and can be linked to ipsilateral ocular hyperpigmentation and glaucoma, but it does not match the characteristic ectropion uveae syndrome association being tested here.\u003C/strong\u003E\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003Edilated cardiomyopathy\u003C/strong\u003E \u003Cstrong\u003Eis a systemic association classically discussed with Alstr\u00F6m syndrome (which features a cone-rod dystrophy), not with congenital ectropion uveae syndrome.\u003C/strong\u003E\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
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  },
  {
    "Id": 1720,
    "Name": "Pediatric intermediate uveitis",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 7-year-old has difficult-to-control intermediate uveitis, and you are considering systemic immunosuppression. Which of the listed agents is usually avoided in children unless disease is extremely severe?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch2\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer\u0026nbsp;\u003Cspan style=\u0022font-weight: 400; letter-spacing: 0.14994px;\u0022\u003Ecyclophosphamide\u003C/span\u003E\u003C/span\u003E\u003C/h2\u003E\n\u003Cp\u003E\u003Cstrong\u003ECyclophosphamide is an alkylating agent, and alkylating immunosuppressives are generally discouraged in children because of high long-term toxicity.\u003C/strong\u003E \u003Cstrong\u003EThe major concerns include profound bone marrow suppression, serious infection risk, future infertility (gonadotoxicity), and an increased risk of secondary malignancy.\u003C/strong\u003E \u003Cstrong\u003EA classic board-relevant adverse effect specific to cyclophosphamide is hemorrhagic cystitis\u003C/strong\u003E, which reflects toxic metabolites affecting the bladder.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EBecause of these risks, cyclophosphamide is typically reserved for only the most severe, vision-threatening, refractory uveitis scenarios when safer steroid-sparing agents have failed or are contraindicated.\u003C/strong\u003E In most pediatric uveitis management pathways, clinicians prefer agents with a more favorable long-term risk profile.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other options are not the best answer:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003Emethotrexate\u003C/strong\u003E is commonly used as a first-line steroid-sparing immunomodulatory therapy in children with uveitis (including JIA-associated disease). \u003Cstrong\u003ECommon issues include gastrointestinal upset\u003C/strong\u003E, and more serious toxicities include \u003Cstrong\u003Ehepatotoxicity, mucositis, and rarely pneumonitis\u003C/strong\u003E, but it remains a standard pediatric option with appropriate monitoring.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003Ecyclosporine\u003C/strong\u003E is also used in selected pediatric uveitis cases; its major limitation is \u003Cstrong\u003Enephrotoxicity\u003C/strong\u003E, and other notable adverse effects include \u003Cstrong\u003Egingival hyperplasia and gastrointestinal symptoms\u003C/strong\u003E, but it is not broadly \u201Cdiscouraged\u201D in children in the same way alkylators are.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003Einfliximab\u003C/strong\u003E (a TNF-\u03B1 inhibitor) is frequently used for refractory noninfectious uveitis in children, especially when there is associated systemic inflammatory disease. \u003Cstrong\u003EThe risks center on infection/reactivation and infusion reactions\u003C/strong\u003E, but it is a commonly accepted steroid-sparing option under specialist supervision.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
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  },
  {
    "Id": 1721,
    "Name": "Neurofibromatosis type 2",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA teenager with bilateral sensorineural hearing loss and a suspected intracranial meningioma is being evaluated for ocular signs of an underlying phakomatosis. Which set of eye findings is most likely to be present?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch2\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: posterior subcapsular cataracts, wedge cortical cataracts, and retinal hamartomas\u003C/span\u003E\u003C/h2\u003E\n\u003Cp\u003E\u003Cstrong\u003EThe history strongly points to neurofibromatosis type 2 (NF2).\u003C/strong\u003E \u003Cstrong\u003EBilateral sensorineural hearing loss is classically due to bilateral vestibular schwannomas, and intracranial meningiomas are also a common tumor type in NF2.\u003C/strong\u003E When a question pairs hearing loss with meningioma in an adolescent, NF2 is the unifying diagnosis.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EIn NF2, the most common ocular abnormality is cataract, particularly posterior subcapsular cataracts.\u003C/strong\u003E \u003Cstrong\u003EWedge-shaped cortical cataracts are also commonly described in NF2\u003C/strong\u003E, and \u003Cstrong\u003Eretinal hamartomas (including combined retinal\u2013RPE hamartomas) can occur as additional ocular findings.\u003C/strong\u003E Therefore, the combination that best matches NF2 is the one that includes \u003Cstrong\u003Eposterior subcapsular cataracts\u003C/strong\u003E, \u003Cstrong\u003Ewedge cortical cataracts\u003C/strong\u003E, and \u003Cstrong\u003Eretinal hamartomas\u003C/strong\u003E.\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other answer choices are wrong:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\n\u003Cp\u003Eposterior subcapsular cataracts, optic nerve melanocytoma, and iris hamartomas\u003Cbr\u003E\n\u003Cstrong\u003EIris hamartomas (Lisch nodules) are much more characteristic of neurofibromatosis type 1 (NF1), not NF2.\u003C/strong\u003E \u003Cstrong\u003EOptic nerve melanocytoma is not a classic hallmark of NF2\u003C/strong\u003E and does not fit the \u201Chearing loss \u002B meningioma\u201D syndrome pattern being tested.\u003C/p\u003E\n\u003C/li\u003E\n\u003Cli\u003E\n\u003Cp\u003Eposterior subcapsular cataracts, neuroblastomas, and combined hamartomas of the retina and RPE\u003Cbr\u003E\n\u003Cstrong\u003ENeuroblastoma is not part of the NF2 tumor spectrum.\u003C/strong\u003E It is classically linked to opsoclonus\u2013myoclonus syndrome rather than NF2. Even though \u003Cstrong\u003Ecombined hamartomas can be seen in NF2\u003C/strong\u003E, the inclusion of \u003Cstrong\u003Eneuroblastomas\u003C/strong\u003E makes this combination inconsistent with the vignette.\u003C/p\u003E\n\u003C/li\u003E\n\u003Cli\u003E\n\u003Cp\u003Eposterior subcapsular cataracts, retinal hamartomas, and optic nerve melanocytoma\u003Cbr\u003E\n\u003Cstrong\u003EPosterior subcapsular cataracts and retinal hamartomas can fit NF2\u003C/strong\u003E, but \u003Cstrong\u003Eoptic nerve melanocytoma is not a typical NF2 association\u003C/strong\u003E, so this set is less appropriate than the option that includes the better-known NF2 lens finding of \u003Cstrong\u003Ewedge cortical cataracts\u003C/strong\u003E.\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1722,
    "Name": "Quantifying cyclodeviation in an acquired 4th nerve palsy",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA child has an acquired trochlear nerve palsy and you want to measure the amount of torsional misalignment. Which test is used to quantify cyclodeviation?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch2\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer:\u0026nbsp;\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003Edouble Maddox rod test\u003C/span\u003E\u003C/span\u003E\u003C/h2\u003E\n\u003Cp\u003E\u003Cstrong\u003ECyclodeviation is a torsional misalignment (incyclotorsion or excyclotorsion), and the classic bedside method to \u003Cem\u003Emeasure\u003C/em\u003E its magnitude is the double Maddox rod test.\u003C/strong\u003E \u003Cstrong\u003EThe test converts each eye\u2019s perceived image into a line, allowing torsion to be quantified by the amount of rotation needed to make the two lines appear parallel.\u003C/strong\u003E In practice, a Maddox rod is placed in front of each eye (usually in a trial frame), the patient views a single light, and the rods are rotated until the patient reports the two lines are aligned/parallel; \u003Cstrong\u003Ethe degree of rotation required corresponds to the amount of subjective torsion.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other answer choices are wrong:\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003EMaddox rod test\u003C/strong\u003E (single Maddox rod) is mainly used to \u003Cstrong\u003Emeasure horizontal or vertical deviations\u003C/strong\u003E, not torsion. It creates a line for one eye and a light for the other, helping quantify the separation in prism diopters rather than cyclotorsion.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003Ered glass test\u003C/strong\u003E helps \u003Cstrong\u003Edetect diplopia patterns\u003C/strong\u003E and can support sensory evaluation (including suppression/ARC in some contexts), but it is \u003Cstrong\u003Enot the standard test to quantify torsion in degrees\u003C/strong\u003E.\u003C/li\u003E\n\u003Cli\u003E\u003Cstrong\u003EParks-Bielchowsky 3-step test\u003C/strong\u003E is a diagnostic framework to \u003Cstrong\u003Eidentify the paretic muscle in vertical strabismus (classically 4th nerve palsy)\u003C/strong\u003E, but it does \u003Cstrong\u003Enot quantify cyclodeviation\u003C/strong\u003E.\u003C/li\u003E\u003C/ul\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1723,
    "Name": "Chronic tearing in a 6\u2011month\u2011old with normal corneas",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA 6\u2011month\u2011old has had persistent tearing in both eyes since early infancy. Exam shows copious clear tearing, clear corneas, normal corneal diameter for age (10.0 mm in both eyes), no photophobia, and otherwise normal ocular findings. What is the best next management?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch2\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: Crigler massage\u003C/span\u003E\u003C/h2\u003E\n\u003Cp\u003E\u003Cstrong\u003EThe presentation is most consistent with congenital nasolacrimal duct obstruction (NLDO).\u003C/strong\u003E \u003Cstrong\u003EChronic, clear tearing beginning in early infancy with a normal ocular exam strongly favors NLDO.\u003C/strong\u003E \u003Cstrong\u003EA key first-step clinical consideration is ruling out primary congenital glaucoma, because glaucoma can also present with tearing in infants; however, congenital glaucoma typically comes with additional red flags such as photophobia, blepharospasm, corneal edema/clouding, and enlarged corneal diameter (buphthalmos).\u003C/strong\u003E \u003Cstrong\u003EHere, the corneas are clear, the corneal diameter is not enlarged, and there is no photophobia, which makes congenital glaucoma unlikely in this vignette.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EFor uncomplicated NLDO at 6 months, the preferred initial treatment is conservative therapy with digital lacrimal sac massage (Crigler massage).\u003C/strong\u003E \u003Cstrong\u003EThis technique increases hydrostatic pressure within the lacrimal sac and can help open the membranous obstruction at the distal nasolacrimal duct (classically at the valve of Hasner).\u003C/strong\u003E \u003Cstrong\u003EMany cases resolve spontaneously during the first year of life, and massage is the standard first-line step while waiting for that natural resolution.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other choices are wrong:\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003Eexamination under anesthesia\u003Cbr\u003E\n\u003Cstrong\u003EThis is not the best next step in a stable infant whose exam is otherwise normal and whose findings fit NLDO without glaucoma signs.\u003C/strong\u003E \u003Cstrong\u003EAnesthesia-based evaluation is generally reserved for cases where the diagnosis is uncertain, the examination cannot be adequately performed in clinic, or there is strong concern for glaucoma/other serious pathology requiring detailed assessment.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003Egoniotomy\u003Cbr\u003E\n\u003Cstrong\u003EGoniotomy is a surgical procedure used to treat primary congenital glaucoma.\u003C/strong\u003E \u003Cstrong\u003EBecause this child lacks the typical glaucoma features (photophobia, corneal haze/edema, enlarged cornea), goniotomy is not indicated.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003Etopical antibiotics for 1-2 weeks\u003Cbr\u003E\n\u003Cstrong\u003ETopical antibiotics can be helpful if there is secondary bacterial conjunctivitis or mucopurulent discharge, but they do not correct the underlying drainage obstruction.\u003C/strong\u003E \u003Cstrong\u003EIn this case, the tearing is described as clear and the remainder of the exam is normal, so antibiotics are not the primary management.\u003C/strong\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1724,
    "Name": "Delayed visual maturation in a healthy 3\u2011month\u2011old",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA healthy full-term 3\u2011month\u2011old does not fixate or track, and this is confirmed on exam. The rest of the eye exam is normal. What is the best next step?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch2\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer: observe closely\u003C/span\u003E\u003C/h2\u003E\n\u003Cp\u003E\u003Cstrong\u003EA normal ocular examination in a young infant who is not yet reliably fixing and following most strongly suggests delayed visual maturation (DVM).\u003C/strong\u003E \u003Cstrong\u003EDVM is a developmental delay in visual attention and visual behaviors rather than a primary structural eye disease.\u003C/strong\u003E \u003Cstrong\u003EImportantly, DVM can be seen in children with neurologic/developmental issues, but it can also occur in otherwise healthy infants and often improves with time.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EAt 3 months of age, careful observation is an appropriate next step because visual behaviors are still maturing and many infants show rapid improvement over the next several weeks.\u003C/strong\u003E \u003Cstrong\u003EJumping immediately to advanced testing (VEP/ERG) is usually reserved for cases with concerning exam findings, systemic red flags, or failure to show improvement as the infant approaches the age when fixation and tracking should be more consistent.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhy the other answer choices are not the best next step right now\u003C/strong\u003E\u003C/p\u003E\n\u003Cul\u003E\n\u003Cli\u003Eperform a visual evoked potential (VEP)\u003Cbr\u003E\n\u003Cstrong\u003EVEP can be useful to assess the integrity of the visual pathway when the diagnosis is uncertain, but it is not the first move in a healthy 3\u2011month\u2011old with a completely normal eye exam.\u003C/strong\u003E \u003Cstrong\u003EIt becomes more appropriate if visual behavior does not improve as the infant gets closer to ~6 months or if additional concerns arise.\u003C/strong\u003E\u003C/li\u003E\n\u003Cli\u003Eorder a MRI of the brain\u003Cbr\u003E\n\u003Cstrong\u003ENeuroimaging is not the routine next step when the eye exam is normal and the infant is otherwise healthy.\u003C/strong\u003E \u003Cstrong\u003EMRI is typically considered when there are neurologic signs, abnormal head growth, seizures, abnormal tone, developmental regression, or other features that raise suspicion for central pathology.\u003C/strong\u003E\u003C/li\u003E\n\u003Cli\u003Eperform an electroretinogram (ERG)\u003Cbr\u003E\n\u003Cstrong\u003EERG helps evaluate retinal function and can be important when a retinal dystrophy is suspected, but a normal ocular exam without other suggestive clues makes immediate ERG less appropriate than observation.\u003C/strong\u003E \u003Cstrong\u003ELike VEP, it becomes reasonable if vision does not begin to emerge as expected or if the clinical picture changes.\u003C/strong\u003E\u003C/li\u003E\n\u003C/ul\u003E\n\u003Cp\u003E\u003Cstrong\u003EPractical follow-up point:\u003C/strong\u003E \u003Cstrong\u003EClose observation means arranging a timely re-check and documenting objective visual behaviors (response to faces/lights, fixation, tracking), and escalating to VEP/ERG and/or neurologic evaluation if the infant fails to improve by the expected developmental window or if any systemic red flags appear.\u003C/strong\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1725,
    "Name": "Retinal detachment",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EWhich of the following is a risk factor that may justify \u003Cspan class=\u0022s1\u0022 style=\u0022\u0022\u003Eprophylactic laser treatment\u003C/span\u003E for lattice degeneration?\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003EWhich of the following is a risk factor that may justify \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eprophylactic laser treatment\u003C/b\u003E\u003C/span\u003E for lattice degeneration?\u003C/p\u003E\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ELattice degeneration \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Edoes not routinely require prophylactic laser\u003C/b\u003E\u003C/span\u003E in the absence of additional risk factors.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ELong-term natural history data (Byer) shows a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Every low risk of retinal detachment (~1% over 10 years)\u003C/b\u003E\u003C/span\u003E in uncomplicated lattice.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ETherefore, routine treatment of lattice (with or without atrophic holes) in low-risk eyes is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enot recommended\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ERisk factors that justify prophylactic laser include:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EHistory of retinal detachment in the fellow eye\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E \u2190 strongest indication\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EHigh myopia\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EFlap (tractional) tears within lattice\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAphakia\u003C/b\u003E\u003C/span\u003E (not pseudophakia)\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAtrophic holes alone\u003C/b\u003E\u003C/span\u003E\u0026nbsp;are typically low risk and do not require treatment.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EPseudophakia\u003C/b\u003E\u003C/span\u003E\u0026nbsp; is not a strong standalone indication (aphakia carries higher risk).\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EIntraocular inflammation\u003C/b\u003E\u003C/span\u003E\u0026nbsp;is not a recognised indication for prophylactic lattice treatment.\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1726,
    "Name": "Cancer associated retinopathy CAR",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 45-year-old Caucasian man presents with progressive bilateral visual loss over several months. He says the vision loss started peripherally and is now affecting central vision. He also reports intermittent photopsia. Intraocular pressures are normal. Goldmann perimetry shows dense ring scotomas in both eyes. Fundus examination is as shown. His vision was normal before this year. Which protein is most likely involved in this condition?\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cimg src=\u0022/upload-2026-04-12-0facb98d-ce5c-4503-be8b-a0594d9441f8.jpg\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThis presentation is most consistent with \u003C/span\u003E\u003Cb\u003Ecancer-associated retinopathy (CAR)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E, a form of \u003C/span\u003E\u003Cb\u003Eparaneoplastic autoimmune retinopathy\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EKey clues are:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ERapidly progressive bilateral visual loss\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EInitial \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eperipheral field loss\u003C/b\u003E\u003C/span\u003E progressing to central involvement\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EPhotopsia\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EDense ring scotomas\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPreviously normal vision, arguing against inherited retinal dystrophy\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\u003Cp class=\u0022p1\u0022\u003EFundus appears normal initially.\u003C/p\u003E\u003C/li\u003E\u003C/ul\u003E\u003Cli style=\u0022margin-bottom: 0.1em; border-radius: 0px !important;\u0022\u003EWith progression, clinically apparent retinal degenerations can be seen (RPE thinning and mottling, attenuation of the arterioles, optic nerve pallor). Other fundus findings such as macular edema, vitreous cells, vascular sheathing, and periphlebitis have been documented.\u003C/li\u003E\u003Cp\u003E\u003C/p\u003E\n\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ECAR is classically associated with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eautoantibodies against recoverin\u003C/b\u003E\u003C/span\u003E, a 23-kDa calcium-binding retinal photoreceptor protein.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThe autoimmune response leads to \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ephotoreceptor degeneration\u003C/b\u003E\u003C/span\u003E, producing symptoms that can mimic retinitis pigmentosa but with a much more rapid onset.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ERhodopsin\u003C/b\u003E\u003C/span\u003E is associated with some forms of inherited \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eretinitis pigmentosa\u003C/b\u003E\u003C/span\u003E, which is usually gradual and longstanding rather than rapidly acquired in midlife.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EOptineurin\u003C/b\u003E\u003C/span\u003E is associated with some forms of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Enormal tension glaucoma\u003C/b\u003E\u003C/span\u003E.\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ELOXL1\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E is strongly associated with \u003C/span\u003E\u003Cb\u003Epseudoexfoliation syndrome/glaucoma\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E.\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003ERemember:\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal; font-weight: bold; text-decoration-line: underline;\u0022\u003EDifferential diagnoses to be considered and ruled out:\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cul\u003E\u003Cli\u003E\u003Cspan style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal;\u0022\u003EOther causes of retinal degeneration such as any hereditary or toxic retinal degeneration.\u0026nbsp;\u003C/span\u003E\u003C/li\u003E\u003Cli\u003E\u003Cspan style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal;\u0022\u003EOptic nerve diseases such as retrobulbar optic neuropathy, optic neuropathy related to smoking/nutritional deficiency, and hereditary optic neuropathy\u0026nbsp;\u003C/span\u003E\u003C/li\u003E\u003Cli\u003E\u003Cspan style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal;\u0022\u003EDrug-related damage to the optic nerve or retina.\u003C/span\u003E\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cspan style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/div\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal; font-weight: bold;\u0022\u003EFurther reading and source of image:\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Ca href=\u0022https://eyewiki.org/Cancer_Associated_Retinopathy\u0022 target=\u0022_blank\u0022\u003ECAR - eyewiki\u003C/a\u003E\u003Cspan style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal; font-weight: bold;\u0022\u003E\u003C/span\u003E\u003C/div\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1727,
    "Name": "Retinitis Pigmentosa",
    "Body": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 34-year-old man is referred with a bilateral retinal abnormality confined to a sector of the fundus, symmetrical bilaterally. He reports mild difficulty with night vision. What is the most appropriate management?\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cimg src=\u0022/upload-2026-04-12-cad5b262-69e1-4bad-94fa-ec8ba0520120.jpg\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cbr\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003EThe image shows \u003C/span\u003E\u003Cb\u003Esector retinitis pigmentosa (RP)\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E with:\u003C/span\u003E\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s2\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESharp demarcation\u003C/b\u003E\u003C/span\u003E between affected and normal retina\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003EBilateral involvement\u003C/b\u003E\u003Cspan class=\u0022s1\u0022\u003E confined to a sector\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThis distinguishes it from:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EGeneralised RP (diffuse involvement)\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESecondary pigmentation (e.g. trauma, inflammation), which is usually \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eunilateral\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ESymptoms are mild and include:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cb\u003ENyctalopia (night vision difficulty)\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOften preserved central vision\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EPathophysiology:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOften associated with \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Erhodopsin mutations\u003C/b\u003E\u003Cb\u003E\u003C/b\u003E\u003C/span\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EThought to involve \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elight-induced retinal toxicity\u003C/b\u003E\u003C/span\u003E in susceptible individuals\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EManagement:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003ENo definitive treatment\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EUV protection and antioxidants\u003C/b\u003E\u003C/span\u003E are commonly advised to potentially slow progression (although evidence is limited)\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003EOther options:\u003C/p\u003E\n\u003Cp class=\u0022p2\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003C/span\u003E\u003C/p\u003E\u003C/li\u003E\u003Cul\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EValproic acid\u003C/b\u003E\u003C/span\u003E: no established role and controversial\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECataract surgery\u003C/b\u003E\u003C/span\u003E: not indicated unless visually significant cataract\u003C/p\u003E\n\u003C/li\u003E\u003Cli\u003E\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EAcetazolamide\u003C/b\u003E\u003C/span\u003E: used for cystoid macular edema, not primary disease\u003C/p\u003E\n\u003C/li\u003E\u003C/ul\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003EImage source:\u003C/div\u003E\u003Cdiv\u003E\u003Ca href=\u0022https://webeye.ophth.uiowa.edu/eyeforum/atlas/pages/sectoral-RP/index.htm#gsc.tab=0\u0022 target=\u0022_blank\u0022\u003ESectoral RP - WebEye\u003C/a\u003E\u003C/div\u003E\u003Cul\u003E\u003Cp\u003E\u003C/p\u003E\n\u003C/ul\u003E\u003Cp\u003E\u003C/p\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1728,
    "Name": "Sclerocornea: identifying the incorrect statement",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich statement is incorrect when describing the typical features of sclerocornea?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch2\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer:\u0026nbsp;\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Ethe cornea is generally steeper than normal eyes.\u003C/strong\u003E\u003C/span\u003E\u003C/h2\u003E\n\u003Cp\u003E\u003Cstrong\u003ESclerocornea is a congenital anterior segment dysgenesis in which the cornea takes on scleral\u2011like characteristics, including opacity and loss of the normal limbal architecture.\u003C/strong\u003E \u003Cstrong\u003EA key anatomic feature is that the cornea is typically flatter than normal, not steeper.\u0026nbsp;\u003C/strong\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003EThe opacity pattern helps distinguish sclerocornea from other causes of congenital corneal opacity.\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003EIn sclerocornea, the peripheral cornea is usually more opaque than the central cornea\u003C/strong\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003E, whereas \u003C/span\u003E\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003EPeter\u2019s anomaly classically has more central corneal opacity due to a posterior corneal defect.\u003C/strong\u003E\u003C/p\u003E\n\u003Cp\u003E\u003Cstrong\u003ESclerocornea is also clinically important because it is frequently associated with systemic abnormalities\u003C/strong\u003E, especially when bilateral or severe. \u003Cstrong\u003EAdditionally, the normal scleral sulcus and limbal demarcation are often absent\u003C/strong\u003E, reflecting abnormal differentiation between cornea and sclera.\u003C/p\u003E\n\u003Cp\u003E\u003C!--StartFragment--\u003E\u003C!--EndFragment--\u003E\u003C/p\u003E\u003Cdiv style=\u0022font-family:\u0027Segoe UI\u0027;font-size:14px;font-style:normal;font-weight:400;line-height:20px\u0022\u003ESclerocornea classically included as the \u201CS\u201D in the mnemonic \u003Cstrong\u003ESTUMPED\u003C/strong\u003E, which stands for \u003Cstrong\u003ESclerocornea\u003C/strong\u003E, \u003Cstrong\u003ETrauma/tears in Descemet\u2019s membrane\u003C/strong\u003E, \u003Cstrong\u003EUlcer\u003C/strong\u003E (e.g. bacterial), \u003Cstrong\u003EMetabolic disorders\u003C/strong\u003E (such as mucopolysaccharidoses including Hurler syndrome), \u003Cstrong\u003EPosterior corneal defect\u003C/strong\u003E (e.g. Peters anomaly), \u003Cstrong\u003EEndothelial defect\u003C/strong\u003E (e.g. CHED), and \u003Cstrong\u003EDermoid\u003C/strong\u003E.\u003C/div\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
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    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
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  },
  {
    "Id": 1729,
    "Name": "Sherrington\u2019s law",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA child with esotropia is noted to have narrowing of the palpebral fissure and retraction of the globe when attempting to adduct the eye. Which fundamental ocular motor principle is violated in this condition?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch2\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer\u0026nbsp;\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003ESherrington\u2019s law\u003C/strong\u003E\u003C/span\u003E\u003C/h2\u003E\n\u003Cp\u003EThe findings of lid fissure narrowing and globe retraction on adduction are classic for Duane syndrome, a congenital ocular motility disorder characterized by anomalous innervation of the lateral rectus muscle. In Duane syndrome, the medial rectus and lateral rectus muscles abnormally contract at the same time during attempted adduction, producing globe retraction and narrowing of the palpebral fissure. This directly violates \u003Cspan style=\u0022font-weight: bold;\u0022\u003ESherrington\u2019s law\u003C/span\u003E of reciprocal innervation, which states that when an agonist muscle contracts, its antagonist should simultaneously relax. Because both antagonist muscles are contracting instead of one relaxing, Sherrington\u2019s law is broken.\u003Cspan style=\u0022font-weight: bold;\u0022\u003E Hering\u2019s law\u003C/span\u003E of equal innervation applies to yoked muscles in the two eyes and is classically violated in dissociated vertical deviation, while \u003Cspan style=\u0022font-weight: bold;\u0022\u003EDonder\u2019s and Listing\u2019s laws\u003C/span\u003E relate to ocular torsion and eye position in space rather than muscle innervation. Therefore, the violated principle in this scenario is Sherrington\u2019s law.\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
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  },
  {
    "Id": 1730,
    "Name": "Primary congenital glaucoma (PCG)",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich statement correctly describes a common clinical or epidemiologic characteristic of patients with primary congenital glaucoma?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch2\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer\u0026nbsp;\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003EPCG is bilateral in approximately two\u2011thirds of case.\u003C/strong\u003E\u003C/span\u003E\u003C/h2\u003E\u003Cp\u003E\u003Cspan style=\u0022letter-spacing: 0.14994px;\u0022\u003EPrimary congenital glaucoma most often presents during the first year of life rather than immediately at birth and shows a clear male predominance, making statements about equal sex distribution and routine diagnosis at birth incorrect; although PCG is a potentially vision\u2011threatening condition, advances in surgical management have significantly reduced poor visual outcomes, with permanent blindness occurring in only about 5\u201315% of affected individuals rather than the much higher percentages suggested, and a well\u2011established epidemiologic feature of PCG is that both eyes are involved in roughly two\u2011thirds of patients, which makes bilateral involvement the true statement.\u003C/span\u003E\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1731,
    "Name": "Inferior rectus resection",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EIn a patient undergoing inferior rectus resection surgery for a hypertropia, which postoperative change in lower eyelid position may be seen?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch2\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer\u0026nbsp;\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Elower lid elevation\u003C/strong\u003E\u003C/span\u003E\u003Cspan style=\u0022font-size: 14px; font-weight: 400; letter-spacing: 0.14994px;\u0022\u003E, because the inferior rectus muscle is anatomically and functionally linked to the lower eyelid retractors through\u0026nbsp; the capsulopalpebral fascia, which is continuous with Lockwood\u2019s ligament and the inferior tarsal attachments; inferior rectus resection shortens and tightens this muscle\u2013fascial complex, increasing tension transmitted to the lower lid retractors and their ligamentous insertions on the tarsus, thereby pulling the lower eyelid upward, whereas inferior rectus recession lengthens and relaxes this system, leading instead to lower lid retraction and widening of the palpebral fissure.\u003C/span\u003E\u003C/h2\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1732,
    "Name": "Ophthalmia neonatorum",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EAt what postnatal age does neonatal conjunctivitis caused by \u003Cem\u003ENeisseria gonorrhoeae\u003C/em\u003E most commonly present?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch2\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer :\u0026nbsp;\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003E3\u20134 days of life\u003C/strong\u003E\u003C/span\u003E\u003Cspan style=\u0022font-size: 14px; font-weight: 400; letter-spacing: 0.14994px;\u0022\u003E, because the timing of ophthalmia neonatorum is a key diagnostic clue and gonococcal conjunctivitis classically presents early, typically between the third and fourth day after birth, reflecting rapid bacterial proliferation after acquisition during passage through the birth canal; this form is notable for producing the most profuse purulent discharge among neonatal conjunctivitides and must be recognized promptly, whereas chemical conjunctivitis usually occurs within the first 24 hours, chlamydial conjunctivitis most often presents around 7 days of life, and HSV conjunctivitis is rare and typically presents later, around 2 weeks of age.\u003C/span\u003E\u003C/h2\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1733,
    "Name": "Normal cup\u2011to\u2011disc ratio in newborns",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhen examining a newborn for suspected primary congenital glaucoma, what cup\u2011to\u2011disc ratio is considered normal for an infant optic nerve?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch2\u003E\u003Cspan style=\u0022font-size: medium;\u0022\u003EAnswer :\u0026nbsp;\u003Cstrong style=\u0022letter-spacing: 0.14994px;\u0022\u003Eless than 0.3\u003C/strong\u003E\u003C/span\u003E\u003Cspan style=\u0022font-size: 14px; font-weight: 400; letter-spacing: 0.14994px;\u0022\u003E, because most normal newborns have small physiologic cups with cup\u2011to\u2011disc ratios below 0.3, and there is typically minimal asymmetry between the two eyes (generally less than 0.2 difference), making larger cups or significant asymmetry concerning for glaucoma in this age group; importantly, unlike adult glaucoma, optic nerve cupping in congenital glaucoma can partially reverse after successful lowering of intraocular pressure, which is why recognizing abnormal cupping relative to expected newborn norms is critical during early evaluation.\u003C/span\u003E\u003C/h2\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1734,
    "Name": "Botulinum toxin in strabismus",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EWhich strabismus scenario is the poorest fit for treatment with botulinum toxin chemodenervation?\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch2\u003EAnswer\u0026nbsp;\u003Cstrong style=\u0022letter-spacing: 0.14994px; font-size: 14px;\u0022\u003Edissociated vertical deviation\u003C/strong\u003E\u003Cspan style=\u0022font-weight: 400; letter-spacing: 0.14994px; font-size: 14px;\u0022\u003E, because dissociated vertical deviation is not fundamentally a \u201Csingle-muscle overaction\u201D problem that can be predictably neutralized by temporarily weakening one extraocular muscle, but rather a supranuclear, dissociated binocular control disorder in which one eye drifts upward (often with extorsion/abduction components) when fusion is disrupted and the magnitude is variable, latent/intermittent, frequently bilateral (even if asymmetric), and tightly linked to early-onset sensory adaptations (latent nystagmus, suppression, inferior oblique overaction), so weakening a rectus with botulinum toxin tends to give inconsistent, non-durable alignment effects and may simply trade a dissociated drift for iatrogenic incomitance, ptosis, or an unwanted hypotropia in primary position; by contrast, botulinum toxin is mechanistically well suited to situations where a clear agonist\u2013antagonist imbalance is driving diplopia or a small/moderate comitant deviation\u2014such as small angle esotropia (temporary MR weakening can reduce the manifest angle and sometimes \u201Creset\u201D fusion in selected cases), acute paralytic strabismus during recovery (weakening the antagonist can reduce diplopia and prevent secondary contracture while nerve function returns), and selected active thyroid eye disease cases when surgery is deferred because measurements are unstable (temporary weakening can palliate diplopia without committing to a definitive recession pattern), making dissociated vertical deviation the least useful indication among the options.\u003C/span\u003E\u003C/h2\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 10,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1735,
    "Name": "Crouzon syndrome (craniosynostosis) presenting with proptosis",
    "Body": "\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003EA child with proptosis has an external appearance shows in the picture below; which gene mutation is classically responsible?\u003C/div\u003E\u003Cdiv style=\u0022color: rgb(0, 0, 0); letter-spacing: normal; font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Cimg src=\u0022/upload-2026-04-21-15703e72-c9bf-42e6-966c-866452e81474.png\u0022\u003E\u003C/div\u003E",
    "Explanation": "\u003C!--StartFragment--\u003E\u003Cdiv style=\u0022font-family: \u0026quot;Segoe UI\u0026quot;; line-height: 20px;\u0022\u003E\u003Ch2\u003EAnswer\u003C/h2\u003E\n\u003Cp\u003E\u003Cstrong\u003EFGFR2\u003C/strong\u003E, because the clinical context is most consistent with Crouzon syndrome, a common autosomal dominant craniosynostosis syndrome in which premature fusion of cranial sutures leads to midface hypoplasia and shallow orbits with resultant proptosis/exposure risk, and the best-established genetic association for Crouzon is activating mutations in \u003Cstrong\u003EFGFR2\u003C/strong\u003E (classically on chromosome 10); this also fits the key differentiator from Apert syndrome\u2014Crouzon typically lacks syndactyly\u2014while the other listed genes point to different entities (TWIST is associated with Saethre\u2013Chotzen syndrome, MYOC is associated with juvenile open-angle glaucoma and some primary open-angle glaucoma cases, and OPTN is associated with normal tension glaucoma).\u003C/p\u003E\u003C/div\u003E\u003C!--EndFragment--\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1736,
    "Name": "RPE function",
    "Body": "\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of the following is a physiological function of the retinal pigment epithelium (RPE)?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\u003Cul\u003E\u003Cli\u003EThe retinal pigment epithelium (RPE) is a single layer of pigmented cells located between:\u003Cul\u003E\u003Cli\u003EThe neurosensory retina\u003C/li\u003E\u003Cli\u003EBruch\u2019s membrane\u003C/li\u003E\u003C/ul\u003E\u003C/li\u003E\u003Cli\u003EAdjacent RPE cells are connected by tight junctions near their apices.\u003C/li\u003E\u003Cli\u003EThese tight junctions form the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eouter blood-retinal (blood-ocular) barrier\u003C/b\u003E\u003C/span\u003E.\u003C/li\u003E\u003Cli\u003EMajor functions of the RPE include:\u003Cul\u003E\u003Cli\u003EFormation of the outer blood-retinal barrier\u003C/li\u003E\u003Cli\u003EMaintenance of the subretinal space\u003C/li\u003E\u003Cli\u003EAbsorption (not reflection) of light\u003C/li\u003E\u003Cli\u003EPhagocytosis of photoreceptor \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eouter segments\u003C/b\u003E\u003C/span\u003E\u003C/li\u003E\u003Cli\u003EParticipation in vitamin A metabolism and the visual cycle\u003C/li\u003E\u003Cli\u003EScar formation and healing responses\u003C/li\u003E\u003C/ul\u003E\u003C/li\u003E\u003Cli\u003EThe RPE generates \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E11-cis-retinaldehyde\u003C/b\u003E\u003C/span\u003E, not all-trans-retinaldehyde, during the visual cycle.\u003C/li\u003E\u003Cli\u003EPhotoreceptor \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eouter segments\u003C/b\u003E\u003C/span\u003E are phagocytosed, not inner segments.\u003C/li\u003E\u003Cli\u003EMelanin within the RPE absorbs stray light to improve image quality.\u003C/li\u003E\u003C/ul\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1737,
    "Name": "    Rod monochromatism",
    "Body": "\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 5-year-old child presents with \u003Cspan class=\u0022s1\u0022\u003E0.6 LogMAR visual acuity OU\u003C/span\u003E, nystagmus, and lightly pigmented fundi. There is no obvious maculopathy or retinal degeneration. ERG shows \u003Cspan class=\u0022s1\u0022\u003Ecomplete absence of cone responses\u003C/span\u003E. What is the most likely diagnosis?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\u003Cul\u003E\u003Cli\u003ERod monochromatism is a form of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ecomplete achromatopsia\u003C/b\u003E\u003C/span\u003E.\u003C/li\u003E\u003Cli\u003EIt presents in early childhood with:\u003Cul\u003E\u003Cli\u003EReduced vision\u003C/li\u003E\u003Cli\u003ENystagmus\u003C/li\u003E\u003Cli\u003EPhotophobia\u003C/li\u003E\u003Cli\u003EAbsent colour discrimination\u003C/li\u003E\u003Cli\u003EAbsent cone responses on ERG\u003C/li\u003E\u003C/ul\u003E\u003C/li\u003E\u003Cli\u003EIt can be confused with albinism because patients may have \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Elightly pigmented fundi\u003C/b\u003E\u003C/span\u003E.\u003C/li\u003E\u003Cli\u003EIn albinism, cone function and colour vision are usually preserved, so a complete absence of cone ERG responses argues against albinism.\u003C/li\u003E\u003Cli\u003ECone dystrophy can show reduced cone responses, but it usually causes progressive macular dysfunction or retinal degeneration, which is absent here.\u003C/li\u003E\u003Cli\u003ECongenital colour vision defects, including achromatopsia, do not show retinal degeneration, unlike cone dystrophy.\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003EFurther reading:\u003C/div\u003E\u003Cdiv\u003E\u003Ca href=\u0022https://eyewiki.org/Achromatopsia\u0022 target=\u0022_blank\u0022\u003EAchromatopsia - Eyewiki\u003C/a\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1738,
    "Name": "Verteporfin photodynamic therapy (PDT)",
    "Body": "\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA patient undergoing verteporfin photodynamic therapy (PDT) for a progressive subfoveal occult choroidal neovascular membrane develops acute back, side, and chest pain during the infusion. What is the most appropriate explanation to give the patient regarding this adverse effect?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\u003Cul\u003E\u003Cli\u003EAcute back, chest, and flank pain is a recognised adverse effect of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Everteporfin infusion during PDT\u003C/b\u003E\u003C/span\u003E.\u003C/li\u003E\u003Cli\u003EThis complication occurs in approximately \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E2.5% of patients\u003C/b\u003E\u003C/span\u003E in major PDT trials.\u003C/li\u003E\u003Cli\u003EThe pain is specifically related to the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Einfusion phase\u003C/b\u003E\u003C/span\u003E of verteporfin administration.\u003C/li\u003E\u003Cli\u003ESymptoms characteristically:\u003Cul\u003E\u003Cli\u003EBegin during the infusion\u003C/li\u003E\u003Cli\u003EResolve completely shortly after the infusion ends\u003C/li\u003E\u003C/ul\u003E\u003C/li\u003E\u003Cli\u003EThe mechanism is not fully understood but is thought to relate to transient infusion-related reactions rather than true cardiopulmonary pathology.\u003C/li\u003E\u003Cli\u003EPersistent symptoms lasting 24-48 hours or recurrent episodes are not typical.\u003C/li\u003E\u003Cli\u003E\u003Cspan style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal;\u0022\u003EThe most common side effect of PDT is verteporfin-induced photosensitivity\u003C/span\u003E\u003C/li\u003E\u003Cli\u003E\u003Cspan style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal;\u0022\u003EThe most frequently reported adverse events (10-30%) were injection site reactions such as pain, edema, inflammation, rashes, hemorrhage, and discoloration; rare cases of skin necrosis have been reported.\u003C/span\u003E\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cspan style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal;\u0022\u003EFurther Reading:\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Ca href=\u0022https://eyewiki.org/Photodynamic_Therapy_(PDT)\u0022 target=\u0022_blank\u0022\u003EPDT - Eyewiki\u003C/a\u003E\u003Cspan style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; letter-spacing: normal;\u0022\u003E\u003C/span\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1739,
    "Name": "Retinal vascularisation - development",
    "Body": "\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EAt what gestational ages is peripheral retinal vascularization normally completed on the nasal and temporal sides of the retina?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\u003Cul\u003E\u003Cli\u003ERetinal vascularization begins at approximately \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003E4\u20135 months of gestation\u003C/b\u003E\u003C/span\u003E.\u003C/li\u003E\u003Cli\u003EVascular development proceeds centrifugally from the optic disc toward the peripheral retina.\u003C/li\u003E\u003Cli\u003ECompletion of vascularization occurs earlier nasally because the nasal retina is anatomically shorter.\u003C/li\u003E\u003Cli\u003ENormal completion times:\u003Cul\u003E\u003Cli\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ENasal retina \u2192 36 weeks gestation\u003C/b\u003E\u003C/span\u003E\u003C/li\u003E\u003Cli\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ETemporal retina \u2192 40 weeks gestation\u003C/b\u003E\u003C/span\u003E\u003C/li\u003E\u003C/ul\u003E\u003C/li\u003E\u003Cli\u003EThese values are important in:\u003C/li\u003E\u003Cul\u003E\u003Cli\u003ERetinopathy of prematurity (ROP) screening\u003C/li\u003E\u003Cli\u003EUnderstanding avascular peripheral retina in premature infants\u003C/li\u003E\u003C/ul\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cimg src=\u0022/upload-2026-05-12-9f9e6805-bbc1-468b-a956-472d88088c47.png\u0022\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan class=\u0022label\u0022 style=\u0022color: rgb(31, 31, 31); font-family: ElsevierGulliver, Georgia, \u0026quot;Times New Roman\u0026quot;, Times, STIXGeneral, \u0026quot;Cambria Math\u0026quot;, \u0026quot;Lucida Sans Unicode\u0026quot;, \u0026quot;Microsoft Sans Serif\u0026quot;, \u0026quot;Segoe UI Symbol\u0026quot;, \u0026quot;Arial Unicode MS\u0026quot;, serif, sans-serif; font-size: 16px; letter-spacing: normal;\u0022\u003E\u0022Figure 1\u003C/span\u003E\u003Cspan style=\u0022color: rgb(31, 31, 31); font-family: ElsevierGulliver, Georgia, \u0026quot;Times New Roman\u0026quot;, Times, STIXGeneral, \u0026quot;Cambria Math\u0026quot;, \u0026quot;Lucida Sans Unicode\u0026quot;, \u0026quot;Microsoft Sans Serif\u0026quot;, \u0026quot;Segoe UI Symbol\u0026quot;, \u0026quot;Arial Unicode MS\u0026quot;, serif, sans-serif; font-size: 16px; letter-spacing: normal;\u0022\u003E.\u0026nbsp;\u003C/span\u003E\u003Cspan style=\u0022color: rgb(31, 31, 31); font-family: ElsevierGulliver, Georgia, \u0026quot;Times New Roman\u0026quot;, Times, STIXGeneral, \u0026quot;Cambria Math\u0026quot;, \u0026quot;Lucida Sans Unicode\u0026quot;, \u0026quot;Microsoft Sans Serif\u0026quot;, \u0026quot;Segoe UI Symbol\u0026quot;, \u0026quot;Arial Unicode MS\u0026quot;, serif, sans-serif; font-size: 16px; letter-spacing: normal;\u0022\u003ETimeline of normal vascular development versus pathological vascular development (ROP phases) by weeks of gestational age. The development of the choriocapillaris starts between 5.5 and 8 weeks and is completed at 20\u201322 weeks. Retinal vascularization starts at around 16 weeks. Retinal blood vessels grow radially from the optic disc towards the ora serrata. Vascularization of the nasal retina is completed at around 36 weeks and that of the temporal retina at 40 weeks. The transition between phase 1 and phase 2 of ROP generally occurs around 32 weeks.\u0022\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003EImage source:\u003C/div\u003E\u003Cdiv\u003E\u003Ca href=\u0022https://www.sciencedirect.com/science/article/pii/S0039625722001692\u0022 target=\u0022_blank\u0022\u003ERetinopathy of prematurity: A review of pathophysiology and signaling pathways\u003C/a\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": true,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1740,
    "Name": "Retinal phototoxicity",
    "Body": "\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich ophthalmic procedure carries the greatest risk of retinal phototoxicity?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\u003Cul\u003E\u003Cli\u003EIndocyanine green (ICG) may act as a \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ephotosensitizer\u003C/b\u003E\u003C/span\u003E, increasing susceptibility of the retina to light-induced toxicity.\u003C/li\u003E\u003Cli\u003EDuring membrane peeling surgery:\u003Cul\u003E\u003Cli\u003EThe endoillumination probe is often positioned \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Every close to the macula\u003C/b\u003E\u003C/span\u003E\u003C/li\u003E\u003Cli\u003EThis significantly increases retinal light exposure\u003C/li\u003E\u003Cli\u003ECombined with ICG, this increases the risk of photochemical retinal injury\u003C/li\u003E\u003C/ul\u003E\u003C/li\u003E\u003Cli\u003EThe macula is particularly vulnerable because:\u003Cul\u003E\u003Cli\u003ESurgical exposure times may be prolonged\u003C/li\u003E\u003Cli\u003EIllumination is concentrated over a small retinal area\u003C/li\u003E\u003C/ul\u003E\u003C/li\u003E\u003Cli\u003EReported manifestations of phototoxicity include:\u003Cul\u003E\u003Cli\u003ERPE changes\u003C/li\u003E\u003Cli\u003ECentral scotoma\u003C/li\u003E\u003Cli\u003EReduced visual acuity\u003C/li\u003E\u003C/ul\u003E\u003C/li\u003E\u003C/ul\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1741,
    "Name": "Peripheral exudative hemorrhagic chorioretinopathy (PEHCR)",
    "Body": "\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 55-year-old woman is noted incidentally after cataract surgery to have an asymptomatic peripheral fundus lesion in the left eye, as shown. What is the most likely diagnosis?\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cimg src=\u0022/upload-2026-05-12-b57ea08f-c477-42c4-835d-b57bcea5cc73.jpg\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\u003Cul\u003E\u003Cli\u003EPEHCR represents a form of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eperipheral choroidal neovascular membrane (CNVM)\u003C/b\u003E\u003C/span\u003E.\u003C/li\u003E\u003Cli\u003ETypical features:\u003Cul\u003E\u003Cli\u003EPeripheral (usually temporal) lesion\u003C/li\u003E\u003Cli\u003EHemorrhagic and exudative appearance\u003C/li\u003E\u003Cli\u003EOften asymptomatic\u003C/li\u003E\u003Cli\u003ECommonly detected incidentally\u003C/li\u003E\u003C/ul\u003E\u003C/li\u003E\u003Cli\u003EEpidemiology:\u003Cul\u003E\u003Cli\u003ETypically affects older patients\u003C/li\u003E\u003Cli\u003EMore common in women\u003C/li\u003E\u003Cli\u003EApproximately 25% may have bilateral lesions\u003C/li\u003E\u003C/ul\u003E\u003C/li\u003E\u003Cli\u003EPresence of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Ehard exudates\u003C/b\u003E\u003C/span\u003E adjacent to the lesion supports PEHCR rather than melanoma.\u003C/li\u003E\u003Cli\u003EChoroidal melanoma is less likely because melanomas rarely produce prominent lipid exudation.\u003C/li\u003E\u003Cli\u003ERhegmatogenous retinal detachment usually presents with:\u003Cul\u003E\u003Cli\u003EFlashes\u003C/li\u003E\u003Cli\u003EFloaters\u003C/li\u003E\u003Cli\u003EVisual field defect\u003C/li\u003E\u003C/ul\u003E\u003C/li\u003E\u003Cli\u003EAcute retinal necrosis typically presents with:\u003Cul\u003E\u003Cli\u003EPain\u003C/li\u003E\u003Cli\u003EReduced vision\u003C/li\u003E\u003Cli\u003EVitritis\u003C/li\u003E\u003Cli\u003EPeripheral necrotizing retinitis\u003C/li\u003E\u003C/ul\u003E\u003C/li\u003E\u003Cli\u003EManagement:\u003C/li\u003E\u003Cul\u003E\u003Cli\u003EObservation is often appropriate\u003C/li\u003E\u003Cli\u003EAnti-VEGF may be considered if exudation threatens the macula\u003C/li\u003E\u003C/ul\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cimg src=\u0022https://eyewiki-images.s3.us-east-va.perf.cloud.ovh.us/thumb/0/06/OCT_before_and_after_Avastin.jpg/573px-OCT_before_and_after_Avastin.jpg\u0022\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; font-size: 12.3704px; letter-spacing: normal; background-color: rgb(248, 249, 250);\u0022\u003EA: A widefield fundus showing infero-temporal quadrant lesion with subretinal fibrosis and hemorrhage. B: OCT at the time of presentation with subretinal fluid extending to the fovea. C: Fundus photo showing partially regressing hemorrhagic lesion. D: On OCT, the previously-seen sunretinal fluid is resolved one week after an injection of\u0026nbsp;\u003C/span\u003E\u003Ca href=\u0022https://eyewiki.org/Bevacizumab\u0022 title=\u0022Bevacizumab\u0022 style=\u0022color: rgb(62, 135, 203); background: none rgb(248, 249, 250); width: 100%; font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; font-size: 12.3704px; letter-spacing: normal; border-radius: 0px !important;\u0022\u003Ebevacizumab\u003C/a\u003E\u003Cspan style=\u0022color: rgb(33, 37, 41); font-family: Lato, \u0026quot;Helvetica Neue\u0026quot;, Helvetica, Arial, sans-serif; font-size: 12.3704px; letter-spacing: normal; background-color: rgb(248, 249, 250);\u0022\u003E, a type of anti-VEGF.\u0026nbsp;\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003EImage source:\u003C/div\u003E\u003Cdiv\u003E\u003Ca href=\u0022https://eyewiki.org/Peripheral_Exudative_Hemorrhagic_Chorioretinopathy\u0022 target=\u0022_blank\u0022\u003EEyewiki - peripheral exudative hemorrhagic chorioretinopathy (PEHCR)\u003C/a\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1742,
    "Name": "Toxoplasma chorioretinitis",
    "Body": "\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 28-year-old man presents with 3 weeks of progressive visual loss in the left eye, associated with floaters, photophobia, and redness. Visual acuity is \u003Cspan class=\u0022s1\u0022\u003E0.0 LogMAR\u003C/span\u003E in the right eye and \u003Cspan class=\u0022s1\u0022\u003E1.1 LogMAR\u003C/span\u003E in the left eye. Fundus examination shows an active chorioretinal inflammatory lesion adjacent to an old scar. If standard therapy is unavailable, which alternative treatment is appropriate?\u003C/span\u003E\u003C/p\u003E\u003Cp class=\u0022p1\u0022\u003E\u003Cimg src=\u0022/upload-2026-05-12-4b45bf6d-29de-47e6-bfbb-919f1f721744.jpg\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\u003Cul\u003E\u003Cli\u003EThe fundus photograph shows \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eactive retinochoroiditis adjacent to an old chorioretinal scar\u003C/b\u003E\u003C/span\u003E.\u003C/li\u003E\u003Cli\u003EThis is typical of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Etoxoplasma chorioretinitis\u003C/b\u003E\u003C/span\u003E, the most common cause of posterior uveitis worldwide.\u003C/li\u003E\u003Cli\u003EClassic treatment is \u201Ctriple therapy\u201D:\u003Cul\u003E\u003Cli\u003EPyrimethamine\u003C/li\u003E\u003Cli\u003ESulfadiazine\u003C/li\u003E\u003Cli\u003ECorticosteroids\u003C/li\u003E\u003C/ul\u003E\u003C/li\u003E\u003Cli\u003EHowever, pyrimethamine may be difficult to obtain or poorly tolerated.\u003C/li\u003E\u003Cli\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ESulfamethoxazole/trimethoprim\u003C/b\u003E\u003C/span\u003E is a recognised alternative oral regimen.\u003C/li\u003E\u003Cli\u003EIt may be used with or without \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eclindamycin\u003C/b\u003E\u003C/span\u003E.\u003C/li\u003E\u003Cli\u003EAnother alternative oral option is \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eazithromycin\u003C/b\u003E\u003C/span\u003E.\u003C/li\u003E\u003Cli\u003EDoxycycline is more relevant for infections such as Lyme disease or Bartonella.\u003C/li\u003E\u003Cli\u003EOral moxifloxacin is not standard therapy for ocular toxoplasmosis.\u003C/li\u003E\u003Cli\u003EFluconazole is antifungal and would not treat toxoplasma retinochoroiditis.\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003EImage source:\u003C/div\u003E\u003Cdiv\u003E\u003Ca href=\u0022https://www.aao.org/education/current-insight/retinal-choroidal-manifestations-of-toxoplasmosis\u0022 target=\u0022_blank\u0022\u003ERetinal and Choroidal Manifestations of Toxoplasmosis\u003C/a\u003E\u003C/div\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 12,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1743,
    "Name": "Peroxisome biogenesis disorders (PBDs)",
    "Body": "\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EA 3-month-old infant presents with seizures, developmental delay, hypotonia, hepatomegaly, and severe bilateral retinal degeneration. The child dies at 5 months of age. What is the most likely diagnosis?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\u003Cul\u003E\u003Cli\u003EZellweger syndrome is the most severe disorder within the \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EZellweger spectrum disorders\u003C/b\u003E\u003C/span\u003E.\u003C/li\u003E\u003Cli\u003EThe Zellweger spectrum consists of:\u003Cul\u003E\u003Cli\u003EInfantile Refsum disease (least severe)\u003C/li\u003E\u003Cli\u003ENeonatal adrenoleukodystrophy\u003C/li\u003E\u003Cli\u003EZellweger syndrome (most severe)\u003C/li\u003E\u003C/ul\u003E\u003C/li\u003E\u003Cli\u003EThese disorders are classified as \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eperoxisome biogenesis disorders (PBDs)\u003C/b\u003E\u003C/span\u003E.\u003C/li\u003E\u003Cli\u003ETypical clinical features of Zellweger syndrome include:\u003Cul\u003E\u003Cli\u003ESevere hypotonia\u003C/li\u003E\u003Cli\u003ESeizures\u003C/li\u003E\u003Cli\u003EDevelopmental delay\u003C/li\u003E\u003Cli\u003EHepatomegaly\u003C/li\u003E\u003Cli\u003ERetinal degeneration\u003C/li\u003E\u003Cli\u003EEarly infant death\u003C/li\u003E\u003C/ul\u003E\u003C/li\u003E\u003Cli\u003EOcular manifestations may include:\u003Cul\u003E\u003Cli\u003EPigmentary retinopathy\u003C/li\u003E\u003Cli\u003EOptic atrophy\u003C/li\u003E\u003Cli\u003ERetinal degeneration\u003C/li\u003E\u003C/ul\u003E\u003C/li\u003E\u003Cli\u003EMost affected infants do not survive beyond the first 6 months of life.\u003C/li\u003E\u003Cli\u003EBatten disease is a neuronal ceroid lipofuscinosis that usually presents later in childhood rather than early infancy.\u003C/li\u003E\u003C/ul\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 14,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1744,
    "Name": "Ophthalmodynamometry",
    "Body": "\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich of these investigation is can differentiate between central retinal vein occlusion (CRVO) and carotid occlusive disease?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\u003Cul\u003E\u003Cli\u003EOphthalmodynamometry measures \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Eretinal arterial pressure\u003C/b\u003E\u003C/span\u003E.\u003C/li\u003E\u003Cli\u003EFindings:\u003Cul\u003E\u003Cli\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECRVO\u003C/b\u003E\u003C/span\u003E \u2192 retinal arterial pressure is usually normal\u003C/li\u003E\u003Cli\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003ECarotid occlusive disease\u003C/b\u003E\u003C/span\u003E \u2192 retinal arterial pressure is reduced\u003C/li\u003E\u003C/ul\u003E\u003C/li\u003E\u003Cli\u003ETherefore, it can help distinguish venous occlusive disease from ocular ischemia secondary to carotid stenosis.\u003C/li\u003E\u003Cli\u003EOCT evaluates retinal structure and macular edema but does not assess retinal arterial perfusion pressure.\u003C/li\u003E\u003Cli\u003EVEP assesses optic pathway conduction and is not specific for differentiating these vascular disorders.\u003C/li\u003E\u003Cli\u003EFluorophotometry measures aqueous humor formation by tracking fluorescein concentration decline in the anterior chamber and is unrelated to retinal vascular perfusion assessment.\u003C/li\u003E\u003C/ul\u003E",
    "Choices": [],
    "HighYield": false,
    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
  },
  {
    "Id": 1745,
    "Name": "Central Serous Chorioretinopathy CSCR",
    "Body": "\n\n\n\n\u003Cp class=\u0022p1\u0022\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003EWhich medication has been investigated for treatment of chronic central serous chorioretinopathy (CSCR) because of its antagonistic effect on mineralocorticoid receptors in the choroid?\u003C/span\u003E\u003C/p\u003E",
    "Explanation": "\n\n\n\n\u003Cul\u003E\u003Cli\u003EChronic CSCR is thought to involve:\u003Cul\u003E\u003Cli\u003EChoroidal vascular hyperpermeability\u003C/li\u003E\u003Cli\u003EIncreased choroidal hydrostatic pressure\u003C/li\u003E\u003Cli\u003EDysfunction of the retinal pigment epithelium (RPE)\u003C/li\u003E\u003C/ul\u003E\u003C/li\u003E\u003Cli\u003EExperimental evidence suggests overactivation of \u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003Emineralocorticoid receptors\u003C/b\u003E\u003C/span\u003E in the choroid contributes to disease pathogenesis.\u003C/li\u003E\u003Cli\u003E\u003Cspan class=\u0022s1\u0022\u003E\u003Cb\u003EEplerenone\u003C/b\u003E\u003C/span\u003E is a selective mineralocorticoid receptor antagonist.\u003C/li\u003E\u003Cli\u003EIt has been investigated as a medical treatment for chronic CSCR with the aim of:\u003Cul\u003E\u003Cli\u003EReducing subretinal fluid\u003C/li\u003E\u003Cli\u003EReducing choroidal thickness\u003C/li\u003E\u003C/ul\u003E\u003C/li\u003E\u003Cli\u003E\u003Cspan class=\u0022Yjhzub\u0022 jsaction=\u0022\u0022 jscontroller=\u0022zYmgkd\u0022 data-sfc-root=\u0022c\u0022 jsuid=\u0022u1Urld_10\u0022 data-sfc-cb=\u0022\u0022 data-processed=\u0022true\u0022 data-copy-service-computed-style=\u0022font-family: \u0026quot;Google Sans\u0026quot;, Arial, sans-serif; font-size: 16px; font-weight: 600; margin: 0px; text-decoration: none; border-bottom: 0px rgb(10, 10, 10);\u0022 style=\u0022font-family: \u0026quot;Google Sans\u0026quot;, Arial, sans-serif; font-size: 16px; font-weight: 600; border-bottom: 0px rgb(10, 10, 10);\u0022\u003EThe VICI Trial Evidence:\u003C!--TgQPHd|[]--\u003E\u003C/span\u003E The major \u003Cspan jsuid=\u0022u1Urld_11\u0022 data-sfc-cp=\u0022\u0022 jsaction=\u0022mouseenter:\u0026amp;u1Urld_11|WOQqYb;mouseleave:\u0026amp;u1Urld_11|Tx5Rb;focusin:\u0026amp;u1Urld_11|mrwrPd;focusout:\u0026amp;u1Urld_11|mFndSc;\u0022 jscontroller=\u0022KMhGd\u0022 data-sfc-root=\u0022c\u0022 data-sfc-cb=\u0022\u0022 data-processed=\u0022true\u0022 data-copy-service-computed-style=\u0022font-family: \u0026quot;Google Sans\u0026quot;, Arial, sans-serif; font-size: 16px; font-weight: 400; margin: 0px; text-decoration: none; border-bottom: 0px rgb(10, 10, 10);\u0022 style=\u0022font-family: \u0026quot;Google Sans\u0026quot;, Arial, sans-serif; font-size: 16px; border-bottom: 0px rgb(10, 10, 10);\u0022\u003E\u003Ca class=\u0022H23r4e\u0022 target=\u0022_blank\u0022 rel=\u0022noopener\u0022 data-hveid=\u0022CAIIAAgACBAQAg\u0022 href=\u0022https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32981-2/fulltext\u0022 ping=\u0022/url?sa=t\u0026amp;source=web\u0026amp;rct=j\u0026amp;url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32981-2/fulltext\u0026amp;ved=2ahUKEwjasIn8wrOUAxW12AIHHYOTAwUQy_kOegoIAggACAAIEBAC\u0026amp;opi=89978449\u0022 data-processed=\u0022true\u0022 data-copy-service-computed-style=\u0022font-family: \u0026quot;Google Sans\u0026quot;, Arial, sans-serif; font-size: 16px; font-weight: 500; margin: 0px; text-decoration: underline 1px rgb(26, 13, 171); border-bottom: 0px rgb(26, 13, 171);\u0022 style=\u0022text-decoration: underline 1px rgb(26, 13, 171); border-bottom: 0px rgb(26, 13, 171);\u0022\u003EVICI trial\u003C/a\u003E\u003C!--TgQPHd|[[\u0026quot;https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32981-2/fulltext\u0026quot;,null,null,[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,[{\u0026quot;1218\u0026quot;:[16]}]],16,null,\u0026quot;Eplerenone for chronic central serous chorioretinopathy in patients ...\u0026quot;,\u0026quot;Eplerenone was not superior to placebo for improving BCVA in people with chronic CSCR after 12 months of treatment. Ophthalmologists who currently prescribe eplerenone for CSCR should discontinue this practice.\u0026quot;,\u0026quot;https://encrypted-tbn3.gstatic.com/images?q\\u003dtbn:ANd9GcTbcGulvG5oELrTeAOrqzb9JN-JAsnz0fZKSoOJCePacGnCpYm_3wI4fBLp2OKkOv5MtzYHZPcaVn9jsZA5wg\u0026quot;,\u0026quot;The Lancet\u0026quot;,\u0026quot;https://encrypted-tbn3.gstatic.com/faviconV2?url\\u003dhttps://www.thelancet.com\\u0026client\\u003dAIM\\u0026size\\u003d64\\u0026type\\u003dFAVICON\\u0026enable_upscaled\\u003dtrue\\u0026fallback_opts\\u003dTYPE,SIZE,URL\u0026quot;,[[1778581114083418,117627061,84120451],null,null,null,null,[[2,0,0,12,127]]]]]--\u003E\u003C/span\u003E concluded that eplerenone was not superior to a placebo in improving visual acuity (BCVA) at 12 months in chronic CSCR patients.\u003C/li\u003E\u003Cli\u003ESpironolactone has also been studied for similar reasons.\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cspan style=\u0022font-weight: bold;\u0022\u003E\u003Cspan style=\u0022color: rgb(31, 31, 31); font-family: ElsevierGulliver, Georgia, \u0026quot;Times New Roman\u0026quot;, Times, STIXGeneral, \u0026quot;Cambria Math\u0026quot;, \u0026quot;Lucida Sans Unicode\u0026quot;, \u0026quot;Microsoft Sans Serif\u0026quot;, \u0026quot;Segoe UI Symbol\u0026quot;, \u0026quot;Arial Unicode MS\u0026quot;, serif, sans-serif; font-size: 16px; letter-spacing: normal;\u0022\u003E\u0026nbsp;M\u003C/span\u003E\u003Ca href=\u0022https://www.sciencedirect.com/topics/medicine-and-dentistry/mineralocorticoid-receptor\u0022 class=\u0022topic-link\u0022 style=\u0022background-color: rgba(0, 0, 0, 0); word-break: break-word; text-decoration: underline 1px rgb(31, 31, 31); color: rgb(31, 31, 31); text-underline-offset: 1px; font-family: ElsevierGulliver, Georgia, \u0026quot;Times New Roman\u0026quot;, Times, STIXGeneral, \u0026quot;Cambria Math\u0026quot;, \u0026quot;Lucida Sans Unicode\u0026quot;, \u0026quot;Microsoft Sans Serif\u0026quot;, \u0026quot;Segoe UI Symbol\u0026quot;, \u0026quot;Arial Unicode MS\u0026quot;, serif, sans-serif; font-size: 16px; letter-spacing: normal;\u0022\u003Eineralocorticoid receptor\u003C/a\u003E\u003Cspan style=\u0022color: rgb(31, 31, 31); font-family: ElsevierGulliver, Georgia, \u0026quot;Times New Roman\u0026quot;, Times, STIXGeneral, \u0026quot;Cambria Math\u0026quot;, \u0026quot;Lucida Sans Unicode\u0026quot;, \u0026quot;Microsoft Sans Serif\u0026quot;, \u0026quot;Segoe UI Symbol\u0026quot;, \u0026quot;Arial Unicode MS\u0026quot;, serif, sans-serif; font-size: 16px; letter-spacing: normal;\u0022\u003E\u0026nbsp;antagonists (\u003C/span\u003E\u003Cspan style=\u0022color: rgb(31, 31, 31); font-family: ElsevierGulliver, Georgia, \u0026quot;Times New Roman\u0026quot;, Times, STIXGeneral, \u0026quot;Cambria Math\u0026quot;, \u0026quot;Lucida Sans Unicode\u0026quot;, \u0026quot;Microsoft Sans Serif\u0026quot;, \u0026quot;Segoe UI Symbol\u0026quot;, \u0026quot;Arial Unicode MS\u0026quot;, serif, sans-serif; font-size: 16px; letter-spacing: normal;\u0022\u003EMRAs) offer short-term benefits in reducing SRF but may have limited long-term durability based on current evidence, highlighting the need for further studies.\u0026nbsp;\u003C/span\u003E\u003C/span\u003E\u003C/div\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cul\u003E\u003Cli\u003EBevacizumab is an anti-VEGF agent and has limited benefit in typical CSCR unless secondary CNV is present.\u003C/li\u003E\u003Cli\u003EHydrochlorothiazide is a thiazide diuretic and has no established role in CSCR.\u003C/li\u003E\u003Cli\u003EAldosterone activates mineralocorticoid receptors and would theoretically worsen rather than treat CSCR.\u003C/li\u003E\u003C/ul\u003E\u003Cdiv\u003E\u003Cbr\u003E\u003C/div\u003E\u003Cdiv\u003EFurther reading:\u003C/div\u003E\u003Cdiv\u003E\u003Ca href=\u0022https://www.sciencedirect.com/science/article/pii/S0002939425003010\u0022 target=\u0022_blank\u0022\u003EEplerenone and Spironolactone for Chronic Central Serous Chorioretinopathy: A Systematic Review and Meta-Analysis\u003C/a\u003E\u003C/div\u003E",
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    "CategoryId": 2,
    "Category": null,
    "ExamQuestions": null,
    "ExamAnswers": null
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]