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Ophthalmology medical question bank

Practise every ophthalmology topic with explained SBAs.

Recall Engine has 450+ ophthalmology questions across 30+ topics. Every question explains each option.

questions
450+
topics
30+
topic notes
20+
clinical skills guides
10+
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Ophthalmology by body system

Ophthalmology has 30+ topics. Each section shows how many questions it has and every topic it covers.

Head, neck, and special senses

450+ questions across 30+ topics. It also has 20+ topic notes and 10+ clinical skills guides.

  • Assessment of squint
  • Basics of squint
  • Blind spot assessment
  • Child vision: amblyopia, screening, and red flags
  • Childhood eye problems
  • Colour vision assessment
  • Conjunctiva and sclera
  • Diplopia, pupils, and eye alignment
  • Direct fundoscopy: technique and presentation
  • Endophthalmitis
  • External eye examination by torch
  • Eye and orbit anatomy
  • Eye and orbital cancers
  • Fundus examination
  • Glaucoma: drugs, lasers, and surgery
  • Glaucoma: recognition and initial management
  • Keratitis and keratoconus
  • Macular degeneration and retinal detachment
  • Neuro-ophthalmology: optic neuritis, papilloedema, and nerve palsies
  • Ocular trauma
  • Ophthalmic history
  • Ophthalmology examination
  • Red eye: causes and urgency
  • Refractive errors
  • Retinal vascular disease
  • Slit lamp examination
  • Squint in children
  • The eye in systemic disease
  • The lens: cataract and ectopia lentis
  • Therapeutics and the eye
  • Uveitis
  • Visual acuity: testing and documentation

Ophthalmology sample questions

These 5 are published ophthalmology questions shown exactly as students see them. Open an answer to see why it is right and why every other option is wrong.

Question 1 · Ophthalmology, Clinical

A man's acute angle closure attack in the right eye has been broken, with a clear cornea and normal IOP. His left eye has an IOP of 20 mmHg. What is appropriate for the left eye?

  1. A. No treatment of the left eye
  2. B. Goniotomy
  3. C. Trabeculectomy
  4. D. Laser trabeculoplasty
  5. E. Laser iridotomy
Show the answer and explanation

Answer: E. Laser iridotomy

Bilateral laser iridotomy is performed once an attack has been broken, signified by a clear cornea and preferably normal IOP. With angle closure glaucoma in one eye, the other eye may be treated as a safety measure.

Why the other options are wrong

  • A. No treatment of the left eye: Doctors may go ahead and treat the other eye as a safety measure.
  • B. Goniotomy: Goniotomy establishes communication between the anterior chamber and Schlemm's canal.
  • C. Trabeculectomy: Trabeculectomy creates a fistula protected by a superficial scleral flap to allow aqueous outflow to the sub-Tenon space.
  • D. Laser trabeculoplasty: Trabeculoplasty is laser to the angle.

Key point: Bilateral laser iridotomy is done once the attack is broken, treating the other eye as a safety measure.

References

Question 2 · Ophthalmology, Clinical

What is the only proven method of slowing optic nerve damage in glaucoma?

  1. A. Controlling diabetes
  2. B. Treating hypertension
  3. C. Avoiding eye injury
  4. D. Correcting high myopia
  5. E. Reducing IOP
Show the answer and explanation

Answer: E. Reducing IOP

The primary aim of treatment is to prevent functional impairment of vision by slowing the rate of ganglion cell loss, and currently the only proven method of achieving this is to reduce IOP. Higher mean IOP predicts progressive visual field loss.

Why the other options are wrong

  • A. Controlling diabetes: Diabetes is a risk factor for open angle glaucoma, while reducing IOP is the only proven way to slow optic nerve damage.
  • B. Treating hypertension: Hypertension is a risk factor for open angle glaucoma, while reducing IOP is the only proven way to slow optic nerve damage.
  • C. Avoiding eye injury: Eye injury or surgery is a risk factor for open angle glaucoma, while reducing IOP is the only proven way to slow optic nerve damage.
  • D. Correcting high myopia: High myopia is a risk factor for open angle glaucoma, while reducing IOP is the only proven way to slow optic nerve damage.

Key point: Reducing IOP is currently the only proven way to slow optic nerve damage.

References

Question 3 · Ophthalmology, Clinical

A 67-year-old man with atrial fibrillation, who stopped his anticoagulant 2 months ago, noticed sudden painless loss of vision in his left eye 90 minutes ago. He has no headache, jaw pain, or scalp tenderness. Left acuity is counting fingers with a relative afferent pupillary defect. The left retina is whitened with a cherry-red fovea and narrowed arterioles. Which is the most appropriate immediate action?

  1. A. Book a routine eye clinic review with fluorescein angiography
  2. B. Start oral aspirin and arrange review by his doctor next week
  3. C. Give a sublingual nitrate and observe the vision for 1 hour
  4. D. Refer at once to the emergency stroke service as an acute ischaemic stroke
  5. E. Massage the globe and arrange anterior chamber paracentesis in clinic
Show the answer and explanation

Answer: D. Refer at once to the emergency stroke service as an acute ischaemic stroke

Sudden painless loss with an afferent pupillary defect and a whitened retina with a cherry-red fovea is a central retinal artery occlusion. In atrial fibrillation off anticoagulation the likely cause is a cardiac embolus. A retinal artery occlusion is a form of acute ischaemic stroke and a medical emergency, so he goes straight to the emergency stroke service, where thrombolysis can be considered in selected patients early after onset and the embolic source and stroke risk are assessed. Because he is over 50, ESR and CRP are still taken, although he has no symptoms of arteritis.

Why the other options are wrong

  • A. Book a routine eye clinic review with fluorescein angiography: A routine appointment treats this as an elective eye problem. A central retinal artery occlusion within 2 hours of onset is a medical emergency with a high early risk of further stroke.
  • B. Start oral aspirin and arrange review by his doctor next week: Starting an antiplatelet drug and waiting a week skips the emergency assessment. In atrial fibrillation the antithrombotic choice belongs to the stroke team after their work-up.
  • C. Give a sublingual nitrate and observe the vision for 1 hour: Vasodilators aim to push the embolus downstream, but there is no good evidence that they help, and an hour of observation wastes the window for stroke treatment.
  • E. Massage the globe and arrange anterior chamber paracentesis in clinic: These conservative measures try to dislodge the embolus by lowering eye pressure, but they rest on weak observational evidence and use up the time in which stroke care can act.

Key point: A central retinal artery occlusion is an ocular stroke: send the patient at once to emergency stroke care; conservative eye measures such as massage or paracentesis are unproven and must not delay referral.

Question 4 · Ophthalmology, Clinical

A 4-year-old child has bacterial conjunctivitis caused by Haemophilus influenzae. Which systemic antibiotic is used?

  1. A. Erythromycin 500 mg twice daily for 14 days
  2. B. Amoxicillin/clavulanic acid
  3. C. Azithromycin 1 g repeated after 1 week
  4. D. Third-generation cephalosporin
  5. E. Benzyl penicillin IM
Show the answer and explanation

Answer: B. Amoxicillin/clavulanic acid

Systemic antibiotics in bacterial conjunctivitis are used only for gonococcal, H. influenzae in children, and meningococcal infection. For H. influenzae in children the choice is amoxicillin/clavulanic acid.

Why the other options are wrong

  • A. Erythromycin 500 mg twice daily for 14 days: Erythromycin 500 mg twice daily for 14 days is an antibiotic regimen for trachoma.
  • C. Azithromycin 1 g repeated after 1 week: Azithromycin 1 g repeated after 1 week is generally the treatment of choice in adult chlamydial conjunctivitis.
  • D. Third-generation cephalosporin: A third-generation cephalosporin is used for gonococcal infection.
  • E. Benzyl penicillin IM: Benzyl penicillin, ceftriaxone, or cefotaxime IM can be used for meningococcal infection.

Key point: Systemic antibiotics in bacterial conjunctivitis are reserved for gonococcal infection, H. influenzae infection in children, and meningococcal infection.

References

Question 5 · Ophthalmology, Clinical

A 66-year-old man with open angle glaucoma also has heart block. Which eye drop is contraindicated for him?

  1. A. Brimonidine
  2. B. Pilocarpine 2%
  3. C. Dorzolamide
  4. D. Timolol
  5. E. Latanoprost
Show the answer and explanation

Answer: D. Timolol

Timolol is a beta-blocker, and beta-blockers are contraindicated in asthma, COPD, and heart block. The patient's heart block therefore excludes timolol.

Why the other options are wrong

  • A. Brimonidine: Brimonidine causes lethargy, dry mouth and eyes, and allergy.
  • B. Pilocarpine 2%: Pilocarpine 2% is a topical treatment in angle closure glaucoma, while the contraindication in heart block belongs to the beta-blocker timolol.
  • C. Dorzolamide: Dorzolamide is usually used in combination with a beta-blocker.
  • E. Latanoprost: Latanoprost is first-line treatment, and its side effects are pigmentation, increased eyelash length, and stinging.

Key point: Timolol is contraindicated in asthma, COPD, and heart block.

References

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