MCQ BASIC SCEINCE

1-Which rectus muscle receives only one ciliary artery:

a. medial rectus
b. lateral rectus
c. inferior rectus
d. superior rectus

All rectus muscles receive two ciliary arteries except the lateral
rectus which receives just one.

2-Which statement is false of the cavernous sinus:

a. occurs on either side of the body of the sphenoid bone
b. contains the internal carotid artery
c. is bound posteriorly by the ethmoid air sinus
d. contains the oculomotor nerve

The cavernous sinus is bound posteriorly by the sphenoid air

sinus. Other statements are true.

3-The blood aqueous barrier is maintained by:

a. tight junctions of the outer pigmented ciliary epithelium
b. hemidesmosomes of the inner non-pigmented ciliary
epithelium
c. tight junctions of the inner non-pigmented ciliary epithelium
d. zonulae occludentes of the inner non-pigmented ciliary
epithelium

The blood-aqueous barrier is maintained by the tight junctions of

the inner nonpigmented ciliary epithelium.

4-The anterior lens capsule contains:

a. crystallin alpha
b. crystallin beta
c. laminin
d. fibrillin

Fibrillin is a major component of the lens capsule as well as the

zonules. This helps provide them with elastic properties.
5-Which of the following is essential for unique genetic
fingerprinting:
a. incomplete dominance
b. variable number tandem repeats
c. restriction fragment length polymorphisms
d. point mutations

Genetic fingerprinting involves the detection of variable number

tandem repeats (VNTR),which are highly polymorphic sequences
of DNA, the pattern of which on blotting is unique for each
individual.

6–Which statement is FALSE regarding dark adaptation of the

human eye:

1. the rods are more sensitive than cones in the dark

2. it is related to the time required to build up rhodopsin stores
3. it is biphasic in the normal population
4. wearing red glasses can shorten the dark adaptation time
5. it takes a shorter time than light adaptation

Light adaptation takes about 5 minutes and dark adaptation

about 20 minutes in the normal population. It is biphasic. The
dark adaptation time is related to the time required to build up
rhodopsin stores. Wearing red glasses can speed up dark
adaptation because red light stimulates rods only minimally in the
light.

7 –Which of the following is FALSE regarding Leber's hereditary

optic atrophy:
a. the enzyme affected is ATPase 6
b. it is mitochondrially inherited
c. it results in demyelination of the optic nerve
d. it is the result of point mutations
e. the papillomacular bundle is the last to be affected

LHOA affects the papillomacular bundle most severely. Other

options are true.

8–Which statement regarding contact lens correction is FALSE:

 a. in myopes, contact lenses reduce the need for convergence
compared with spectacle
b. truncation of lenses provides greater stability
c. correction of astigmatism requires a toric lens
d. contact lens power is calculated from the spectacle
correction and the back vertex distance
e. keratoconus can be corrected by a hard contact lens

Contact lens correction of myopia increases the need for

convergence because of the loss of the base-in effect of the
spectacle lenses. All other statements are correct.
9 – Which of the following statements is TRUE about
macrophages:
a. they express constitutively high levels of MHC class II
molecules
b. they secrete cytokines such as TNF/IL1
c. they circulate in the blood
d. they are short-lived cells
e. they are unimportant in the pathogenesis of autoimmune
disease

Macrophages are the tissue form of blood monocytes. They are

long-lived phagocytic cells, and are important mediators of the
innate immune response. Macrophages are able to phagocytose
foreign particles,microbes and injured or dead host cells. They
have receptors on their surface pattern recognition receptors,
which recognise microbial components. These cells also have
surface receptors that recognise the Fc portion of immunoglobulin
as well as complement components. Binding of these receptors to
their ligands enhances phagocytosis of antigen; a process termed
opsonisation. Phagocytosed microbes are killed by macrophages
that secrete reactive oxygen intermediates and possess potent
microbicidal properties. These cells also produce pro-
inflammatory
cytokines such as IL1, IL6 and TNF. Macrophages are also
important antigen presenting cells. They express high levels of
MHC class II molecules on their surface when activated. These
molecules present exogenously derived antigen to helper T-cells.
They also express co-stimulatory molecules which play an
important role in T-cell activation. These cells secrete IL12 which
is the cytokine required to direct T-cell differentiation to the Th1
subset. The macrophage response can cause host cell damage,
and they play a major role in the pathogenesis of diseases like
rheumatoid arthritis, sarcoid, T.B and tuberculoid leprosy.
10 – Regarding HLA proteins:
a. HLA class II antigens are absent from macrophages
b. HLA tissue typing is carried out in all forms of
transplantation to prevent rejection
c. HLA class I antigens are expressed on all cells with nuclei
d. HLA proteins are found within the cytoplasm of the cells

HLA typing is not necessary for routine corneal grafts. HLA

antigen is coded by chromosome 6. It is found on the cell surface
and can be divided into two classes:
 Class I is found on the surface of all nucleated cells. Its main
function is to allow cytotoxic T-lyphocytes (CD8+) to recognize
and eliminate virus-infected cells.
 Class II is found on macrophages, dendritic cells, B lymphocytes
and some endothelial cells and its function is to initiate the
immune response by interaction with T helper cells (CD4+)

11 – Where is the image formed by an object lying between the

centre of curvature and the principle focus of a concave mirror:
a. between the principle focus and the mirror
b. outside the centre of curvature
c. behind the mirror
d. between the centre of curvature and the principle focus
 For an object lying between the centre of curvature and the
principle focus of a concave mirror, the image formed is real,
inverted and enlarged; and it lies behind the centre of curvature

12 – Which of the following best describes the mode of action of

the fluoroquinolones:
a. inhibit cell membrane synthesis
b. inhibit protein synthesis
c. inhibit nucleic acid synthesis
d. inhibit cell wall synthesis

Fluoroquinolones such as ciprofloxacin inhibit DNA replication by

their action on bacterial DNA gyrase.

13 –The long ciliary nerve arises from:

a. the anterior ciliary nerve
b. the optic nerve
c. the ciliary ganglion
d. the nasociliary nerve

The long ciliary nerve, which passes through the choroid and
transmits sensory fibres to the cornea, iris and ciliary body (as
well as sympathetic fibres to the dilator pupillae muscle) is a
branch of the nasociliary nerve, itself a branch of the ophthalmic
nerve. The short ciliary nerve arises from the ciliary ganglion and
carries sensory (from the nasociliary), sympathetic and
parasympathetic fibres.

14 –Branches of the pterygopalatine ganglion enter the orbit

through:
a. the inferior orbital fissure
b. the foramen ovale
c. the optic canal
d. the superior orbital fissure

15 – The nerve of the second pharyngeal arch is:

a. the maxillary nerve
b. the mandibular nerve
c. the ophthalmic nerve
d. the facial nerve
e. the lacrimal nerve

16–Which structure forms part of the medial wall of the orbit:

a. the frontal bone
b. the maxillary bone
c. the zygomatic bone
d. the greater wing of sphenoid

The medial wall is made up of the ethmoid bone, the lacrimal

bone, a small part of the lesser wing of the sphenoid, and the tip
of the maxilla

17– Which of the following is a recognized side-effect of

acetazolamide:
a. metabolic alkalosis
b. renal calculi
c. hyperkalaemia
d. hypernatraemia

Acetazolamide is a carbonic anhydrase inhibitor. It can cause

metabolic acidosis,hypokalaemia, hyponatraemia, renal calculi,
fatigue, paraesthesia of limbs and Steven-Johnson's syndrome

18 –Which is the site of pathology in Coats disease:

a. the basement membrane of capillaries
b. the arteriolar and venular endothelium
c. the pericytes
 d. the media of medium and small vessels
e. the intima of large vessels

The vascular abnormality in Coats disease is the result of an

abnormal endothelium in arterioles and venules. This causes
massive leakage of lipid-rich plasma into the retina and the
subretinal space.

19 – The conjunctival epithelium consists of:

a. 10-15 layers of cells
b. single layer of cuboidal cells and goblet cells
c. 2-5 layers of cells
d. 50-100 layers of cells

The conjunctival epithelium consists of 2-5 layers of epithelial

cells. It varies from a stratified squamous non-keratinising
epithlium to a stratified columnar epithelium.

20 –What colour excitation filter does a fluorescein angiography

camera have:
a. green
b. blue
c. orange
d. yellow

Fluorescein sodium is an orange dye which is excited by blue light

of wavelength 465-490nm. It then emits yellow-green light (520-
530nm). For this reason, an angiography camera has a blue
excitation filter to illuminate the fundus with blue light for
maximal fluorescein absorbance. The camera then has a yellow-
green barrier light which blocks blue light and exposes the
camera only to the yellow-green light from the fluorescein.

21 –Which statement is TRUE regarding prisms:

a. convergence insufficiency is the commonest therapeutic use
of prisms
b. the Maddox rod is an objective measure of squint
c. the prism cover test is a subjective measure of squint
 d. prisms can be stacked one on top the other to produce an
additive effect

Prisms cannot be stacked on top the other for additive effect

because the angle of incidence changes in successive layers. The
prism cover test is an objective measure of squint while the
Maddox rod is a subjective measure of squint. Convergence
insufficiency is the commonest therapeutic use of prisms.

22-Which is FALSE regarding uveal melanoma:

a. the most common site of metastasis is the brain
b. it is more common in the choroid than the iris
c. iris melanomas may cause secondary glaucoma
d. the tumours can be non-pigmented

The most common site of metastasis of uveal melanoma is the

liver. Other statements are true

23 –If the parents of a child with a congenital eye defect were

normal but found to be first cousins, what is the most likely mode
of inheritance:
a. autosomal recessive
b. mitochondrial inheritance
c. autosomal dominant
d. X-linked recessive

When parents are phenotypically normal but produce an affected

child it implies a recessive gene. Consanguinity increases the risk
of autosomal recessive disorders because of the smaller gene pool
creating more likelihood of homozygous gene loci in the offspring.

24 –All are TRUE of the human pituitary gland EXCEPT:

a. it is ectodermal in origin
b. it is connected to the hypothalamus by the infundibulum
c. the anterior and posterior lobes have a common vascular
system
d. it derives its blood supply from the circle of Willis

The pituitary gland has independent vascular systems for the

anterior and posterior lobes.
Other options supplied are true.

25 –Which statement is TRUE regarding the lacrimal drainage

system:
 a. the inferior punctum is located more medially than the
superior punctum
b. in 50% of people, the lacrimal canaliculi open directly into
the lacrimal sac
c. the nasolacrimal duct may be closed at 6 months post
delivery
d. the lacrimal drainage duct is lined by a single layer of
columnar epithelium

The superior punctum is located more medially than the inferior

punctum. In only 10% of people do the lacrimal canaliculi open
directly into the lacrimal sac in the remaining 90% they open into
the common canaliculus. The nasolacimal duct may be closed for
the first 12 months of life after this time consideration should be
given to surgery. The lacrimal drainage duct is lined by stratified
ciliated columnar epithelium.

26 –Which statement is FALSE about Descemet's membrane:

a. it consists of a banded anterior third and a non-banded,
homogenous posterior two thirds
b. it is 50 micrometers thick
c. it is rich in basement membrane glycoproteins
d. it is the modified basement membrane of the corneal
endothelium

Descemet's is 8-12 micrometers thick. Other options are true

27 –Which is FALSE regarding light waves:

a. waves that are in phase create constructive interference
b. anti-glare spectacle coatings use destructive interference
c. constructive interference is used in the corneal stroma
d. waves that are exactly in phase are called coherent

Light waves that are exactly in phase are called coherent, while out of
phase waves aretermed incoherent. Waves that are in-phase produce
constructive interference where there is summation of amplitude while
waves that are out of phase produce destructive interference where
there is subtraction of amplitude. Destructive interference is used in the
corneal stroma to reduce scatter and therefore maintain clarity; it also
used in antiglare coatings on spectacles.

28–Regarding immune hypersensitivity reactions:

a. Arthus reaction is a type IV reaction
b. contact dermatitis is a type IV reaction
c. anaphylaxis occurs in patients who have had no previous
antigen exposure
 d. positive Mantoux test is a type III reaction

 Type I: anaphylaxis, urticarial

 Type II: haemolytic anaemia (antibody binding to antigen
presented on the cellsurface)
 Type III: Arthus reaction (immune complex mediated)
 Type IV: Mantoux and contact dermatitis (cell-mediated)

29 –Which is FALSE regarding bacterial virulence factors:

a. streprokinase initiates clot formation by its effect on plasmin
b. coagulase facilitates deposition of a protective fibrin coat on
the bacteria
c. collagenase allows bacterial spread by disrupting connective
tissue
d. hyalurondiase dissolves extracellular matrix hyaluronate

Streptokinase activates fibrinolysin, causing release of plasmin

and resulting in dissolution of clots, allowing bacteria to spread
through tissues.

30 –In diabetic retinopathy, which of the following changes are

commonly observed:
a. macroaneurysms
b. increase in number of pericytes
c. cotton wool spots due to retinal nerve fibre ischaemia
d. thinning of the capillary basement membrane

In diabetic retinopathy, the capillary basement membrane is

thickened. There is a decrease in the number of pericytes.
Microaneurysms not macroaneurysms are a feature of diabetic
retinopathy. Cotton wool spots represent RNFL ischaemia.

31 –The sphenoid bone transmits all of the following structures

EXCEPT:
a. optic nerve
b. internal carotid artery
c. middle meningeal artery
d. mandibular branch of the trigeminal nerve

The internal carotid artery grooves the body of the sphenoid but
does not enter the cranium through it. The ICA enters the skull
through the carotid canal in the petrous temporal bone and
travels to the middle cranial fossa via the foramen lacerum.
32 –Which of the following is TRUE about the visual pathway:
a. the visual pathway synapses in the medial geniculate body
b. congruous hemianopia occurs if there is a lesion in the optic
tract
c. the posterior cerebral artery supplies most of the optic
radiation and the visual cortex
d. the inferior colliculi are the relay stations for the light reflex

The lateral geniculate body is the centre for visual fibre synapses.
Incongruous hemianopia occurs in lesion of the optic tract.
Congruous hemianopia occurs if the lesion is in the optic radiation
or the visual cortex. The calcarine sulcus on the medial aspect of
the occipital lobe is the main visual centre. The superior colliculi
are involved in the light reflex. The posterior cerebral artery
supplies most of the posterior visual pathway.

33 –Differential diagnosis of leucocoria includes all EXCEPT:

a. persistent hyperplastic primary vitreous
b. Coats disease
c. Stargardt's disease
d. retinopathy of prematurity

Stargardt's disease is an inherited juvenile macular degeneration

and is not associatedwith leucocoria.

34 –Which cells are responsible for signal modulation reaching the

ganglion cells of the retina:
a. bipolar cells
b. astrocytes
c. amacrine cells
d. Muller cells

Amacrine cells, together with horizontal cells, are believed to play

a crucial role in signal modulation (mostly inhibitory) reaching the
ganglion cells. Bipolar cells serve as a connector or intermediary
between the photoreceptor and the ganglion cells. Astrocytes and
Muller cells are glial cells and perform a supportive role both
structurally and nutritionally.

35 –All of the following drugs impair accommodation EXCEPT:

a. phenothiazine
b. topical atropine
c. topical pilocarpine
d. topical cocaine
Accommodation occurs under parasympathetic control. It is
impaired by parasympathetic antagonists e.g. atropine,
cylopentolate, tropicamide and phenothiazine. Pilocarpine is a
parasympathomemetic and enhances accommodation.
36 –The following are true about the muscles of facial expression
EXCEPT:
a. procerus is responsible for frowning
b. the frontalis is deficient medially
c. paralysis of the orbicular oculi results in widening of the
palpebral fissure
d. corrugator is responsible for vertical glabellar wrinkles
The frontalis is deficient laterally and therefore lateral brow
ptosis is commoner in the elderly.

37 –Which statement is FALSE regarding respiratory airway

resistance:
a. it increases with the radius of the airway
b. it increases with the length of the airway
c. it can be measured using the peak-flow meter
d. it is increased by histamine
e. it is greater in expiration than inspiration

Airway resistance is directly proportional to the length of the

airway and is indirectly proportional to the fourth power of the
airway radius. It is increased by histamine which causes
bronchoconstriction. It is greater in expiration than inspiration.
Peak-flow meter can be used to measure airway resistance.

38 –A patient has a successful allogeneic bone marrow transplant.

He now develops a skin rash and abnormal liver function tests.
This is likely to represent:
a. Type IV hypersensitivity
b. Type I hypersensitivity
c. Type II hypersensitivity
d. Type III hypersensitivity

The patient has developed graft versus host disease. This

disorder occurs in immunocompromised individuals post
allogeneic bone marrow and solid organ transplant. T-
lymphocytes from the graft react to allogeneic antigens, and
cause cellmediated damage by activation of effector cells. Acute
GVHD presents with skin manifestations, hepatitis, and enteritis
developing within 100 days of allogeneic haematopoietic cell
transplantation (HCT). Chronic GVHD describes a syndrome
developing after day 100. Graft versus host disease is a type IV
(TH1 mediated)
hypersensitivity disorder.

39–Regarding the meibomian glands which is FALSE:

a. they secrete lipid droplets in an apocrine manner
b. they are modified sebaceous glands
c. they number approximately 30 in the upper tarsal plate
d. their secretions aid in tear film stability
The meibomian glands secrete lipid droplets in a holocrine
manner. Other options are true
40–Which statement is FALSE regarding retinoblastoma:
a. metastatic dissemination is usually via the lymphatics
b. it may be successfully treated with radiotherapy and
chemotherapy
c. it appears macroscopically as a smooth white mass
d. it is due to mutation in a tumour suppressor gene

Metastatic dissemination of retinoblastoma is via the blood

stream. Other options are true.

41–Which statement is FALSE of the parotid gland:

a. it receives post-ganglionic parasympathetic fibres from the
otic ganglion
b. its sheath is innervated by the second cervical nerve
c. it contains a duct which opens into the mouth opposite the
upper canine tooth
d. it is composed of serous acini which contribute to the saliva

The parotid gland duct opens opposite the upper second molar
(not the canine). The other options are true.

42–Which of the following is TRUE about coronary circulation in

the left ventricle:
a. at rest the blood in the coronary vein is 50% saturated with
oxygen
b. flow is greater during systole than in diastole
c. it receives an equivalent supply of blood compared to the
right ventricle
d. noradrenalin causes vasodilatation of the coronary artery

The right ventricle receives less blood than the left ventricle. This
is related to the work load each ventricle performed being higher
in the left than the right ventricle. During the systole, vessels are
compressed by the myocardium and this reduces flow. Coronary
venous blood is only about 25% saturated with oxygen in the
resting person.

43–Which is FALSE regarding Southern Blotting:

a. gel electrophoresis is utilized to separate fragments
b. restriction endonucleases cut the initial DNA into fragments
c. fluorescent labeled DNA probes are required
d. it is a technique for analyzing DNA

Southern blotting is a technique for analyzing DNA. The steps are

as follows:
 restriction endonucleases cut human DNA into fragments
 fragments are separated by gel electrophoresis
 the fragments are denatured to single strands and blotted on
nitrocellulose
 specific radio-isotope labeled DNA probes are used to bind
complementary strands on the blotted fragments

44–Ocular effects of adrenergic agonists include all EXCEPT:

a. mydriasis
b. contraction of Muller's muscle
c. ciliary muscle relaxation
d. increased outflow of aqueous
e. dilation of conjunctival and episcleral vessels

Adrenergic agonists cause:

 mydriasis
 ciliary muscle relaxation
 increased aqueous formation (though selective alpha-2
stimulation will reduce formation)
 increased aqueous outflow
 constriction of conjunctival and episcleral vessels
 contraction of Muller's muscle

45–Goblet cells secrete:

a. aqueous
b. mucous
c. lipid
d. oil

Goblet cells, such as are found in the conjunctiva, secrete mucous

which is an important constituent of the tear film.
46–All of the following antibiotics inhibit bacterial cell wall
synthesis EXCEPT:
a. Ceftriaxone
b. Vancomycin
c. Flucloxacillin
d. Erythromycin

Macrolides such as erythromycin inhibit protein synthesis by

binding to a subunit of the bacterial ribosome. Penicillins (e.g.
flucloxacillin), vancomycin and cephalosporins all work by
inhibiting cell wall synthesis.

47–The corneal epithelium obtains its oxygen from:

a. the air
b. the aqueous
c. the precorneal tear film
d. the conjunctival

The corneal epithelium obtains its oxygen from the precorneal

tear film. The endothelium and the keratocytes in the deep
stroma by contrast obtain their oxygen supply from the aqueous
humour.

48–All of the following are true of the facial nerve EXCEPT:

a. it supplies secretomotor fibres to the submandibular and
sublingual glands
b. it exits the skull through the styloid foramen
c. it does not contain sensory nerve fibres
d. it supplies the second pharyngeal arch muscles

The facial nerve contains sensory (taste) sensation from the

anterior two-thirds of the tongue and a small area of the external
ear. Other options are true.

49–The corneal epithelium obtains its glucose directly from:

a. the stroma
b. the ciliary vasculature
c. the limbal vasculature
d. the tear film

The glucose metabolized in the corneal epithelium comes from the

stroma by way of the aqueous and the limbal vessels.

50–Which statement is FALSE about the conjunctiva:

 a. its epithelium is continuous with the corneal epithelium at
the limbus
b. it is bound loosely to the tarsal plate
c. its epithelium is continuous with the lid skin at the eye lid
margin
d. it is responsible for the production of the mucous component
of the tear film

The palpebral conjunctiva is firmly adherent to the tarsal plate.

The bulbar conjunctiva is also tightly adherent at the limbus. The
conjunctival epithelium is continuous with both the corneal
epithelium at the limbus and with the lid skin at the muco-
cutaneous junction of the lid margin. Goblet cells within the
conjunctiva are responsible for the mucous component of the tear
film.

51–In A-scan biometry, a one diopter IOL power error could result
from an axial length error of:
a. 4 mm
b. 0.4 mm
c. 8mm
d. 1 mm
e. 0.04 mm

0.4mm compression error can result in a 1 diopter error in the

calculated IOL power.

52–Above the annulus of Zinn, the superior orbital fissure

transmits:
a. the optic nerve
b. the trochlear nerve
c. the abducens nerve
d. the oculomotor nerve

The trochlear nerve together with the lacrimal nerve, the frontal
nerve and the superior ophthalmic vein pass within the superior
orbital fissure but above the annulus of Zinn.

53–An increase in the number of chromosomes occurs in:

a. Retinoblastoma
b. Fragile-X syndrome
c. Turner's syndrome
 d. Klinefelter's syndrome

Klinefelter's syndrome is xxY - there is an extra X sex

chromosome. Turner's syndrome is one chromosome short, XO.
The number is normal for fragile-X syndrome and retinoblastoma.

54–The lamina papyracea of the orbit refers to:

a. the orbital floor
b. the medial wall
c. the lateral wall
d. the orbital roof

The lamina papyracea refers to the paper-thin medial wall, which

is semi-transparent, theethmoidal air sinuses being easily seen
through the dried skull.

55–Which immunoglobulin class has the highest individual

molecular weight?
a. IgA
b. IgG
c. IgE
d. IgD
e. IgM

IgM is a pentamer, consisting of five immunoglobulin units,

making it the largest of the antibody classes.

56–The ciliary ganglion:

a. contains parasympathetic nerve fibres that innervate the
dilator pupillae
b. if damaged, produces a pupil that is unreactive to light but is
normal to accommodation
c. contains preganglionic axons from the Edinger-Westphal
nucleus
d. lies medial to the optic nerve

The ciliary ganglion lies lateral to the optic nerve. It contains

parasympathetic nerve fibres that innervate the sphincter
pupillae. If the parasympathetic fibres are damaged, the pupil
fails to react to light and responds to accommodation sluggishly.

57–Which is FALSE regarding retinal vascularization:

a. the new vessels always leak on fluorescein angiography
b. it occurs under the control of factors including VEGF
c. it can occur both within and on the surface of the retina
d. blood vessels form from the arterial side of the capillary bed

New vessels arise from the venous side of the capillary bed. Other
options are true.

58–Which is FALSE regarding polymerase chain reaction (PCR):

a. it usually involves 20 to 50 cycles to amplify the DNA
b. it can be used to diagnose viral infections
c. it can be used to determine genome mutations
d. the first stage involves the use of primers

The first stage of PCR involves denaturation of the target DNA. In

the second stage primers are used to hybridize to the target
nucleic acid region. In the third stage,amplification of the target
region is achieved by multiple cycles involving the DNA
polymerase enzyme. The amplified sequence can then be analysed
for mutations using techniques such as single-strand
polymorphisms or restriction fragment length polymorphisms.

59–Put the following corneal tissues in order from lowest energy

consumption to highest:
a. epithelium, endothelium, stroma
b. stroma, endothelium, epithelium
c. stroma, epithelium, endothelium
d. epithelium, stroma, endothelium

The stromal keratocytes have the lowest energy consumption. The

endothelium cells have the highest energy consumption, about 5
times that of the corneal epithelium, due to the activity of the
endothelial pump.

60–Which immunoglobulin molecule has the longest serum half-

life?
a. IgG
b. IgA
c. IgD
d. IgM
 e. IgE

IgG has the longest half-life, 21 to 23 days. IgA is second at about

6 days, followed by IgM (5 days), IgD (3 days), and IgE (2 days).

61–An epidural haematoma is most likely to be caused by:

a. embolus of the anterior cerebral artery
b. laceration of the middle meningeal artery
c. laceration of the superior cerebral bridging veins
d. rupture of a berry aneurysm

An epidural haematoma is most often caused by laceration of the

middle meningeal artery.

62–Which of the following tests provides a subjective measure of

latent horizontal deviation:
a. the cover test
b. the alternate cover test
c. the horizontal Maddox rod
d. the vertical Maddox rod

A horizontal Maddox rod tests for subjective latent horizontal

deviation, while a vertical rod tests for subjective latent vertical
deviation. The cover and alternate cover tests are subjective
measures.

63–In a histological section of the retina, which layer occurs

immediately above (inner to) the outer plexiform layer:
a. inner nuclear layer
b. inner plexiform layer
c. outer nuclear layer
d. outer segment
e. ganglion cell
The eight layers of the neurosensory retina from outer to inner,
that is from the RPE upwards are:
 outer segment
 inner segment
 outer nuclear
 outer plexiform
 inner nuclear
 inner plexiform
 ganglion cell
 nerve fibre layer
64–Natural killer cells:
a. are small agranular lymphocytes
b. can recognise MHC class II and peptide antigen
 c. are activated by interferons
d. only kill target cells in the absence of antibody
e. are important in the early response to bacterial infection

Natural killer (NK) cells are large agranular lymphocytes that can
kill virally infected cells by antibody-dependent and -independent
mechanisms. They are not phagocytic. NK cell killing is especially
important in the early response to viral infection. They also play
an important role in the control of the early phases of infection
with intracellular pathogens such as Leishmania and Listeria
monocytogenes. NK cells do not express Tcell
receptors and do not recognise MHC class II molecules (cf. T-
cells). They express a number of non-specific adhesion molecules,
which mediate attachment to target cells. Human NK cells express
membrane proteins that recognise specific allelic forms of MHC
class I molecules bound to self-peptide. On binding their ligand,
these receptors inhibit NK cell killing. If the concentration of class
I molecules on a cell is reduced, or the range
of peptides is markedly altered (as can occur in viral infection),
NK cells are no longer inhibited and cytolysis occurs. These cells
release granules containing perforin and granzymes, which lyse
target cells and then induce apoptotic cell death. NK cells also
express receptors for the Fc region of IgG and are important
mediators of antibodydependent cellular cytotoxicity. The killing
activity of NK cells is enhanced by IFNgamma,
IFN-beta, and IL-12.

65–Which of the following is TRUE about medical testing:

a. a positive predictive value is also known as the true positive
rate
b. a test with a high sensitivity has few false negatives
c. the positive predicitive value of a test will be the same in
any population
d. a test with a low specificity will have many false negatives
e. the positive predictive value of a test does not depend on
the pretest probability

The positive predictive value is the probability that if you test

positive, you have the disease. The positive predictive value
depends upon prevalence of the disease and pretest probability is
the same as disease prevalence.
Sensitivity means true positive rate. A test with high sensitivity
will have few false negatives.
A test with low specificity will have many false positives.
66–Which is FALSE regarding transcription:
a. it occurs in the cytoplasm
b. it proceeds in a 5 to 3 direction
c. it begins by the binding of a promoter
d. it is catalyzed by RNA polymerase

Transcription is the process whereby the DNA code is read in the

nucleus and a complementary messenger RNA is produced which
leaves for the cytoplasm where protein synthesis can occur.
Transcription occurs under the action of RNA polymerase in a 5 to
3 direction.

67–Which statement is FALSE regarding Muller's muscle:

a. it is composed of thin striated muscle
b. it is attached to the superior portion of the tarsal plate
c. it receives sympathetic innervation
d. it occurs on the inferior aspect of the levator palpebrae
superioris
e. it assists in elevating the lid

Muller's muscle is composed of a small band of smooth muscle.

Other options supplied are true.

68–The volume of aqueous humour in the anterior chamber is:

a. 6 microlitres
b. 400 microlitres
c. 15 microlitres
d. 250 microlitres
e. 3 microlitres

There are 250 microlitres of aqueous in the anterior chamber.

69–The suprachoroid is continuous with which ocular layer:

a. the lamina densa
b. the lamina cribrosa
c. the lamina vitrea
d. the lamina fusca

The suprachoroid is the outermost layer of the choroid. It is an

avascular transition layer between the choroid and sclera
comprising melanocytes, firoblasts and connective tissue fibres. It
is continuous with the lamina fusca, which is the inner layer of the
sclera. The lamina vitrea is another term for Bruch's membrane.
The lamina cribrosa transmits the optic nerve. The lamina densa
is part of the basement membrane of the corneal
epithelium.

70–Base-in prisms:
a. can be used to treat convergence insufficiency
b. can be used to measure horizontal fusional amplitude
c. can be used in the management of esophoria
d. can be used in the management of VIth nerve palsy
e. are used in the diagnosis of microtropia

Base-in prisms can be used to measure horizontal fusional

amplitude. However, other options are incorrect as base-out
prisms are used in the management of esophoria,convergence
insufficiency and VIth nerve palsy. A 4 prism-dioptre base-out
prism is used to examine for the suppression scotoma of
microtropia.

71–Which statement is FALSE regarding the beta-blockers:

a. they decrease the intraocular pressure by increasing the
aqueous outflow
b. they have negative inotropic and chronotropic effects
c. they cause hypotension
d. those with intrinsic sympathetic activities are less likely to
cause bradycardia

Beta-blockers decrease IOP by decreasing aqueous flow. Other

options supplied are true.

72–Which of the following is the most probable site of action for

ADH?
a. proximal convoluted tubule
b. distal convoluted tubule
c. collecting duct
d. descending limb Loop of Henle
e. ascending limb Loop of Henle

The collecting duct is normally impermeable to water, it becomes

permeable under the actions of antidiuretic hormone (ADH). As
much as three-quarters of the water from urine can be reabsorbed
as it leaves the collecting duct by osmosis.
73–Which statement about Down's syndrome is FALSE:
a. amniocentesis is a more accurate prenatal test for Down's
than hormonal tests
b. the risk of Down's is associated with the age of the mother
c. it is most commonly caused by chromosomal disjunction
during meiosis
d. it is associated with congenital glaucoma

Down's syndrome is associated with cataract, myopia and

keratoconus but not glaucoma.

74–Corneal endothelium has a density in middle-aged adulthood

of :
a. 2500 cells/mm2
b. 6000 cells/mm2
c. 1000 cells/mm2
d. 4000 cells/ mm2
The corneal density is about 2500 cells/mm2 in middle age.
75–A 16-year-old patient with AIHA (autoimmune haemolytic
anaemia) is about to have a therapeutic splenectomy.Which
prophylactic treatment do you NOT need to give her:
a. pneumococcal vaccine
b. meningococcal vaccine
c. penicillin prophylaxis
d. HIb vaccine
e. tetanus booster

One complication of splenectomy is infection with encapsulated

bacteria such as pneumococcus, haemophilus influenza and
meningococcus. This is because the spleen is important in the
induction of protective immune responses to thymus-independent
antigens. Macrophages in the marginal zones of lymphoid follicles
in the spleen trap polysaccharides, which then persist for long
periods on the surface of these cells. These antigens are
recognised by specific B lymphocytes, which mount an immune
response ina T cell-independent fashion.
The patient will maintain her immunity to tetanus.

76– An anterior communicating artery aneurysm is most likely to

produce:
a. a homonymous lower quadrantanopia
b. a homonymous upper quadrantanopia
c. a bitemporal lower quadrantanopia
d. a bitemporal upper quadrantanopia
An anterior communicating artery aneurysm is most likely to
compress the upper portion of the optic chiasm, producing a
bitemporal lower quandrantanopia.

77–Melanocyes may be found in all the following layers EXCEPT:

a. the choroid stroma
b. the corneal epithelium
c. the conjunctival epithelium
d. the iris stroma

The corneal epithelium is devoid of melanocytes. It is also rare to

find immunocompetent cells in the cornea such as dendritic cells,
especially further from the limbus.

78–Which of the following is FALSE regarding the orbicularis oculi:

a. its lacrimal component on contraction draws the lacrimal
papillae medially
b. the orbital portion draws the skin of the forehead and cheek
towards the orbit
c. the palpebral portion acts solely under involuntary control to
close the eyelids
d. it is innervated by branches of the facial nerve

The palpebral portion of orbicularis acts under both voluntary and

involuntary control to close the eyelids during normal blinking.
The lacrimal portion draws the lacrimal papillae medially and
dilates the lacrimal sac during blinking. The orbital portion draws
the skin of the forehead, temple, cheek and orbital margin
towards the medial angle of the orbit firmly closing the lids.

79–Regarding the optic nerve which statement is FALSE:

a. the dura and arachnoid mater surrounding the optic nerve
blend with the sclera
b. the orbital portion of the optic nerve extends backward and
laterally from the eye to the optic canal
c. the orbital portion of the optic nerve is covered by 3 layers
of meninges
d. optic nerve fibres are myelinated by oligodendroytes
posterior to the sclera

The orbital portion of the optic nerve extends backward and

medially from the back of the eye to the optic canal. Other
statements are true.
80–Which is FALSE regarding restriction fragment length
polymorphisms:
a. they represent artificially induced variations
b. they are created from restriction endonucleases
c. they can be utilized in gene linkage studies
d. they are most commonly point mutations in the genome
Restriction fragment length polymorphisms represent the natural
variation in the human genome, most commonly point mutations.
As a result of these natural variations,restriction endonuclease
enzymes cleave the human DNA in different positions in the
laboratory creating different lengths of DNA, which can then be
detected by Southern Blotting. RNFLs are useful for tracking gene
transmission in families among other uses.

81–Which of the following nerves travel through the lateral wall of

the cavernous sinus at the level of the pituitary fossa:
a. 4th, 5th and 6th cranial nerves
b. 6th cranial nerve
c. 3rd, 4th, 5th and 6th cranial nerves
d. 3rd and 4th cranial nerves
e. 3rd, 4th and 5th cranial nerves

The 3rd, 4th and 5th cranial nerves travel through the lateral wall
of the cavernous sinus.
The 6th nerve travels through the cavernous sinus but goes
through it rather than involving the lateral wal

82–Regarding the synthesis of neurotransmitters:

a. cholinesterase synthesises acetylcholine
b. dopa decarboxylase is involved in adrenaline synthesis
c. catechol-o-methyl transferase (COMT) synthesises dopamine
d. monoamine oxidase synthesises noradrenaline

Cholinesterase breaks down acetylcholine. MAO and COMT break

down adrenaline and noradrenaline (MAO in the synapse, COMT
intracellularly). Dopa decarboxylase is responsible for the
synthesis of dopamine and by extension adrenaline and
noradrenaline.
 83– The polymerase chain reaction:
a. cannot be used for prenatal diagnosis as insufficient sample
is usually collected
b. replicates deoxyribonucleic acid (DNA) but not ribonucleic
acid (RNA)
c. cannot be used to diagnose viral infections
d. requires the temperature to be cycled between 55 and 94
degrees
e. relies on the maintenance of a folded DNA structure at all
times

The polymerase chain reaction (PCR) can be used to exponentially amplify specific
intended segments of DNA. It is based on the principle that the two strands of DNA
denature i.e. separate (and thus unfold) at high temperatures, and that
complementary strands of DNA recombine when cooled. The DNA sequences
bordering the intended target must be known in order to design primers. The
sequence of the primers is complementary to the 5' ends of the region to be
amplified. This is because DNA is synthesised in a 5'-3' direction. These primers need
to be specific and bind strongly, therefore the optimal length is 17 - 20 bp. Heating to
95 degrees C pulls the two DNA strands apart. The temperature of the reaction is
then dropped to < 50 degrees C, to allow annealing to occur. The annealing
temperature differs depending on the nature of the primers and the template DNA.
The temperature is elevated to 70 degrees C, the optima ltemperature for the DNA
polymerase. This polymerase is derived from volcanic bacteria.
The cycle is then repeated; this process results in the exponential amplification of the
target DNA. Reverse transcriptase PCR can be used to amplify RNA. As the PCR
reaction exponentially amplifies DNA, very small amounts of initial template DNA are
required for this technique. It can therefore be used for prenatal diagnosis of genetic
conditions and congenital infection.
84–Free nerve endings in the skin transmit:
a. proprioception
b. pain and temperature
c. light touch
d. vibration

The cutaneous receptors are as follows:

 Meissner's corpuscles: light touch
 Pacinian corpuscles: pressure and vibration receptors
 Merkel discs: light touch
 Free nerve endings: pain and temperature

85– Hip flexion was measured in a sample of adults and compared

with their age. The correlation coefficient was found to be -0.64 (p
= 0.03) and regression coefficient -0.012 (p = 0.12).Which of the
following is TRUE?
 a. we can use the regression coefficient to calculate hip flexion
in children
b. the null hypothesis is that the correlation coefficient equals
1
c. regression coefficients can take any value between -1 and 1
d. for a year's increase in age, hip flexion decreases by 0.64
units
e. correlation coefficients measure the strength of the
association between one variable and another

Regression coefficients are the gradient of the line of best fit and
can take any value.
Correlation coefficients range between -1 to +1. The regression
coefficient cannot be used to calculate for children because we
cannot assume the gradient stays the same outside our sample
range.

86–Which nerve passes close to the petrous part of the temporal

bone:
a. V nerve
b. VI nerve
c. IV nerve
d. III nerve

The sixth nerve exits the brainstem at the junction of the pons
and medulla. It runs upward in the pontine cistern. It pierces the
dura and at the tip of the petrous temporal bone makes a sharp
turn forward to enter the cavernous sinus.

87–All the following are true of retinitis pigmentosa EXCEPT:

a. individuals are typically affected in early adult life
b. it can lead to tunnel vision
c. retinal atrophy is evident with fine and course strands of
pigmentation
d. retinal vessels are relatively unaffected
e. it causes night blindness
RP is a heterogenous group of conditions which can be caused by
a host of mutations, some of which code for rhodopsin. In addition
to peripheral retinal atrophy with streaks of pigmentation (bone-
spicule appearance) microscopy reveals evidence of retinal vessel
attenuation and hyalinization.

88 –Which drug and side-effect pair is NOT correctly matched:

a. corticosteroids: osteoporosis
b. tacrolimus: gingival hyperplasia
c. cyclosporine: bone marrow suppression
d. azathioprine: diarrhea

Cyclosporin and tacrolimus both inhibit interleukin-2. They do not

cause bone marrow suppression (unlike other immunomodulators
such as azathioprine and methotrexate) but they can cause
hypertension, hyperlipidameia, glucose intolerance, hirsutism and
gingival
hyperplasia.

89–All are true of Human Papilloma virus EXCEPT:

a. serotypes HPV-16 and HPV-18 are implicated in cervical
carcinoma
b. it induces epithelial proliferation
c. it can cause conjunctival papillomas
d. it is an RNA virus

HPV is a DNA virus. Other options are true.

90 –HLA B27:
a. is a class II major histocompatibility antigen
b. reduces the risk of anterior uveitis
c. is found on antigen presenting cells
d. is found in 8% of the general population

HLA-B27 is a class I major histocompatibility antigen and is found

in most cells.
Class II HLA antigens and not class I HLA antigens are expressed
on antigen presenting cells like the B lymphocytes. It is
associated with ankylosing spondylitis (90% of patients have HLA
B27) which is associated with increased risk of anterior uveitis. It
is also found in 8% of the general population.

91 –Which statement is FALSE about the sclera:

a. it is covered posteriorly by the conjunctiva
 b. it allows passage of the optic nerve through the lamina
cribrosa
c. it consists of three layers, the innermost of which is called
the lamina fusca
d. it is composed of irregularly arranged collagenous lamellae

The sclera is covered anteriorly by the conjunctiva and posteriorly

by the fascia bulbi also known as Tenon's capsule.

92 –How many ganglion nerve fibres are there in the human eye:
a. 120 million
b. 1.2 million
c. 100,000
d. 12 million
e. 6.5 million

There are 1.2 million ganglion cells in the eye.

93 –Which is FALSE regarding the histology of the conjunctiva:

a. its stroma contains a rich vascular network
b. mucus-secreting goblet cells are most abundant in the
bulbar conjunctiva
c. its epithelium varies from a stratified squamous to a
stratified columnar epithelium
d. its epithelium contains MHC class II dendritic cells

The conjunctival epithelium contains mucus-secreting goblet cells

which are most abundant in the fornices and the plica
semiluminaris. Other options are true.

94 –The lateral ventricles are connected to the third ventricle by:

a. the magna cistern
b. the foramen of Munro
c. the aqueduct of Sylvius
d. the great cerebral vein of Galen

The interventricular foramen of Munro connects the lateral

ventricles to the thirdventricle. The aqueduct of Sylvius connects
the third and fourth ventricles.
95– Pick the incorrect statement about apoptosis:
a. it can be induced by cytokines and NK cells
b. it results in the generation of an inflammatory response
c. it is inhibited by the oncogene bcl-2
d. it is characterized by condensation of nuclear chromatin
e. it results in cell death without necrosis

Apoptosis is programmed cell death and occurs in embryonic

development and healthy tissue. The whole process is under
genetic control and is influenced by a number of proto-oncogenes,
oncogenes and tumor suppressor genes. Cancer could be
considered a failure of apoptosis. The commonest translocation in
hematological malignancies is Chr14/18 creating the oncogene
bcl-2 that blocks apoptosis.

96–Which is FALSE regarding open angle glaucoma:

a. temporal nerve fibres are more susceptible than nasal fibres
b. fibres from the papillomacular bundle tend to be spared
c. the optic cup is enlarged more horizontally than vertically
d. mutations have been identified in the GLCA1 gene in some
families

The optic cup is enlarged more vertically than horizontally. Other

options are true.

97 –Which condition results in the accumulation of bi-refringent

crystals in the conjunctiva,cornea, choroid and retina:
a. cystinosis
b. Tay-Sachs
c. Gaucher's
d. phenylketonuria
e. homocystinuria

Cystinosis occurs due to a disturbance in membrane transport of

cystine. Ocular manifestations include the accumulation of cystine
crystals in the conjunctiva, cornea,choroid, RPE and retina.

98-What is the transposition of +4.0 DS/+1.50 DC at 90 degrees:

+4.00 DS/ -1.50 DC at 180
+6.00 DS/ -1.50 DC at 180
+5.50 DS/ -1.50 DC at 180
-4.00 DS/ -1.50 DC at 90
To transpose cylinders, sum the sphere and cylinder, change the
sign of the cylinder and rotate the axis of the cylinder through 90
degrees.

99 –The Northern blot is a technique used in molecular biology

research to study:
a. mitochondrial DNA
b. double-stranded DNA
c. RNA
d. single-stranded DNA

Northern blot is a technique for analysing RNA. Southern blot

analyses DNA.

100 –The sphincter pupillae muscle:

a. is composed of striated muscle fibres in a circumferential
ring
b. is responsible for pupillary dilatation
c. is innervated by the short ciliary nerves
d. is derived from mesoderm

The sphincter pupillae muscle is composed of smooth muscle

fibres in a circumferential ring. It is derived from neuroectoderm.
It is responsible for pupillary constriction and is supplied by
parasympathetic fibres via the short ciliary nerves.

101–Which statement is FALSE regarding Acanthamoeba:

a. it is the most common cause of corneal ulcer in contact lens
wearer
b. acanthamoeba keratitis is difficult to treat with conventional
antibiotics
c. swimming with contact lenses is a risk factor for
acanthamoeba keratitis
d. it can be cultured from the nasopharynx of normal people

Acanthamoeba corneal infection is rare and usually occurs in

contact lens wearers. It is not the most common infection in
contact lenses wearers, however. The most common cause of
corneal ulcer in contact lens wearer is bacterial infection.
Swimming with contact lenses is a risk factor for acanthamoeba.
It can be killed by chemical means such as hydrogen peroxide or
by boiling contaminated water for 10 minutes at a temperature of
70-80 degrees centigrade. Acanthamoeba keratitis is difficult to
eradicate.
 MCQ BASIC SCEINCE
102 - 200
102-All of the following are branches of the nasociliary nerve EXCEPT;
a. the supratrochlear nerve
b. the anterior ethmoid nerve
c. the long ciliary nerves
d. posterior ethmoid nerve
e. the sensory root to the ciliary ganglion

The supratrochlear nerve supplies the skin of the medial brow and forehead and
is a
terminal branch of the frontal nerve, itself a branch of the ophthalmic nerve.

103 – Which of the following materials is LEAST likely to cause a granulomatous

tissue reaction:
a. sebum
b. cotton suture
c. silicone
d. wood
e. vegetable matter

Silicone is relatively inert immunologically hence its use as implant material e.g.
intraocular lenses and glaucoma drainage tubes.

104 –A nationwide cross-sectional survey was conducted to compare the

prevalence of respiratory symptoms among university students who have
smoked compared to those who have not smoked.Which one of the following
tests is best used to compare its prevalence?
a. Logistic regression analysis
b. Spearmann's correlation
c. Chi square test
d. Kaplan Meier curve
e. Mann Whitney test
In order to compare the prevalence in two groups, the chi square test is most
appropriate.

105 - Regarding prions, pick the FALSE statement:

a. they are resistant to the action of proteases
b. they are derivatives of normal cell membrane proteins
c. they are a cause of Alzheimer's disease
d. they are resistant to ionizing radiation
e. they contain no genetic material

Prions are glycoproteins derived from a gene on chromosome 20, which codes
for a
normal membrane protein of indeterminate function. A modified version of this
protein
can occur and lead to spongiform change of the neural tissue. Unlike its normal
precursor, the prion protein is resistant to heat, ionizing radiation, proteases,
disinfectants and formaldehyde. Diseases caused by prion proteins affect
humans and animals. They manifest as progressive fatal neurodegenerative
conditions. Included are Kuru,Creutzfeldt-Jakob disease (CJD) and Gerstmann-
Straussler-Scheinker (GSS) in humans;bovine spongiform encephalopathy (BSE)
in cattle; and scrapie in sheep.

106 – A focimeter uses which colour of light:

a. blue
b. green
c. yellow
d. red
A focimeter uses green light in order to eliminate chromatic aberration.

107– Parasympathetic agonists instilled topically to the eye can cause all
EXCEPT:
a. conjunctival toxicity
b. iris cysts
c. reduced salivation
d. bradycardia

Parasympathetic agonists such as pilocarpine can cause conjunctival toxicity,

iris cysts and cataracts locally. Systemically, they can cause muscarinic effects
including increased salivation, bradycardia, sweating and vomiting.

108–The region of DNA coding for a specific protein product is termed:

a. primer
b. exon
c. allele
d. promoter
e. intron

An exon refers to the sequence of DNA coding for a specific product. Between
exons
(remember: exons are expressed) are non-coding sequences called introns.
Introns are spliced out of the code during transcription.

109–The inferior oblique inserts on which quadrant of the globe:

a. anterolateral
b. posterolateral
c. posteromedial
d. anteromedial

The inferior oblique inserts on the posterolateral quadrant, mostly below the
horizontal.

110–Which of the following drugs is most likely to cause Stevens-Johnson

syndrome:
a. phenothiazines
b. amiodarone
c. sulphonamides
d. penicillin
Stevens-Johnson syndrome can occur as a consequence of a severe drug
reaction and is typically associated with sulphonamides.

111–Which statement is FALSE about the corneal endothelium:

a. the cells contain large numbers of mitochondria
b. the cells become more homogenous with age
c. the cells have a low regenerative capacity
d. the cells are polygonal in shape
The corneal endothelial cells become more heterogenous with age, taking on a
variety of shapes, rather than the regular hexagonal pattern typical in the
young.

112–Which statement is FALSE regarding the nerve supply to the lacrimal gland:
a. it receives sympathetic innervation from the superior cervical ganglion
b. it is supplied with sensory innervation via the lacrimal nerve
c. the lacrimatory nucleus receives input from the hypothalamus
d. its parasympathetic innervation travels along the lesser petrosal
nerve

Parasympathetic innervation to the lacrimal gland travels via the nervus

intermedius to the greater petrosal nerve, where it joins with the deep petrosal
nerve in the pterygoid canal before synapsing in the pterygopalatine ganglion.
From here fibres reach the lacrimal gland via the retro-orbital plexus. The lesser
petrosal nerve synapses with the otic ganglion and is responsible for
parasympathetic innervation to the parotid gland.

113–Which nutrient medium is NOT correctly matched with the organisms it

encourages to grow:
a. Lowenstein-Jensen: tuberculosis
b. non-nutrient e.coli-enriched agar: pseudomonas
c. Theyer-Martin: gonococcus
d. Sabouraud's agar: fungus

Non-nutrient e.coli-enriched agar is used to cultivate acanthoemeba. Other

options are correctly matched.

114–Options for microbial sterilization include all of the following EXCEPT:

a. gamma irradiation
b. 160 degree Celsius dry heat for 30 minutes
c. ethylene oxide
d. high temperature steam of 134 degrees Celsius for 3 minutes

Dry heat sterilization requires a temperature of 160 degrees Celsius for a

duration of at least 120 minutes. Steam sterilization can be achieved at 120
degrees Celsius in 15 minutes or at 134 degrees Celsius in 3 minutes.

115 –Which is FALSE regarding Leber's hereditary optic atrophy:

a. it has an insidious onset
b. it affects boys more than girls
c. peripapillary telangiectasia are characteristic
d. it is mitochondrially inherited
LHON is characterized by rapid onset visual failure. It affects boys more than
girls for
reasons that are not understood. On presentation, there is papilloedema and
peripapillary telangiectasia progressing to optic atrophy and vision loss.

116–Which of the following drugs is a cytochrome P450 enzyme inhibitor:

a. nicotine
b. chloramphenicol
c. rifampicin
d. phenytoin
Chloramphenicol is a P450 enzyme inhibitor while the other options supplied are
all
P450 enzyme inducers.
117–Which is FALSE regarding orbital tumours:
a. astrocytic hamartomas are associated with tuberous sclerosis
b. rhabdomyosarcoma is the most common orbital malignancy in childhood
c. optic nerve gliomas carry a good prognosis
d. optic meningioma is more indolent in children

Optic meningioma is more aggressive in children than adults. Other options are
true.

118–The sixth cranial nerve nucleus is in:

a. the cephalic pons
b. the midbrain
c. the caudal pons
d. the medulla

The sixth nerve nucleus resides in the caudal pons anterior to the fourth
ventricle.

119–At what level of protein structure can an alpha-helix be formed:

a. tertiary structure
b. quinternary structure
c. secondary structure
d. primary structure
e. quarternary structure

There are four levels of protein structure; primary, secondary, tertiary and
quarternary.
 Primary structure refers to a simple polypeptide chain in its simple, unfolded
state.
 Secondary structure shows slightly more complex arrangements, such as
alphahelixes and beta-sheets.
 Tertiary structure refers to a folded protein which assumes a three
dimensional
structure.
 Quarternary structure involves two or more polypeptide chains interacting to
form
a dimer.

120–The fifth cranial nerve:

a. provides sensory innervations to the whole face
 b. arises from the midbrain
c. is involved in the blink reflex
d. supplies parasympathetic fibres to the salivary gland
e. innervates the muscle of facial expression

The fifth cranial nerve provides sensation to the face except for a region around
the angle of the mandible which is supplied by C2 and C3 in the form of the
great auricular nerve.
The mandibular branch of the fifth nerve supplies the muscles of mastication,
but the
seventh nerve supplies muscles of facial expression.
Corneal sensation is provided by the ophthalmic branch of the fifth nerve and is
involved in the blink reflex.
The fifth cranial nerve does not contain parasympathetic nerves fibres of its
own.

121 –Where does myelination of the ganglion nerve fibres commence:

a. upon exiting the lamina cribrosa
b. within the retinal nerve fibre layer
c. at the optic nerve head
d. in the distal third of the intra-orbital optic nerve

Ganglion nerve fibres become myelinated by oligodendrocytes immediately on

exiting
the lamina cribrosa.

122 –Which statement is FALSE regarding the lateral geniculate body (LGN):
a. the LGN sends the bulk of its fibres to cortex area 17
b. it is composed of six laminae or cell layers
c. upper retina fibres synapse more medially in the LGN than lower retina
fibres
d. crossed fibres from the nasal retinae terminate on layers 2, 3 and
5

Crossed fibres from the nasal retinae terminate on layers 1, 4 and 6. Un-crossed
fibres(those from the ipsilateral eye) terminate on layers 2, 3 and 5. Other
options provided are true.

123 –The lateral corticospinal tracts decussate at:

a. the spinal level
b. the medullary pyramids
c. the graceate and cuneate nuclei
d. the thalamus

The lateral corticospinal tracts mediate voluntary, skilled motor activity. Fibres
originate in the motor cortex, descend through the medullary pyramids where
over 90% of fibres decussate to form the lateral corticospinal tracts (the
remainder form the ventral corticospinal tracts). The lateral corticospinal tracts
then synapse with second order motor neurones in the ventral horn of the spinal
column which directly innervate skeletal muscle.
124 –Which of the following viruses can potentially cause malignancy by binding
to p53 and inactivating it:
a. HIV
b. HPV
c. EBV
d. HBV
e. HCV

A number of viruses have been associated with malignancy. HPV produces a

protein
called E6 that binds to and inactivates p53. This therefore means that DNA
replication can occur even if the DNA molecules are damaged, and this of course
increases the chances of a malignancy. EBV produces a protein making the cell
more resistant to apoptosis, again increasing the likelihood it will undergo
oncogenic change. Hep B and Hep C are associated with hepatocellular
carcinoma. HIV is associated with Kaposi's sarcoma.

125 –The rate of production of aqueous humour is approximately:

a. 30 microlitres per minute
b. 3 microlitres per minute
c. 3 millilitres per minute
d. 2 millilitres per minute

The rate of production of aqueous is between 2 and 4 microlitres per minute

126 –Which statement is FALSE about the medial canthus:
a. it lies closer to the eyeball than the lateral canthus
b. it forms a less acute angle than the lateral canthus
c. it helps form a triangular zone called the lacus lacrimalis where tears
accumulate
d. it can have different shapes in different races

The medial canthus is further away from the globe than the lateral canthus. It is
about
6mm from the eyeball and is separated by a triangular zone called the lacus
lacrimalis,where tears accumulate for drainage.

127 –Which statement is TRUE about cones:

a. blue cones are the least common of the three types of cones
b. they are found only in the macula
c. all cones are coded by DNA found on the X-chromosome
d. absence of red cones results in protanomaly

Absence of red cones results in protanopia. Cones are found outside the macula
but in much smaller numbers. Red and green receptors are coded by DNA on the
Xchromosome but the blue is on Chromosome 7.

128–The excretory ducts of the lacrimal gland secrete tears into:

a. the superomedial fornix
b. the inferomedial fornix
c. the superotemporal fornix
d. the inferotemporal fornix
The lacrimal gland, situated in the lacrimal fossa superotemporally, secretes
tears into the superotemporal fornix via approximately 12 excretory ducts.

129- Which statement is TRUE about reflection:

a. a concave mirror always produces an inverted, real, enlarged image
b. for a spherical reflecting surface the focal length is equal to the radius of
curvature
c. the angle of incidence is the angle between the incident ray and the
reflecting surface
d. reflection at a plane surface produces a virtual image
e. a convex mirror always produces an erect, virtual, enlarged image

The angle of incidence is the angle between the incident ray and the normal to
the
reflecting surface. For a spherical reflecting surface the focal length is equal to
half the radius of curvature. A convex mirror always produces an erect, virtual,
diminished image.
The image produced by a concave mirror is only inverted, real and enlarged if
the object is between the centre of curvature and the principal focus.

130 –The effects of corticosteroids include all EXCEPT:

a. increasing the catabolism of immunoglobulins
b. increasing the amount of lymphoid cells in spleen and lymph
nodes
c. promoting the breakdown of proteins
d. inhibiting the peripheral utilisation of glucose

Corticosteroids are used to control inflammation because of their ability to

reduce
immune responses. Some of these abilities include:
 reducing the lymphoid contents within the lymph nodes and spleen
 decreasing certain prostaglandins production such as leukotriene
 reducing the macrophage-mediated lysosomal contents
 impairing the function of macrophages and increasing the catabolism of
immunoglobulins.Inhibition of peripheral glucose utilisation (resulting in
impaired glucose tolerance and diabetes) and increased protein breakdown are
some of the known side effects of corticosteroids.

131–Gram negative rods include all EXCEPT:

a. Proteus vulgaris
b. Haemophilus influenza
c. Streptococcus pneumoniae
d. Pseudomonas aeruginosa

Streptococcus is a Gram positive cocci, not a Gram negative rod. All other
options are Gram negatives which can cause ocular disease.

132 –The anterior spinal artery is derived from:

a. the vertebral artery
b. the basilar artery
c. the ascending aorta
d. the subclavian artery
The anterior spinal artery is formed by union of branches from the two vertebral
arteries.
133–All of the following are ocular features of Trisomy 21 except:
a. keratoconus
b. cataract
c. Bruschfield spots
d. hypermetropia
e. epicanthal folds

The ocular features of Down's syndrome include:

 keratoconus
 cataract
 myopia
 Brushfield spots
 epicanthal folds

134–Which is FALSE regarding reflection of light at a plane surface:

a. the image is upright
b. the image is real
c. the image is laterally inverted
d. the angle of incidence is equal to the angle of reflection

The image produced on reflection at a plane surface is virtual, upright and

laterally
inverted.

135 –Cyclosporin:
a. decreases the production of interleukin-2 (IL-2)
b. suppresses mainly the humoral immunity
c. is derived from bacteria
d. causes bone marrow suppression as its major adverse effect

Cyclosporin is derived from a soil fungus. It suppresses mainly the cell-mediated

immune reactions and the humoral immunity is only little affected. It works by
binding to proteins within the cells called cyclophilin which inhibits the
production of a number of interleukins especially IL-2. IL-2 is the primary
chemical stimulus for T-lymphocyte
proliferation. Cyclosporin, unlike other immunosuppressants, does not cause
bone
marrow suppression. Its main adverse effect is nephrotoxicity. It is metabolised
by the liver and excreted in the bile.

136 –Which is FALSE regarding the rod photoreceptors:

a. the cilium connects the inner segment to the outer segment
b. the inner half of the inner segment is known as the ellipsoid
c. the ellipsoid contains numerous mitochondria
d. they are separated by an interphotoreceptor matrix

The inner half of the inner segment is known as the myoid while the outer half of
the
inner segment is known as the ellipsoid. The myoid contains numerous
organelles
including Golgi apparatus and smooth ER while the ellipsoid contains numerous
mitochondria.

137 –Virulence factors include all of the following EXCEPT:

a. Ig A-proteases
b. Capsular polysaccharides in Haemophilus influenzae
c. Streptococcal M protein
d. Beta lactamases

Virulence factors are molecules expressed and secreted by pathogens that

enable them to achieve the following: colonization, immunoevasion,
immunosuppression, and entry into and out of cells. All of the above are
virulence factors except beta lactamases, which hydrolyse penicillin (and
therefore play a role in antibiotic resistance) but which have no direct effect on
host tissue or defenses.

138 –Choose the FALSE statement regarding parathyroid hormone:

a. it decreases calcium absorption from the gastrointestinal tract
b. it increases 1,25 dihydroxy-vitamin D3 production by hydroxylation in the
kidney
c. it increases calcium release from bone
d. it is a peptide hormone

Parathyroid hormone is a peptide hormone. It raises serum calcium

concentration by
increasing calcium release from bone and increasing gastrointestinal absorption
of
calcium. It increases the renal hydroxylation of Vitamin D3.

139 –The dorsal column of the spine transmits:

a. autonomic motor pathways
b. pain and temperature
c. volitional motor pathways
d. vibration, touch and proprioception

The dorsal column of the spine transmits vibration, light touch and
proprioception. Fibres ascend the column, synapse in the gracile and cuneate
nucleus of the medulla where they decussate before ascending to the thalamus.
140 –The superior oblique inserts on which quadrant of the globe:
a. posterosuperior
b. anteroinferior
c. posteroinferior
d. anterosuperior

The superior oblique inserts on the posterosuperior quadrant of the globe.

141 –Most of the refractive power of the eye comes from:

a. the lens
b. the cornea
c. the vitreous
d. the iris

The surface of the cornea with associated tear film is responsible for most of the
refraction of the eye.

142–The anterior and posterior ethmoidal nerves are branches of:

a. the nasociliary nerve
b. the maxillary nerve
c. the abducens nerve
d. the trochlear nerve
e. the oculomotor nerve

The anterior and posterior ethmoial nerves are derived from the nasociliary
nerve.

143 –Which statement is NOT true about the vitreous:

a. the central vitreous is more dense than the cortical vitreous
b. it has a high viscosity roughly 2-4 times that of water
c. Type 2 collagen and hyaluronan are major constituents
d. it is composed of 98% water

The central vitreous is more liquid than the cortical zone, which consists of more
densely arranged collagen fibrils. Other options are true.

144 –The nasociliary nerve:

a. supplies the sphenoidal air sinus
b. gives off the supratrochlear nerve which innervates the medial forehead
c. innervates the cornea but not the sclera
d. carries within it parasympathetic fibres from the internal carotid plexus

The nasociliary nerve innervates both the cornea and sclera. It supplies the
anterior and posterior ethmoidal air cells and sphenoid sinus. It carries
sympathetic fibres from the internal carotid plexus. The supratrochlear nerve is
a branch of the frontal nerve.

145 –The nasolacrimal duct is lined by:

a. simple cuboidal epithelium
b. stratified columnar ciliated epithelium
c. stratified squamous non-keratinised epithelium
d. stratified squamous keratinized epithelium

The nasolacrimal duct is lined by stratified columnar ciliated epithelium

146 –A father suffers from an X-linked recessive condition. What is the chance
that his son will also be affected:
a. 100%
b. 0%
c. 50%
d. 75%
e. 33%

The answer is 0%. His son inherits the Y chromosome from his father and
therefore will not be affected. We recommend drawing a 2 x 2 box of
chromosomal probabilities.
147 –Which branch of the external carotid artery contributes to the blood supply
of the lateral palpebral margin:
a. ophthalmic artery
b. angular artery
c. lacrimal artery
d. transverse facial artery

The eyelids are supplied by the palpebral arcades (marginal and peripheral
arcades)
which are themselves supplied from both medial and palpebral ends by feeder
arteries as follows:
 medial palpebral artery: supplied by the angular artery (branch of facial
artery,
branch of external carotid) and the dorsalis nasi (branch of ophthalmic artery,
branch of internal carotid)
 the lateral palpebral artery: supplied by the transverse facial artery (branch of
external carotid) and the lacrimal artery (branch of ophthalmic artery, branch of
internal carotid)

148–A 22-year-old patient is known to have recurrent Neisserial infections.

Which of the following is he most likely deficient of?
a. C4
b. C1
c. C3
d. C5
e. C2

C5-9 are complements involved in the terminal pathway (membrane attack

complex) and deficiency predisposes to Neisserial infections.

149–As a diagnostic test polymerase chain reaction suffers MOST from which
limitation:
a. false-negatives
b. inter-observer variation
c. false-positives
d. low reproducibility
e. time consuming

PCR is fast, fully automated and highly reproducible. However, because it

amplifies
DNA material to such a scale, it suffers from high false-positives due to
contamination.

150–All of the following visual acuity tests use letters EXCEPT:

a. Sheridan-Gardiner
b. Kay's
c. LogMAR
d. Snellen

The Snellen letter chart is the most widely used visual acuity chart, though it is
being
replaced in many centres by the LogMAR test. The LogMAR is more precise
because of the regular spacing of letters. The Sheridan-Gardiner and the
STYCAR charts use letters,but they are restricted to the letters that children are
most familiar with (such as T, X, V,O, H). The Kay's is a picture card test where
the test-taker matches images; it is useful for pre-school children. The Cardiff
test also uses pictures. They are suitable for 18 months to 3 years. The Catford
drum uses oscillating dots on a drum and is used for babies.

151–Which is FALSE regarding gene cloning:

a. restriction endonucleases are utilised
b. bacteria replicate the required segment of DNA
c. DNA ligase cleaves sections of human DNA
d. vectors transfer the material to bacteria

In the cloning process:

 restriction endonucleases cleave sections of human DNA
 DNA ligase incorporates human DNA into a vector
 the vector transfers the DNA to bacteria
 bacteria replicate the required segment of DNA.

152–Which statement is FALSE regarding the cell membrane:

a. it is freely permeable to ions
b. it contains a lipid bilayer
c. the presence of gap junctions allows the transfer of molecules between
cells
d. microvilli are usually found in absorptive cells

The cell membrane is permeable to lipid molecules but impermeable to ions.

Other
options supplied are true.

153 –The pH of tears is:

a. 6.5
b. 8
c. 7
d. 7.5
The normal pH of tears is 7.5.

154 –All statements regarding Type I collagen are true EXCEPT:

a. it is the main type of collagen found in basement membrane
b. it is the most common collagen
c. it is found in skin and bone
d. it is found in cornea

Type 4 is the main type of collagen found within the basement membrane. Other
options are true.

155-Dot hemorrhages are due to rupture of capillaries in which layer:

a. Bruch's membrane
b. the nerve fibre layer
c. the internal limiting membrane
d. the inner plexiform layer
e. the outer plexiform layer
Dot hemorrhages are a result of rupture of capillaries in the outer plexiform
layers. They are smaller and more circumscribed than flame hemorrhages.

156-Regarding the interleukins choose the FALSE statement:

a. they can function as growth and differentiation factors
b. the major pro-inflammatory interleukins are IL-1, IL-6 and TNF
c. they are all pro-inflammatory to some degree
d. they are synthesized mainly by T cells
e. they are associated with the development of hypotension

An interleukin is a cytokine produced mainly by T-cells. IL-4, IL-10 and IL-13 act
to
suppress inflammatory cytokines and the immune response. Interleukins also
function as growth and differentiation factors.

157-The polymerase chain reaction:

a. requires the use of oligonucleotide primers
b. has low sensitivity and specificity
c. does not require prior knowledge of the DNA sequence being assayed
d. cannot be used to detect RNA of interest

PCR is an in vitro amplification of a specific DNA segment that allows for the
synthesis of millions of copies of that DNA segment in a short span of time. It is
necessary to know at least some of the DNA sequence in the region to be
assayed before amplification can be performed. The PCR consists of a three-step
cycle: denaturation, primer binding, and DNA synthesis. Oligonucleotide primers
are essential to detect the DNA of interest. RNA can also be detected with PCR
using reverse transcriptase. The technique is highly specific and sensitive. The
high sensitivity is one of its major drawbacks because of the major risk of false-
positive reaction caused by contamination.

158-The following structures enter the circle of Zinn EXCEPT:

a. nasociliary nerve
b. trochlear nerve
c. abducent nerve
d. superior branch of the oculomotor nerve

Four nerves pass through the circle of Zinn:

 abducent nerve
 inferior branch of the oculomotor nerve
 superior branch of the oculomotor nerve
 nasociliary nerve
The trochlear nerve passes into the orbit outside and superior to the circle of
Zinn.

159-Which process produces the most net ATP per molecule of glucose:
a. gluconeogenesis
b. glycolysis
c. citric acid cycle
d. pentose phosphate pathway
The citric acid cycle produces the most energy- the equivalent of 30 molecules
of ATP for each glucose molecule that enters. Glycolysis produces 6 molecules of
ATP for each glucose molecule. The pentose phosphate cycle produces pentose
for DNA/RNA synthesis and NADPH for biosynthetic reactions, while
gluconeogenesis is an anabolic(not catabolic) process involving the production
of glucose from precursors.

160-Which is FALSE regarding the synaptic terminals of the photoreceptors:

a. spherules are broader than pedicles
b. pedicles have more numerous connections than spherules
c. photoreceptor nuclei are connected to pedicles and spherules by an inner
rod fibre
d. the synaptic terminal of the cone is termed the pedicle

The synaptic terminal of the cone is termed the pedicle and the terminal of the
rod is
termed the spherule. Pedicles are broader than spherules and have more
neuronal
connections. The terminals are connected to the cell body by an inner rod fibre

161-Which statement is FALSE about the corneal epithelium:

a. it responds rapidly to disruptions by amoeboid sliding movements
b. the epithelial cells rest on a basal lamina comprising the lamina lucida and
lamina densa
c. new cells are derived from mitosis in the limbal basal layer
d. adhesion between epithelial cells and the Bowman's is facilitated
by Type II collagen

Adhesion between epithelial cells and Bowman's layer is maintained by

hemidesmosomes and by a complex mesh of anchoring fibrils and plaques
composed of Type VII and Type VI collagen (not Type II).

162-Which is FALSE of a 20 dioptre condensing lens used for indirect

ophthalmoscopy:
a. it produces an erect and laterally inverted image
b. it produces more magnification than a 28 dioptre lens
c. the refractive state of the patient's eye affects the size and position of the
image
d. it is held further away from the patient than a 28 dioptre lens

The image produced by a condensing lens is inverted both vertically and

laterally. Other options are true.

163-All statements about the levator superioris are true EXCEPT:

a. it is attached to the lesser wing of the sphenoid bone
b. it turns into aponeurosis where the superior transverse ligament of
Whitnall is found
c. it is attached to the circle of Zinn
d. it originates at a point superolateral to the optic foramen

The levator superioris is not attached to the circle of Zinn. All other statements
are true.

164-The following are true about pain sensation EXCEPT:

a. it ascends the spinal cord in the dorsal column tracts
 b. local anesthetics that block sodium channels in nerve fibers can reduce
pain sensation
c. it arises by stimulation of free nerve endings
d. it is transmitted to the central nervous system by unmyelinated C fibers
e. the thalamus is important in the perception of pain

The majority of pain sensation arises from the stimulation of free nerve endings.
Pain
sensation is transmitted to the CNS in small unmyelinated C fibers. It is then
transmitted to the thalamus in the spinothalamic tracts. Local anaesthetics work
by blocking sodium channels in nerve fibers.

165-The maxillary artery:

a. arises from the internal carotid artery
b. gives off its main branches in the pterygopalatine fossa
c. gives rise to the inferior alveolar artery which supplies the maxillary
gingival circulation
d. supplies the maxillary incisor teeth by way of its infraorbital
branch

The maxillary artery is a branch of the external carotid artery. The maxillary
artery gives off its main branches within the infratemporal fossa: the middle
meningeal artery and the inferior alveolar artery that supply the mandibular
gingiva. It enters the pterygopalatine fossa and splits into small branches that
accompany the maxillary nerve. The infraorbital artery is a branch of the
maxillary artery and its own branches supply the maxillary incisor teeth.

166-Which statement is true about chloroquine:

a. it causes reversible toxic maculopathy
b. it is safer than hydroxychloroquine at equivalent dose
c. it causes posterior subcapsular cataract
d. it binds to the melanin of the RPE

Chloroquine is more toxic to the retina dose-for-dose than hydroxychloroquine. It

can
cause corneal deposition and anterior subcapsular cataract neither of which is of
visual significance. It is bound to the melanin in the retinal pigment epithelium
which is believed to be the reason for its toxicity. It causes Bull's eye
maculopathy which may progress despite stopping the medication

167-Human lymphocyte antigens (HLA):

a. are found on red blood cells
b. play an important role in antigen recognition by the T
lymphocytes
c. matching is important for routine corneal graft
d. are coded by genes found on the X-chromosome

HLA genes are found on chromosome 6. They are found on cells with nuclei and
therefore not on the red blood cells. HLA are essential for antigen recognition by
the T lymphocytes. Matching of HLA is important for organ transplant but routine
corneal graft(by virtue of its lack of blood vessels) are not usually needed.

168-Which statement is FALSE regarding chloramphenicol:

 a. it inhibits peptidyltransferase
b. it is bactericidal
c. it is effective against both Gram-positive and Gram-negative bacteria
d. it acts by inhibiting bacterial protein synthesis
Chloramphenicol acts by inhibiting bacterial peptidyltransferase necessary for
protein
synthesis. It is effective against both Gram-positive and Gram-negative bacteria.
It is
bacteriostatic rather than bactericidal. It is one of the commonest topical
antibiotics
available. Its systemic use is limited by its potential to cause a fatal aplastic
anaemia.

169-Which of the following statements is FALSE about nitric oxide:

a. it promotes platelet aggregation and adhesion
b. it exists in a free radical form
c. it causes cell death by interference with lipid membranes
d. it can act as a neurotransmitter
e. its production is stimulated by TNF

Nitric oxide (NO) or EDRF is synthesized from the oxidation of nitrogen atoms in
the
amino acid L-arginine by the enzyme nitric oxide synthase. It is produced in
many tissues and has several diverse biological functions. Nitric oxide dilates
arteries and arterioles,regulates cardiac contractility and inhibits platelet
aggregation and adhesion. Nitric oxide has been identified as a neurotransmitter
in the CNS and PNS and is thought to play a role in memory formation. Excessive
nitric oxide production mediates hypotension in septic shock. Synthetic nitrates
such as GTN and sodium nitroprusside act after conversion to nitric oxide.

170-ALL of the following events occur after 24 hours of fasting EXCEPT:

a. lipolysis
b. the brain switches from using glucose to ketone bodies
c. muscle breakdown
d. the blood glucose concentration is maintained
e. hepatic gluconeogenesis

After 24 hours of fasting:

 the liver undergoes gluconeogenesis as the storage of glycogen is usually
insufficient to maintain the blood glucose level
 lipolysis occurs
 the blood glucose concentration is usually maintained
 the brain switches from using glucose to ketone bodies which are derived
from
fatty acid oxidation in the liver.
Note: muscle breakdown does not occur until much later.

171-The following are features of malignant tumours EXCEPT:

a. cellular pleomorphism
b. nuclear hyperchromatism
c. nuclear pleomorphism
d. increased cytoplasmic: nuclear ratio
Malignant cells typically shows cellular and nuclear pleomorphism with nuclear
hyperchromatism. There is a decrease in the cytoplasmic: nuclear ratio

172-Which statement is FALSE about the dural venous sinuses:

a. they are lined by endothelial cells
b. they drain venous blood from the brain and cranial bones
c. their walls contain smooth muscle cells
d. they are valveless

The walls of the dural venous sinuses are lined by endothelial cells in common
with other veins but they do not contain smooth muscle cells. Other options
supplied are true.

173-The most common site for ocular metastases is:

a. the cornea
b. the retina
c. the choroid
d. the ciliary body

The choroid is a highly vascular tissue and is the most common ocular site for
metastases.Common primaries are the breast, prostate, lung and colon.

174-The actions of the following antibiotics are correct EXCEPT:

a. chloramphenicol inhibits bacterial protein synthesis
b. metronidazole interferes with DNA synthesis
c. sulphonamides interferes with folic acid synthesis
d. fusidic acid interferes with protein synthesis
e. tetracycline inhibits cell synthesis

Tetracycline interferes with bacterial protein synthesis. All other statements are
true.

175-Which is TRUE regarding rod photoreceptors:

a. their discs are not enclosed by cell membrane
b. their concentration is lower in the periphery
c. peak sensitivity to light at wavelength of 496nm
d. the rod:cone ratio is 10:1

Rod photoreceptor discs are enclosed within a cell membrane (unlike those of
cones).The rod concentration is higher in the periphery relative to the centre.
The ratio of rods:cones is 20:1. The peak sensitivity of rods is at 496nm.

176-Which is the only extraocular muscle not to originate at the orbital apex:
a. the superior rectus
b. the superior oblique
c. the inferior rectus
d. the inferior oblique

The inferior oblique is the only extrocular muscle to originate outside the orbital
apex. It originates behind the orbital margin lateral to the nasolacrimal duct and
passes between the eye and the lateral rectus.

177-All of the following are true about Hepatitis B EXCEPT:

 a. it is a DNA virus
b. it is associated with hepatocellular carcinoma
c. a carrier is identified by the presence of surface antigen in the presence of
Ig G against hepatitis B
d. it has an incubation period of 2 to 6 weeks

Hepatitis B is a DNA virus. It has an incubation period of 2 to 6 months. About

10% of
infected individuals become chronic carriers. Hepatitis B surface antigen
(HBsAg) is a
protein antigen produced by the virus. This antigen is the earliest indicator of
acute
hepatitis B and frequently found in infected people before symptoms appear.
HBsAg
disappears from the blood during the recovery. In some patients, chronic
infection occurs and the HBsAg remains positive. Chronic hepatitis B carrier is
associated with a high risk of developing hepatocellular carcinoma.

178-The basal lamina of the inner layer of the optic cup differentiates into:
a. internal limiting membrane
b. Bruch's membrane
c. nerve fiber layer
d. retinal pigment epithelium
e. external limiting membrane

The basal lamina of the inner layer of the optic cup becomes the internal limiting
membrane. The basal lamina of the outer layer of the optic cup becomes
incorporated into Bruch 's membrane.

179-Which statement regarding apoptosis is FALSE:

a. it causes inflammation which may damage surrounding cells
b. it causes the plasma membrane to undergo zeiosis
c. it is the normal physiological process of programmed cell death
d. it results in products that are removed by phagocytosis

Apoptosis is a normal physiological process of programmed cell death. Apoptosis

does not cause inflammation (unlike necrosis). The plasma membrane
undergoes blebbing called zeiosis. The products of apoptosis are removed by
phagocytosis.

180-A large research study was conducted to test a new drug in cancer. The risk
of dying with placebo is 15 percent and with the new drug is 10 percent at five
years.
What is the number needed to treat to prevent one death in 5 years?
a. 20
b. 50
c. 4
d. 200
e. 10

The absolute risk reduction is 5%. Definition of NNT is 100 / ARR, in this case It is
100 /5 = 20
181-Which statement about the trochlear nerve is FALSE:
a. it pierces the dura to enter the medial wall of the cavernous sinus
b. it travels anteriorly beneath the free edge of the tentrorium cerebelli
c. it enters the orbit via the superior orbital fissure outside the tendinous ring
d. it travels above the superior cerebellar artery and below the posterior
cerebral artery as it winds around the crus of the midbrain

The trochlear nerve pierces the dura to enter the lateral wall of the cavernous
sinus.

182-All are true of Neisseria gonorrhoeae EXCEPT:

a. it is a Gram-negative diplococcus
b. its growth is optimal on blood agar
c. it can cause Ophthalmia neonatorum
d. it is sensitive to penicillin

Growth of Neisseria is optimal on enriched chocolate media such as Thayer-

Martin.
183-Allowing 5 minutes between two eye drops works on the principle of:
a. pharmacodynamics
b. saturation kinetics
c. bioavailability
d. pharmacokinetics

Allowing time between drops ensures sufficient absorption, that is, it is a

pharmacokinetic consideration. Pharmacokinetics deals with the liberation,
absorption,distribution, metabolism and excretion of drugs. Pharmacodynamics
refers to the physiological mechanisms whereby drugs perform their actions.
Bioavailability refers to the concentration of a drug reaching the circulation (thus
an iv drug has a bioavailability of 100%).

184-Which is FALSE regarding wound healing by secondary intention:

a. may occur when the wound becomes infected
b. may occur when there is irreparable skin loss
c. tends to occur more quickly than healing by primary intention
d. may occur when the wound dehisces

Wound healing by secondary intention is slower than by primary intention where

wound edges are well opposed. Other statements are true.

185-Which statement is FALSE regarding orbital pseudotumour:

a. it causes oedema of orbital tissues with fibrosis in the late stages
b. it responds poorly to systemic steroids
c. it is a non-granulomatous inflammation
d. infiltrates are predominantly lymphocytic

Orbital pseudotumour usually responds rapidly to corticosteroids, though other

immunosuppresants such as azathioprine may be used if there is an inadequate
response.

186-When a patient stands up from a lying position, the following occurs:

a. peripheral vasodilatation
 b. bradycardia
c. renin secretion is reduced
d. a significant drop of cerebral blood flow
e. cardiac output is reduced

On standing from a lying position, there is a reduction in venous return, which in

turn
decreases the cardiac output. To maintain the blood pressure, the baroceptors
initiates peripheral constriction. There is an increase in the secretion of renin
and angiotensin.Tachycardia occurs to maintain the cardiac output. The cerebral
flow remains constant due to autoregulation.

187-Sex hormones exert their action by:

a. inhibiting translation
b. enhancing transcription after binding to receptors in the
cytoplasm
c. releasing a second messenger
d. binding to specific membrane receptors
e. interacting with DNA directly
Sex hormones (estrogen, testosterone, progesterone) are steroid hormones. All
steroid hormones bind specific cytoplasmic receptors, and then bind DNA.
Thyroid hormones also act this way. Contrast this with non-steroid hormones
such as epinephrine, which interact with the cell membrane and then release a
2nd messenger. As a result they act more quickly.

188-Which of the following statements regarding the analysis of trial data is

correct?
a. parametric tests may be applied to non-normally distributed data
b. the t-test is a parametric test
c. one-tailed tests will suffice for the majority of clinical trials
d. intention to treat analyses are preferable because they require a smaller
sample size
e. the Mann-Whitney and Wilcoxon tests are parametric tests

One-tailed tests will not suffice for the majority of clinical trials because in
clinical trials we almost always perform two tailed tests. Parametric tests cannot
be applied to non normally distributed data, but non-parametric tests may be
applied to normal data (but give less good results). The Mann-Whitney and
Wilcoxon tests are non-parametric tests.

189-Which of the following metals can produce a pyogenic response if retained

in tissue:
a. iron
b. copper
c. magnesium
d. zinc
e. aluminium

Retained tissue copper produces a pyogenic immune response for reasons that
are not understood.

190-Which is FALSE regarding Von-Hippel-Lindau syndrome:

a. it is associated with capillary haemangiomata of the retina
 b. it is associated with optic nerve glioma
c. it is associated with renal cell carcinoma
d. it is dominantly inherited

Von-Hippel-Lindau syndrome is an autosomal dominant syndrome due to a

mutation in chromosome 3. It is associated with capillary haemangiomata of the
retina, renal cell carciona and haemangioblastoma of the cerebellum.
Optic nerve glioma is associated with NF-1.

191-All are true of the lens epithelium EXCEPT:

a. it is a simple cuboidal epithelium
b. mitotic activity is maximal in the polar regions
c. the epithelial cell sinks deeper into the lens as further cells are laid down
during mitosis
d. it produces lens fibres by a process involving elongation

Mitotic activity of lens epithelial cells is maximal in the equatorial and pre-
equatorial
regions known as the germative zone. Other statements are true.

192-Ischaemia due to occlusion of a calcarine artery would be expected to

produce:
a. incongruous contralateral homonymous hemianopia with macular sparing
b. incongruous contralateral homonymous hemianopia
c. congruous contralateral homonymous hemianopia with macular
sparing
d. congruous contralateral homonymous hemianopia

Ischaemia to a calcarine artery produces a congruous defect (more posterior the

defect,more congruous) and there is often macular sparing because of
anastomoses between the middle and posterior cerebral arteries at the very
pole, where the macular fibres terminate.

193-Which cause and effect pair is NOT correctly matched:

a. ruptured lens capsule: phacomorphic glaucoma
b. melanoma of iris compressing angle: secondary angle closure glaucoma
c. central retinal vein occlusion: rubeotic glaucoma
d. peripheral anterior synechiae: secondary angle closure glaucoma

Phacomorphic glaucoma (not phacolytic glaucoma) refers to secondary angle

closure due to lens intumescence. Phacolytic glaucoma occurs when lens
proteins are released into the anterior chamber, which create an intense
granulomatous reaction with macrophages.These macrophages and lens
material can block the trabecular meshwork leading to a rise in pressure and the
term phacolytic glaucoma.

194-Regarding wound infections all of the following are TRUE except:

a. Staphylococcus aureus is a rare cause of surgical wound
infections
b. MRSA wound infection can occur due to wound contamination by hospital
staff
c. opportunistic infections occur in patients with reduced immune defences
d. necrotizing fasciitis is caused by streptococcus
Staph aureus is a commensal on the skin and is the most common cause of
post-surgical wound infection. Other options are true.

195-Which is FALSE regarding Toxoplasma infection:

a. congenital infection may cause hydrocephalus and retinochoroiditis
b. congenital infection occurs when a woman is previously exposed
to toxoplasma
c. congenital infection is more likely to be recurrent
d. ocular reactivation occurs at the border of a previous retinchoroidal scar

Congenital infection occurs when a mother becomes infected for the first time
during
pregnancy. Other options are true.

196-Which of the following best describes the mode of action of sulphonamides:

a. inhibit cell membrane synthesis
b. inhibit cell wall synthesis
c. inhibit protein synthesis
d. inhibit nucleic acid synthesis

Sulphonamides act by inhibiting folate metabolism, which is essential for

bacterial DNA synthesis and survival.

197-Bruschfield spots are associated with:

a. Sturge-Weber syndrome
b. Neurofibromatosis Type 1
c. Neurofibromatosis Type 2
d. Down's syndrome
Bruschfield spots are small nodules on the iris and occur in Down's syndrome.
The ocular features of Down's syndrome include:
 keratoconus
 cataract
 myopia
 Brushfield spots
 epicanthal folds

198-Which is FALSE regarding the cone photoreceptor:

a. the outer segments are shorter in cones than rods
b. cone lamellae are not enclosed by a membrane
c. the synaptic terminals of cones are called spherules
d. cone lamellae have a longer lifespan than rods

The synaptic terminals of the cones are called pedicles while those of the rod
are termed spherules. They synapse with bipolar and horizontal cells.

199-MHC Class II cell surface antigens are expressed on all the following cells
EXCEPT:
a. B cells
b. dendritic cells
c. erythrocytes
d. macrophages
Major histocompatibility complex (MHC) class II molecules are expressed on the
surfaces of antigen-presenting cells - including macrophages, dendritic cells, and
B cells.They serve to stimulate CD4+ Th-cells and initiate cytokine release that
regulates other cellular processes associated with immune responses. The Dr,
Dp, and Dq regions code for these antigens.

200-The following are true about the vortex veins EXCEPT:

a. there are usually 4 to 7 in each eye
b. they drain into the superior and inferior ophthalmic veins
c. they exit the eye at the equator
d. they drain the retina and the choroid

The vortex veins drain the choroid, ciliary body and the iris (not the retina).
 MCQ BASIC SCEINCE
201- 300
201-In which part of the nephron does water absorption not take place?
a. collecting duct
b. ascending limb of Loop of Henle
c. descending limb of Loop of Henle
d. proximal convoluted tubule
e. distal convoluted tubule

Unlike the descending limb, the ascending limb of Henle's loop is impermeable to water, a critical feature
of the countercurrent exchange mechanism employed by the loop. The ascending limb actively pumps
sodium out of the filtrate, generating the hypertonic interstitium that drives countercurrent exchange.
Though the collecting duct is normally impermeable to water, it becomes permeable under the actions of
antidiuretic hormone (ADH). As much as three-fourths of the water from urine can be reabsorbed as it
leaves the collecting duct by osmosis.

202-The lens is derived embryologically from:

a. neuroectoderm
b. mesoderm
c. ectoderm
d. endoderm
203–Which is TRUE of Toxoplasma gondii infection:
a. it
b. is more common in immunocompromised patients than cytomegalovirus
c. it can be transmitted through dog faeces
d. acquired infection usually causes a severe acute illness
e. it can be transmitted from undercooked meat
Your answer was INCORRECT Explanation Toxoplasma gondii is the commonest protozoal parasite to
affect the eye. It is transmitted from ingestion of undercooked meat or the ingestion of soil contaminated
with infected cat faeces. (Toxocara is transmitted through dog faeces). Congenital infection may result in
severe symptoms including hydrocephalus, intracranial calcification and mental retardation. Acquired
infection is often asymptomatic. It is less commonly associated with immunocompromise than CMV
retinitis
204–Which of the following structures exits the cranium through the foramen ovale:
a. the greater petrosal nerve
b. the mandibular nerve
c. the oculomotor nerve
d. the main meningeal artery
e. sympathetic nerve fibres

Your answer was INCORRECT Explanation The mnemonic MALE is useful for remembering the
structures that pass through the foramen ovale: Mandibular nerve, Accessory meningeal artery, Lesser
petrosal nerve and Emissary vein

205– The hemoglobin-oxygen dissociation curve shifts to the right in ALL cases EXCEPT:
a. increase in hydrogen ion concentration
b. increase in 2,3 diphosphoglycerate (2,3 DPG)
c. hypothermia
d. increase in pCO2
Shifting the hemoglobin-oxygen dissociation curve to the right increases the release of oxygen to the
tissues. This shift occurs in acidosis, raised temperature and increased 2,3 DPG.
206–The third cranial nerve arises from the brain stem between which two branches of the basilar artery:
I. the posterior cerebral artery II. the labyrinthine artery III. the superior cerebellar artery IV. the anterior
inferior cerebellar artery
a. III and IV
b. I and IV
c. I and II
d. I and III
The third cranial nerve arises from the brainstem between the posterior cerebral artery and the superior
cerebellar artery.
207–Which of the following is TRUE about cerebrospinal fluid:
a. only the third ventricle contains the choroidal plexus which secretes CSF
b. cerebrospinal fluid contains the same concentration of glucose as the blood
c. its normal volume in humans is about 130 ml
d. it is found in the space between the dura mater and the arachnoid
Cerebrospinal fluid is found in the subarachnoid space ie between the pia mater and the arachnoid. The normal
amount is 130 ml and the normal intracranial pressure is 100 ml of water (varying between 60 to 150 ml of water, or
about 7-15mmHg). It is produced by the choroidal plexus of the lateral ventricle, third ventricle and the fourth
ventricle. It contains 60% of the concentration of glucose found in the plasma. Few cells and trace protein are found
in the normal state.

208–Which statement regarding HIV is FALSE:

a. it can be passed from mother to foetus
b. it gains entry into cells with CD4 cell-surface receptor molecules
c. its core protein p24 can be used to monitor progression of AIDS
d. it is a single-stranded DNA virus
HIV is a single-stranded RNA virus. Other options are true
209– Which statement about the foramen lacerum is FALSE:
a. it transmits pre-ganglionic parasympathetic fibres
b. it occurs at the apex of the petrous temporal bone
c. it transmits the internal carotid artery
d. its lower end is covered by connective tissue
Your answer was CORRECT Explanation The foramen lacerum transmits sympathetic nerves associated
with the internal carotid artery but not parasympathetic fibres. Other options are true.
210–What is the spherical equivalent of the toric lens of power +2.00DS/+2.00DC:
a. 4.00DS
b. 1.50DS
c. 3.00DS
d. 2.00DS
The spherical equivalent of a toric lens is calculated by addition of the spherical power and half the
cylindrical power.
211–Which stage of trachoma is characterized by fibrous replacement of inflamed tissue:
a. Stage IV
b. Stage I
c. Stage III
d. Stage II
Trachoma has the following recognized stages:  Stage I: involvement of the conjunctival stroma  Stage Stage I: involvement of the conjunctival stroma  Stage I: involvement of the conjunctival stroma  Stage Stage
II: involvement of the cornea with pannus formation  Stage I: involvement of the conjunctival stroma  Stage Stage III: fibrous replacement of inflamed tissue  Stage I: involvement of the conjunctival stroma  Stage
Stage IV: contraction with entropion and trichiasis.
212–The following are true of prisms EXCEPT:
a. they are used in the assessment of binocular function
b. a combination of base-up and base-down prisms are used to measure vertical deviation
c. they are an important part of a Javal Schiotz keratometer
d. the power in prism dioptres is half the apex angle in degrees
The power in prism diopters is roughly equal to the apex angle in degrees.
213–Which option is FALSE regarding the lens fibres:
a. older lens fibres are distinguished by larger nuclei
b. during elongation the lens cell nucleus migrates anteriorly as the cell is pushed deeper in the lens
c. lens fibres are arranged with little intercellular spaces
d. during elongation the apical portion of the lens cell passes anteriorly
Older lens fibres are found deeper within the lens substance. The older lens fibres are anucleate and are
incapable of producing lens proteins known as crystallins unlike younger more superficial lens fibres. Other
options are true.
214–Which of the following is NOT true of prisms:
a. the dipersive power is independent of the refractive index of the prism
b. the image formed by a prism is displaced towards the apex of the prism
c. decentering a convex lens induces image displacement towards the centre of the lens
d. the position of minimum deviation is when the angle of incidence equals the angle of emergence
e. the Porro prism inverts an image and deviates the light path through 180 degrees
Decentering a convex lens induces image displacement towards the periphery of the lens which is the
apex of the induced prism.
215–Which is FALSE regarding the conjunctiva:
a. it contains parasympathetic nerves from the pterygoplatine ganglion
b. it contains accessory lacrimal glands responsible for reflex tear production
c. its blood supply is derived partly from vessels that supply the lids
d. its nerve supply includes the long ciliary nerve
The conjunctiva contains parasympathetic nerves from the pterygopalatine ganglion. Its blood supply is
derived partly from the vessels supplying the superficial lids but also from the anterior ciliary arteries,
which are branches of the ophthalmic artery. The bulbar conjunctiva is supplied with sensory innervation
by the long ciliary nerve, a branch of the nasociliary nerve. The palpebral conjunctiva is supplied by the
supraorbital, supratrochlear and lacrimal (all branches of the ophthalmic nerve) and by the infraorbital
nerve (a branch of the maxillary nerve). Accessory lacrimal glands exist in the conjunctiva and these are
responsible for baseline tear production. Reflex tearing is the responsibility of the lacrimal gland.
216–Which statement regarding the caliber of arterioles is NOT correct:
a. angiotensin II causes vasoconstriction
b. adrenaline causes vasodilatation in skeletal muscles
c. decreased oxygen tension causes vasodilatation
d. increased noradrenergic impulse causes vasodilatation
Vasodilatation of the arterioles occurs in decreased oxygen tension and the presence of adrenaline in
skeletal muscle. Vasoconstriction occurs in the presence of angiotensin II, increased noradrenergic
discharge and locally released serotonin.
217–Blunt ocular trauma with separation of the ciliary muscle attachment is likely to cause:
a. rubeotic glaucoma
b. phacomorphic glaucoma
c. phacolytic glaucoma
d. chronic open angle glaucoma
e. angle recession glaucoma
Angle recession glaucoma occurs following blunt trauma. The ciliary muscle attachment to the scleral spur
is disrupted causing deepening of the angle and damage to the trabecular meshwork causing rise in intra-
ocular pressure.
218–Tetracycline is associated with which ocular side-effect:
a. papilloedema
b. cataract
c. retinal toxicity
d. glaucoma
e. corneal opacification
219–The supraorbital nerve is derived from:
a. the lacrimal nerve
b. the zygomaticotemporal nerve
c. the trochlear nerve
d. the frontal nerve
220–All of the following are true of the kidney EXCEPT:
a. it plays an important role in red blood cell production
b. over 99% of filtered water is reabsorbed by the kidney
c. antidiuretic hormone decreases the water permeability of the collecting duct
d. the blood flow accounts for 25% of the total cardiac output
The kidneys receive approximately 25% of the total cardiac output. Over 99% of the filtered water is
reabsorbed by the kidney. Antidiuretic hormone increases the water permeability of the collecting duct
and hence increases water retention. The kidney secrets erythropoietin which is essential for red blood cell
production.
221–If a father and a paternal grandfather of a boy with a congenital eye defect have the same disease,
what is the most likely mode of inheritance:
a. autosomal dominant
b. mitochondrial inheritance
c. X-linked recessive
d. autosomal recessive
Genetic diseases passing from one generation to the next are typical of autosomal dominant inheritance.
This case is not X-linked because X-linked recessive conditions pass from mother to son. Mitochondrial
inheritance passes from the mother to offspring (male or female).
222–Which is FALSE regarding neutralization of lenses:
a. the neutralizing lens is placed against the back surface of the spectacle lens
b. astigmatic neutralization requires each meridian to be neutralized separately
c. the spectacle lens is equal in power and sign to the neutralizing lens
d. neutralization occurs when there is no with or against movement
The spectacle lens is equal in power and opposite in sign to the neutralizing lens. Other statements are
true.
223–The numerator in the toric formula:
a. specifies the prismatic correction
b. specifies the axis and power of the meridian of maximal power
c. specifies the power of the spherical surface
d. specifies the axis and power of the base curve
The numerator in the toric formula specifies the power of the spherical surface. The denominator in the
toric formula specifies the power and axis of the cylindrical element.
224–Which statement is FALSE about the ECG:
a. the T wave indicates ventricular repolarisation
b. increased PR interval occurs in first degree heart block
c. the P wave indicates arterial repolarisation
d. the QRS complex indicates ventricular depolarization
In the ECG, the P wave indicates arterial depolarisation, while the QRS complex indicates ventricular
depolarisation. The T wave represents ventricular repolarisation. An increased PR interval indicates first
degree heart block.
225–Which is FALSE regarding the RPE cells:
a. they are approximately 50 micrometers in height
b. they are connected by tight junctions
c. they possess apical microvilli to increase surface area
d. they contain large numbers of lysosomes and mitochondria
The RPE cells measure 14 micrometers tall in the centre of the retina and 10 micrometers in the periphery.
Other options are true.
226–Regarding adrenaline and noradrenaline:
a. their release is under the control of the pituitary gland
b. both cause increased peripheral resistance of the blood vessels
c. both are produced by the adrenal medulla
d. both cause vasodilatation in the skeletal muscles
Explanation Both adrenaline and noradrenaline are produced by the adrenal medulla. They are secreted in
response to stress. Adrenaline causes vasodilatation in the skeletal muscles but noradrenaline has no such
effect. While adrenaline decreases the peripheral resistance of the blood vessels, noradrenaline increases
it.
227–Which of the following extraocular muscles can perform intortion of the globe:
a. the superior oblique
b. the medial rectus
c. the inferior oblique
d. the inferior rectus
The primary, secondary and tertiary actions of the recti are respectively:
 Stage I: involvement of the conjunctival stroma  Stage Medial rectus: Adduction (no secondary or tertiary actions)  Stage I: involvement of the conjunctival stroma  Stage Superior rectus: Elevation, Intortion,
Adduction  Stage I: involvement of the conjunctival stroma  Stage Inferior rectus: Depression, Extorsion, Adduction  Stage I: involvement of the conjunctival stroma  Stage Inferior oblique: Extorsion, Elevation,
Abduction  Stage I: involvement of the conjunctival stroma  Stage Superior oblique: Intorsion, Depression, Abduction  Stage I: involvement of the conjunctival stroma  Stage Lateral rectus: Abduction (no
secondary or tertiary actions)
228–Which of the following statements about blood test results is FALSE:
a. macrocytic anaemia occurs in folate deficiency
b. hypersegmentation of the neutrophilic nucleus occurs in vitamin B12 deficiency
c. decreased erythropoietin production as in renal failure causes microcytic anaemia
d. normochromic normocytic anaemia is seen in chronic disease
e. microcytic hypochromic anaemia is seen in iron deficiency anaemia
Iron deficiency anaemia causes microcytic hypochromic red blood cells. Folate and/or vitamin B12
deficiency causes macrocytic hypochromic red blood cells. Both folate and vitamin B12 deficiency are
essential for the maturation of DNA so their deficiency can cause hypersegmentation of the neutrophilic
DNA. Chronic disease causes normocytic normochromic anaemia. Erythropoietin is an essential hormone
for red blood cell production - its absence will cause normochromic normocytic anaemia.
229–How thick is the choroid:
a. 200-300 micrometers
b. 300-500 micrometers
c. 50-100 micrometers
d. 100-200 micrometers
The choroid is 100-200 micrometers thick, being thickest at the posterior pole and thinner anteriorly.
230–is Which virus NOT known to be associated with human cancer:
a. Epstein-Barr Virus
b. Human Immunodeficiency Virus
c. Herpes Zoster Virus
d. Human Papilloma Virus
Viruses associated with human cancer:
 Stage I: involvement of the conjunctival stroma  Stage Epstein-Barr virus: Burkitt's lymphoma and nasopharyngeal carcinoma  Stage I: involvement of the conjunctival stroma  Stage Human Papilloma virus:
cervical cancer  Stage I: involvement of the conjunctival stroma  Stage Hepatitis B and C: hepatic cancer  Stage I: involvement of the conjunctival stroma  Stage Human Immunodeficiency Virus: Kaposi's sarcoma
and non-Hodgkin's lymphoma

231–All of the following are TRUE of the neuronal action potential EXCEPT:
a. it is associated with an increased permeability of the membrane to sodium ions
b. its velocity is affected by the diameter of the nerve fibers
c. its velocity is faster in nerves that are myelinated than unmyelinated
d. it is an all or nothing phenomenon
e. its amplitude decreases as it travels along the nerve fibers
The amplitude of an action potential does not change as it travels along the nerve fibers. All other options
are true.
232–A 30-year-old patient is known to have hypogammaglobulinaemia. Which one of the following
organisms is the patient susceptible to?
a. Pneumococcus
b. E coli
c. Salmonella
d. Legionella
e. Bacteroides
IgG deficiency leads to susceptibility towards infection with encapsulated organisms (staph, strep
pneumoniae, haemophilus) and also pneumocystis carinii infection.
233–Which of the following is TRUE of the third ventricle:
a. it is posterior to the pineal body
b. its roof is formed by the optic chiasm
c. it contains choroid plexus in its roof
d. it is connected to the fourth ventricle by the foramen of Monro
The third ventricle is connected to the lateral ventricles via the interventricular foramen of Monro. It is
connected to the fourth ventricle by the aqueduct. The optic chiasm is situated at the junction between
the floor and the anterior wall of the third ventricle. The pineal body is a midline body which is posterior
to the third ventricle. The choroid plexus in the roof of the third ventricle secretes cerebrospinal fluid.
234–Which is FALSE about spectacle correction of aphakia:
a. the field of vision is decreased by a lenticular form lens
b. the ring scotoma is due to high induced prism of the lens periphery
c. it minimises objects
d. increasing the back vertex distance of an aphakic correction increases effective power
Objects are magnified in aphakic correction. All other statements are correct.
235–Which of the following drugs is a photosensitizer:
a. tetracycline
b. corticosteroids
c. amiodarone
d. isoniazid
Photosensitising agents absorb visible and UV radiation. Examples include amiodarone, phenothiazines
and psoralens.
236–Which mutation is MOST likely to cause premature termination of translation:
a. insertion of a single base into an intron of DNA
b. deletion of an entire gene
c. insertion of a single base change in a promoter
d. insertion of a single base into an exon of DNA
A single base insertion in the exon or coding region would cause a frameshift mutation and usually leads to
premature termination of translation. A single base insertion in the intron (or non-coding region) would be
less likely to have this effect. Meanwhile a mutation within the promoter region would most likely alter
gene regulation. Deletion of the entire gene would lead to complete lack of translation.
237-Which immunoglobulin has NOT been detected in tear samples?
a. IgA
b. IgG
c. IgD
d. IgE
e. IgM
All major immunoglobulin classes except IgD have been detected in human tears. IgA (secretory
immunoglobulin) is the primary immunoglobulin in tears.
238-All of the following are true of dark adaptation EXCEPT:
a. rods are more sensitive than cones during dark adaptation
b. there is a shift in peak spectral sensitivity from 555 nm to 505 nm with dark adaptation
c. its takes about 12 minutes in humans
d. biphasic changes only occur in organisms where the retina processes both rods and cones
Dark adaptation may take up to 30 minutes. The Perkinje effect describes the shift in spectral sensitivity
from 555nm to 505nm with dark adaptation. Rods are more sensitive than cones. Organisms with only
rods exhibit monophasic change.

239-The sphenoidal sinus drains into the:

a. the lesser meatus
b. the middle meatus
c. the inferior meatus
d. the superior meatus
The nasal meatus are as follows:
 Stage I: involvement of the conjunctival stroma  Stage the superior meatus receives the opening of the sphenoid and posterior ethmoidal sinuses  Stage I: involvement of the conjunctival stroma  Stage the
middle meatus receives the openings of the anterior ethmoidal sinuses, frontal sinus and the maxillary
sinus  Stage I: involvement of the conjunctival stroma  Stage the inferior meatus receives the opening of the nasolacrimal duct
240-A sample of 50 men has a mean CD4 count of 1200 cells/mm3 with a standard deviation of 80
cells/mm3. Which of the following is true?
a. the variance equals 160 cells/mm3
b. 5% of men will have CD4 counts greater than 1360 cells/mm3
c. approximately 95% of men will have a CD4 count between 1040 and 1360 cells/mm3
d. a man with a CD4 count of 1120 cells/mm3 lies 2 standard deviations below the mean
e. approximately 68% of men will have a CD4 count between 1180 and 1220 cells/mm3
This data is normally distributed so approximately 95% of the population will lie within +-2SD of the mean
which is 1200+2 (80) and 1200-2 (80) which is between 1040 and 1360.
241-Which is FALSE regarding Haemophilus influenzae:
a. it is a common cause of sinusitis
b. it is always encapsulated
c. it is a Gram negative coccobacilli
d. it is best grown on chocolate agar
Haemophilus is not always encapsulated with a polysaccharide coat but when it is the virulence is
enhanced as it can avoid phagocytosis.
242-Which statement regarding the levator palpebrae superioris is FALSE:
a. it inserts into both the skin of the upper lid and the tarsal plate
b. its muscle belly passes forward below superior rectus
c. on its inferior aspect is Muller's muscle
d. it is supplied by the superior division of the oculomotor nerve
e. the medial horn of its aponeurosis inserts into the frontolacrimal suture
The muscle belly of the levator palpebrae superioris passes forward above (not below) the superior rectus
close to the orbital roof. It inserts into both the skin of the upper lid causing the horizontal palpebral
sulcus and also onto the anterior surface of the tarsal plate. The medial horn of its aponeurosis becomes
the medial palpebral ligament and inserts into the frontolacrimal suture.
243-The ciliary ganglion:
a. contains sensory nerve fibres
b. is found between the optic nerve and the medial rectus
c. is a sympathetic relay ganglion for fibers from the Edinger-Westphal nucleus
d. has a motor nerve that goes to the inferior oblique
The ciliary ganglon is found between the optic nerve and the lateral rectus muscle contains. It contains:
 Stage I: involvement of the conjunctival stroma  Stage a parasympathetic ganglion which receives its parasympathetic preganglion fibres from the Edinger-
Westphal nucleus and which supplies the sphincter papillae  Stage I: involvement of the conjunctival stroma  Stage sensory fibres leaving the posterior globe
 Stage I: involvement of the conjunctival stroma  Stage sympathetic postganglionic fibres from the superior cervical sympathetic ganglion which supply the
dilator pupillae
244-Which of the following statements regarding diagnostic tests is TRUE?
1. a high number of false negatives means the test has a low specificity
2. an imprecise test is of no clinical value
3. the validity of a test refers to its ability to give the same result when measured by different
observers
4. sensitivity is also known as the true negative rate
5. positive predictive value is dependent on the prevalence of the disease
The positive predictive value is dependent on the prevalence of the disease, this is the only true
statement in the above question. It means that if a disease is very rare and you test positive, it is still
unlikely that you have it.
The validity of a test, which is also called accuracy, is the ability of the test to give a true reading of what it
is purporting to measure.
Sensitivity is also called the true positive rate. It is the probability that if you have the disease, you will test
positive. A high number of false negatives implies low sensitivity.
Specificity depends upon true negatives. It is the probability that if you do not have the disease, you will
test negative. A high number of false positives implies low specificity.
245-All of the following are involved in the pathway of taste sensation EXCEPT:
1. nucleus of solitary tract
2. greater petrosal nerve
3. chorda tympani
4. geniculate ganglion
Taste sensation from the anterior two-thirds of the tongue passes via the chorda tympani to the
geniculate ganglion, where the cell body of the sensory neurone resides. The fibres continue via the nervus
intermedius of CN VII to the nucleus of the solitary tract.
246- Which is FALSE regarding sterilization:
a. it can be achieved with ethylene oxide
b. it can be achieved at high pressures using an autoclave
c. it can be achieved with gamma radiation
d. dry heat is more effective than wet heat
e. it involves the destruction of all microbial life so that none can replicate
Moist heat is more effective than dry heat, which requires higher temperatures and longer exposure to
achieve sterilization.
247-The major histocompatibility antigen complex in humans (human leukocyte antigen [HLA] system) is
coded for by genes located on chromosome:
a. 18
b. 21
c. 11
d. 6
e. 13
The human leukocyte antigen (HLA) complex governs immune response and surveillance and is encoded
for by genes on chromosome 6.
248-The inferior orbital floor is formed by:
a. the lacrimal, maxillary and zygoma bones
b. the maxillary, zygoma and palatine bones
c. the frontal and maxillary bones
d. the palatine, sphenoid and maxillary bones
The orbital floor is formed by the maxilla, zygoma and palatine bones.
249-Which statement is FALSE regarding prismatic corrections:
a. an 8 dioptre convex lens decentered 5 mm upwards has a prismatic power equivalent to a 4 prism
dioptre base-up prism
b. a 6 dioptre concave lens decentered laterally by 2.5 mm has a prismatic power equivalent to a 1.5
prism dioptre base-in prism
c. a 4 dioptre base-up prism for the right eye is equivalent to a 2 prism dioptre base-up prism for the
right eye with a 2 prism dioptre base-up prism for the left eye
d. a 3 prism dioptre base-out prism in front of the right eye is equivalent to a 1 dioptre baseout prism
in front of the right eye and 2 prism dioptre base-out prism in front of the left eye
A 4 dioptre base-up prism for the right eye is equivalent to a 2 prism dioptre base-up prism for the right
eye with a 2 prism dioptre base-down prism for the left eye. All other options are correct.
250-The following stages are involved in leukocyte movement to a site of inflammation EXCEPT:
a. rolling
b. migration
c. division
d. adhesion
Movement of leukocytes into the site of inflammation involve the following stages: rolling, firm adhesion,
tight adhesion, migration.
251-Which is FALSE regarding the ciliary body:
a. the posterior portion is termed the pars plicata
b. it is 5-6 mm wide
c. it extends posteriorly to the ora serrata
d. it extends anteriorly to the scleral spur
The anterior portion of the ciliary body is termed the pars plicata. It is 2mm wide and composed of about
70 ciliary processes. The posterior portion of the ciliary body is approximately 4mm wide and is termed the
pars plana.
252-he lateral geniculate nucleus sends the large proportion of its fibres to:
a. the reticular formation
b. the inferior colliculus
c. the superior colliculus
d. the visual cortex
e. the hypothalamus
The primary role of the lateral geniculate nucleus is a relay station for the conscious pathway of visual
perception. To this end, it sends the majority of its fibres to the visual cortex, also called area 17. It also
has connections to the superior colliculus, reticular formation and hypothalamus.
253- The prismatic effect of a spherical lens:
a. is inversely proportional to the power of the lens
b. can prevent the jack-in-the-box phenomenon
c. increases toward the periphery of a lens
d. increases towards the centre of a lens
The prismatic effect of a spherical lens increases towards the periphery of a lens. It can cause intolerance
of lenses, particularly high-powered lenses, if the lens is not properly centred. It explains the jack-in-the-
box effect for wearers of high-powered lenses and it is also is the underlying mechanism for spherical
aberration of lenses. The prismatic effect produced is directly proportional to the spherical power of the
lens and to the distance of rays from the centre of the lens. The prismatic power is calculated by the
formula:
P=FxD
Where P is the prismatic power in prism diopters, F is the lens power in diopters and D is the distance from
the centre of the lens in centimeters.
254-Chromosomes replicate during:
a. G0
b. interphase
c. G1
d. S phase
e. prophase
Chromosomal replication occurs in the S phase as the cell prepares for mitosis.
255-Which extraocular muscle is inserted nearest to the cornea:
a. lateral rectus
b. inferior rectus
c. superior rectus
d. medial rectus
The insertions of the recti muscles from the limbus are as follows:
 Stage I: involvement of the conjunctival stroma  Stage medial rectus 5.6mm  Stage I: involvement of the conjunctival stroma  Stage inferior rectus 6.6mm  Stage I: involvement of the conjunctival stroma  Stage lateral rectus 7.0mm  Stage I: involvement of the conjunctival stroma  Stage superior rectus 7.8mm

256-All the statements below are true of the middle meningeal artery EXCEPT:
a. it does not supply the brain
b. it supplies the meninges
c. it lies within the inner layer of dura
d. it enters the skull through the foramen ovale
The middle meningeal artery enters the skull through the foramen spinosum.
257-Which statement is FALSE regarding nerve supply to the cornea:
a. the nerve fibres are mainly A-delta and C-fibres which transmit pain and temperature
b. the corneal nerve supply originates from the ophthalmic division of the trigeminal nerve
c. nerve bundles in the peripheral cornea initially travel below the anterior one-third of the stroma
d. nerves lose their perineurium and myelin sheaths 2mm from the limbus
Corneal nerves lose their perineurium and myelin sheaths 1mm from the limbus; this helps to maintain
corneal clarity. Other options are true.
258-Which statement is TRUE of astigmatism:
a. oblique astigmatism indicates the principal meridians are not at 90 degrees to each other
b. it does not change through life
c. a stenopaeic slit can be used to assess the axis of astigmatism
d. when corrected with a minus cylinder at axis 90 degrees, it is called 'with the rule'
A minus cylinder at axis 90 degrees represents 'against-the-rule' astigmatism. In oblique astigmatism the principal
meridians are at right angles but they do not lie within 20 degrees of the horizontal or vertical meridians.
Astigmatism changes with age: with increasing age the tendency is for the horizontal curvature of the cornea to
become greater than the vertical curvature

259-Normal stereoacuity is:

a. 60 seconds of arc
b. 300 seconds of arc
c. 10 seconds of arc
d. 150 seconds of arc
Normal stereoacuity is approximately 60 seconds of arc, though some individuals have stereoacuity of 15
seconds of arc (the limit of the Frisby test) or better.
260-Which is TRUE regarding lymphatic drainage of the eye and adnexa:
a. no such drainage exist
b. drainage occurs directly into the cavernous sinus
c. only lymphatics from the eyelid drain to the cervical chain
d. half drains into the cavernous sinus and half into the cervical chain
The eyelids have lymphatic drainage laterally to the preauricular and intraparotid lymph nodes and
medially to the submandibular and submental lymph nodes. These all drain into the cervical chain. There
are no lymphatics in the deep orbit.
261-urface ectoderm forms all of the following structures EXCEPT:
a. eyelid
b. sclera
c. cornea
d. conjunctiva
The sclera is derived from the mesoderm. The conjunctiva, cornea and eyelid are all derived from the
surface ectoderm.
262-Hard exudates are found in which layer of the retina:
a. the inner plexiform layer
b. the outer plexiform layer
c. the nerve fibre layer
d. the internal limiting membrane
e. Bruch's membrane
Your answer was INCORRECT Explanation Hard exudates are caused by underperfusion leading to damage
to the endothelium of deep capillaries. This causes leakage of plasma into the outer plexiform layer.
263-Whih one of the following regarding malignant transformation in tissues is FALSE:
a. mutations in the p53 gene is the most common mutation seen in solid tumours
b. cancer usually results from the accumulation of mutations in multiple genes rather than from
single genetic defect
c. mutations in the p53 gene may make cancer cells resistant to radiotherapy
d. apoptosis does not occur in cells once they have undergone malignant transformation
e. resistance to chemotherapy agents may occur due to mutant genes
Cancer cells usually die from apoptosis. p53 mutations are the most common in solid tumours. Cancer
syndromes due to a single genetic defect do occur but are rare.
264-Which of the following is FALSE regarding hard exudates:
a. they are well circumscribed lesions
b. they are caused by leakage of plasma
c. they contain foamy macrophages with lipid in their cytoplasm
d. they occur in the inner plexiform layer
e. they are caused by endothelial damage to deep capillaries
Hard exudates occur in the outer plexiform layer. Other options are true.
265-Which of the following enters the orbit through the annulus of Zinn:
a. the lacrimal nerve
b. the nasociliary nerve
c. the frontal nerve
d. the trochlear nerve
The frontal, lacrimal and trochlear nerves enter the superior orbital fissure above the tendinous ring.
Structures that enter the orbit through the ring include: the nasociliary nerve, the abducent nerve, the
oculomotor nerve.
266-Which statement is FALSE about Descemet's membrane:
a. it occurs between the posterior stroma and the endothelium
b. it is rich in Type II collagen
c. it is 8-12 micrometers thick
d. it is continuous posteriorly with the trabecular meshwork
Descemet's membrane is rich in basement membrane glycoproteins, laminin, and Type IV collagen (but
not Type II collagen).
267-Cephalosporins work by:
a. inhibiting protein synthesis
b. inhibiting DNA synthesis
c. inhibiting cell wall synthesis
d. inhibiting folate biosynthesis
Cephalosporins prevent bacterial cell wall synthesis
268-Which is TRUE of sterilisation:
a. it can be achieved by wiping surgical instruments with alcohol swab
b. moist heat takes longer than dry heat to sterilize instruments
c. it involves the removal of all microorganisms except spores
d. it can be achieved by boiling surgical instruments in water for 10 minutes
e. ethylene oxide gas is used to sterilise instruments which are heat sensitive
Sterilisation is the removal of all microorganisms including spores. Disinfection is the removal of most but
not all microorganisms. Sterilisation can be achieved with moist heat in autoclave which takes shorter
period than dry heat. Ethylene oxide gas is useful for heat sensitive instruments. Irradiation and chemical
germicides are other techniques of sterilisation.
269-The seventh cranial nerve during its course traverses:
a. the foramen ovale
b. the stylomastoid foramen
c. the jugular foramen
d. the foramen rotundum
The seventh cranial nerve traverses the internal auditory meatus of the petrous temporal bone, the facial
canal and emerges from the stylomastoid foramen to enter the parotid gland.
270-The foramen ovale transmits all of the following EXCEPT:
a. accessory meningeal artery
b. maxillary nerve
c. mandibular nerve
d. the lesser petrosal nerve
Explanation The foramen ovale transmits the mandibular nerve, accessory meningeal artery, the lesser
petrosal nerve and the emissary vein. The maxillary nerve is transmitted through the foramen rotundum.
271-Which drug can cause macular toxicity in aphakic eyes:
a. epinephrine
b. acetazolamide
c. timolol
d. latanoprost
Epinephrine causes macular oedema in 20-30% of apakic eyes undergoing treatment for glaucoma and is
therefore contraindicated in these circumstances.
272-The foramen rotundum pierces:
a. the greater wing of sphenoid
b. the mandible
c. the maxilla
d. the lesser wing of sphenoid
The foramen rotundum pierces the greater wing of sphenoid.
273-Regarding transforming growth factor-beta (TGF-b):
a. it is synthesised and secreted only by a specific subset of Natural Killer cells
b. mutations in the receptor for TGF-b have been associated with hereditary haemorrhagic
telangiectasia
c. it binds to specific DNA sequences to activate transcription of DNA
d. it stimulates cell proliferation in normal tissues
e. it is a single polypeptide chain of 44 amino acids
TGF-beta is a member of a family of dimeric polypeptide growth factors that includes bone morphogenic
proteins and activins. Virtually every cell in the body, including epithelial, endothelial, haematopoietic,
neuronal, and connective-tissue cells, produces TGF-beta and has receptors for it. TGF-beta regulates the
proliferation and differentiation of cells, embryonic development, wound healing, and angiogenesis.There
are three isoforms of TGF-beta: TGF-beta1, TGF-beta2, and TGF-beta3. Each isoform is encoded by a
distinct gene and is expressed in both a tissue-specific and a developmentally regulated fashion. During
development, TGF-beta1 and TGF-beta3 are expressed early in structures undergoing morphogenesis, and
TGF-beta2 is expressed later in mature and differentiating epithelium. TGF-beta regulates cellular
processes by binding to three high-affinity cell-surface receptors known as types I, II, and III. Mutations in
TGB-beta receptor are associated with hereditary haemorrhagic telangiectasia. TGF-beta is a potent
inhibitor of cell proliferation in most epithelial, endothelial, and haematopoietic cells. It arrests the cell
cycle in the G1 phase. In cancer cells, mutations in the TGF-beta pathway have been described that confers
resistance to growth inhibition by TGF-beta, thus allowing uncontrolled cellular proliferation.
274-Which statement regarding Cytomegalovirus is FALSE:
a. it is a double-stranded DNA virus
b. it rarely cause retinitis if the patient has a CD4 counts of more than 200 per cubic mm
c. it is the most common viral infection in HIV patients
d. in normal people it usually remains dormant in the nerve ganglia
Cytomegalovirus is a double-stranded DNA virus. It rarely causes problems for immunocompetent
patients. In HIV patients, cytomegaloviral retinitis usually indicates decreased CD4+ counts to less than 50
per mm3. Most cases of cytomegalovirus infection in the immunocompromised are the result of
reactivation. The precise site where these viruses remain latent following initial infection of the
immunocompetent patient is not yet known.
275-Choose the incorrect statement. Tumour suppressor genes:
a. include the gene encoding the p53 protein
b. normally function to inhibit the cell cycle
c. were originally derived from retroviruses
d. act recessively at the cellular level
e. are involved in the development of neurofibromatosis
Tumour suppressor genes are involved in the control of cell growth and differentiation. Both genes need
to be defective (two hits) for loss of regulation and tumorigenesis to occur. Most of the genes responsible
for the dominantly inherited cancer syndromes are tumour suppressor genes. For example, in type I
neurofibromatosis, loss of both NF1 genes (one by inheritance and the other by somatic mutation) results
in neurofibromatosis. The normal function of NF1 is as a GTPase-activating protein that converts ras from
its active, growth-promoting, GTP-bound form to the inactive GDPbound form. Other examples include:
BRCA1 and 2 in familial breast/ovarian cancer, FPC, familial retinoblastoma, familial melanoma, hereditary
multiple exostoses, tuberous sclerosis, Von Hippel-Lindau syndrome.

276-Which statement is FALSE about extraocular muscle:

a. type C fibres are required for tonic contractions
b. type A fibres are fast twitch and required for saccadic movements
c. extraocular muscle contains large numbers of specialized sensory and proprioceptive nerve
endings such as muscle spindles and Golgi tendon organs
d. type B fibres are slow twitch and needed for smooth pursuit
e. extraocular muscle is less vascular than skeletal muscle
Extraocular muscle is more vascular than skeletal muscle. In fact, it is the most vascular muscle in the
body after the myocardium.
277-All of the following definitions are correct EXCEPT:
a. hypoplasia is failure of formation of an embryonic mass
b. aplasia is failure of differentiation of an embryonic cell mass to organ specific tissue
c. metaplasia is differentiation of a mature tissue into a different mature tissue
d. dysgenesis is failure of organization of tissue into an anatomically correct organ
Hypoplasia is failure of a developing organ to reach its full size. Agenesis is failure of formation of an
embryonic mass. All other definitions are correct.
278-All are true of adenovirus EXCEPT:
a. it can be spread by droplet infection
b. it contains double-stranded DNA
c. it contains an icosahedral capsid
d. serotypes 3,7,8 and 19 are responsible for pharnygoconjunctival fever
e. it is a common cause of upper respiratory tract symptoms
Adenovirus has two ocular disease presentations: pharyngoconjunctival fever (in which upper respiratory
tract symptoms precede ocular features) and keratoconjunctivitis (in which ocular involvement
predominates). Serotypes 3, 7, 8 and 19 are responsible for epidemic keratoconjunctivitis while serotypes
1, 2, 3, 5, 7 and 14 cause pharyngoconjunctival fever.
279-The sixth cranial nerve on its path to the orbit passes through:
a. the pontine cistern
b. the cerebral aqueduct
c. the magna cistern
d. the spinal cistern
The sixth cranial nerve after exiting the brain stem near to the pons-medullary junction ascends the
pontine cistern. It passes forward through the cavernous sinus before entering the orbit via the superior
orbital fissure.
280-Which statement is FALSE regarding corneal shape:
a. it is more curved in the centre than in the periphery
b. the cornea is thicker in the periphery than in the centre
c. average central corneal thickness is approximately 570 micrometers
d. the corneal diameter is smaller horizontally than vertically
The cornea is smaller in the vertical diameter (10.6mm) than in the horizontal diameter (11.7mm). Other
options are true.
281-In fluorescein angiography, pseudoautoflourescence occurs due to:
a. overlap in the spectral transmission of the excitation and barrier filters
b. use of a large bolus of fluorescein
c. ocular tissues which emit baseline fluorescence
d. overexposure of the angiography film
Fluorescein sodium is an orange dye which is excited by blue light of wavelength 465490nm. It then emits
yellow-green light (520-530nm). For this reason, an angiography camera has a blue excitation filter to
illuminate the fundus with blue light for maximal fluorescein absorbance. The camera then has a yellow-
green barrier light which blocks blue light and exposes the camera only to the yellow-green light from the
fluorescein. Pseudoautoflourescence occurs due to overlap in the spectral transmission of the excitation
and barrier filters, meaning that some blue reflected light does pass through the barrier and appear as
fluorescence.
282-The following are typical of Sjogren's syndrome EXCEPT:
a. increase in the number of conjunctival goblet cells
b. a lymphocytic cellular infiltrate
c. associated connective tissue disorder
d. involvement of the lacrimal gland and the oral mucosa
In Sjogren's syndrome there is a lymphocytic cellular infiltrate affecting the acinar glands of the
conjunctiva, oral mucosa and lacrimal gland. There is resulting dry eye and dry mouth. It is commonly
associated with other connective tissue autoimmune diseases such as rheumatoid arthritis. The number of
conjunctival goblet cells is reduces.
283-The superior sagittal sinus drains posteriorly into:
a. the straight sinus
b. the sigmoid sinus
c. the cavernous sinus
d. the transverse sinus
The superior sagittal sinus drains posteriorly into the transverse sinus, which in turn joins the sigmoid
sinus.
284-Which is FALSE regarding central retinal vein occlusion:
a. it is predisposed by the physiological narrowing of the retinal vein in the lamina cribrosa
b. hypertension and diabetes are risk factors
c. on rare occasions the central retinal vein may recanalise
d. it is characterized by a hemorrhagic retinopathy
e. rubeotic glaucoma is common
Examination of histological specimens reveals recanalization of the central retinal vein in most cases.
Other options are true.
285-Macrophages:
a. are involved in type III hypersensitivity response
b. are derived from blood monocytes
c. cannot produce cytokines
d. have shorter life span than neutrophils
Macrophages are derived from blood monocytes. They have a longer life span than neutrophils. They
produce tumor necrosis factors and interleukins. They are involved in type IV hypersensitivity response.
286-Which is FALSE regarding the refractive power of a curved surface:
a. it is proportional to the radius of curvature of the surface
b. it is proportional to the difference in refractive indices of the media
c. it is measured in diopters
d. it is determined by and obeys the principles of Snell 's law
The refractive power of a curved surface is determined by the principles of Snell's law. It is measured in
diopters and is equal to the difference in refractive indices of the media divided by the radius of curvature.
As such, the power is directly proportional to the difference in refractive indices but indirectly proportional
to the radius of curvature of the surface.
 287-Which of the following statements regarding medical statistics is TRUE?
a. an odds value of 25% corresponds to a 1 in 4 risk of getting disease
b. a cohort study is an example of an interventional study
c. incidence is independent of the time period under study
d. the increase in female mortality from bronchial carcinoma is an example of a secular trend
e. a case-control study is prospective
A secular trend is a slow growing trend over time, as opposed to an epidemic or seasonal trend. Incidence
refers to the number of cases over a defined period of time. Odds value is the ratio of the odds of getting a
disease in one group to the other, and does not equate to absolute risk.
288-Typically, the antibody class produced to an antigen that has been previously exposed to the immune
system is:
a. IgM
b. IgE
c. IgG
d. IgD
e. IgA
IgG is the major antibody formed following exposure to an antigen that has previously been encountered.
289-Which bone is NOT a constituent of the orbital floor:
a. sphenoid bone
b. palatine bone
c. maxilla
d. zygoma
The orbital floor is composed of: the orbital plate of the maxilla, the orbital surface of the zygoma and the
orbital process of the palatine bone.
290-Which layer overlies the Bowman's layer:
a. the lamina fusca
b. the lamina densa
c. the lamina vitrea
d. the lamina lucida
Overlying the Bowman's layer is the basal lamina of the corneal epithelium, which is itself composed of
two layers:  Stage I: involvement of the conjunctival stroma  Stage the lamina lucida: which is more superficial  Stage I: involvement of the conjunctival stroma  Stage the lamina densa: which is deeper
291-Which statement is TRUE about the nucleic acids:
a. histones mark the initiation site for transcription
b. introns are more common than exons on the DNA
c. in RNA thymine is replaced by uracil
d. they contain purine and pyrimidine which are bound together by hydrogen
Purine and pyrimidine are bound by covalent bounds. Introns are the region of DNA generating the
precursor part of RNA which is excised during transcription and therefore not a part of messenger RNA.
The exon, by contrast, generates the RNA used in the mRNA, which is transcribed into protein (remember:
eXons are eXpressed). Histone is a protein which is found in association with DNA in chromosomes and
performs a structural role.

292-How many cell layers are there in the corneal epithelium:

a. 3
b. 10-12
c. 5-6
d. 2
There are five or six layers of cells comprising the stratified non-keratinised squamous epithelium of the
cornea.
 293-All of the following pass through the common tendinous ring EXCEPT:
a. inferior division of oculomotor nerve
b. nasociliary nerve
c. frontal nerve
d. superior division of oculomotor nerve
The frontal nerve passes superior to the common tendinous ring. Structures passing within the ring
include: the oculomotor nerve (superior and inferior divisions), aduncent nerve, nasociliary nerve,
sympathetic root of the ciliary ganglion and on occasion the inferior ophthalmic vein.
294-The main glycosaminoglycan of the cornea is:
a. hyaluronate
b. chondroitin sulphate
c. keratan sulphate
d. dermatan sulphate
The cornea comprises glycosaminoglycans which are important in maintaining regular spacial
arrangements of collagen fibrils. The main glycosaminoglycans of the corneal stroma are keratan sulphate
and dermatan sulphate. The corneal stroma is unusual in that it contains no hyaluronate
295-Which statement is FALSE regarding the inferior oblique muscle:
a. it is inserted about 17mm behind the limbus
b. its posterior edge inserts behind the fovea
c. it arises from the posterior lacrimal crest of the infero-nasal orbital rim margin
d. its primary action is extortion
The inferior rectus normally inserts 1 mm anterior and below the fovea. Other options are true.
296-All are true of the Maddox rod EXCEPT:
a. it produces a straight line in the plane of the long axis of the lenses
b. it is used to determine the degree of latent deviation for distance
c. it is useful in the detection of macular disease
d. it is composed of cylindrical lenses
A Maddox rod forms an image perpendicular to the plane of the long axis of the lenses. All other
statements are true.
297-Which sinus lies below the orbital floor:
a. sphenoidal sinus
b. frontal sinus
c. maxillary sinus
d. ethmoidal sinus
The maxillary sinus lies below the orbital floor. Tumour and infection can spread from the maxillary sinus
to the orbit through the floor.
298-Which of the following is NOT an example of apoptosis?
a. the killing of virus infected cells by cytotoxic T-cells
b. the formation of synapses in the brain
c. coagulative necrosis of myocytes following myocardial infarction
d. the sloughing off of the endometrium during menstruation
e. the formation of fingers and toes during embryogenesis
Apoptosis is programmed cell death and does not trigger inflammation. It can be induced by:  Stage I: involvement of the conjunctival stroma  Stage Signals
arising within the cell  Stage I: involvement of the conjunctival stroma  Stage Death activators binding to the cell surface  Stage I: involvement of the conjunctival stroma  Stage Reactive oxygen species
299-Which statement is false regarding natural killer (NK) cells:
a. they interact with MHC class I molecules
b. they have a role in recognizing and killing tumor cells
c. they secrete gamma interferon
d. they are a subset of T-lymphocytes
e. they lack the T-cell receptor
Explanation NK cells are a subset of lymphocytes derived from bone marrow progenitors. They function in
cellular cytotoxicity and are not phagocytic. NK cell killing is especially important in the control of the early
phases of infection with intracellular pathogens such as herpes viruses, Leishmania and Listeria
monocytogenes. They also play a role in the destruction of tumor cells. NK cells do not express T-cell
receptors. They express a number of non-specific adhesion molecules, which mediate the attachment to
target cells. Human NK cells express membrane proteins that recognize specific allelic forms of MHC class I
molecules bound to self-peptide. On binding their ligand, these receptors inhibit NK cell killing. If the
concentration of class I molecules on a cell is reduced, or the range of peptides is markedly altered (as can
occur in viral infection), NK cells are no longer inhibited and cytolysis occurs. These cells release granules
containing perforin and granzymes, which lye target cells and then induce apoptotic cell death. NK cells
also express receptors for the Fc region of IgG and are important mediators of antibodydependent cellular
cytotoxicity. The killing activity of NK cells is enhanced by IFNgamma, IFN-beta, and IL-12. They also
secrete IL-1 and GM-CSF.
300-The nerve supply to the levator palpebrae superioris is derived from:
a. the supraorbital nerve
b. the supratrochlear nerve
c. the nerve to the medial rectus
d. the nerve to the superior oblique
e. the nerve to the superior rectus
The nerve to the superior rectus supplies the levator palperae superioris which it pierces from below.
Question 301 part 4 BASIC SCIENCES

301-The pretectal nucleus is involved in:

a. conscious vision
b. the pupillary light reflex
c. the arousal function
d. photoperiod regulation
e. the visual grasp reflex

After the decussation of fibres in the optic chiasm, 90% of fibres pass along the lateral root of
the optic tract towards the lateral geniculate nucleus and on to the occipital cortex for
conscious vision. 10% of fibres travel along the medial root of the optic tract and are
responsible for unconscious stimuli. These fibres target:
i. the superior colliculus: involved in visual grasp reflex, automatic scanning of images
ii. the pretectal nucleus: involved in pupillary light reflex
iii. the parvocellular reticular formation: arousal function
iv. the retinohypothalamic tract : photoperiod regulation

302-All of the following substances are used in Gram staining EXCEPT:

a. iodine
b. Congo red
c. alcohol
d. safranin
e. Crystal violet

Congo red is not used in Gram staining. The Gram staining process is as follows:
i. Crystal violet (which is purple in colour) is applied and this attaches to negatively
charged groups in the cell wall, membrane and cytoplasm.
ii. The further addition of iodine strengthens this attachment.
iii. The addition of alcohol or acetone-alcohol decolorizes the crystal violet and iodine
causing the stain to diffuse out of the cell. This diffusion is lower in Grampositive cell
walls because of the greater thickness and chemical composition (particularly teichoic
acids).
iv. Safranin or neutral red is then used as a counter-stain. This binds to free negatively
charged groups that are not already binding to crystal violet.

303-Keloid scars:
a. tend not to extend beyond the original incisional scar
b. are rare in the deltoid region
c. are caused by excess deposition of fibrin in the wound
d. are distinguished from hypertrophic scars by their extent.

Keloid scars unlike hypertrophic scars extend beyond the original wound. They are caused by
excessive deposition of collagen. They are most common in the sternum and deltoid regions.
304-Choose which statement is FALSE regarding trinucleotide DNA repeats:
a. they demonstrate genetic imprinting
b. they are the molecular basis for genetic anticipation
c. they are the cause of fragile X syndrome
d. they are the cause of Huntington's disease
e. they can produce a neurotoxic polyglutamine peptide sequence

Trinucleotide repeats occur to a variable degree in the coding and non-coding areas of genes
in the normal population (exhibit polymorphism). When the number of repeats exceeds 30,
the DNA becomes unstable and may expand up to several thousand copies and interfere with
gene expression leading to disease.The number of trinucleotide repeats increases with
successive generations leading to more severe disease; this is called genetic anticipation.
Genetic imprinting is the phenomenon of differential gene expression depending on the sex of
the parent who transmitted it.
Diseases related to trinucleotide repeat expansion include: myotonic dystrophy,
spinocerebellar ataxia, Friedrich's ataxia and X-linked bulbospinal neuropathy (Kennedy's
syndrome

305-The ventilation to perfusion ratio is maximum at:

a. equal in both lungs
b. the apex of the lung
c. the middle lobe
d. the medial lobe
e. the base of the lung

The apex of the lung is maximally ventilated and perfusion in this region is less; hence, ratio
of ventilation to perfusion is maximum in this part.

306-Which is the most common cause of human blindness globally:

a. Trachoma
b. Diabetic retinopathy
c. Glaucoma
d. Age-Related macular degeneration

307-Dysplasia:
a. is associated with increased cell staining with haematoxylin
b. involves the transformation of one mature cell type into another
c. is associated with a reduced cell number
d. is irreversible

Dysplasia is associated with increased cell number and nuclear abnormalities such as
hyperchromasia (increased cell staining with haematoxylin) and pleomorphism (altered
nuclear size and nuclear shape). Dysplasia may be caused by diverse cellular insults including
physical, chemical and viral insults. It may be reversible in its early stages. Metaplasia is the
transformation of one mature cell type into another.
308-All are true of the corrugator supercilii EXCEPT:
a. it is supplied by divisions of the temporal branch of the facial nerve
b. it draws the eyebrow upwards and medially
c. it assists in protecting the eyes in bright light
d. it produces vertical skin furrows on the forehead

The corrugator supercilii draws the eyebrow downwards and medially to produce vertical skin
furrows on the forehead. Other options are true.

309-A glass prism of refracting angle 30 degrees is placed in the position of minimum
deviation. How much deviation will it produce:
a. 60 degrees
b. 30 degrees
c. 45 degrees
d. 15 degrees

For a prism of refractive index n and refractive angle a, in the position of minimum deviation:
angle of deviation = (n-1) x a
Therefore, for a glass prism: angle of deviation = (1.5-1) x a = a/2

310-The meridian of minimum curvature of a toric lens is called:

a. the spherical equivalent
b. principle axis
c. the optical cylinder
d. the base curve

The principle meridian of minimum curvature of a toric lens is called the base curve.

311-Which statement about lignocaine is FALSE:

a. it inhibits the uptake of potassium into nerve cell membranes
b. it has a local vasodilatory effect
c. toxicity causes drowsiness and slurred speech
d. it is alkaline in solution

Lignocaine blocks the uptake of sodium into nerves (not potassium). Lignocaine toxicity causes
tingling around the mouth, followed by drowsiness and slurred speech which leads to
convulsions and then coma.

312-A point of light viewed through a vertical Maddox rod will produce:
a. a line perpendicular to the long axis of the rods
b. a line oriented in the direction of corneal astigmatism
c. a line perpendicular to the direction of corneal astigmatism
d. a line parallel to the long axis of the rods

A point of light viewed through a Maddox rod will produce a straight line perpendicular to the
long axis of the rods.
313-Which statement is FALSE about the parotid gland:
a. it receives its secretomotor fibres from the glossopharyngeal nerve
b. it is a serous gland
c. the parotid duct enter the oral cavity by piercing the buccinator
d. it is covered by a thick capsule derived from the deep cervical fascia
e. the facial nerve exits the gland anteromedially before dividing into 5 branches

The facial nerve divides within the parotid gland before exiting it anteromedially. All other
options are true.

314-Which statement is FALSE regarding the tarsal plates:

a. they are 1mm thick
b. they measure 25-30mm from medial to lateral borders
c. they consist of dense fibrous connective tissue
d. the lower tarsal plate is greater in height than the upper tarsal plate

The upper tarsal plate (10-12mm) is greater in height than the lower lid tarsal plate (5mm).

315-Which is FALSE regarding Gullstrand's schematic eye:

a. it is a model of the human eye based on thick lens formulae
b. the axial length is 24.4 mm
c. the nodal points lie on either side of the cornea
d. the cornea is 0.5 mm thick
e. the refractive index of the cornea is less than that of the lens

The nodal points lie either side of the posterior pole of the lens.

316-The choroid is composed of:

a. 5 layers
b. 3 layers
c. 2 layers
d. 4 layers

The choroid is composed of 5 layers:

i. Bruch's membrane
ii. the choriocapillaris
iii. Haller's layer
iv. Sattler's layer
v. the suprachoroid

317-Corneal endothelial density at birth is:

a. 3-4000 cells per square millimeter
b. 10,000 cells per square millimeter
c. 6000 cells per squre millimeter
d. 2500 cells per square millimeter
Corneal endothelial cell density at birth is 3-4000 cells per square millimeter. This falls to
2500cells per square millimeter in meddle age and 2000 cells per square millimeter in old age.
Density below 800 cells per square millimeter leads rapidly to oedema.
318-Which of the following is a recognized side-effect of systemic chloramphenicol
administration:
a. aplastic anaemia
b. thrombocytopaenia
c. haemolytic anaemia
d. idiopathic thrombocytopaenic purpura

Chloramphenicol is one of the commonest topical antibiotics in use in ophthalmology but its
systemic use is limited by its potential to cause a fatal aplastic anaemia.

319-All the following are true about the pre-aponeurotic fat EXCEPT:
a. it is located between the orbital septum and the levator
b. the lateral pad is larger than the medial pad
c. the medial pad has more fibrous tissue than the lateral pad
d. the medial pad has a yellowish appearance whereas the lateral pad is white

The pre-aponeurotic fat pad is located between the orbital septum and the levator. It is
divided into medial and lateral portions by the trochlear. The lateral pad is larger and more
yellowish in colour whereas the medial pad is whitish. The difference is due to the higher
content of fibrous tissue in the whitish medial pad.

320-Bleeding time is increased in ALL of the following EXCEPT:

a. thrombocytopaenia
b. vitamin C deficiency
c. anaemia
d. aspirin ingestion

Anaemia does not increase bleeding time.

Increased bleeding time occurs in:
Thrombocytopaenia Disseminated Intravascular Coagulation (DIC) Platelet disorders
Capillary wall abnormalities (such as in vitamin C deficiency) Von Willebrand's Disease
Medications: including Aspirin, Warfarin, NSAIDs, Streptokinase, Urokinase

321-Damage to the oculomotor nerve would be expected to cause:

a. a dilated pupil unresponsive to light and accommodation
b. a dilated pupil unresponsive to light but responsive to accommodation
c. a constricted pupil unresponsive to light but responsive to accommodation
d. a constricted pupil unresponsive to light and accommodation

Damage to the parasympathetic fibres supplying the sphincter pupilae results in a dilated
pupil that does not respond to light or accommodation.

322-All are true of the lens capsule EXCEPT:

a. it is produced by the lens epithelium and lens fibres
b. it is approximately 50 micrometers thick at the anterior pole
c. it completely envelops the lens
d. it contains basement membrane glycoproteins

The lens capsule varies in thickness being thinnest at the poles, measuring about 2
micrometers at the posterior and 15 micrometers at the anterior pole. Other options are true.
323-The image formed by a thin concave lens is:
a. virtual, erect, magnified, further from the lens than object
b. virtual, erect, at infinity
c. real, inverted, outside F2
d. virtual, erect, diminished, inside F2

The image formed by a thin concave lens is virtual, erect, diminished and inside F2. We
recommend being familiar with drawing ray diagrams by producing, from the top of any
object, 2 lines (a) one passing through the nodal point undeviated, (b) the other parallel to the
principle action passing through the second principle focus.

324-A Maddox rod is composed of:

a. concave cylindrical lenses
b. concave spherical lenses
c. convex cylindrical lenses
d. convex spherical lenses

A Maddox rod is composed of strong convex cylindrical lenses oriented parallel to each other
mounted side by side.

325-Which statement about the lacrimal gland is FALSE:

a. it receives secretomotor innervation from the Edinger-Westphal nucleus
b. it receives sensory supply from the trigeminal nerve
c. it receives its blood supply principally from a branch of the ophthalmic artery
d. it is similar histologically to the salivary glands

The lacrimal gland receives its blood supply from the lacrimal artery, a branch of the
ophthalmic artery. Its sensory innervation is derived from the lacrimal nerve, an early branch
of the ophthalmic nerve (V1). Its parasympathetic innervation travels from the superior
salivatory nucleus along the seventh nerve, synapsing in the pterygopalatine ganglion, before
continuing to the lacrimal gland via the zygomatic nerves, branches of the maxillary nerve
(V2).

326-Which chromosome or gene defect is associated with retinoblastoma:

a. PAX 6
b. HOX
c. chromosome 11
d. chromosome 18
e. chromosome 13

Retinoblastoma is caused by a defect in the Rb gene located on the long arm of chromosome
13.

327-Which statement is FALSE regarding aminoglycosides:

a. they require aerobic transport mechanisms to enter the bacterial wall
b. they act on messenger RNA
c. they are effective against streptococci
d. they are not as effective against systemic infection if given orally
 Aminoglycosides require aerobic transport mechanisms to enter the bacterial cell and are
therefore not effective against Streptococcus and strict anaerobes which do not have
oxidative transport mechanisms. All other statements are true.

328-Regarding oedema all are true EXCEPT:

a. it is caused by increased escape of fluid from capillaries and venules
b. in oedema secondary to cardiac failure, the permeability of the vessel walls is
unchanged
c. transudate contains more protein than exudates
d. the tissue pressure is important in controlling the amount of oedema
e. increased venous capillary hydrostatic pressure increases oedema

All statements are true except that a transudate contains more protein than an exudate.

329-The sixth cranial nerve:

a. arises from a nucleus closely related to the facial nerve
b. passes through the medial wall of the cavernous sinus
c. is involved in the light reflex
d. innervates the lacrimal gland

The sixth cranial nerve nucleus is found medial to the facial nerve nucleus. It is a pure motor
nerve and supplies only the lateral rectus muscle. It enters the orbit by passing through the
lateral wall of the cavernous sinus. It is not involved in the light reflex

330-The trigeminal nerve is responsible for all of the following EXCEPT:

a. proprioception to the muscles of facial expression
b. tactile sensation to the external ear pinna
c. motor innervation of the muscles of mastication
d. nociceptive sensation to the anterior scalp

The skin of the pinna is supplied by branches of the cervical nerves.

The trigeminal nerve is responsible for:
i. tactile, nociceptive and thermal sensation to the face, and up to the vortex of the
scalp
ii. motor innervation of the muscles of mastication
iii. proprioceptive sensation from the muscles of mastication, muscles of facial expression
and the extraocular muscles

331-The hyaloid artery:

a. forms part of the vascular propria lentis
b. Bergmeister's papillae is the anterior remnant
c. regresses after birth
d. communicates freely with the choroidal circulation throughout development

The hyaloid artery supplies the lens and the inner layer of the optic cup. It forms the vascular
propria lentis which supplies the lens. It regresses before birth. Mitterdorf's dot is the anterior
remnant of the hyaloid artery whereas the Bergmeister's papillae is the posterior remnant.
The choroidal circulation arises from the long and short posterior ciliary arteries and does not
communicate with the hyaloid artery.
332-Which is TRUE of the optic nerve:
a. it contains more fibres in adult than in foetal life
b. it has its longest course within the cranium
c. it enters the middle cranial fossa lateral to the internal carotid artery
d. it has the ciliary ganglion on its lateral side

The optic nerve enters the middle cranial fossa medial to the internal carotid artery. Its
longest course is within the orbit. It has more fibres in foetal life.

333-Which is the most common type of collagen in the sclera?

a. Type 5
b. Type 7
c. Type 1
d. Type 2
e. Type 3

The sclera is composed mainly of Type 1 collagen.

334-Which statement regarding amyloid is FALSE:

a. it appears as extracellular eosinophilic hyaline material
b. it is a complication of chronic infection
c. it shows an apple green birefringence in polarised light
d. it occurs in patients with multiple myeloma
e. it is made up of calcified protein

Amyloid is a fibrillar glycoprotein (not a calcified protein) which appears as extracellular

eosinophilic hyaline material. It shows an apple green birefringence in polarised light.
Amyloidosis may occur in multiple myeloma, in which case the amyloid is made up of the light
chain of immunoglobulin. Secondary amyloidosis occurs in chronic infection.

335-In a sample of 100 patients on a cardiac rehabilitation programme, maximum exercise

tolerances on treadmill testing were normally distributed with a mean of 8 minutes and a
standard deviation of 2 minutes. Which of the following conclusions is valid?
a. nearly all patients will have exercised for 8 minutes or more
b. the coefficient of variation equals 2.5%
c. around 5% of patients will have exercised for less than 4 minutes
d. the coefficient of variation equals 25%
e. all will have exercised for less than 14 minutes
Variance is a measure of the spread of observations around the mean; and it equals to the
standard deviation squared which would be 4 minutes. The co-efficient of variation is the
standard deviation divided by the mean, which in this case is 2/8 or 25%.

336-In secondary lymphoid organs:

a. T-cells form primary follicles
b. B-cells in primary follicles express IgD and IgM on their surface
c. T-cells and B-cells form follicles in the red pulp of the spleen
d. CD8 T-cell responses are important for optimal activation of B-cells
e. most recirculating lymphocytes are memory B-cells

Peripheral (secondary) lymphoid organs include spleen, lymph nodes, mucosal asociated lymphoid
tissue, the cutaneous immune system and liver. Lymph nodes are widely distributed and encounter
pathogens entering the body from all possible sites. In lymphoid organs, T-cells and B-cells are
segregated with B-cells aggregating to form follicles. Primary follicles are formed by non-activated B-
cells which have not undergone class switching, i.e., they express IgM and IgD rather than IgG, E or A.
CD8 T-cells are cytotoxic T-cells. T-helper cells are important for optimal activation of B-cells in
secondary lymphoid organs.
The spleen is specialised to trap and mount an immune response against blood borne antigens. It is
comprised of the red pulp which contains an abundance of erythrocytes. The white pulp forms a sleeve
around penetrating arterioles and contains numerous Tcells. An area called the marginal zone is closely
associated with this periarteriolar lymphoid sheath (PALS) and is rich in B-cell follicles. The marginal
zone and PALS are populated by interdigitating dendritic cells - specialised in the presentation of
antigen to T-cells. Macrophages located in the marginal zones of the spleen are very efficient at
trapping and retaining polysaccharide antigens. These are then presented to B-cells and an appropriate
immune response is initiated.
Lymph nodes are the first organised lymphoid structure to encounter antigens that enter the tissues.
Lymph nodes are divided into the cortex, the paracortex, and the medulla. The outermost cortex
contains lymphocytes (mostly B-cells), macrophages and follicular dendritic cells arranged in primary
follicles. Beneath the cortex is the paracortex, which has large numbers of T-lymphocytes and
interdigitating dendritic cells which have migrated from peripheral tissue to the lymph node after
endocytosis of antigenic material. The medulla is the innermost layer of the lymph node, and consists of
lymphocytes and many antibody secreting plasma cells.
Lymphocytes recirculate throughout the body. Naive T-cells recirculate between blood and lymphoid
organs. They do not enter tissues due to a lack of expression of the necessary adhesion molecules.
Memory T-cells follow a different route. They also recirculate between blood and lymphoid organs but
enter peripheral tissues as well, reflecting the possession of appropriate homing receptors. Therefore,
memory T-cells can encounter antigens in sites other than lymphoid organs. Memory B-cells recirculate
between blood and lymphoid organs, and retain the ability to migrate through germinal centers.
However, the majority of recirculating lymphocytes in secondary lymphoid organs are T-lymphocytes.

337-Regarding the p53 protein, which one of the following statements is FALSE:
a. it suppresses cell division
b. it is a transcription factor
c. it is a regulator of apoptosis
d. a mutation of p53 is the primary defect in the Li Fraumeni syndrome
e. it is found only in cells that have undergone malignant transformation

The normal function of p53 is to down-regulate the cell cycle by preventing the cell from
entering mitosis. p53 is known as the guardian of the genome. When there is DNA damage, it
influences transcription to facilitate DNA repair, or if the damage is too great, initiates
apoptosis. It is commonly mutated in many tumours (50%) and in the rare autosomally
inherited Li Fraumeni syndrome. In this syndrome, individuals inherit a single mutated copy
and are predisposed to a spectrum of chilhood and adult tumourssarcomas, breast tumours,
brain tumours and leukaemia.

338-Cerebrospinal fluid is produced by the choroid plexus which is located in the:

I. Lateral ventricles II. Third ventricle III. Fourth ventricle
a. II and III
b. I only
c. I and II
d. I, II and III

The CSF is produced by the choroid plexus of the lateral, third and fourth ventricles of the
brain.
339-What is the most common site for an ocular malignant melanoma:
a. ciliary body
b. iris
c. choroid
d. conjunctiva

Malignant melanoma occurs most frequently in the choroid, where there is the largest
volume of pigmented tissue in the eye, followed by the ciliary body and iris respectively.

340-Which statement about the subarachnoid space is FALSE:

a. it is located between the pia mater and the arachnoid mater
b. it contains the cerebrospinal fluid
c. it contains the meningeal vessels
d. it extends to the lower border of the second sacral vertebra

The subarachnoid space is located between the arachnoid mater and the pia mater. It
contains cerebral vessels and cerebrospinal fluid. The meningeal vessels are extradural.

341-Which structure is of ectodermal origin:

a. the corneal stroma
b. the ciliary muscle
c. iris stroma
d. the sclera

The following ocular structures are of ectodermal origin:

retina retinal pigment epithelium epithelium of the ciliary body
Mesenchymal tissues include:
the sclera the iris stroma the ciliary body

342-Which statement regarding the chorda tympani is FALSE:

a. it contains secretomotor nerves that supply the salivary glands
b. it contains parasympathetic nerves that supply the lacrimal nerve
c. it contains sensory neurons that supply the anterior two-third of the tongue
d. it passes between the internal jugular vein and the internal carotid artery as it passes
anteriorly

The chorda tympani is a branch of the nervus intermedius which in turn is a sensory
component of the facial nerve. It contains: the parasympathetic nerve fibres that supply the
salivary glands and the sensory nerve fibres that innervate the anterior two-third of the
tongue. Anatomically, it passes between the internal jugular vein and internal carotid artery
as it travels anteriorly. The greater petrosal nerve that contains parasympathetic nerve fibres
to the lacrimal nerve exits the nervus intermedius at the geniculate body and therefore is not
part of the chorda tympani.

343-Which of the following is FALSE regarding the aminoglycosides:

a. they are useful against streptococci
b. drug monitoring is recommended
c. they inhibit protein synthesis
d. they can cause ototoxicity
 Aminoglycosides such as gentamycin inhibit protein synthesis by interfering with the reading
of codons from messenger RNA. They require aerobic transport mechanisms to enter cells and
are therefore ineffective against anaerobes and streptococci, which do not exhibit oxidative
transport mechanisms. They can cause ototoxicity and nephrotoxicity necessitating drug dose
monitoring.

344-All are features of thyroid eye disease EXCEPT:

a. fibrosis between muscle fibres in chronic disease
b. perivascular lymphocytic infiltration of extraocular muscles
c. swelling of extraocular muscles on orbital imaging
d. raised T3 and T4
e. raised TSH

Thyroid eye disease occurs in Grave's disease where the circulating T3 and T4 are markedly
elevated but the TSH is low due to negative feedback of thyroid hormones on the pituitary.
Other options above are true.

345-All of the following are true of Listing's reduced eye EXCEPT:

a. it treats the eye as a single refracting surface
b. the principal plane lies within the anterior chamber
c. the nodal point lies at the anterior surface of the lens
d. it has the same refractive power as Gullstrand's schematic eye

The nodal point is at the posterior surface of the lens - all other options are true.

346-Which is FALSE of the levator palpebrae superioris:

a. its origin blends with the superior rectus
b. it is responsible for opening the eyelids
c. the lateral horn of its aponeurosis forms the lateral palpebral ligament
d. its origin is the greater wing of sphenoid

The origin of the levator palpebrae superioris is the lesser wing of sphenoid above and in front
the optic canal. Its origin blends with the superior rectus. The lateral horn of its aponeurosis
forms the lateral palpebral ligament which inserts into the lateral orbital tubercle.

347-The spinothalamic tracts transmit:

a. volitional motor pathways
b. vibration, touch and proprioception
c. pain and temperature
d. autonomic motor pathways

The spinothalamic tracts of the spinal column transmit pain and temperature. First order
neurones synapse at the spinal level, second order neurones cross the midline at the spinal
level before ascending to synapse in the thalamus.

348-All of the following viruses are associated with human carcinoma EXCEPT:
a. Epstein-Barr virus
b. Human Papilloma virus
c. Hepatitis C
d. HIV
e. Hepatitis A
Viruses that are associated with carcinoma include: Epstein-Barr virus (nasopharyngeal
carcinoma), hepatitis B and C (hepatocellular cancer), HIV virus (lymphoma, Kaposi's sarcoma),
human papilloma virus (cervical cancer).

349-Wessely's rings are a manifestation of what type of hypersensitivity?

a. Type II
b. Type I
c. Type V
d. Type IV
e. Type III

Wessely's rings, also known as immune rings, are ring infiltrates of the corneal stroma, parallel
to the limbus. Some corneal rings are probably formed as antigen from a corneal infiltrate
encounters antibody from peripheral corneal blood vessels. The infiltrate generally contains
complement factors and polymorphonuclear neutrophils (PMNs).

350-Which statement regarding the sigmoid sinus is FALSE:

a. it is at risk of thrombosis if there is severe mastoid inflammation
b. it contains blood from the cavernous sinus
c. it grooves the temporal bone
d. it is a continuation of the transverse sinus

The sigmoid is a continuation of the transverse sinus and it ends below the jugular foramen. It
grooves the occipital bone. It receives blood from the cavernous sinus via the superior and
inferior petrosal sinuses. Because of its close proximity to the mastoid air cells, infection in
this region can cause thrombosis.

351-How thick is the corneal epithelium?

a. 100-120 micrometers
b. 40 nanometers
c. 10-15 micrometers
d. 50-60 micrometers

The corneal epithelium is 50-60 micrometers thick.

352-CD4+ cells:
a. are cytotoxic cells
b. regulate the immune functions by secreting interleukin-2
c. produce antibodies
d. are B lymphocytes

CD4+ cells are known as T helper cells and account for 65% of circulating lymphocytes. They
are responsible for regulating the immune functions and secrete interleukin-2.
CD8+ cells are either cytotoxic T cells or suppressor T cells and have cytotoxic and regulatory
functions respectively
353-A 20 dioptre concave spectacle lens produces a prismatic effect of 60 prism dioptres. How
decentred is the lens:
a. 3 meters
b. 20 meteres
c. 0.33 meters
d. 3 centimeters

The prismatic power is calculated by the formula:

P=FxD
Where P is the prismatic power in prism diopters,
F is the lens power in diopters and
D is the distance from the centre of the lens in centimeters.
354-The sclera:
a. is thickest behind the insertions of the aponeurotic tendons of the extraocular muscles
b. consists of regularly arranged collagen
c. is composed mainly of collagen Type 1
d. has more proteoglycans and glycosaminoglycans in its matrix than the cornea

The sclera consists of dense irregular connective tissue, unlike the cornea which is regular in
arrangement. The sclera also has less proteoglycans and glycosaminoglycans in its matrix than
the cornea. The sclera is thinnest behind the insertions of the aponeurotic tendons and is
composed mainly of Type 1 collagen.
355-The scarring of disciform macular degeneration is the result of:
a. hyalinization of RPE
b. hyperplasia of RPE
c. dysplasia of RPE
d. fibrous metaplasia of RPE

Following choroidal neovascularization with haemorhage and leakage into the retina there is
fibrous metaplasia of RPE cells with deposition of collagen causing the discshaped mass
known as a disciform scar.

356-Which cellular component of the immune system has cytotoxic activity that is antibody
dependent?
a. natural killer (NK) cells
b. plasma cells
c. B-lymphocytes
d. T-lymphocytes
e. killer cells

Killer, or K, cells require antibody to effect cell death through so-called antibodydependent
cellular cytotoxicity (ADCC).

357-Which statement is FALSE of the pentose phosphate pathway:

a. it occurs in the cytoplasm
b. it is important in gluconeogenesis
c. it produces ribose which is important for nucleotide synthesis
d. it produces NADP for use in reductive biosynthetic reactions
 The pentose phosphate pathway converts glucose-6-phosphate to ribose with the production
of NADPH. Ribose is important for the synthesis of nucleic acids (DNA and RNA) while NADPH
is important for use in reductive biosynthetic reactions such as fatty acid synthesis. The
pathway also permits gluconeogenesis, the production of glucose from unrelated precursors.

358-Which statement about topical eye drops is FALSE:

a. timolol is a non-selective beta-1 and beta-2 blocker
b. phenylephrine is a non-selective beta-agonist
c. betaxolol is a selective beta-1 blocker
d. apraclodine is an alpha-2 partial agonist

Phenylephrine is a non-selective alpha-agonist. Other options are true.

359-Fibrotic retinal scarring after injury occurs due to proliferation of:

a. microglia
b. retinal pigment epithelial cells
c. astrocytes
d. Muller cells

The astrocytes are responsible for retinal scar tissue formation.

The function of the various retinal neuroglial cells is summarized below:
The Muller cells: are the principle supporting glial cells of the retina and are analogous to
central nervous system oligodendrocytes.
The astrocytes: form a honeycomb scaffold perpendicular to the Muller cells. They are
responsible among other functions for laying down scar tissue in injured or diseased retina.
The microglia: are highly specialized mononuclear phagocytic cells

360-With regard to the lacrimal drainage system:

a. congenital blockage is due mainly to delay in development of the puntum.
b. the nasolacrimal duct is narrowest at the lowest end
c. the nasolacrimal duct drains into the superior meatus
d. the upper lacrimal punctum is medial to the lower punctum

The upper lacrimal punctum is medial to the lower punctum. The nasolacrimal duct is
narrowest in the middle than either end. The duct runs drains via the inferior meatus.
Congenital blockage is usually due to failure of the lower end of the nasolacrimal duct
becoming patent.

361-Corneal compression can be suspected by comparing the following readings between

scans:
a. lens thickness
b. anterior chamber depth
c. corneal thickness
d. posterior chamber depth

The A-scan produces measurements for anterior chamber depth, lens thickness, and total eye
length. The normal ACD reading is between 2.5 and 4 mm. An outlier AC depth measurement
much smaller than others taken for the same eye, suggests compression of the cornea during
that reading.
362-A loupe with a magnification of x8 has a lens power of:
a. 4 dioptres
b. 32 dioptres
c. 2 dioptres
d. 8 dioptres

For the loupe, power of lens in diopters = magnification x 4

363-Which is FALSE of the stretch reflex:

a. it is inhibited by impulses from Golgi tendon organ
b. it originates in the muscle spindle
c. it is decreased in lesions of the motor cortex
d. it is a monosynaptic reflex with a response time of 1 msec

The stretch reflex is increased (not inhibited) by upper motor neurone lesions.

364-Muscles involved in opening the jaw include:

a. the medial pterygoid
b. the temporalis
c. the masseter
d. the lateral pterygoid

Jaw opening muscles: lateral pterygoid and mylohyoid.

Jaw closing muscles: medial pterygoid, temporalis and masseter.

365-The foramen rotundum transmits:

a. the maxillary nerve
b. the accessory meningeal artery
c. the lesser petrosal nerve
d. the mandibular nerve

The foramen rotundum transmits the maxillary nerve and the small veins of the cavernous
sinus. The other options supplied are transmitted through the foramen ovale.

366-Histamine causes:
a. negative chronotropic action
b. bronchodilatation
c. vasoconstriction
d. increased gastric acid secretion

Histamine causes: bronchoconstriction, vasodilation and increased gastric acid secretion. It

has a positive chronotropic action resulting from a direct effect on heart receptors and by
baroreceptor reflex due to vasodilatation.

367-During a cataract operation, the intraocular lens is accidentally placed in the sulcus rather
than within the capsular bag. This will result in:
a. myopic shift
b. hypermetropic shift
c. irregular astigmatism
d. with-the-rule astigmatism
 368-Which one of the following human leukocyte antigen (HLA) markers is associated with
the presumed ocular histoplasmosis syndrome (POHS)?
a. B8
b. B27
c. A29
d. B5
e. B7

Human leukocyte antigens (HLA) associations include:

i. A29: Birdshot chorioretinitis
ii. B7 and DR2: Presumed ocular histoplasmosis syndrome (POHS) and multiple
sclerosis (MS) B8: Sarcoidosis, intermediate uveitis
iii. B27: Idiopathic iritis, psoriatic arthritis, inflamm bowel disease, ankyl
spondylitis, Reiter's
iv. B44: Retinal vasculitis B51: Behcet's disease (in Asians only)
v. DR4: juvenile rheumatoid arthritis (JRA), Vogt-Koyanagi-Harada (VKH)
syndrome, sympathetic ophthalmia (SO)

369-A pure H-1 histamine agonist would cause all EXCEPT:

a. increased gastric acid secretion
b. capillary dilatation
c. increased vascular permeability
d. bronchospasm

H1 receptors cause:
increased vascular permeability arteriolar and capillary dilatation smooth muscle
contraction bronchospasm CNS depressant
H2 receptors cause:
increased pepsin and acid secretion increased myocardial stroke volume

370-All statements are true of the vitreous EXCEPT:

a. Cloquet's canal is a remnant of the hyaloid vein
b. the vitreous is attached to the inner limiting membrane of the retina especially near
retinal vessels
c. the cortical vitreous is attached to the pars plana via the vitreous base
d. vitreous cells known as halocytes bear similarities to macrophages

Cloquet's canal is a remnant of the hyaloid artery, which supplies the lens and vitreous in the
fetal eye.

371-Which is FALSE regarding the effects of contact lens wear on the cornea:
a. there is disturbance to the tear mucin layer
b. oxygen transfer from the tear film to the epithelium is reduced
c. there is a rise in lactate concentrations
d. the corneal stroma is thinned

The corneal stroma is thickened in contact lens wear due to impairment of deturgescent
mechanisms. Other options are true.
372-Which statement is FALSE about the occipitofrontalis:
a. it causes vertical wrinkling of the forehead
b. it is supplied by temporal branches of the facial nerve
c. upon contraction it draws the scalp backwards and elevates the brows
d. it covers the dome of the skull from the eyebrows to the nuchal lines

The occipitofrontalis draws the scalp backwards and elevates the brows causing horizontal or
transverse wrinkles on the forehead and scalp.

373-The following extraocular muscles are correctly paired as yoked muscles EXCEPT:
a. right superior oblique and left inferior rectus
b. right medial rectus and left lateral rectus
c. right superior rectus and left inferior oblique
d. right inferior rectus and left superior rectus

Yoked muscles receive equal and simultaneous innervation in accordance with the Hering 's
law. The right inferior rectus is yolked with the left superior oblique (as the eyes look right and
downwards). Other options supplied are true

374-Active transport occurs in all of the following EXCEPT:

a. glucose absorption from the gut
b. water reabsorption from the proximal convoluted tubule
c. potassium excretion in the distal convoluted tubule
d. movement of sodium ions across the cell membrane
e. water reabsorption from the collecting ducts of the kidneys

Glucose absorption from the gut, potassium excretion in the distal convoluted tubule and
water reabsorption from the collecting ducts are all examples of active transport, involving
ATP. Water reabsorption from the proximal convoluted tubule occurs due to the
concentration gradient.

375-Which statement is FALSE of drug metabolism:

a. Phase I involves oxidation reactions
b. Phase II may involve the addition of glucuronate
c. Phase II involves reducing the water solubility
d. Cytochrome P450 enzymes carry out Phase I metabolism but not Phase II

Phase I drug metabolism involves oxidation reactions and can be carried out by the
cytochrome P450 enzymes. Phase II metabolism involves conjugation reactions, such as the
addition of glucuronate, glutamine and acetate groups. This conjugation makes the molecules
more water soluble for excretion.

376-The infraorbital nerve is a terminal branch of:

a. the lacrimal nerve
b. the maxillary nerve
c. the nasociliary nerve
d. the frontal nerve
e. the mandibular nerve

The infraorbital nerve is a terminal branch of the maxillary nerve .

377-Which statement is FALSE about the optic nerve:
a. the optic disc is approximately 1.5mm in diameter
b. the raised papilla of the optic disc is more prominent nasally than temporally
c. the maculopapillary bundle constitutes 90% of all axons leaving the eye
d. the intra-ocular portion of the optic nerve is unmyelinated

The raised papilla of the optic disc is more prominent temporally than nasally owing to the
entry of the maculopapillary bundle temporally.

378-Which statement is FALSE regarding the thyroid gland:

a. it is supplied by branches of the internal carotid artery
b. it increases in size during pregnancy
c. it moves with swallowing because it is enclosed by the pretracheal fascia
d. it contains 4 parathyroid glands supplied by the inferior thyroid artery

The thyroid gland is supplied by the superior thyroid artery which is a branch of the external
carotid artery and the inferior thyroid artery which is a branch of the brachial artery. The four
parathyroid glands are supplied by the inferior thyroid artery. The thyroid gland increases in
size during pregnancy.

379-The following are true of the spleen EXCEPT:

a. it has a major haemopoietic function in foetus
b. it contains T cells in the white pulp
c. if removed in an adult this reduces susceptibility to infection
d. it contains B cells in the follicles

The spleen forms the interface between the blood and the lymphatic system. It contains the
white pulps and the red pulps. The white pulps surround the arterioles and contain T cells. B
cells are found in the follicles. The red pulps remove old or damaged red blood cells from the
circulation. Splenectomy predisposes patients to certain infections such as malaria and
pneumoccal infections.

380-Which is FALSE regarding the composition of the aqueous humour compared to plasma:
a. there is a higher concentration of ascorbate in aqueous
b. there is a higher concentration of lactate in aqueous
c. there is a lower concentration of albumin in the aqueous
d. there is a higher concentration of sodium in the aqueous

The aqueous humour has a lower concentration of virtually all constituents compared to the
plasma, with the exception of lactate, ascorbate and chloride. It therefore has a lower protein,
glucose, sodium, potassium and bicarbonate concentrations.

381-Retinoblastoma:
a. is associated with loss of the short arm of chromosome 13
b. is autosomal dominant in the inherited form
c. is inherited in the majority of bilateral cases
d. is sporadic in the minority of unilateral cases
Retinoblastoma is associated with loss of the long arm of chromosome 13. When inherited it
appears like an autosomal dominant condition but at the genetic levels both alleles must be
affected to produce the disease. Both unilateral and bilateral cases are sporadic in the
majority of cases.
382-Which statement is FALSE about the corneal epithelium:
a. it is a stratified non-keratinized squamous epithelium
b. its basement membrane is called the Bowman's layer
c. Dendritic cells decline sharply in density from the periphery towards the centre of the
cornea
d. MHC Class II cells are rare in the central corneal

The corneal epithelial basement membrane is called the basal lamina and comprises the
lamina lucida and the lamina densa. The Bowman's layer is an acellular region of the anterior
stroma. Other options above are true

383-Two heterozygous parents for a recessive condition want to know the risk that their child
will be a carrier. What will you advise them:
a. 75%
b. 50%
c. 33%
d. 100%
e. 25%

There is a 1 in 2 chance of being a carrier. We recommend drawing a 2x2 box of chromosomal

probabilities.

384-What is the spherical equivalent of a toric lens with power +2.00DS/-2.00DC:

a. +1.00 DS
b. -2.00 DS
c. +0.00 DS
d. +4.00 DS

The spherical equivalent of a toric lens is calculated by addition of the spherical power and
half the cylindrical power.

385-Which statement about the human lens is FALSE:

a. it has a higher refractive index in the nucleus than the cortex
b. it contains a higher concentration of sorbitol in the diabetic
c. it contains nucleated cells mainly on its posterior surface
d. glucose is metabolised mainly by anaerobic glycolysis

The lens contains nucleated cells mainly on its anterior surface. Other statements are true.

386-The glucose level in the normal cerebrospinal fluid is:

a. equal to the level in arterial blood
b. lower than in arterial blood
c. higher than in arterial blood
d. equal to the level in venous blood
Almost all constituents of CSF are found in lower concentration than that of blood with the
exception of Chloride and H+, which are higher. Thus, the pH and the PO2 of the CSF are lower
than that of the arterial blood. Protein is lower in the CSF (in fact it is almost absent in the
normal CSF). The glucose in CSF is 2/3 that of the blood.
387-Which is TRUE of prostaglandin analogues:
a. they lower IOP mainly by increasing uveoscleral flow
b. they lower IOP mainly by decreasing aqueous production
c. they increase IOP mainly by increasing aqueous production
d. they increase IOP mainly by an effect on the central nervous system

Prostaglandin analogues lower IOP mainly by increasing uveoscleral flow

388-Atropine:
a. causes paralysis of the iris dilator muscle
b. causes ciliary body contraction
c. increases gastric emptying
d. has a sedative effect
e. increases sweating

Atropine is a cholinergic antagonist. It causes:

delayed gastric emptying reduced sweating sedation when administered
systematically cycloplegia via ciliary body paralysis
mydriasis via iris sphincter muscle paralysis

389-Which condition is associated with excessive sunlight exposure:

a. Fuch's endothelial dystrophy
b. Granular dystrophy
c. Labrador keratopathy
d. Lattice dystrophy
e. Reis-Buckler dystrophy

Labrador keratopathy is associated with excessive sunlight exposure causing deposition of

keratinoid particles of protein in the stroma.

390-The trabecular meshwork arises from:

a. endoderm
b. neural crest mesenchyme
c. neuroectoderm
d. surface ectoderm
e. mesodermal mesenchyme

The trabecular meshwork develops from neural crest derived mesenchyme.

391-Which of the following statements regarding the standard error of the mean is true?
a. the standard error of the mean has no units
b. the standard error of the mean is the standard deviation of the sampling distribution
of the mean
c. as sample size increases, standard error of the mean becomes greater
d. the standard error of the mean is proportional to the sample size
e. the standard error of the mean is usually greater than the standard deviation

If one were to take several samples from the same population, all would result in normal
distribution curves, but they would be slightly different from each other. Each mean would be
scattered around the true population mean. The standard error of the mean is a measure of
this scatter, i.e. how accurate is the sample mean as an estimate of the true population mean.
Note, SEM = Standard deviation/square root of sample size
This demonstrates that S.E.M. is affected by two factors:
As sample size increases, S.E.M. decreases
As standard deviation increases, S.E.M. increases
Note that S.E.M. is always smaller than standard deviation.

392-All are true of anaphylaxis EXCEPT:

a. it is produced by Ig E antibody
b. it causes degranulation of basophils and mast cells
c. it causes decreased eosinophil counts
d. it causes urticarial

All statements are true except that anaphylaxis causes eosinophil counts to increase not
decrease.

393-All of the following are TRUE about antigen presenting cells (APCs) except:
a. They induce clonal T cell proliferation by producing interleukin-1
b. Neutrophils are antigen presenting cells
c. Langerhan's cells are the antigen presenting cells of the epidermis
d. Tumour necrosis factor alpha can turn endothelial cells into antigen presenting cells
e. CD8+ cells only recognise antigen presenting cells bearing MHC (major
histocompatibility complex) class I

Langerhan's cells are the antigen presenting cells of the epidermis. CD8+ cells recognise APCs
bearing MHC class I molecules whereas CD4+ recognise APCs bearing MHC class II molecules.
Antigen presenting cells are B lymphocytes, mononuclear phagocytes, tissue macrophages,
dendritic cells, Langerhan's cells and activated endothelial cells but not neutrophils.

394-All of the following muscles are supplied by the facial nerve EXCEPT:
a. temporalis
b. corrugator supercilii
c. fronalis
d. levator labii superioris
e. procerus

The muscles of facial expression are innervated by the facial nerve and include:
procerus frontalis corrugator supercilii orbicularis oculi zygomaticus major and
minor levator labii nasalis depressor supercilii occipitofrontalis.
The temporalis is a muscle of mastication supplied by the trigeminal nerve.

395-Which statement about the optic nerve is FALSE:

a. there are approximately 1.2 million ganglion cell axons in the nerve fibre layer of the
eye
b. glaucoma damages the intra-orbital portion of the optic nerve
c. there is a high proportion of glial cells in the region of the lamina cribrosa
d. the optic nerve fibres pierce the lamina cribrosa which consists of irregular collagen
bundles in figure-of-eight patterns

Glaucoma damages the intra-ocular portion of the optic nerve, that is, the portion of the optic
nerve between the optic disc and its exit from the sclera. Other options supplied are true
396-The inner capillary plexus of the retina is contained in:
a. the inner nuclear layer
b. the inner plexiform layer
c. the inner segment
d. the ganglion cell layer

The inner capillary plexus of the retina is contained in the ganglion cell layer.

397-Bowman's membrane:
a. terminates as the Schwalbe's line
b. is a basement membrane
c. is 50 microns thick
d. does not regenerate but heals by scaring

Bowman's membrane is not a true basement membrane. It is 8-12 um thick and cannot
regenerate from injury but is replaced by scar tissue from stromal keratocytes. Descemet's
membrane terminates as Scwhalbe's line.

398-Which is FALSE regarding mitochondrial genetics:

a. males cannot pass a mitochondrial condition to their offspring
b. mitochondrial DNA is circular
c. mitochondria contain their own tRNA and rRNA necessary for protein synthesis
d. the sperm do not possess mitochondria

Sperm contain many mitochondria necessary for the flagellate movements. However the
mitochondria do not enter the ova and therefore are not passed on to offspring.

399-All are true of mycobacteria EXCEPT:

a. they are aerobic
b. they are best cultured on Lowenstein-Jensen medium
c. they are usually Gram negative
d. they are acid fast
Mycobacteria cannot be stained with Gram stain and require special staining techniques such
as the Ziehl-Neelsen stain.

400-The main source of image imperfection in a small pupil is:

a. coma aberration
b. spherical aberration
c. diffraction
d. chromatic aberration

In a small pupil, abberations from refractive elements of the eye such as chromatic and
spherical abberations are reduced but diffraction, caused by light being disturbed as it passes
through a small opening, is increased.
Question 401 part 5 BASIC SCIENCES

401-Which is FALSE regarding indocyanine green:

a. it is absorbed by the RPE layer
b. it emits infrared light
c. it absorbs infrared light
d. it is better for viewing the choroidal circulation than fluorescein angiography

Indocyanine green (ICG) is not absorbed by the RPE cells, unlike fluorescein, and therefore provides a better
view of the choroidal circulation. It is useful in delineating occult choroidal neovasculation such as polypoid
CNV, which is not visible in fluorescein. The ICG dye absorbs light of wavelength 805nm and reflects light of
wavelength 835nm, both being in the infrared spectrum.

402-A ray of light parallel to the principle focus of a thin lens will:
a. be refracted parallel to the principle plane of the lens
b. reflect off the lens by total internal reflection
c. be refracted through the focal point of the lens
d. pass through undeviated

A ray of light passing through principle focus of a thin lens will be refracted through the focal point of the
lens. It is an important principle in the construction of ray diagrams, as for any object, one can predict the
image produced by drawing 2 lines (a) one passing through the nodal point undeviated, (b) the other parallel
to the principle action passing through the second principle focus.

403-The outer capillary plexus of the retina is contained in:

a. the inner plexiform layer
b. the inner nuclear layer
c. the outer nuclear layer
d. the ganglion cell layer

The outer capillary plexus of the retina is contained in the inner nuclear layer.

404-Regarding antiobiotic usage:

a. rifampicin is only effective against tuberculosis
b. intravenous vancomycin is useful in treating post-operative endophthalmitis
c. fusidic acid is ineffective against staphylococcus aureus infection
d. gentamicin is effective against Gram negative bacteria

Fusidic acid is effective against Staphylococcus aureus but resistance can occur. Vancomycin is ineffective
against endophthalmitis when given intravenously as the drug penetration into the vitreous cavity is poor.
Gentamicin is effective against mainly Gram negative bacteria (less so against Gram positives).

405-All of the following are likely to be found in a chalazion EXCEPT:

a. multinucleate giant cells
b. fat spaces
c. neutrophils
d. T lymphocytes
e. macrophages
A chalazion is the definitive example of a lipogranuloma where the release of fat (sebum from the meibomian
glands) into tissue results in a chronic inflammatory response. Neutrophils are not typical of a chronic
lipogranuloma, which is normally populated by macrophages, multinucleate giant cells and lymphocytes.

406-Microfilarial load was analysed in a cohort of children and found to be associated with age. The
regression coefficient was 0.024. Which of the following is TRUE?
a. the fact that the regression coefficient is so small means that it is unlikely to be significant
b. the null hypothesis would state that the regression coefficient is zero
c. we can use the regression coefficient to calculate microfilarial load in elderly adults
d. regression coefficients can take any value between 0 and 1
e. the regression coefficient is an estimate of the strength of the association between age and
microfilarial load

Regression coefficients are the gradient of the line of best fit and so can take any value. A small regression
coefficient may still be statistically significant (that is statistically significantly different to zero) and may have
a high correlation coefficient (r near to +1 or -1). A regression coefficient of zero, however, implies no relation
and therefore the null hypothesis. In this case, we cannot use the regression coefficient to calculate
microfilarial load in elderly adults because we cannot assume the gradient stays the same outside our sample.
The correlation coefficient is an estimate of the strength of an association.

407-The accumulations of goblet cells on the tarsal conjunctiva are called:

a. Henle's crypts
b. Haller's layer
c. Sattler's layer
d. Manz's glands

The accumulation of goblet cells on the tarsal conjunctiva are Henle's crypts. Manz's glands are the
accumulation of goblet cells on the bulbar conjunctiva nasal to the limbus.

408-Regarding the herpes zoster virus:

a. shingles results from primary infection of herpes zoster virus
b. it can be inactivated by the administration of intravenous gentamycin
c. it is a RNA virus
d. it remains in the nerve ganglia for life in patients with previous infection

Herpes zoster virus is a DNA virus. It can be inactivated by acyclovir. Following the initial infection
(chickenpox) it stays in the nerve ganglia for life and can become reactivated in time of weakened immune
system. The reactivation usually takes the form of shingles.

409-Which is FALSE regarding the iris:

a. narrowing of the pupil increases the depth of focus
b. the dilator pupillae is a continuation of the pigmented ciliary epithelium
c. iris vessels are non-fenestrated
d. narrowing of the pupil reduces optical aberrations

The dilator pupillae is a continuation of the non-pigmented ciliary epithelium. The posterior pigmented iris
epithelium is a continuation of the ciliary body pigmented cells.
.
410-Which statement is NOT true of vitreous degeneration:
a. it usually commences in the late thirties
b. it is implicated in the pathophysiology of posterior vitreous detachment
c. it involves collagen fibrils coming out of suspension
d. it involves liquefaction of the collagen gel called syneresis

Vitreous degeneration commences in humans in the late teens. Other statements are true.

411-All of the following are true about the pituitary fossa EXCEPT:
a. it forms part of the anterior cranial fossa
b. it contains cavernous sinus laterally on either side
c. it is bounded by the anterior and posterior clinoid processes
d. its roof is formed by dura mater
e. it lies above the body of the sphenoid

The pituitary fossa is part of the middle cranial fossa. All other options supplied are true

412-Midget ganglion cells and midget bipolar cells are most common in:
a. the nasal periphery
b. the peri-papillary region
c. the fovea
d. the temporal periphery

Midget ganglion and midget bipolar cells synapse with cones in a 1:1:1 ration and occur most often in the
fovea. This neural exclusivity helps to explain the high resolution of the foveal region.

413-What is the pattern of inheritance of Best diseases?

a. autosomal dominant
b. X-linked recessive
c. autosomal recessive
d. mitochondrial

Best disease is an autosomal dominant hereditary macular degeneration

414-Zeil-Neilsen stain is best used to visualize:

a. Treponema pallidum
b. Mycobacterium tuberculosis
c. Acanthoemeba
d. Haemophilus

Zeil-Neilsen stain is used for mycobacteria.

415-A 21-year-old man with insulin dependent diabetes mellitus presents with hypothyroidism. His HLA
(human leukocyte antigen) haplotype is most likely to be:
a. HLA B51
b. HLA B27
c. HLA DR4 and DR1
d. HLA A1 B8 DR3
 HLA A1 B8 DR3 is commonly associated with organ specific autoimmune disease. IDDM can also be
associated with DR4. HLA B27 is strongly associated with seronegative arthritis, and HLA B51 is associated
with Behcet's disease. HLA DR1 and DR4 (or a shared epitope in these class II proteins) is associated with RA
(rheumatoid arthritis).

416-The primary visual cortex is referred to as:

a. area 18
b. area 20
c. area 19
d. area 17

The primary visual cortex is also known as area 17 in the map of the human cerebrum.

417-Which of the following does NOT apply in hypovolaemic shock:

a. the urine output decreases
b. the pulse rate increases
c. there is a fall in renin concentration
d. the blood flow to the brain and kidneys are initially maintained
e. there is a loss of more than 20% of the blood volume

Renin secretion is increased during hypovolaemic shock to maintain the plasma volume by conserving water.
All other options are true.

418-All are true of Acanthoemeba EXCEPT:

a. it is a common cause of corneal ulcer in contact lens wearers
b. acanthoemeba keratitis is resistant to conventional antibiotic drops
c. it is a commensal and may be recovered from nasal and pharyngeal swabs
d. it is best grown on non-nutrient E.coli infused agar

Acanthoemeba is an uncommon cause of contact lens related corneal ulceration, which is usually caused by
pseudomonas. However, it is more likely in contact lens wearers. It is grown on non-nutrient e.coli agar and is
difficult to culture. It responds poorly to conventional first-line antibiotic drops.

419-The Bruch's membrane is composed of:

a. 4 layers
b. 2 layers
c. 5 layers
d. 3 layer

420-All of the following antibiotics inhibit cell wall synthesis EXCEPT:

a. gentamicin
b. cephalosporins
c. vancomycin
d. penicillins

Penicillins, cephalosporins and vancomycin all inhibit cell wall synthesis. Aminoglycosides such as gentamicin
inhibit bacterial protein synthesis.
421-Which of the following describes retinal oedema following blunt trauma:
a. commotio retinae
b. retinoschisis
c. cystoid macular oedema
d. serous retinal detachment
e. retinal macroangiopathy

Commotio retinae describes diffuse retinal oedema following blunt trauma likely due to transient ischaemia
and disruption of axoplasmic flow.

422-Which antibiotic does NOT inhibit bacterial cell wall synthesis:

a. benzylpenicillin
b. vancomycin
c. cephalosporins
d. ciprofloxacin

Ciprofloxacin is a quinolone antibiotic, which blocks DNA synthesis by inhibiting DNA gyrase. Meanwhile
penicillins, cephalosporins and vancomycin all inhibit cell wall synthesis.

423-The following are true about the Fc regions of immunoglobulins EXCEPT:

a. they are responsible for antibody binding
b. they are involved in mast cell binding
c. they are involved in the activation of the complement cascade
d. they determine the ability of the immunoglobulins for transplacental transfer

Antibody binding is carried out by the Fab (antibody) fragments. Other options are true.

424-Which statement is FASLE regarding glucagon:

a. it inhibits gluconeogenesis in the liver
b. it is secreted by alpha-islet cells of the pancreas
c. it is a polypeptide hormone
d. it has a positive cardiac inotropic effect

Glucagon stimulates gluconeogenesis. All other options are true.

425-All of the following are useful stains for identifying fungi EXCEPT:
a. Gram stain
b. Gomori methenamine silver
c. PAS (periodic acid-Schiff)
d. Haematoxylin and eosin (H & E)

Fungi stain:
pink with H & E purple with PAS black with Gomori methenamine silver

426-Regarding CO2 in venous blood:

a. it is carried mainly by the haemoglobin
b. CO2 does not cross the blood brain barrier
c. it is transported mainly in the form of bicarbonate ions
d. oxygenated haemoglobin binds CO2 more readily than deoxygenated haemoglobin
CO2 is converted to hydrogen ions and bicarbonate ions by the carbonic anhydrase in the red blood cells.
Most bicarbonate ions leave the red blood cells and are carried in the plasma. Only 5% of CO2 is bound to the
haemoglobin. Deoxygenated haemoglobin binds CO2 better than oxygenated haemoglobin. CO2 crosses the
blood brain barrier readily.

427-Which of the following genetic conditions is NOT associated with increased risk of cancer:
a. Chromosome 13q deletion
b. Neurofibromatosis Type 1
c. Turner's syndrome
d. Neurofibromatosis Type 2
e. Down's syndrome

Turner's syndrome is not associated with an increased risk of cancer. Chromosome 13q deletion is associated
with retinoblastoma. Neurofibromatosis Type 1 is associated with meningioma, glioma and
phaeochromocytoma. Neurofibromatosis Type 2 is associated with bilateral acoustic neuroma. Down's
syndrome is associated with acute leukemia.

428-Which of the following is integral to the structure of cellular basement membranes?

a. laminin
b. fibrillin
c. Type II collagen
d. Elastin

Laminin is an extracellular matrix protein integral to the structure of basement membranes.

429-A randomised controlled trial for a new drug compared to placebo, has been undertaken in a cohort of
100 patients. The trial follows the principle of intention to treat.
Which of the following must occur in an intention-to-treat analysis?
a. exclusion of the patients who did not take the new drug
b. exclusion of the patients who dropped out due to side effects
c. inclusion of patients who were still living after the trial
d. in both groups patients who drop out are included in analysis at the end of the trial
e. exlusion of the patients who were not followed up

An intention-to-treat analysis requires that patients who drop out (e.g. due to side effects) should still be
included in statistical analysis at the end of the trial.

430-A reduction in the number of chromosomes occurs in:

a. Fragile-X syndrome
b. Retinoblastoma
c. Klinefelter's syndrome
d. Turner syndrome
e. Down's syndrome

Turner syndrome has 1 less sex chromosome XO. Down's syndrome and Klinefelter's have an extra
chromosome (trisomy 21, and xxY respectively). Fragile X and retinoblastoma have the normal number of
chromosomes.
431-Which is FALSE regarding the central retinal artery:
a. its large arterial branches travel in the nerve fibre layer
b. its large arterial branches contain a thin internal elastic lamina
c. it pierces the optic nerve about 1cm behind the eye
d. it is a branch of the ophthalmic artery

The arterial branches of the central retinal artery contain no internal elastic lamina, which is lost at the optic
disc. This means they are not involved in temporal arteritis. The other statements above are true.

432-Which of the following statements is TRUE regarding the thyroid hormones:

a. T4 is more active than T3
b. in the serum most of the thyroid hormones are bound to albumin
c. they are steroid hormones
d. thyroid hormones sensitize the myocardium to noradrenaline

Thyroid hormones are peptides not steroids. T3 is the more active form compared to T4. Over 99% of thyroid
hormones are bound to the protein in serum and the most common protein that binds these hormones is the
globulin thyroxine-binding globulin (TBG). Thyroxine sensitizes myocardium to noradrenaline.

433-Which is true of endotoxin:

a. it is derived from the cell wall of Gram negative bacteria
b. it elicits an antibody response which may protect the host from future attack
c. it cannot survive autoclaving
d. it is involved in botulism

Endotoxins are lipopolysaccharides derived from the cell wall of gram negative bacteria. They are heat stable,
non-antigenic, cause septicaemia and fever and activate the alternative complement pathway.

434-Which statement is FALSE regarding the visual pathway:

a. the optic tract leaves the chiasm and winds around the cerebral peduncles
b. the lateral root of the optic tract terminates in the medial geniculate body
c. the optic tracts divide into a large lateral root and a smaller medial root
d. the fibres from the nasal hemiretina decussate at the chiasm

The lateral root of the optic tract terminates in the lateral geniculate body and is concerned with conscious
vision.

435-The posterior pituitary gland secretes:

a. thyrotrophin
b. oxytocin
c. adrenocorticotrophic hormone (ACTH)
d. prolactin

The anterior pituitary gland secretes:

prolactin
ACTH TSH LH and FSH GH
The posterior pituitary gland secretes:
oxytocin ADH
436-Which of the following promotes proliferation of cells during development:
a. collagen
b. proteoglycans
c. hyalaronan
d. fibronectin

Fibronectin is an extracellular matrix protein that binds to surface proteins called integrins on cell membranes
and also binds to other extracellular matrix proteins. It has an important role in cell growth, differentiation,
migration and wound healing among other roles.

437-Which statement is NOT true regarding corneal healing:

a. stromal keratocytes transform into fibroblasts to heal stromal wounds
b. the Bowman's layer regenerates more slowly than the epithelium
c. the corneal epithelium heals from the limbus centrally
d. Descemet's membrane does not regenerate

Neither the Bowman's layer nor Descemet's membrane can regenerate. Endothelial cells cannot replicate
either and must slide to fill defects. Other statements above are true.

438-The retinal pigment epithelium is continuous anteriorly with:

a. the pigmented ciliary epithelium
b. the non-pigmented ciliary epithelium
c. the scleral spur
d. the pigmented trabecular meshwork

The RPE is continuous anteriorly with the pigmented ciliary epithelium.

439-Which statement regarding hypermetropia is FALSE:

a. it is present in most children between the ages of 2 and 6 years
b. it should be fully corrected in esotropic children
c. contact lens correction reduces the demand for accommodation
d. it delays the onset of presbyopia

In hypmertropia presbyopia develops earlier. All other options are true.

440-Which is FALSE regarding the corneal stroma:

a. it contains glycosaminglyans including hyaluronate
b. it has a higher water content than the sclera
c. the main collagen is Type I
d. collagen fibril diameter is highly regular

The cornea comprises glycosaminoglycans which are important in maintaining regular spacial arrangements
of collagen fibrils. The main GAG's of the corneal stroma are keratan sulphate and dermatan sulphate. The
corneal stroma is unusual in that it contains no hyaluronate.
Note that the corneal stroma has a higher hydration than most tissues including the sclera with a water
content of 80%, in spite of the endothelium pump. This is because of the high water-imbibing properties of
the cornea, due to its high glycosaminoglycan content.
441-HLA B27 is most strongly associated with:
a. Behcet syndrome
b. ankylosing spondylitis
c. sympathetic ophthalmitis
d. Birdshot chorioretinopathy

The following HLA associations are recognized:

ankylosing spondylitis: B27 Behcet syndrome: B51 Birdshot chorioretinopathy: A29

442-A 4-month-old baby receives his third vaccination against diptheria, tetanus and pertussis.
Which of the following is most true of his antibody response:
a. genetic recombination produces heavy and light chains from the same gene
b. it is unimportant in his subsequent response to infection with diptheria
c. the diversity of antibody specificities is identical to the number of different B-cell clones
d. his B-cells cannot switch antibody production from IgG to IgM

Immunoglobulin genes coding for heavy and light chains are located on different chromosomes. The genes
encoding the heavy chain are found on chromosome 14 in humans. Genes encoding the kappa light chain are
found on chromosome 2 and the human lambda light chain gene cluster is located on chromosome 22. Each
locus has a similar organisation - the variable region genes are composed of multiple gene segments (+/- 100 -
200) separated by non-coding DNA. At the 3' end of these genes are additional coding sequences which
comprise the joining (J) and diversity (D) segments. Only the heavy chain gene locus has diversity segments. J
and D segments code for the carboxyl terminal ends of the variable domains. Different V, J and D genes
recombine to give rise to contiguous DNA that codes for the variable domain of the protein. The constant
region genes are located at varying distances from the 3' end of the V genes. Splicing of the primary RNA
transcript aligns the constant genes adjacent to the recombined VDJ DNA segments. Random recombination
of different V, D, and J gene segments generates antibody diversity. Diversity is also increased as there is
imprecise joining between the 3' end of a V gene and the 5' end of a J segment in a light chain or the ends of
V, J, and D segments in a heavy chain. These ends can recombine at any of several nucleotides in the germline
sequence. Additional diversity is provided by the action of TdT - an enzyme which adds extra nucleotides to
the rearranged VJ or VDJ segments. It must also be remembered that the combination of different light chains
with different heavy chains contributes to the range of antibody produced. After the mature B-cell has left the
bone marrow and is activated by specific antigen, the cell enters the germinal centre of lymph nodes and
spleen where it undergoes somatic hypermutation. This process introduces point mutations into the variable
region exons of both heavy and light chains, particularly in the hypervariable region. These mutations serve to
increase the affinity of the BCR for the specific antigen. Follicular dendritic cells present specific antigen to the
rapidly mutating B-cell population, and only those cells baring surface antibody with high affinity can
'outcompete' other cells, receive a survival signal, and avoid apoptosis. Thus, the diversity of antibody
specificities far exceeds the number of different B-cell clones. RAG1/2 are necessary to recombine
immunoglobulin and T-cell receptor genes. These proteins recognise a signal sequence adjacent to the points
at which recombination will take place; the RAG proteins introduce a single strand DNA break, and initiate
somatic recombination. In their absence, there is no rearrangement of the Ig or TCR genes which remain in
the germline configuration. This impairs B-cell and T-cell development and results in the SCID phenotype.
Mature B-cells leaving the bone marrow express IgM and IgD as the B-cell receptor. After activation in the
periphery these cells can switch antibody production to IgG, IgE, or IgA by a process termed switch
recombination. They are however unable to switch back to production of IgM after isotype switch has
occured as the process involves a looping out and deletion of intervening DNA encoding the Cm and Cd
region. The antibody response (blocking antibodies) is important in the provision of protective immunity
against diptheria toxin.
443-Which mediator of acute inflammation is NOT derived from cells:
a. cytokines
b. leukotriene
c. complement
d. histamine

Most mediators are derived from cells with the exception of: complement, kinin, clotting factors, and
fibrinogen, which are all derived from the plasma.

444-The fourth cranial nerve nucleus resides in:

a. the medulla
b. the upper pons
c. the caudal pons
d. the midbrain

The fourth cranial nerve nucleus resides in the midbrain.

445-The depth of the anterior chamber depth is:

a. 1.1mm
b. 5.1 mm
c. 3.1 mm
d. 1.5 mm

The average adult eye has an anterior chamber depth of 3.1mm.

446-The internal carotid artery:

a. gives rise to the posterior cerebral arteries
b. traverses the foramina transversaria of the cervical vertebra 1-6
c. forms the basilar artery
d. enters the cranium through the carotid canal
The internal carotid artery enters the cranium through the carotid canal and terminates as the middle and
anterior cerebral arteries. The vertebral artery transverses the foramina transversaria of the cervical
vertebrae 1-6. The basilar artery is formed by the vertebral artery.

447-The functions of the following sensory receptors are correct EXCEPT:

a. free nerve endings for nociception
b. Ruffini's corpuscles for proprioception
c. Meissner's corpuscles for touch
d. Pacinian corpuscles for nociception
All statements are correct except Pacinian corpuscles are for vibration and proprioception.

448-Which is FALSE regarding retinopathy of prematurity:

a. the medial retina is usually the last to be perfused in a premature infant
b. it can result in abnormal vascular proliferation
c. it can be treated by laser photocoagulation
d. it may lead to retinal detachment
 The temporal retina is usually the last to be perfused in a premature infant, and it is from this area of
ischemic retina that growth factors are produced that drive new abnormal vessel formation. If left untreated
vasoproliferation can lead to retinal detachment and blindness.

449-The orbital wall which is most likely to be involved in a blow-out fracture is:
a. the lateral wall
b. the floor
c. the roof
d. the medial wall

The medial orbital wall is the thinnest orbital wall but the orbital floor is the most likely to be involved.

450-The cells of the retinal pigment epithelium:

a. contain melanin granules
b. are shorter at the fovea than elsewhere in the retina
c. are of mesenchymal origin
d. form the inner blood-retina barrier

The cells of the retinal pigment epithelium are of ectodermal origin. They are taller in the fovea and flatten
towards the periphery. They contain melanin granules which absorb excess light and prevent radical damage
to the cell. They phagocytose the photoreceptors segment and store vitamin A and therefore play an
important part in the regeneration of photoreceptors. They form the outer blood-retina barrier.

451-A 36 dioptre convex lens used as a loupe will produce a magnification of:
a. 12x
b. 3x
c. 6x
d. 9x
For the loupe, power of lens in diopters = magnification x 4

452-All statements are true about the oculomotor nerve and its branches EXCEPT:
a. the superior division of the oculomotor nerve supplies the superior rectus and the levator palpebrae
superioris
b. pre-ganglionic parasympathetic fibres from the oculomotor nerve pass to the ciliary ganglion via the
branch of the inferior division that supplies the inferior oblique
c. the inferior division of the oculomotor nerve supplies the medial rectus, inferior rectus and inferior
oblique
d. post-ganglionic parasympathetic fibres reach the eye via the long ciliary nerves
Post-ganglionic parasympathetic fibres reach the eye after leaving the ciliary ganglion via the short ciliary
nerves, to supply the choroid, the sphincter pupillae of the iris and the ciliary muscle.

453- A 16-year-old with eczema has several anaphylactic attacks to an unknown trigger. Which of the
following is most true of his illness:
a. attacks are unlikely to be triggered by inhaled or ingested antigen
b. histamine antagonists have no role in his management
c. he is likely to have higher IgE levels than his unaffected sibling
d. exposure to the triggering antigen is likely to occur several hours before the attack
e. IgM levels reflect disease activity
 Anaphylaxis and eczema are examples of IgE-mediated (immediate) type I hypersensitivity reactions. This
type of reaction tends to be triggered by inhaled or ingested antigen. IgE antibody produced in response to
these antigens binds with high affinity to receptors on mast cells and basophils (sensitisation). Later exposure
to the same allergen (usually at low dose) cross-links these receptors and results in degranulation of mast
cells with release of vasoactive substances - histamine, 5HT, heparin, prostaglandins and leukotrienes.
Histamine is the major effector molecule of the immediate phase. The reaction occurs rapidly after antigen
exposure within 2 to 30 minutes and results in increased vascular permeability and smooth muscle
constriction. As the immediate hypersensitivity reaction subsides (+/- 4-6 hrs later), the late phase reaction
develops. This is characterised by infiltration of inflammatory cells including eosinophils. Other clinical
manifestations of type I hypersensitivity include allergic rhinitis, bronchial asthma, hay fever and food
allergies. Atopic individuals tends to have higher levels of circulating IgE and are therefore prone to this type
of allergic reaction. Histamine antagonists are useful to counteract mast cell released histamine.

454 -The retinal pigment epithelial cells are connected by:

a. desmosomes
b. gap junctions
c. tight junctions
d. hemidesmosomes

The retinal pigment epithelial are connected by tight junctions which play a vital role in maintaining the
integrity of the blood-retina barrier.

455-The inferior branch of the oculomotor nerve supplies the following structures EXCEPT:
a. medial rectus
b. dilator pupillae of the iris
c. inferior oblique muscle
d. ciliary body

The inferior branch of the oculomotor nerve, via its parasympathetic fibres, supplies the ciliary muscle and
the sphincter pupillae muscle of the iris. It does not, however, supply the dilator pupillae, which is supplied by
sympathetic fibres travelling via the nasociliary nerve. The inferior branch also provides motor innervation to
the inferior rectus, medial rectus and inferior oblique.

456-All of the following are TRUE of the autonomic nervous system EXCEPT:
a. botulin toxin blocks acetylcholine receptors
b. preganglionic sympathetic fibres are usually shorter than preganglionic parasympathetic
c. acetylcholine is the neurotransmitter at both sympathetic and ganglia
d. pre-ganglionic sympathetic cell bodies are found in the lateral horn of the spinal chord
Botulin toxin inhibits the exocytosis of acetylcholine in the preganglionic fibers. The other options are true.

457-The largest cranial nerve is:

a. the oculomotor
b. the vagus
c. the facial
d. the trigeminal

The trigeminal nerve is the largest cranial nerve leaving the brainstem, as it supplies sensation to the entire
face.
458-The Bruch's membrane is also known as:
a. the lamina fusca
b. the lamina densa
c. the lamina cribrosa
d. the lamina vitrea

Bruch's membrane is otherwise known as the lamina vitrea. The lamina fusca is the outer layer of the sclera.
The lamina cribrosa transmits the optic nerve. The lamina densa is part of the basement membrane of the
corneal epithelium.

459-Graves' disease is a manifestation of what type of hypersensitivity?

a. Type IV
b. Type V
c. Type III
d. Type II
e. Type I

Graves' disease and myasthenia gravis are examples of Type V hypersensitivity. In these conditions,
antibodies react with cell surface receptors and either stimulate or depress cellular function.

460-Which statement is FALSE about the corneal epithelium:

a. it is 50-60 micrometers thick
b. its anterior surface has numerous microvilli
c. it is a stratified non-keratinized squamous epithelium
d. epithelial cells are held together by numerous hemi-desmosomes

Corneal epithelial cells are held together by numerous desmosomes. Hemi-desmosomes anchor the epithelial
cells to the underlying basal lamina. Other options are true.

461-Regarding X-linked recessive disease:

a. the fathers pass the abnormal gene to their sons
b. the maternal age is a factor in passing the abnormal gene to the offsprings
c. the mother is always the carrier
d. female offspring of a carrier female have a 50:50 chance of being a carrier

X-linked recessive disease is always manifested phenotypically in the male due to the absence of a paired X-
chromosome. However, some females may also exhibit the signs and symptoms of the disease despite being a
carrier (variable penetrance). This may occur if the normal X-chromosome is inactivated. The mother is not
always the carrier

462-Which statement is INCORRECT regarding the wave theory of light:

a. light waves are coherent if they have the same frequency and amplitude
b. destructive interference contributes to the clarity of the cornea
c. destructive interference results from the interaction of light waves of opposite phase
d. wavelength of light is inversely proportional to its frequency
e. low reflection coatings depend upon the property of destructive interference

Light waves are coherent if they are in phase with one another. All other options are true.
463- Which one of the following cytokines is commonly secreted by the T-helper 2 cell:
a. IL-2
b. IFN-gamma
c. IL-4
d. TNF-alpha
e. IL-1

TH1 cells commonly secrete IFN gamma and IL2, leading to B cell, natural killer and macrophage activation.
TH2 cells secrete IL3, 4,5 and 6, leading to mast cells and eosinophil activation.

464-All of the following receive blood draining from the cavernous sinus EXCEPT:
a. sigmoid sinus
b. superior petrosal sinus
c. superficial middle cerebral vein
d. inferior petrosal sinus

The superficial middle cerebral vein drains into the cavernous sinus. Other options supplied are true.

465-Which is FALSE regarding bifocal glasses:

a. the optical centre lies midway between the distance and reading segments
b. decentration of the reading segment can be used to treat diplopia for near
c. the executive type may be used in the treatment of accommodative spasm
d. they are used in the management of convergence excess esotropia

The distance and reading segments of bifocals have separate optical centres - so the statement is false.

466-The variable regions of the immunoglobulin molecule correspond to:

a. the carboxy termini of the light chains
b. the amino termini of both the light and heavy chains
c. the amino termini of the light chains
d. the carboxy termini of both the light and heavy chains

The variable regions of the immunoglobulin molecule are the amino termini of both the light and heavy
chains.

467-Zonuluae occludantes occur:

a. between retinal pigment epithelial cells
b. in the choriocapillaris
c. between corneal epithelial cells and the Descemet's membrane
d. between pigmented ciliary epithelial cells

Zonulae occludantes refer to tight junctions between cells. Tight junctions occur between retinal pigment
epithelial cells of the retina which is vital to the integrity of the bloodretinal barrier. They also occur between
non-pigmented ciliary epithelium which is important in the blood aqueous barrier.
468-All of the statements below are true about chromatic aberration EXCEPT:
a. the degree of chromatic aberration in the human eye is 2-3 dioptres
b. blue light is more deviated by refraction than red
c. it cannot be corrected by optical means
d. perspex produces greater dispersion of light than crown glass
e. it is the basis of the duochrome test
-Achromatic lenses can overcome chromatic aberration

469-Which is the FALSE statement about mitochondrial DNA:

a. a defect in mtDNA can give rise to Leber's hereditary optic atrophy
b. a defect in mtDNA can cause myoclonic epilepsy and ragged red fibres (MERRF)
c. the genome lacks introns
d. it is inherited exclusively through the paternal line
e. it is heterogeneous from cell to cell in the same individual

Mitochondria possess genomes that are distinct from nuclear DNA. Mitochondrial DNA is composed of a
circular loop of double-stranded DNA. Spermatozoa contain abundant mitochondria but these are confined to
the tail region and do not penetrate the ovum on fertilization. Thus, the mitochondrial genome is inherited
from the mother. In mammals, there are no introns and genes overlap.
The mitochondrial genome encodes 37 genes that produce structural RNA (22 tRNA, and 2 rRNA), and
proteins that form part of the oxidative phosphorylation electron transport chain (complex I, III, IV and V).
Complex II consists entirely of nuclear DNA encoded subunits. Each cell has thousands of mitochondria;
therefore, the mtDNA content within an individual is heterogeneous.
Defects in mtDNA give rise to a heterogeneous group of disorders characterized by the presence of abnormal
muscle fibrils called red ragged fibers. This appearance isdue to the accumulation of abnormal mitochondria.
Mutations of mitochondrial DNA have been implicated in Leber's hereditary optic atrophy (LHON) - painless
subacute visual loss, with central field defects, abnormal color vision and optic atrophy. Myoclonic epilepsy
and ragged red fibers (MERRF) is characterized by myoclonus, epilepsy and ataxia with the frequent
occurence of dementia, optic atrophy and variable degrees of deafness. Other diseases include; Leigh disease,
Kearns-Sayre syndrome, familial progressive external opthalmoplegia (PEO), MELAS (mitochondrial
myopathy, encephalopathy, lactic acidosis and stroke-like episodes).

470-Which is TRUE of the back vertex distance:

a. it is used in determining the power of a reading addition
b. it is greater in a trial frame than in a phoropter
c. it is measured from the anterior orbital rim
d. increased back vertex distance decreases the effective power of a concave lens

Back vertex distance is measured from the anterior corneal surface. It is greater in a phoropter than in a
trial /8frame. The back vertex distance is not used in determining the power of the reading addition.9/687
6542//8

471-Which is FALSE regarding Giant cell arteritis:

a. biopsy reveals patchy vessel involvement
b. there is often obliteration of the artery lumen
c. Giant cells are found mostly in the internal elastic lamina
d. it can affect the central retinal arteries and retinal arterioles
Giant cell arteritis can affect the cerebral arteries, the ophthalmic artery and the central retinal artery but it
will not affect retinal arterioles because they do not possess an elastic layer.
472-All of the pairs below are correctly matched EXCEPT:
a. Type IV hypersensitivity: giant cell arteritis
b. Type II hypersensitivity: Arthus reaction
c. Type IV hypersensitivity: contact dermatitis
d. Type I hypersensitivity: angioedema

All are correctly matched except Arthus reaction is a Type III (not Type II) hypersensitivity.
Type I hypersensitivity is provoked by re-exposure to a specific antigen. These exposures may be by
ingestion, inhalation, injection, or direct contact. It is mediated by IgE antibodies and produced by the
immediate release of histamine, arachidonate and derivatives of basophils and mast cells. The reaction may
be local or systemic.
In Type II hypersensitivity, the antibodies produced by the immune response bind to antigens on the
patient's own cell surfaces. IgG and IgM antibodies bind to these antigens to form complexes that activate the
classical pathway of complement for eliminating cells presenting with foreign antigen. The reaction takes
hours to a day. Hemolytic anemia is an example.
In Type III hypersensitivity, soluble immune complexes form in the blood and are deposited in various
tissues where they may trigger an immune response according to the classical pathway of complement
activation. The reaction takes hours to days to develop. Serum sickness and Arthus reaction are classical
examples.
Type 4 hypersensitivity is often called delayed type as it takes two to three days to develop. Unlike the
other hypersensitivities which are antibody mediated it is a type of cell-mediated response.

473-Which of the following statements regarding complement is true:

a. the classical complement pathway can be activated by IgG and IgM
b. the only function of complement activation is the lysis of pathogens
c. the alternative pathway involves activation by lectin
d. compliment proteins are produced by most epithelial cells

Complement proteins are synthesised by macrophages and hepatocytes. There are 9 plasma proteins (heat
labile) circulating in an inactive form.
There are three pathways of complement activation: the classical and alternative complement pathway and
the lectin pathway. All share a common terminal set of events which lead to the formation of the membrane
attack complex which lyses pathogens.
The classical pathway is activated by immune complexes or by antibody bound to antigen on e.g., the
bacterial cell wall. IgM (most efficiently), IgG1, IgG2, IgG3, but not IgA can activate the classical pathway.
The alternative complement pathway is activated in the absence of antibody by bacterial cell wall
constituents e.g., LPS, techoic acid, some viruses, dextran, and occasionally IgA.
The lectin pathway is initiated by binding of serum lectin to mannose-containing proteins or to CHO on the
bacteria or viruses.
The membrane attack complex (MAC) formed by complement activation is capable of lysing a broad spectrum
of microorganisms - particularly enveloped viruses and gramnegative bacteria. However, gram-positive
bacteria are generally resistant to complement-mediated lysis due to the thick layer of peptidoglycan in their
cell wall or due to capsular sialic acid. Other microorganisms can evade lysis by the MAC by various
mechanisms. Deficiencies in terminal complement components result in infections with Neisseria spp, but
generalised susceptibility to infection is not noted. Therefore, lysis of organisms by the MAC is only one of the
multitude of effects of the complement pathway:
 its most important function is performed by intermediates which facilitate the uptake and destruction of
pathogens and immune complexes. Complement components (e.g., C3b, C5a and C4b) are recognised by
specific receptors on phagocytes and enhance phagocytosis of the coated pathogen.
C3a, C4a and C5a act as anaphylatoxins - they induce smooth muscle contraction and increase vascular
permeability.
C3a and C5a mediate degranulation of mast cells with histamine release and vasodilatation resulting in the
recruitment of antibody, complement and phagocytic cells to the site of infection.
Complement plays an important part in viral neutralisation by coating the virus and blocking their
attachment to cellular receptors.
The complement system also promotes the phagocytic clearance of immune complexes.
Complement derivatives promote humoral immunity by aiding in antigen presentation to B cells in
germinal centres, and by binding to a receptor on B cells which acts as a co-stimulator.

474-Which type of collagen is important in the formation of anchoring fibrils connecting the corneal
epithelium to the underlying Bowman's layer:
a. Type VII
b. Type V
c. Type II
d. Type I

Type VII collagen forms an integral part of hemidesmosomes and the anchoring fibril architecture of the
corneal epithelium to the Bowman's.

475-All are true of the oculomotor nerve parasympathetic fibres EXCEPT:

a. they follow the inferior division of the third nerve after its bifurcation in the cavernous sinus
b. they synapse in the ciliary ganglion
c. they originate from the Edinger-Westphal nuclei in the midbrain
d. they are transmitted via the long ciliary nerve to the iris sphincter

The parasympathetic fibres are transmitted via the short ciliary nerve to the iris sphincter.

476-Which of the following processes most commonly leads to Duchenne, rather than Becker, Muscular
Dystrophy?
a. lyonization
b. chromosomal non-disjunction
c. out of frame mutation
d. DNA mismatch repair
e. X-autosome translocation

Muscular dystrophy is caused by an abnormality of the dystrophin gene and its protein product. If an out-of-
frame mutation occurs, the gene will not be transcribed properly and the dystrophin protein will not be
produced at all. This leads to Duchenne Muscular Dystrophy (DMD), with its severe symptoms and limited
lifespan. In contrast, Becker Muscular Dystrophy is not as severe. This is because the mutation in the gene in
this disease is in-frame, in other words the C and N-terminus binding regions are preserved, it is only the
middle part of the protein that is produced wrongly. This leads to less limitation of function and a milder form
of the disease compatible with a normal lifespan and prolonged ambulation. X-autosome translocation and
lyonization explain the occasional appearance of this disease in females.
477-The left recurrent laryngeal nerve:
a. supplies the cricothyroid muscle
b. arises from the vagus nerve as it crosses the first part of the subclavian artery
c. is a pure motor nerve
d. courses superiorly in the groove between the esophagus and trachea

The left recurrent laryngeal nerve arises from the vagus nerve as it crosses the arch of the aorta. It ascends in
the groove between the trachea and esophagus and lies anterior to the sympathetic trunk. It also has a
sensory component that supplies part of the mucous membrane of the larynx and trachea. It supplies all the
laryngeal muscles except the cricothyroid muscle which is supplied by the external laryngeal nerve.

478-All statements are true of the abducens nerve EXCEPT:

a. it courses upwards in the pontine cistern
b. it is bound down to the brainstem close to its origin by the anterior superior cerebellar artery
c. it enters the orbit through the superior orbital fissure and within the tendinous ring
d. it changes from a vertical to horizontal course on reaching the apex of the petrous temporal bone

The abducens nerve is bound down to the brainstem close to its origin by the anterior inferior cerebellar
artery

479-Which of the following is FALSE regarding the identification of lenses:

a. measurement of plastic lenses with a Geneva lens measure requires a correction factor
b. it is best to place a neutralising lens against the back surface of the spectacle lens
c. prismatic power is best measured with a focimeter
d. the Geneva lens measure determines surface curvature

Prismatic power cannot be measured with a focimeter.

480-Which statement is TRUE regarding refraction:

a. a convex spherical curved surface causes parallel light to diverge
b. the refracting power of a spherical curved surface in air is equal to its refractive index divided by its
radius of curvature
c. on passing into a medium of greater refractive index, light is deviated away from the normal to the
interface
d. Snell's law states that the angle of incidence divided by the angle of refraction is equal to the change
in refractive index

Light is deviated towards the normal to the interface on passing into a medium of greater refractive index.
Snell's law slates that the sine of the angle of incidence divided by the sine of the angle of refraction is equal
to the change in refractive index. A convex spherical curved surface causes parallel light to converge.

481-In a survey of 200 patients, 61 have a slow-rising pulse, 40 of whom have aortic stenosis on echo. A
further 4 also have aortic stenosis on echo, who are not found to have a slow-rising pulse.
Which of the following is correct?
a. the specificity of a slow-rising pulse for AS equals 21/156
b. the positive predictive value of a slow-rising pulse for diagnosing AS equals 40/44
c. the pretest probability of aortic stenosis is 44/200
d. we cannot be sure of the prevalence of aortic stenosis in this sample
e. the sensitivity of a slow-rising pulse for AS equals 40/61
For this and similar questions you should plot a standard sensitivity-specificity table and plot the values.
Pretest probability of this test is same as disease prevalence, that is 40 + 4 / 200 = 44/200 and this is the
correct option.

482-The following are true of oncogenes EXCEPT:

a. gene translocation can transform proto-oncogenes
b. mutated proto-oncogenes are associated with cancer
c. proto-ongenes cause abnormal cell division
d. ras oncogenes are the most commonly observed oncogenes in human tumours

Proto-oncogenes are genes that are necessary for normal cell division and proliferation. Mutations in proto-
oncogenes by viral insertion, gene translocation or other means can produce oncogenes, which are un-
regulated. ras oncogenes are the most commonly observed oncogenes in human tumours.

483-In which part of a cell is the G protein located?

a. mitochondrion
b. cell membrane
c. nucleus
d. nuclear membrane
e. cytoplasm

G proteins are so-called because they bind the guanine nucleotides GDP and GTP. They are heterotrimers (i.e.,
made of three different subunits) associated with the inner surface of the plasma membrane and
transmembrane receptors. These are called G-proteincoupled receptors (GPCRs).

484-The following are true about inositol triphosphate (IP3) EXCEPT:

a. it increases the intracellular concentration of calcium
b. it acts as a second messenger
c. it causes smooth muscle relaxation
d. it is increased by activation of a1-adrenoreceptors

IP3 is a secondary messenger increased by activation of alpha-adrenoreceptors. It binds to the endoplasmic

reticulum membrane and increases the intracellular calcium concentration and this in turn results in smooth
muscle contraction, increased secretion from exocrine glands and the force and rate of cardiac contraction.

485-The posteriorly directed fibres of the optic radiation are supplied by:
a. lateral striate artery
b. anterior cerebral artery
c. anterior choroidal artery
d. posteror choroidal artery
The posteriorly directed fibres of the optic radiation are supplied by the lateral striate artery which is a branch
of the middle cerebral artery.

486-The image formed by an object outside the focal point F1 of a thin covex lens is:
a. virtual, erect, magnified, further from the lens than object
b. virtual, erect, at infinity
c. real, inverted, outside F2
d. virtual, erect, diminished, inside F2
The image formed by an object outside the focal point F1 of a thin convex lens is real, inverted and outside F2.
We recommend being familiar with drawing ray diagrams by producing, from the top of any object, 2 lines (a)
one passing through the nodal point undeviated, (b) the other parallel to the principle action passing through
the second principle focus.

487-Which is TRUE about Staphylococcus epidermidis:

a. the majority are sensitive to penicillin
b. they are coagulase positive
c. they are destroyed by povidone iodine
d. they appear as Gram positive cocci in chains

Staphylococcus epidermidis are coagulase negative Gram +ve cocci which occur in bunches. They are resistant
to penicillin. Although they are skin commensals, they can give rise to infection. They are destroyed by
povidone iodine.

488-Which statement is FALSE regarding the lens:

a. the adult lens measures approximately 10mm in diameter
b. it is supplied with nourishment from both the aqueous and vitreous humours
c. the anterior radius of curvature is greater than the posterior curvature
d. the lens becomes less round with age

The lens becomes more round with age. Other options are true.

489-Which of the following is NOT associated with increased risk of tumours:

a. Turner's syndrome
b. Type II neurofibromatosis
c. Down's syndrome
d. Type I neurofibromatosis
e. Chromosome 13q deletion

Turner syndrome is not related to an increased risk of cancer.

Type I neurofibromatosis is associated with meningioma, optic nerve glioma and phaeochromocytoma.
Type II neurofibromatosis is associated with bilateral acoustic neuroma.
Down's syndrome is associated with an increased risk of leukemia.
Chromosome 13q deletion is associated with the development of retinoblastoma.

490-Which is FALSE regarding Chlamydia trachomatis:

a. it is an obligate intracellular parasite
b. immunofluorescence can be used to identify infection
c. it is highly sensitive to erythromycin
d. it grows in McCoy culture media
e. subtypes D to K cause trachoma

Subtypes A to C cause trachoma (eye to eye contact) while subtypes D to K cause paratrachoma (sexually
transmitted).
491-The dorsal root of the spinal column transmits:
a. post-ganglionic sympathetic fibres
b. pre-ganglionic sympathetic fibres
c. sensory neurones
d. motor neurones

The dorsal root transmits sensory neurones whose cell bodies reside in the dorsal root ganglion. Motor
neurones are transmitted through the ventral roots, including somatic (skeletal motor) and visceral
(sympathetic and parasympathetic) components.

492-The foramen ovale pierces:

a. the maxilla
b. the ethmoid
c. the lesser wing of sphenoid
d. the greater wing of sphenoid

The foramen ovale pierces the greater wing of sphenoid.

493-Which is FALSE regarding the cross-cylinder:

a. the handle is mounted at 45 degrees to the axes of the cylinders
b. the markings on the lens correspond to the axes of power of the cylinders
c. it can be used to check the power of the trial cylinder prescribed
d. it can be used to check the axis of the trial cylinder prescribed

The markings on a cross-cylinder correspond to the axes of no power of the individual cylinders. As such, the
power of each cylinder lies at 90 degrees to the marked axis, which corresponds to the marked axis of the
other cylinder, of opposite sign.

494-Mean cholesterol level in 300 men and women was measured to be 4.9 and 5.3 mmol/l, respectively.
Which of the following does NOT apply?
a. the t-test would be a good way of testing whether the difference were due to chance
b. the alternative hypothesis would state that this difference is real
c. this difference may be due to chance
d. a Type I error would occur if the null hypothesis were rejected when it were true
e. a Type II error would occur if a difference were found where none existed

The t-test is used in order to determine whether the means of two normal distributions are the same or not.
A Type I error is a false positive (falsly rejecting the null hypothesis) and a Type II error is a false negative
(falsly retaining the null hypothesis).

495-Which of the following is FALSE regarding sympathetic ophthalmitis:

a. it can lead to phthisis bulbi
b. it can occur after traumatic injury to one eye
c. it is a bilateral granulomatous pan-uveitis
d. Dalen-Fuchs nodules are an accumulation of macrophages in the retinal neurons
Sympathetic ophthalmitis is a bilateral granulomatous pan-uveitis which can occur after traumatic injury to
one eye, usually where uveal tissue is incarcerated in sclera. DalenFuch's nodules occur which are an
accumulation of macrophages in the retinal pigment epithelium. The condition can lead to exudative retinal
detachment secondary to severe inflammation, with consequent hypotony and phthisis bulbi.

496-Leber's hereditary optic neuropathy is an example of:

a. mitochondrial inheritance
b. autosomal dominance inheritance
c. X-Linked recessive inheritance
d. autosomal recessive inheritance

497-Which is FALSE regarding corneal epithelial wound healing:

a. mitotic activity takes place at the limbus
b. full ultrastructural integrity is only restored after 2-3 weeks
c. healing depends on intercellular signaling mediated by matrix components and integrins
d. epithelial cells initially slide as a sheet of single cells to cover defects

While most corneal defects are closed within 24-48 hours, full ultrastructural integrity with the formation of
hemidesmosomes and Type VII collagen anchoring fibrils takes many more months. This explains the
recurrent corneal erosion syndrome in many patients with a previous epithelial defect.

498-The apices of the retinal pigment epithelium are in closest approximation to:
a. the inner plexiform layer
b. the retinal nerve fibre layer
c. the photoreceptor outer segment
d. the photoreceptor inner segment

The apices of the RPE are in close approximation with the photoreceptor outer segments.

499-The following are true about cholesterol EXCEPT:

a. cholesterol is the most abundant sterol found in human tissue
b. it is essential for the production of thyroxine
c. HMG CoA reductase is the main regulator enzyme of cholesterol synthesis
d. all the carbon atoms of cholesterol are derived from acetyl CoA

Thyroxine is not a steroid hormone (it is a peptide) and therefore it is not formed from cholesterol. Other
options are true.

500-A 10 dioptre concave lens is decentred by 30 mm. What is the prismatic effect produced:
a. 10 dioptres
b. 100 dioptres
c. 300 dioptres
d. 30 dioptres

The prismatic power is calculated by the formula:

P=FxD
Where P is the prismatic power in prism diopters, F is the lens power in diopters and D is the distance from
the centre of the lens in centimeters.
 Question 501 part 6 BASIC SCIENCES

501-Which statement is FALSE regarding ciprofloxacin:

a. it acts on DNA polymerase
b. it is a fluoroquinolone antibiotic
c. it is effective against Pseudomonas
d. it is effective against Staphylococcus

Ciprofloxacin is a fluoroquinolone antibiotic. It inhibits bacterial DNA synthesis by its action on bacterial DNA
gyrase. It is effective against many species of Pseudomonas, Staphylococcus and Haemophilus.

502-Choose the CORRECT statement. Phagocytic cells:

a. release histamine which affects the adaptive immune system
b. initiate firm attachment by binding to MHC class I on the endothelium
c. have receptors that recognise viral membrane constituents
d. require clonal expansion to mount an effective response
e. are important for the resolution of inflammation

The major phagocytic cells of the immune response are macrophages and neutrophils. Phagocytes of the innate immune
system recognise common motifs on invading pathogens using cell surface pattern recognition receptors. They are part of the
innate immune system and mount a rapid response that does not require clonal expansion. These cells phagocytose foreign
particles and microbes. They are also important for the clearing of apoptotic cells and debris in the resolution phase.
Phagocytic cells have surface receptors that recognise the Fc portion of immunoglobulin as well as complement components.
Binding of these receptors to their ligands enhances phagocytosis of antigen; a process termed opsonisation. Internalised
microbes are killed by phagocytes that secrete reactive oxygen intermediates and possess potent microbicidal properties.
These cells initiate and amplify the adaptive immune response by producing pro-inflammatory cytokines such as IL1, IL6 and
TNF. Phagocytic cells enter tissues by rolling on selectins and binding via integrins to ICAM (and similar molecules). They
transmigrate by binding to PECAM and similar adhesion molecules. Mast cells release histamine when antigen binds and
cross-links cell surface IgE.

503-Which statement is FALSE about the corneal stroma:

a. it is composed of 200-250 layers of flattened collagenous lamellae
b. the main glycosaminoglycans in the cornea are keratin sulphate and chondroitin
c. the corneal stroma contains blood and lymphatic vessels only in the anterior stromal layers
d. keratocytes are stellate in shape

The corneal stroma normally contains no blood or lymphatic vessels. Other options are true.

504-Which is TRUE of contact lenses:

a. fluorescein should be used to check the fit of soft contact lenses
b. contact lenses can be used in the management of ptosis
c. only preservative-free ophthalmic medications should be used in hard lenses
d. scleral contact lenses are not fenestrated

Contact lenses can be used to treat ptosis - a ptosis prop can be made by moulding a ledge onto a contact lens.
Soft contact lenses become impregnated with preservatives but there is no necessity to use preservative-free for
hard lenses. Flourescein stains soft contact lenses and therefore is not used to check fit. Scleral contact lenses are
fenestrated.
505-A 4-year-old boy presents with recurrent abscesses, which respond poorly to antibiotics.
What cell is most likely to be defective:
a. Macrophage
b. Neutrophil
c. B-cell
d. T-cell
e. Eosinophil

Neutrophils are granulocytes with multilobed nuclei. They are phagocytes and are an important cellular components of the
innate immune response. They circulate in the blood stream and only enter tissues if there is inflammation (unlike
macrophages) to which they are principally directed by IL8. These cells possess receptors for immunoglobulin G and for
complement components. They phagocytose opsonised antigen and release toxic oxygen compounds (respiratory burst),
nitric oxide, phospholipases and proteases from granules to kill internalised organisms. Patients with neutrophil defects suffer
from recurrent chest infections with bacteria or fungi, recurrent skin abscesses often caused by Staphylococcus aureus and
poor wound healing. Primary neutrophil deficiencies are rare and are usually due to an inherited abnormality of the
neutrophil itself. The problem can affect phagocytosis or the metabolic pathways involved in intracellular killing

506-Acute inflammation:
a. is always harmful
b. causes increased vascular permeability coupled with infiltration of inflammatory cells
c. causes the release of C8a, a potent chemokine
d. causes the release of CRP, the half-life of which is several days

The combination of increased vascular permeability and cellular influx gives rise to the calor, rubor and dolor of the
inflammatory process. CRP is an acute phase protein which is synthesised by hepatocytes as a result of the acute
inflammatory process. It is secreted in increased amounts within 6 hours of an acute inflammatory stimulus. CRP has a halflife
of about 12 hours. C-reactive protein binds to phosphocholine moieties found on microbial polysaccharides. It acts as an
opsonin-enhancing phagocytosis, and also activates the classical complement pathway. Acute infection results in activation of
complement. C5a is a complement intermediate which acts as a potent chemokine.

507-A letter published in a journal suggests that an established antiepileptic drug may cause gum hyperplasia. The
manufacturer wishes to set up a study to determine rapidly and efficiently whether this is true.Which one of
following techniques is most appropriate?
a. double-blind, randomized, placebo controlled study
b. dose-ranging study
c. sequential trial
d. case-control study
e. meta-analysis

An established drug should have many trials published on data. Meta-analysis incorporates the data in order to
identify effects which some trials may be too small to detect.

508-The maxillary sinus drains into:

a. the inferior meatus
b. the middle meatus
c. the superior meatus
d. the lateral meatus
509-The image formed by an object inside the focal point F1 of a thin convex lens is:
a. real, inverted, outside F2
b. virtual, erect, diminished, inside F2
c. virtual, erect, at infinity
d. virtual, erect, magnified, further from the lens than object

The image formed by an object inside the focal point F1 of a thin convex lens is virtual, erect, magnified and
further from the lens than the object. We recommend being familiar with drawing ray diagrams by producing,
from the top of any object, 2 lines (a) one passing through the nodal point undeviated, (b) the other parallel to the
principle action passing through the second principle focus.

510-The parasympathetic nerve supply to the lacrimal gland travels through which of the following structures:
a. cavernous sinus
b. lesser petrosal nerve
c. otic ganglion
d. pterygopalatine ganglion

The parasympathetic nerve supply to the lacrimal gland involves the superior salivatory nucleus, the nervus
intermedius of the seventh cranial nerve, the greater petrosal nerve, the pterygopalatine ganglion where it
synapses, before travelling to the lacrimal gland.

511-Which is FALSE regarding Staphylococcus aureas:

a. it is the main commensal of the outer eye
b. it grows well on blood agar
c. it produces exotoxin
d. it is a Gram positive bacteria
e. it is aerobic and non-motile

Staphylococcus produces numerous virulence factors including lipase, proteinase and hyaluronidase but it does
not produce exotoxins.

512-How long is a rod photoreceptor:

a. 12 micrometers
b. 15 micrometers
c. 100 micrometers
d. 50 micrometers

Explanation A rod photoreceptor is 100-120 micrometers long while a cone is 60-75 micrometers.

513-The principle of diffraction is used in:

a. anti-glare spectacle coatings
b. the Placido disc
c. the stromal cornea to aid clarity
d. multi-focal intra-ocular lenses

Some multi-focal intra-ocular lenses use the principle of diffraction, which is the interference of waves of light as
they encounter an obstruction or opening, in order to create multi-focality.
514-The Geneva lens measure assesses:
a. the surface curvature of a lens
b. the axes of an astigmatic lens
c. the vertex power of a lens
d. the power of prism

The Geneva lens measure assesses the surface curvature of a lens. The total power of the lens can be determined
by the sum of the surface powers. The Geneva lens is calibrated for Crown glass and requires a correction factor
for any other material.

515-A 14-year-old girl presents with high fever, rigors and myalgia. Nasal aspirate is positive for influenza
virions.Which of the following is true of her B cell response?
a. deficiency of either CD40 or CD40L still results in the production of IgG
b. affinity maturation takes place in the blood stream
c. the antibody response to the virus does not require T cell help
d. memory cells are not formed as repeated infections with influenza often occur
e. her B cells express immunoglobulin on their surface

B cells usually require T cell help for full activation. B cells are activated in the primary immune response which initially
produce IgM. With continuing T cell help, B cells then undergo heavy chain class switching and enter the germinal centres in
secondary lymphoid organs. The germinal centres are the sites of immunoglobulin affinity maturation and memory B cell
formation. Various factors including nature of T cell help, antigen exposure site and cytokine profile determine the isotype of
the heavy chain produced. CD40 and CD40L are required for co-stimulation by T cells. Deficiency of either CD40 or CD40L
impairs class switching. Certain antigens can activate B cells in the absence of T cell help, called thymus-independent antigen.
T cell-independent B cell responses are mainly due to carbohydrate antigen e.g., pneumococcal polysaccharide. These
antigens are not processed and presented in association with MHC molecules, and therefore cannot activate T helper cells.
Most TI antigens have highly repetitive epitopes (e.g., LPS/endotoxin), which are able to cross-link the B cell surface
immunoglobulin and activate these cells. Some T cell-independent antigens can cause the proliferation of B cells regardless of
their specificity, polyclonal B cell activation. Antibody responses to Tindependent antigens consist mainly of IgM antibodies of
low affinity without the production of memory cells. The influenza virus will activate T- and B cells, and result in memory cell
production. Genetic mutation in the virus is responsible for immune evasion and repeated infections.

516-A statistician wants to compare the significance of HbA1c glucose levels in a group of 100 patients before and
after treatment with a new diabetic drug. What is the most appropriate statistical test?
a. likelihood ratios
b. chi square test
c. Kaplan-Meier curve
d. paired t test
e. logistic regression analysis

In a clinical trial where the input variable is type of treatment - a nominal variable - and the outcome may be some clinical
measure which is normally distributed, the required test is then the T-test. The paired t-test and the Wilcoxon signed-rank
test are often conducted to compare two continuous outcomes from paired observations. An assumption underlying these
tests is that the responses from pair to pair are mutually independent.

517-Which statement is FALSE regarding the lacrimal gland:

a. the orbital portion is larger than the palpebral portion
b. destruction of the palpebral portion removes 50-70% of tear production
c. the orbital portion is lodged in the lacrimal fossa
d. the orbital and palpebral portions are connected via an isthmus
The lacrimal gland is composed of two portions: a larger orbital portion and a smaller palpebral portion (about
one-quarter the size). The three to five main excretory ducts of the orbital portion must traverse the palpebral
portion, which contributes a further five to seven ducts to the total of about 12 excretory ducts. As all ducts pass
through it, destruction of the palpebral portion renders the entire gland non-functional.

518-In a survey of 100 men admitted to a hospital 30 have disordered liver function tests (LFTs), 21 of which have
palmar erythema. Six of those without disordered LFTs are also judged to have palmar erythema.
Which of the following statements is correct?
a. we cannot be sure of the pre-test probability of liver disease in this population
b. the predictive value of a positive test will be the same across all populations
c. palmar erythema has a specificity of 64/70 as a marker of liver disease
d. the sensitivity of palmar erythema as a marker for liver disease is 21/27
e. if a patient has palmar erythema, the probability that he has liver disease is equal to 21/30

True positives: 21, false positives: 6, true negatives: 64; false negatives:9. Sensitivity of palmer erythema would be
21/(6+64); the probability of liver disease with palmer erythema would be 21/(21+6).

519-All of the following are TRUE about the chemoreceptor in the carotid body EXCEPT:
a. it is involved in reflex peripheral vasoconstriction
b. it is stimulated by a decrease in PO2 of arterial blood
c. it is stimulated by an increase in PCO2
d. it is inhibited by a decrease in pH of arterial blood

The carotid body is stimulated by increase in PCO2, decrease in PO2 and pH. When stimulated it causes reflex
peripheral vasoconstriction.

520-Which is TRUE of acid-base balance in the body:

a. increased hydrogen ions concentration inhibits respiration
b. increased bicarbonate ions concentration increases respiration
c. the normal venous plasma is less acidic than the arterial plasma
d. the anion gap is increased in ketoacidosis

The normal arterial pH is 7.4 and that of the venous is slightly lower. Acidosis (increased hydrogen ions
concentration) increases respiration and alkalosis (increased bicarbonate ions concentration) decreases
respiration. The anion gap is defined as the difference between the concentration of cations other than sodium
and the concentration of anions other than chloride and bicarbonate ions. It is increased in ketoacidosis and lactic
acidosis.

521-Which statement is FALSE about the foramena:

a. the jugular foramen transmit the vagus nerve
b. the foramen spinosum transmits the accessory meningeal artery.
c. the foramen ovale transmits the mandibular nerve
d. the stylomastoid foramen transmit the facial nerve

The foramen spinosum transmits the middle meningeal artery. The accessory meningeal travels through the
foramen ovale. Other statements are true.
522-All of the following muscles have their origin in the tendinous ring EXCEPT:
a. superior oblique
b. lateral rectus
c. inferior rectus
d. medial rectus

The superior oblique originates superomedial to the optic canal. The inferior oblique originates behind the orital
margin lateral to the nasolacrimal duct. All other extraocular muscles (that is all four recti) originate from the
tendinous ring.

523-Uveal tissue is most strongly attached to the sclera at:

a. the scleral spur
b. the optic disc
c. the macula
d. the ora serrata

524-Choose the one correct statement. Regarding antibodies:

a. IgE can bind to receptors on mast cells, basophils and eosinophils
b. a specific B-cell always produces the same class of antibody
c. the IgG subclasses are not transported across the placenta
d. IgG3 and IgG1 are the most effective complement-fixing antibodies
e. IgM and IgA are largely confined to the blood
An immunoglobulin molecule is composed of two identical heavy chains and two identical light chains. Both heavy and light
chains are made up of a variable domain (the amino acid sequence of the domain varies among different antibodies) attached
to one constant domain (light chain) or many constant domains (in the case of the heavy chain). The variable domain of
antibodies results from the rearrangement of the gene segments encoding this domain. Light chains are the products of
successful rearrangements at either the kappa or lambda gene loci. Heavy chains are derived from a successful variable gene
rearrangement spliced to one of a number of constant-region genes. The choice of constant-region gene determines the class
or isotype of the immunoglobulin. There are important functional and structural differences between the isotypes. The
primary immune response results in the production of IgM. Subsequent activation of antibody results in class switching - the
B-cell which originally produced IgM switches to the production of antibody with the same specificity, but of a different
isotype.
There are five main isotypes of immunoglobulin in humans: IgM, IgG, IgA, IgE, and IgD. IgG antibodies have 4 subclasses-IgG1
to 4, and IgA has two subclasses-IgA1 and IgA2.
Characteristics of the different immunoglobulon isotypes:
IgG (80% of total immunoglobulin): activates the classical complement pathway; transferred across the placenta;
monomeric; important immunoglobulin in the secondary immune response.
IgM (6% of total Ig): activates the classical complement pathway +++; IgM fixes complement most effectively; pentameric
structure; present on the membranes of B cells; mostly confined to the intravascular space; important in the primary immune
response.
IgA (10-15 % of total serum Ig): is the predominant immunoglobulin in the external secretions; activates the alternative
complement pathway; secretory IgA dimeric form with J chain; occasionally exists as a tetramer; IgA is very important for
mucosal immunity.
IgD (<1% of total serum Ig): B cell surface Ig; possible role in B/T cell activation.
IgE (0.001% of total serum Ig): binds with high affinity to mast cells and are involved in active immunity against helminth
parasites.

525-Which statement is FALSE with respect to lens development:

a. the foetal lens is more spherical than the adult
b. the lens first appears as vesicles with a single layer of epithelial cells
c. the lens is formed from neural crest cells
d. the lens first appears at 27 days of gestation
526-Reis-Buckler dystrophy affects which layer of the cornea:
a. Descemet's membrane
b. corneal epithelium
c. Bowman's layer
d. corneal endothelium
e. stroma

Reis-Buckler dystrophy is an autosomal dominant dystrophy affecting the Bowman's layer. Clinically there are fine
reticular opacities in the superficial cornea in early adult life.

527-Which is FALSE regarding the skin tumours:

a. squamous cell carcinoma is more common in the immunocompromised
b. basal cell carcinoma is more common than squamous cell carcinoma
c. sebaceous gland carcinoma has a poorer prognosis than squamous cell carcinoma
d. squamous cell carcinoma spreads haemotogenously

Squamous cell carcinoma spreads by the lymphatics. Other statements are true.

528-The image formed by a prism:

a. is always undeviated
b. is always deviated towards the apex
c. is always deviated towards the base
d. may deviate towards the apex or towards the base dependent on the angle of incidence

The image formed by a prism is erect, virtual and displaced towards the apex.

529-Which of the following is FALSE regarding the complement system:

a. C5b-9 attacks the cell membrane
b. activation causes recruitment of inflammatory cells
c. the classic pathway is activated by the cell wall of bacteria
d. deposition of C3b on the bacterial cell wall causes phagocytosis by leucocytes

The complement system is a complex system of serum proteins that interact in a cascade. There are two pathways
by which complement activation is initiated

530-All of the following are caused by defects in mitochondrial DNA except:

a. Leber's hereditary optic neuropathy
b. Kearn-Sayer's syndrome
c. Leigh disease
d. Leber's congenital amaurosis

Leber's congenital amaurosis is an autosomal recessive condition.

531-All of the following are muscles of facial expression EXCEPT:

a. nasalis
b. levator labii superioris
c. buccinator
d. zygomaticus major

The muscles of facial expression are innervated by the facial nerve and include:
 procerus frontalis corrugator supercilii orbicularis oculi zygomaticus major and minor levator
labii nasalis depressor supercilii occipitofrontalis
The buccinator is a muscle of mastication.

532-Which statement about the sella turcica is FALSE:

a. it is positioned at the central part of the ethmoid body
b. the anterior and posterior clinoid processes give attachment to the tentorium cerebelli
c. it occurs between the two cavernous sinuses
d. the central hollow of the sella turcica is called the hypophyseal fossa

The sella turcica is located at the central part of the sphenoid body. Other options are true.

533-Hyalinization of vessel walls is associated with all EXCEPT:

a. diabetes
b. hyperlipidaemia
c. ageing
d. hypertension

Hyalinization of vessel walls occurs when the walls become thickened due to deposition of collagen. It occurs with
ageing, diabetes and hypertension. Hyperlipidaemia predisposes to atheroma but it is not a cause of hyalinization.

534-All of the following are features of hypertensive retinopathy EXCEPT:

a. hyalinization
b. retinal hemorrhages
c. lymphocytic infiltration of vessel walls
d. fibrinoid necrosis
e. hard exudation

Hypertensive retinopathy results in hyalinization of blood vessel walls. Further vessel narrowing and ischaemia
lead to retinal hemorrhages, fibrinoid necrosis of the vessels with exudation and papilloedema. Lymphocytic
infiltration is not a feature of hypertensive retinopathy.

535-A Jackson cross-cylinder with axis markings of +0.50 and -0.50 is named a:
a. -0.50 D cross-cylinder
b. plano cross-cylinder
c. +1.00 D cross-cylinder
d. +0.50 D cross-cylinder

The cross-cylinder is named by the power of the cylinder in the toric formula. A lens with markings of +0.50D and -
0.50D has a toric equation of: -0.50DS/+1.0DC. Thus, the cylinder is named a 1.00D cross-cylinder, which is marked
on the handle.

536-A local anaesthetic would be expected to penetrate tissues best:

a. when administered with a vasodilator
b. when the solution is warmed
c. when in an alkaline solution
d. when the tissue is inflamed

Local anaesthetics are weak bases and penetrate tissues best when they are in an alkaline solution where a
greater proportion is non-ionised (lipophilic). Anaesthetics penetrate inflamed tissue poorly because it is an acidic
environment. Warming an anaesthetic reduces the pain involved in instilling it but does not affect its penetrating
ability. Anaesthetics are often administered together with vasoconstrictors to retard vascular absorption.

537-Which statement is FALSE regarding the lens:

a. it contains lens epithelium under the anterior but not the posterior lens capsule
b. it contains an anterior inverted Y-shaped suture and a posterior Y-shaped suture
c. its anterior lens capsule is thicker than its posterior lens capsule
d. it has a lower refractive power than the cornea

The anterior Y-shaped suture of the lens is upright and the posterior oneis inverted. Other options are true.

538-Which corneal dystrophy is a localized form of mucopolysaccharidosis:

a. Lattice dystrophy
b. Macular dystrophy
c. Meesman's dystrophy
d. Granular dystrophy
e. Avellino dystrophy

Macular dystrophy is an autosomal recessive corneal stromal dystrophy. It is a localised form of

mucopolysaccharidosis with mucopolysaccharide granules in the cytoplasm of keratocytes.

539-One of the following statements regarding interferons is incorrect:

a. IFN-beta is of therapeutic benefit in multiple sclerosis
b. IFN-alpha and IFN-beta have an anti-viral action
c. IFN-gamma is produced by T lymphocytes and NK cells in response to viral infection
d. IFN-gamma upregulates the expression of MHC class I and II molecule
e. All the interferons are structurally similar and bind to the same receptor on the surface of target cells

Interferons are cytokines. There are three types of interferons - IFN-alpha is produced primarily by mononuclear phagocytes,
INF-beta is produced by fibroblasts and interferon-gamma is produced by T cells and NK cells. IFN-alpha and IFN-beta are
termed type I interferons. The type I interferons bind to the same cell surface receptor. The interferons are anti-viral proteins
produced by cells in response to viral infection. Their functions include:
inhibition of protein synthesis and DNA replication in virus-infected cells increase in MHC class I expression and antigen
presentation in all cells activation of NK cells to kill virus-infected cells.Interferon alpha has been shown to inhibit cell
proliferation in vitro. This cytokine is an endogenous pyrogen and is one of the causes of fever and myalgia in infection.
Indications for alpha-IFN therapy include hairy cell leukemia (90% response rate), renal cell carcinoma, chronic active hepatitis
B or C, juvenile laryngeal papillomatosis (HPV induced) and Kaposi's sarcoma in AIDS.
Gamma-IFN acts as an immune regulator and augments phagocytic activity; it has its own receptor. It is used clinically in
patients with chronic granulomatous disease, although its precise mechanism of action is unclear. It may increase production
of superoxide ion in neutrophils in these patients. IFN-beta is used in the treatment of patients with multiple sclerosis.

540-The optic canal transmits all of the following EXCEPT:

a. post-ganglionic parasympathetic fibres
b. the ophthalmic artery
c. the optic nerve
d. meningeal coverings
The optic canal transmits sympathetic nerves in association with the ophthalmic artery but does not transmit
parasympathetic fibres. All other options are true.

541-Following major surgery, the body shows ALL of the following responses EXCEPT:
a. decreased lipolysis
 b. decreased peripheral glucose uptake
c. decreased protein synthesis
d. increased protein breakdown

The body following surgery initiates the stress response under cortisol and catecholamine control resulting in:
increased protein breakdown, decreased protein synthesis, increased lipolysis, increased glycogenolysis and
reduced peripheral glucose uptake.

542-Structures visible on gonioscopy from anterior to posterior are:

a. Schwalbe's line, pigmented trabecular meshwork, non-pigmented trabecular meshwork, scleral spur,
ciliary body
b. Schwalbe's, pigmented trabecular meshwork, non-pigmented trabecular meshwork, ciliary body, scleral
spur
c. Schwalbe's line, non-pigmented trabecular meshwork, pigmented trabecular meshwork, ciliary body,
scleral spur,
d. Schwalbe's line, non-pigmented trabecular meshwork, pigmented trabecular meshwork, scleral spur,
ciliary body

The order of visible structures on gonioscopy from anterior to posterior are: Schwalbe's line, non-pigmented
trabecular meshwork, pigmented trabecular meshwork, scleral spur, ciliary body

543-During wound healing all are true EXCEPT:

a. macrophages are common features at the late stage of healing
b. healing by first intention occurs in a clean and closely approximated wound
c. the tensile strength of the scar is determined by the amount of collagen in the wound
d. granulation tissue is the first phase of healing

All statements are true except that giant cells, macrophages and lymphocytes are features of chronic inflammation
and are not common features in wound healing.

544-The maxillary division of the trigeminal nerve is a derivative of:

a. the second pharyngeal arch
b. the fourth pharyngeal arch
c. the first pharyngeal arch
d. the third pharyngeal arch

The maxillary and mandibular branches of the trigeminal nerve are derivatives of the superior and inferior
components of the first pharyngeal arch respectively.

545-Venous drainage of the choroid occurs via:

a. the posterior choroidal vein
b. the vortex veins
c. the anterior choroidal vein
d. the central retinal vein

The venous drainage of the choroid occurs via the large vortex veins. There are 4-6 vortex veins in the eye which
pierce the sclera via emissary canals.

546-When there is unilateral damage to the cervical sympathetic ganglia, ocular findings include all of the
following EXCEPT:
 a. failure of the pupil to react to light
b. paralysis of Muller 's muscle
c. low intraocular pressure
d. updrawing of the lower eyelid

Horner 's syndrome causes miosis but the pupil can still react to light which is mediated by the parasympathetic
autonomic nervous system.

547-All of the following are features of Horner's syndrome EXCEPT:

a. conjunctival injection
b. a small pupil that does not react to light
c. up-drawing of the lower eyelid
d. partial ptosis that disappears with topical phenylephrine
e. decreased sweating of the skin around the eye

Horner's syndrome occurs when there is interruption of the cervical sympathetic neurons that supply the orbit.
Features of Horner's syndrome include: miosed eye that reacts normally to light, partial ptosis that disappears
with topical phenylephrine, conjunctival injection due to loss of the sympathetic tone of the blood vessels, up
drawing of the lower eyelid with resultant apparent enophthalmos and decreased sweating of the face.

548-The chromosomes line up at the equator of the cell at which phase of mitosis:
a. interphase
b. metaphase
c. prophase
d. anaphase

The stages of mitosis are:

i. interphase: chromosomes prepare to divide
ii. prophase: the chromosomes condense
iii. metaphase: the chromosomes line up on the equator of the cell
iv. anaphase: the chromosomes begin to separate
v. telophase: chromosomes have segregated to the poles and the nuclear membrane reforms

549-The subretinal space occurs between:

a. the internal limiting membrane and the neural retina
b. the RPE and its basement membrane
c. the RPE and the neural retina
d. the RPE basement membrane and Bruch's membrane

The subretinal space is a potential space between the RPE and the neural retina which only becomes evident in
pathologic states, for example retinal detachment.

550-The retina:
a. contains an optic disc which is lateral to the macula
b. has more cones than rods
c. receives all its blood supply from the central retinal artery
d. has cones and rods on its inner surface

There are 20 times more rods than cones. Both cone and rod photoreceptors lie on the outer surface of the retina.
The optic disc is medial to the macula. The central retinal artery is the only artery that supplies the retina.
551-Acyclovir:
a. is active against all viruses within the herpes family
b. inhibits DNA polymerase
c. should be dosed twice daily as maximum
d. is more effective against herpes simplex keratitis if given orally than topically

Acyclovir acts by inhibiting DNA polymerase. It is not effective against cytomegalovirus, a member of the herpes
family. Both topical and oral acyclovir are effective against herpes simplex keratitis. It is usually dosed 5x per day

552-Sorbitol is produced from glucose by the action of:

a. catalase
b. aldose reductase
c. pyruvate kinase
d. glutathione reductase

In states of excess glucose, as occurs in diabetes, glucose is diverted by aldose reductase to the production of
sorbitol. Sorbitol cannot be transported out of cells easily, thereby disrupting the osmotic and metabolic balance
of the cell. It is believed that the sorbitol pathway plays an important role in the development of cataract by its
effect on lens fibre cells. Indeed, aldose reductase inhibitors have been shown to prevent the development of
cataract.

553-The principle supporting glial cells of the retina are:

a. the Muller cells
b. the amacrine cells
c. the microglia
d. the astrocytes

The principle retinal neuroglial cells are as follows:

The Muller cells: are the principle supporting glial cells of the retina and are analogous to central nervous
system oligodendrocytes.
The astrocytes: form a honeycomb scaffold perpendicular to the Muller cells. They are responsible among other
functions for laying down scar tissue in injured or diseased retina.
The microglia: are highly specialized mononuclear phagocytic cells
Note: amacrine cells are an association neurone involved in signal modulation.

554-The corneal reflex involves all of the following EXCEPT:

a. the ophthalmic nerve
b. the short ciliary nerve
c. the facial nerve
d. the nasociliary nerve

The corneal reflex refers to the reflex blink when the cornea is touched. The afferent pathway of the corneal reflex
involves: the long ciliary nerve (not the short ciliary nerve), the nasociliary nerve, the ophthalmic nerve and the
trigeminal nerve. The first synapse is in the spinal nucleus of the trigeminal nerve and the second synapse is in the
facial nucleus. The efferent stimulus travels along the facial nerve causing contraction of the orbicularis oculi
resulting in a blink response.

555-The volume of the globe is:

a. 15ml
 b. 6.5ml
c. 3 ml
d. 12ml

556-Which statement is FALSE regarding the corneal endothelium:

a. it is a stratified squamous epithelium
b. its basement membrane is the Descemet's membrane
c. it has a critical role in maintaining the state of corneal hydration
d. the cells are polygonal in shape

The corneal endothelium is a simple squamous epithelium. Other options are true

557-All statements below are true of the trochlear nerve EXCEPT:

a. its nucleus lies in the anterior part of the periaqueductal grey matter in the inferior colliculus
b. its fibres decussate immediately after leaving the brainstem
c. it emerges from the posterior aspect of the brain stem
d. it supplies only somatic efferent innervation to the superior oblique

The trochlear nerve is unusual in that it decussates before leaving the brainstem. It is also unusual in that it is the
only somatic efferent nerve to emerge from the posterior aspect of the central nervous system.

558-Which statement is true of the aqueous humour:

a. its rate of formation is about 2.5ul/minute
b. its glucose levels are higher than that of the plasma
c. it has a lower lactic acid concentration than in the plasma
d. it contains the same concentration of protein as in the plasma

The aqueous humour is produced at between 2 to 3 ul/minute. It has a very low protein concentration compared
with the blood. It has a higher lactic acid concentration and slightly lower glucose. The ascorbate concentration is
between 10 to 50 times that of the plasma.

559-A 34-year-old smoker presents with glomerulonephritis and pulmonary haemorrhage. Blood tests reveal anti
glomerular basement membrane antibodies.Which type of hypersensitivity reaction is likely to be causing the
tissue damage:
a. Type I
b. Type III
c. Type III and IV
d. Type IV
e. Type II

The patient has Goodpastures Syndrome - a clinical manifestation of a type II hypersensitivity reaction. Autoantibodies are
produced against the glomerular basement membrane and the alveolus. Anti-GBM disease commonly presents with
haematuria, nephritic urinary sediment, sub-nephrotic proteinuria and rapidly progressive renal failure over weeks, with or
without pulmonary haemorrhage. When pulmonary haemorrhage occurs, it usually predates nephritis by weeks or months.
Pulmonary changes can vary from fluffy pulmonary infiltrates on CXR to catastrophic pulmonary haemorrhage. The gold
standard for diagnosis is renal biopsy which shows diffuse proliferative GN with focal necrotizing lesions and crescent
formation. Immunofluorescence shows linear depositon of IgG and complement. Anti-GBM antibodies can be detected by
serology. In type II hypersensitivity reactions, antibodies are directed against cell-surface or matrixassociated antigen. IgG or
IgM bound to the cell surface activates the complement cascade or promotes phagocytosis of antibody-coated cells. Antibody
dependent cellular cytotoxicity may also result. In this process, leukocytes such as NK cells bind to antibody via Fc receptors
and release cytotoxic granules to destroy the antibody-coated cells. Transfusion reactions, autoimmune haemolytic anaemia
and Goodpasture's disease are examples of type II hypersensitivity reactions. In type II reactions, bound antibody can
interfere with the normal function of cellular receptors, e.g., myasthenia gravis. In this disease, autoantibodies bind to
acetylcholine receptors at the neuromuscular junction. This interferes with normal motor end plate function and also results
in a reduction in receptor numbers. Occasionally, bound antibody can activate receptors, e.g., in Graves disease, stimulatory
antibodies directed against the TSH receptor result in hyperthyroidism.

560-The following are all clinical uses of prisms EXCEPT:

a. objective measurement of squint angle by prism cover test
b. assessment of simulated blindness
c. measurement of fusional reserve by using increasingly powerful prisms
d. detection of microtropia by using a four-dioptre base-in prism

Microtropia describes a very small esotropia and it can be detected clinically by using a 4 dioptre base-out prism.
When put before the deviating eye there is no movement as the image remains within the suppression scotoma.
However, when placed before the normal fixing eye, movement occurs.

561-Which statement is TRUE regarding diagnostic lenses:

a. the panfundoscope lens is a combination of 2 concave lenses
b. the 78 dioptre lens produces an erect image which is then inverted by the slit lamp
c. in indirect ophthalmoscopy a 20D lens must be held nearer to the patient than a 30D lens
d. the Hruby lens produces an erect diminished image

The image produced by the 78 dioptre lens is inverted. The panfundoscope consists of 2 convex lenses. A 20
dioptre lens must be held further from the patient than a 30 dioptre lens in indirect ophthalmoscopy.

562-The ciliary ganglion lies between the optic nerve and:

a. the lateral rectus
b. the superior rectus
c. the medial rectus
d. the inferior rectus

563-Which statement is FALSE regarding cocaine:

a. it induces miosis of the pupil
b. it has an anaesthetic effect when applied locally
c. it increases body temperature
d. it causes tachycardia and hypertension
e. it inhibits the reuptake of monoamines at the synaptic space

Cocaine causes pupil dilation not constriction. Other options are true.

564-During accommodation for near:

a. the amount of light entering the eye increases
b. the field of vision decreases
c. the ciliary muscle relaxes
d. the thickness of the lens decreases
During accommodation the ciliary muscle contracts and thus the lens becomes thicker. The pupils constrict and
therefore both the field of vision and the amount of light entering the eye are reduced.

565-Which nerve runs along the length of the inferior orbital fissure towards the lateral orbital wall:
a. the zygomatic nerve
 b. the zygomaticofacial nerve
c. the infraorbital nerve
d. the zygomaticotemporal nerve

The zygomatic nerve runs the length of the inferior orbital fissure towards the lateral orbital wall, where it pierces
the zygoma as 2 branches: the zygomaticotemporal and zygomaticofacial nerves.

566-As it winds around the crus of the midbrain, the trochlear nerve runs immediately beneath which vessel:
a. the posterior cerebral artery
b. the anterior cerebral artery
c. the inferior cerebellar artery
d. the superior cerebellar artery
e. the basilar artery

The trochlear nerve runs immediately beneath the posterior cerebral artery and above the superior cerebellar
artery.

567-Maximal number of axon in the optic nerve is achieved during:

a. 5 weeks gestation
b. 40 weeks gestation
c. 2 weeks after delivery
d. 15 weeks gestation

The maximal number of axons in the optic nerve is achieved at 14-15 weeks gestation when they number nearly 6
million. The number declines steadily thereafter so that at birth there are approximately 1.3million.

568-Which corneal dystrophy shows the deposition of amyloid microscopically:

a. Granular dystrophy
b. Meesman's dystrophy
c. Fuch's dystrophy
d. Lattice dystrophy

Lattice dystrophy is an autosomal dominant stromal dystrophy characterized by fine criss-crossing lines in the
stroma. Microscopy reveals these deposits consist of amyloid. Amyloid deposition is also present in Avellino
dystrophy.

569-Zonulae occludens are also known as:

a. tight junctions
b. gap junctions
c. hemidesmosomes
d. desmosomes
Zonulae occludens are tight junctions, which are specialized junctions between cells that help to form a barrier
against paracellular diffusion of all molecules, including water and ions. They are important in the blood-aqueous
and blood-retinal barriers.

570-Which of the following best describes the mode of action of tetracycline:

a. inhibits protein synthesis
 b. inhibits cell wall synthesis
c. inhibits cell membrane synthesis
d. inhibits nucleic acid synthesis

Tetracyclines inhibit protein synthesis by their action on aminoacyltransferase RNA and the messanger RNA-
ribosome complex. They have a broad spectrum of activity against Gram-positive and Gram-negative bacteria and
Chlamydia.

571-The foramen spinosum transmits:

a. the maxillary nerve
b. the lesser petrosal nerve
c. the accessory meningeal artery
d. the middle meningeal artery

The foramen spinosum transmits the middle meningeal artery and vein and the meningeal branch of the
mandibular nerve.

572-Which is FALSE regarding the sclera:

a. it is more hydrated than the cornea
b. it contains mainly Type I collagen
c. it is mostly acellular with only sparse numbers of fibroblasts
d. its collagen fibres are less regular than the cornea

The cornea is more hydrated (80% water) than the sclera (70% water). Other options supplied are true.

573-Which of the following immunoglobulin classes is/are important in antigen reception at the lymphocyte cell
surfaces for anamnestic immune responses?
1. IgD 2. IgG 3. IgM 4. IgE
a. 4 only
b. 1, 2, and 3
c. 1, 2, 3, and 4
d. 2 and 4
e. 1 and 3

Following initial exposure to an antigen, IgG will be produced in great abundance and may thereafter participate
in the reidentification of the antigen, as well as response to it. IgE, after initial sensitization, binds to mast cell
surfaces. Cross-linking by antigen of bound IgE molecules leads to histamine release (Type I hypersensitivity).

574-Which is FALSE regarding endotoxins:

a. they cause fever
b. they are heat stable
c. they are produced by Gram negative bacteria
d. they are proteins

Endotoxins are lipopolysaccharides derived from the cell wall of lysed or dead Gramnegative bacteria. They are
heat stable and non-antigenic. They produce:
fever septic shock induction of complement

575-A father suffers from an autosomal dominant condition. What is the chance that his daughter will be affected:
a. 75%
 b. 50%
c. 100%
d. 25%
e. 33%

There is a 1 in 2 chance of passing his gene and therefore a 50% chance of an affected daughter. The chance is
obviously the same for his son, as this is an autosomal condition. We recommend drawing a 2x2 box of
chromosomal probabilities.

576-The following are true about the cavernous sinus EXCEPT:

a. it is traversed by the optic nerve
b. it is traversed by the maxillary branch of the trigeminal nerve
c. it is traversed by the trochlear nerve
d. it lies on the body of the sphenoid bone

The optic nerve does not traverse the cavernous sinus. The chiasm lies superior and medial to each cavernous
sinus. Other statements are true.

577-The primary muscle responsible for lid closure is:

a. Muller's muscle
b. the orbicularis oculi
c. the frontalis
d. the corrugator supercilii
e. the levator palpebrae superioris

The main muscle responsible for lid closure is the orbicularis oculi. The levator palpebrae superioris is responsible
for lid opening. The corrugator supercilii and frontalis are muscles of facial expression. Muller's muscle assists in
lid elevation under sympathetic innervation.

578-Which is FALSE regarding the ophthalmic artery:

a. the ophthalmic artery lies superolateral to the optic nerve on entering the orbit
b. the anterior ciliary arteries are derived from muscular branches of the ophthalmic artery which course
along the recti muscles
c. the ophthalmic artery is a branch of the internal carotid artery
d. the ophthalmic artery enters the orbit via the orbital canal

The ophthalmic artery is positioned inferolateral to the optic nerve at the orbital apex. It then winds around the
optic nerve to pass above the nerve as it proceeds anteriorly in the orbit above the medial rectus and under the
superior oblique.

579-Choose the one correct statement. The thymus:

a. is required for T-lymphocyte maturation
b. is involved in affinity maturation
c. contains myeloid stem cells
d. is large in adult life
e. is involved in deletion of autoreactive B-cells

The thymus is a primary lymphoid organ required for the maturation of T-lymphocytes. It has two lobes divided into multiple
lobules by septa. Each lobule consists of an outer cortex and an inner medulla. The cortex is mainly composed of immature
thymocytes (developing T-cells) enveloped by branched cortical epithelial cells and scattered macrophages. The medulla
consists of mature thymocytes and medullary epithelial cells. There are also macrophages, bone marrow derived dendritic
cells and Hassall's corpuscles.
T-cell precursors arise in the bone marrow and then migrate to the thymus where they undergo maturation to mature T-cells.
This organ provides a specialised environment in which these developing T-cells undergo positive and negative selection to
ensure MHC restriction and to eliminate autoreactive T-cells. The cells that first populate the thymus have not rearranged
their TCR genes and are TCR-/CD4- CD8-. Rearrangement of the beta chain of the TCR and surface expression of this chain as
part of the pre-T-cell receptor induces proliferation and the expression of both CD4 and CD8. These cells are now referred to
as double positive thymocytes (DP). TCR alpha chain rearrangement results in the expression of the mature TCR on the cell
surface. These DP thymocyte now undergo positive and negative selection to ensure that their TCR recognises foreign antigen
bound to self MHC, but is not autoreactive - i.e. it does not have a high affinity for self peptide /MHC complexes. 99% of all
thymocytes fail these selective processes. The thymic cortical epithelial cells mediate positive selection of developing T-cells,
and negative selection is predominately mediated by bone-marrow derived dendritic cells and macrophages. Those
thymocytes that are positively selected down-regulate either CD4 or CD8 depending on which class of MHC is recognised by
their TCR. The mechanisms of this process are controversial. The single positive (SP) thymocytes migrate to the periphery and
are now termed mature peripheral T-cells.The human thymus is fully developed before birth, and the rate of T-cell production
is greatest before puberty. The thymus is largest in childhood, and the organ decreases in size after puberty. A thymoma may
cause enlargement in adulthood. Affinity maturation of B-lymphocytes is a process resulting in the production of high affinity
antibody post B-cell activation. It takes place in the germinal centres of secondary lymphoid organs and does not involve the
thymus.

580-During phototransduction:
1. 11-cis-retinal molecules are converted to all-trans-retinal
2. hyperpolarisation occurs due to closure of potassium channels
3. transducin converts GTP to GDP
4. dark current only occurs in the presence of photoreceptors stimulation

Transducin converts GDP to GTP. Dark current is present in the dark. In the presence of light, the sodium channels
(not potassium) close and give rise to hyperpolarization. 11 cis-retinal molecules are converted into trans-retinal.

581-Ethambutol is associated with which ocular side-effect:

a. retinal toxicity
b. corneal deposits
c. nystagmus
d. optic neuritis

Ethambutol and isoniazid, both anti-tuberculous medications, are known to be associated with optic neuritis.

582-Which is a constituent of the lateral orbital wall:

a. ethmoid
b. palatine bone
c. lesser wing of sphenoid
d. greater wing of sphenoid

Explanation The lateral wall of the orbit is composed of the greater wing of sphenoid posteriorly and the
zygomatic bone anteriorly.

583-Which of the following components is NOT necessary for a successful polymerase chain reaction (PCR)?
a. ribosomes
b. a primer sequence
 c. a piece of DNA
d. nucleotides
e. Taq polymerase

The polymerase chain reaction has revolutionised molecular biology. It allows the amplification of one sequence of DNA (or
RNA) from a very small amount of the original molecule. A PCR vial will contain several components; a piece of DNA (RNA),
large quantities of the necessary nucleotides, large quantities of the primer sequence and the DNA polymerase. This last
element is called Taq polymerase. Initially, the mixture is simply heated to 90 degress centigrade to unwind the DNA strands.
It then has to be cooled to 55 degrees centigrade to allow complementary primer sequences to bind to the orginal DNA
strands. Following this the temperature is raised again to 75 degrees C, which is the optimal temperature for Taq polymerase.
It begins to add nucleotides to the primer sequence and eventually the original DNA template strands are replicated. This
process is repeated severeal hundreds of times, each time doubling the amount of DNA material. A ribosome is not needed.

584-Which is FALSE regarding Borrelia burgdoferi:

a. it cannot be detected by ELISA
b. it can cause Lyme disease
c. it is a spirochaete
d. it is best visualized by dark-ground microscopy

Borrelia is a spirochaete and in common with this family it is helical in structure, flagellate and is best visualized by
dark-ground microscopy. It causes Lyme disease with transmission via ticks. It can be detected by ELISA to
measure specific IgM and IgG antibodies.

585-Which is FALSE regarding catoptric images:

a. the first is the basis of Hirschberg's test
b. the fourth image can be used to analyse accommodation
c. the second image is utilized by the keratometer
d. the third image is utilized in measuring anterior chamber depth

The first image is utilised by the keratometer.

586-Which statement is FALSE regarding accommodation:

a. the AC/A is greater than normal in convergence excess esotropia
b. cyclopentolate reduces accommodation
c. there is a strict relationship between accommodation and convergence
d. it declines rapidly at the age of 60

Accommodation is absent by the age of 60. All other options true.

587-A 15-year-old girl presents with a fever and a sore throat. On examination her pharynx and tonsils were red
and inflamed and the tonsils were studded with white exudates. Which cells are most likely to be the first to
respond to this infection:
a. plasma cells
b. CD8 positive T-cells
c. natural killer cells
d. macrophages
e. neutrophils

This is likely to be a bacterial infection (most likely beta haemolytic streptococci). The first cells to respond to a
bacterial infection are the neutrophils (components of the innate immune response) followed later by
macrophages and cells of the adaptive immune system. Natural killer cells are important in the response to viral
infection.

588-Which blood test is positive in over 90% of patients with Wegener's granulomatosis:
a. p-ANCA
b. anti-rho
c. anti-ds DNA
d. c-ANCA
e. rheumatoid factor

c-ANCA which is antineutrophil cytoplasmic antibody is positive in over 90% of patients with systemic Wegener's.

589-Which is TRUE regarding the eyelids:

a. the meibomian glands secrete a mucinous solution
b. the lower lid is supplied by the maxillary division of the trigeminal nerve exclusively
c. there are more meibomian glands in the upper than lower lids
d. the orifices of the meibomian glands are anterior to the root of eyelashes

The meibomian gland secretion is lipid rich and is an important component of the tear film. There are about 30
meibomian glands in the upper tarsal plate and slightly fewer in the lower tarsal plate. The orifices of the
meibomain glands are found posterior to the root of the eyelashes. The lower eyelid is supplied by branches of the
infraorbital nerve (a division of maxillary nerve) and infratrochlear nerve (branch of the ophthalmic nerve)

590-The outer layer of the tear film is composed of:

a. aqueous
b. blood
c. lipid
d. mucus
The tear film is composed of three layers:
an outer oily or lipid layer containing secretions from the meibomian glands
a middle aqueous layer containing protein, electrolytes and water secreted from the lacrimal glands
an inner mucin layer derived from goblet cells and conjunctival epithelial cells

591-The seventh cranial nerve exits the brainstem:

a. from the dorsal surface of the pons
b. at the cerebellopontine angle
c. from the ventral midbrain
d. at the border of the midbrain and pons laterally
The seventh cranial nerve exits the brainstem at the cerebellopontine angle.

592-Which condition is characterized by cyst formation due to an unstable corneal epithelium:

a. Cogan's dystrophy
b. Thiel-Behnke dystrophy
c. Reis-Buckler dystrophy
d. Lattice dystrophy
e. Meesman's dystrophy

Microcyst formation due to an unstable corneal epithelium is observed in Cogan's microcystic dystrophy.

593-The lacrimal sac fossa is made up of:

 a. lacrimal bone only
b. ethmoid bone and lacrimal bone
c. palatine bone and lacrimal bone
d. maxillary bone and lacrimal bone

The lacrimal fossa is made up of the frontal process of the maxillary bone and the lacrimal bone

594-Which is FALSE regarding Thromboxane A2:

a. it is produced mainly by the endothelium of the capillaries
b. it causes platelet aggregation
c. it acts through cyclic adenosine monophosphate (cAMP) mediation
d. it causes vasoconstriction

Thromboxane A2 is produced by platelets. It plays an important role in platelet aggregation and its action is
mediated via cAMP. It also causes vasoconstriction. Prostacyclin opposes the action of Thromboxane A2 and
inhibits platelet aggregation.

595-All of the following are TRUE about aneurysm EXCEPT:

a. a true aneurysm contains all three layers of the vessel wall
b. a saccular aneurysm involves the whole circumference of the artery
c. a berry aneurysm typically occurs at the circle of Willis
d. a dissecting aneurysm occurs when the arterial media is deficient

An aneurysm is an abnormal localised dilatation of a blood vessel. True aneurysms contain all three layers of the
vessel wall. A false aneurysm or pseudoaneurysm is a haematoma that forms outside the vessel wall, and is
contained by surrounding tissues, as a result of a leaking artery. Berry aneurysm is found in the Circle of Willis and
is caused by vessel wall deficiency. Saccular aneurysm involves only part of the circumference of the vessel wall
whereas fusiform aneurysm involves the entire circumference. Dissecting aneurysm occurs in arterial media
deficiency as in Marfan's syndrome.

596-Northern blotting:
a. allows rapid detection of an infective organism
b. involves the polymerase chain reaction
c. involves electrophoresis
d. is used to detect DNA molecules

A northern blot is very similar to a Southern blot except that it is RNA rather than DNA which is extracted, run on a
gel and transferred to a filter membrane. It is mRNA which is isolated and hybridised in northern blots. It is used to
determine if RNA of a particular sequence is present.

597-The retinal pigment epithelium is:

a. a stratified non-keratinised squamous epithelium
b. a monolayer of myoepithelial cells
c. a monolayer of columnar epithelial cells
d. a stratified keratinized squamous epithelium

The RPE is a monolayer of columnar/cuboidal epithelial cells.

598-Which technique is best for detecting chromosomal gains, losses and translocations:
 a. FISH
b. ELISA
c. RFLP
d. PCR

FISH (fluorescent in situ hybridization) involves attaching a complementary strand of DNA which is fluorescently
labeled to specific sequences on the chromosome. It is useful in detecting chromosomal gains, losses and
translocations.

599-Typically, the first class of antibody produced against a newly encountered antigen is:
a. IgG
b. IgM
c. IgE
d. IgD
e. IgA IgM peaks earlier and disappears earlier than IgG during the primary immune response.

600-Epstein-Barr virus is implicated in all of the following EXCEPT:

a. non-Hodgkin's lymphoma
b. infectious mononucleosis
c. Burkitt's lymphoma
d. nasopharyngeal carcinoma

EBV is implicated in:

Burkitt's lymphoma
nasopharyngeal carcinoma
infectious mononucleosis
 MCQ BASIC SCEINCE
601 – 700

601-Which statement is true of the EOG:

a. it gives an absolute value in microvolts
b. it depends on a normal retinal pigment epithelium
c. it can be easily produced in anaesthetized patients
d. the maximal dark response exceeds the light response in normal people

The EOG is an indirect measure of the standing potential of the eye. It depends on a normal retinal
pigment epithelium. It requires co-operation of the patient who moves the eyes back and forth over a
specific distance. The light response is higher than dark response. The result is given as a ratio between
light to dark response. The normal ratio is more than 180%

602-Which of the following is commonly added to penicillin to prevent its inactivation by beta-lactamase
enzymes:
a. hyaluronic acid
b. clavulanic acid
c. glucuronic acid
d. fucidic acid

Clavulanic acid is a beta-lactamase inhibitor commonly added to amoxicillin (coamoxiclav) to prevent its
degradation by bacterial beta-lactamase enzymes.

603-All of the following are muscles of facial expression EXCEPT:

a. Orbicularis oculi
b. Platysma
c. Buccinator
d. Frontalis
e. Temporalis

All the choices above are muscles of facial expression (arising from the second pharyngeal arch, and
supplied by the facial nerve) except the temporalis, which (together with the masseter, lateral and medial
pterygoid) is a muscle of mastication. These muscles arise from the first pharyngeal arch and are supplied
by the mandibular branch of the trigeminal nerve.

604-Sterilization at 121 degrees Celsius at 100 kPa requires:

a. 15 minutes
b. 3 minutes
c. 60 minutes
d. 100 minutes

Sterilisation at 120 degrees Celsius requires at least 15 minutes. At 132 degrees Celsius sterilization can be
achieved in 3 minutes.

605-Which is FALSE regarding acyclovir:

a. it is a guanine derivative
b. it can be used long-term for prophylaxis
c. it inhibits DNA polymerase
d. it acts against all herpes viruses
e. it can be administered both topically and orally
Acyclovir acts against the herpes group of viruses but it is not effective against all herpes viruses; it has
minimal action against cytomegalovirus.

606-Regarding mitochondrial DNA:

a. it accounts for 10% of total human DNA
b. sperm do not contain mitochondrial DNA
c. it encodes protein needed for oxidative phosphorylation
d. the inheritance of mitochondrial disorders is similar to X-linked recessive disorders

Mitochondrial DNA accounts for 0.5% of total human DNA. The sperm is rich in mitochondrial DNA but it is
destroyed soon after fertilization. Mitochondrial DNA inheritance is maternal and is distinct from X-linked
disorders.

607-The ophthalmic artery runs:

a. superolateral to the optic nerve
b. inferomedial to the optic nerve
c. superomedial to the optic nerve
d. inferolateral to the optic nerve

The ophthalmic artery runs inferolateral to the optic nerve.

608- 100 men have their serum uric acid measured. The mean is 5.6 mg per 100 ml with a standard
deviation of 1.0 mg per 100 ml. Which of the following is NOT true?
a. the standard error of the mean is equal to 0.1 mg per 100 ml
b. the standard error of the mean allows us to estimate how close our sample mean is likely to be to
the population mean
c. we would have a better estimate of the true population mean if our sample size were greate r
d. the standard error of the mean would be halved if we doubled sample size
e. we would have a better estimate of the true population mean if the standard deviation of our
sample were less

If we were to take several samples from the same population, all would result in normal distribution
curves, but would be slightly different from each other. Each mean would be scattered around the true
population mean. The standard error of the mean is a measure of this scatter, i.e. how accurate is the
sample mean as an estimate of the true population mean.
Note, SEM = Standard deviation/square root of sample size
This demonstrates that S.E.M. is affected by two factors:
As sample size increases, S.E.M. decreases As standard deviation increases, S.E.M. increases
Note that S.E.M. is always smaller than standard deviation.

609-The pterygopalatine fossa is spanned by:

a. the mandibular nerve
b. the frontal nerve
c. the lacrimal nerve
d. the maxillary nerve
e. the zygomaticotemporal nerve

The pterygopalatine fossa is spanned by the maxillary nerve before it enters the orbit via the inferior
orbital fissure as the infraorbital nerve.
 610-The lipid-lowering effect of a new drug is compared to atorvastatin. The significance level is set at
0.01 and a difference is found (p = 0.001). What is the best conclusion to draw?
a. the alternative hypothesis should be accepted
b. the probability of a type I error occuring is 1%
c. the p-value associated with this statin means that it is a clinically significant new drug
d. a larger sample should have been used
e. the trial would have been better run against placebo

Where the p-value is less than the critical value, there is good evidence to accept the alternative
hypothesis. The p-value is the probability of committing a Type I error, which in this case is 0.1%. Clinical
significance (the effect in the real world) is not related to statistical significance.

611-Which is FALSE regarding the detection of lens types with a cross drawn on a piece of paper:
a. a concave lens causes with movement
b. spherical lenses cause no distortion of the cross
c. a prism displaces one line of the cross regardless of its position with respect to the cross
d. astigmatic lenses cause distortion of the cross when it is lined with the principle meridia

Astigmatic lenses cause distortion of the cross except when the arms of the cross are aligned with the
principle meridia of the lens. As such, the toric lens can be rotated about the cross and once the cross is
undistorted (arms at 90 degrees) the principle meridia are aligned and can be marked out on the lens.

612-The corneal endothelium utilizes most of its glucose:

a. for ATP production anaerobically with conversion to lactate
b. for ATP production aerobically via the Krebb's cycle
c. for the production of sorbitol via the aldose reductase pathway
d. for the production of antioxidants via the pentose phosphate pathway

The corneal endothelium has a high energy requirement to maintain its pump mechanism. As such, the
major metabolic pathway for glucose is in the production of ATP, which it accomplishes via anaerobic
glycolysis. A smaller proportion of glucose is metabolized aerobically via the Krebb's cycle. Some glucose is
also diverted to the pentose phosphate pathway, which is important for the production of antioxidants
such as glutathione and ascorbic acid. The production of sorbitol from glucose is a minor pathway and only
occurs to a significant degree in hyperglycemic states

613-Which statement is FALSE regarding the orbicularis oculi:

a. the palpebral fibres pass within the eyelid anterior to the orbital septum and tarsal plate
b. the orbital fibres run circumferentially in an elliptical fashion around the orbital margin
c. the palpebral portion originates from the medial palpebral ligament
d. the lacrimal portion is attached to the anterior lacrimal crest
e. the orbital portion arises from the medial palpebral ligament

The lacrimal portion is attached to the posterior lacrimal crest. Other options are true.

614-In which condition do Hassall-Henle warts form?

a. Fuch's dystrophy
b. T cell lymphoma
c. Reis-Buckler
d. Human papilloma virus infection
 Hassall-Henle warts refer to the nodular excrescences on the posterior surface of Descemet's membrane
found in Fuch's dystrophy.

615-Myelin of the peripheral nerves is produced by:

a. Muller cells
b. Schwann cells
c. oligodendrocytes
d. fibroblasts
e. macrophages

Myelin of the peripheral nerve is produced by Schwann cells whereas that of the central nervous system is
produced by oligodendrocytes.

616-Which statement is FALSE regarding aqueous outflow:

a. contraction of the anterior ciliary muscle increases aqueous outflow by its mechanical action on
the trabecular meshwork
b. the trabecular meshwork terminates anteriorly at Schwalbe's line
c. the trabecular meshwork cells maintain the state of hydration of the trabecular connective tissue
but have no phagocytic capacity
d. the cribriform trabecular meshwork occurs immediately beneath Schlemm's canal and has the
highest resistance of all meshwork layers

The trabecular meshwork can be subdivided into three anatomical zones: the innermost uveal meshwork,
the corneoscleral meshwork and the outermost cribriform meshwork, which is adjacent to Schlemm's
canal and has the highest resistance to flow. The anterior ciliary muscle fibres are attached to the
trabecular meshwork and on contraction they open the meshwork, increasing aqueous flow. Note that
trabecular cells have phagocytic capacity in addition to maintaining the health and hydration of the
connective tissues.

617-All of the following are true of the retinal pigment epithelium EXCEPT:
a. the cells have a low regenerative capacity
b. its cells are more flattened in the centre than in the periphery
c. it is derived from neuro-ectoderm
d. the cells are hexagonal and highly organized

RPE cells are more flattened in the periphery than in the centre. Other options are true.

618-The abducens nerve:

a. lies medial to the internal carotid artery in the cavernous sinus
b. contains sympathetic nerve fibres
c. enters the orbit within the tendinous ring
d. is the most slender cranial nerve

The abducens nucleus is located in the floor of the fourth ventricle. It is a pure motor nerve and lies lateral
to the internal carotid artery in the cavernous sinus. The trochlear nerve is the most slender of all cranial
nerves.
 619-In the rod photoreceptor, discs or lamellae migrate from the base to the tip of the outer segment
over:
a. 24 hours
b. 2 hours
c. 30 days
d. 10 days
e. 3 days

Migration of a disc from the base of the rod outer segment where it is formed to the tip where it is shed
takes 10 days.

620-Regarding Type II Diabetes Mellitus:

a. there is a substantial loss of beta-cells in the islets of Langerhans
b. there is an increased risk amongst first-degree relatives
c. the tissue response to insulin is normal
d. it is less common than type I diabetes mellitus
e. it is associated with certain HLA groups

Type II diabetes mellitus (DM) is more common than Type I DM. Unlike Type I DM, the beta-cells in the
islets of Langerhans are usually not lost in Type II DM. There is, however, resistance of cellular response to
insulin in Type II DM. There is an increased risk of Type II DM amongst the first degree relatives of
sufferers. Type I DM is associated with certain HLA groups but not Type II DM.

621-How long is a cone photoreceptor:

a. 120 micrometers
b. 12 micrometers
c. 70 micrometers
d. 15 micrometers

A rod photoreceptor is 100-120 micrometers long while a cone is 60-75 micrometers.

622-The following are true about the lacrimal gland EXCEPT:

a. the palpebral portion drains into the superior conjunctival fornix through 12 ducts
b. the lymphatic drainage is to the parotid gland
c. it receives secretomotor innervation from the third cranial nerve
d. the palpebral portion of the gland is 1/4 the size of the orbital portion

The lacrimal gland contains two parts: palpebral and orbital. The palpebral portion is about 1/4 the size of
the orbital portion. The palpebral portion contains 12 ducts that originate from the orbital part and pass
into the palpebral part before opening into the superior conjunctival fornix. Surgical excision of the
palpebral part will cause scarring of the ducts whereas removal of the orbital part will remove the nerve
innervation - therefore excision of either part will affect tear secretion. The lacrimal gland receives its
secretomotor innervation from the facial nerve. Its lymphatics drain into the parotid nodes.

623-Both Descemet 's membrane and the lens capsule are composed mainly of which type of collagen:
a. Type III
b. Type I
c. Type II
d. Type IV
Both Descemet 's membrane and the lens capsule are composed mainly of Type IV collagen, which is a
non-fibrillar structural collagen important to the formation of basement membranes.

624-All of the following are corneal stromal dystrophy's EXCEPT:

a. Lattice dystrophy
b. Labrador keratopathy
c. Avellino dystrophy
d. Meesman's dystrophy
e. macular dystrophy

Meesman's dystrophy is a corneal epithelial dystrophy while the other options are all stromal

625-Which statement is FALSE regarding slit-lamp illumination:

a. specular reflection is used to examine the corneal endothelium
b. retro-illumination is optimised by co-axial illumination
c. sclerotic scatter requires co-axial illumination
d. sclerotic scatter depends upon internal reflection within the cornea

Sclerotic scatter requires off-axis illumination, not co-axial. Other statements are true.

626-Which of the following is TRUE about the pituitary gland:

a. the posterior lobe secretion affects thyroid hormone secretion
b. a portal system exists between the posterior pituitary gland and the hypothalamus
c. it is drained by the cavernous sinus
d. it is situated above the optic chiasm

The pituitary gland is located below the optic chiasm. The portal system exists between the anterior
pituitary gland and the hypothalamus. TSH is secreted by the anterior lobe.

627-All of the following are examples of metastatic calcification EXCEPT:

a. hyperparathyroidism
b. atheroma
c. skeletal metastasis
d. hypervitaminosis
Metastatic calcification occurs where there is deposition of calcium in normal tissue due to
hypercalcaemic states. Atheroma, where calcium is deposited as a consequence of hyalinised and necrotic
tissue, is an example of dystrophic calcification.

628-All of the following are true of a pterygium EXCEPT:

a. it is predisposed in hot dry environments
b. it occurs most commonly at the limbus inferiorly
c. the conjunctival stroma is hyalinised
d. there is degeneration of elastin histologically

Pterygium is a condition characterized by thickening and hyalinization of the conjunctival stroma with
deposition of degenerating elastin. It is most common at the limbus in the interpalpebral fissure. It is more
common in hot, dusty environments
 629-Tear film mucins are secreted mainly by:
a. the acinar cells of the accessory lacrimal glands
b. the acinar cells of the lacrimal gland
c. corneal epithelial cells
d. conjunctival goblet cells

The mucin component of the tear film is the innermost layer. It provides a link between the hydrophobic
cornea surface and the aqueous secretion of the lacrimal glands. It is produced by the goblet cells of the
conjunctival epithelium.

630-Which is FALSE regarding the genetics of retinitis pigmentosa:

a. the rhodopsin gene is implicated in autosomal dominant RP
b. it is a heterogenous group of cone-rod dystrophies
c. X-linked RP usually presents in childhood
d. approximately 80% of RP is autosomal dominant

Figures vary but RP is heterogenous with about 20% autosomal recessive, 20% autosomal dominant, up to
25% X linked and 25% appear isolated.

631-During DNA replication, where can Okazaki fragments be found?

a. attached to RNA molecules
b. the replication fork
c. the leading strand
d. the lagging strand
e. the parent strand

DNA replication is a semiconservative process, in other words one strand of the original DNA molecule is
incorporated into each of the two daughter strands. The DNA helix (parent strand) is initially unwound by a helicase.
The double helix is opened up to form two single strands that act as templates. This occurs at the replication fork.
DNA polymerase adds nucleotides to these templates to allow a new DNA strand (leading strand) to grow in a 5' to 3'
direction. DNA polymerase can ONLY do this in the 5' to 3' direction. So how can a further strand be made in the 3' to
5' direction using the second template (the lagging strand)? The answer is that synthesis of this strand is
discontinuous and involves the synthesis of short nucleotide strands called Okazaki fragments by a different DNA
polymerase. These are then joined together by DNA ligase.

632-Approximately how many meibomian glands are there on the upper lid:
a. 120
b. 40
c. 30
d. 80
e. 60

There are approximately 30 meibomian glands on the upper lid and slightly fewer on the lower lid.

633-Serum amylase and gamma-gutamyl transferase were compared within a population of 900
inpatients. Which of the following is true?
a. the same methods for determining the correlation coefficient can be applied irrespective of
whether the data are normally or non-normally distributed
b. an r-value of 0.96 implies significant cause and effect
c. the null hypothesis would state that r equals zero
d. correlation coefficients take a value between 0 and 1
Correlation coeffecients range from -1 to +1. A high degree of association does not imply cause and effect.
Statistical methods for determining association depend on whether the population is normally distributed
or not.

634-Phthisis bulbi is an example of:

a. dystrophic calcification
b. metastatic calcification
c. senile calcification
d. metamorphic calcification

Phthisis bulbi is an example of dystrophic calcification where calcium is deposited in diseased or necrotic
tissue. In phthisis bulbi, calcification usually occurs in the metaplastic fibrous tissue derived from the
proliferation of RPE cells in a hypotonic eye.

635-Which nerve is transmitted through the temporal bone:

a. olfactory nerve
b. facial nerve
c. mandibular nerve
d. vagus nerve
Only the facial nerve and the vestibulocochlear nerves are transmitted through the temporal bone.

636-The cerebrospinal fluid (CSF):

a. is normally produced at a rate of 100ml per day
b. is formed mainly in the choroid plexus
c. flows from the lateral ventricles through the aqueduct into the third ventricle
d. is found in greater volume in the skull than in the spine

The normal rate for CSF production is 400- 500ml per day. The normal volume is 150ml. There is more CSF
in the spine than in the skull. CSF is formed mainly by choroid plexus. It flows from the lateral ventricles
into the third ventricle through the interventricular foramen of Munro and then through the aqueduct into
the fourth ventricle.

637-In response to acute haemorrhage, the following compensatory events occur EXCEPT:
a. vasoconstriction of the renal efferent arterioles
b. cerebral vasoconstriction
c. raised circulating angiotensin II concentration
d. increased chemoreceptor discharge
A drop in blood volume reduces baroreceptor stretch which in turn increases sympathetic output. This
results in generalised vasoconstriction, except for the brain and heart vessels. The renal efferent arterioles
constrict more than the afferent arterioles. Hypoxia from a reduced volume increases chemoreceptor
discharge.

638-Vagal stimulation causes ALL of the following EXCEPT:

a. delayed A-V conduction
b. a fall in heart rate
c. decreased stroke volume
d. increased ventricular contractility

Vagal stimulation increases the parasympathetic activities resulting in: slowing of the heart rate, delayed
A-V conduction, decreased stroke volume, decreased atrial and ventricular contractility
639-Where is drusen deposited in age-related macular degeneration:
a. between the RPE cell and its basement membrane
b. between the RPE basement membrane and Bruch's membrane
c. between Bruch's and the choriocapillaris
d. between the RPE cell and the outer photoreceptor layer
Drusen is situated between the basement membrane of the RPE and the Bruch's membrane.

640-Which statement is FALSE about the corneal stroma:

a. sensory nerve fibres are present in the posterior stromal layers en route to the epithelium
b. is composed of 200-250 layers of flattened collagenous lamellae
c. collagenous lamellae are oriented parallel to the corneal surface
d. is a dense connective tissue of remarkable regularity

Sensory nerve fibres are present in the anterior stromal layers en route to the epithelium

641-The first cell that an antigen typically contacts in the cascade of immune response is the:
a. macrophage
b. plasma cell
c. natural killer (NK) cell
d. T-lymphocyte
e. B-lymphocyte

Macrophages can initiate the immune cascade by phagocytosing antigen and presenting it to T cells.
Macrophages are also known as antigen-presenting cells. Flag:
642-Which condition involves deposition of a light-chain-derived amyloid:
a. Alzheimer's disease
b. rheumatoid arthritis
c. familial Mediterranean fever
d. Waldenstrom macroglobulinaemia

Amyloid can be derived from proliferation of light chain fragments of immunoglobulin, as in Waldenstrom
macroglobulinaemia and multiple myeloma.

643-Six prism diopters of left esotropia are best corrected by:

a. 3 dioptres base-in left eye, 3 dioptres base-in right eye
b. 3 dioptres base-out left eye, 3 dioptres base-out right eye
c. 6 dioptres base-out left eye
d. 3 dioptres base-out left eye, 3 dioptres base-in right eye

Generally when prescribing prisms the correction is split between the two eyes.

644-The pterygopalatine ganglion:

a. is a sympathetic ganglion
b. receives preganglionic parasympathetic fibers from the lesser petrosal nerve
c. contains preganglionic fibers that arise in the lacrimal nucleus of the facial nerve
d. contains secretomotor nerve to the parotid gland

The pterygopalatine ganglion is a parasympathetic ganglion. Its preganglionic fibers arise from the lacrimal
nucleus of the facial nerve and they run in the greater petrosal nerve before synapsing in the ganglion. The
ganglion contains secretomotor nerve fibres to the lacrimal gland.
645-Which is FALSE regarding the accommodation mechanism:
a. fibres mediating accommodation reach the ciliary muscle by the long ciliary nerves
b. contraction of the ciliary muscle induces relaxation of the zonule
c. accommodation is mediated via fibres from the third cranial nerve
d. contraction of the ciliary muscle moves the ciliary muscle forward

Parasympathetic innervation of the ciliary muscle is derived from the third cranial nerve via the Edinger-
Westphal nucleus. The pre-ganglionic fibres synapse in the ciliary ganglion and reach the ciliary muscle by
the short (not long) ciliary nerves.

646-Which statement is FALSE regarding a cross-cylinder:

a. it can determine both the axis and the power of the cylindrical correction
b. the handle is positioned between the principal axes
c. the power and sign of the 2 cylinders in the cross are equal
d. it is equivalent to a pair of cylindrical lenses with their axes at right angles to one another

The power of the cylinders is equal but the signs are opposite.

647-What is the mode of action of the imidazole antimicrobials:

a. inhibits folate synthesis
b. inhibits protein synthesis
c. inhibits cell membrane synthesis
d. inhibits mitochondrial oxidation

The imidazoles are antimycotic agents which inhibit the synthesis of sterols which are an important
constituent in fungal cell membranes.

647-All are true of E.coli EXCEPT:

a. it is a facultative anaerobe
b. it ferments glucose
c. it is a Gram negative rod
d. it is non-motile
e. it grows well on MacConkey agar

E. coli is motile with polar flagella. Other options are true.

648-How thick is the tear film?

a. 4 micrometers
b. 2 micrometers
c. 9 micrometers
d. 13 micrometers

The tear film measures 7-9 micrometers.

649-Which statement is true of the ERG:

a. the b wave is produced by the photoreceptors
b. it cannot be performed on anaesthetized patients
c. dark adaptation increase the amplitude of the a and b waves as well as the latency
d. it is affected by optic neuritis
 The ERG records retinal activity. It can be performed on anesthetized patients. It is not affected by the
ganglion cells and therefore not affected by optic neuritis. It contains an upgoing a wave produced by
photoreceptors and downgoing b wave produced by Muller and bipolar cells. Dark adaptation increases
the amplitude the a and b waves as well as the latency.

650-The systemic amyloid associated with rheumatoid arthritis is derived from:

a. serum AA protein
b. immunoglobulin light chains
c. prealbumin
d. polypeptide hormones

Amyloid deposition may be derived from a number of sources depending on the pathology. It may occur
secondary to systemic disease such as rheumatoid, in which case it is derived from serum AA protein, an
acute phase reactant. It may occur from light chain immunoglobulins as in myeloma and
macroglobulinaemia. It may occur from polypeptoid hormones as in carcinoma of the thyroid. In
Alzheimers it is derived from prealbumin.

651-Which statement is FALSE regarding oncogenes:

a. mutated proto-oncogenes are associated with cancer
b. viral insertion can disrupt normal proto-oncogenes
c. proto-oncogenes regulate the normal cell division
d. oncogenes are associated with a reduced risk of cancer
Oncogenes are derived from normal proto-oncogenes by mutation. The mutation can be brought about by
point mutation, viral insertion, gene translocation or gene amplification. Proto-oncogenes regulate normal
cell division while oncogenes increase the risk of malignant transformation of a cell.

652-All of the following are produced from arachadonic acid EXCEPT:

a. thromboxane
b. prostaglandins
c. fibrinogen
d. leukotrienes

Fibrinogen is a plasma protein produced in the liver. Prostaglandins, thromboxane and leukotrienes are all
eiconsanoids, produced from arachadonic acid. Prostaglandins and thromboxane require cyclo-oxygenase,
while leukotrienes require lipoxygenase.

653-A teratoma is a tumour deriving from:

a. striated muscle
b. meningeal tissue
c. cartilage
d. germ cells
A teratoma is a tumour arising from germ cells.

654-The cell bodies of the ganglion cells are located in which retinal layer:
a. ganglion cell layer
b. nerve fibre layer
c. inner nuclear layer
d. outer nuclear layer
The ganglion cell bodies are located in the ganglion cell layer, which is the innermost nucleated layer of the
retina.
655-Which statement is FALSE about the tarsal plate:
a. the tarsal plates are modified thickenings of the orbital septum
b. the muco-cutaneous junction occurs at the level of the meibomian gland openings
c. the upper lid tarsal plate contains about 30 meibomian glands
d. the grey line marks the posterior boundary of the tarsal plate

The grey line marks the anterior boundary of the tarsal plate and is a useful surgical landmark dividing the
lid skin and contents from the tarsal plate and orbital contents. The muco-cutaneous junction between the
skin of the lid and the conjunctiva occurs at the level of the meibomian gland openings.

656-All are true of Botulinum toxin EXCEPT:

a. it can be used as treatment for essential blepharospasm
b. it is produced by Clostridium perfringens
c. it can be inactivated by heating
d. it prevents the release of acetylcholine from the nerve terminal

Botulinum toxin is produced by Clostridium botulinum. It is an exotoxin and is therefore denatured by

heat. It produces its effect by inhibiting exocytosis of acetylcholine from cholinergic terminals.

657-The subarachnoid space terminates at the level of:

a. the fourth lumbar vertebra
b. the third lumbar vertebra
c. the second sacral vertebra
d. the coccyx

The subarachnoid space terminates at the second sacral vertebra

658-Which is FALSE regarding exotoxins:

a. they are heat-resistant
b. they are proteins
c. tetanus toxoid is an example
d. they produce an antibody response

Exotoxins are proteins released by Gram-positive bacteria and produce specific effects at sites distant to
their release. They are highly toxic, antigenic and are readily destroyed by heat.

659-Regarding mitochondrial DNA all are true EXCEPT:

a. a male with a mitochondrial disorder can pass it on to his daughter only
b. it is expressed in muscle cells
c. it is responsible for coding enzymes used in oxidation
d. it is circular and double-stranded

Mitochondrial DNA are transmitted via the maternal line only. Both sperm and ova have mitochondria but
the sperm mitochondria do not enter the ova. Mitochondrial DNA is
expressed in mitochondria rich tissue such as the muscles, the neural tissues and the myocardium. Patients
with mitochondrial disorders are therefore susceptible to myopathy and cardiomyopathy. DNA in the
mitochondria code for enzymes involved in oxidation and energy production.
 660-Which statement regarding the foramen is correct:
a. The carotid canal is in the maxillary bone
b. The foramen ovale occurs in the frontal bone
c. The jugular foramen occurs between the temporal bone and the occipital bone
d. The stylomastoid foramen is in the occipital bone

The sytlomastoid foramen is found in the temporal bone between the mastoid process and the styloid.
The carotid canal is on the inferior surface of the petrous part of the temporal bone. The jugular foramen is
formed between the temporal and occipital bones. The foramen ovale is found in the greater wing of the
sphenoid

661-The inferior orbital fissure transmits all of the following EXCEPT:

a. the zygomatic nerve
b. the lacrimal nerve
c. branches from the pterygopalatine ganglion
d. the infraorbital nerve

The lacrimal nerve passes through the superior (not inferior) orbital fissure. Other options supplied are
true.

662-Raised intracranial pressure:

a. is associated with a decrease in blood pressure
b. is associated with a decrease in pulse rate
c. is associated with an increase in the respiratory rate
d. may be reduced by hyperventilation

Raised intracranial pressure is associated with:

raised blood pressure raised pulse rate periodic respiration.
Hyperventilation decreases the PCO2 and can be used to reduce the intracranial pressure by decreasing
the cerebral blood flow to the arachnoid granulations. However, the reduction in cerebral blood flow may
exacerbate cerebral ischemia.

663-Stimulation of the sympathetic nervous system results in all of the following EXCEPT:
a. contraction of the bladder detrusor muscle
b. pupillary dilatation
c. vasoconstriction of the skin and mucous membrane
d. decreased gastrointestinal motility

Sympathetic nervous system stimulation causes pupil dilatation, reduced gastrointestinal motility and
causes bronchodilatation. It diverts blood away from the skin and mucous membrane by vasoconstriction
and relaxes the detrusor muscle of the bladder

664--2.00 DS/ -1.00 DC x 170 is equivalent to:

a. -3.00 DS/ + 1.00 DC x 80
b. +8.00 DS/-2.50 DC x 135
c. + 11.50 DS/+2.75 DC x 12
d. + 3.75 DS/-6.25 DC x 75

-2.00 DS/ -1.00 DC x 170 is equivalent to -3.00DS/+1.00DC x 80

665-Which is FALSE regarding acute retinal necrosis:
a. it can be caused by herpes zoster virus
b. viral inclusion bodies cannot be detected in the retina histologically
c. specimens show hemorrhagic necrosis
d. it can be caused by herpes simplex virus

Viral inclusion bodies are visible on light microscopy within the retinal neurones and the RPE.

666-The anterior ethmoid foramen is found:

a. between the frontal and ethmoid bones
b. within the sphenoid bone
c. between the ethmoid bone and lacrimal bone
d. within the frontal bone

The anterior ethmoid foramen occurs at the junction of the frontal and ethmoid bones in the medial
orbital wall. It transmits the anterior ethmoidal vessels and the anterior ethmoidal nerve.

667-Which orbital communication occurs between the greater and lesser wings of the sphenoid:
a. inferior orbital fissure
b. foramen ovale
c. foramen rotundum
d. superior orbital fissure

668-Which is FALSE regarding stereoacuity:

a. the normal stereoacuity is 60 seconds of arc
b. it requires images to fall on Panum's area
c. it cannot be measured without polarizing spectacles
d. it is measured in seconds of arc

Stereoacuity can be measured by several tests. The Titmus test requires polarizing spectacles but not the
Frisby test.

669-Which of the following is MOST likely in Sturge-Weber syndrome:

a. retinal haemangiomata
b. choroidal haemangioma
c. astrocytic hamartomas
d. Lisch nodules

Sturge-Weber syndrome is characterized by naevus flammeus of the facial skin with angioma of the
meninges. It is associated intra-ocularly with:
choroidal haemangioma glaucoma due to vascular proliferation in the angle

670-Which is FALSE regarding retinal capillaries:

a. they are surrounded by pericytes and astrocyte foot processes
b. they are absent entirely from the foveola
c. they are surrounded by a thin basal lamina
d. their endothelial cells are joined by tight junctions
The retinal capillary endothelial cells are joined by tight junctions. They are surrounded by a thick (not
thin) basal lamina. They are also surrounded by pericytes and astrocyte foot processes, all of which play an
important role in the integrity of the blood-retinal barrier.

671-All of the following are TRUE of keloid scars EXCEPT:

a. it is otherwise known as a hypertrophic scar
b. steroid therapy can reduce the formation of keloid
c. it is more likely to develop if a wound becomes infected
d. Patients of Afro-Caribbean origin with dark complexion are at higher risk
A hypertrophic scar is raised but does not go beyond the boundary of the original wound, unlike keloid. All
other statements are true.

672-All of the following are muscles of mastication EXCEPT:

a. lateral pterygoid
b. medial pterygoid
c. buccinator
d. masseter

All the choices above are muscles of mastication except the buccinator. Muscles of mastication (masseter,
lateral and medial pterygoid) arise from the first pharyngeal arch and are supplied by the mandibular
branch of the trigeminal nerve. The buccinator is a muscle of facial expression and together with the other
muscles of facial expression, it arises from the second pharyngeal arch, and is supplied by the facial nerve.

673-Which of the following statements regarding intention-to-treat analyses is correct?

a. they are preferable because they require a smaller sample size
b. they are preferable because they assess the efficacy of a new treatment
c. they are preferable because they remove potential biases in the trial
d. they are preferable because they do not require us to blind patients to the treatment they are
receiving
e. they are preferable because they allow us to randomise patients to different treatment arms
where this would otherwise be unethical

Intention-to-treat analyses assess outcomes by the groups to which patients were originally assigned,
irrespective of whether they actually received the intervention. It is done for two reasons:
Statistically: patients dropping out or transferring to other arms may not do so randomly, if we did not
do an ITT analysis we would introduce bias Clinically: ITT analyses assess an intervention's likely effect
in day-to-day practice (effectiveness) rather than under ideal conditions (efficacy).

674-The cribriform plate is part of:

a. the maxilla
b. the ethmoid bone
c. the frontal bone
d. the sphenoid bone

The cribriform plate is part of the ethmoid bone and it transmits the olfactory nerves.
675-Which of the following diseases does NOT involve abnormal G protein activity?
a. myasthenia gravis
b. cholera
c. pseudohypoparathyroidism
d. pituitary adenomas
e. McCune-Albright syndrome

G proteins can be inhibitory or stimulatory. In general they consist of three subunits, alpha, beta and
gamma. When the alpha unit is activated it binds GTP and separates from the rest of the complex to cause
effects downstream. As it does so, GTP is converted to GDP. The alpha subunit, with GDP bound, then
rejoins the rest of the complex. Cholera toxin causes a stimulatory G protein (Gs) to be continually
switched on, leading to severe diarrhoea. Similiar G protein abnormalities have been found in all the other
diseases listed bar myasthenia gravis, which is an autoimmune disorder targeting post-synaptic ACh
receptors.

676-Regarding pilocarpine which statement is FALSE:

a. it facilitates aqueous drainage
b. it causes pupillary contraction
c. it draws on the scleral spur and opens the trabecular meshwork
d. it has no effect on aqueous secretion

Pilocarpine facilitates aqueous drainage by constricting the iris and by opening the meshwork from its
action on the ciliary muscle. It also reduces aqueous secretion by reducing blood flow to the ciliary body.

677-Which rectus muscle inserts 7.0 mm from the cornea:

a. superior rectus
b. inferior rectus
c. lateral rectus
d. medial rectus

The insertion distances of the four recti muscles from the limbus are as follows:
medial rectus 5.6mm inferior rectus 6.6mm lateral rectus 7.0 mm superior rectus 7.8mm

678-Compared to blood the CSF has:

a. lower glucose
b. more lymphocytes
c. higher immunoglobulins
d. higher protein

Most constituents exist in lower concentration in the CSF compared to blood, including glucose, which is
60% of its blood concentration. Only chloride, magnesium and hydrogen ions are in higher concentration in
the CSF.

679-Which statement is FALSE regarding the geniculocalcarine tracts, or optic radiations:

a. the fibres from the inferior portion of the retina take a wider course
b. the fibres initially pass anteriorly to form a loop called the loop of Miller
c. the axons are destined for the occipital cortex
d. the tract passes through the temporal lobe
e. the axons have their cell bodies in the lateral geniculate nucleus
The geniculocalcarine tracts initially pass anteriorly to form a loop called the loop of Meyer (not Miller)
which passes through the parietal and temporal lobes. Fibres from the inferior retina (corresponding to the
superior visual field) take a wider course passing deeper into the temporal lobe than fibres from the
superior retina. Fibres from the macula tend to have the straightest course.

680-Which of the following is TRUE about smooth muscle:

a. it shows visible striation
b. it is composed of single nucleated cells that act as a synctium
c. it contains troponin
d. it acts under somatic nervous control

Smooth muscle shows no visible striation. It is innervated by the autonomic nervous system. It contains
myosin, actin and tropomyosin but not troponin. It is made up of single nucleated cells that act as a
syncytium.

681-Fibres from the optic chiasm to the superior colliculus are involved in all EXCEPT:
a. the visual grasp reflex
b. automatic scanning of images
c. visual association pathways
d. the pupillary light reflex

After the decussation of fibres in the optic chiasm, 90% of fibres pass along the lateral root of the optic
tract towards the lateral geniculate nucleus and on to the occipital cortex for conscious vision. 10% of
fibres travel along the medial root of the optic tract and are responsible for unconscious stimuli. These
fibres target:
the superior colliculus: involved in visual grasp reflex, automatic scanning of images
the pretectal nucleus: involved in pupillary light reflex
the parvocellular reticular formation: arousal function
the retinohypothalamic tract : photoperiod regulation

682-The following are true about the trigeminal nerve EXCEPT:

a. it innervates the paranasal sinuses
b. it emerges from the brain stem between the pons and the medulla
c. it supplies the muscles of mastication
d. it emerges from the brain stem as separate sensory and motor roots

The trigeminal nerve emerges from the brain stem at the junction between the pons and the middle
cerebellar peduncle.

683-All are true of the sympathetic trunk EXCEPT:

a. in the thorax it is covered by the pleura
b. in the neck it lies alongside the bodies of the cervical vertebrae
c. it extends from the base of the skull to the lower lumbar region
d. it enters the thorax anterior to the neck of the first rib

The sympathetic trunk extends from the base of the skull to the coccyx. In the neck, it is covered by the
prevertebral fascia and lies alongside the bodies of the cervical vertebrae. It enters the thorax through the
neck of the first rib. In the thorax it is covered by the pleura.
684-In a sample of 200 gastroenterology inpatients, 25 were felt to have ascites on clinical examination.
Ultrasound on all revealed 100 to have ascites, of which 21 had been detected clinically.
Which of the following interpretations is NOT correct:
a. a high number of false negatives would mean a low sensitivity
b. positive predictive values of clinical exam for ascites is 21/25
c. sensitivity on clinical exam for ascites is 21/25
d. prevalence of ascites in this sample was 50%
e. the high proportion of true negatives means the test has a high specificity

The incorrect option above would be true if it was 21/(21+79).

685-Which human tissue has the highest oxygen consumption per weight:
a. myocardium
b. renal cortex
c. retina
d. choroid

The retina is a highly active metabolic tissue, with the highest consumption of oxygen per weight in the
human.

686-Which statement is FALSE regarding cytomegalovirus retinitis:

a. it is typically seen in immunocompromised patients
b. infected cells are enlarged with an owl-eye appearance
c. retinal hemorrhaging is characteristic
d. it is characterized by areas of retinal necrosis

CMV retinitis demonstrates areas of retinal necrosis usually without hemorrhage.

687-Which layer occurs immediately beneath the nerve fibre layer of the retina:
a. internal limiting membrane
b. outer segment
c. inner plexiform layer
d. inner nuclear layer
e. ganglion cell

The eight layers of the neurosensory retina from outer to inner, that is from the RPE upwards are:
outer segment inner segment outer nuclear outer plexiform inner nuclear inner
plexiform ganglion cell nerve fibre layer

688-The crystalline lens strongly absorbs which wavelength of light:

a. UV-B
b. IR-B
c. UV-C
d. UV-A

The crystalline lens strongly absorbs UV-A, which is the nearest UV (315nm-400nm) light to the visible
spectrum. UV-B and UV-C are usually absorbed by the cornea and sclera.
689-Which of the following structures on its cell surface allows a hepatocyte to alert the immune system
to a virus that has infected it:
a. T-cell receptor
b. Immunoglobulin D
c. Class I major histocompatibility complex
d. Fc receptor
e. Class II major histocompatibility complex

Every nucleated cell in the body expresses class I major histocompatibility complex (MHC) molecules,
which present intracellular material on the cell surface. Degraded virus is presented to circulating CD8+
(cytotoxic) T-cells which are then activated. The result is destruction of the infected cell. MHC class II
molecules are only expressed on specialised antigen presenting cells but are inducible on
endothelial/epithelial cells. Peptides presented on MHC class II molecules are primarily derived from the
extracellular environment and are recognised by CD4+(T-helper) cells. Immunoglobulin is produced by B-
cells and is there are 5 different classes (G, A, M, D, E). IgD is immunoglobulin bound to the surface of B-
cells. It acts as the B-cell receptor. Fc receptors are expressed on various cells and allow the Fc portion of
an immunoglobulin molecule to bind to these cells.

690-Which is FALSE regarding alpha-adrenergic agonists:

a. apraclonidine is an alpha-1 agonist
b. alpha-2 receptors are located mostly on the presynaptic nerve endings
c. alpha-1 receptors mediate excitatory responses
d. alpha-1 agonists cause a rise in IOP

Alpha-1 agonists are excitatory, principally causing smooth muscle contraction, as in the contraction of
the dilator pupillae muscle. This dilatation causes an early rise in IOP.
Alpha-2 agonists occur mainly on the presynaptic nerve endings and are inhibitory as they prevent further
release of neurotransmitter. Alpha-2 agonists such as clonidine cause a reduction in IOP and this is thought
to be mediated centrally by the stimulation of the medullopontine sympathetic nerve and by reducing
aqueous production locally. Apraclonidine is a partial alpha-2 agonist.

691-Immunoglobulin G:
a. is the main immunoglobulin in normal conjunctiva
b. contains two antigen-binding sites
c. is the least common immunoglobulin in plasma
d. cannot cross the placenta

IgG is the most common immunoglobulin in plasma, accounting for about 75% of the circulating
immunoglobulins in healthy individuals. IgG antibodies predominate during a secondary antibody
response. Thus, the appearance of specific IgG antibodies generally corresponds with the 'maturation' of
the antibody response, which is switched on upon repeated contact with an antigen. It crosses the
placenta freely. It has two antigen binding sites. The main immunoglobulin in conjunctiva is IgA.

692-Which is FALSE regarding the rod lamellae:

a. they are shed predominantly in the evening
b. they number up to 1000 in each outer segment
c. they are phagocytosed by the RPE
d. they are contained within a membrane

Rod lamellae are shed in a circadian rhythm predominantly in the early morning.
693-Which statement about the Bowman's layer is FALSE:
a. it is a modified acellular region of stroma
b. it is 8-12 micrometers thick
c. it terminates abruptly at the limbus
d. it is composed mainly of Type II collagen
The Bowman's layer consists of fine, randomly arranged collagen fibrils which are mainly Types I, III, V and
VI.

694-The image formed by an object outside the centre of curvature of a concave mirror is:
a. real, inverted and diminished
b. virtual, inverted and enlarged
c. real, inverted and enlarged
d. erect, virtual and enlarged

For an object outside the centre of curvature of a concave mirror, the image formed is real, inverted and
diminished; and it lies between the centre of curvature and the principle focus.

695-During A-scan biometry, corneal compression from excessive pressure from the probe will:
a. cause an artificial shortening of the axial length
b. have no affect on the measurement
c. damage the probe
d. cause an artificial lengthening of the axial length

Corneal compression from excessive pressure during A-scan biometry causes an artificial shortening of the
axial length.

696-Which vessels are typically affected in Takayasu's disease:

a. small and medium sized arteries
b. any large vessel with an elastic lamina
c. vessels arising from the aortic arch
d. renal arterioles
Takayasu's disease affects major vessels arising from the arch of the aorta.

697-Acquired optic nerve disease tends to cause:

a. red-green defects
b. deuteranopia
c. blue-yellow defects
d. symmetric depreciation of colours

red-green defects: acquired optic nerve disease (except glaucoma and autosomal dominant optic
atrophy)
blue-yellow defects: acquired retinal disease (except cone dystrophy and Stargardt's)

698-Which artery supplies the lateral root of the optic tract:

a. anterior choroidal artery
b. anterior cerebral artery
c. posteror choroidal artery
d. lateral striate artery
e. posterior communicating artery
The lateral root of the optic tract is supplied by the anterior choroidal artery.
699-The corneal endothelium obtains its oxygen from:
a. the air
b. the conjunctival
c. the precorneal tear film
d. the aqueous

The corneal epithelium obtains its oxygen from the precorneal tear film. The endothelium and the
keratocytes in the deep stroma by contrast obtain their oxygen supply from the aqueous humour.

700-The most common corneal dystrophy is:

a. Reis-Buckler dystrophy
b. Labrador keratopathy
c. Fuch's endothelial dystrophy
d. Granular dystrophy
e. Lattice dystrophy

Fuch's endothelial dystrophy is the most common corneal dystrophy, occurring in the elderly with a female
preponderance
 Question 701 part 8 BASIC SCIENCES

701-The frontal eye field is primarily concerned with:

a. fixation
b. saccades
c. dolls-head reflex
d. visual memory
e. ductions

The frontal eye field is concerned with voluntary control of eye movements (saccades).

702-Which is FALSE regarding mitosis and the cell cycle:

a. biosynthesis occurs during G1
b. G0 is the rest phase
c. chromosomes align in the centre of the nucleus during metaphase
d. chromosomal separation begins in telophase

Chromosomal separation begins in anaphase with completion of separation during

telophase

703-Which is FALSE regarding Human Immunodeficiency Virus (HIV):

a. it gains entry by binding to CD4 antigen on the cell surface
b. the earliest sign of infection is p24 protein in the blood
c. Type II is primarily homosexually transmitted
d. it affects CD4 positive T cells

Type I HIV occurs primarily in urban centres in the USA and Europe and is more common in
homosexuals and intravenous drug abusers. Type 2 is more common in Africa and is mainly
heterosexually transmitted.

704-Which of the following lymphocytes has cytotoxic activity without a specific antigen
receptor and is not antigen specific?
a. natural killer (NK) cells
b. B-lymphocytes
c. macrophages
d. T-lymphocytes
e. plasma cells

Natural killer (NK) cells are a distinct class of lymphocytes that have the ability to lyse a
wide variety of cell types. It is felt that they represent the front-line defense against viral
infections and neoplasia. NK cells may be involved in ocular protection against
cytomegalovirus (CMV) retinitis or herpes simplex ocular infections.

705-The visible wavelengths of light are:

a. 600nm-900nm
b. 500nm-820nm
c. 400nm-780nm
d. 380nm-650nm

The visible spectrum of light is 400nm-780nm.

706-Which statement about keratocytes is FALSE:
a. keratocytes are stellate in shape
b. keratocytes are connected to neighbouring cells by tight junctions
c. keratocytes are modified fibroblasts
d. keratocytes are flattened cells and occur between collagenous lamellae

Keratocytes are connected to neighbouring cells by gap junctions

707-Regarding interferon:
a. it activates macrophages
b. it acts by neutralizing exotoxin
c. it is a virus specific molecule
d. it can be produced by endothelial cells

Interferon is a glycoprotein produced by T lymphocytes and macrophages. There are three

types: alpha, beta and gamma. It has non-specific antiviral properties. Its effects include:
direct anti-proliferative action on tumour and virus infected cells activation of natural
killer cells and macrophages increased expression of class I HLA antigen on tumour or
infected cells.

708-Which are the myelin-forming cells of the central nervous system:

a. microglia
b. oligodendrocytes
c. Schwann cells
d. Astrocytes

The glial cells of the central nervous system include:

Oligodendrocytes: the myelin-forming cells of the CNS.
Astrocytes: perform a variety of structural and functional roles including metabolic,
healing, blood-brain and blood-retinal barriers.
Microglia: are monocytes and perform phagocytosis

709-The abducens nerve near its exit from the brain stem is pinned down by:
a. the posterior inferior cerebellar artery
b. the anterior inferior cerebellar artery
c. the superior cerebellar artery
d. the posterior cerebral artery

The sixth cranial nerve is pinned down near to its exit from the pons by the anterior inferior
cerebellar artery.

710-Which of the following is true regarding the normal distribution?

a. it would be unusual for the mean, mode and median to have the same value
b. approximately 68% of values will fall between limits with a value of -2z and 2z
c. a value with a z-score of -2 lies two variances below the mean
d. approximately 5% of values will be above 2 standard deviations from the mean
e. 95% of values will fall within 1.96 standard deviations either side of the mean

A normal distribution is a theoretical frequency distribution to which many biological data

approximate. It is defined as a symmetrical bell-shaped distribution in which mean = mode =
median. It is sufficient to describe a normal distribution by mean and SD and by no other
data.
Variance is a measure of the spread of observations about the mean and it is equal to the
SD (Standard deviation) squared.
The units of z-score are in standard deviation such that a value with a z-score of +1 lies 1
standard deviation above the mean.
In a normal distribution:
About 68% of the observations fall within 1 s.d. on the either side of the mean About
95% of the observations fall within 2 s.d. on the either side of the mean (more exactly, 95%
observations fall within 1.96 s.d. either side) About 99% of the observations fall within 3
s.d. on the either side of the mean

711-The cornea:
a. contains Descemet's membrane which is not a true basement membrane
b. is thicker centrally than peripherally
c. contains 4,000 endothelium cells per square mm at birth
d. has a completely acellular collagenous stroma

The cornea is thicker peripherally (about 1.2 mm) than centrally (average 0.5 to 0.6 mm). It
contains about about 3-4000 cells per square mm at birth, the number decreases with age. It
contains Descemet's membrane, which is produced by the endothelial cells and forms its
basement membrane. It contains flattened keratocytes within the stroma. Other cells such
as macrophages, lymphocytes or neutrophils may be seen.

712-Which structure passes through the superior orbital fissure, usually inferior to the
common tendinous ring:
a. nasociliary nerve
b. abducent nerve
c. inferior division of the oculomotor nerve
d. inferior ophthalmic vein

The inferior ophthalmic vein passes through the superior orbital fissure but usually outside
and inferior to the common tendinous ring. Other options supplied always pass through the
common tendinous ring.

713-Which margin of the orbital rim is thickest:

a. the lateral margin
b. the inferior margin
c. the medial margin
d. the superior margin

The lateral margin of the orbital margin is thickest, probably because it is the most exposed
and therefore most prone to trauma.

714-Which statement is FALSE about the ciliary body:

a. it is supplied with parasympathetic innervation via the short ciliary nerves
b. contraction of the ciliary body reduces the flow of aqueous though the trabecular
meshwork
c. it is supplied with blood from both the long posterior ciliary arteries and the anterior
ciliary arteries
d. it is supplied with sympathetic innervation which synapses in the superior cervical
ganglion

Contraction of the ciliary body increases aqueous flow by the action of the anterior fibres on
the scleral spur, which moves inward and posteriorly, thereby opening up the neighbouring
trabecular meshwork.
715- All of the following structures pass through the superior orbital fissure outside the
common tendinous ring EXCEPT:
a. the superior division of the oculomotor nerve
b. the frontal nerve
c. the trochlear nerve
d. the lacrimal nerve

The superior division of the oculomotor nerve passes through the superior orbital fissure
and within the tendinous ring. The other options pass through the superior orbital fissure
but above the tendinous ring.

716-The following are ocular associations of rheumatoid arthritis EXCEPT:

a. scleromalacia perforans
b. iritis
c. scleritis
d. peripheral corneal ulceration
Rheumatoid arthritis due to its associated immune-complex vasculitis impairs the
circulation to the anterior segment of the eye leading to: corneal ulceration, scleritis and
thinning of the sclera (scleromalacia perforans).

717-The basilar artery is a branch of:

a. the spinal artery
b. the posterior cerebral artery
c. the vertebral artery
d. the posterior communicating artery

The basilar artery is derived from the junction of the two vertebral arteries.

718-Choose the one correct statement. Regarding antibodies:

a. idiotype is determined by genetic variation in the heavy and light chains
b. they recognise only the peptide antigen
c. the class is determined by the presence of either kappa or lambda light chains
d. they consist of one heavy and one light chain
e. there are always 3 constant domains on each heavy chain

All immunoglobulins consist of 4 polypeptide chains - 2 identical heavy chains bound to 2

identical light chains. Each light chain consists of a varible domain (the amino acid
sequence varies among light chains of different antibodies) and a constant domain. There
are two types of light chains - lambda and kappa chains. No functional differences have
been found between antibodies composed of lambda or kappa light chains. Each heavy
chain consists of one variable domain and a number of constant domains - IgM and IgE
have 4 heavy chain constant domains, whereas IgG, IgD and IgA have 3 heavy chain
constant domains. The variable domains of both the heavy and the light chains combine to
form the antigen-binding site, and confer specificity on the antibody. The unique sequence
of the variable regions of the antigen-binding site of individual antibody molecules is termed
the idiotype. The heavy chain constant region of different antibodies differs in structure, and
it is this portion of the antibody that determines the class (isotype) and thus its different
properties and effector functions. There are five immunoglobulin isotypes in humans- IgG,
IgM, IgA, IgE and IgD. Antibodies bind to conformational epitopes i.e., sites on the antigen
surface brought together by folding - they recognise tertiary and quarternary structures of
proteins and carbohydrates. Some antibodies recognise and bind to linear segments of
polypeptide. The enormous antibody repertoire in humans is mostly the result of
combinatorial rearrangement of germline immunoglobulin genes encoding the variable
regions of the heavy and light chains.
719-Which of the following best describes the mode of action of gentamicin:
a. inhibits cell wall synthesis
b. inhibits protein synthesis
c. inhibits nucleic acid synthesis
d. inhibits cell membrane synthesis

Gentamicin is an aminoglycoside and it prevents protein synthesis by preventing the

reading of codons from messenger RNA.

720-The most appropriate culture medium for acanthoemaba is:

a. nutrient-deficient agar with E.coli overlay
b. McConkey agar
c. chocolate agar
d. Lowenstein-Jensen medium

Acanthoemeba is notoriously difficult to culture. The best medium is nutrient-deficient agar

with E.coli overlay.

721-The termination of Descemet's membrane gives rise to:

a. the scleral spur
b. Schlemm's canal
c. Schwalbe's line
d. the pigmented trabecular meshwork

The termination of Descemet's membrane gives rise to Schwalbe's line, which is an

important landmark in gonioscopy.

722-Which test requires the use of polarized spectacles:

a. Frisby test
b. TNO test
c. Titmus test
d. Sheridan-Gardiner test

The Titmus, TNO and Frisby are all tests of stereoacuity. The Titmus test requires polarized
spectacles to be worn while the TNO test requires red-green spectacles. The Frisby test is
taken without spectacles. The Sheridan-Gardiner is a test of visual acuity and does not
require spectacles or aids.

723-The effect of a new technique of retinal surgery on the length of hospital stay following
retinal detachment is compared to current best practice. Critical level is set at 0.01. A
difference is found where p=0.004. Which of the following is TRUE?
a. a Type II error would occur if we rejected the null hypothesis when it were true
b. the probability of a Type I error occurring would be 0.004
c. the power of this trial may have been increased by looking at a smaller number of
individuals
d. acting on the basis of a false positive finding is the same as committing a Type II
error
e. the null hypothesis should be retained

The null hypothesis states that there is no difference between two populations being
compared and that the difference is due to chance. The p value is the probability of a Type I
error (false positive) which occurs when the null hypothesis is rejected when it is true. A
Type 2 error (false negative) occurs when the null hypothesis is accepted when it should
have been rejected (there is a difference).
724-Regarding MHC molecules:
a. they are not required for T-cells to recognise antigen
b. class I molecules consist of a homodimer of an alpha, beta or gamma chain
c. class II molecules are expressed by all cells
d. they can determine the responsiveness of an individual to certain peptides
e. genes encoding MHC molecules are scattered throughout the genome

The MHC loci in humans is located on the short arm of chromosome 6. It includes genes
encoding class I, class II and class III molecules.
Class I antigens (HLA A, B, and C) are present on all nucleated cells. They consist of a
single transmembrane polypeptide chain associated with beta-2microglobulin.
MHC class I molecules present antigenic peptides derived from within the cytosol
(endogenously e.g. viral antigens) to CD8+ T-cells. MHC class II antigens e.g. (HLA DR, DP,
DQ) consist of two polypeptide chains and are found on antigenpresenting cells (dendritic
cell, Langerhans cells, macrophages, B-cells) and occasionally activated T-cells. These
molecules present antigenic peptides derived from outside cells (exogenously) such as
bacterial antigens to CD4+ T-cells.
MHC class III genes encode complement components including C4 (A and B), C2 and
factor B. Other proteins that are encoded within this region include TNFalpha, lymphotoxins
(LTA, LTB), and 21-hydroxylase.
Non-classical class I-like genes or class IB molecules (e.g., HLA-E, F, G) are also encoded
by the MHC. These are nonpolymorphic proteins expressed with Beta-2microglobulin. The
precise role of the non-classical MHC class I molecules is not clear but may be important in
inhibiting killing by NK cells.
T-cells only recognise peptide antigen in combination with MHC.
The MHC haplotype may determine responsiveness to particular peptides by determining
whether the peptide is presented by the MHC molecules that are encoded by the
represented alleles.

725-Regarding T lymphocytes:
a. Helper T cells enhance the immune response
b. T lymphocytes contain Fc receptors
c. Suppressor T cells are the primary effector T cells
d. T lymphocytes produce antibodies when activated

B cells, not T cells contain Fc receptors. Cytotoxic T cells are the primary effector T cells.
Helper T cells produce interleukins and together with suppressor (or regulatory) T cells
regulate the immune response.

726-Antibodies perform all of the following functions EXCEPT:

a. facilitate differentiation of B cells
b. trigger the complement cascade
c. neutralization of toxins
d. opsonisation

Antibody binding:
facilitates phagocytosis (a process termed opsonisation) neutralizes bacterial toxins
triggers the complement cascade
Antibody binding plays no role in the differentiation of B cells.
727-Bipolar cell bodies lie in which layer of the retina:
a. outer nuclear layer
b. inner plexiform layer
c. outer plexiform layer
d. inner nuclear layer
Bipolar cell bodies are found in the inner nuclear layer.

728-How long is the intraorbital segment of the optic nerve:

a. 10mm
b. 5 mm
c. 1mm
d. 25 mm

The optic nerve segments are as follows:

intraocular: 1mm orbital: 25-30 mm intracanalicular: 4-10mm intracranial: 10mm

729- All statements are true of the prostaglandins EXCEPT:

a. they cause pain when applied directly to the nerve endings
b. non-steroidal anti-inflammatory drugs reduce prostaglandins production by
inhibiting cyclooxygenase
c. leukotrienes produce increased vascular permeability
d. thromboxane A2 causes both vasoconstriction and platelet aggregation

Prostaglandins sensitise the nerve endings to pain but do not themselves produce pain.
Cyclooxygenase is the rate determining enzyme in their production and is inhibited by non-
steroidal anti-inflammatory drugs. Thromboxane A2 causes both vasoconstriction and
platelet aggregation. Leukotrienes are involved in allergic reaction and inflammation. They
produce bronchoconstriction, vasoconstriction and increased vascular permeability

730-All of the following are important to the corneal endothelial pump EXCEPT:
a. Na/K ATPase
b. Na/HCO3 ATPase
c. Na/H antiport
d. GLUT3 transporter

The endothelium pump mechanism is a fairly complex process and involves:

At the aqueous interface: Na/HCO3 co-transporter and HCO3/Cl exchanger At the
stromal interface: Na/K ATPase and Na/H antiporter
GLUT is an active glucose transporter and has no role in the endothelium pump.

731-A recent multi-centre study reports that the 10-yr risk of death due to cardiac causes is
12% on placebo and 8% on drug X. The authors conclude that 'a 33% reduction in cardiac
deaths is seen with X'.
The figure '33%' represents which of the following?
a. number needed to treat
b. relative risk reduction
c. control event rate
d. experimental event rate
e. absolute risk reduction
If a drug reduces the incidence of heart attacks from 10% to 5% then, the control event rate
(CER) is 10% and the experimental event rate (EER) is 5%.
The relative risk reduction (RRR) is 50%.
The absolute risk reduction (ARR) is 5%.
The number needed to treat (NNT) is 100/5 = 20.
732-Which of the following is TRUE about exotoxins:
a. it is resistant to inactivation by heat
b. it is produced by both Gram positive and Gram negative bacteria
c. it is produced by Clostridium botulinum
d. it can be detected using the Limulus test

Exotoxin is produced by Gram positive bacteria. It is made up of protein and is inactivated

by heat. When injected into the body it causes the formation of antibodies. Botulinum toxin
is an exotoxin produced by Clostridium botulinum. Limulus Tests is a sensitive method for
detection of bacterial endotoxins.

733-Which statement about ras oncogenes is false:

a. they are mutated proto-oncogenes
b. they encode for proteins which act as signal transducers
c. they are only expressed in malignant tissues
d. they are highly conserved in evolution
e. they encode for proteins with sequence homology to G proteins

Oncogenes were originally found as genes carried by cancer-inducing viruses. They are the
mutated form of normal eukaryote genes called proto-oncogenes, which are highly
conserved in evolution because of their central role in cell growth and differentiation. Proto-
oncogenes/oncogenes encode for growth factors, growth factor receptors, enzymes, and
transcription factors and in the case of ras oncogenes, intracellular signal transducers, low
molecular weight G-proteins. Under normal circumstances, G-proteins bind GTP when
activated, and are inactivated by their own GTPase activity. A single amino acid mutation is
sufficient to change the ras proto-oncogene into an oncogene. Ras oncogenes inhibit their
GTPase activity resulting in ongoing activation. Ras is the commonest oncogene in human
tumors, others include myc, rel, fos, and jun.

734-Which of the following cells is typically found in a granuloma:

a. Epithelioid cells
b. B lymphocytes
c. Langerhan's cells
d. Neutrophils

A typical granuloma contains multinucleated giant cells (called Langhan's cells) surrounded
by epitheliod cells, which are activated macrophages. Langhan's cells must not be confused
with Langerhan's cells, which are dendritic cells in the epidermis.

735-Which statement is FALSE about the light reflex of the pupil:

a. it is impaired in patients with unilateral cataract
b. it involves the superior colliculus
c. it is impaired in destructive lesion of the pretectal nuclei
d. it is impaired if the ciliary ganglion is damaged

The afferent pathway of the pupillary light reflex involves in order: the optic nerves, optic
chiasm, optic tracts, the pretectal nuclei in the midbrain, and finally (bilateral projection to)
the Edinger-Westphal nuclei. The efferent (parasympathetic) pathway involves: the Edinger-
Westphal cell group of the oculomotor nucleus, the ciliary ganglion (synapse), and the short
ciliary nerves reaching the iris. Cataract does not impair the pupillary light reflex.
736-Which best describes the course of the ophthalmic artery in the orbit in relation to the
optic nerve:
a. inferior to lateral
b. inferior to medial
c. medial to superior
d. superior to lateral

The ophthalmic artery enters the orbit infero-lateral to the optic nerve, with which it is in
close association. In the posterior third of the orbit the ophthalmic artery travels superiorly
and medially across the optic nerve to travel superior and medially to the optic nerve.

737-The ration of cones: bipolar cells : ganglion cells in the fovea is usually:
a. 2:1:1
b. 1:1:1
c. 1:1:3
d. 3:1:1
e. 1:2:2

In the fovea the ratio is 1:1:1, while in the periphery the bipolar cell may receive input from
50-100 rods.

738-Which modality of treatment uses infrared light:

a. photodynamic therapy
b. NdYAG capsulotomy
c. pan retinal photocoagulation
d. transpupillary thermotherapy

Transpupillary thermotherapy (TTT) uses infrared light to heat the treated area (up to 40
degrees Celsius). It is used in the treatment of choroidal melanoma.

739-The anteroposterior diameter of the adult eye is:

a. 25-27mm
b. 23-25mm
c. 20-23mm
d. 27-30mm

The normal anteroposterior diameter of the adult eye is 24.5mm though this varies, being
longer in myopes and shorter in hypermetropes.

740-Which is false regarding translation:

a. aminoacyl-tRNA synthetase is an important enzyme
b. it occurs in the cytoplasm
c. it occurs in a 5 to 3 direction
d. anticodons occur on mRNA

Anti-codons refer to the complementary sequences of nucleotides on the tRNA molecules

as they attach onto the mRNA molecule at the ribosome.

741-All are true of acetazolamide EXCEPT:

a. it reduces intra-ocular pressure by reducing aqueous production
b. its site of action is the non-pigmented ciliary epithelium
c. it can cause renal stones
d. it can cause hyperkalaemia
e. it is a carbonic anhydrase inhibitor
Acetazolamide is a carbonic anhydrase inhibitor which reduces IOP by its effect on the non-
pigmented ciliary epithelium secretory function. Acetazolamide has a number of side effects
including:
hypokalaemia acidosis fatigue paraesthesia dermatitis renal stones

742-Class II MHC proteins are found on the surface of all of the following EXCEPT:
a. Langerhans' cells
b. dendritic cells
c. neutrophils
d. macrophages

Class II MHC proteins are found only on surface of certain cells: macrophages, B cells,
dendritic cells of the spleen, Langerhans cells of the skin.

743-Which is FALSE regarding a focimeter:

a. the target is usually a ring of dots
b. the collimating lens is fixed
c. prismatic power can be measured
d. determination of bifocal add requires back vertex power measurement

Spectacles are designated by their back vertex power, so this is what is measured for the
distance element of spectacles in a focimeter. However, to determine the near segment add
in bifocal lenses, it is necessary to measure the front vertex power (as the near add is at the
front of the spectacle) and subtract the front vertex power of the distance from the front
vertex power of the near to determine the near add.

744-The first cell in the eye to produce melanin is:

a. retinal pigment epithelium
b. iris melanocyte
c. uveal melanocyte
d. conjunctival melanocyte

The retinal pigment epithelium cells are the first in the eye to produce melanin.

745-The most comprehensive method to test colour vision is:

a. D-15
b. Lanthony New Colour Test
c. Ishihara plates
d. Farnsworth-Munsell hue 100

The most comprehensive test for colour vision is the Farnsworth-Munsell hue 100 which
comprises 84 coloured discs in four groups of 21. The D-15 test is shorter and cannot
distinguish mild defects. The Ishihara plates are designed for discerning red-green defects
(the most common inherited) though they are often used as a screen for reduced colour
vision. The Lanthony New Colour Test is designed for children.

746-Which statement about the primary visual cortex is FALSE:

a. the area above the calcarine fissure is known as the cuneus gyrus
b. it extends as far posteriorly as the occipital pole
c. it occurs on the lateral surface of the occipital cortex
d. it is supplied by the posterior cerebral artery
The primary visual cortex occurs on the medial surface of the occipital cortex. The area
above the calcarine fissure is known as the cuneus gyrus and that below the fissure known
as the lingual gyrus.

747-B lymphocytes:
a. differentiate into either plasma cells or memory cells on antigen exposure
b. play an important part in cell-mediated immunity
c. constitute 70% of the circulating pool of small lymphocytes
d. can be easily differentiated from T lymphocytes using the light microscope

B cells play an important part in humoral immunity while T cells are involved in cellmediated
immunity. On encountering antigens, B cells may differentiate into plasma cells which
produce antibodies or memory cells. B cells constitute 30% of circulating lymphocytes while
T cells constitute 70%. B and T cells cannot be distinguished using light microscope.

748-The main collagen of the corneal stroma is:

a. Type V
b. Type II
c. Type VII
d. Type I

Type I collagen comprises 50-55% of the collagen in the corneal stroma. The regular
arrangement and regular fibril diameter of the Type 1 collagen in the corneal stroma is
believed to be important in maintaining its clarity. Type VI collagen is also important in the
stroma, while Types III and V are less abundant but may play important roles in maintaining
regularity of spacing.

749-Which statement regarding the rate of diffusion of a drug across a membrane is FALSE:
a. it is inversely proportional to the thickness of the membrane
b. it is directly proportional to the difference in concentration across the membrane
c. it is increased the more hydrophilic the drug
d. it is decreased the more ionized the drug

According to Fick's Law:

Rate of diffusion = diffusion coefficient x concentration gradient / membrane thickness
The diffusion coefficient itself is a function of lipid solubility, ionization and molecular size.

750-Which is TRUE regarding the pinhole:

a. it fully corrects all refractive errors
b. the stenopaeic slit acts as an elongated pinhole
c. it can help differentiate between macular and optic nerve disorders
d. multiple pinholes have more effect than a single aperture

The pinhole overcomes only low to moderate refractive error. Pinhole exam cannot
differentiate macular from optic nerve disorders. Single aperture pinholes are as effective as
multiple aperture pinholes.

751-Which statement is FALSE regarding G proteins:

a. they bind GTP but not GDP
b. they are found in all types of cells
c. they are reduced in activity in pseudohypoparathyroidism
d. they are commonly mutated in patients with acromegaly
e. they link cell surface receptors to secondary messenger pathways
G proteins link an external stimulus or first messenger with secondary messenger pathways
that ultimately lead to a change in the state of the cell. This is a fundamental and ubiquitous
process in biology. Activation of a receptor by the first messenger causes the G protein to
release GDP and bind GTP enabling interaction with a secondary messenger system such
as cyclic-GMP. Increased G protein activity is seen in 40% of patients with pituitary
somatotroph tumors and also following cholera infection. Decreased G protein activity is
seen in pseudohypoparathyroidism.

752-Which statement about Clostridium tetani is FALSE:

a. it produces an exotoxin
b. it causes gas gangrene
c. it is an obligatory anaerobe
d. it is motile
Clostridium is a genus of Gram positive obligate anaerobes capable of producing
endospores. Gangrene is caused by Clostridium perfringins while tetanus is produced by
the tetanus toxoid of Clostridium tetani.

753-What is the most common lacrimal gland tumour:

a. adenocarcinoma
b. adenoid cystic carcinoma
c. pleomorphic adenoma
d. mucoepidermoid carcinoma
Pleomorphic adenoma, otherwise known as benign mixed tumour, is the most common
tumour of the lacrimal gland. It is a benign, slow growing lesion and has a high recurrence
rate following excision. Excision is recommended as there is a risk of malignant conversion
to pleomorphic carcinoma.

754-Which statement is FALSE about the corneal stroma:

a. the collagenous lamellae are oriented parallel to the corneal surface
b. collagenous lamellae are orientated at right angles to each other
c. it is a dense connective tissue of high regularity
d. it is composed of 20-40 layers of flattened collagenous lamellae

The corneal stroma is composed of 200-250 layers of flattened collagenous lamellae. Other
options are true.

755-Which is TRUE regarding interferon:

a. it acts by neutralizing exotoxin
b. it binds to specific viral sequences
c. it integrates with the DNA of virus infected cells
d. it increases HLA expression on the cell surface

Interferon is a glycoprotein produced by T lymphocytes and macrophages. There are three

types: alpha, beta and gamma interferon. It has has non-specific antiviral properties
including: direct antiproliferative action on tumour and virus infected cells, activation of
natural killer cells and macrophages, increased expression of class I HLA antigen on tumour
or infected cells.

756-The oculomotor nerve nucleus lies in:

a. the medulla
b. the midbrain
c. the hypothalamus
d. the pons
The oculomotor nerve nucleus is found in the periaqueductal grey matter in the midbrain.
757-Regarding DNA analysis which statement is FALSE:
a. Northern blotting is used to detect DNA sequences
b. Southern blotting is primarily used to detect DNA sequences
c. Western blotting is used to detect specific proteins in a mixture of protein
d. Gel electrophoresis is used in both Southern and Northern blotting

Northern blotting is used for detecting RNA sequences. Other statements are true.

758-A 25-year-old patient is known to have C3 deficiency. This is likely to predispose to

which form of infection?
a. Mycoplasma
b. Neisseria
c. Legionella
d. Pneumococcus
e. Staphylococcus

C3 deficiency predisposes to life threatening infections by encapsulated organisms such as

pneumococcus.

759-All of the following agents are active against Pseudomonas EXCEPT:

a. gentamicin
b. neomycin
c. ciprofloxacin
d. benzylpenicillin

Pseudomonas is naturally resistant to penicillins and most beta-lactam derived antibiotics.

Pseudomonas is sensitive to aminoglycoside and quinolone antibiotics.

760-The suspensory ligament of Lockwood arises from all the following structures except:
a. the sheath of inferior rectus muscle
b. check ligaments of lateral rectus muscle
c. the sheath of superior rectus muscle
d. check ligaments of medial rectus muscle

The suspensory ligament of Lockwood forms a hammock-like support for the globe. It is
composed of:
the sheath of inferior rectus the medial check ligament the lateral check ligament
sheath of inferior oblique

761- A post-marketing surveillance study of a new drug therapy for a cardiac condition was
carried out on 20,000 subjects who had completed clinical trials. Which one of the following
accurately reflects information generated from such a study?
a. cost benefit analysis
b. cost effectiveness
c. adverse events profile
d. comparative therapeutic benefit

Phase 0 trials are also known as human microdosing studies.

Phase I trials are designed to assess the safety (pharmacovigilance), tolerability,
pharmacokinetics, and pharmacodynamics of a drug.
Phase II studies are sometimes divided into Phase IIA and Phase IIB.
Phase IIA is specifically designed to assess dosing requirements (how much drug should
be given).
 Phase IIB is specifically designed to study efficacy (how well the drug works at the
prescribed doses).
Phase III studies are randomized controlled multicenter trials on large patient groups (300-
3,000 or more depending upon the disease/medical condition studied) and are aimed at
being the definitive assessment of how effective the drug is, in comparison with current
'gold standard' treatment.
Post-marketing surveillance (phase IV study) assesses potential adverse effects of newly
marketed drugs.

762-Which is FALSE regarding Best disease:

a. a yellow disc is visible over the fovea on fundoscopoy
b. there is accumulation of lipofuscin in the retinal outer plexus
c. it involves degeneration of the macula
d. it is autosomal dominant

Best disease is a hereditary autosomal dominant macular degeneration characterized

histologically by massive accumulation of lipofuscin in the RPE cells with atrophy of the
overlying photoreceptor layer.

763-Which is FALSE regarding the rods:

a. their outer segment is thinner than the cone photoreceptor
b. the lamellae are enclosed by a cell membrane
c. maximum spectral sensitivity is 555nm
d. the outer segment contains rhodopsin

Maximal spectral sensitivity of the rods is 496 nm.

764-The central corneal thickness is:

a. 0.4 mm
b. 0.7 mm
c. 0.5 mm
d. 0.6 mm
e. 0.3 mm

Average central corneal thickness is 0.52mm.

765-Which is FALSE regarding the cross-cylinder:

a. the patient is asked to look at the smallest line he can see on the chart
b. the 0.50D cylinder is used to check the power in patients with good VA
c. the 1.00D cylinder is used to check the power in patients with poor VA
d. the 1.00D cylinder is used to check the axis of the cylinder in all patients

A patient is usually asked to look at two lines above the smallest he can see, allowing him to
discriminate the sharpness of images with the cross. Other options are true.

765-Which of the following organelles contains a double stranded circular DNA?

a. peroxisome
b. Golgi body
c. nucleus
d. ribosome
e. mitochondrion

Mitochondrial DNA (mtDNA) is a small, closed-circular molecule of double stranded DNA

that exhibits a strict maternal transmission and is present within cells in multiple copies.
766-Which statement is FALSE regarding the vascular and nerve supply of the lids:
a. the lids are a site of anastomoses between the internal and external carotids
b. the infraorbital nerve supplies the lower lid medially
c. the zygomaticofacial nerve supplies the upper lid laterally
d. the pretarsal portion derives its blood supply from branches of the external carotid

The zygomaticofacial nerve supplies the lower lid laterally, while the lateral palpebral branch
of the lacrimal nerve supplies the upper lid laterally. The infraorbital nerve supplies the
medial two-thirds of the lower lids, while the supraorbital and supratrochlear nerves supply
the medial two-thirds of the upper lid. Regarding vascular supply, the pretarsal portion
derives its arterial supply from the superficial temporal and facial arteries, which are
branches of the external carotids, while the post-tarsal portion is supplied by branches of
the anterior ciliary arteries which are branches of the ophthalmic artery (internal carotid).

767-The blood supply to the laminar part of the optic disc is from:
a. the internal carotid artery
b. the short posterior arteries
c. the long posterior arteries
d. the central retinal artery

The blood supply to the optic nerve head is as follows:

superficial nerve fibre layer: branches of the central retinal artery
prelaminar: peri-papillary choroidal arterioles
laminar: short posterior ciliary arteries
post-laminar: small branches of central retinal artery and pial branches from choroidal
arterioles, central retinal artery and ophthalmic artery.

768-Which statement is FALSE about the oculomotor nerve:

a. it can be affected by an anterior communicating artery aneurysm
b. its nucleus resides in the midbrain
c. it traverses the cavernous sinus before entering the orbit
d. it divides into superior and inferior divisions near the superior orbital fissure

The oculomotor nerve runs alongside the posterior communicating artery on its journey to
the orbit and can be compromised by a PCA aneurysm.

769-The corneal endothelial cell density is:

a. 1500 cell/mm2
b. 3000 cell/mm2
c. 1000 cell/mm2
d. 5000 cell/mm2

Average corneal endothelial density in adulthood is between 2500 and 3000 cells/mm2.

770-Which complement component is present in the highest serum concentrations?

a. C9
b. C1q
c. C3
d. C4
e. C5

C3 is present in serum at the highest concentration.

771-How thick is the corneal epithelium:
a. 100 micrometers
b. 5 micrometers
c. 50-60 micrometers
d. 25 micrometers

The corneal epithelium is 50-60 micrometers thick.

772-Which statement is FALSE about the corneal epithelium:

a. it is a stratified keratinized squamous epithelium
b. cells are held together by numerous desmosomes
c. it is 50-60 micrometers thick
d. cells are held to the underlying basal lamina by hemidesmisomes

The cornea is a stratified non-keratinized squamous epithelium. Other options are true.

773-Which structure drains into the middle meatus:

a. the posterior ethmoidal sinus
b. the maxillary sinus
c. the sphenoid sinus
d. the nasolacrimal duct

The nasal meatus are as follows:

the superior meatus receives the opening of the posterior ethmoidal sinuses
the middle meatus receives the openings of the anterior ethmoidal sinuses, frontal sinus
and the maxillary sinus
the inferior meatus receives the opening of the nasolacrimal duct

774-Which is FALSE regarding topical steroid eye drops:

a. they must enter the cell in order to have an effect
b. they can cause increased intraocular pressure
c. prednisolone phosphate has better corneal penetration than prednisolone acetate
d. they can cause cataract

Prednisolone acetate is more lipophilic and therefore penetrates the cornea better than
prednisolone phosphate. Other options are true.

775-All of the following are Gram negative rods EXCEPT:

a. Pseudomonas
b. Haemophilus
c. Neisseria
d. E. coli
e. Brucella

Neisseria are Gram negative cocci. All other options are Gram negative rods.

776-Zonulae adherens are otherwise known as:

a. gap junctions
b. tight junctions
c. hemidesmosomes
d. desmosomes
Zonulae adherens are desmosmes, which are specialized adherens junctions between cells.
There main role is in mechanical adhesion.
777-Which statement is FALSE about the ciliary muscle:
a. its inner circular muscle fibres are also known as Muller's muscle
b. its outer longitudinal fibres are attached to the scleral spur
c. its middle radial fibres are continuous with the corneoscleral trabeculae
d. it comprises the anterior two-thirds of the ciliary body
e. during accommodation the ciliary body moves backward and inward

During accommodation, it is believed that the ciliary body moves forward and inward, which
lessens the tension on the zonules, allowing increased curvature of the lens. Other options
supplied are true.

778-All of the following nerves pass through the cavernous sinus EXCEPT:
a. oculomotor nerve
b. mandibular nerve
c. trochlear nerve
d. maxillary nerve
e. ophthalmic nerve

The cavernous sinus receives the third, fourth, sixth, V1 and V2 but not the mandibular
nerve (V3).

779-Which is FALSE of glycolysis:

a. it produces two molecules of ATP and two molecules of NADH
b. it occurs in the mitochondria
c. it does not require oxygen
d. it results in glucose splitting into two molecules of pyruvate
Glycolysis is the conversion of glucose to two molecules of pyruvate with the production of
two NADH and two ATP molecules. It occurs in the cytoplasm and does not require oxygen.

780-Which cells play the role of wandering phagocytes in the retina:

a. Muller cells
b. microglia
c. retinal pigment epithelial cells
d. astrocytes

The microglia are responsible for phagocytosis and immune defense in the retina.
The function of the various retinal neuroglial cells is summarized below:
The Muller cells: are the principle supporting glial cells of the retina and are analogous to
central nervous system oligodendrocytes.
The astrocytes: form a honeycomb scaffold perpendicular to the Muller cells. They are
responsible among other functions for laying down scar tissue in injured or diseased retina.
The microglia: are highly specialized mononuclear phagocytic cells

781-Insulin:
a. is made up of two chains joined by three disulphide bonds
b. has an elimination half-life of about 60 minutes after subcutaneous injection
c. is synthesised by the alpha cells of the islets of Langerhans
d. circulates in the blood mostly bound to globulin

Insulin contains two chains, A and B, joined by three disulphide bonds. Insulin is secreted
by the beta cells of the islets of Langerhans as proinsulin. It circulates in the blood mainly
as free hormones. Despite its short half-life of 10 minutes, its pharmacological effect is
prolonged due to bonding with the tissue receptors.
782-Functions of the retinal pigment epithelium include all EXCEPT:
a. phagocytosis of rod and cone outer segments
b. transport and storage of metabolites and vitamins
c. reflection of excess light
d. selectively permeable barrier between the choroid and neuroretina

The melanin of the RPE assists in the absorption (not reflection) of light within the eye, thus
reducing scatter. Other options are true.

783-Which statement is FALSE about the iris:

a. the anterior border layer is composed of modified stroma which is deficient in areas
b. the iris stroma is a loose connective tissue in free communication with the aqueous
c. the dilator pupillae is composed of myoepithelial cells which are lightly pigmented
and innervated by sympathetic fibres
d. the apices of the posterior pigment epithelium oppose the basal processes of the
overlying myoepithelial cells

The apices of the heavily pigmented posterior pigment epithelium oppose the apices of the
myoepithelial cells and this doule layer of epithelium constitutes the major site of the blood-
aqueous barrier.

784-All of the following cause granulomatous inflammation EXCEPT:

a. mycobacterium
b. Bartonella
c. Borrelia bergdorferi
d. Treponema pallidum
e. Moraxella

Granulomatous reactions are caused by intra-cellular organisms, which initiate a cell

mediated response with marcrophages, lymphocytes and plasma cells. Moraxella is a Gram
negative bacilli and would not typically cause a granulomatous response.

785-Which of the following arteries and its branches supplies the lateral geniculate body:
a. anterior cerebral
b. lateral striate
c. posterior cerebral artery
d. middle cerebral artery

The posterior cerebral artery supplies the LGN via its branches called the posterior
choroidal arteries. The anterior choroidal artery, a branch of the internal carotid, also helps
to supply the LGN.

786-The corneal endothelium is held in to its underlying basal lamina by:

a. gap junctions
b. tight junctions
c. hemidesmosomes
d. desmosomes

The corneal endothelium is held to its underlying basal lamina by hemidesmosomes.

Endothelial cells are held together to each other by desmosomes.
787-The following are true of G-protein cell signaling EXCEPT:
a. the a-subunit of G protein activates adenylate cyclase
b. G-proteins are made up of three subunits
c. protein kinase is inactivated by cAMP
d. activation of a membrane receptor causes an exchange of GDP for GTP

Protein kinase is activated by cAMP. All other statements are true.

788-The following are major functions of the complement system EXCEPT:

a. opsonization
b. cytolysis of micro-organisms
c. removal of antibody-antigen complexes
d. production of inflammatory mediators

The complement system has three main functions: opsonisation, cytolysis of pathogenic
organisms, and the production of inflammatory mediators. Opsonisation refers to the
process in which C3 is attached to immune complexes, bacteria or bacterial products.
Removal of antibody-antigen complexes is NOT a role of complement.

789-Which statement is FALSE about the corneal endothelium:

a. it is a simple squamous epithelium
b. it has a critical role in maintaining the state of corneal hydration
c. the cells are polygonal in shape
d. the Descemet's membrane is not the true basement membrane of the endothelium

The Descemet's membrane is indeed the modified basement membrane of the corneal
endothelium. Other options supplied are true.

790-Which is FALSE regarding the optic chiasm:

a. upper retinal fibres lie superiorly in the chiasm
b. superior nasal retinal fibres form Wilbrand 's knee
c. macula fibres primarily decussate posteriorly and superiorly
d. inferior nasal fibres decussate anteriorly and inferiorly

The layout of the optic chiasm fibres are as follows:

a. temporal hemiretinal fibres continue ipsilaterally
b. nasal hemiretinal fibres decussate
c. inferior nasal fibres in decussating loop forward into the opposite optic nerve
for a short distance called Wilbrand 's knee (junctional scotoma)
d. fibres from upper retinal quadrants lie superior
e. fibres from the lower retinal quadrants lie inferior
f. inferior nasal fibres decussate anteriorly and inferiorly
g. superior nasal fibres decussate posteriorly and superiorly
h. macula fibres decussate primarily in the posterior superior portion of the
chiasm

791-Mean systolic blood pressure (SBP) of a sample of 100 consultants is 162 mmHg with a
standard deviation of 10 mmHg. Which of the following can be said?
a. approximately 68% of consultants will have an SBP between 152 and 172 mmHg
b. z-score of a consultant with an SBP of 182 mmHg is +0.5
c. z-score of a consultant with an SBP of 132 mmHg is +3
d. variance equals 20 mmHg
e. approximately 68% of consultants will have an SBP between 157 and 167 mmHg
68% of observations fall within +- 1SD of the mean. Accordingly, about 68% of the
observations will fall between 152 mmHg and 162 mmHg. Note variance is equal to the
standard deviation squared. A z-score of +1 indicates that the value is 1 standard deviation
above the mean.

792-With regard to cellular signal transduction which of the following statements is FALSE:
a. secondary messengers cannot be activated other than by a G protein
b. the acetylcholine receptor acts as a sodium channel
c. steroid hormones affect gene expression by indirectly binding to DNA
d. reduced G protein activity is seen in Albright's hereditary osteodystrophy
e. G proteins typically interact with first and secondary messengers

The steroid hormone receptor complex binds to DNA. Steroid hormones bypass the need for
G-proteins; and some membrane receptors activate secondary messenger systems via
direct enzymatic action, usually in a cascade mechanism. Albright's hereditary
osteodystrophy ispseudohypoparathyroidism. This syndrome is associated with mutations
in the gene encoding a subunit of a G protein (Gsa). Second messenger systems include:
adenylate cyclase/cyclic AMP, phosphatidylinositol/diacylglycerol, and receptor-linked ion
channels.

793-The arachnoid villi drain CSF into:

a. the straight sinus
b. the sigmoid sinus
c. the superior sagittal sinus
d. the cavernous sinus

The superior sagittal sinus drains the cerebral bridging veins and, through the arachnoid
villi, the cerebrospinal fluid.

794-Which statement is FALSE about Descemet's membrane:

a. it is rich in laminin
b. it is continuous posteriorly with the ciliary body
c. it is rich in basement membrane glycoproteins
d. it is the modified basement membrane of the corneal endothelium

It is continuous posteriorly with the trabecular meshwork. Other options are true.

795-Which is FALSE regarding the refractive index:

a. the refractive index of a material is related to its optical density
b. the refractive index from medium 1 to medium 2 is the refractive index of medium 2
divided by the refractive index of medium 1
c. the absolute refractive index of air is approximately zero
d. the refractive index from medium 1 to medium 2 is equal to the angle of incidence
divided by the angle of refraction

The refractive index from medium 1 to medium 2 is equal to the sin of the angle of incidence
divided by the sin of the angle of reflection.

796-Which of the following nerves is positioned most medially in the cavernous sinus:
a. oculomotor nerve
b. abducent nerve
c. trochlear nerve
d. maxillary nerve
The abducent nerve is located most medially in the cavernous sinus. It is more likely to be
involved in cavernous sinus thrombosis because it is less protected than the other nerves
III, IV, V1 and V2 which are against and protected by the lateral wall of the sinus.

797-Chloroquine causes which ocular side effect:

a. cataract
b. retinal degeneration
c. glaucoma
d. optic neuritis
e. Steven's Johnson syndrome

Chloroquine binds to melanin in the RPE cells leading to long-term retinal toxicity.

798-The vertebral artery is derived from:

a. the spinal artery
b. the ascending aorta
c. the basilar artery
d. the subclavian artery

The vertebral arteries are derived from the subclavian artery. They give rise to the anterior
spinal arteries and the posterior inferior cerebellar arteries. They then join together to form
the basilar artery.

799-A group of experienced ophthalmic surgeons report on a randomised placebocontrolled

trial comparing a particular retinal surgery technique as compared to a sham
operation. Their study concludes that 'using this advanced surgical technique reduces the
risk of vision loss from 4.3% to 3.8% (p<0.05)'.
What has this study proved about the surgical procedure:
a. its efficacy
b. its acceptability
c. its usefulness
d. its effectiveness
e. its safety

This is an experienced group of retinal surgeons working in ideal conditions and

demonstrates procedural efficacy. It is often difficult to generalise the findings in a study
group to everyday practice.
Efficacy = the effect of something under ideal or laboratory conditions.
Effectiveness = the effect of something in the real world.

800-Which statement about necrotizing fasciitis is FALSE:

a. high doses of benzylpenicillin given intravenously are indicated
b. streptococci are most commonly implicated
c. excision of the necrotic tissue should be carried out within 48 hours
d. hyperbaric oxygen may limit the spread

Wide surgical excision should be carried out immediately without delay. Other options are
true.
 Question 801 part 9 BASIC SCIENCES

801-The lateral geniculate nucleus consists of how many laminae or cell layers:
a. 5
b. 4
c. 6
d. 15
e. 3
The LGN consists of six laminae or cell layers.

802-In the orbit:

a. the ciliary ganglion is medial to the optic nerve
b. the ophthalmic artery is the first branch of the internal carotid artery
c. the ophthalmic artery emerges from the optic canal
d. the superior ophthalmic vein passes through the common tendinous ring

The superior ophthalmic vein passes backward through the superior orbital fissure outside the common
tendinous ring. The ophthalmic artery is NOT the first branch of the internal carotid artery. It enters the
orbit through the optic canal. The ciliary ganglion is situated lateral to the optic nerve.

803-Which ocular condition is predisposed in a patient with homocystinuria:

a. macular degeneration
b. glaucoma
c. dislocation of the lens
d. retinal macroaneurysm
e. angle recession

Patients with homocystinuria are more likely to suffer lens dislocation due to weakened zonular fibres.

804-A prism which produces a linear apparent deviation of 2cm of an object 1 meter away has a power
of:
a. 2 dioptres
b. 0.5 dioptres
c. 20 dioptres
d. 1 dioptre

1 prism diopter of power is defined as that which produces a linear apparent displacement of 1cm of an
object 1 m away. A displacement of 2cm therefore represents a power of 2 dioptres.

805-The image formed by an object lying between the centre of curvature and the principle focus of a
concave mirror is:
a. erect, virtual and enlarged
b. real, inverted and diminished
c. real, inverted and enlarged
d. virtual, inverted and enlarged

For an object lying between the centre of curvature and the principle focus of a concave mirror, the
image formed is real, inverted and enlarged; and it lies behind the centre of curvature
806-Regarding the orbit:
a. the lateral walls are approximately parallel
b. The volume of the orbit is 30ml
c. the medial walls are set approximately 45 degrees from the sagittal plane
d. the orbit is widest at the orbital margin
e. the orbit is roughly pyramidal in shape with base at the optic canal and apex at the orbital margin

The orbit is pyramidal with apex at the optic canal and base at the orbital margin. The medial walls are
approximately parallel, while the lateral walls are set approximately 45 degrees from the sagittal plane.
The orbit is widest 1.5cm behind the orbital margin. The volume of the orbits is approximately 30ml.

807-A subdural haematoma is most likely to result from:

a. rupture of a Berry aneurysm
b. laceration of the middle meningeal artery
c. embolus of the anterior cerebral artery
d. laceration of the superior cerebral bridging veins

A subdural haematoma is most likely to occur from laceration to the superior cerebral bridging veins. An
epidural haematoma occurs from rupture of the middle meningeal artery, while a ruptured Berry
aneurysm would cause a sub-arachnoid haemmorhage.

808-Which of the following are typical histological changes seen in benign hypertension:
a. hyalinization and intimal proliferation of the muscular media of the medium sized arteries and
arterioles
b. loss of endothelial cells of arterioles
c. formation of new vessels
d. fibrinoid necrosis of small arteries and arterioles

Intimal proliferation and hyalinization of the muscular media are the two histological features commonly
seen in benign hypertension especially in the medium-sized renal arteries and renal arterioles. Fibrinoid
necrosis of small arteries and arterioles are seen in malignant hypertension. Loss of endothelial cells of
arterioles occur in diabetes mellitus.

809-The cavernous sinuses:

a. extend from the inferior orbital fissure to the apex of the temporal bone
b. contain the internal carotid artery on their lateral wall
c. open posteriorly into the petrosal sinuses
d. contain the oculomotor nerve on their medial wall

The cavernous sinuses extend from the superior orbital fissure to the apex of the temporal bone. They
open posteriorly into the petrosal sinuses. They contain the internal carotid artery on their medial wall
and the oculomotor nerve on their lateral wall.

810-The following arteries form the circle of Willis EXCEPT:

a. the posterior cerebral arteries
b. the posterior communicating arteries
c. the middle cerebral arteries
d. the anterior cerebral arteries

The following arteries make up the circle of Willis:

 Anterior cerebral arteries Anterior communicating artery Internal carotid arteries Posterior
cerebral arteries Posterior communicating arteries
The basilar artery and middle cerebral arteries, though they supply the brain, are not considered part of
the circle.

811-Cotton wool spots in the retina occur at the level of:

a. the outer segments
b. the outer plexiform layer
c. the retinal pigment epithelium
d. the nerve fibre layer
e. the internal limiting membrane

Cotton wool spots are fluffy white swellings in the nerve fibre layer of the retina due to ischaemia and
interruption of axoplasmic flow.

812-The inability to visualize the iridocorneal structures of the eye on a slit lamp without the assistance
of special lenses is an example of the optical principle of:
a. chromatic aberration
b. diffraction
c. total internal reflection
d. spherical aberration

Total internal reflection occurs when light moving from a denser medium to a less dense medium hits the
surface at an angle greater than the critical angle. At this point, light is reflected back rather than passing
into the second medium. It explains why the structures of the iridocorneal cannot be viewed without the
assistance of special mirrored devices.

813-A lens with a focal length of 10 meters has a power of:

a. 10 dioptres
b. 0.01 dioptres
c. 0.1 dioptres
d. 1 dioptres

The dioptric power of a lens is equal to the reciprocal of the focal length measured in meters.

814-Which of the following is FALSE regarding central retinal artery occlusion:

a. it often leads to rubeotic glaucoma
b. it results in a cherry red spot on fundoscopy
c. it is more commonly due to embolus than thrombosis
d. it is associated with hypertension

Central retinal artery occlusion leads to total infarction of the inner retinal tissue. This means there are
no vasoactive factors released to drive neovascularisation. As a result rubeotic glaucoma is rare occurring
in fewer than 5% of cases, unlike CRVO where up to 50% are affected with rubeosis.

815-Which statement is FALSE regarding leakage of lens protein into the anterior chamber:
a. it can induce a giant cell granulomatous reaction
b. it can physically block trabecular outflow called phakolytic glaucoma
c. it can occur spontaneously
d. it can cause a rise in pressure by macrophages obstructing the trabecular meshwork
Lens protein leaking into the anterior chamber can occur spontaneously in a cataractous lens or
secondary to trauma. The lens protein can induce a massive giant cell granulomatous reaction or it can
cause a more low-grade macrophage response. In the latter, intra-ocular pressure may rise due to
blockage of the trabecular meshwork by macrophages (called phakolytic glaucoma) or due to blockage of
the meshwork by lens matter (called lens particle glaucoma

816-Which statement is FALSE regarding the visual pathway:

a. the lateral root of the optic tract is attached to the outer wall of the third ventricle
b. the medial root of the optic tract carries about 30% of optic nerve fibres
c. the lateral geniculate nucleus is a part of the thalamus
d. the medial root of the optic tract connects to the superior colliculus
e. the posterior cerebral artery runs below and parallel to the optic tract

The medial root of the optic tract carries approximately 10% of optic nerve fibres. It connects to both the
superior colliculus and the pretectal area.

817-Which of the following passes through the foramen rotundum:

a. the mandibular nerve
b. the meningeal artery
c. the facial nerve
d. the maxillary nerve

Only the maxillary nerve passes through the foramen rotundum. The mandibular nerve and the
meningeal artery pass through the foramen ovale. The facial nerve passes through the styloid foramen.

818-The optic canal is located in the:

a. maxillary bone
b. lesser wing of the sphenoid bone
c. palatine bone
d. greater wing of the sphenoid bone

The optic canal is located in the lesser wing of the sphenoid bone.

819-Which is FALSE regarding the choroid:

a. it has a non-fenestrated capillary bed
b. it is responsible for nourishing the outer retina
c. it has a high vascular flow-rate
d. its inner surface forms Bruch's membrane

The capillaries of the choriocapillaris are fenestrated. Other options are true.

820-Retinal capillary endothelial cells are surrounded by all EXCEPT:

a. pericytes
b. astrocyte foot processes
c. Muller cells
d. basal lamina

Retinal capillary endothelial cells are surrounded by:

a thick basal lamina pericytes astrocyte foot processes
821-The Bowman's layer:
a. is 50-60 micrometers thick
b. is a modified corneal epithelial basement membrane
c. is a modified acellular region of stroma
d. extends approximately 1mm posterior to the limbus

The Bowman's layer is a modified acellular region of stroma. It is 8-12 micrometers thick and terminates
abruptly at the limbus.

822-All are true of Neurofibromatosis Type 1 EXCEPT:

a. Lisch nodules occur which are melanocytic proliferations on the iris
b. it is associated with opic nerve glioma
c. it is characterized by cafe-au-lait spots
d. it is associated with acoustic neuroma

NF Type 1 occurs from a mutation in the NF-1 gene on chromosome 17. It is characterized by:
cafe-au-lait spots Lisch nodules goniodysgenesis retinal hamartomas optic nerve glioma
NOTE: acoustic neuroma is associated with NF Type 2.

823-Phase II drug metabolism:

a. involves hydrolysis of drugs
b. decreases drug water solubility
c. involves conjugation reactions
d. prevents drug excretion by the kidneys or liver

Phase II drug metabolism involves a conjugation reaction and the addition of glucuronic acid is the most
common. The process increases drug water solubility and facilitates drug excretion by the kidneys or
liver.

824-Which are the phagocytic cells of the central nervous system:

a. oligodendrocytes
b. Schwann cells
c. astrocytes
d. microglia

The glial cells of the central nervous system include:

Oligodendrocytes: the myelin-forming cells of the CNS.
Astrocytes: perform a variety of structural and functional roles including metabolic, healing, blood-
brain and blood-retinal barriers.
Microglia: are monocytes and perform phagocytosis

825-Which immunoglobulin class is considered the oldest phylogenetically?

a. IgA
b. IgE
c. IgM
d. IgD
e. IgG

IgM or IgM-like immunoglobulins tend to be the only type present in organisms with the most
rudimentary immune systems.
826-Mean systolic blood pressure (SBP) of a sample of 100 consultants is 162 mmHg and follows a
normal distribution with a standard deviation of 10 mmHg. Which of the following can be said?
a. approximately 68% of consultants will have an SBP between 157 and 167 mmHg
b. a consultant with an SBP of 132 mmHg lies 3 standard deviations above the mean
c. variance equals 20 mmHg
d. a consultant with an SBP of 182 mmHg lies half a standard deviation above the mean
e. approximately 68% of consultants will have an SBP between 152 and 172 mmH

827-The Prentice position of a prism:

a. does not obey Snell's law
b. is usually specified for plastic ophthalmic prisms
c. occurs when either surface of the prism is normal to light
d. occurs when the angle of incidence equals the angle of emergence

The Prentice position of a prism occurs when one surface of the prism is normal to the ray of light so that
all deviation occurs at the other surface. The strength of a prism in the Prentice position is greater than
the position of minimum deviation, which occurs when the angle of incidence equals the angle of
emergence. The Prentice position is usually specified for glass ophthalmic prisms while the position of
minimum deviation is specified for plastic ophthalmic prisms.

828-The superior orbital fissure transmits all of the following EXCEPT:

a. the infraorbital nerve
b. the abducent nerve
c. the trochlear nerve
d. the lacrimal nerve
e. the frontal nerve

The following structures pass through the superior orbital fissure:

Lazy: the lacrimal nerve French: the frontal nerve Tarts: the trochlear nerve
Sit: superior division of oculomotor nerve
Nakedly: nasociliary nerve In: inferior division of oculomotor nerve
Anticipation: abducens nerve nerve and the nasociliary nerve

829-Systemic side-effects of beta-adrenergic blockade include all EXCEPT:

a. syncope
b. central nervous system depression
c. bronchodilation
d. bradycardia

Beta-blockers cause bronchospasm not bronchodilation. Other options are true.

830-Which is FALSE regarding retinoblastoma:

a. inherited cases are due to a defect on chromosome 6
b. its prevalence is 1 in 20,000 live births
c. it is a tumour of photoreceptor cells
d. approximately 40% of cases are inherited

The Rb tumour suppressor gene implicated in retinoblastoma resides on the long arm of chromosome 13.
831-Which condition is associated with astrocytic hamartomas within the retina:
a. Tuberous sclerosis
b. Von-Hippel Lindau syndrome
c. Neurofibromatosis Type 2
d. Neurofibromatosis Type 1

Tuberous sclerosis is an autosomal dominant condition characterized by multiple astrocytic hamartomas

across many tissues including CNS, muscle and kidney. In the eye it causes astrocytic hamartomas within
the retina.

832-Which statement is FALSE about the origins of the oculomotor nerve:

a. its nuclei originate in the inferior colliculus
b. the nerve leaving the brainstem initially passes forward, laterally and downward in the
interpeducular fossa
c. its nerve fibres emerge from the brainstem at the border of the midbrain and the pons
d. it contains parasympathetic fibres which originate in the Edinger-Westphal nucleus

The oculomotor nuclei originate in the superior (not inferior) colliculus of the midbrain in the ventral
region of the periaqueductal grey matter. The oculomotor nerve nuclei are of 2 main types: motor nuclei
which innervate the extraocular muscles and the EdingerWestphal nucleus which supplies
parasympathetic fibres to the choroid, iris and ciliary body.

833-All are true of the tear film EXCEPT:

a. it contains secretions from the meibomian glands
b. it contributes to the refractive function of the eye
c. it is composed of an outer lipid layer
d. it is increased with topical atropine

The tear film is decreased by atropine, which is an anti-muscurinic and reduces parasympathetic input to
the lacrimal gland.

834-Which is FALSE regarding the visual pathway:

a. the mammillary bodies are posterior to the chiasm
b. the optic nerves travel within the subarachnoid space after leaving the orbits
c. the optic chiasm occurs at the floor of the fourth ventricle
d. the anterior communicating artery lies above the optic chiasm

The optic chiasm is situated at the junction of the anterior wall and floor of the third ventricle. Other
statements are true.

835-Which of the following statements is FALSE about the eye:

a. it is situated in the anterior portion of the orbit
b. large eyes tend to be myopic
c. it is nearer the floor of the orbit than the roof
d. it has a diameter of approximately 23mm

The eye is situated nearer the roof of the orbit than the floor. Other options are true.
836-Which is FALSE of the abducens nerve:
a. it passes through the cavernous sinus lying medial to the ascending internal carotid
b. its nucleus lie in the midpons
c. it has the longest intracranial course of any cranial nerve
d. it emerges from the brainstem at the border of the pons and medulla near the midline

The abducens nerve passes through the cavernous sinus and lies lateral to the ascending portion of the
internal carotid artery.

837-All of the following are true about elastin EXCEPT:

a. it is an insoluble protein
b. it is an integral component of deformable tissues such as arterial walls
c. it is integral to the structure of the lens zonule
d. it has a very regular tertiary structure

Elastin has a very irregular coil-like tertiary structure, unlike collagen which is a regular triple helix. It
does not occur in all tissues but is an important component of deformable tissues such as arterial cell
walls and the lens zonules.

838-Which is FALSE regarding glycosaminoglycans:

a. they perform an important structural role in the vitreous
b. they are important in maintaining transparency of the cornea
c. they are comprised of long chains of repeating dipeptides
d. the most common glycosaminoglycan in the cornea is keratan sulphate

Glycosaminoglycans are long chains of repeating disaccharides. They can occur on their own, or attached
to proteins when they are known as proteoglycans. They have important structural and regulatory roles
in tissues. In the eye, GAG's are important to the resilience of the vitreous (mainly hyaluronic acid) and
they also maintain corneal transparency by regulating collagen fibril diameter and spacing in the corneal
stroma (keratan sulphate).

839-An ischaemic event in the left temporal lobe would most likely produce:
a. a contralateral congruous homonymous hemianopia
b. a bitemporal heminanopia
c. a contralateral incongruous homonymous hemianopia
d. a contralateral lower quadrantanopia
e. a contralateral upper quadrantanopia

The temporal lobe receives those fibres of the geniculocalcarine tract (optic radiation) corresponding to
the inferior retina, which is the upper half of the visual field. It will therefore result in a contralateral
upper quadrantanopia.

840-Which statement is FALSE regarding the inferior rectus muscle:

a. it is innervated from its superior surface
b. it is inserted 6.5 cm behind the limbus
c. it is the main depressor of the globe when the eye is adducted
d. it lies inferior to the inferior oblique muscle

The inferior rectus actions are: depression, medial rotation of the eye ball and extorsion. The effect of
depression is greatest when the eyeball is abducted. Other options above are true.
841-Which is FALSE regarding the photoreceptors:
a. rods are longer than cones
b. the photoreceptor outer segments are in closest proximity to the RPE microvilli
c. axons from the photoreceptors synapse in the inner plexiform layer
d. the outer limiting membrane occurs at the junction of the inner and outer segments

Axons from the photoreceptors synapse in the outer plexiform layer where they communicate with
bipolar cells and horizontal cells.

842-Which antibiotic inhibits protein synthesis by binding to the 30S ribosome subunit:
a. erythromycin
b. tetracycline
c. rifampicin
d. sulphonamide
e. chloramphenicol

Macrolides (such as erythromycin) and chloramphenicol inhibit protein synthesis by binding to the 50S
subunit of the bacterial ribosome.
Tetracyclines and aminoglycosides inhibit protein synthesis by binding to the 30S subunit of bacterial
ribosomes.
Sulphonamide inhibits biosynthesis of folic acid.
Rifampin inhibits RNA synthesis by inhibiting DNA-dependent RNA polymerase.

843-All of the following are ocular manifestations of Wegener's EXCEPT:

a. scleritis
b. orbital mass
c. iritis
d. corneoscleral ulceration

Wegener's can cause corneascleral ulceration, scleritis and an orbital mass. However, iritis is not
specifically associated with Wegener's granulomatosis.

844-Which statement is FALSE regarding basal cell carcinoma:

a. it is associated with UV exposure
b. it spreads via the lymphatics
c. it is the most common malignant tumour in clinical ophthalmology
d. it is characterized by a central ulcer with rolled edges

Basal cell carcinoma spreads by local invasion. Other statements are true.

845-Infection with which pathogen is characteristically associated with an owl-eye inclusion body:
a. Chlamydia trachomatis
b. cytomegalovirus
c. herpes zoster virus
d. Borrelia bergdoferi

Owl-eye inclusion bodies are characteristic of cytomegalovirus infection as seen for example in
cytomegalovirus retinitis in immunocompromised patients.
846-All are true of the pterygopalatine ganglion EXCEPT:
a. it supplies the sphincter pupillae of the iris
b. it supplies secretomotor fibres to the glands of the nose
c. it supplies parasympathetic fibres to the lacrimal gland
d. it is located in the pterygopalatine fossa

The pterygopalatine ganglion does not supply the iris, which is supplied with parasympathetic
innervation via the oculomotor nerve synapsing in the ciliary ganglion. Other statements are true.

847-Which statement is FALSE regarding Toxocara infection:

a. it can cause a rapid inflammation in the retinal mid-periphery
b. eggs are passed in dog faeces
c. it is associated with an increase in eosinophil count
d. it can cause a low-grade fibrous reaction in the retina
e. larvae when active produce an intense inflammatory response

Toxocara laravae do not elicit an inflammatory response but when they die, the immune system
becomes activated which can cause one of the following in the eye:
low grade fibrous retinal involvement rapid retinal inflammation with eosinophilia vitritis and
pars planitis

848-Which statement about the ciliary ganglion is FALSE:

a. the motor root of the ciliary ganglion emerges from the branch of the oculomotor nerve
supplying the inferior oblique
b. the ciliary ganglion lies between the lateral rectus and the optic nerve
c. the sensory root of the ciliary ganglion emerges from the nasociliary nerve
d. the long ciliary nerves emerge from the ciliary ganglion to supply the orbit

Short ciliary nerves emerge from the ciliary ganglion to supply the orbit. Other options are true

849-The layer of choroid comprising large arteries and veins is:

a. Haller's layer
b. Sattler's layer
c. the choriocapillaris
d. Bruch's membrane

Haller's layer lies within the choroid and comprises large arteries and veins.
Sattler's layer, which lies above Haller's layer, is composed of arterioles and venules which supply the
choriocapillaris directly above.

850-Which of the following trial designs is most appropriate for the situation described:
a. a one-tailed analysis to compare the rate of side effects in a new treatment compared to current
best treatment.
b. a randomised-controlled trial to look at the association between sleeping position and sudden
infant death syndrome.
c. a case-control study to determine whether a toxic chemical which leaked briefly into a city's
water supply is related to lung cancer.
d. a cohort study to investigate the association between smoking and the risk of choroidal
melanoma.
e. a case-control study to investigate the association between smoking and the risk of choroidal
melanoma.
Case-control studies are most appropriate for rare outcomes and common exposures; cohort studies for
rare exposures and common outcomes. RCTs using human subjects are not always ethical. Two-tailed
tests look for a difference in any direction while a onetailed test looks only for an increase or only for a
decrease (and is consequently rarely used in clinical trials).

851-What is the second most common method of human immunodeficiency virus (HIV) transmission in
Western countries?
a. blood transfusions
b. sexual intercourse
c. intravenous drug use
d. transplacental transmission

Intravenous drug use accounts for approximately 25% of cases of human immunodeficiency virus (HIV)
transmission. Sexual intercourse accounts for 70% of cases.

852-From anterior to posterior the medial orbital wall is composed of:

a. lacrimal bone, maxilla, ethmoid, sphenoid
b. lacrimal bone, maxilla, sphenoid, ethmoid
c. maxilla, lacrimal bone, ethmoid, sphenoid
d. maxilla, ethmoid, lacrimal, sphenoid

The medial orbital wall is composed (anterior to posterior) of: the frontal process of the maxilla, the
lacrimal bone, the orbital plate of the ethmoid and the body of the sphenoid.

853-The commonest defect of colour vision is due to:

a. deuteranomaly
b. deuteranopia
c. protanopia
d. protanomaly

The commonest defect of colour vision is deuteranomaly which occurs in 5% of men and 0.3% of women.
It is due to a shift in the spectral sensitivity of green cones. Deuteranopia indicates complete absence of
green cones and is rare. The genes for red and green pigment are on the X chromosome while
chromosome 7 carries the blue pigment gene. Thus deuteranomaly and protanomaly are X-linked.

854-Which of the following statements is FALSE regarding the CSF:

a. blockage of the arachnoid granulation causes communicating hydrocephalus
b. it is produced by the modified ependymal cells of the choroid plexus
c. it flows from the ventricles to the subarachnoid space via the roof of the 3rd ventricle
d. it is absorbed mainly through the arachnoid granulations in the superior sagittal sinus
The ventricular system communicates with the subarachnoid space via the roof of the fourth ventricle.

855-Diabetic retinopathy is characterized histologically by all EXCEPT:

a. loss of pericytes
b. cotton wool spots due to nerve fibre ischemia
c. thinning of the capillary basement membrane
d. degeneration of capillary endothelial cells
e. hyalinization of vessels
In diabetes there is thickening and multilayering of the basement membrane of small vessels. Other
statements are true.
856-Which is FALSE regarding polyarteritis nodosa:
a. it can affect retinal and choroidal vessels
b. it causes coagulative necrosis of vessel walls
c. it affects medium and small sized arteries
d. it leads to ischaemia of tissues including heart, lung and kidney

Polyarteritis causes fibrinoid necrosis of vessel walls leading to thrombosis and ischaemia.

857-Which is TRUE of parasympathetic antagonists administered topically to the eye:

a. they decrease lacrimal secretions
b. they activate muscarinic receptors
c. they produce miosis
d. they cause ciliary muscle contraction

Parasympathetic antagonists inhibit acetylcholine muscarinic receptors by definition. They produce

mydriasis, cycloplegia and they reduce lacrimal secretions.

858-The image formed by an object within the principle focus of a concave mirror is:
a. real, inverted and diminished
b. virtual, inverted and enlarged
c. erect, virtual and enlarged
d. real, inverted and enlarged

For an object within the principle focus of a concave mirror, the image formed is erect, virtual and
enlarged; and it lies behind the mirror.

859-Henle's fibre is formed by:

a. outer nuclear layer
b. outer plexiform layer
c. inner plexiform layer
d. inner nuclear layer

In the macular region the outer plexiform layer is known as Henle's fibre layer.

860-The maxillary sinus drains into the:

a. the inferior meatus
b. the superior meatus
c. the lesser meatus
d. the middle meatus

The nasal meatus are as follows:

the superior meatus receives the opening of the sphenoid and posterior ethmoidal sinuses
the middle meatus receives the openings of the anterior ethmoidal sinuses, frontal sinus and the
maxillary sinus
the inferior meatus receives the opening of the nasolacrimal duct

861-The frontal eye field lies in the vascular territory of:

a. the middle cerebral artery
b. the anterior cerebral artery
c. the spinal artery
d. the posterior cerebral artery
The frontal eye field is in the territory of the middle cerebral artery. This might seem counter-intuitve as
the frontal eye field is in the frontal lobe, but remember that the middle cerebral artery supplies the
lateral convexity of the brain while the anterior cerebral artery supplies the medial surface of the
hemisphere.

862-Which of the following immunoglobulins are pentameric:

a. Ig G
b. Ig M
c. Ig E
d. Ig D
e. Ig A
Monomeric immunoglobulins contain the basic structure of two identical light chains and two identical
heavy chains linked by disulphide bonds

863-Which cells connect the photoreceptors to the ganglion cells:

a. cones
b. bipolar cells
c. amacrine cells
d. horizontal cells

Bipolar cells are primarily responsible for transmission from photoreceptors to ganglion cells

864-Which is FALSE regarding the prognosis of uveal melanoma:

a. monosomy 3 is associated with metastatic spread
b. the prognosis is worse in the elderly
c. ciliary body melanoma carries a worse prognosis than choroid melanoma
d. spindle cells carry a poorer prognosis than epithelioid cells
Epithelioid cells carry a poorer prognosis than spindle cells. Other options are true.

865-All of the following ophthalmic materials are effectively inert EXCEPT:

a. silicone encircling bands
b. PMMA intra-ocular lenses
c. hyaluronic acid
d. silicon oil
e. Molteno drainage tubes
Silicon oil produces a low-grade macrophage reaction after it is emulsified. All other materials mentioned
do not typically cause an inflammatory response; though they may become covered with fibrous
capsules.
.
866-What wavelength of light is emitted by fluorescein sodium:
a. 835nm
b. 465nm
c. 805nm
d. 525nm
Fluorescein:
absorbs blue light of 465-490nm wavelength
emits yellow-green light of wavelength 520-530nm
Indocyanine green:
absorbs 805nm infrared light
emits 835nm infrared light
867-Which statement is FALSE regarding progressive outer retinal necrosis:
a. it occurs in immunosuppressed patients
b. it can be caused by herpes simplex virus
c. it can be caused by herpes zoster infection
d. it usually involves vitritis and retinal vasculitis

Progressive outer retinal necrosis (PORN) involves destruction of the outer retina without the
accompanying vitritis and vasculitis associated with acute retinal necrosis.

868-Fluorescein dye absorbs light of which wavelength:

a. yellow
b. blue
c. red
d. green

Fluorescein absorbs and is excited by blue light (465-490nm). It is for this reason that white light from
the flash of a fluorescein angiography camera passes through a blue 'excitation' filter.

869-The oculomotor nerve supplies:

a. the lateral rectus muscle
b. the cornea
c. the superior oblique muscle
d. the ciliary muscle

The oculomotor nerve supplies all the extraocular muscles with motor innervation except the superior
oblique muscle (trochlear nerve) and the lateral rectus (abducent nerve).It also supplies parasympathetic
innervation to the eye, which emanates from the EdingerWestphal nucleus and synapses in the ciliary
ganglion on its way to the globe via the short ciliary nerves. The ciliary muscle and the sphincter muscle
are supplied by these parasympathetic fibres. The cornea is supplied by the trigeminal nerve.

870-A 10 degree refractive angle glass prism in the position of minimum deviation has a power of
approximately:
a. 20
b. 100
c. 5
d. 10
A 10 degree refractive angle glass prism in the position of minimum deviation deviates light through 5
degrees (deviation= angle/2) and has a power of 10 prism diopters (1 prism diopter = half an angle of
apparent deviation) assuming refractive index of 1.5.

871-Which statement is TRUE about the ABO blood groups:

a. patients with blood group O are regarded as universal recipients
b. anti-A and anti-B antibodies are found in patients with blood group AB
c. blood group O is the most common type
d. patients with blood group B are regarded as universal donors
e. blood group A is the least common type

Blood group O is the most common and blood group AB is the least common. Blood group O is regarded
as universal donors and blood group AB as universal recipients.
Anti-A and anti-B antibodies are found in patients with blood group O. Blood group AB contains no
antibodies against any ABO group.
873-Which statement is FALSE about the corneal stroma:
a. transparency of the cornea depends on regular spacing of collagen fibrils
b. the main glycosaminoglycans in the cornea are keratan sulphate and chondroitin
c. collagenous lamellae are composed principally of Type III collagen
d. collagenous lamellae are oriented parallel to the corneal surface

The lamellae are composed principally of Type I collagen. Other options are true.

874-The angular magnification produced by an image positioned at the focal point F1 of a convex lens is
equal to:
a. infinity
b. zero
c. one
d. the dioptric power of the lens divided by four

The angular magnification produced by an image positioned at the focal point F1 of a convex lens is equal
to one. This is because the image lies at infinity and therefore the angle subtended by the object and the
image are equal, producing an angular magnification of one.
Remember: angular magnification = apparent image size/apparent object size or, angular magnification =
tan(angle image)/ tan (angle object)

875-A study examined the effect of a new drug on stroke prevention over 10 years. 10% of patients in
the placebo group had stroke in comparison to 5% of patients in the treatment group.
What is the relative risk reduction?
a. 10%
b. 20%
c. 15%
d. 50%
e. 5%

The relative risk reduction (RRR) = (5/10) x 100 = 50%

The absolute risk reduction (ARR) = 10% - 5% = 5%

876-Which process is used to separate RNA molecules?

a. Eastern Blot
b. Gel Blot
c. Northern Blot
d. Western Blot
e. Southern Blot

DNA molecules can be separated by a process called Southern Blotting, named after the man who
invented the technique. Therefore when a technique to separate RNA molecules became available, it was
given the name of a Northern Blot. A Western Blot is used for proteins. There is no Eastern blot. The term
Gel Blot is not generally used.

877-Sterilisation can be achieved by all of the following EXCEPT:

a. a dry fan-assisted oven to a temperature of 160 degrees C for 1 hour
b. an autoclave with steam to a temperature of 121 degrees C for 120 minutes
c. Gamma-radiation
d. ethylene oxide
 Dry heat takes much longer than steam and a temperature of 160 degrees in a fan-assisted oven will
take several hours to achieve sterilization.

878-Which is FALSE regarding topical eye drops:

a. cocaine prevents the reuptake of noradrenaline at nerve endings
b. brimonidine is a selective alpha-1 agonist
c. epinephrine stimulates both alpha and beta receptors
d. hydroxyamphetamine increases the release of noradrenaline from nerve terminals
e. phenylephrine stimulates alpha receptors

Brimonidine is a selective alpha-2 agonists. The other options are true.

879-Local anaesthetics work by:

a. blocking potassium channels
b. exciting potassium channels
c. blocking sodium channels
d. exciting sodium channels

Local anaesthetics work by blocking sodium channels and therefore preventing the propagation of an
action potential across the nerve.

880-Which of the following hormones does NOT utilise cAMP as its second messenger?
a. adrenaline
b. TSH
c. PTH
d. glucagon
e. insulin

Currently, four second messenger systems are recognised in cells. They are used to amplify the small
signal received at the cell membrane when a ligand binds to a receptor. A number of important
hormones lead to a rise in intracellular cAMP, which increases the activity of protein kinase A. These
include adrenaline and noradrenaline, PTH, TSH, Glucagon, FSH, LH, calcitonin and ADH. The receptor for
insulin is a tyrosine kinase. Following binding of the hormone, the receptor phosphorylates itself, then a
variety of other targets. Other second messengers include calcium, cyclic GMP and phosphoinositides.

881-Which of the following statements regarding bias is correct?

a. bias can be corrected at the analysis stage of a trial
b. the value of RCTs is that they remove all sources of bias
c. case-control studies are least susceptible to bias
d. blinding is an attempt to remove bias
e. bias is due to random error

Bias refers to systematic (as opposed to random) error. RCTs remove all sources of confounding, not bias.
Case-control studies are retrospective, and therefore particularly susceptible to bias.

882-Exotoxins are liberated from:

a. fungi
b. Gram positive bacteria
c. Gram negative bacteria
d. Mycobacteria
 Exotoxins are proteins released by Gram-positive bacteria and produce specific effects at sites distant to
their release. They are antigenic and are readily destroyed by heat.

883-Translation is controlled by:

a. peptidyl transferase
b. RNA polymerase
c. DNA polymerase
d. DNA gyrase

Translation is the production of an amino acid sequence from mRNA in the cytoplasm. It is controlled by
2 main enzymes: aminoacyl-tRNA synthetase (which helps join tRNA to its specific amino acid) and by
peptidyl transferase which involves the uncoupling of the tRNA from the amino acid and joining of the
amino acid to the growing polypeptide chain.

884-Which is FALSE regarding a Maddox rod:

a. to test for horizontal muscle imbalance the rod should be vertical
b. light parallel to the axis of the cylinders passes through the cylinder undeviated
c. a horizontal line is produced on the retina perpendicular to the rod axis
d. it uses convex cylindrical lenses mounted side by side

Maddox rod uses strong convex cylindrical lenses mounted side by side. Light that is parallel to the axis
of the cylinders passes through the cylinders undeviated and this light is focused by the eye to produce a
straight line, which is perpendicular to the rod axis. The Maddox is used to test muscle imbalance. To test
for horizontal muscle imbalance the Maddox rod should be horizontal to give a vertical line (and vice
versa for vertical muscle imbalance).

885-Which is FALSE of the image formed by a convex mirror:

a. it lies between the mirror and the principle focus
b. virtual
c. inverted
d. diminished

The image formed by a convex mirror, irrespective of the distance of the object from the mirror, is
virtual, erect and diminished; and it is located behind the mirror, between the mirror and the principle
focus.
886-Which of the following is TRUE regarding mitochondrial DNA:
a. disease involving mitochondrial DNA show an autosomal dominant inheritance
b. it is a double-stranded straight DNA
c. mutation of mitochondrial DNA is more common than nuclear DNA
d. diseases involving the mitochondrial DNA affect only the muscles

Mitochondrial DNA has a double stranded round DNA. It has no intron or repair system and therefore
more susceptible to mutation than the nuclear DNA. Mitochondrial DNA disorders commonly involve the
muscle but also the nerves such as in Leber's optic neuropathy. They are inherited maternally.

887-Which statement is FALSE about Descemet's membrane:

a. it is not the true basement membrane of the corneal endothelium
b. it occurs between the posterior stroma and the endothelium
c. it is 8-12 micrometers thick
d. it is continuous posteriorly with the trabecular meshwork
Descemet's is the modified basement membrane of the corneal endothelium. All other options are true.

888-The supratrochlear nerve is derived from:

a. the nasociliary nerve
b. the frontal nerve
c. the trochlear nerve
d. the lacrimal nerve
e. the supraorbital nerve

The supratrochlear nerve supplies the skin of the medial brow and forehead and is a terminal branch of
the frontal nerve, itself a branch of the ophthalmic nerve.

889-All are true of Toxoplasma EXCEPT:

a. adult chorioretinal involvement implies secondary reactivation
b. it is an obligate intracellular protozoon
c. infection can be acquired from inadequately cooked meet
d. congenital toxoplasma may result in intracranial calcification and mental retardation

Adult disease may be from reactivation of prior infection in utero or it may arise from primary infection
in adulthood.

890-Which of the following is NOT contained in the pterygo-palatine fossa:

a. the pterygopalatine ganglion
b. the maxillary nerve
c. the maxillary artery
d. the lesser superficial petrosal nerve

The pterygopalatine fossa is the distribution centre for the main vessels and nerves of the middle third of
the face. The greater and deep petrosal nerves join together before entering the pterygo-palatine fossa.
The lesser superficial petrosal nerve does not pass through the pterygo-palatine fossa, it synapses in the
otic ganglion and supplies the parotid gland.

891-All are true of acanthoemeba EXCEPT:

a. it is sensitive to 3rd generation cephalosporins
b. it is very difficult to culture
c. it is more common in soft contact lens wearers
d. it is a free-living protozoon
Acanthoemeba corneal involvement is poorly responsive to conventional antibiotics, including the latest
generation cephalosporins. Treatment requires propamidine isethionate, chrohexidine and
polyhexamthyl biguanide.

892-Which of the following hypersensitivity reaction types involve the participation of antibodies?
1. Type I 2. Type II 3. Type III 4. Type IV
a. 4 only
b. 1, 2, and 3
c. 1 and 3
d. 1, 2, 3, and 4
Type I reactions involve cross-linking of IgE bound to mast cells and basophils. Type II reactions
frequently feature IgG or IgM interaction with either cytotoxic cells or circulating immunoglobulins and
antigens and the subsequent deposition of those complexes. (Note that some type II processes are not
strictly antibody dependent.) Type III reactions result from antigen-antibody complex formation.
893-Which is FALSE regarding dispersive power:
a. light of shorter wavelength is deviated more than light of longer wavelength
b. it is measured by the angle formed between the red and blue light around yellow
c. it is related to the refractive index of the material
d. dispersion occurs in the formation of a rainbow

Dispersive power is not related to refractive index. It is measured by the angle formed between the red
and blue light around yellow. Light of shorter wavelength (violet) is deviated more than light of longer
wavelength (red). Dispersion of wavelengths occurs through water droplets in the formation of a
rainbow.

894-Which structure drains into the superior meatus:

a. the frontal sinus
b. the maxillary sinus
c. the nasolacrimal duct
d. the posterior ethmoidal sinus
The nasal meatus are as follows:
the superior meatus receives the opening of the posterior ethmoidal sinuses the middle meatus
receives the openings of the anterior ethmoidal sinuses, frontal sinus and the maxillary sinus the
inferior meatus receives the opening of the nasolacrimal duct

895-The analgesic effect of a new drug is compared to morphine. The significance level is set at 0.05 and
a difference is found (p = 0.09). What is the best conclusion to draw?
a. a larger sample should have been used
b. the trial would have been better run against placebo
c. the drug should not be recommended for clinical practice
d. the probability that the difference found arose by chance is greater than we are prepared to
accept
e. the alternative hypothesis should be accepted
Where the p-value is less than the critical value, there is good evidence to accept the alternative
hypothesis. The p-value is the probability of committing a Type I error (false positive), that is, rejecting
the null hypothesis when in fact the difference occurred by chance.

896-Two heterozygous parents for a recessive condition want to know their chances of having a child
NOT affected with the disease. What will you advise them:
a. 75%
b. 50%
c. 100%
d. 25%
e. 33%

There is a 1 in 4 chance of being affected (homozygous) and therefore a 75% chance of not having the
disease. We recommend drawing a 2x2 box of chromosomal probabilities.

897-Regarding anti-sense oligonucleotides, which statement is FALSE:

a. they are a normal constituent of eukaryotic cells.
b. they are effective against viral RNA
c. they could be used to target the translation of oncogenes
d. they bind to target RNA and block its processing
e. they are composed of DNA
Anti-sense oligonucleotides are short sequences of DNA, which are complementary to the target RNA.
They have to be delivered into the cell by cationic liposomes, microinjection or viral vectors. The
sequences also have to be modified to prevent degradation by nucleases. This technique could be used to
prevent the processing of activated oncogene products or could be used to target viral RNA.

898-Which is TRUE of ionizing irradiation:

a. mitotic cells are more sensitive to radiation than non-mitotic cells
b. the main cellular target for radiation is the cell membrane
c. it cannot be used to sterilise surgical instruments
d. x-rays have deeper penetration than gamma rays
e. genetic alteration from radiation is usually due to gene deletion

The main cellular target for radiation is the DNA and the principal action is strand breakage. Gamma rays
are more penetrative than X-rays. Dividing cells are more radiosensitive than non-dividing cells.
Radiation can be used to sterilize surgical instruments.

899-In which condition are you LEAST likely to find a cotton wool spot:
a. ischaemic central retinal vein occlusion
b. pre-proliferative diabetic retinopathy
c. central retinal artery occlusion
d. malignant hypertension

Cotton wool spots are a sign of microvascular ischaemia and are found commonly in hypertension and
diabetes. They can also occur in HIV and vasculitic diseases. They may also be seen after the evolution of
an ischaemic CRVO leaves areas of retina underperfused. They are not a characteristic of CRAO.

900-Endotoxins:
a. are found in the bacterial cytoplasm
b. can often survive autoclaving
c. are produced mainly by Gram positive bacteria
d. elicit the classical pathway of the complement system

Endotoxins are lipopolysaccharides derived from the cell wall of gram negative bacteria. They are heat
stable unlike exotoxins. They are non-antigenic as against exotoxin. They cause septicemia and fever and
activate the alternative pathway (non-antibody mediated) of the complement system.
 Question 901 part 10 BASIC SCIENCES

901-All of the following are true regarding nuclear DNA except:

1. nuclear DNA exists as nucleoprotein complex by wrapping around histones
2. exons code for messenger DNA
3. ionic bonds exist between the paired bases
4. introns exist between coding sequences of the DNA

Hydrogen bonds exist between the paired bases. Other options supplied are true.

902-Which of the following is a monosynaptic reflex:

1. corneal reflex
2. blink reflex
3. knee jerk reflex
4. withdrawal reflex

Monosynaptic reflexes usually originate and terminate in the same muscle with a very fast response of
about 20 milliseconds. Apart from the knee jerk reflex, the other options supplied above are polysynaptic
reflexes.

903-Which of the following forms part of the lacrimal sac fossa:

1. frontal process of maxilla
2. ethmoid bone
3. palatine bone
4. frontal bone

The lacrimal sac fossa is formed by the lacrimal bone and the frontal process of the maxilla

904-The following are true about blood coagulation EXCEPT:

1. vitamin K is responsible for the production of factors II, VII, IX and X
2. thrombin converts fibrinogen to fibrin
3. platelets are essential for blood clotting
4. heparin inhibits blood coagulation through its interference with vitamin K metabolism

Heparin increases the activity of anti-thrombin III which inhibits the clotting cascade. All other statements
are true.

905-Which is FALSE regarding systemic lupus erythematosus:

1. it is a multisystem autoimmune condition
2. anti-double stranded DNA bodies are raised
3. phospholipid antibodies are raised
4. ocular involvement is common
5. a small vessel vasculitis may occur

Ocular involvement with SLE is rare. When present it can produce:

retinal microinfarcts central retinal artery occlusion central retinal vein occlusion
choroidopathy
906-Which antibiotic is NOT a good choice for chlamydia infection:
1. rifampicin
2. erythromycin
3. tetracycline
4. cephalosporin

Chlamydia is an obligate intracellular organism and antibiotics such as cephalosporins that target bacterial
cell walls will have little effect.

907-The following are true about entopic phenomenon EXCEPT:

1. asteroid hyalosis causes significant visual disturbance due to entopic phenomenon
2. the size of one's pupil can be observed with a pinhole
3. it can be produced by cells in the vitreous
4. it can be produced by palpation of the eyeballs

Entopic phenomenon are visual perceptions that are produced by the structures of one's own eyes e.g.
cells in the vitreous or through eyeball palpation. The edge of one's pupil can be seen when a uniformly
illuminated background is viewed through a pinhole.

908-Which statement is FALSE about the ciliary processes:

1. the pigmented epithelium actively secretes aqueous humour
2. they contain an outer pigmented and an inner non-pigmented epithelium
3. the epithelium is derived from neuroectoderm
4. the apices of the pigmented and non-pigmented epithelium face one another

The ciliary processes form an intergral part of the blood-aqueous barrier. Macromolecules escape the
highly fenestrated capillaries in the stroma of the ciliary processes, and then cross the pigmented epithelial
cells, held together by permeable junctions. At the inner non-pigmented epithelium, there are numerous
tight junctions controlling the passage of molecules and the cells actively secrete aqueous humour with
high numbers of mitochondria.

909-Which of the following drugs is NOT used in the treatment of HIV/AIDS virus:
1. etanercept
2. lamivudine
3. T-20
4. efavirenz
5. combivir

All of the above are used in the treatment of HIV except etanercept which is used in the treatment of
rheumatoid arthritis, psoriasis, psoriatic arthritis and ankylosing spondylitis. It is an anti-TNF alpha drug
which suppresses the immune system and therefore would not be used in a patient with HIV.
Lamivudine is a nucleoside reverse transcriptase inhibitor
Efavirenz is a non-nucleoside reverse transcriptase inhibitor
Zidovudine and Lamivudine are packaged together as combibir
T-20 is a fusion inhibitor; it sticks to gp41 to prevent HIV entering the cell
910-Which of the following aminoglycosides is most likely to induce allergic reaction when applied to the
eye:
1. gentamicin
2. tobramycin
3. neomycin
4. amikacin
Allergic conjunctivitis is most common with topical neomycin, occurring in up to 8% of patients.

911-How many rods are there in the retina:

1. 1.2 million
2. 6.6 million
3. 12 million
4. 9 million
5. 115 million

There are 115 million rods in the human eye.

912-The image formed by a prism is:

1. erect, real, displaced towards the apex
2. erect, virtual, displaced towards the apex
3. inverted, virtual, displaced towards the base
4. erect, real, displaced towards the base

The image formed by a prism is erect, virtual and displaced towards the apex.

913-Which of the following branches of the ophthalmic division of the trigeminal nerve enters the orbit
outside the circle of Zinn:
1. frontal and nasociliary nerves
2. frontal, lacrimal and nasociliary nerves
3. frontal and lacrimal nerves
4. lacrimal and nasociliary nerves

There are three main branches of the first division of the trigeminal nerve: frontal, lacrimal and
nasociliary. The frontal and lacrimal nerves travel outside the circle of Zinn while the nasociliary nerve
travels within the circle of Zinn.

914-All of the following are true of IOP-lowering agents EXCEPT:

1. prostaglandin analogues reduce IOP by increasing trabecular outflow
2. pilocarpine increases aquous outlflow by direct mechanical effect on the ciliary body muscle
3. apraclonidine decreases aqueous formation
4. beta-blockers decrease aqueous production by their effect on the ciliary body

Prostaglandin analogues reduce IOP by increasing uveoscleral outflow. Other options are true.

915-Regarding genetic tests:

1. restriction endonucleases cut the DNA into lengths of about 20 nucleotide base sequences
2. mRNA can be detected with Southern blotting
3. polymerase chain reaction requires the use of DNA polymerase
4. DNA can be detected with Northern blotting
Southern blotting is used to detect DNA whereas Northern blotting is for mRNA. Restriction endonucleases
cut the DNA into lengths of 4 to 6 nucleotide base sequences.

916-Protein degradation takes place in which one of the following areas?

1. peroxisome
2. mitochondria
3. Golgi body
4. ribosome
5. proteasome

There are two major intracellular organelles to digest damaged or unneeded proteins:
lysosomes: for extracellular proteins from endocytosis, receptor mediated endocytosis & phagocytosis
proteasomes: for endogenous proteins (proteins synthesised within cell) transcription factors, cell cycle
cyclins, virus coded proteins, improperly folded proteins due to translation errors and proteins damaged
by cytosol molecules.

917-Which corneal dystrophy is characterized histologically by hyaline bodies:

1. Lattice dystrophy
2. Granular dystrophy
3. Meesman's dystrophy
4. Macular dystrophy
5. Avellino dystrophy

Granular dystrophy is an autosomal dominant corneal stromal dystrophy in which opaque granules of
non-birefringent hyaline bodies form in the anterior stroma.

918-Which immunoglobulin class(es) may exist in polymer form?

1. IgA 2. IgD 3. IgM 4. IgG
1. 1, 2, and 3
2. 2 and 4
3. 4 only
4. 1, 2, 3, and 4
5. 1 and 3

IgA may exist in a dimeric form (two subunits), especially when secreted. IgM is produced as a pentamer
(five subunits).

919-Human T cell lymphotrophic viruses (HTLV) are implicated in all of the following EXCEPT:
a. nasopharyngeal carcinoma
b. Sezary syndrome
c. T cell lymphomas
d. mycosis fungoides

HTLV is implicated in T cell lymphomas including mycosis fungoides and Sezary syndrome. It is endemic in
Japan, Africa and the Caribbean. EBV is associated with nasopharyngeal carcinoma.
920-Regarding T cells:
a. CD8 T cells are activated by T helper cells
b. cytotoxic T cells recognise antigen bound by MHC class II molecules
c. these cells tend to reside in a particular lymph node
d. CD4 T cells can lyse virally infected cells
e. only CD4 T cells proliferate in the mixed lymphocyte reaction

Lymphocytes are specialised cells which mediate the immune response. T lymphocytes are subdivided into
T-helper cells (CD4+) and cytotoxic T-cells (CD8+). T helper cells augment cell-mediated immunity by
activating macrophages and CD8 cytotoxic T cells and also stimulate the humoral (B cell mediated) immune
response. The main function of cytotoxic T cells is to lyse infected target cells.
T lymphocytes bear receptors on their surface that recognise specific foreign peptide antigen presented in
the groove of cell surface proteins termed MHC molecules. CD8+ cytotoxic T lymphocytes recognise
peptide presented by MHC class I molecules and CD4+ T helper cells recognise peptide presented by MHC
class II molecules. Whereas, class II MHC proteins are only expressed on certain cell types termed
professional antigen presenting cells (dendritic cell, macrophages, B cells); MHC class I proteins are present
on all nucleated cells.
Lymphoid organs are the sites where antigens are concentrated and naive T lymphocytes continually
recirculate from the blood through these organs. This increases the chances of immune cells encountering
their specific antigen. After activation, effector T lymphocytes acquire the ability to extravasate to sites of
inflammation where they accumulate. Memory T lymphocytes follow a different route to naive T
lymphocytes. They preferentially patrol sites of inflammation.
The mixed lymphocyte reaction occurs when donor and recipient lymphocytes are mixed. The foreign HLA
molecules are recognised by CD4+ T cells. These cells proliferate and stimulate CD8+ T cells to proliferate
and lyse the foreign cells.

921-The anterior portion of the optic radiation is supplied by:

a. anterior choroidal artery
b. posterior cerebral
c. lateral striate artery
d. posteror choroidal artery
The anterior portion of the optic radiation is supplied by the anterior choroidal artery.

922-Regarding lens fibres:

a. the lens bow is posteriorly oriented
b. deep lens fibres actively synthesise crystallins
c. lens fibres may measure up to 12mm in length
d. lens fibres are rich in microfilaments and microtubules oriented perpendicular to the long axis of
the cell

Lens fibres may measure up to 12mm in length. Superficial lens fibres actively synthesise lens proteins
called crystallins. Lens fibres are rich in microfilaments and microtubules which are oriented parallel to the
long axis of the cell. The lens bow, created by the elongation of the lens fibres coupled with the anterior
migration of the nuclei as the maturing lens fibres sink deeper into the lens, is anteriorly oriented.

923-Regarding head injury:

a. countercoup lesions occur at site perpendicular to impact
b. diffuse axonal injury only occurs when the brain moves within an intact skull
c. the brain heals by gliosis
d. diffuse axonal injury is caused by secondary brain damage
Diffuse axonal injury is caused by primary brain damage during impact. It can occur in both opened and
closed head injury. Countercoup lesions occur at the site diagonal to the site of impact.

924-All of the following are TRUE about the chromosomes EXCEPT:

a. mitosis results in 2 daughter cells each with a full complement of chromosomes
b. 23 chromosomes are found in germinal cells
c. Klinefelter's syndrome results from an extra Y chromosome in the male
d. the Barr body is due to an inactivated X chromosome

In Klinefelter's syndrome, the male cell has an extra X chromosome. Other statements are true.

925-The concentration of adrenaline at the adrenergic synapse is:

a. increased by noradrenaline receptor blockers
b. decreased by cocaine
c. decreased by mono-amineoxidase-inhibitors
d. controlled mainly by the activity of the enzyme COMT

The concentration of adrenaline in the synaptic cleft is increased by:

cocaine which inhibits adrenaline uptake MAO inhibitors which block the metabolism of adrenaline
noradrenaline receptor blockers and partial agonists of noradrenaline (as they prevent the binding and
uptake of adrenaline at the post-synaptic receptor).
Note that COMT is involved in the metabolism of adrenaline intracellularly not at the neuronal synapse.

926-All of the following are true of necrosis EXCEPT:

a. enzymatic necrosis occurs in acute pancreatitis
b. liquefaction necrosis occurs in brain infarction
c. chalk necrosis occurs in tuberculosis
d. coagulative necrosis occurs in coronary infarction

There are several types of necrosis (cell death). All of the associations above are correct with the exception
of tuberculosis which involves casseous necrosis (not chalk necrosis, which is a non-entity).

927-Toxacara canis:
a. is a intracellular protozoan
b. is a nematode
c. is a fungus
d. is a helminth

Toxocara canis is a helminth. The adult forms are found in the intestines of dogs and cats where they lay
eggs that are secreted in the faeces. Treatment is with oral thiabendazole.

928-Which of the following attaches cells to the extracellular matrix and to ligands on other cells:
a. peripheral membrane protein
b. glycoproteins
c. microtubules
d. integrins
e. microfilaments

Integrins are heterodimeric transmembrane proteins that contain alpha and beta subunits. They need
magnesium and calcium to work.
929-Which is FALSE of the optic chiasm:
a. it has the internal carotid artery as its immediate lateral relation
b. it forms the floor of the recess of the third ventricle
c. it is inferior to the olfactory tract
d. it is in close relation to the oculomotor nerve superiorly
The oculomotor nerves lie on the lateral side of the optic chiasm. Other statements are true.

930-Which statement is FALSE regarding trachoma:

a. it responds to tetracycline
b. Stage III is characterized by fibrous replacement of inflammatory tissue
c. it can be spread by direct contact
d. Stage I involves the cornea

Trachoma is characterized by the following recognized stages:

Stage I: involvement of the conjunctival stroma Stage II: involvement of the cornea with pannus
formation Stage III: fibrous replacement of inflamed tissue Stage IV: contraction with entropion and
trichiasis.

931-Which of the following structures contains fifth cranial nerve fibers:

a. ciliary ganglion
b. geniculate ganglion
c. trigeminal ganglion
d. otic ganglion
The otic ganglion is a parasympathetic ganglion located immediately below the foramen ovale. It
communicates with the glossopharyngeal and facial nerves.
The geniculate ganglion contains the facial nerve.
The trigeminal ganglion contains the fifth cranial nerve.
The ciliary ganglion contains the third cranial nerve.
The pterygopalatine ganglion (or sphenopalatine ganglion) is a parasympathetic ganglion found in the
pterygopalatine fossa. It receives a sensory, a motor, and a sympathetic root. Its sensory root is derived
from two sphenopalatine branches of the maxillary nerve. Its motor root is derived from the nervus
intermedius through the greater superficial petrosal nerve. Its sympathetic root is derived from the carotid
plexus through the deep petrosal nerve.

932-Which statement is FALSE regarding the zonules:

a. they are radially inserted on the lens capsule ranging from 2mm anterior to 1mm posterior to the
equator
b. their site of synthesis is believed to be the non-pigment epithelial cells of the ciliary body
c. they arise from the pars plana ciliary epithelium
d. they contain a high collagen content
The zonules are composed of a unique fibrous non-collagenous protein similar in properties to elastin.
Other options are true.

933-The nasolacrimal duct drains via:

a. the inferior meatus
b. the middle meatus
c. the medial meatus
d. the superior meatus
e. the lesser meatus
The nasolacrimal duct drains into the inferior meatus of the nasal cavity.
934-Which of the following bones is NOT a component of the medial orbital wall:
a. maxilla
b. lacrimal bone
c. frontal bone
d. ethmoid

The medial orbital wall is composed of: the frontal process of the maxilla, the lacrimal bone, the orbital
pate of the ethmoid and the body of the sphenoid.

935-MRSA (methicillin-resistant Staphylococcus aureus):

a. is more likely to cause deeper infection than ordinary Staphylococcus aureus strains
b. is not usually present in healthy immunocompetent adults
c. is sensitive to vancomycin
d. is resistant to iodine solution

Vancomycin is effective therapy for MRSA. The infection caused by MRSA is no more deeper than the
ordinary strain. It is an important cause of nosocomial pathogen. It is transmitted between patients via the
hands of health workers. Some of whom may be healthy carriers. MRSA is found to colonize the nose,
axilla and groins. It is killed by exposure to iodine.

936-Which is FALSE regarding the organization of the primary visual cortex:

a. fibres from the superior retina pass to the upper lip of the calcarine sulcus
b. the cells in Layers II and III project to the lateral geniculate nucleus
c. the line of Gennari is formed by myelinated fibres projecting to Layer IV
d. Layer IV is more cellular and receives input from the macula

There are six basic layers of the primary visual cortex. The layers have well established connections
including:
Layer IV: receives fibres from the macula
Layer II and III: project to the secondary visual cortex
Layer V: projects to the superior colliculus
Layer VI: projects to the LGN

937-Which statement is FALSE about the intra-cranial course of the oculomotor nerve:
a. it runs forward in the lateral wall of the cavernous sinus
b. it divides into superior and inferior branches before entering the orbit
c. it passes between the posterior cerebral artery and the superior cerebellar artery
d. it grooves the posterior clinoid process
e. it enters the orbit through the superior orbital fissure within the tendinous ring

The oculomotor nerve divides into superior and inferior branches after it enters the orbit through the
superior orbital fissure. Other statements supplied are true.

938-Which is TRUE of the arterial supply of the orbit:

a. the inferior rectus unlike other recti receives only one muscular artery
b. the central retinal artery enters the optic nerve on its superior surface
c. the ophthalmic artery arises from the internal carotid within the cavernous sinus
d. the eyelids are supplied mainly by branches of the external carotid artery
The central retinal artery enters the optic nerve on its inferior surface. The lateral rectus and not the
inferior rectus receives only one muscular artery. The eyelids are supplied mainly by the medial and the
lateral palpebral arteries, branches of the internal carotid artery.

939-Which is the only immunoglobulin class to readily cross the human placenta?
a. IgA
b. IgE
c. IgM
d. IgD
e. IgG

IgG transfer occurs both passively and by active transport across the placenta. Minimal amounts of IgA
also may cross by passive diffusion.

940-A mother is a carrier of an X linked recessive condition. What is the chance that her daughter will also
be a carrier:
a. 50%
b. 100%
c. 0%
d. 33%
e. 75%

The answer is 50%. We recommend drawing a 2 x 2 box of chromosomal probabilities.

941-Which statement is FALSE regarding the ribosomes:

a. they are involved in transcription of protein
b. they consist of granules made up of RNA and proteins
c. they are found mainly in the cytoplasm
d. their functions are inhibited by chloramphenicol

Ribosomes are involved in the translation of protein not transcription, which is the process whereby
messanger RNA is produced from the DNA sequence. All other statements are true.

942-Secretory Ig A:
a. is responsible for mucosal immunity
b. is transferred across placenta to the foetus
c. is found in the plasma
d. is assembled in the lymph nodes
e. is pentameric

IgA is a dimer. It is responsible for mucosal immunity. It is transported across the mucosal epithelium
bound to a receptor complex. It is not found in plasma and does not cross the placenta.

943-Which is FALSE regarding the choriocapillaris:

a. its lobules are fed by arterioles in Haller's layer
b. its density is greatest at the macula
c. its capillaries are wide-bore
d. its capillaries are fenestrated
The hexagonal lobules or divisions of the choriocapillaris are each fed from arterioles arising in Sattler's
layer. Haller's layer lies beneath Sattler's layer and contains major arteries and veins.
944-All of the following are examples of non-granulomatous inflammatory reactions EXCEPT:
a. multiple sclerosis
b. Bechet's disease
c. syphilis
d. thyroid eye disease

Syphilis is characterized by a granulomatous inflammatory process.

945-In the classic wheal-and-flare reaction, which of the following is NOT involved:
a. mast cells
b. eosinophils
c. IgE
d. basophils
e. macrophages

Macrophages are NOT a part of the acute-phase hypersensitivity Type I reaction.

946-Which antibody class(es) fix(es) complement?

1. IgA 2. IgM 3. IgD 4. IgG
a. 1 and 3
b. 4 only
c. 1, 2, and 3
d. 2 and 4
e. 1, 2, 3, and 4

IgA and IgE may play a role in activating the alternative pathway, but neither directly binds complement
components nor initiates the complement cascade like IgG and IgM.

947-The following are true about the autonomic nervous system EXCEPT:
a. parasympathetic fibres enter the orbit through the inferior branch of the oculomotor nerve
b. Horner's syndrome can occur due to an aneurysm of the internal carotid artery
c. the parasympathetic post-ganglionic fibres supplying the lacrimal gland arise from the ciliary
ganglion
d. the sympathetic system originates in the posterolateral hypothalamus

The parasympathetic fibres to the lacrimal gland arise from the pterygopalatine ganglion. Other
statements are true.

948-All of the following are true of cerebrospinal fluid EXCEPT:

a. the chloride level is higher than that of arterial blood
b. the protein level is lower than that of arterial blood
c. the glucose level is lower than that of venous blood
d. the PO2 is the same as that of arterial blood
e. the pH is lower than that of arterial blood

Almost all constituents of CSF are found in lower concentration than that of blood with the exception of
Chloride and H+, which are higher. Thus, the pH and the PO2 of the CSF are lower than that of the arterial
blood. Protein is lower in the CSF (in fact it is almost absent in the normal CSF). The glucose in CSF is 2/3
that of the blood.
949-The corneal epithelium utilizes most of its glucose:
a. for ATP production aerobically via the Krebb's cycle
b. for ATP production anaerobically with conversion to lactate
c. for the production of sorbitol via the aldose reductase pathway
d. for the production of antioxidants via the pentose phosphate pathway

The corneal epithelium utilizes most of its glucose (85%) for the production of ATP via glycolysis
anaerobically with lactate production. A small proportion of glucose is metabolized aerobically via the
Krebb's cycle. Some glucose is also diverted to the pentose phosphate pathway, which is important for the
production of antioxidants such as glutathione and ascorbic acid. The production of sorbitol from glucose
is a minor pathway and only occurs to a significant degree in hyperglycemic states.

950-Four prism diopters of right hyperphoria are best corrected by:

a. 2 dioptres base-out right eye, 2 dioptres base out left eye
b. 4 dioptres base-down right eye
c. 2 dioptre base-down right eye, 2 diopter base-up left eye
d. 4 dioptres base-up left eye

Generally, when prescribing prisms the correction is split between the two eyes.

951-All of the following are true of the optic canal EXCEPT:

a. it is narrowest posteriorly
b. it is formed by the two roots of the lesser wing of the sphenoid
c. it passes anteriorly, inferiorly and laterally from the middle cranial fossa to the orbit
d. it transmits the ophthalmic artery

The optic canal is narrowest anteriorly. Other options supplied are true.

952-Which of the following is associated with Wegener's granulomatosis:

a. multinucleate giant cells in the internal elastic lamina
b. small vessel vasculitis with granulomatous infiltration
c. medium sized vasculitis with fibrinoid necrosis
d. a linear deposition of IgG along the basement membrane

Wegener's is characterized histologically by small vessel vasculitis with necrosis and granulomatous
inflammation.

953-The orbicularis oculi is supplied with motor innervation by:

a. the fourth cranial nerve
b. the sixth cranial nerve
c. the seventh cranial nerve
d. the third cranial nerve
e. the fifth cranial nerve

The orbicularis is a muscle of facial expression and is supplied by the facial nerve (seventh cranial nerve).
It is the primary muscle responsible for lid closure.
954-The angle of minimum deviation of a prism occurs when:
a. the angle of incidence divided by the angle of emergence equals the refractive index
b. the angle of emergence is normal to the surface of the prism
c. the angle of incidence is normal to the surface of the prism
d. the angle of incidence equals the angle of emergence

The angle of minimum deviation of a prism occurs when the angle of incidence equals to the angle of
emergence.

955-A cross-cylinder uses:

a. a sphero-cylindrical lens with power of cylinder twice the sphere and opposite in sign
b. two cylindrical lenses of equal power and sign at 90 degrees
c. two prismatic lenses of equal and opposite sign at 45 degrees
d. two cylindrical lenses of equal power and opposite sign at 45 degrees

A cross-cylinder is a sphero-cylindrical lens with the power of the cylinder twice the sphere and opposite in
sign. This is the same as superimposing two cylindrical lenses of equal power but opposite sign with axes
at right angle.

956-All are true of Hepatitis C except:

a. intravenous drug users are more at risk
b. it is a single stranded RNA virus
c. it is less likely to lead to liver cirrhosis than Hepatitis B
d. it is implicated in malignant transformation

Hepatitis C is more likely to lead to carrier status and chronic hepatitis (up to 60% of infections) that He B.

957-Which of the following is a Gram-positive cocci:

a. Streptococcus sp.
b. Haemophilus sp.
c. Moraxella sp.
d. Meningococcus sp.
e. E. coli sp.

Streptococcus species are Gram positive cocci. Other options supplied are all Gram negative species

958-Which is FALSE regarding Human Immunodeficiency Virus (HIV):

a. the diagnosis of AIDS cannot be made on the basis of T lymphocyte counts
b. the earliest sign of infection is p24 core protein in the blood
c. infection can be diagnosed by detection of antibodies using ELISA
d. antibodies to HIV have no real protective or neutralizing function
The diagnosis of AIDS can be made both on clinical grounds by the manifestation of indicator diseases or it
can be made on the basis of T cell count where CD4 T cell count falls below 200 per microliter.

959-Which statement about keratocytes is FALSE:

a. keratocytes are flattened cells and occur between lamellae
b. keratocytes are ovoid in shape
c. keratocytes are connected to neighbouring cells by gap junctions
d. keratocytes are modified fibroblasts
Keratocytes are stellate in shape. Other options are true.
960-All are true of mucous membrane pemphigoid EXCEPT:
a. it can cause blistering of mucosa
b. it is an autoimmune response against basement membrane components
c. pathologically there is linear deposition of IgM and C3
d. it can cause a fibrinous reaction with scarring and symblepharon of the lids
e. it can be diagnosed by immunofluorescence

Immunoflourescence study demonstrates linear deposition of IgG (not IgM) and C3 along the basement
membrane.

961-A prism with an apparent angle of deviation of 30 degrees is equivalent to:

a. 30 dioptres
b. 90 diptores
c. 60 dioptres
d. 15 dioptres

Under standard conditions of ophthalmic usage:

1 prism diopter = half a degree angle of apparent deviation

962-All are true of the blood supply to the retina EXCEPT:

a. the retinal circulation has a high oxygen exchange
b. the retinal circulation has a high flow rate
c. the tight junctions of the RPE are important in the integrity of the blood-retina barrier
d. the inner two-thirds of the retina is nourished by branches of the central retinal artery

The retinal circulation has a low flow rate (25mm/s) and a high oxygen exchange. By contrast, the
choroidal circulation has a high flow-rate and a low oxygen exchange.

963-Which of the following is true about body potassium:

a. potassium leaves the cells in the presence of insulin
b. the concentration of the plasma potassium increases at time of metabolic acidosis
c. aldosterone decreases urinary excretion of potassium
d. 90% of the total body potassium is found in the serum

Most of the body potassium is found within the cells. The concentration of plasma potassium rises in
metabolic acidosis. Potassium enters the cells in the presence of insulin. Aldosterone causes sodium
retention and potassium loss.

964-Choose the correct statement regarding co-stimulation of T-cells:

a. it only occurs in the thymus
b. it is always required for T-cell activation
c. it can activate T-cells without antigen binding
d. it triggers the production of IL2

Superantigens such as TSST-1 can activate T-cells without co-stimulation. These bacterial toxins comprise
proteins which exert their effect by forming a bridge between the MHC complex of antigen-presenting cells
and T-cell receptors. Because binding to Tcell receptors is indiscriminate, excess stimulation of T-cell
proliferation occurs. Costimulation of T-cells by professional antigen presenting cells is mediated by the
B7/CD28 ligand complex. This co-stimulation triggers the production of IL2, which drives T-cell
proliferation. Co-stimulation without antigen signaling is ineffective.
Interaction of the TCR with MHC on an antigen presenting cell in the absence of costimulation can result in
T-cell anergy. CD40/CD40L binding mediates T-cell and B-cell interactions and isotype switching. This
interaction is also necessary for optimal T-cell function

965-Which of the following occurs locally in acute inflammation:

a. histamine concentration is increased
b. monocytes are the first cells seen in the extracellular space
c. reduced vascular permeability
d. constriction of the small blood vessels

In acute inflammation, there is vasodilatation, stasis of blood and retraction of the endothelial cells
making the blood vessels leaky. Neutrophils are the first cells seen in the extracellular space. Histamine is
an important mediator that causes vasodilatation and increased vascular permeability.

966-When comparing the means of two large samples, which of the following statements is TRUE?
a. the null hypothesis is that the population means are different
b. the null hypothesis is that the population means are the same
c. the alternative hypothesis is that the sample is different
d. the null hypothesis is that the sample means are the same
e. there is no null hypothesis

The null hypothesis is that the population means are the same. Note that although we perform tests and
draw our conclusions from samples, null and alternative hypotheses refer to the truth, i.e. they refer to
our populations.

967-Karyotype can be obtained from all of the following EXCEPT:

a. retinoblastoma cells
b. erythrocytes
c. chorionic villi
d. neutrophils

Normal erythrocytes do not contain nuclei and therefore it is not possible to obtain a karyotype. All other
cells listed will contain nuclei with a full complement of chromososmes.

968-Amiodarone is commonly associated with which ocular side-effect:

a. corneal opacification
b. glaucoma
c. herpetic keratitis
d. nystagmus
Amiodarone can commonly cause corneal opacification known as vortex keratopathy

969-Which statement is TRUE about the offspring of a female carrier of an X-linked recessive disorder and
a normal male:
a. half of their sons will be symptomatic
b. half of their daughters will be symptomatic
c. half of their children will symptomatic
d. half of their sons will be asymptomatic carriers

Half of the sons will have the condition as they have a 50% chance of inheriting the X chromosome from
the mother. The other half will have a normal X chromosome.
970-ALL of the following hormones counteract the hypoglycemic effect of insulin EXCEPT:
a. growth hormone
b. thyroxine
c. cortisol
d. adrenaline
e. glucagon

There are five hormones which counteract the hypoglycemic effect of insulin:
glucagon cortisol growth hormone adrenaline noradrenaline

971-Which branch of the external carotid artery contributes to the blood supply of the medial eyelids:
a. lacrimal artery
b. transverse facial artery
c. ophthalmic artery
d. angular artery

The eyelids are supplied by the palpebral arcades (marginal and peripheral arcades) which are themselves
supplied from both medial and palpebral ends by feeder arteries as follows:
medial palpebral artery: supplied by the angular artery (branch of facial artery, branch of external
carotid) and the dorsalis nasi (branch of ophthalmic artery, branch of internal carotid)
the lateral palpebral artery: supplied by the transverse facial artery (branch of external carotid) and the
lacrimal artery (branch of ophthalmic artery, branch of internal carotid)

972-All of the following will influence the diffusion coefficient of a drug EXCEPT:
a. the thickness of the cell membrane
b. the degree of ionization of the drug
c. the molecular size of the drug
d. the lipid solubility of the drug

The diffusion coefficient of a drug is determined by its lipid solubility, ionization and molecular size. The
thickness of the cell membrane will affect the rate of diffusion as per Fick's law, but it has no influence on
an individual drug's diffusion coefficient.

973-Which is FALSE about the superior orbital fissure:

a. is approximately 22mm long
b. it is bound by the lesser and greater wings of sphenoid
c. it is comma-shaped, being wider at its lateral than medial end
d. it is the largest communication between the orbit and the cranial cavities

The superior orbital fissure is comma-shaped, being wider at its medial end than laterally.

974-Where does the image formed by an object outside the centre of curvature of a concave mirror lie:
a. behind the mirror
b. between the principle focus and the mirror
c. outside the centre of curvature
d. between the centre of curvature and the principle focus

For an object outside the centre of curvature of a concave mirror, the image formed is real, inverted and
diminished; and it lies between the centre of curvature and the principle focus.
975-The lacrimal fossa is formed by:
a. the frontal bone and the lacrimal bone
b. the frontal process of the maxillary bone and the ethmoid bone
c. the frontal process of maxillary bone and the lacrimal bone
d. the lacrimal bone and the ethmoid bone

The lacrimal fossa is formed by the lacrimal bone and the frontal process of the maxilla. It houses the
lacrimal sac.

976-Psammoma bodies are seen histologically in:

a. optic nerve glioma
b. choroidal melanoma
c. retinoblastoma
d. optic nerve meningioma

Psammoma bodies are seen histologically in mengiomas

977-Which is true of local anaesthetics:

a. their effects are weakened by administration with sodium bicarbonate
b. they are weak acids
c. their action is shortened by concurrent adrenaline administration
d. they inhibit the sodium ion pump

Explanation Local anaesthetics inhibit the sodium pump, preventing initiation of an action potential. They
are weak bases. Local anaesthetic activity can be enhanced by altering the pH of a drug preparation to
maximise the amount of drug in the unionised (unprotonated) form. Local acidosis such as caused by
wound infection greatly reduces the action of local anesthetics. Sodium bicarbonate on the other hand
makes local anaesthetic more hydrophobic thereby increasing its cellular penetration. This increases its
potency. The use of adrenaline causes vasoconstriction and decreases the rate of removal of LA by the
blood.

978-A 23 year old male complains of reduced vision. Systemic enquiry reveals he is under investigation for
progressive muscle weakness. On examination he has cataracts, an expressionless face, frontal balding and
gonadal atrophy. How is this condition inherited:
a. mitochondrial
b. autosomal recessive
c. autosomal dominant
d. X-linked recessive

This is a case of myotonic dystrophy which is an autosomal dominant condition due to a mutation in
chromosome 19.

979-Which of the following muscles is supplied by the contralateral oculomotor nucleus:

a. levator superioris
b. superior rectus
c. inferior oblique
d. inferior rectus

The axons for most of the extraocular muscles are uncrossed from the nucleus to the eye (in other words,
ipsilateral innervation). However there are 2 exceptions:
 the levator palpebrae come from both sides of the central caudal subnucleus via crossed and uncrossed
pathways
the superior rectus muscle innervation comes from the superior rectus subnucleus on the contralateral
side (contralateral innervation)

980-Which of the following anti-fungal agents act by interfering with the cell wall of the fungi:
a. Griseofluvin
b. 5-fluorocytosine
c. Cyclohexidine
d. Amphotericin B

Polyene antifungal drugs (Amphotericin, nystatin, and pimaricin) interact with sterols in the cell
membrane to form channels through which small molecules leak from the inside of the fungal cell to the
outside. Azole antifungal drugs (Fluconazole, itraconazole, and ketoconazole) inhibit cytochrome P450-
dependent enzymes (particularly C14-demethylase) involved in the biosynthesis of ergosterol, which is
required for fungal cell membrane structure and function. Grisan (Griseofluvin) binds to tubulin,
preventing microtubule assembly. Glutaramide (Cycloheximide) inhibits protein synthesis at ribosomal
level. Antimetabolite antifungal drugs (5-Fluorocytosine) acts as an inhibitor of both DNA and RNA
synthesis via the intracytoplasmic conversion of 5-fluorocytosine to 5-fluorouracil.

981-With regard to immunoglobulin A:

a. it is secreted by the lacrimal gland
b. it is the heaviest immunoglobulin
c. it is effective against gonococcus
d. it is the first immunoglobulin to be produced when the body is invaded by viruses

IgA is dimeric and therefore lighter than IgM, which is a pentamer. It is excreted in the tears and milk and
is an important line of defense of mucous membranes. It activates the alternative complement pathway
(unlike many antibodies that activate the classical pathway). It is ineffective against gonococcus, which
produces a protease against IgA. IgM is the first antibody to appear in infection.

982-The thinnest orbital wall is:

a. the medial wall
b. the orbital floor
c. the orbital roof
d. the lateral wall

The medial wall is the thinnest of the orbital walls and is largely transparent in the dried skull.

983-Meissner's corpuscles are responsible for:

a. light touch
b. vibration
c. pain
d. temperature

The cutaneous receptors are as follows:

Meissner's corpuscles: light touch
Pacinian corpuscles: pressure and vibration receptors
Merkel discs: light touch
Free nerve endings: pain and temperature
985-Vergence movement:
a. is limited by the near point and far point of accommodation
b. is stimulated by sharp images on the retina
c. is an involuntary eye movement
d. is more rapid than pursuit movement

Vergence movement is a tracking movement which is slower than pursuit movement. It is voluntary but
can be stimulated by blurred images on the retina. It is required for binocular single vision and stereopsis
and is limited by the near point and the far point of accommodation

986-Which statement is FALSE about the corneal epithelium:

a. it is 50-60 micrometers thick
b. Dendritic cells decline sharply in density from the periphery towards the centre of the cornea
c. MHC Class I cells are rare in the central corneal
d. it is a stratified non-keratinized squamous epithelium

MHC Class II cells are rare in the central cornea because the central cornea is devoid of immunocompetent
cells that contain MHC Class II. Other options are true.

987-Which statement about thrombus is FALSE:

a. it involves mainly the intrinsic and extrinsic clotting cascade
b. it can cause embolism
c. platelets form the first layer of thrombus
d. it can occur in both arteries and veins

A thrombus is a solid mass of blood constituents forming within the vascular system, i.e. both arteries and
veins. Unlike simple clotting in which the clotting cascade plays an important role, thrombus is formed by
the interaction between the platelets and the blood constituents. Fragments of the thrombus may break
off into circulation causing embolism.

988-Rods are responsible for all of the following EXCEPT:

a. contrast
b. spatial resolution
c. motion
d. brightness

The rods are responsible for:

contrast brightness spatial resolution
The cones are responsible for:
fine resolution spatial resolution colour vision

989-The primary muscle responsible for lid opening is:

a. Muller's muscle
b. the levator palpebrae superioris
c. the orbicularis oculi
d. the corrugator supercilii
e. the frontalis
The main muscle responsible for lid opening is the levator palpebrae superioris. The orbicularis oculi is the
main muscle responsible for lid closure. The corrugator supercilii and frontalis are muscles of facial
expression. Muller's muscle assists in lid elevation under sympathetic innervation
990-Which is FALSE regarding cataract:
a. it is predisposed by mechanical trauma to the lens
b. it involves the breakdown of crystallins to albuminoids
c. it is predisposed by ultra-violet radiation
d. hypocalcaemia has been shown to delay cataract progression

Cataract progression is enhanced by any metabolic disturbance that alters the microenvironment,
disrupting the lens fibre cells. This includes diabetes, hypocalcaemia, ionizing radiation and mechanical
trauma.

991-Which statement is FALSE regarding nerve supply to the cornea:

a. the corneal nerve supply is mainly from the short ciliary nerves
b. nerve bundles enter the peripheral cornea in a radial manner
c. individual nerve fibres terminate in the superficial epithelial layers as an intra-epithelial plexus
d. nerves must pierce Bowman's layer to enter the corneal epithelium

The corneal nerve supply is mainly from the long ciliary nerves.

992-A posterior communicating artery aneurysm is most likely to cause:

a. a seventh nerve palsy
b. a sixth nerve pasy
c. a fifth nerve pasy
d. a third nerve palsy
e. a fourth nerve palsy

A posterior communicating artery aneurysm is most likely to cause a third nerve palsy as the third nerve
on its exit from the brainstem runs alongside and lateral to the posterior communicating artery.

993-Actinomyces is most likely to cause:

a. acute retinal necrosis
b. trabeculitis
c. keratitis
d. conjunctivitis
e. canaliculits

Actinomyces is a Gram-positive filament which is a common cause of canaliculitis and dacrocystitis

994-All statements are true of Schlemm's canal EXCEPT:

a. it is lined by endothelium
b. it is a circumferential channel filled with aqueous humour
c. it is drained by collector channels and aqueous veins
d. it drains aqueous humour by the non-conventional pathway
e. the aqueous from Schlemm's canal can join either the deep episcleral venous plexuses or drain
directly into superficial conjunctival veins

Drainage of aqueous humour via the Schlemm's canal is described as the conventional outflow pathway
and is responsible for 70-90% of aqueous outflow. The nonconventional pathway refers to drainage of
aqueous via the intercellular spaces between ciliary muscle fibres and the loose connective tissue of the
suprachoroidal space. Other options supplied above are true
995-A ray of light passing through the nodal point of a thin lens will:
a. be refracted through the focal point of the lens
b. pass through undeviated
c. be refracted parallel to the principle plane of the lens
d. reflect off the lens by total internal reflection

A ray of light passing through the nodal point of a thin lens will pass through undeviated. It is an important
principle in the construction of ray diagrams, as for any object, one can predict the image produced by
drawing 2 lines (a) one passing through the nodal point undeviated, (b) the other parallel to the principle
action passing through the second principle focus.

996-The great cerebral vein of Galen drains the deep cerebral veins into:
a. the straight sinus
b. the superior sagittal sinus
c. the cavernous sinus
d. the sigmoid sinus

The great cerebral vein of Galen drains the deep cerebral veins into the straight sinus.

997-Regarding the total cerebral blood flow:

a. it shows significant increase if there is an increase in carbon dioxide concentration in the arterial
blood
b. it shows significant decrease if the mean systemic blood pressure is reduced from 140 to 60 mmHg
c. it is increased during intense mental activity
d. it is regulated by the sympathetic nervous system

The cerebral blood flow is autoregulated and the sympathetic nervous system plays little role.
Autoregulation is very effective in maintaining the blood flow between mean systemic blood pressure of
between 60 to 140 mmHg. In the presence of increased serum acidity as in raised arterial carbon dioxide
concentration, the cerebral blood flow is increased.

998-The intraocular pressure can fluctuate in all scenarios below EXCEPT:

a. diurnally
b. with eye movements
c. with fluid intake
d. in idiopathic optic neuritis

The intraocular pressure does not fluctuate specifically with optic neuritis. All other options are true. IOP
is higher in winter, higher in the morning, higher when the eye is moved away from primary position, and
higher with increased body fluid.

999-Which is FALSE regarding blot hemorrhages:

a. they occur in the outer plexiform layer
b. they can be viewed with the red-free filter on ophthalmoscopy
c. they occur in diabetic retinopathy
d. they are larger than dot hemorrhages

Blot hemorrhages are typical of diabetic retinopathy and are easily visible on ophthalmoscopy. Often the
red-free filter is useful for identifying retinal hemorrhages. Blot hemorrhages are bigger than dot
hemorrhages and are due to bleeding from capillaries tracking between the photoreceptors and the RPE.
1000-Which of the following is FALSE about ocular drug delivery:
a. an acidic or alkaline pH can increase drug absorption
b. ointments have a longer corneal contact time than drops
c. an acidic or alkaline pH can increase drug clearance
d. an increased blink rate increases topical drug absorption

An increased blink rate reduces the topical drug absorption by increasing clearance. Eye drop solutions are
often made more acidic or alkaline in order to ensure the drug (whether weak acid or weak base) is more
un-ionised and therefore lipid soluble to increase corneal absorption. However, acidic and alkaline pH will
also tend to initiate irritation and lacrimation, increasing drug clearance

1001-The following statements about restriction endonucleases are true EXCEPT:

a. they cut DNA at defined sequences
b. they are natural products of bacteria
c. they cut double-stranded DNA molecules
d. they act by breaking the hydrogen bonds between bases

Restriction endonucleases act by breaking the sugar-phosphate backbones of the DNA. Other statements
are true.

1002-A lens with a focal length of 25 cm has a power of:

a. 4 dioptres
b. 0.04 dioptres
c. 0.25 dioptres
d. 25 dioptres

The dioptric power of a lens is equal to the reciprocal of the focal length measured in meters.

1003-Which statement is FALSE regarding the facial nerve:

a. it gives off the deep petrosal nerve as a branch to the sphenopalatine ganglion
b. its fibres exit the brainstem in the cerebellopontine angle
c. it transmits taste fibres for the anterior 2/3rds of the tongue
d. it has a sensory component that supplies the outer ear

The facial nerve gives off the greater petrosal nerve (not the deep petrosal nerve) which mediates tear
secretion. Other options are true.

1004-Which is FALSE regarding the blood supply through the choroid:

a. the blood flow in the choroid is among the highest in the body
b. blood drains from the choroid by the vortex veins
c. the choroidal capillaries are highly fenestrated
d. the percentage oxygen transfer in choroidal capillaries is high

The oxygen transfer in choroidal capillaries is low, with only 5-10% of the oxygen having been extracted.
The blood flow, however, is high at 1400 ml/min per 100g of tissue, which is higher than the perfusion
through the kidney.
1005-Where is the image produced by an object positioned at the focal point F1 of a thin convex lens:
a. infinity
b. inside F2
c. further from the lens than the object
d. outside F2

The image formed by an object positioned at the focal point F1 of a thin convex lens is virtual, erect and at
infinity. We recommend being familiar with drawing ray diagrams by producing, from the top of any
object, 2 lines (a) one passing through the nodal point undeviated, (b) the other parallel to the principle
action passing through the second principle focus.

1006-All of the following are true of lymph nodes EXCEPT:

a. B lymphocytes predominate in the follicles of the cortex
b. T lymphocytes predominate in the paracortex
c. plasma cells are found chiefly in the paracortex
d. secondary follicles develop upon antigenic stimulation

Plasma cells are found mainly in the medulla. All other statements are true.

1007-The lateral geniculate nucleus is supplied by:

a. the anterior cerebral artery
b. the posterior choroidal artery
c. the posterior cerebral artery
d. the anterior choroidal artery

The lateral geniculate nucleus is supplied by the anterior choroidal artery, which is itself a branch of the
internal carotid artery.

1008-Parasympathetic fibres to the lacrimal gland travel via all EXCEPT:

a. the deep petrosal nerve
b. the nervus intermedius
c. the zygomatic branch of the maxillary nerve
d. the pterygopalatine ganglion

The parasympathetic supply to the lacrimal nerve begins in the lacrimal nucleus of the facial nerve. The
preganglionic fibres travel via the nervus intermedius and its greater petrosal branch to synapse in the
pterygopalatine ganglion. The postganglionic fibres enter the zygomatic branch of the maxillary nerve and
travel via the zygomaticotemporal nerve to innervate the lacrimal gland

1009-Which is TRUE about the orbit:

a. the nasal bone forms part of the medial orbital wall
b. the lesser wing of sphenoid forms part of the lateral wall
c. the palatine bone forms part of the posterior orbital wall
d. it has a volume of about 200 ml

The volume of the orbit is approximately 30 ml. The greater (not the lesser) wing of sphenoid forms part of
the lateral orbital wall. The nasal bone does not form any part of the orbital wall
1010-Flame hemorrhages occur in which layer of the retina:
a. the outer plexiform layer
b. Bruch's membrane
c. the internal limiting membrane
d. the inner plexiform layer
e. the nerve fibre layer

Flame hemorrhages follow rupture of a small arteriole with blood tracking into the nerve fibre layer. The
shape and direction of a flame hemorrhage is due to the direction of passage of the nerve fibres.

1011-Which is NOT true regarding ocular drug delivery:

a. preservatives can enhance drug delivery
b. addition of polyvinyl alcohol reduces the viscosity of a drop
c. particulate suspensions can be used in the delivery of steroids
d. the corneal epithelium presents a greater barrier to hydrophilic than lipophilic drugs

Addition of polyvinyl alcohol will tend to increase the viscosity of a drop, therefore allowing it to linger
longer in the eye. Other options are true.

1012-Which is TRUE regarding the image formed by an object lying within the principle focus of a concave
mirror:
a. it is inverted
b. it is enlarged
c. it lies between the centre of curvature and the principle focus
d. it is real

For an object within the principle focus of a concave mirror, the image formed is erect, virtual and
enlarged; and it lies behind the mirror.

1013-In Best disease there is massive accumulation of which substance in the RPE cells:
a. lipofuscin
b. melanin
c. drusen
d. myelin
e. lipid

Best disease is a hereditary autosomal dominant macular degeneration characterized histologically by

massive accumulation of lipofuscin in the RPE cells with atrophy of the overlying photoreceptor layer.

1014-Which statement is FALSE regarding Streptococcus pneumoniae:

a. it is aerobic and non-motile
b. it is capable of alpha-haemolysis
c. it is a Gram positive cocci
d. it is susceptible to phagocytosis

Strep pneumoniae produces a capsular polysaccharide which makes it resistant to phagocytosis. Other
options are true.
1015-The basal tear production rate is:
a. 20 microlitres per minute
b. 1.2 microlitres per minute
c. 5 microlitres per minute
d. 10 micolitres per minute

Basal tear production is 1.2 microlitres per minute but a massive increase is possible through reflex
secretion induced by mechanical and psychological stimuli.

1016-The endothelial cells of the iris capillaries:

a. are highly fenestrated
b. are characterized by many gap junctions between endothelial cells
c. normally leak fluorescein on angiography
d. have a thickened basal lamina

The iris capillaries form the major site of the blood-aqueous barrier and are structurally specialized for this
purpose. The iris capillaries are non-fenestrated, they are connected by numerous tight junctions, and they
have a thickened basal lamina strengthened by perivascular collagenous hyalinised layers.

1017-Which is TRUE regarding the image formed by an object outside the centre of curvature of a concave
mirror:
a. it is virtual
b. it lies between the centre of curvature and the principle focus
c. it is erect
d. it is enlarged

For an object outside the centre of curvature of a concave mirror, the image formed is real, inverted and
diminished; and it lies between the centre of curvature and the principle focus.

1018-The macula lutea corresponds anatomically to:

a. the area centralis
b. the fovea
c. the peripheral retina
d. the foveola

There is some ambiguity between clinical and anatomic terms for the regions of the fundus. In summary:
clinical : anatomical posterior pole: area centralis (the area between the vascular arcades) macula
lutea: fovea (1.5 mm diameter area, yellow from xanthophyll) fovea centralis: foveola (0.35mm central
depression with thickened margins)

1019-Where does RNA splicing occur?

a. ribosome
b. lysosome
c. peroxisome
d. Golgi body
e. Nucleus

RNA splicing occurs in the nucleus. This forms mRNA, which travels out of the nucleus into the cytoplasm
for RNA translation.
1020-Which of the following structures arises from the third pharyngeal pouch:
a. the parafollicular cells
b. the thymus
c. the superior parathyroid gland
d. thyroid gland
e. the tympanic membrane

The thymus is the only option above arising from the third pharyngeal pouch. The tympanic membrane
arises from the first pharyngeal pouch. The superior parathyroid gland arises from the fourth pharyngeal
pouch. The parafollicular gland arises from the fifth pharyngeal pouch.

1021-The facial nerve is responsible for all of the following EXCEPT:

a. motor innervation to the muscles of facial expression
b. motor innervation to the stapedius
c. parasympathetic innervation to the parotid gland
d. taste sensation to the anterior two-thirds of the tongue

The facial nerve is responsible for the parasympathetic supply to the pterygopalatine ganglion which
supplies the lacrimal gland (not the parotid), as well as the choroid and glands in and around the nose and
mouth. The facial nerve also supplies motor innervation to the muscles of facial expression, the stapedius,
the stylohyoid and the digastric. Finally, the facial nerve is responsible for taste sensation to the anterior
twothirds of the tongue.

1022-Which of the following immunoglobulin classes is/are important in antigen reception at the surface
of lymphocytes in primary immune responses?
1. IgD 2. IgG 3. IgM 4. IgE
a. 2 and 4
b. 1 and 3
c. 1, 2, and 3
d. 1, 2, 3, and 4
e. 4 only

IgM, IgG, and IgD can be demonstrated on the surface of virgin B-lymphocytes and are involved with
binding antigen, leading to the activation of the cells, and confer the capability for anamnestic responses.

1023-Select the FALSE statement below. The optic nerve blood supply:
a. includes the pial vessels
b. the majority of capillaries run external to the optic nerve
c. includes the central retinal vessels and their branches
d. includes the scleral vessels called the circle of Zinn-Haller

The majority of capillaries pierce the nerve and course within the nerve via the glial septae.

1024-All are involved in the parasympathetic pathway to the lacrimal gland EXCEPT:
a. the pterygoplatine ganglion
b. the superior salivatory nucleus
c. the nervus intermedius
d. the lesser petrosal nerve
The parasympathetic pathway to the lacrimal gland begins in the superior salivatory nucleus in the pons.
Fibres pass via the nervus intermedius of CN VII, the greater petrosal nerve to the pterygopalatine
ganglion, where post-ganglionic fibres leave for the lacrimal gland.

1025-Which is FALSE regarding a prism:

a. the angle of deviation is dependent on the refracting angle of the prism
b. the angle of deviation is dependent on the angle of incidence
c. the angle of deviation is dependent on the refractive index
d. the angle of deviation is largest when the angle of incidence equals the angle of emergence

The angle of deviation of a prism is dependent on three factors:

the refractive index of the prism the refractive angle of the prism the angle of incidence of light
The angle of deviation is smallest when the angle of incidence equals the angle of emergence, at which
point it is called the angle of minimum deviation.

1026-All of the following statements regarding the culture mediums in microbiology are true EXCEPT:
a. Nutrient poor agar with E.coli overlay is useful for acanthamoeba
b. Lowenstein-Jensen medium is best for mycobacteria
c. Chocolate agar is best for the growth of Haemophilus and Neisseria organisms
d. Blood agar is best for anaerobic microbes
e. McConkey agar is best for Gram negative bacteria

Blood agar is best for aerobic microbes. Chocolate agar is a nutrient medium used in culturing fastidious
organisms such as Haemophilus species and Neisseria. It comprises sheep blood that provides factors X
(hemin) and V (nicotinamide adenine dinucleotide) necessary for Haemophilus growth. McConkey agar is
used in identification of lactose fermenting, Gram-negative enteric pathogens and for inhibiting growth of
Gram-positive organisms. Nutrient poor agar with E. coli overlay provides nutrient for the growth of
acanthamoeba. Lowenstein-Jensen medium is used primarily for mycobacteria culture.

1027-Which is FALSE regarding the use of the cross-cylinder to assess the axis of a trial lens during a
refraction:
a. the axis of the trial lens is moved towards the axis of positive sign on the cross
b. the process is repeated until the cross offers equally unacceptable options to the patient
c. the handle is held in line with the axis of the trial lens
d. the cylindrical axis is usually assessed before the cylindrical power

The axis of the trial lens is moved towards the axis of the same sign on the cross-cylinder. Other options
are true.

1028-All of the following insert into the lateral tubercle of Whitnall EXCEPT:
a. suspensory ligament of eyeball
b. Whitnall's ligament
c. lateral canthal tendon
d. check ligament of eyeball

Whitnall's ligament inserts 10 mm above the tubercle of Whitnall.

 1029-The image formed by an object lying between the centre of curvature and the principle focus of a
concave mirror is:
a. it is diminished
b. it lies between the centre of curvature and the principle focus
c. it is inverted
d. it is virtual

For an object lying between the centre of curvature and the principle focus of a concave mirror, the image
formed is real, inverted and enlarged; and it lies behind the centre of curvature.

1030-Which of the following terms is NOT correctly matched:

a. point mutation: a single nucleotide substitution
b. frame-shift mutation: deletion of bases leading to incorrect reading during translation
c. repeat expansion: insertion of a repeated codon of three bases
d. missense mutation: a nucleotide change resulting in a stop codon

A missense mutation is a single nucleotide change resulting in a different amino acid. A nonsense mutation
is a single nucleotide change resulting in a stop codon

1031-The short ciliary nerve arises from:

a. the ciliary ganglion
b. the optic nerve
c. the anterior ciliary nerve
d. the nasociliary nerve

The short ciliary nerve arises from the ciliary ganglion and carries sensory (from the nasociliary),
sympathetic and parasympathetic fibres (predominantly from the third nerve but also from the seventh).
The long ciliary nerve, which passes through the choroid and transmits sensory fibres to the cornea, iris
and ciliary body (as well as sympathetic fibres to the dilator pupillae muscle) is a branch of the nasociliary
nerve, itself a branch of the ophthalmic nerve.

1032-Which is the largest extraocular muscle:

a. inferior rectus
b. superior rectus
c. medial rectus
d. lateral rectus

The medial recuts is the largest extraocular muscle.

1033-Regarding drug metabolism:

a. lipid-soluble beta-antagonists cause bad dreams more often than watersoluble betaantagonists
b. hepatic drug metabolism often involves conversion of a water-soluble into a more lipidsoluble
drug
c. drugs with a high affinity for plasma protein have a very large volume of distribution
d. renal failure significantly increases the plasma protein binding of drugs
Lipid soluble drugs enters the blood brain barriers more readily and therefore have more central nervous
system side effects. A highly plasma protein binding drug stays in the vascular component and therefore
has a volume of distribution of about 4-5 liters. Hepatic drug metabolism often converts a lipid-soluble
drug into a watersoluble one. Renal failure causes decreased plasma protein concentration and therefore
less binding for drugs.
1034-All of the following are true of the vitreous EXCEPT:
a. it is a hydrogel with a water content of 98%
b. it has a high concentration of hyaluronic acid
c. it contains mainly type I collagen
d. it is firmly attached to the pars plana

The vitreous contains mainly Type II collagen fibres. It is firmly attached to: the pars plana via the vitreous
base, the posterior lens capsule, around the optic disc, along the blood vessels.

1035-The circle of least confusion in Sturm's conoid coincides with the focal point of:
a. the average of the maximum and minimum curvatures
b. the base curve
c. the meridian of maximum curvature
d. the spherical equivalent

The circle of least confusion in Sturm's conoid coincides with the focal point of the spherical equivalent of
the toric lens.

1036-At the limbus the following transitions occur EXCEPT:

a. the random array of collagenous lamellae of the sclera become the regularly arranged corneal
lamellae
b. Descemet's membrane and Bowman's layer terminate
c. the conjunctival epithelium becomes the stratified squamous keratinised corneal epithelium
d. conjunctival capillaries derived from the anterior ciliary arteries terminate
The conjunctival epithelium becomes the stratified squamous non-keratinised corneal epithelium. Other
options are true.

1037-Acetylcholine is released at all of the following sites EXCEPT:

a. parasympathetic postganglionic neurons
b. sympathetic postganglionic neurons innervating the iris
c. parasympathetic preganglionic neurons
d. sympathetic postganglionic neurons that innervates the sweat glands
e. sympathetic preganglionic neurons

Cholinergic neurons are found at the following:

all preganglionic neurons parasympathetic postganglionic neurons sympathetic postganglionic
neurons that serve the sweat glands sympathetic postganglionic neurons on blood vessels in the
skeletal muscle.
Note: the remainder of postganglionic sympathetic neurons are noradrenergic.

1038-Anaphylactic reactions involve all of the following EXCEPT:

a. Mast cells
b. Basophils
c. Ig E
d. Langhan's giant cells
e. Histamine
Anaphylactic reaction (Type I hypersensitivity) involves the bindings of Ig E (which have reacted with
specific antigen) to mast cells or basophils leading to cell degranulation, histamine release and
anaphylaxis. Langhan's multinucleate giant cells occur in type IV hypersensitivity (e.g. granuloma
formation).
1039-Which is FALSE regarding the lacrimal gland:
a. the acinus inner wall is lined by stratified columnar cells
b. the lacrimal gland receives innervation from the trigeminal nerve
c. a layer of myoepithelial cells surrounds each acinus
d. the secretion from the lacrimal gland contains IgA
e. the secretion from the lacrimal gland is primarily proteinaceous

A lacrimal gland acinus is composed of a single layer of columnar cells whose apices are directed towards
the central lumen. Surrounding the columnar cells are myoepithelial cells. The secretion is primarily
proteinaceous but it also contains lysozymes, lactoferrin and IgA, which are important in ocular defense.
The lacrimal gland receives sensory innervation from the trigeminal nerve and also parasympathetic
innervation originating from the lacrimatory nucleus via the nervus intermedius and greater petrosal nerve
synapsing in the pterygopalatine ganglion.

1040-Where is the image formed by an object lying within the principle focus of a concave mirror:
a. between the centre of curvature and the principle focus
b. between the principle focus and the mirror
c. behind the mirror
d. outside the centre of curvature

For an object within the principle focus of a concave mirror, the image formed is erect, virtual and
enlarged; and it lies behind the mirror.

1041-A cross-cylinder is a type of:

a. toric lens
b. convex cylindrical lens
c. concave cylindrical lens
d. prismatic lens

The cross-cylinder also known as the Jackson's cross-cylinder is a toric or spherocylindrical lens.

1042-A 15-year-old presents with glandular fever. Which cells are not involved in the initial presentation of
viral antigen to T-helper cells:
a. macrophages
b. neutrophils
c. Kupfer cells
d. B cells
e. dendritic cells
Neutrophils do not present antigen via class II MHC molecules which mediate the initial presentation of antigen to T-
helper cells. Initial presentation of antigen to naive Tlymphocytes requires the participation of cells with special
properties. These professional antigen presenting cells express high levels of MHC class II molecules and
costimulatory molecules B7.1 and B7.2. The presentation of peptide antigen accompanied by costimulatory signals,
results in activation and differentiation of the naive T-cell into an effector lymphocyte. Professional antigen
presenting cells include Langerhans cells in the skin, interdigitating dendritic cells, follicular dendritic cells in lymph
nodes, macrophages (in all forms - e.g. Kupfer cells) and B-cells. Langerhans cells do not express costimulatory
molecules which are needed to fully activate T-cells. These cells are however able to endocytose antigen and then
migrate to the lymphoid organs where they differentiate into mature dendritic cells. Dendritic cells constitutively
express class II MHC, B7.1 and B7.2 and possess potent co-stimulatory activity. Class II MHC molecules and co-
stimulatory proteins are upregulated on macrophages and B-lymphocytes only after activation by antigen. B-cells
play an important role in antigen presentation during the secondary immune response, as their high affinity receptor
is able to take up and process small quantities of antigen.
1043-All of the following structures pass through the foramen ovale EXCEPT:
a. the mandibular nerve
b. the emissary vein
c. the accessory meningeal artery
d. the greater petrosal nerve

The mnemonic MALE is useful for remembering the structures that pass through the foramen ovale:
Mandibular nerve, Accessory meningeal artery, Lesser petrosal nerve and Emissary vein.

1044-A unilateral blind eye is most likely to be caused by:

a. a stroke affecting the anterior choroidal artery
b. an aneurysm of ophthalmic artery
c. a pituitary tumour
d. a stroke affecting the lateral striate artery
e. a stroke affecting the anterior cerebral artery

An aneurysm of the ophthalmic artery can cause compressive atrophy of the optic nerve resulting in
unilateral blindness. A pituitary tumour would cause a bitemporal hemianopia while stroke of the anterior
choroidal or lateral striate arteries which supply the optic tracts and radiations would cause a
homonomous hemianopia. An anterior cerebral artery stroke is unlikely to have primary visual symptoms.

1045-Which is FALSE regarding amyloid:

a. amyloid is an insoluble protein
b. amyoid demonstrates red birefringence in polarized light
c. amyloid is deposited in the cornea in lattice dystrophy
d. Waldenstrom macroglobulinaemia is a systemic form of amyloidosis

Amyloid demonstrates apple-green birefringence when stained with Congo red and examined with
polarized light.

1046-A study compared carotid endarterectomy with medical therapy for stroke prevention over 2 years.
18% of patients in the medical therapy group developed a stroke, compared with 8% in the carotid
endarterectomy group. What is the number needed to treat over 2 years to prevent 1 stroke?
a. 100 /(18 - 8)
b. 100 / 18
c. (18-8) / 100
d. 20%
e. 100 /8
NNT is defined as number needed to treat to prevent 1 event.
NNT = 100/ARR (ARR= Absolute risk reduction)
ARR = |CER - EER|
Where: CER = control group event rate EER = experimental group event rate

1047-The following are true about the lacrimal gland EXCEPT:

a. it is situated within the zygomatic process of the frontal bone
b. botulinum toxin inhibits lacrimal gland tear production
c. it is responsible for reflex tear production
d. the orbital portion is smaller than the palpebral portion
The orbital portion is 3-4 times larger than the palpebral portion. Other options are true.
1048-Fibrillins are an important constituent of:
a. the corneal stroma
b. the corneal epithelium
c. the zonules
d. the sclera

Fibrillins are extracellular microfibrils which have an important structural role in longrange elasticity of
tissues. It is a vital component of the lens zonule, the anterior lens capsule and the vitreous.