1. With regard to ptosis:

    a. the most common abnormality in congenital ptosis is in the levator
        muscle

    b. lid lag on downgaze is a feature of senile ptosis

    c. in Horner's syndrome, ptosis is due to paralysis of the Muller's
        muscle

    d. the levator function is good in aponeurotic defect

    e. raised skin crease is a feature of congenital ptosis.

answer1.    a.T    b.F    c.T    d.T    e.F
In congenital ptosis, the ptosis is usually caused by abnormality of the levator muscle. The muscle is fibrotic sometimes with fat infiltration and as a result the muscle can neither relax or contract.
 

2. True statements about eyelid lesions include:

    a. basal cell carcinoma affects the upper lid more commonly than
        the lower lid

    b. recurrent follicular conjunctivitis can be the result of molluscum
        contagiosum

    c. keratoacanthoma can resolve spontaneously without treatment

    d. sebaceous cell carcinoma has a worse prognosis than squamous
        cell carcinoma

    e. basal cell carcinoma is common in patients with xeroderma
        pigmentosa

answer2.    a.F    b.T    c.T    d.T    .eT
Basal cell carcinoma is more common in the lower lid than the upper lid.
Keratoacanthoma can resolve spontaneously but usually leave a scar.
 

3. The following are true about tumours arising from hair follicles:

    a. trichoepithelioma is commoner in women than men

    b. women with multiple trichilemmomas have an increased risk of
        breast cancer

    c. calcification is a feature of pilomatrixoma

    d. pilomatrixoma is commoner in children than adult

    e. malignant transformation is common in pilomatrixoma

answer3.    a.T    b.T    c.T    d.T    e.F
Tumours of hair follicles origin include trichoepithelioma, trichilemmomas and pilomatrixoma.
Cowden's disease consists of multiple trichilemmomas and breast cancer.
Malignant transformation is rare in pilomatrixoma.
 

4. In blepharochalasis:

    a. most affected patients are in their 40s

    b. there are recurrent lid oedema

    c. there are levator disinsertion

    d. the condition is associated with Ascher's syndrome

    e. systemic steroid is useful

answer4.    a.F    b.T    c.F    d.T    e.F
Blepharochalasis begins in the teenage years and consists of recurrent, mild and transient attack of lid oedema.
Over time, the skin becomes lax and atrophy causing redundancy of skin.
Treatment is blepharoplasty for functional or cosmetic reasons.
 

5. The nasolacrimal canal is made up of the following bones:

    a. maxillary

    b. lacrimal

    c. inferior turbinate

    d. palatine

    e. frontal

answer5.    a.T    b.T    c.T    d.F    e.F
 

6. The Müller's muscle:

    a. is innervated by the parasympathetic nerve

    b. has the peripheral arcade of the upper lid running
        on its anterior surface

    c. is about 5 mm long

    d. arises from the superior rectus

    e. elevates the upper lid by about 2 mm

answer6.    a.F    b.T    c.F    d.F     e.T
It is innervated by the sympathetic nerve. It is about 12 to 15 mm long.
It arises from the undersurface of the levator muscles.
 

7. The following are true about the treatment of basal cell carcinoma:

    a. Mohs' micrographic excision should be performed in all cases of
        lower lid basal cell carcinoma

    b. Mohs' micrographic excision is useful for the diagnosis of basal
        cell carcinoma

    c. Mohs' micrographic excision allows three dimensional examination
        of tumour margins

    d. aggressive tissue removal is avoided in Mohs' micrographic
        excision

    e. before Mohs' tissue excision the skin is spread with zinc sulphate
        paste

answer7.    a.F    b.F    c.T    d.F    e.F
In Mho's tissue excision, the tissue is examined 3-dimensionally for tumour. Usually, the excision is performed by the dermatologist or pathologist so that concern about reconstruction does not prevent aggressive tumour removal.
Mohs' excision helps to preserve tissue and is therefore useful in large tumour or tumour. It also helps to ensure the highest cure rate especially in tumours that involves the medial canthus with an increased risk of orbital invasion.
Zinc sulphate paste is not longer use as it is toxic to the globe.
 

8. The following are true:

    a. in epicanthus tarsalis, the medial canthal skin fold arises from the
        lower lid

    b. epicanthus inversus is a cause of in-growing eye lashes

    c. euryblepharon is a feature of Treacher-Collin's syndrome

    d. in distichiasis, there is an extra row of eyelashes in the orifices of
        the meibomian gland

    e. ankyloblepharon refers to the fusion of the upper and lower eyelids

answer8.    a.F    b.F    c.T    d.T    e.T
In epicanthus tarsalis the epicanthal fold arises from the upper lid where as in epicanthus inversus, the fold arises from the lower lid. In epicanthus paloebralis, the fold arises from both the upper and lower lids.
Epiblepharon consists of a horizontal fold of skin and pretarsal muscle which can overrides the lower lid margin causing in-growing eye lashes.
 

9. Blepharophimosis:

    a. is an autosomal dominant condition

    b. epicanthus inversus is a feature

    c. has nasal bridge hypoplasia

    d. has hypertelorism

    e. is associated with mental retardation

answer9.    a.T    b.T    c.T    d.T    e.F
 

10. In congenital obstruction of the nasolacrimal duct:

    a. the success rate of probing at 12 months of age is about 60%

    b. 85% of the cases are bilateral

    c. the blockage is found most commonly at the common canaliculus

    d. in congenital dacryocystocele, the skin is usually inflamed and hot

    e. in congenital dacryocystocele, the sac contains amniotic fluid

answer10.    a.F    b.F    c.F    d.F    e.T
The success rate is 90% or higher.
About 1/3 is bilateral.
Blockage is mainly at the valve of Hasner
Inflammation is uncommon in congenital dacryocystocele.
 

11. Upper lid retraction may be seen in:

    a. Grave's eye disease

    b. an eye with contralateral ptosis

    c. hepatic failure

    d. hydrocephalus in children

    e. Parinaud's syndrome

answer11.    a.T    b.T    c.T    d.T    e.T
Upper lid retraction in Parinaud's syndrome is termed Collier's sign.
 

12. During dacryorhinostomy, the following are usually removed:

    a. maxillary bone

    b. frontal bone

    c. lacrimal bone

    d. lacrimal fossa

    e. ethmoid bone

answer12.    a.T    b.F    c.T    d.T    e.F
The lacrimal bone and part of the maxillary bone are usually removed

13. The following are true about chronic canaliculitis caused by
      Actinomyces:

    a. it is the most common cause of chronic canaliculitis

    b. this infection is caused by a fungus

    c. bloody tear is a feature

    d. syringing is usually normal despite epiphora

    e. dacryorhinostomy is the treatment of choice

answer13.    a.T    b.F    c.T    d.T    e.F
It is a gram-positive organisms.
Debridement is used to treat these patients but some patients may also respond to irrigation with penicillin or cephalosporins.

 

14. Features of eyelid keratoacanthoma include:

    a. malignant transformation in 50% of cases

    b. loss of eyelashes

    c. rapid growth

    d. ulcerated surface filled with keratin

    e. spontaneous resolution

answer14.    a.F    b.T    c.T    d.T    e.T
Malignant transformation is rare.
 

15. Features of Goldenharg's syndrome:

    a.  eyelid coloboma

    b. Duane's syndrome

    c. optic nerve hypoplasia

    d. ptosis

    e. lipodermoid

answer15.    a.T    b.T    c.T    d.F    e.F
 

16. Hypertelorism is seen in:

    a. Curzon's syndrome

    b. frontal encephalocele

    c. blepharophimosis

    d. capillary haemangioma

    e. Turner's syndrome

answer16.    a.T    b.T    c.F    d.F    e.T
Hypertelorism refers to an increased distance between bony orbits whereas telecanthus refers to an increased distance between the medial canthi.

 

17. The following are contributory  factors in senile (involution)
       entropion:

    a. atrophy of the orbital fat

    b. migration of the preseptal orbicularis over the pretarsal muscle

    c. dehiscence of the lower lid retractor

    d. horizontal lower lid laxity

    e. fat herniation through the orbital septum

answer17.    a.T    b.T    c.T    d.T    e.F
 

18. The following are true about Jones dye test in epiphora:

    a. it is used to diagnose complete obstruction of the lacrimal drainage
        system

    b. if the Jones 1 (primary) test is normal, the cause may be due to
        hypersecretion of tear

    c. if the Jones 1 (primary) test is negative, the obstruction is in the
        common canaliculus

    d. if the Jones II (secondary) test is negative, the abnormality may be
        due to pump failure

    e. if the Jones II (secondary) test is positive, there is a partial
       nasolacrimal duct obstruction

answer18.    a.F    b.T    c.F    d.T    e.T
Jones dye test is only useful in patients with suspected partial obstruction of the lacrimal system.
In Jones 1 (primary) test, a positive test suggests the epiphora may be caused by tear hypersecretion whereas a negative test suggests either pump failure of a partial obstruction where the site is unknown.

 

19. True statements about cavernous haemangioma include:

    a. it is commoner is female than male

    b. spontaneous resolution is common

    c. it is well-encapsulated

    d. retina striae is a recognized sign

    e. the proptosis increases with Valsalva's manoeuvre

answer19.    a.T    b.F    c.F    d.T    e.F
Cavernous haemangioma is the most common benign tumour in adult, commoner in females than males. The lesion rarely resolved spontaneously and surgical excision is the treatment of choice in symptomatic cases.
 

20. In a patient with laceration to the upper lid:

    a. the presence of fat herniation indicates the orbital septum is
        penetrated

    b. the presence of lacrimal gland indicates the orbital septum is
        penetrated

    c. the orbital septum should be resutured if penetrated

    d. in the presence of ptosis, exploration should be delayed for at least
        72 hours to avoid retrobulbar haemorrhage

    e. ptosis is usually caused by damage to the oculomotor nerve

answer20.    a.T    b.T    c.F    d.F    e.F
The fat and orbital part of the lacrimal gland are situated just behind the orbital septum and therefore their presence indicate penetration of the orbital septum.
Suturing of the orbital septum can lid retraction due to contraction of the scar tissue.
Ptosis is usually caused by damage to the levator aponeurosis. Early repair is recommended as delay may make repair difficult due to scar formation.