Ophthalmic Imaging and Investigations (OCT, FFA, B-scan, Perimetry, Biometry, Topography) MCQs

Ophthalmology · 69 free questions with answers & explanations.

1. On spectral-domain OCT of the macula in a patient with central serous chorioretinopathy (CSCR), the earliest detectable finding before clinical symptom onset is:
2. Fluorescein angiography (FFA) shows a 'smokestack' leakage pattern in one eye of a 35-year-old male. This pattern is pathognomonic of:
3. A 60-year-old diabetic patient undergoes automated visual field testing. The pattern of field loss most characteristic of glaucomatous optic neuropathy (as opposed to other optic nerve diseases) is:
4. Optical coherence tomography angiography (OCTA) is preferred over conventional FFA for imaging which of the following conditions?
5. In A-scan biometry for IOL power calculation, which formula is most accurate for an extremely long axial length (>26 mm)?
6. B-scan ultrasonography is MOST useful for clinical evaluation in which of the following scenarios?
7. Goldmann kinetic perimetry differs from static automated perimetry (Humphrey) primarily in that Goldmann perimetry:
8. On spectral-domain OCT of the macula, a patient with chronic central serous chorioretinopathy shows subretinal fluid, retinal pigment epithelium (RPE) detachment, and a highly reflective thickened choroid. The imaging finding that most specifically distinguishes pachychoroid from other maculopathies in this context is:
9. Fluorescein fundus angiography (FFA) in a patient with branch retinal artery occlusion shows a hypofluorescent zone in the early arteriovenous phase and hyperfluorescence in the late phase at the same location. The best explanation is:
10. B-scan ultrasonography of the posterior segment in a patient with a dense cataract shows a dome-shaped hyperechoic lesion attached to the optic nerve head that does not move on kinetic B-scan (no aftermovement). The most likely diagnosis is:
11. During automated static perimetry (Humphrey 24-2 SITA-Standard), a patient with suspected normal tension glaucoma shows a reproducible superior arcuate scotoma respecting the horizontal meridian in the nasal hemi-field. The reliability indices show fixation losses 2/20, false positive rate 2%, false negative rate 8%. The most important feature indicating this is a true glaucomatous defect rather than artefact is:
12. Optical coherence tomography angiography (OCTA) of a patient with neovascular AMD reveals a type 1 (sub-RPE) choroidal neovascular membrane. The vascular slab that best visualises this lesion is:
13. In Goldmann applanation tonometry, the mire half-circles are wider than the standard when the tear film fluorescein concentration is excessively high (over-fluorescein). The correct adjustment to achieve accurate IOP measurement is to:
14. Corneal topography using Placido disc-based keratometry in a patient who wears rigid gas-permeable contact lenses for keratoconus shows a central flat island surrounded by steepening. The most likely interpretation is:
15. On spectral-domain OCT, a patient with dry AMD shows a hyperreflective band immediately above the RPE that is thinner than the RPE itself and does not shadow underlying structures. Which layer does this represent?
16. During fluorescein angiography of a patient with central serous chorioretinopathy (CSCR), the characteristic leakage pattern most often seen is:
17. A 60-year-old diabetic patient undergoes optical coherence tomography angiography (OCTA). The image shows a well-demarcated avascular zone with irregular margins in the superficial capillary plexus. This finding is most consistent with:
18. On Humphrey visual field testing using SITA-Standard 24-2 program, a patient shows a pattern deviation plot with a cluster of 3 adjacent points with p<1% depression in the superior nasal arcuate region, and the glaucoma hemifield test result is 'outside normal limits.' The most appropriate next step is:
19. Which parameter obtained from partial coherence interferometry (IOLMaster) is most critical for accurate IOL power calculation in post-LASIK eyes?
20. Fundus autofluorescence (FAF) imaging uses the intrinsic fluorophore of the RPE. Which molecule is primarily responsible for the autofluorescence signal in a normal eye?
21. On spectral-domain OCT of the macula, a 62-year-old diabetic shows loss of the ellipsoid zone (photoreceptor inner segment–outer segment junction) without any macular oedema. This OCT finding is most indicative of:
22. During fundus fluorescein angiography (FFA), the 'transit time' from arm to retina is normally about 10–15 seconds. In which phase of FFA do arteriovenous shunts (retinal arteriovenous malformations) characteristically appear to fill?
23. A 55-year-old with a suspected choroidal melanoma undergoes B-scan ultrasonography. Which set of features on B-scan is MOST characteristic of malignant choroidal melanoma?
24. In automated perimetry using the Humphrey Field Analyzer, which global index MOST specifically reflects the pattern (non-uniform spatial distribution) of visual field loss, with relative insensitivity to diffuse depression?
25. Using the SRK/T formula for IOL power calculation, which biometric parameter has the GREATEST influence on the calculated IOL power?
26. Corneal topography using Placido disc technology measures which surface of the cornea?
27. On spectral-domain OCT of the macula, the innermost hyperreflective band corresponds to which structure?
28. Fundus fluorescein angiography (FFA) in a patient with central serous chorioretinopathy (CSCR) most characteristically shows which pattern of leakage?
29. A B-scan ultrasound of the eye shows a highly reflective, acoustically dense membrane with after-movement ('on-movement') on dynamic scan. This finding is most consistent with which diagnosis?
30. In Humphrey visual field testing, a 'double arcuate scotoma' connecting to the blind spot on both sides of fixation is MOST characteristic of which condition?
31. The SRK/T formula for IOL power calculation is most accurately described as which type of formula?
32. On Heidelberg retinal tomography (HRT), which parameter best correlates with ganglion cell loss in glaucoma diagnosis?
33. Corneal topography using Placido disc principle measures which property of the cornea DIRECTLY?
34. On optical coherence tomography (OCT) of the macula, a patient with central serous chorioretinopathy (CSCR) shows which characteristic finding in the outer retinal layers?
35. Fundus fluorescein angiography (FFA) in branch retinal vein occlusion (BRVO) involving the superotemporal vein shows all of the following EXCEPT:
36. B-scan ultrasonography is specifically indicated for evaluation of the posterior segment when:
37. In Humphrey automated perimetry using the 24-2 testing pattern, the mean deviation (MD) of -10 dB in a glaucoma patient most accurately reflects:
38. The SRK/T formula for IOL power calculation is most appropriate for which clinical scenario?
39. Optical coherence tomography angiography (OCTA) differs from conventional FFA in that it:
40. On OCT angiography of a patient with wet age-related macular degeneration, a neovascular network is detected in the outer retina/sub-RPE slab. Which OCT-A flow slab is most relevant for detecting type 1 (sub-RPE) choroidal neovascularisation?
41. Fluorescein angiography of a 38-year-old woman shows a 'smokestack' pattern of hyperfluorescence — an early focal hyperfluorescent dot with upward expansion into an umbrella configuration. What is the most likely diagnosis?
42. A B-scan ultrasound shows a dense, mobile, reflective mass behind the lens that moves with eye movement ('shower of floaters' on dynamic scan). The overlying retina is attached. What does this finding most likely represent?
43. Automated perimetry in a patient with normal tension glaucoma reveals a defect that is denser superiorly, respects the horizontal midline, and has a sharp nasal step. Which perimetric pattern is described?
44. Corneal topography shows central corneal steepening with an inferior-superior asymmetry index (I-S value) > 1.4 D and a best-fit sphere of 50 D centrally. Pachymetry shows inferior corneal thinning. Which condition is most likely?
45. On spectral domain OCT, a patient with diabetic macular oedema (DME) is found to have disruption of the ellipsoid zone (EZ) at the fovea in addition to intraretinal fluid. How does EZ disruption affect the prognosis of anti-VEGF treatment for DME?
46. On spectral-domain OCT of the macula, a 62-year-old man shows a hyporeflective sub-retinal fluid pocket with adjacent retinal pigment epithelium irregularity and no choroidal thickening. The MOST likely diagnosis is:
47. Fluorescein angiography of a patient with branch retinal vein occlusion shows a 'blocked' or hypofluorescent area corresponding to the distribution of flame haemorrhages. The mechanism of this hypofluorescence is:
48. A-scan biometry in a 55-year-old man gives an axial length of 26.2 mm and a keratometry of 43.5 D. Using the SRK-II formula with an A-constant of 118.4, the calculated IOL power is closest to:
49. On Humphrey visual field testing, a patient with suspected normal-tension glaucoma shows a dense paracentral scotoma respecting the horizontal meridian in the superior field. Which parameter BEST indicates disease severity in this case?
50. Corneal topography of a 24-year-old contact lens wearer shows inferior steepening with a best-fit sphere irregularity and a scissoring reflex on retinoscopy. The MOST likely diagnosis is:
51. B-scan ultrasonography of a 45-year-old diabetic with dense vitreous haemorrhage shows a highly reflective, mobile membrane attached at the optic disc extending to the periphery. The MOST likely finding is:
52. Indocyanine green angiography (ICGA) is SUPERIOR to fluorescein angiography for imaging which of the following?
53. OCT angiography (OCTA) detects retinal blood flow based on which principle?
54. A 55-year-old diabetic patient undergoes optical coherence tomography (OCT) of the macula. The report describes a hyporeflective space between the neurosensory retina and retinal pigment epithelium (RPE) with an intact ellipsoid zone. Which of the following best characterizes this finding?
55. On fundus fluorescein angiography (FFA), a retinal pigment epithelium (RPE) detachment appears as which of the following?
56. A patient with suspected open globe injury presents to the emergency department. The primary ophthalmic investigation of choice to assess the posterior segment without risking further damage is:
57. Corneal topography using Placido disk technology measures which of the following optical parameters?
58. In automated perimetry (Humphrey visual field test), the 'mean deviation' (MD) reflects:
59. The SRK/T formula for IOL power calculation is considered superior to older SRK-II formula in which clinical scenario?
60. A 58-year-old diabetic patient undergoes spectral-domain OCT of the macula. The image shows disruption of the ellipsoid zone (IS/OS junction) with preservation of the outer nuclear layer. Which visual function correlates BEST with ellipsoid zone integrity on OCT?
61. Optical coherence tomography angiography (OCTA) of a 65-year-old man shows an area of flow signal void at the level of the deep capillary plexus (DCP) with corresponding thinning of the inner nuclear layer. This pattern is MOST characteristic of:
62. On fluorescein angiography, a well-defined area of hyperfluorescence that increases in size AND intensity from early to late frames is called:
63. A 45-year-old woman is referred for Humphrey visual field testing for suspected normal-tension glaucoma. The report shows a MD of −4.2 dB, PSD of 5.8 dB, and a clustered inferior nasal step with GHT result 'outside normal limits.' The reliability indices show fixation losses of 3/18, false positives 8%, and false negatives 2%. What is the MOST appropriate interpretation?
64. During pre-operative biometry for cataract surgery, the SRK/T formula is LEAST accurate for which axial length range?
65. On B-scan ultrasonography, a highly reflective, acoustically dense lesion is noted attached to the optic disc, casting an acoustic shadow. The lesion shows no after-movement. The MOST likely diagnosis is:
66. A patient with AMD is being treated with intravitreal anti-VEGF. OCT shows a significant reduction in central retinal thickness from 450 µm to 280 µm after 3 injections, with resolution of subretinal fluid. However, on optical coherence tomography angiography (OCTA), a persistent flow signal is still detected within the sub-RPE complex. What does this finding indicate?
67. In Humphrey visual field testing, a patient with suspected glaucoma has a mean deviation (MD) of -8 dB and a pattern standard deviation (PSD) of 7 dB. The glaucoma hemifield test (GHT) reports 'outside normal limits.' The RNFL shows diffuse thinning on OCT. How would this field be classified on the Hodapp-Parrish-Anderson (HPA) scale?
68. A patient is scheduled for cataract surgery. The axial length on IOL Master biometry is 28.5 mm. Using the SRK/T formula, which optical constant most critically affects the predicted postoperative refraction in this eye?
69. Fluorescein angiography of a patient with central serous chorioretinopathy (CSCR) shows a classic 'smokestack' pattern of hyperfluorescence. What does this pattern represent pathophysiologically?