A 65-year-old woman has noted a slowly enlarging, raised, pearly nodule on her upper eyelid for the past 2 years. On physical examination there is a non-tender 0.5 cm diameter nodule with central ulceration. This lesion is excised and on microscopic examination is composed of fairly uniform dark blue cells with scant cytoplasm. Nodules of these cells extend into the dermis. Which of the following is the most likely risk factor for development of this woman's lesion?
A Use of mascara
B Gene mutation
C Herpes simplex virus infection
D Sunlight exposure
E Glaucoma
F Sjogren syndrome
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A 60-year-old man has noted decreasing vision on the right for the past year. He has no eye pain. Funduscopic examination reveals a darkly pigmented uveal mass. Which of the following is the most likely diagnosis?
A Diabetic retinopathy
B Retinoblastoma
C Melanoma
D Tay-Sachs disease
E Cytomegalovirus retinopathy
A 56-year-old woman has noted increasingly frequent headaches for the past year. She recently had her vision checked, and her intraocular pressure was found to be increased. Which of the following is the most significant result of her condition, if not treated?
A Cataract formation
B Conjunctivitis
C Hypertensive retinopathy
D Optic nerve damage
E Strabismus
F Melanoma
G Proliferative retinopathy
An 18-year-old primigravida gives birth following an uncomplicated pregnancy to a term male infant. On examination the infant has no congenital anomalies noted at birth. Mother and baby go home a day later. The mother brings the baby back to clinic two weeks later because she has noted that his conjunctivae appear reddish, and there is a copious discharge of yellowish material from the eyes. She is advised that, if this is not treated, there is a risk for corneal ulceration, perforation, and scarring leading to blindness. Which of the following maternal historical findings is most likely to be present in this case?
A She had an elevated hemoglobin A1C throughout the pregnancy
B Her diet was deficient in B vitamins
C She is a commercial sex worker
D Her family has a history of blindness
E She has an acute mastitis
A 30-year-old G3 P2 woman gives birth following premature rupture of membranes at 30 weeks gestation to a girl infant. The infant developed hyaline membrane disease at birth and required mechanical ventilation with oxygen therapy for 4 weeks. The child is now 3 years old and is found to be visually impaired. Funduscopic examination reveals retinal detachment on the left. Which of the following is the most likely pathogenesis for this child's condition?
A Retinal damage by oxygen species of free radicals
B Hereditary hexosaminidase A deficiency
C Germinal matrix hemorrhage at birth
D Alobar holoprosencephaly
E Mutation of a tumor suppressor gene on chromosome 13
A 70-year-old woman has noted the appearance of a "spot" discoloring the sclera of her right eye for the past 2 years. Her physician notes a 0.3 cm raised yellowish-white lesion near the limbus. Her visual acuity is not decreased. Her intraocular pressure is normal. Which of the following is the most likely diagnosis?
A Hordeolum
B Pinguecula
C Pterygium
D Basal cell carcinoma
E Herpes simplex virus infection
A 34-year-old woman has noted right eye pain and irritation for the past day. On slit lamp examination with fluorescein dye she is noted to have an irregular dendritic corneal ulcer. She is most likely to have an infection with which of the following organisms?
A Candida albicans
B Pseudomonas aeruginosa
C Hemophilus aegypticus
D Acanthameba
E Cytomegalovirus
F Herpes simplex virus
G Chlamydia trachomatis
A 17-year-old girl has had visual problems for the past 2 years. On physical examination she is 188 cm tall. She has long, thin fingers. Examination of her eyes reveals dislocated lenses. Which of the following is the most likely diagnosis?
A Marfan syndrome
B Osteogenesis imperfecta
C Glaucoma
D Aging
F Vitamin A deficiency
A 4-year-old boy has slowly lost vision in his right eye over the past 6 months. Other children in his family have had a similar problem, with many losing vision in both eyes. On physical examination there is leukocoria, and an intraocular tumor is present. The eye is enucleated. Microscopic examination of the mass shows small blue cells that form rosettes, and there is focal dystrophic calcification. There is invasion into the optic nerve. An abormality involving which of the following genes is most likely to be present?
A APC
B BCL2
C K-RAS
D N-MYC
E RB
F TP53
A 41-year-old woman with a history of intravenous drug abuse presents with a 1 day history of severe headache and high fever. On physical examination her temperature is 39 C. She has marked nuchal rigidity. A serologic assay for Streptococcus pneumoniae antigen is positive. Which of the following funduscopic examination findings is most likely to be present in this woman?
A Deepening of the optic cup with excavation
B Arteriolar narrowing
C Neovascularization of the optic nerve
D An elevation and swelling of the optic nerve
E Flame-shaped hemorrhages
A 50-year-old man has had decreasing visual acuity for the past 4 years. A funduscopic examination reveals a proliferative retinopathy. His BMI is 32. Laboratory studies show a serum glucose of 171 mg/dL and a hemoglobin A1C of 8.8%. Which of the following funduscopic findings is most characteristic for this man's ocular disease?
A Capillary microaneurysms
B Dot and blot hemorrhages
C Neovascularization
D Flame-shaped hemorrhages
E Hard exudates
A 42-year-old man notes a slightly painful and slowly enlarging nodule on his right upper eyelid over the past month. On physical examination the 0.7 cm nodule is firm with no overlying skin ulceration. The conjunctiva and the cornea of the right eye appear normal. Biopsy of this lesion is performed and microscopic examination shows inflammation consisting of lymphocytes admixed with epithelioid cells and giant cells. Which of the following is the most likely diagnosis?
A Pinguecula
B Hordeolum (stye)
D Chalazion
E Actinic keratosis
A 62-year-old woman has noted decreasing vision for the past 2 years. On funduscopic examination there is deepening of the optic cup with excavation. Which of the following abnormal findings is most likely to characterize her disease process?
A Elevated serum glucose
B Hypercholesterolemia
C Homocystinuria
D Increased intraocular pressure
E Elevated blood pressure
A 30-year-old man has noted cloudy vision and eye discomfort for the past 3 days. On physical examination there is corneal clouding. He uses contact lenses. Which of the following complications of contact lens wear has he most likely developed?
A Band keratopathy
B Acanthameba infection
D Staphylococcus aureus infection
E Herpes simplex infection
A 72-year-old man has had a lesion of his lower eyelid slowly enlarging for 3 years. On physical examination there is a 0.4 cm in diameter nodule of the lower medial left eyelid with slightly raised, pearly edges and an ulcerated center. This lesion is excised, and aseries of tissue samples for frozen section are sent to surgical pathology to make sure the lesion is completely excised. Which of the following neoplasms is this man most likely to have?
A Basal cell carcinoma
B Glioma
C Retinoblastoma
D Squamous cell carcinoma
E Malignant melanoma
A 62-year-old man has received no medical care or check-ups for years. He now sees a physician because of decreasing visual acuity for the past year. On physical examination he has a non-healing ulcer on his left foot. His BMI is 31. On funduscopic examination he has a background retinopathy. Laboratory studies show his fasting blood glucose is 154 mg/dL with hemoglobin A1C of 7.6%. Which of the following retinal lesions is most likely to be present in this man?
A Neovascularization of the disc
B Vitreous hemorrhage
C Fibrous proliferation
D Dot and blot hemorrhages
E Papilledema
A 78-year-old man is bothered by slightly decreased vision on the left, worsening over the past 3 years. He has no pain in the eye. On physical examination there is a slightly raised, yellowish-white 0.2 x 0.4 cm lesion that encroaches from the conjunctiva onto the corneal surface of his left eye. The funduscopic examination is unremarkable. Which of the following is the most likely diagnosis?
B Primary acquired melanosis
D Herpes simplex keratitis
E Pinguecula
A 63-year-old man has noted decreased visual acuity for the past 2 years and goes to an optometrist for a new pair of glasses. He reports no eye pain or headaches. The optometrist notes excavation of the optic cup of both eyes on funduscopic examination. His blood pressure is 135/85 mm Hg. His intraocular pressure is increased. His Hgb A1C is 3.8%. Which of the following is the most likely diagnosis?
A Astrocytoma
B Optic neuritis
C Macular degeneration
D Cataracts
A 23-year-old G2 P1 woman gives birth at 34 weeks gestation to a girl infant. During the pregnancy there was decreased fetal movement. Multiple congenital anomalies are noted at birth, including cyclopia with blindness, cleft lip and palate, and post-axial polydactyly of all extremities. The infant dies within an hour of delivery. A karyotype of this infant's cells is most likely to show which of the following karyotypes?
A 45, X
B 46, XX
C 47, XX, +13
D 47, XX, +18
E 47, XX, +21
F 47, XXX
G 69, XXX
A 17-year-old boy has had increasing difficulty with vision for the past 6 years. On physical examination there is corneal opacification, lymphoid follicles on the upper tarsal conjunctiva, vascular pannus, and lid inversion. There is no erythema or swelling. Which of the following infectious agents is most likely to produce these findings?
A Acanthameba
B Candida albicans
C Chlamydia trachomatis
D Hemophilus aegypticus
E Herpes simplex virus
F Rubella virus
G Staphylococcus aureus
A 79-year-old has experienced worsening visual problems for the past 5 years, and it is now difficult for him to read. On physical examination the center of his visual fields is most affected, but his visual fields are not decreased. On funduscopic examination there are discrete thickenings called drusen in the retina, but no exudates, and there is atrophy of the retinal pigment epithelium. His intraocular pressure is normal. Which of the following is the most likely diagnosis?
A Central retinal arterial occlusion
B Cytomegalovirus retinitis
D Proliferative retinopathy
E Sympathetic ophthalmia
An 81-year-old woman has had difficulty seeing with her left eye for the past 3 years. On physical examination she has an opacification of the crystalline lens on the left. The degree of opacification makes funduscopy impossible. The cornea and conjunctiva of the left eye are unremarkable. She has 20/100 visual acuity in the remaining eye, with myopia, and funduscopy on the right is normal. Which of the following is the most likely diagnosis?
A Amblyopia
B Cataract
C Open angle glaucoma
D Pinguecula
E Pterygium
F Trachoma
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