Optometry / Ophthalmic Science Licensing Exam preparation SET 2

Q1

The energy of a photon is inversely proportional to its wavelength. What is the energy of a photon with a wavelength of 500 nm? (Use h c = 1240 eV-nm)

A

2.48 eV

B

1.24 eV

C

3.10 eV

D

0.62 eV

Q2

Which of the following is a requirement for Total Internal Reflection to occur?

A

Light must travel from a lower n to a higher n medium

B

Light must travel from a higher n to a lower n medium

C

The angle of incidence must be less than the critical angle

D

The refractive index of both media must be identical

Q3

If an object is placed at the center of curvature (C) of a concave mirror, the image formed will be:

A

Virtual, erect, and same size

B

Real, inverted, and diminished

C

Real, inverted, and same size

D

Real, erect, and magnified

Q4

What is the effect of a base-in prism on the image of an object?

A

Shifts the image nasally

B

Shifts the image temporally

C

Shifts the image superiorly

D

No shift in image position

Q5

A patient presents with blurred distance vision, but near vision is normal. Retinoscopy shows a +2.00 D reflex at a working distance of 0.5 m. What is the most appropriate corrective lens?

A

- 2.00 D concave lens

B

+2.00 D convex lens

C

+2.50 D convex lens

D

- 2.50 D concave lens

Q6

A patient 60 years old complains of difficulty reading small print at 30 cm. Which of the following is the most appropriate initial prescription?

A

Single-vision distance lenses with a +2.00 D reading add

B

Bifocal lenses with a +2.00 D near segment

C

Progressive addition lenses with a +2.50 D add

D

Monovision soft contact lenses

Q7

Which of the following conditions can cause a false low visual acuity reading on a Snellen chart despite normal retinal function?

A

Uncorrected refractive error

B

Optic neuritis

C

Macular degeneration

D

Glaucoma

Q8

The scleral emissa are channels through the sclera that allow for the passage of which structures?

A

Anterior ciliary arteries and nerves

B

Long posterior ciliary arteries and nerves

C

Short posterior ciliary arteries and vortex veins

D

All of the above

Q9

Which layer of the retina provides the major structural support and contains the nuclei of retinal ganglion cells?

A

Internal limiting membrane

B

Nerve fiber layer

C

Ganglion cell layer

D

Inner plexiform layer

Q10

Which of the following statements about the annulus of Zinn is correct?

A

It is the common origin for the four rectus muscles

B

It encloses the optic nerve

C

It forms the posterior limiting membrane of the orbit

D

It lies within the orbital septum

Q11

After leaving the eye, the optic nerve fibers from the nasal retina:

A

Cross at the optic chiasm

B

Remain ipsilateral

C

Enter the optic tract without crossing

D

Terminate in the lateral geniculate nucleus directly

Q12

What happens to the retinoscopic shadow when moving from a myopic eye to a hypermetropic eye during retinoscopy?

A

It remains stationary

B

It changes direction

C

It becomes dimmer

D

It increases in brightness

Q13

The most appropriate action if a patient reports discomfort during ophthalmoscopy due to the ophthalmoscope touching the cornea is to:

A

Increase the light intensity

B

Apply topical anesthetic

C

Use a lower diopter lens

D

Add a tear film substitute

Q14

An A-scan ultrasound shows a high-amplitude spike followed by a smaller secondary reflection. What does the secondary reflection most likely represent?

A

Retinal pigment epithelium

B

Macula

C

Internal limiting membrane

D

Cornea

Q15

Which of the following is the main advantage of using a digital lensmeter over a manual one?

A

It is cheaper to maintain

B

It automatically measures lens power without alignment

C

It requires no calibration

D

It can measure any lens regardless of coating

Q16

A patient with 6/60 distance VA is asked to count fingers at 3 m. This corresponds to which logMAR value?

A

1.30

B

1.50

C

1.70

D

2.00

Q17

The "working distance" in retinoscopy is defined as the distance between:

A

The examiner's eye and the patient's spectacle plane

B

The retinoscope light source and the patient's cornea

C

The examiner's peephole and the patient's spectacle plane

D

The patient's far point and the examiner's peephole

Q18

Which of the following factors does NOT significantly affect Goldmann applanation tonometry?

A

Corneal thickness

B

Corneal curvature

C

Astigmatism

D

Aqueous humor dynamics

Q19

Which of the following prescriptions represents the correct way to write a hyperopic (farsighted) correction with astigmatism?

A

OD: -3.00 -1.00 x 90

B

OD: +3.00 +1.00 x 90

C

OD: +3.00 -1.00 x 90

D

OD: -3.00 +1.00 x 90

Q20

A patient with a +2.50 D add requires a bifocal. The segment height is measured from the:

A

Bottom of the lens

B

Lower edge of the frame

C

Horizontal midline of the lens

D

Lower lid margin

Q21

A 30-year-old patient has a 10 prism diopter base-up vertical deviation in the right eye. Which prism should be placed in the right lens?

A

10 prism diopters base-down

B

10 prism diopters base-up

C

10 prism diopters base-in

D

10 prism diopters base-out

Q22

Which of the following is a common side effect when a patient first uses photochromic lenses?

A

Temporary color distortion

B

Permanent color shift

C

Increased glare

D

Reduced visual acuity in bright light

Q23

When measuring the bridge width for a child's frame, the most accurate method is:

A

Estimating based on facial appearance

B

Using a bridge gauge on the nasal bridge

C

Measuring the distance between the inner canthi

D

Using a standard bridge width for all children

Q24

A patient with a history of dry eye is being fitted with a daily disposable lens. Which lens characteristic is most beneficial for this patient?

A

Low water content

B

High modulus of elasticity

C

High oxygen transmissibility

D

Thick central zone

Q25

Which of the following is the most appropriate next step for a patient with a Schirmer I value of 3 mm/5 min and a normal tear break-up time?

A

Prescribe preservative-free artificial tears with hyaluronic acid

B

Start topical corticosteroids

C

Recommend switching to rigid gas-permeable lenses

D

Initiate punctal plugs

Q26

A patient using monthly replacement soft lenses develops a central corneal opacity after a minor abrasion. Which complication is most likely?

A

Subepithelial infiltrates

B

Corneal ulceration

C

Stromal scar formation

D

Anterior chamber reaction

Q27

A patient complains of distance blur and intermittent eye strain. Uncorrected visual acuity is 6/9 in both eyes. The most appropriate first-line correction is

A

Single-vision distance lenses

B

Progressive addition lenses

C

Bifocal lenses

D

Contact lenses with toric design

Q28

Which type of cataract is typically associated with Hypocalcemia?

A

Cortical cataract

B

Nuclear cataract

C

Punctate/Small white opacities in the cortex

D

Posterior subcapsular cataract

Q29

Which type of conjunctivitis is characterized by the presence of 'cobblestone' papillae on the superior tarsal conjunctiva?

A

Vernal Keratoconjunctivitis (VKC)

B

Atopic Keratoconjunctivitis

C

Giant Papillary Conjunctivitis

D

Trachoma

Q30

A patient with long-standing hypertension presents with bilateral visual field defects and optic atrophy. Fundus shows arteriolar narrowing and optic disc pallor. Which condition is most likely?

A

Chronic hypertensive optic neuropathy

B

Non-arteritic anterior ischemic optic neuropathy

C

Optic neuritis

D

Glaucoma

Q31

A child presents with a head tilt to the right, right eye shows limited elevation, and left eye appears higher. Which cranial nerve palsy is most consistent with these findings?

A

Left fourth nerve palsy

B

Right fourth nerve palsy

C

Right third nerve palsy

D

Left sixth nerve palsy

Q32

Which of the following best defines sensory fusion?

A

The motor coordination of the extraocular muscles

B

The brain's ability to merge two slightly different images into one

C

The eye's ability to focus light onto the retina

D

The alignment of the visual axes

Q33

A patient cannot look up when the eye is fully adducted. Which muscle is most likely weak?

A

Inferior oblique

B

Superior rectus

C

Inferior rectus

D

Superior oblique

Q34

A child with amblyopia is successfully treated to 20/20 vision. However, they still lack stereopsis. This indicates a failure in:

A

Pleoptics

B

Binocularity

C

Refraction

D

Accommodation

Q35

When selecting a low-vision aid for distance tasks, what is the typical range of magnification for a bi-optic telescope?

A

1× - 2×

B

2× - 4×

C

4× - 6×

D

6× - 10×

Q36

A patient with advanced retinitis pigmentosa shows complete loss of peripheral vision but retains central vision. Which visual field term best describes this finding?

A

Ring scotoma

B

Tunnel vision

C

Altitudinal defect

D

Bitemporal hemianopia

Q37

In the WHO SAFE strategy for trachoma control, the 'F' component stands for:

A

Facial cleanliness

B

Fever management

C

Focal antibiotics

D

Fundus examination

Q38

Which of the following statements about amblyopia detection in school screening is TRUE?

A

Amblyopia can be diagnosed solely by reduced visual acuity without checking for refractive error

B

Amblyopia is only detectable after age 12

C

Early detection and treatment before age 7 yields the best visual outcomes

D

Amblyopia is always associated with strabismus

Q39

Repeated application of topical anesthetic drops can lead to which corneal complication?

A

Keratopathy with epithelial breakdown

B

Increased intraocular pressure

C

Posterior subcapsular cataract

D

Retinal detachment

Q40

Which of the following is the most potent class of medications for lowering IOP as first-line therapy?

A

Beta-blockers

B

Carbonic Anhydrase Inhibitors

C

Prostaglandin Analogues

D

Alpha-agonists

Q41

A patient receiving cataract surgery experiences marked intraoperative bleeding after receiving preoperative topical NSAIDs. Which drug interaction should be suspected?

A

interaction with aspirin

B

interaction with warfarin

C

interaction with prostaglandin analogs

D

interaction with beta-blockers

Q42

A young adult presents with a low-grade (≤8 PD) exophoria and complains of eye strain during computer use. What is the best initial management?

A

Prescribe base-out prisms

B

Vision therapy for vergence training

C

Immediate strabismus surgery

D

Spectacle with base-in prism

Q43

A patient undergoes a retinal examination where a laser beam enters the cornea (n=1.376) from air at an angle of incidence of 20 degrees. What is the angle of the laser beam inside the cornea relative to the normal?

A

20.0 degrees

B

15.8 degrees

C

25.3 degrees

D

14.6 degrees

Q44

A patient develops corneal microcysts after several months of wearing high-DK silicone hydrogel lenses. What is the most appropriate immediate management?

A

Switch to daily disposable lenses

B

Prescribe topical steroids

C

Increase lens wearing schedule to continuous wear

D

Perform corneal scraping

Q45

Which of the following findings is most characteristic of active trachoma?

A

Pseudomembrane on the tarsal conjunctiva

B

Follicles on the upper tarsal conjunctiva with subsequent scarring

C

Ring corneal infiltrate

D

Ciliary flush with hypopyon

Q46

A +15.00 D spectacle lens is placed at a vertex distance of 14 mm. To maintain the same effective power at the cornea, what happens to the lens power if the vertex distance is increased to 18 mm?

A

The lens power must be increased

B

The lens power must be decreased

C

The lens power remains the same

D

The lens must be converted to a minus lens

Q47

During subjective refraction, the examiner notices that the patient consistently chooses the lens with more minus power when asked "Which is clearer?" but visual acuity does not improve beyond 6/9. What is the most likely explanation?

A

The patient has a latent hyperopia that is being over-corrected

B

The patient is experiencing a phoria that improves with more minus

C

The patient is exhibiting a placebo effect

D

The patient's pupil is abnormally dilated

Q48

A thin cornea most commonly leads to which type of error when measuring IOP with Goldmann applanation tonometry?

A

Under-estimation due to low corneal rigidity

B

Over-estimation due to high corneal rigidity

C

Mis-placement of fluorescein

D

Incorrect mire alignment

Q49

In a trial frame, the interpupillary distance (IPD) is altered by turning which component?

A

Horizontal bar

B

Pupillary distance screws

C

Lens holder

D

Vertical riser

Q50

What is the primary purpose of the 'Referral Chain' established by the National Eye Care Programme in Nepal?

A

To ensure patients only visit tertiary hospitals

B

To streamline the flow of patients from community screening to specialized surgery

C

To eliminate the need for primary health centers

D

To increase the cost of healthcare for urban patients

Q51

A patient reports that objects appear to be "wavy" when looking at a plain wall, especially after prolonged near work. Which symptom does this best describe?

A

Macular distortion due to early AMD

B

Uncorrected astigmatism causing meridional blur

C

Ocular migraine aura

D

Corneal edema

Q52

In a progressive lens, the term "corridor length" refers to:

A

Vertical distance between distance and near optical centers

B

Horizontal distance from the fitting cross to the near zone

C

Length of the wearer's pupillary distance

D

Distance between the two lens blanks

Q53

A patient reports that objects on the left side of his visual field are not seen, yet he can read normally. Visual field testing confirms loss of the left visual field in both eyes. Which lesion location best explains this finding?

A

Right optic tract

B

Left optic tract

C

Right occipital lobe

D

Left optic radiation

Q54

In the context of refractive surgery, which pre-operative corneal thickness threshold generally disqualifies a patient from undergoing LASIK in Nepal?

A

Less than 500 µm

B

Less than 550 µm

C

Less than 600 µm

D

Less than 450 µm

Q55

A 45-year-old patient complains of difficulty seeing objects at a distance. Their prescription is -1.00D sphere and -0.50D cylinder at axis 180°. What is the total refractive power in the 90° meridian?

A

-1.00D

B

-1.50D

C

-0.50D

D

+0.50D

Q56

When dispensing spectacles for a patient with a cycloplegic prescription of +8.00 D sphere, which lens material is most appropriate to keep lens weight low while maintaining optical quality?

A

High-index CR-39

B

Standard Crown glass

C

Polycarbonate

D

Standard plastic (CR-39) with high index coating

Q57

At what age does intermittent exotropia most commonly become evident in children?

A

At birth

B

Around 6 months of age

C

Between 2 and 5 years of age

D

After puberty

Q58

Using Prentice's rule, a - 8.00 D lens is decentered 6 mm temporally. What induced prism (magnitude and base direction) results?

A

4.8 Δ base-in

B

4.8 Δ base-out

C

3.2 Δ base-in

D

3.2 Δ base-out

Q59

A mirror forms a virtual image that is half the size of the object. Which type of mirror and object position best fits this description?

A

Convex mirror, object far away

B

Concave mirror, object between centre of curvature and focal point

C

Plane mirror, object at any distance

D

Concave mirror, object beyond centre of curvature

Q60

What is the principal reason for performing gonioscopy in a patient suspected of glaucoma?

A

To assess central corneal thickness

B

To evaluate the angle status

C

To measure intraocular pressure directly

D

To examine retinal vessels

Q61

A multi-layer anti-reflection coating applied to both surfaces of a spectacle lens typically reduces total reflected light to approximately what percentage of the incident light?

A

5%

B

15%

C

30%

D

50%

Q62

When a spectacle prescription contains both spherical and cylindrical components, which component must be adjusted for vertex distance when converting to a contact lens?

A

Only the spherical component

B

Only the cylindrical component

C

Both spherical and cylindrical components

D

Neither component

Q63

A bright red, sectoral area of the bulbar conjunctiva blanches readily after instillation of a vasoconstrictor eye drop. What is the most likely diagnosis?

A

Episcleritis

B

Subconjunctival hemorrhage

C

Scleritis

D

Conjunctival neoplasm

Q64

Which systemic carbonic anhydrase inhibitor used in acute angle-closure glaucoma can cause a non-anion-gap metabolic acidosis as a systemic adverse effect?

A

acetazolamide

B

methazolamide

C

brinzolamide

D

timolol

Q65

A central corneal thickness of 600 µm is measured in a patient. How will this most likely affect the intraocular pressure reading obtained with Goldmann applanation tonometry?

A

It will overestimate the true intraocular pressure

B

It will underestimate the true intraocular pressure

C

It will have no effect on the measured pressure

D

The effect will depend on the patient's age

Q66

A 45-year-old hyperopic patient can see distant objects clearly but requires a +2.00 D lens for clear near vision at 30 cm. What is the patient's accommodative lag at that distance?

A

0.33 D

B

0.67 D

C

1.00 D

D

1.33 D

Q67

During subjective refraction, the examiner places a +2.00 D lens in front of the patient's eye before starting the test. What is the main purpose of this initial lens?

A

To relax accommodation and uncover latent hyperopia

B

To stimulate accommodation for near work

C

To test the patient's tolerance for high plus power

D

To correct existing myopia before fine-tuning

Q68

Which property of a light source determines the axial (depth) resolution in spectral-domain optical coherence tomography (OCT)?

A

Spectral bandwidth of the source

B

Average power of the source

C

Polarization state of the source

D

Temporal coherence length of a monochromatic source

Q69

A 40-year-old patient with suspected color vision deficiency undergoes visual acuity testing. Which statement regarding the recording of best-corrected visual acuity is correct?

A

Record only the better eye result

B

Record both eyes together

C

Record each eye separately

D

Record as combined amblyopia score

Q70

In primary gaze position, which extraocular muscle is chiefly responsible for upward rotation (elevation) of the eye when the eye is abducted 30 degrees?

A

Superior rectus

B

Inferior oblique

C

Oblique muscles only

D

Superior oblique

Q71

In the prescription OD -3.00 / -2.00 x 180, what is the power in the horizontal meridian (180°)?

A

-3.00 D

B

-5.00 D

C

-1.00 D

D

0.00 D

Q72

During fundus examination, the 'blind spot' corresponds anatomically to which structure?

A

The fovea centralis

B

The optic disc

C

The ora serrata

D

The macula lutea

Q73

An 8-year-old with intermittent exotropia performs 'antisuppression' exercises using red-green filters and a tranaglyph/cheiroscope before fusion training. What is the primary purpose of this step?

A

To eliminate suppression of the deviating eye and establish simultaneous binocular input

B

To improve distance visual acuity

C

To assess color vision defects

D

To dilate the pupil for retinal examination

Q74

The superior fornix is bounded medially by which of the following?

A

Lacrimal lake

B

Lacrimal gland

C

Medial canthal tendon

D

Superior tarsal plate

Q75

Which of the following is the most common bacterial organism isolated in microbial keratitis associated with extended wear of silicone hydrogel lenses?

A

Staphylococcus epidermidis

B

Pseudomonas aeruginosa

C

Acinetobacter baumannii

D

Candida glabrata

Q76

The 'prism cover test' is specifically designed to measure the magnitude of a deviation by:

A

Measuring the corneal light reflex

B

Using prisms to eliminate the recovery movement

C

Measuring the near point of convergence

D

Testing the AC/A ratio

Q77

A +2.00 D cylindrical lens has its axis at 90°. At what angle does the maximum refractive power act?

A

0°

B

45°

C

90°

D

180°

Q78

What logMAR value corresponds to the visual-acuity cutoff that typically triggers referral in school-screening programs?

A

0.2

B

0.3

C

0.4

D

0.5

Q79

Incorporating a UV-absorbing agent into an AR coating primarily serves to:

A

Increase lens thickness

B

Increase anti-reflection efficiency

C

Reduce UV transmission

D

Enhance scratch resistance

Q80

A patient with proliferative diabetic retinopathy undergoes pan-retinal photocoagulation (PRP). Which of the following complications is most effectively prevented by the procedure?

A

Neovascular glaucoma

B

Diabetic macular edema

C

Vitreous hemorrhage

D

Retinal detachment

Q81

A keratometer uses an assumed refractive index of 1.3375 for the cornea. What does this index represent?

A

The true refractive index of the corneal stroma.

B

A fictitious index that combines the corneal refractive index and the posterior corneal surface power.

C

The refractive index of the tear film covering the cornea.

D

The average refractive index of the entire ocular media.

Q82

During the treatment of amblyopia, which age group has minimal improvement?

A

Full recovery possible

B

Partial improvement possible

C

Minimal improvement

D

No improvement

Q83

A practitioner wants to convert a patient from monthly-replacement hydrogel lenses to daily-disposable lenses. Which of the following changes in lens prescription is NOT required?

A

Adjustment of base curve to match corneal curvature more precisely

B

Reduction of lens power by 0.25 D to account for reduced lens dehydration

C

Re-evaluation of lens diameter for optimal centration

D

No change; power, base curve, and diameter can remain the same

Q84

A contact lens wearer presents with fine, superficial punctate keratopathy (SPK) located primarily under the lens optic zone. This is most likely a result of:

A

Contact lens-induced dry eye

B

Microbial keratitis

C

Corneal neovascularization

D

Acanthamoeba keratitis

Q85

When performing retinoscopy on a highly hyperopic patient without cycloplegia, the reflex motion observed at the standard 67-cm working distance is most likely:

A

With

B

Against

C

Scissor

D

Blurred

Q86

Which of the following is the most critical factor when determining the 'Reverse Curve' power in an Ortho-K lens fitting?

A

The patient's age

B

The desired amount of central flattening

C

The diameter of the iris

D

The thickness of the sclera

Q87

When a prescription includes an ADD of +1.75 DS, the most likely age group of the patient is:

A

20-30 years

B

35-45 years

C

45-55 years

D

60-70 years

Q88

Under NECP, which low vision device is most frequently supplied to patients unable to benefit from spectacles?

A

Handheld magnifier

B

Binocular telescope

C

Low vision spectacles

D

Contact lenses

Q89

In a LogMAR chart, if a patient reads 3 out of 5 letters on a line, how is the score typically recorded for that specific line?

A

The line is marked as 'passed'

B

The line is marked as 'failed'

C

The score is recorded as 0.6 LogMAR

D

The score is recorded as a fraction of the line

Q90

In thyroid-associated orbitopathy, which extraocular muscle is most commonly involved, causing restrictive myopathy and limited upward gaze?

A

Superior rectus

B

Inferior rectus

C

Superior oblique

D

Inferior oblique

Q91

A child has been prescribed spectacles for myopia control. What is the most appropriate measure to ensure adherence to daily wear schedules?

A

Provide a reward chart tracking daily wear days with stickers for completed hours

B

Explain the scientific evidence linking uncorrected myopia to further progression

C

Offer special privileges tied strictly to meeting nightly and school schedule goals

D

Distribute free colored lenses visible outside the clinic to mark compliance

Q92

Which pharmacologic agent is most commonly used for penalizing the dominant eye in amblyopia therapy in Nepalese clinical practice?

A

Atropine 1% eye drops

B

Timolol 0.5% eye drops

C

Pilocarpine 2% eye drops

D

Fluorescein dye

Q93

Which of the following is a common side effect of an incorrectly centered prism prescription in a first-time wearer?

A

Immediate improvement in visual acuity

B

Spatial distortion or 'swimming' sensation

C

Increased sensitivity to bright light

D

Complete loss of peripheral vision

Q94

Which of the following is the normal range for corneal curvature as measured by keratometry?

A

38–42 D

B

40–44 D

C

42–46 D

D

44–48 D

Q95

A patient with anisometropia (OD +3.00 D, OS –3.00 D) is best served by which lens type to minimize image size disparity?

A

Single-vision spherical lenses

B

Single-vision aspheric lenses

C

Bifocal lenses

D

Progressive lenses

Q96

Optic atrophy is not seen in:

A

Retinitis pigmentosa

B

Methanol poisoning

C

Central retinal artery occlusion (CRAO)

D

Polypoidal choroidal vasculopathy

Q97

A 12‑year‑old patient with slowed vergence dynamics is asked to look alternately at a target that jumps between 40 cm and 6 m every 5 seconds. Which orthoptic exercise is being performed and what is its primary therapeutic goal?

A

Jump vergence – to increase the speed of vergence responses

B

Pencil push‑up – to increase convergence amplitude

C

Brock string – to improve tonic vergence control

D

Base‑out prism bar – to enhance fusional convergence

Q98

Which of the following is the most likely ocular side effect of long-term use of topical corticosteroids?

A

Pupillary constriction

B

Decrease in intraocular pressure

C

Posterior subcapsular cataract

D

Increased corneal sensitivity

Q99

Which part of the orbicularis oculi muscle is primarily responsible for creating the negative pressure that draws tears into the lacrimal sac during blinking?

A

Orbital portion

B

Preseptal (pretarsal) portion

C

Lacrimal (Horner's) portion

D

Palpebral (pretarsal) portion

Q100

A 50-year-old patient presents with a cataract caused by chronic exposure to infrared radiation (e.g., glassblowers). Where is the opacity typically located?

A

Peripheral cortex

B

Posterior capsule

C

Central nucleus

D

Anterior capsule