TRY OUT 16 September 2020

SOAL PUPIL

1. Anisocoria that is greater in the light than in the dark that does not respond to
pilocarpine 1% is most likely due to what condition?
a. Physiologic anisocoria
b. pharmacologic pupillary dilation
c. Adiepupil _
d. CN III palsy

2. A 20-year-old nurse in an ophthalmology clinic complains of right-sided brow ache.

Examination of both eyes is normal except for the presence of a 1.5 mm, nonreactive
right pupil. The pupil does not dilate in darkness. The left pupil is 4 mm and briskly
reactive. She has no ptosis and normal ocular motility. The anterior chamber has no cell
and flare. What is the most likely etiology?
a. Exposure to a cholinergic (pilocarpine-like) substance in the right eye
b. Exposure to an anticholinergic (atropine-like) substance in the right eye
c. Horner's syndrome in the right eye
d. Uveitis

3. A 27 year old man with monthly migraine headache has a dilated pupil and blurred
vision. He denies diplopia. His last headache was 2 weeks ago and resolved after 1 day.
Visual acuity is 20/20 OU, ocular motility is normal, and there is no ptosis. The pupils
measure 5 mm OD, 6,5mm OS, and they constrict to 3mm with light stimulus. Direct and
consensual reactions are the same in each eye. That is the next step in managing this
patient ?
a. Urgent noninvasive angiography (MRI or CT angiography)
b. Hospital admission to a neuro intensive care unit
c. Reassurance and outpatient observation
d. Laboratory screening for organophosphate poisoning

4. A 37 year-old woman describes persistent and worsening headache for 2 days and
diplopia since yesterday. Visual acuity is normal, and the fundus is unremarkable.
Extraocular movement appear grossly normal; cover testing shows the following
exotrophia 5 prism diopters (-), right hypertropia 4- in primary gaze exotrophia 9-, right
hypertrophia 3- on right gaze; exotrophia 1-, right hypertrophia 7- on left gaze; and
exotrophia 6-, left hypertrophia 4- downgaze. Both pupil react to light with a less brisk
response on the left. What systemic risk factors are most relevant to this clinical
presentation?
a. A classic migraine headache since age 16 years?
b. Smoking 1 pack cigarretes daily for 20 years
c. Numbness in both feet
d. Diabetes mellitus
5. A 44 year old female present with gradual onset of diplopia. She has 4 mm of ptosis.
Complete absence of upgaze and adduction and a 50% reduction of abduction. The pupil
is 5 mm and poorly reactive but there is no afferent pupillary defect. Visual acuity is
normal as are the result of external and fundus evaluation. The lesion most likely
localizes to which one of the following areas?
a. cavernosus sinus
b. orbit
c. Brain Stem
d. Chiasma

6. A previously healthy 24 year old woman complains of blurred vision and mild pain
around the right eye for 2 days. Visual acuity is 20/100 OD with a right RAPD.
Funduscopy is a normal. An MRI shows 2 ovoid periventricular white matter lesions.
Which of the following statements is true?
a. Immunotherapy (eg. Interferon beta 1b) Should be considered to decrease the
risk of developing multiple sclerosis
b. she should be treated with intravenous methylprednisolone to ensure visual
recovery
c. Her risk of developing multiple sclerosis in 25% over the next 15 years
d. the most likely cause of transient monocular loss of vision in 24 year old
woman is cerebral arteriovenous malformation

7. Seorang ibu mengeluh mata kanan kabur agak mendadak dan disertai rasa sakit saat
mata bergerak. Didapatkan visus mata kanan 6/24, defek aferen pupil relatif serta
adanya gangguan penglihatan warna. Pemeriksaan dengan funduskopi pada kedua mata
normal. Mata kiri dalam batas normal. Diagnosis yang paling mungkin pada ibu ini
adalah;
a. Neuropati optik iskemik anterior
b. Neuropati optik toksik akut
c. Neuropati optik defisiensi
d. Neuritis retrobulbar
e. Neuroretinitis

8. A 25 year-old alcoholic male present with blurred eye of the right eye after motor
accident 1 week ago. He has visual acuity of hand movement OD and 1.0 OS. The
examination is otherwise normal except for the pupillary finding, there is RAPD OD. On
Ophthalmoscopy examination, it reveals normal on both eyes. The most common
diagnosis in this patient:
A. Posterior Ischemic Optic Neuropathy
B. Traumatic Optic Neuropathy
C. Toxic Optic Neuropathy
E. Optic Disc Atrophy
D. Hereditary Optic Neuropathy

9. A woman 37 year old comes to the hospital with a chief complaint of decreased visual
acuity on the right eye that has occurred gradually for 5 days. This is accompanied with
 eye pain particularly on the eye movement. On examination, the visual acuity of 0.3 OD
and 1.0 OS. RAPD is found in the right eye and the funduscopy revealed normal optic
disc on both eyes. The most common visual field defect that will be revealed in her right
eye is:
A. Bitemporal Hemianopia
B. Altitudinal inferior
C. Homonimousheminanopia
D. Central / cecocentral scotoma
E. Enlargement of blind spot

10. LAKI-LAKI 29 thn, dirujuk oleh refraksionist dengan keluhan anisokoria. Pupil tidak
berespons terhadap cahaya. nampak ireguler, pasien tidak mengalami keluhan. Pada
pemeriksaan membaca dekat kedua mata mengalami miosis, namun kurang dilatasi
dalam gelap. psasien kemudian di rujuk ke dokter mata. Apakah diagnosanya?
a. Adie tonic pupil
b. Horner syndrome
c. Argyl pupil
d. Light near dissociation
e. Hutchinson pupil

11. LAKI-LAKI 29 thn, dirujuk oleh refraksionist dengan keluhan anisokoria. Pupil tidak
berespons terhadap cahaya. nampak ireguler, pasien tidak mengalami keluhan. Pada
pemeriksaan membaca dekat kedua mata mengalami miosis, namun kurang dilatasi
dalam gelap. Lesi pasien tersebut terletak dimana?
a. Rostral nucleus
b. Vestibular nucleus
c. Ganglion siliar
d. Sfingter Iris
e. Nucleus edingerwespal

12. seorang laki-laki dikonsulkan dari refraksionis dengan pupil irregular. saat gelap
anisokoria tidak jelas dengan test melihat dekat pupil berespon baik. Berespon dengan
mydriatil topical. kelainan pada pasien ini terletak pada: dx adie tonic / horner syndrom
a. Midbrain
b. Dorsal midbrain
c. ganglion servikalis (adie tonic pupil)
d. ..

13. Soal diatas, diagnosisnya adalah:

a. Horner syndrome (ptosis, miosis, anhidrosis)
b. Adhie tonik pupil
c. perubahan pupil karena farmakologik
d. Argyll pupil

14. A woman 28 year old came with photophobia. On examination the visual acuity is 20/20
OU. There was no limitation on eye movement of both eyes. Anterior and posterior
segment are within normal limit except for the pupil on the right eye that is dilated,
 poorly reactive and only segmental constricted. This anisocoria looks greater in bright
light. However both pupil constrict at a near stimulus and immediately following
relaxation of near stimulus, the left pupil quickly redilates, but the right redilates more
slowly. The most common diagnosis for the above patient is:
a. Adie’s tonic pupil
b. Horner syndrome
c. Third nerve palsy
d. Pharmacologic pupil
e. Physiologic anisocoria

15. A woman 36 y.o is referred by general practitioner with anisocoria. The patient have no
symptom and report that anisocoria was first noticed by her husband. On examination,
the visual acuity is 20/20 OU. No limitation on the eye movement of both eyes. Anterior
and posterior segments are wnl except for the pupil on the RE that is dilated poorly
reactive and only segmental constricted. This anisocoria looks greater inbright light.
However both pupils constrict to a near stimulus and immediately following relaxation
of near stimulus, the left pupil quickly redilates, but the right redilates more slowly. The
most common diagnosis for the patient above :
A. Adie’s tonic pupil
B. Horner syndrome
C. Pharmacologic pupil
D. Physiologic anisocoria
E. Third nerve palsy

SOAL PAPIL

16. Children with optic nerve hypoplasia should undergo MRI to evaluate for what finding?
a. bifid septum pellucidum
b. empty sella
c. ec topic posterior pituitary bright spot
d. chiasmal glioma

17. What symptom should suggest arteritic anterior ischemic optic neuropathy in a patient
with an acute optic neuropathy?
a. Sudden vision loss
b. pain that accompanies eye movements
c. prior transient monocular visual loss
d. severe color vision deficit

18. Which of the following exogenous agents/drugs is not a typical cause of toxic-nutritional
optic neuropathy?
a. Chloramphenicol
b. Methanol
c. Hydroxychloroquine sulfate (Plaquenil)
 d. Ethambutol

19. A 41 years old woman come to your policlinic with complain of blurred vision since 3
months ago, and become worse since her pregnancy 1 month ago. Her examination
reveals vision of 6/40 OD and 6/12 OS, pupils demonstrate an afferent pupillary defect
of the right eye. Right fundus examination demonstrate peripapillary retinal NFL drop
out and mild disc pallor, and LE no visible abnormalities. Ishihara test show
dyschromatopsia on both eyes. Visual field examination found an appearance as below
→ bitemporal hemianopsia
The most common lesion producing clinical appearance as above is: (hal 162)
a. Frontal trauma with chiasmal contusion
b. CNS mass lesions that produce third ventricle dilation
c. Pituitary adenoma
d. Secondary posterior chiasmal compression
e. Craniopharyngioma

20. A 64 year old woman report awakeing 2 days earlier with blurred vision in the inferior
visual field OD. This morning she noted extension of visual loss to the superior visual
field OS. She has left weak and tired and recently she developed a headache.
Examination reveals visual acuity of hand motion in the affected eye with an afferent
pupillary defect and pale optic disc edema. The following statements are true except:
a. The optic disc usually becomes visibly atrophic 4 – 8 weeks
b. This clinical scenario most likely represent arteritic AION
c. The major goal is to prevent visual loss in the fellow eye
d. Corticosteroid therapy should begin immediately

21. A 3 year old boy with right eye protute and gradual loss of vision since 4 months. No
history of pain, red eye, and trauma. Examination showed optic disc swelling. CT scan
shoed intraconal retrobulbar massfrom nervus opticus, sharp margin, and homogen with
contrast enhancement. Correct statement :
a. Differential diagnosed ith Rhabdomyosarcoma
b. Usually malignant tumors
c. Diagnosed more accurate with MRI examination
d. Necessary to perform a biopsy
e. Require immediate surgical ecciion

22. A 6 years old woman report awakening 3 days earlier with blurred vision in the inferior
visual field OD. This morning she noted extension of visual loss to the superior visual
field OS. She has left weak and tired, and recently she developed a headache.
Examination reveals visual acuity of hand motion in the affected eye, with an afferent
papillary defect and pale optic disc edema. The following statements are true except :
a. the optic disc usually becomes visibly atrophic 4 weeks
b. this clinical scenario most likely represent arteritic AION
c. the major goal is to prevent visual loss in the fellow eye
d. corticosteroid therapy should begin immediately
23. A patient is referred from Neuro-surgery Department with a right parasellar meningioma
that compressing the right optic tract that is shown on CT scan. On examination we
reveal visual acuity of 20/25 OD and 20/20 OS with left optic disc atrophy. We perform
visual field test with Humphrey 30.2. We expect to find:
A. Right mild RAPD with homonymous hemianopia ipsilateral to the lesion
B. Right mild RAPD with homonymous hemianopia contralateral to the lesion
C. Left mild RAPD with homonymous hemianopia contralateral to the lesion
D. Left mild RAPD with homonymous hemianopia ipsilateral to the lesion
E. No RAPD with homonymous hemianopia ipsilateral to the lesion.

24. A woman 29 year old comes to the hospital with a chief complaint of decreased visual
acuity on the right eye that has occurred gradually for 5 days. This is accompanied with
eye pain particularly on the eye movement. On examination, the visual acuity of 20/25
OD and 20/20 OS. RAPD is found in the right eye and the funduscopy is within normal
limit OS and there is edema and hyperemia on optic disc OD. The eye pain on the eye
movement is caused by
a. The meninges of the optic nerve that are supplied by sensory nerve fibers
b. The superior oblique that partially originate from the sheath of the optic nerve
c. The medial rectus partially originate from the sheath of the optic nerve
d. Inflammatory and thrombotic occlusion of the posterior ciliary artery

25. The most common diagnosis in this patient:

A. Non-Arteritic Ischemic Optic Neuropathy
B. Papillitis
C. Idiopathic Intracranial Hypertension
D. Arteritic Anterior Ischemic Optic Neuropathy
E. Papilledema

26. A woman 71 year old comes to the hospital with a chief complaint of sudden visual loss
of the left eye that is accompanied with headache. On examination, visual acuity of
20/20 OD and 20/100 OS. There is no limitation on the eye movement examination.
Anterior segment is within normal limit except for the RAPD that is found on the left eye.
Funduscopy examination reveal optic disc swelling on the left eye, right eye is within
normal limit. Visual field test is performed and there is altitudinal pattern on the left
eye.The most common diagnosis in this patient:
A. Non-Arteritic Ischemic Optic Neuropathy
B. Papillitis
C. Posterior Ischemic Optic Neuropathy
D. Arteritic Anterior Ischemic Optic Neuropathy
E. Neuritis Retrobulbar.
27. The most appropriate therapy for patient above:
a. Methyl prednisolone 1 mg/BW immediately
b. Methyl prednisolone IV 1 gr/day for 1 week
c. Methyl prednisolone IV 1 gr/day for 5-7 days followed by oral up to 100 mg tap off
for 3-12 months
d. Methyl prednisolone IV 1 gr/day for 2-3 days followed by oral up to 100 mg tap off
for 3-12 months
e. Methyl prednisolone IV 1 gr/day for 2-3 days followed by oral up to 100 mg tap off
for 3-6 months

28. A 51 years old man came to polyclinic with sudden blured vision on the right eye. He is
excellent general health with history of smoking. His right fundus showed blurred edge
in his optic nerve, hyperemis,with peripapillary hemorhage. His visual field was arcuata
defect. The left eye was wnl. Wich is the following is least likely to be present in this
patient: dx NAION) hal 128 AAO NO
a. Normal visual acuity
b. Pain on eye movement (optic neuritis)
c. Elevated blood pressure
d. RAPD
e. Normal ESR

29. Seorang perempuan 35 tahun datang dengan keluhan buram kedua mata. Pada
pemeriksaan didapatkan AVOD 1/300 dan AVOS 6/6. Ditemukan adanya RAPD pada
mata kanan. pada pemeriksaan funduskopi OD ditemukan papil bulat, batas tegas,
pucat, dan CDR tidak dapat dinilai sedangkan pada mata kiri ditemukan papil blat, batas
kabur, hiperemis dan CDR tidak dapat dinilai. Pada pemeriksaan lapang pandang OS
ditemukan pelebaran bintik buta. Pemeriksaan yang paling sesuai pada psien ini
untukmenentukan diagnosis adalah:
a. pemeriksaan lumbal pungsi untuk mencari tanda infeksi
b. pemeriksaan MRI kepala dan sumsum tulang untuk mencari demyelinasi
c. pemeriksaan kekentalan darah untuk mencari ada tidaknya hiperkoagulasi
d. pemeriksaan CT Scan kepala dengan kontras untuk mencari adanya space
occupying lesion

30. A 25 y.o girl was referred from neurologist with a chief complaint of gradually visual loss
of both eyes that has been accompanied by severe headache for the last 3 weeks. On
examination, visual acuity of both eyes are 0,1. There is no limitation on the eye
movement examination. Anterior segment is wiyhin normal limit. Funduscopy
examination reveal optic disc swelling of both eyes. Visual field test reveal enlargement
of blind spot of both eyes. The patient is overweight with no history of ischemic systemic
disease such as DM, HT, dyslipidemia.MRI and MRA is wnl, however there is an increase
opening pressure in lumbar puncture procedure that was performed with no other CSF
abnormality. The most common diagnosis in this patient :
A. NAION
B. Papiliitis
C. AAION
D. Idiopathic Intracranial Hypertension
 E. Papilledema

31. 35 year old female presented with blurred vision on both eyes and headache (+), vomit
(+). No RAPD was found and optic disc showed a massive edema. What kind of visual
defect would the examiner found in this patient?
a. Bitemporal hemianophia
b. Pie in the sky
c. Pie on the floor
d. Enlargement of blind spot
e. Altitudinal

32. A 51 year old man came to policlinic with chief complain sudden blurred vision of the
right eye. He is excellent general health with history of smoking. His right fundus showed
blurred edge in his optic nerve, hyperemis with peripapillary haemorrhage. His visual
field was arcuata. The left eye was within normal limit.
The most common diagnosis in this patient :
a. Nonarteritic Ischemic Optic Neuropathy
b. Papilitis
c. Arteritic Anterior Ischemic Optic Neuropathy
d. Idiopathic Intracranial Hypertension
e. Papilledema

33. A woman 71 year old comes to the hospital with a chief complaint of sudden visual loss
of the left eye that is accompanied with headache and tenderness of temporal. On
examination, VA OD 20/20 and OS 20/100. There is no limitation on the eye movement
examination. Anterior segment is within normal limit except for the RAPD that is found
on the left eye. Funduscopy examination reveal optic disc swelling on the left eye, right
eye is within normal limit. Visual field test is performed and there is altitudinal pattern
on the left eye.. The most common diagnosis in this patient :
a. Nonarteritic Ischemic Optic Neuropathy
b. Papillitis
c. Posterior Ischemic Optic Neuropathy
d. Arteritic Anterior Ischemic Optic Neuropathy
e. Neuritis Retrobulbar

34. A patient is referred from neurology department with a stroke that affect the left optic
tract that is shown on CT scan. On examination we reveal visual acuity of 20/25 OD and
20/20 OS with right optic disc atrophy. We perform visual field test with Humphrey 30.2.
We expect to find :
a. Left mild RAPD with homonymous hemianopia left to the lesion
b. Left mild RAPD with homonymous hemianopia right to the lesion
c. Right mild RAPD with homonymous hemianopia right to the lesion
d. Right mild RAPD with homonymous hemianopia left to the lesion
e. No RAPD with homonymous hemianopia left to the lesion

35. 56 year old man, while on therapy for TB, complained of decreased vision on both eyes,
visual acuity were 20/100 and 20/200 on right and left eye respectevely. On funduscopy
 showed mild swelling of the optic nerve and axudate radiated around macula. The
diagnosis of this patient is :
a. Optic neuritis
b. Neuroretinitis
c. Toxic optic neuropathy
d. Age related macular degeneration

36. In a motor vehicle accident, a 23 year old man struck in the right frontal area of his head
and lost consciousness for 2 hours. On awakening he noted that his vision was reduced
in the right eye. From examination was found RAPD on the right eye and normal
appearing of the optic disc. Diagnosis of this patient:
a. Toxic optic neuropathy
b. Compressive optic neuropathy
c. Traumatic optic neuropathy
d. Contussio cerebri
e. Subdural hemorrhage

37. Soal diatas… The pathogenesis of this condition is injury of the optic nerve within the
a. Orbit
b. Canal
c. Chiasma
d. Tract
e. Brain

38. Laki-laki, 20 th, penglihatan mata kanan buram tiba-tiba tanpa rasa sakit. Pemeriksaan:
RAPD (+) gr.II, scotoma cecocentral (+). Funduskopi: diskus optikus hiperemis, terangkat,
penebalan retina peripapil, telangiectasia, dan tortuosity pembuluh darah retina. FFA:
tidak ditemukan tanda kebocoran/ staining dikus optikus. Diagnosis kasus ini adalah ….
a. Non arteritic anterior ischemic optic neuropathy
b. Papilitis
c. Infiltrative optic neuropathy
d. Horner syndrome
e. Leber hereditary optic neuropathy

Soal NO GENERAL
39. Damage to what anatomical pathway causes Balint syndrome?
a. Medial longitudinal fasciculus
b. ventral occipitotemporal
c. dorsaloccipitoparietal
d. optic tract

40. Which of the following clinical signs is expected in patients with bilateral fourth cranial
nerve (CN IV) palsies?
a. intorsion of the hypertropic eye
b. chin up position
c. V-pattern esotropia
 d. hypertropia that worsens on upgaze

41. A 48-year-old woman suddenly develops painful vision loss in her right eye. Two weeks
later, she develops similar symptoms in her left eye. Her examination shows visual acuity
when counting fingers with the right eye and hand motion with the left eye, no rela- tive
afferent pupillary defect but sluggish pupils, normal dilated examination in the right eye
and mild ONH edema in the left eye. MRI shows bilateral enhancement of the optic
nerves. After treatment with IV methylprednisolone, she experiences only minimal
vision recovery. What underlying condition is the most likely cause of her bilateral vision
loss?
a. MS
b. neuromyelitis optica
c. giantcellarteritis
d. adverse effect of fingolimod treatment

42. Tubulointerstitial nephritis is associated with what ocular condition?

a. bilateral anterior uveitis
b. cataract formation
c. serous retinal detachment
d. papilledema

43. Leber congenital amaurosis can be best diagnosed with what test?
a. A- scan ultrasonography
b. electroretinography
c. fluorescein angiography
d. optical coherence tomography

44. Which of the following statements does not fully describe chiasmal lesions?
a. Patients with an empty sella syndrome without a mass or active
pseudotumor cerebri may develop chiasmal field defects.
b. Meningiomas that affect the chiasm are more often seen in males.
c. A patient who has had pituitary apoplexy may have normal visual fields.
d. Optic chiasmal and diabetes insipidus are often associated.

45. A 63-year-old right-handed man has an isolated infarct of the entire left parietal lobe.
Which of the following would you least expect to find on examination?
a. Impaired optokinetic nystagmus with the tape going to the left
b. Acalculia
c. Right-left confusion
d. A right homonymous hemianopsia, worse in the superior hemifield than in
the inferior hemifield

46. A 32-year-old woman complains of intermittent diplopia, usually lasting about half an
hour when she first wakes up in the morning, with a few months' duration. She also
notes some irritation and pressure around her eyes. Acuity, color plates, and visual fields
are all normal. Externally, the right upper eyelid is at the upper limbus. The left covers
 the upper 2 mm of the cornea. There is slight injection OU with some chemosis on the
left. Versions are normal, but cover testing demonstrates a small left hypertropia (or
right hypotropia) on up gaze. Corneal sensation is normal. Several months later, the left
eyelid of this patient becomes slightly ptotic, and she develops a 12-PD exotropia at
distance, with a moderate underaction of adduction of the right eye. Horizontal forced
testing is normal. What is the most likely diagnosis?
a. Internuclear ophthalmoplegia
b. Myasthenia gravis
c. Chronic progressive external ophthalmoplegia
d. Worsening dysthyroid ophthalmopathy

47. What condition is associated with an abnormally high number of crossed fibers in the
optic chiasm?
a. ocular albinism
b. optic nerve hypoplasia
c. achromatopsia
d. morning glory disc anomaly

48. A 75-year-old woman with long-standing hypertension reports 3 days of horizontal

diplopia worse when looking to the right. It is constant at distance and brothers her
most when driving. It is not present when reading. Examination shows a deficit of
abduction of the right eye. What is the next step in managing this patient?
a. Obtain a basic metabolic panel, complete blood count with differential, eryhrocyte
sedimentation rate and C – reactive protein determination
b. Send her to the local emergency department for urgent cranial imaging
c. Prescribe base-out prism to correct the diplopia
d. Advise observation and re-examination in 3 months

49. A 61 year old man present with a 1 week history of redness and pain of the right eye. He
had a chronic sinus problem. On examination, his visual acuity is 20/20. His right upper
eyelid is swollen. The right conjunctiva is injected with dilated episcleral vessel inferiorly.
The underlying sclera appears inflamed. His ocular motility is limited, and there is 2 mm
proptosis in the right eye. A CT scan shows a diffuse infiltrate in the right inferior orbit.
There is also thickening of the left nasal mucosal. Which of the following test would be
most beneficial in diagnosing this patients condition?
a. serum rheumatoid factor
b. conjunctival culture for bacterial and viral pathogen
c. serum eryhtrocyte sedimentation rate (ESR) and C-reactive protein
d. serum antineutrophyl cytoplasmic antibodies (ANCAs)

50. A 68 year old patient presents with transient visual loss and double vision. The patient
works in telemarketing and has noted recent tongue discomfort after 1 hour on the job.
Which of the following results supports your suspected diagnosis?
a. Erythrocyte sedimentation rate = 10mm/hr, C-Reactive protein = 10 (normal < 1)
b. Negative result on temporal artery biopsy
 c. Normal platelet count
d. Family history of autoimmune disease

51. A patient with bilateral anterior and intermediate uveitis is suspected of having
sarcoidosis. There are no conjunctival or eyelid granulomata. Chest x-ray shows no
abnormalities and serum angiotensin-converting enzyme (ACE) level is normal. Which of
the following is the most appropriate examination for confirming the diagnosis of
sarcoidosis?
a. biopsy of the conjunctiva
b. evaluation of HLA-B27 status
c. repeat serum ACE test to rule out laboratory error
d. high-resolution computed tomographic scan of the chest

52. A 67 year old women developed variable double vision 1 month ago and appears to have
fatigable ptosis. She has no systemic symptoms. Which of the following statement is
true?
a. a improvement of 2 mm in ptosis following a 2- minute ice application to the
eyelid confirms the diagnosis of myasthenia
b. a normal anti-acethylcholine receptor antibody level effectively rules out
myasthenia gravis
c. Her risk of developing generalized myasthenia is about 20%
d. The 30% occurrence of concomitant thyroid eye disease may complicate the
diagnosis of myasthenia

53. A patient with bilateral anterior and intermediate uveitis is suspected having sarcoidosis.
There are no conjungtival eyelid granulomata. Chest x-rays shows no abnormalities and
serum angiotensin converting enzym (ACE) level is normal. Which of the following is the
most appropriate examination for confirming the diagnosis of sarcoidosis?
a. Biopsy of conjungtiva
b. Evaluation of HLA-B27 status
c. Repeat serum ACE test to rule out laboratory error
d. High resolution computed tomographic scan of the chest

54. What is the triad of reactive arthritis syndrome ?

a. Urethritis, polyarthritis and conjunctival inflammation
b. Ulcerative colitis, polyarthritis, and conjunctival inflammation
c. Genital ulcers, polyarthritis, and vasculitis
d. Palmar rashes, pauciarticular arthritis, and fever

55. Seorang perempuan 30 tahun datang dengan keluhan penglihatan kabur dan dobel sejak
3 tahun yang lalu. Juga didapatkan keluhan kelemahan pada ekstremitas. Pada MRI
menunjukkan “black holes” . diagnosis paling tepat pada pasien ini:
a. Multiple sclerosis
b. Pseudotumor
c. Myastenia gravis
d. Neuritis optic
56. A – 25 year old girl was referred from neurologist with a chief complaint of gradually
visual loss of both eye that has been accompanied by severe headache for the last 3
weeks. On examination, visual acuity of both eyes are 0.1. There is no limitationon the
eye movement examination. Anterior segment is within normal limit. Funduscopy
examination reveal optic disc swelling of both eyes. The patient is overweight with no
history of ischemic systemic disease such as DM, HT, dislypidemia MRI and MRA is
within normal limit, how ever there is an increase opening pressurein lumbar puncture
procedure that was performed with no other CSF abnormality. The most common
diagnosis in this patient is :

a. NAION
b. Papilitis
c. AAION
d. Idiopathic intracranial hypertension
e. Papiledema

57. A 24 years old smoker present with painless, semiacute, progressive visual loss in his
right eye. Both eyes are normal on funduscopy and MRI results are normal. 3 months
later the affected eye has not improve and vision in the patient left eye has deteriorated.
Repeated MRI and LP negative result. The complete blood count and assay for
antinuclear antibody, fluorescein, treponemal antibody absorption, angiotension
converting enzyme, lyme titer, vitamin B12 and asam folat are normal. What is the most
likely diagnosis?
e. Leber hereditary optic neuropathy
f. Multiple sclerosis
g. Tobacco alcohol optic neuropathy
h. Posterior ischemic optic neuropathy

58. A 67 years old woman developed variable double vision 1 month ago and appears to
have fatigable ptosis. She has no systemic symptoms. Which of the following statement
is true?
a. a improvement of 2 mm in ptosis following a 3 minute ice application to the eyelid
confirmes the diagnosis of myasthenia
b. a normal anti-acethylcoline receptor antibody level effectivity rules out myasthenia
gravis
c. her risk of developing generalized myasthenia is about 20 %
d. the 30% occurence of concomittant thyroid eye disease may complicate the
diagnosis of myasthenia

59. A 50 year old man comes to the hospital with a chief complain of double vision that is
disappeared when he closes one of his eyes. He denies any history of trauma. He has a
history of hypertension, diabetes mellitus and dislipidemia. On examination, the visual
acuity of both eyes are 1.0. There is an exotropia with limitation in adduction of left eye.
However it will adduct during accommodative convergence. There is a jerk nystagmus of
abducting fellow eye. The other eye examination is unremarkable. The most common
diagnosis of this patient:
A. Medial rectus palsy
 B. Third nerve palsy
C. InternuclearOphthalmoplegia
D. Horisontal right gaze palsy
E. One and a half syndrome

60. A 55-year-old patient with diabetes presents with double vision. Which of the following
finding will let you order MRI of the brain as the initial diagnostic test?
A. Isolated pupil sparing complete third nerve palsy of 9 months’ duration
B. Isolated sixth nerve palsy of 1 week duration.
C. Right fourth cranial nerve palsy with bilateral ptosis that clearly gets worse as
the day progress, present for 1 week
D. Isolated pupil sparing complete third nerve palsy of 3 days duration
E. Lid retraction OU, restriction of upgaze OU, injection over medial and lateral
recti muscleOU and elevation of intraocular pressure from 16-28 mmHg in both
eyes with upgaze.

61. Altitudinal pattern that is revealed on visual field examination is caused by a lesion at:
A. Pre-chiasm
B. Chiasm
C. Temporal lobe
D. Parietal lobe
E. Occipital lobe
62. Pasien laki-laki, 17 Tahun, datang dengan keluhan mata tidak bisa bergerak ke atas dan
ke bawah. Riwayat kecelakaan lalu lintas 2 minggu yll. Visus kedua mata 6/6.
Pemeriksaan selanjutnya yang dilakukan pada pasien?
a. Force duction test
b. Exofthalmometer hertel
c. WFDT
d. Ishihara

63. A 34-years old woman, complained of intermittent diplopia and eyelid dropping
especially while driving. She had no other relevant medical history before. Her symptom
resolved after resting. Other sign that we might found in this patient is:
a. darlymple sign
b. sunset phenomenon
c. cogan lid twitch
d. lagophthalmos
b. anisocoria

64. Pasien laki-laki tua, nyeri kepala sejak 2 hari. Riwayat hipertensi dan mengeluh lapang
pandang tepi kedua mata hilang. Diagnosa pada pasien ini adalah:
a. Craniopharingioma
b. pituitary adenoma (hal 162 - NO)
 c. pituitary apoplexy
d. …

65. Pasien laki-laki nyeri kepala (+) riwayat hipertensi. Defek lapang pandang hemianopia
bitemporal, diagnosis pasien tersebut :
a. Craniopharyngioma
b. apoplexia
c. adenoma hipofise
d. hipofise posterior

66. pasien wanita 30 tahun mengeluh pandangan ganda, merasa tidak seimbang, merasa
kesemutan di wajah sebelah kiri,…kemungkinan kelainan pada pasien tersebut adalah:
a. tumor di Cerebellopontine angle
b. …

67. A survey was conducted among 15-45 years old in a population to investigate whether
gender is associated with tobacco use. The prevalence of cigarette smoking aws 28% for
males aged 15-45 years old and 4% for females aged 15-45 years. In this study:
a. cigarette smoking is the outcome and gender is the exposure
b. there is no outcome: gender and smoking are both exposures
c. cigarette smoking is the outcome and age 15-45 years is the exposure
d. the results suggest the effect of age on smoking is modified by gender

68. A 41 years old lady complains of slowly progressing visual field defect on both eyes. Her
menstruation stopped 5 years ago, without contraception. She got merried seven years
before without any child. On examination her visual acuity was 6/12 on both eyes and
bitemporal hemianopia was found. What the most likely diagnosis?
a. Supraclinoid meningioma
b. Pituitary macroadenoma
c. Craniopharyngoma
d. Carotid aneurysm
e. Hemangioma

69. Ptosis neurogenik disertai miosis, anhidrosis, dan hipopigmentasi iris merupakan
manifestasi klinis khas dari keadaan…
A. Horner syndrome
B. Congenital oculomotor nerve (CN III) palsy
C. Marcus Gunn jaw winking syndrome
D. Third cranial nerve misdirection
E. Muller muscle syndrome

70. Soal tentang MG…… (lupa). Perbaikan ptosis setelah ice-pack test pada Myasthenia
Gravis diakibatkan oleh…
A. Perbaikan transmisi neuromuscular
B. Peningkatan enzim acetylcholinestrase
C. Penurunan jumlah reseptor acetylcholine
 D. Berkurangnya kerusakan reseptor pada motor end-plate
E. Meningkatnya antibody acetylcholine receptor

71. Seorang wanita 57 tahun datang dengan keluhan proptosis mata kanan sejak 1 tahun
yang lalu disertai sakit kepala. Pada pemeriksaan didapatkan adanya asimetri pada
bagian temporal kepala penderita. Dari pemeriksaan CT Scan didapatkan osifikasi pada
tulang sphenoid kanan penderita. Diagnosis paling tepat dengan keluhan di atas adalah:
a. Grave’s orbitopathy
b. Psedotumor
c. Meningioma
d. Glioma
e. NHML

72. One of common causes of transient binocular visual loss:

a. Demyelinating disease
b. Congenital disc disease
c. Systemic hypotension
d. Migraine
e. Vasospasm

73. .