- Most common complication of hyper-mature sclerotic cataract is
a) Dislocation of lens
b) Phakomorphic glaucoma
c) Uveitis
d) Neo-vascularization of retina
Answer: Dislocation of lens
Explanation:
Types of hyper-mature cataract:
Hyper-mature shrunken cataract-
When cortex disintegrates and transform into pultaceous mass. The lens become inspissated and shrunken, the anterior capsule becomes thickened.
Anterior chamber is deep in cases of hyper-mature (shrunken) cataract.
Tremulousness of iris in cases of hyper-mature shrunken cataract
Associated degeneration of the zonules may lead to dislocation of lens which can produce iridocyclitis.
Morgagnian Hyper-mature Cataract:
Following maturity, sometimes cortex becomes fluid and nucleus sinks into the bottom.
The liquefied cortex become milky and nucleus is seen as brown mass, visible as semicircular line in pupillary area altering its position with change in position of the head.
- What is the most common eye manifestation of allergy to tubercular bacilli?
a) Koeppe’s nodules
b) Posterior scleritis
c) Phlyctenular conjunctivitis
d) Optic neuritis
Answer: Koeppe’s nodules
Explanation:
Koeppe’s nodules are small nodules seen at the inner margin of the iris in patients with chronic granulomatous anterior uveitis, which occurs in conditions such as tuberculosis and sarcoidosis.
The nodules are composed of epithelioid cells and giant cells surrounded by lymphocytes.
The most common eye manifestation of allergy to tubercular bacilli is Koeppe’s nodule.
Most common etiology phlyctenular conjunctivitis is tuberculosis.
- Horner’s syndrome consists of
a) Miosis and enophthalmos
b) Miosis and exophthalmos
c) Miosis and proptosis
d) Miosis and ptosis
Answer: Miosis and ptosis
Explanation:
Horner syndrome results from an interruption of the sympathetic nerve supply to the eye and is characterized by the classic triad of miosis, partial ptosis, and anhidrosis.
Iris hetero-chromia (hetero-chromia iridis) – The affected iris may remain blue when the other iris changes to brown; this may be present if the lesion is in a child younger than 2 years but is uncommon in older patients.
Iris pigmentation is under sympathetic control during development, which is completed by the age of 2 years
Signs: Miosis, partial ptosis, anhidrosis, enophthalmos, loss of ciliospinal reflex and bloodshot conjunctiva
- Which morphological type of cataract is most visually handicapping?
a) Cortical
b) Nuclear
c) Posterior sub-scapular
d) Zonular
Answer: Posterior sub-scapular
Explanation:
A posterior polar cataract is a round, discoid, opaque mass that is composed of malformed and distorted lens fibers located in the central posterior sub-capsular area of the lens; right in the path of light on its way to the retina.
This location is its most significant feature, in addition to its proximity to and possible adherence with the posterior capsule.
Posterior polar cataract removal is a challenge to the surgeon because of its adherence to or the associated weakness of the posterior capsule.
Posterior polar cataract surgery is associated with an increased incidence of rupture of the posterior capsule.
A posterior sub-capsular cataract often interferes with reading vision, reduces vision in bright light, and causes glare or halos around lights at night and maximum visual impairment as it lies closer to the nodal point of eye.
- Common ocular manifestation in Trisomy 13 is:
a) Capillary hemangioma
b) Bilateral microphthalmos
c) Neurofibroma
d) Dermoid cyst
Answer: Bilateral microphthalmos
Explanation:
The gross and microscopic eye findings in case of the 13-trisomy syndrome- Severe microphthalmia, coloboma of the ciliary body, cataracts, detached retina, and retinal dysplasia
- All of the following conditions are contraindicated or likely to worsen in a case of primary open angle glaucoma, when treated with timolol maleate 0.5% eye drops, except:
a) Hypertension
b) Hypercholesterolemia
c) Depression
d) Bronchial asthma
Answer: Hypertension
Explanation:
Contra-indication of Timolol
Cardiogenic shock
Heart block
Cardiac insufficiency
Obstructive airway disease
Adverse affects:
Alters lipid profile
Worsens peripheral vascular disease
Causes CNS side effects like depression, anxiety, confusion, drowsiness and disorientation
- Which one of the following is not used in glaucoma?
a) Timolol
b) Physostigmine
c) Donepezil
d) Dipivefrin
Answer: Donepezil
Explanation:
Medications used in glaucoma
Beta-adrenergic blockers- Timolol maleate
Adrenergic agonists- Brimonidine
Less-selective sympathomimetics- Dipivefrin, Epinephrine
Carbonic anhydrase inhibitors- Acetazolamide, Dorzolamide
Prostaglandin analogs- Latanoprost, Bimatoprost
Miotic agents (para-sympathomimetics)- Pilocarpine
-
A 35 year old insulin dependent diabetes mellitus (IDDM) patient on insulin for the past 10 years complains of gradually progressive painless loss of vision. Most likely he has:
a) Cataract
b) Vitreous hemorrhage
c) Total rhegmatogenous retinal detachment
d) Tractional retinal detachment not involving the macula
Answer: Cataract
Explanation:
Patients present with chronic, slowly progressive and generally painless visual loss. The reduction in vision is usually bilateral, though frequently asymmetrical, and occurs over weeks to years.
The more common conditions that cause gradual loss of vision can be divided into two groups based on the reversibility of the visual loss.
Cataracts, refractive error, corneal blindness and early diabetic macular edema are generally reversible.
Optic atrophy, glaucoma, retinal degeneration and age-related macular degeneration usually cause permanent loss of vision.
Senile cataract occurs earlier and more frequently in diabetics. -
In human corneal transplantation, the donor tissue is
a) Synthetic polymer
b) Donated human cadaver eyes
c) Donated eyes from live human beings
d) Monkey eyes
Answer: Donated human cadaver eyes
Explanation:
Corneal transplantation, also known as corneal grafting, is a surgical procedure where a damaged or diseased cornea is replaced by donated corneal tissue (the graft) in its entirety (penetrating keratoplasty) or in part (lamellar keratoplasty).
The graft is taken from a recently deceased individual with no known diseases or other factors that may affect the viability of the donated tissue or the health of the recipient.
The cornea should be removed from cadaveric donors within 6 hours after death, sometimes up-to 12 hours after death in cold climate countries.
The most common retro-bulbar orbital mass in adults is-
a) Neurofibroma
b) Meningioma
c) Cavernous hemangioma
d) Schwannoma
Answer: Cavernous hemangioma
Explanation:
Cavernous hemangiomas are the most common intra-orbital tumors found in adults.
These benign, vascular lesions are slow growing and can manifest as a painless, progressively proptotic eye. Most of these tumefactions are exceedingly unilateral.
- Vitamin B12 deficiency is likely to cause
a) Bi-temporal hemi-anopia
b) Bi-nasal hemi-anopia
c) Heteronymous hemi-anopia
d) Centro-cecal scotoma
Ans: d
Explanation:
Vitamin B12 deficiency typically presents with hematologic or neurologic signs.
Well recognized neurologic manifestations include peripheral poly-neuropathy, myelopathy, optic neuropathy, psychiatric disturbances, and dementia.
An unusual but well documented manifestation of cobalamin deficiency is optic neuropathy. This may present as a sub-acutely progressive decrease in visual acuity with a cecocentral scotoma (i.e., a scotoma obscuring central vision and enlarging the blind spot).
Wernicke’s hemi-anopia pupillary response is seen in lesions at
a) Optic tract
b) Optic chiasma
c) Optic radiation
d) Lateral geniculate body
Ans: a
Explanation:
This phenomenon is caused by division of the optic tract that results in a contra-lateral homonymous hemi-anopia.
Though the direct and consensual responses still occur, the pupils fail to react when a narrow pencil of light is shone onto the non-seeing (blind) part of the retina, but they do react if it falls onto the seeing retinal areas.
It is also characterized by ptosis on the same side as the hemi-anopia and anisocoria with the larger pupil also on the same side as the hemi-anopia.
The macular area is often involved and optic atrophy may follow.
Due to fact that the pupillary and visual fibers deviate in the posterior aspect of the optic tract, Wernicke’s Hemi-anopic pupil occurs as a result of a lesion in the optic tract in an area that precedes the splitting of the two types of fibers.
- SAFE strategy has been developed for the control of a
a) Onchocerciasis
b) Trachoma
c) Ocular trauma
d) Refractive error
Ans: b
Explanation:
International efforts to eliminate trachoma as a blinding disease will be based on the WHO-developed strategy – a combination of interventions known by the acronym “SAFE” which stands for surgery for trichiasis (inturned eyelashes), antibiotics, facial cleanliness and environmental improvement.
These interventions will be community-targeted and will seek community involvement through the primary health care approach.
- Arlt’s line is seen in
a) Vernal Kerato-conjunctivitis
b) Pterygium
c) Ocular pemphigoid
d) Trachoma
Ans: d
Explanation:
Arlt’s line: Horizontal, linear scarring of the upper tarsal conjunctiva and classical sign of trachoma infection
- Horner’s syndrome is characterized by all of the following except
a) Miosis
b) Enophthalmos
c) Ptosis
d) Cycloplegia
Ans: d
Explanation:
Horner syndrome (Horner’s syndrome) results from an interruption of the sympathetic nerve supply to the eye and is characterized by the classic triad of miosis (i.e., constricted pupil), partial ptosis, and loss of hemi-facial sweating (i.e., anhidrosis).
Presentation of Horner’s syndrome:
Miosis
Anhidrosis
Partial ptosis
Apparent Enophthalmos
Increased amplitude of accommodation
Iris hetero-chromia (hetero-chromia iridis)
Paradoxical contra-lateral eyelid retraction
Transient decrease in intraocular pressure and changes in tear viscosity
Absence of a horizontal eyelid fold in the ptotic eye, especially in patients with congenital Horner syndrome
Red conjunctivae
- The most common second malignancy in survivors of retinoblastoma is:
a) Thyroid cancer
b) Nasopharyngeal carcinoma
c) Optic glioma
d) Osteosarcoma
Answer: Osteosarcoma
Explanation:
Survivors of the heritable form of retinoblastoma subsequently develop second primary Osteo-sarcomas at substantially greater frequency than either the general population or survivors of non-heritable retinoblastoma.
The same gene (called the RB gene) that is abnormal in many children with a rare type of eye cancer called retinoblastoma may also be associated with Osteo-sarcoma. RB is a tumor suppressor gene that normally controls the growth of cells.
- Transport of ascorbic acid to lens is done by
a) Myoinositol
b) Choline
c) Taurine
d) Na+/K+ ATPase
Answer: Na+/K+ ATPase (?)
Explanation:
Humans cannot synthesize vitamin C, rendering dietary sources an obligate necessity. Regardless of whether or not vitamin C is synthesized de novo, its uptake into tissues must be largely facilitated by active transport through the sodium-dependent vitamin C transporters (SVCT1 and 2) in order to be concentrated against a gradient.
Recently, two specific transporters for vitamin C (SVCT1, SVCT2) have been cloned in the human.
Na+ dependent transport of ascorbic acid in normal lens epithelium is most likely mediated by SVCT2 rather than by SVCT1.
- Persistent primary hyperplastic vitreous (PPHV) is associated with
a) Patau syndrome
b) Edward syndrome
c) Trisomy 14
d) Down syndrome
Answer: Patau syndrome
Explanation:
Persistent hyperplastic primary vitreous (PHPV) is a rare congenital developmental anomaly of the eye that results following failure of the embryological, primary vitreous and hyaloid vasculature to regress.
Persistent primary hyperplastic vitreous (PPHV) is associated with
Trisomy 13 (Patau syndrome)
Norrie disease
Walker-Warburg syndrome
- Increased LDH in aqueous humor suggested a diagnosis of
a) Gyrate atrophy
b) Glaucoma
c) Retinoblastoma
d) Galactosemia
Answer: Retinoblastoma
Explanation:
Lactate dehydrogenase (LDH) is a glycolytic enzyme that uses glucose as an energy source.
It is present in high concentrations within metabolically active cells.
Normally, its concentration in serum and aqueous humor is low and the ratio of aqueous humor to serum LDH is less than 1.0 in patients with ocular disease other than retinoblastoma.
However, aqueous humor for eyes with retinoblastoma exhibits increased LDH activity expressed as an aqueous humor/LDH ratio of greater than 1.0.
- Arden index is related to
a) ERG (Electroretinogram)
b) EOG (Electrooculogram)
c) VER (Visual evoked response)
d) Perimetry
Answer: EOG (Electrooculogram)
Explanation:
Electro-oculography (EOG) is a technique for measuring the corneo-retinal standing potential that exists between the front and the back of the human eye. The resulting signal is called the electro-oculogram.
The EOG consists of two potentials: the standing potential (resting potential, dark phase) which is evoked by moving the eyes in the dark and originates from the retinal pigment epithelium and the light potential (light rise) which is evoked by moving the eyes in a lighted environment and originates from the photoreceptors. Clinically, the ratio between the light and dark potentials (sometimes also called the Arden index or Arden ratio) is assessed.
If that ratio is less than 1.8 it indicates a malfunction of the structures from which the potential originates.
The EOG is also used to monitor eye movements.
- The most common mode of spread of Retinoblastoma is
a) Optic nerve
b) Trans-scleral
c) Lymphatogenous
d) Hematogenous
Answer: Optic nerve
Explanation:
The most common mode of spread of Retinoblastoma is by direct invasion of optic nerve with extension into the central nervous system.
- Herbert’s pits are seen in
a) Trachoma
b) Acute end-ophthalmitis
c) Thyroid ophthalmopathy
d) Iridocyclitis
Answer: Trachoma
Explanation:
Corneal signs of Trachoma:
Superficial keratitis
Herbert follicles
Pannus
Corneal ulcer
Herbert pits
Corneal opacity
- Most common muscle involved in Grave’s ophthalmopathy is
a) Medial rectus
b) Lateral rectus
c) Inferior rectus
d) Superior rectus
Answer: Inferior rectus
Explanation:
Ocular motility defects in Grave’s ophthalmopathy:
Convergence weakness- Mobius’s sign
The most common ocular motility defect is uni-lateral elevator palsy caused by an involvement of the inferior rectus muscle followed by failure of abduction due to involvement of medial rectus muscle.
Exophthalmos is a common and classical sign of disease.
- Haab’s striae is seen in
a) Trachoma
b) Congenital glaucoma
c) Scleritis
d) Cataract
Answer: Congenital glaucoma
Explanation:
Haab’s striae are horizontal breaks in the Descemet’s membrane associated with congenital glaucoma.
This occurs because Descemet’s membrane is less elastic than the corneal stroma.
- Muddy appearance of iris is seen in
a) Glaucoma
b) Iridocyclitis
c) Iris cyst
d) Persistent papillary membrane
Answer: Iridocyclitis
Explanation:
Anterior uveitis or Iridocyclitis:
Iris usually becomes muddy in color during active phase and may show hyper-pigmented and de-pigmented areas in healed stage.
Iris nodules: Koeppe’s nodules and Busacca’s nodules
Irregular pupil shape or festooned pupil
- Normal flora of the eye constitutes
a) E. coli
b) B. proteus
c) C. gonococci
d) Diphtheroids
Answer: Diphtheroids
Explanation:
Normal ocular flora remains:
The most commonly reported bacteria include coagulase-negative Staphylococcus (CNS), Staphylococcus aureus, Streptococcus spp., Corynebacterium spp., and Proprioni-bacterium acnes.
Corynebacterium diphtheriae and the non-diphtherial corynebacteria collectively referred to as diphtheroids.
Commonly-isolated pathogenic organisms include gram negative rods such as Pseudomonas aeruginosa, Haemophilus influenzae and fungal species.
- Transparency of cornea is mainly due to which layer
a) Endothelium
b) Descemet’s membrane
c) Bowman’s membrane
d) None
Answer: Endothelium
Explanation:
The human cornea is comprised mainly of the stroma, which lies between Bowman’s layer anteriorly and Descemet’s membrane posteriorly.
The corneal epithelium forms the most superficial layer of the cornea while the endothelium lies deepest and is in contact with the aqueous humor of the anterior chamber.
The epithelium and endothelium play important roles in maintaining corneal transparency by serving as a mechanical barrier to fluid diffusion and by creating a gradient that allows osmotic transport of water out of the stroma.
- Vossius ring is seen in
a) Epi-scleritis
b) CRAO
c) Blunt trauma
d) Penetrating trauma
Answer: Blunt trauma
Explanation:
Vossius ring is a circular ring of brown pigment seen on the anterior capsule.
It occurs due to striking of the contracted pupillary margin against the crystalline lens.
It is smaller than the size of pupil.
- True about blow out fracture of the orbit is
a) Involve root of orbit
b) Downward gaze difficult
c) Enophthalmos
d) b and c
Answer: d
Explanation:
Blow out fractures of the orbit mainly involve orbital floor and medial wall.
Clinical features:
Peri-orbital edema and blood extra-vasation
Emphysema of eye lids
Paraesthesia and anesthesia
Ipsilateral epistaxis
Proptosis
Enophthalmos and mechanical ptosis
Diplopia
Severe ocular damage rarely
- Most common complication of corneal transplant is
a) Lenti-conus
b) Melting of cornea
c) Neo-vascularization
d) Post transplant astigmatism
Answer: Post transplant astigmatism
Explanation:
Complications of keratoplasty or corneal grafting or corneal transplant:
Early complications:
Flat anterior chamber
Iris prolapse
Infection
Secondary glaucoma
Epithelial defect
Primary graft failure
Late complications:
Recurrence of disease
Astigmatism