FMGE 2019 - Ophthalmology PYQs Practice Questions

Q: A person with a visual acuity of 6/60 in the right eye and 3/60 in the left eye would be categorized into which type of blindness?

Moderate visual impairment. ***Moderate visual impairment*** - According to the **WHO International Classification of Diseases (ICD-11)**, moderate visual impairment is defined as visual acuity **< 6/18 to ≥ 6/60** in the better eye with best possible correction. - This patient's better eye (right eye) has a visual acuity of **6/60**, which falls at the **upper limit** of the moderate visual impairment category. - This is the standard classification used in Indian medical examinations and follows WHO guidelines. *Legal blindness* - **Legal blindness** is a **US administrative/legal term**, not a WHO classification category. It is defined as visual acuity **< 6/60 (or 20/200)** in the better eye, or visual field < 20 degrees. - Since this patient has exactly **6/60** (not less than 6/60), they do **not** meet the strict criteria for legal blindness. - This term is less commonly used in Indian medical literature, where WHO classifications are standard. *Low vision* - **Low vision** is a broad umbrella term that includes all categories of visual impairment from mild to severe, but it is not a specific classification category. - While this patient does have low vision, the more specific and appropriate classification is moderate visual impairment. *Normal vision* - **Normal vision** is defined as visual acuity of **6/6 to 6/12** in the better eye. - This patient's visual acuity of **6/60** represents significant visual impairment, far below the normal range. [Practice more Ophthalmology PYQs on OnCourse]

Q: Phlyctenular conjunctivitis is primarily associated with hypersensitivity to which of the following?

Staphylococcus. ***Staphylococcus*** - **Phlyctenular conjunctivitis** is characterized by delayed (Type IV) hypersensitivity reactions to bacterial antigens, most commonly from **Staphylococcus aureus**. - This condition often presents with small, nodular lesions (phlyctenules) on the conjunctiva or cornea, which are essentially collections of inflammatory cells responding to bacterial proteins. - **Important note**: **Mycobacterium tuberculosis** is another well-documented cause of phlyctenular conjunctivitis, particularly in TB-endemic regions, and should be considered in the differential diagnosis. - Other triggers include protein antigens from organisms colonizing the ocular surface. *Chlamydia* - While **Chlamydia trachomatis** can cause chronic conjunctivitis (e.g., trachoma, adult inclusion conjunctivitis), it does not typically lead to the distinct nodular lesions seen in phlyctenular conjunctivitis. - Ocular chlamydial infections are primarily characterized by follicular conjunctivitis and pannus formation. *Pneumococcus* - **Streptococcus pneumoniae** (Pneumococcus) is a common cause of acute bacterial conjunctivitis, characterized by purulent discharge and redness. - However, it is not associated with the specific delayed hypersensitivity reaction that defines phlyctenular conjunctivitis. *Aspergillus* - **Aspergillus** species are fungi and are more commonly implicated in fungal keratitis or allergic bronchopulmonary aspergillosis, particularly in immunocompromised individuals. - Fungal infections of the conjunctiva are rare and do not typically manifest as phlyctenular conjunctivitis. [Practice more Ophthalmology PYQs on OnCourse]

Q: Chronic granulomatous inflammation in upper lid (painless swelling) is characteristic of:

Chalazion. ***Chalazion*** - A chalazion is a **chronic**, sterile, **lipogranulomatous** inflammation of the **meibomian glands**. - It presents as a **painless**, firm, round swelling in the eyelid, often in the upper lid due to the larger meibomian glands. *Trachoma* - Trachoma is a **chronic keratoconjunctivitis** caused by *Chlamydia trachomatis*. - It primarily affects the conjunctiva and cornea, leading to scarring, entropion, and eventual blindness, not a painless eyelid swelling. *Internal Hordeolum* - An internal hordeolum is an **acute** bacterial infection of a **meibomian gland**, forming an abscess. - It is typically **painful**, red, and tender, contrasting with the painless nature of the given presentation. *External hordeolum* - An external hordeolum (stye) is an **acute** bacterial infection of the **glands of Zeis or Moll** at the lid margin. - It is usually **painful**, red, and tender, presenting as a small pustule or nodule on the eyelid margin, not a deep-seated painless swelling. [Practice more Ophthalmology PYQs on OnCourse]

Q: Which of the following is seen in retinitis pigmentosa?

Arteriolar attenuation. ***Arteriolar attenuation*** - **Arteriolar attenuation** is a classic finding in retinitis pigmentosa, reflecting the progressive loss of retinal tissue and the associated reduction in metabolic demand, leading to narrowing of the retinal arterioles. - This sign indicates the ongoing degeneration of photoreceptors and the underlying retinal layers, which is characteristic of the disease. *Neovascularization* - **Neovascularization** (abnormal new blood vessel growth) is typically associated with conditions like proliferative diabetic retinopathy or age-related macular degeneration. - It is not a primary feature of retinitis pigmentosa, which is a degenerative disease rather than an ischemic or proliferative one. *Papilledema* - **Papilledema** is swelling of the optic disc due to increased intracranial pressure. - It is not a feature of retinitis pigmentosa; rather, the optic disc in retinitis pigmentosa often appears waxy pale due to optic atrophy. *Retinal artery thrombosis* - **Retinal artery thrombosis** involves the sudden blockage of a retinal artery, leading to acute vision loss and often presenting with a 'cherry-red spot' on the macula. - This is an acute vascular event and is not characteristic of the chronic, progressive degeneration seen in retinitis pigmentosa. [Practice more Ophthalmology PYQs on OnCourse]

Q: Which of the following is an advantage of contact lenses over normal glasses?

Improved peripheral vision. ***Improved peripheral vision*** - Contact lenses sit directly on the cornea, moving with the eye and eliminating the **frame obstruction** and **edge distortions** associated with glasses. - This provides a wider and more natural **field of view**, enhancing peripheral vision. *Reduced prismatic effect* - While contact lenses do reduce the **magnification/minification** compared to glasses, the prismatic effect is a specific distortion most pronounced in **strong thick spectacle lenses** and can induce visual discomfort, which contact lenses inherently minimize. - This effect is due to the distance between the spectacle lens and the eye, which contact lenses eliminate. *Decreased risk of infection* - Wearing contact lenses inherently carries a **higher risk of eye infections** if proper hygiene and care are not meticulously followed. - Unlike glasses, contact lenses require regular cleaning, disinfection, and proper storage to prevent bacterial or fungal contamination. *UV protection (in specific lenses)* - While some contact lenses incorporate **UV-blocking agents**, this is not a universal feature of all contact lenses and is also available in many spectacle lenses. - UV protection from contact lenses primarily shields the cornea and iris but does not fully protect the surrounding ocular tissues like glasses (especially wrap-around styles) can. [Practice more Ophthalmology PYQs on OnCourse]

Question 1

A person with a visual acuity of 6/60 in the right eye and 3/60 in the left eye would be categorized into which type of blindness?

Accepted Answer

Moderate visual impairment

Answer

Legal blindness

Answer

Normal vision

Answer

Low vision

Question 2

Phlyctenular conjunctivitis is primarily associated with hypersensitivity to which of the following?

Accepted Answer

Staphylococcus

Answer

Chlamydia

Answer

Pneumococcus

Answer

Aspergillus

Question 3

Chronic granulomatous inflammation in upper lid (painless swelling) is characteristic of:

Accepted Answer

Chalazion

Answer

Trachoma

Answer

Internal Hordeolum

Answer

External Hordeolum

Question 4

Which of the following is seen in retinitis pigmentosa?

Accepted Answer

Arteriolar attenuation

Answer

Neovascularization

Answer

Papilledema

Answer

Retinal artery thrombosis

Question 5

Which of the following is an advantage of contact lenses over normal glasses?

Accepted Answer

Improved peripheral vision

Answer

Reduced prismatic effect

Answer

Decreased risk of infection

Answer

UV protection (in specific lenses)

Question 6

Keratometer is used to assess:

Accepted Answer

Curvature of cornea

Answer

Curvature of lens

Answer

Thickness of cornea

Answer

Diameter of cornea

Question 7

A patient presents with convergent squint in one eye. Vision in the squinting eye is 6/60, and vision in the non-squinting eye is also 6/60. What is the most appropriate next step in management?

Accepted Answer

Refraction and treat underlying cause of poor vision

Answer

Glasses

Answer

Squint surgery

Answer

Botulinum toxin

Question 8

Appropriate treatment for mild congenital ptosis?

Accepted Answer

LPS Resection

Answer

Frontalis sling procedure

Answer

Antibiotics and hot compression

Answer

Wedge resection of conjunctiva

Question 9

A 20-year-old male complains of repeated changes in glasses prescription. This is most likely caused by:

Accepted Answer

Keratoconus

Answer

Cataract

Answer

Glaucoma

Answer

Pathological myopia

Question 10

A person is not able to count fingers from a distance of 6 meters. He shall be categorized into which type of blindness?

Accepted Answer

Severe visual impairment

Answer

Moderate visual impairment

Answer

Near-total blindness

Answer

Profound visual impairment

FMGE 2019 — Ophthalmology