INI-CET 2017 - Ophthalmology PYQs Practice Questions

Q: Identify the instrument used: (AIIMS Nov 2017)

Episiotomy scissors. ***Episiotomy scissors*** - These scissors are characterized by their **blunt, angled tip** on one blade, which is designed to protect the fetal head during an episiotomy. - The image clearly shows this specific design, making them ideal for cutting soft tissues in a controlled manner without puncturing underlying structures. *Dissection scissors* - Dissection scissors typically have **sharp tips**, either straight or curved, and are used for cutting and separating tissues with precision. - They lack the blunt, angled tip characteristic of episiotomy scissors. *Mayo scissors* - **Mayo scissors** are heavy-duty scissors, typically used for cutting **fascia, sutures, and dense tissues**. - They often have straight or slightly curved blades without the protective blunt tip seen in episiotomy scissors. *Metzenbaum scissors* - **Metzenbaum scissors** are known for their **long handles and relatively short, delicate blades**, designed for cutting and dissecting fine, delicate tissues. - Their blades are typically slender and do not feature the angled, blunt tip of episiotomy scissors. [Practice more Ophthalmology PYQs on OnCourse]

Q: Identify the FFA picture:

NPDR. ***NPDR*** - The image shows areas of **capillary non-perfusion** (dark areas without visible blood flow) and **microaneurysms** (small bright dots due to damaged capillaries). These are characteristic findings of **Non-Proliferative Diabetic Retinopathy (NPDR)** on fluorescein angiography. - There is no evidence of neovascularization, which is the hallmark of proliferative diabetic retinopathy. *PDR* - **Proliferative Diabetic Retinopathy (PDR)** is characterized by the presence of **neovascularization** (new, abnormal blood vessel growth) on the retina or optic disc. - This image does not show any signs of neovascularization, which would appear as brightly fluorescing, tangled vessels. *Familial dominant drusen* - **Familial dominant drusen** are typically seen as yellow-white deposits under the retinal pigment epithelium and would manifest on FFA as **hyperfluorescent spots**, but usually with a different distribution and appearance than the microaneurysms seen here. - This image reflects widespread microvascular damage consistent with a retinal vascular disease, not primarily drusen. *Birdshot choroidopathy* - **Birdshot choroidopathy** is a chronic, bilateral posterior uveitis characterized by multiple, depigmented choroidal lesions (birdshot lesions). - On FFA, these lesions would typically show **hypofluorescence** in the early phases due to blocked choroidal fluorescence and possible late staining, which is not depicted in this image. [Practice more Ophthalmology PYQs on OnCourse]

Q: Identify the refractive error shown in the image:

Astigmatism. ***Astigmatism*** - The image shows that light rays from a single point source are **not focused at a single point** on the retina, but rather spread across multiple focal points or a line. This pattern is characteristic of **astigmatism**, where the eye's cornea or lens has an irregular curvature. - Specifically, rays 1 and 2 converge at one point, while rays 3 and 4 converge at a different point, indicating that the eye has different refractive powers along different meridians, which defines **astigmatism**. *Myopia* - In **myopia (nearsightedness)**, light rays from a distant object focus **in front of the retina**, not at multiple planes or lines as depicted. - Myopia would show all rays converging to a single point before reaching the retina, resulting in a blurry image. *Hypermetropia* - In **hypermetropia (farsightedness)**, light rays from a distant object focus **behind the retina**, assuming the eye is unaccommodated. - This condition would show the rays converging to a single point beyond the retinal plane, not divergent focal points within the eye. *Presbyopia* - **Presbyopia** is an age-related condition where the eye's **lens loses its flexibility**, making it difficult to focus on nearby objects. - It primarily affects near vision and does not typically involve the multiple focal points for distant vision as shown in the image. [Practice more Ophthalmology PYQs on OnCourse]

Q: A patient has the following presentation. After administration of an intravenous drug to the patient, in 6 minutes his symptoms have resolved. The diagnosis of the patient is:

Myasthenia gravis. The question refers to an accompanying image (not provided in the text, but essential for context) showing a patient with **ptosis** (drooping eyelid) and possibly other ocular muscle weakness. The key information is that symptoms resolve within 6 minutes after administration of an intravenous drug. This rapid and complete resolution of symptoms following drug administration is highly characteristic of a specific condition and a specific diagnostic test. ***Myasthenia gravis*** - The rapid resolution of symptoms (ptosis and possibly other ocular muscle weakness) within 6 minutes after intravenous drug administration is the hallmark of a positive **Tensilon test**. - The **Tensilon test** involves injecting **edrophonium**, a short-acting acetylcholinesterase inhibitor, which temporarily increases acetylcholine at the neuromuscular junction, improving muscle strength in patients with **myasthenia gravis**. *Sixth nerve palsy* - Sixth nerve palsy (abducens nerve palsy) causes **diplopia** (double vision) and an inability to abduct the affected eye. - While symptoms may fluctuate or improve with treatment, they would not resolve completely in 6 minutes with a diagnostic agent like edrophonium. *Third nerve palsy* - Third nerve palsy (oculomotor nerve palsy) can cause **ptosis**, **diplopia**, and impairment of eye movements (inability to adduct, elevate, or depress the eye). - Nerve palsies are structural or neurological deficits that do not rapidly reverse with a cholinergic agonist like edrophonium. *Tolosa-Hunt syndrome* - Tolosa-Hunt syndrome is a rare inflammatory disorder characterized by **painful ophthalmoplegia** (paralysis of eye muscles), often affecting the third, fourth, and/or sixth cranial nerves. - It typically responds to corticosteroids, but symptoms would not resolve in 6 minutes with an intravenous drug, and the diagnostic approach is different. [Practice more Ophthalmology PYQs on OnCourse]

Q: What is the diagnosis?

Third nerve palsy. ***Third nerve palsy*** - The image shows **ptosis** (drooping of the eyelid) and **pupil dilation** with the eye deviated **down and out**, which are classic signs of a complete third nerve palsy. - The **oculomotor nerve (CN III)** innervates most extraocular muscles (**superior, medial, inferior recti, and inferior oblique**), the **levator palpebrae superioris**, and the **parasympathetic fibers to the pupillary constrictor muscle**. *Sixth nerve palsy* - A sixth nerve palsy (**abducens nerve**) would cause an inability to **abduct the eye** (move it outwards) leading to an **esotropia** (eye turned inward at rest) and **horizontal diplopia**, which is not depicted. - Symptoms primarily affect the **lateral rectus muscle**. *Myasthenia gravis* - Myasthenia gravis can cause **ptosis** and **diplopia**, but typically presents with **variable and fluctuating weakness** that worsens with fatigue. - It does not usually cause the fixed, specific pattern of strabismus and pupillary involvement seen in a severe third nerve palsy. *Tolosa-Hunt syndrome* - Tolosa-Hunt syndrome is a **painful ophthalmoplegia** caused by **non-specific inflammation** in the cavernous sinus or orbital apex. - While it can affect cranial nerves III, IV, V1, and VI, leading to **ophthalmoplegia** and **ptosis**, the defining feature is often **severe orbital pain**, which cannot be assessed from the image alone, and the specific constellation of symptoms in the image points more directly to a third nerve lesion rather than an inflammatory syndrome. [Practice more Ophthalmology PYQs on OnCourse]

Question 1

Identify the instrument used: (AIIMS Nov 2017)

Accepted Answer

Episiotomy scissors

Answer

Dissection scissors

Answer

Mayo scissors

Answer

Metzenbaum scissors

Question 2

Identify the FFA picture:

Accepted Answer

NPDR

Answer

PDR

Answer

Familial dominant drusen

Answer

Birdshot choroidopathy

Question 3

Identify the refractive error shown in the image:

Accepted Answer

Astigmatism

Answer

Myopia

Answer

Hypermetropia

Answer

Presbyopia

Question 4

A patient has the following presentation. After administration of an intravenous drug to the patient, in 6 minutes his symptoms have resolved. The diagnosis of the patient is:

Accepted Answer

Myasthenia gravis

Answer

Sixth nerve palsy

Answer

Third nerve palsy

Answer

Tolosa-Hunt syndrome

Question 5

What is the diagnosis?

Accepted Answer

Third nerve palsy

Answer

Sixth nerve palsy

Answer

Myasthenia gravis

Answer

Tolosa-Hunt syndrome

Question 6

A 60-year-old male underwent a cataract surgery. After 1 year he came with complaints of diminished vision and the finding shown in the image. Diagnosis is?

Accepted Answer

6th nerve palsy

Answer

2nd nerve palsy

Answer

3rd nerve palsy

Answer

4th nerve palsy

Question 7

A 60-year-old male underwent a cataract surgery. After 1 year he came with complaints of diminished vision and the finding shown in the image. Diagnosis is?

Accepted Answer

After cataract

Answer

Irvine-Gass syndrome

Answer

UGH syndrome

Answer

Endophthalmitis

INI-CET 2017 — Ophthalmology