INI-CET 2022 — Ophthalmology
3 Previous Year Questions with Answers & Explanations
Which triad is seen after an acute attack of angle-closure glaucoma?
A 27-year-old female patient presents with sudden diminishing vision associated with a relative afferent pupillary defect in the right eye. On examination, the left eye is normal. Which of the following combinations of investigations would be most appropriate?
Which of the following is not a feature of keratoconus?
INI-CET 2022 - Ophthalmology INI-CET Practice Questions and MCQs
Question 1: Which triad is seen after an acute attack of angle-closure glaucoma?
- A. Gaucher triad
- B. Virchow triad
- C. Vogt's triad (Correct Answer)
- D. Hutchinson's triad
Explanation: ***Vogt's triad*** - **Vogt's triad** refers to the classical findings seen after an acute attack of **angle-closure glaucoma**. - The triad consists of: **glaukomflecken** (anterior subcapsular lens opacities from ischemic necrosis of lens epithelium), **iris stromal atrophy** (sectoral iris atrophy in the area of ischemia), and **fixed mid-dilated pupil** (due to iris sphincter damage). - These signs indicate **ischemic damage** to the anterior segment following the acute episode of elevated intraocular pressure. *Gaucher triad* - **Gaucher triad** refers to the characteristic systemic symptoms of **Gaucher disease**, an inherited lipid storage disorder. - It involves **hepatosplenomegaly**, **bone pain**, and **thrombocytopenia**, which are unrelated to glaucoma. *Virchow triad* - The **Virchow triad** describes the three main factors contributing to **thrombus formation**: **stasis** of blood flow, **endothelial injury**, and **hypercoagulability**. - This triad is relevant to cardiovascular pathology, not the effects of angle-closure glaucoma. *Hutchinson's triad* - **Hutchinson's triad** is a set of symptoms associated with **congenital syphilis**. - It includes **interstitial keratitis**, **Hutchinson's teeth**, and **eighth nerve deafness**, which are entirely distinct from ocular hypertension.
Question 2: A 27-year-old female patient presents with sudden diminishing vision associated with a relative afferent pupillary defect in the right eye. On examination, the left eye is normal. Which of the following combinations of investigations would be most appropriate?
- A. MRI brain and orbits + Visual evoked potentials
- B. Visual evoked potentials + Blood tests
- C. MRI brain and orbits + Blood tests
- D. MRI brain and orbits + Visual evoked potentials + Blood tests (Correct Answer)
Explanation: ***MRI brain and orbits + Visual evoked potentials + Blood tests*** - The combination of **sudden diminishing vision** and a **relative afferent pupillary defect (RAPD)** in one eye strongly suggests **optic neuritis**. - **MRI brain and orbits** is crucial to identify demyelinating lesions characteristic of **multiple sclerosis** and to rule out other causes of optic neuropathy, while **visual evoked potentials (VEPs)** confirm optic nerve dysfunction and can detect subclinical demyelination. **Blood tests** are essential to exclude other inflammatory or autoimmune conditions that can mimic optic neuritis. *MRI brain and orbits + Visual evoked potentials* - While these two investigations are critical for diagnosing **optic neuritis** and assessing for **multiple sclerosis**, they might miss systemic causes of optic neuropathy that can be identified via targeted **blood tests**. - Excluding systemic inflammatory or autoimmune conditions is crucial for complete patient management and preventing recurrence or progression. *Visual evoked potentials + Blood tests* - This combination is insufficient as it omits the **MRI brain and orbits**, which is vital for visualizing the optic nerve and brain for demyelinating lesions and ruling out compressive or infiltrative etiologies. - An **MRI** provides structural information that VEPs and blood tests alone cannot, making it indispensable in this clinical scenario. *MRI brain and orbits + Blood tests* - This combination lacks **Visual evoked potentials (VEPs)**, which provide objective evidence of **optic nerve demyelination** and can detect subclinical involvement, aiding in diagnosis and prognosis. - VEPs are particularly valuable in diagnosing **optic neuritis** and monitoring its recovery or progression.
Question 3: Which of the following is not a feature of keratoconus?
- A. Haab's striae (Correct Answer)
- B. Irregular astigmatism
- C. Scissoring reflex
- D. Munson's sign
Explanation: ***Haab's striae*** - **Haab's striae** are characteristic of congenital glaucoma, presenting as horizontal breaks in Descemet's membrane due to increased intraocular pressure and corneal stretching. - In contrast, keratoconus involves **vertical breaks in Descemet's membrane** (due to corneal thinning and protrusion), known as Vautin's striae or Vogt's striae, not Haab's striae. *Irregular astigmatism* - **Irregular astigmatism** is a hallmark of keratoconus, resulting from the asymmetric and non-uniform thinning and protrusion of the cornea. - This irregular corneal shape leads to a significant reduction in visual acuity that cannot be fully corrected with spherical or regular cylindrical lenses. *Scissoring reflex* - The **scissoring reflex** (or scissoring phenomena) is an objective finding observed during retinoscopy in patients with keratoconus, indicating significant irregular astigmatism. - It refers to the opposing movements of the retinoscopic reflex, resembling the opening and closing of scissors, as the light across the pupil is neutralized. *Munson's sign* - **Munson's sign** is a classic clinical finding in advanced keratoconus, where the lower eyelid protrudes in a V-shape when the patient looks downwards. - This protrusion is caused by the conical shape of the cornea pushing against the eyelid.