NEET-PG 2012 Practice Questions

Q: Unilateral lacrimal gland destruction may be caused by?

Fracture of roof of orbit. ***Fracture of roof of orbit*** - The **lacrimal gland** is situated in the **lacrimal fossa** on the anterior-lateral part of the **orbital roof**. A fracture in this specific area can directly damage the gland. - Trauma to the **orbital roof** can lead to laceration, avulsion, or compression of the lacrimal gland, resulting in its destruction and impairing tear production. *Inferior orbital fissure fracture* - The **inferior orbital fissure** transmits nerves and vessels to the orbit but is located inferior to the lacrimal gland, making direct injury unlikely. - Fractures here are more associated with **infraorbital nerve damage** or disruption of orbital contents into the maxillary sinus, not lacrimal gland destruction. *Fracture of lateral wall* - The **lateral wall of the orbit** forms the outer boundary and protects structures deeper within the orbit, but the lacrimal gland is situated superiorly and anteriorly. - While significant trauma to the lateral wall can impact orbital contents, it is less likely to directly cause unilateral lacrimal gland destruction compared to a direct roof fracture. *Fracture of sphenoid* - Fractures of the **sphenoid bone** are typically more posterior and central, affecting structures like the **optic canal** or **cavernous sinus**. - While it can indirectly affect orbital function, it is not a direct cause of isolated lacrimal gland destruction due to its anatomical location.

Q: Satellite nodules are typically associated with which of the following conditions?

Fungal corneal ulcer. ***Fungal corneal ulcer*** - **Satellite lesions** (small, isolated infiltrates surrounding a larger central ulcer) are a characteristic feature of **fungal keratitis**, indicating the spread of fungal hyphae. - Unlike bacterial ulcers, fungal ulcers often have a feathery, indistinct margin and can be slow-growing. *Tuberculosis* - Ocular tuberculosis can present with granulomatous inflammation, often involving the uvea or retina, but **satellite nodules** around a corneal ulcer are not typical. - Corneal involvement in tuberculosis is rare and usually manifests as interstitial keratitis or phlyctenular keratitis. *Sarcoidosis* - Ocular sarcoidosis commonly causes **uveitis**, conjunctival nodules, or retinal vasculitis. - While it can cause corneal deposits or band keratopathy, it does not typically present with satellite lesions around a primary corneal ulcer. *Viral ulcer* - Viral corneal ulcers, particularly those caused by **herpes simplex virus**, often present as **dendritic ulcers** or geographic ulcers. - Although epithelial lesions can spread, the distinct **satellite infiltrates** in the stroma seen in fungal infections are not characteristic of viral keratitis.

Q: Recurrent anterior uveitis with increased intraocular tension is seen in which of the following conditions?

Posner-Schlossman syndrome. ***Posner-Schlossman syndrome*** - Characterized by **recurrent, unilateral, non-granulomatous anterior uveitis** associated with markedly **elevated intraocular pressure (IOP)**. - The condition is also known as **glaucomatocyclitic crisis**, highlighting the episodic inflammation and glaucoma. - Key features include **acute attacks** lasting hours to weeks with **dramatic IOP elevation** (often >40 mmHg). *Foster-Kennedy syndrome* - This syndrome is defined by ipsilateral **optic atrophy**, contralateral **papilledema**, and often **anosmia**, typically due to a frontal lobe tumor. - It does not involve anterior uveitis or primary elevated intraocular tension. - This is a neuro-ophthalmologic syndrome, not an inflammatory ocular condition. *Vogt-Koyanagi-Harada syndrome* - An autoimmune disorder affecting pigmented tissues, leading to **bilateral granulomatous panuveitis**, often with hearing loss, vitiligo, poliosis, and neurological symptoms. - While it involves uveitis, it is typically **bilateral and panuveitis**, not recurrent unilateral anterior uveitis. - IOP may be elevated but not the defining feature with dramatic episodic rises. *Fuchs heterochromic iridocyclitis* - A chronic, **unilateral, low-grade anterior uveitis** with characteristic iris heterochromia. - May have mild IOP elevation but **not recurrent episodic attacks** with marked pressure spikes. - Inflammation is typically **quiet and chronic** rather than acute and recurrent.

Q: Which of the following conditions is least likely to be associated with neovascular glaucoma?

Open angle glaucoma. ***Open angle glaucoma*** ✓ - **Open-angle glaucoma** is a primary **neurodegenerative disease** of the optic nerve, characterized by progressive loss of **retinal ganglion cells** and their axons, leading to characteristic **optic neuropathy** and visual field defects. - It does **NOT** directly cause **neovascularization** or increased VEGF production, which are the underlying mechanisms for **neovascular glaucoma**. - This is the **least likely** association among the given options. *Diabetes* - **Diabetic retinopathy** is a **major cause** of **neovascularization** due to retinal ischemia and increased production of **vascular endothelial growth factor (VEGF)**, which can lead to **neovascular glaucoma**. - **Neovascularization** on the iris (rubeosis iridis) and angle can block aqueous outflow, causing a severe, rapidly progressing form of secondary glaucoma. *CRVO (Central Retinal Vein Occlusion)* - **CRVO** leads to significant retinal ischemia and subsequent release of **VEGF**, which prompts the growth of new, fragile blood vessels. - These new vessels (neovascularization) can grow in the iris and angle, obstructing aqueous humor outflow and causing **neovascular glaucoma**. - **Ischemic CRVO** is one of the **most common causes** of neovascular glaucoma. *Eale's disease* - **Eale's disease** is an **idiopathic occlusive vasculitis** primarily affecting the **peripheral retinal veins**, leading to **retinal ischemia**. - This ischemia stimulates **neovascularization** and the production of **VEGF**, increasing the risk of **neovascular glaucoma** due to the formation of new blood vessels in the anterior chamber.

Q: Laser iridotomy is done in?

Angle closure glaucoma. ***Angle closure glaucoma*** - **Laser iridotomy** creates a small hole in the iris, allowing aqueous humor to flow directly from the posterior to the anterior chamber, thus relieving pupillary block and opening the angle. - This procedure is the definitive treatment to prevent further **angle closure attacks** and is also used prophylactically in eyes at risk. *Open angle glaucoma* - This condition involves an **open angle** but impaired outflow of aqueous humor through the **trabecular meshwork**. - Laser iridotomy is not indicated as it does not address the primary outflow obstruction in the trabecular meshwork. *Pigmentary glaucoma* - This is a type of **open-angle glaucoma** caused by pigment dispersion that clogs the trabecular meshwork, leading to increased intraocular pressure. - While pigment can be released from the iris, the primary issue is the **trabecular meshwork obstruction**, which is not directly resolved by iridotomy. *None of the options* - This option is incorrect because **angle closure glaucoma** is a clear indication for laser iridotomy.

Q: What type of deposit is commonly associated with age-related macular degeneration?

Drusen. ***Drusen*** - **Drusen** are yellow deposits of extracellular material that accumulate beneath the **retinal pigment epithelium (RPE)**. - Their presence is a hallmark sign of **age-related macular degeneration (AMD)** and can lead to vision loss by disrupting retinal function. *Iron* - While iron can accumulate in ocular tissues in conditions like **siderosis bulbi** (due to retained intraocular foreign bodies), it is not a characteristic deposit of macular degeneration. - Ocular iron deposition typically causes different pathologies, such as retinal dysfunction or glaucoma, rather than AMD. *Lipochrome* - **Lipochrome** refers to a class of pigments, including **lipofuscin**, which can accumulate in cells as a byproduct of cellular metabolism and aging. - Although lipofuscin buildup occurs in the RPE with age, **drusen** are the specific, organized extracellular deposits pathognomonic for macular degeneration. *Hemosiderine* - **Hemosiderin** is an iron-storage complex formed from the breakdown of hemoglobin, found in situations of hemorrhage or chronic bleeding. - It is not a typical deposit found in macular degeneration; its presence in the retina usually indicates a history of retinal hemorrhage.

Q: What does extraretinal fibrovascular proliferation at the ridge indicate?

Stage III Retinopathy of Prematurity. ***Stage III Retinopathy of Prematurity*** - Extraretinal fibrovascular proliferation at the ridge is the defining characteristic of **Stage III Retinopathy of Prematurity (ROP)**. - This stage signifies significant **neovascularization** extending into the vitreous, increasing the risk of **retinal detachment**. *Normal retina* - A normal retina does not exhibit **fibrovascular proliferation** or a distinct ridge, as its vascularization is fully developed and confined to the retinal plane. - Absence of any abnormal vascular growth or demarcation line indicates a healthy, mature retinal structure. *Stage II Retinopathy of Prematurity* - Stage II ROP is characterized by a **ridge** that is elevated and appears three-dimensional, but it **lacks extraretinal fibrovascular proliferation**. - This stage represents progression from Stage I, where the demarcation line becomes a prominent ridge, but without new vessel formation outside the retina. *Stage I Retinopathy of Prematurity* - Stage I ROP is characterized by a thin, flat **demarcation line** distinguishing vascularized from avascular retina, without any significant elevation or fibrovascular proliferation. - This initial stage indicates an arrested phase of retinal vascular development, but without the more severe signs of neovascularization.

Q: In which condition is the swinging light test positive?

Optic neuritis. ***Optic neuritis*** - The swinging light test (also known as the **Marcus Gunn pupil** or relative afferent pupillary defect, RAPD) is positive when there is a significant **asymmetry in the afferent visual pathway** between the two eyes. - In optic neuritis, the **optic nerve** is inflamed and demyelinated, impairing the transmission of light signals to the brain, which leads to a paradoxical pupillary dilation when the light is swung from the unaffected to the affected eye. *Conjunctivitis* - This is an **inflammation of the conjunctiva**, the membrane lining the eyelid and sclera, which primarily affects the ocular surface. - It does not involve the optic nerve or afferent pupillary pathways, so the swinging light test would be **negative**. *Glaucoma* - Glaucoma is a condition characterized by **progressive optic nerve damage**, often associated with elevated intraocular pressure, leading to peripheral vision loss. - While it causes optic neuropathy, a positive swinging light test is typically seen only in **severe, asymmetric cases** and is not its primary diagnostic feature. *Keratoconus* - This is a non-inflammatory eye condition in which the normally round dome-shaped cornea **thins and bulges outward into a cone-like shape**. - It affects the **cornea's shape and vision quality**, but not the optic nerve or the afferent pupillary reflex pathway, thus the swinging light test would be negative.

Q: Most common malignant tumour of eyelid is ?

Basal cell carcinoma. ***Basal cell carcinoma*** - **Basal cell carcinoma (BCC)** accounts for approximately 85-95% of all eyelid malignancies, making it the most common type. - It often presents as a **pearly nodule** with telangiectatic vessels, frequently affecting the lower eyelid. *Squamous cell carcinoma* - **Squamous cell carcinoma (SCC)** is the second most common eyelid malignancy, but it is significantly less frequent (5-10%) than BCC. - SCC has a **higher metastatic potential** compared to BCC. *Malignant melanoma* - **Malignant melanoma** is a rare but highly aggressive eyelid tumor, accounting for less than 1% of all eyelid malignancies. - It is characterized by its **pigmented appearance** and rapid growth pattern. *Sebaceous gland carcinoma* - **Sebaceous gland carcinoma** is a relatively uncommon, but aggressive, tumor of the eyelid, comprising about 1-5% of cases. - It often mimics benign lesions like a **chalazion** or chronic blepharitis, leading to delayed diagnosis.

Q: Bilateral ptosis is seen in all except which of the following?

Hyperthyroidism (Graves' disease). ***Hyperthyroidism (Graves' disease)*** - **Hyperthyroidism** causes eyelid retraction, leading to a **stare** or **lid lag**, rather than **ptosis**. - **Graves' ophthalmopathy** can cause proptosis (bulging eyes) and conjunctival injection, but does not typically manifest as ptosis. *Congenital* - **Congenital ptosis** is often present at birth due to improper development of the **levator palpebrae superioris muscle**. - It can be **bilateral** and is usually isolated, without other systemic symptoms. *Trauma* - **Traumatic ptosis** can occur if the **levator muscle**, **aponeurosis**, or **third cranial nerve** is damaged. - This can be **bilateral** depending on the nature and extent of the head trauma. *Myotonic dystrophy* - **Myotonic dystrophy** is a **hereditary muscle disorder** characterized by progressive muscle weakness. - **Bilateral ptosis** is a very common early sign of **myotonic dystrophy**, often accompanied by **facial weakness** and **myotonia**.

Question 1

Unilateral lacrimal gland destruction may be caused by?

Accepted Answer

Fracture of roof of orbit

Answer

Inferior orbital fissure fracture

Answer

Fracture of lateral wall

Answer

Fracture of sphenoid

Question 2

Satellite nodules are typically associated with which of the following conditions?

Accepted Answer

Fungal corneal ulcer

Answer

Tuberculosis

Answer

Sarcoidosis

Answer

Viral ulcer

Question 3

Recurrent anterior uveitis with increased intraocular tension is seen in which of the following conditions?

Accepted Answer

Posner-Schlossman syndrome

Answer

Foster-Kennedy syndrome

Answer

Vogt-Koyanagi-Harada syndrome

Answer

Fuchs heterochromic iridocyclitis

Question 4

Which of the following conditions is least likely to be associated with neovascular glaucoma?

Accepted Answer

Open angle glaucoma

Answer

Diabetes

Answer

CRVO

Answer

Eale's disease

Question 5

Laser iridotomy is done in?

Accepted Answer

Angle closure glaucoma

Answer

Pigmentary glaucoma

Answer

None of the options

Answer

Open angle glaucoma

Question 6

What type of deposit is commonly associated with age-related macular degeneration?

Accepted Answer

Drusen

Answer

Iron

Answer

Lipochrome

Answer

Hemosiderine

Question 7

What does extraretinal fibrovascular proliferation at the ridge indicate?

Accepted Answer

Stage III Retinopathy of Prematurity

Answer

Normal retina

Answer

Stage II Retinopathy of Prematurity

Answer

Stage I Retinopathy of Prematurity

Question 8

In which condition is the swinging light test positive?

Accepted Answer

Optic neuritis

Answer

Conjunctivitis

Answer

Glaucoma

Answer

Keratoconus

Question 9

Most common malignant tumour of eyelid is ?

Accepted Answer

Basal cell carcinoma

Answer

Malignant melanoma

Answer

Squamous cell carcinoma

Answer

Sebaceous gland carcinoma

Question 10

Bilateral ptosis is seen in all except which of the following?

Accepted Answer

Hyperthyroidism (Graves' disease)

Answer

Trauma

Answer

Congenital

Answer

Myotonic dystrophy

NEET-PG 2012

Anatomy

Ophthalmology