What is the drug of choice for treating intermediate uveitis?
Which agent is known to cause corneal ulcers that may resemble fungal infections?
Which of the following conditions is least likely to cause proptosis?
Dacryocystorhinostomy involves?
Surgery of choice for chronic acquired dacryocystitis
Commotio retinae affects which part of the retina -
Parachute lesions are associated with which of the following conditions?
Which of the following is a specific sign of albinism?
Epithelial xerosis of conjunctiva is caused by?
Snow banking is seen in?
NEET-PG 2013 - Ophthalmology NEET-PG Practice Questions and MCQs
Question 31: What is the drug of choice for treating intermediate uveitis?
- A. Atropine
- B. Antibiotics
- C. Topical steroids
- D. Systemic steroids (Correct Answer)
Explanation: ***Systemic steroids*** - **Systemic steroids** are the **drug of choice** for treating intermediate uveitis, especially when inflammation is significant or vision is threatened. - They effectively suppress the expansive **intraocular inflammation** typical of intermediate uveitis, which often involves the **vitreous** and **peripheral retina**. *Atropine* - **Atropine** is a **cycloplegic agent** primarily used to relieve ciliary spasm and prevent synechiae formation in anterior uveitis. - It does not address the underlying **inflammation** of intermediate uveitis, which is located more posteriorly. *Antibiotics* - **Antibiotics** are used to treat bacterial infections and are not indicated for **intermediate uveitis**, which is typically an **inflammatory** or **autoimmune disorder**. - They would be appropriate only if the uveitis were secondary to an **infectious cause**, which is not the primary characteristic of intermediate uveitis. *Topical steroids* - **Topical steroids** are effective for **anterior uveitis** but often fail to reach sufficient concentrations in the **vitreous** and **peripheral retina** to control the inflammation of intermediate uveitis. - **Intermediate uveitis** primarily affects the ciliary body, vitreous, and peripheral retina, requiring **systemic agents** for adequate therapeutic effect.
Question 32: Which agent is known to cause corneal ulcers that may resemble fungal infections?
- A. Nocardia asteroides (Correct Answer)
- B. Mycobacterium
- C. Klebsiella pneumoniae
- D. Chlamydia trachomatis
Explanation: ***Nocardia asteroides*** - This organism can cause **Nocardia keratitis**, which often presents with a **feathery or crystalline appearance** in the cornea, mimicking a fungal infection. - It tends to occur in patients with **contact lens use** or ocular trauma and requires specific antimicrobial treatment different from fungal therapy. *Mycobacterium* - **Atypical mycobacteria** can cause chronic, indolent corneal ulcers, particularly after trauma or surgery. - While they can be challenging to diagnose, their appearance typically differs from the **feathery morphology** associated with fungal or Nocardia infections. *Klebsiella pneumoniae* - **Klebsiella pneumoniae** is a common cause of **bacterial keratitis**, especially in contact lens wearers. - Infections usually manifest as a rapidly progressing infiltrate with significant inflammation and often produce abundant **mucopurulent discharge**, not typically mistaken for fungal infections. *Chlamydia trachomatis* - **Chlamydia trachomatis** is the causative agent of **trachoma**, leading to recurrent conjunctivitis and eventually corneal scarring and blindness in endemic areas. - It does not cause acute corneal ulcers that resemble fungal infections; rather, it results in a chronic inflammatory process with **follicular conjunctivitis** and **pannus formation**.
Question 33: Which of the following conditions is least likely to cause proptosis?
- A. Sarcoidosis
- B. Myxoedema (Correct Answer)
- C. Grave's disease
- D. Pituitary adenoma
Explanation: ***Myxoedema*** - **Myxoedema** is associated with severe **hypothyroidism** and is characterized by non-pitting edema due to the accumulation of **glycosaminoglycans** in tissues. - While it can cause facial puffiness, it is **least likely** to cause **proptosis** as there is no direct mechanism for an increase in orbital contents to push the eye forward. *Grave's disease* - **Grave's disease** is the most common cause of **proptosis** due to **immune-mediated inflammation** and accumulation of **glycosaminoglycans** and fat in the orbital tissues, leading to expansion. - This condition specifically affects the **extraocular muscles** and fat, causing bulging of the eyes. *Sarcoidosis* - **Orbital sarcoidosis** can cause **proptosis** due to the formation of **granulomas** within the orbit, leading to mass effect and inflammation. - It can affect any part of the eye and orbit, leading to varied clinical presentations including axial or non-axial globe displacement. *Pituitary adenoma* - A **pituitary adenoma** itself does not directly cause proptosis as it is located in the **sella turcica**, posterior to the orbits. - However, **large adenomas** can cause proptosis indirectly if they invade the **cavernous sinus** and obstruct venous return from the orbit, or if they are associated with **acromegaly**, which can lead to bony overgrowth of the orbital structures and surrounding tissues.
Question 34: Dacryocystorhinostomy involves?
- A. Opening the terminal blocked end of the nasolacrimal duct
- B. Complete excision of the lacrimal sac
- C. Insertion of a drainage tube in the lacrimal sac
- D. Connecting the lacrimal sac to the nose by opening the medial wall (Correct Answer)
Explanation: ***Connecting the lacrimal sac to the nose by opening the medial wall*** - A **dacryocystorhinostomy (DCR)** is a surgical procedure to create a new drainage pathway between the **lacrimal sac** and the **nasal cavity**. - This bypasses an obstruction in the **nasolacrimal duct**, allowing tears to drain properly into the nose. *Opening the terminal blocked end of the nasolacrimal duct* - This describes a **dacryocystoplasty** or an attempt to probe the existing duct, which is a less invasive procedure than a DCR and often insufficient for complete obstruction. - While it aims to restore tear flow, it specifically addresses the terminal end rather than creating a new anastomosis. *Complete excision of the lacrimal sac* - This procedure is known as a **dacryocystectomy**, which is typically performed for tumors or chronic infections of the lacrimal sac that cannot be resolved otherwise. - It results in permanent dry eye and does not aim to restore tear drainage but rather to remove the problematic sac. *Insertion of a drainage tube in the lacrimal sac* - This describes **intubation** of the lacrimal drainage system, often using silicone tubes, which is usually a temporary measure to keep the duct patent after a procedure or for partial obstructions. - It is not the definitive surgical creation of a new permanent pathway, as achieved with a DCR.
Question 35: Surgery of choice for chronic acquired dacryocystitis
- A. Dacryocystorhinostomy (Correct Answer)
- B. Dacryocystectomy
- C. Conjunctivo-cystorhinostomy
- D. None of the options
Explanation: ***Dacryocystorhinostomy*** - This procedure creates a new connection between the **lacrimal sac** and the **nasal cavity**, bypassing the obstructed nasolacrimal duct. - It is the **surgery of choice** for chronic acquired dacryocystitis as it provides a permanent solution for tear drainage. *Dacryocystectomy* - This involves **excision of the lacrimal sac**, which can relieve symptoms of infection but eliminates the sac's function. - It is generally reserved for cases where dacryocystorhinostomy is contraindicated or has failed, and is **not the primary choice** for restoring tear flow. *Conjunctivo-cystorhinostomy* - This procedure creates a bypass from the **conjunctiva** directly to the **nasal cavity**, typically used when the canaliculi are also obstructed. - It is a more complex surgery indicated for **proximal lacrimal system obstruction** (e.g., canalicular block) rather than isolated nasolacrimal duct obstruction. *None of the options* - **Dacryocystorhinostomy** is the well-established and most effective surgical intervention for chronic acquired dacryocystitis. - Therefore, this option is incorrect as there is a suitable surgical choice available.
Question 36: Commotio retinae affects which part of the retina -
- A. Posterior pole (Correct Answer)
- B. Peripheral retina
- C. Inferior-nasal part
- D. Superior-nasal part
Explanation: ***Posterior pole*** - **Commotio retinae**, also known as Berlin's edema, primarily affects the **posterior pole** of the retina, particularly the macula. - This condition results from **blunt trauma** to the globe, causing disruption of the outer retinal photoreceptors and retinal pigment epithelium, leading to retinal whitening in the area of impact. *Peripheral retina* - While blunt trauma can affect the peripheral retina, commotio retinae specifically refers to the **edematous whitening** that occurs more centrally. - Trauma to the periphery is more commonly associated with **retinal tears or detachments**, rather than the diffuse whitening seen in commotio retinae. *Inferior-nasal part* - This is a specific quadrant of the retina, but commotio retinae is not confined to or preferentially found in the **inferior-nasal part**. - The location of commotio retinae depends on the **point of impact** and the transmission of force, but symptoms are most prominent when the macula at the posterior pole is involved. *Superior-nasal part* - Similar to the inferior-nasal part, the **superior-nasal part** is a specific retinal quadrant. - Commotio retinae is a more generalized finding of retinal edema and whitening due to trauma, not consistently localized to this particular region, though it can occur if that area is directly impacted.
Question 37: Parachute lesions are associated with which of the following conditions?
- A. Eale's disease (Correct Answer)
- B. Diabetes
- C. Sickle cell anemia
- D. None of the options
Explanation: ***Eale's disease*** - **Eale's disease** is an idiopathic retinal perivasculitis affecting young males, characterized by recurrent vitreous hemorrhages. - In the context of this question (NEET-2013), the term "parachute lesions" refers to the characteristic pattern of hemorrhages seen in Eale's disease. - The disease features retinal periphlebitis, capillary non-perfusion, and neovascularization leading to vitreous hemorrhage. - **Note:** The term "parachute hemorrhages" in broader ophthalmology typically describes preretinal/subhyaloid hemorrhages that settle inferiorly (boat-shaped), more commonly seen in proliferative diabetic retinopathy. *Diabetes* - **Diabetic retinopathy** presents with microaneurysms, dot-blot hemorrhages, hard exudates, cotton-wool spots, and neovascularization. - While proliferative diabetic retinopathy can cause preretinal "parachute-shaped" hemorrhages (boat-shaped hemorrhages that settle inferiorly), this is not the association being tested in this NEET-2013 question. - The specific context of this exam question associates the term with Eale's disease. *Sickle cell anemia* - **Sickle cell retinopathy** features characteristic sea-fan neovascularization in the peripheral retina. - Can cause salmon-patch hemorrhages, black sunburst lesions, and angioid streaks. - While vitreous hemorrhage can occur, "parachute lesions" is not standard terminology for sickle cell retinopathy manifestations. *None of the options* - This option is incorrect because **Eale's disease** is the correct answer according to the NEET-2013 exam key.
Question 38: Which of the following is a specific sign of albinism?
- A. Iris transillumination (Correct Answer)
- B. Sensitivity to light (photophobia)
- C. Involuntary eye movements (nystagmus)
- D. Decreased visual acuity
Explanation: ***Iris transillumination*** - This is a highly **specific sign** of albinism, resulting from the severe reduction or absence of pigment in the iris. - When light shines through the pupil, it passes through the unpigmented iris, creating a visible red reflex, indicating the lack of pigment that normally blocks the light. *Sensitivity to light (photophobia)* - While common in albinism due to the lack of pigment in the iris and retina allowing more light to enter the eye, **photophobia is not specific** to albinism. - It can be a symptom of various other ocular conditions like uveitis, corneal abrasions, or migraines. *Involuntary eye movements (nystagmus)* - **Nystagmus is frequently associated with albinism** due to foveal hypoplasia and impaired visual development but is **not specific**. - It can also be caused by neurological disorders, inner ear problems, or other ocular conditions. *Decreased visual acuity* - **Reduced vision is a characteristic feature of albinism** resulting from foveal hypoplasia and abnormal optic nerve pathways, but it is **not specific** to the condition. - Numerous eye conditions, such as refractive errors, cataracts, and retinal diseases, can lead to decreased visual acuity.
Question 39: Epithelial xerosis of conjunctiva is caused by?
- A. Xerophthalmia (Correct Answer)
- B. Infectious conjunctivitis caused by Chlamydia trachomatis
- C. Autoimmune blistering conjunctivitis
- D. Bacterial conjunctivitis due to Corynebacterium diphtheriae
Explanation: ***Xerophthalmia*** - **Xerophthalmia** is a medical condition characterized by **dryness of the eye**, often due to **vitamin A deficiency**. - **Epithelial xerosis of the conjunctiva** is one of the early and hallmark signs of xerophthalmia, representing the drying and thickening of the conjunctival epithelium due to goblet cell loss and squamous metaplasia. *Infectious conjunctivitis caused by Chlamydia trachomatis* - This typically causes **trachoma**, characterized by chronic inflammation, scarring, and eventual blindness. - While it can lead to dryness and scarring in later stages due to **symblepharon** or **entropion**, it does not primarily manifest as epithelial xerosis. *Autoimmune blistering conjunctivitis* - This condition involves **immune-mediated inflammation** leading to subepithelial blistering, scarring, and shrinkage of the conjunctiva. - It results in significant **ocular surface damage** and vision loss but is distinct from the primary epithelial changes seen in xerosis due to vitamin A deficiency. *Bacterial conjunctivitis due to Corynebacterium diphtheriae* - **Diphtheritic conjunctivitis** is a severe form of bacterial conjunctivitis that causes a distinctive **"pseudomembrane"** on the conjunctiva. - It leads to acute inflammation and potentially systemic illness, not primarily epithelial xerosis.
Question 40: Snow banking is seen in?
- A. White coat syndrome
- B. Eales syndrome
- C. Diabetic kidney disease
- D. Intermediate uveitis (Correct Answer)
Explanation: ***Intermediate uveitis*** - **Snow banking** refers to the accumulation of inflammatory exudates on the surface of the **pars plana** and **ora serrata**, a characteristic sign of intermediate uveitis. - This condition primarily affects the **vitreous** and peripheral retina, often leading to symptoms like **floaters** and **decreased vision**. *White coat syndrome* - This refers to a phenomenon where a patient's **blood pressure is elevated** in a clinical setting due to anxiety, but is normal outside of the medical environment. - It has no ophthalmic manifestations or association with "snow banking." *Eales syndrome* - This is an idiopathic inflammatory condition primarily affecting the **peripheral retinal vasculature**, leading to **vasculitis**, occlusion, and neovascularization. - While it can cause vitreous hemorrhage, it does not typically present with "snow banking" as a primary feature. *Diabetic kidney disease* - This is a complication of **diabetes mellitus** characterized by damage to the small blood vessels in the kidneys, leading to impaired kidney function. - It is a systemic condition with no direct relationship to ocular "snow banking" or uveitis.