NEET-PG 2015 - Ophthalmology Practice Questions

Q: Which of the following is NOT a feature of Primary Infantile (Congenital) glaucoma?

Aniridia may be associated. ***Aniridia may be associated*** - **Aniridia** is a congenital absence of the iris that causes **secondary glaucoma**, not primary infantile glaucoma. - Aniridia-associated glaucoma is a distinct entity from primary congenital glaucoma (PCG), which occurs due to isolated developmental abnormalities of the anterior chamber angle. - This is **NOT a feature** of primary infantile glaucoma, making it the correct answer to this negation question. *Treatment includes trabeculotomy* - **Trabeculotomy** or **goniotomy** are the primary surgical treatments for primary infantile glaucoma. - These procedures aim to improve aqueous outflow by incising or opening the trabecular meshwork. - This is a **true feature** of the management of primary infantile glaucoma. *Buphthalmos can occur* - **Buphthalmos** (\"ox eye\") refers to the enlargement of the globe due to elevated intraocular pressure in infants when the sclera is still distensible. - It is a **classic clinical sign** of primary infantile glaucoma, typically occurring before age 3 years. - This is a **characteristic feature** of the condition. *Cornea is typically enlarged and cloudy* - The **cornea becomes enlarged** (increased horizontal corneal diameter >12 mm in newborns) due to stretching from elevated IOP. - **Corneal cloudiness** results from corneal edema and Haab's striae (breaks in Descemet's membrane). - These are **pathognomonic findings** in primary infantile glaucoma.

Q: Which is the most powerful refractive surface of the eye?

Cornea. ***Cornea*** - The **cornea** is the eye's outermost, transparent layer, responsible for approximately **two-thirds of the total refractive power** of the eye due to its highly curved anterior surface and the significant change in refractive index from air to corneal tissue. - Its fixed curvature and consistent refractive index make it the primary and most powerful component in bending light rays to focus them on the retina. *Conjunctiva* - The **conjunctiva** is a thin, translucent mucous membrane that lines the inner surface of the eyelids and covers the anterior sclera (white part of the eye). - Its primary function is protection and lubrication, producing mucus and tears, but it plays **no significant role in light refraction**. *Vitreous* - The **vitreous humor** is a transparent, gel-like substance that fills the space between the lens and the retina, maintaining the eye's shape. - It has a refractive index very similar to water (approximately 1.334) and contributes **minimally to the eye's total refractive power** because light has already been significantly refracted by the cornea and lens before reaching it. *Lens* - The **lens** is a transparent, biconvex structure located behind the iris, providing the remaining **one-third of the eye's refractive power**. - While crucial for **accommodation** (changing focal length to see objects at different distances), its refractive power is less than the cornea's, and its ability to change shape is what makes it unique, not its absolute power.

Q: Pseudopapilledema with tigroid fundus appearance is seen in?

Myopia. ***Myopia*** - **Pseudopapilledema** with a **tigroid fundus** (tessellated or salt-and-pepper appearance) is characteristically observed in high myopia due to the oblique entry of the **optic nerve** into the globe and thinning of the choroid and retinal pigment epithelium. - The pseudopapilledema is caused by the crowding of axons and glial tissue within the optic disc, giving a raised appearance, and is distinct from true papilledema which involves **optic disc edema** due to increased **intracranial pressure**. - The tigroid fundus results from the visibility of underlying **choroidal vessels** through the attenuated retinal pigment epithelium in the stretched, elongated myopic eye. *Hypermetropia* - **Hypermetropia** (farsightedness) typically presents with a small, compact optic disc, but does not exhibit the specific findings of **pseudopapilledema** or tigroid fundus. - This condition is characterized by the eye being too short or the lens having insufficient power, causing light to focus behind the retina. *Astigmatism* - **Astigmatism** is characterized by an **irregularly shaped cornea** or lens, leading to blurred vision at all distances. - While it can cause some distortion, it is not associated with the specific optic disc appearance of **pseudopapilledema** or the fundus changes seen in high myopia. *Presbyopia* - **Presbyopia** is an age-related condition where the eye's natural lens loses its flexibility, making it difficult to focus on **near objects**. - It affects the **accommodative ability** of the eye and does not manifest with any characteristic changes in the optic disc morphology such as **pseudopapilledema** or retinal/choroidal changes.

Q: Posterior staphyloma is seen in which condition?

Myopia. ***Myopia*** - A **posterior staphyloma** is an outward bulging of the posterior sclera and choroid, which is a common complication of **high myopia**. - It occurs due to the excessive elongation of the eyeball in myopic eyes, leading to thinning and weakening of the posterior sclera. *Hypermetropia* - This condition involves the eye being too short or the cornea being too flat, causing light to focus behind the retina, and is not associated with posterior staphyloma. - Hypermetropia is typically associated with **smaller axial length** and doesn't lead to the structural changes that cause staphyloma. *Astigmatism* - Astigmatism results from an **irregular curvature of the cornea or lens**, causing light to focus at multiple points on the retina, leading to blurred vision. - It describes a refractive error related to the shape of the optical surfaces, not an outward bulging of the posterior eye wall. *Presbyopia* - This is an **age-related decline in the eye's ability to focus on near objects** due to hardening of the crystalline lens and weakening of the ciliary muscles. - Presbyopia is a normal aging process of the lens and has no association with the structural changes of the posterior sclera seen in staphyloma.

Q: What is the average axial length of the human eyeball?

24 mm. ***24 mm*** - The **average axial length** of the human eyeball is approximately **24 mm**. - This length is crucial for **emmetropia**, where parallel light rays focus precisely on the retina. *16 mm* - An axial length of **16 mm** would indicate extreme **hyperopia** (farsightedness), as the eyeball would be significantly too short [1]. - This would result in light focusing behind the retina, leading to blurry vision. *20 mm* - An axial length of **20 mm** is still considerably shorter than average, suggesting **significant hyperopia**. - This deviation from the norm would impair visual acuity without corrective lenses. *28 mm* - An axial length of **28 mm** would classify the eye as significantly **myopic** (nearsighted), as the eyeball would be too long [1]. - In this case, light would focus in front of the retina, causing distant objects to appear blurry [1].

Q: What is the most common eye lesion in HIV?

Cotton wool spots. ***Cotton wool spots*** - These are the most common ocular manifestation in HIV-positive individuals, resulting from **ischemic retinal nerve fiber layer damage**. - While not vision-threatening themselves, their presence indicates **microvascular damage** and can be a sign of systemic disease progression. *Kaposi Sarcoma of Lid* - While Kaposi sarcoma can affect the eyelids in HIV patients, it is **not the most common ocular lesion**. - It presents as a **reddish-purple nodule** or plaque and is an indicator of advanced immunosuppression. *CMV Retinitis* - Cytomegalovirus (CMV) retinitis is a significant and **vision-threatening opportunistic infection** in advanced HIV. - However, it occurs in patients with **severe immunosuppression** (low CD4 counts) and is less common overall than cotton wool spots. *Choroiditis* - Choroiditis, an inflammation of the choroid, can occur in HIV patients due to various opportunistic infections or directly from the virus. - It is **less prevalent** than cotton wool spots and typically requires specific etiologies beyond HIV itself.

Q: The most common type of strabismus seen in myopes is?

Intermittent Exotropia. ***Intermittent Exotropia*** - Myopes often employ less **accommodative effort** for near tasks, leading to reduced **accommodative convergence** and an increased tendency for the eyes to drift outwards. - This outward deviation, or **exotropia**, is frequently intermittent, especially during fatigue or inattention. *Intermittent Esotropia* - **Esotropia** is an inward turn of the eye and is typically associated with **hyperopia** due to excessive accommodative effort leading to increased accommodative convergence. - While it can be intermittent, it is not the most common form of strabismus in myopic individuals. *Esotropia hypotropia complex* - This complex involves both an inward deviation (**esotropia**) and a downward deviation (**hypotropia**). - It is not typically seen in healthy myopes and would suggest other underlying **neurological** or **structural abnormalities**. *Exotropia Hypotropia complex* - While **exotropia** can be common in myopes, the additional presence of **hypotropia** (downward deviation) suggests a more complex strabismic picture. - This combination is not the most frequent strabismus seen in uncomplicated myopia and may indicate **cranial nerve palsies** or **orbital anomalies**.

Q: All of the following are complications of traumatic hyphema except which of the following?

Corneal Ulcer. ***Corneal Ulcer*** - A **corneal ulcer** is typically caused by infection, trauma, or exposure keratitis and is not a direct complication of blood in the anterior chamber from a **traumatic hyphema**. - While prolonged elevation of **intraocular pressure** from hyphema could theoretically impair corneal health, a direct ulcer is not a typical or primary complication. *Rebleeding* - **Rebleeding** is a common and serious complication of hyphema, usually occurring 2-7 days after the initial injury. - It often results in a more significant bleed and carries a higher risk of complications such as **elevated intraocular pressure** and **blood staining of the cornea**. *Pupillary Block* - **Pupillary block** can occur if the amount of blood from the hyphema prevents the flow of aqueous humor from the posterior to the anterior chamber. - This blockage leads to a buildup of **aqueous humor** in the posterior chamber, causing the iris to bow forward and potentially precipitating **acute angle-closure glaucoma**. *Posterior synechiae* - **Posterior synechiae** can develop due to inflammation (uveitis) associated with the hyphema, where the iris adheres to the anterior lens capsule. - This complication can lead to **irregular pupil shape**, **pupillary block glaucoma**, or other visual disturbances.

Q: Unilateral frontal blisters with upper lid edema and conjunctivitis is seen in?

Herpes Zoster Ophthalmicus. ***Herpes Zoster Ophthalmicus*** - This condition is characterized by a **unilateral vesicular rash** (blisters) in the **trigeminal dermatome (V1)**, which includes the forehead and upper eyelid, along with significant **lid edema** and **conjunctivitis**. - **Hutchinson's sign** (lesions on the tip, side, or root of the nose) indicates a high risk of ocular involvement due to the nasociliary nerve innervation. *Acanthamoeba Keratitis* - This is an **amoebic infection** of the cornea typically associated with **contact lens wear** and often presents with severe pain and a **ring infiltrate** in the cornea. - It does not typically present with unilateral frontal blisters or significant lid edema. *Herpes Simplex* - Herpes simplex typically causes **recurrent corneal ulcers** (dendritic or geographic) and sometimes blepharitis, but not the widespread **unilateral frontal blisters** seen in the trigeminal distribution. - While it can cause conjunctivitis and lid edema, the pattern of skin lesions is the key differentiator. *Neuroparalytic Keratitis* - This condition results from **trigeminal nerve damage**, leading to corneal anesthesia and subsequent **trophic corneal ulceration**. - It presents primarily with **corneal findings** (epithelial defects, ulcers) due to impaired sensation and tear film stability, not initial vesicular skin lesions or prominent lid edema.

Q: Strabismic amblyopia is more common in patients with:

Constant strabismus. **Constant Strabismus** - In **constant strabismus**, one eye is always deviated, leading to **continuous suppression** of the image from the deviated eye by the brain. - This consistent suppression prevents proper visual development in the deviated eye, resulting in **amblyopia**. *Alternating strabismus* - In **alternating strabismus**, the deviation switches between the two eyes, allowing each eye to take turns fixing. - This alternation helps maintain relatively good visual acuity in both eyes, making **amblyopia less common** or severe. *Latent strabismus* - **Latent strabismus** (phoria) is a deviation that is only present when binocular fusion is disrupted (e.g., when one eye is covered). - Since fusion is typically maintained in daily vision, there is **no constant suppression** of one eye, and amblyopia is rare. *Intermittent strabismus* - **Intermittent strabismus** involves periods of deviation alternating with periods of straight eye alignment, often varying with fatigue or visual tasks. - While it can lead to amblyopia, it is **less common and severe** than with constant strabismus because there are periods when the visual input from both eyes is utilized.

Question 1

Which of the following is NOT a feature of Primary Infantile (Congenital) glaucoma?

Accepted Answer

Aniridia may be associated

Answer

Treatment includes trabeculotomy

Answer

Buphthalmos can occur

Answer

Cornea is typically enlarged and cloudy.

Question 2

Which is the most powerful refractive surface of the eye?

Accepted Answer

Cornea

Answer

Conjunctiva

Answer

Vitreous

Answer

Lens

Question 3

Pseudopapilledema with tigroid fundus appearance is seen in?

Accepted Answer

Myopia

Answer

Astigmatism

Answer

Presbyopia

Answer

Hypermetropia

Question 4

Posterior staphyloma is seen in which condition?

Accepted Answer

Myopia

Answer

Hypermetropia

Answer

Astigmatism

Answer

Presbyopia

Question 5

What is the average axial length of the human eyeball?

Accepted Answer

24 mm

Answer

16 mm

Answer

20 mm

Answer

28 mm

Question 6

What is the most common eye lesion in HIV?

Accepted Answer

Cotton wool spots

Answer

Kaposi Sarcoma of Lid

Answer

CMV Retinitis

Answer

Choroiditis

Question 7

The most common type of strabismus seen in myopes is?

Accepted Answer

Intermittent Exotropia

Answer

Intermittent Esotropia

Answer

Esotropia Hypotropia complex

Answer

Exotropia Hypotropia complex

Question 8

All of the following are complications of traumatic hyphema except which of the following?

Accepted Answer

Corneal Ulcer

Answer

Pupillary Block

Answer

Posterior synechiae

Answer

Rebleeding

Question 9

Unilateral frontal blisters with upper lid edema and conjunctivitis is seen in?

Accepted Answer

Herpes Zoster Ophthalmicus

Answer

Herpes Simplex

Answer

Neuroparalytic Keratitis

Answer

Acanthamoeba Keratitis

Question 10

Strabismic amblyopia is more common in patients with:

Accepted Answer

Constant strabismus

Answer

Alternating strabismus

Answer

Latent strabismus

Answer

Intermittent strabismus

NEET-PG 2015 — Ophthalmology