NEET-PG 2017 Practice Questions

Q: The chart shown in the image is:

Snellen's chart. ***Snellen's chart*** - The image displays a series of rows with **optotypes (letters)** that decrease in size, which is characteristic of a **Snellen chart**. - This chart is specifically used to measure **visual acuity** by determining the smallest row of letters a person can read at a specific distance. *Ishihara's chart* - **Ishihara charts** are used to test for **color blindness** and consist of plates with colored dots that form numbers or patterns, which are not depicted in the image. - The chart shown focuses on letter recognition and size differentiation, not color perception. *Farnsworth-Munsell hue test* - The **Farnsworth-Munsell hue test** is used for precise **color discrimination** and involves arranging caps of varying hues in a continuum. - This test is distinct from the letter-based visual acuity chart shown in the image. *Pelli-Robson chart* - The **Pelli-Robson chart** is used to measure **contrast sensitivity**, presenting letters of a constant size but decreasing contrast. - While it uses letters, the chart in the image has letters of decreasing size, indicating a visual acuity test rather than contrast sensitivity.

Q: Identify the stain instilled in the eye in the following image:

Fluorescein stain. ***Fluorescein stain*** - The image shows a **green-yellow fluorescence** under cobalt blue light, which is characteristic of **fluorescein dye** pooling in areas of epithelial defect or healthy tear film. - Fluorescein is a commonly used diagnostic dye in ophthalmology to visualize **corneal abrasions**, ulcers, or contact lens-related issues as it stains damaged corneal epithelial cells. *Rose Bengal stain* - **Rose Bengal** stains devitalized epithelial cells and mucus a **red or purple color**, not green or yellow. - It is particularly useful for identifying **dry eye syndrome** and herpes simplex keratitis but would appear distinctly different from the image. *Lissamine green stain* - **Lissamine green** stains damaged or devitalized conjunctival and corneal cells a **blue-green color**, similar to Rose Bengal. - While it has a greenish hue, it typically does not fluoresce and produces a distinct staining pattern different from the bright, uniform green seen with fluorescein under blue light. *Rhodamine stain* - **Rhodamine** dyes, which are typically **red or pink fluorescent**, are not routinely used as a standard ophthalmic stain for general corneal evaluation. - Its spectral properties and clinical applications are distinct from the common diagnostic dyes used on the ocular surface.

Q: A patient from slum presents with grittiness in eyes. Everted eyelid shows: (Recent NEET Pattern 2016-17)

Trachoma. ***Trachoma*** - The image shows **conjunctival follicles** and **gritty sensation** in a patient from a slum, which are classic signs of Trachoma caused by *Chlamydia trachomatis*. The everted eyelid typically reveals these characteristic follicles. - Trachoma is prevalent in areas with **poor sanitation** and **limited access to water**, consistent with a "slum" setting. *Vernal conjunctivitis* - Characterized by **giant papillae (cobblestone papillae)** on the upper tarsal conjunctiva, often associated with a history of allergies and intense itching. - While it can cause grittiness, the picture does not show the typical giant papillae, but rather smaller, more numerous follicles. *Eales disease* - This is an **idiopathic inflammatory vaso-occlusive disease** affecting the retinal vessels, primarily in young adult males. - It presents with **recurrent vitreous hemorrhages and retinal detachment**, not primarily with conjunctival findings or grittiness. *Phlyctenular keratoconjunctivitis* - Involves the formation of **phlyctenules** (small, nodular lesions) on the conjunctiva or cornea, often associated with delayed hypersensitivity to microbial antigens, such as *Staphylococcus* or *Mycobacterium tuberculosis*. - While it can cause grittiness and photophobia, the follicular pattern in the image is not typical of phlyctenules.

Q: All are causes of the presentation shown below except:

Buphthalmos. ***Buphthalmos*** - **Buphthalmos** refers to congenital glaucoma causing **enlargement of the eyeball** with increased corneal diameter (>12 mm). - Classical features include **corneal edema**, **Haab's striae**, and **increased intraocular pressure**. - Buphthalmos does **NOT cause blue sclera**. The sclera in congenital glaucoma is typically normal in color, though the enlarged globe and corneal changes are prominent. - This is the correct answer as it does not cause the presentation shown (blue sclera). *Marfan syndrome* - **Marfan syndrome** is a genetic disorder affecting **fibrillin-1**, leading to connective tissue abnormalities. - Causes **scleral thinning** resulting in **blue sclera** due to visualization of underlying choroidal pigment. - Other ocular features include **ectopia lentis** (upward lens subluxation), **myopia**, and **retinal detachment**. - Systemic features: aortic root dilation, tall stature, arachnodactyly, pectus deformities. *Ehlers-Danlos syndrome* - A group of inherited connective tissue disorders with **collagen defects** (various types affecting different collagen types). - Causes **blue sclera** due to **scleral thinning** and transparency. - Other features include **skin hyperextensibility**, **joint hypermobility**, **tissue fragility**, and easy bruising. - Ocular complications: keratoconus, retinal detachment, globe rupture with minimal trauma. *High hypermetropia* - While **high hypermetropia** primarily refers to a refractive error with light focusing behind the retina, in the context of this question it likely refers to conditions with **nanophthalmos** (abnormally small eye). - Some forms of **microphthalmos with nanophthalmos** can have associated **scleral thickening or abnormalities** that may give a bluish appearance in rare syndromic cases. - However, this association is tenuous compared to the clear connective tissue disorders listed above.

Q: A 30-year-old school teacher presents with complaints of red eye with photophobia. Ocular findings are shown below. All are true about the condition shown except: (Recent NEET Pattern 2016-17)

Muddy iris. ***Muddy iris*** - A "muddy iris" appearance refers to loss of the normal iris architecture and fine details due to **diffuse iris stromal edema** - This is a characteristic feature of **non-granulomatous (acute) anterior uveitis**, not granulomatous uveitis - The images show **granulomatous anterior uveitis** (evidenced by mutton-fat KPs), where muddy iris is typically **absent** or less prominent - **This is the correct answer** as it is NOT a typical feature of the condition shown *Mutton-fat keratic precipitates* - The left image shows large, greasy-looking deposits on the corneal endothelium - These are characteristic **mutton-fat keratic precipitates (KPs)** composed of macrophages and epithelioid cells - These are **pathognomonic for granulomatous uveitis** and are clearly visible in the condition shown *Dalen-Fuchs nodules* - These are yellowish-white collections of lymphocytes and epithelioid cells between **Bruch's membrane and the RPE** in the peripheral fundus - They are a feature of **granulomatous posterior uveitis**, particularly in **Vogt-Koyanagi-Harada (VKH) disease** and sympathetic ophthalmia - While not visible in these anterior segment images, they **can coexist** in patients with granulomatous panuveitis *Aqueous flare* - The right image (slit lamp beam) shows visible **aqueous flare** - cloudiness in the anterior chamber - This indicates **protein leakage** from breakdown of the blood-aqueous barrier - This is a **direct sign of active inflammation** and is commonly seen in both granulomatous and non-granulomatous uveitis

Q: The given FFA appearance occurs due to accumulation of dye in which of the following layers of retina?

Inner plexiform layer. ***Inner plexiform layer*** - In **cystoid macular edema (CME)**, fluid accumulation occurs in multiple retinal layers, with the **inner plexiform layer** and **inner nuclear layer** being significantly involved. - The characteristic **petaloid (flower-petal) pattern** on fluorescein angiography results from fluid accumulation arranged around the foveal center in a radial pattern. - The **Müller cells**, which span the retina vertically, contribute to the formation of cystoid spaces when their supporting function is disrupted. **Note:** While the **outer plexiform layer (Henle's layer)** is classically described as the primary site of CME in many textbooks due to the radial arrangement of Henle fibers, fluid accumulation also prominently involves the **inner nuclear and inner plexiform layers**, and different imaging modalities and stages of CME may show variable involvement. *Outer plexiform layer* - The outer plexiform layer (also called **Henle's layer** at the macula) is frequently cited as a primary site of fluid accumulation in CME. - The radial arrangement of photoreceptor axons (Henle fibers) in this layer can contribute to the characteristic petaloid pattern. - Modern OCT imaging often shows cystoid spaces involving both outer plexiform and inner nuclear layers. *Ganglion cell layer* - The ganglion cell layer is the most superficial retinal layer containing neuronal cell bodies. - This layer is **not typically involved** in the cystoid fluid accumulation pattern of CME. - Edema here would present differently, potentially obscuring vessels or causing diffuse thickening. *Outer nuclear layer* - The outer nuclear layer contains photoreceptor cell bodies (nuclei of rods and cones). - This layer is **not characteristically involved** in CME's petaloid pattern. - Fluid in this layer is more associated with conditions like **outer retinal edema**, **retinoschisis**, or certain forms of retinal detachment.

Q: A 75-year-old Englishman living in India presents to OPD with complaints of gradual onset painless, progressive blurring of central vision. He says he could earlier drive to the hospital by himself but is not able to do so now. Slit lamp examination is normal. Fundus examination is given below. What is the diagnosis?

Age-related macular degeneration. ***Age-related macular degeneration*** - The patient's age (75 years), gradual painless progressive blurring of **central vision**, and the presence of **drusen** (small yellow deposits) and a **macular hemorrhage** (red spot) on the fundus exam are all characteristic features of wet age-related macular degeneration. - The inability to drive due to vision loss further points to significant central vision impairment, which is a hallmark of AMD, especially the wet form due to **neovascularization** and hemorrhage. *Central serous retinopathy* - Typically affects younger to middle-aged individuals, often associated with stress or corticosteroid use, contrasting with the patient's age. - Characterized by **serous fluid detachment** of the neurosensory retina, not usually significant hemorrhage as seen in the image. *Cystoid macular edema* - Presents with **cyst-like fluid accumulation** within the retina, often leading to a flower petal-like appearance on imaging, which is not depicted in this fundus image. - Can be associated with various conditions like diabetes, retinal vein occlusion, or inflammation, and while it causes central vision loss, the funduscopic appearance here is more consistent with AMD. *Rhegmatogenous retinal detachment* - Usually presents with sudden vision loss, **floaters**, or **flashes of light**, and a "curtain" coming over the vision, which differs from the gradual onset described. - Fundus examination would typically show a detached, billowing retina, often with a retinal tear, not the macular changes with drusen and hemorrhage seen here.

Q: The test shown below is used for the evaluation of

Macular degeneration. ***Macular degeneration*** - The image shown is an **Amsler grid**, a diagnostic tool used to detect **visual disturbances** caused by changes in the retina, especially the macula. - The straight lines appearing wavy or distorted, as seen in the right panel, are characteristic findings in **macular degeneration** or other macular pathologies. - The Amsler grid is the standard screening tool for **age-related macular degeneration (AMD)** and other macular disorders. *Glaucoma* - Glaucoma primarily affects the **optic nerve** and typically causes **peripheral vision loss**, which is not directly assessed by an Amsler grid. - Visual field tests (perimetry) are used for glaucoma diagnosis, not the Amsler grid. *Cataracts* - Cataracts involve **clouding of the lens** of the eye, leading to blurred vision, glare, and difficulty with night vision. - They do not typically cause the **distortion of straight lines** that an Amsler grid helps to detect. *Retinal detachment* - Retinal detachment usually presents with symptoms like flashes of light, **floaters**, or a curtain-like shadow in the vision. - While it can affect vision, the Amsler grid specifically detects **macular distortion**, which is the hallmark of macular pathology rather than peripheral retinal detachment.

Q: A 60-year-old patient during annual check-up had a report of HbA1C of $10 \%$. What does the given fundus examination show?

Proliferative retinopathy. ***Proliferative retinopathy*** - The image shows **neovascularization**, which are new, abnormal blood vessels growing on the surface of the retina or optic disc. This is the hallmark of proliferative retinopathy. - There are also extensive **hard exudates**, retinal hemorrhages, and signs of significant retinal damage consistent with advanced diabetic retinopathy. *Nonproliferative retinopathy* - This stage is characterized by **microaneurysms**, **dot and blot hemorrhages**, hard exudates, and cotton wool spots, but crucially **lacks neovascularization**. - While many features of nonproliferative retinopathy are present (e.g., hemorrhages, exudates), the presence of visible new vessels confirms progression to the proliferative stage. *Neovascularization of the disc* - While **neovascularization of the disc** (NVD) is indeed a feature seen in the image, characterized by the growth of new abnormal vessels on or within one disc diameter of the optic disc, it is a *component* or *sign* of proliferative retinopathy, not the overarching diagnosis. - Proliferative retinopathy encompasses NVD and/or neovascularization elsewhere (NVE), along with other severe changes. *Subhyaloid hemorrhage* - A **subhyaloid hemorrhage** appears as a boat-shaped or D-shaped collection of blood lying beneath the posterior hyaloid face, often obscuring retinal details. - While hemorrhage is present in the image, there is no distinct subhyaloid collection of blood; instead, the picture shows widespread intraretinal and likely preretinal hemorrhages as part of the severe proliferative process.

Q: Which of the following cells in the brain are responsible for handling information regarding ability to read the slide below? (Recent NEET Pattern 2016-17)

Parvocellular cells. ***Parvocellular cells*** - **Parvocellular cells** (P-cells) are responsible for processing detailed visual information, including **color**, **form**, and fine **texture**. Reading the Ishihara test requires the ability to distinguish specific colors and fine patterns. - They have **small receptive fields** and transmit information about high spatial resolution and chromatic detail, crucial for tasks such as reading and recognizing fine visual cues. *Magnocellular cells* - **Magnocellular cells** (M-cells) are primarily involved in detecting **motion** and processing **low-spatial frequency information**, such as global shape and location. - They have **large receptive fields** and are not primarily responsible for detailed color or pattern discrimination needed for reading. *Purkinje cells* - **Purkinje cells** are a type of large, extensively branched neuron located in the **cerebellar cortex**. - Their primary function is motor coordination, balance, and motor learning, not visual processing or reading. *Pyramidal cells* - **Pyramidal cells** are excitatory neurons found in the cerebral cortex and hippocampus, characterized by their pyramidal-shaped cell bodies. - While they are involved in complex cognitive functions, including parts of visual perception, they are not the specific cells in the primary visual pathway responsible for initial processing of fine details and color as required for reading this type of visual test.

Question 1

The chart shown in the image is:

Accepted Answer

Snellen's chart

Answer

Ishihara's chart

Answer

Farnsworth-Munsell hue test

Answer

Pelli-Robson chart

Question 2

Identify the stain instilled in the eye in the following image:

Accepted Answer

Fluorescein stain

Answer

Rose Bengal stain

Answer

Lissamine green stain

Answer

Rhodamine stain

Question 3

A patient from slum presents with grittiness in eyes. Everted eyelid shows: (Recent NEET Pattern 2016-17)

Accepted Answer

Trachoma

Answer

Vernal conjunctivitis

Answer

Eales disease

Answer

Phlyctenular keratoconjunctivitis

Question 4

All are causes of the presentation shown below except:

Accepted Answer

Buphthalmos

Answer

Marfan syndrome

Answer

Ehlers-Danlos syndrome

Answer

High hypermetropia

Question 5

A 30-year-old school teacher presents with complaints of red eye with photophobia. Ocular findings are shown below. All are true about the condition shown except: (Recent NEET Pattern 2016-17)

Accepted Answer

Muddy iris

Answer

Mutton-fat keratic precipitates

Answer

Dalen-Fuchs nodules

Answer

Aqueous flare

Question 6

The given FFA appearance occurs due to accumulation of dye in which of the following layers of retina?

Accepted Answer

Inner plexiform layer

Answer

Outer plexiform layer

Answer

Ganglion cell layer

Answer

Outer nuclear layer

Question 7

A 75-year-old Englishman living in India presents to OPD with complaints of gradual onset painless, progressive blurring of central vision. He says he could earlier drive to the hospital by himself but is not able to do so now. Slit lamp examination is normal. Fundus examination is given below. What is the diagnosis?

Accepted Answer

Age-related macular degeneration

Answer

Central serous retinopathy

Answer

Cystoid macular edema

Answer

Rhegmatogenous retinal detachment

Question 8

The test shown below is used for the evaluation of

Accepted Answer

Macular degeneration

Answer

Glaucoma

Answer

Cataracts

Answer

Retinal detachment

Question 9

A 60-year-old patient during annual check-up had a report of HbA1C of $10 \%$. What does the given fundus examination show?

Accepted Answer

Proliferative retinopathy

Answer

Nonproliferative retinopathy

Answer

Neovascularization of the disc

Answer

Subhyaloid hemorrhage

Question 10

Which of the following cells in the brain are responsible for handling information regarding ability to read the slide below? (Recent NEET Pattern 2016-17)

Accepted Answer

Parvocellular cells

Answer

Magnocellular cells

Answer

Purkinje cells

Answer

Pyramidal cells

NEET-PG 2017

Ophthalmology

Physiology