Primary Eye Care — MCQs
A multivariate analysis was conducted to examine the relationship between risk of developing blindness and age. The results are shown in the table below. Which of the following is true?
All of the following conditions are immediate priorities in the WHO's "Vision -2020: The Right to sight" except:
Which is the commonest cause of ocular morbidity in the community -
You are working in a primary health center (PHC) situated in a high seismic zone. Which of the following actions should you take as part of preparedness for an emergency?
Under NPCB, screening of school children is first done by -
All of the following are the targets for National Programme for Control of Blindness (NPCB), EXCEPT:
Sudden painful loss of vision seen in
The golden period of eye donation is
Vision 2020 "The right to sight" includes all except-
What does the following image show?
Primary Eye Care Indian Medical PG Practice Questions and MCQs
Question 1: A multivariate analysis was conducted to examine the relationship between risk of developing blindness and age. The results are shown in the table below. Which of the following is true?
- A. 60-69 y age group shows statistically significant association with blindness
- B. <50 y age group serves as the reference category
- C. >80 y age group has the strongest association with blindness risk (Correct Answer)
- D. 50-59 y age group has the highest odds ratio for blindness risk
Explanation: ***>80 y age group has the strongest association with blindness risk*** - The odds ratio for the **>80 years** age group is **2.1**, which is the highest among all age groups listed in the table, indicating the strongest association with blindness risk. - A higher odds ratio means a greater likelihood of the outcome (blindness) compared to the reference category. - All age groups shown have **p-values <0.001**, confirming statistical significance. *60-69 y age group shows statistically significant association with blindness* - While the 60-69 y age group has an odds ratio of **1.5** with **p<0.001**, indicating statistical significance, it does not have the strongest association compared to the **>80 y** age group (OR 2.1). - Statistical significance confirms the association is real, but effect size (OR) determines strength of association. *<50 y age group serves as the reference category* - The table shows an **Odds Ratio (OR) of 1.1** for the **<50 y** age group, indicating it is also being compared to a reference (which would have OR = 1.0). - The reference category is not explicitly shown in the table but would typically be an even younger age group or overall population baseline. *50-59 y age group has the highest odds ratio for blindness risk* - The odds ratio for the **50-59 y** age group is **1.2**, which is lower than the **>80 y** age group (OR 2.1), the **70-79 y** age group (OR 1.6), and the **60-69 y** age group (OR 1.5). - This statement is incorrect as the **>80 y** age group clearly has the highest odds ratio for blindness risk.
Question 2: All of the following conditions are immediate priorities in the WHO's "Vision -2020: The Right to sight" except:
- A. Cataract
- B. Epidemic conjunctivitis (Correct Answer)
- C. Onchocerciasis
- D. Trachoma
Explanation: ***Epidemic conjunctivitis*** - While **epidemic conjunctivitis** can cause significant discomfort and temporary vision impairment, it is generally **self-limiting** and rarely leads to permanent blindness. - It was not identified as one of the top five global causes of avoidable blindness targeted by the Vision 2020 initiative. *Cataract* - **Cataract** is the **leading cause of blindness** globally, accounting for approximately half of all cases. - It is a highly treatable condition through surgery, making it a critical priority for Vision 2020. *Onchocerciasis* - Also known as **river blindness**, onchocerciasis is a parasitic disease that causes severe visual impairment and blindness. - It is a significant public health problem in several regions, particularly in Africa, and was a key focus of Vision 2020 due to its widespread impact and the availability of preventive chemotherapy. *Trachoma* - **Trachoma** is the **leading infectious cause of blindness** worldwide, caused by *Chlamydia trachomatis*. - Given its preventable and treatable nature, and its prevalence in many impoverished areas, it was designated as one of the priority diseases under Vision 2020.
Question 3: Which is the commonest cause of ocular morbidity in the community -
- A. Vitamin A deficiency
- B. Ocular injury
- C. Refractive error (Correct Answer)
- D. Cataract
Explanation: ***Refractive error*** - **Uncorrected refractive errors**, such as **myopia**, **hyperopia**, and **astigmatism**, are the most common cause of avoidable visual impairment globally. - While not leading to complete blindness, they significantly reduce quality of life and productivity if not corrected with **spectacles** or **contact lenses**. *Vitamin A deficiency* - This deficiency is a major cause of **preventable childhood blindness** in developing countries. - It primarily leads to **xerophthalmia**, including **night blindness**, **Bitot's spots**, and ultimately **corneal scarring**. *Ocular injury* - **Trauma** to the eye can cause severe and permanent vision loss, especially in certain occupational settings or age groups. - However, the overall prevalence of significant ocular morbidity from injury in the general community is **lower** than that from uncorrected refractive errors. *Cataract* - **Cataracts** are the leading cause of **blindness worldwide**, particularly in older individuals. - While a major cause of visual impairment, it is most often treated with **surgery**, making uncorrected refractive errors a more prevalent cause of *morbidity* in the broader community that often goes undetected or unaddressed.
Question 4: You are working in a primary health center (PHC) situated in a high seismic zone. Which of the following actions should you take as part of preparedness for an emergency?
- A. Ensure all financial and other resources are available for disaster preparedness.
- B. Increase public awareness through campaigns and loudspeakers.
- C. Follow instructions given over the phone or radio by higher officials.
- D. Conduct a simulation for the disaster and assess the response. (Correct Answer)
Explanation: ***Conduct a simulation for the disaster and assess the response.*** - **Simulation exercises** are crucial for testing the effectiveness of a disaster preparedness plan and identifying weaknesses in the response system. - This allows for refinement of protocols, training of personnel, and ensuring that all team members understand their roles during an actual emergency. *Ensure all financial and other resources are available for disaster preparedness.* - While important for effective disaster management, simply "ensuring" resources are available is not an action of preparedness, but rather an **enabling condition**. - This statement focuses on the availability of resources rather than a proactive step to prepare the PHC for an emergency. *Increase public awareness through campaigns and loudspeakers.* - **Public awareness campaigns** are vital for community preparedness, but this action is primarily for the general population and not a specific preparedness action for the PHC itself in terms of its operational readiness. - While a PHC might be involved in public awareness, its core preparedness involves internal actions to ensure its functionality during a disaster. *Follow instructions given over the phone or radio by higher officials.* - This describes a reaction during or immediately before a disaster, rather than a proactive **preparedness measure**. - Relying solely on real-time instructions from higher officials during an emergency without prior planning can lead to delays and inefficiencies.
Question 5: Under NPCB, screening of school children is first done by -
- A. Ophthalmologic assistant
- B. Medical officer
- C. Village health guide
- D. School teachers (Correct Answer)
Explanation: ***School teachers*** - Under the **National Programme for Control of Blindness (NPCB)**, screening of school children follows a **three-tier approach**. - **School teachers** are trained to conduct the **first level/initial screening** using simple vision tests like **Snellen charts**. - They identify children with potential vision problems and refer them for further detailed assessment. - This approach maximizes coverage as teachers have regular contact with children and can screen large numbers efficiently. - The NPCB specifically includes **teacher training modules** for basic vision screening as part of the School Eye Screening Programme. *Ophthalmologic assistant* - Ophthalmic assistants/paramedical workers conduct the **second level screening** - the detailed assessment of children referred by teachers. - They perform comprehensive vision testing and identify specific refractive errors and eye conditions. - They are not the first point of contact in school screening due to resource limitations and the scale of screening required. *Medical officer* - Medical officers and ophthalmologists are involved in the **third tier** - providing diagnosis, treatment, and management of identified cases. - They handle complex cases, prescribe spectacles, and provide surgical interventions when needed. - They also supervise the overall program but do not conduct initial mass screening. *Village health guide* - Village health guides work primarily in community settings for general health promotion and basic healthcare. - While they contribute to community health awareness, they are not specifically involved in the structured school eye screening program under NPCB.
Question 6: All of the following are the targets for National Programme for Control of Blindness (NPCB), EXCEPT:
- A. Development of 50 pediatric ophthalmic units
- B. Increase cataract surgery rate to 450 operations per lakh population
- C. Intraocular lens implantation in more than 80 percent cataract surgery cases
- D. 100% coverage of vitamin A prophylaxis doses from 9 months to 3 years of age (Correct Answer)
Explanation: ***100% coverage of vitamin A prophylaxis doses from 9 months to 3 years of age*** - This objective is typically associated with the **Reproductive and Child Health (RCH) program** and efforts to combat **Vitamin A deficiency**, not directly with the core targets of the National Programme for Control of Blindness (NPCB). - While vitamin A deficiency can lead to blindness, the NPCB's primary focus has historically been on treatable causes of blindness such as **cataract** and **refractive errors**. *Development of 50 pediatric ophthalmic units* - The NPCB aims to **strengthen ophthalmic services**, and the development of specialized pediatric units is a crucial component to address childhood blindness. - This target aligns with the program's focus on **preventing and treating blindness** across all age groups, including children. *Increase cataract surgery rate to 450 operations per lakh population* - **Cataract** is the leading cause of blindness in India, and increasing the **cataract surgery rate** is a key strategic objective of the NPCB to reduce the burden of preventable blindness. - This specific numerical target reflects the program's commitment to **scaling up surgical interventions**. *Intraocular lens implantation in more than 80 percent cataract surgery cases* - The NPCB emphasizes not just the quantity but also the **quality of cataract surgeries** performed. - Promoting **intraocular lens (IOL) implantation** in a high percentage of cases ensures better visual outcomes and rehabilitation for patients.
Question 7: Sudden painful loss of vision seen in
- A. Angle closure glaucoma (Correct Answer)
- B. Endophthalmitis
- C. Acute uveitis
- D. Central retinal artery occlusion
Explanation: ***Angle closure glaucoma*** - This is the **classic presentation** of sudden, painful vision loss in ophthalmology - Characterized by **acute increase in intraocular pressure** (often >40 mmHg) causing severe eye pain, headache, nausea, and vomiting - Vision loss is rapid due to damage to the **optic nerve** and corneal edema - The pain is intense and sharp due to stretching of ocular structures - **Key distinguishing feature**: Mid-dilated fixed pupil, corneal edema, shallow anterior chamber *Endophthalmitis* - Also causes **sudden painful vision loss** and is a sight-threatening emergency - Pain is severe with rapid onset of vision loss, redness, and hypopyon - **Differentiating features**: History of recent ocular surgery, trauma, or intravitreal injection; presence of hypopyon (layered pus in anterior chamber) - While both can present similarly, endophthalmitis typically has **obvious intraocular inflammation** and relevant preceding history *Acute uveitis* - Presents with **ocular pain**, **redness**, **photophobia**, and blurred vision - Vision loss is usually **gradual**, not sudden and complete - Pain is moderate, described as dull aching rather than severe acute pain - Rarely causes sudden severe vision loss unless complicated *Central retinal artery occlusion* - Causes **sudden, painless loss of vision** - this is the key distinguishing feature - Described as "curtain coming down" or sudden blackout of vision - **Absence of pain** differentiates it from acute angle-closure glaucoma - Cherry-red spot on fundoscopy is pathognomonic
Question 8: The golden period of eye donation is
- A. 24 hours
- B. 12 hours
- C. 18 hours
- D. 6 hours (Correct Answer)
Explanation: ***6 hours*** - The **golden period** for eye donation, specifically for the removal of the **cornea**, is ideally within **6 hours** of death. - This timeframe is critical to ensure the **viability and quality** of the corneal tissue for successful transplantation, as cellular degradation begins rapidly after cessation of circulation. *24 hours* - While some tissues can be recovered up to 24 hours post-mortem, the **cornea's viability** for transplantation significantly decreases after the initial 6-hour window. - Beyond 6 hours, the risk of **cellular damage** and reduced graft success rate increases considerably. *12 hours* - A 12-hour window is generally considered too long for optimal **corneal tissue viability**. - While tissue might still be recoverable, the **quality and success rate** of the transplant are significantly lower compared to donation within 6 hours. *18 hours* - An 18-hour period is far beyond the recommended timeframe for **corneal donation**. - At this point, the **cellular integrity** of the cornea is highly compromised, making it unsuitable for transplantation.
Question 9: Vision 2020 "The right to sight" includes all except-
- A. Measles induced blindness (Correct Answer)
- B. Onchocerciasis
- C. Trachoma
- D. Cataract
Explanation: ***Measles induced blindness*** - Vision 2020 primarily targets conditions that are either preventable or treatable with *cost-effective interventions* and contribute significantly to *avoidable blindness*. - While measles can cause blindness, the specific program focuses on a defined list of priority diseases for intervention, and measles-related blindness is generally addressed through broader public health initiatives (vaccination) rather than direct "right to sight" surgical or direct medical interventions for established blindness. *Onchocerciasis* - **Onchocerciasis** (river blindness) is a major focus of Vision 2020 due to its profound impact on sight, particularly in endemic areas. - It is a **preventable** and **treatable** cause of blindness through mass drug administration. *Trachoma* - **Trachoma** is recognized as one of the leading infectious causes of blindness globally and is explicitly targeted by Vision 2020 through the **SAFE strategy** (Surgery, Antibiotics, Facial cleanliness, Environmental improvement). - It is a highly **preventable** and **treatable** condition, fitting the program's objectives. *Cataract* - **Cataract** is the leading cause of blindness worldwide and is highly **treatable** through a relatively simple and cost-effective surgical procedure. - Providing cataract surgery is a cornerstone of the Vision 2020 initiative to restore sight.
Question 10: What does the following image show?
- A. Anterior uveitis
- B. Membranous conjunctivitis
- C. Pannus (Correct Answer)
- D. Pseudomembranous conjunctivitis
Explanation: ***Pannus*** - The image distinctly shows **new blood vessels growing into the cornea** from the limbus, which is characteristic of pannus formation. This vascularization often accompanies chronic inflammation or hypoxia. - This condition is a hallmark of certain ophthalmic diseases, such as **trachoma** or chronic irritation from prolonged **contact lens wear**. *Anterior uveitis* - Anterior uveitis presents with inflammation of the iris and ciliary body, typically causing **ciliary flush**, **miosis**, and cells/flare in the anterior chamber, which are not the primary features shown. - While uveitis can sometimes lead to corneal changes, the prominent **vascularization extending onto the cornea** is not its defining visual characteristic. *Membranous conjunctivitis* - Membranous conjunctivitis is characterized by the formation of a **true membrane on the conjunctiva** that binds tightly to the underlying epithelium, often caused by severe bacterial infections like *Corynebacterium diphtheriae*. - The image does not show a membrane on the conjunctival surface; instead, it highlights **corneal vascularization**. *Pseudomembranous conjunctivitis* - Pseudomembranous conjunctivitis involves a **fibrinous exudate loosely adherent** to the conjunctiva, which can be peeled off without significant bleeding, as seen in adenoviral conjunctivitis. - The findings in the image, specifically **vascular ingrowth into the cornea**, are not consistent with the appearance of a pseudomembrane on the conjunctiva.
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