FMGE 2023 - Ophthalmology PYQs Practice Questions

Q: Following cataract surgery, a patient comes with complaints of decreased visual acuity. On examination, posterior capsular opacification is seen. What type of laser can be used to treat this condition?

Nd YAG laser. ***Nd YAG laser*** - The **Nd YAG laser** (Neodymium-doped Yttrium Aluminum Garnet) is the gold standard for treating **Posterior Capsular Opacification (PCO)**, which causes secondary visual decline after cataract extraction. - It employs **photodisruption** (a non-thermal process creating plasma) to precisely cut an opening in the opacified posterior capsule, restoring the visual axis (YAG capsulotomy). *Femto laser* - The **Femtosecond laser** is commonly used for creating the corneal flap in **LASIK** or performing certain steps (**capsulotomy**, lens fragmentation) during primary cataract surgery. - It is not typically used for the treatment of *established* PCO as the **Nd YAG** laser procedure is faster, more efficient, and specifically designed for posterior capsule cutting. *Argon fluoride* - **Argon fluoride** is the emission medium for the **Excimer laser**, which operates in the ultraviolet spectrum. - The primary application of the Excimer laser in ophthalmology is **photoablation** of corneal tissue for refractive surgery (e.g., **PRK** and **LASIK**). *Argon* - The **Argon laser** is a thermal laser used primarily for **photocoagulation** in retinal conditions, such as treating **diabetic retinopathy** or performing peripheral iridotomy. - It is unsuitable for PCO treatment because its thermal mechanism would cause unnecessary heat damage to surrounding structures, unlike the non-thermal **photodisruption** of the Nd YAG laser. [Practice more Ophthalmology PYQs on OnCourse]

Q: Which of the following is the right lateral rectus yoke muscle?

Left medial rectus. ***Left medial rectus***- The **yoke muscle** concept is based on **Hering's Law of Equal Innervation**, which requires equal stimulation for the muscle pair responsible for parallel movement in both eyes.- When the **right lateral rectus** abducts the right eye during gaze to the right (**dextroversion**), the **left medial rectus** must simultaneously adduct the left eye to maintain conjugate gaze [1]. *Right superior oblique*- This muscle primarily causes **intorsion** and depression of the right eye, and is not involved in primary lateral movements [1].- It acts conjugately with the **Left Inferior Rectus** when the gaze is directed down and to the right. *Left lateral rectus*- This muscle is responsible for **abduction of the left eye**, which contributes to gaze to the **left (levoversion)** [1].- It is the yoke muscle for the **Right medial rectus**. *Right medial rectus*- This muscle is the **antagonist** of the right lateral rectus, responsible for adduction of the right eye [1].- It works with the left lateral rectus when moving the gaze to the **left (levoversion)**. [Practice more Ophthalmology PYQs on OnCourse]

Q: A 3-year-old child has amblyopia in the right eye. What is the preferred treatment for this child?

Occlusion Therapy. ***Occlusion Therapy*** - This is the **cornerstone treatment** for functional amblyopia in children aged 3 to 7, as the visual system remains plastic and responsive to stimulation during this critical period. - It involves **patching the better-seeing eye** for designated periods to force the use and subsequent strengthening of vision in the amblyopic eye. - Occlusion therapy is most effective when combined with appropriate refractive correction if needed. *Observation* - Amblyopia is a **developmental disorder** requiring timely intervention during the critical period (before age 7-9) to prevent permanent visual loss. - Observation alone will result in **cortical suppression** becoming irreversible, leading to poor long-term visual acuity. - Active treatment is essential; the condition will not resolve spontaneously. *Spectacles with near addition* - **Refractive correction** (spectacles) is an essential adjunct when refractive errors (hyperopia, astigmatism, anisometropia) contribute to amblyopia, but **occlusion therapy remains the primary treatment** for established amblyopia. - Near addition (bifocals) is primarily used to treat **accommodative esotropia**, not as primary amblyopia therapy. - Spectacles alone are insufficient to reverse cortical suppression in functional amblyopia. *Radial keratotomy* - This is an **outdated refractive surgical technique** involving corneal incisions to correct myopia in adults. - It is **absolutely contraindicated** and medically inappropriate for treating amblyopia or refractive errors in a 3-year-old child. - Modern pediatric amblyopia management relies on non-surgical approaches during the critical visual development period. [Practice more Ophthalmology PYQs on OnCourse]

Q: A 70-year-old patient who has been using presbyopia glasses for the past few years can now read the newspaper comfortably without the glasses. What is the most likely diagnosis?

Index myopia. ***Index myopia*** - This classic phenomenon, often referred to as **"second sight,"** is caused by an increase in the refractive index of the crystalline lens nucleus due to early **nuclear sclerosis** (a type of cataract). - The change in refractive index leads to an acquired **myopic shift**, which effectively compensates for the patient's existing **presbyopia**, allowing near vision without reading glasses. *Index hypermetropia* - **Index hypermetropia** (a hyperopic shift) would significantly worsen the patient's near vision, making it even more difficult to read without correction. - It is typically associated with a decrease in the refractive index of the lens, sometimes seen in **cortical cataracts** or in highly unstable blood sugar levels (uncontrolled diabetes). *Regression of presbyopia* - **Presbyopia** is an irreversible, age-related process caused by the progressive hardening of the lens and loss of accommodative power. - A genuine biological **regression** of presbyopia does not occur; the apparent improvement in near vision is always attributable to an index shift toward **myopia**. *None of the above* - This option is incorrect because the sudden improvement in near vision in an elderly patient previously requiring reading glasses is a highly specific clinical sign of **index myopia** due to evolving **nuclear cataract**. [Practice more Ophthalmology PYQs on OnCourse]

Q: A patient presents to you with pain and redness in the right eye following an injury during welding. On examination, the following is observed. Which of the following is the appropriate next step in managing this patient? ![img-12.jpeg](img-12.jpeg)

Removal by 26G needle. ***Removal by 26G needle*** - The image shows a superficial **corneal foreign body**, a common injury in welders. The definitive initial management is the physical removal of the object. - This procedure is typically performed under topical anesthesia using a slit lamp for magnification, with a fine instrument like a sterile **26-gauge needle** or a foreign body spud to gently lift the object from the cornea. *Steroids and antibiotics* - While topical antibiotics are often prescribed *after* the foreign body is removed to prevent infection, they do not address the primary problem, which is the object itself. - The use of **steroids** is generally contraindicated in the presence of a corneal epithelial defect as they can impede healing and increase the risk of a secondary infection, particularly fungal keratitis. *Surgical exploration* - Surgical exploration in an operating room is indicated for suspected **penetrating ocular injuries** or an **intraocular foreign body**, where the object has perforated the globe. - The foreign body in the image appears superficial and is not indicative of a full-thickness injury that would necessitate invasive surgical exploration. *Keratoplasty* - **Keratoplasty**, or a corneal transplant, is a major surgical procedure reserved for severe corneal scarring, opacity, or structural damage that significantly impairs vision. - This is an entirely inappropriate and excessive treatment for a small, superficial foreign body that can be removed with a minimally invasive office-based procedure. [Practice more Ophthalmology PYQs on OnCourse]

Question 1

Following cataract surgery, a patient comes with complaints of decreased visual acuity. On examination, posterior capsular opacification is seen. What type of laser can be used to treat this condition?

Accepted Answer

Nd YAG laser

Answer

Argon

Answer

Argon fluoride

Answer

Femto laser

Question 2

Which of the following is the right lateral rectus yoke muscle?

Accepted Answer

Left medial rectus

Answer

Right superior oblique

Answer

Right medial rectus

Answer

Left lateral rectus

Question 3

A 3-year-old child has amblyopia in the right eye. What is the preferred treatment for this child?

Accepted Answer

Occlusion Therapy

Answer

Radial keratotomy

Answer

Observation

Answer

Spectacles with near addition

Question 4

A 70-year-old patient who has been using presbyopia glasses for the past few years can now read the newspaper comfortably without the glasses. What is the most likely diagnosis?

Accepted Answer

Index myopia

Answer

Index hypermetropia

Answer

Regression of presbyopia

Answer

None of the above

Question 5

A patient presents to you with pain and redness in the right eye following an injury during welding. On examination, the following is observed. Which of the following is the appropriate next step in managing this patient? ![img-12.jpeg](img-12.jpeg)

Accepted Answer

Removal by 26G needle

Answer

Keratoplasty

Answer

Steroids and antibiotics

Answer

Surgical exploration

Question 6

Fundoscopy findings are shown in the image below. What is the most likely diagnosis? ![img-41.jpeg](img-41.jpeg)

Accepted Answer

CRAO

Answer

Diabetic retinopathy

Answer

CRVO

Answer

Cystoid macular edema

Question 7

Fundoscopy findings are shown in the image below. What is the most likely diagnosis?

Accepted Answer

CRAO

Answer

CRVO

Answer

Cystoid macular edema

Answer

Diabetic retinopathy

FMGE 2023 — Ophthalmology