Ophthalmology
7 questionsA 5-month-old baby is brought by the mother with complaints of the left upper eyelid moving up and down during breastfeeding or thumb sucking, which disappears when the baby is not being fed. What is the most likely diagnosis?
A patient has a history of a flying metallic foreign body injury to the eye. On examination, there is evidence of intraocular metallic foreign body with progressive visual deterioration. Which of the following substances is most likely causing the toxic deposition in ocular tissues?
A patient presents with vision problems and has a history of cataract surgery. OCT finding is shown below. What is the syndrome most likely associated with these findings?
The cover-uncover test is performed to diagnose various eye conditions. Which of the following is not detected by this test?
A 3-year-old child presents with epiphora, and probing reveals a soft block at 7 mm. What is the best treatment option for this condition?
A patient presents with eyelid crusting and a thready sensation between the cornea and lids. What is the most likely diagnosis?
A patient presents with proptosis that increases when bending down. What is the most likely diagnosis?
FMGE 2025 - Ophthalmology FMGE Practice Questions and MCQs
Question 171: A 5-month-old baby is brought by the mother with complaints of the left upper eyelid moving up and down during breastfeeding or thumb sucking, which disappears when the baby is not being fed. What is the most likely diagnosis?
- A. Myasthenia Gravis
- B. 3rd CN palsy
- C. Marcus Gunn Jaw-Winking Syndrome (Correct Answer)
- D. Lagophthalmos
Explanation: ***Marcus Gunn Jaw-Winking Syndrome***- This classic presentation involves **trigemino-oculomotor synkinesis**, where activation of the mandibular division of the **trigeminal nerve (V3)** during sucking or chewing causes involuntary co-contraction of the levator palpebrae superioris muscle (innervated by CN III).- The resulting unilateral ptosis is temporarily relieved (eyelid elevates or 'winks') only during jaw movement, confirming the mechanical synkinetic link.*Lagophthalmos*- This condition describes the **inability to close the eyelids completely**, leading to risk of corneal exposure and drying.- It is usually caused by **facial nerve palsy (CN VII)**, severe proptosis, or scarring, and does not involve intermittent, movement-related eyelid retraction.*Myasthenia Gravis*- Myasthenia gravis causes **fatigable ptosis** and diplopia that typically worsens with sustained muscle use or activity (e.g., end of the day or prolonged crying/sucking), distinguishing it from synkinesis.- Congenital myasthenia involves poor sucking effort and generalized or ocular muscle weakness, but the trigger mechanism is *fatigue*, not specific jaw movement.*3rd CN palsy*- A complete third cranial nerve palsy results in **severe ptosis** (paralysis of the levator palpebrae superioris) and limitations in eye movement (superior, inferior, medial recti, inferior oblique).- Although ptosis occurs, CN III palsy does not explain the *intermittent* and *synkinetic* nature of the eyelid movement linked specifically to mandibular division (V3) activity.
Question 172: A patient has a history of a flying metallic foreign body injury to the eye. On examination, there is evidence of intraocular metallic foreign body with progressive visual deterioration. Which of the following substances is most likely causing the toxic deposition in ocular tissues?
- A. Glass
- B. Iron (Correct Answer)
- C. Aluminum
- D. Wood
Explanation: ***Iron*** - A metallic flying foreign body (often iron-containing) retained in the eye causes **siderosis bulbi**, a condition characterized by toxic **iron deposition** in ocular structures. - Iron ions diffuse from the retained foreign body and deposit in the cornea, lens, iris, and retina, leading to **progressive visual loss** and characteristic findings like rust-brown discoloration of the anterior lens capsule, heterochromia iridis, and retinal toxicity. - Siderosis bulbi is a serious complication requiring urgent removal of the iron-containing foreign body. *Aluminum* - Aluminum foreign bodies can cause **chalcosis** when copper-containing, but pure aluminum is relatively **inert** in the eye. - Aluminum does not cause the same toxic deposition syndrome as iron and is not associated with siderosis bulbi. *Wood* - Wood is an **organic foreign body** that primarily causes severe **inflammatory reactions** and carries a high risk of **endophthalmitis** (intraocular infection). - Wood does not cause metallic ion deposition or the specific toxicity pattern seen in siderosis bulbi. *Glass* - Glass foreign bodies are generally **inert** and well-tolerated in the eye, causing primarily mechanical trauma. - Glass does not leach metallic ions and does not cause toxic chemical deposition like siderosis bulbi.
Question 173: A patient presents with vision problems and has a history of cataract surgery. OCT finding is shown below. What is the syndrome most likely associated with these findings?
- A. Central Serous Retinopathy
- B. Irvine-Gass Syndrome (Correct Answer)
- C. Posner-Schlossman Syndrome
- D. Elschnig Pearls
Explanation: ***Irvine-Gass Syndrome*** - This syndrome is defined as the development of **cystoid macular edema (CME)** after intraocular surgery, most commonly **cataract surgery**, which matches the patient's history. - The Optical Coherence Tomography (OCT) image clearly shows characteristic **intraretinal fluid-filled cysts** and thickening in the macular region, which are hallmark signs of CME. *Posner-Schlossman Syndrome* - This condition, also known as glaucomatocyclitic crisis, involves recurrent episodes of **acute unilateral uveitis** and **high intraocular pressure**. - While inflammation can cause CME, it is not the primary feature, and the diagnosis relies on signs of anterior chamber inflammation and pressure spikes, not postoperative macular changes. *Central Serous Retinopathy* - This condition is characterized by the accumulation of **subretinal fluid**, creating a serous detachment of the neurosensory retina, which appears as a large fluid-filled space under the retina on OCT. - The provided OCT shows **intraretinal cysts**, not subretinal fluid, which is the key differentiating feature from CSR. *Elschnig Pearls* - These are a type of **posterior capsule opacification (PCO)**, a common complication of cataract surgery where residual lens epithelial cells proliferate on the posterior capsule. - PCO causes blurry vision by obstructing the visual axis but is a condition of the lens capsule, not the retina, and would not produce the macular edema seen on this OCT.
Question 174: The cover-uncover test is performed to diagnose various eye conditions. Which of the following is not detected by this test?
- A. Lateral Nystagmus
- B. Manifest Squint
- C. Latent Squint
- D. Amblyopia (Correct Answer)
Explanation: ***Amblyopia*** - Amblyopia, often called a "lazy eye," is a neurodevelopmental disorder characterized by reduced **visual acuity** in one eye, which is not correctable by refractive means alone. - It is diagnosed by assessing vision with tools like a **Snellen chart**, whereas the cover-uncover test is designed to evaluate **ocular alignment** and motor fusion, not sensory function like visual acuity. *Latent Squint* - A latent squint, or **heterophoria**, is a tendency for the eyes to misalign when binocular vision is interrupted, such as when one eye is covered. - The **uncover** portion of the test reveals a phoria, as the eye that was covered will move to re-establish fixation once the occluder is removed. *Manifest Squint* - A manifest squint, or **heterotropia**, is a constant, observable misalignment of one eye. - The **cover test** component identifies a tropia by observing the movement of the uncovered eye; if it moves to take up fixation when the other eye is covered, a manifest squint is present. *Lateral Nystagmus* - **Nystagmus** is an involuntary, rhythmic movement of the eyes. Certain types, like latent nystagmus, become apparent or worsen when one eye is occluded. - The cover-uncover test, by breaking binocular fusion, can elicit or accentuate **latent nystagmus**, making it observable to the examiner.
Question 175: A 3-year-old child presents with epiphora, and probing reveals a soft block at 7 mm. What is the best treatment option for this condition?
- A. External Dacryocystorhinostomy (DCR)
- B. Endonasal Dacryocystorhinostomy (DCR)
- C. Dacryocystectomy
- D. Conjunctivodacryocystorhinostomy (CDCR) (Correct Answer)
Explanation: ***Conjunctivodacryocystorhinostomy (CDCR) / Jones Tube*** - A **soft block** on probing indicates an obstruction within the **canalicular system**, as the probe meets a spongy resistance and cannot enter the lacrimal sac. - **Conjunctivodacryocystorhinostomy (CDCR)**, also known as conjunctival DCR or Jones tube placement, is the surgical procedure that bypasses the obstructed canaliculi by creating a new passage from the conjunctival sac to the nasal cavity with a Jones tube. - In this case, the soft block at 7 mm suggests canalicular obstruction, which cannot be addressed by standard DCR procedures that target nasolacrimal duct obstruction. *Endonasal Dacryocystorhinostomy (DCR)* - This procedure is the treatment of choice for **nasolacrimal duct (NLD) obstruction**, not canalicular obstruction. - NLD obstruction is identified by a **hard stop** during probing, where the probe passes through the canaliculi and contacts the bony lacrimal fossa wall. *External Dacryocystorhinostomy (DCR)* - Like the endonasal approach, external DCR is indicated for **NLD obstruction** (a **hard stop**), which is not the finding in this case. - It involves creating a fistula between the lacrimal sac and nasal mucosa through an external skin incision. *Dacryocystectomy* - This procedure involves the complete removal of the lacrimal sac and is reserved for conditions like **lacrimal sac tumors** or intractable chronic dacryocystitis. - It is a destructive procedure that eliminates the sac as a source of infection but does not resolve the **epiphora** (tearing).
Question 176: A patient presents with eyelid crusting and a thready sensation between the cornea and lids. What is the most likely diagnosis?
- A. Meibomian Gland Dysfunction
- B. Dry Eye Syndrome
- C. Chronic Blepharitis (Correct Answer)
- D. Conjunctivitis
Explanation: ***Chronic Blepharitis***- This condition is characterized by chronic inflammation of the eyelid margins, leading directly to the observed **eyelid crusting** and debris accumulation at the base of the eyelashes. - The **thready sensation** (often described as a foreign body sensation or stringy mucus) is classic, resulting from poor tear film stability and excessive friction between the chronically inflamed lid margin and the ocular surface.*Dry Eye Syndrome*- While it causes a foreign body sensation, primary uncomplicated dry eye syndrome is less typically associated with significant, persistent **eyelid margin crusting**.- Symptoms are primarily due to inadequate aqueous tear production or excessive evaporation, leading to ocular surface damage, often diagnosed using the **Schirmer test** or tear film breakup time.*Meibomian Gland Dysfunction*- MGD is specifically an obstruction or hypersecretion disorder of the meibomian glands, typically manifesting as poor **lipid layer quality** of the tear film.- Key clinical findings include inspissated gland orifices and telangiectasia on the lid margin, rather than the primary presenting complaint being generalized **eyelid crusting** and debris.*Conjunctivitis*- This typically involves generalized **conjunctival injection** (redness) and discharge (watery, purulent, or mucoid) affecting the entire ocular surface.- While it can cause morning crusting (matting), the chronic presentation focused on the lid margin with persistent **thready sensation** is more characteristic of blepharitis than acute or subacute conjunctival inflammation.
Question 177: A patient presents with proptosis that increases when bending down. What is the most likely diagnosis?
- A. Orbital Cellulitis
- B. Orbital Varices (Correct Answer)
- C. Cavernous Sinus Thrombosis
- D. Thyroid Eye Disease
Explanation: ***Orbital Varices***- This condition involves abnormal orbital veins that swell when orbital venous pressure increases, hence the classic finding of worsening proptosis or **intermittent proptosis** upon bending down or performing the **Valsalva maneuver**.- The proptosis is usually non-pulsatile and often unilateral, resulting from passive congestion of the venous malformation.*Thyroid Eye Disease*- Proptosis in **Thyroid Eye Disease** (**Graves' ophthalmopathy**) is typically caused by chronic inflammation and expansion of **extraocular muscles** and orbital fat, making the proptosis constant.- The severity of proptosis is usually stable and does not fluctuate rapidly or dramatically with maneuvers that increase venous pressure.*Cavernous Sinus Thrombosis*- This condition presents acutely with constant, painful, and progressive proptosis accompanied by **ophthalmoplegia** (due to multiple cranial nerve palsies) and systemic signs like high fever and severe headache.- The clinical picture is typically severe and life-threatening, involving signs of inflammation and infection, not positional congestion.*Orbital Cellulitis*- **Orbital cellulitis** is an acute infectious process characterized by constant, painful, and typically unilateral proptosis, along with severe eyelid swelling (*chemosis*) and **systemic symptoms** (fever).- Proptosis in this condition is fixed and progressive, driven by inflammation and pus formation, and not prone to intermittent worsening simply upon bending down.
Pediatrics
1 questionsAn unvaccinated 5-year-old child of a migrant worker family was brought to the casualty with fever and a characteristic skin rash. Upon eye examination, Bitot's spot was seen. What is the appropriate management?
FMGE 2025 - Pediatrics FMGE Practice Questions and MCQs
Question 171: An unvaccinated 5-year-old child of a migrant worker family was brought to the casualty with fever and a characteristic skin rash. Upon eye examination, Bitot's spot was seen. What is the appropriate management?
- A. Only measles vaccine
- B. Institutional Isolation, nutritional management with vitamin A supplement
- C. Give measles vaccine and vitamin A supplement
- D. Isolate and give nutritional supply with vitamin A supplement (Correct Answer)
Explanation: ***Isolate and give nutritional supply with vitamin A supplement*** - The child presents with signs consistent with **active measles infection** (fever, rash, unvaccinated status), necessitating **isolation** (respiratory/droplet precautions) to prevent community spread of this highly contagious disease. - The presence of **Bitot's spot** indicates severe **Vitamin A deficiency**; routine management of measles, particularly with signs of xerophthalmia, requires immediate **high-dose Vitamin A supplementation** to reduce morbidity and mortality, including preventing blindness. *Give measles vaccine and vitamin A supplement* - The **measles vaccine** is a live attenuated vaccine and is absolutely **contraindicated** in a child currently suffering from acute measles infection. - While **Vitamin A supplementation** is correctly identified, the inclusion of the vaccine makes this management plan incorrect and inappropriate. *Institutional Isolation, nutritional management with vitamin A supplement* - This option is clinically very similar to the correct answer; however, the designation of **institutional isolation** (which implies a hospital setting) might not be mandatory for every case compared to emphasizing basic isolation and immediate essential therapy (Vitamin A). - The crucial components—isolation, nutritional support, and **Vitamin A supplementation**—are appropriately listed but slightly less precise than the most commonly cited first-line management steps in the correct option. *Only measles vaccine* - Administering only the **measles vaccine** is inappropriate as it is a live vaccine contraindicated during acute illness and provides no benefit for the current infection. - This option fails to address the critical complication of **Vitamin A deficiency** evident by the **Bitot's spot**, which is an urgent medical priority.
Psychiatry
2 questionsA doctor asked the patient what her age is and she told him that she is married to an older man, and she has 2 kids of 15 and 18 years, and she is 39 years old. What is the disorder present?
A patient was asked a direct question about her age. Instead, she provided excessive and unnecessary details about her marriage and children before eventually answering the question. This is characteristic of which speech pattern?
FMGE 2025 - Psychiatry FMGE Practice Questions and MCQs
Question 171: A doctor asked the patient what her age is and she told him that she is married to an older man, and she has 2 kids of 15 and 18 years, and she is 39 years old. What is the disorder present?
- A. Flight of ideas
- B. Tangentiality
- C. Derailment
- D. Circumstantial speech (Correct Answer)
Explanation: ***Circumstantial speech***- This thought process is characterized by including **excessive, irrelevant details** in the conversation before finally reaching the point or answering the question.- The patient eventually answered the question (age 39) but only after providing unnecessary associated details (married to an older man, kids' ages).*Derailment*- Also known as **loose associations**, this involves a continuous shifting from one subject to another in a way that is illogical or completely unrelated.- In derailment, the main point or question is usually completely lost as the flow moves to an entirely new, unlinked topic.*Flight of ideas*- This involves a rapid, continuous succession of thoughts where the shift between topics is based on **distractibility or recognizable associations** (like rhyming or wordplay).- It is typically characterized by **pressured speech** and is often seen in the manic phase of **Bipolar Disorder**.*Tangentiality*- This speech pattern occurs when the patient responds to a question in an obliquely relevant way but **never provides the actual answer** or reaches the main point.- The thread of conversation moves away from the initial topic (takes a tangent) and does not return, unlike **circumstantial speech**.
Question 172: A patient was asked a direct question about her age. Instead, she provided excessive and unnecessary details about her marriage and children before eventually answering the question. This is characteristic of which speech pattern?
- A. Circumstantial speech (Correct Answer)
- B. Derailment
- C. Flight of ideas
- D. Tangentiality
Explanation: **_Circumstantial speech_** - This pattern is characterized by the inclusion of **excessive, unnecessary details** and parenthetical remarks that delay the completion of a thought or the answer to a question. The speaker eventually returns to the original point or answers the question after a circuitous route, meaning the **goal of the thought is eventually reached**. *Derailment* - Also known as **loose associations**, this refers to a pattern where the speaker shifts topics that are unrelated or connected only remotely and illogically. It represents a significant form of **formal thought disorder**, where the train of thought breaks down, often observed in schizophrenia. *Flight of ideas* - This involves an extremely rapid, pressured speech pattern where the thoughts accelerate and quickly shift from one topic to the next, often connected by **punning, rhyming, or environmental stimuli**. It is a prominent feature of the **manic phase** of bipolar disorder, reflecting accelerated cognitive processing. *Tangentiality* - The speaker moves from the initial thought to another thought that is related but fails to return to the original point or answer the question (**Goal of the thought is never reached**). This differs from circumstantiality because the subject deviates and **never actually answers the direct question** posed by the interviewer.