NEET-PG 2012 - Ophthalmology Practice Questions

Q: Recurrent anterior uveitis with increased intraocular tension is seen in which of the following conditions?

Posner-Schlossman syndrome. ***Posner-Schlossman syndrome*** - Characterized by **recurrent, unilateral, non-granulomatous anterior uveitis** associated with markedly **elevated intraocular pressure (IOP)**. - The condition is also known as **glaucomatocyclitic crisis**, highlighting the episodic inflammation and glaucoma. - Key features include **acute attacks** lasting hours to weeks with **dramatic IOP elevation** (often >40 mmHg). *Foster-Kennedy syndrome* - This syndrome is defined by ipsilateral **optic atrophy**, contralateral **papilledema**, and often **anosmia**, typically due to a frontal lobe tumor. - It does not involve anterior uveitis or primary elevated intraocular tension. - This is a neuro-ophthalmologic syndrome, not an inflammatory ocular condition. *Vogt-Koyanagi-Harada syndrome* - An autoimmune disorder affecting pigmented tissues, leading to **bilateral granulomatous panuveitis**, often with hearing loss, vitiligo, poliosis, and neurological symptoms. - While it involves uveitis, it is typically **bilateral and panuveitis**, not recurrent unilateral anterior uveitis. - IOP may be elevated but not the defining feature with dramatic episodic rises. *Fuchs heterochromic iridocyclitis* - A chronic, **unilateral, low-grade anterior uveitis** with characteristic iris heterochromia. - May have mild IOP elevation but **not recurrent episodic attacks** with marked pressure spikes. - Inflammation is typically **quiet and chronic** rather than acute and recurrent.

Q: What is the most common cause of anterior uveitis?

Idiopathic. ***Idiopathic*** - In a significant proportion of cases of **anterior uveitis**, a specific cause cannot be identified, leading to a diagnosis of idiopathic uveitis. - This highlights the multifactorial nature of the condition, where various triggers or underlying predispositions may not always be evident. *CMV* - **Cytomegalovirus (CMV)** typically causes a **posterior uveitis** or **retinitis**, especially in immunocompromised individuals. - While CMV can rarely cause anterior uveitis, it is not the most common cause. *Toxoplasma* - **Toxoplasmosis** is a frequent cause of **posterior uveitis** or **chorioretinitis**, characterized by focal necrotic lesions in the retina. - It is not a common cause of isolated anterior uveitis, although anterior chamber inflammation can occur secondary to posterior disease. *Ankylosing spondylitis* - **Ankylosing spondylitis** is a well-known systemic condition associated with **acute anterior uveitis**. - However, while a significant association exists, it is not the single most common cause when considering all cases of anterior uveitis, many of which remain idiopathic.

Q: Satellite nodules are typically associated with which of the following conditions?

Fungal corneal ulcer. ***Fungal corneal ulcer*** - **Satellite lesions** (small, isolated infiltrates surrounding a larger central ulcer) are a characteristic feature of **fungal keratitis**, indicating the spread of fungal hyphae. - Unlike bacterial ulcers, fungal ulcers often have a feathery, indistinct margin and can be slow-growing. *Tuberculosis* - Ocular tuberculosis can present with granulomatous inflammation, often involving the uvea or retina, but **satellite nodules** around a corneal ulcer are not typical. - Corneal involvement in tuberculosis is rare and usually manifests as interstitial keratitis or phlyctenular keratitis. *Sarcoidosis* - Ocular sarcoidosis commonly causes **uveitis**, conjunctival nodules, or retinal vasculitis. - While it can cause corneal deposits or band keratopathy, it does not typically present with satellite lesions around a primary corneal ulcer. *Viral ulcer* - Viral corneal ulcers, particularly those caused by **herpes simplex virus**, often present as **dendritic ulcers** or geographic ulcers. - Although epithelial lesions can spread, the distinct **satellite infiltrates** in the stroma seen in fungal infections are not characteristic of viral keratitis.

Q: In which condition is retinal astrocytoma commonly seen?

Tuberous sclerosis. ***Tuberous sclerosis*** - **Retinal astrocytoma**, also known as **retinal astrocytic hamartoma**, is a common ocular manifestation of **tuberous sclerosis complex (TSC)** [1]. - These lesions can appear as **mulberry-like nodules** or flat, whitish patches on the retina. - Found in approximately **40-50% of patients** with tuberous sclerosis. *Sturge weber syndrome* - Characterized by a **port-wine stain (facial nevus flammeus)**, **leptomeningeal angioma**, and **glaucoma**. - Ocular manifestations include **choroidal hemangiomas** and increased episcleral venous pressure. - Does not typically involve **retinal astrocytomas**. *Von Hippel-Lindau syndrome* - Associated with **retinal capillary hemangioblastomas** (vascular tumors) and various tumors in other organs like the kidneys, pancreas, and brain. - This condition involves **vascular tumors** in the retina, not astrocytic tumors. - Important differential as it also presents with retinal lesions. *Neurofibromatosis* - A neurocutaneous syndrome characterized by **café-au-lait spots**, **neurofibromas**, and **Lisch nodules** (iris hamartomas). - Ocular manifestations include **optic nerve gliomas** and iris hamartomas, but **not retinal astrocytomas**. - NF-1 is the most common neurocutaneous syndrome but has different retinal pathology. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1318-1319.

Q: What is the most common cause of intermittent proptosis in adults?

Orbital varix. ***Orbital varix*** - An **orbital varix** is essentially a varicose vein within the orbit, which can cause intermittent proptosis. - Proptosis in an orbital varix is often exacerbated by activities that increase venous pressure, such as **Valsalva maneuvers**, crying, or bending over. *Thyroid ophthalmopathy* - This condition is characterized by **persistent proptosis**, lid retraction, and ophthalmoplegia, rather than intermittent symptoms. - While it can cause proptosis, it typically presents as **constant and progressive** rather than intermittent proptosis that varies with head position or straining. *Neuroblastoma* - This is a **malignant tumor** that primarily affects infants and young children, not typically adults. - Orbital metastasis from neuroblastoma would cause **progressive, constant proptosis** rather than intermittent proptosis. *Retinoblastoma* - **Retinoblastoma** is a malignant tumor of the retina that primarily affects young children, typically under the age of 5. - While it can cause proptosis in advanced stages, it presents as **constant and progressive proptosis** due to tumor growth, not intermittent proptosis.

Q: Foster's Fuchs spots are specifically associated with which condition?

Myopia. ***Myopia*** - **Foster's-Fuchs spots** are a pathognomonic finding in **pathologic myopia**, characterized by subretinal neovascularization and hemorrhage at the macula. - This condition is associated with high degrees of **myopia** (nearsightedness), leading to thinning and stretching of the retina and choroid. - The spots represent **pigmented scars** from resolved choroidal neovascular membrane hemorrhages. *Hypermetropia* - **Hypermetropia** (farsightedness) does not typically lead to Foster's-Fuchs spots; these spots are specific to the degenerative changes seen in high myopia. - Ocular complications in hypermetropia are different and may include **angle-closure glaucoma** or **accommodative esotropia**. *Astigmatism* - **Astigmatism** is an optical defect where the eye fails to focus light equally on the entire retina, causing blurred vision at any distance. - It is not associated with the development of **Foster's-Fuchs spots**, which are a specific macular degeneration seen in myopia. *Presbyopia* - **Presbyopia** is the age-related loss of accommodation due to decreased lens elasticity. - It is a physiological change and is not associated with **Foster's-Fuchs spots** or the structural changes seen in pathologic myopia.

Q: Corneal endothelial cell count is measured by?

Specular microscope. ***Specular microscope*** - A **specular microscope** is specifically designed to provide a high-magnification, non-contact view of the **corneal endothelium**, allowing for direct visualization and counting of endothelial cells. - It measures cell density, morphology, and polymegethism, which are crucial for assessing corneal health, especially before and after intraocular surgeries. *Ophthalmoscope* - An **ophthalmoscope** is used to examine the **fundus** or the back of the eye, including the retina, optic disc, macula, and blood vessels. - It does not have the magnification capabilities required to visualize or count individual corneal endothelial cells. *Synoptophore* - A **synoptophore** is an instrument used to diagnose and treat **strabismus** (eye misalignment) and to assess **binocular vision**. - Its function involves showing different images to each eye to test fusion, suppression, and stereopsis, unrelated to corneal cell count. *Amsler's grid* - **Amsler's grid** is a diagnostic tool used to detect **macular degeneration** and other retinal diseases that affect central vision. - It consists of a grid of straight lines and helps identify distortion or missing areas in the patient's central visual field.

Q: What condition is characterized by a salt and pepper fundus appearance in the retina?

Congenital syphilis. ***Congenital syphilis*** - The **"salt and pepper" fundus** appearance is a classic ophthalmologic finding in congenital syphilis, resulting from diffuse pigmentary retinopathy. - This condition is caused by widespread pigmentary changes in the retina, affecting both the retinal pigment epithelium and neurosensory retina. - It represents chronic, bilateral, and symmetric chorioretinitis that is pathognomonic for congenital syphilis. *Congenital toxoplasmosis* - While it can cause chorioretinitis, congenital toxoplasmosis typically presents with **focal, destructive lesions** rather than diffuse "salt and pepper" pigmentary changes. - Classic ocular lesions are often described as a **"headlight in the fog"** or inactive, pigmented chorioretinal scars. *Congenital histoplasmosis* - Ocular histoplasmosis syndrome (OHS) is usually acquired, not congenital, and causes **discrete chorioretinal scars** ("histo spots") often in the macula or peripapillary region. - It does not result in a diffuse **"salt and pepper" fundus** appearance. *Congenital rubella* - Congenital rubella syndrome can cause pigmentary retinopathy, but the pattern is typically **patchy or mottled** rather than the classic "salt and pepper" appearance. - Other ocular findings include cataract, microphthalmos, and glaucoma.

Q: What condition is characterized by cherry red spot at the macula with retinal whitening?

CRAO. ***CRAO*** - **Central retinal artery occlusion (CRAO)** is characterized by **sudden, profound, painless monocular vision loss**. - The classic funduscopic finding is a **cherry-red spot at the macula** with diffuse **retinal whitening** due to ischemia. *CRVO* - **Central retinal vein occlusion (CRVO)** presents with **painless vision loss** but typically shows **hemorrhages**, **dilated tortuous veins**, and **cotton wool spots** on funduscopic exam. - It does not usually cause retinal whitening or a cherry-red spot. *Diabetic retinopathy* - **Diabetic retinopathy** is characterized by **microaneurysms**, **hemorrhages**, **hard exudates**, and **cotton wool spots**, and can lead to neovascularization. - It does not present with acute retinal whitening or a cherry-red spot in the macula. *Syphilitic retinopathy* - **Syphilitic retinopathy** can cause a variety of presentations, including **retinal vasculitis**, **chorioretinitis**, and **optic neuritis**. - It does not typically manifest as a cherry-red spot with diffuse retinal whitening at the macula.

Q: Which type of congenital cataract is commonly associated with significant visual defects?

Nuclear cataract. ***Nuclear cataract*** - It involves the **nucleus** of the lens, which is the central and most visually critical part. - This type of cataract can cause **significant visual impairment** due to its central location and density, impacting early visual development. *Punctate Cataract* - These are **small, dot-like opacities** that are usually clinically insignificant and do not typically cause significant visual defects. - They are often **peripheral** or very fine, thus not obstructing the central visual axis. *Blue dot cataract* - Also known as **cerulean cataract**, this type consists of small, bluish opacities in the lens cortex. - While congenital, it often has **minimal impact on vision** and is frequently observed incidentally. *Fusiform cataract* - This cataract forms in the shape of a **spindle or needle**, usually along the visual axis. - While it can sometimes cause minor visual compromise, its impact is generally **less severe** compared to a dense nuclear cataract.

Question 1

Recurrent anterior uveitis with increased intraocular tension is seen in which of the following conditions?

Accepted Answer

Posner-Schlossman syndrome

Answer

Foster-Kennedy syndrome

Answer

Vogt-Koyanagi-Harada syndrome

Answer

Fuchs heterochromic iridocyclitis

Question 2

What is the most common cause of anterior uveitis?

Accepted Answer

Idiopathic

Answer

CMV

Answer

Toxoplasma

Answer

Ankylosing spondylitis

Question 3

Satellite nodules are typically associated with which of the following conditions?

Accepted Answer

Fungal corneal ulcer

Answer

Tuberculosis

Answer

Sarcoidosis

Answer

Viral ulcer

Question 4

In which condition is retinal astrocytoma commonly seen?

Accepted Answer

Tuberous sclerosis

Answer

Sturge weber syndrome

Answer

Von Hippel-Lindau syndrome

Answer

Neurofibromatosis

Question 5

What is the most common cause of intermittent proptosis in adults?

Accepted Answer

Orbital varix

Answer

Thyroid ophthalmopathy

Answer

Neuroblastoma

Answer

Retinoblastoma

Question 6

Foster's Fuchs spots are specifically associated with which condition?

Accepted Answer

Myopia

Answer

Astigmatism

Answer

Hypermetropia

Answer

Presbyopia

Question 7

Corneal endothelial cell count is measured by?

Accepted Answer

Specular microscope

Answer

Ophthalmoscope

Answer

Synoptophore

Answer

Amsler's grid

Question 8

What condition is characterized by a salt and pepper fundus appearance in the retina?

Accepted Answer

Congenital syphilis

Answer

Congenital rubella

Answer

Congenital toxoplasmosis

Answer

Congenital histoplasmosis

Question 9

What condition is characterized by cherry red spot at the macula with retinal whitening?

Accepted Answer

CRAO

Answer

CRVO

Answer

Diabetic retinopathy

Answer

Syphilitic retinopathy

Question 10

Which type of congenital cataract is commonly associated with significant visual defects?

Accepted Answer

Nuclear cataract

Answer

Punctate Cataract

Answer

Blue dot cataract

Answer

Fusiform cataract

NEET-PG 2012 — Ophthalmology