NEET-PG 2012 - Ophthalmology Practice Questions

Q: What is the most common complication of pars planitis?

Cataract (clouding of the lens). **Cataract (clouding of the lens)** - **Cataract formation** is the most common ocular complication in patients with pars planitis, often due to chronic inflammation or steroid use. - The inflammation can disrupt lens metabolism, leading to **opacification** over time. *Retinal detachment (separation of retina)* - While possible, **retinal detachment** is a less common complication of pars planitis compared to cataract formation. - It can occur in severe cases, often due to vitreous traction on fragile peripheral retina or tears associated with **snowbanking**. *Cystoid macular edema (swelling of central retina)* - **Cystoid macular edema (CME)** is a significant cause of vision loss in pars planitis but is not the most frequent complication overall. - It results from the inflammatory compromise of the blood-retinal barrier, leading to fluid accumulation in the **macula**. *Glaucoma (increased intraocular pressure)* - **Glaucoma** can occur in pars planitis, often secondary to chronic inflammation affecting the **trabecular meshwork** or prolonged steroid use. - However, it is less common than cataracts and CME as a primary complication.

Q: What is the most common orbital tumor in children?

Hemangioma. ***Hemangioma*** - **Capillary hemangioma** is the **most common benign orbital tumor/mass** in children, typically presenting in the first few months of life. - It is characterized by **rapid growth during the first year**, followed by **spontaneous involution** (usually complete by age 5-7 years). - These lesions are composed of rapidly proliferating endothelial cells and can cause **proptosis, ptosis**, and, if large, **amblyopia** due to visual axis obstruction or induced astigmatism. - Management is often conservative (observation) unless vision-threatening, in which case systemic steroids or propranolol may be used. *Nerve sheath tumor* - **Optic nerve sheath meningiomas** and **schwannomas** are rare in children, typically presenting in older adults. - While they can cause visual impairment and proptosis, their incidence in the pediatric population is significantly lower than hemangiomas. *Lymphoma* - **Orbital lymphoma** is exceedingly rare in children and is typically a tumor of adulthood, often associated with systemic lymphoma. - When it does occur in children, it might be a manifestation of a more widespread lymphoproliferative disorder. *Meningioma* - **Meningiomas** generally arise from arachnoid cap cells and are less common in children than in adults. - In children, they are more often associated with **neurofibromatosis type 2** and tend to be more aggressive.

Q: Which virus is most commonly associated with disciform keratitis?

Herpes Simplex Virus (HSV). ***Herpes Simplex Virus (HSV)*** - **HSV** is the most common cause of **infectious disciform keratitis**, often following a primary ocular HSV infection or reactivation. - Disciform keratitis caused by HSV is a form of **immune-mediated stromal keratitis**, characterized by corneal edema, inflammation, and potential vision loss. *Rubella Virus* - While Rubella can cause ocular manifestations, such as **congenital cataracts** and **glaucoma** in infants, it is not typically associated with disciform keratitis in adults or children. - **Congenital rubella syndrome** is the primary context for ophthalmic issues related to this virus. *Human Immunodeficiency Virus (HIV)* - HIV can lead to various ocular complications, such as **CMV retinitis**, **Kaposi's sarcoma** of the conjunctiva, and **HIV retinopathy**. - However, HIV itself is **not directly linked** to disciform keratitis. *Hepatitis B Virus (HBV)* - HBV infection primarily affects the **liver** and is not commonly associated with direct ocular infections like keratitis. - Ocular manifestations are rare and often nonspecific, mainly related to systemic immune responses rather than direct viral replication in the eye.

Q: Which of the following statements is false about phacolytic glaucoma?

Primarily caused by iris-lens contact. ***Primarily caused by iris-lens contact*** - This statement is **FALSE** because **phacolytic glaucoma** is caused by the leakage of **lens proteins** from a **hypermature cataract** into the **anterior chamber**, not by iris-lens contact. - **Iris-lens contact** is the mechanism in **pupillary block glaucoma** and **acute angle-closure glaucoma**, not in phacolytic glaucoma. - The pathophysiology involves **macrophages** engulfing leaked lens proteins and obstructing the **trabecular meshwork**. *Open angle glaucoma* - This statement is true because **phacolytic glaucoma** is definitively an **open-angle glaucoma**. - It involves obstruction of the **trabecular meshwork** by **macrophages** laden with **lens proteins**, which is an open-angle mechanism. - The angle remains anatomically open but functionally blocked. *Seen in hypermature stage of cataract* - This statement is true because **phacolytic glaucoma** develops when the **lens capsule** of a **hypermature (Morgagnian) cataract** becomes permeable. - This permeability allows **high-molecular-weight lens proteins** to leak into the **aqueous humor**. *Lens induced glaucoma* - This statement is true as **phacolytic glaucoma** is a specific type of **lens-induced glaucoma**, arising from the toxic effects of **leaked lens material**. - Other forms of **lens-induced glaucoma** include **phacomorphic glaucoma**, **lens-particle glaucoma**, and **phacoanaphylactic glaucoma**.

Q: What is the term for the fusion of the palpebral and bulbar conjunctiva?

Symblepharon. ***Symblepharon*** - **Symblepharon** is the term for the adhesion between the **palpebral conjunctiva** (lining the eyelid) and the **bulbar conjunctiva** (covering the eyeball). - This condition can limit eye movement and cause chronic irritation, often resulting from severe conjunctival inflammation or injury. *Trichiasis (inward growth of eyelashes)* - **Trichiasis** refers to the misdirection of eyelashes such that they rub against the cornea or conjunctiva. - It causes irritation, foreign body sensation, and can lead to corneal abrasion, but it does not involve fusion of conjunctival layers. *Ectropion (outward turning of eyelid)* - **Ectropion** is a condition where the lower eyelid turns outward or sags away from the eyeball. - This exposes the conjunctiva, causing dryness, irritation, and epiphora (excessive tearing), but it is not a fusion of conjunctival tissues. *Tylosis (thickening of skin on palms and soles)* - **Tylosis** is a medical term referring to diffuse **hyperkeratosis** or thickening of the skin, typically observed on the palms and soles. - This condition is completely unrelated to the conjunctiva or eye structures.

Q: In the context of homocystinuria, which direction does the lens typically subluxate?

Inferonasal. ***Inferonasal*** - In **homocystinuria**, the **ectopia lentis** (lens subluxation) often occurs due to weakening of the **zonular fibers**. - The classic direction for lens subluxation in homocystinuria is **inferior and nasal**. *Inferotemporal* - While lens subluxation can occur in various directions, **inferotemporal** is not the classic or most common presentation in homocystinuria. - This direction is less specific and does not strongly point to homocystinuria as the underlying cause. *Superonasal* - **Superonasal** dislocation of the lens is more characteristic of **Marfan syndrome**, which is important to differentiate from homocystinuria. - This direction helps distinguish different causes of lens ectopia. *Superotemporal* - **Superotemporal** lens subluxation is the hallmark of **Marfan syndrome**, a genetic connective tissue disorder. - This specific finding is crucial for differential diagnosis in patients presenting with lens ectopia.

Q: Bilateral ptosis is seen in all except which of the following?

Hyperthyroidism (Graves' disease). ***Hyperthyroidism (Graves' disease)*** - **Hyperthyroidism** causes eyelid retraction, leading to a **stare** or **lid lag**, rather than **ptosis**. - **Graves' ophthalmopathy** can cause proptosis (bulging eyes) and conjunctival injection, but does not typically manifest as ptosis. *Congenital* - **Congenital ptosis** is often present at birth due to improper development of the **levator palpebrae superioris muscle**. - It can be **bilateral** and is usually isolated, without other systemic symptoms. *Trauma* - **Traumatic ptosis** can occur if the **levator muscle**, **aponeurosis**, or **third cranial nerve** is damaged. - This can be **bilateral** depending on the nature and extent of the head trauma. *Myotonic dystrophy* - **Myotonic dystrophy** is a **hereditary muscle disorder** characterized by progressive muscle weakness. - **Bilateral ptosis** is a very common early sign of **myotonic dystrophy**, often accompanied by **facial weakness** and **myotonia**.

Q: Metamorphopsia is seen in?

Posterior uveitis. ***Posterior uveitis*** - **Metamorphopsia**, or the perception of distorted images, can occur in **posterior uveitis** due to inflammation affecting the **retina** or **choroid**, leading to retinal edema or detachment. - Inflammatory processes in the posterior segment can cause disruption of photoreceptor alignment and function, altering the perception of straight lines and object shapes. *Anterior uveitis* - Primarily affects the **iris** and **ciliary body**, causing symptoms like **pain**, **photophobia**, **redness**, and reduced vision due to cellular exudates in the anterior chamber. - While vision can be affected, **metamorphopsia** is not a typical hallmark of anterior uveitis, as the retinal architecture is generally preserved. *Cataract* - Involves **clouding of the eye's natural lens**, leading to blurred vision, glare, and dullness of colors. - It does not cause **metamorphopsia** because the retinal structure and its perception of shapes remain intact; the distortion is primarily visual clarity, not shape. *Glaucoma* - Characterized by **progressive optic nerve damage** and visual field loss, often associated with elevated intraocular pressure. - While it causes vision impairment, typically starting with **peripheral vision loss**, it does not cause **metamorphopsia**, as the retina itself is usually not distorted.

Q: Jack in box scotoma is seen after correction of Aphakia by?

Spectacles. ***Spectacles*** - **Jack-in-the-box scotoma** describes a visual phenomenon where objects appear to jump into and out of the field of vision. This occurs due to the **peripheral scotoma** and **ring scotoma** created by high-plus aphakic spectacle lenses. - Aphakic spectacles cause significant **magnification of the central visual field** (about 25-30%) and a corresponding minification/displacement of the peripheral field, leading to areas where objects are transiently obscured or reappear. *IOL* - An **intraocular lens (IOL)** replaces the natural lens within the eye, providing a much more stable and centered optical correction. - IOLs generally do not cause significant magnification changes or the peripheral scotoma associated with aphakic spectacles. *Contact lens* - **Contact lenses** sit directly on the cornea, offering a visual correction that is much closer to the nodal point of the eye than spectacles. - This placement results in less peripheral distortion and magnification compared to spectacles, making jack-in-the-box scotoma unlikely. *None of the options* - As **aphakic spectacles** are known to cause jack-in-the-box scotoma, this option is incorrect.

Q: Which type of cataract is associated with the phenomenon known as 'second sight'?

Nuclear cataract. ***Nuclear cataract*** - A nuclear cataract causes the lens to become more **myopic** or nearsighted due to an increase in its **refractive index**. - This temporary increase in nearsightedness can allow elderly individuals who previously needed reading glasses (due to presbyopia) to read without them, a phenomenon known as "**second sight**." *Cortical cataract* - Cortical cataracts primarily affect the **outer layer or cortex** of the lens, appearing as spokes or wedges radiating from the periphery. - They tend to cause **glare** and **reduced peripheral vision**, but generally do not improve near vision. *Zonular cataract* - A zonular cataract is a **congenital type of cataract**, characterized by opacity in specific layers (lamellae) of the lens, often in the fetal nucleus. - It does not typically lead to the "second sight" phenomenon, as it is present from birth and affects vision differently. *Punctate cataract* - Punctate cataracts are small, **dot-like opacities** scattered throughout the lens, often considered benign. - They are usually **incidental findings** and rarely cause significant visual disturbances or "second sight."

Question 1

What is the most common complication of pars planitis?

Accepted Answer

Cataract (clouding of the lens)

Answer

Retinal detachment (separation of retina)

Answer

Cystoid macular edema (swelling of central retina)

Answer

Glaucoma (increased intraocular pressure)

Question 2

What is the most common orbital tumor in children?

Accepted Answer

Hemangioma

Answer

Nerve sheath tumor

Answer

Lymphoma

Answer

Meningioma

Question 3

Which virus is most commonly associated with disciform keratitis?

Accepted Answer

Herpes Simplex Virus (HSV)

Answer

Rubella Virus

Answer

Human Immunodeficiency Virus (HIV)

Answer

Hepatitis B Virus (HBV)

Question 4

Which of the following statements is false about phacolytic glaucoma?

Accepted Answer

Primarily caused by iris-lens contact

Answer

Open angle glaucoma

Answer

Lens induced glaucoma

Answer

Seen in hypermature stage of cataract

Question 5

What is the term for the fusion of the palpebral and bulbar conjunctiva?

Accepted Answer

Symblepharon

Answer

Trichiasis (inward growth of eyelashes)

Answer

Ectropion (outward turning of eyelid)

Answer

Tylosis (thickening of skin on palms and soles)

Question 6

In the context of homocystinuria, which direction does the lens typically subluxate?

Accepted Answer

Inferonasal

Answer

Inferotemporal

Answer

Superonasal

Answer

Superotemporal

Question 7

Bilateral ptosis is seen in all except which of the following?

Accepted Answer

Hyperthyroidism (Graves' disease)

Answer

Trauma

Answer

Congenital

Answer

Myotonic dystrophy

Question 8

Metamorphopsia is seen in?

Accepted Answer

Posterior uveitis

Answer

Cataract

Answer

Glaucoma

Answer

Anterior uveitis

Question 9

Jack in box scotoma is seen after correction of Aphakia by?

Accepted Answer

Spectacles

Answer

IOL

Answer

Contact lens

Answer

None of the options

Question 10

Which type of cataract is associated with the phenomenon known as 'second sight'?

Accepted Answer

Nuclear cataract

Answer

Cortical cataract

Answer

Zonular cataract

Answer

Punctate cataract

NEET-PG 2012 — Ophthalmology