NEET-PG 2013 - Ophthalmology Practice Questions

Q: Commotio retinae affects which part of the retina -

Posterior pole. ***Posterior pole*** - **Commotio retinae**, also known as Berlin's edema, primarily affects the **posterior pole** of the retina, particularly the macula. - This condition results from **blunt trauma** to the globe, causing disruption of the outer retinal photoreceptors and retinal pigment epithelium, leading to retinal whitening in the area of impact. *Peripheral retina* - While blunt trauma can affect the peripheral retina, commotio retinae specifically refers to the **edematous whitening** that occurs more centrally. - Trauma to the periphery is more commonly associated with **retinal tears or detachments**, rather than the diffuse whitening seen in commotio retinae. *Inferior-nasal part* - This is a specific quadrant of the retina, but commotio retinae is not confined to or preferentially found in the **inferior-nasal part**. - The location of commotio retinae depends on the **point of impact** and the transmission of force, but symptoms are most prominent when the macula at the posterior pole is involved. *Superior-nasal part* - Similar to the inferior-nasal part, the **superior-nasal part** is a specific retinal quadrant. - Commotio retinae is a more generalized finding of retinal edema and whitening due to trauma, not consistently localized to this particular region, though it can occur if that area is directly impacted.

Q: Parachute lesions are associated with which of the following conditions?

Eale's disease. ***Eale's disease*** - **Eale's disease** is an idiopathic retinal perivasculitis affecting young males, characterized by recurrent vitreous hemorrhages. - In the context of this question (NEET-2013), the term "parachute lesions" refers to the characteristic pattern of hemorrhages seen in Eale's disease. - The disease features retinal periphlebitis, capillary non-perfusion, and neovascularization leading to vitreous hemorrhage. - **Note:** The term "parachute hemorrhages" in broader ophthalmology typically describes preretinal/subhyaloid hemorrhages that settle inferiorly (boat-shaped), more commonly seen in proliferative diabetic retinopathy. *Diabetes* - **Diabetic retinopathy** presents with microaneurysms, dot-blot hemorrhages, hard exudates, cotton-wool spots, and neovascularization. - While proliferative diabetic retinopathy can cause preretinal "parachute-shaped" hemorrhages (boat-shaped hemorrhages that settle inferiorly), this is not the association being tested in this NEET-2013 question. - The specific context of this exam question associates the term with Eale's disease. *Sickle cell anemia* - **Sickle cell retinopathy** features characteristic sea-fan neovascularization in the peripheral retina. - Can cause salmon-patch hemorrhages, black sunburst lesions, and angioid streaks. - While vitreous hemorrhage can occur, "parachute lesions" is not standard terminology for sickle cell retinopathy manifestations. *None of the options* - This option is incorrect because **Eale's disease** is the correct answer according to the NEET-2013 exam key.

Q: Which of the following is a specific sign of albinism?

Iris transillumination. ***Iris transillumination*** - This is a highly **specific sign** of albinism, resulting from the severe reduction or absence of pigment in the iris. - When light shines through the pupil, it passes through the unpigmented iris, creating a visible red reflex, indicating the lack of pigment that normally blocks the light. *Sensitivity to light (photophobia)* - While common in albinism due to the lack of pigment in the iris and retina allowing more light to enter the eye, **photophobia is not specific** to albinism. - It can be a symptom of various other ocular conditions like uveitis, corneal abrasions, or migraines. *Involuntary eye movements (nystagmus)* - **Nystagmus is frequently associated with albinism** due to foveal hypoplasia and impaired visual development but is **not specific**. - It can also be caused by neurological disorders, inner ear problems, or other ocular conditions. *Decreased visual acuity* - **Reduced vision is a characteristic feature of albinism** resulting from foveal hypoplasia and abnormal optic nerve pathways, but it is **not specific** to the condition. - Numerous eye conditions, such as refractive errors, cataracts, and retinal diseases, can lead to decreased visual acuity.

Q: Epithelial xerosis of conjunctiva is caused by?

Xerophthalmia. ***Xerophthalmia*** - **Xerophthalmia** is a medical condition characterized by **dryness of the eye**, often due to **vitamin A deficiency**. - **Epithelial xerosis of the conjunctiva** is one of the early and hallmark signs of xerophthalmia, representing the drying and thickening of the conjunctival epithelium due to goblet cell loss and squamous metaplasia. *Infectious conjunctivitis caused by Chlamydia trachomatis* - This typically causes **trachoma**, characterized by chronic inflammation, scarring, and eventual blindness. - While it can lead to dryness and scarring in later stages due to **symblepharon** or **entropion**, it does not primarily manifest as epithelial xerosis. *Autoimmune blistering conjunctivitis* - This condition involves **immune-mediated inflammation** leading to subepithelial blistering, scarring, and shrinkage of the conjunctiva. - It results in significant **ocular surface damage** and vision loss but is distinct from the primary epithelial changes seen in xerosis due to vitamin A deficiency. *Bacterial conjunctivitis due to Corynebacterium diphtheriae* - **Diphtheritic conjunctivitis** is a severe form of bacterial conjunctivitis that causes a distinctive **"pseudomembrane"** on the conjunctiva. - It leads to acute inflammation and potentially systemic illness, not primarily epithelial xerosis.

Q: Which of the following conditions is least likely to cause proptosis?

Myxoedema. ***Myxoedema*** - **Myxoedema** is associated with severe **hypothyroidism** and is characterized by non-pitting edema due to the accumulation of **glycosaminoglycans** in tissues. - While it can cause facial puffiness, it is **least likely** to cause **proptosis** as there is no direct mechanism for an increase in orbital contents to push the eye forward. *Grave's disease* - **Grave's disease** is the most common cause of **proptosis** due to **immune-mediated inflammation** and accumulation of **glycosaminoglycans** and fat in the orbital tissues, leading to expansion. - This condition specifically affects the **extraocular muscles** and fat, causing bulging of the eyes. *Sarcoidosis* - **Orbital sarcoidosis** can cause **proptosis** due to the formation of **granulomas** within the orbit, leading to mass effect and inflammation. - It can affect any part of the eye and orbit, leading to varied clinical presentations including axial or non-axial globe displacement. *Pituitary adenoma* - A **pituitary adenoma** itself does not directly cause proptosis as it is located in the **sella turcica**, posterior to the orbits. - However, **large adenomas** can cause proptosis indirectly if they invade the **cavernous sinus** and obstruct venous return from the orbit, or if they are associated with **acromegaly**, which can lead to bony overgrowth of the orbital structures and surrounding tissues.

Q: Normal level of visual acuity is attained at which age

6 years. ***6 years*** - **Normal adult visual acuity (20/20 or 6/6)** is typically achieved around the age of **6 years** as the visual system fully matures. - This age allows for the complete development of **foveal vision** and **binocular functions**. *6 months* - At 6 months of age, an infant's visual acuity is still developing and is typically around **20/200 to 20/400**. - While significant visual development occurs by this age, including **face recognition and tracking objects**, it is not yet at adult levels. *1 year* - By one year, visual acuity improves to approximately **20/50 to 20/100**. - Infants at this age are able to **distinguish fine details** and have improved **depth perception**, but full maturity is still some years away. *3 years* - At 3 years of age, visual acuity is generally around **20/30 to 20/40**. - Children at this stage are able to perform **visual tasks** like drawing and recognizing letters, but subtle refinements are still ongoing.

Q: What is the normal aqueous production rate in the human eye?

2 µl/min. ***2 µl/min*** - The ciliary body in the human eye continuously produces **aqueous humor** at a typical rate of approximately **2.0-3.0 µl/min**. - This rate is crucial for maintaining **intraocular pressure (IOP)** and providing nutrients to avascular eye structures like the **cornea** and **lens**. - This translates to approximately **3-4 ml per day** of aqueous humor production. *2 ml/min* - This rate is significantly **higher** than the actual production of aqueous humor, which is measured in microliters per minute. - Such a high production rate would lead to a rapid and severe increase in **intraocular pressure**, causing damage to the eye. *5 ml/min* - This value is an **excessively high** rate of fluid production and is not physiologically correct for aqueous humor. - It would result in unsustainable and damaging **intraocular pressure** levels. *5 µl/min* - While closer to the correct order of magnitude, **5 µl/min** is generally considered to be at the higher end or slightly above the average physiological range for aqueous humor production. - Most sources cite the normal range as being between **2-3 µl/min**.

Q: Maximum correction of myopia can be done by?

LASIK. ***LASIK*** - **LASIK (Laser-Assisted In Situ Keratomileusis)** allows for significant correction of high myopia by reshaping the cornea with an excimer laser. - It involves creating a **corneal flap** and then ablating tissue underneath, offering precise and stable vision correction for a wide range of refractive errors. - Among the given corneal refractive procedures, LASIK can correct myopia up to **-10 to -12 D**. *Radial keratotomy* - **Radial keratotomy (RK)** involves making radial incisions in the cornea to flatten it, primarily used for low to moderate myopia (up to -3 to -4 D). - It has a higher risk of **unpredictable outcomes**, induced astigmatism, and glare compared to modern laser procedures. *Photorefractive keratectomy* - **Photorefractive keratectomy (PRK)** involves direct ablation of the corneal surface without creating a flap, which is suitable for moderate myopia (up to -8 to -10 D). - While effective, PRK typically has a **longer recovery period** and more post-operative pain than LASIK. *Orthokeratology* - **Orthokeratology (Ortho-K)** uses specially designed rigid contact lenses worn overnight to temporarily reshape the cornea and correct myopia. - The effect is **temporary**, requiring continuous lens wear to maintain vision correction, and is generally limited to low to moderate myopia (up to -4 to -6 D).

Q: What is the first-line treatment for acute angle closure glaucoma?

Acetazolamide. **Acetazolamide** - **Acetazolamide** (oral or intravenous) is a carbonic anhydrase inhibitor that rapidly reduces intraocular pressure by decreasing aqueous humor production, making it the **first-line medical treatment** for acute angle-closure glaucoma. - While other agents are used, acetazolamide provides the quickest and most significant initial reduction in **intraocular pressure (IOP)**, which is crucial in preventing permanent vision loss. *IV mannitol* - **Intravenous mannitol** is an osmotic diuretic used to draw fluid from the vitreous humor to lower **IOP** significantly, but it is typically reserved for cases where **acetazolamide** alone is insufficient or for very high **IOPs**. - It is often considered a second-line or adjunctive agent rather than the initial first-line treatment. *Pilocarpine* - **Pilocarpine** is a miotic agent that constricts the pupil, which helps to pull the iris away from the trabecular meshwork and open the angle. - However, it should only be administered *after* the **intraocular pressure** has been significantly lowered (e.g., with acetazolamide), as it can worsen angle closure in an inflamed eye with very high **IOP**. *Beta blocker eyedrops* - **Topical beta-blockers** (e.g., timolol) reduce **IOP** by decreasing aqueous humor production and are a common treatment for various types of glaucoma. - While useful in acute angle-closure glaucoma, they act more slowly than **acetazolamide** and are typically used as an adjunct rather than the sole initial first-line treatment.

Q: What are the characteristic features of Posner-Schlossman syndrome?

Unilateral glaucomatous changes with mild anterior uveitis. ***Unilateral glaucomatous changes with mild anterior uveitis*** - Posner-Schlossman syndrome, also known as **glaucomatocyclitic crisis**, is characterized by recurrent, acute attacks of **unilateral elevated intraocular pressure** (glaucomatous changes). - These attacks are accompanied by **mild anterior uveitis**, which typically presents with few or no precipitates and minimal redness. *Ipsilateral optic atrophy with contralateral papilloedema* - This constellation of symptoms, known as **Foster Kennedy syndrome**, is associated with intracranial masses, not Posner-Schlossman syndrome. - It involves **optic atrophy** in one eye due to direct pressure on the optic nerve and **papilledema** in the other eye due to increased intracranial pressure. *Granulomatous uveitis with iris heterochromia* - **Granulomatous uveitis** is characterized by large mutton-fat keratic precipitates and often seen in diseases like sarcoidosis or tuberculosis, which is not typical for Posner-Schlossman. - **Iris heterochromia** (different colored irises) is a characteristic feature of **Fuchs' heterochromic cyclitis**, another form of chronic anterior uveitis, but not Posner-Schlossman syndrome. *None of the options* - This option is incorrect as one of the provided choices accurately describes the characteristic features of Posner-Schlossman syndrome. - The other options describe different ophthalmological conditions.

Question 1

Commotio retinae affects which part of the retina -

Accepted Answer

Posterior pole

Answer

Peripheral retina

Answer

Inferior-nasal part

Answer

Superior-nasal part

Question 2

Parachute lesions are associated with which of the following conditions?

Accepted Answer

Eale's disease

Answer

Diabetes

Answer

Sickle cell anemia

Answer

None of the options

Question 3

Which of the following is a specific sign of albinism?

Accepted Answer

Iris transillumination

Answer

Sensitivity to light (photophobia)

Answer

Involuntary eye movements (nystagmus)

Answer

Decreased visual acuity

Question 4

Epithelial xerosis of conjunctiva is caused by?

Accepted Answer

Xerophthalmia

Answer

Infectious conjunctivitis caused by Chlamydia trachomatis

Answer

Autoimmune blistering conjunctivitis

Answer

Bacterial conjunctivitis due to Corynebacterium diphtheriae

Question 5

Which of the following conditions is least likely to cause proptosis?

Accepted Answer

Myxoedema

Answer

Sarcoidosis

Answer

Grave's disease

Answer

Pituitary adenoma

Question 6

Normal level of visual acuity is attained at which age

Accepted Answer

6 years

Answer

6 months

Answer

1 year

Answer

3 years

Question 7

What is the normal aqueous production rate in the human eye?

Accepted Answer

2 µl/min

Answer

2 ml/min

Answer

5 ml/min

Answer

5 µl/min

Question 8

Maximum correction of myopia can be done by?

Accepted Answer

LASIK

Answer

Radial keratotomy

Answer

Photorefractive keratectomy

Answer

Orthokeratology

Question 9

What is the first-line treatment for acute angle closure glaucoma?

Accepted Answer

Acetazolamide

Answer

Pilocarpine

Answer

Beta blocker eyedrops

Answer

IV mannitol

Question 10

What are the characteristic features of Posner-Schlossman syndrome?

Accepted Answer

Unilateral glaucomatous changes with mild anterior uveitis

Answer

Ipsilateral optic atrophy with contralateral papilloedema

Answer

Granulomatous uveitis with iris heterochromia

Answer

None of the options

NEET-PG 2013 — Ophthalmology