NEET-PG 2013 - Ophthalmology Practice Questions

Q: Interstitial keratitis is associated with all of the following except:

Acanthamoeba. ***Acanthamoeba*** - **Acanthamoeba keratitis** is a **suppurative keratitis** characterized by a painful, ring-shaped infiltrate with epithelial ulceration, typically associated with contact lens use and contaminated water exposure. - It causes **ulcerative stromal inflammation**, not the **non-ulcerative deep stromal inflammation** that characterizes classic interstitial keratitis. - **This is NOT a cause of interstitial keratitis.** *Syphilis* - **Congenital syphilis** is the **CLASSIC cause** of bilateral **interstitial keratitis**, often presenting in late childhood with "salmon patch" appearance, photophobia, lacrimation, and eventual ghost vessels. - The inflammation is **non-ulcerative and chronic**, affecting the **deep corneal stroma** with preservation of epithelium. - This is the most important association with interstitial keratitis to remember. *Chlamydia Trachomatis* - **Chlamydia trachomatis** causes **trachoma**, a chronic keratoconjunctivitis leading to **superficial keratitis with pannus formation** (superficial vascularization from the limbus). - The corneal involvement in trachoma is **superficial**, not the deep stromal inflammation seen in classic interstitial keratitis. - While listed in some references, **Chlamydia is NOT a standard cause of interstitial keratitis** in major ophthalmology textbooks. - **Note:** This option is potentially debatable, but Acanthamoeba is the more definitively incorrect answer. *Herpes Zoster Virus (HZV)* - **Herpes zoster ophthalmicus** can lead to **interstitial keratitis** and **disciform keratitis** (immune-mediated stromal inflammation with disc-shaped corneal edema). - Similarly, **HSV (Herpes Simplex Virus)** causes stromal keratitis, a form of interstitial keratitis. - The corneal involvement includes **deep stromal inflammation, scarring**, and potential neurotrophic changes leading to vision impairment.

Q: Non-sterile hypopyon is seen in ?

Fungal infection. ***Fungal infection*** - **Fungal keratitis** produces a **non-sterile hypopyon**, meaning the hypopyon contains actual fungal elements and organisms, not just inflammatory cells alone. - This is characteristically seen with **filamentous fungi** (Aspergillus, Fusarium) and yeast (Candida), which can directly invade the anterior chamber. - The hypopyon is typically **indolent, greyish-white, and does not shift with position** unlike bacterial hypopyon, and shows poor response to antibacterial therapy. - **Fungal culture and KOH mount** are diagnostic. *Pneumococcal infection* - **Bacterial keratitis** caused by *Streptococcus pneumoniae* produces a **sterile hypopyon** consisting purely of inflammatory cells (polymorphonuclear leukocytes) without organisms in the anterior chamber. - Presents with **acute onset, severe pain, and rapid progression** with a dense stromal infiltrate. - The hypopyon is **white, mobile, and shifts with head position**. *Pseudomonas aeruginosa infection* - **Pseudomonas keratitis** causes an aggressive infection with a **sterile hypopyon** due to intense inflammatory response. - Characterized by **rapidly progressive stromal necrosis** with a ground-glass appearance and greenish discharge. - Often associated with **contact lens wear** and can lead to corneal perforation within 24-48 hours. *Gonococcal conjunctivitis* - **Neisseria gonorrhoeae conjunctivitis** causes severe **hyperacute purulent conjunctivitis** with copious discharge. - Typically does **not cause hypopyon** unless there is secondary corneal ulceration leading to keratitis or endophthalmitis. - Primary manifestation is conjunctival inflammation, chemosis, and lid edema.

Q: Keratitis in contact lens wearers is caused by all except?

Pneumococcus. ***Pneumococcus*** - While *Streptococcus pneumoniae* (Pneumococcus) can cause bacterial keratitis, it is **classically associated with corneal ulcers following trauma** rather than contact lens wear. - In contact lens-related keratitis, Pneumococcus is **significantly less common** compared to *Pseudomonas*, which dominates as the primary bacterial pathogen in this setting. - Pneumococcal keratitis typically presents with a **well-demarcated, dense purulent ulcer with hypopyon**, often following corneal injury. *Pseudomonas* - **_Pseudomonas aeruginosa_** is **the most common cause of bacterial keratitis in contact lens wearers**, accounting for the majority of severe cases. - It thrives in moist environments such as contaminated contact lens cases and solutions, producing **exotoxins and proteases that cause rapid corneal destruction and tissue melt**. - Presents with a **rapidly progressive, dense stromal infiltrate** with a characteristic **ground-glass appearance** and potential for perforation. *Aspergillus* - **_Aspergillus_ species** are an important cause of **fungal keratitis**, particularly associated with contact lens wear, poor lens hygiene, and contaminated lens solutions. - Fungal keratitis presents with **feathery-edged infiltrates, satellite lesions**, and ring-shaped infiltrates, often requiring antifungal therapy. - More common in tropical climates and agricultural settings. *Chlamydia* - **_Chlamydia trachomatis_** is primarily a cause of **trachoma** (chronic follicular conjunctivitis leading to scarring) and **adult inclusion conjunctivitis**. - While it can cause **superficial punctate keratitis and pannus formation** in trachoma, it is **NOT a typical cause of acute suppurative keratitis in contact lens wearers**. - The acute bacterial and fungal keratitis seen in contact lens wearers is a different clinical entity from chlamydial conjunctivitis/keratopathy.

Q: Fluorescein angiography is used to examine -

Retinal vasculature. ***Retinal vasculature*** - **Fluorescein angiography** involves injecting fluorescein dye into a vein and taking rapid photographs of the retina as the dye perfuses, allowing for detailed visualization of the **retinal blood vessels**. - This technique is crucial for diagnosing and monitoring conditions like **diabetic retinopathy**, **macular degeneration**, and **retinal vascular occlusions** by identifying leaks, non-perfusion areas, and abnormal vessel growth. *Ciliary vasculature* - The **ciliary body vasculature** is not directly visualized by standard fluorescein angiography as it is located anterior to the retina within the uveal tract. - While some dye may perfuse the ciliary body, the primary imaging target and diagnostic utility of fluorescein angiography are the **retinal and choroidal circulations**. *Corneal vasculature* - The normal **cornea is avascular**, meaning it does not contain blood vessels. - **Corneal neovascularization** (new vessel growth) can occur due to pathology, but fluorescein angiography is not the primary or most suitable technique for assessing corneal vessels, which are more readily visible with slit-lamp biomicroscopy. *Conjunctival vasculature* - The **conjunctiva** contains numerous small vessels, but these are superficial and can be directly observed with a slit lamp or even the naked eye. - Fluorescein angiography is an invasive procedure with a higher spatial resolution designed for deeper, more intricate vascular networks like those in the retina, making it overkill and inappropriate for routine assessment of the **conjunctival vasculature**.

Q: Most common type of scleritis is

Anterior. ***Anterior*** - **Anterior scleritis** accounts for approximately **98%** of all scleritis cases, making it the most common type. - It involves inflammation of the sclera anterior to the **equator of the globe**, visible on external examination. - Anterior scleritis is further subdivided into **diffuse, nodular,** and **necrotizing** forms based on clinical presentation and severity. *Diffuse anterior* - **Diffuse anterior scleritis** is the most common subtype of anterior scleritis, characterized by widespread inflammation. - While common among anterior types, it represents a subset rather than the overall most common anatomical category. *Nodular anterior* - **Nodular anterior scleritis** presents with discrete nodules of inflamed scleral tissue. - It is less common than diffuse anterior scleritis but more common than necrotizing forms. *Posterior* - **Posterior scleritis** is rare, accounting for only about **2%** of all scleritis cases. - It involves inflammation posterior to the **equator of the globe** and can be difficult to diagnose due to its hidden location, often presenting with pain, proptosis, and vision loss.

Q: Most common cause of ptosis in adults

Aponeurotic. ***Aponeurotic*** - **Aponeurotic ptosis** is the most common cause of adult-onset ptosis, resulting from a dehiscence, disinsertion, or stretching of the **levator aponeurosis**. - It typically presents as a gradual onset of ptosis and often occurs bilaterally, though one eye may be more affected. *Idiopathic* - While many cases may initially be labeled idiopathic, a specific cause, such as **aponeurotic changes**, is often identified upon closer examination. - This term is a general descriptor and not a specific pathophysiological mechanism. *Myasthenia gravis* - **Myasthenia gravis** can cause fluctuating ptosis that worsens with fatigue, but it is not the most common cause overall. - It is an **autoimmune neuromuscular junction disorder** characterized by weakness in various skeletal muscles. *Paralysis of 3rd nerve* - **Third nerve palsy** causes ptosis along with other signs like an **out-and-down eye deviation** and a **dilated pupil** (if parasympathetic fibers are involved). - While it causes significant ptosis, it is less common than aponeurotic ptosis and presents with a distinct constellation of symptoms.

Q: All are ophthalmological emergencies except -

CRVO. ***CRVO*** - Central Retinal Vein Occlusion (CRVO) is characterized by painless **vision loss** due to retinal hemorrhage and edema, but it is generally *not* considered an immediate, vision-threatening emergency in the same vein as the other options. - While it requires prompt evaluation and management to preserve vision, CRVO allows for a less urgent intervention compared to conditions that can lead to permanent vision loss within hours. *Endophthalmitis* - **Endophthalmitis** is a severe inflammation of the intraocular fluids and tissues, typically caused by infection, and can lead to rapid and irreversible vision loss if not treated urgently. - It presents with pain, redness, reduced vision, and hypopyon (pus in the anterior chamber), necessitating immediate antibiotic treatment and surgical intervention. *Acute congestive glaucoma* - **Acute congestive glaucoma** (acute angle-closure glaucoma) involves a sudden increase in intraocular pressure, causing severe pain, redness, corneal edema, and profound vision loss. - If left untreated, the high pressure can cause irreversible damage to the optic nerve within hours, making it a true ocular emergency. *CRAO* - **Central Retinal Artery Occlusion (CRAO)** is a sudden, painless loss of vision in one eye due to blockage of the central retinal artery, leading to retinal ischemia. - It is an ocular emergency because irreversible retinal damage and vision loss can occur within 90-120 minutes of the occlusion, requiring immediate intervention to restore blood flow.

Q: Surgery of choice in a patient with congenital ptosis with good levator action is:

LPS resection. ***LPS resection*** - **Levator palpebrae superioris (LPS) resection** is the surgery of choice for congenital ptosis with **good levator action** (typically defined as >8-10 mm of levator function). - This procedure directly shortens and strengthens the **levator muscle**, improving eyelid elevation. *Fascia lata sling surgery* - This procedure is indicated for patients with **poor or absent levator function** (typically 10 mm). - It involves resecting a small amount of **Müller's muscle**, **conjunctiva**, and occasionally the **tarsal plate**, but is less effective for moderate-to-severe ptosis. *Müller's resection* - **Müller's muscle resection** is generally reserved for **mild ptosis** (1-2 mm) that responds positively to the **phenylephrine test**. - It primarily addresses ptosis due to sympathetic denervation or mild aponeurotic disinsertion, not significant congenital ptosis with good levator function.

Question 1

Interstitial keratitis is associated with all of the following except:

Accepted Answer

Acanthamoeba

Answer

Syphilis

Answer

Chlamydia Trachomatis

Answer

Herpes Zoster Virus (HZV)

Question 2

Non-sterile hypopyon is seen in ?

Accepted Answer

Fungal infection

Answer

Pneumococcal infection

Answer

Pseudomonas aeruginosa infection

Answer

Gonococcal conjunctivitis

Question 3

Keratitis in contact lens wearers is caused by all except?

Accepted Answer

Pneumococcus

Answer

Chlamydia

Answer

Aspergillus

Answer

Pseudomonas

Question 4

Fluorescein angiography is used to examine -

Accepted Answer

Retinal vasculature

Answer

Ciliary vasculature

Answer

Corneal vasculature

Answer

Conjunctival vasculature

Question 5

Most common type of scleritis is

Accepted Answer

Answer

Diffuse anterior

Answer

Nodular anterior

Answer

Posterior

Question 6

Most common cause of ptosis in adults

Accepted Answer

Aponeurotic

Answer

Idiopathic

Answer

Myasthenia gravis

Answer

Paralysis of 3rd nerve

Question 7

All are ophthalmological emergencies except -

Accepted Answer

CRVO

Answer

Endophthalmitis

Answer

Acute congestive glaucoma

Answer

CRAO

Question 8

Surgery of choice in a patient with congenital ptosis with good levator action is:

Accepted Answer

LPS resection

Answer

Fascia lata sling surgery

Answer

Fasanella-Servat operation

Answer

Müller's resection

NEET-PG 2013 — Ophthalmology