What is the primary predisposing factor for retinopathy of prematurity?
Which of the following statements is false regarding Eale's disease?
Purtscher's retinopathy is associated with -
What is the typical appearance of a subhyaloid hemorrhage in the eye?
Most common age related change in vitreous?
Muscae volitantes is seen in?
Which of the following statements is MOST likely false regarding optic neuritis?
The most common type of strabismus seen in myopes is?
Dalrymple's sign of ocular Graves' disease refers to which of the following?
D Shaped pupil is seen in which condition?
NEET-PG 2015 - Ophthalmology NEET-PG Practice Questions and MCQs
Question 41: What is the primary predisposing factor for retinopathy of prematurity?
- A. Oxygen toxicity
- B. Carbohydrate excess
- C. Low birth weight
- D. Low gestational age (Correct Answer)
Explanation: ***Low gestational age*** - **Prematurity** is the most significant risk factor, as the **retinal vasculature** is still immature and susceptible to abnormal development. - The earlier the gestational age, the **higher the risk** of ROP developing and progressing to severe stages. *Low birth weight* - While strongly correlated with ROP, **low birth weight** is often a consequence of prematurity rather than the primary predisposing factor itself. - Many term infants can have low birth weight due to **intrauterine growth restriction** but do not typically develop ROP. *Oxygen toxicity* - **Supplemental oxygen** can exacerbate ROP by causing initial **vasoconstriction** and subsequent abnormal vessel proliferation. - However, it acts as a secondary trigger in an already vulnerable, premature retina, not the primary predisposing factor. *Carbohydrate excess* - **Carbohydrate excess** is not a recognized predisposing factor for retinopathy of prematurity. - This condition is primarily related to the **vascular development of the retina** in premature infants.
Question 42: Which of the following statements is false regarding Eale's disease?
- A. Optic neuritis (Correct Answer)
- B. AKT is given
- C. Vitreous Hemorrhage
- D. Retinal detachment may occur
Explanation: ***Correct Answer: Optic neuritis*** - This statement is **false** because **Eale's disease** is a **peripheral retinal vasculitis** (periphlebitis) that primarily affects the **peripheral retinal veins**. - The condition does **NOT involve the optic nerve**, and **optic neuritis is NOT a recognized feature or complication** of Eale's disease. - The disease process is confined to the retinal vasculature and does not extend anteriorly to involve the optic disc or nerve in typical cases. *AKT is given* - While the exact etiology of Eale's disease remains uncertain, there is a **historical and clinical association with tuberculosis**, particularly in TB-endemic regions like India. - In clinical practice, **anti-tubercular therapy (ATT/AKT) is often empirically administered** when TB cannot be ruled out or when there is suspicion of systemic TB. - Some studies suggest ATT may help reduce inflammation and prevent recurrence in selected cases. *Vitreous Hemorrhage* - This is a **hallmark complication** of Eale's disease, particularly in stage 3 (proliferative stage). - **Recurrent vitreous hemorrhage** occurs due to rupture of fragile neovascular vessels that form in response to retinal ischemia. - It is one of the most common presentations requiring intervention. *Retinal detachment may occur* - **Tractional retinal detachment** is a recognized complication resulting from contraction of **fibrovascular proliferative membranes**. - **Rhegmatogenous retinal detachment** can also occur if vitreoretinal traction causes retinal breaks. - Both types may require surgical intervention (vitrectomy).
Question 43: Purtscher's retinopathy is associated with -
- A. Head trauma (Correct Answer)
- B. Diabetes Mellitus
- C. Wilson's disease
- D. Rheumatoid arthritis
Explanation: ***Head trauma*** - **Purtscher's retinopathy** is a rare occlusive microvasculopathy characterized by sudden vision loss and specific retinal findings, classically associated with **head or chest trauma**. - The condition occurs due to **fat embolization** and **leukoembolization** with complement activation, leading to occlusion of retinal precapillary arterioles. - Classic findings include **cotton wool spots**, intraretinal hemorrhages, and **Purtscher flecken** (polygonal areas of retinal whitening between the optic disc and macula). - The term "Purtscher's retinopathy" specifically refers to trauma-induced cases, while "Purtscher-like retinopathy" describes similar findings from non-traumatic causes (acute pancreatitis, fat embolism syndrome, amniotic fluid embolism). *Diabetes Mellitus* - **Diabetic retinopathy** is associated with chronic hyperglycemia causing microvascular damage, characterized by microaneurysms, dot-blot hemorrhages, hard exudates, and venous beading. - It involves gradual progressive changes over years, not acute embolic occlusion from trauma. - Advanced stages include **proliferative diabetic retinopathy** with neovascularization and diabetic macular edema. *Wilson's disease* - **Wilson's disease** is an autosomal recessive disorder of copper metabolism affecting the liver, brain, and eyes. - Ocular manifestations include **Kayser-Fleischer rings** (copper deposition in Descemet's membrane) and sunflower cataracts. - It does not cause acute retinal vascular occlusion or the specific findings of Purtscher's retinopathy. *Rheumatoid arthritis* - **Rheumatoid arthritis** is a chronic autoimmune inflammatory disease primarily affecting joints. - Ocular manifestations include **keratoconjunctivitis sicca** (dry eyes), **episcleritis**, **scleritis**, and peripheral ulcerative keratitis. - It is not associated with Purtscher's retinopathy, which is specifically linked to traumatic or embolic events.
Question 44: What is the typical appearance of a subhyaloid hemorrhage in the eye?
- A. Boat shaped (Correct Answer)
- B. Crescent shaped
- C. Round
- D. Flame shaped
Explanation: ***Boat shaped*** - A subhyaloid hemorrhage is located beneath the **hyaloid membrane** (the posterior vitreous cortex), which is attached to the retina. - The collected blood often assumes a **dependent, gravity-influenced shape**, appearing flat on top and curved underneath, resembling a boat. *Crescent shaped* - This shape is not characteristic of a typical subhyaloid hemorrhage; it might be seen in other types of hemorrhages or detachment patterns. - **Crescentic shapes** are more commonly associated with certain types of **retinal detachments** or tears where fluid accumulation takes on a curved boundary. *Round* - While hemorrhages can be round, a subhyaloid hemorrhage typically spreads out due to gravity within the confined space, resulting in a more distinct shape. - A **perfectly round hemorrhage** is less common in the subhyaloid space as blood tends to layer out rather than remain as a sphere. *Flame shaped* - **Flame-shaped hemorrhages** are typically found in the **nerve fiber layer** due to the orientation of nerve fibers. - These hemorrhages are shallower and follow the linear arrangement of nerve fibers, unlike the larger, more globular subhyaloid bleeds.
Question 45: Most common age related change in vitreous?
- A. Anterior vitreous detachment
- B. Vitreous hemorrhage
- C. Vitritis
- D. Posterior vitreous detachment (PVD) (Correct Answer)
Explanation: ***Posterior vitreous detachment (PVD)*** - As we age, the **vitreous body** undergoes liquefaction and shrinkage, leading to its separation from the **retina**, most commonly posteriorly. - This is a very common and usually benign age-related phenomenon, often presenting with **floaters** and **flashes of light**. *Anterior vitreous detachment* - **Anterior vitreous detachment** is much less common than PVD and not typically considered the most frequent age-related change. - It often occurs secondary to **trauma** or specific surgical procedures rather than spontaneous aging alone. *Vitreous hemorrhage* - **Vitreous hemorrhage** is a pathological condition involving bleeding into the vitreous humor, often due to **diabetic retinopathy**, retinal tears, or trauma. - It is not a normal age-related change but a complication of underlying disease. *Vitritis* - **Vitritis** refers to inflammation of the vitreous humor, commonly associated with **uveitis** or infections. - It is an inflammatory disease process, not a physiological age-related degeneration of the vitreous.
Question 46: Muscae volitantes is seen in?
- A. Vitreous detachment (Correct Answer)
- B. Vitreous Hemorrhage
- C. Remains of primitive hyaloid vasculature
- D. Eale's disease
Explanation: ***Vitreous detachment*** - **Muscae volitantes** (Latin for "flying flies") is the classical term for **vitreous floaters** - **Posterior vitreous detachment (PVD)** is the **most common cause** of muscae volitantes - PVD occurs due to **vitreous liquefaction** and **vitreoretinal separation**, causing **collagen fibers and cellular debris** to cast shadows on the retina - These floaters are typically described as **spots, cobwebs, or threads** that move with eye movement - PVD is extremely common, particularly **after age 50-60 years**, and in **myopic patients** *Remains of primitive hyaloid vasculature* - **Hyaloid remnants** (such as **Mittendorf's dot** or **Bergmeister's papilla**) are **congenital developmental anomalies** - While these can occasionally be visible as small opacities, they are **not the classical cause** of muscae volitantes - These are typically **stationary** rather than "floating" as the term implies *Vitreous Hemorrhage* - Causes **sudden onset** of numerous floaters, often described as **"shower of red blood cells"** or dense black spots - Associated with **significant vision loss** and requires urgent evaluation - Not the benign, chronic floaters typical of muscae volitantes *Eale's disease* - **Peripheral retinal vasculitis** causing **recurrent vitreous hemorrhages** - Floaters occur secondary to **hemorrhage**, not the primary pathology of muscae volitantes - Presents with **recurrent episodes** and **vision loss**, not isolated benign floaters
Question 47: Which of the following statements is MOST likely false regarding optic neuritis?
- A. Abnormal electroretinogram (Correct Answer)
- B. Decreased pupillary reflex
- C. Decreased visual acuity
- D. Abnormal visual evoked potentials (VEP)
Explanation: ***Abnormal electroretinogram*** - Optic neuritis primarily affects the **optic nerve**, which is responsible for transmitting visual information from the retina to the brain. - The **electroretinogram (ERG)** measures the electrical activity of the **retina** in response to light, which is usually normal in optic neuritis as the retina itself is not the primary site of pathology. *Decreased pupillary reflex* - Optic neuritis often causes a **relative afferent pupillary defect (RAPD)**, where the affected eye's pupil dilates instead of constricting when light is swung from the unaffected to the affected eye. - This indicates a decrease in the afferent nerve signal transmission due to damage to the optic nerve. *Decreased visual acuity* - A hallmark symptom of optic neuritis is **acute vision loss**, which can range from mild blurring to severe vision impairment. - This vision loss is typically unilateral and can progress over several days. *Abnormal visual evoked potentials (VEP)* - **VEPs** measure the electrical activity of the brain in response to visual stimuli, assessing the integrity of the optic nerve and visual pathways. - In optic neuritis, the demyelination and damage to the optic nerve cause a **slowing of nerve conduction**, leading to increased latency and reduced amplitude in VEPs.
Question 48: The most common type of strabismus seen in myopes is?
- A. Intermittent Exotropia (Correct Answer)
- B. Intermittent Esotropia
- C. Esotropia Hypotropia complex
- D. Exotropia Hypotropia complex
Explanation: ***Intermittent Exotropia*** - Myopes often employ less **accommodative effort** for near tasks, leading to reduced **accommodative convergence** and an increased tendency for the eyes to drift outwards. - This outward deviation, or **exotropia**, is frequently intermittent, especially during fatigue or inattention. *Intermittent Esotropia* - **Esotropia** is an inward turn of the eye and is typically associated with **hyperopia** due to excessive accommodative effort leading to increased accommodative convergence. - While it can be intermittent, it is not the most common form of strabismus in myopic individuals. *Esotropia hypotropia complex* - This complex involves both an inward deviation (**esotropia**) and a downward deviation (**hypotropia**). - It is not typically seen in healthy myopes and would suggest other underlying **neurological** or **structural abnormalities**. *Exotropia Hypotropia complex* - While **exotropia** can be common in myopes, the additional presence of **hypotropia** (downward deviation) suggests a more complex strabismic picture. - This combination is not the most frequent strabismus seen in uncomplicated myopia and may indicate **cranial nerve palsies** or **orbital anomalies**.
Question 49: Dalrymple's sign of ocular Graves' disease refers to which of the following?
- A. Retraction of the upper lid (Correct Answer)
- B. Lid lag
- C. Proptosis
- D. Convergence insufficiency
Explanation: ***Retraction of the upper lid*** - **Dalrymple's sign** specifically refers to the **wide-eyed stare** seen in **Graves' ophthalmopathy** due to **retraction of the upper eyelid**. - This symptom is caused by sympathetic overactivity of the **levator palpebrae superioris muscle**. *Lid lag* - **Lid lag (Graefe's sign)** is a different ocular sign where the **upper eyelid lags behind the globe** on downward gaze. - While also seen in **Graves' disease**, it is distinct from constant upper lid retraction. *Proptosis* - **Proptosis**, or **exophthalmos**, is the **forward protrusion of the eyeball** from the orbit. - This is a common feature of **Graves' ophthalmopathy**, but it is not what Dalrymple's sign refers to. *Convergence insufficiency* - **Convergence insufficiency (Moebius sign)** refers to the **inability to maintain convergence** during near vision. - While this can occur in **thyroid eye disease**, it is not Dalrymple's sign.
Question 50: D Shaped pupil is seen in which condition?
- A. Anterior synechiae
- B. Anterior Uveitis
- C. Iridodialysis (Correct Answer)
- D. Iridodonesis
Explanation: ***Iridodialysis*** - **Iridodialysis** is a disinsertion or separation of the iris from its root at the ciliary body. - This separation creates a D-shaped or keyhole pupil, as the detached portion of the iris no longer contributes to the circular pupillary margin. *Anterior Uveitis* - **Anterior uveitis** is inflammation of the iris and ciliary body, primarily causing miosis (constricted pupil), not a D-shaped pupil. - It can lead to posterior synechiae, resulting in an irregular, but not typically D-shaped, pupil. *Anterior synechiae* - **Anterior synechiae** involve adhesions between the iris and the corneal endothelium or trabecular meshwork. - While they can cause an irregular pupil shape, they typically pull the iris towards the cornea rather than creating a D-shape from iris root disinsertion. *Iridodonesis* - **Iridodonesis** refers to tremors or wobbling of the iris, often seen in cases of aphakia or subluxated lenses, due to lack of support. - It describes a movement disorder of the iris rather than an abnormal, fixed pupil shape like a D-shaped pupil.