NEET-PG 2024 - Ophthalmology PYQs Practice Questions

Q: Identify the visual field defect shown in the image.

Bitemporal hemianopia. ***Bitemporal hemianopia*** - The image shows loss of vision in the **temporal (outer) halves of both visual fields**, which is characteristic of bitemporal hemianopia. - This defect typically results from a lesion at the **optic chiasm**, compressing the crossing nasal retinal fibers, often due to a **pituitary tumor**. *Binasal hemianopia* - This condition involves visual loss in the **nasal (inner) halves of both visual fields**, which is the opposite of what is depicted. - It is a rare defect that can be caused by lesions affecting the **uncrossed temporal retinal fibers** on both sides, such as from bilateral carotid artery aneurysms. *Homonymous hemianopia* - A homonymous hemianopia involves the **same half of the visual field in both eyes** (e.g., right visual field loss in both eyes), resulting from a lesion posterior to the optic chiasm. - The image clearly shows different halves affected in each eye (temporal fields), not the same half. *Altitudinal defect* - An altitudinal defect involves the **loss of vision in the upper or lower half of the visual field** in one or both eyes, respecting the horizontal midline. - The visual field loss shown in the image is vertical, affecting the temporal halves, not the upper or lower halves. [Practice more Ophthalmology PYQs on OnCourse]

Q: A patient presented with gradual loss in night vision and peripheral vision. Based on the fundoscopic image provided, what is the most likely diagnosis?

Retinitis pigmentosa. ***Retinitis pigmentosa*** - The fundoscopic image exhibits **bone spicule-like pigment deposits** in the periphery, **attenuation of retinal vessels**, and a **waxy pallor of the optic disc**, which are characteristic signs of retinitis pigmentosa. The clinical presentation of gradual loss in **night vision (nyctalopia)** and **peripheral vision** (tunnel vision) is classic for this inherited retinal dystrophy, as it primarily affects the **rod photoreceptors** first. *Retinal hemorrhage* - Retinal hemorrhages appear as **red blotches or streaks** on the fundus and are usually associated with conditions like **hypertension**, **diabetes**, or **retinal vein occlusion**. This image does not show acute red hemorrhages, but rather **dark, aggregated pigment**, and the symptoms do not align with sudden vision changes often seen in acute hemorrhages. *Fundus albipunctatus* - This condition is characterized by numerous **small, discrete, white or yellowish dots** scattered throughout the retina, usually sparing the macula. While it can cause night blindness, the fundoscopic image here shows **bone spicule pigmentation** and **vascular attenuation**, not the widespread white dots typical of fundus albipunctatus. *Fundus flavimaculatus* - This refers to Stargardt disease or fundus flavimaculatus, which presents with **yellowish flecks** (pisiform or fish-tail shaped) scattered in the posterior pole and mid-periphery, along with **macular degeneration**. The image does not show these distinct yellow flecks or evident macular changes, and the pigmentary changes are more consistent with retinitis pigmentosa. [Practice more Ophthalmology PYQs on OnCourse]

Q: What is the diagnosis if a patient can only see 3 green dots on the Worth 4 Dot test?

Right eye suppression. ***Right eye suppression*** - Seeing **three green dots** exclusively indicates that the patient is only perceiving input from the **left eye**. - In the Worth 4 Dot test, the **left eye** (viewing through a green filter) sees **three green dots**: the white dot at the top (which appears green through the filter) plus the two lateral green dots. - The **right eye** (viewing through a red filter) normally sees **two red dots**: the white dot at the top (which appears red) plus the red dot at the bottom. - Since the patient sees only **three green dots**, the visual input from the **right eye is being suppressed**. *Crossed diplopia* - **Crossed diplopia** (heteronymous diplopia) occurs when the image from the right eye is perceived to the left of the image from the left eye. - This typically occurs with **exotropia** (divergent strabismus) and would result in seeing **five or more dots** (patient perceives both eyes' images but misaligned), not just three green. *Uncrossed diplopia* - **Uncrossed diplopia** (homonymous diplopia) occurs when the image from the right eye is perceived to the right of the image from the left eye. - This is usually associated with **esotropia** (convergent strabismus) and would also lead to the perception of **five or more dots** (both eyes' images perceived but misaligned), not only three green dots. *Left eye suppression* - If there were **left eye suppression**, the patient would see **two red dots** from the right eye only (the white dot appearing red plus the red dot at the bottom). - Seeing **three green dots** confirms the **left eye input is dominant** and the **right eye is suppressed**. [Practice more Ophthalmology PYQs on OnCourse]

Q: A patient presents to the OPD with the finding shown in the image. What is the most likely diagnosis?

Limbal dermoid. ***Limbal dermoid*** - A **limbal dermoid** is a congenital benign tumor typically found at the **limbus**, the junction between the cornea and sclera. - It appears as a **raised, yellowish-white mass** and may contain elements like hair follicles or sebaceous glands. *Pyogenic granuloma* - A **pyogenic granuloma** is a rapidly growing, benign vascular lesion that typically occurs after trauma or surgery. - It presents as a **red, pedunculated nodule** that bleeds easily, unlike the described finding. *Papilloma* - **Papillomas** are benign epithelial tumors caused by the human papillomavirus (HPV). - They appear as **small, fleshy growths** with a cauliflower-like surface and are less common at the limbus. *Pinguecula* - A **pinguecula** is a common, benign yellowish growth on the conjunctiva, usually located on the nasal side of the cornea. - It does not typically involve the **cornea** or appear as a raised mass like a dermoid tumor. [Practice more Ophthalmology PYQs on OnCourse]

Q: A patient, three years post-surgery, presents with the condition shown in the image and complains of decreased vision. What is the most likely diagnosis?

Posterior Capsular Opacification. ***Posterior Capsular Opacification*** - The image (especially part B, the **red reflex view**) shows a cloudy membrane with **Elschnig pearls** and fibrous tissue behind the intraocular lens, which is characteristic of **PCO**. - PCO commonly occurs months to years after cataract surgery and causes **decreased vision** due to scattering of light. *Corneal Dystrophy* - Corneal dystrophies primarily affect the **cornea**, leading to various forms of corneal opacification, and would typically appear as cloudiness or irregularities within the corneal layers. - While it can cause decreased vision, the opacification seen in the image is clearly behind the iris plane and involves the posterior capsule, not the cornea. *Pseudophakic Bullous Keratopathy* - This condition involves **corneal edema** and **bullae formation** due to endothelial cell dysfunction, leading to a hazy cornea. - The image does not show corneal edema or bullae; instead, the primary pathology is located at the **posterior capsule** of the intraocular lens. *Posterior Subcapsular Cataract (PSC)* - A PSC is a type of cataract that forms **before cataract surgery** and affects the natural crystalline lens. - The patient is three years post-surgery, indicating that the natural lens has been replaced, making a PSC (of the natural lens) an impossible diagnosis in this context. [Practice more Ophthalmology PYQs on OnCourse]

Question 1

Identify the visual field defect shown in the image.

Accepted Answer

Bitemporal hemianopia

Answer

Binasal hemianopia

Answer

Homonymous hemianopia

Answer

Altitudinal defect

Question 2

A patient presented with gradual loss in night vision and peripheral vision. Based on the fundoscopic image provided, what is the most likely diagnosis?

Accepted Answer

Retinitis pigmentosa

Answer

Retinal hemorrhage

Answer

Fundus albipunctatus

Answer

Fundus flavimaculatus

Question 3

What is the diagnosis if a patient can only see 3 green dots on the Worth 4 Dot test?

Accepted Answer

Right eye suppression

Answer

Crossed diplopia

Answer

Uncrossed diplopia

Answer

Left eye suppression

Question 4

A patient presents to the OPD with the finding shown in the image. What is the most likely diagnosis?

Accepted Answer

Limbal dermoid

Answer

Pyogenic granuloma

Answer

Papilloma

Answer

Pinguecula

Question 5

A patient, three years post-surgery, presents with the condition shown in the image and complains of decreased vision. What is the most likely diagnosis?

Accepted Answer

Posterior Capsular Opacification

Answer

Corneal Dystrophy

Answer

Posterior Subcapsular Cataract (PSC)

Answer

Pseudophakic Bullous Keratopathy

Question 6

Identify the diagnosis based on the clinical image shown.

Accepted Answer

Herbert's pits

Answer

Horner-Trantas spots

Answer

Pannus

Answer

Corneal dystrophy

Question 7

A patient presents with eye ache and difficulty in vision after watching a movie. What will be the first line of management?

Accepted Answer

Mannitol with Pilocarpine

Answer

Mannitol with Moxifloxacin

Answer

Mannitol with Atropine

Answer

Mannitol with lubricating eye drops

Question 8

A patient presents with sudden painful diminution of vision, difficulty looking in light (photophobia), and circumcorneal congestion with hypopyon. What is the most likely diagnosis?

Accepted Answer

Acute anterior uveitis

Answer

Acute conjunctivitis

Answer

Episcleritis

Answer

Acute congestive glaucoma

Question 9

A patient presents with a nodular swelling near the limbus, which does not blanch with topical vasoconstrictors and recurs after treatment. Based on the image and clinical presentation, what is the most probable diagnosis?

Accepted Answer

Scleritis with rheumatoid arthritis

Answer

Episcleritis with rheumatoid arthritis

Answer

Pinguecula

Answer

Dry eye

NEET-PG 2024 — Ophthalmology