Internal Medicine
1 questionsWhich of the following conditions is associated with ectopia lentis?
NEET-PG 2013 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 891: Which of the following conditions is associated with ectopia lentis?
- A. Homocystinuria (Correct Answer)
- B. Alport syndrome
- C. Lowe syndrome
- D. Sulphite oxidase deficiency
Explanation: ***Homocystinuria*** - **Ectopia lentis** (lens dislocation) is a common and characteristic ocular manifestation of homocystinuria. - The lens typically dislocates **downward and inward**, differentiating it from Marfan syndrome. *Alport syndrome* - Characterized by **glomerulonephritis**, **sensorineural hearing loss**, and ocular abnormalities. - Ocular manifestations include **anterior lenticonus** (which can be mistaken for ectopia lentis in some descriptions), posterior polymorphous corneal dystrophy, and retinal flecks, but not classic ectopia lentis. *Lowe syndrome* - Also known as oculocerebrorenal syndrome of Lowe, it primarily affects the **eyes, brain, and kidneys**. - Ocular features include **congenital cataracts** and glaucoma, but not ectopia lentis. *Sulphite oxidase deficiency* - This is a rare metabolic disorder affecting the metabolism of sulfur-containing amino acids, leading to severe neurological symptoms. - While it can manifest with **cataracts** and **lens subluxation** in some cases, ectopia lentis is more characteristically associated with homocystinuria, and the overall clinical picture of sulphite oxidase deficiency is dominated by severe neurological impairment.
Ophthalmology
9 questionsSnow banking is seen in?
Panophthalmitis involves ?
Polyopia/diplopia is seen in which type of cataract?
In senile nuclear cataract what type of myopia is seen?
"Bread-crumb" appearance is seen in ?
Elschnig's pearls are a clinical sign of which condition?
Foldable lens is made up of?
Van Herick angle grade '3' of anterior chamber denotes
Krukenberg spindles -
NEET-PG 2013 - Ophthalmology NEET-PG Practice Questions and MCQs
Question 891: Snow banking is seen in?
- A. White coat syndrome
- B. Eales syndrome
- C. Diabetic kidney disease
- D. Intermediate uveitis (Correct Answer)
Explanation: ***Intermediate uveitis*** - **Snow banking** refers to the accumulation of inflammatory exudates on the surface of the **pars plana** and **ora serrata**, a characteristic sign of intermediate uveitis. - This condition primarily affects the **vitreous** and peripheral retina, often leading to symptoms like **floaters** and **decreased vision**. *White coat syndrome* - This refers to a phenomenon where a patient's **blood pressure is elevated** in a clinical setting due to anxiety, but is normal outside of the medical environment. - It has no ophthalmic manifestations or association with "snow banking." *Eales syndrome* - This is an idiopathic inflammatory condition primarily affecting the **peripheral retinal vasculature**, leading to **vasculitis**, occlusion, and neovascularization. - While it can cause vitreous hemorrhage, it does not typically present with "snow banking" as a primary feature. *Diabetic kidney disease* - This is a complication of **diabetes mellitus** characterized by damage to the small blood vessels in the kidneys, leading to impaired kidney function. - It is a systemic condition with no direct relationship to ocular "snow banking" or uveitis.
Question 892: Panophthalmitis involves ?
- A. Inner coat of eyeball
- B. Inner and outer coat but sparing tenon's capsule
- C. All structures of the eyeball including Tenon's capsule (Correct Answer)
- D. None of the options
Explanation: ***All structures of the eyeball including Tenon's capsule*** - **Panophthalmitis** is a severe inflammation or infection that affects **all coats of the eyeball** (sclera, choroid, retina). - Crucially, it also extends to the **intraocular contents** and the **Tenon's capsule**, leading to potential destruction of the entire eye. *Inner coat of eyeball* - This description is characteristic of **uveitis** (inflammation of the uvea: iris, ciliary body, choroid) or **endophthalmitis** if it extends to the vitreous and retina. - However, **panophthalmitis** is a more extensive condition, involving more than just the inner coats. *Inner and outer coat but sparing tenon's capsule* - This scenario describes **endophthalmitis**, which involves inflammation of the internal structures of the eye (vitreous, retina, choroid) and potentially the sclera. - However, the sparing of Tenon's capsule differentiates it from **panophthalmitis**, which expressly includes involvement of this fibrous sheath. *None of the options* - This option is incorrect because Option C accurately describes the comprehensive nature of **panophthalmitis**, which is an inflammation of all ocular structures, including Tenon's capsule. - The definition of panophthalmitis is critical in distinguishing it from less severe inflammatory conditions of the eye.
Question 893: Polyopia/diplopia is seen in which type of cataract?
- A. Nuclear cataract
- B. Posterior subcapsular cataract
- C. Anterior polar cataract
- D. Cortical cataract (Correct Answer)
Explanation: ***Cortical cataract*** - **Cortical cataracts** cause spokes or vacuoles that refract light in multiple directions, leading to **polyopia** or **diplopia**. - The irregular opacities disrupt the light path, causing the brain to perceive **multiple images**. *Nuclear cataract* - **Nuclear cataracts** primarily affect central vision and cause **myopic shift**, not typically polyopia or diplopia. - They cause **blurry vision** and difficulty seeing in dim light as the lens nucleus hardens and yellows. *Posterior subcapsular cataract* - **Posterior subcapsular cataracts** are characterized by glare and difficulty with reading, mainly affecting near vision. - They form at the back of the lens, close to the nodal point, causing earlier onset of **visual symptoms** with less impact on polyopia. *Anterior polar cataract* - **Anterior polar cataracts** are usually small, well-demarcated opacities at the front of the lens that typically do not cause significant visual impairment. - They rarely cause **polyopia** unless they are very large or dense, which is uncommon.
Question 894: In senile nuclear cataract what type of myopia is seen?
- A. Curvature myopia
- B. Axial myopia
- C. Index myopia (Correct Answer)
- D. Lenticular myopia
Explanation: **Index myopia** - **Senile nuclear cataract** involves opacification and hardening of the lens nucleus, which increases the **refractive index** of the lens. - This results in a stronger refractive power of the eye, causing light to focus in front of the retina, characteristic of **myopia**. *Curvature myopia* - Occurs when there is an increase in the **curvature of the cornea** or lens, leading to increased refractive power. - While lens curvature can change, the primary mechanism in nuclear cataracts is refractive index change, not solely curvature. *Axial myopia* - Arises from an **elongation of the eyeball**, making the axial length too long relative to the refractive power. - This is a structural change in the eye's shape, not directly caused by changes within the lens itself due to cataract. *Lenticular myopia* - This term is a broader category that refers to myopia caused by changes in the lens, which **index myopia** falls under. - However, "index myopia" is more specific and accurately describes the underlying mechanism in senile nuclear cataracts.
Question 895: "Bread-crumb" appearance is seen in ?
- A. Cataract due to CMV infection
- B. Complicated cataracts (Correct Answer)
- C. Cataract due to diabetes
- D. Cataract due to Toxoplasmosis
Explanation: ***Complicated cataracts*** - A "bread-crumb" appearance, specifically referring to small, refractile opacities in the posterior capsule, is a characteristic finding in **complicated cataracts**. - These cataracts often develop due to chronic intraocular diseases such as **uveitis**, **retinal detachment**, or **intraocular tumors**, leading to secondary lens changes. *Cataract due to diabetes* - Diabetic cataracts typically present as "snowflake" opacities in younger patients or accelerated nuclear/cortical sclerosis in older patients, not a "bread-crumb" appearance. - They are often associated with poor glycemic control and metabolic changes affecting lens hydration and protein structure. *Cataract due to CMV infection* - Cataracts associated with **cytomegalovirus (CMV) infection** are more common in congenital infections and can manifest as varying degrees of lens opacification, but "bread-crumb" is not a typical description. - Congenital CMV can cause a spectrum of ocular abnormalities, including microphthalmia, chorioretinitis, and optic atrophy, in addition to cataracts. *Cataract due to Toxoplasmosis* - **Toxoplasmosis** primarily causes **chorioretinitis**, especially in congenital cases, with lens involvement being less common and not typically described as having a "bread-crumb" appearance. - If a cataract develops, it's usually secondary to inflammation or direct lens invasion, but the characteristic morphology differs.
Question 896: Elschnig's pearls are a clinical sign of which condition?
- A. Chronic uveitis
- B. Secondary cataract (Correct Answer)
- C. Cystoid macular oedema
- D. None of the options
Explanation: ***Secondary cataract*** - **Elschnig's pearls** are bladder-like cells formed by **proliferation of residual equatorial lens epithelial cells** following extracapsular cataract extraction (ECCE) or phacoemulsification - They migrate posteriorly along the posterior capsule, contributing to **posterior capsular opacification (PCO)** - PCO is commonly called **"secondary cataract"** or **"after-cataract"** and is the most common complication of cataract surgery - Presents with **gradual visual decline** months to years after initially successful cataract surgery - Treated with **Nd:YAG laser capsulotomy** *Chronic uveitis* - While chronic uveitis causes various ocular complications (**synechiae**, **band keratopathy**, **cataract formation**, **macular edema**), **Elschnig's pearls are not a sign of uveitis** - They are specifically a **post-surgical complication** of cataract extraction, not an inflammatory finding - Uveitis patients may develop cataracts requiring surgery, which could subsequently lead to Elschnig's pearls, but this is an indirect relationship *Cystoid macular oedema* - **CME** involves fluid accumulation in the macula forming **cyst-like spaces**, causing decreased central vision - Can occur after cataract surgery (Irvine-Gass syndrome) or with uveitis - Has **completely different pathophysiology and clinical appearance** from Elschnig's pearls - CME affects the **retina**, while Elschnig's pearls involve the **lens capsule** *None of the options* - Incorrect because **secondary cataract (PCO)** is the established correct answer for Elschnig's pearls
Question 897: Foldable lens is made up of?
- A. PMMA
- B. Hydrogel
- C. Silicone (Correct Answer)
- D. None of the options
Explanation: ***Silicone*** - **Silicone** was one of the **first materials** used for foldable intraocular lenses (IOLs) and remains widely used today. - Its excellent **elastomeric properties** allow the lens to be folded or rolled for insertion through a **small incision** (typically 2.8-3.2 mm) in modern cataract surgery. - Silicone IOLs are **hydrophobic** and have high biocompatibility with minimal inflammatory response. - **Clinical advantage**: Silicone's flexibility enables **sutureless small-incision cataract surgery**, reducing astigmatism and recovery time. *PMMA* - **PMMA (Polymethyl methacrylate)** is a **rigid material** and was the standard for IOLs before the development of foldable lenses. - Its rigidity requires a **large incision** (5.5-7 mm) for insertion, resulting in more induced astigmatism and longer recovery. - PMMA is not foldable and therefore is not used in modern small-incision cataract surgery. *Hydrogel* - **Hydrophilic acrylic (hydrogel)** is actually another material used for foldable IOLs, along with hydrophobic acrylic. - However, in the context of this question, **silicone** is the most recognized answer as it was the **first foldable material** introduced. - Hydrogel IOLs can absorb water and require different handling during insertion. *None of the options* - This is incorrect as **silicone** is definitively a material used for foldable IOLs.
Question 898: Van Herick angle grade '3' of anterior chamber denotes
- A. Wide open angle
- B. Closed angle
- C. Narrow angle
- D. Moderately open angle (Correct Answer)
Explanation: ***Moderately open angle*** - A **Von Herick angle grade 3** indicates that the width of the peripheral anterior chamber is approximately **one-quarter to one-half** the thickness of the peripheral cornea. - This assessment suggests a **moderately open anterior chamber angle**, indicating that while there is some risk of angle closure, it is not immediately narrow. *Wide open angle* - A **wide open angle** is typically represented by a **Von Herick grade 4**, where the anterior chamber angle is as wide or wider than the corneal thickness. - This grade signifies a **low risk of angle closure** and good aqueous outflow. *Narrow angle* - A **narrow angle** is generally associated with **Von Herick grades 1 or 2**, where the anterior chamber is significantly shallower. - Grade 1 indicates an angle width of **less than one-quarter** of peripheral corneal thickness, posing a higher risk of angle closure. *Closed angle* - A **closed angle** represents an extreme case where the **iris is in contact with the trabecular meshwork**, blocking aqueous outflow. - This condition is not typically graded in the Von Herick system as an existent angle, but rather as an absence of a visible angle (grade 0 or **"slit"**).
Question 899: Krukenberg spindles -
- A. Involve anterior surface of cornea
- B. Involve anterior lens surface
- C. Involve posterior surface of lens
- D. Involve posterior surface of cornea (Correct Answer)
Explanation: **Involve posterior surface of cornea** - **Krukenberg spindles** are vertical, spindle-shaped deposits of **pigment (melanin)** on the posterior surface of the cornea. - They are a characteristic finding in **pigment dispersion syndrome** and **pigmentary glaucoma**, where iris pigment is released and circulated in the aqueous humor, eventually depositing on the corneal endothelium. *Involve anterior surface of cornea* - Deposits on the anterior corneal surface are less common and typically indicate external factors or specific corneal dystrophies, not Krukenberg spindles. - **Krukenberg spindles** are specifically formed by pigment circulating within the anterior chamber, which deposits on the posterior corneal surface due to aqueous humor flow. *Involve anterior lens surface* - Pigment deposits can occur on the anterior lens capsule, but these are typically diffuse or in a "bull's eye" pattern and are not referred to as **Krukenberg spindles**. - **Krukenberg spindles** are defined by their specific "spindle" shape and location on the cornea. *Involve posterior surface of lens* - Deposits on the posterior lens surface are usually associated with specific conditions like **uveitis** (posterior synechiae) or related to retinal issues, not pigment dispersion syndrome or **Krukenberg spindles**. - The formation of **Krukenberg spindles** is directly linked to the flow of aqueous humor and gravity affecting pigment particles in the anterior chamber.