NEET-PG 2024 Practice Questions

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**.

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.

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.

Q: Identify the diagnosis based on the clinical image shown.

Herbert's pits. ***Herbert's pits*** - The image displays characteristic **pits at the limbus**, which are a hallmark of healed follicular conjunctivitis, specifically **Herbert's pits**. - These pits are pathognomonic for **trachoma**, a chronic keratoconjunctivitis caused by *Chlamydia trachomatis*. *Horner-Trantas spots* - These are small, raised, gelatinous white dots found at the limbus, typically containing **eosinophils**. - They are characteristic of **vernal keratoconjunctivitis**, an allergic inflammatory condition, and not seen in the provided image. *Pannus* - **Pannus** refers to the growth of **vascularized connective tissue** onto the cornea. - While pannus is also a feature of trachoma, the image specifically shows distinct limbal pits, rather than diffuse vascularization. *Corneal dystrophy* - **Corneal dystrophies** are a group of inherited, bilateral, and progressive corneal disorders that manifest as opacities or structural changes in the cornea. - The findings in the image, such as pits, are inflammatory in origin and distinct from the typically stromal or epithelial changes seen in corneal dystrophies.

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

Mannitol with Pilocarpine. ***Mannitol with Pilocarpine*** - This combination is appropriate for **acute angle-closure glaucoma (AACG)**, which can be triggered by pupillary dilation (e.g., in a dark movie theater). **Mannitol** is an osmotic diuretic that rapidly reduces intraocular pressure. - **Pilocarpine** is a miotic agent that constricts the pupil, pulling the iris away from the trabecular meshwork and opening the drainage angle to facilitate aqueous humor outflow. *Mannitol with Moxifloxacin* - While mannitol helps with intraocular pressure, **Moxifloxacin is an antibiotic** used to treat bacterial infections. - There is no indication of an ocular infection in this scenario, so an antibiotic would not be the first-line treatment for sudden eye pain and vision difficulty after watching a movie. *Mannitol with Atropine* - Adding **Atropine, a cycloplegic agent**, would cause further pupillary dilation, which would worsen acute angle-closure glaucoma and increase intraocular pressure. - Atropine is contraindicated in AACG and would exacerbate the patient's condition. *Mannitol with lubricating eye drops* - While mannitol helps with intraocular pressure, **lubricating eye drops** are used for dry eyes or surface irritation, not for acute angle-closure glaucoma. - Lubricating drops do not address the underlying pathology of increased intraocular pressure due to angle closure.

Q: 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?

Acute anterior uveitis. ***Acute anterior uveitis*** - The constellation of **sudden painful diminution of vision**, **photophobia**, **circumcorneal congestion**, and **hypopyon** (pus in the anterior chamber, visible as a whitish fluid level in the image) is highly characteristic of acute anterior uveitis. - This condition involves inflammation of the iris and ciliary body, leading to these severe symptoms and signs. *Acute conjunctivitis* - Characterized by **redness**, **itching**, and **discharge**, but typically lacks significant pain, photophobia, or vision loss. - Hypopyon is not a feature of acute conjunctivitis; the congestion is diffuse and not pericorneal. *Episcleritis* - Presents with **localized redness** and mild discomfort, but generally without pain, photophobia, or vision changes. - Episcleritis does not typically involve the anterior chamber with hypopyon. *Acute congestive glaucoma* - Involves severe eye pain, blurred vision, ciliary congestion, and often a **fixed, mid-dilated pupil** due to acutely elevated intraocular pressure. - While it shares some symptoms like pain, photophobia, and blurred vision, **hypopyon is not a typical finding** in acute congestive glaucoma, which differentiates it from uveitis.

Q: 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?

Scleritis with rheumatoid arthritis. ***Scleritis with rheumatoid arthritis*** - The image shows **deep, violaceous conjunctival injection** with surrounding edema and a nodular appearance near the limbus, consistent with **nodular scleritis**. Scleritis is inflammation of the sclera, often characterized by severe pain and association with systemic autoimmune diseases like **rheumatoid arthritis**, which can cause destructive lesions and recurrence. - The characteristic **deep vessel engorgement that does not blanch with phenylephrine** and the history of recurrence further support scleritis. *Episcleritis with rheumatoid arthritis* - Episcleritis presents with a **more superficial, bright red injection** involving the episclera, which generally **blanches with topical phenylephrine** and is less painful than scleritis. - While episcleritis can be associated with rheumatoid arthritis, the clinical features described (nodular swelling, deep injection) are more typical of scleritis. *Pinguecula* - A pinguecula is a **yellowish patch or bump** on the conjunctiva, typically on the nasal side of the eye, that is **not inflamed** unless irritated. - It consists of **degenerated collagen fibers** and elastic tissue, and does not present with the diffuse, deep vascular injection seen in the image. *Dry eye* - Dry eye is characterized by **ocular dryness, irritation, and sometimes a foreign body sensation**, but it typically causes **diffuse conjunctival hyperemia** rather than a localized, nodular, deep inflammation with surrounding edema as shown. - While dry eye can be associated with autoimmune diseases, its appearance is not consistent with the depicted nodular lesion.

Q: A 2 -month-old child presents with the following condition as shown in the image. What is the ideal management protocol?

Medical management. ***Medical management*** - The image shows **epicanthal folds**, which are normal in many Asian infants and children. They are **congenital, benign skin folds** that cover the inner corner of the eye. - In a 2-month-old child, these folds are a normal variant and typically **recede with age**. No medical intervention, surgical or otherwise, is usually required. *Operate immediately* - **No medical indication** for immediate surgery as epicanthal folds are not a pathological condition requiring urgent correction. - Surgical intervention for cosmetic purposes is typically considered much later in life, if at all, when facial features are more developed. *Surgery after 6 months of age* - Epicanthal folds are **still a normal finding** in infants up to 6 months of age and often persist for several years. - Premature surgical correction could be unnecessary as the folds may resolve naturally with the development of the **nasal bridge**. *Surgery after 2 years of age* - While epicanthal folds can still be present at 2 years of age, surgery is **rarely indicated** unless they cause significant vision problems (e.g., pseudostrabismus) or severe cosmetic concerns that persist into later childhood. - By this age, many children will have developed a more prominent nasal bridge, which can lessen the appearance of the folds naturally. *Refer to pediatric ophthalmology for evaluation* - While specialist referral might be considered if there are concerns about **vision impairment or true strabismus**, isolated epicanthal folds in a 2-month-old infant are a **normal anatomical variant** that does not require specialist evaluation. - Referral would be appropriate only if there were functional concerns beyond the cosmetic appearance of the folds.

Question 1

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 2

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 3

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 4

Which of the following statements is false?
![img-48.jpeg](img-48.jpeg)

Accepted Answer

The management corresponds to improvement in thyrotoxic state

Answer

Seen in More than 10% of patients with hyperthyroidism

Answer

NOSPECS score is used to classify

Answer

Can lead to visual loss

Question 5

Identify the diagnosis based on the clinical image shown.

Accepted Answer

Herbert's pits

Answer

Horner-Trantas spots

Answer

Pannus

Answer

Corneal dystrophy

Question 6

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 7

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 8

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

Question 9

A child presenting with leukocoria has an intraocular mass. Microscopic examination shows rosettes with scanty cytoplasm and positive synaptophysin. What is the most likely diagnosis?

Accepted Answer

Retinoblastoma

Answer

Medulloblastoma

Answer

Neuroblastoma

Answer

Ependymoma

Question 10

A 2 -month-old child presents with the following condition as shown in the image. What is the ideal management protocol?

Accepted Answer

Medical management

Answer

Operate immediately

Answer

Surgery after 6 months of age

Answer

Surgery after 2 years of age

Answer

Refer to pediatric ophthalmology for evaluation

NEET-PG 2024

Ophthalmology

Pathology

Pediatrics