Which agent is known to cause corneal ulcers that may resemble fungal infections?
Which of the following conditions is NOT diagnosed by fluorescein angiography?
Parachute lesions are associated with which of the following conditions?
Which of the following is a specific sign of albinism?
Epithelial xerosis of conjunctiva is caused by?
Which Goldmann type is considered the standard in perimetry?
"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
NEET-PG 2013 - Ophthalmology NEET-PG Practice Questions and MCQs
Question 31: Which agent is known to cause corneal ulcers that may resemble fungal infections?
- A. Nocardia asteroides (Correct Answer)
- B. Mycobacterium
- C. Klebsiella pneumoniae
- D. Chlamydia trachomatis
Explanation: ***Nocardia asteroides*** - This organism can cause **Nocardia keratitis**, which often presents with a **feathery or crystalline appearance** in the cornea, mimicking a fungal infection. - It tends to occur in patients with **contact lens use** or ocular trauma and requires specific antimicrobial treatment different from fungal therapy. *Mycobacterium* - **Atypical mycobacteria** can cause chronic, indolent corneal ulcers, particularly after trauma or surgery. - While they can be challenging to diagnose, their appearance typically differs from the **feathery morphology** associated with fungal or Nocardia infections. *Klebsiella pneumoniae* - **Klebsiella pneumoniae** is a common cause of **bacterial keratitis**, especially in contact lens wearers. - Infections usually manifest as a rapidly progressing infiltrate with significant inflammation and often produce abundant **mucopurulent discharge**, not typically mistaken for fungal infections. *Chlamydia trachomatis* - **Chlamydia trachomatis** is the causative agent of **trachoma**, leading to recurrent conjunctivitis and eventually corneal scarring and blindness in endemic areas. - It does not cause acute corneal ulcers that resemble fungal infections; rather, it results in a chronic inflammatory process with **follicular conjunctivitis** and **pannus formation**.
Question 32: Which of the following conditions is NOT diagnosed by fluorescein angiography?
- A. Diabetes retinopathy
- B. Hypertensive retinopathy (Correct Answer)
- C. Central serous retinopathy
- D. Choroidal neovascularization
Explanation: ***Hypertensive retinopathy*** - This condition is primarily diagnosed by **clinical fundoscopic examination**, not fluorescein angiography - Diagnosis is based on characteristic clinical findings: **arteriovenous nicking, copper/silver wire arterioles, cotton-wool spots, flame-shaped hemorrhages, and papilledema** in severe cases - **Fluorescein angiography** is rarely needed and only used in research settings or to assess severe complications; it is **not a standard diagnostic tool** for hypertensive retinopathy *Diabetic retinopathy* - **Fluorescein angiography** is extensively used for diagnosing and staging diabetic retinopathy - It helps identify **microaneurysms, capillary non-perfusion areas, macular edema, and neovascularization** - Essential for detecting **proliferative diabetic retinopathy** and planning laser photocoagulation *Central serous retinopathy* - **Fluorescein angiography** shows characteristic **"smokestack" or "inkblot" pattern** of leakage at the RPE level - Demonstrates one or more **leakage points** with progressive pooling of dye in the subretinal space - While **OCT** is now preferred for initial diagnosis, FA remains valuable for identifying leakage sites and guiding treatment *Choroidal neovascularization* - **Fluorescein angiography** is the gold standard for diagnosing **choroidal neovascularization (CNV)** - Shows **early hyperfluorescence with progressive leakage** from abnormal vessels - Critical for determining the **type (classic vs occult), location, and extent** of CNV for treatment planning
Question 33: Parachute lesions are associated with which of the following conditions?
- A. Eale's disease (Correct Answer)
- B. Diabetes
- C. Sickle cell anemia
- D. None of the options
Explanation: ***Eale's disease*** - **Eale's disease** is an idiopathic retinal perivasculitis affecting young males, characterized by recurrent vitreous hemorrhages. - In the context of this question (NEET-2013), the term "parachute lesions" refers to the characteristic pattern of hemorrhages seen in Eale's disease. - The disease features retinal periphlebitis, capillary non-perfusion, and neovascularization leading to vitreous hemorrhage. - **Note:** The term "parachute hemorrhages" in broader ophthalmology typically describes preretinal/subhyaloid hemorrhages that settle inferiorly (boat-shaped), more commonly seen in proliferative diabetic retinopathy. *Diabetes* - **Diabetic retinopathy** presents with microaneurysms, dot-blot hemorrhages, hard exudates, cotton-wool spots, and neovascularization. - While proliferative diabetic retinopathy can cause preretinal "parachute-shaped" hemorrhages (boat-shaped hemorrhages that settle inferiorly), this is not the association being tested in this NEET-2013 question. - The specific context of this exam question associates the term with Eale's disease. *Sickle cell anemia* - **Sickle cell retinopathy** features characteristic sea-fan neovascularization in the peripheral retina. - Can cause salmon-patch hemorrhages, black sunburst lesions, and angioid streaks. - While vitreous hemorrhage can occur, "parachute lesions" is not standard terminology for sickle cell retinopathy manifestations. *None of the options* - This option is incorrect because **Eale's disease** is the correct answer according to the NEET-2013 exam key.
Question 34: Which of the following is a specific sign of albinism?
- A. Iris transillumination (Correct Answer)
- B. Sensitivity to light (photophobia)
- C. Involuntary eye movements (nystagmus)
- D. Decreased visual acuity
Explanation: ***Iris transillumination*** - This is a highly **specific sign** of albinism, resulting from the severe reduction or absence of pigment in the iris. - When light shines through the pupil, it passes through the unpigmented iris, creating a visible red reflex, indicating the lack of pigment that normally blocks the light. *Sensitivity to light (photophobia)* - While common in albinism due to the lack of pigment in the iris and retina allowing more light to enter the eye, **photophobia is not specific** to albinism. - It can be a symptom of various other ocular conditions like uveitis, corneal abrasions, or migraines. *Involuntary eye movements (nystagmus)* - **Nystagmus is frequently associated with albinism** due to foveal hypoplasia and impaired visual development but is **not specific**. - It can also be caused by neurological disorders, inner ear problems, or other ocular conditions. *Decreased visual acuity* - **Reduced vision is a characteristic feature of albinism** resulting from foveal hypoplasia and abnormal optic nerve pathways, but it is **not specific** to the condition. - Numerous eye conditions, such as refractive errors, cataracts, and retinal diseases, can lead to decreased visual acuity.
Question 35: Epithelial xerosis of conjunctiva is caused by?
- A. Xerophthalmia (Correct Answer)
- B. Infectious conjunctivitis caused by Chlamydia trachomatis
- C. Autoimmune blistering conjunctivitis
- D. Bacterial conjunctivitis due to Corynebacterium diphtheriae
Explanation: ***Xerophthalmia*** - **Xerophthalmia** is a medical condition characterized by **dryness of the eye**, often due to **vitamin A deficiency**. - **Epithelial xerosis of the conjunctiva** is one of the early and hallmark signs of xerophthalmia, representing the drying and thickening of the conjunctival epithelium due to goblet cell loss and squamous metaplasia. *Infectious conjunctivitis caused by Chlamydia trachomatis* - This typically causes **trachoma**, characterized by chronic inflammation, scarring, and eventual blindness. - While it can lead to dryness and scarring in later stages due to **symblepharon** or **entropion**, it does not primarily manifest as epithelial xerosis. *Autoimmune blistering conjunctivitis* - This condition involves **immune-mediated inflammation** leading to subepithelial blistering, scarring, and shrinkage of the conjunctiva. - It results in significant **ocular surface damage** and vision loss but is distinct from the primary epithelial changes seen in xerosis due to vitamin A deficiency. *Bacterial conjunctivitis due to Corynebacterium diphtheriae* - **Diphtheritic conjunctivitis** is a severe form of bacterial conjunctivitis that causes a distinctive **"pseudomembrane"** on the conjunctiva. - It leads to acute inflammation and potentially systemic illness, not primarily epithelial xerosis.
Question 36: Which Goldmann type is considered the standard in perimetry?
- A. Goldmann type I (small stimulus size)
- B. Goldmann type II (medium-small stimulus size)
- C. Goldmann type IV (large stimulus size)
- D. Goldmann type III (commonly used stimulus size) (Correct Answer)
Explanation: ***Goldmann type III (commonly used stimulus size)*** - This stimulus size is the **international standard** for kinetic perimetry and ensures comparability of visual field charts worldwide. - It provides a balance between **sensitivity** and minimizing the effects of **pupil size** and other ocular factors. *Goldmann type I (small stimulus size)* - While very small, this stimulus type is **not the standard** for general perimetry. - It is sometimes used for detecting **subtle defects** or for patients with very good visual acuity, but its small size can make it harder to detect. *Goldmann type II (medium-small stimulus size)* - This stimulus size is **smaller than the standard** and is not universally adopted for perimetry. - It offers slightly more sensitivity than the standard but can be more affected by **refractive errors** or media opacities. *Goldmann type IV (large stimulus size)* - This stimulus is **much larger than the standard** and is typically used for detecting **gross defects** or in patients with severely impaired vision. - Its large size makes it **less sensitive** to smaller visual field abnormalities.
Question 37: "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 38: 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 39: 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 40: 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"**).