NEET-PG 2013 - Ophthalmology Practice Questions

Q: Krukenberg spindles -

Involve posterior surface of cornea. **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.

Q: What is the most common symptom associated with congenital glaucoma?

Excessive tearing. ***Excessive tearing*** - **Epiphora**, or excessive tearing, is one of the most common early symptoms of **congenital glaucoma** in infants. - This symptom occurs due to **corneal irritation** and **damage** resulting from elevated intraocular pressure. *Eye pain* - While glaucoma can cause eye pain, it is less commonly reported as the *initial* and *most frequent* symptom in **congenital glaucoma** in infants who cannot verbalize their discomfort. - **Irritability** or excessive crying might be indirect signs of pain, but tearing is a more direct and observable sign. *Sensitivity to light* - **Photophobia**, or sensitivity to light, is another common symptom of congenital glaucoma. - However, **excessive tearing** often precedes or co-occurs with photophobia as an initial presenting symptom in infants. *Itching of the eyes* - **Ocular itching** is typically associated with **allergic conjunctivitis** or other inflammatory conditions, not directly with congenital glaucoma. - Itching is not a primary or common symptom of elevated intraocular pressure in infants.

Q: Drug of choice for open angle glaucoma:

Latanoprost. ***Latanoprost*** - **Prostaglandin F2α analogs** like latanoprost are generally considered **first-line therapy** for open-angle glaucoma due to their efficacy and once-daily dosing. - They work by **increasing uveoscleral outflow** of aqueous humor, thereby lowering intraocular pressure (IOP). *Acetazolamide* - **Acetazolamide** is a **carbonic anhydrase inhibitor** that reduces aqueous humor production. - It is typically used for **acute angle-closure glaucoma** or when initial treatments fail, often due to systemic side effects with long-term use. *Timolol* - **Timolol** is a **non-selective beta-blocker** that reduces aqueous humor production. - While effective, it is often a second-line agent or used in combination due to potential systemic side effects like **bronchospasm** and **bradycardia**. *Brimonidine* - **Brimonidine** is an **alpha-2 adrenergic agonist** that reduces aqueous humor production and increases uveoscleral outflow. - It is typically used as a second-line agent or in combination therapy due to potential side effects like **ocular pruritus** and **allergic conjunctivitis**.

Q: What is the first-line treatment for acute angle closure glaucoma?

Acetazolamide. **Acetazolamide** - **Acetazolamide** (oral or intravenous) is a carbonic anhydrase inhibitor that rapidly reduces intraocular pressure by decreasing aqueous humor production, making it the **first-line medical treatment** for acute angle-closure glaucoma. - While other agents are used, acetazolamide provides the quickest and most significant initial reduction in **intraocular pressure (IOP)**, which is crucial in preventing permanent vision loss. *IV mannitol* - **Intravenous mannitol** is an osmotic diuretic used to draw fluid from the vitreous humor to lower **IOP** significantly, but it is typically reserved for cases where **acetazolamide** alone is insufficient or for very high **IOPs**. - It is often considered a second-line or adjunctive agent rather than the initial first-line treatment. *Pilocarpine* - **Pilocarpine** is a miotic agent that constricts the pupil, which helps to pull the iris away from the trabecular meshwork and open the angle. - However, it should only be administered *after* the **intraocular pressure** has been significantly lowered (e.g., with acetazolamide), as it can worsen angle closure in an inflamed eye with very high **IOP**. *Beta blocker eyedrops* - **Topical beta-blockers** (e.g., timolol) reduce **IOP** by decreasing aqueous humor production and are a common treatment for various types of glaucoma. - While useful in acute angle-closure glaucoma, they act more slowly than **acetazolamide** and are typically used as an adjunct rather than the sole initial first-line treatment.

Q: What are the characteristic features of Posner-Schlossman syndrome?

Unilateral glaucomatous changes with mild anterior uveitis. ***Unilateral glaucomatous changes with mild anterior uveitis*** - Posner-Schlossman syndrome, also known as **glaucomatocyclitic crisis**, is characterized by recurrent, acute attacks of **unilateral elevated intraocular pressure** (glaucomatous changes). - These attacks are accompanied by **mild anterior uveitis**, which typically presents with few or no precipitates and minimal redness. *Ipsilateral optic atrophy with contralateral papilloedema* - This constellation of symptoms, known as **Foster Kennedy syndrome**, is associated with intracranial masses, not Posner-Schlossman syndrome. - It involves **optic atrophy** in one eye due to direct pressure on the optic nerve and **papilledema** in the other eye due to increased intracranial pressure. *Granulomatous uveitis with iris heterochromia* - **Granulomatous uveitis** is characterized by large mutton-fat keratic precipitates and often seen in diseases like sarcoidosis or tuberculosis, which is not typical for Posner-Schlossman. - **Iris heterochromia** (different colored irises) is a characteristic feature of **Fuchs' heterochromic cyclitis**, another form of chronic anterior uveitis, but not Posner-Schlossman syndrome. *None of the options* - This option is incorrect as one of the provided choices accurately describes the characteristic features of Posner-Schlossman syndrome. - The other options describe different ophthalmological conditions.

Q: Which of the following is not a cause of exudative retinal detachment?

High myopia. ***High myopia*** - **High myopia** is a risk factor for **rhegmatogenous retinal detachment**, which is caused by a retinal break, not by fluid accumulation from a vascular or inflammatory process. - In rhegmatogenous detachment, vitreous fluid passes through the break into the subretinal space, separating the **neurosensory retina** from the **retinal pigment epithelium**. *Toxemia of pregnancy* - **Toxemia of pregnancy** (preeclampsia/eclampsia) can cause **exudative retinal detachment** due to choroidal ischemia and dysfunction of the retinal pigment epithelium, leading to fluid leakage. - The elevated **blood pressure** and systemic vascular changes impair choroidal perfusion, resulting in serous fluid accumulation beneath the retina. *Scleritis* - **Posterior scleritis** can lead to **exudative retinal detachment** by causing inflammation and edema of the choroid and sclera, which in turn compromises the integrity of the retinal pigment epithelium. - The inflammatory process increases vascular permeability, allowing fluid to leak into the subretinal space. *Central serous retinopathy* - **Central serous retinopathy** is a classic example of **exudative retinal detachment**, characterized by serous fluid accumulation under the macula. - This occurs due to dysfunction or a break in the **retinal pigment epithelium**, often associated with stress and corticosteroid use, leading to fluid leakage from the choroid.

Q: Which of the following is NOT a feature of CMV retinitis?

Cracked mud appearance. ***Cracked mud appearance*** - **"Cracked mud appearance"** is not a term used to describe CMV retinitis. The classic descriptions include **"pizza pie"**, **"cottage cheese and ketchup"**, and **"brush-fire"** appearances. - CMV retinitis presents with **necrotizing retinitis** with hemorrhages and granular opacification, not a cracked or atrophic pattern. - This option describes a **non-existent finding** in the context of CMV retinitis. *Immunosuppression* - **Immunosuppression**, especially due to **HIV/AIDS** (CD4 count <50 cells/μL), organ transplantation, or chemotherapy, is a **primary risk factor** for CMV retinitis. - It is crucial for the **reactivation** of latent CMV infection, leading to opportunistic disease. - While technically a predisposing condition rather than a "feature" of the disease itself, it is strongly associated with CMV retinitis. *Brush-fire appearance* - The **"brush-fire appearance"** is a classic description of CMV retinitis, referring to the **active leading edge** of the infection with confluent areas of necrosis and hemorrhage spreading across the retina. - This term captures the **fulminant necrotizing retinitis** with yellow-white retinal opacification and hemorrhages. *Perivasculitis* - **Perivasculitis**, or inflammation around the retinal blood vessels, is a **characteristic pathological feature** of CMV retinitis. - It often manifests as **frosted branch angiitis** (white sheathing around retinal vessels), which can be seen in severe cases.

Q: What condition is characterized by an "umbrella" configuration on fluorescein angiography?

Central serous retinopathy. ***Central serous retinopathy*** - The "umbrella" or "smokestack" configuration on **fluorescein angiography** is a classic finding in central serous retinopathy, indicating leakage of dye creating a mushroom-shaped plume. - This leakage originates from the **retinal pigment epithelium (RPE)** into the subretinal space, causing serous detachment of the neurosensory retina. *Retinitis pigmentosa* - Characterized by **progressive photoreceptor degeneration** and **pigmentary changes** in the retina, often described as "bone-spicule" pigmentation. - Fluorescein angiography in retinitis pigmentosa typically shows **atrophy** and **window defects**, not an umbrella pattern of leakage. *Rhegmatogenous retinal detachment* - Involves a **full-thickness break in the retina** that allows vitreous fluid to pass into the subretinal space, causing the retina to detach. - Fluorescein angiography is generally not used for primary diagnosis and would not show an umbrella pattern, but rather **non-perfusion** or vascular changes in the detached area. *Eale's disease* - A rare **idiopathic obliterative periphlebitis** primarily affecting the retinal veins, leading to recurrent vitreous hemorrhages and retinal neovascularization. - Fluorescein angiography would reveal **vascular sheathing**, **non-perfusion**, and **neovascularization**, which are distinct from the umbrella configuration.

Q: Birdshot retinopathy is characterized by all except?

Unilateral. ***Unilateral*** - **Birdshot retinopathy** is characteristically a **bilateral** inflammatory condition affecting both eyes, even if the onset may be asymmetric. - The disease involves widespread inflammation of the **choroid** and **retina**, typically presenting in both eyes simultaneously or sequentially. - Unilateral presentation would be highly atypical and should prompt consideration of alternative diagnoses. *Common in females* - Birdshot retinopathy shows a **clear female predominance**, with approximately **2-3 times more females affected than males** (60-75% of cases). - This demographic trend is a well-established feature of the disease. - However, it does occur in both sexes and is still considered characteristic of the condition. *HLA-A29 positive* - A strong association with the **HLA-A29 allele** is a hallmark of birdshot retinopathy, found in **over 95% of affected individuals**. - This genetic marker is highly specific and often used to support the diagnosis. - HLA-A29 testing is considered part of the diagnostic workup. *Creamy yellow spots* - The presence of characteristic **creamy yellow-white choroidal lesions**, resembling birdshot scatter, is a defining clinical feature. - These lesions are typically located in the **mid-peripheral and posterior fundus**, distributed radially around the optic disc. - The "birdshot" appearance refers to the scattered pattern resembling shotgun pellet distribution.

Q: The most common cause of vitreous hemorrhage in adults is

Diabetes. ***Diabetes*** - **Proliferative diabetic retinopathy (PDR)** leads to the formation of new, fragile blood vessels (neovascularization) on the retinal surface or optic disc. - These new vessels are prone to bleeding into the **vitreous cavity**, making diabetes the most common cause of vitreous hemorrhage in adults. *Retinal hole* - A retinal hole or tear can lead to **rhegmatogenous retinal detachment** but does not commonly cause significant vitreous hemorrhage on its own. - While a tear can sometimes be associated with a small amount of hemorrhage, it is not the MOST common cause of widespread vitreous bleeding. *Trauma* - **Ocular trauma**, such as blunt or penetrating injuries, can certainly cause vitreous hemorrhage due to direct damage to retinal or choroidal blood vessels. - However, in the general adult population, **systemic diseases** like diabetes are statistically more frequent causes of spontaneous vitreous hemorrhage than acute trauma. *Hypertension* - Severe **hypertensive retinopathy** can cause retinal hemorrhages, microaneurysms, and cotton wool spots, but it typically does not lead to large-volume vitreous hemorrhage. - While hypertension can contribute to the severity of other retinal conditions, it is not the primary direct cause of vitreous hemorrhage itself.

Question 1

Krukenberg spindles -

Accepted Answer

Involve posterior surface of cornea

Answer

Involve anterior surface of cornea

Answer

Involve anterior lens surface

Answer

Involve posterior surface of lens

Question 2

What is the most common symptom associated with congenital glaucoma?

Accepted Answer

Excessive tearing

Answer

Eye pain

Answer

Sensitivity to light

Answer

Itching of the eyes

Question 3

Drug of choice for open angle glaucoma:

Accepted Answer

Latanoprost

Answer

Acetazolamide

Answer

Brimonidine

Answer

Timolol

Question 4

What is the first-line treatment for acute angle closure glaucoma?

Accepted Answer

Acetazolamide

Answer

Pilocarpine

Answer

Beta blocker eyedrops

Answer

IV mannitol

Question 5

What are the characteristic features of Posner-Schlossman syndrome?

Accepted Answer

Unilateral glaucomatous changes with mild anterior uveitis

Answer

Ipsilateral optic atrophy with contralateral papilloedema

Answer

Granulomatous uveitis with iris heterochromia

Answer

None of the options

Question 6

Which of the following is not a cause of exudative retinal detachment?

Accepted Answer

High myopia

Answer

Scleritis

Answer

Toxemia of pregnancy

Answer

Central serous retinopathy

Question 7

Which of the following is NOT a feature of CMV retinitis?

Accepted Answer

Cracked mud appearance

Answer

Perivasculitis

Answer

Brush-fire appearance

Answer

Immunosuppression

Question 8

What condition is characterized by an "umbrella" configuration on fluorescein angiography?

Accepted Answer

Central serous retinopathy

Answer

Retinitis pigmentosa

Answer

Rhegmatogenous retinal detachment

Answer

Eale's disease

Question 9

Birdshot retinopathy is characterized by all except?

Accepted Answer

Unilateral

Answer

Common in females

Answer

Creamy yellow spots

Answer

HLA-A29 positive

Question 10

The most common cause of vitreous hemorrhage in adults is

Accepted Answer

Diabetes

Answer

Retinal hole

Answer

Trauma

Answer

Hypertension

NEET-PG 2013 — Ophthalmology