NEET-PG 2013 - Ophthalmology Practice Questions

Q: In which condition is a positive forced duction test observed?

Mechanical restriction of ocular movement. ***Mechanical restriction of ocular movement*** - A **positive forced duction test** indicates a physical impediment to eye movement, meaning the eye cannot be passively moved beyond a certain point. - This test is crucial for differentiating between **muscle restriction** (e.g., thyroid eye disease, orbital floor fracture with muscle entrapment, post-surgical adhesions) and muscle weakness or paralysis. - When the examiner attempts to passively rotate the globe, there is **resistance** indicating mechanical tethering or restriction of the extraocular muscles. *Non-concomitant strabismus* - This refers to a squint where the magnitude of deviation varies with the direction of gaze. - While it can be caused by muscle restriction, non-concomitant strabismus itself is a **type of ocular misalignment**, not the specific finding of a forced duction test. - The forced duction test helps determine the **cause** of non-concomitant strabismus (mechanical vs. paralytic). *No condition* - This option is incorrect because a positive forced duction test specifically indicates mechanical obstruction or restriction in eye movement. - A positive result always points to an underlying pathological condition affecting ocular motility, not a normal finding. *Extraocular muscle paralysis* - In cases of **muscle paralysis**, the eye cannot move actively in the direction of the paralyzed muscle's action. - However, the **forced duction test would be negative** as the globe can be passively moved in all directions because there is no mechanical restriction. - This differentiates paralytic strabismus (negative test) from restrictive strabismus (positive test).

Q: The earliest change noticed in hypertensive retinopathy is:

Arteriolar spasm. ***Arteriolar spasm*** - **Arteriolar spasm** is the **earliest functional change** and is characterized by increased vascular tone in response to elevated blood pressure. - This spasm is a dynamic process and often leads to **narrowing of the retinal arterioles**, which can be observed during fundoscopic examination. *Soft exudate* - **Soft exudates**, also known as **cotton wool spots**, represent areas of **ischemic retinal nerve fiber layer** damage due to obstruction of precapillary arterioles. - These are typically seen in later stages of hypertensive retinopathy, indicating more significant vascular damage and ischemia. *Venospasm* - **Venospasm**, or narrowing of retinal veins, is **not a primary or early finding** in hypertensive retinopathy. - While venous changes like tortuosity can occur, arterial changes dominate the early pathogenesis. *Hard exudate* - **Hard exudates** are yellow-white deposits of **lipid and protein** that leak from damaged capillaries, often indicative of chronic retinal edema and incompetent blood-retinal barrier. - These usually appear in **more advanced stages** of hypertensive retinopathy and are not considered the earliest change.

Q: Which of the following is a specific sign of albinism?

Iris transillumination. ***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.

Q: Epithelial xerosis of conjunctiva is caused by?

Xerophthalmia. ***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.

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: Hordeolum internum is?

Acute infection of Meibomian gland. ***Acute infection of Meibomian gland*** - A **hordeolum internum** is an acute, purulent infection of the **Meibomian glands**, which are sebaceous glands located within the tarsal plate of the eyelid. - The infection primarily manifests on the **inner surface of the eyelid** due to the gland's location, causing localized inflammation and pain. *Acute infection of Zeis gland* - An acute infection of a **Zeis gland** (a sebaceous gland connected to an eyelash follicle) is known as a **hordeolum externum**, or external stye. - Unlike a hordeolum internum, a **hordeolum externum** usually points externally at the lid margin. *Acute infection of Moll gland* - An acute infection of a **Moll gland** (apocrine sweat glands located near the lid margin) is also a type of **hordeolum externum**. - While it's an acute infection of an eyelid gland, it is not specifically referred to as a **hordeolum internum**. *Chronic infection of Zeis gland* - A chronic infection of a **Zeis gland** is not a typical designation for eyelid lesions; chronic inflammatory processes of sebaceous glands often lead to conditions like a **chalazion**, though chalazia are more commonly associated with Meibomian glands. - This option incorrectly identifies the gland for a hordeolum internum and specifies **chronic infection**, whereas a hordeolum is inherently **acute**.

Q: In congenital dacryocystitis, the blockage occurs at?

Nasolacrimal duct. ***Nasolacrimal duct*** - **Congenital dacryocystitis** is primarily caused by an obstruction in the **nasolacrimal duct**, specifically at the **valve of Hasner** at its distal end near the inferior meatus. - This blockage prevents the proper drainage of tears into the nasal cavity, leading to tear overflow (epiphora), mucoid discharge, and potential secondary infection. - Present in approximately **5-6% of newborns**, with most cases resolving spontaneously by 12 months of age. *Punctum* - Congenital **punctal agenesis** is rare and not the typical site of obstruction in congenital dacryocystitis. - The puncta are usually patent in this condition. *Lacrimal canaliculi* - Obstruction of the **lacrimal canaliculi** is uncommon in congenital cases. - Canalicular obstruction is more often acquired (trauma, infection, medications). *Lacrimal sac* - The **lacrimal sac** itself is not the site of primary obstruction in congenital dacryocystitis. - The sac may become distended due to downstream obstruction at the nasolacrimal duct.

Q: At which anatomical location is the opening created in dacryocystorhinostomy?

Middle meatus. ***Middle meatus*** - In **dacryocystorhinostomy (DCR)**, the anastomosis is created between the **lacrimal sac** and the nasal cavity at the level of the **middle meatus**. - The lacrimal sac is located **lateral to the middle turbinate**, making this the anatomically appropriate site for creating the surgical opening. - This placement allows direct drainage of tears from the lacrimal sac into the nasal cavity, **bypassing the obstructed nasolacrimal duct**. - The **middle meatus** provides optimal access and physiological tear drainage. *Inferior meatus* - The **nasolacrimal duct** naturally drains into the **inferior meatus** under normal anatomy. - However, DCR is performed to **bypass** an obstructed nasolacrimal duct, so the anastomosis is created more **superiorly** at the lacrimal sac level. - The inferior meatus is **below** the level of the lacrimal sac and would not provide direct access to it. *Superior meatus* - The **superior meatus** is located above the superior turbinate and receives drainage from the **posterior ethmoidal sinuses**. - This location is **too superior** for DCR and does not correspond to the anatomical position of the lacrimal sac. *Sphenoethmoidal recess* - The **sphenoethmoidal recess** is the most superior and posterior area, receiving drainage from the **sphenoid sinus**. - This location is far too **superior and posterior** to be used for lacrimal drainage surgery.

Q: Surgery of choice for chronic acquired dacryocystitis

Dacryocystorhinostomy. ***Dacryocystorhinostomy*** - This procedure creates a new connection between the **lacrimal sac** and the **nasal cavity**, bypassing the obstructed nasolacrimal duct. - It is the **surgery of choice** for chronic acquired dacryocystitis as it provides a permanent solution for tear drainage. *Dacryocystectomy* - This involves **excision of the lacrimal sac**, which can relieve symptoms of infection but eliminates the sac's function. - It is generally reserved for cases where dacryocystorhinostomy is contraindicated or has failed, and is **not the primary choice** for restoring tear flow. *Conjunctivo-cystorhinostomy* - This procedure creates a bypass from the **conjunctiva** directly to the **nasal cavity**, typically used when the canaliculi are also obstructed. - It is a more complex surgery indicated for **proximal lacrimal system obstruction** (e.g., canalicular block) rather than isolated nasolacrimal duct obstruction. *None of the options* - **Dacryocystorhinostomy** is the well-established and most effective surgical intervention for chronic acquired dacryocystitis. - Therefore, this option is incorrect as there is a suitable surgical choice available.

Question 1

In which condition is a positive forced duction test observed?

Accepted Answer

Mechanical restriction of ocular movement

Answer

Non-concomitant strabismus

Answer

No condition

Answer

Extraocular muscle paralysis

Question 2

The earliest change noticed in hypertensive retinopathy is:

Accepted Answer

Arteriolar spasm

Answer

Soft exudate

Answer

Venospasm

Answer

Hard exudate

Question 3

Which of the following is a specific sign of albinism?

Accepted Answer

Iris transillumination

Answer

Sensitivity to light (photophobia)

Answer

Involuntary eye movements (nystagmus)

Answer

Decreased visual acuity

Question 4

Epithelial xerosis of conjunctiva is caused by?

Accepted Answer

Xerophthalmia

Answer

Infectious conjunctivitis caused by Chlamydia trachomatis

Answer

Autoimmune blistering conjunctivitis

Answer

Bacterial conjunctivitis due to Corynebacterium diphtheriae

Question 5

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

Accepted Answer

Acetazolamide

Answer

Pilocarpine

Answer

Beta blocker eyedrops

Answer

IV mannitol

Question 6

Hordeolum internum is?

Accepted Answer

Acute infection of Meibomian gland

Answer

Chronic infection of Zeis gland

Answer

Acute infection of Moll gland

Answer

Acute infection of Zeis gland

Question 7

In congenital dacryocystitis, the blockage occurs at?

Accepted Answer

Nasolacrimal duct

Answer

Punctum

Answer

Lacrimal canaliculi

Answer

Lacrimal sac

Question 8

Dacryocystorhinostomy involves?

Accepted Answer

Connecting the lacrimal sac to the nose by opening the medial wall

Answer

Opening the terminal blocked end of the nasolacrimal duct

Answer

Complete excision of the lacrimal sac

Answer

Insertion of a drainage tube in the lacrimal sac

Question 9

At which anatomical location is the opening created in dacryocystorhinostomy?

Accepted Answer

Middle meatus

Answer

Superior meatus

Answer

Sphenoethmoidal recess

Answer

Inferior meatus

Question 10

Surgery of choice for chronic acquired dacryocystitis

Accepted Answer

Dacryocystorhinostomy

Answer

Dacryocystectomy

Answer

Conjunctivo-cystorhinostomy

Answer

None of the options

NEET-PG 2013 — Ophthalmology