NEET-PG 2013 - Ophthalmology Practice Questions

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.

Q: Fluorescein angiography is used to examine -

Retinal vasculature. ***Retinal vasculature*** - **Fluorescein angiography** involves injecting fluorescein dye into a vein and taking rapid photographs of the retina as the dye perfuses, allowing for detailed visualization of the **retinal blood vessels**. - This technique is crucial for diagnosing and monitoring conditions like **diabetic retinopathy**, **macular degeneration**, and **retinal vascular occlusions** by identifying leaks, non-perfusion areas, and abnormal vessel growth. *Ciliary vasculature* - The **ciliary body vasculature** is not directly visualized by standard fluorescein angiography as it is located anterior to the retina within the uveal tract. - While some dye may perfuse the ciliary body, the primary imaging target and diagnostic utility of fluorescein angiography are the **retinal and choroidal circulations**. *Corneal vasculature* - The normal **cornea is avascular**, meaning it does not contain blood vessels. - **Corneal neovascularization** (new vessel growth) can occur due to pathology, but fluorescein angiography is not the primary or most suitable technique for assessing corneal vessels, which are more readily visible with slit-lamp biomicroscopy. *Conjunctival vasculature* - The **conjunctiva** contains numerous small vessels, but these are superficial and can be directly observed with a slit lamp or even the naked eye. - Fluorescein angiography is an invasive procedure with a higher spatial resolution designed for deeper, more intricate vascular networks like those in the retina, making it overkill and inappropriate for routine assessment of the **conjunctival vasculature**.

Q: Most common type of scleritis is

Anterior. ***Anterior*** - **Anterior scleritis** accounts for approximately **98%** of all scleritis cases, making it the most common type. - It involves inflammation of the sclera anterior to the **equator of the globe**, visible on external examination. - Anterior scleritis is further subdivided into **diffuse, nodular,** and **necrotizing** forms based on clinical presentation and severity. *Diffuse anterior* - **Diffuse anterior scleritis** is the most common subtype of anterior scleritis, characterized by widespread inflammation. - While common among anterior types, it represents a subset rather than the overall most common anatomical category. *Nodular anterior* - **Nodular anterior scleritis** presents with discrete nodules of inflamed scleral tissue. - It is less common than diffuse anterior scleritis but more common than necrotizing forms. *Posterior* - **Posterior scleritis** is rare, accounting for only about **2%** of all scleritis cases. - It involves inflammation posterior to the **equator of the globe** and can be difficult to diagnose due to its hidden location, often presenting with pain, proptosis, and vision loss.

Q: Most common cause of ptosis in adults

Aponeurotic. ***Aponeurotic*** - **Aponeurotic ptosis** is the most common cause of adult-onset ptosis, resulting from a dehiscence, disinsertion, or stretching of the **levator aponeurosis**. - It typically presents as a gradual onset of ptosis and often occurs bilaterally, though one eye may be more affected. *Idiopathic* - While many cases may initially be labeled idiopathic, a specific cause, such as **aponeurotic changes**, is often identified upon closer examination. - This term is a general descriptor and not a specific pathophysiological mechanism. *Myasthenia gravis* - **Myasthenia gravis** can cause fluctuating ptosis that worsens with fatigue, but it is not the most common cause overall. - It is an **autoimmune neuromuscular junction disorder** characterized by weakness in various skeletal muscles. *Paralysis of 3rd nerve* - **Third nerve palsy** causes ptosis along with other signs like an **out-and-down eye deviation** and a **dilated pupil** (if parasympathetic fibers are involved). - While it causes significant ptosis, it is less common than aponeurotic ptosis and presents with a distinct constellation of symptoms.

Q: All are ophthalmological emergencies except -

CRVO. ***CRVO*** - Central Retinal Vein Occlusion (CRVO) is characterized by painless **vision loss** due to retinal hemorrhage and edema, but it is generally *not* considered an immediate, vision-threatening emergency in the same vein as the other options. - While it requires prompt evaluation and management to preserve vision, CRVO allows for a less urgent intervention compared to conditions that can lead to permanent vision loss within hours. *Endophthalmitis* - **Endophthalmitis** is a severe inflammation of the intraocular fluids and tissues, typically caused by infection, and can lead to rapid and irreversible vision loss if not treated urgently. - It presents with pain, redness, reduced vision, and hypopyon (pus in the anterior chamber), necessitating immediate antibiotic treatment and surgical intervention. *Acute congestive glaucoma* - **Acute congestive glaucoma** (acute angle-closure glaucoma) involves a sudden increase in intraocular pressure, causing severe pain, redness, corneal edema, and profound vision loss. - If left untreated, the high pressure can cause irreversible damage to the optic nerve within hours, making it a true ocular emergency. *CRAO* - **Central Retinal Artery Occlusion (CRAO)** is a sudden, painless loss of vision in one eye due to blockage of the central retinal artery, leading to retinal ischemia. - It is an ocular emergency because irreversible retinal damage and vision loss can occur within 90-120 minutes of the occlusion, requiring immediate intervention to restore blood flow.

Q: Surgery of choice in a patient with congenital ptosis with good levator action is:

LPS resection. ***LPS resection*** - **Levator palpebrae superioris (LPS) resection** is the surgery of choice for congenital ptosis with **good levator action** (typically defined as >8-10 mm of levator function). - This procedure directly shortens and strengthens the **levator muscle**, improving eyelid elevation. *Fascia lata sling surgery* - This procedure is indicated for patients with **poor or absent levator function** (typically 10 mm). - It involves resecting a small amount of **Müller's muscle**, **conjunctiva**, and occasionally the **tarsal plate**, but is less effective for moderate-to-severe ptosis. *Müller's resection* - **Müller's muscle resection** is generally reserved for **mild ptosis** (1-2 mm) that responds positively to the **phenylephrine test**. - It primarily addresses ptosis due to sympathetic denervation or mild aponeurotic disinsertion, not significant congenital ptosis with good levator function.

Question 1

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 2

At which anatomical location is the opening created in dacryocystorhinostomy?

Accepted Answer

Middle meatus

Answer

Superior meatus

Answer

Sphenoethmoidal recess

Answer

Inferior meatus

Question 3

Surgery of choice for chronic acquired dacryocystitis

Accepted Answer

Dacryocystorhinostomy

Answer

Dacryocystectomy

Answer

Conjunctivo-cystorhinostomy

Answer

None of the options

Question 4

Fluorescein angiography is used to examine -

Accepted Answer

Retinal vasculature

Answer

Ciliary vasculature

Answer

Corneal vasculature

Answer

Conjunctival vasculature

Question 5

Most common type of scleritis is

Accepted Answer

Answer

Diffuse anterior

Answer

Nodular anterior

Answer

Posterior

Question 6

Most common cause of ptosis in adults

Accepted Answer

Aponeurotic

Answer

Idiopathic

Answer

Myasthenia gravis

Answer

Paralysis of 3rd nerve

Question 7

All are ophthalmological emergencies except -

Accepted Answer

CRVO

Answer

Endophthalmitis

Answer

Acute congestive glaucoma

Answer

CRAO

Question 8

Surgery of choice in a patient with congenital ptosis with good levator action is:

Accepted Answer

LPS resection

Answer

Fascia lata sling surgery

Answer

Fasanella-Servat operation

Answer

Müller's resection

NEET-PG 2013 — Ophthalmology