Eye

1/26/2016
DrBhatiaMedicalCoachingInstitute:OnlineTestPlatform
EYE
SWTEYE
Marking:+1MarksforcorrectanswerandnonegativeMarkingforincorrectanswer.
TestDuration(mins):120
TimeLeft(mins):120
Instructions
Oncethetesthasstarted,donotpresstherefreshbutton(orF5onyourkeyboard)
Itisadvisabletosavethetestregularlytoavoidlosingyourinformation,savetestreferstostoringtheattemptedpartofthetest.
Incaseofaccidentalfailureofinternetconnectivitythesystemwillsavetheattemptedportionofthetestautomatically.
Oncethetesttimeisover,youwillbeawardedagracedurationtowrapupthetestand"Submit"it.
Submittestreferstothefinalcompletionoftest;onceyousubmitthetestyouwillnotbeabletoedit/previewyouranswers.
Pleaseensurethatyouareconnectedtotheinternet,whilesubmittingthetest.
SWTEYE
(Q.1) OCT(Opticalcoherencetomography)isbasedon?
(a)
Highcoherenceinterferometry
(b)
Lowcoherenceinterferometry
(c)
Noncoherenceinterferometry
(d)
Polarization
YourResponse:
b
CorrectAnswer:
Exp:
OpticalCoherenceTomography(OCT)ISanewimagingmodalitythatproduceshighresolution,cross
sectionalimagesofocularstructuresinvivo.
OCTproducesdetailedtwodimensionalimagesoftheretinaandmeasuresretinalthicknesswitha
longitudinalimageresolutionofapproximately10microns.
TheprinciplesofOCTaresimilartoBmodeultrasound,howeverOCTutiIizesthereflectionofIightwaves
fromdifferentstructuresintheeyeratherthansound.
Lowcoherentlight,producedbyacontinouswavesuperluminescentdiodesource,isdirectedintotheeye
andisreflectedattheboundariesoftissueswithdifferentopticalproperties.
(Q.2) Redgreencolordefectmaybeseeninfollowingconditionsexcept:
(a)
Opticneuritis
(b)
Conedystrophy
(c)
Choroidaldetachment
(d)
Stargardt'sdisease.
YourResponse:
c
CorrectAnswer:
Exp:
Deuteranopiareferstoabsentofthemiddlewavelengthi.e.greencone.
Bluepigmentgeneisfoundonchromosome7whereasredandgreenpigmentgeneon
chromosomeX.
Redgreendefectisseeninacquiredopticnervedisease,conedystrophyandStargardt'sdisease.
Blueyellowdefectsinmostretinaldystrophy.Blueyellowdefectinglaucomaandautosomal
dominantopticneuropathy.
http://dbmci.examonair.com/Result/ShowAllQuestionInHtml.aspx?testid=4434
1/82
1/26/2016
(Q.3) Mostcommontypeoflidcarcinomais:
(a)
(b)
(c)
(d)
YourResponse:
CorrectAnswer:
Exp:
Squamouscell
Basalcell
Adenocarcinoma
Melanoma
c
Themostcommonmalignantepithelialgrowthoflidisbasalcellcarcinoma(rodentulcer).Itfrequently
arisesfromthelowereyelid,followedinrelativefrequencybythemedialcanthus
(Q.4) Aadvantageofindirectophthalmoscopeoverdirectophthalmoscopeinclude:
(a)
Binocularview
(b)
Highermagnification
(c)
Erectimage
(d)
Theinstrumentissmallersize
YourResponse:
a
CorrectAnswer:
Exp:
Directophthalmoscopehasthefollowingadvantagesoverindirectophthalmoscope:easilyportable,virtual
anderectimageandlargermagnification(15X).
Ontheotherhand,indirectophthalmoscopehasthefollowingadvantages:binocularity,higherfieldofview
andthepresenceofteachingmirror.
(Q.5) Inwhichofthefollowingcondition,Christmastreecataractisseen:
(a)
Myotonicdystrophy
(b)
Trauma
(c)
Diabetes
(d)
Wilsondisease
YourResponse
:
Correct
a
Answer:
Exp:
Inmyotonicdystrophy,posteriorsubcapsularstellateopacities
(Christmastreecataract).
(Q.6) Whichofthefollowingiscommonestmalignancycausingbilateralproptosisinpediatricpopulation?
(a)
Retinoblastoma
(b)
BilateralRhabdomyosarcoma
(c)
ALL
(d)
AML
YourResponse:
d
CorrectAnswer:
Exp:
ThecommoncausesofbilateralproptosisincludegranulocyticsarcomaduetoAML/Myelodysplastic
syndromeandmetastaticneuroblastoma.
2/82
1/26/2016
Rhabdomyosarcomaandretinoblastomararelyproducebilateralproptosis.
Themostcommonmalignancycausingunilateralproptosisinchildren:
InIndiaRetinoblastoma
InWesternpopulationRhabdomysarcoma
ThemostcommonprimaryorbitalmalignancyinchildrenRhabdomyosarcoma
ThemostcommonmetastaticorbitalmalignancyinchildrenNeuroblastoma
(Q.7) Whatisthediagnosis?
(a)
(b)
(c)
(d)
YourResponse:
CorrectAnswer:
Exp:
Epicanthus
Microblepharon
Cryptophthalmos
Colobomaofthelid
a
Thisisasemilunarfoldofskin,situatedaboveandsometimescoveringtheinnercanthus.
Itisusuallybilateralandgivestheappearancethattheeyesarefarapartandhaveaconvergentsquintand
thebridgeofthenoseisflat.
Itmaydisappearasthenosedevelops.Itisnormalinmongolianraces,anddeformitycanberemediedby
plasticsurgery.
(Q.8) Inwhichofthefollowingcondition,bandshapedkeratopathyisseen:
(a)
Angularconjunctivitis
(b)
Eales'disease
(c)
VitaminDpoisoning
(d)
Keratoconus
YourResponse:
CorrectAnswer: c
Exp:
Bandshapedkeratopathyisacommonconditioninold,blindandshrunkeneyesandin
Stillsdiseaseofchildren.
Sometimesitisassociatedwithhyperparathyroidism,vitaminDpoisoningandsarcoidosis.
Itispresentintheinterpalpebralareaformingacontinuousbandacrossthecornea.
(Q.9) Thefollowingtestsareusedintestingthevisionofpreverbalchildrenexcept:
(a)
(b)
(c)
LogMAR
STYCAR
Catforddrum
3/82
1/26/2016
(d)
SheridanGardinertests
YourResponse:
CorrectAnswer:
Exp:
a
FarnsworthMunsellhue100testcontains84colourdiscstobearrangedinorderofclosest
colourmatch.
Thecoloursonlydifferinhuewithsamebrightnessandsaturation.
Ishiharatestplatesaremainlyforcongenitalredgreencolourdefect.
WavylinesareusedinIshiharaplatesforilliteratesorchildren.LanthonyNewColourTest
canbeusedinchildren.
(Q.10) Cornealhysteresisisstudiedusing:
(a)
GoldmannApplanationtonometry
(b)
Goldmannperimetry
(c)
Cornealtopography
(d)
DynamicContourTonometry
YourResponse:
d
CorrectAnswer:
Exp:
CornealhysteresisassessesthebiomechanicalstrengthofthecorneaandisassessedbyDynamic
ContourTonometry(DCT)
(Q.11) Trueaboutretinoblastoma?
(a) Asomaticmutationisdetectedinabout95%ofallpatientsofretinoblastoma
(b) Changesonchromosome11qhavebeenobservedingermcellmutations.
(c) 5060%casesareinheritedasanautosomaldominanttrait.
(d) AssociationwithconcomitantEwingssarcomaiswellknown.
YourResponse:
a
CorrectAnswer:
Exp:
Asomaticmutationisdetectedinabout95%ofallpatientsofRetinoblastoma.Intheotherpatients,itis
inheritedasanautosomaldominanttrait.
Changesonchromosome13qhavebeenobservedingermcellmutationsincasesofRetinoblastoma.
Retinoblastomasmaythenoccuratseverallocationsintheretinaorbilaterally.Whereretinoblastomais
inheritedasanautosomaldominanttrait.
Themostcommonsecondmalignancyinpatientswithretinoblastomaosteosarcoma.
(Q.12) Thedrugofchoiceofhypertensiveuveitisis
(a)
(b)
(c)
(d)
YourResponse:
CorrectAnswer:
Exp:
Phosphatidyliodine
Latanoprost
Phenylephrine
Pilocarpine
c
HypertensiveuveitisInacutephaseofthediseasepresenceofexudatesandinflammatorycellsintheAC
maycausecloggingoftrabecularmeshworkresultinginthedecreaseddrainageandthusariseinIOP
Latanoprost(0.0005%)syntheticdrugwhichisanesteranalogueofprostaglandinF2alpha,itisonly
4/82
1/26/2016
drugwhichexclusivelyactsbyincreasingvesperaloutflowandbycausingreductioninepiscleralvenous
pressure
Sideeffectsincludeconjunctivalhyperaemia,foreignbodysensationandincreasedpigmentationofthe
iris
Dipivefrin(propineorDIphenylephrine)sympathomimeticdrugs(Adrenergicdrugs)
Mechanismofaction
Increaseaqueousoutflowresultsbyvirtueofbothalphaandbetareceptorstimulation
Decreasedaqueoushumourproductionoccursduetostimulationofalphareceptorsintheciliarybody
Sideeffectssystemicincludeshypertension,tachycardiaheadache,palpitation,tremors,nervousness
andanxiety
(Q.13) Thefollowinginstrumentisusedforwhichofthefollowing?
Fundusexamination
(a)
(b)
(c)
(d)
YourResponse:
CorrectAnswer:
Binocularvision
Colorvision
Farvision
b
Exp:
Thisopticalinstrumentiscalledassynoptophorewhichisusedfortheexaminationofbinocularvision,the
capacityforfusionandthemusclebalance.
(Q.14) Zieglerknifeisusedforwhichsurgery?
(a)
(b)
(c)
(d)
YourResponse:
CorrectAnswer:
Exp:
Cataract
Glaucoma
Lidsurgery
Noneoftheabove
d
(Ref:Parson,20thedition,Page269)
Itisusedtomanageposteriorcapsularopacification(PCO)inchildrenwhocannotbemanagedwith
Nd:YAGcapsulotomy.Aninstrumentusedforcuttingtheopacifiedposteriorcapsuleofthelensoftheeye
beforeaspiratingit.
5/82
1/26/2016
(Q.15) FollowingarefeaturesofOculomotornervepalsyexcept:
(a)
(b)
(c)
(d)
YourResponse:
CorrectAnswer:
Exp:
Diplopia
Ptosis
Miosis
Lateraldeviationofeye.
c
Thethirdnerveisamidlinestructurethatcontainsbothsympatheticmotorandvisceralnuclei.
Itinnervatestheipsilateralmedialrectus,inferiorrectus,andinferiorobliquemusclesaswellasthe
contralateralsuperiorrectusmuscle.
Acentralnucleusinnervatesbothlevatorpalpebraesuperiorismuscles.
Moreover,axonsfromvisceralnucleiprojectipsilateralparasympatheticoutflowtothepupillarysphincter
andciliaryganglion,whichcontrolpupillaryreflexesaswellasaccommodation.
Therefore,amidbraininfarction(involvingthenucleusoftheoculomotornerve),ifcomplete,willproduce
aunilateralthirdnervepalsycharacterizedbyipsilateralptosisandinabilitytoturntheeyeupward,
downward,andinward.Bilateralptosisandparalysisofthecontralateralsuperiorrectusmusclewillresult.
Pupillaryinvolvementwillalsobecomplete(dilatedpupil).Moredistallesionscanproducesingleor
multipleextraocularmuscleabnormalitieswithorwithoutpupillaryderangement.
Itisalsoimportanttorecognizethatthethirdnervemaybeimpingedalongitsextracranialextent.
(Q.16) Retinoblastomadiffersfrompseudogliomainthatitcauses
(a)
Decreasedintraocularpressure
(b)
Blurringofvision
(c)
Enlargementoftheopticforamen
(d)
Alloftheabove
YourResponse:
c
CorrectAnswer:
Exp:
(pseudogliomaisaTermgiventotheD/Dofleucocoria)
Increasedintraocularpressureisseeninretinoblastoma(andsocausesenlargementofopticforamen)
whereasloweredintraocularpressureiscommoninpseudoglioma
Calcificationsoccursin75%ofcasesandisalmostpathognomicofretinoblastoma
Bscanultrasounddisplaysacauliflowerlikemassesarisingfromretinawithorwithoutaretinal
detachmentorvitreoushemorrhage
Pseudogliomahaveaverydifferentultrasonographicpicture
Ifthelacticdehydrogenaseactivityisraisedintheaqueousrelativetotheserumlevel,itissuggestiveof
Retinoblastoma.
Retinoblastomabeingamalignanttumor,causeserosionandenlargementopticalformen
(Q.17) Choroidalneovascularizationcanbeseeninallthefollowingexcept:
(a)
(b)
(c)
(d)
YourResponse:
CorrectAnswer:
Hypermetropia
Angioidstreak
Trauma
Myopia
a
6/82
1/26/2016
Exp:
(Ref.Basaksophathalmology2nded.pg.162)
Choroidalneovascularization
Astheouterlayersoftheretinareceivenourishmentfromchoriocapillaris,degenerationofchoroidis
oftenassociatedwithatrophyofretina.
Secondarydegenerationsoccurfollowinginflammatorylesions,trauma,myopia,orinlatestagesof
glaucoma.
AngioidstreaksaremostcommonlyseeninPseudoxanthomaelasticum.
TheycanalsobeseeninPagetsdisease,EhlersDanlossyndrome,sicklecelldisease,andrarelyin
acromegaly,hypercalcemia,andleadpoisoning.
Angioidstreakmaycausevisualimpairmentduetoinvolvementoffovea,choroidalneovascularizationor
choroidalrupture.
(Q.18) AssessmentandaidingfordevelopmentoffundsfortheNationalBlindnessControlProgrammeisdoneby:
(a)
(b)
(c)
(d)
YourResponse:
CorrectAnswer:
Exp:
UNICEF
WorldBank
DANIDA
WHO
b
(Ref.ParksTextbookofPSMbyK.Park21steditionpageNo.401)
FundingfortheNPCB
TheallocationoffundsfortheNPCBincreasedwiththestartoftheWorldBankfinancedProjectin1995.
ThetotaloutlayfortheNPCBintheNinthFiveYearPlanwasRs480crore.In200102,theoutlaywasRs
127.57crore,ofwhichthemajorcontributioncamefromtheWorldBank(75.7%)and16.4%fromthe
GovernmentofIndia.
AftertheendoftheWorldBankfinancedProjectin200102,theNPCBisbeingsustainedmainlythrough
thedomesticbudgetforwhichanallocationofRs445crorehasbeenmadeintheTenthFiveYearPlan.
TheGovernmentofIndiacontributed84.6%oftheRs85.59crorefortheProgrammein200203and
90.5%oftheRs86.96crorein200304;theremainingfundscomefromDanishassistance.
Themajorpartofthefundingwenttothedistricts(87.52%),therebyindicatingthatalargequantumof
theearmarkedfundsgodirectlyforpatientcare.OfthefundsutilizedattheCentralandStatelevels,the
majorpartisspentoninformation,educationandcommunication(IEC)activities,training,review,
monitoringandevaluation.
(Q.19) AboutBestdisease,falseis?
(a) Itisarecessivegeneticdisorder
(b) Sunnysideupeggyolk"ischaracteristicfeature
(c)
ERGisnormal,butanabnormalEOGishallmarkofthisdisease
(d) ThereisnosatisfactorytreatmentavailableforBest'sdisease.
YourResponse:
a
CorrectAnswer:
Exp:
Best'sdisease,alsocalledVitelliformmaculardystrophy,isanautosomaldominant(i.e.,50%offamily
membershaveit)formofgeneralizedretinalpigmentepithelium(RPE)dystrophy.T
heRPEisalayerofcellsinthebackoftheeyethatprovidesnourishmenttotheretinaand
photoreceptors.
Clinically,Best'sdiseaseischaracterizedbyoneormorelesionsinthebackoftheeyethatsometimes
7/82
1/26/2016
takesontheappearanceofa"sunnysideupeggyolk"intheearlystagesofthediseaseandlaterappears
asa"scrambledegg."
Dependingonthelocusofthelesion(s)itmayormaynotaffectvision.
Ifitdoesnotaffectvision,thenthepatientisanasymptomaticcarrierofthedisease.
Whenitdoesaffectvision,visualacuitymayrangefrom20/30to20/200(legalblindness).
ThereisnotreatmentavailableforBest'sdisease.ThediagnostictestforBest'sdiseaseistheelectro
oculogram(EOG),Visualacuityoftenremainsgood,andtheergisnormal.
Anabnormalelectrooculogram(EOG)isthehallmarkofthedisease.
(Q.20) Falseregardingfungalcornealulcer?
(a)
Signsaremorepronouncedascomparedtosymptoms
(b)
Satellitelesionsareseen
(c)
Topicalsteroidsmaybeused
(d)
Perforationisrare
YourResponse:
c
CorrectAnswer:
Exp:
Injurybyvegetativemattercausesfungalulcer.TypicallySymptoms<signs.
DrylookingulcerwithfeatheryextensionsandImmunering(Wesleysring).
Satellitelesionsmayoccur.Hypopyonisfixed.Perforationisrare.Nocornealvascularization.
Steroidsarecontraindicated.
(Q.21) Theonsetofpresbyopiadependsonthefollowingfactorsexcept:
(a)
Thesizeofthepupil
(b)
Sexofthepatient
(c)
Therefractivestateofthepatient
(d)
Amplitudeofaccommodation
YourResponse:
b
CorrectAnswer:
Exp:
Presbyopiaistheagerelatedlossoftheabilitytocomfortablysustaintheaccommodationnecessaryfor
clearnearvision.
Itsonsetisdependenton:theamplitudeofaccommodationtaskrequiredrefractivestateofthepatients
(earlierwithhypermetropiathanmyopia)sizeofthepupil(smallpupilhasapinholeeffect)latitudewhere
patientlives(onsetisearlierinthetropicthantemperatecountries)
(Q.22) Superonasalavulsionofthevitreousbaseispathognomonicof:
(a)
Traumaticretinaldetachment.
(b)
Earlyacutevitreoushemorrhage
(c)
Vitreoretinalmembrane
(d)
Rhegmatogenousretinaldetachment
YourResponse:
a
CorrectAnswer:
Exp:
Vitreousbaseavulsionispathognomonicforbluntoculartrauma.
Thevitreousbaseisfirmlyattachedtotheperipheralneurosensoryretinaaswellastothenonpigmented
epitheliumoftheparsplana.
Incasesofsubstantialblunttraumatotheglobe,avulsionoftheVitreousBaseoccurs.Itistypicallylocated
8/82
1/26/2016
intheinferotemporalorsuperotemporalquadrants.
(Q.23) Sphericalaberrationinhumaneyeisreducedbywhichofthefollowing?
(a) Theanteriorsurfaceofthecorneaisflatterperipherallythancentrally
(b) Thecortexofthelenshasahigherrefractiveindexthanthenucleus
(c) Thelenshasvariableanteriorsurfacecurvature
(d) Theretinahasaradiusofcurvaturewhichisshortercentrallythanperipherally
YourResponse:
CorrectAnswer: a
Exp:
Thefollowinginhumaneyereducessphericalaberration:
Theanteriorsurfaceofthecorneaisflatterperipherallythancentrally.
Thenucleusofthelensoftheeyehasahigherrefractiveindexthanthelenscortex.
Thepresenceofirisreduceslightcomingfromtheperipherallens.
Theretinalconesaremoresensitivetolightenteringtheeyeparaxiallythantolight
enteringobliquely.
(Q.24) Duaslayerislocated:
(a)
BetweenthecornealstromaandDescemet'smembrane
(b)
BetweentheendotheliumandDescemet'smembrane
(c)
Posteriortotheendothelium
(d)
BetweenepitheliumandBowmanslayer
YourResponse:
a
CorrectAnswer:
Exp:
Dua'slayer,accordingtoa2013paperbyHarminderSinghDua'sgroupattheUniversityofNottingham,is
alayerofthecorneathatis15micronsthickandlocatedbetweenthecornealstromaandDescemet's
membrane.
(Q.25) Allofthefollowingarenewstrategiesforcataractsurgeryexcept:
(a)
IOLimplantation.
(b)
Freeophthalmicservice.
(c)
Fixedfacilitysurgicalapproach.
(d)
Outreacheyecamps
YourResponse
:
CorrectAnswer d
:
Exp:
(Ref.BasakOphthalmology3rded.344)
"Revisedstrategyistoshiftfromtheeyecampapproachtoafixedfacility
surgicalapproach"
(Q.26) Visiblespectrumoflightinhuman:
(a)
(b)
(c)
200280nm
280315nm
315400nm
9/82
1/26/2016
(d)
400700nm
YourResponse:
CorrectAnswer:
Exp:
(Ref.GuytonPhysiology11th/pg.631;Figure507)
Theeyesconvertenergyinthevisiblespectrumintoactionpotentialsintheopticnerve.
Thewavelengthsofvisiblelightrangefromapproximately397nmto723nm.
Theimagesofobjectsintheenvironmentarefocusedontheretina.Thelightraysstrikingtheretina
generatepotentialsintherodsandcones.
Impulsesinitiatedintheretinaareconductedtothecerebralcortex,wheretheyproducethesensationof
vision.
(Q.27) Pterygiumischaracterizedby?
(a)
Excessivecollagendegenerationofthesubconjunctivaltissue
(b) Acuteinflammatoryreactionofthesubconjunctivaltissue
(c)
Pseudovascularizationofconjunctiva
(d) Conjunctivaltumor
YourResponse:
a
CorrectAnswer:
Exp:
PTERYGIUM
Pterygiumusuallyreferstoabenigngrowthofthesubconjunctivaltissue
Pterygiumintheconjunctivaischaracterizedbyelastoticdegenerationofcollagenandfibrovascular
proliferation.
Apterygiumcommonlygrowsfromthenasalsideofthesclera.
Itiscausedbyultravioletlightexposure(e.g.sunlight),lowhumidity,anddust.
Thepredominanceofpterygiaonthenasalsideispossiblyaresultofthesun'srayspassinglaterally
throughthecorneawhereitundergoesrefractionandbecomesfocusedonthelimbicarea.
Sunlightpassesunobstructedfromthelateralsideoftheeye,focusingonthemediallimbusafterpassing
throughthecornea.
Onthecontralateralside,however,theshadowofthenosemediallyreducestheintensityofsunlight
focusedonthelateral/temporallimbus.
(Q.28) Irispearlsareseeninuveitisof
(a)
(b)
(c)
(d)
YourResponse:
CorrectAnswer:
Exp:
Syphilis
Leprosy
Tuberculosis
Sarcoidosis
b
Alltheabovearecausesofgranulomatousuveitis.Leprosyleadstoonlyanterioruveitiswhileothersare
causesofpanuveitis.
Featuresofgranulomatousuveitisare
MuttonfatKPs
Broadbasedposteriorsynechiae&
Irisnodule(KoeppesonpupilandBusaccasonirissurface).Inleprosyirisnodulesarewhiteknownasiris
10/82
1/26/2016
pearls(pathognomonic).
BeadedCornealnervesareseeninleprosy.
(Q.29) Whichoffollowingisassociatedwithintensevitritis?
(a)
CMVretinitis
(b)
Acuteretinalnecrosis
(c)
Progressiveouternecrosis
(d)
HIVretinopathy
YourResponse:
b
CorrectAnswer:
Exp:
AllaremanifestationsofHIV/AIDSineye.CMVretinitisisseeninpatientswithCD4<50,hastypicalcheese
andketchupappearanceandistreatedwithgancyclovir.Thereismildmoderatevitritis.
ARN&PORNarecausedbyherpesandvaricellazoster.
Acuteretinalnecrosis(ARN)isaclinicalsyndromecharacterizedbyvitritis,severeocclusivevasculitis
whichproducesafullthickness,necrotizingretinitis.
Thediseaseiscausedbyanacuteinfectionwithamemberoftheherpesvirusfamily,usuallyVZVorHSV.
Theprognosisispoor,withsignificantvisualloss.
Clinicalcoursemostoftenleadstodetachmentoftheatrophicretina,regardlessantiviraltreatment.
HIVretinopathyiscausedbyHIVvirusitselfandisthemostcommoneyemanifestation.Itischaracterised
byCottonwoolspotsandhasnospecifictreatment.
(Q.30) WhichofthefollowingisnottrueaboutJackson'scrosscylinder?
(a) Doesnotblurtheimagewhenplacedbeforeanemmetropiceye
(b) Doesnotalterthesphericalequivalentofanametropiceye
(c) Isusedtochecktheaxisofthecylindersubjectively
(d) Isusedtocheckthepowerofthecylindersubjectively
YourResponse:
a
CorrectAnswer:
Exp:
Crosscylinderexamination(otherwiseknownasJackson'scrosscylinder)isanexaminationusedforthe
finalfinetuningoftheaxisandstrengthofastigmatismafteritsdeterminationthroughretinoscopy,
stellatecycleorautomaticrefractometry.
Withtheadventoftechnology,techniqueslikeretinoscopyandcrosscylinderexaminationmightseem
outdatedandusefulonlytothepersonnelofhumanitarianmissions.
Theydohoweverprovideanaccuratealternativeandtheirusegivesathoroughunderstandingofthe
principlesofrefraction.
Placedbeforeanemmetropiceye,thecrosscylinderblurstheimage.Placedbeforeanametropiceye,the
crosscylinderdoesnotalterthesphericalequivalent,butitwillenlargeorcontracttheintervalofSturm,
blurringorclarifyingtheimage,asitincreasesordecreasesthenetastigmaticametropia.
Thecrosscylinderisusedforsubjectiverefinementofaxisandpowerofcylinderafterplacingthebest
availableestimateofrefractionbeforetheeye(retinoscopy,astigmaticdialtest,orpreviousrefraction).
(Q.31) Hereditarydiseasesassociatedwithretinitispigmentosaincludethefollowingexcept:
(a)
(b)
(c)
(d)
YourResponse:
EagleBardetsyndrome
BassenKornzweigdisease
KearnsSayresyndrome
Refsumsdisease
11/82
1/26/2016
CorrectAnswer:
Exp:
Retinitispigmentosamayoccurinassociationwithrare,hereditarysystemicdiseaseslike
olivopontocerebellardegeneration,BassenKornzweigdisease,KearnsSayresyndrome,Refsumsdisease.
Chronictreatmentwithchloroquine,hydroxychloroquine,andphenothiazines(especiallythioridazine)can
producevisuallossfromatoxicretinopathythatresemblesretinitispigmentosa.
(Q.32) Whichcranialnervepalsyproduceshorizontaldiplopia,worseongazetothesideofthelesion?
(a)
VI
(b)
(c)
IV
(d)
YourResponse:
CorrectAnswer:
II
III
Exp:
Thesixth(abducens)cranialnerveinnervatesthelateralrectusmuscle.Apalsyproduceshorizontal
diplopia,worseongazetothesideofthelesion.
Anuclearlesionhasdifferentconsequences,becausetheabducensnucleuscontainsinterneuronsthat
projectviathemediallongitudinalfasciculustothemedialrectussubnucleusofthecontralateral
oculomotorcomplex.
Therefore,anabducensnuclearlesionproducescompletelateralgazepalsy,fromweaknessofboththe
ipsilaterallateralrectusandthecontralateralmedialrectus.
(Q.33) Radiusofcurvature(mm)ofanteriorsurfaceof
cornea?
8.4
(c)
(d)
Your
Response
:
Correct b
Answer:
5.8
(a)
(b)
Exp:
7.8
4.8
(Ref.GuytonPhysiology11th/pg.617)
TheCornea
RefractiveIndex:1.3
Posterior(back)Surface
Distancealongaxisfromcornealpole:.55
mm
Anterior(front)Surface
Radiusofcurvature:7.8mm
Posteriorcornealsurface:6.5mm
(Q.34) TrueaboutIridocornealEndothelialSyndrome?
(a)
(b)
Neovascularizationofiris
Progressivediffuseirisatrophy
12/82
1/26/2016
(c)
Diffusebilateralsenileirisdegeneration
(d) DepositionofacidmucopolysaccharidesinDescemetsmembrane
YourResponse:
b
CorrectAnswer:
Exp:
(Ref.Basaksophthalmology2nded.pg.161)
IRIDOCORNEALENDOTHELIALSYNDROME
Unknownetiology.
Characterizedby
i.Glaucoma,ii.Irisatrophy,iii.Decreasedendothelium,andiv.Irisnodules.
Aftermetaplasia,thecornealendotheliumproliferates,andDescemetsmembranelikematerialcovers
theanteriorsurfaceandangleoftheanteriorchamber,causingirisanomaliesandsecondaryglaucoma.
Thespectrumincludes3conditions:
i.Progressiveessentialirisatrophyii.Chandlerssyndromeiii.Irisnaevussybdrome
(Q.35) Thefollowingistrueforaccommodationexcept:
(a) Thefarpointofdistinctvisionofanemmetropiceyeisatinfinity
(b) Rangeofaccommodationisthedifferenceindioptricpowerbetweentheeyeatrestandfullyaccommodatedeye
(c) Dynamicrefractionreferstothedioptricpoweroftheaccommodatedeye
(d) Staticrefractionreferstothedioptricpowerofarestingeye
YourResponse:
b
CorrectAnswer:
Exp:
Rangeofaccommodationreferstothedistancebetweenthefarpointandthenearpoint.Thedifference
indioptricpowerbetweentheeyesatrestandthefullyaccommodatedeyeiscalledtheamplitudeof
accommodation.
(Q.36) Snowbankingisseenin:
(a)
Parsplanitis
(b)
(c)
Endophthalmitis
Ealesdisease
(d)
Coatsdisease
Your
Response
:
Correct a
Answer:
Exp:
(Ref.Parsonsdiseaseofeye19th
ed.360)
Snowbankingisseeninpars
planitis.
(Q.37) CausativefactorforMaculardegenerationindiabetesmellitus?
(a)
Retinalischemia
(b)
(c)
Neovascularization
(d)
Lipiddeposition
Hemorrhages
13/82
1/26/2016
YourResponse:
CorrectAnswer:
Exp:
a
(Ref.Basaksophthalmology2nded.pg.16,299,300)
BlindnessinDMisprimarilytheresultofprogressivediabeticretinopathyandclinicallysignificantmacular
edema.
Diabeticretinopathyisclassifiedintotwostages:
nonproliferativeand
proliferative.
Nonproliferativediabeticretinopathyusuallyappearslateinthefirstdecadeorearlyintheseconddecade
ofthediseaseandismarkedbyretinalvascularmicroaneurysms,blothemorrhages,andcottonwool
spots.Mildnonproliferativeretinopathyprogressestomoreextensivedisease,characterizedbychangesin
venousvesselcaliber,intraretinalmicrovascularabnormalities,andmorenumerousmicroaneurysmsand
hemorrhages.Thepathophysiologicmechanismsinvokedinnonproliferativeretinopathyincludelossof
retinalpericytes,increasedretinalvascularpermeability,alterationsinretinalbloodflow,andabnormal
retinalmicrovasculature,allofwhichleadtoretinalischemia.
(Q.38) Chalazionis?
(a)
Lipogranuloma
(b)
(c)
Acutebacterialinfection
InfectionoftheglandsofZeisorMoll
(d)
Stye
YourResponse:
CorrectAnswer:
Exp:
a
(Ref.ParsonsdiseasesofEye19thed.467)
Chalazionisachronicnonspecific,noninflammatorygranulomaofMeibomianglandswithalipomatous
center.
ThelipidcomponentofthetearfilmisproducedbysebaceousglandsknownasMeibomianglands
(locatedinthetarsalplatesalongtheeyelidmargins)andtheglandsofZeis(whichopenintothehair
folliclesoftheeyelashes).
AnenlargementofaMeibomianglandisknownasachalazionorhordeoluminternumwhilean
infectionofaZeisglandisknownasahordeolumexternumorstye.
Belowthelipidlayerislocatedtheaqueouslayerofthetearfilm.
Thismiddlelayeristhethickestofthethreetearlayers,anditisformedprimarilybytheglandsof
KrauseandWolfringandsecondarilybythelacrimalgland,allofwhicharelocatedintheeyelids.
(Q.39) Tearbreakuptime(TBUT)is:
(a)
<4seconds
(b)
(c)
58seconds
(d)
YourResponse:
CorrectAnswer:
1012seconds
Exp:
IntestingforTearBreakUpTime,sodiumfluoresceindyeisaddedtotheeyeandthetearfilmisobserved
undertheslitlampwhilethepatientavoidsblinkinguntiltinydryspotsdevelop.Thelongerittakes,the
morestablethetearfilm.Ashorttearbreakuptimeisasignofapoortearfilm.
<10seconds
Generally,>10secondsisthoughttobenormal,5to10seconds,marginal,and<5secondslow(withhigh
14/82
1/26/2016
likelihoodofdryeyesymptoms).
Meibomiamglanddysfunction,wherenotenoughlipidissecretedbythemeibomianglandstosealthe
aqueoustearsandretardevaporation,isacommoncauseoftearfilminstability.
(Q.40) Thefollowingaretrueaboutmyopiaallexcept:
(a)
(b)
Thesecondprincipalfocusliesbehindtheretina
Thepresenceofposteriorstaphylomasuggestsaxialmyopia
(c)
Nucleosclerosisisacauseofindexmyopia
(d)
Highmyopiamaybetreatedwithclearlensextraction
YourResponse:
a
CorrectAnswer:
Exp:
Inmyopia,thesecondprincipalfocusliesinfrontoftheretina.
Myopiamaybeclassifiedintoaxialmyopia(inwhichtheeyeisabnormallylongasinhighmyopiawhich
canproducestaphyloma)orrefractiveorindexmyopiainwhichtherefractivepoweroftheeyeis
increasedasinkeratoconusandnuclearsclerosis.
(Q.41) Falseabouttheimageformedbyanindirectophthalmoscope:
(a)
(b)
Isupsidedown
Isreal
(c)
Islaterallyinverted
(d)
Isnotaffectedbytherefractivestateofthepatient
YourResponse:
d
CorrectAnswer:
Exp:
Theimageformedbytheindirectophthalmoscopeisrealandinverted(bothverticallyandlaterally).
Itissituatedbetweentheobserverandthecondensinglens.
Theimageformedisaffectedbytherefractivestateofthepatientbutnottothesameextentaswith
directophthalmoscope.
(Q.42) Thefollowingaretrueabouthypermetropiaallexcept:
(a) Almost10timesmorecommoninfemalesthaninmales.
(b) Accommodationisusedtoachievenormalvision
(c) Aphakiaisaformofhypermetropia
(d) Patientwhohashypermetropicrefractionfollowingcataractsurgerywillhaveproblemforbothnearanddistantreading.
YourResponse:
a
CorrectAnswer:
Exp:
Thesecondprincipalfocusofhypermetropialiesbehindtheretina.
Accommodationisusedtocorrecttheemmetropiatocertainextent.
Theyrequirereadingglassesearlierthanthenormalpopulation.
Aphakiaisaformofhypermetropia.Followingcataractsurgery,theaccommodativeabilityoftheeyeis
lost.
Therefore,ifthepatientishypermetropic,thevisionwillbeblurredfordistantandnear.
Thisisthereasonwhymostpatientsaremadeslightlymyopicsothattheycanachieveareasonablevision
withoutglassesfordistance.
15/82
1/26/2016
(Q.43) Inayoungpatientcomplainingofflashesofbrightlight,"aveilfallinginfrontoftheeye,"withpainlesslossofvision,themost
likelyclinicaldiagnosisis?
(a)
Retinaldetachment
(b)
(c)
Ealesdisease
(d)
YourResponse:
CorrectAnswer:
Macularhole
Exp:
Vitreoushemorrhage
a
Ifthepatientcomplainsofflashesofbrightlight,"acurtainfallinginfrontoftheeye,"orfloatingblack
specks,thesefindingsmaybeanindicationofretinaldetachment.
Aretinaldetachmentispainless.Peopleusuallyseeanincreaseinsmall,floatingobjects(floaters)ormany
flashesofbrightlightthatlastlessthanasecond.
Peripheralvisionistypicallylostfirst,andvisionlossspreadsasthedetachmentprogresses.
Thelossofvisionresemblesacurtainorveilfallingacrossthelineofsight.
Ifthemaculabecomesdetached,visionrapidlydeteriorates,andeverythingbecomesblurred.
(Q.44) Tonicpupilisleastlikelytobeseeninwhichofthefollowingcondition?
(a)
ShyDragersyndrome
(b)
(c)
Syphilis
(d)
YourResponse:
CorrectAnswer:
Exp:
Diabetes
Amyloidosis
b
Whenthenearstimulusisremoved,thepupilredilatesveryslowlycomparedwiththenormalpupil,
hencethetermtonicpupil.
InAdiessyndrome,atonicpupiloccursinconjunctionwithweakorabsenttendonreflexesinthelower
extremities.
Thisbenigndisorder,whichoccurspredominantlyinhealthyyoungwomen,isassumedtorepresenta
milddysautonomia.
TonicpupilsarealsoassociatedwithShyDragersyndrome,segmentalhypohidrosis,diabetes,and
amyloidosis.
Occasionally,atonicpupilisdiscoveredincidentallyinanotherwisecompletelynormal,asymptomatic
individual.
Thediagnosisisconfirmedbyplacingadropofdilute(0.125%)pilocarpineintoeacheye.
(Q.45) Whichofthefollowingisassociatedwithipsilateraloculomotorpalsywithcontralateralhemiparesis?
(a)
(b)
(c)
(d)
YourResponse:
CorrectAnswer:
Exp:
Nothnagelssyndrome
Benediktssyndrome
Weberssyndrome
Claudessyndrome
c
InNothnagelssyndrome,injurytothesuperiorcerebellarpedunclecausesipsilateraloculomotorpalsy
andcontralateralcerebellarataxia.
InBenediktssyndrome,injurytotherednucleusresultsinipsilateraloculomotorpalsyandcontralateral
16/82
1/26/2016
tremor,chorea,andathetosis.
Claudessyndromeincorporatesfeaturesofboththeaforementionedsyndromes,byinjurytoboththered
nucleusandthesuperiorcerebellarpeduncle.
InWeberssyndrome,injurytothecerebralpedunclecausesipsilateraloculomotorpalsywith
contralateralhemiparesis.
(Q.46) Inclusionconjunctivitisiscausedby?
(a)
(b)
Chlamydiapneumoniae
Chlamydiatrachomatis
(c)
Chlamydiapsittaci
(d)
L1,L2,L3serovars
YourResponse:
b
CorrectAnswer:
Exp:
Chlamydiae
Chlamydiaeareobligateintracellularparasitesthatcausemucosalinfections.
Thechlamydialpeptidoglycanwallisunusualinthatitlacksmuramicacid.
Its2formsare:
Elementarybody(small,dense),whichEnterscellviaendocytosis.
InitialorReticulatebody,whichReplicatesincellbyfission.
Chlamydiatrachomatiscausesreactivearthritis,inclusionconjunctivitis,andnongonococcalurethritis.
ChlamydiatrachomatisisinfactthemostcommoncauseofsexuallytransmitteddiseaseintheUnited
Statesandisalsoresponsibleforthemajorityofcasesofinfantconjunctivitisandinfantpneumonia.
LGVisasexuallytransmitteddiseasecausedbyC.trachomatisofimmunotypesL1,L2,andL3.
Labdiagnosis:cytoplasmicinclusionsseenonGiemsaorfluorescentantibodystainedsmear.
C.pneumoniaeandC.psittacicauseatypicalpneumonia;transmittedbyaerosol.
Treatment:erythromycinortetracycline.
(Q.47) Scleraisthinnestat:
(a)
(b)
Limbus
Equator
(c)
Anteriortoattachmentofsuperiorrectus
(d)
Posteriortoattachmentofsuperiorrectus
YourResponse:
d
CorrectAnswer:
Exp:
(Ref.Parsonssdiseasesofeye20thed.210)
Thescleravariesinthicknessbeingthickest(1mm)attheposteriorpole,neartheopticnerveandthinnest
(0.3mm)justbehindtheinsertionofrectusmuscles.
(Q.48) Apersonhasrestrictedeyemovementsinalldirections,ptosisbutnosquintordiplopia.Whatisthediagnosis?
(a)
(b)
Myasthenia
CPEO
(c)
Multiplecranialnervepalsy
(d)
Thyroidmyopathy
YourResponse:
b
17/82
1/26/2016
CorrectAnswer:
Exp:
(Ref.Harrison17th/2690;OphthalmologybyGerhardK.Langpg.486;Pocketatlasofophthalmology
pg.63)
Chronicprogressiveexternalophthalmoplegia(CPEO)
CPEOisamitochondriopathy.Thereisslowlyprogressiveweaknessofalltheocularmuscleswitha
variabledegreeofmotilitydisordersandcorrespondingdoublevision,andsubsequentlythereisalso
involvementofthelimbmuscles.
Bilateralptosiswithgreatlyimpairedlevatorfunctionisoftenobserved.
Inadditionthereisweaknessofthemusclesoffacialexpression,particularlytheorbicularisoculi.
AspecialformistheKearnsSayresyndrome.Alongwiththemuscleweakness,therearechangesinthe
funduslikethoseofretinitispigmentosaandalsocardiacarrhythmias,hearingdisorders,andmental
retardation.
CausaltreatmentofCPEOisnotpossible.
(Q.49) HornerssyndromeischaracterizedbythefollowingEXCEPT?
(a)
(b)
Ptosis
Miosis
(c)
Heterochromiairidis
(d)
Apparentexophthalmos
YourResponse:
d
CorrectAnswer:
Exp:
(Ref.VictorAdamsNeurology,pg296.)
Hornersyndromeischaracterizedby
a.Ptosisb.Miosisc.Anhydrosis,d.Enophthalmose.Lossofciliospinalrefles
CONGENITALHornersyndrome,whichmaybeinheritedasanautosomaldominanttrait,ischaracterized
byfailureofoneeyetodevelopnormaliriscolor(heterochromiairidis).
(Q.50) Mostisolatedtrochlearnervepalsiesaredueto?
(a)
(b)
(c)
(d)
YourResponse:
CorrectAnswer:
Exp:
Idiopathic
Closedheadinjuries
Aneurysmalrupture
Diabetesmellitus
a
Isolatedtrochlearnervepalsyoccursfromallthecauseslistedabovefortheoculomotornerve,except
aneurysm.
Thetrochlearnerveisparticularlyapttosufferinjuryafterclosedheadtrauma.
Thefreeedgeofthetentoriumisthoughttoimpingeuponthenerveduringaconcussiveblow.
Mostisolatedtrochlearnervepalsiesareidiopathicandhencediagnosedbyexclusionasmicrovascular.
Spontaneousimprovementoccursoveraperiodofmonthsinmostpatients.
Abasedownprism(convenientlyappliedtothepatientsglassesasastickonFresnellens)mayserveasa
temporarymeasuretoalleviatediplopia.
Ifthepalsydoesnotresolve,theeyescanberealignedbyweakeningtheinferiorobliquemuscle.
(Q.51) Blowoutfractureoforbitmostcommonlyleadstofractureof:
18/82
1/26/2016
(a)
Lateralwall
(b)
Roofoforbit
(c)
Medialwalloforbit
(d)
Posteriormedialwalloffloor
YourResponse:
d
CorrectAnswer:
Exp:
(Ref.OphthalmologyAShortTextbookGerhardK.Langpg.507)
BlowoutFracture
Etiology:
Blowoutfracturesoftheorbitresultfromblunttrauma.Bluntobjectsofsmalldiameter,suchasafist,
tennisball,orbaseball,cancompressthecontentsoftheorbitsoseverelythatorbitalwallfractures.This
fractureusuallyoccurswheretheboneisthinnest,alongthepaperthinflooroftheorbitoverthemaxillary
sinus.Theringshapedbonyorbitalrimusuallyremainsintact.Thefracturecanresultinprotrusionand
impingementoforbitalfatandtheinferiorrectusanditssheathsinthefracturegap.Wherethemedial
ethmoidwallfracturesinsteadoftheorbitalfloor,emphysemaintheeyelidswillresult.
Symptomsanddiagnosticconsiderations:
Themoreseverethecontusion,themoreseveretheintraocularinjuriesandresultingvisualimpairment
willbe.Impingementoftheinferiorrectuscanresultindiplopia,especiallyinupwardgaze.Initially,the
diplopiamaygounnoticedwhentheeyeisstillswollenshut.Alargebonedefectmayresultin
displacementoflargerportionsofthecontentsoftheorbitalcavity.Theeyemayrecedeintotheorbit
(enophthalmos)andthepalpebralfissuremaynarrow.Injurytotheinfraorbitalnerve,whichcourses
alongtheflooroftheorbit,mayresult.Thiscancausehypesthesiaoftheskinofthecheek.
Crepitusuponpalpationduringexaminationoftheeyelidswellingisasignofemphysemaduetocollapse
oftheethmoidalaircells.Thecrepitusiscausedbyairenteringtheorbitfromtheparanasalsinuses.The
patientshouldrefrainfromblowinghisorhernoseforthenextfourorfivedaystoavoidforcingairor
germsintotheorbit.
(Q.52) Neovascularglaucomaisnotseenin:
(a)
JRA
(b)
(c)
CRVO
(d)
YourResponse:
CorrectAnswer:
Eales'disease
Exp:
CRAO
a
Neovascularglaucoma(NVG)ischaracterizedbyformationofnewvesselsonthesurfaceofiris
(rubeosisiridis).andtrabecularmeshworkwhichleadstoraisedintraocularpressure.Itis
commonlycausedbyretinalischemiaduetothefollowingdiseases:
CRVO
Diabeticretinopathy
CRAO
Eales'disease
Longstandingretinal
detachment
Sicklecellretinopathy
Intraoculartumors
NVGoccursin510%ofCRAO.
InJRA,glaucomagenerallypresentsasacuteangleclosure,duetoposteriorsynechiae,orchronic
angleclosure,which
resultsfromprogressive,peripheralanteriorsynechiae.
(Q.53) Fortificationspectraarefeatureof?
19/82
1/26/2016
(a)
Maturecataract
(b)
Immaturecataract
AmaurosisFugax
(c)
(d)
YourResponse:
CorrectAnswer:
Migraine
d
Exp:
Inatypicalattack,asmallcentraldisturbanceinthefieldofvisionmarchestowardtheperiphery,leavinga
transientscotomainitswake.
Theexpandingborderofmigrainescotomahasascintillating,dancing,orzigzagedge,resemblingthe
bastionsofafortifiedcity,hencethetermfortificationspectra.
Patientsdescriptionsoffortificationspectravarywidelyandcanbeconfusedwithamaurosisfugax.
Migrainepatternsusuallylastlongerandareperceivedinbotheyes,whereasamaurosisfugaxisbriefer
andoccursinonlyoneeye.
Migrainephenomenaalsoremainvisibleinthedarkorwiththeeyesclosed
(Q.54) InERG'A'wavescorrespondsto:
(a)
Rodsandcones
(b)
(c)
Nervebundlelayer
(d)
YourResponse:
CorrectAnswer:
Pigmentepithelium
Exp:
ERG
Artifact
Awave
Activityofrodsandcones
Bwave
Bipolarcell
Cwave
Retinalpigmentepithelium(RPE)
(Q.55) Swingingflashlighttestcanbehelpfultoelicit?
(a)
(b)
ArgyllRobertsonpupil
Adiestonicpupil
(c)
MarcusGunnpupil
(d)
Subtleinequalityinpupilsize
YourResponse:
c
CorrectAnswer:
Exp:
Aneyewithnolightperceptionhasnopupillaryresponsetodirectlightstimulation.
20/82
1/26/2016
Iftheretinaoropticnerveisonlypartiallyinjured,thedirectpupillaryresponsewillbeweakerthanthe
consensualpupillaryresponseevokedbyshiningalightintotheothereye.
Thisrelativeafferentpupillarydefect(RAPD)MarcusGunnpupilcanbeelicitedwiththeswinging
flashlighttest.
Itisanextremelyusefulsigninretrobulbaropticneuritisandotheropticnervediseases,whereitmaybe
thesoleobjectiveevidencefordisease.
(Q.56) AllthefollowingaretrueaboutRetinitispunctataalbescensexcept?
(a)
Autosomaldominant
(b)
(c)
Retinalpigmentationinepithelium
Particularlyinvolvesposteriorpoleofretina
(d)
Whitedotsonfundusexamination
YourResponse:
c
CorrectAnswer:
Exp:
(Ref:PersonsDiseasesoftheeye20/ePage310)
Retinitispunctataalbescensisaprogressivedegenerativedisorderoftheretinacharacterizedbythe
presenceofnumerouswhitedotsattheleveloftheretinalpigmentepithelium.
Ithasanautosomaldominantmodeofinheritanceandatleastsomecasesareduetomutationin
theRDSgene.Thedotsarefoundthroughoutthefundus,buttendtosparetheposteriorpole.
Despiteaffectedthesamepartsoftheretinaasretinitispigmentosathepigmentarychangesareabsent.
Theretinalpigmentepitheliumhashyperchromaticnuclei,irregularlydistributedmelanin(especiallyatthe
posteriorpole),andcytoplasmicvauoles.
Retinitispunctataalbescensisoneofseveralretinaldiseaseswithwhiteretinaldots(fleckedretina
syndrome).
Otherconditionswithwhitedotsincludefundusalbipunctatus(Stargardtdisease)and
Doynefamilialmaculopathy.
(Q.57) Fleischerringisadistinctfeatureof:
(a)
(b)
Keratoconus
Pterygium
(c)
Congenitalocularmelanosis
(d)
CongenitalepithelialMelanosis
YourResponse:
a
CorrectAnswer:
Exp:
(Ref.Parson,DiseasesofEye,19thed.568)
TYPEOFPIGMENT DISORDER
Iron
LOCATION
Keratoconus(Fleischerring)
Cornealepithelium
Oldopacity(HudsonStahliline)Q
Cornealepithelium
Pterygium(Stockersline)
Cornealepithelium
Filteringbleb(Ferrysline)
Cornealepithelium
Copper
Wilsonsdisease,Chalcosis(KFring)
Descemetsmembrane
Melanin
Pigmentdispersionsyndrome(Krukenbergsspindle)
Endothelium
(Q.58) ForaneonatewithThresholdRetinopathyofprematurity,mostappropriateRxwouldbe:
(a)
Photocoagulation
21/82
1/26/2016
(b)
LessO2flow
Surgery
(c)
(d)
YourResponse:
CorrectAnswer:
Exp:
Retinopathyofprematurity
Antioxidants
ROPasper
severity
Meaning
Plusdisease Signofvascularactivitywhichaccompanyany
ROP
stage,indicatinggreaterlikelihoodof
progressiontostageIII(i.e.ridgewith
extraretinalfibrovascularproliferation).
Rx
Retinalablationwithlaser
photocoagulationforthoseprogresing
toprethreshold/thresholddisease
Prethreshold ROPwithincreasedlikelihoodofprogressionto
ROP
retinaldetachmentifleftuntreated.
(Q.59) ICGangiographyisprimarilyindicatedin?
(a)
MinimalclassicalCNV
(b)
(c)
OccultCNV
AngioidstreakswithCNV
(d)
Polypoidalchoroidalvasculopathy
YourResponse:
b
CorrectAnswer:
Exp:
Inalandmarkarticle,YannuzziandassociatesdemonstratedthatICGvideoangiographywasextremely
usefulinidentifyingwelldemarcatedlocalizedareasofneovascularizationinwhathadbeenclassifiedas
occultCNVbystandardfluoresceinangiography.
(Q.60) Entropionis:
(a)
(b)
Inversionofeyelid
Inversionofeyelashes
Eversionofeyelid
(c)
(d)
YourResponse:
CorrectAnswer:
Eversionofeyelashes
a
Exp:
Entropionisaconditioninwhichthelowereyelidturnsinward,rubbingagainsttheeye.Entropionoccurs
mostcommonlyasaresultofaging.Infectionandscarringinsidetheeyelidareothercausesofentropion.
Whentheeyelidturnsinward,theeyelashesandskinrubagainsttheeye,makingitred,irritatedand
sensitivetolightandwind.
Ifentropionisnottreated,aneyeulcermayform.Withsurgery,theeyelidcanbeturnedoutwardtoits
normalposition,protectingtheeyeandimprovingthesesymptoms.
(Q.61) Afterradiationinducedinjurycataractisseeninwhichpartoflens?
(a)
Anteriorcortical
(b)
(c)
Posteriorcortical
(d)
Nucleus
Subcapsular
22/82
1/26/2016
YourResponse:
CorrectAnswer:
Exp:
CATARACT
APPEARANCE
1.
Aftercataract(Posteriorcapsularopacity) Elschnigpearl&RingsofSoemerrings
2.
Brown/Cataractabrunescens
Nuclear/hardcataract
3.
Blackcataract/Cataractanigrans
4.
Bluedotcataract(Punctate)
Mostcommoncongenitalcataract
5.
ComplicatedCataract
Breadcrumbappearance&Polychromaticluster
6.
ConcussionCataract
RosetteshapedCataract
7.
Coronarycataract
DevelopmentalCataractatpuberty
8.
Chalcosis
Sunflowercataract
9.
DiabeticCataract(Juvenile)
Snowflake/stormappearance
10.
HypermaturesenileCataract
MorgagnianCataract
11.
Lamellar/Zonular
Riders
12.
Radiationinducedcataract
Posteriorcapsularcataract
(Q.62) Whatsizeofdonorcorneaistakeninkeratoplasty?
(a)
2mm
(b)
(c)
(d)
YourResponse:
CorrectAnswer:
4mm
Exp:
Penetratingkeratoplasty
6mm
8mm
Keratoplastyisreferredtoascornealtransplantationorgrafting.
LamellarKeratoplastyisapartialthicknesscornealgrafting.
PenetratingKeratoplastyisafullthicknesscornealgrafting.
Lamellarrefractivekeratoplastyinvolvestheplacementofalenticuleonorwithinthecorneatoalterits
refractivepower,usuallybychangingitsanteriorcurvature.Lamellarkeratoplastyhastheadvantageof
beingprimarilyoutsidetheeye,makingitaprocedurethatpreservesendothelium.Theriskofrejection
becomeslessofanissue.Therisksofwoundleaksorflatanteriorchambersassociatedwithanintraocular
proceduremaybeeliminated:
2types:
Onlay
Inlay
TheSurgicalProcedure
Decideaboutgraftsize
Usuallygraftsizeisnobiggerthan8.5mmindiametertoavoidpostopincreaseinintraocularpressure,
anteriorsynechiae,andvascularization.
Anidealsizeis7.5mm.Smallersizeswouldgiverisetoastigmatismduetosubsequenttissuetension.
Excisionofdonortissue
Excisionofrecipienttissue
(Q.63) Suddenpainfullossofvisionisseenin:
(a)
Papillitis
23/82
1/26/2016
(b)
Centralretinalveinobstruction
(c)
Opticneuritis
(d)
All
YourResponse:
c
CorrectAnswer:
Exp:
Papillitisispainless.Onlyretrobulbarneuritisispainful.
CRVOcausesdecreasedvisionduetomacularedema(painless),CRVOcausesgradual,painfullossofvision
duetoneovascularglaucoma
REDPAINFULEYE
SUDDENVISUALLOSS
CHRONICVISUALLOSS
Cornealabrasions
Amaurosisfugax(TIAofretina)
Cataract
Keratitis
Factitious
Retinitispigmentosa
Herpesophthalmicus
GradeIVHypertensiveretinopathywith
macularstar
POAG
Anterioruveitisor
iridocyclitis
CRVO/BRVO
Epiretinalmembrane
Acuteangleclosure
glaucoma
Anteriorischemicopticneuropathy
DryARMD
Endophthalmitis
Posteriorischemicopticneuropathy
Melanoma&otherocular
tumors
Opticneuritis
Centralserous
chorioretinopathy
Posterioruveitis
Diabeticretinopathy.
Toxicopticneuropathy
Refractiveerror
Vitreoushemorrhage
RD
Classicmigraine
Occipitalinfarct
WetARMD
(Q.64) An18yrsoldboycomestotheeyecasualtywithhistoryofinjurywithatennisball.Onexaminationthereisnoperforationbut
thereishyphema.Themostlikelysourceofthebloodis:
(a)
Irisvessels
(b)
Circulariridismajor
(c)
Shortposteriorciliaryvessels
(d)
Circulariridismajor
YourResponse:
b
CorrectAnswer:
Exp:
(Ref.EssentialofOphthalmologybyBasak2nded.8,303)
Giliarybodyissuppliedbybranchesofmajorcircleofirisformedbytwolongposteriorciliaryarteries&
sevenanteriorciliaryarterieswhichformtheminorcircleifiristhatliesintheirisstroma.
Shortposteriorciliaryarteriesoriginatefromophthalmicarteryas23branches,whicharesubdividedinto
1020branchesthatperforatethescleraaroundopticnerve&directlycommunicatewiththechorio
capillaries.
Hyphaema(collectionofbloodinanteriorchamber)resultsfrominjurytosmallbranchesofcirculusiridis
majorduetotearbetweenlongitudinal&circularfibersoftheciliarymuscles(mostlikelysourceafter
24/82
1/26/2016
blunteyetrauma)&mayalsoresultfrominjurytocapillariesofcirculusiridisminorwhenthereis
sphincterictear.
(Q.65) Treatmentofchoiceforphlyctenularconjunctivitisis
(a)
(b)
(c)
(d)
YourResponse:
CorrectAnswer:
Exp:
Topicalsteroids
Sodiumcromoglycate
Zincoxide
AKT
a
(Ref.Parson,Diseasesofeye,18thed.,140)
Aphlyctenule(alsocalledphlycten)isacharacteristicnodularaffectionoccurringasanallergicresponseof
theconjunctivalandcornealepitheliumtosomeendogenousallergenstowhichtheyhavebecome
sensitized.
Aphlyctenule,orphlycten,isasmall,yellowishorpinkishwhitenodulesurroundedbyhyperemic
conjunctiva.Phlyctenmaybesingleormultipleandcanoccuranywhereontheconjunctiva,and
occasionallyonthecorneosclerallimbuswhereitcanbemistakenforacornealforeignbody.
Aetiology:
>Tuberculoprotein
>Toxinsfromstaphylococcusorstreptococcus
>Toxinsfromintestinalparasites
ClinicalTypes:
>Phyctenularconjunctivitis
>PhyctenularKeratoconjunctivitis
>PhyctenularKeratitis
Symptoms:
>Rednesswithformationofbleb
>Irritationandlacrimation
>Painandphotophobia
Treatment:
>Corticosteroideyedrop
>Incaseofsecondaryinfection,firsttreatbacterialconjunctivitisbylocalantibioticdropsandthentreat
withlocalcorticosteroiddrops.
>Whencorneainvolvedatropin(1%)eyeointment
>Improvementofthenutritionalstatus
>Treatmentofcausalfactorseg.
Treatmentoftuberculosis
Treatmentoftonsillitisoradenitis
Antihelminticsforintestinalparasites.
Phlyctenularkeratoconjunctivitis
Isadelayedallergicreactiontomicrobialproteinsortoxins(e.g.staphylococcalinflammation,TB
proteins).
Steroideyedrops.
(Q.66) Recoveryincataractsurgeryisfastestwithwhichofthefollowing?
25/82
1/26/2016
(a)
(b)
(c)
(d)
YourResponse:
CorrectAnswer:
Exp:
ICCE
ECCE
Phacoemulsification
ECCEwithIOL
c
(Ref.Parson,DiseasesofEye,18thed.,305;19thed.,180,326)
Principlesofphacoemulsification(asophisticatedformofecce)
Emulsificationoflensnucleusandcorticalmatterbyultrasonicvibrationsusinghollow1mmtitanium
needlevibratingat40,000times/secandthenremovedbysimultaneousirrigationandaspiration.
Assmallas35.5posteriorlimbalgroove/scleraltunnelismadeandwhenincisionis3mm,itiscalled
Suturelesssurgery.
Advantages
Suturelesssurgery
Fastestrecoveryaftersurgery
Earlystabilizationofrefractionwithminimalornoastigmatism
WholeposteriorcapsuleandpartofanteriorareleftintactforinthebagPCIOL.
Disadvantages
Expensiveequipments
Difficulttechnique
Highlytrainedandexperiencedsurgeonneeded
Difficulttouseingrade3+or4+nuclearsclerosis
Complicationswiththebeginnerslikeirisdamage,mixingoflensmaterialwithvitreouscanoccur.
(Q.67) Diplopiaisdiagnosticfeatureof
(a)
(b)
(c)
(d)
YourResponse:
CorrectAnswer:
Concomitantsquint
Exp:
Paralyticsquint
Latentsquint
All
b
(Ref.Parson,DiseasesofEye,18thed.,342;19thed.,180,326;Basak,Ophthalmology,2nded.,298)
Criterion
Concomitantstrabismus
Paralyticstrabismus
Onset
Atanearlyage,initiallyonly
periodically.
Atanyage,suddenonset
Cause
Hereditary,uncorrected
refractive
Diseaseoforinjurytoocularmuscles,nerves,
ornuclei.
error,perinatalinjury
Diplopia
None;imagesuppressed
(exceptin
Diplopiaispresent.
latestrabismuswithnormal
sensory
development)
Compensatory
None
Present
26/82
1/26/2016
headposture
Depthperception
Notpresent
Presentonlywhenpatientassumes
compensatoryheadposture.
Visualacuity
Usuallyunilaterallyreduced
visualacuity
Nochangeinvisualacuity.
Angleofdeviation
Constantineverydirectionof Variable,increasinginthedirectionofactionof
gaze
theparalyzedmuscle.
(Q.68) ScleralExpansionBandsareusedintemanagementof:
(a)
(b)
Myopia
(c)
(d)
YourResponse:
CorrectAnswer:
Presbyopia
Astigmatism
keratoconus
c
Exp:
Schacharintroducedscleralexpansionbandsforsurgicalreversalofpresbyopia.
Originally,theimplantwasdesignedasacontinuousringthatwasplacedintothesclera.
However,presbyopicpatientshadasmuchas10Dofaccommodation,andcomplicationslikeanterior
segmentischemia,bandrotation,andextrusionoccurredaftersurgery.
Themodifiedandimproveddesignofthisprototypeconsistsoffourpolymethylmethacrylate(PMMA)
bandsthatareplacedinfourscleraltunnelsatdepthsof350to400minordertocreatemorespace
betweenthelensandthesclera.
ThisfollowsthetheoryofaccommodationdescribedbySchachar.
Hehypothesizedthatduringaccommodation,thecentralpartofthecrystallinelenssteepensbecauseof
tensionontheequatoriallenszonulesandarelaxedstatusoftheanteriorandposteriorzonules.
Accordingtohistheory,increasingtheworkingdistanceoftheciliarymuscle,achievedbyimplantationof
expansionbands,mightincreasetheamplitudeofaccommodation.
ThistheorycontradictsHelmholtz'stheoryandisnotsupportedbyrecentexperimentalstudies.
(Q.69) Topicalsteroidsareusedintreatmentof
(a)
(b)
Fungalkeratitis
Disciformkeratitis
Viralkeratitis
(c)
(d)
YourResponse:
CorrectAnswer:
Exp:
(Ref.Parson,DiseaseofEye,19thed.,221;Basaksopthalmology,2nded.,123)
Pyogenickeratitis
Disciformkeratitis
Disciformkeratitisisadeepkeratitis(stromal)withdisclikeedema,mainlycausedbyherpesvirus
(sometimesduetovacciniaandherpeszostervirus).
Corticosteroidsaretreatmentofchoice.Topicalcorticosteroiddrops(45timesdaily)underantiviral
cover(acyclovirointment)aregiven.Cycloplegicsmaybeused.
(Q.70) InSturgeWebersyndrome,theocularmanifestationis:
(a)
Retinalhemorrhage
(b)
Pulsatingexophthalmos
27/82
1/26/2016
(c)
Lischnodules
(d)
Hemangiomaofchoroidandglaucoma
YourResponse:
d
CorrectAnswer:
Exp:
EncephalotrigeminalangiomatosisorSturgeWebersyndromechildwithsensorimotorseizures
contralateraltoafacial"portwinestain."
Weberprovidedthefirstradiographicdemonstrationofanimportantcomponentofthedisorder,
intracerebralmeningealangiomatouscalcification(characteristictramlinecalcificationseeninsimpleX
ray)ipsilateraltoatrigeminalnevus.
Hemangiomaofchoroidandglaucomaisalsopresent.
(Q.71) Whichofthefollowingmuscleinlidisattachedtouppermarginofsuperiortarsus:
(a)
(b)
(c)
(d)
YourResponse:
CorrectAnswer:
Exp:
Superiorrectus
Muller'smuscle
Levatorpalpebrae
Superioroblique
b
SuperiortarsalmuscleorMuller'smuscleisattacheddirectlytotheuppermarginofsuperiortarsusandis
coveredbyconjunctivaonitsinferiorsurface.
Thetarsiare2thin,elongatedplatesofdensefibroustissueabout2.5cmlong;1isplacedineacheyelid.
Thetarsusoftheuppereyelidislarger,semiovalinshapeandabout10mminheightatthecenter.
Itgraduallynarrowstowardsitsextremities.
(Q.72) Presbyopiaoccursasaresultofthefollowingexcept:
(a)
Lossofelasticityofthecapsule
(b)
Sclerosisoflensfibres
(c)
Reducedanteriormovementofthelens
(d)
Reducedcontractionoftheciliarymuscle
YourResponse:
c
CorrectAnswer:
Exp:
Presbyopiaismultifactorialandisbelievedtoresultfrompoorciliarymusclecontractionwithageand
agerelatedsclerosisandlossofelasticityofthelensfibresandthelenscapsule.
(Q.73) Inachildthenormalresolutionvisualacuitylevelssuchasthatofadultsi.e.6/6isattainedbywhichage?
(a)
(b)
(c)
4months
(d)
YourResponse:
CorrectAnswer:
6years
Exp:
Thenewborn'seyeisshort,23Dhypermetropicandfoveaisimmature
1year
3years
Verysoonafterbirththebabycan'fix'orlookatalighthelpafewincheswaymomentarily.
28/82
1/26/2016
1monththefixationoflightbecomesmoresteadyandthebabydevelopsapreferenceforlookingata
faceorfacelikestimulusoveranyotherobjectnearby
3monthbinocularvisionandeyecoordinationareestablishedandtheeyewillfollowatorchhelpedin
frontofthefaceorpersonmovingacrosstheroom.
4monththeinfantdisplayarecognitionpatternsimilartoadultifafaceispresentedupsidedown
6monthofageabilitytoreachout,graspandplaywithsmallobjectsandeffortstoadjustpositiontoseaa
toydevelop
From9monthonwardsformaltestsofvisioncanbeattempted,butitisnotuntil6yearsofagethatthe
normalresolutionvisualacuitylevelssuchasthatofadultsi.e.6/6,20120areattained.
Maturationofinfantvisualfunctionhasbeenstudiedbytwotechniquesthepatternvisualevoked
potential(VEPs)andpreferentiallookingbehavior.Inchildrenyoungerthan2yearstheVEPtestproves
moresuccessful.Inchildrenover2yearswhocanmanagebothtests
Thecriticalperiodfordevelopingthefixationreflexinbothunilateralandbilateralvisualdeprivation
disorderisbetween2and4monthsofage.Anycataractdenseenoughtoimpairvisionmustbedealtwith
beforethisageandtheearliestpossibletimeispreferred.
(Q.74) WhatpercentofretinoblastomasareBilateral?
(a)
(b)
(c)
(d)
YourResponse:
CorrectAnswer:
Exp:
10
20
30
50
c
Retinoblastomaisthemostcommonprimarymalignantintraoculartumorinchildren,occurringin
approximatelyoneof20000births.In30%ofallcases,itisbilateral.
(Q.75) Whichofthefollowingcranialnervepalsyleavestheeyedownandout?
(a)
(b)
Trochlear
(c)
(d)
YourResponse:
CorrectAnswer:
Optic
Exp:
CN3lesioncausesdilatedpupil,downandouteye,droopyeyelid.
Oculomotor
Abducens
OculomotorNerve
Thethirdcranialnerveinnervatesthemedial,inferior,andsuperiorrecti;inferioroblique;levator
palpebraesuperioris;andtheirissphincter.
Totalpalsyoftheoculomotornervecausesptosis,adilatedpupil,andleavestheeyedownandout
becauseoftheunopposedactionofthelateralrectusandsuperioroblique.
(Q.76) Organisminvadingintactcornealmembraneis
(a)
Staphylococcus
(b)
(c)
(d)
Your
Streptococcus
Gonococcus
Pneumococcus
29/82
1/26/2016
Response:
Correct
Answer:
Exp:
(Ref.ParsonDiseaseofEye,19thed.,206&Basaks
opthalmology,2nded.,114)
Intactcornealepitheliumcannotbepenetratedbyanyorganism
EXCEPT,
Neisseriagonorrhea
Neisseriameningitides
Corynebacteriumdiphtheriae
(Q.77) Peripheraliridectomyismustinwhichofthefollowing?
(a)
(b)
(c)
Primaryopenangleglaucoma
Absoluteglaucoma
Closedangleglaucoma
(d)
Cataract
YourResponse:
c
CorrectAnswer:
Exp:
(Ref.ParsonDiseaseofEye,19thed.,117,133,306;Basak,Ophthalmology,2nd330)
Filtrationsurgeryforpacg:
Principle:
Theaqueoushumorisdrainedthroughtheanteriorchamberthroughasubconjunctivalscleralopening,
circumventingthetrabecularmeshwork.Formationofathinwalledfiltrationblebisasignofsufficient
drainageofaqueoushumor.
Technique:
Firstaconjunctivalflapisraised,whichmaybeeitherfornixbasedorlimbalbased.Thenapartial
thicknessscleralflapisraised.Accesstotheanteriorchamberisgainedviaagoniotomyperformedwitha
1.5mmtrephineatthesclerocornealjunctionorviaarectangulartrabeculectomyperformedwithascalpel
anddissectingscissors.Aperipheraliridectomyisthenperformedthroughthisopening.Thescleralflapis
thenlooselyclosedandcoveredwithconjunctiva.
Comment:
Apermanentreductioninintraocularpressureisachievedin8085%oftheseoperations.
Peripheraliridectomy(incisionalprocedure)
Wherethecorneaisstillswollenwithedemaortheirisisverythick,anopenproceduremayberequired
tocreateashunt.
Alimbalincisionismadeat12oclockundertopicalanesthesiaorgeneralanesthesia,throughwhicha
basaliridectomyisperformed.
Todayperipheraliridectomyisrarelyperformed,inonlyin12%ofallcases.
Whenthepatientreportsclearprodromalsymptomsandtheangleoftheanteriorchamberappears
constricted,thesafestprophylaxisistoperformaNd:YAGlaseriridotomyorperipheraliridectomy.
(Q.78) Visualacuityininfantsistestedwiththehelpof
(a)
(b)
Landoltsrings
(c)
(d)
YourResponse:
Perimeter
4dottest
Slitlamp
a
30/82
1/26/2016
CorrectAnswer:
Exp:
(Ref.Parson,DiseaseofEye,19thed.,93)
Visualacuityismeasureofspatialresolutionofeyeoranestimationofitsabilitytodiscriminatebetween
twopatients.
ALandoltC,alsoknownasaJapaneseVisionTest,LandoltringorLandoltbrokenring,isanoptotype,i.e.
astandardizedsymbolusedfortestingvision.
ItwasdevelopedbytheSwissbornophthalmologistEdmundLandolt.
TheLandoltCconsistsofaringthathasagap,thuslookingsimilartotheletterC.
Thegapcanbeatvariouspositions(usuallyleft,right,bottom,topandthe45positionsinbetween)and
thetaskofthetestedpersonistodecideonwhichsidethegapis.
ThesizeoftheCanditsgaparereduceduntilthesubjectmakesaspecifiedrateoferrors.
Theminimumperceivableangleofthegapistakenasmeasureofthevisualacuity.Itisgenerallypractised
inthelaboratory.
(Q.79) Irisbombeoccursdueto:
(a)
(b)
(c)
(d)
YourResponse:
CorrectAnswer:
Exp:
AdherentGlaucoma
AnteriorSynechiae
PosteriorSynechiae
Ringsynechiae
d
(Ref.Basaks,Ophthalmology,2nded.,pg148)
Ring(annular)synechiae
Posteriorsynechiaeextendingfor360degreesaroundthepupil(seclusiopupillae),preventthepassageof
aqueousfromtheposteriortotheanteriorchamber.Thisgivesrisetoforwardbowingoftheperipheral
iriscausinganirisbombe.
ThismayleadtoelevationofIOPduetosecondaryangleclosurebytheperipheraliris.
(Q.80) Conjunctivalfollicleintrachomawillshow?
(a)
(b)
(c)
(d)
YourResponse
:
Correct
c
Answer:
Exp:
Plasmacell
Epithelioidcells
Lymphocytes
Mastcells
(Ref.BasaksOpthalmology,2nded.,pg100)
TrachomaChronicRareintemperatecountriesbutendemicinwarm
31/82
1/26/2016
climates
Lymphoidfolliclesonthepalpebralconjunctivaoftheupper
eyelid.
cicatricialentropion,ptosis,trichiasis,cornealscarring,xerosisof
theconjunctiva.
Causativeagent:Chlamydiatrachomatis(serotypeAC)
(Q.81) A25yearoldmalepresentswithsuddenpainlesslossofvision.Theocularandsystemicexaminationisnormal.Whatisprobable
diagnosis?
(a)
(b)
(c)
Retinaldetachment
Ealesdisease
Glaucoma
(d)
YourResponse:
CorrectAnswer:
Opticneuritis
Exp:
SuddenpainlesslossofvisionoccursinEalesdiseaseduetovitreoushemorrhage.Howevertheocular
examinationwouldrevealvasculitisandvitreoushemorrhage.
Retrobulbarneuritis(opticneuritis)causessuddenprofoundlossofvision.However,ocularexamination
doesnotrevealanyabnormality.
Disease
Features
Eale'sdisease anidiopathicperipheralperiphlebitistypicallyaffectingbotheyesofayoungmale.
presentingfeaturebeingsuddenblurringofvisionduetovitreoushaemorrhage.
unsatisfactorytreatment,laserpanretinalphotocoagulation&parsplanavitrectomy
Opticneuritis isaninflammatory,demyelinatingconditionthatcausesacute,usuallymonocular,visual
loss.
Mostcasesofacutedemyelinatingopticneuritisoccurinwomen(twothirds)andtypically
developinpatientsbetweentheagesof20and40.
(Q.82) Retinitispigmentosaisassociatedwithfollowingexcept:
(a)
Refsum'sdisease
(b)
HallavardianSpatzdisease
(c)
NARP
(d)
Abetalipoproteinemia
YourResponse
:
Correct
b
Answer:
Exp:
Systemicdiseasesassociatedwithretinitispigmentosa:
a.LaurenceMoonBiedlsyndromeb.Usher'ssyndrome
c.Cockayne'ssyndromed.NARPandNeuronalceroid
lipofuscinosis
e.Hallgren'ssyndromef.Waardenburgsyndrome,
g.BardetBiedlsyndromeh.Abetalipoproteinemia
i.KearnsSayresyndromej.Refsumdisease
k.Alportsyndrome
l.Mucopolysaccharidoses(eg,Hurlersyndrome,Scheiesyndrome,
Sanfilipposyndrome)
32/82
1/26/2016
(Q.83) Photophthalmiaisseenwith
(a)
(b)
Ultravioletrays
Infraredrays
Gammarays
(c)
(d)
YourResponse:
CorrectAnswer:
Xrays
a
Exp:
Photoophthalmiareferstooccurrenceofmultiplecornealepithelialerosionsduetotheeffectof
ultravioletraysespeciallyfrom311to290nm
Snowblindnessduetoreflectedultravioletraysfromsnowsurface.
Clinicalfeaturessevereburningpain,lacrimation,photophobia,blepharospasm,swellingofpalpebral
conjunctivaandretrotarsalfolds
ProphylaxisCrooke'sglasswhichcutsoffallinfraredandultravioletraysshouldbeusedbythosewho
arepronetoexposureegoWeldingworkers,cinemaoperators
Treatment
Coldcompresses
Padandbandagewithantibioticsfor24hours,healsmostofthecases
Oralanalgesicsifpainisintolerable
Singledoseoftranquilisers
*Photoretinitisdueinfraredrays(eclipseburnofretina)
(Q.84) Angularconjunctivitisiscausedbywhichofthefollowingorganism:
(a)
(b)
(c)
(d)
YourResponse:
CorrectAnswer:
Exp:
Fungus
Bacteroides
Virus
Moraxella
d
AngularconjunctivitisordiplobacillaryconjunctivitisiscausedtypicallyduetoMoraxella.Moraxellaisa
diplobacillusconsistingofapairoflarge,thickrods,placedendtoend.
Thisformofconjunctivitisrespondstooxytetracyclineointment.Zincoxideointmentactsbyinhibitingthe
proteolyticenzymes.
(Q.85) Hornerssyndromecanbecausedbyfollowingexcept:
(a)
Medialmedullarysyndrome
(b)
Carotidaneurysm
(c)
PostoperativeRaynaudsdisease
(d)
Multiplesclerosis
YourResponse:
a
CorrectAnswer:
Exp:
(Ref.HandbookofneurosurgbyGreenberg7th/pg.833;H17th/pg.2527)
ThetriadofmiosiswithipsilateralptosisandanhidrosisconstitutesHorner'ssyndrome,although
33/82
1/26/2016
anhidrosisisaninconstantfeature.Alsoenophthalmosandhyperemiaofeyecanoccur.
CausesofHornerssyndrome
1storderneuron
centralneurons
Vascularocclusion(usuallyPICA)
Syringobulbia
Intraparenchymal(hypothalamic,
brainstem)neoplasm
2ndorderneuron
Preganglionic
Lateralsympathectomies
Significantchesttrauma
Pancoasttumor
Highthoracicorcervicalneuroblastoma
3rdorderneuron
Postganglionic
Necktrauma
(1%hydroxyamphitaminecausesNErelease (mostcommon
type)
fromnerveendingsatneuroeffector
junctioncausingpupildilattionin2ndorder
Carotiddiseases(e.g.carotiddissection)
butnotin3rdorderneuronlesions)
Shullbaseneoplasms
Cervicalbonyabnormalities
Migraine
Cavernoussinuslesions(e.g.
meningioma)
Note:withinvolvemntonlyoffibrson
ICA,anhidrosisdoesnotoccur.
(Q.86) Paralysisof3rd,4th&6thnerveswithinvolvementofophthalmicdivisionof5thnerve,localizesthelesionto:
(a)
(b)
(c)
CavernousSinus
Apexoforbit
Brainstem
Baseofskull
(d)
YourResponse:
a
CorrectAnswer:
Exp:
Site
Lateralwallof
CavernousSinus
Cranialnerves
involved
III,IV,VI&first
divisionofVoften
withproptosis
EponymicSyndrome
FoixTolsaHunts
Usualcause
Aneurysmsorthrombosisof
CavernousSinus,invasivetumors
fromSinuses&Sella;benign
granulomas
(Q.87) RecentlyusedtopicalNSAIDforophthalmicuse
(a)
(b)
Indomethacin
Nepafenac
Flurbiprofen
(c)
(d)
YourResponse:
CorrectAnswer:
Exp:
NepafenacisthenewlylaunchedTopicalNSAIDforophthalmicuse.
Oxyphenbutazone
NepafenacisaNSAID,usuallysoldasaeyedrop(0.1%solution).
Itisusedtotreatpainandinflammationassociatedwithcataractsurgery.
Itisusedinmanagementofcystoidsmacularedemabecauseofitsgoodpenetrationinto
theposteriorsegment.
34/82
1/26/2016
(Q.88) Trueaboutcomplicatedcataractis
(a)
(b)
Hypertensionisalmostalwayscomplicatedbycataract
Occursonlyinfemales
(c)
Morethan50%casesleadfurthertoendophthalmitis
(d)
Occursonposteriorsurfaceoflens
YourResponse:
d
CorrectAnswer:
Exp:
(Ref.Parson,DiseaseofEye,19thed.,297;Baskasophthalmology2nded.181)
Complicatedcataracts
Resultsfromadisturbanceofthelensmetabolismduetoinflammatoryordegenerativeoculardiseases.
Canoccurasacomplicationofanyprotractedintraocularinflammation,especially
Chroniciridocyclitis,
Retinalvasculitis
Retinitispigmentosa.
Thereisapumicelikeposteriorsubcapsularcataractthatprogressesaxiallytowardthenucleus.
Theopacityusuallycommencesinposteriorcortexintheaxialplane(posteriorcorticalcataract).
Thisformofcataractproducesextremelightscatteringandwithslitlampexamination,theopacityshows
acharacteristicrainbowdisplayofcolors,thepolychromaticluster.
Theopacityhasabreadcrumbappearance
Visionismuchimpairedeveninearlystage,duetopositionoftheopacitynearnodalpointofeye.
Operativeandvisualprognosisisusuallypoor.
(Q.89) Intraoculartensionisdecreasedbyallexcept
(a)
(b)
Pilocarpine
(c)
(d)
YourResponse:
CorrectAnswer:
Apraclonidine
Exp:
(Ref.Parson,DiseaseofEye,18thed.,31)
Atropine
Tropicamide
Occularhypotensivedrugs
1.
Carbonicanhydraseinhibitor
Acetazolamide,
Methazolamide,
Ethoxzolamide
Dichlorophenamide,and
Dorzolamide(topical)
2.
Parasympathomimetics
(miotics)
Pilocarpine
Carbachol
Physostigmine
Demecarium
3.
Sympathomimetic
Epineprine
Dipivefrine
Clonidine
Brimonidine
35/82
1/26/2016
Apraclonidine
4.
adrenergics
Timolol
Betaxalol
Levobunolol
Carteolol
5.
Hyperosmoticagents
Metoprolol,
Glycerol
Mannitol
Urea
Isosorbide
6.
Prostaglandinanalogues
Latanoprost(PGF2a)
(Q.90) ThegoldstandardinvestigationforCarotidCavernousFistulas:
(a)
(b)
(c)
Digitalsubtractionangiography
DynamicGadoliniumenhancedMRA
DynamicContrastenhancedmultisliceCT
(d)
ColorDopplerstudywitha7MHZlineartransducer
YourResponse:
a
CorrectAnswer:
Exp:
CarotidCavernousFistulas
Withanteriordrainagethroughtheorbittheseproduceproptosis,diplopia,glaucoma,andcorkscrew,
arterializedconjunctivalvessels.
Directfistulasusuallyresultfromtrauma.Theyareeasilydiagnosedbecauseoftheprominentsigns
producedbyhighflow,highpressureshunting.
Indirectfistulas,orduralarteriovenousmalformations,aremorelikelytooccurspontaneously,especially
inolderwomen.
Thesignsaremoresubtleandthediagnosisisfrequentlymissed.
Thecombinationofslightproptosis,diplopia,enlargedmuscles,andaninjectedeyeisoftenmistakenfor
thyroidophthalmopathy.
Abruithearduponauscultationofthehead,orreportedbythepatient,isavaluablediagnosticclue.
Imagingshowsanenlargedsuperiorophthalmicveinintheorbits.
DSAisbestandgoldstdinvestigationforconfirmingthediagnosisinadditiontothefactthatCarotid
cavernousshuntscanbeeliminatedbyintravascularembolization.
(Q.91) Appreciationofcolorisfunctionof?
(a)
(b)
(c)
(d)
YourResponse:
CorrectAnswer:
Exp:
Rods
Cones
Both,RodsandCones
Choroid
b
(Ref.Parsons,DiseaseofEye,19thed.,131;Khurana,Ophthalmology,3rded.,250)
Sensationofanycolourisdeterminedbytherelativefrequencyofimpulsesforconesystem.
Theappreciationofcolorsisfunctionofconesandoccursinphotopicvision.
Normalcolorvisionistrichromatic,thebasisofYoungHelmoltztrichromatictheoryofcolourvision.
Othertheoriesofcolorvisionare:
36/82
1/26/2016
HeringorHurvichandJamesLaw(trichromaticsignalfromconesfedintosubsequentneuralstageand
exhibitspectralapponentandspectralnonopponentproperty),and
EdwinLandwavelengththeory.
Conesarephotoreceptorstightlypackedinfoveacentraliswheretherearenorodsandotherlayersof
retinaareverythinhere.
(Q.92) Advantagesofbinocularindirectophthalmoscopyareallexcept
(a)
(b)
(c)
Peripheralretinacanbevisualized
Widerretinalfieldvisualized
Opacitiesinthemediavisualized
(d)
Morebrightimagesseen
YourResponse:
c
CorrectAnswer:
Exp:
(Ref.Parsons,Diseasesofeye,19thed.,131;18thed.,89)
Ophthalmoscopy
Features
Directophthalmoscopy
Indirectophthalmoscopy
Vitreousopacity
Seen
Opacitiespenetrated
Condensinglens
Notrequired
Required
Examinationdistance Ascloseaspossibleto
patient
anarmsdistance
Accessiblefundus
view
Slightbeyondequator
Widerperipheryofretina,seenuptoora
serrata
Image
Virtual,erect
Inverted,real
Areaoffieldinfocus 2D
8D
Magnification
15times
45times
InHazymedia
Notuseful
Usefulanddetermining
Illumination
NotsoBright
Bright
Absent
Present
10 Steropsis
(Q.93) Atropineiscontraindicatedin
(a)
(b)
(c)
Narrowangleglaucoma
Openangleglaucoma
Congenitalglaucoma
(d)
Steroidinducedglaucoma
YourResponse:
a
CorrectAnswer:
Exp:
(Parson,DiseasesofEye,18thed.,221)
USESOFATROPINE
Atropineisindicatedinchildrenbelowageof7yearsduringretinoscopy.
Itisusedas1%ointmentfor3consecutivedaysbeforeperformingretinoscopy.
Itseffectlastsfor10to20days.
1%atropineeyeointment/dropisusedindecreasingpainfromciliaryspasmandtopreventformationof
posteriorsynechiaefromsecondaryiridocyclitisinpatientsofcornealulcer.
Inacutephasegofiridocyclitis:
Givescomfortandresttotheeyebyrelievingciliaryspasm.
37/82
1/26/2016
Preventformationofsynechiaeandmaybreakthesame.
Reducesexudationbydecreasinghyperaemiaandvascularpermeability.
Increasesbloodsupplyofanterioruveabydecreasingpressureofciliaryarteries.
Inaccommodativespasm.
Aspenalizationtreatmentinamblyopia.
Inaccommodativeconvergentsquint.
Contraindicationtoatropine
Anglecloserglaucoma.
Veryshallowanteriorchamber.
Openanteriorchamber.
IrisfixationIOL.
(Q.94) Highestrefractoryofindexisat:
(a)
(b)
Antsurfaceofcornea
Postsurfaceofcornea
(c)
Centeroflens
(d)
Posteriorcapsuleoflens
YourResponse:
c
CorrectAnswer:
Exp:
(Ref:Duanesophthalmology2006edition,vol1,chapter33)
Table:TheGullstrandSchematicEye
Element
Surface
Radius(mm)
Thickness(mm) Refractiveindex Position(mm)
Air
Cornea
1.000
Anterior
7.7
Posterior
6.5
Aqueous
Anteriorlens
cortex
Anterior
10.0
Posterior
7.911
Lenscore
Posteriorlens
cortex
Anterior
5.76
Posterior
6.0
Vitreous
Retina
0.50
0.0
0.50
3.10
1.336
0.546
1.386
3.60
2.419
1.406
4.146
0.635
1.386
6.565
7.20
16.80
12.0
1.376
1.336
24.0
(Q.95) Mostcommoncauseofleukocoriainnewbornis
(a)
Congenitalcataract
(b)
Toxocarainfection
(c)
Retinoblastoma
(d)
CMVinfection
YourResponse
:
CorrectAnswer a
:
38/82
1/26/2016
Exp:
(Ref.Khuranaophthalmology4thed.242;ClinicalOphthalmologyby
Kanski,3rded.,225)
AMAUROTICCATSEYE/WHITEPUPILLARYREFLEX(LEUKOCORIA)
a.Congenitalcataractb.Retinoblastoma
c.PHPV(persistenthyperplasticprimaryvitreous)d.ROP
(retinopathyofprematurity)
e.ExtensiveRetinaldetachmentf.MetastaticEndophthalmitis
g.Organizedvitreoushemorrhageh.Toxocaragranuloma
i.Coatsdiseasej.Norriesdisease(pseudotumorof
retina)
k.Massiveretinalgliosisl.Medulloepithelioma
m.PseudogliomaofBlochSclzbergersyndromen.Funduscoloboma
o.Largeatrophicchorioretinalscar
(Q.96) Thefollowingopticalinstrumentisusedfor?
(a)
(b)
(c)
Fielddefect
(d)
YourResponse:
CorrectAnswer:
Nearvision
Exp:
Squint
Colorvision
b
Hessscreentestisusedtomeasurethedegreeofdeviation,andparticularlytomeasureanyprogressive
increaseordecrease,theHessscreentestisuseful.
Itconsistsofatangentscreenmarkedinredlinesonablackclothwithredspotsattheintersectionofthe
15degreeand30degreelineswiththemselvesandwiththehorizontalandverticallines;overitthree
greenthreadsaresuspendedinsuchawaythattheycanbemovedoverthescreeninanydirectionbya
pointer.
Thepatient,wearingredandgreenglasses,isaskedtoplacethejunctionofthethreethreadsoverthered
spotsinturn.
Throughtheredglasshecanonlyseetheredmarkersandthroughthegreen,thegreenthreads,sothat
heindicatedthepointatwhichoneeyeislookingwhentheotherfixesaspot.
Thepositiononwhichtheindicatorappearstocoincidewiththespotgivesapermanentrecordofthe
primaryandsecondarydeviation.
39/82
1/26/2016
(Q.97) Steroidinducedcataractis
(a)
(b)
(c)
(d)
YourResponse:
CorrectAnswer:
Posteriorsubcapsular
Anteriorsubcapsular
Nuclearcataract
Cupuliformcataract
Exp:
a
Steroidinducedcataractsteroidsbothsystemicandtopicalarecataractogenic.Thelensopacitiesare
initiallyposteriorsubcapsular;latertheanteriorsubcapsularregionbecomesaffected
Posteriorsubcapsularopacitiesareassociatedwithuseoftopicalaswellassystemicsteroidschildrenare
moresusceptiblethanadults
DruginducedcataractcausedbySteroids,Chlorpromazine,Busulphan,Amiodarone,Gold,
Allopurinol
(Q.98) Whichofthefollowingtumormostcommonlypresentswithbilateralproptosis?
(a)
Leukemia
(b)
Adenocarcinoma
(c)
Fibroushistiocytoma
(d)
Cavernoushemangioma.
YourResponse
:
Correct
a
Answer:
Exp:
98.Ans.a.Leukemia
Causesofbilateralproptosis:
a.Thyroideyediseaseb.Secondariesfromneuroblastoma
c.Leukemicinfiltration.d.Symmetricallymphoma
orlymphosarcoma,
e.Ewingssarcomaandf.craniofacialdysostosise.g.
oxycephaly(towerskull).
g.Osteitisdeformans,ricketsandacromegaly.h.Mikuliczs
syndrome,
i.andlatestagesofcavernoussinusthrombosis.
(Q.99) Comparedwithspectacles,thecontactlenses:
(a)
(b)
(c)
Increasethefieldofvision
Magnifyimagesinhypermetropia
Minifyimagesinmyopia
(d)
Donotreduceaniseikoniaandopticalaberration
YourResponse:
a
CorrectAnswer:
Exp:
Spectaclemagnifiesandminifiesimagesinhypermetropiaandmyopiarespectively.
Ascontactlensestendtoreturntheimagestonearnormalsize,theimagesareminifidinhypermetropia
andmagnifiedinmyopia.
Aniseikoniaie.differencesinimagesizeisreducedwithcontactlenses.
40/82
1/26/2016
Contactlensallowthepatienttolookthroughtheopticalcentreinalldirectionofgaze,opticalaberration
isreducedcomparedwithspectacles.
(Q.100) NotafeatureofVenalkeratoconjunctivitisis
(a)
(b)
(c)
Morecommoninsummers
Cobblestoneappearance
Fascicularcornealulcer
(d)
Keratoconus
YourResponse:
c
CorrectAnswer:
Exp:
FascicularulcerisseeninPhlyctenularkeratoconjunctivitis..VKCisIgEmediatedallergytopollens.
Alsoknownasspringcatarrh&ismoreinsummers,Severeitchingandrednessleadstochronicrubbing
whichcanleadtosecondarykeratoconus.
UpperpalpebralpapillaearefoundwhichmaybegiantleadingtoCobblestoneappearance.Leadsto
shieldulcer.
Treatedwithantihistaminics,masrcellstabilizersandtopicallowstrengthsteroids.
(Q.101) Whichofthefollowingistreatmentforchronicdacryocystitis?
(a)
(b)
Dacryocystorhinostomy
Dacryocystectomy
(c)
Massaging
(d)
Syringing
YourResponse
:
CorrectAnswer a
:
Exp:
(Ref.andParsons,DiseaseofEye,19thed.,501,Basak,Ophthalmology,
2nded.,282,336)
Dacryocystorhinostomy(DCR)isthetreatmentofchoiceforchronic
dacryocystitis.
(Q.102) Refractionatanteriorsurfacecorneaismaximumbecause
(a)
(b)
Anteriorsurfaceofcorneahassmallercurvature
Thereisgreaterdifferencebetweenrefractiveindicesofair&cornea.
(c) Itisavasculartransparenttissue.
(d) Alloftheabove.
YourResponse:
b
CorrectAnswer:
Exp:
(Ref.Basak,Ophthalmology,2nded.,4)
Refractivemedia
Refractivemedium
RefractiveIndex
Cornea
1.38
Aqueoushumor
1.33
Lens
1.4
Vitreoushumor
1.34
41/82
1/26/2016
Air
Maximumrefractionoccursatanteriorsurfaceofcorneabecause:
1.Anteriorsurfaceofcorneahasgreatercurvature,&
2.Thereisgreaterdifferencebetweenrefractiveindicesofair&cornea.
Refractivesurface
Refractivepower
Anteriorsurfaceofcornea
+48D
Posteriorsurfaceofcornea
4D
Lensofeye(Vivo)
+15D
Lensofeye(takenout)
+150D
(Q.103) "Jackinthebox"phenomenonisbecauseof:
(a)
Lossofaccommodation
(b)
Reducedvisualacuity
(c)
Prismaticeffect
(d)
Sphericalaberration
Your
Response:
Correct
c
Answer:
Exp:
Difficultiesofaphakiaanditscorrectionbyspectaclesareas
under:
Imagemagnificationof30%
Lackofphysicalcoordination
Sphericalaberrationproducinga"pincushioneffect"Q
"Jackinthebox"Qringscotomaduetoprismaticeffectsat
theedgeoflens
PrismaticerrorsQduetodisplacedopticalcentersofthe
lenses
Reducedvisualfieldsandpooreccentricacuity,
Inaccuratecorrectionduetoerroneousvertexdistances
PhysicalinconvenienceandcosmeticblemishduetoYheavy
spectaclelenses
(Q.104) Aftercataractisbesttreatedwith:
(a)
(b)
ARGONLASER
NdYAGLASER
EXIMERLASER
(c)
HolmiumLASER
(d)
YourResponse:
CorrectAnswer: b
Exp:
Aftercataract
Posteriorcapsularopacification(PCO)followingECCE&discissionof
congenital/traumaticcataract.
Morecommoninchildren
42/82
1/26/2016
Elschnigspearl(Balloonlenscell)Q
Soemmeringsring(Ringbehindirisformedbylensfibers)Q
Rx:
Discissionorneedling
Capsulotomy/membranectomyNdYAGLASERcapsulotomy(safe,noninvasive&quick
OPDprocedure).Q
(Q.105) Pseudohypopyonisseenin
(a)
Cornealulcer
Uveitis
(b)
Glaucoma
(c)
Retinoblastoma
(d)
YourResponse:
d
CorrectAnswer:
Exp:
(Ref.Nelson,Pediatrics,7thed.,2115)
Signs(presenting)ofretinoblastomaare:
Initialsigniswhitepupillaryreflex(Leukocoria)
Strabismusissecondmostfrequentinitialsignofretinoblastoma.
Pseudohypopyon(tumorcellslayeredinferiorlyinfrontofiris),causedbytumorseedingin
anteriorchamberoftheeye,
Hyphema,
Vitreoushaemorrage
Signsoforbitalcellulitis.
(Q.106) Tubularvisioniscausedby:
(a)
(b)
(c)
Retinitispigmentosa
Narrowangleglaucoma
Nuclearcataract
(d)
Papilledema
YourResponse:
a
CorrectAnswer:
Exp:
(Retinitispigmentosa)(Ref.Basak,Ophthalmology,2nded.,203)
Astheprimaryopenangleglaucomaadvancestheglaucomatousfielddefectinduetogeneralized
constrictionofperipheralfieldalongwithdoublearcuatescotomaleadstotubularfieldofvision(tubular
vision),inwhichonlythecentralvisionremains.
Causesoftubularvisioninclude:
a.CRAOwithsparingofcillioretinalartery.b.Highmyopia
c.POAGd.Retinitispigmentosa
(Q.107) Ophthalmianeonatorumismostcommonlycausedby
(a)
(b)
Chemicals
Gonococcalinfection
(c)
(d)
Chlamydiaoculogenitalis
Purulentconjunctivitisbybacteria
43/82
1/26/2016
YourResponse:
CorrectAnswer:
Exp:
Ophthalmianeonatorumisconjunctivitisoccurringduringfirstmonthoflife,asaresultof
carelessnessatthetimeofbirth.
Anydischargefromeye(evenwatery)during1stweekoflifeshouldbesuspectedbecausetearsare
notsecretedearlyinlife.
MostcommoncauseofneonatalblindnesstreatmentSulphacetamide10%dropsQIDorTetracycline.
Prophylaxis:Credesmethodbyusing1%silvernitratejustafterbirth(obsoleteasitcauseschemical
conjunctivitis)
Etiology
Timeofmanifestation
Comment
Chemicals
Hours
10%sulfacetamide
Gonococcal
13days
Mostseriousnow,rare
Otherbacterial
45days
Chlamydial
510days
Mostcommoncause
(Q.108) Styeoccursduetoinflammationof:
Muller'sgland
(c)
(d)
YourResponse:
CorrectAnswer:
Meibomiangland
Exp:
STYEorHORDEOLUMINTERNUMisasuppurativeinflammationofoneoftheZeis'gland.
(a)
(b)
Lacrimalgland
Zeis'gland
d
Intheearlystagesofdiseasetheglandbecomeswollen,hardandpainful.
Usuallythewholeedgeofthelidisedematous.
Subsequentlyabscessisformedwhichpointsnearthebaseofoneofthecilia.Painisconsiderable
untilpusisevacuated.
(Q.109) Ringscotomaisseenin?
(a)
(b)
(c)
Chronicsimpleglaucoma
Papillitis
Opticatrophy
(d)
Choroidaldegeneration
YourResponse:
a
CorrectAnswer:
Exp:
(Ref.Basaks,Ophthalmology,2nded.,p203)
Chronicsimpleglaucoma
Inchronicopenangleglaucoma,arelativelylargerarea,ofdefectintheformofarchingscotoma,which
eventuallyfillstheentirearcuatearea,fromblindspottothemedianraphe,isBjerrumsorarcuate
scotoma.
Withfurtherprogression,adoublearcuate(ringorannular)scotomatawilldevelop.
Othercausesofringscotoma:
i.Highmyopiaii.Aphakicspectaclecorrection
iii.Retinitispigmentosaiv.Panretinalphotocoagulation
44/82
1/26/2016
(Q.110) Whichofthefollowingisnotcorrectregardingmaculalutea?
(a)
Containsyellowpigment
(b)
Containslargenumberofcones
(c)
Containsrods
(d)
Liesatposteriorpole
YourResponse:
c
CorrectAnswer:
Exp:
(Ref.Graysanatomy,11thed.,SectionX,1c)
Inthemaculaluteathenervefibersarewantingasacontinuouslayer,theganglioniclayerconsistsof
severalstrataofcells,therearenorods,butonlycones,whicharelongerandnarrowerthaninother
parts,andintheouternuclearlayerthereareonlyconegranules,theprocessesofwhichareverylong
andarrangedincurvedlines.
Inthefoveacentralistheonlypartspresentare(1)thecones;(2)theouternuclearlayer,theconefibers
ofwhicharealmosthorizontalindirection;(3)anexceedinglythininnerplexiformlayer.Thepigmented
layeristhickeranditspigmentmorepronouncedthanelsewhere.
Attheoraserrata,thenervouslayersoftheretinaendabruptly,andtheretinaiscontinuedonwardasa
singlelayerofcolumnarcellscoveredbythepigmentedlayer.
(a)
Hordeoluminternum
(b)
Hordeolumexternum
(c)
Chalazion
(d)
Blepharospasm
YourResponse:
b
CorrectAnswer:
Exp:
ThisisasuppurativeinflammationofaZeisgland.Intheearlystagestheglandbecomesswollen,hard
andpainful,andusuallythewholeedgeofthelidisoedematous.
Anabscessformswhichgenerallypointsnearthebaseofoneofthecilia.
Thepainisconsiderableuntilthepusisremoved.Styesoftenoccursincrops,ormayalternatewithboils
ontheneck,carbuncles,oracne,usuallyindicatingadeficientresistancetostaphylococci.
Itiscommonestinyoungadults,butmayoccuratanyage,especiallyindebilitatedpersons.
(Q.112) Inlateralrectusmuscleparalysis,thediplopiaproducedis:
(a)
Uncrossed
45/82
1/26/2016
(b)
Crossed
(c)
Both
(d)
YourResponse:
CorrectAnswer:
None
a
Exp:
Paralysisoflateralrectusmuscle:Thereislimitationofoutwardmovementofeyeballandfaceisturned
towardstheparalyzedside.Homonymous(uncrossed)diplopiaoccursonlookingtotheparalyzedside.
Diplopia(doublevision)isthechiefcomplaintofthepatientsofparalysisofextrinsicmusclesofeyeball.
Iftheobjectasseenbytherighteyeistotherighttotheobjectseenbythelefteye,thentheconditionis
knownashomonymous(uncrossed)diplopia.
Onthecontraryiftheobjectasseenbythelefteyeliesapparentlytotherightoftheobjectasseenby
therighteye,theconditionisknownasheteronymous(crossed)diplopia.
(Q.113) Shaffersignisseenin:
(a)
Acuteglaucoma
(b)
(c)
Retinaldetachment
Uveitis
(d)
YourResponse:
CorrectAnswer:
Retinoblastoma
Exp:
(Ref:Parson,29thEdition,Page312)
Pigmentintheanteriorvitreous(tobaccodustingorShaffersign)isusuallypresent.
Afterafewweeks,aretinaldetachmentmaypresentwithmorefixedfolds,retinalthinning,intraretinal
cysts,subretinalfibrosis,anddemarcationlines.
Theselinesarepresentusuallyatthejunctionoftheattachedanddetachedretina.
(Q.114) Completeocclusionofthecentralretinalarteryischaracterizedby?
(a)
Rothsspots
(b)
(c)
Cherryredfovea
(d)
YourResponse:
CorrectAnswer:
Exp:
Hollenhorstplaques
Cottonwoollesions
b
Completeocclusionofthecentralretinalarteryproducesarrestofbloodflowandamilkyretinawitha
cherryredfovea.
Emboliarecomposedofeithercholesterol(Hollenhorstplaque),calcium,orplateletfibrindebris.
Whitecenteredretinalhemorrhages(Rothsspots)areconsideredpathognomonicforsubacutebacterial
endocarditis,buttheyalsoappearinleukemia,diabetes,andmanyotherconditions.
(Q.115) Thepowerofacontactlensisdeterminedbywhichofthefollowingallexcept?
(a)
(b)
Thickness
(c)
Oxygenpermeability
Posteriorcurvature
46/82
1/26/2016
(d)
Refractiveindex
YourResponse
:
CorrectAnswer c
:
Exp:
Thepowerofacontactlensisdeterminedbyits:
a.Anteriorcurvatureb.Posteriorcurvaturec.Thicknessd.
Refractiveindex.
(Q.116) NotseeninLaurenceMoonBiedlsyndrome:
(a)
(b)
Obesity
Retinitispigmentosa
(c)
Sexualunderdevelopment
(d)
Retinaldetachment
YourResponse:
d
CorrectAnswer:
Exp:
LAURENCEMOONBIEDLSYNDROMEisacombinationofobesity,sexualunderdevelopment,mental
retardation,retinaldegeneration,polydactyly,anddeformityoftheskull.
Itisinheritedasanautosomalrecessivetrait.LaurenceMoonBiedlsyndromeisthemostcommon
syndromeassociatedwithretinitispigmentosa.
(Q.117) WhichofthefollowingeyediseasemostcommonlyhasAutosomaldominantinheritancepattern?
(a)
Gyrateatrophy
(b)
(c)
BestDisease
(d)
YourResponse:
CorrectAnswer:
Exp:
Retinoschisis
StargardtDisease
b
BestDisease(VitelliformDystrophy)ischaracterizedbyalesioninthemacula,whichleadstoimpaired
centralvisioninoneorbotheyes.Itisanautosomaldominantdisease.
StargardtDisease/FundusFlavimaculatus
Thisformofmaculardegenerationusuallyappearsbeforetheageof20.Itischaracterizedbyareduction
ofcentralvisionwithapreservationofperipheralvision.Inmostaffectedfamilies,Stargardtandfundus
flavimaculatusareautosomalrecessivediseases,althoughautosomaldominantfamilieshavebeen
identified.
(Q.118) Ridersareseenin?
(a)
Bluedot
(b)
(c)
Zonularcataract
(d)
YourResponse:
CorrectAnswer:
Exp:
Coralliformcataract
Traumaticcataract
b
InZONULARCATARACTtheopacityisusuallysharplydemarcatedandtheareaofthelenswithinand
aroundtheopaquezoneisclear,althoughlinearopacitieslikespokesofawheel,calledriders,mayrun
47/82
1/26/2016
outwardstowardstheequator.
Occasionallytwosuchringsofopacityareseen.
(Q.119) Causesofcherryredspotonfundusincludefollowingexcept:
(a)
TaySachsdisease,
(b)
(c)
NiemannPickdisease,
Sandhoffsdisease
(d)
Fabrysdisease
Your
Response:
Correct
d
Answer:
Exp:
D/Dofcherryredspotonfundus
a.CRAO,b.Bluntinjury(Berlinsedemaofmacula),
c.TaySachsdisease,d.NiemannPickdisease,
e.Sandhoffsdisease
(Q.120) Whenusingtheplanemirrortechniqueduringretinoscopy,whichoneofthefollowingstatementsstandswrong?
(a)
A'with'movementisneutralizedwithapluslens
(b)
An'against'movementisneutralizedwithaminuslens
(c)
A'with'movementalwaysindicateshypermetropia
(d)
An'against'movementalwaysindicatesmyopia
YourResponse:
a
CorrectAnswer:
Exp:
Withtheplanemirrortechnique,pluslensisusedtoneutralizewithmovementandminuslensfor
againstmovement.
Whileanagainstmovementalwaysindicatesmyopia,awithmovementmaybeseeninmyopicpatientif
themyopiaislessthanthedioptricvalueoftheobserver'sworkingdistance(forexampleatadistanceof
2/3m,awithmovementisseenifthemyopiaislessthan1.50D.
Theneutralpointoccurswhenthepatient'sfarpointcoincideswiththeobserver'snodalpoint..
(Q.121) Painlesslossofvisionisseenin:
(a)
Vitreoushemorrhage
(b)
(c)
Opticatrophy
Developmentalcataract
(d)
AcuteAngleclosureglaucoma.
YourResponse:
a
CorrectAnswer:
Exp:
Vitreoushemorrhageisassociatedwithsuddenpainlesslossofvision&onattemptedophthalmoscopy
thefundusglowischaracteristicallyabsentasthefundusishiddenbyadarkredhazeofblood.
Itcanoccurduetoretinal&vitreousdetachment,indiabetes,sicklecelldisease,hypertension&otheris
chemicoccurdisease.
(Q.122) Inelectroretinogram(ERG),awave,largenegativewaveisgeneratedby:
48/82
1/26/2016
(a)
Retinalpigmentepithelium
(b)
(c)
Rods&conesreceptoractivity.
Responseofamacrinecells
(d)
All
YourResponse:
CorrectAnswer:
Exp:
ERG
Electroretinographymeansgrossrecordofelectricalpointial,changesintheretinaoften
stimulationwithlength.
Largenegativeawavewhichreflectsphotoreceptor(rods&cones)activity.
Thenalargepositivebwavefollowsduetoresponseofbipolarcells.
Lastly,asmallpositivecwaveisgeneratedbyretinalpigmentepitheliallayer.
Durationofentireresponse<250ms.
USES:
Usefulindistinguishingretinalandopticnervedysfunctionfrommaculardiseases.
Assessesretinalfunctioninpresenceofopacityinmediainsiderosisbulbi.
Usefulin
Corticalandhystericalblindness,
Retinitispigmentosa,
Chorioretinitis,
Rodandconedysfunction,and
Toxicretinopathy.
(Q.123) Retinoscopyisusedto?
(a)
Todeterminedegreeofametropia.
(b)
(c)
ToknowconditionofRefraction
Testingvisualacuity
(d) Tomeasureastigmatismofanteriorcornealsurface.
YourResponse:
CorrectAnswer: a
Exp:
Retinoscopy
Mostpracticalmethodofestimatingconditionofrefractionobjectively,with
accommodationatrest.
Principleistomakeeveryobservingeyeemmetropic,sothatemergingraysshould
formparallelbeam.
StreakretA)Todeterminedegreeofametropia.
inoscopyeasilydeterminesaxisofastigmatism,canbedoneinanyposition,children
andpreoperatively.
Cycloplegiamayberequiredchildren,howevernotadvisableundercycloplegia.
Itshouldpreferablybeconductedinadarkroom.
Sourceoflightshouldbebehindthepatient.
Inhypermetropia,emmetropia&myopia<1Dreflexmoves,reflexsamedirection.
Inmyopiaof1Dnomovement.
Inmyopia>1Dshadowmovesoppositedirection.
49/82
1/26/2016
(Q.124) Indacryocystorhinostomy(DCR)lacrimalsacisdirectlyopenedinto:
(a)
Superiornasalmeatus
(b)
Middlenasalmeatus
(c)
(d)
YourResponse:
CorrectAnswer:
Inferiornasalmeatus
Nasolacrimalduct
b
Exp:
(Ref.Basaks,Opthalmology,2nded.,pg,282,336)
DACROCYSTORHINOSTOMY(DCR)issurgicalprocedureofchoiceinchronicdacryocystitis,inwhicha
communicationismadebetweenlacrimalsacandmiddlemeatusofnose.
Contraindications:a.DNSb.Atrophicrhinitisc.Carcinomaoflacrimalsac
(Q.125) Amongtheretinalganglioncells,thefastestsignaltransmissiontothebrainandpromptresponsivenessforrapidchangesin
visualimageisthefunctionof:
(a)
Wcells
(b)
(c)
Ycells
(d)
YourResponse:
CorrectAnswer:
Horizontalcells
Exp:
Xcells
b
(Ref.Aldersphysiologyofeye10thed.718)
Theconesrespondtobrightlightandmediatehighresolutionvisionandcolorvision.
Therodsrespondtodimlightandmediatelowerresolution,blackandwhite,nightvision.
Humanshavethreedifferenttypesofcones(trichromaticvision).
Whenlightfallsonareceptoritsendsaproportionalresponsesynapticallytobipolarcells,whichinturn
signaltheretinalganglioncells.Thereceptorsarealsocrosslinkedbyhorizontalcellsandamacrine
cells,whichmodifythesynapticsignalbeforetheganglioncells.
Intheretinalganglioncellstherearetwotypesofresponse,dependingonthereceptivefieldofthecell.
InONcells,anincrementinlightintensityinthecenterofthereceptivefieldcausesthefiringrateto
increase.InOFFcells,itmakesitdecrease.Beyondthissimpledifference,chromaticsensitivityandthe
typeofspatialsummationalsodifferentiateganglioncells.
CellsshowinglinearspatialsummationaretermedXcells(alsocalledparvocellular,P,ormidget
ganglioncells),andthoseshowingnonlinearsummationareYcells(alsocalledmagnocellular,M,or
parasolretinalganglioncells).
AccordingtoLoewenfelditappearsthat3maintypesofganglioncellsmakeuptheprimateretina
dependingonthepropertiesofthemajorclassesofganglioncellsandtheirprojections:thealpha,beta
andgammacells.IncatsthesecorrespondtotheY,XandWcells,respectively.
(Q.126) A19yrboywitha2yrH/Oreduced&fluctuatingvisionalongwithchangeinpupillaryshapeandiriscolourinhislefteye
presentedtotheglaucomaclinic.O/Erevealeddistinctunilateralstretchholes,irisarchitecturechangesandlocalizedirisatrophy.
IOPwas16inRt&36mmHginLteye.Gonioscopyoftheleftanglerevealedbroadbasedperipheralanteriorsynechiaeat
approximately2O'clockto10O'clockposition.Theopticdiscofthelefteyehadaverticalcupof0.9whichmanifestassuperior
andinferiorarcuatescotoma.Specularmicroscopyshowedunilateralabnormalendotheliumwithirregularcellsofvariableshape
andsize.
Whatcanbeprobablediagnosis?
(a)
Glaucoma
50/82
1/26/2016
(b)
Iridocornealendothelialsyndrome
(c)
Uveitis
(d)
None
YourResponse:
CorrectAnswer:
Exp:
b
http://www.aao.org/publications/eyenet/201110/pearls.cfm
Unknownetiology.
Characterizedby
i.Glaucoma,ii.Irisatrophy,
iii.Decreasedendothelium,andiv.Irisnodules.
Aftermetaplasia,thecornealendotheliumproliferates,andDescemetsmembranelikematerialcovers
theanteriorsurfaceandangleoftheanteriorchamber,causingirisanomaliesandsecondaryglaucoma.
Thespectrumincludes3conditions:
i.Progressiveessentialirisatrophyii.Chandlerssyndrome
iii.Irisnaevussybdrome
Iridocornealendothelial(ICE)syndromecomprisesaspectrumofthreeclinicalvariations:Chandler
syndrome,progressiveirisatrophyandCoganReesesyndrome.Althoughinitiallydescribedseparately
andwithdistinctclinicalmanifestations,thesevariantsarelinkedbyafundamentaldefectofthecorneal
endotheliumasshownbyhistopathologicandultrastructuralstudies
ClinicalFeatures
DistinguishingclinicalfeaturesofICEsyndromeareasfollows.
Symptoms.
Acommonpresentingcomplaintisanacquiredabnormalityoftheshapeorpositionofonepupil.
SomepatientswithICEsyndromereportreducedvision,whichistypicallyworseinthemorningbecause
ofcornealedemathatdevelopswhentheeyelidsareclosedduringsleepandimprovesduringthedayas
thecorneadehydrateswithexposuretoair.
Signs.
ClinicalexaminationofapatientwithICEsyndromeusuallyrevealsabnormalitiesofthecornea,anterior
chamberangleandiris.
ThetypicalcornealabnormalityinICEsyndromeisseenbyslitlampexaminationasafine,hammered
silverappearanceoftheposteriorcornea,similartothatofFuchsdystrophybutlesscoarse.
Onspecularmicroscopy,cornealendothelialcellsarereducedinnumberandrevealvariabledegreesof
pleomorphisminsizeandshape,withlossofhexagonalmargins.
Theseabnormalcellsalsoshowdarklightreversal,withcellboundariesappearingbrightandcellsurfaces
dark.
ThesecellsaresometimescalledICEcells,andthetissuetheyform,ICEtissue.
Thetypicalanteriorchamberangleabnormality,whichisalsocommontoallvariationsofICEsyndrome,
isseenbygonioscopyasperipheralanteriorsynechiaethatmayextendanteriortoSchwalbesline.These
iridotrabecularadhesionsarebroadbasedandtypicallyprogressgraduallyaroundthecircumferenceof
theangle,eventuallyleadingtoangleclosureandIOPelevation.
(Q.127) ERGdepicts:
(a) Changesinrestingpotentialofeyeinducedbyaflashoflight
(b) Informationaboutanteriorchamber
(c) Functionalabnormalitiesofpigmentlayerofretina
(d) Conditionsinvolvingganglioncellsandhigherpathway
YourResponse
:
CorrectAnswer
51/82
1/26/2016
Exp:
(Ref.OphthalmologybyA.K.Khurana2nded.40;Ganongphysiology21st
ed.162)
Electroretinography
Itistherecordofchangesinrestingpotentialofeyeinducedbyaflashof
light.
NormalERGhas:
Awave:Negativewavearisingfromrodsandcones
Bwave:LargepositivewavegeneratedbyMullercells,butrepresents
activityofbipolarcells.
Cwave:Positivewaverepresentingmetabolicactivityofretinalpigment
epithelium.
FovealERGcanprovideinformationaboutmacula.
ERGisusefulindetectingfunctionalabnormalitiesofouterretina.
ERGisnormalindiseasesinvolvingganglioncellsandhigherpathway,suchas
opticatrophy.
(Q.128) InwhichofthefollowingconditionFrillexcisionisdone:
(a)
Foreignbodyineye
(b)
(c)
Panophthalmitis
Endophthalmitis
(d)
Intraoculartumor
YourResponse:
b
CorrectAnswer:
Exp:
OnlyindicationofeviscerationofeyeballaresomecasesofpanophthalmitisQtopreventtheextension
ofinfectionuptheopticnervesheath.
OneofthemethodsofeviscerationisFrillexcisioninwhichtheinsertionsofextraocularmusclesarecut
andgreaterpartofscleraisexcisedleavingonlyacollarofscleraaroundtheopticnerve.
(Q.129) Trueaboutmacularhole?
(a)
ItismorecommoninMalesthaninfemales
(b)
Usuallybilateral
(c)
Watzke'ssignpositive
(d)
Majorityofmacularholesresolvespontaneously.
YourResponse:
c
CorrectAnswer:
Exp:
Amacularholeisalesioninthefovea.Amacularholelookslikeaholeordepressedcircularorovalarea
thattypicallyisreddishinappearance.
Tothepatientamacularholelookslikeadarkareaorscotomainwhichthepatientcan'tseethrough.
Priortoafullblownmacularhole,a"premacularholelesion"maybepresentandthesehavebeen
referredtobyvariousnamesincludingmacularcyst,involutionalmacularthinningorimpendingmacular
hole.
Dependingontheseverity,sizeandlocationofthemacularhole,thepatientmayhavefromabout20/50
to20/400visualacuityintheaffectedeye.
TheslitlampcanbeusedtodetectthepresenceofmacularholeusingtheWatzke'ssign.Somemacular
holes,about10%,partiallyresolveorimprove,butthemajorityarepermanentasisthelossofvision.
52/82
1/26/2016
Usuallyonlyoneeyeisaffectedandwomenareaffectedmuchmorethanmen.Traumatotheeye
accountsforabout15%ofmacularholes,whiletherestaretypicallyassociatedwithaging(50and
older).
(Q.130) Trueaboutthekeratometerisfollowingexcept?
(a) Usesthecorneaasaconvexmirrorinthemeasurementofcornealcurvature
(b) Measuresonlythecentral3mmofthecornea
(c) Canbemisleadinginpatientswhohavehadcornealtransplantation
(d) Ismoreimportantinfittingsoftcontactlensthanrigidgaspermeablecontactlens
YourResponse:
d
CorrectAnswer:
Exp:
ThekeratometerusesthefirstPurkinjeSamson'simage.
Itmeasuresonlythecentral3mmandcanbemisleadinginpatientswhohavehadradialkeratectomy
orcornealtransplant.
Tonegatetheocularmovement,thecentralimageisdoubledduringkeratometry.
Keratometryisimportantforcontactlensfittingbutmoresoforrigidgaspermeable(RGP)contact
lensthansoftcontactlens.
(Q.131) Ectopialentisisafeatureof:
(a)
Marfanssyndrome
(b)
Homocystinuria
(c) WeilMarchesanisyndrome
(d) Alloftheabove
Your
Response
:
Correct d
Answer:
Exp: Causesoflensdislocation
53/82
1/26/2016
(Q.132) Tigroidfundusisseenin?
(a)
Severemyopia
(b)
(c)
Choroidalsclerosis
Retinitispigmentosa
(d)
YourResponse:
CorrectAnswer:
Retinoblastoma
Exp:
b
Inpeoplehavingalightpigmentation,thechoroidandsometimesitslargervesselsmaybevisible.
Sometimesthepigmentbetweenthechoroidalvesselsisparticularlydense,orthepigmentisdeficientin
theretinalpigmentaryepithelium,whilethechoroidisdeeplypigmented;thechoroidalvesselsarethen
seentobeseparatedbydeeplypigmentedpolygonalareas(tigroidortesselatedfundus).
Thisappearanceisoftenduetoaconditioncalledchoroidalsclerosisandmaybeaccompaniedbyadry
agerelatedmaculardegeneration.
(Q.133) Cobblestoneappearanceofconjunctivaisseenin:
(a)
(b)
Springcatarrh
Angularconjunctivitis
(c)
Eczematousconjunctivitis
(d)
Trachoma
YourResponse
:
CorrectAnswer a
:
Exp:
(Ref:OphthalmologybyAKKhurana2nded.100)
Springcatarrh(vernalkeratoconjunctivitis)
Recurrent,bilateral,interstitial,selflimitingallergic
Signs:
Palpebralform:
Presenceofhard,flattoppedpapillaearrangedincobblestoneor
pavementstonefashion.
Papillaemayhypertrophytoproducecauliflowerlikeexcrescences(Giant
papillae).
Bulbarform:
Duskyredtriangularcongestionofbulbarconjunctivainpalpebralarea.
Gelatinousthickenedaccumulationoftissuearoundlimbus
Discretewhitishraiseddotsalongthelimbus(HornerTrantasspots)
Mixedform:Featuresofpalpebralandbulbarform.
Vernalkeratopathy:
Punctuateepithelialkeratitis
Ulcerativevernalkeratitis(Shieldcornealulcer)
Vernalcornealplaques
Subepithelialscarring
Pseudogerontoxon(classicalCupidsbowoutline)
Rx:
Topicalvasoconstrictors
54/82
1/26/2016
Sodiumcromoglycate(2%)
Weakaceticaciddrops(0.20.5%)
Topicalantihistaminics
Topicalsteroids(Medrysone,betamethasone,dexamethasone)
topicalCyclosporine.
(Q.134) Bullseyemaculopathycanbecausedbywhichofthefollowing?
(a)
(b)
Quinine
Chloroquine
Amiodarone
(c)
Digoxin
(d)
YourResponse:
b
CorrectAnswer:
Exp:
(Ref.KDTripathiPharmacology5thed.239)
Chloroquine
Chloroquine,basicallyaantimalarialdrugs,isalsofoundtoinduceremissioninupto50%patients
ofRheumatoidarthritis.
Chloroquine/hydroxychloroquineareemployedinmildernonerosivedisease
Whengivenforrheumatoidarthritis,ithastobegivenforlongperiods.
Thisislesscommonandreversibleincaseofhydroxychloroquine,whichispreferredover
chloroquine.
Otheradverseeffectsare:
i.Rashes,ii.Grayingofhair,iii.Irritablebowelsyndrome,
iv.Myopathyandv.Neuropathy.
(Q.135) Commonestcauseofposteriorstaphylomais:
(a)
(b)
Glaucoma
Retinaldetachment
(c)
Iridocyclitis
(d)
Highmyopia
Your
Response:
Correct
d
Answer:
Exp:
(Ref:OphthalmologybyAKKhurana2nded.151)
POSTERIORSTAPHYLOMA
Itreferstobulgingofweaksclerabehindtheequatorlined
bythechoroid.
Commoncausesare:
Pathologicalmyopia,
Posteriorscleritisand
Perforatinginjuries.
DiagnosedbestonindirectophthalmoscopyandUSG(Bscan)
Itisseenasanexcavatedareawithretinalvesselsdippingin
it.
55/82
1/26/2016
(Q.136) Tyndalleffectisusedin?
(a)
Biomicroscopy
(b)
(c)
Fluorescenceangiography
Treatmentofretinoblastoma
(d)
Checkingofintraocularpressure
YourResponse:
a
CorrectAnswer:
Exp:
Thebasisofbiomicroscopyofthevitreousbody,aqueousflareistheTyndalleffect.
Thisismaximalwithahighintensityofprojectedlight,agoodcontrastbetweentheobservedstructure
andbackground,alargeangleofseparationbetweenobserverandilluminationaxesandwhenviewedby
adarkadaptedeye.
(Q.137) Squintcausedbyexcessiveeffortofconvergencewithsustainedaccommodationisdueto:
(a)
Myopia
(b)
Hypermetropia
Astigmatism
(c)
(d)
YourResponse:
CorrectAnswer:
Exp:
(Ref.ParsonsDiseaseofEye18thed.341,Basakophthalmology2nded.298)
Anisometropia
Hypermetropia
Thesecondprincipalfocusofhypermetropialiesbehindtheretina.
Accommodationisusedtocorrecttheemmetropiatocertainextent.
Theyrequirereadingglassesearlierthanthenormalpopulation.
Aphakiaisaformofhighhypermetropia.
Followingcataractsurgery,theaccommodativeabilityoftheeyeislost.
Therefore,ifthepatientishypermetropic,thevisionwillbeblurredfordistantandnear.Thisisthe
reasonwhymostpatientsaremadeslightlymyopicsothattheycanachieveareasonablevisionwithout
glassesfordistance.
(Q.138) Rossetesarecharacteristicallyseenin:
(a)
Retinoblastoma
(b)
(c)
Pulmonaryblastoma
(d)
YourResponse:
CorrectAnswer:
Exp:
Hepatoblastoma
Pancreatoblastoma
a
(Ref.Robbinspathology7thed.500,1442;Table.1010;Basaksophthalmology3rd.ed.227)
Nephroblastoma(Wilmstumor),hepatoblastoma,andneuroblastoma,Ewingstumor,.Owingtotheir
primitivehistologicappearance,havebeencollectivelyreferredtoassmallroundbluecelltumors.
Therosettesseenare:
FlexnerWintersteinerrosettes(specific)
56/82
1/26/2016
HomerWrightrosettes
(Q.139) ThebestaccountedfunctiontoMIP26inlens?
(a)
Glucosetransport
(b)
Regulationofwatercontent
(c)
Ionicbalance
(d)
Anerobicglycolysis
YourResponse:
b
CorrectAnswer:
Exp:
MIP26
FUNCTION:
Waterchannel.
Mayberesponsibleforregulatingtheosmolarityofthelens.
SUBCELLULARLOCATION:
Membrane;
Multipassmembraneprotein.
TISSUESPECIFICITY:
Majorcomponentoflensfibergapjunctions.
DOMAIN:
Aquaporinscontaintwotandemrepeatseachcontainingthreemembranespanningdomainsandapore
formingloopwiththesignaturemotifAsnProAla(NPA).
DISEASE:
DefectsinMIPareacauseofautosomalrecessivecongenitalcataract.
(Q.140) Riddochphenomenonisseeninlesionof?
(a)
(b)
Retina
EdingerWestphalnucleus
(c)
Occipitallobe
(d)
Optictract
YourResponse:
c
CorrectAnswer:
Exp:
Occipitallobehemianopiasareextremelycongauous,havingahomogeneousdensitywithsparingofthe
macula.
Riddochphenomenon,inwhichappreciationofadimkinetictargetisretainedwithinthedefectivevisual
fieldwithlossofappreciationofastaticbrighttarget,istypicalofanoccipitallesion.
(Q.141) TrueaboutARP?
(a)
(b)
Lightreflexispresent
Accommodationreflexispresent
(c)
SynonymouswithAdiespupil
(d)
Associatedwithdorsalmidbrainlesions
YourResponse:
b
CorrectAnswer:
57/82
1/26/2016
Exp:
ThesyphiliticlesionofthetectumaffectingthepupillarypathwayoftenresultsinArgyllRobertson
pupilwhereinthepupilsaresmallandthelightreactionisimpaired,butthereactiontoconvergenceand
accommodationareretained.
(Q.142) Phlyctenisdueto
(a)
(b)
Endogenousallergen
Exogenousallergen
(c)
Persistentirritation
(d)
Infection
YourResponse:
a
CorrectAnswer:
Exp:
(Ref:AKKhurana2nded:102)
PHLYCTENULARKERATOCONJUCTIVITISisacharacteristicnodularinflammationoccurringasanallergic
responsebyconjunctival&cornealepitheliumtosomeendogenousallergenstowhichtheyhavebecome
sensitized.ItistypeIVcellmediatedreactiontostaphylococcusproteins(mostcommon
cause),tuberculosisproteins,orMoraxellaAsxenfieldbacillusandcertainparasites(worminfestation).
(Q.143) Heteronymoushemianopiaisduetolesionat
(a)
Opticnerve
(b)
(c)
Opticchiasma
Lateralgeniculatebody
(d)
Cerebralcortex
YourResponse:
b
CorrectAnswer:
Exp:
(Ref.Harrison'sPrinciplesofInternalMedicine16thEdition164165)
Heteronymoushemianopia
Heteronymoushemianopiameansbitemporalorbinasalhemianopia.
Attheopticchiasm,fibersfromnasalganglioncellsdecussateintothecontralateraloptictract.
Crossedfibersaredamagedmorebycompressionthanuncrossedfibers.
Asaresult,masslesionsofthesellarregioncauseatemporalhemianopiaineacheye.
Tumorsanteriortotheopticchiasm,suchasmeningiomasofthetuberculumsella,produceajunctional
scotomacharacterizedbyanopticneuropathyinoneeyeandasuperiortemporalfieldcutintheother
eye.
Moresymmetriccompressionoftheopticchiasmbyapituitaryadenoma,meningioma,
craniopharyngioma,glioma,oraneurysmresultsinabitemporalhemianopia.
Homonymoushemianopia
Itisdifficulttolocalizeapostchiasmallesionaccurately,becauseinjuryanywhereintheoptictract,
lateralgeniculatebody,opticradiations,orvisualcortexcanproduceahomonymoushemianopia,i.e.,a
temporalhemifielddefectinthecontralateraleyeandamatchingnasalhemifielddefectintheipsilateral
eye.
(Q.144) Argonlaserisnotusefulin
(a)
C.R.V.occlusion
(b)
(c)
Retinitispigmentosa
Retinaldetachment
58/82
1/26/2016
(d)
Diabeticretinopathy
YourResponse:
CorrectAnswer:
Exp:
(Ref.Harrison'sPrinciplesofInternalMedicine16thEdition172)
Retinitispigmentosa
Thisisageneraltermforadisparategroupofrodandconedystrophies
Itischaracterizedbyprogressivenightblindness,visualfieldconstrictionwitharingscotoma,lossof
acuity,andanabnormalelectroretinogram(ERG).
Itoccurssporadicallyorinanautosomalrecessive,dominant,orXlinkedpattern.
Irregularblackdepositsofclumpedpigmentintheperipheralretina,calledbonespiculesbecauseoftheir
vagueresemblancetothespiculesofcancellousbone,givethediseaseitsname.
Thenameisactuallyamisnomerbecauseretinitispigmentosaisnotaninflammatoryprocess.
Mostcasesareduetoamutationinthegeneforrhodopsin,therodphotopigment,orinthegenefor
peripherin,aglycoproteinlocatedinphotoreceptoroutersegments.
VitaminA(15,000IU/day)slightlyretardsthedeteriorationoftheERGinpatientswithretinitis
pigmentosabuthasnobeneficialeffectonvisualacuityorfields.
Someformsofretinitispigmentosaoccurinassociationwithrare,hereditarysystemicdiseases
(olivopontocerebellardegeneration,BassenKornzweigdisease,KearnsSayresyndrome,Refsums
disease).
Chronictreatmentwithchloroquine,hydroxychloroquine,andphenothiazines(especially
thioridazine)canproducevisuallossfromatoxicretinopathythatresemblesretinitispigmentosa.
Thereisnospecifictherapyforretinitispigmentosa.
Geneticcounsellinghelpsinthenonpropagationofthedisease.
(Q.145) Photoretinitisisduetoexposureto
(a)
U.V.rays
(b)
(c)
Infraredrays
Gammarays
(d)
Xrays
YourResponse:
CorrectAnswer: b
Exp:
Photoretinitisisprimarilyaburnofthefoveolarregionresultingfrominfrared
raysofbrightsunlight.
HencealsocalledSOLARRETINOPATHY/ECLIPSEBURNofretina.
(Q.146) KayserFleischerringinvolvestheregionof
(a)
(b)
Bowmansmembrane
(c)
Stroma
Descemetsmembrane
(d)
Epithelium
YourResponse:
b
CorrectAnswer:
Exp:
(Ref:AKKhurana2nded.378;ParsonsDiseaseOfEye19thed.568)
59/82
1/26/2016
PIGMENTTYPEDISORDERLOCATION
IronKeratoconusCornealepithelium
(Fleischerring)
OldopacityCornealepithelium
(HudsonStahhline)
PterygiumCornealepithelium
(Stockersline)
FilteringblebCornealepithelium
(Ferrysline)
CopperWilsonsdisease,ChalcosisDescemetsmembrane
(KFring)
MelaninPigmentdispersionsyndromeEndothelium
(Krukenbergsspindle)
Kfring
KayserFleischer(KF)ringincorneaisadiagnosticfeatureofWilsonsdiseaseorhepatolenticular
degeneration.
ItisagoldenbrownringwhichoccursduetodepositionofcopperunderperipheralpartsofDescemets
membraneofthecornea.
(Q.147) Superiororbitalfracturedoesnotinvolve
(a)
IIcranialnerve
(b)
IIIcranialnerve
IVcranialnerve
(c)
(d)
YourResponse:
CorrectAnswer:
Exp:
(Ref.Harrison'sPrinciplesofInternalMedicine16thEd.)
VIcranialnerve
Superiororbitalfissurefracture
Superiororbitalfissuresyndrome,alsoknownasRochonDuvigneaud'ssyndrome,isaneurological
disorderthatresultsifthesuperiororbitalfissureisfractured.
Involvementofthecranialnervesthatpassthroughthesuperiororbitalfissuremayleadtodiplopia,
paralysisofextraocularmotions,exophthalmos,andptosis.
Blindnessorlossofvisionindicatesinvolvementoftheorbitalapex,whichismoreserious,requiring
urgentsurgicalintervention.
(Q.148) PilocarpinecausesallEXCEPT
(a)
Salivation
(b)
Miosis
(c)
Sweating
(d)
Cycloplegia
Your
Response:
Correct
d
Answer:
60/82
1/26/2016
Exp:
Pilocarpine
Pilocarpineisalocalparasympathomimeticocular
hypotensivedrug
Itsmioticeffectisusefulinthemanagementofangleclosure
glaucoma.
Itisnotacycloplegicdrug.
However,itssystemiceffectsinclude
i.Increasedsweating,ii.Increasedsalivation,
iii.Bronchospasm&iv.Abdominalcramps.
Contraindicationstopilocarpine:
i.Inflammatoryglaucomaii.Malignant
glaucomaiii.Allergy
(Q.149) Stockerslineispathognomonicof
(a)
Cholestaticjaundice
(b)
Pterygium
(c)
Hemochromatosis
(d)
Decreasedceruloplasminlevel
YourResponse:
b
CorrectAnswer:
Exp:
TYPEOFPIGMENT
DISORDER
LOCATION
Keratoconus(Fleischerring)
Cornealepithelium
Oldopacity(HudsonStahhline)
Cornealepithelium
Pterygium(Stockersline)
Cornealepithelium
Filteringbleb(Ferrysline)
Cornealepithelium
Copper
Wilsonsdisease,Chalcosis(KFring)
Descemetsmembrane
Melanin
Pigmentdispersionsyndrome(Krukenbergs
spindle)
Endothelium
Iron
(Q.150) Besttovisualizecornealendothelium
Fundoscopy
(c)
(d)
YourResponse:
CorrectAnswer:
Slitlampexam
(a)
(b)
Exp:
Specularmicroscopy
Operatingmicroscopy
b
Specularmicroscopy
Itisvitaltocountandstudymorphologyofcornealendothelialcells,especiallyinthecasesofcataract
withsuspectedendothelialdystrophy.
Normalcellcountis20002500cells/mm2.
IOLimplantationiscontraindicatedifthecellcountis<1500/mm2.
Specularreflectionbyslitlampbiomicroscope(specularmicroscopy)allowsvisualizationofcorneal
endotheliumbyviewinglightreflectedbackfromthisinterface,countofendothelialcellsispossibleusing
anElsergrid.
61/82
1/26/2016
(Q.151) Formaddoxrodtestdistancefrompatientshouldbe?
(a)
0.5m
(b)
1m
(c)
(d)
YourResponse:
CorrectAnswer:
2m
6m
Exp:
Diagnosisofheterophoria/latentstrabismusdependsontheabolishingfusionsothat,withitscontrol,
theeyesassumetheirpositionofrest.
Severaltestsareavailableforassessingangleofdeviation:
Covertest
Madoxrodtest(Therodisheldinfrontoftheeyes,imageofhighestpointclosetoeyebecomedissimilar
andfusionbecomesdissociated).Testsperformanceat6meterand35cmdistance.
Maddoxwingtest
Prismvergencetest
Synaoptophore
(Q.152) Pinkfunduscanbeseeninallthefollowingconditions
except
(a)
Papilledema
(b)
Pseudopapilledema
(c)
Papillitis
(d)
Retinitispigmentosa
Your
Response
:
Correct d
Answer:
Exp:
(Q.153) Primaryangle=secondaryangleofdeviationisseeninwhichsquint
(a)
Concomitant
(b)
Paralytic
Latent
(c)
(d)
YourResponse:
CorrectAnswer:
Exp:
Squint
None
S.No.
Concomitant(Aparalytic)
Paralytic(Nonconcomitant)
1.
Suddenonset
Insidiousonset
2.
Developmentalorigin
Acquired
3.
Infantsandchildren
Adultsaffected
4.
Diplopia
Nodiplopia
5.
Normalheadposture
Abnormalheadposture
62/82
1/26/2016
6.
Nofalseprojection
Falseprojection+
7.
Angleofsquintconstantinalldirectionof
gaze
Variableangleofsquint
8.
Normalocularmovement
Occularmovementsrestricted
9.
Secondaryangleofdeviation=primaryangle Secondaryangle>primary
10.
Amblyopia
Noamblyopia
11.
Goodsurgicalresults
Notsatisfactory/contraindicated
(Q.154) Rosettecataractisseenin
(a)
Concussioninjury
(b)
Penetratinginjury
(c)
(d)
YourResponse:
CorrectAnswer:
Diabetesmellitus
Exp:
(Ref.Parson,DiseasesofEye,18thed.,283;Basak,Ophthalmology,2nded.,182,305)
Chalcosis
a
CATARACT
Aftercataract(postcapopacity)
Elschnigpearl&ringsofSoemerrings
Brown/(cataractabrunescens)
Blackcataract/(cataracatnigrans)
Bluedotcataract(punctate)
Mostcommoncongenitalcataract
Complicatedcataract
Breadcrumbappearance
Concussioncataract
Rosetteshapedcataract
Coronarycataract
Developmentalcataractatpuberty
Chalcosis
Sunflowercataract
Diabeticcataract
Snowflake/stormappearance
Hypermaturesenilecataract
Morgagniancataract
Lamellar/zonular
Riders
(Q.155) Lensusedtotreatmyopiais
(a)
Convex
(b)
Concave
(c)
Cylindrical
(d)
Anyoftheabove
YourResponse:
CorrectAnswer b
:
Exp:
(Ref.Parson,DiseasesofEye,18thed.,65)
Myopia(shortsightedness)
Mostcommonisaxialmyopia
Clinicallysimplemyopiaismostcommon
Ifits>6D,calledhighmyopia
Treatment
OpticalConcavelenses
63/82
1/26/2016
Surgical
a).Radialkeratotomyb).Keratophakiac).Keratomileusis
d).LAISK(LaserassistedinsituKeratomileusis)e).Fukalasoperationf).
Scleroplasty
MinusIOL
ExcimerLASER(Photorefractivekeratoplasty/PRK)
IndicationsforLASIK:
a).Stablerefractiveerrorb).Age>21yearsc).Unsatisfactoryresultofnon
surgicaltreatment
ContraindicationforLASIK:
a).Cornealthinningdisordersb).Diabetesmellitus
(Q.156) Alloccurinprocessofaccommodationofeyeallexcept
(a)
(b)
Contractionofsphincterpupillae
Dilatationofpupil
(c)
Changeinlenscurvature
(d)
Contractionofciliarymuscles
YourResponse
:
CorrectAnswer b
:
Exp:
(Ref.Parson,DiseasesofEye,18thed.,49,Basak,2nded.,68)
ACCOMODATIONisabilitytoseenearobjectsclearly,byincreasing
convergingpowerofeye.
Componentsofneartriadinclude:
Constrictionofciliarymusclesandsphincterpupillae
Constrictionofpupil
Changeinlenscurvature(anteriorsurface)
(Q.157) DacryocystorhinostomyiscontraindicatedinallEXCEPT
(a)
Atrophicrhinitis
(b)
(c)
DNS
Carcinomalacrimalgland
(d)
Chronicdacryocystitis
YourResponse:
CorrectAnswer: d
Exp:
(Ref.Parson,DiseasesofEye,18thed.,376,19thed.,501504;Basak,
Ophthomology2nded.,282,336)
Dacrocystorhinostomy(DCR)
Itissurgicalprocedureofchoiceinchronicdacrocystitis.
Acommunicationismadebetweenlacrimalsacandmiddlemeatusofnose.
Contraindications:
i.DNSii.Carcinomaoflacrimalglandiii.Rhinitis(Atrophic)
(Q.158) Abductionandelevationofeyeiscaused
by
64/82
1/26/2016
(a)
Superioroblique
(b)
(c)
Inferioroblique
Superiorrectus
(d) Medialrectus
Your
Response
:
Correct b
Answer:
Exp:
(Q.159) Whichfieldofvisionislasttogoinchronicsimpleglaucoma?
(a)
Nasal
(b)
(c)
Peripheral
(d)
YourResponse:
CorrectAnswer:
Temporal
Exp:
Central
d
InPOAG(chronicsimpleglaucoma)glaucomatousdiscchangesarecharacteristicwithcuppingstartingin
inferiortemporalquadrant,followedbybayonetingsign,baringofcircumlinearvessels,splinter
hemorrhages,neuralrimthinning,polarnotching,laminardotsignandopticpallorandatrophy.
Fielddefectsincludeisoptercontraction,baringofblindspot,arcuate(Bjerrum)scotoma,superior
paracentralscotoma,Seidelsscotoma,ringscotoma,Roennesnasalstep,tubularfieldandlastlyonly
temporalislandofvision.
TreatmentofPOAG(primaryopenangleglaucoma):
Medicaltreatmentisalwaysfirstinplace,operativetreatmentislastresort.
Pilocarpine,betablockers,epinephrine,dipivefrin,dorzolamide,andlatanoprostareused.
LatanoprostisaPGanalogue,whichactsbyincreasingtheuveoscleraloutflow.
LASERArgonLaserTrabeculoplasty(ALT)
Newertrabeculotomywithantimetabolitesandvalveimplantation.
Filteringsurgeries.
TreatmentofPACG(primaryangleclosureglaucoma)
Pilocarpine24%,butdefinitiveissurgery,PBI,butnowreplacedinmostcasesbyLASERiridotomy.
ColoredhalosessentialsymptomofPACG.
(Q.160) Besttreatmentforbuphthalmosis
(a)
(b)
Trabeculectomy
(c)
Cryotherapy
Goniotomy
(d)
Conservative
Your
Response:
Correct
b
Answer:
Exp:
Buphthalmos
Treatmentofchoiceforbuphthalmosisgoniotomy.
65/82
1/26/2016
Eventualsuccessratewithgoniotomyis85%.
Howeverinresistantcasestrabeculectomyandtrabeculotomyare
helpful.
Trabeculotomyisusefulwhencornealcloudingispresentorwhen
goniotomyfails.
(Q.161) Whichofthefollowingdrugisbeingusedinthetreatmentofdiabeticretinopathy?
(a)
Etanercept
(b)
(c)
Eculizumab
Bevacizumab
Infliximab
(d)
YourResponse:
CorrectAnswer:
Exp:
Bevacizumabisadrugthatblocksangiogenesis,thegrowthofnewbloodvessels.
Itisusedtotreatvariouscancers,includingcolorectal,lung,andkidneycancer,andeyedisease.
BevacizumabisahumanizedmonoclonalantibodythatinhibitsvascularendothelialgrowthfactorA(VEGF
A).
VEGFAisachemicalsignalthatstimulatesangiogenesisinavarietyofdiseases,especially
incancer,retinalproliferationofdiabetesintheeye.
(Q.162) DamagetonervesupplyingSuperiorobliquecausesdiplopiainwhichdirection?
(a)
(b)
Horizontalanddownward
(c)
Horizontalandupward
Verticalanddownward
(d)
Verticalandupward
YourResponse:
a
CorrectAnswer:
Exp:
(Ref.BDCVol.3.4th/pg.115)
Trochlearor4thcranialnerveproducesdiplopiaduetoparalysisofSuperiorobliquemusclewhichoccurs
inhorizontalanddownwardgaze.
(a)
(b)
Blepharophimosis
(c)
Ankyloblepharon
(d)
Ectropion
Symblepharon
66/82
1/26/2016
YourResponse:
CorrectAnswer:
Exp:
d
Cicatricialectropioniscommonlytheresultofburns,traumaandchronicinflammationsoftheskinwhich
shortentheanteriorlamellaoftheeyelid,i.e.theskinmusclelayers.Thispullstheeyelidmarginaway
fromtheglobe.
(Q.164) LocalAntifungalagentusedincornealfungalinfection?
(a)
Silversulfadiazine
(b)
(c)
Neomycin
Griseofulvin
(d)
Natamycin
YourResponse
:
CorrectAnswer d
:
Exp:
Treatmentofmycotickeratitis
Scrapinganddebridement
Atropineeyeointment
Antifungaldrugs:
Topical
Natamycin(5%)eyedrops,1hourly.Effectiveagainstmostcommonfungi.
Miconazole(1%)eyeointment,5timesdaily.
Nystatineyeointment,5timesdaily.Onlyeffectiveagainstcandida,andless
potent.
TopicalamphoterecinB(0.25%),1hourly,effectiveagainstAspergillusand
candida.
Systemic
Ifulcerismarginalorperforated,tab.Ketoconazoleorfluconazolefor23
weeksmaybetried.
Therapeuticfullthicknesskeratoplastyismuchbettersolution.
(Q.165) Awelldefinedfocallesionintheconeofextraocularmusclesoftheeyewithproptosisinachild.Thediagnosiswillbe?
(a)
Cavernoushemangioma
(b)
(c)
Hemangioendothelioma
Capillaryangioma
(d)
Retinoblastoma
YourResponse:
a
CorrectAnswer:
Exp:
(Ref.Grainger&Allison'sDiagnosticRadiology:ATextbookofMedicalImaging,4thEd.pg.2534)
Thecapillaryangiomaisatumourofearlychildhood.Itformsasoft,bluishmass,whichmayinvolveany
partoftheorbit,includingtheeyelid.
USshowsitasawelldefinedanteriorsoftlesionwithsmallirregularechoes.CDFIshowspathognomonic
featureswithhighflowwithinimmaturevesselsinahypervascularizedmass.Sincethesetumoursregress
eitherspontaneouslyoraftersteroids,CTisonlyindicatedfortumourswithretrobulbarextension.
Cavernoushaemangioma,thecommonestprimaryretrobulbartumour,isaslowgrowing,welldefined,
67/82
1/26/2016
roundedorovalmassconsistingoflargevascularspacessurroundedbyafirmcapsule.Usuallyitlies
withinthemusclecone,displacingtheopticnerve,andiswelldepictedbyUS,CT,andMRI.Phleboliths
arenotuncommon.
(Q.166) Rothsspotsareoccurdueto?
(a)
Retinalhemorrhages
(b)
(c)
Retinalinfarct
(d)
YourResponse:
CorrectAnswer:
Retinaledema
Retinaldetachment
Exp:
Whitecenteredretinalhemorrhages(Roth'sspots)areconsideredpathognomonicforsubacutebacterial
endocarditis,buttheyalsoappearinleukemia,diabetes,andmanyotherconditions.
(Q.167) TELECANTHUSmeans?
(a)
Increasedintercanthaldistancewithnormalinterpupillarydistance.
(b)
Increaseddistancebetweenmedialcanthusandeyelids
(c) Widelyseparatedmedialwalloforbits
(d) Widelyseparatednoseandmedialcanthi
YourResponse:
a
CorrectAnswer:
Exp:
Telecanthus,referstoincreaseddistancebetweenthemedialcanthioftheeyes,whiletheinterpupillary
distanceisnormal.
Thisisincontrasttohypertelorism,wheretheinterpupillarydistanceisincreased.
Thedistancebetweentheinnercornerofthelefteyeandtheinnercorneroftherighteye,iscalled
intercanthaldistance.
Inmostpeople,theintercanthaldistanceisequaltothedistancebetweentheinnercornerandtheouter
cornerofeacheye,thatis,thewidthoftheeye.
Thesituation,whereintercanthaldistanceisintenselybiggerthanthewidthoftheeye,iscalled
telecanthus.
Thiscanbeanethnicindexoranindicationforhypertelorismorhypotelorism,ifitiscombinedwith
abnormalrelationtotheinterpupillarydistance.
(Q.168) Seafanretinaisseenin?
(a)
(b)
CRAO
(c)
Sicklecelldisease
SLE
(d)
YourResponse:
CorrectAnswer:
Gauchersdisease
Exp:
(Ref.Khuranaophthalmology5th/pg.271)
Prolifertiveretinopathycanoccurinsicklecelldisease:
68/82
1/26/2016
Stage1:Peripheralarteriolarocclusion
Stage2:PeripheralAVanastomoseswhichappeartobedilatedpreexistentcapillarychannels.
Stage3:Sproutingofnewvesselsfromanastomoses.Initiallythenewvesselslieflatontheretina,havea
seafanconfigurationandfedbyasinglearterioleanddrainedbysinglevein.
Stage4:Vitreoushemorrhage.
Stage5:ExtensivefibrovascularproliferationandtractionalRD.
(Q.169) Keraticprecipitatesandcellsinanteriorchamberaresuggestiveof?
(a)
(b)
Glaucoma
(c)
Conjunctivitis
Scleritis
Iridocyclitis
(d)
YourResponse:
CorrectAnswer:
Exp:
(Ref.Khuranaophthalmology5th/pg.271)
Signsofanterioruveitis:
Circumcornealinjection
Keraticprecipitates(KP)arecellulardepositsonthecornealendothelium.KPmostforminmidand
inferiorzonesofcornea.
i.Endothelialdustingii.MediumsizeKPs
iii.LargeKPs(MuttonfatKps)granulomatousuveitis.iv.OldKPs
Cells
Aqueosflare
Irisnodules(KoeppeandBusaccanodules)
(Q.170) Antiglaucomadrugthatislongactingandusedoncedaily?
(a)
Brimonidine
(b)
(c)
Dorzolamide
Latanoprost
Timolol
(d)
YourResponse:
d
CorrectAnswer:
69/82
1/26/2016
Exp:
(Ref.KDT6th/pg.144)
Drug/class
Aqueous
secretion
Trabecularoutflow
Uveoscleraloutflow
1. blockers(Timolol)
2. Miotics(Pilocarpine)
3. Adrenaline/Dipivefrine
4. Brimonidine/apraclonidine
5. Prostaglandins(Latanoprost)
6. Carbonicanhydraseinhibitors
(Q.171) Whichofthefollowingisnottrueaboutthedirectophthalmoscope?
(a)
(b)
Givesanangularmagnificationof15X
Givesarealerectimage
(c)
Makesthediscofamyopeappearslargerthanthatofahypermetrope
(d) Isbetterthanindirectophthalmoscopeindetectingdiabeticmaculopathy
YourResponse:
d
CorrectAnswer:
Exp:
Thedirectophthalmoscopegivesanangularmagnificationof15X.Theimageformedisvirtualanderect.
Thesizeoftheopticdiscwhenviewedthroughadirectophthalmoscopeislargerinmyopethan
emmetrope,whichinturnislargerthaninhypermetrope.
Diabeticmaculopathyisbetterdetectedwithindirectophthalmoscope.
(Q.172) FosterKennedysyndromeisdueto
(a)
Frontallobetumour
(b)
(c)
Parietallobetumor
(d)
YourResponse:
CorrectAnswer:
Exp:
Temporallobetumour
Occipitallobetumour
a
FOSTERKENNEDYSYNDROMEisassociatedwitholfactoryorsphenoidalmeningioma&frontallobe
tumours.
Inthisconditionthereoccurspressureopticatrophyonthesideoflesions&papilloedemaontheother
side(duetoraisedintracranialpressure).
(Q.173) Retinoscopywithaplanemirrorfromadistanceofonemetergivesnoimage.Diagnosis
is
(a)
Aphakia
(b)
Emmetropia
(c)
(d)
YourResponse
:
Correct
Myopia1D
Hypermetropia
70/82
1/26/2016
Answer:
Exp:
(Q.174) Inophthalmoplegicmigraine,whichnerveisinvolvedfirst?
(a)
(b)
IVcranialnerve
(c)
VIcranialnerve
IIIcranialnerve
IIcarinalnerve
(d)
YourResponse:
CorrectAnswer: b
Exp:
(Ref.Harrison'sPrinciplesofInternalMedicine16thEd.88)
Ophthalmoplegicmigraine
Ophthalmoplegicmigraineisanuncommondisorderusuallyhavingitsonsetinthefirst
decadeoflife
Themigrainousattackisfollowedbypartialparalysisofthethirdand/orthesixthcranial
nerve.
Theparalysismaylastfordaysorweeks.
Ptosis,limitationofocularmovementssemidilatedpupilsandsluggishpupillaryreactionsare
theclassicalfeatures
Recoveryisgradualandtendstobecomelesscompletewithrepeatedattacks.
(Q.175) Notacommonsymptomofconjunctivitis:
(a)
(b)
Pain
(c)
Discharge
(d)
YourResponse:
CorrectAnswer:
Irritation
Exp:
Redness
a
Conjunctivitisisthemostcommoncauseofared,painfuleye.ButPainisminimal,Painisminimal,and
thevisualacuityisonlyslightlyreduced.
Themostcommonviralcauseisadenovirusinfection.
Itcausesawaterydischarge,mildforeignbodysensation,andphotophobia.
Bacterialinfectionproducesamoremucopurulentexudate.
(Q.176) AllthefollowingdrugsareusedinacuteanterioruveitisEXCEPT
(a)
Pilocarpine
(b)
Atropine
Timolol
(c)
Propranolol
(d)
YourResponse:
CorrectAnswer: a
Exp:
Treatmentofacuteanterioruveitis
cycloplegicsdilatationofthepupilandrelaxationoftheciliarymusclewithsuch
as:
71/82
1/26/2016
i.atropineQ1%ii.cyclopentolateoriii.homatropine2%.
NSAIDS(Aspirin)
Localandsystemiccorticosteroids
Immunosuppressivedrugs
Hotfomentation
Pilocarpineisdirectactingparasympathomimeticdrug.
Itcausescontractionoflongitudinalmuscleofciliarybodyandopensspacein
trabecularmeshwork
itiscontraindicatedinanterioruveitis
(Q.177) Vossiusringis
(a)
(b)
Pigmentationonthecornea
Depigmentationoftheiris
(c)
Circularpigmentrimontheanteriorcapsuleoflens
(d) Degenerationoftheretina
YourResponse:
CorrectAnswer: c
Exp:
VOSSIUSRINGisacircularringofbrownpigmentseenontheanteriorcapsuleof
thelens.
Itoccursduetoimprintofcontractedpupillarymarginagainstthecrystallinelens,
duringblunttrauma
(Q.178) Pepper&Saltappearanceoffundusisduetotheinfectionof
(a)
Rubella
(b)
Herpes
(c)
(d)
YourResponse:
CorrectAnswer:
AIDS
Exp:
Measles
a
(Ref:ParsonsDiseasesifEye20thed.302,AKKhuranaophthalmology3rded:288)
APPEARNACEONFUNDOSCOPY
DIAGNOSIS
Saltandpepperfundus
Congenitalrubella
CongenitalsyphilisMayousBattendisease
Lebersamaurosis
Thioridazinetoxicity
(Q.179) CornealNeovascularizationcanbepreventedby
(a)
(b)
Photocoagulation
(c)
Systemiccorticosteroids
Radiationofpituitary
(d)
Localcorticosteroids
YourResponse:
CorrectAnswer: a
72/82
1/26/2016
Exp:
Thevascularisationofthecorneamaybepreventedbyphotocoagulatingthevessles..
Applicationofcorticosteroids&Thioteopaorbirradiationiseffective.Intractablecasesare
dealtwithperitomy.
(Q.180) TheonlyindicationforArgusIIis:
(a)
(b)
Retinitispigmentosa
Retinoblastoma
(c)
Retinaldetachment
(d)
choroidalneovascularization
YourResponse:
a
CorrectAnswer:
Exp:
Theartificialretina,calledtheArgusIIRetinalProsthesisSystem,isthefirstimplantabledevicetotreat
theconditionandisapprovedforpeopleoverage25withadvancedRPwhocanseesomelight.
Thedeviceconsistsofapanelofelectrodesthataresurgicallyimplantedintheeye,andapairofglasses
withanattachedcamera.
Thecamerasendsimagestotheelectrodes,essentiallybypassingthedamagedretinaandtappinginto
theopticnervethatsignalsthebrain.
(Q.181) ChronicIridocyclitisisafeatureofwhichofthefollowingdisease:
(a)
PolyarticularRFve
(b)
PolyarticularRF+ve
(c)
(d)
YourResponse:
CorrectAnswer:
Exp:
PauciarticulartypeI
PauciarticulartypeII
c
JRA
Systemic
Polyarticular
Polyarticular
Pauciarticular
Pauciarticular
RFve
RF+ve
TypeI
TypeII
Percentage
20%
25%
10%
30%
15%
Sacroiliitis
No
No
Rare
No
Common
Iridocyclitis
No
Rare
No
50%chronic 20%acute
Rheumatoid
factor
Negative
Negative
100%
Negative
Negative
ANA
Negative
25%
75%
60%
Negative
Boys/girls
60%boys
90%girls
80%girls
80%girls
90%boys
(Q.182) Forpanophthalmitistrueis
(a)
Mostcommoncauseisendogenous
(b)
(c)
Painlessocularmovementsareseen
Ophthalmologistmayelecttodoaparsplanavitrectomy
(d)
Noneoftheabove
YourResponse:
c
CorrectAnswer:
Exp:
Panophthalmitis >inflammationofalllayersoftheeye.
73/82
1/26/2016
Etiology
Endogenous(215%)>fromthehematogenousspreadoforganismsfroma
distantsourceofinfection.Seenwith(endocarditis,immunosuppressiveagents
orcandidalinfectionsinIVdrugusers).Exogenous(60%)>directinoculation
(mostfromocularsurgery,canbefromforeignbodies,blunt/penetrating
trauma).MostduetoG+suchasStaphaureusorepi.
Riskfactors
Recenteyesurgery,fevers,oculartrauma,hammeringsteelwithsteel,working
withbalingwire,orworkinginanindustrialsetting.
S/s
Pain(worsewithoccularmovement),erythema,lidswelling,occulard/c,and
blurredordecreasedvisualacuity.Rangesfromwhitenodulesontheiris/retina
orchoroidtoinflammationofalltheoculartissueswithpurulentexudate.Fungal
endophthalmitismaypresentasanindolentcourse(dayswks).Candidalmay
presentwithhighfever,thendayslaterwithocularsxs.Otherfindingsinclude
injectedconjunctiva,hypopyon,chemosis,decredreflex,proptosis(latefinding),
papillitis,cottonwoolspots,cornealedema,Rothspots(whitecentered
hemorrhagesintheretina).
Rx
Peretiology.Tetshot,admit,startempiricAbx(topical+Vanc+aminoglycoside
ora3rdGenCeph,+ClindauntilBacillusspcanberuledoutifsoilcontamination,
+FluconazolePO),considerintravitrealAbxifvisualacuityislimitedtolight
perception.Cycloplegicagent(atropine),andtopicalsteroidsareoftenused.
Ophthalmologistmayelecttodoaparsplanavitrectomy.AspirationofpusforCx
andpossiblyintraocularsteroids.
(Q.183) Finchamstestisdonetodifferentiatebetween
(a)
Acutecongestiveglaucomaandcataract
(b)
Chronicsimpleglaucomaandcataract
(c)
Acutecongestiveglaucomaandchronicsimpleglaucoma
(d)
Chronicsimpleglaucomaandiridocyclitis
YourResponse:
a
CorrectAnswer:
Exp:
Finchamstestcandifferentiatedbetweenthehalosofglaucoma&immaturecataract.
ColouredhalosinPACGoccurduetoaccumulationoffluidinthecornealepitheliumandalterationinthe
refractiveconditionofthecorneallamellae.
Thesemustbedifferentiatedfromthosefoundinacutepurulentconjunctivitis&earlycataractous
changes.Inconjunctivitis,haloscanbeeliminatedbyirrigatingthedischarge.
Thehalosofglaucoma&immaturecataractmaybedifferentiatedbyFinchamstestinwhichstenopaeic
slitispassedacrosspupil.
GlaucomatousHaloremainsintactwhilehaloduetocataractisdiscontinuousorsegmented
(Q.184) Chloroquineinlargedosescauses
(a)
Cornealdeposits
(b)
Glaucoma
(c)
Cataract
(d)
Irreversibleretinopathy
YourResponse:
d
CorrectAnswer:
Exp:
(Ref:ParsonsDiseasesifEye20thed.302,AKKhuranaophthalmology2nded:26,253)
74/82
1/26/2016
APPEARNACEONFUNDOSCOPY
DIAGNOSIS
Bullseyemaculopathy
Chloroquine
Severeretinaltelangiectesia
Coatsdisease
Saltandpepperfundus
Congenitalrubella
Congenital.syphilisLebersamaurosis
MayousBattendisease
Thioridazinetoxicity
Candlewaxappearance
Sarcoidosis
CherryRedspot
NiemannPicksdisease
(Mnemonic:PickMyQTBags)
Multiplesulfatasedeficiency
Quinineamblyopia
Taysachsdisease
Berlinsedema(Commotioretinae)duetoblunttrauma
CRAO
Gauchersdisease
Sandhoffdisease
Sialoidosistype1and2
(Q.185) Peripheryofretinaisbestvisualizedwithwhichofthefollowing:
(a)
(b)
Indirectophthalmoscopy
(c)
Retinoscopy
Ultrasonography
(d)
Directophthalmoscopy
YourResponse:
a
CorrectAnswer:
Exp:
Theindirectophthalmoscopicexaminationisanimportantproceduretoexaminethedetailsoffundus
mainlytheperiphery.Imageformedistrue,invertedand5timesmagnified.
(Q.186) Growthofthemicrovasculatureduringocularangiogenesisisnotstimulatedby?
(a)
IL8
(b)
(c)
Fibroblastgrowthfactor
VascularEndothelialGrowthFactor
(d)
TransformingGrowthFactor
YourResponse:
a
CorrectAnswer:
Exp:
(Ref.Robbinspathology7thed.97)
Importantcytokines
Name
MajorCellularSource
SelectedBiologicEffects
IFN,
Macrophages(IFN),
fibroblasts(IFN)
Antiviral
IFN(interferon)
Tcells,NKcells
Activatesmacrophages,TH1
differentiation
TNF(tumornecrosisfactor
alpha)
Macrophages,Tcells
Cellactivation,fever,cachexia,
antitumor
75/82
1/26/2016
TNF(tumornecrosisfactorbeta), Tcells
LT(lymphotoxin)
ActivatesPMNs
IL1(interleukin1)
Macrophages
Cellactivation,fever
IL2(interleukin2)
Tcells
Tcellgrowthandactivation
IL3(interleukin3)
Tcells
Hematopoiesis
IL4(interleukin4)
Tcells,mastcells
Bcellproliferationandswitching
toIgE,TH2differentiation
IL5(interleukin5)
Tcells
Differentiationofeosinophils,
activatesBcells
IL7(interleukin7)
Bonemarrowstromacells
Tcellprogenitordifferentiation
IL8(interleukin8)
Macrophages,Tcells
Chemotacticforneutrophils
IL10(interleukin10)
Macrophages,Tcells
Inhibitsactivatedmacrophages
anddendriticcells
IL12(interleukin12)
Macrophages
DifferentiationofTcells,
activationofNKcells
GMCSF(granulocytemacrophage Tcells,macrophages,
colonystimulatingfactor)
monocytes
Differentiationofmyeloid
progenitorcells
MCSF(monocytemacrophage
colonystimulatingfactor)
Macrophages,monocytes,
fibroblasts
Differentiationofmonocytesand
macrophages
GCSF(granulocytecolony
stimulatingfactor)
Fibroblasts,
monocytes,macrophages
Stimulatesneutrophilproduction
inbonemarrow
(Q.187) LDHinaqueoushumorisincreasedin
(a)
Galactosemia
(b)
Retinoblastoma
(c)
Glaucoma
(d)
Gyrateatrophy
Your
Response:
Correct
b
Answer:
Exp:
TotalLDHactivityinserumaswellasaqueousismuchhigherin
retinoblastomacases.
(Q.188) Downbeatnystagmusisseenwith?
(a)
(b)
Alcoholism
(c)
Pontinetumor
(d)
YourResponse:
CorrectAnswer:
Exp:
Chiarimalformation
Mniresdisease
b
Downbeatnystagmusoccursfromlesionsnearthecraniocervicaljunction(Chiarimalformation,basilar
invagination).
Ithasalsobeenreportedinbrainstemorcerebellarstroke,lithiumoranticonvulsantintoxication,
alcoholism,andmultiplesclerosis.
Upbeatnystagmusisassociatedwithdamagetothepontinetegmentum,fromstroke,demyelination,or
tumor.
76/82
1/26/2016
(Q.189) WhichofthefollowingisusuallynothelpfulindifferentiatingCRVOfromCRAO?
(a)
Dilatedretinalveins
(b)
Tortuousretinalveins
(c)
Ophthalmodynamometry
(d)
Retinalarterypressuremeasurement
YourResponse:
d
CorrectAnswer:
Exp:
Thepressurewithinthecentralveindependsontheintracranialpressure(ICP),becausetheopticnerveis
surroundedbycerebrospinalfluidinitssheath.
Whentheveincollapsesorpulsates,ICPishigherthanorequaltothepressurewithintheopticnerve.
Thepressureofthecentralretinalveincanbemeasuredbyanoninvasivemethod
ophthalmodynamometry.
(Q.190) Eyelea(Aflibercept)?
(a) VEGFR1antagonist
(b) VEGFR2antagonist
(c) VEGFR1and2antagonist
(d) BindstocirculatingVEGFmolecules
Your
Response
:
Correct d
Answer:
Exp:
OtherantiVEGFs:
MonoclonalantibodyBevacizumab
(Avastin)
AntibodyderivativeRanibizumab
(Lucentis)
AptamerPegaptanib(Macugen)
FusionproteinsAflibercept(VEGFTrap,
Eyelea)
MiscellaneoussiRNABevasiranib
(Q.191) TrueaboutJuxtafovealretinaltelangiectasiaisthefollowingexcept:
(a)
(b)
Telangiectasiaofthemacularcapillarybuds
VariantofCoatsdisease
(c)
MayhaveassociatedDiabetesMellitus
(d)
Structuralabnormalityofcapillarybuds
YourResponse:
d
CorrectAnswer:
Exp:
Juxtafovealretinaltelangiectesia
Aconditionthatischaracterizedbyexudationordiffusionabnormalitiesfromectatic(dilatedand
tortuousbloodvessels)andincompetentretinalcapillariesinthejuxtafoveolarregion
Canbefoundasadevelopmentalorcongenitalvascularanomalyoranacquiredcondition.
77/82
1/26/2016
IJRThasbeeninterpretedasavariantofCoatsdiseasebysomeauthors.
SignsandSymptoms:Idiopathicjuxtafovealretinaltelangiectasia(IJRT)comesintwoforms:unilateralor
bilateral.Theunilateralformoccursonlyinmenandpatientswillbeasymptomaticuntilafterage40.The
bilateralformoccursequallyinmenandwomenbetweentheagesof40and60,withanaverageageof
55.
Patientsmaybevisuallyasymptomaticormayexperienceaslightvisionreduction,butmostpatients
maintain20/40visionorbetter.Patientsmaycomplainofmetamorphopsia.Patientsmayalsohavea
coincidenthistoryofischemicvasculardiseasessuchasdiabetes.
Fluoresceinangiogramshowsleakagefromtelangiectaticvesselsandblockagefromthehemorrhages.
Telangiectaticvesselsaremorecommonlyobservedtemporaltothefovea.
Clinicalfeatures:
decreasedvisionsecondarytoserousexudation,macularedemaorhardexudatesinareasadjacentto
thetelangiectasis
Management:
Earlylaserphotocoagulationmaybehelpfulinrestoringandpreservingcentralacuityforgroup1
Group2and3typicallydonotrespondtophotocoagulation
Treatmentofneovascularizationwhenitdevelopsingroup2
(Q.192) Trueaboutincontinentiapigmentiincludethefollowingexcept:
(a)
Xlinkeddominant
(b)
Primaryskinabnormality
(c) Avascularityofperipheralretina
(d) Ocularinvolvementisseeninalmost100%casesandistypicallyunilateral
YourResponse:
d
CorrectAnswer:
Exp:
Incontinentapigmenti
Incontinentiapigmenti(IP)isanXlinkeddominantneurocutaneoussyndromewithcutaneous,
neurologic,ophthalmologic,anddentalmanifestations.
Frequentlyaffectfemalesandlethalinmales.
Extracutaneousmanifestationsseeninmorethanhalfpatient
Dentaldefect,delayeddentition,missingteeth
Oculardefectsstrabismus,nystagmus,bluesclera,cataract,retinalvascularabnormalities,retinal
pigmentation,opticartophy
CNSmentalretardation,epilepsy,spasticparalysis,microcephaly
Ophthalmologicmanifestationsmaybecomeevidentwithinthefirstfewweekstomonthsoflifeandmay
progressrapidlytopermanentvisualdeficits.
Retinalvasoocclusiveeventswithresultantischemiaarebelievedtobetheprimarymechanism
underlyingocularpathology.
Retinalmanifestationsincluderetinaldetachment,proliferativeretinopathy,fibrovascularretrolental
membranes,fovealhypoplasia,vitreoushemorrhages,andatrophyoftheciliarybody.
Nonretinalmanifestationsincludestrabismus,opticnerveatrophy,conjunctivalpigmentation,
microphthalmia,keratitis,cataracts,irishypoplasia,nystagmus,anduveitis.
(Q.193) Whatisyourdiagnosisofthispatientwhosfluoresceinangiogramsisgivenbelow?
78/82
1/26/2016
(a)
Retinaldetachment
(b)
(c)
Papilledema
Agerelatedmaculardegeneration
(d)
Hypertension
YourResponse:
CorrectAnswer: c
Exp:
Exudativewettypeofagerelatedmaculardegenerationshowingasubretinalchoroidal
neovascularmembrane.
(Q.194) Bull'seyeretinallesionisseenin:
(a)
(b)
Leadtoxicity
Ethambutoltoxicity
(c)
Chloroquinetoxicity
(d)
Oralcontraceptivetoxicity
YourResponse:
a
CorrectAnswer:
Exp:
Lenticonusisabulgingofthelenscapsuleandtheunderlyingcortex.Thediagnosisoflenticonusis
essentiallyaclinicaldiagnosismadebybiomicroscopicexamination.
Lenticonusanterior;lenticonusanteriorispartoftheAlportsyndrome
Lenticonusposterior;lenticonusposteriorismorecommonthanlenticonusanteriorandissometimes
foundinLowesyndrome
(Q.195) Treatmentofadvanceddiabeticretinopathyincludesthefollowingexcept:
(a)
Sealthetearandreattachtheretina
(b)
(c)
Removalepiretinalmembrane
Vitrectomy
(d)
Exophotocoagulation
YourResponse:
d
CorrectAnswer:
Exp:
Advanceddiabeticretinopathy
treatmentofpdr
79/82
1/26/2016
Panretinalphotocoagulation
Medicalvitrectomy
Medicaltherapy
VEGFinhibitorsforPDR
IntravitrealglucocorticoidsforPDR
IncaseoftractionalRD,vitrectomyisdonefollowedbyepiretinalmembranepeeling,
endophotocoagulationandsiliconeoil/intravitrealgasinfusion
(Q.196) Cattletrackappearanceoffundoscopy?
(a)
CRAO
(b)
(c)
CRVO
CMVretinitis
HIVretinitis
(d)
YourResponse:
CorrectAnswer:
Exp:
CRAO
Determinethedegreeofvisionloss(eg,nolightperception,handmovement,countingfingers).
Ocularexaminationincludesthefollowing:
Afferentpupillarydefect.
Performanopticnerveexaminationtolookforsignsoftemporalarteritis.Criticalsignsincludeafferent
pupillarydefect
Cherryredspotandagroundglassretinamaytakehourstodevelop.
Thefunduscopicfindingstypicallyresolvewithindaystoweeksoftheacuteevent,sometimesleavinga
paleopticdiscastheonlyphysicalfinding.
Cattletrackappearanceonfundoscopy
Embolicanbeseeninabout20%ofpatientswithCRAO.
Boxcarsegmentationcanbeseeninbotharteriesandveins.Thisisasignofsevereobstruction.
Performacardiovascularexaminationformurmursorcarotidbruits.
Performasystemicexaminationfortemporaltenderness,jawclaudication,muscleweakness,andfever
toevaluatefortemporalarteritis.
(Q.197) WhichofthefollowingismostcharacteristicfeatureofVonRecklinghausendisease?
(a)
DeformedanteriorchamberwithreducedangleofAC
(b)
(c)
Glaucoma
Choroidalhemangioma
(d) Subretinalneovascularization
YourResponse:
CorrectAnswer b
:
Exp:
(Ref.EssentialsofophthalmologybySamarKBasak2nded.220)
OcularmanifestationsofvonReclinghausensdiseaseinclude:
Plexiformtumorsoflidswithptosis
Thickenedcornealnerves
Pulsatingproptosis(duetotransmittedcerebralpulsationsthroughthedefects
intheorbitalwalls)
80/82
1/26/2016
Gliomaoftheoptictract
Congenitalglaucoma
(Q.198) WhichofthefollowingisseenwithSarcoidosis?
(a)
(b)
Bandkeratopathy
(c)
Choroidplaques
(d)
YourResponse:
CorrectAnswer:
Exp:
Angioidstreak
Cataractanigra
a
(Ref.Parsonsdiseasesofeye20thed.201202)
Eyemanifestationsofsarcoidosis
Eyeinvolvementoccursin~25%ofpatientswithsarcoidosis,anditcancauseblindness.
Theusuallesionsinvolvetheuvealtract,iris,ciliarybody,andchoroid.
Ofthosepatientswitheyeinvolvement,~75%haveanterioruveitisand25to35%haveposterioruveitis.
Thereisblurredvision,tearing,andphotophobia.
Uveitiscandeveloprapidlyandmayclearspontaneouslyovera6to12monthperiod.Italsocan
developinsidiouslyandbechronic.
Theuveitisoftenoccursinassociationwithretinalvasculitis.
Conjunctivalinvolvementisalsocommon,usuallywithsmall,yellownodules.
Whenthelacrimalglandisinvolveakeratoconjunctivitissiccasyndromeresults.
(Q.199) ThefollowingisusedinCollagencrosslinking
(a)
Thiamine+IR
(b)
Thiamine+UV
(c)
(d)
YourResponse:
CorrectAnswer:
Exp:
Riboflavin+UV
Riboflavin+IR
c
CornealcollagencrosslinkingisatechniquewhichusesUVlightandaphotosensitizer(riboflavin)to
strengthenchemicalbondsinthecornea.
Indication:
Tohaltprogressiveandirregularchangesincornealectasia
Keratoconus
PostLASIKectasia
Contraindications
Cornealthicknessoflessthan400microns
Priorherpecticinfectionisacontraindicationbecauseitmayresultinviralreactivation
Concurrentinfection
Severecornealscarringoropacification
Historyofpoorepithelialwoundhealing(asindiabetes)
Severeocularsurfacedisease(eg.dryeye)
Autoimmunedisorders
81/82
1/26/2016
(Q.200) Munsonsignisseenin?
(a)
Retinaldetachment
(b)
(c)
Keratoconus
Aftercataract
(d)
Uveitis
YourResponse:
b
CorrectAnswer:
Exp:
Keratoconus(ConicalCornea)
Thisisfrequentlyduetoacongenitalweaknessofthecornea,thoughitonlymanifestsitselfafter
puberty.However,itcanalsooccursecondarilyfollowingtraumainwhichcaseitisunilateral,orin
patientswithvernalkeratoconjunctivitisorDownsyndromeduetorepeatedrubbingoftheeye.
Thecorneathinsnearthecentreandprogressivelybulgesforwards,liththeapexoftheconealways
beingslightlybelowmecentreofthecornea.
Thecorneaisatfirsttransparentandthevisionisimpairedduetomyopicastigmatism.Iftheconditionis
marked,theconical,napeiseasilyrecognizedinprofile,particularlybytheacutebulgegiventothelower
lidwhenthepatientlooksdown(Munsonsign)
82/82

Eye

Încărcat de

Informații document

Drepturi de autor

Formate disponibile

Partajați acest document

Partajați sau inserați document

Opțiuni de partajare

Vi se pare util acest document?

Este necorespunzător acest conținut?

Drepturi de autor:

Formate disponibile

Eye

Încărcat de

Drepturi de autor:

Formate disponibile

1/26/2016

Thickness(mm) Refractiveindex Position(mm)

S-ar putea să vă placă și