Q-121. True Statements regarding Direct Ophthalmoscopy are A/E:
a) 2 disc diameter field of vision
b) Image is virtual and erect
c) Magnification is 5 times
d) Self illuminated device
Answer: Magnification is 5 times
Explanation:
Direct Ophthalmoscopy is self illuminated device and most commonly plasticized method for routine fundus examination.
Characteristics of image formed in Direct Ophthalmoscopy:
Erect
Virtual
15 times magnification in emmetropes
Q-122. Granular dystrophy of cornea diagnosed by which stain?
a) Masson Trichrome
b) Congo red
c) PAS
d) Colloid iron
Answer: Masson Trichrome
Explanation:
Granular corneal dystrophy is an autosomal-dominant, bilateral, non-inflammatory condition that results in milky granular hyaline deposits in anterior stroma with clear-areas between these deposits.
When corneal specimens are obtained, light microscopy reveals eosinophilic hyaline deposits in the corneal stroma. Masson Trichrome stains the deposits bright red.
Q-123. A person comes with history of painful loss of vision with delayed recovery of vision after exposure to bright light. Most likely diagnosis is-
a) Retro-bulbar Neuritis
b) Aortic arch syndrome
c) Ocular Ischemic Syndrome
d) All
Answer: Retro-bulbar Neuritis
Explanation:
Sudden painful loss of vision:
Acute-angle closure glaucoma
Fracture of the lesser wing of the sphenoid bone
Optic neuritis
Temporal arteritis
Uveitis
Clinical presentations of retro-bulbar Neuritis:
Painful, sudden, progressive and profound visual loss
Lowered dark adaption
Visual obscuration in bright light
Impairment of color vision
Important point:
The most common reason for painless sudden visual loss is ischemia.
Q-124. Steroids are contra-indicated in
a) Herpes keratitis
b) Atopic dermatitis
c) Fungal corneal ulcer
d) Exposure keratitis
Answer: Herpes keratitis
Explanation:
Herpetic keratitis:
Epithelial keratitis:
Topical steroid are contraindicated in epithelial keratitis.
Stromal keratitis:
It is due to delayed type of hypersensitivity reaction to HSV.
Topical steroids are used for treatment.
Q-125. Right trochlear nerve palsy, all are present except
a) Right hypertropia
b) Diplopia on upper gaze and adduction
c) Right ex-torsion
d) Right head tilt
Answer: Right head tilt
Explanation:
Unilateral trochlear nerve (CN IV) palsy:
Hyper-deviation
Hypertropia on side of trochlear nerve palsy
Excyclo-torsion: Compensated by head tilt to opposite shoulder
Limited depression in adduction
Diplopia- vertical and worse on looking down
Q-126. Most common fungal infection of eye in HIV
a) Aspergillosis
b) Candidiasis
c) Cryptococcus
d) Coccidiosis
Answer: Candidiasis
Explanation:
Candidiasis:
It is an opportunistic infection caused by Candida albicans.
It occurs in immuno-compromised patients, which include patients suffering from AIIDS, malignancies, those receiving long term antibiotics, steroids or cytotoxic drugs.
Important point:
Candida end-ophthalmitis is characterized by areas of severe retinal necrosis associated with vitreo-retinal abscesses. Vitreous exudates present as puff ball or cotton ball colonies, which when joined by exudative strands form string of pearls.
Q-127. Key-hole visual defect is seen in lesions involving
a) Optic chiasma
b) Lateral geniculate body
c) Optic disc
d) Occipital lobe
Answer: Occipital lobe
Explanation:
Lesions of the visual cortex:
Congruous homonymous hemianopia usually sparing macula (Key-hole vision) is a feature of occlusion of posterior cerebral artery supplying the anterior part of occipital cortex.
Congruous homonymous macular defect (Key-hole visual defect) occurs in lesion of the tip off the occipital cortex following head injury or gun-shot injury.
Important point:
Pupillary light reflexes are normal and optic atrophy doesn’t occur following visual cortex lesion.
Q-127. Common ocular manifestation in Trisomy 13 is:
a) Capillary hemangioma
b) Bilateral microphthalmos
c) Neurofibroma
d) Dermoid cyst
Answer: Bilateral microphthalmos
Explanation:
The gross and microscopic eye findings in case of the 13-trisomy syndrome- Severe microphthalmia, coloboma of the ciliary body, cataracts, detached retina, and retinal dysplasia
Q-128. Pt presents with chuna particles fallen into the eye. Which of the followings should be done?
a) Repeated irrigation of conjunctival sac with NS
b) Frequent instillation of Na citrate drops
c) Thorough slit lamp exam
d) Double eversion of lids and removal of chuna particles
Answer: Repeated irrigation of conjunctival sac with NS, Frequent instillation of Na citrate drops and Double eversion of lids and removal of chuna particles
Explanation:
Kids have lost eyesight due to sudden bursting of packets of chuna or calcium hydroxide, an additive used with chewing tobacco, and children are at the risk of “irreversibly” damaging their eyes in families where this habit is prevalent.
Once chuna enters the eye, it sticks into the eye under the eyelid. Even thorough washing doesn’t remove all the particles.
Chuna particles leach from under the eyelid and get into cornea, destroying its outer covering called epithelium.
The tear secretion system gets completely destroyed and the eye becomes dry. It can lead to complete blindness.
Immediate response to such a situation should be vigorous washing of eye with water or with 0.9% saline if available.
After irrigation, the conjunctival fornices should be examined for chemical embedded in the tissue and swept with a swab to remove trapped particles. The superior fornices are exposed by using double eyelid eversion
The incidence of ulceration and perforation in the cornea of alkali-injured eyes is significantly reduced by treatment with tri-sodium citrate or sodium ascorbate. Topical citrate reduces the inflammatory response in the cornea by inhibiting polymorphonuclear leukocytes.
Q-129. True statements regarding diabetic retinopathy
a) Flame shaped hemorrhage
b)Neo-vascularization
c) Hard exudates
d) Exudative macular edema
e) Arterio-venous nipping
Answer: Flame shaped hemorrhage, Neo-vascularization, Hard exudates and Exudative macular edema
Explanation:
Hypertensive retinopathy:
Vasoconstriction
Arteriolar reflex and Arterio-venous nipping
Increased vascular permeability
Diabetic retinopathy:
Non proliferative:
Micro-aneurysm
Retinal hemorrhage
Hard exudates
Retinal edema
Cotton wool spot
Dark Blot hemorrhage
Proliferative Diabetic Retinopathy:
Neo-vascularization
Diabetic maculopathy:
Exudative macular edema
Ischemic maculopathy
Advanced diabetic eye disease:
Persistent vitreous hemorrhage
Tractional retinal detachment
Neo-vascular glaucoma
Q-130. The following are found in higher concentrations in aqueous humor than in plasma:
a) Protein
b) Glucose
c) Ascorbic acid
d) Urea
e) Lactic acid
Answer: Ascorbic acid and Lactic acid
Aqueous humor composition:
The composition of aqueous humor differs from that of plasma.
The greatest differences are the low protein and high ascorbate concentrations in the aqueous relative to plasma.
Lactate is also normally in excess in the aqueous, presumably as a result of glycolytic activity of the lens, cornea, and other ocular structures.
Glucose, urea, and non-protein nitrogen concentrations are slightly less than in plasma.