AIIMS/ NEET-PG 2017 Ophthalmology MCQs 21-30

Q-21. Persistent primary hyperplastic vitreous (PPHV) is associated with
a) Patau syndrome
b) Edward syndrome
c) Trisomy 14
d) Down syndrome

Answer: Patau syndrome
Explanation:
Persistent hyperplastic primary vitreous (PHPV) is a rare congenital developmental anomaly of the eye that results following failure of the embryological, primary vitreous and hyaloid vasculature to regress.
Persistent primary hyperplastic vitreous (PPHV) is associated with
Trisomy 13 (Patau syndrome)
Norrie disease
Walker-Warburg syndrome

Q-22. Increased LDH in aqueous humor suggested a diagnosis of
a) Gyrate atrophy
b) Glaucoma
c) Retinoblastoma
d) Galactosemia

Answer: Retinoblastoma
Explanation:
Lactate dehydrogenase (LDH) is a glycolytic enzyme that uses glucose as an energy source.
It is present in high concentrations within metabolically active cells.
Normally, its concentration in serum and aqueous humor is low and the ratio of aqueous humor to serum LDH is less than 1.0 in patients with ocular disease other than retinoblastoma.
However, aqueous humor for eyes with retinoblastoma exhibits increased LDH activity expressed as an aqueous humor/LDH ratio of greater than 1.0.

Q-23. Arden index is related to
a) ERG (Electroretinogram)
b) EOG (Electrooculogram)
c) VER (Visual evoked response)
d) Perimetry

Answer: EOG (Electrooculogram)
Explanation:
Electro-oculography (EOG) is a technique for measuring the corneo-retinal standing potential that exists between the front and the back of the human eye. The resulting signal is called the electro-oculogram.
The EOG consists of two potentials: the standing potential (resting potential, dark phase) which is evoked by moving the eyes in the dark and originates from the retinal pigment epithelium and the light potential (light rise) which is evoked by moving the eyes in a lighted environment and originates from the photoreceptors. Clinically, the ratio between the light and dark potentials (sometimes also called the Arden index or Arden ratio) is assessed.
If that ratio is less than 1.8 it indicates a malfunction of the structures from which the potential originates.
The EOG is also used to monitor eye movements.

Q-24. The most common mode of spread of Retinoblastoma is
a) Optic nerve
b) Trans-scleral
c) Lymphatogenous
d) Hematogenous

Answer: Optic nerve
Explanation:
The most common mode of spread of Retinoblastoma is by direct invasion of optic nerve with extension into the central nervous system.

Q- 25. Most common complication of hyper-mature sclerotic cataract is
a) Dislocation of lens
b) Phakomorphic glaucoma
c) Uveitis
d) Neo-vascularization of retina

Answer: Dislocation of lens
Explanation:
Types of hyper-mature cataract:
Hyper-mature shrunken cataract-
When cortex disintegrates and transform into pultaceous mass. The lens become inspissated and shrunken, the anterior capsule becomes thickened.
Anterior chamber is deep in cases of hyper-mature (shrunken) cataract.
Tremulousness of iris in cases of hyper-mature shrunken cataract
Associated degeneration of the zonules may lead to dislocation of lens which can produce iridocyclitis.
Morgagnian Hyper-mature Cataract:
Following maturity, sometimes cortex becomes fluid and nucleus sinks into the bottom.
The liquefied cortex become milky and nucleus is seen as brown mass, visible as semicircular line in pupillary area altering its position with change in position of the head.

Q-26. What is the most common eye manifestation of allergy to tubercular bacilli?
a) Koeppe’s nodules
b) Posterior scleritis
c) Phlyctenular conjunctivitis
d) Optic neuritis

Answer: Koeppe’s nodules
Explanation:
Koeppe’s nodules are small nodules seen at the inner margin of the iris in patients with chronic granulomatous anterior uveitis, which occurs in conditions such as tuberculosis and sarcoidosis.
The nodules are composed of epithelioid cells and giant cells surrounded by lymphocytes.
The most common eye manifestation of allergy to tubercular bacilli is Koeppe’s nodule.
Most common etiology phlyctenular conjunctivitis is tuberculosis.

Q-27. Horner’s syndrome consists of
a) Miosis and enophthalmos
b) Miosis and exophthalmos
c) Miosis and proptosis
d) Miosis and ptosis

Answer: Miosis and ptosis
Explanation:
Horner syndrome results from an interruption of the sympathetic nerve supply to the eye and is characterized by the classic triad of miosis, partial ptosis, and anhidrosis.
Iris hetero-chromia (hetero-chromia iridis) – The affected iris may remain blue when the other iris changes to brown; this may be present if the lesion is in a child younger than 2 years but is uncommon in older patients.
Iris pigmentation is under sympathetic control during development, which is completed by the age of 2 years
Signs: Miosis, partial ptosis, anhidrosis, enophthalmos, loss of ciliospinal reflex and bloodshot conjunctiva

Q-28. Which morphological type of cataract is most visually handicapping?
a) Cortical
b) Nuclear
c) Posterior sub-scapular
d) Zonular

Answer: Posterior sub-scapular
Explanation:
A posterior polar cataract is a round, discoid, opaque mass that is composed of malformed and distorted lens fibers located in the central posterior sub-capsular area of the lens; right in the path of light on its way to the retina.
This location is its most significant feature, in addition to its proximity to and possible adherence with the posterior capsule.
Posterior polar cataract removal is a challenge to the surgeon because of its adherence to or the associated weakness of the posterior capsule.
Posterior polar cataract surgery is associated with an increased incidence of rupture of the posterior capsule.
A posterior sub-capsular cataract often interferes with reading vision, reduces vision in bright light, and causes glare or halos around lights at night and maximum visual impairment as it lies closer to the nodal point of eye.

Q-29. 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-30. All of the following conditions are contraindicated or likely to worsen in a case of primary open angle glaucoma, when treated with timolol maleate 0.5% eye drops, except:
a) Hypertension
b) Hypercholesterolemia
c) Depression
d) Bronchial asthma

Answer: Hypertension
Explanation:
Contra-indication of Timolol
Cardiogenic shock
Heart block
Cardiac insufficiency
Obstructive airway disease
Adverse affects:
Alters lipid profile
Worsens peripheral vascular disease
Causes CNS side effects like depression, anxiety, confusion, drowsiness and disorientation