Ophthalmology MCQ 51-80

  1. On Fundoscopic examination of a patient, a red dot is seen. He has a history of being hit by a tennis ball. What is the probable cause?
    a) Macular hole
    b) Berlin’s edema
    c) Macular tear
    d) Macular bleed

Answer: Berlin’s edema
Explanation:
Berlin’s edema or Commotio retinae:
It is common occurrence following a blow on the eye.
It manifests as milky white cloudiness involving a considerable area of the posterior pole with a cherry red spot in the foveal region.
It may disappear after some days or may be followed by pigmentary changes.

  1. Ocular dendritic cells have
    a) HLA 1
    b) HLA 2
    c) Both
    d) None

Answer: HLA 2
Explanation:
The uveal tract contains rich networks of both resident macrophages and MHC class II dendritic cells.
MHC class II: B cells, Macrophage and dendritic cells

  1. A patient presented with unilateral proptosis which was compressible and increases on bending forward. No thrill or bruit was present. MRI shows a retro-orbital mass with enhancement. The likely diagnosis is
    a) AV malformations
    b) Orbital encephalocoecle
    c) Orbital varix
    d) Neurofibromatosis

Answer: Orbital varix
Explanation:
Orbital varices are a vascular hamartoma typified by a plexus of low pressure, low flow, thin walled and distensible vessels that intermingle with the normal orbital vessels.
If freely communicating with the orbital circulation, engorgement of varices can occur by increasing venous pressure through the Valsalva maneuver, bending posture, coughing or straining and these, in turn, lead to the clinical characteristics of variable proptosis, intermittent pain, and orbital hemorrhage.

  1. A 40 year old male with diabetes presents with vitreous hemorrhage. What is the cause?
    a) Posterior retinal detachment
    b) Neo-vascularization at disc
    c) Central retinal vein occlusion
    d) Trauma to central retinal artery

Answer: Neo-vascularization at disc
Explanation:
Proliferative diabetic retinopathy in diabetics:
It is more common in patients with juvenile onset diabetes.
The hallmark of proliferative diabetic retinopathy is the occurrence of neo-vascularization.
Diabetic vitreous hemorrhage secondary to proliferative diabetic retinopathy is a cause of severe vision loss in diabetic patients.

  1. A young adult presented with diminished vision. On examination he has anterior uveitis, vitritis, focal necrotizing granuloma and macular spot. What is the most probable diagnosis?
    a) Proteus syndrome
    b) White dot syndrome
    c) White dot syndrome
    d) Ocular toxoplasmosis

Answer: Ocular toxoplasmosis
Explanation:
Ocular toxoplasmosis:
Congenital toxoplasmosis:
Convulsion
Chorio-retinitis
Intra-cranial calcification
Important points:
In active stage, the typical lesion is necrotic granulomatous retino-choroiditis involving the macular region.
Typical chorio-retinal lesion of acquired toxoplasmosis is similar to congenital toxoplasmosis.

  1. Bilateral proptosis in children is the most common presentation of
    a) Neurofibromatosis
    b) Chloroma
    c) Cavernous hemangioma
    d) Malignant fibrous histiocytoma

Answer: Chloroma
Explanation:
Granulocytic sarcoma (Chloroma) is a rare solid tumor composed of primitive cells of the myeloid series. Initially it is called Chloroma, because typical forms have a green color caused by high levels of myeloperoxidase in these immature cells.
It may occur in the brain, para-nasal sinuses, skeleton, chest, or abdomen.
It occurs in younger patients with myelogenous leukemia and other myelo-proliferative disorders.
Important point:
Most common presentation of Chloroma in children is proptosis.
Most common cause of bilateral proptosis in children is metastatic neuroblastoma.

  1. Tonometer used for irregular surface of the cornea
    a) Maklakow tonometer
    b) Draeger tonometer
    c) Rebound tonometer
    d) Mackay- Marg tonometer

Answer: Mackay- Marg tonometer
Explanation:
Tonometer used for irregular surface of the cornea: Mackay- Marg tonometer
Tonometry with variation in applanation surface: Maklakow tonometer

  1. Tonometry with variation in applanation surface is
    a) Maklakow tonometer
    b) Draeger tonometer
    c) Rebound tonometer
    d) Mackay-Marg tonometer

Answer: Maklakow tonometer
Explanation:
Tonometer used for irregular surface of the cornea: Mackay- Marg tonometer
Tonometry with variation in applanation surface (Area of applanation): Maklakow tonometer

  1. Ciliary muscles are embryo-logically derived from
    a) Neural ectoderm
    b) Mesoderm
    c) Surface ectoderm
    d) Neural crest

Answer: Neural crest
Explanation:
Ciliary epithelium- Neural ectoderm
Ciliary muscles- Neural crest

  1. Which of the following is the most common complication after lens extraction in persistent hyperplastic primary vitreous?
    a) Retinal detachment
    b) Vitreous hemorrhage
    c) Orbital cellulites
    d) Keratitis

Answer: Retinal detachment
Explanation:
Retinal detachment (Most common) and vitreous hemorrhage are common complication after lens extraction in persistent hyperplastic primary vitreous.
Persistent hyperplastic primary vitreous (PHPV) is a congenital anomaly in which the hyaloid vasculature persists beyond fetal life.

  1. Which of the following protozoan affects the eye?
    a) E. histolytica
    b) E. coli
    c) Giardia lamia
    d) Toxoplasma

Answer: Toxoplasma
Explanation:
Congenital toxoplasmosis:
Convulsion
Chorio-retinitis
Intra-cranial calcification
Important points:
In active stage, the typical lesion is necrotic granulomatous retino-choroiditis involving the macular region.
Typical chorio-retinal lesion of acquired toxoplasmosis is similar to congenital toxoplasmosis.
Important point:
Protozoan Acanthamoeba causes keratitis.

  1. Which of the following not given as eye drops in corneal ulcer?
    a) Fluorometholone
    b) Olopatadine
    c) Methylcellulose
    d) Chloramphenicol

Answer: Fluorometholone
Explanation:
Fluorometholone is corticosteroid.
Corticosteroid is contra-indicated in corneal ulcer.
Important point:
Patient with severe ulcers may benefit from the use of corticosteroids as Adjuvantive therapy.

  1. The combination of fixed and dilated pupil with iris atrophy and secondary glaucoma following penetrating keratoplasty is known as
    a) Benedikt’s syndrome
    b) Posner-Schlossman syndrome
    c) Urrets-Zavalia syndrome
    d) Kaufman syndrome

Answer: Urrets-Zavalia syndrome
Explanation:
Urrets-Zavalia syndrome:
It is characterized by fixed and dilated pupil with iris atrophy and secondary glaucoma following penetrating keratoplasty for kerato-conus.
An acute increase in intraocular pressure and ischemia of the iris most probably play a major role

  1. Which of the following pairs of drugs is correctly matched with its mechanism of action?
    a) Pilocarpine-Increased uveoscleral outflow
    b) Latanoprost- Carbonic anhydrase inhibitor
    c) Brimonidine- Decreased aqueous formation
    d) Betaxolol-Increased trabecular outflow

Answer: Brimonidine- Decreased aqueous formation
Explanation:
Prostaglandins such as Latanoprost:
Increased out flow
Cholinomimetics such as pilocarpine:
Ciliary muscle contraction, opening of trabecular meshwork and increased outflow
Diuretics such as Acetazolamide:
Decreased aqueous secretion due to lack of HCO3-
Beta blockers:
Decreased aqueous secretion from the ciliary epithelium
Alpha2 selective agonist such as Brimonidine:
Decreased aqueous secretion

  1. Salt and pepper retinopathy is observed in all of the following except
    a) Fundus flavimaculatus
    b) Congenital rubella
    c) Thioridazine toxicity
    d) After healing of macular edema

Answer: After healing of macular edema
Explanation:
Salt and pepper retinopathy:
Area of hypo-pigmentation due to atrophic retinal changes (Salt) with pigmentary alterations from pigment migration (Pepper) in large portions of retina
Salt and pepper fundus:
Congenital syphilis and rubella
Drug toxicity: Thioridazine, chloroquine and deferoxamine
Stargardt’s disease or Fundus flavimaculatus
Refsum disease
Kearns Sayre Syndrome
Leber congenital amaurosis

  1. Calcification is seen in all of the following except
    a) PHPV
    b) Retinoblastoma
    c) Choroidal osteoma
    d) Optic nerve head drusen

Answer: PHPV
Explanation:
Calcification is seen in:
Retinoblastoma
Choroidal osteoma
Optic nerve head drusen
Important points:
In adults the most common intra-orbital calcifications occur at the tendinous insertion of the ocular muscles and the optic nerve head, also called ‘optic disc drusen’.
In children, calcifications occur in Retinoblastoma

  1. In a district hospital in India, an ophthalmologist is expected to perform which of the following surgeries most commonly
    a) Trabeculectomy
    b) Phaco-emulsification
    c) Dacryocystectomy
    d) Bilamellar tarsal rotation

Answer: Phaco-emulsification
Explanation:
In a district hospital in India, an ophthalmologist is expected to perform Phaco-emulsification (Cataract) surgeries most commonly.

  1. A 55 yr old diabetic patient present with unilateral transient obscuration for 2-3 days followed by sudden diminution of vision. Which of the following tests would you order?
    a) Serum homo-cysteine level
    b) Serum creatinine level
    c) Serum ACE levels
    d) Quantiferon gold TB test

Answer: Serum homo-cysteine level
Explanation:
Transient obscuration of vision followed by sudden diminution of vision→ Central retinal vascular pathology
Diabetes is risk factor for central retinal vascular occlusion.
Hyper-Homocystinemia has been found an independent risk factor for central retinal vascular occlusion.
The majority of hyperhomocystinemia is caused by low levels of folate and Vitamin B12.

  1. A patient presents with an upper eyelid swelling. Diagnosis of chalazion is made. Histopathology would reveal
    a) Suppurative granulomatous inflammation
    b) Lipo-granulomatous inflammation
    c) Xantho-granulomatous inflammation
    d) Foreign body granulomatous inflammation

Answer: Lipo-granulomatous inflammation
Explanation:
Chalazion is also called a tarsal or meibomian cyst.
It is a chronic non-infective granulomatous inflammation (Lipo-granulomatous inflammation) of meibomian gland.

  1. An infant weighing less than 1000 gm is more likely to develop which of the following complications?
    a) Cataract
    b) Retinopathy of prematurity
    c) Retinal detachment
    d) Glaucoma

Answer: Retinopathy of prematurity
Explanation:
Retinopathy of prematurity (ROP) is abnormal blood vessel development in the retina.
Retinopathy of prematurity is usually confined to those with a birth weight of less than 1.5 kg and/ or a gestational age of 32 weeks.

  1. Most common intraocular metastasis in females is from which of the following primary tumor?
    a) Breast
    b) Ovary
    c) Cervix
    d) Endometrium

Answer: Breast
Explanation:
Most common primary tumor causing intra-ocular metastasis:
Women: Breast cancer
Men: Lung cancer

  1. Ocriplasmin is the newer drug used in which of the following
    a) Retinal break
    b) Vitreo-macular adhesion
    d) Sub-macular bleed
    c) Diabetic macular bleed

Answer: Vitreo-macular adhesion
Explanation:
Ocriplasmin Intravitreal Injection is a proteolytic enzyme indicated for the treatment of symptomatic vitreo-macular adhesion.

  1. The risk of rhegmatogenous retinal detachment is increased in all of the following except?
    a) Hyperopia
    b) Pseudo-phakia
    c) Lattice degeneration
    d) Trauma

Answer: Hyperopia
Explanation:
Rhegmatogenous or primary retinal detachment:
Usually associated with a retinal break through which sub-retinal fluid seep and separate the sensory retina from pigmentary epithelium.
Predisposing factors:
Age
Sex- More common in males
Myopia
Aphakia
Retinal degeneration
Senile posterior vitreous detachment
Trauma

  1. The most common presentation of retinoblastoma is
    a) Leukocoria and Pseudo-hypopyon
    b) Leukocoria and Hyphema
    c) Leukocoria and Strabismus
    d) Leukocoria and Heterochromia iridis

Answer: Leukocoria and Strabismus
Explanation:
Retinoblastoma is caused by retinoblastoma gene (RB), which is a mutation in the long arm of chromosome 13.
Leukocoria (white pupillary reflex or cat’s eye reflex) is the most common presenting sign of retinoblastoma.
Strabismus, which occurs as a result of visual loss, is the second most common mode of presentation.

  1. Which of the following is false regarding acute conjunctivitis?
    a) Pupil is not affected
    b) Vision is not affected
    c) Topical antibiotic is the treatment of choice
    d) Cornea is infiltrated

Answer: Cornea is infiltrated
Explanation:
Acute conjunctivitis:
Acute conjunctivitis can be caused by numerous bacteria, virus or allergens.
Symptoms are hyperemia, lacrimation, irritation, and discharge.
Treatment is with topical antibiotics, augmented by systemic antibiotics in more serious cases.

  1. About degenerative myopia which of the following is true?
    a) Myopic degeneration can lead to retinal detachment
    b) It is more common in men than women
    c) Less than – 6D
    d) Optic disc swelling is seen

Answer: Myopic degeneration can lead to retinal detachment
Explanation:
Pathological/ degenerative/ progressive myopia:
Myopia > -5 D
Eye ball length > 26 mm
Progressive choroidal degeneration
Complications of Pathological/ degenerative/ progressive myopia:
Retinal detachment
Complicated cataract
Vitreous hemorrhage
Choroidal hemorrhage
Strabismus fixus convergence

  1. In which of the following optic atrophy is not seen
    a) Optic neuritis
    b) Methanol poisoning
    c) Retinitis pigmentosa
    d) Central retinal artery occlusion

Answer: Retinitis pigmentosa
Explanation:
Optic nerve is caused by damage to nerve fibres at any point from ganglion cells of retina to lateral geniculate body.
Causes of optic atrophy:
Retinal causes:
Central retinal artery occlusion
Retinitis pigmentosa
Toxic: Quinine and Methyl alcohol
Optic nerve:
Ischemic optic neuropathy
Optic and retro-optic neuropathy
Chronic glaucoma
Papillo-edema, Optic nerve glioma or Meningioma
Toxic: Alcohol
Pernicious anemia
Optic tract:
Pituitary adenoma

  1. Regarding indirect ophthalmoscopy, all are true except
    a) Can be used in hazy medium
    b) The image is real and erect
    c) Convex lens is used
    d) Magnification is 4-5 times

Answer: The image is real and erect
Explanation:
Indirect Ophthalmology:
Essential for the assessment and management of retinal detachment and other peripheral retinal lesions
Convex lens is used.
Image: Rear, inverted and magnified (4-5 times)

  1. Pigment deposited in band shaped kerato-pathy
    a) Iron
    b) Calcium
    c) Melanin
    d) Amyloid

Answer: Calcium
Explanation:
Band keratopathy is characterized by the appearance of a band across the central cornea, formed by the precipitation of calcium salts on the corneal surface.

  1. Intra-ocular solid tumour causing bilateral proptosis in children
    a) Rhabdomyosarcoma
    b) Retinoblastoma
    c) PNET
    d) Neuroblastoma

Answer: Neuroblastoma
Explanation:
Most common presentation of Chloroma in children is proptosis.
Most common cause of bilateral proptosis in children is metastatic neuroblastoma.