- Most common ocular feature in rheumatoid arthritis is
a) Uveitis
b) Ectopic lentis
c) Kerato-conjunctivitis
d) Epi-scleritis
Answer: Kerato-conjunctivitis
Explanation:
Ocular manifestations involved with RA are Kerato-conjunctivitis sicca, episcleritis, scleritis, Keratitis, cranial nerve palsies, geniculo-cortical blindness and retinal vasculitus.
Kerato-conjunctivitis sicca (KCS) is the most common ocular manifestation of RA; it occurs in 15-25% of patients.
- Snow banking is seen in
a) Anterior uveitis
b) Posterior uveitis
c) Intermediate uveitis
d) None
Answer: Intermediate uveitis
Explanation:
Fundus findings in intermediate uveitis (Pars planitis):
Whitish exudates present near the ora serrata in the inferior quadrants.
The typical exudates are referred as snow ball opacities.
These may coalesce to form a grey white plaque called snow banking.
- Argyll Robertson pupil are seen in all except
a) Chronic alcoholism
b) Encephalitis
c) Hypertension
d) Diabetes mellitus
Answer: Hypertension
Explanation:
The Argyll Robertson pupil has been defined as a pupil that is small and constricts poorly to direct light but briskly when a target within reading distance is viewed (“light-near dissociation”). It is caused by a lesion in the region of Tectum.
Causes:
Brain injury
Encephalitis
Neuro-syphilis
Thiamine (Vitamin B1) deficiency
Parinaud syndrome
Tabes dorsalis
A pseudo-Argyll Robertson pupil is a neurological sign indicating a normal near reflex but the absence of a light reflex (light-near dissociation), a lack of miosis, and pupil irregularity.
It has been reported in patients with diabetes mellitus, multiple sclerosis, Wernicke’s encephalopathy, sarcoidosis, tumors, and hemorrhage.
- Bitots spots are seen in
a) Bulbar conjunctiva
b) Palpabral conjunctiva
c) Cornea
d) Eye lid
Answer: Bulbar conjunctiva
Explanation:
Bitot’s spot is extension of xerotic process.
Bitots spot is raised, silvery white, foamy, triangular patch of keratinized epithelium, situated on the bulbar conjunctiva in the inner palpabral area.
It is usually bilateral and temporal and less frequently nasal.
- In a case of anisocoria when 1% pilocarpine is instilled into the eye with abnormally dilated pupil, no response occurs. Cause of anisocoria may be
a) Adie’s pupil
b) Horner’s syndrome
c) Pharmacological blockage
d) Uncal herniation
Answer: Pharmacological blockage
Explanation:
Causes of anisocoria (Unequal pupil sizes):
Horner syndrome and physiologic anisocoria:
Produce normally reactive pupils with anisocoria greater in darkness
Oculomotor nerve palsy:
Poorly reactive and mydriatic compared with the contra-lateral pupil
Tonic pupils:
Respond poorly to light but briskly to a near target, and they maintain this near-induced miosis for a prolonged period (tonic). The classic tonic pupil is the Adie tonic pupil.
The pharmacologically dilated pupil:
Larger than in most other causes of anisocoria
The pupil fails to respond to light stimuli, near stimuli, or 1% pilocarpine solution.
Mechanical iris disruption can also account for such findings and can be distinguished with slit lamp examination.
- Drug used in LUMINATE programme for non infectious uveitis is
a) Voclosporin
b) Methotrexate
c) Infliximab
d) Cyclosporine
Answer: Voclosporin
Explanation:
Voclosporin is a next-generation calcineurin inhibitor. Calcineurin inhibitors are potent immuno-suppressants that reversibly inhibit T-cell proliferation and prevent release of pro-inflammatory cytokines by blocking the activity of the calcium-regulated serine-threonine phosphatase calcineurin, an enzyme found in cell cytoplasm.
A new agent for the treatment of noninfectious uveitis: LUMINATE (Lux Uveitis Multicenter Investigation of a New Approach to Treatment) trials of steroid-sparing voclosporin
If voclosporin proves to be an effective and safer treatment for noninfectious uveitis, inflammation will be controlled, visual acuity will be maintained, and the need to take corticosteroids will be reduced or eliminated.
If the LUMINATE program is successful, voclosporin will become the first steroid-sparing immunosuppressive drug approved by the FDA for the treatment of uveitis.
- Mizuo phenomenon is seen in
a) Fundus Albipunctatus
b) Oguchi’s disease
c) Fundus amaculateus
d) Choroidermia
Answer: Oguchi’s disease
Explanation:
Mizuo–Nakamura phenomenon is a phenomenon observed in Oguchi’s disease.
Oguchi’s disease is characterized by a golden-brown fundus with a yellow-gray ‘metallic’ sheen in the light-adapted state.
After complete dark adaptation, the fundus appears normal, and this disappearance of the shiny, yellow, fundus reflex is called the Mizuo–Nakamura phenomenon.
- Following a RTA on fourth day a person developed proptosis and pain over right eye. On examination there is bruise on the eye and forehead. What may be the diagnosis?
a) Fracture sphenoid
b) Cavernous sinus thrombosis
c) Internal carotid artery aneurysm
d) Carotid cavernous fistula
Answer: Carotid cavernous fistula
Explanation:
Carotid cavernous fistula:
Abnormal communication between the cavernous sinus or dural veins and the carotid arterial system
Presentation days or weeks after head injury:
Proptosis
Conjunctival chemosis
Whooshing noise in head
Ophthalmoplegia in 60-70 % due to ocular motor nerve damage
The 6th nerve damage is most frequently affected because of its free floating location within the cavernous sinus.
Investigation:
CT/ MRI Findings:
Prominence of superior ophthalmic vein and diffuse enlargement of extra-ocular muscles
Choice of investigation→ Selective arterio-graphy of both internal and external carotid arteries
- A patient developed proptosis and diplopia of 2 months duration following injury. On examination there is chemosis conjunctival redness, and external ocular nerve palsy. Investigation of choice is
a) MRI
b) CECT
c) MR angiography
d) Intra arterial digital subtraction angiography
Answer: Intra arterial digital subtraction angiography
Explanation:
See above explanation
- Oculomotor nerve palsy causes all except
a) Miosis
b) Ptosis
c) Outward eye deviation
d) Diplopia
Answer: Miosis
Explanation:
Oculomotor nerve palsy:
Ptosis
Lateral squint
Dilatation of pupil
Loss of accommodation
Slight proptosis
- Most radio-sensitive layer in retina
a) Retinal pigment epithelium
b) Ganglion cell layer
c) Rods and cones
d) Bipolar cells
Answer: Retinal vascular epithelium
Explanation:
All retinal cells are relatively radio-resistant, and the non-replicating neural cells are highly radio-resistant.
The relative radio-sensitivity of the retinal vascular cells seems to be related to the conformation of their nuclear chromatin.
Most radio-resistant cells in retina: Retinal pigment epithelium
Most radio-sensitive cells in retina: Retinal vascular epithelium > Rods
- Percentage of endothelial loss in Descemet’s stripping automated endothelial keratoplasty
a) 5%
b) 10-20%
c) 30-40%
d) 50-60%
Answer: 30-40%
Explanation:
Descemet’s stripping automated endothelial keratoplasty (DSAEK):
DSAEK is a partial thickness cornea transplant procedure that involves selective removal of the patient’s Descemet membrane and endothelium, followed by transplantation of donor corneal endothelium in addition to donor corneal stroma.
The procedure is used to treat corneal edema in the setting of endothelial dystrophies (such as Fuchs corneal dystrophy and posterior polymorphous corneal dystrophy), pseudophakic bullous keratopathy, irido-corneal endothelial (ICE) syndrome, and endothelial failure in the setting of prior intraocular surgery or of a previous PK graft.
A major disadvantage of DSAEK:
24-59 % endothelial cell loss
- A pt present with sudden B/L loss of vision with loss of light perception. The loss is more on right side. Papillary reflex, opto-kinetic nystagmus is present. Pt cannot touch his fingers on closing his right eye. What is diagnosis?
a) Optic neuritis
b) Anterior ischemic optic neuropathy
c) CMV retinitis
d) Functional vision loss
Answer: Functional vision loss
Explanation:
Sudden visual loss rules out CMV retinitis.
Presence of pupillary reflex→ Unimpaired lower visual pathways (Thus rule out optic neuritis and anterior ischemic optic neuropathy)
Negative finger test→ Functional vision loss
Functional Visual Loss is a decrease in visual acuity and/or visual field not caused by any organic lesion. It is therefore also called non-organic visual loss.
The decrease in visual acuity may involve one or both eyes and may vary from mild blurriness to complete blindness.
Functional Visual Loss is commonly associated with concurrent diagnoses of depression, anxiety, panic attacks, and fibromyalgia.
- Most radio-resistant cells in retina
a) Retinal pigment epithelium
b) Ganglion cell layer
c) Rods and cones
d) Bipolar cells
Answer: Retinal pigment epithelium
Explanation:
All retinal cells are relatively radio-resistant, and the non-replicating neural cells are highly radio-resistant.
The relative radio-sensitivity of the retinal vascular cells seems to be related to the conformation of their nuclear chromatin.
Most radio-resistant cells in retina: Retinal pigment epithelium
Most radio-sensitive cells in retina: Retinal vascular epithelium > Rods
- In Herpes Zoster Keratitis all occurs except
a) Pseudo-dendritic keratitis
b) Anterior endothelial keratitis/uveitis
c) Sclero-keratitis
d) Endothelitis
Answer: Sclero-keratitis
Explanation:
Herpes Zoster Keratitis:
Pseudo-dendritic
Kerato-uveitis and Endothelitis
Anterior endothelial keratitis
Punctate epithelial keratitis
Disciform keratitis
Episcleritis and scleritis
Iridocyclitis
Important point:
Sclero-keratitis is the least common type of ocular involvement in Herpes Zoster Keratitis.
- Corneal dystrophies are usually
a) Primarily unilateral
b) Primarily bilateral
c) Primarily unilateral without systemic disease
d) Primarily bilateral with systemic disease
Answer: Primarily bilateral
Explanation:
Corneal dystrophies:
Inherited disorder and restricted to the cornea
Non inflammatory
Not associated with systemic diseases
Bilateral and manifested occasionally at birth but more usually first or second decade
- Weakness of both adduction and abduction is seen in
a) Duane’s retraction syndrome type 1
b) Duane’s retraction syndrome type 2
c) Duane’s retraction syndrome Type 3
d) All
Answer: Duane’s retraction syndrome Type 3
Explanation:
Duane’s retraction syndrome is a rare, congenital disorder of eye movement.
Duane’s retraction syndrome type 1: Most common type
Abduction is limited, but adduction is normal or nearly so.
Duane’s retraction syndrome type 2:
Adduction of the affected eye is limited, whereas abduction of the eye is normal or only slightly limited.
Duane’s retraction syndrome type 3:
Adduction and abduction of the affected eye is limited.
- Area of fundus seen with direct ophthalmoscope is
a) 1 DD
b) 2 DD
c) 3 DD
d) 4 DD
Answer: 2 DD
Explanation:
Direct ophthalmoscope:
Most common practised method for routine fundus examination
Image is erect, virtual and 15 times magnified in emmetropes (More in myopes and less in hypermetropes)
Area of field: 2 Disc Dioptres
- Gyrate atrophy patient with defective ornithine amino-transferase will be benefited by
a) Ornithine free diet
b) Arginine free diet
c) Pyridoxine and Vit B12
d) Vitamin B1 B6 and B12
Answer: Arginine free diet
Explanation:
Gyrate atrophy, a recessive eye disease involving progressive vision loss due to chorio-retinal degeneration, is associated with the deficiency of the mitochondrial enzyme ornithine amino-transferase with consequent hyperornithinemia.
Ornithine is mainly produced from arginine.
Near total elimination of arginine with supplementation of essential amino acids has been found to be beneficial in gyrate dystrophy.
- In patients with anterior uveitis, decrease in vision due to posterior segment involvement can occur because of
a) Visual floaters
b) Inflammatory disc edema
c) Exudative retinal detachment
d) CME
Answer: CME
Explanation:
Cystoid macular edema:
Cystoid macular edema refers to collection of fluid in outer plexiform and inner nuclear layer of retina, central around the foveola.
It occurs in a variety of pathological conditions such as intraocular inflammation (uveitis, Behcet’s), central or branch retinal vein occlusion, diabetic retinopathy and most commonly following cataract extraction.
Clinical features:
Visual loss
Ophthalmoscopy: Honey comb appearance
Fundus flourscein angiography: Flower petal appearance