INI-CET 2026 - Ophthalmology PYQs Practice Questions

Q: A patient has sudden painful loss of vision with RAPD but a normal-appearing optic disc on fundoscopy. What is the diagnosis?

Retrobulbar neuritis. ***Retrobulbar neuritis*** - This condition presents with **acute, painful loss of vision** and an **afferent pupillary defect (RAPD)**, while the fundoscopic exam appears normal initially because the inflammation is located behind the optic nerve head. - It is a common manifestation of **multiple sclerosis** and requires careful neurologic evaluation for demyelinating disease. *AION* - Anterior Ischemic Optic Neuropathy typically presents with **painless** loss of vision. - Fundoscopy reveals an **edematous, swollen optic disc** (or disc at risk), unlike the normal-appearing disc found in retrobulbar neuritis. *Central retinal artery occlusion* - This condition presents with **painless**, sudden vision loss and a characteristic **cherry-red spot** on the macula. - Fundoscopy typically shows a **pale retina** due to ischemia rather than a normal-appearing optic nerve head. *Papilledema* - This presents with bilateral optic disc swelling due to **raised intracranial pressure**, usually without acute, sudden loss of vision. - Visual acuity is generally **preserved** in the early stages, unlike the significant loss seen in optic neuritis. [Practice more Ophthalmology PYQs on OnCourse]

Q: What is the expected amplitude of accommodation in a healthy child?

14D. ***14D*** - In a healthy child, the **amplitude of accommodation** is approximately **14 diopters (D)**, reflecting the high elasticity of the **crystalline lens**. - As individuals age, this amplitude gradually decreases due to **presbyopia**, which is related to the loss of lens flexibility. *2D* - An amplitude of **2D** is typically seen in individuals around the age of **50 to 55 years**. - This level suggests significant **presbyopia**, requiring reading aids for near vision. *5D* - An amplitude of **5D** is generally expected in adults around the age of **40 years**. - This indicates the early stages of **presbyopia** where near vision task efficiency begins to decline. *25D* - An amplitude of **25D** is physiologically implausible for the human eye, as the maximum accommodation in an infant is typically around **16-18D**. - Such a high value would far exceed the known anatomical and optical limits of the **accommodation reflex**. [Practice more Ophthalmology PYQs on OnCourse]

Q: Images show café-au-lait spots, Lisch nodules on the iris, and swelling near the eye. Identify the most likely syndrome:

NF-1. ### ***NF-1 (Neurofibromatosis type 1)*** - The combination of **café-au-lait macules** and **Lisch nodules** (iris hamartomas) represents classic pathognomonic clinical features of **Neurofibromatosis type 1**. - The swelling near the eye likely represents a **plexiform neurofibroma**, which is a highly characteristic, often congenital manifestation of this condition involving peripheral nerves. *Tuberous sclerosis* - Commonly presents with **ash-leaf spots** (hypopigmented macules) rather than hyperpigmented café-au-lait spots, and **angiofibromas** on the face. - Ocular findings typically include **retinal astrocytic hamartomas** rather than iris Lisch nodules, emphasizing a key diagnostic distinction. *Sturge-Weber syndrome* - Characterized by the **port-wine stain** (nevus flammeus) in the distribution of the **trigeminal nerve** on the face, not cafe-au-lait spots. - Ocular involvement usually manifests as **glaucoma** or choroidal hemangioma, distinguishing it from the neurofibromas seen in NF-1. *Von Hippel-Lindau disease* - Known for the development of **retinal capillary hemangioblastomas**, not iris Lisch nodules or neurofibromas. - Systemic associations primarily involve **hemangioblastomas** of the CNS and **renal cell carcinoma**, unlike the dermal and iris signs listed. [Practice more Ophthalmology PYQs on OnCourse]

Q: Which of the following correctly describes the changes that take place during dark adaptation? A) Retinol is converted to vitamin D B) Dilated pupils C) Eyes sensitive to light D) Functional rhodopsin is formed (Opsin binds with 11-cis-retinal)

D only. ***D only*** - During dark adaptation, the regeneration of photopigments, specifically **rhodopsin**, is the critical chemical event required for scotopic (low-light) vision. - This process involves the binding of **11-cis-retinal** back to **opsin** to restore the functional photopigment after it has been bleached by light exposure. *A and B* - While **pupil dilation** (mydriasis) does occur in the dark to allow more light into the eye, the conversion of **retinol** to **vitamin D** is a metabolic process unrelated to the physiology of dark adaptation. - Vitamin A (retinol) is essential for the visual cycle, but it is not converted to vitamin D during this process. *B only* - Although **pupil dilation** is a component of the eye's adjustment to low light conditions, it is not the only physiological change involved. - Focusing solely on pupil dilation ignores the more important biochemical synthesis of **rhodopsin** and the resultant increase in retinal sensitivity. *B, C and D* - While pupil dilation (B), increased sensitivity to light (C), and rhodopsin regeneration (D) all occur during dark adaptation, the framing of the question requires identifying the primary mechanism, and D is the most specific biochemical requirement. - In many educational contexts regarding the *photochemistry* of dark adaptation, the regeneration of rhodopsin is the definitive step, whereas dilation is a reflex adjustment. [Practice more Ophthalmology PYQs on OnCourse]

Q: Which of the following structures is NOT part of the trabecular outflow pathway?

Uveoscleral pathway. ***Uveoscleral pathway*** - This is an **alternative aqueous humor drainage route** that bypasses the trabecular meshwork entirely. - It drains fluid through the **suprachoroidal space** and is therefore distinct from the conventional trabecular outflow pathway. *Trabecular meshwork* - This is the **primary site** of aqueous humor drainage in the conventional pathway located at the **iridocorneal angle**. - It acts as a filter through which aqueous humor must pass to reach the collector channels. *Schlemm's canal* - This circular channel collects aqueous humor after it has passed through the **trabecular meshwork**. - It serves as a vital component of the **conventional outflow system**, transporting fluid to the episcleral veins. *Collector vessels* - These vessels drain aqueous humor from **Schlemm's canal** into the episcleral venous plexus. - They are integral components that facilitate the final stage of the **trabecular outflow pathway**. [Practice more Ophthalmology PYQs on OnCourse]

Question 1

A patient has sudden painful loss of vision with RAPD but a normal-appearing optic disc on
fundoscopy. What is the diagnosis?

Accepted Answer

Retrobulbar neuritis

Answer

AION

Answer

Central retinal artery occlusion

Answer

Papilledema

Question 2

What is the expected amplitude of accommodation in a healthy child?

Accepted Answer

14D

Answer

2D

Answer

5D

Answer

25D

Question 3

Images show café-au-lait spots, Lisch nodules on the iris, and swelling near the eye. Identify the
most likely syndrome:

Accepted Answer

NF-1

Answer

Tuberous sclerosis

Answer

Sturge-Weber syndrome

Answer

Von Hippel-Lindau disease

Question 4

Which of the following correctly describes the changes that take place during dark adaptation?
A) Retinol is converted to vitamin D
B) Dilated pupils
C) Eyes sensitive to light
D) Functional rhodopsin is formed (Opsin binds with 11-cis-retinal)

Accepted Answer

D only

Answer

A and B

Answer

B only

Answer

B, C and D

Question 5

Which of the following structures is NOT part of the trabecular outflow pathway?

Accepted Answer

Uveoscleral pathway

Answer

Schlemm's canal

Answer

Collector vessels

Answer

Trabecular meshwork

Question 6

Which features help distinguish central nystagmus from peripheral nystagmus?

Accepted Answer

All of the above

Answer

Direction and duration

Answer

Latency

Answer

Fatigue

INI-CET 2026 — Ophthalmology