NEET-PG 2013 - Ophthalmology Practice Questions

Q: Foldable lens is made up of?

Silicone. ***Silicone*** - **Silicone** was one of the **first materials** used for foldable intraocular lenses (IOLs) and remains widely used today. - Its excellent **elastomeric properties** allow the lens to be folded or rolled for insertion through a **small incision** (typically 2.8-3.2 mm) in modern cataract surgery. - Silicone IOLs are **hydrophobic** and have high biocompatibility with minimal inflammatory response. - **Clinical advantage**: Silicone's flexibility enables **sutureless small-incision cataract surgery**, reducing astigmatism and recovery time. *PMMA* - **PMMA (Polymethyl methacrylate)** is a **rigid material** and was the standard for IOLs before the development of foldable lenses. - Its rigidity requires a **large incision** (5.5-7 mm) for insertion, resulting in more induced astigmatism and longer recovery. - PMMA is not foldable and therefore is not used in modern small-incision cataract surgery. *Hydrogel* - **Hydrophilic acrylic (hydrogel)** is actually another material used for foldable IOLs, along with hydrophobic acrylic. - However, in the context of this question, **silicone** is the most recognized answer as it was the **first foldable material** introduced. - Hydrogel IOLs can absorb water and require different handling during insertion. *None of the options* - This is incorrect as **silicone** is definitively a material used for foldable IOLs.

Q: In senile nuclear cataract what type of myopia is seen?

Index myopia. **Index myopia** - **Senile nuclear cataract** involves opacification and hardening of the lens nucleus, which increases the **refractive index** of the lens. - This results in a stronger refractive power of the eye, causing light to focus in front of the retina, characteristic of **myopia**. *Curvature myopia* - Occurs when there is an increase in the **curvature of the cornea** or lens, leading to increased refractive power. - While lens curvature can change, the primary mechanism in nuclear cataracts is refractive index change, not solely curvature. *Axial myopia* - Arises from an **elongation of the eyeball**, making the axial length too long relative to the refractive power. - This is a structural change in the eye's shape, not directly caused by changes within the lens itself due to cataract. *Lenticular myopia* - This term is a broader category that refers to myopia caused by changes in the lens, which **index myopia** falls under. - However, "index myopia" is more specific and accurately describes the underlying mechanism in senile nuclear cataracts.

Q: Which of the following conditions is associated with ectopia lentis?

Homocystinuria. ***Homocystinuria*** - **Ectopia lentis** (lens dislocation) is a common and characteristic ocular manifestation of homocystinuria. - The lens typically dislocates **downward and inward**, differentiating it from Marfan syndrome. *Alport syndrome* - Characterized by **glomerulonephritis**, **sensorineural hearing loss**, and ocular abnormalities. - Ocular manifestations include **anterior lenticonus** (which can be mistaken for ectopia lentis in some descriptions), posterior polymorphous corneal dystrophy, and retinal flecks, but not classic ectopia lentis. *Lowe syndrome* - Also known as oculocerebrorenal syndrome of Lowe, it primarily affects the **eyes, brain, and kidneys**. - Ocular features include **congenital cataracts** and glaucoma, but not ectopia lentis. *Sulphite oxidase deficiency* - This is a rare metabolic disorder affecting the metabolism of sulfur-containing amino acids, leading to severe neurological symptoms. - While it can manifest with **cataracts** and **lens subluxation** in some cases, ectopia lentis is more characteristically associated with homocystinuria, and the overall clinical picture of sulphite oxidase deficiency is dominated by severe neurological impairment.

Q: Polyopia/diplopia is seen in which type of cataract?

Cortical cataract. ***Cortical cataract*** - **Cortical cataracts** cause spokes or vacuoles that refract light in multiple directions, leading to **polyopia** or **diplopia**. - The irregular opacities disrupt the light path, causing the brain to perceive **multiple images**. *Nuclear cataract* - **Nuclear cataracts** primarily affect central vision and cause **myopic shift**, not typically polyopia or diplopia. - They cause **blurry vision** and difficulty seeing in dim light as the lens nucleus hardens and yellows. *Posterior subcapsular cataract* - **Posterior subcapsular cataracts** are characterized by glare and difficulty with reading, mainly affecting near vision. - They form at the back of the lens, close to the nodal point, causing earlier onset of **visual symptoms** with less impact on polyopia. *Anterior polar cataract* - **Anterior polar cataracts** are usually small, well-demarcated opacities at the front of the lens that typically do not cause significant visual impairment. - They rarely cause **polyopia** unless they are very large or dense, which is uncommon.

Q: "Bread-crumb" appearance is seen in ?

Complicated cataracts. ***Complicated cataracts*** - A "bread-crumb" appearance, specifically referring to small, refractile opacities in the posterior capsule, is a characteristic finding in **complicated cataracts**. - These cataracts often develop due to chronic intraocular diseases such as **uveitis**, **retinal detachment**, or **intraocular tumors**, leading to secondary lens changes. *Cataract due to diabetes* - Diabetic cataracts typically present as "snowflake" opacities in younger patients or accelerated nuclear/cortical sclerosis in older patients, not a "bread-crumb" appearance. - They are often associated with poor glycemic control and metabolic changes affecting lens hydration and protein structure. *Cataract due to CMV infection* - Cataracts associated with **cytomegalovirus (CMV) infection** are more common in congenital infections and can manifest as varying degrees of lens opacification, but "bread-crumb" is not a typical description. - Congenital CMV can cause a spectrum of ocular abnormalities, including microphthalmia, chorioretinitis, and optic atrophy, in addition to cataracts. *Cataract due to Toxoplasmosis* - **Toxoplasmosis** primarily causes **chorioretinitis**, especially in congenital cases, with lens involvement being less common and not typically described as having a "bread-crumb" appearance. - If a cataract develops, it's usually secondary to inflammation or direct lens invasion, but the characteristic morphology differs.

Q: Elschnig's pearls are a clinical sign of which condition?

Secondary cataract. ***Secondary cataract*** - **Elschnig's pearls** are bladder-like cells formed by **proliferation of residual equatorial lens epithelial cells** following extracapsular cataract extraction (ECCE) or phacoemulsification - They migrate posteriorly along the posterior capsule, contributing to **posterior capsular opacification (PCO)** - PCO is commonly called **"secondary cataract"** or **"after-cataract"** and is the most common complication of cataract surgery - Presents with **gradual visual decline** months to years after initially successful cataract surgery - Treated with **Nd:YAG laser capsulotomy** *Chronic uveitis* - While chronic uveitis causes various ocular complications (**synechiae**, **band keratopathy**, **cataract formation**, **macular edema**), **Elschnig's pearls are not a sign of uveitis** - They are specifically a **post-surgical complication** of cataract extraction, not an inflammatory finding - Uveitis patients may develop cataracts requiring surgery, which could subsequently lead to Elschnig's pearls, but this is an indirect relationship *Cystoid macular oedema* - **CME** involves fluid accumulation in the macula forming **cyst-like spaces**, causing decreased central vision - Can occur after cataract surgery (Irvine-Gass syndrome) or with uveitis - Has **completely different pathophysiology and clinical appearance** from Elschnig's pearls - CME affects the **retina**, while Elschnig's pearls involve the **lens capsule** *None of the options* - Incorrect because **secondary cataract (PCO)** is the established correct answer for Elschnig's pearls

Q: Commotio retinae affects which part of the retina -

Posterior pole. ***Posterior pole*** - **Commotio retinae**, also known as Berlin's edema, primarily affects the **posterior pole** of the retina, particularly the macula. - This condition results from **blunt trauma** to the globe, causing disruption of the outer retinal photoreceptors and retinal pigment epithelium, leading to retinal whitening in the area of impact. *Peripheral retina* - While blunt trauma can affect the peripheral retina, commotio retinae specifically refers to the **edematous whitening** that occurs more centrally. - Trauma to the periphery is more commonly associated with **retinal tears or detachments**, rather than the diffuse whitening seen in commotio retinae. *Inferior-nasal part* - This is a specific quadrant of the retina, but commotio retinae is not confined to or preferentially found in the **inferior-nasal part**. - The location of commotio retinae depends on the **point of impact** and the transmission of force, but symptoms are most prominent when the macula at the posterior pole is involved. *Superior-nasal part* - Similar to the inferior-nasal part, the **superior-nasal part** is a specific retinal quadrant. - Commotio retinae is a more generalized finding of retinal edema and whitening due to trauma, not consistently localized to this particular region, though it can occur if that area is directly impacted.

Q: Epithelial xerosis of conjunctiva is caused by?

Xerophthalmia. ***Xerophthalmia*** - **Xerophthalmia** is a medical condition characterized by **dryness of the eye**, often due to **vitamin A deficiency**. - **Epithelial xerosis of the conjunctiva** is one of the early and hallmark signs of xerophthalmia, representing the drying and thickening of the conjunctival epithelium due to goblet cell loss and squamous metaplasia. *Infectious conjunctivitis caused by Chlamydia trachomatis* - This typically causes **trachoma**, characterized by chronic inflammation, scarring, and eventual blindness. - While it can lead to dryness and scarring in later stages due to **symblepharon** or **entropion**, it does not primarily manifest as epithelial xerosis. *Autoimmune blistering conjunctivitis* - This condition involves **immune-mediated inflammation** leading to subepithelial blistering, scarring, and shrinkage of the conjunctiva. - It results in significant **ocular surface damage** and vision loss but is distinct from the primary epithelial changes seen in xerosis due to vitamin A deficiency. *Bacterial conjunctivitis due to Corynebacterium diphtheriae* - **Diphtheritic conjunctivitis** is a severe form of bacterial conjunctivitis that causes a distinctive **"pseudomembrane"** on the conjunctiva. - It leads to acute inflammation and potentially systemic illness, not primarily epithelial xerosis.

Q: Stocker's line is seen in?

Pterygium. **Pterygium** - **Stocker's line** is a **ferrous deposit** that appears as a brown or yellow line at the leading edge of a **pterygium**. - Its presence signifies the progressive nature of the pterygium, indicating ongoing iron deposition due to chronic epithelial degeneration and remodeling. *Glaucoma* - Glaucoma is characterized by **optic nerve damage** and **visual field loss**, usually associated with elevated intraocular pressure. - It does not involve the formation of Stocker's line, which is a corneal or conjunctival finding. *Posterior scleritis* - Posterior scleritis is an **inflammation of the sclera** behind the equator of the globe, often presenting with pain, vision loss, or choroidal folds. - It does not involve the characteristic Stocker's line, which is specific to pterygium. *Diabetic retinopathy* - Diabetic retinopathy involves **microvascular damage** to the retina, leading to vision loss, and is characterized by microaneurysms, hemorrhages, and neovascularization. - It is a retinal disease and does not present with Stocker's line.

Question 1

Foldable lens is made up of?

Accepted Answer

Silicone

Answer

PMMA

Answer

Hydrogel

Answer

None of the options

Question 2

In senile nuclear cataract what type of myopia is seen?

Accepted Answer

Index myopia

Answer

Curvature myopia

Answer

Axial myopia

Answer

Lenticular myopia

Question 3

Which of the following conditions is associated with ectopia lentis?

Accepted Answer

Homocystinuria

Answer

Alport syndrome

Answer

Lowe syndrome

Answer

Sulphite oxidase deficiency

Question 4

Polyopia/diplopia is seen in which type of cataract?

Accepted Answer

Cortical cataract

Answer

Nuclear cataract

Answer

Posterior subcapsular cataract

Answer

Anterior polar cataract

Question 5

"Bread-crumb" appearance is seen in ?

Accepted Answer

Complicated cataracts

Answer

Cataract due to CMV infection

Answer

Cataract due to diabetes

Answer

Cataract due to Toxoplasmosis

Question 6

Elschnig's pearls are a clinical sign of which condition?

Accepted Answer

Secondary cataract

Answer

Chronic uveitis

Answer

Cystoid macular oedema

Answer

None of the options

Question 7

Commotio retinae affects which part of the retina -

Accepted Answer

Posterior pole

Answer

Peripheral retina

Answer

Inferior-nasal part

Answer

Superior-nasal part

Question 8

All statements are true about trachoma except:

Accepted Answer

Marked papillary hyperplasia with limbal follicles are seen in stage III

Answer

Strains mainly responsible are A, B, Ba and C

Answer

Trachoma is caused by bedsonian organism of psittacosis - lymphogranuloma - trachoma (PLT) group.

Answer

Corneal ulceration is a complication

Question 9

Epithelial xerosis of conjunctiva is caused by?

Accepted Answer

Xerophthalmia

Answer

Infectious conjunctivitis caused by Chlamydia trachomatis

Answer

Autoimmune blistering conjunctivitis

Answer

Bacterial conjunctivitis due to Corynebacterium diphtheriae

Question 10

Stocker's line is seen in?

Accepted Answer

Pterygium

Answer

Glaucoma

Answer

Posterior scleritis

Answer

Diabetic retinopathy

NEET-PG 2013 — Ophthalmology