Ophthalmology MCQs with Answers
1. Atropine eyedrop is contraindicated in
a. Acute iridocyclitis
b. Acute congestive glaucoma
c. Corneal ulcer
d. Malignant glaucoma
2. Differential diagnosis of arcuate scotoma
a. Myopic degeneration
c. Retrobulbar neuritis
d. All of the above
3. Age-related macular degeneration (ARMD) is responsible for which type of visual field defect?
c. Bitemporal hemianopia
d. Binasal hemianopia
4. Risk factors for primary open-angle glaucoma are all except
a. Family history of glaucoma
b. High myopia
d. Young age
5. The most visually disabling type of cataract is
a. Cortical cataract
b. Nuclear cataract
c. Posterior sub capsular cataract
d. Anterior capsular cataract
6. Proliferative diabetic retinopathy is characterized by
b. Cotton wool spots
7. At birth eye is usually:
8. The fastest acting cycloplegic drug is:
9. Lattice degeneration is seen in:
10. Aqueous cells will be graded as +++ if the number of cells in AC is
b. 16- 25
11. Clinically Significant Macular Edema includes
a. Macular edema within 500 microns of foveola
b. hard exudates within 500 microns of foveola
c. neovascularization in fovea
d. both a & b
12. Doughnut shaped scotoma ia a finding of
a. Primary Open Angle Glaucoma
b. Central Serous Chorioretinopathy
c. Retinitis Pigmentosa
13. Color haloes is the symptom of
a. Mucopurulent conjunctivitis
14. Synonym of zonular cataract
a. Senile cataract
b. Lamellar cataract
c. Sub-capsular cataract
d. Soft cataract
15. The theory that in accommodation the ciliary muscle contracts, relaxing the tension of the zonule of zinn
a. Young-Helmholtz theory
b. Percival’s theory
c. Sheard’s theory
d. young’s experiment
16. In the log MAR chart, if a patient misses two letters of 0.8 line, the VA will be
17. Swimming pool conjunctivitis is caused by:
a. Chlamydia Trachomatis
b. Adenovirus type 8
c. Picorna virus
18. Viral infections usually cause:
b. Kerato conjunctivitis
19. The earliest symptom to occur in corneal ulcer is:
c. Loss of sensation
d. Diminished vision
20. Munson’s sign is seen in:
21. Safe Strategy includes all of the following except
c) Face washing
d) Environmental Improvement
22. True about Trachoma is:
a) Is a disease of high infectivity
b) Prevalence of severe and moderate trachoma in >1% in children less than 10 years is indicated for mass treatment
c) Irritant like kajal also predispose
d) It is the non-avoidable cause of blindness.
23. In the grading of Trachoma, Trachomatous Inflammation-follicular is defined as the presence of:
a) Five or more follicles in the lower tarsal conjunctiva
b) Three or more follicles in the lower tarsal conjunctiva
c) Five or more follicles in the upper tarsal conjunctiva
d) Three or more follicles in the upper tarsal conjunctiva
24. Mass Treatment of trachoma is undertaken, when the prevalence is more than
25. Single drug treatment recommended for Trachoma control is
26. First Clinical Sign of Vitamin A Deficiency is
a) Night Blindness
b) Conjunctival Xerosis
c) Bitot’s Spot
27) Daily requirement of Vitamin-A by an adult man is
a) 350 mcg
b) 100 mcg
c) 600 mcg
d) 2000 mcg
28) No. of doses for treatment of Vitamin A deficiency is
29) The most common cause of blindness in Nepal is
30) WHO defines blindness if the visual acuity is less than
31) All of the following can be seen with ocular adenoviral infection except:
a) Preauricular lymphadenopathy
b) large central geographic corneal erosions
c) Multifocal subepithelial infiltrates.
d) Enlarged corneal nerves
32) All of these diagnostic tests are useful in evaluating a patient with a retained magnetic intraocular foreign body except:
a) indirect ophthalmoscopy
b) computed tomography
d) magnetic resonance imaging (MRI)
33) Which of the rectus muscles inserts the closes to the limbus?
a) lateral rectus
b) medial rectus
c) superior rectus
d) inferior rectus
34) Tylosis refers to :
a) loss of lashes
b) misdirection of lashes
c) blocked meibomian orifices
d) hypertrophied drooping lid
35) Retinoscopy is?
a) visualization of retina alone
b) visualization of retina and all other posterior segment contents
c) objective measurement of the refractive error of the patient
d) subjective measurement of the refractive error of the patient
36) Substance deposited in Band Shaped Keratopathy is?
a) calcium phosphate
b) magnesium phosphate
c) magnesium sulphate
37) Which is NOT a feature of 3rd Nerve palsy?
d) Outwards Deviation of eye
38) T dot sign in fluorescent angiography is seen in
a) Progressive macular oedema
c) Arteriovenous shunt
39) Fluorescein staining would be most useful in
a) Bullous keratopathy
b) Stromal dystrophies
c) Corneal neovascularization
d) Contact lens fitting
40) In fluorescein angiography dye is injected into
a) Ophthalmic artery
b) Retinal artery
c) External carotid
d) Antecubital vein
41) Name the condition in which there is clear irrigation but fluorescein does not leak into the nose
a) Normal lacrimal passage
b) Blockage of lacrimal passage
c) Upper canalicular block
d) Lower canalicular block
42) The image in indirect ophthalmoscopy is
a) Erect, virtual and magnified
b) Erect, real and magnified
c) Inverted, real and magnified
d) Erect, virtual and normal
43) Direct ophthalmoscopy magnification of the image in comparison to indirect type is times:
44) Direct ophthalmoscope projects:
a) Virtual, erect and magnified image
b) Real, inverted and magnified image
c) Real, erect and condensed image
d) Virtual, inverted and condensed image
45) The presence of Kayser Fleischer ring is pathognomonic of
b) Lowe’s syndrome
c) Wilson’s disease
46) Condition which is always bilateral
a) Infantile glaucoma
c) Acute congestive glaucoma
d) All of the above
47) Conditions causing large pupils are all except:
d) Horner’s syndrome
48) Earliest sign of siderosis bulbi is:
a) Rusty deposits in the subcapsular epithelium
b) Fleisher’s ring
c) Pigmentary retinopathy
d) Red brown staining of iris
49) The corneal endothelium is best examined by:
b) Distant direct ophthalmoscope
c) Slit lamp
d) Specular microscope
50) Coloured haloes are seen in all except :
b) Mucopurulent conjunctivitis
c) Acute anterior uveitis
Antimuscarinics such as atropine are contraindicated in acute congestive glaucoma because of the increased likelihood of producing complete obstruction of the outflow of aqueous humor, resulting in an acute increase in intraocular pressure (IOP) in response to relaxation of the ciliary muscles.
In corneal ulcer, acute iridocyclitis atropine is used to relieve spasm and pain. In malignant glaucoma 1st line treatment first-line management include mydriatic- cycloplegic agents. Cycloplegics tighten the lens zonules by relaxing the ciliary muscle, puling the lens-iris diaphragm posteriorly, and alleviating the ciliary block.
Differential diagnosis of arcuate scotoma includes: Chorioretinal lesions such as myopic degeneration, atypical retinitis pigmentosa, photoreceptor degeneration. Optic disc lesions such as drusen, pits, coloboma, chronic papilledema, optic nerve lesions such as retrobulbar neuritis, pituitary tumors, aneurysms, Arteritic and non arteritic ischemic optic neuropathy.
ARMD is responsible for central or paracentral scotoma with normal peripheral findings.
Peripheral visual field loss can occur in retinintis pigmentosa, glaucoma, degenerative myopia, Rhegmatogenous retinal detachment, CNS tumor, Multiple sclerosis, neurotoxic drugs, vascular disease such as diabetic mellitus, aneurysms. Bitemporal hemianopia is caused by damage to optic chiasm and can occur from the direct or indirect effects of variety of lesions, including tumors, aneurysms, and, less frequently, inflammatory and ischemic diseases.
Binasal hemianopia can occur because of bilateral internal carotid artery aneurysms, hydrocephalous, intracranial mass lesions, elevated intracranial pressure.
Risk factor of primary open angle glaucoma are family history, high myopia, high intraocular pressure, Hypertension, diabetes mellitus, thyroid disorders, cigrarrete smoking, steroid usage, and age greater than 40 years. Thus, young age is not the risk factor of glaucoma.
Posterior sub capsular cataract is the most visually disabling type of cataract since the clouding is close to the nodal point. It often interferes the near reading vision especially in bright light and causes glare and halos around light at night. Anything that constrict the pupil makes it very difficult for people with this type of cataract. PSCC is associated with aging, steroids, trauma, ionizing radiation, intraocular inflammation, high myopia, atopic dermatitis and retinitis pigmentosa
Neovascularization is a hallmark of Proliferative diabetic retinopathy. PDR is characterized by the growth of new, abnormal blood vessels. These new blood vessels are fragile and can cause large hemorrhages in the eye.
Non-proliferative diabetic retinopathy is characterized by the growth of microaneurysms that eventually cause retinal ischemia.
Most babies are hyperopic at birth (physiological hyperopia). It is caused by the diameter of the eyeball being smaller than normal or the cornea being too flat. It usually disappears after few years of birth.
Tropicamide is the fastest acting cycloplegic drug. The onset of action is 15-30 min and lasts 4-6 hrs. With cyclopentolate 1%, effect occurs in 30-90 minutes and effect lasts for 6-18 hours. Atropine is the most potent of the cycloplegic agents and has a slow onset of effect with duration of action lasting up to 2 weeks
Lattice degeneration is most common in patient with myopia but rarely can be seen in disease such as Stickler syndrome, Ehlers-Danlos, and Marfan syndrome
SUN grading of anterior chamber cells and flare
Clinically significant macular edema is seen when one of the following occurs:
a) Retinal thickening at or within 500 microns or 1/3-disc diameter of center of macula.
b) Hard exudates at or within 500 microns of the center of the macula with adjacent retinal thickening.
c) Retinal thickening GREATER than 1-disc diameter in size which is within 1-disc diameter from the center of the macula.
Doughnut shape scotoma is a finding of Retinitis Pigmentosa. Central scotoma is seen in CSR. Altitudinal/arcuate defects focal central/centrocaecal scotoma is seen in optic neuritis.
Color haloes is a symptom of Cataract, Acute congestive glaucoma, mucopurulent conjunctivitis. Occasionally, halos around light is a side effect of LASIK surgery, cataract surgery, or from wearing of eyeglasses or contact lenses.
Synonym of zonular cataract is lamellar cataract. Lamellar cataract is the cataract in which opacity is limited to the cortex.
The most widely held theory of accommodation was proposed by von Helmholtz in 1856: “When viewing a far object, the circularly arranged Müller’s ciliary muscle is relaxed, allowing the lens zonules and suspensory ligaments to pull on the lens, flattening it in the periphery. The source of the tension is the pressure that the vitreous and aqueous humours exert outwards onto the sclera.”
According to von Helmholtz, when viewing a near object, the ciliary muscles contract (resisting the outward pull of the sclera) causing the lens zonules to relax which allows the lens to spring into a thicker form.
Each letter has a score value of 0.02 log units. Since there are 5 letters per line, the total score for a line on the LogMAR chart represents a change of 0.1 log units. The formula used in calculating the score is:
LogMAR VA = 0.1 + LogMAR value of the best line read – 0.02 X (number of optotypes read)
Adult inclusion conjunctivitis is caused by Chlamydia trachomatis and is usually sexually acquired; in rare cases it can be acquired by swimming in a contaminated swimming pool hence the term swimming pool conjuctivitis. Adenovirus type 3 and 7 is associated with swimming pool conjunctivitis. Epidemic keratoconjuctivitis occurs mainly in adults and is highly contagious, caused by types 8,19 and 37.
Virus such as Adenovirus, Herpes simplex type 1, Varicella zoster often causes keratitis.
Corneal ulcers are extremely painful due to nerve exposure, and can cause watering
Munson’s sign is seen in keratoconus. Other signs include Rizzuti’s sign, Charleux’s sign, Vogt’s striae, Fleischer’s ring, Apical scarring, Scissoring reflex.
Irritant like kajal also predispose
Five or more follicles in the upper tarsal conjunctiva
10% (Indication of mass treatment in Trachoma >10% prevalence of severe and moderate trachoma in children <10 years of age -New Guidelines of WHO)
26. b) Conjunctival Xerosis
27. c) 600 mcg (retinol daily requirement)
28. c) 3 doses (1, 2 and 14th day each)
29. a) Cataract
30. c) 3/60
31. d) Enlarged corneal nerves
32. d) magnetic resonance imaging (MRI)
33. b) Medial Rectus
35. c) objective measurement of the refractive error of the patient
36. a) calcium phosphate
37. c) Miosis
38. a) Progressive macular oedema
39. d) Contact lens fitting
40. d) Antecubital vein
41. c) Upper canalicular block
42. c) Inverted, real and magnified
43. b) 3
44. a) Virtual, erect and magnified image
45. c) Wilson’s disease
46. b) Megalocornea
47. d) Horner’s syndrome
48. a) Rusty deposits in the subcapsular epithelium
49. d) Specular microscope
50. c) Acute anterior uveitis