INI CET 22ND JULY 2021

OPHTHALMOLOGY QUESTIONS

Dr Vineet Sehgal
MBBS MD (AIIMS)
Ophthalmology made Easy

Questions are based upon the recollection by students. The language and options may
be different.

To join our e learning module whatsapp us at 8826622125 or mail at

ophthalmologymadeeasy@gmail.com

1. Drug contraindicated in angle closure glaucoma with uveitis

a. CA inhibitors
b. Beta blockers
c. PG Analogues
d. IV Mannitol

Or

A 52 year old woman presented with redness of eye and pain. On examination, there
were cells in the anterior chamber and corneal precipitates. Her IOP was found to be 38
mmHg. Which of the following drugs should be avoided?

a. CA inhibitors
b. Beta blockers
c. PG Analogues
d. IV Mannitol

Ans: C

In any patient of acute uveitis the anti glaucoma medication to avoid is PG Analogue as it can
lead to rebound inflammation.

High Yield Facts regarding angle closure glaucoma

- Most common type glaucoma in India

- Women are more predisposed
- Gonioscopy is the investigation of choice
 - Nd Yag Iridotomy is the procedure of choice
- The drug that is approved for use is Pilocarpine
- In acute congestive glaucoma the IV Mannitol is the first drug to be used as it can lead to
rapid decrease in vitreous volume and shrinkage. Syrup glycerol and acetazolamide are
the other drugs which are very useful in these cases

2. Most common/characteristic way of spread of Retinoblastoma (Rb) is

a. Lymphatics
b. Optic nerve
c. Direct Spread
d. Hematogenous

Ans: B

Optic nerve is the most common way of spreading RB.

Retinoblastoma is m ost common intraocular tumor of children

Clinical presentation

⮚ Most common clinical presentation of retinoblastoma is leukocoria followed by

strabismus.
⮚ Mc secondary cancer in RB patients: Osteosarcoma (soft tissue sarcoma)
⮚ Trilateral retinoblastoma is bilateral RB with pinealoblastoma.
⮚ Quadrilateral RB: Pinealoblastoma, Bilateral Retinoblastoma, suprasellar tumor.
⮚ Most common site of metastasis: CNS

Investigations

⮚ IxOC- MRI Head and orbit with gadolinium contrast.

USG B scan showing Retinoblastoma

Metastasis

⮚ It is associated most commonly with optic nerve head spread.

For more details about retinoblastoma and other ocular tumors refer to OME Notes & e
book

3. All the cardinal gazes of the patient suffering from brain stroke has been shown here.
Which nerve is most probably be affected

A. 3rd nerve
B. 6th nerve
C. 4th nerve
D. 7th nerve

Ans: 3rd nerve Palsy

As you can see in the primary position there is a ptosis and on dextro version, dextro
elevation and dextro depression there is no movement of the left eye except abduction
so this patient is suffering from 3rd nerve palsy.
Clinical Features

• Ptosis due to Paralysis of LPS

• (Nuclear Palsy would cause B/L Palsy)
• Deviation of eye down and out
• Difficulty in near vision (Due to Involvement of ciliary muscle)
• Mydriasis (Due to Sphinctor pupillae)

Hess Chart Showing 3rd Nerve Palsy

For Nerve Palsies please see our videos and OME Notes
Q4) A patient presented with a visual field defect as shown here. He may be suffering
from a lesion of which part of the visual pathway?

R L

a. Right Occipital Lobe

b. Left Occipital Lobe
c. Right Optic Tract
d. Central Chiasma

Ans: B. Left Occipital Lobe

Remember

Nasal fibers are meant to relay the temporal visual field and vice versa

So in the following picture, the following findings are observed

- Right Temporal hemianopia with Macular Sparing

- Left Nasal hemianopia with macular sparing

So they collaborate with Left Occipital Lobe involvement

- As Left Temporal fibers and Right Nasal Fibers would be involved

Posterior Cerebral artery lesion with the middle cerebral artery sparing leads to the macular
sparing feature. Middle cerebral artery supplies the tip of the occipital lobe.

For Visual Pathway Defects please see our videos and OME Notes

Q5) Most common lacrimal gland tumour is

A. Pleomorphic adenoma
B. Non Hodgkin's lymphoma
C. Mucoepidermoid carcinoma
D. Adenoid cystic carcinoma
Ans: B

Non Hodgkin’s lymphoma and Inflammatory tumors constitute 50 % of lacrimal gland tumors.
Pleomorphic adenoma is the most common epithelial lacrimal gland tumor.

For Lacrimal gland tumors please see our videos and OME Notes

Q6) All are components of SAFE strategy except

a. Surgery
b. Antibiotics
c. Facial Cleanliness
d. Engaging the Community participation

Ans: D

E in SAFE strategy stands for Environmental Cleanliness and not Engagement

SAFE strategy is advocated for Eradication of trachoma

S: Surgery
A: Antibiotic
F: Facial Cleanliness
E: Environmental Cleanliness

For Community Ophthalmology please see our videos and OME Notes

Q 7) A patient presented with a swollen left eye and history of vegetative matter trauma a
few days back. The patient also had hypopyon and corneal ulcer. The most common
class of microorganism involved is

a. Amoeba
b. Viral Keratitis
c. Phycomycosis
d. Bacterial keratitis

Ans: C

Phycomycosis

Ans: C
The signs and symptoms are suggestive of fungal corneal ulcer (Phycomycosis)

Fungal Corneal Ulcer

Clinical Scenario:

- Young male presenting with discharge & associated with trauma to eye with animal tail &
vegetable matter.

R/F

- H/o immunosuppression
- Steroids use
- Previous corneal insult like BSK, viral keratitis, bullous keratopathy

Most common fungal infection in India – Aspergillus fumigatus

• Other common
• Candida, Fusarium, Alternaria

Clinical Features: Symptoms is less than signs of disease

Signs

• Dry looking
• Pigmented Ulcer: Dermatiaceous fungi
• Immune ring of wessely
• Satellite lesions
• Large Infected hypopyon which is thick, immobile & convex
• Corneal vascularization is absent

TREATMENT

• No steroids
• Microbiologically confirm before starting the treatment
• Supportive treatment with cycloplegics

DRUGS

• Voriconazole
• Intravitreal Amphotericin B can be used in candida induced endophthalmitis
• Natamycin

Dr Vineet Sehgal Ophthalmology E learning module

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