Last 5 Year PYQs in Ophthalmology for INI-CET

Q1. What is the probable diagnosis based on the observed blanching of vascularity following the administration of 10 % phenylephrine, as depicted in the provided image?

1. Nodular episcleritis
2. Nodular scleritis
3. Nodular phlycten
4. Scleral ectasia

Ans. 1)  Nodular episcleritis

• The probable diagnosis based on the observed blanching of vascularity following the administration of 10% phenylephrine is nodular episcleritis.
• Phenylephrine Test: This test is utilized to differentiate between nodular episcleritis, scleritis, and phlyctenular keratoconjunctivitis.

• 1% phenylephrine is applied initially. If blood vessels blanch, it indicates conjunctival congestion (phlyctenular keratoconjunctivitis).
• If blanching doesn't occur with 1%, the concentration is increased to 10% phenylephrine. If blanching occurs with 10%, it signifies episcleritis.
• If blanching still doesn't occur even with 10%, then it is identified as scleritis.

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Q2. Which lens is utilized in direct gonioscopy?

1. Goldmann
2. Koeppe
3. Zeiss
4. Sussman

Ans. 2) Koeppe

• Koeppe lenses are specifically designed for direct gonioscopy. They are small, handheld lenses with a concave shape and a mirrored surface. They are placed directly on the eye's surface to visualize the anterior chamber angle.

Q3. Please identify the structure that is indicated.

1. Canal of petit
2. Canal of hannover
3. Hyaloid canal 
4. Pars plana

Correct Answer 1 : Canal of Petit

• The Canal of Petit, also known as the Hyaloid Canal, is a small vestigial structure located in the vitreous cavity of the eye. It is a remnant of the fetal hyaloid system, which is involved in the development of the eye. However, it is not a marked structure in the provided image.

Q4. What is the causative agent of the ocular condition as shown in the image?

1. Chlamydia
2. Mycoplasma
3. Pseudomonas
4. Staphylococcus

Ans. 1) Chlamydia

• The image shows follicles resembling sago grain on the upper palpebral conjunctiva, which is suggestive of trachoma and the organism causing this condition is Chlamydia trachomatis. 

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Q5. What is the accurate order of staining in patients with dry eyes?

1. Fluorescein stain
2. Lissamine green
3. Rose Bengal stain

1. 1, 3, 2
2. 1, 2, 3
3. 2,1, 3
4. 3, 2, 1

Ans. 2) 1, 2, 3

The correct sequence of staining in dry eyes is: i, ii, iii

1. Fluorescein stain
2. Lissamine green
3. Rose Bengal stain

This sequence is typically used in evaluating and diagnosing dry eye conditions, also known as keratoconjunctivitis sicca (KCS). Each of these dyes serves a specific purpose in assessing the ocular surface and identifying areas of dryness, damage, or irritation.

1. Fluorescein stain: This is commonly the first stain used. It helps assess the integrity of the corneal epithelium and highlights areas of epithelial disruption or damage.
2. Lissamine green: Lissamine green stain helps identify and evaluate damage to the conjunctival epithelium, which is the mucous membrane that covers the white part of the eye (sclera) and lines the inside of the eyelids. It helps in assessing conjunctival health and identifying staining patterns that indicate dry eye.
3. Rose Bengal stain: Rose Bengal is used to detect areas of cell damage and epithelial irregularities on the ocular surface. It can highlight punctate epithelial erosions, a common finding in dry eye.

Q6. What is the function of the superior oblique muscle?

1. Intorsion, abduction, depression
2. Intorsion, adduction, elevation
3. Extorsion, abduction, depression
4. Extorsion, adduction, elevation

Ans. 1) Intorsion, abduction, depression

The superior oblique muscle plays an integral role in eye movement. This muscle's precise actions are intorsion, depression, and eye abduction, making Option 1 the correct answer.

• Intorsion: This is the inward rotation of the eye, where the top of the eye rotates towards the nose.
• Depression: This refers to the downward movement of the eye, primarily when it's in an abducted position.
• Abduction: This is the outward movement of the eye, away from the nose.

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Q7. After an acute episode of angle-closure glaucoma, which triad of symptoms is typically observed?

1. Vogt’s triad
2. Virchow triad
3. Hutchinson’s triad
4. Gaucher triad

Ans. 1) Vogt’s triad

• Vogt's Triad is the combination of clinical findings typically seen following an acute episode of angle-closure glaucoma. 
• This triad consists of:

• Dilated non-reactive pupil.
• Glaukomflecken (anterior subcapsular opacity of lens secondary to ischemia).
• Patches of iris atrophy

Q8. Which of the listed conditions is associated with the presence of punched-out lesions on the retina?

1. Posterior staphyloma
2. Fundal coloboma
3. Congenital Rubella
4. Toxoplasmosis

Ans. 4) Toxoplasmosis

• Toxoplasmosis, an infection caused by the parasite Toxoplasma gondii, is recognized as a condition associated with "punched-out" lesions of the retina.
• These lesions are characterized by their distinct, round or oval, well-demarcated, and atrophic appearance that resembles "punched-out" areas.
• They are often associated with inflammatory signs when active but may appear as scarred or pigmented lesions when inactive or old.

Q9. What would be the next investigative step for a 27-year-old female patient who presents with sudden vision loss accompanied by a relative afferent pupillary defect in her right eye, while her left eye appears normal on examination?

1. MRI brain & orbit
2. Myelin oligodendrocyte glycoprotein (MOG) and neuromyelitis optica (NMO) antibodies
3. Blood sugar
4. Thyroid profile

1. 1, 2 and 3
2. 1 and 2
3. 2 and 3
4. 3 and 4

Ans. 1) 1, 2 and 3

• The sudden decrease in vision and relative afferent pupillary defect (RAPD) suggests a problem with the optic nerve in the right eye, most likely due to optic neuritis, which can be associated  with demyelinating diseases like multiple sclerosis (MS) or neuromyelitis optica (Devic’s disease).

• MRI scan of the brain and orbit should preferably be performed in each case presenting with acute optic neuritis to check for nerve swelling, optic nerve glioma, cerebral, and brainstem lesion.
• MOG and NMO antibodies: These antibodies are seen in autoimmune conditions affecting the central nervous system, like multiple sclerosis and neuromyelitis optica (NMO). The detection of these antibodies can help confirm the diagnosis.
• Blood sugar levels have to be checked. Optic neuritis is primarily treated with steroids, as steroids may precipitate hyperglycemia in individuals with DM.
• A thyroid profile could be relevant in cases of thyroid eye disease, but this typically presents different symptoms, such as eye protrusion, redness, and double vision. Given the scenario, thyroid dysfunction is less likely.

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Q10. Which of the following is not characteristic of pterygium?

1. Rate of recurrence is 95%
2. It is a fibrovascular growth
3. The parts of a pterygium are the head, neck and body
4. Has progressive and regressive type

Ans. 1) Rate of recurrence is 95%

Pterygium, an eye condition, is characterized by benign growth of the conjunctiva over the cornea.

• The recurrence rate after surgical excision is around 30- 50%. Recurrence rates vary, depending on the surgical technique used for pterygium removal. With modern surgical techniques and the use of adjunctive therapies such as Mitomycin C or autografts, the recurrence rate can be as low as 5%.

Q11. What is the most frequently occurring tumor found in the lacrimal gland?

1. Adenoid cystic carcinoma
2. Lymphoma
3. Pleomorphic adenoma
4. Mucoepidermoid carcinoma

Ans. 3) Pleomorphic adenoma

• The most common lacrimal gland tumor is pleomorphic adenoma.

Q12. What is the most frequently observed eye symptom of COVID-19?

1. A retinal vein thrombosis
2. Viral keratouveitis
3. Follicular conjunctivitis 
4. Pseudomembranous conjunctivitis

Ans. 3) Follicular conjunctivitis 

In the context of COVID-19 pandemic the most common ocular manifestation reported in numerous studies is follicular conjunctivitis. Conjunctivitis as well as "pink eye" is an inflammation or infection of the conjunctiva, the transparent membrane that lines your eyelid and covers the white part of your eyeball. Follicular refers to the presence of follicles or lymphoid hyperplasia primarily located in the palpebral conjunctiva and it is typically seen in viral infections, including COVID-19.

While COVID-19 can affect multiple organ systems and cause a variety of complications, follicular conjunctivitis is the most common ocular manifestation associated with the disease, making Option 3 the correct answer.

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Q13. Which of the following medications should not be administered to a patient with a known case of angle closure glaucoma who has also been diagnosed with major depressive disorder?

1. Amitriptyline
2. Sertraline
3. Mirtazapine
4. Fluvoxamine

Ans. 1) Amitriptyline

• The drug that should be avoided in a patient with angle closure glaucoma who has been diagnosed with major depressive disorder is amitriptyline. This medication, which is classified as a tricyclic antidepressant (TCA), has anticholinergic effects that can provoke the onset of acute angle closure glaucoma by causing pupillary dilation and obstructing the outflow of the aqueous humor.

Q14. Based on the image provided, what is the likely location of the lesion in a patient who is experiencing difficulty perceiving the lateral fields?

1. Optic chiasma
2. Right optic tract
3. Left optic tract
4. Right optic radiation

Ans. 1) Optic chiasma

The lateral visual field defect, as shown in the image, is of bitemporal hemianopia, i.e., the nasal fibers to the retina of both the eyes are damaged, leading to loss of vision on the temporal side of the visual field.

• The lesion at optic chiasma is responsible for bitemporal hemianopia as the nasal fibers from the retina decussate at optic chiasma.

Q15. Which muscle is paralyzed in a patient who has left-sided head tilt resulting in right hypotropia that worsens with right head tilt and dextroversion?

1. Right superior oblique
2. Right superior rectus
3. Right inferior oblique
4. Left inferior oblique

Ans. 2) Right superior rectus

Paralysis of the right superior rectus muscle is involved in the described clinical presentation.

• The right superior rectus muscle is responsible for elevating and adducting the eye. When this muscle is paralyzed, it leads to a weakness or paresis of the muscle, resulting in an inability to fully elevate and adduct the affected eye. As a result, the patient presents with a left-sided head tilt to compensate for the vertical misalignment.
• When the patient tries to straighten their head, the misalignment becomes more prominent, leading to right hypotropia (downward deviation of the affected eye). This occurs because the unopposed action of the intact inferior rectus muscle causes the eye to be pulled downward.
• On dextroversion (looking to the right) and right head tilt, the imbalance between the paralyzed right superior rectus muscle and the intact muscles on the opposite side becomes more pronounced, exacerbating the hypotropia.

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Q16. What is the procedure depicted in the provided image?

1. Nasolacrimal duct syringing
2. Anterior ethmoidal nerve block
3. Infraorbital nerve block
4. Trephination of frontal sinus

Ans. 2) Anterior ethmoidal nerve block.

• In the image provided, the procedure being depicted is the anterior ethmoidal nerve block. This is a technique used to anesthetize the anterior ethmoidal nerve, which is a branch of the ophthalmic division of the trigeminal nerve (cranial nerve V1). The anterior ethmoidal nerve provides sensory innervation to the anterior ethmoidal sinuses, the nasal cavity, and the anterior portion of the nasal septum.
• The block involves the injection of a local anesthetic agent near the anterior ethmoidal nerve as it exits the anterior ethmoidal foramen. This can be done using various approaches, including transcutaneous, transnasal, or transconjunctival routes.

Q17. What is the proper sequence for administering eye drops and eye ointment?

1. Eye drops first, ointment 15 min later
2. Ointment first, eye drops 15 min later
3. Eye drops first, then ointment immediately
4. Ointment first, then eye drops immediately.

Ans. 1) Eye drops first, ointment 15 minutes later

• When administering both eye drops and eye ointment, it is generally recommended to follow a specific order to ensure optimal effectiveness and minimize potential interactions.
• Eye drops are usually prescribed to be administered before applying eye ointment. By instilling the eye drops first, they can penetrate the eye and exert their therapeutic effect. Waiting for about 15 minutes before applying the eye ointment allows for adequate absorption and action of the eye drops.

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