mcq in ophthalmology and optometry part: 20

Optometry and Opthalmology mcq 

1.The Mydriasis Provocative Test is a test for which glaucoma

1. A. POAG
2. B. PACG✓
3. C. NTG
4. D. All

Mydriatic provocative test is usually not preferred nowadays because this is not

physiological. In this test either a weak mydriatic or simultaneously a mydriatic and

miotic (10% phenylephrine and 2% pilocarpine) are used to produce a mid-dilated pupil.

A pressure rise of more than 8 mm Hg is considered positive.

2. Dark room test is a provocative test for

1. A. POAG
2. B. PACG✓
3. C. NTG
4. D. None

In Darkroom test IOP is recorded and patient is made to lie prone in a darkroom for 1

hour. Patient should must remain awake so that pupils remain dilated. After 1 hour, the

IOP is again measured. An increase in IOP of more than 8 mm Hg is considered

diagnostic of PACG suspect.

3. Mydriatics are contraindicated if the anterior chamber is

1. a. Deep
2. b. Shallow✓
3. c. Normal
4. d. Irregular

This is because of the risk of angle closure glaucoma.

4. Pachymetry is done in

1. a. Glaucoma
2. b. Fuch's distrophy
3. c. Before LASIK
4. d. All✓

pachymetery is the measurement of thickness of cornea Pachymetery is important in Keratoconus screening, IOP measurements, before surgeries like LASIK, Limbal Relaxing Incisions (LRI) etc

5. Treatment of choice for the other eye in primary narrow angle glaucoma is

1. A. Trabeculectomy
2. B. Laser iridotomy✓
3. C. Laser trabeculoplasty
4. D. Iridectomy

6. 100 days glaucoma is seen in:

1. a. Central retinal artery occlusion
2. b. Central retinal vein occlusion✓
3. c. Neovascular glaucoma
4. d. Steroid induced glaucoma

100 days Glaucoma is a neovascular glaucoma occurring in CRVO. It consists of

occlusion of central retinal vein without significant retinal ischemia. This results in a

venous stasis. Recurrent hemorrhages are frequent and neovascularization of retina and

optic disc develop. Retina undergoes pigmentary and atrophic changes. Serious

complications are cystoid degeneration of macula, optic atrophy and hemorrhagic or

neovascular glaucoma.

Hemorrhagic glaucoma is also known as 100 day glaucoma because it starts 3 months

after the episode of central retinal vein occlusion.

7. In early glaucomatous cupping, disc is:

1. a. Round
2. b. Oval vertically✓
3. c. Oval horizontally
4. d. Pinpoint

Early glaucomatous changes include:

• 1. Vertical oval disc
• 2. Asymmetry of >0.2 between the eyes
• 3. Large cup, ie 0.6 or more
• 4. Pallor of the disc
• 5. Splinter haemorrhages
• 6. Atrophy of RNFL

8. The eyes susceptible to angle closure glaucoma are:

1. a) Hypermetropic eye✓
2. b) Myopic eye
3. c) Astigmatic eye
4. d) Pseudophakic eye

Hypermetropic eyes are usually small, axial length lesser and Anterior chamber is

shallow. So People with hypermetropia tend to be more at risk for narrow-angle

glaucoma

9. Beta Blockers lower IOP mainly by

1. A) Decreased aquous production✓
2. B) Increased aquous drainage
3. C) Lower episcleral venous peressure
4. D) All of above

Topical beta-blockers reduce the intraocular pressure (IOP) by blockade of sympathetic

nerve endings in the ciliary epithelium causing a fall in aqueous humour production. Two types of topical beta-blockers are available for use in glaucoma: nonselective, which block both beta 1- and beta 2-adrenoceptors; and cardioselective, which block only beta 1-receptors. Of the beta-Blockers commercially available, timolol, levobunolol, metipranolol and carteolol are nonselective, and betaxolol is cardioselective.

Pilocarpine contracts longitudinal muscle of ciliary body and opens spaces in trabecular

meshwork, thereby mechanically increasing aqueous outflow carbonic anhydrase inhibitor like Dorzolamide lowers IOP by decreasing aqueous secretion.

10. Rapid change in presbyopic correction is a classical feature of

1. a. Retinal detachment
2. b. open angle glaucoma✓
3. c. closed angle glaucoma
4. d. Senile Cataract

There are typically no early warning signs or painful symptoms of open-angle glaucoma.

It develops slowly and sometimes without noticeable sight loss for many years.

due to constant pressure on the ciliary muscle and its nerve supply ,accommodative

failure happens and frequent changes in presbyopic glasses may be noticed

Other early symptoms include delayed dark adaptation mild headache and eyeache.

11. Coloured halos around light are not seen in

1. a. early stages of closed angle glaucoma
2. b. early stages of cataract
3. c. acute mucopurulent conjunctivitis
4. d. Corneal aberrations✓

Coloured halos in PACG occur due to accumulation of fluid in the corneal epithelium and alteration in the refractive condition of the corneal lamellae. In early senile cataract, due to presence of water droplets in the lens coloured halos may occur. In conjunctivits the

halos are due to discharge and can be eliminated by irrigating the eyes. Emsley-Fincham stenopaeic test is used to differentiate between halos due cornea and halo due to lens. When stenopaeic slit is passed across the pupil, lenticular halo will show a break in the halo due to abrupt varied density in cataract, whereas a corneal halo will show reduced brightness (but no break) in the halo as any change in edema if present is gradual.

12. In Van Herick slit-lamp grading, closed angle is graded as

1. a. Grade 0✓
2. b. Grade 1
3. c. Grade 4
4. d. None of the above

The Van Herick technique for grading the depth of anterior chamber angles is one of the

easiest methods to estimate the “openness” of the angle. With an optic section of the limbal cornea, orient your beam at about a 60 degree angle and compare the width of the corneal section and the width of the shadow adjacent to it. VH grade 0 indicate closed angle Other grades

1:1 – Open angle, VH grade 4

1:1/2 – Open angle, VH grade 3

1:1/4 – Narrow angle, VH grade 2 (Angle Closure Possible) 1: <1/4 – very narrow Angle, likely to be angle closure VH grade 1

13. Increased ocular pressure in Buphthalmos causes all the following EXCEPT

1. a. streching of sclera
2. b. corneal vascularisation✓
3. c. corneal curvature promisence
4. d. Rupture of Descemet’s memebrane

14. All are causes of Sudden painless loss of vision except

1. A. Central serous retinopathy
2. B. Optic neuritis
3. C. Primary Open Angle Glaucoma✓
4. D. Nonischaemic central retinal vein occlusion

15. Glaucoma which is also known as Chronic Simple Glaucoma

1. A. Primary Angle Closure Glaucoma
2. B. Primary Open Angle Glaucoma✓
3. C. Normal Tension Glaucoma
4. D. Congenital Glaucoma

16. Test not used in glaucoma evaluation

1. A. Pachymetery
2. B. Perimetry
3. C. Keratometry✓
4. D. Ophthalmoscopy

17. Night blindness may occur in all except

1. a. Vitamin A deficiency
2. b. High myopia
3. c. Angle closure glaucoma✓
4. d. Oguchis disease

Night blindness may occur in Open angle glaucoma. In advanced cases of primary open

angle glaucoma, dark adaptation may be so much delayed that patient gives history of

night blindness.

18. POAG field changes may include all the following except:

1. a. Arcuate scotoma.
2. b. Hemianopia✓
3. c. Enlarged blind spot
4. d. Tubular vision

Hemianopic defects are due to lesions in visual pathway

19. All the following are features of POAG except:

1. a. Tubular vision
2. b. Enlarged blind spot
3. c. General depression of isopters
4. d. Loss of central fields✓

20. In acute angle closure glaucoma the pupil is:

1. a. Rounded, irreactive and dilated
2. b. Pin point constricted
3. c. Oval, vertically dilated✓
4. d. Normal sized, reactive

21. Early features of chronic simple glaucoma include all except:

1. a. Mild headache
2. b. Acute onset✓
3. c. Frequent change of persbyopic glasses
4. d. Clear cornea

22. Chances of PACG increase in all except:

1. a. Small cornea
2. b. Flat cornea✓
3. c. Shallow AC
4. d. Short axial length

23. Main cause of painless progressive loss of vision in adults

1. A. Cataract✓
2. B. Open angle glaucoma
3. C. ARMD
4. D. Progressive myopia

24. Neuosensory part of retina contains how many layers

1. A. 7
2. B. 8
3. C. 9✓
4. D. 10

Including pigment epithelium there are 10 layers. There is a space between pigment

epithelium and Neuro sensory part of retina. Interphotoreceptor matrix (IPM) is present in

the potential space between pigment epithelium and the neurosensory retina and it

constitutes a strong binding mechanism between the two (by binding pigment epithelium=to the photoreceptor).

Constituent molecules of IPM include:

Inter photoreceptor retinal binding protein (IRBP), proteoglycan- glycosaminoglycans

(sulphated and nonsulphated chondroitin and hyaluronic acid), fibronectin, sialoprotein

associated with rods and cones (SPARC), intercellular adhesion molecules,hyaluronic

acid receptor (CD44 antigen), and lysosomal enzymes (matrix metalloproteinases and

tissue inhibitors of metalloproteinases(TIMP).

25. Retinal layer which is close to vitreous body

1. A. Pigment epithelium
2. B. External limiting membrane
3. C. Internal limiting membrane✓
4. D. Nerve fibres layer

26. Retinal layer which is close to choroid

1. A. Pigment epithelium✓
2. B. External limiting membrane
3. C. Internal limiting membrane
4. D. Nerve fibres layer

Pigment epithelium is firmly adherent to the underlying basal lamina (Bruch’s membrane)

of the choroid.

27. Retinal layer which act as antireflecive layer

1. A. Pigment epithelium✓
2. B. External limiting membrane
3. C. Internal limiting membrane
4. D. Nerve fibres layer

28. In retinal detachment, fluid accumulate between

1. A. Retina and choroid
2. B. Pigment epithelium and rest of retina✓
3. C. Internal limiting membrane and rest of retina
4. D. Outer nuclear layer and inner nuclear layer

29. The first order neurones of visual pathway consists

1. A. Rods and cones
2. B. Bipolar cells✓
3. C. Ganglion cells
4. D. Lateral geniculate body

30. Diameter of foveola

1. A. 5.5 mm
2. B. 1.5mm
3. C. 0.35mm✓
4. D. 0.1mm

31. Retina is thickest at

1. A. Ora serrate
2. B. Equatorial region
3. C. Peripapillary region✓
4. D. Macular region

32. Retina is thinnest at

1. A. Ora serrate✓
2. B. Fovea
3. C. Foveola
4. D. Macula

33. True regarding blood supply of retina

1. A. Whole retina is vascular
2. B. Whole retina is avascular
3. C. Outer four layers are avascular (pigment epithelium to outer nuclear layer)✓
4. D. Only Pigment epithelium layer is avascular

34. Most common cause of CRAO

1. A. Embolism✓
2. B. Angiospasm
3. C. Retinal arteritis
4. D. Raised IOP

All the above are causes of CRAO, Emboli from the carotid artery and those of cardiac

origin are the most common cause of CRAO. Atherosclerosis related thrombosis at the

level of lamina cribrosa is another common cause of CRAO.

35. In CRAO, patient may complaint

1. A. Sudden painless loss of vision✓
2. B. Gradual painless loss of vision
3. C. Sudden painful loss of vision
4. D. None

36. Cherry red spot is seen in

1. A. CRAO✓
2. B. CRVO
3. C. BRVO
4. D. Diabetic retinopathy

37. Cattle truck appearance is seen in

1. A. CRAO✓
2. B. CRVO
3. C. BRVO
4. D. Diabetic retinopathy

38. Neo vascular glaucoma is a complication of

1. A. Diabetic retinopathy
2. B. Eales’ disease
3. C. CRVO
4. D. All✓

Neovascular glaucoma is usually associated with neovascularization of iris (rubeosis

iridis). It is a common feature of diseases like Proliferative diabetic retinopathy CRVO

Sickle-cell retinopathy Eales’ disease Chronic intraocular inflammations intraocular

tumours Retinal detachment CRAO 

39. Hard exudates are seen in

1. A. Outer nuclear layer
2. B. Outer plexiform layer✓
3. C. Ganglion cell layer
4. D. Nerve fibre layer

40. Cotton wool spots are seen in

1. A. Outer nuclear layer
2. B. Outer plexiform layer
3. C. Ganglion cell layer
4. D. Nerve fibre layer✓