QIAIUNCC/EYE-TEST-3 huggingface dataset:
Question: In the grading of trachoma, follicular stage is defined as the presence of
Options:
A. Three or more foliicles in the lower tarsal conjunctiva
B. Five 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

Rationale: WHO classification for Trachoma &;FISTO&;: 1. TF: Trachomatous inflammation-follicular. It is the stage of active trachoma with predominantly follicular inflammation. To diagnose this stage at least five or more follicles (each 0.5 mm or more in diameter) must be present on the upper tarsal conjunctiva. Fuher, the deep tarsal vessels should be visible through the follicles and papillae. 2. TI : Trachomatous inflammation intense. This stage is diagnosed when pronounced inflammatory thickening of the upper tarsal conjunctiva obscures more than half of the normal deep tarsal vessels. 3. TS: Trachomatous scarring. This stage is diagnosed by the presence of scarring in the tarsal conjunctiva. These scars are easily visible as white, bands or sheets (fibrosis) in the tarsal conjunctiva. 4. TT: Trachomatous trichiasis. TT is labelled when at least one eyelash rubs the eyeball. Evidence of recent removal of inturned eyelashes should also be graded as trachomatous trichiasis. 5. CO: Corneal opacity. This stage is labelled when easily visible corneal opacity is present over the pupil. This sign refers to corneal scarring that is so dense that at least pa of pupil margin is blurred when seen through the opacity. The definition is intended to detect corneal opacities that cause significant visual impairment (less than 6/18). Reference :- A K KHURANA 7th edition ; page:-66

Answer: OPTION C IS CORRECT.
Question: Which one of the following would be true if only the left optic nerve was severed?
Options:
A. Shining a light in the left eye would elicit the papillary reflex in both eyes
B. Shining a light in the left eye would elicit the papillary reflex in the opposite eye only
C. Shining a light in the left eye would elicit the papillary reflex in both eyes
D. Shining a light in the left eye would elicit the papillary reflex in the opposite eye only

Rationale: Shining a light in the right eye would elicit the papillary reflex in both eyes; even though the optic nerve to the left eye was destroyed, the consensual reflex is intact because the left oculomotor nerve carries the innervation to the papillary muscles. The stimulus from the right eye crosses to the opposite side at the level of the tectum of the midbrain. However, the light in the left eye would not produce any effect because the retinal receptor would not carry the information to the brain stem. Permanent dilation would most likely occur only if the oculomotor nerve to the left eye was severed.

Answer: OPTION C IS CORRECT.
Question: The ocular features of retinitis pigmentosa include –
Options:
A. Bony corpuscular appearance
B. Waxy pallor of the optic disc
C. Attenuation of the retinal arterioles
D. All of the above

Rationale: Clinical features of retinitis pigmentosa

Retinal pigmentary changes (Bone spicule intraneural retinal pigmentation) : - Retina studded with small, jet-black spots resembling bone corpuscles with a spidery outline. These pigmentary changes are typically perivascular and retinal veins (never arteries) have a sheath of pigment for part of their course. These changes affect equatorial region initially sparing the posterior pole and periphery. Later in the course of disease whole retina is involved.
Attenuated and thread like retinal arterioles and veins.
Pale and waxy optic disc (consecutive optic atrophy).
Thinning and atrophy of retinal pigment epithelium (RPE) in mid and far peripheral retina with relative sparing of RPE at macula.

Answer: OPTION D IS CORRECT.
Question: Features of Laurence-Moon-Bardet-Biedl syndrome include all of the following EXCEPT:
Options:
A. Hypogonadism
B. Obesity
C. Polydactyly
D. Cataract

Rationale: Laurence-Moon-Bardet-Biedel Syndrome: -Autosomal recessive disorder of hypogonadotropic hypogonadism -characterised by Mental retardation Obesity Polydactyly Retinitis pigmentosa Hypogonadism - delayed pubey

Answer: OPTION D IS CORRECT.
Question: A 64-year-old man presents to the clinic because he is experiencing generalized weakness. He notes difficulty getting out of a chair, and lifting objects above his head as examples of the muscle weakness. He has lost 15 lb and feels unwell. On physical examination, there is a blue purple rash on his eyelids and knuckles, and muscle strength in his proximal muscles is rated 4 out of 5. His laboratory investigations are abnormal for an elevated creatinine kinase (CK) level. He is started on prednisone therapy. Which of the following is the most important in monitoring response to therapy?
Options:
A. testing of muscle strength
B. sedimentation rates
C. urine transaminase enzymes
D. EMG

Rationale: The goal of therapy is to increase muscle strength and function, so following muscle strength is the key clinical assessment of response to therapy. The course of muscle necrosis in dermatomyositis can also be followed by repeated CK determinations. Repeated muscle biopsies or EMGs are rarely required.

Answer: OPTION A IS CORRECT.
Question: A 30 year old male with history of high grade fever with rigors followed by profuse sweating is admitted in ICU care after an episode of generalised tonic clonic seizure. The patient was comatose with no focal neurological deficit or signs of meningeal irrritation. The eyes were divergent, pout reflex was present. An impoant cause of death in this setting is:
Options:
A. Acidosis
B. Aspiration
C. Hypoglycemia
D. Anemia

Rationale: Here the clinical features are suggestive of cerebral malaria. FACTS: Coma is a characteristic feature of falciparum malaria Death - 20 % despite treatment Onset - gradual/sudden following a convulsion Diffuse symmetric encephalopathy without any focal deficits Cerebral Malaria - Impoant complications: Hypoglycemia - common complication and with poor prognosis Acidosis - An impoant cause of death from cerebral malaria ARDS Renal Impairment Ref: Harrison, Edition - 18, page - 1692.

Answer: OPTION A IS CORRECT.
Question: Chronic simple glaucoma features are :
Options:
A. Raised IOP with no optic nerve damage.
B. Raised IOP with optic nerve damage.
C. Perimetric damage with no optic nerve changes.
D. Pink disc.

Rationale: Glaucoma definition is CHRONIC OPTIC NEUROPATHY with characteristic visual field changes with IOP increased as major but not the only risk factor. B is correct as raised IOP is the most impoant preventable risk factor. A is wrong as there is no optic nerve damage. This condition is called ocular hypeension. C is wrong as there can be AION , RP and various other diseases that can cause visual field defects and not only glaucoma. D is also wrong as pink disc is seen in hypermetropia and not in glaucoma.

Answer: OPTION B IS CORRECT.
Question: Cause of acute loss of vision in a patient of alcoholic pancreatitis is:
Options:
A. Puscher's retinopathy
B. Sudden alcohol withdrawal
C. Acute congestive glaucoma
D. CRAO

Rationale: Answer is A (Puscher's retinopathy) Puscher's retinopathy is a relatively unusual complication of acute pancreatitis. It is manifested by sudden and severe loss of vision. It is believed to be due to occlusion of the posterior retinal aery with aggregated granulocytes. Peculiar Fundoscopic appearance : Cotton wool spots and hemorrhages confined to an area limited by the optic disk and macula.deg

Answer: OPTION A IS CORRECT.
Question: Metastatic calcification is most commonly seen in (NOTRELATED)
Options:
A. Cornea
B. Extensor tendon
C. Lungs
D. Renal tubules

Rationale: .

Answer: OPTION D IS CORRECT.
Question: Not a function of district blindness control society
Options:
A. Training of ophthalmologists
B. Financial and material management
C. Social mobilization
D. Creating public awareness

Rationale: Training of ophthalmologists are included in the teiary care hospitals District blindness Control Society * Planning -preparation of district Micro-plan * Implementation of programme * Monitoring of programme * Financial and material management * Social mobilization * Creating public awareness * Procurement of consumable and non-consumable items * Arrangement of screening camp * Record keeping and maintaining

Answer: OPTION A IS CORRECT.
Question: Agenesis of corpus callosum with retinal colobomas and intellectual disability is seen in:
Options:
A. Alagille syndrome
B. Aicardi syndrome
C. Ape syndrome
D. Ataxia telangiectasia

Rationale: Aicardi syndrome: - Characterized by Agenesis of corpus callosum Retinal colobomas Infantile spasms in girls Intellectual disability Alagille Syndrome- Triangular faces, conjugated jaundice Ape syndrome is a genetic disorder characterized by skeletal abnormalities. A key feature ofApe syndrome is the premature closure of the bones of the skull. Ataxia telangiectasia is a rare childhood disease. It affects the brain and other pas of the body. Ataxia refers to uncoordinated movements during walking. Telangiectasias are enlarged blood vessels (capillaries) just below the surface of the skin.

Answer: OPTION B IS CORRECT.
Question: Painless loss of vision is seen in all, EXCEPT:
Options:
A. Papilledema
B. Papillitis
C. Angle closure glaucoma
D. CRAO

Rationale: Acute angle-closure glaucoma is an ophthalmic emergency that causes severe visual loss without treatment. Symptoms include ocular pain, blurred vision, lacrimation, halos around lights, frontal headache, nausea, and vomiting. Causes of Sudden Painless Loss of Vision: Retinal detachment Vitreous haemorrhage Retinal vein occlusion Retinal aery occlusion Wet age related macular degeneration Anterior ischemic optic neuropathy Optic neuritis Cerebrovascular accident Papillitis Papilledema

Answer: OPTION C IS CORRECT.
Question: Most common type of senile cataract-
Options:
A. Cunieform
B. Nuclear
C. Cupuliform
D. None

Rationale: Most common type of senile cataract is cunieform coical (70%) followed by nuclear (25%) and cupuliform.

Answer: OPTION A IS CORRECT.
Question: A patient presents with diplopia with limitations of adduction in the left eye and abducting saccade in the right eye. Convergence is preserved. Most likely etiology is-
Options:
A. Partial 3rd nerve palsy
B. Internuclear ophthalmoplegia
C. Duane's reactionary syndrome
D. Absence of medial rectus muscle

Rationale: This patient has:-

Limitations of adduction in left eye
Abduction (abducting saccade) in right eye
Convergence is preserved

This is seen in internuclear ophthalmoplegia.
During right horizontal (lateral) gaze the central pathway is:- 
Left frontal eye field → contralateral (right) PPRF → Right abducens nuclei (causing abduction of right eye) → Right medial longitudinal fasciculus → contralateral oculomoter nerve → medial rectus (adduction of left eye). So, abduction of right eye is accompanied by adduction of left eye for right lateral gaze. In right internuclear ophthalmoplegia there is damage to right medial longitudinal fasciculus. Therefore, signal transmission is normal upto abducens nucleus (abduction of right eye is possible), but it cannot be further transmitted to controlateral 'oculomotor nucleus (adduction of left eye is not possible). Thus, on attempting right lateral gaze, abduction of right eye is possible but adduction of left eye does not occur. There may be saccades in right eye during abduction.
Convergence is maintained in internuclear ophthalmoplagia as the pathway for convergence is different and does not involve medial longitudinal fasciculus. The convergence pathways run directly into the midbrain without involving MLF.

Answer: OPTION B IS CORRECT.
Question: Small opacities in the media of the eye are best detected by:
Options:
A. Distant direct ophthalmoscopy
B. Direct ophthalmoscopy
C. Indirect ophthalmoscopy
D. All of the above

Rationale: Ans. Distant direct ophthalmoscopy

Answer: OPTION A IS CORRECT.
Question: A 25-year-old man presents with acute, painless loss of vision in the right eye. The appearance of the optic nerve of the right eye is hyperemic. Of the entities listed, the most likely cause may include:
Options:
A. Vitamin BI2 deficiency
B. Ethambutol hydrochloride toxicity
C. Leber hereditary optic neuropathy (LHON)
D. Dominant optic atrophy

Rationale: Leber hereditary optic neuropathy (LHON) Hereditary, toxic, and nutritional deficiency optic neuropathies commonly present with bilateral, insidious vision loss. In some cases, there can be asymmetry in visual acuity and visual fields. LHON often presents as acute or subacute unilateral vision loss that is followed within several months by vision loss in the fellow eye. The appearance of the optic nerve in LHON is characterized by a triad of circumpapillary telangiectasia, swelling of the nerve fiber layer around the disc, and absence of leakage on fluorescein angiography. LHON should be included in the diagnosis of acute unilateral vision loss from such disorders as optic neuritis and ischemic optic neuropathy.

Answer: OPTION C IS CORRECT.
Question: Pinch purpura around eyelids is one of the most common finding in
Options:
A. Fabry's disease
B. Primary systemic amyloidosis
C. Porphyria cutanea tarda
D. none

Rationale: Amyloidosis is a generic term, originally coined by Rudolf Virchow in 1854, which denotes extracellular deposition of a proteinaceous substance, amyloid composed of one of a family of biochemically unrelated proteins.Amyloidosis can be classified as systemic and cutaneous amyloidosis. Systemic amyloidosis is classified into primary and secondary. Primary systemic amyloidosis is a rare disorder. Wilks in 1856, was the first to describe primary systemic amyloidosis. Primary systemic amyloidosis may be idiopathic or myeloma associated. Primary and myeloma-associated systemic amyloidosis typically involve the tongue, hea, gastrointestinal tract, skeletal and smooth muscle, carpal ligaments, nerves, and skin. Cutaneous involvement is seen in 40% patients with AL amyloidosis. Cutaneous manifestations depend on the site of amyloid deposited. Amyloid deposition in superficial dermis produces shiny waxy translucent papules, and common sites of predilection are eyelids, retroauricular areas, neck, and axillae. Amyloid deposits in the deep reticular dermis and subcutis produce nodules and tumefactions. Amyloid infiltration of blood vessel walls produces capillary wall fragility leading to purpura clinically. Periorbital area is the most common site of purpura and may be demonstrable by pinching the skin . Ref - Harrison's internal medicine 20e topic Amyloidosis

Answer: OPTION B IS CORRECT.
Question: A 32-year-old man is admitted to the emergency department with visual problems. Radiographic examination reveals a tumor of the adenohypophysis (anterior pituitary gland). Physical examination reveals a loss of the lateral halves of the fields of vision of both eyes (bitemporal hemianopia or "tunnel vision"). Which of the following structures was most likely compressed by the tumor?
Options:
A. Optic nerve
B. Optic chiasm
C. Optic tract
D. Oculomotor

Rationale: Compression of the optic chiasm can cause bitemporal hemianopia due to compression of nerve fibers coming from the nasal hemiretinas of both eyes. The optic chiasm is located in very close proximity above the pituitary gland. Compression of an optic nerve would cause complete blindness in the affected eye. Compression of an optic tract would cause homonymous hemianopia. Compression of the oculomotor nerve would cause the eye to deviate "out and down" (paralysis of the four extraocular muscles innervated by this nerve), ptosis (paralysis of levator palpebrae), and mydriasis (paralysis of constrictor pupillae). Compression of the abducens nerve would cause paralysis of the lateral rectus muscle, leading to medial deviation (adduction) of the eye.

Answer: OPTION B IS CORRECT.
Question: Tributaries of cavernous sinus are all except
Options:
A. Inferior cerebral vein
B. Central vein of retina
C. Sphenoparietal sinus
D. Superior cerebral vein

Rationale: TRIBUTARIES OF CAVERNOUS SINUS; From orbit- Superior ophthalmic vein Inferior ophthalmic vein Central vein of retina From brain- Superficial middle cerebral vein Inferior cerebral vein From meninges- Sphenoparietal sinus Frontal trunk of middle meningeal vein Ref BDC volume3,sixth edition pg 194

Answer: OPTION D IS CORRECT.
Question: Condition which is always bilateral:
Options:
A. Infantile glaucoma
B. Megalocornea
C. Acute congestive glaucoma
D. All of the above

Rationale: Ans. Megalocornea

Answer: OPTION B IS CORRECT.
Question: Consider the following four events of development of fetus: UPSC 08; COMEDK 15 Development of external genitalia Appearance of scalp hair Centers of ossification in bones Formation of eyelashes and eye brows What is the order in which they appear from lower to higher gestation?
Options:
A. 1, 3, 2, 4
B. 1, 3, 4, 2
C. 3, 1, 4, 2
D. 3, 1, 2, 4

Rationale: Ans. 3, 1, 2, 4

Answer: OPTION D IS CORRECT.
Question: In hirschberg corneal reflex test, corneal light reflex falls in the centre of in between the border of pupil and limbus, the angle of squint is
Options:
A. 15°
B. 30°
C. 45°
D. 60°

Rationale: A. border of pupil - 15o.
B. limbus - 45o.
Centre of in B/w A & B (45o - 15o = 30o).

Answer: OPTION B IS CORRECT.
Question: The mother of a one and a half year old child gives history of increasing proptosis of left eye for the past 1 month. Examination revels left eye white reflex. On computed tomography scan of the orbit there is left orbital mass with calcification mainly centred within the globe. The most likely diagnosis is?
Options:
A. Congenital cataract
B. Retinoblastoma
C. Endophthalmitis
D. Coats disease

Rationale: Retinoblastoma: 1 Most common Intraocular tumor of childhood. 2. Malignant primary neoplasm of retina that arises from neuroectodermal cells of retina (pigment layer). 3. May be a congenital lesion that is present but not usually apparent at bih; average age of diagnosis is 13 months. 4. Principle symptom = unilateral blindness. 5. Primary sign = Leukocoria. 6. It is bilateral in about 30% cases. 7. It is histologically composed of round cells with 'Rosette' pattern 8. Other round cell tumors include neuroblastoma, Ewing's sarcoma, NHL, etc. When bilateral, follows AD with complete penetrance pattern. Chromosome 13 mutation (100% in B/L and 15% in U/L). Histopathology: Flexner Wintersteiner rosettes. It is a PNET. Morphologic forms 1. Endophytic 2. Exophytic 3. Diffuse form Type based on location 1. Unilateral (70%) 2. Bilateral (30%) 3. Trilateral (<1%) ? Bilateral RB plus pineal or suprasellar tumor 4. Tetra/Quadrilateral (< 0.1%) ? Bilateral RB plus pineal and suprasellar mass. CT Scan Calcification--Intraocular mass centered posteriorly in globe with moderate or intense CT with punctate or finely speckled calcification (<90%) with or without extraocular extension. MRI: best for seeing extraocular extension. Treatment: 1. Small sized tumor - (plaque or ext. beam) with/without vitreous seeding 2. Large RB - local extension: Enucleation ? External beam . 3. Unilateral tumor without invasion has excellent prognosis. Coats disease - Increased density in all or pa of vitreous in normal sized globe without calcification. Congenital cataract - Vitreous normal, lens is dense.

Answer: OPTION B IS CORRECT.
Question: The progression of which of the following diseases is retarded by chronic use of enalapril ?
Options:
A. Diabetic nephropathy
B. Diabetic retinopathy
C. Hypertensive nephropathy
D. All of the above

Answer: OPTION D IS CORRECT.
Question: A 56 year old woman came to the emergency room 3 hours after visual loss in the right eye. Visual sensitivity limits to light perception in the right eye. Examination reveals pupillary defect whereas anterior surface of both eye are normal. Fundus examination shows a red lesion with pale retina. Probable diagnosis
Options:
A. Central vein occlusion
B. Proliferative diabetic retinopathy
C. Background diabetic retinopathy
D. Central retinal artery occlusion

Rationale: Answer: d) Central retinal artery occlusion (KANSKI 8th ED, P-552)RETINAL ARTERY QCCLUSioNEtiology* Atherosclerosis - related thrombosis at the level of lamina cribrosa - most common cause* Emboli from carotid artery and cardiac origin> Cholesterol emboli (Hollenhorst plaque)> Calcium emboli> Platelet fibrin emboli - cause retinal ischemic attacks* Retinal arteritis - Polyarteritis nodosa, SLE, Wegener's granulomatosis, Scleroderma* Angiospasm, Raised IOP, Thrombophilia* Rare causes - Sickle cell anemia, retinal migraine, Oral contraceptives, polycythemia, Antiphospholipid syndromeClinical features* More common in males; Mean age at onset - 60 years* Usually unilateral* Central retinal artery occlusion (CRAO)> Obstruction at the level of lamina cribrosa> Sudden painless loss of vision> Markedly reduced visual acuity> Absent direct pupillary reflex - Total and profound afferent pupillary defect (APD) (amaurotic pupil)> Marked narrowing of retinal arteries and mild narrowing of retinal veins> The orange reflex from the intact choroid stands out at the thin foveola, in contrast to the surrounding pale retina, giving rise to a 'cherry-red spot' appearance> Milky white retina> Cherry red spot in the center of macula> Cattle truck appearance - segmentation of blood column in retinal vein> Atrophic changes - grossly attenuated thread like arteries and consecutive optic atrophy> FFA - delay in arterial filling and masking of choroidal vasculature due to retinal edema* Branch retinal artery occlusion (BRAO) - Obstruction at a bifurcationTreatment* No effective treatment available currently* Immediate lowering of IOP by> Intermittent ocular massage> IV mannitol or acetazolamide> Paracentesis of anterior chamber* Inhalation of carbogen or Meduna's Mixture (95 % O2 and 5 % CO2) - to relieve angiospasm* Steroids in cases of giant cell arteritisComplication - Neovascular glaucoma

Answer: OPTION D IS CORRECT.
Question: A 15 year old male presents with hematuria. He has previous diagnoses of deafness and corneal dystrophy. Urinalysis shows 1 + proteins, no ketones, no glucose, 1+blood, and no leukocytes. A renal biopsy reveals tubular epithelial foam cells by light microscopy. By electron microscopy, the glomerular basement membrane shows areas of attenuation, with splitting and lamination of lamina dense in other thickened areas. The most probable diagnosis is -
Options:
A. Acute tubular necrosis
B. Bergers disease
C. Membranous glomerulonephritis
D. Alport syndrome

Answer: OPTION D IS CORRECT.
Question: Cornea veicillata is caused by
Options:
A. Erythromycin
B. Amiodarone
C. Timolol
D. Tetracycline

Rationale: Cornea veicillata: *This is a whorl-like opacity in the corneal epithelium seen in patients on long-term treatment with medication such as amiodarone, chloroquine, phenothiazines, and indomethacin. *It is also seen in patients with Fabry disease and its carrier state. *The condition is generally asymptomatic, harmless and reversible on stopping the drug. *The whorl-like pattern shows the direction of migration of corneal epithelial cells. *Occasionally the condition has been known to cause glare and surface discomfo which responds to topical lubricants. Cornea veicillata, also called voex keratopathy or whorl keratopathy, is a condition characterised by corneal deposits at the level of the basal epithelium forming a faint golden-brown whorl pattern. It is seen in Fabry disease or in case of prolonged amiodarone intake Ref- Parson's; 21st edition; Pg No. 214

Answer: OPTION B IS CORRECT.