QIAIUNCC/EYE-TEST-3 huggingface dataset:
Question: A male patient 59 year old complains of multiple swellings in the neck, fever, and weight loss. He gives a history of hypertension treatment. General examination reveals painless lymph nodal enlargement in the neck and on blood investigation, anaemia is revealed. Lymph node biopsy shows typical owl eye-shaped appearance cells.
What can be the most probable diagnosis for this patient?
Options:
A. Multiple myeloma
B. Hodgkin’s lymphoma
C. Non-hodgkin’s lymphoma
D. Burkitt’s lymphoma

Rationale: Hodgkin lymphoma, like NHL, usually manifests  as  painless  lymphadenopathy.  Although  a definitive  distinction  from  NHL  can  be  made  only  by examination  of  a  tissue  biopsy,  several  clinical  features favor  the  diagnosis  of  Hodgkin  lymphoma.   After the diagnosis is established, staging is used to guide therapy  and  determine  prognosis.
Younger patients with more favorable subtypes tend to present with stage I or stage II disease and usually are free of so-called “B symptoms” (fever, weight loss, night sweats). Patients with advanced disease (stages III and IV) are more likely to  exhibit  B symptoms  as  well  as  pruritus  and  anemia.
The sine qua non of Hodgkin lymphoma is the Reed-Sternberg (RS) cell, a very large cell (15 to 45 µm in diameter) with an enormous multilobate nucleus, exceptionally prominent nucleoli, and abundant, usually slightly eosinophilic cytoplasm. Particularly characteristic are cells with two mirror-image  nuclei  or  nuclear  lobes,  each  containing  a  large (inclusion-like)  acidophilic  nucleolus  surrounded  by  a clear zone, features that impart an owl-eye appearance.

​Difference between Hodgkin Lymphoma and Non-Hodgkin Lymphoma

Answer: OPTION B IS CORRECT.
Question: Commonest cause of posterior staphyloma is:
Options:
A. Glaucoma
B. Retinal detachment
C. iridocyclitis
D. High myopia

Rationale: Ans. d (High myopia). (Ref: Ophthalmology by AK Khurana 2nd ed. 151)POSTERIOR STAPHYLOMA# It refers to bulge of weak sclera lined by the choroid behind the equator.# Common causes are:- Pathological myopia,- Posterior scleritis and- Perforating injuries.# Diagnosed best on ophthalmoscopy# It is seen as an excavated area with retinal vessels dipping in it.Excessively progressive degenerative myopia leads to sclerectasia circumscribed behind or posterior staphyloma. This is a sharply demarcated bulging of the entire posterior pole, which is associated with massive chorioretinal atrophy.

Answer: OPTION D IS CORRECT.
Question: Rosette cataract is seen after
Options:
A. Blunt trauma to eye
B. Copper foreign body in eye
C. Penetrating injury to eye
D. Infection

Rationale: Cataract Features Sunflower Wilson's disease / chalcosis **Keyser - Fleisher ring - characteristic of Wilson's disease Snow flake DM Christmas tree Myotonic dystrophy Oil drop Galactosemia Rosette shapes Blunt trauma Other features of blunt trauma 1. Commotio retina (berlin's edema)- milky white cloudiness involving the posterior pole with a cheer red spot in the foveal region 2. Vossius's ring - circular ring of brown pigment seen on the anterior capsule FABRY's disease Propeller / spoke like Complicated cataract Mostly posterior sub capsular cataract Bread crump appearance Polychromatic lusture Punctate / blue dot cataract M/C congenital cataract in children No loss of vision Atopic dermatitis Shield cataract Anterior sub capsular cataract

Answer: OPTION A IS CORRECT.
Question: Density of cells in adult corneal endothelium ?
Options:
A. 2000 cells/mm2
B. 3000 cells/mm2
C. 4000 cells/mm2
D. 5000 cells/mm2

Rationale: Ans. is 'b' i.e., 3000 cells/mm2 The cell density of corneal endothelium is around 3000 cells/mm2 in young adults, which decreases with the advancing age.

Answer: OPTION B IS CORRECT.
Question: Steroid is contraindicated in –
Options:
A. Herpes keratitis
B. Atropic dermatitis
C. Fungal corneal ulcer
D. Exposure keratitis

Rationale: here: -Topical corticosteroids enhance fungal replication and corneal invasion and therefore, contraindicated in a fungal corneal ulcer.
Now, option 'a' requires specific mention here:-
Topical corticosteroids are contraindicated in herpetic keratitis. But not in all forms of herpetic keratitis :-


Epithelial herpetic keratitis (Dendritic ulcer, geographic ulcer) → Topicla corticosteroids are contraindicated.
Stromal keratitis (Disciform & Diffuse necrotic) → Topical corticosteroids along with topical antiviral drugs are used as the first line of treatment.


So, my opinion for this type of question is that :-

i) If herpetic keratitis has given as the option, then look at other options. If any of the other options is a clear cut contraindication for corticosteroid (e.g. fungal corneal ulcer in this question), consider that option as your answer. If no ther option is a contraindication for topical corticosteroid, consider herpetic keratitis as the answer.
ii) If examiner has specifically mentioned dendritic ulcer as an option, consider it as the answer.

Answer: OPTION C IS CORRECT.
Question: First clinical sign of Vitamin-A deficiency is
Options:
A. Night blindness
B. Conjunctival xerosis
C. Bitot’s spots
D. Keratomalacia

Rationale: All the ocular manifestations of Vitamin-A deficiency are collectively known as 'Xerophthalmia' (Dry Eye) –
Xerophthalmia is most common in children aged 1 - 3 years

'First clinical sign' of Vitamin-A deficiency: Conjunctival xerosis
'First clinical symptom' of Vitamin-A deficiency: Night blindness
Conjunctival xerosis in Xerophthalmia has a characteristic appearance of 'emerging like sand banks at receding tide
'Bitot's Spots' are triangular, pearly-white or yellowish, foamy spots on bulbar conjunctiva, on either side of cornea; In young children they indicate Vitamin-A deficiency, whereas in adults they are often inactive sequelae of earlier disease

Answer: OPTION A IS CORRECT.
Question: Thickest poion of sclera is ?
Options:
A. Anterior to rectus muscle inseion
B. Posterior to rectus muscle inseion
C. Posterior pole
D. Limbus

Rationale: Ans. is 'c' i.e., Posterior pole o The thickness of the sclera varies according to location : ? At the limbus, the sclera is 0.8 mm thick. Anterior to the rectus muscle inseions, it is 0.6 mm thick. Posterior to the rectus muscle inseions, it is 0.3 mm thick (Thinnest poion). At the equator, it is 0.5 to 0.8 mm thick. At the posterior pole, it is greatest than 1 mm thick.

Answer: OPTION C IS CORRECT.
Question: Schwable's ring is seen in which layer of cornea
Options:
A. Bowmann's membrane
B. Stroma
C. Descemet's membrane
D. Substantia propria

Rationale: Ans. is 'c' i.e., Descemet's membrane Histology of cornea The cornea has five distinct layers (from superficial to deep) : ? Epithelium : - It is the outermost pa of cornea and is composed of stratified squamous non-keratinized epithelial cells. Bowman's membrane : - It is not a true membrane but simply a condensed superficial pa of stroma. destroyed, it does not regenerate. Stroma (Substantia propria) : - This layer constitutes most of the cornea (90% of thickness). It consists of collagen fibrils (lamellae) embedded in hydrated matrix ofproteoglycans. Descemet's membrane : - This layer bounds the stroma posteriorly. In the periphery it appears to end at the anterior limit of trabecular meshwork as Schwahle's ring. Endothelium : - It is a single layer of flat polygnonal cells. The endothelial cells contain 'active-pump' mechanism and is the most impoant layer in maintaining the transparency of cornea.

Answer: OPTION C IS CORRECT.
Question: Scleral buckling is used for treatment of-
Options:
A. Cataract
B. Scleritis
C. Retinal detachment
D. Vitreous hemorrhage

Rationale: In retinal detachment to maintain chorioretinal apposition, scleral buckling is done. Inward indentation of sclera to provide external tamponade (scleral buckling). Scleral buckling is achieved by inseing an explant (silicone sponge or solid silicone band) with the help of mattress type sutures applied in the sclera. Ref: khurana 5 th edition , page no.297

Answer: OPTION C IS CORRECT.
Question: The subconjunctival cyst is seen in –
Options:
A. Toxoplasmosis
B. Cysticercosis
C. Leishmaniasis
D. Chap's disease

Rationale: Parasitic cysts occurs in subconjunctival cysticercus, hydatid cyst and filarial cyst.

Answer: OPTION B IS CORRECT.
Question: Reye's syndrome is characterized by –
a) Viral infection is seen
b) Present as deep jaundice
c) Cerebral edema
d) Microvesicular fatty infiltration
Options:
A. acd
B. bcd
C. abc
D. cda

Answer: OPTION A IS CORRECT.
Question: Which antiglaucoma drugs can be used in Asthamatic patient
Options:
A. Timolol
B. Betoxolol
C. Propanolol
D. All the above

Rationale: Refer kDT 6/e p 145 Betaxolol is a selective beta1 receptor blocker used in the treatment of hypeension and glaucoma. Being selective for beta1 receptors, it typically has fewer systemic side effects than non-selective beta-blockers, for example, not causing bronchospasm as timolol may

Answer: OPTION B IS CORRECT.
Question: Maddox rod test is used for testing ?
Options:
A. Macular function
B. Lens opacity
C. Amount of tear production
D. Vitreous hemorrhage

Rationale: Ans. is 'a' i.e., Macular function

Answer: OPTION A IS CORRECT.
Question: A 60 year old male patient operated for cataract 6 months back now complains of floaters and sudden loss of vision. The diagnosis is –
Options:
A. Vitreous hemorhage
B. Retinal detachment
C. Central retinal artery occlusion
D. Cystoid macular edema

Rationale: Amongst the given options, retinal detachment and vitreous hemorrhage can cause floaters with sudden loss of vision. However, vitreous hemorrhage is not a late complication of cataract surgery.
Late complications ofcataract surgely are - cystoid macular oedema, retinal detachment, epithelial ingrowth, fibrous ingrowth, vitreous touch syndrome, after cataract.

Answer: OPTION B IS CORRECT.
Question: If the refractive power of the unaccommodated eye of an emmetropic woman is 60 diopters (D), the axial length of her eye is closest to?
Options:
A. 14.5mm
B. 15.5mm
C. 16.5mm
D. 17.5mm

Rationale: The focal point of an optical system (in meters) is the reciprocal of the refractive power of the system. Therefore, the focal point is 1/60 diopter (D), or 16.7 mm. An emmetropic eye forms a focused image of a distant object on the retina without accommodation. If the axial length is 16.5 mm, the image will be focused on the retina. Ref: Chang D.F. (2011). Chapter 2. Ophthalmologic Examination. In P. Riordan-Eva, E.T. Cunningham, Jr. (Eds), Vaughan & Asbury's General Ophthalmology, 18e.

Answer: OPTION C IS CORRECT.
Question: Full thickness skin graft can be taken from the following sites except -
Options:
A. Elbow
B. Back of neck
C. Supraclavicular area
D. Upper eyelids

Rationale: Ans. is 'Back of neck'

Answer: OPTION B IS CORRECT.
Question: The laryngeal mask airway used for securing the airway of a patient in all of the following conditions, EXCEPT:
Options:
A. In a difficult intubation
B. In cardiopulmonary resuscitation
C. In a child undergoing an elective/routine eye surgery
D. In a patient with a large tumour in the oral cavity

Rationale: Oropharyngeal abscess or mass is a contraindication to the use of laryngeal mask airway. Ref: Sho Textbook of Anaesthesia By Ajay Yadav, 2nd Edition, Page 36

Answer: OPTION D IS CORRECT.
Question: Corneal sensations are decreased in all of the following conditions except:
Options:
A. Recurrent corneal erosion syndrome
B. Herpetic keratitis
C. Neuroparalytic keratitis
D. Leprosy

Rationale: Ans. Recurrent corneal erosion syndrome

Answer: OPTION A IS CORRECT.
Question: Snake eye appearance is resembled by occlusal view of which tooth
Options:
A. Upper 1st premolar
B. Lower 1stpremolar
C. Upper 2nd premolar
D. Lower 2nd premolar

Answer: OPTION B IS CORRECT.
Question: What is the most common eye pathology in rheumatoid ahritis?
Options:
A. Scleritis
B. Episcleritis
C. Keratoconjunctivitis sicca
D. Anterior uveitis

Rationale: Answer- C. Keratoconjunctivitis siccaMC ocular manifestation of RA- Dry eye(Keratoconjunctivitis sicca).

Answer: OPTION C IS CORRECT.
Question: Which of the following is TRUE about amplitude of accommodation in a healthy individual?
Options:
A. Is the difference between near point and far point
B. Is about 10 diopters in emmetropic eye
C. Increases as age advances
D. Changes with spherical aberration

Rationale: The difference between the dioptric power needed to focus at near point (P) and far point (R) is called amplitude of accommodation (A). Thus A = P - R (P= dioptric power needed to see clearly at near point, R= dioptric power needed to see clearly at far point). Spherical aberration has nothing to do with accommodation. The amplitude of accommodation decreases throughout life from 14D at the age of 10 years to 6D at 40 years and almost 0D by the age of 60 years. Ref: Ophthalmology: Expe Consult By Myron Yanoff, Jay S. Duker, Jay S. Duker, 2009, Page 389 ; A K Khurana, 4th edition, Page 41

Answer: OPTION B IS CORRECT.
Question: Conjunctival ulceration may suggest:
Options:
A. Embedded foreign body
B. Tuberculosis
C. Syphillis
D. Syphillis

Rationale: Ans. Syphillis

Answer: OPTION D IS CORRECT.
Question: The commonest cause of rubeosis iridis is
Options:
A. Diabetes mellitus
B. Central retinal vein occlusion
C. Central retinal aery occlusion
D. Carotid stenosis

Rationale: Ans. Diabetes mellitus

Answer: OPTION A IS CORRECT.
Question: Which nerve lesion could produce the condition where stimulation of right cornea results in the blinking of the left eye but not the right eye?
Options:
A. Left trigeminal
B. Left facial
C. Right trigeminal
D. Right facial

Rationale: Summary of blink reflex:Ipsilateral blinkContralateral blinkNormalPresentPresentFacial nerve lesionAbsentPresentTrigeminal nerve lesionAbsentAbsent

Answer: OPTION D IS CORRECT.
Question: Retinoblastoma spreads through?
Options:
A. Vascular invasion
B. Direct invasion
C. Optic nerve
D. Lymphatic

Answer: OPTION C IS CORRECT.
Question: All the following signs could result from infection with in the right cavernous sinus except-
Options:
A. Constricted pupil in response to light
B. Engorgement of the retinal veins upon ophthalmoscopic examination
C. Ptosis of the right eyelid
D. Right ophthalmoplegia

Rationale: Cavernous sinus thrombosis *Patient develops severe pain in the eye and forehead of the involved side. *Conjunctiva is swollen and congested. *Proptosis *Ptosis (due to 3rd N.Palsy) *Dilated pupil (due to 3rd N involvement ) *Retinal veins shows congestion. *Papilloedema *Fundus may be normal Ref: Khurana 7th/e p.428

Answer: OPTION A IS CORRECT.
Question: Horner's syndrome. All true except
Options:
A. Miosis
B. Anhydrosis
C. Hyperchromatic iris
D. Apparent exophthalmos

Rationale: Horner syndrome due to sympathetic pathway to head and neck. *Brainstem,cervical pa of spinalcord or stellate ganglion are common site of lesion *Characterised by miosis,paial ptosis,anhydrosis,enophthalmos,hyperchromatic iris,flushing of face. Ref Harrison20th edition pg 2345

Answer: OPTION D IS CORRECT.
Question: Swinging flash light test is used to examine:
Options:
A. Cornea
B. Pupil
C. Lens
D. Conjunctiva

Rationale: Pupil

Answer: OPTION B IS CORRECT.
Question: A 40-year-old female graduate student had an excruciating headache. When she looked in the mirror, she noticed that her eyelid was drooping; when she lifted the eyelid, she saw that her eyeball was looking down and out and her pupil was huge. She complained of both blurred and double vision. An magnetic resonance angiogram scan showed an aneurysm of the cerebral aerial circle. Which aery gives rise to the offending aneurysm?
Options:
A. Anterior choroidal
B. Anterior communicating
C. Charcot-Bouchard's
D. Posterior communicating

Rationale: Posterior communicating aerycan give rise to aberry aneurysm, whichcompresses the 3rd cranial nerveand results in incomplete third nerve palsy. Acommunicating aerymay harbor berry aneurysm that impinge on theoptic chiasmacausing a bitemporal lower quadrantanopia. Charcot-Bouchard microaneurysmsare found in the territory of the lateral striate aeries and are the commonest cause of non-traumaticintra-parenchymal hemorrhage.

Answer: OPTION D IS CORRECT.
Question: Which of the below is a feature of Osteogenesis imperfecta?
Options:
A. Blue sclera
B. Cataract
C. Anterior uveitis
D. Retinal detachment

Rationale: Ans. is 'a' i.e., Blue sclera o Osteogenesis imperfecta, also known as brittle bone disease, is due to defective collagen type 1 synthesis.o It is inherited mostly as autosomal dominant but autosomal recessive pattern also seen in severe form. Clinical features of osteogenesis imperfecta# Blue sclera# Dentinogenesis imperfecta a Generalized osteoporosis# Osteoporosis given rise to bowing and multiple fractures. Fracture are usually due to trivial trauma but surprisingly heal well.# Other features: Deafness due to otosclerosis, joint laxity, dwarfism, broad skull, poorly calcified decidual teeth (Permanent teeth are normal).# Radiology shows wormian bones in the skull.

Answer: OPTION A IS CORRECT.
Question: Immune ring is a feature of -
Options:
A. Interstitial keratitis
B. Fungal corneal ulcer
C. Bacterial corneal ulcer
D. Herpes simplex keratitis

Rationale: A sterile immune ring (yellow line of demarcation)may be present where fungal antigen and host antibodies meet.Its a sign in fungal corneal ulcer Reference:Comprehensive ophthalmology,AK Khurana,6th edition,page no.106

Answer: OPTION B IS CORRECT.
Question: Examination of the fundus shows Cherry red spot in all of the following conditions, EXCEPT:
Options:
A. Gaucher's disease
B. Tay Sach's disease
C. Niemann Pick Disease
D. Central retinal vein occlusion

Rationale: Cherry red spot is an ophthalmoscopic finding caused by the abnormal accumulation of products like gangliosides in the ganglion layer of the retina. The absence of ganglion cells in the area gives rise to a cherry-red spot surrounded by white cells filled with storage material. As the cells sta to die, optic atrophy becomes visibly apparent. Cherry red spot is seen in: Berlin's oedema Gaucher's disease Tay sach's disease Neimann pick's disease Central retinal aery occlusion Ref: Ophthalmology By A.K Khurana, 4th Edition, Page 257, 478; Harrison's Principles of Internal Medicine By Robe J. Hopkin, Gregory A. Grabowski, Chapter 355, Page 2452

Answer: OPTION D IS CORRECT.
Question: The wavelength of laser {in nanometers} for shaping cornea in refractive surgery is-
Options:
A. 193 nm
B. 451 nm
C. 532 nm
D. 1064nm

Rationale: *Corneal Reshaping procedures such as photorefractive keratectomy (PRK) and Laser Assisted is Situ Keratomileusis (LASIK) are performed by lasers in the ultraviolet wavelength of 193nm to 213 nm. The most commonly used laser for such procedures is the Argon Fluride Excimer Laser (ARF) with a length of 193nm. Ref: Yanoff 3rd/e p.43

Answer: OPTION A IS CORRECT.
Question: A 66 year old presents to emergency with sudden onset severe pain, blurring vision in right eye. Examination reveals decreased visual acuity with shallow cornea, hazy cornea in the same eye.Eye has a stony hard consistency.Likely diagnosis is:
Options:
A. Keratitis
B. Uveitis
C. Conjunctivitis
D. Glaucoma

Rationale: Glaucoma

Answer: OPTION D IS CORRECT.
Question: Fetal /choroidal fissure is closed by which week of gestation
Options:
A. 3rd week
B. 4th week
C. 6th week
D. 8th week

Rationale: Fetal fissure is closed by 6th week Failure to close can lead to formation of coloboma(eg- pear shaped coloboma of iris,chorioretinal coloboma i)

Answer: OPTION C IS CORRECT.
Question: Elschnig's pearls is seen in -
Options:
A. Wilson's disease
B. Secondary cataract
C. Complicated cataract
D. Congenital cataract

Rationale: Clinical types of after cataract(secondary cataract). After cataract may present as thickened posterior capsule, or dense membranous after cataract or Soemmering's ring which refers to a thick ring of after cataract formed behind the iris, enclosed between the two layers of capsule or Elschnig's pearls in which the vacuolated subcapsular epithelial cells are clustered like soap bubbles along the posterior capsule. REF IMG

Answer: OPTION B IS CORRECT.
Question: Base of the skul fracture presents with invovlement of the petrous temporal bone, which of the following impoant sign is seen -
Options:
A. Subconjuctival hematoma
B. CSF rhinorrhoea
C. Raccoon eyes
D. Battle sign

Rationale: Ans. is 'd' i.e., Battle sign Battle's sign (or mastoid echymosis) is bruising or ecchymiosis over the mastoids (i.e. behind the ear). Seen in pterous temporal bone base-of-skull fracture. Raccoon's sign or periorbital ecchymosis is seen in subgaleal haemorrhage (d/t frontal trauma)

Answer: OPTION D IS CORRECT.
Question: Tear drop sign: (Repeat)
Options:
A. floor of orbit
B. Retinoblastoma
C. Dry eyes
D. Congenital nasolacrimal duct obstruction

Rationale: Ans: A ( floor of the orbit) Ref: Basok Essentials of ophthalmology 5th edition, pg no 421: kanski 7th edition clinical ophthalmology, pg no 873- 874Explanation:Blow out fracture of orbit:Caused by a sudden increase in the orbital pressure by an impacting object of size > 5cm like tennis ball or fist.The fracture usually involves the floor of the orbit, along the thin bone covering the infra orbital canal.Two types:Pure Blow Out fracture does not involve the orbital rim or the other bonesImpure Form involves other bonesSymptoms:Diplopia - due to the entrapment of muscle into the fracture , intraorbital hemorrhage or injury to the muscle itselfDouble Diplopia - Diplopia in both upgaze & downgaze due to entrapment of both Inferior rectus (Depression) & inferior oblique (Elevation)Periocular ecchymosis & edemaEnophthalmosInfraorbital nerve anaesthesia Investigations: X-ray (WATER'S view) - kTear Drop Sign ' because of the protruding orbital tissue from the floor if the orbit into the maxillary antrum.Management:Conserv ative management with antibiotics & anti inflammatory drugsOrbital floor repair with bone graft, silicone plate within 2 weeksIndications:Fracture involving > one third of the floorPersisting diplopiaEnophthalmos > 2mmBlow-In Fracture:Sudden rise of pressure in the maxillary antrum due to trauma to the face with subsequent elevation of bone fragments into the orbit.

Answer: OPTION A IS CORRECT.
Question: Among the following, the structure that passes deep to the flexor retinaculum is?
Options:
A. Tibialis anterior
B. Tibialis posterior
C. Peroneus brevis
D. Peroneus longus

Rationale: Tibialis posterior is the deepest and most centrally located muscle in the deep posterior compament of the leg. It arises from the upper posterior aspect of tibia, fibula and interosseous membrane and passes medially deep to the flexor retinaculum. Its tendons flares and inses into the navicular, tarsal bones, and bases of the second, to fouh metatarsals. Flexor retinaculum is a thick band of deep fascia on the medial aspect of the ankle Medial calcaneal nerve and medial calcaneal aery pierce the retinaculum. Structures passing below it from above down are: Tibialis posterior tendon Flexor digitorum longus tendon Flexor hallucis longus tendon Posterior tibial aery Tibial nerve.

Answer: OPTION B IS CORRECT.
Question: Dilated pupil is seen in all of the follow ing EXCEPT
Options:
A. Papillitis
B. Optic atrophy
C. Acute glaucoma
D. Pontine haemorrhage

Rationale: (D) Pontine haemorrhage # Pupil in Acute congestive glaucoma - mid dilated, vertically oval non-reacting Absolute glaucoma -dilated pupil with painful, blind eye Acute cunjuctivitis - normal briskly reading Acute anterior uveitis -small irregular & sluggishly reacting

Answer: OPTION D IS CORRECT.