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###Rationale: Hypersensitivity. Although the incorrect choices may cause eye irritation, seasonal conjunctivitis is typically caused by allergies to pollens that are released during a particular time of the year. Allergic rhinitis (hay fever) is the most common type I hypersensitivity disease in adults. It may be caused by pollen, house dust, animal dandruff, and many other allergens. Antigens inhaled react with the IgE attached to basophils in the nasal mucosa, thereby triggering the release of vasoactive substances stored in cytoplasmic granules. Histamine, the main mediator released from mast cells, increases the permeability of mucosal vessels, causing edema and sneezing.Diagnosis: Conjunctivitis, hypersensitivity reaction ###Answer: OPTION D IS CORRECT.

###Question: A 35-year-old man asks for advice regarding seasonal eye itching and runny nose. Recurrent conjunctivitis in this patient is most likely caused by which of the following mechanisms of disease? ###Options: A. Autoimmunity B. Bacterial infection C. Chemical toxicity D. Hypersensitivity

Being a doctor, your task is to answer the medical questions based on the patient's description. Analyze the question and answer with the best option.

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###Rationale: Trichuris REF: Jawetz, Melnick, & Adelberg's Medical Microbiology, 24TH edition chapter 46 Table 46-4 "Trichinella infectes by ingestion of undercooked pork which contains encysted larvae in the straited muscle" About option (B); Infective forms of T cruzi do not pass to humans by triatomine a bug bite (which is the mode of entry of the nonpathogenic T rangeli); rather, they are introduced when infected bug feces are rubbed into the conjunctiva, the bite site, or a break in the skin. For other options See APPENDIX-74 for "DISEASES DUE TO HELMINTHS" ###Answer: OPTION D IS CORRECT.

###Question: Which among the following doesn't affect Eyes? ###Options: A. Onchocerca volvulus B. Trypanosoma C. Loa loa D. Trichuris

Your identity is a doctor, kindly provide answers to the medical questions with consideration of the patient's description. Analyze the question and answer with the best option.

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###Rationale: Ans. Increased mitotic figures in centre of cornea ###Answer: OPTION B IS CORRECT.

###Question: Corneal transparency is maintained by all except: ###Options: A. Relative dehydration B. Increased mitotic figures in centre of cornea C. Unmyelinated nerve fibers D. Uniform spacing of collagen fibrils

Given your background as a doctor, please provide your insight in addressing the medical questions based on the patient's account. Analyze the question and answer with the best option.

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###Rationale: Clinical features: Progressive unilateral sensory neural healing loss often accompanied by tinnitus. Vestibular symptoms seen are unsteadiness and rarely veigo. Cranial nerve involvement: Vth cranial nerve: Reduced corneal sensitivity, numbness or paraesthesia of face. VIIth nerve: Hypoesthesia of posterior metal wall, loss if taste and reduced lacrimation. IX and X nerves: Dysphagia and hoarseness due to palatial, pharyngeal and laryngeal paralysis. XI and XII, III, IV and VI are affected. Brainstem involvement: Ataxia, weakness and numbness of the arms and legs with exaggerated tendon reflexes. Cerebellar involvement: Pressure symptoms. Finger-nose test, knee heel test, dysdiadochokinesia, ataxia gait and inability to walk along a straight line with the tendency to fall to the affected side. Raised intracranial tension: Headache, nausea, vomiting, diploma, papilloedema. Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 125 ###Answer: OPTION D IS CORRECT.

###Question: In a patient with acoustic neuroma, all are seen except ###Options: A. Facial nerve may be involved B. Reduced corneal reflex C. Cerebellar signs D. Acute episode of veigo

Your identity is a doctor, kindly provide answers to the medical questions with consideration of the patient's description. Analyze the question and answer with the best option.

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###Rationale: Cigarette smoking is associated with a fivefold increased risk for adenocarcinoma of the pancreas. Cholelithiasis (choice B) and alcohol abuse (choice A) are associated with pancreatitis, not pancreatic adenocarcinoma.Diagnosis: Pancreatic adenocarcinoma ###Answer: OPTION C IS CORRECT.

###Question: A 65-year-old woman presents with a 5-week history of yellow skin and sclera, anorexia, and epigastric pain. Her past medical history is significant for insulin-dependent diabetes mellitus. She smoked one pack of cigarettes a day for the past 20 years. Physical examination reveals jaundice and a palpable gallbladder. Laboratory studies show a serum bilirubin level of 10 mg/dL, mostly in the conjugated form, and an elevated alkaline phosphatase (260 U/L). A CT scan of the abdomen discloses a mass in the head of the pancreas and multiple nodules in the liver measuring up to 3 cm. Which of the following is the most important risk factor for the neoplasm arising in the patient? ###Options: A. Alcohol abuse B. Cholelithiasis C. Cigarette smoking D. Diabetes mellitus type 1

In your capacity as a doctor, it is expected that you answer the medical questions relying on the patient's description. Analyze the question and answer with the best option.

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###Rationale: Vitreous wick syndrome is not seen in phacomorphic glaucoma. Vitreous Wick Syndrome Can be seen In: ICCE ECCE PHACOEMULSIFICATION with Posterior Capsular Rent Etiology: Vitreous comes in Anterior Chamber. Clinical Features Cause pupillary peaking. Corneal endothelium damage. Secondary glaucoma. Increase chances of Retinal Detachment. Cystoid macular edema. ###Answer: OPTION D IS CORRECT.

###Question: Not true regarding vitreous wick syndrome: ###Options: A. More commonly seen in ICCE or ECCE B. Vitreous comes in anterior chamber C. Can cause secondary glaucoma D. Seen in phacomorphic glaucoma

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###Rationale: B i.e. Oval & veical In acute congestive glaucoma pupil is veically oval, dilated & nonreacting Q and anterior chamber is very shallow Q; where as in acute anterior uveitis pupil is small, irregular & sluggishly reacting Q and anterior chamber is deep. ###Answer: OPTION B IS CORRECT.

###Question: In acute congestive glaucoma, pupil is: ###Options: A. Oval and horizontal B. Oval and veical C. Circular D. Slit like

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###Rationale: In vitamin A deficiency there is metaplasia of squamous epithelium and goblet cell atrophy Refer: Khurana 6th edition page number 382 ###Answer: OPTION A IS CORRECT.

###Question: Conjunctiva in vitamin A deficiency shows ###Options: A. Hyperplasia of squamous epithelium B. Actinic degeneration C. Macrophage infiltration D. Hyperplasia of goblet cells

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###Rationale: Ans. is 'b' i.e.. Primary systemic amyloidosis o Purpura of the eyelids following pinching (pinch purpura) is a characteristicfeature of primary systemic amyloidosiso Pinch purpura of the eyelids are seen in about 30% of the cases ofprimary systemic amyloidoses.o It occurs due to involvement of cutaneous blood vessels in primary1 systemic amyloidosis.o The most common skin lesions are pete hie or ecchymoses due to amyloid deposition within blood vessel walls with subsequent fragility and dermal hemorrhage.o These are o ften seen at sites predisposed to trauma, such as the hands or intertriginous areas.o Pinching the skin gives charaterstic purpura lesions known as "pinch purpura".o Purpura around the eyes may occur spontaneously but is also seen following proctoscopy or vomiting (postproctoscopic purpura).o Dermatological involvement occur in about 30% - 40% patients with systemic amyloidosis.o Other dermatological manifestations include waxy or translucent papules and lets frequently tense hemorrhagic bullae.o Histopathology of the cutaneous lesions reveal amyloid deposits in the dermis.o Occular findings in primary generalized amyloidosis includes :Purpura of the eyelids.B/l symmetrical small amyloid papules of the skin of the eyelids.PtosisOphthalmalgia or evidence of amyloid neuropathes affective pupillary function or both.Subconjunctival hemorrhages. ###Answer: OPTION B 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 of the above

Considering your role as a medical practitioner, please use the patient's description to answer the medical questions. Analyze the question and answer with the best option.

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###Rationale: Vernal Keratoconjuctivits is bilateral, recurrent, interstitial, self-limiting, allergic inflammation of the conjunctiva which has seasonal incidence. It is usually seen in boys of age group 4-20 years especially during the summer season. Children usually presents with severe burning and itching sensation in the eye. Other associated symptoms include photophobia, lacrimation and ropy discharge from the eyes. Vernal keratoconjunctivitis, also known as "spring catarrh," "seasonal conjunctivitis" or "warm weather conjunctivitis". The upper palpebral conjunctiva often has giant papillae that give a cobblestone appearance. A stringy conjunctival discharge and a fine, fibrinous pseudomembrane (Maxwell-Lyons sign) may be noted. Patients with atopic dermatitis (eczema) often also have atopic keratoconjunctivitis. The symptoms and signs are a burning sensation, mucoid discharge, redness, and photophobia. Ref: Comprehensive Ophthalmology By A.K Khurana, 4th Edition, Page 745 ; Nijm L.M., Garcia-Ferrer F.J., Schwab I.R., Augsburger J.J., Correa Z.M. (2011). Chapter 5. Conjunctiva & Tears. In P. Riordan-Eva, E.T. Cunningham, Jr. (Eds), Vaughan & Asbury's General Ophthalmology, 18e. ###Answer: OPTION D IS CORRECT.

###Question: Which of the following is the cause of recurrent bilateral conjunctivitis occurring during hot weather in young boys with symptoms of burning, itching, and lacrimation with polygonal raised areas in the palpebral conjunctiva? ###Options: A. Trachoma B. Phlyctenular conjunctivitis C. Atopic Keratoconunctivitis D. Vernal Keratoconjunctivitis

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###Rationale: Lamellar or zonular cataract is the most common type of congenital cataract, accounting for about 50% cases. Here, development of the lens is interfered at a later stage. Typically, this cataract occurs in a zone of foetal nucleus surrounding the embryonic nucleus. The main mass of the lens internal and external to the zone of cataract is clear, except for small linear opacities like spokes of a wheel (riders) which may be seen towards the equator. Ref: Ophthalmology by Khurana, 2005, Page 187. ###Answer: OPTION B IS CORRECT.

###Question: Which among the following is the commonest type of congenital cataract? ###Options: A. Nuclear B. Zonular C. Capsular D. Coralliform

You're a doctor, kindly address the medical queries according to the patient's account. Analyze the question and answer with the best option.

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###Rationale: Ans. is 'd' i.e., Patellar tendon Clinical criteria for diagnosis of brain death is : Coma (widesperead coical destruction) : There is unresponsiveness to all form of stimuli. Stimuli do not produce any motor responceexcept spinally mediated reflexes, i.e. spinal reflexes may be intact e.g. deep tendon reflex. Absent of brainstem reflexes : Pupillary reflex, oculovestibular reflex, corneal reflex, pharyngeal and tracheal reflexes. Signs of brain stem (lower) destruction : Apnea, pulse rate invariant and unresponsive to atropine. ###Answer: OPTION D IS CORRECT.

###Question: Brain death indicated by suppression of reflexes all except? ###Options: A. Oculovestibular B. Corneal C. Pharyngeal D. Patellar tendon

In your capacity as a doctor, it is expected that you answer the medical questions relying on the patient's description. Analyze the question and answer with the best option.

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###Rationale: Symblepharon is adhesion of bulbar conjunctiva with palpebral conjunctiva Refer Khurana 6th edition page number 374 ###Answer: OPTION D IS CORRECT.

###Question: Alkali injury to eye causes ###Options: A. Globe perforation B. Retinal detachment C. Optic neuritis D. Symblepharon

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###Answer: OPTION D IS CORRECT.

###Question: An old patient Ram Kishore having asthma and glaucoma is to receive a β blocker. Regarding β blocking drugs: ###Options: A. Metoprolol blocks β2 receptors selectively B. Esmolol's pharmacokinetics are compatible with chronic topical use C. Nadolol lacks β2 blocking action D. Timolol lacks the local anaesthetic effects of propranolol

Your identity is a doctor, kindly provide answers to the medical questions with consideration of the patient's description. Answer with the best option directly.

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###Rationale: Coicosteroids Used to suppress the tissue destruction associated with many chronic inflammatory diseases, including RA and systemic lupus erythematosus. Induce the synthesis of an inhibitor of phospholipase A2 and block the release of arachidonic acid from the plasma membranes of inflammatory cells. Myeloperoxidase catalyzes the conversion of H2O2 , in the presence of a halide (e.g., chloride ion) to form hypochlorous acid. Superoxide dismutase reduces the superoxide radical to H2O2. ###Answer: OPTION C IS CORRECT.

###Question: A 25-year-old woman presents with a 2-week history of febrile illness and chest pain. She has an erythematous, macular facial rash and tender joints, paicularly in her left wrist and elbow. A CBC shows mild anemia and thrombocytopenia. Coicosteroids are prescribed for the patient. This medication induces the synthesis of an inhibitor of which of the following enzymes in inflammatory cells? ###Options: A. Lipoxygenase B. Myeloperoxidase C. Phospholipase A2 D. Superoxide dismutase

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###Rationale: Iris shadow is absent in mature senile cataract. ###Answer: OPTION D IS CORRECT.

###Question: Not a feature of Mature Senile Cataract among the following is ###Options: A. Pearly white colored B. Diminision of Vision C. Glare D. Iris shadow

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###Rationale: Retinal nerve infarcts ###Answer: OPTION A IS CORRECT.

###Question: Cotton wool spots in diabetic retinopathy are due to: ###Options: A. Retinal nerve infarcts B. Retinal holes C. Retinal haemorrhage D. Macular degeneration

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###Rationale: Ans. Myopia ###Answer: OPTION A IS CORRECT.

###Question: Uveal effusion syndrome may be associated with all of the following except: ###Options: A. Myopia B. Ciliochoroidal detachment C. Structural defect in Sclera D. Nanophthalmos

Considering your role as a medical practitioner, please use the patient's description to answer the medical questions. Analyze the question and answer with the best option.

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###Rationale: Chryiasis is deposition of gold in stroma of cornea. Type of Pigment Name of Deposit Disorder Location in Cornea Iron Stocker's line Pterygium Epithelium Hudson-Stahli line In old age Epithelium Ferry's line Filtering bleb Epithelium Fleischer's ring Keratoconus Epithelium Coat's white ring Previous Metallic foreign body injury Bowman's layer Siderosis Stroma Blood staining of cornea Stroma Copper Kayser-Fleischer ring Wilsons's Disease Descement's membrane Melanin Krukenberg's spindle Pigment dispersion syndrome Endothelium Silver Argyrosis Stroma Gold Chrysiasis Stroma ###Answer: OPTION B IS CORRECT.

###Question: Chyriasis is deposition of ###Options: A. Silver in stroma of cornea B. Gold in stroma of cornea C. Iron in basement membrane D. Copper in descement's membrane

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###Rationale: Descement membrane: toughest layer of cornea Descement's Membrane : *Act as a basement membrane for the endothelial cells *Type 4 & type 8 are most common type of collagen in DM *Toughest layer that provides protection from perforation *Responsible for descemetocele formation. *Site of deposition of copper as KF ring in wilson's disease (. If dua layer is in option then go for that) Endothelium is responsible for behaving like a pump that maintains the relatively dehydrated state of the cornea thereby maintaining its transparency The other options are all true ###Answer: OPTION B IS CORRECT.

###Question: All of the following are true about layers of cornea except : ###Options: A. Predescemet's layer is also known sd Dua's layer B. Type 2 & type 4 type of collagen are present in Descement membrane C. Corneal Stroma is the thickest layer of the cornea D. Endothelium is responsible for maintaining relatively dehydrated state of cornea

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###Rationale: Gentamycin causes macular infarction (retinotoxic). Preferably the aminoglycosides should be avoided intravitreally. Ref : Khurana page no. 169 ###Answer: OPTION A IS CORRECT.

###Question: Which drug can cause macular toxicity when given intravitreally ? ###Options: A. Gentamicin B. Vancomycin C. Dexamethasone D. Ceftazidime

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###Rationale: A i.e. Inhibition of anaerobic glycolysis Endothelium provides a leaky barrier to aqueous humor by allowing molecules & electrolytes of small size (2-3nm) to penetrate through focal tight junctions (maculae occludentes). This barrier function is Ca" dependent. The delicate balance between fluid entering corneal stroma (barrier function) and fluid egressing (4-5 Ju1/cm2/hour) the stroma (Na+ K+ ATPase pump function) maintain the corneal hydration at a fixed level of 78%. Any change would cause corneal oedema. Corneal stroma contains glycosaminoglycans (GAG) which is the main cause of corneal hydration and swelling pressure (50mmHg). GAG has anionic charges 1/t separation of one molecule from other making it a sponge like structure that can swell & get hydrated The GAG anionic repulsion expands the tissue and sucks in fluid with equal pressure called imbibation pressure (-30 mmHg) Intraocular pressure (20) = Swelling pressure (50) + Imbibation pressure (-30) Corneal oedema occurs if IOP exceeds SP as in glaucoma or if SP is low (with normal 10P) as in endothelial dystrophy. Endothelial pump is dependent on presence of Cl- & HCO3- and can be slowed down by carbonic anhydrase inhibitor. Basolateral Na+/2HCO3 cotranspo, Na+/KV2C1- cotranspo, C1-/HCO3- exchange, apical anion channels permeable to both Cl- & HCO3- and carbonic anhydrase mediated CO2 diffusion mode of apical HCO3 flux are various anion transpo mechanisms in endothelium. When ATP produced by both glycolysis and aerobic respiration was inhibited by 0.1 mmol/l iodoacetamide, the endothelial cells could not survive but when ATP synthesis alone by aerobic respiration was inhibited by 1.0 mmol/L KCN, the endothelial cells survived for at least 1 week on the ATP produced by anaerobic glycolysisQ. ###Answer: OPTION A IS CORRECT.

###Question: Ionic exchange in the corneal endothelium depends upon the metabolic rate. Which of the following can block Ionic exchange in corneal endothelium? ###Options: A. Inhibition of anaerobic glycolysis B. Activation of anaerobic glycolysis C. Activation of cAMP phosphodiesterase inhibitors D. Interference with electron chain transpo

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###Rationale: The hints point towards phlyctenular keratoconjunctivitis Phlyctenular conjunctivitis * Nodular response of conjunctival epithelium to endogenous antigen * Organisms: TB, S. aureus (mc), M. axenfield * Age: 3-15 yr * Girls > Boys * Predisposition in Low Socioeconomic status, Unhygenic surroundings Pathophysiology * Stage of Nodule Formation * Ulceration * Granulation * Healing Types : Conjunctival Involvement * Simple * Necrotizing * Miliary Corneal Involvement * Ulcerative: Sacrofulaceous/ Fascicular/ Miliary * Diffuse infiltative Treatment * Topical steroids * Antibiotic ointment * Atropine (1%) in case of corneal involvement ###Answer: OPTION C IS CORRECT.

###Question: A 7 yr patient came to opd with nodule on conjunctiva. He has history of taking TB treatment in the past. The nodule with has now encroached the limbus. What is the possible diagnosis. ###Options: A. Trachoma B. Vernal keratoconjunctivits C. Phylectenular keratoconjunctivitis D. Limbus stem cell deficiency

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###Rationale: distal tubule, paicularly its first pa, is in an extension of the thick segment of the ascending limb. It is relatively impermeable to water, and continued removal of the solute in excess of solvent fuher dilutes the tubular fluid(hypotonic fluid). Ref:- Ganong, pg num:-684 ###Answer: OPTION D IS CORRECT.

###Question: In normal kidneys, which of the following is true of the osmolarity of renal tubular fluid that flows through the early distal tubule in the region of the macula densa?(2018) ###Options: A. Usually isotonic compared with plasma B. Usually hypeonic compared with plasma C. hypeonic compared with plasma in antidiuresis D. Usually hypotonic compared with plasma

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###Rationale: Ans. is 'b' i.e., Hypermetropic Eve at birtho Anteroposterior diameter of eye ball is about 16 5 mm (70% of adult size). Adult size is attained by 7-8 yearso Corneal diameter is about 10 mm. Adult size (11.7 mm) is attained by 2 years of age.o Anterior chamber is shallow and angle is narrowo Lens is spherical at birth.o RetinaApart from macular area, the retina is fully differentiated. Macula differentiates 4-6 months afterbirtho Myelination of optic nerve fibres has reached the lamina cribrosao New born is usually hypermetropic by +2 to +3D.o Orbit is more divergent (50deg) as compared to adult (45deg).o Lacrimal gland is still underdeveloped and tears are not secreted. ###Answer: OPTION B IS CORRECT.

###Question: Newborn eye with respect to refractive error is - ###Options: A. Emmetropic B. Hypermetropic C. Myopic D. Astigmatic

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###Rationale: Ans. C. Phenyl ketonuriaIdentifying features:* Blue eyes, blonde hair and fair skin is a classical description of a case of PKU. The child is intellectually disabled and they have mousy body odour. ###Answer: OPTION C IS CORRECT.

###Question: A 2-year-old intellectutually disabled child is having blue eyes, blonde hair and fair skin. He also have a peculiar body odour. What is the diagnosis? ###Options: A. MSUD B. Isovaleric aciduria C. Phenyl ketonuria D. Canavan's disease

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###Rationale: After cataract is treated by Nd-YAG laser posterior capsulotomy ###Answer: OPTION C IS CORRECT.

###Question: YAG laser is used in - ###Options: A. Retinal detachment B. Diabetes C. After-cataract D. Refractive errors

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###Rationale: Foy percent of retinoblastomas are heritable; the child inherits one mutant allele through the germline and a somatic mutation in the other allele occurs, resulting in the loss of function of that gene. This leads to tumor development, often with multiple tumors in both eyes. Penetrance, however, is not complete, since the second mutation is a chance event. Sixty percent of retinoblastomas are sporadic; both alleles are inactivated by somatic mutation. Because this is a rare event, tumors usually are in only one eye and present at a later age. To detect a mutation in the Rb gene and differentiate between heritable and sporadic cases of retinoblastoma, PCR is the most appropriate technique of the choices given. Using the appropriate primers, a deletion can be detected as a change in size of the DNA band amplified. In heritable cases, one chromosome will show the altered length from the deletion or the translocation in any cell in the body. In sporadic retinoblastoma, samples isolated from anywhere other than the tumor should have two normal alleles. DNA footprinting is a protocol used to detect specific protein binding to DNA molecules by comparing the fragmentation patterns of DNA bound with the protein of interest vs. unbound DNA following digestion with DNase I. If the bound protein protects against DNase I digestion, the position of the protein on the DNA can be deduced by the loss of the characteristic fragment. FACS uses antibodies coupled to fluorescent markers to determine cell surface molecules on whole cells. It is very useful for determining the stage of development or activation of cells, but does not give you any insight into the DNA. Nohern blotting, the RNA counterpa to Southern blotting, will determine the size and abundance of mRNA of a specific gene in a given sample of RNA. RNA is not able to be cleaved by restriction enzymes the way the DNA can; however, RNA molecules for different proteins are of different lengths. The sample is separated by agarose gel electrophoresis, transferred to a nitrocellulose membrane, and probed with a specific, labeled probe. This will be exposed to film and the bands will appear, revealing the size and the abundance of specific mRNAs. ###Answer: OPTION D IS CORRECT.

###Question: A patient presents with retinoblastoma. He has a single tumor in one eye. Which of the following test could be used to determine whether this is a heritable or sporadic tumor? ###Options: A. DNA footprinting B. Fluorescence-activated cell soing (FACS) C. Nohern blotting D. PCR

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###Rationale: Latanoprost, a stable long-acting PGF2derivative, was the first prostanoid used for glaucoma. The success of latanoprost has stimulated development of similar prostanoids with ocular hypotensive effects, and bimatoprost, travoprost, and unoprostone are now available. These drugs act at the FP receptor and are administered as drops into the conjunctival sac once or twice daily. Adverse effects include irreversible brown pigmentation of the iris and eyelashes, drying of the eyes, and conjunctivitis. Ref: Katzung 11th edition Chapter 18. ###Answer: OPTION A IS CORRECT.

###Question: Which of the following arachidonic acid derivative is used in treatment of glaucoma? ###Options: A. Latanoprost B. Iloprost C. Alprostadil D. None of the above

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###Rationale: Onabotilinum toxin A has recently been approved to prevent a headache in adult patients with chronic migraine. ###Answer: OPTION B IS CORRECT.

###Question: Onabotulinum toxin A can be used for the treatment of: ###Options: A. Cervical dystonia. B. Chronic migraine. C. Blepharospasm. D. Strabismus.

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###Rationale: Ans. is 'a' i.e., SnowflakeDiabetic cataracto Cataract is considered as a major cause of visual impairment in diabetic patients. Senile cataract tends to develop at an earlier age and more rapidly than usual in diabetic patients,o The enzyme aldolase reductase catalyzes the reduction of glucose to sorbitol through the polyol pathway, a process linked to the development of diabetic cataract.NADPH* dependent aldolase reductase reduces excessive glucose to sorbitol and intracellular accumulation of sorbitol leads to osmotic changes resulting in hydropic lens fibers that degenerate and form sugar cataract,o The typical diabetic cataract is snowflake cataract, i.e., dense white subcapsular opacities in the anterior and posterior cortex resembling a snowstorm.o As blood- sugar levels fluctuate, visual acuity and refractive error can change - Fluctating refractive error. This causes frequent change in optimal eyeglass prescription. ###Answer: OPTION A IS CORRECT.

###Question: Cata ract in diabetes - ###Options: A. Snowflake B. Sunflower C. Nuclear cataract D. Oil drop

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###Rationale: i.e. (Ciliary body): (320-IBSth Embryology 8th)CILIARY BODY - (8 - Khurana 4th)* The two layers of epithelium of ciliary body develop from the anterior part of the two layers of optic cup (Neuroectodermal)* Stroma of ciliary body, ciliary muscle and blood vessels are developed from the vascular layer of mesenchyme surrounding the optic cupThe cells of the adrenal cortex arise from coelomic epithelium (Mesoderm). The cells of adrenal medulla are derived from the neural crest (ectoderm) (300 - IBS- Embryology 8th)DERIVATIVES OF MESODERM1. All connective tissues including loose areolar tissue filling the interstics between other tissues, superficial and deep fascia, ligaments, tendons, aponeuroses and dermis of the skin2. Specialized connective tissues like adipose tissue reticular tissue, cartilage and bone3. Dentine of teeth4. All muscles (smooth, striated and cardiac Except the musculature of the iris (ectoderm) and ciliary muscle (neural crest?)5. Heart, all blood vessels and lymphatics, and blood cells6. Kidney, ureters, trigone of bladder, posterior wall of part of the female urethra, posterior wall of upper half of prostatic part of male urethra and the inner glandular zone of the prostate7. Ovary, uterus, uterine tubes, upper part of vagina8. Testis, epidydimis, ductus deferens, seminal vesicle, ejaculatory duct9. Lining mesothelium of pleural, pericardial and peritoneal cavities and of tunica vaginalis10. Lining mesothelium of bursae and joints11. Substance of cornea; sclera; choroid12. Substance of ciliary body and iris13. Duramater; pia - arachnoid (?) microglia14. Adrenal cortexSTRUCTURES DERIVED FROM THE EMBRYONIC LAYERSSurface EctodermNeural EctodermAssociated paraxial mesenchyme / Mesoderm* The crystalline lens* Epithelium of the cornea* Epithelium of the conjuctiva* Lacrimal gland* Epithelium of eyelids and its derivatives viz cilia, targal glands and conjunctival glands* Epithelium lining the lacrimal apparatus* Retina with its pigment epithelium* Epithelial layers of the ciliary body* Epithelial layers of iris* Sphincter and dilator pupillae muscles* Optic nerve (neuroglia and nervous elements only)* Melanocytes* Secondary vitreous* Ciliary zonules (tertiary vitreous)* Blood vessels of choroid, iris, ciliary vessels, central retinal artery, other vessels* Primary Vitreous* Substantia propria, Descemet's membrane and endothelium of cornea* Sclera* Stroma of iris* Ciliary muscle* Sheaths of optic nerve* Extraocular muscles* Upper and medial walls of the orbit* Connective tissue of upper eyelid ###Answer: OPTION A IS CORRECT.

###Question: All are masodermal in origin EXCEPT ###Options: A. Ciliary body B. Cyclic membrane C. Adrenal cortex D. Trigone of bladder

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###Rationale: A i.e. Concussion injury Angle recession involves rupture of face of ciliary body, the poion that lies between the iris root and the scleral spur. It is detected gonioscopically as widening of ciliary body band. It is seen in large number of blunt trauma Q patients but glaucoma Q develops in 6-9%. ###Answer: OPTION A IS CORRECT.

###Question: Secondary glaucoma associated with angle recession is seen in ###Options: A. Concussion injury B. Radiation injury C. Penetrating injury D. Chemical injury

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###Rationale: The Javal-Schiotz model keratometer consists of two illuminated 'mires' (A and B) fixed on a rotatable circular arc (C) and a viewing telescope T. The double images (aa1 and bb1) of the mires (A and B) are formed on the cornea. Keratometry readings are obtained by coinciding the images a1 and b. The readings are noted first in the horizontal meridian and then the arc is rotated by 90o and the readings are noted in the veical meridian. Reference : A K KHURANA Comprehensive Ophthalmology; edition 4, page-554 ###Answer: OPTION D IS CORRECT.

###Question: Corneal thickness is measured by all Except ###Options: A. OCT B. Utrasonography C. Orbscan D. Javal Schiotz method

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###Rationale: Ans. (b) MyopiaRef: Clinical ophthalmology By Sandeep Saxena 2/e, p. 445'The presence of posterior staphyloma (Scarpa's Staphyloma) is pathognomonic of pathologic myopia' ###Answer: OPTION B IS CORRECT.

###Question: Scarpa's Staphyloma is seen in ###Options: A. Retinal Detachment B. Myopia C. Glaucoma D. Iridocyclitis

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###Rationale: Investigations to be done in open-angle glaucoma are :Slit lamp examinationTonometryGonioscopyDirect ophthalmoscopyPerimetry ###Answer: OPTION A IS CORRECT.

###Question: In open-angle glaucoma investigation least done is ###Options: A. Indirect ophthalmoscopy B. Tonometry C. Direct ophthalmoscopy D. Perimetry

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###Rationale: Decreased visual acuity may occur as a result of macular involvement or severe vitreous inflammation. ... An active toxoplasmic retinochoroiditis is whitish and moderately exudative with ill-defined borders and involves the macula in a majority of patients. ###Answer: OPTION A IS CORRECT.

###Question: Macula involvement is common in - ###Options: A. Toxoplasma B. Malaria C. CMV D. Syphilis

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###Rationale: (Refer: K. Park’s Textbook of Preventive and Social medicine, 24th edition, pg no: 74, 76, 87) THE INFORMATION IN THE QUESTION IS INSUFFICIENT TO CONCLUDE It may be a Quasi randomized trial or it can be just clinical trial where the patient may serve as his control Since association is determined, hence it can be indirectly understood as there are 2 groups There is an intervention in the study – so it is not a case control or cohort study or cross sectional study There is no mention of randomization of intervention in the groups which is the heart of RCT ###Answer: OPTION C IS CORRECT.

###Question: In a prospective study, 1200 patients were randomly selected to study the effect of a new drug. The drug will be given for 5 years and its association with cataract will be studied. What tyepe of study is this? ###Options: A. Case control study B. Cohort study C. Randomized clinical trial D. Cross-sectional study

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###Rationale: 1st image shows tonsillitis with membrane formation in infectious mononucleosis. Peripheral blood film shows atypical lymphocytes or Downey cells are lymphocytes that become large as a result of antigen stimulation. ###Answer: OPTION D IS CORRECT.

###Question: A 4-year-old child presented with fatigue, malaise, fever, sore throat, headache, nausea, abdominal pain and myalgia. On examination generalized lymphadenopathy and hepatosplenomegaly was noted. There was marked tonsillar enlargement along with palatal petechiae, rashes and edema of the eyelids. Peripheral smear is given below.Paul Bunnel test was performed and was positive. All of the following except one can be caused by the above organism? ###Options: A. Nasopharyngeal carcinoma B. Non Hodgkins Lymphoma C. Diffuse gastric carcinoma D. Primary effusion lymphoma.

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###Rationale: Methanol is metabolised to formic acid & formaldehyde ,which produces these kinds of symptoms. Ref: kKD Tripathi 8th ed. ###Answer: OPTION A IS CORRECT.

###Question: In methyl alcohol poisoning there is CNS depression,cardiac depression and optic nerve atrophy.These effects are produced due to: ###Options: A. Formaldehyde and formic acid B. Acetaldehyde C. Pyridine D. Acetic acid

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###Rationale: The iris is thinnest at its attachment to the ciliary body (base) so that if it tends to give way in this region. ###Answer: OPTION C IS CORRECT.

###Question: Iris is thinnest at: ###Options: A. Ciliary zone B. pupil margin C. Base D. Collarette

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###Rationale: *Meningiomas show intense contrast enhancement with Early enhancement and Delayed Washout (Early to come and Late to Go) which has been referred to as Mother in Law Sign *Owls eye sign - spinal cord ischemia *Tiger Eye Sign - Halloverden Spatz Disease *Inveed Napolean Hat Sign - b/l Spondylolisthesisof L5 over S1 in frontal pelvic radiograph ###Answer: OPTION A IS CORRECT.

###Question: A Radiological sign of meningioma: ###Options: A. "Mother-in-law" sign B. Owl eye sign C. Tiger eye sign D. Inveed napoleon hat sign

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###Rationale: Cyclosporine selectively suppresses cell-mediated immunity, prevents graft rejection and vet leaves the recipient with enough immune ctivity to combat bacterial infection. Unlike cytotoxic immunosuppressants, it is free of toxic effects on bone marrow and RE system. Humoral immunity remains intact. However, it is a nephrotoxic-the major limitation and impairs liver function. Other adverse effects are sustained the rise in BP, precipitation of diabetes, anorexia, lethargy, hyperkalemia, oppounistic infections, hirsutism, gum hyperplasia, tremor and seizures. Cyclosporine is the most effective drug for the prevention and treatment of graft rejection reaction. It is routinely used in the renal, hepatic, cardiac, bone marrow and other transplantations. For induction, it is staed orally 12 hours before the transplant and continued for as-long-as needed. ESSENTIALS of MEDICAL PHARMACOLOGY SIXTH EDITION -KD TRIPATHI Page:854 ###Answer: OPTION A IS CORRECT.

###Question: Complication of cyclosporine therapy is: ###Options: A. Hypeension B. Pulmonary fibrosis C. corneal deposits D. Nephrotoxicity

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###Rationale: The most common complication of recurrent anterior uveitis is a cataract. ###Answer: OPTION C IS CORRECT.

###Question: What is the most common complication in recurrent anterior uveitis – ###Options: A. Staphyloma B. Glaucoma C. Cataract D. Vitreal haemorrhage

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###Rationale: Ans. A i.e. Pterygium Pterygium Elastatoic degeneration with proliferation of vascularized granulation tissue, Stocker's line is seen ###Answer: OPTION A IS CORRECT.

###Question: Mitomycin C drops are used in: September 2012 ###Options: A. Pterygium B. Ophthalmia nodosa C. Spring catarrh D. Dry eye

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###Rationale: Diabetic macular edema (DME) / Can develop at any stage of retinopathy. Now the leading cause of vision loss in persons with diabetes. Increased vascular permeability causes plasma leaks from the macular vessels, leading to swelling and formation of hard exudates at the central retina. Incidence over 10 years (1) 20% in persons with type 1 DM (2) 25% in persons with type 2 DM who require insulin (3) 14% in persons with type 2 DM who do not require insulin Very Impoant VEGF (vascular endothelial growth factor) is one of the many cytokines that plays an impoant role in diabetic retinopathy. VEGF is a marker for oxidative stress and induces hyperpermeability of macular capillaries, contributing to macular oedema. The molecular mechanisms involved in endothelial damage and macular ischemia are complex and involves sorbitol pathway, AGE formation (advanced glycation end products), protein kinase C, renin-angiotensin system, inflammation, oxidation and alterations in gene expression. Ref: Diabetic Retinopathy, By David J. Browning, Page 205, Springer, 2010. ###Answer: OPTION A IS CORRECT.

###Question: All of the following are implicated in the pathogenesis of macular oedema in diabetic retinopathy, EXCEPT: ###Options: A. Retinal pigment epithelium dysfunction B. Oxidative stress C. VEGF (vascular endothelial growth factor) D. Increased protein kinase-C

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###Rationale: Ans: d (Oblique) Ref: AK Khurana, ed, p. 60-61; 4th p. 36Astigmatism: A type of refractive error in which refraction varies in different meridian so that light entering the eye cannot converge to a point focus but form focal lines.Regular astigmatism: Refractive index changes uniformly: 2 principal mediaIrregular astigmatism: Irregular change of refractive index in different meridian multiple mediaAccording to etiologyTypes of regular astigmatism(depending on axis & angle between two principal meridian)1. Comeal astigmatism2. Lenticular astigmatisma. Curvaturalb. Posturalc. Index3. Retinal astigmatism1. With the rule astigmatism: Two principal meridian right angle to one another but more curved than vertical2. Against the rule: Horizontal media more curved than vertical3. Oblique astigmatism: Two principal media are not horizontal or vertical though these are at right angles to each other4. Bioblique astigmatism: Two principle meridian are not vertical or horizontal and also not perpendicular to each other. ###Answer: OPTION D IS CORRECT.

###Question: When the largest diameter and shortest diameter are perpendicular to each other the type o astigmatism is: ###Options: A. Regular B. Irregular C. Lenticular D. Oblique

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###Rationale: Ans. Chronic progressive external ophthalmoplegia ###Answer: OPTION B IS CORRECT.

###Question: A 26 years old male with restriction of eye movements in all directions and moderate ptosis but with no diplopia or squint. Diagnosis is: ###Options: A. Thyroid ophthalmopathy B. Chronic progressive external ophthalmoplegia C. Myasthenia gravis D. Multiple cranial nerve palsies

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###Rationale: Ans. is 'b' i.e. Drug-induced cardiac toxicity A woman with H/O doxorubicin intake and presenting with complaints of congestive cardiac failure suggests cardiac toxicity due to doxorubicin.Doxorubicin causes cardiac toxicity which can manifest either acutely with ECG changes, arrhythmias, and hypotension or be delayed, and present with congestive heart failure.Congestive cardiac failure occurs due to cardiomyopathy.About 5% of the patients who receive > 550 mg/m2 of doxorubicin will develop congestive cardiac failure. ###Answer: OPTION B IS CORRECT.

###Question: A 45-year-old woman underwent a modified radical mastectomy 4 years ago. She was treated for multiple bone metastases with cyclophosphamide, doxorubicin, and fluorouracil for 6 months. She is complaining of exertion on exercise, swelling of the legs, and swelling around eyes in the morning. On examination, she has bilateral rales in the lungs, S1, S2 audible, S3, S4 gallop present. Her BP is 149/117 mm Hg, PR is 80/min, and RR is 18/min. What is the most likely cause for her cardiac condition? ###Options: A. Systolic dysfunction CHF B. Drug induced cardiac toxicity C. Metastatic cardiac disease D. Pneumonia

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###Rationale: The macula lutea is an area of the retina approximately 5.5 mm in diameter that is rich in cones, situated about 2 disc diameters (DD) temporal to the optic disc (1 DD= 1.5 mm). That is totally 3mm. The central 1.5 mm of the macula is termed the fovea, which has a small central depression approximately 0.35 mm in diameter called the foveola. The vision is most acute at the foveola, where only cones are found; each cone directly relays to a single ganglion cell. Ref: Parsons' Diseases of the Eye By Ramanjit Sihota & Radhika Tandon, 21st edition, Page 302. ###Answer: OPTION C IS CORRECT.

###Question: Macula lutea of the retina lies from the optic disc at a distance of: ###Options: A. 1 mm B. 2 mm C. 3 mm D. 4 mm

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###Rationale: Answer- A. KeratoconusThe KISA index is used in cases ofkeratoconus and is derived using 4 indices:Central keratometry KInferior- Superior keratometry (I-S)Astigmatism Index (AST) ###Answer: OPTION A IS CORRECT.

###Question: KISA% is associated with ###Options: A. Keratoconus B. Keratoglobus C. Hypermetropia with astigmatism D. Terrien's marginal degeneration

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###Rationale: NF-1 is the most common phakomatosis, affecting 1:4000 individuals, and presents in childhood. The gene locus is on 17q11. For NF- 1, the diagnostic criteria are met if two or more of the following features listed are present: 1. Six or more cafe au lait (CAL) macules greater than 5 mm in prepubeal patients and greater than 15 mm in postpubeal patients 2. Two or more neurofibromas of any type, or one plexiform neurofibroma 3. Axillary or inguinal freckling 4. Optic nerve glioma 5. Two or more Lisch nodules (iris hamaomas) 6. A distinctive osseus lesion such as sphenoid wing dysplasia or coical thinning of long bones, with or without pseudoahrosis 7. A first degree relative with NF- 1 based on the preceding criteria The ocular features are as follows: Orbital involvement: Optic nerve glioma Other neural tumors Spheno-orbital encephalocele Eyelid neurofibromas Iris lesions: Lisch nodules Congenital ectropion uveae Mammillations Prominent corneal nerves Glaucoma--Congenital and infantile glaucomas are common Fundus lesions: Choroidal naevi (not hemangioma) Retinal astrocytomas Anterior chamber angle malformations ###Answer: OPTION B IS CORRECT.

###Question: The ocular symptom of Von Recklinghausen disease is ###Options: A. Deformed anterior chamber with reduced angle of AC B. Glaucoma C. Choroidal hemangioma D. Subretinal neovascularization

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###Rationale: The afferent component of corneal reflex is mediated by trigeminal nerve and efferent component is mediated by facial nerve which innervates the orbicularis oculi muscle. In this reflex, touching the cornea from the side while the subject looks forward evokes blinking. Ref: Comprehensive Ophthalmology By A K Khurana, 4th Edition, Pages 292-3; Color Atlas of Neurology By Reinhard Rohkamm, Page 26. ###Answer: OPTION C IS CORRECT.

###Question: Which of the following nerve constitute the afferent component of corneal reflex? ###Options: A. Vagus nerve B. Facial nerve C. Trigeminal nerve D. Glossopharyngeal nerve

Being a doctor, your task is to answer the medical questions based on the patient's description. Analyze the question and answer with the best option.

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###Rationale: Orbicularis oculi shuts the eyes when contracted. It is a muscle of facial expression and is, therefore, innervated by the facial nerve. The four rectii muscles arise from the tendinous ring around the optic foramen, and medial pa of the superior orbital fissure. Superior oblique arises superior and medial to the ring and inferior oblique arises from the floor of the orbit. All the extra-ocular muscles are innervated by the oculomotor nerve except the superior oblique(SO4 -trachlear nerve) and the lateral rectus.(LR6 -abducens nerve) Sphincter pupillae is innervated by parasympathetic fibres from the oculomotor(3rd) nerve. These fibres are carried by the sho ciliary nerves.(SP-P) Dilator pupillae is innervated by sympathetic fibres carried the long ciliary nerves.(branch of 5th nerve)(DP-S) ###Answer: OPTION D IS CORRECT.

###Question: Which statement best describes the muscles of the eye? ###Options: A. The superior and inferior obliques arise from the tendinous ring. B. The superior oblique is innervated by the oculomotor nerve. C. Sphincter pupillae is innervated by sympathetic nerves. D. Closure of the eye is controlled by the facial nerve.

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###Rationale: Ans. d. Ciliary muscles (Ref: Parson 20/e p5; Grays Anatomy 40/ep702) Ciliary muscles develop from Neural crest, not from neural crestDerivative of neural ectoderm:Ciliary- body epitheliumQIris epitheliumQSmooth muscles of iris (constrictorQ and dilator pupillaeQ)Part of vitreousRetinal pigment epitheliumQRetinaQ (its 9 sensory- layers)Optic vesicle and cupOptic nerveQ (fibers)Primordial Tissues and Ocular DerivativesNeural-EctodermSurface-EctodermMesodermNeural crest* Ciliary body epitheliumQ* Iris epitheliumQ* Smooth muscles of iris (constrictorQ and dilator pupil laeQ)* Part of vitreous Retinal pigment epitheliumQ* Retina (its 9 sensory layers) Optic vesicle and cup * Optic nerveQ (fibers)* Conjunctival epithelium* Corneal epithelium* Lacrimal glands * Tarsal glands * Lens* Extra-ocular musclesQ* Vascular endothelium of eye and orbit * Corneal stroma* Sclera* Iris* Choroid* Part of vitreous* Orbital bones* Orbital connective tissue* Ciliary musclesQ * Ciliary ganglionQ* Schwann cells of ciliary nerves* Meningeal sheath of optic nerve* Conjunctival and uveal melanocytes* ScleraQ* Trabecular meshwork of endothelium * Corneal stroma, keratocytes and endotheliumQ* Iris stroma * Choroidal stroma Part of vitreous ###Answer: OPTION D IS CORRECT.

###Question: Which of the following is not a derivative of neural ectoderm? ###Options: A. Sphincter pupillae B. Retina C. Dilator pupillae D. Ciliary muscles

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###Rationale: B i.e. Refractory Error ###Answer: OPTION B IS CORRECT.

###Question: Which is the commonest cause of occular morbidity in the community ###Options: A. Cataract B. Refractive error C. Occular injury D. Vitamin A deficiency

As a medical professional, your responsibility is to address the medical questions using the patient's description. Analyze the question and answer with the best option.

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###Rationale: BASIC ANATOMY * Retina is the light sensitive tissue of the eye * Derived from neural ectoderm. * Extends from optic disc to ora serrata * Embryologically derived into two pas * Outer Pigmented Layer: Forms RPE (6th week) Inner neural layer: Neurosensory retina(40th week) LAYERS OF RETINA 1. Inner limiting membrane 2. Nerve fiber layer 3. Ganglion cell layer 4. Inner plexiform layer 5. Inner nuclear layer 6. Outer plexiform layer 7. Outer nuclear layer 8. External limiting membrane 9. Photoreceptor layer 10. Retinal pigment epithelium. ###Answer: OPTION B IS CORRECT.

###Question: Retina is derived from ###Options: A. surface ectoderm B. neural ectoderm C. mesoderm D. endoderm

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###Rationale: Harada's disease and exudative retinopathy of coat's can cause exudative retinal detachment. ###Answer: OPTION C IS CORRECT.

###Question: Causes of exudative retinal detachment –a) Central retinal artery occlusion b) Hypertensive retinopathyc) Harada's syndromed) Coat's disease ###Options: A. ab B. bc C. cd D. ac

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###Rationale: Ans: (b) KeratoconusRef: Kanski, Clinical Ophthalmology, 8th edition, Page 218-220; A.K. Khurana's Comprehensive Ophthalmology, 6th edition, Page 131KERATOCONUSDefined as non-inflammatory bilateral ectactic condition of cornea in which the cornea assumes a conical shape secondary to stromal thinning and protrusion.The diagnosis is keratoconus with acute hydrops.Etiology: Not clear.Symptoms: Defective vision due to progressive myopia and irregular astigmatism.Signs:Window reflex is distorted.Slit lamp:Thinning and ectasia of cornea.Fleischer"s ring at the base of the cone.Vogt's line (deep stromal striae due to stretching of cornea).Retinoscopy: Scissoring/Yawning reflex.Distant direct ophthalmoscopy: Oil Droplet Reflex.Munson's Sign: Bulging of lower lid on downward gaze.Management:Spectacle correction in early cases.Rigid gas permeable contact lenses.Intra corneal ring segments (INTACS).Collagen cross linking.Deep anterior lamellar keratoplasty / penetrating keratoplasty.Remember:Acute hydrops is a complication of keratoconus where the descemet's membrane ruptures and aqueous enters the cornea. ###Answer: OPTION B IS CORRECT.

###Question: A 20-year-old boy came with complaints of sudden pain in the left eye with loss of vision. On examination, left eye cornea was hazy and on looking down, there was a bulging in the lower eyelid. Retinoscopy shows scissoring reflex and oil drop sign was positive in both eyes, what is the diagnosis? ###Options: A. Corneal dystrophy B. Keratoconus C. Pathological myopia D. Keratoglobus

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###Rationale: Decreased radius of curvature of Cornea is an etiology for myopia, not increased radius of curvature. ###Answer: OPTION C IS CORRECT.

###Question: NOT an etiology for Myopia is ###Options: A. Increased axial length B. Increased curvature of Cornea C. Increased radius of curvature of Cornea D. Increased accommodative effort

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###Rationale: Hydrocephalus Most common cause is Aqueductal stenosis Macewen sign is cracked pot sound produced on percussion of skull in raised intracranical tension. "Sun set" sign of eyes seen. ###Answer: OPTION A IS CORRECT.

###Question: True statement about hydrocephalus is ###Options: A. Macewen sign seen B. Sun rise sign of eyes is seen C. Most common cause is Dandy - waler malformation D. All of the above

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###Rationale: Keratomalacia is due to vitamin A deficiency. "Vitamin A deficiency is the most common cause of blindness in children in India". __ Philip Reily "Vitamin A deficiency is the single most important cause of blindness in children". — Wykoff ###Answer: OPTION A IS CORRECT.

###Question: Blindness in a child is most commonly due to - ###Options: A. Keratomalacia B. Congenital cataract C. Glaucoma D. Injuries

Being a doctor, your task is to answer the medical questions based on the patient's description. Analyze the question and answer with the best option.

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###Rationale: The accommodation reflex is performed by constriction of the pupil when trying to focus on a near object. This function is controlled by the parasympathetic nerve fibers carried in the oculomotor nerve from the Edinger-Westphal nucleus of the midbrain that synapse in the ciliary ganglion. Postganglionic axons act on the sphincter pupillae muscle to cause reduction in pupil diameter and on the ciliary muscle to cause relaxation of the suspensory ligament, allowing the lens to adopt a more spherical shape for near focusing. If there is a lack of accommodation, it means the action of the ciliary muscle is compromised. The ciliary muscle also gets parasympathetic innervation by postganglionic neurons evoked from the ciliary ganglion by GVE fibers of oculomotor nerve whose cell bodies are located in the Edinger-Westphal nucleus. The superior salivatory nucleus is involved with lacrimation and salivation, not the ciliary muscle and accommodation. The superior cervical ganglion is a sympathetic ganglion; its postganglionic axons innervate the dilator pupillae muscle, which causes mydriasis, but not the miosis of accommodation. The trigeminal ganglion does not have parasympathetic fibers and does not innervate the ciliary muscle for accommodation. ###Answer: OPTION D IS CORRECT.

###Question: A 32-year-old woman is admitted to the hospital after losing consciousness and collapsing in the middle of the street. A neurologic examination reveals absence of the accommodation reflex of her right eye. Which of the following is most likely involved in the pathology in this patient? ###Options: A. Superior salivatory nucleus B. Superior cervical ganglion C. Nervus intermedius D. Edinger-Westphal nucleus

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###Rationale: Answer- A. Giant papillary conjunctivitisCorneal complications : - Corneal abrasion, Corneal edema, Corneal vascularization, Microbial keratitis (pseudomonas, acanthamoeba), Sterile corneal infiltrate.Giant papillary conjunctivitis ###Answer: OPTION A IS CORRECT.

###Question: Continuous contact lens wear may lead to ###Options: A. Giant papillary conjunctivitis B. Anterior uveitis C. Nuclear Cataract D. Trachoma

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###Rationale: Orphan Annie eye nuclei is usually seen in papillary carcinoma of thyroid gland. Where as, Hashimoto's thyroiditis has Huhle cells (oncocytic metaplasia). Ref: Ricardo V. Lloyd,(2010) , Chapter 9, "Pathology of Thyroid Gland", In the book, "Endocrine Pathology: Differential Diagnosis and Molecular Advances", 2nd Edition ; Robbin's Basic Pathology, 7th Edition, Pages 1169, 1178; Endocrine Pathology By Lioyd, (2004), Page 160 ###Answer: OPTION D IS CORRECT.

###Question: All of the following are TRUE about Hashimoto's Thyroiditis, EXCEPT: ###Options: A. Follicular Destruction B. Increase in Lymphocytes C. Oncocytic metaplasia D. Orphan Annie eye nuclei

You're a doctor, kindly address the medical queries according to the patient's account. Analyze the question and answer with the best option.

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###Rationale: Hirschberg test (for Tropias or manifest squint) Flash a torch at the forehead (Glabella) of patient, ask the patient to look at the light Ohophoric- Reflection of light is exactly at the center of the pupil Heterophoric- Reflection of light is not at the center of the pupil ###Answer: OPTION B IS CORRECT.

###Question: Hirschberg test measures: ###Options: A. Cataract B. Strabismus C. Refractive error D. Glaucoma

Given your profession as a doctor, please provide responses to the medical questions using the patient's description. Analyze the question and answer with the best option.

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###Rationale: Ans: d (Thyroid gland) Ref: Dhingra 4th ed p 223Scattered lymphatics in the subepithelial layer of pharynx forms masses at certain places, collectively termed as waldeyer ring.The masses are:1) Nasopharyngeal tonsil (Adenoids)2) Palatine tonsil3) Lingual tonsil4) Tubal tonsil (in fossa of Rossen Muller)5) Lateral pharyngeal band6) Nodules in posterior pharyngeal wall. ###Answer: OPTION D IS CORRECT.

###Question: Which among the following is not a part of Waldeyer ring: ###Options: A. Lingual tonsil B. Palatine tonsil C. Adenoids D. Thyroid gland

In your capacity as a doctor, it is expected that you answer the medical questions relying on the patient's description. Analyze the question and answer with the best option.

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###Rationale: Immune Reconstitution Inflammatory syndrome (IRIS) In patients with CD4 count <100 cells/mm3. In HIV infection, an exaggerated inflammatory reaction to a disease-causing microorganism that sometimes occurs when the immune system begins to recover following treatment with antiretroviral (ARV) drugs. 2 IRIS scenarios : Unmasking- Flare-up of an underlying occult oppounistic infection. Paradoxical- Symptomatic relapse of a prior infection despite microbiologic treatment success. MECHANISM : Increased inflammation as the recovering immune system recognizes the antigens , there is hypothesized reconstitution of antigen-specific T cell-mediated immunity with activation of the immune system following HIV therapy against persisting antigen, whether present as intact organisms, dead organisms, or debris.(as body's immune response recovers following HAA) There is a cytokine storm with a predominant type-1 helper T-cell interferon-gamma response. (Delayed hypersensitivity) Cryptococcus neoformans is the usual pathogen eliciting more severe disease Rx- Systemic coicosteroids during IRIS may be beneficial in preventing death or progressive neurological deterioration. ###Answer: OPTION A IS CORRECT.

###Question: All are true about Immune Reconstitution Inflammatory syndrome (IRIS) except: ###Options: A. It occurs when CD4 cell count is < 50 cells/mm3 B. Develops after initiation of anti-retroviral therapy C. Associated with delayed type of hypersensitivity D. Does not require a specific antimicrobial therapy for recovery

Being a doctor, your task is to answer the medical questions based on the patient's description. Analyze the question and answer with the best option.

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###Rationale: Hypomagnesemia is least likely to cause cataract MISCELLANEOUS CATARACTS Diabetes- Snowflake/ snowstorm cataract Wilson's- Sunflower cataract, chalcosis. Bread crump appearance- Complicated cataract Coicosteroid cause posterior subcapsular cataract.(Note topical steroids cause glaucoma more; systemic cause cataract more). Oil drop cataract -galactosemia is reversible (deficiency of GPUT) Anterior lenticonus- Alpo Posterior Lenticonus- Lowe Syndrome Shield cataract- Atopic dermatitis. Radiation can cause PSC cataract. Hypocalcemic cataract - Tetanic cataract Myotonic dystrophy- Christmas tree cataract Persistent hyaloid aery&mittendorf dot -can be a cause of Posterior polar cataract. ###Answer: OPTION D IS CORRECT.

###Question: Which of the following is not a cause of cataract ###Options: A. Diabetes B. Wilson disease C. Galactosemia D. Hypomagnesemia

Your identity is a doctor, kindly provide answers to the medical questions with consideration of the patient's description. Analyze the question and answer with the best option.

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###Rationale: Anterior polar cataract. It involves the central pa of the anterior capsule and the adjoining superficial-most coex. It may arise in the following ways: Due to delayed development of anterior chamber: Due to corneal perforation:Such cataracts may also be acquired in infantile stage and follow contact of the lens capsule with the back of cornea, usually after perforation due to ophthalmia neonatorum or any other cause. ###Answer: OPTION B IS CORRECT.

###Question: Causes of anterior polar cataract - ###Options: A. DM B. Perforating corneal injury C. Irradiation D. Chalcosis

Being a doctor, your task is to answer the medical questions based on the patient's description. Analyze the question and answer with the best option.

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###Rationale: A i.e. Eyelids ###Answer: OPTION A IS CORRECT.

###Question: What disappears first in post moem rigidity? ###Options: A. Eyelids B. Neck C. Lower limbs D. Upper limbs

Considering your role as a medical practitioner, please use the patient's description to answer the medical questions. Analyze the question and answer with the best option.

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###Rationale: Ans. is 'b' i.e Fovea Centralis Fovea centralis, is a depression or pit situated at the posterior pole of eye, 3 mm to the temporal side of the optic disc.Here the retinal layer consists only of cones and other layers are completely absentFovea is the most sensitive part of retinaFovea is surrounded by a small area, the macula lutea, which although not so sensitive, in more so than other parts of retina. ###Answer: OPTION B IS CORRECT.

###Question: Most sensitive part of retina is ###Options: A. Macula B. Fovea-centralis C. Optic disc D. Peripheral-retina

Being a doctor, your task is to answer the medical questions based on the patient's description. Analyze the question and answer with the best option.

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###Rationale: (Decreases aquous formation): Ref: 222-KH, 87-KDTMechanism of actions of beta-adrenergic blockersTimolol and levobunolal are non selective beta 1 (Cardiac) and beta 2 (smooth muscle, pulmonary) receptor blockers, causes lower IOP by blockade of beta - 2 rceptors in the ciliary process resulting in decreased aquous production.* Betaxolol are thought to increase the perfusion of the optic nerve head (305-P) cardio selective* Metipranolol: only in preservative free units, it is therefore useful in patients allergic to preservatives or wearing soft contact lens (in whom benzolkonium chloride should be avoided)Mode of action of ocular hypotensive drugs (87-KDT)Drugs/classAqueous secretionTrabecular outflowUveoscleral outflow1. b-blockers (Timolol)|----2. Miotics (Pilocarpine)--|--3. Adrenal ine/Dipi ve fri ne|?||4. Brimonidine/Apraclonidine|--|?5. Prostaglandins (latanoprost--|?|6. Carbonic anhydrase inhibitors|---- ###Answer: OPTION C IS CORRECT.

###Question: Mechanism of action of beta-blockers in glaucoma is ###Options: A. Increases uveo-scleral out flow of aqueous B. Increases trabecular mesh work out flow C. Decreaes aqueous production D. Constant aqueous production in ciliary body

Your role as a doctor requires you to answer the medical questions taking into account the patient's description. Analyze the question and answer with the best option.

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###Rationale: "Pseudomonas aeruginosa is the most common organism encountered in contact lens-related acute keratitis and corneal ulcer". -Holland & Mannis Acanthamoeba is the 2nd most common cause. ###Answer: OPTION C IS CORRECT.

###Question: A soft contact lens users have corneal keratitis cause is – ###Options: A. Acanthamoeba – ulcer B. Erosion of cornea C. Pseudomonas infection D. Herpes infection

Given your background as a doctor, please provide your insight in addressing the medical questions based on the patient's account. Analyze the question and answer with the best option.

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###Rationale: The nerve fibers forming the optic nerve exit the eye posteriorly through a hole in the sclera that is occupied by a mesh-like structure called the lamina cribrosa. It is formed by a multilayered network of collagen fibers that inse into the scleral canal wall. It is absent in morning glory syndrome. Ref khurana 6/e ###Answer: OPTION A IS CORRECT.

###Question: Lamina cribrosa is absent in - ###Options: A. Morning glory syndrome B. Nanophthalmia C. Colobama of retina D. Optic nerve agenesis

You're a doctor, kindly address the medical queries according to the patient's account. Analyze the question and answer with the best option.

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###Rationale: Centre of the lens [Ref: Parson 20/e p52, 53, and 59J Repeat. from May10 ###Answer: OPTION C IS CORRECT.

###Question: Which component of the eye has maximum refreactive index: ###Options: A. Anterior surface of the lens B. Posterior surface of the lens C. Centre of the lens D. Cornea

Given your profession as a doctor, please provide responses to the medical questions using the patient's description. Analyze the question and answer with the best option.

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###Rationale: Morgagnian cataract complicates into phacolytic glaucoma Refer: Khurana 6th edition page number 187 ###Answer: OPTION C IS CORRECT.

###Question: Most common senile cataract causing glaucoma is ###Options: A. Incipient type B. Nuclear type C. Morgagnian hyper mature D. Sclerotic hypermature

Your identity is a doctor, kindly provide answers to the medical questions with consideration of the patient's description. Analyze the question and answer with the best option.

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###Rationale: B i.e. Natamycin ###Answer: OPTION B IS CORRECT.

###Question: Which of the following is the drug of choice for treatment of corneal ulcers caused by filamentous fungi? ###Options: A. Itraconazole B. Natamycin C. Nystatin D. Fluconazole

In your capacity as a doctor, it is expected that you answer the medical questions relying on the patient's description. Analyze the question and answer with the best option.

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###Rationale: Hunter's disease and sanfilippo disease present with clear cornea. ###Answer: OPTION B IS CORRECT.

###Question: Which of the following mucopolysaccharidosis present with clear cornea? ###Options: A. Hurler disease B. Hunter disease C. Scheie disease D. Morquio disease

Given your profession as a doctor, please provide responses to the medical questions using the patient's description. Analyze the question and answer with the best option.

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###Rationale: Ans. is 'b' i.e., Glaucoma Amongst the given options cataract and glaucoma are complications of coisosteroids. Cataract occurs after systemic administration, while glaucoma occurs after topical therapy. ###Answer: OPTION B IS CORRECT.

###Question: Topical Steroid is associated with ? ###Options: A. Post subcapsular cataract B. Glaucoma C. Uveitis D. Ptosis

As a healthcare professional, please evaluate the patient's description and offer your expertise in answering the medical questions. Analyze the question and answer with the best option.

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###Rationale: Ans. Superficial corneal opacities ###Answer: OPTION D IS CORRECT.

###Question: Deep anterior lamellar keratoplasty is indicated in: ###Options: A. Disease of deeper cornea e.g. endothelial damage B. Full thickness corneal opacities C. Bullous keratopathy D. Superficial corneal opacities

Given your profession as a doctor, please provide responses to the medical questions using the patient's description. Analyze the question and answer with the best option.

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###Rationale: Ans. is 'a' i.e., Cretinism ###Answer: OPTION A IS CORRECT.

###Question: Infant with no social smile, no eyebrows, protruded tongue. Diagnosis - ###Options: A. Cretinism B. Down's syndrome C. Mucopolysaccharidosis D. Rickets

Being a doctor, your task is to answer the medical questions based on the patient's description. Analyze the question and answer with the best option.

medmcqa

###Rationale: Arcuate field defect akin to glaucoma seen in conditions which cause optic nerve compressions ###Answer: OPTION C IS CORRECT.

###Question: Arcuate field defect akin to glaucoma is seen in- ###Options: A. Pituitary tumor B. Occipital lobe infarct C. Optic nerve lesion D. None of the above

As a medical professional, your responsibility is to address the medical questions using the patient's description. Analyze the question and answer with the best option.

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###Rationale: Ans. is 'b' i.e., 30 mmo Optic nerve is about 47-50 mm in length and can be divided into 4 parts : -i)Intraocular part (1 mm):#It begins at optic disc (optic nerve head) and exits the nerve through a hole in sclera that is occupied by a mesh-like structure called the lamina cribrosa. The nerve fibres from the retina leave the eye through pores (holes) in lamina cribrosa, a sieve-like structure made up of collagen meshwork.ii)Intraorbital part (30 mm):#Extends from back of the eyeball (at lamina cribrosa) to the optic foramina.iii)Intracanalicular part (6-9 mm):#It lies within the optic canal and closely related to ophthalmic artery which crosses obliquely over it.iv)Intracranial part (10 mm):#It lies above the cavernous sinus and converges with its fellow from contralateral side to form optic chiasma. ###Answer: OPTION B IS CORRECT.

###Question: Intraorbital length of the optic nerve - ###Options: A. 1 mm B. 30mm C. 6-9mm D. 10mm

Your identity is a doctor, kindly provide answers to the medical questions with consideration of the patient's description. Analyze the question and answer with the best option.

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###Answer: OPTION B IS CORRECT.

###Question: All of the following is true of facial nerve except: ###Options: A. Supplies motor branches to the muscles of facial expression B. It has no sensory component C. The muscles of the eyelid will be spared in upper motor neuron lesions D. It is a nerve of 2nd arch

You're a doctor, kindly address the medical queries according to the patient's account. Answer with the best option directly.

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###Rationale: A i.e. Berlin's edema ###Answer: OPTION A IS CORRECT.

###Question: A person suffered an injury in right eye with a tennis ball. Following which he developed pain and on fundus examination a red spot is seen at the macula. What is the most probable diagnosis ###Options: A. Berlin's edema B. Macular bleed C. Macular hole D. Macular tear

Being a doctor, your task is to answer the medical questions based on the patient's description. Analyze the question and answer with the best option.

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###Rationale: Function of Macula Densa (Tubulo glomerular feedback): Macula densa senses change in NaCl concentration. For autoregulation of GFR. ###Answer: OPTION D IS CORRECT.

###Question: True about Macula Densa is/are: ###Options: A. Also known as Tubulo glomerular feedback. B. Macula densa senses change in NaCl concentration. C. For autoregulation of GFR. D. All of the above.

You're a doctor, kindly address the medical queries according to the patient's account. Analyze the question and answer with the best option.

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###Rationale: Ans. is 'c' i.e., Enteritis ###Answer: OPTION C IS CORRECT.

###Question: Following are complications of chicken pox except- ###Options: A. Meningitis B. Pneumonia C. Enteritis D. Reyes Syndrome

Your role as a doctor requires you to answer the medical questions taking into account the patient's description. Analyze the question and answer with the best option.

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###Rationale: Annular posterior synechiae (ring synechiae) are 360o adhesions of pupillary margin to anterior capsule of lens. These prevent the circulation of aqueous humour from posterior chamber to anterior chamber (seclusio pupillae). Thus, the aqueous collects behind the iris and pushes it anteriorly (leading to 'iris-bombe' formation) ###Answer: OPTION C IS CORRECT.

###Question: Iris bombe is due to - ###Options: A. Segmental posterior synechiae B. Total posterior synechiae C. Ring synechiae D. Anterior synechiae

As a medical professional, your responsibility is to address the medical questions using the patient's description. Analyze the question and answer with the best option.

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###Rationale: *The Stenopic slit found in all the trial sets is 1-2 mm by 15-35 mm in size. It splits an opaque disc into two halves. *It has many uses in Ophthalmology. *Fincham test is used to differentiate that coloured halos are due to early cataract or acute congestive glaucoma related corneal decompensation. * A stenopic slit is passed across the pupil& halos are observed. If those are broken halos , cataract is the most common cause. If brightness is reduced but halos are intact, cornea is the common cause. *Stenopic slit is useful in finding out the axis of the cylinder. *Stenopic slit is used in cases of corneal opacities to find out the optimal site for optical iridectomy. After dilating the pupil with a mydriatic, the slit is rotated in front of the eye and the axis which gives maximum clarity is chosen for optical iridectomy. Ref: Parson's Diseases of the eye, 22nd/e p.204 ###Answer: OPTION B IS CORRECT.

###Question: Use of stenopaeic slit are all except:- ###Options: A. Fincham's test B. Corneal tattooing C. Optical Iridectomy D. To find out the axis in astigmatism

Given your profession as a doctor, please provide responses to the medical questions using the patient's description. Analyze the question and answer with the best option.

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###Rationale: "Onodi cell" is the posterior most posterior ethmoid cell extending lateral to the sphenoid sinus. While removing disease from the Onodi cells there are chances of injury to optic nerve and internal carotid which lie in the vicinity. The posterior ethmoidal cells in the floor of orbit are known as "Haller cells". ###Answer: OPTION A IS CORRECT.

###Question: Onodi cells and haller cells are seen in relation to: ###Options: A. Optic nerve and floor of orbit B. Optic nerve and frontal sinus C. Optic nerve and ethmoid air cells D. Optic chiasma and nasolacrimal duct

You're a doctor, kindly address the medical queries according to the patient's account. Analyze the question and answer with the best option.

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###Rationale: Ans. is 'a' i.e., Nystagmus Illuminated frenzel galsses (+20 lenses) are useful for abolishing fixation and thus revealing peripheral vestibular nystagmus. ###Answer: OPTION A IS CORRECT.

###Question: Illuminated frenzel glasses are used in detecting? ###Options: A. Nystagmus B. Heterophoria C. Esotropia D. Astigmatism

Being a doctor, your task is to answer the medical questions based on the patient's description. Analyze the question and answer with the best option.

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###Rationale: Shifting fluid is seen in exudative retinal detachmentwhich occurs due to exudation of fluid from the choroid which collects in the subretinal space. -Causes: Inflammatory conditions like choroiditis, posterior scleritis Choroidal tumors like melanoma Toxemia of pregnancy Malignant hypeension Coats disease -Clinical features: Floaters due to vitritis but no photopsia Visual field defect Detached retina appears smooth & convex in configuration. No break is seen. -Treatment: Systemic steroids Treatment of the cause ###Answer: OPTION A IS CORRECT.

###Question: Shifting fluid sign is seen in: ###Options: A. Exudative retinal detachment B. Tractional retinal detachment C. Rhegmatogenous retinal detachment D. Retinal hole

Given your background as a doctor, please provide your insight in addressing the medical questions based on the patient's account. Analyze the question and answer with the best option.

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###Rationale: Ans. is 'b' i.e., Corneal ulcer with full thickness ###Answer: OPTION B IS CORRECT.

###Question: Children with apathy, general weakness, loosening of skin, marasmic features also has X3 B xerophthalmia features. Eye finding will be ? ###Options: A. Corneal ulcer with thickening B. Corneal ulcer with full thickness C. Hyperemia D. Conjunctivalxerosis

Given your background as a doctor, please provide your insight in addressing the medical questions based on the patient's account. Analyze the question and answer with the best option.

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###Rationale: This syndrome was first reported by Guthkelch in 1971. ###Answer: OPTION D IS CORRECT.

###Question: Shaken baby syndrome triad includes all except: ###Options: A. Retinal hemorrhaging B. Brain swelling C. Subdural hematoma D. CSF Rhinorrhea

Given your background as a doctor, please provide your insight in addressing the medical questions based on the patient's account. Analyze the question and answer with the best option.

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###Rationale: Keratic precipitates are cellular deposits on corneal endothelium compared to epitheloid cells, lymphocytes, polymorphs. ###Answer: OPTION B IS CORRECT.

###Question: Keratic precipitates are seen in which layer of the cornea? ###Options: A. Corneal epithelium B. Corneal endothelium C. Descemet's membrane D. Bowman's membrane

As a healthcare professional, please evaluate the patient's description and offer your expertise in answering the medical questions. Analyze the question and answer with the best option.

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###Rationale: Knudson gave the hypothesis that there are two mutations needed for Retinoblastoma to manifest. Either both hits are on somatic cells or one is at the somatic cells and one is at germ cell. Respectively, it can be sporadic or a hereditary case Refer khurana 6/e p 303 ###Answer: OPTION B IS CORRECT.

###Question: Knudsen's two hit hypothesis is for ###Options: A. Glaucoma B. Retinoblastoma C. Optic glioma D. Meningioma

You're a doctor, kindly address the medical queries according to the patient's account. Analyze the question and answer with the best option.

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###Rationale: Ans. is 'a' i.e., Rodent ulcer ###Answer: OPTION A IS CORRECT.

###Question: Commonest tumour at inner canthus of eye - ###Options: A. Rodent ulcer B. Dermoid cyst C. Malignant melanoma D. Buruli ulcer

Being a doctor, your task is to answer the medical questions based on the patient's description. Analyze the question and answer with the best option.

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###Rationale: Ans. is 'b' i.e., CRVO Ocular emergencies include those conditions that result in acute, severe pain in association with sudden vision loss, or that may lead to vision loss if left untreated; and traumatic conditions that affect globe or adnexa. Comon ophthalmic emergencies are :- Acute congestive glaucoma Ulcerative or traumatic corneal diseases Hyphema Acute blindness Eyelid or conjunctival laceration Anterior lens subluxation Ruptured globe Optic neuritis Endophthalmitis Orbital cellulitis Central retinal aerial occlusion (CRAG) Retinal detachment ###Answer: OPTION B IS CORRECT.

###Question: All are ophthalmological emergencies except ? ###Options: A. CRAO B. CRVO C. Acute congestive glaucoma D. Endophthalmitis

As a medical professional, your responsibility is to address the medical questions using the patient's description. Analyze the question and answer with the best option.

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###Rationale: Ans. Neuroparalytic keratitis ###Answer: OPTION D IS CORRECT.

###Question: Diabetes mellitus can cause the following in the eye except: ###Options: A. Cataract B. Retinopathy C. Anterior ischemic neuropathy D. Neuroparalytic keratitis

Given your background as a doctor, please provide your insight in addressing the medical questions based on the patient's account. Analyze the question and answer with the best option.

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