M2 Annual 2024 (30 Keys) PDF Ophthalmology Exam Paper

## PAPER CODE U **62.** An 80 years old female presented to Eye OPD with sudden onset pain right eye with decreased vision and associated nausea. On examination she has right corneal edema with mid dilated pupil and IOP of 50mmHg. Left eye is normal except having shallow anterior chamber. What is...

## PAPER CODE U **62.** An 80 years old female presented to Eye OPD with sudden onset pain right eye with decreased vision and associated nausea. On examination she has right corneal edema with mid dilated pupil and IOP of 50mmHg. Left eye is normal except having shallow anterior chamber. What is the immediate next step of management? * Intravenous Mannitol, oral acetazolamide and Pilocarpine 4% * Surgical Peripheral iridectomy in right eye * Laser iridotomy in right eye * Topical antibiotics in right eye * Trabeculectomy in right eye **63.** A 19 years old boy presents to your clinic with droopy eyelids on right side. Visual acuity is 6/6 in the both eyes. On examination, there is mild right ptosis. On slit lamp examination you notice that the iris is slightly lighter in colour on the right side. Right pupil is miosed. What is your diagnosis? * Aponeurotic ptosis * Blepharophimosis syndrome * Congenital myogenic ptosis * Congenital Horner syndrome * Congenital heterochromia **64.** A 70 years old patient having cataract in his right eye is brought to the OPD for surgery. After assessment of the patient the teacher told the students that the cataract surgery cannot be performed in all of the following conditions except: * Chronic dacryocystitis * Acute bacterial conjunctivitis * Corneal ulcer * Retinitis pigmentosa * Acute anterior uveitis **65.** The most common systematic disorder associated with cataract are all of the following except: * Diabetes mellitus * Hypertension * Myotonic dystrophy * Atopic dermatitis * Neurofibromatosis **66.** Ectopia lentis is a condition of the eye, in which natural crystalline lens in a person is: * Having bulge in the anterior capsule * Having bulge in the post capsule * Displaced from its normal position * More spherical in shape * Anterior capsule is attached to the iris throughout the pupillary margin **67.** In 65 years old lady, having been operated upon her right eye for cataract surgery, endophthalmitis develops on the 1" post- operative day. The treatment option available to treat her at this stage are all of the following except: * Topical fortified eyes drops against gram +ve and-ve bacteria, one hourly * Subconjunctival injection of broad spectrum antibiotics * Pars plana vitrectomy * Intravitreal injection of antibiotics * Evisceration of the eye **68.** During extracapsular cataract extraction, if the post capsule is ruptured and there is loss of vitreous, all of the following complication can be expected except: * Retinal detachment * Secondary glaucoma * Vitreous touch syndrome * Vitreous wick syndrome * Scleromalacia **69.** In case of screening and follow up of a glaucoma patient, all of the following visual field defects can be detected except: * Arcuate scotoma * Paracentral scotoma * Enlargement of blind spot * Ring scotorna * Incongruous Homonymous hemianopia **70.** In a glaucomatous patient, who is also asthmatic, which of the following drops should be avoided to prescribe * Parasympathomimetic * Sympathomimetic * Beta blockers * Carbonic anhydrase inhibitors * Prostaglandin analogues **71.** An elderly diabetic patient visited eye OPD for routine checkup. His pupils were dilated by instilling mydriatic eye drops, for examination of retina. He reported few hours later with the complaint of pain in eyes and headache. When he was examined, his cornea was hazy and his IOP was 30mmHg in right eye and 28mmHg in left eye. What was the predisposing reason of his raised intraocular pressure after dilation of pupils. * He was having Rubeosis iridis * He was having posterior synechiae * He was having ciliary muscle spasm * He was having grade 1 and 2 angle in three quadrants according to Shaffer classification * He was having grade 4 angle in all quadrants according to Shaffer classification **72.** A 3 months child is brought to the OPD by his parents with the compliant of defective vision and abnormal eye movements. On examination the child is having bilateral dense cataracts. The best treatment option in this child is: * Bilateral cataract extraction with posterior chamber IOL implantation * One eye cataract extraction and posterior chamber IOL implantation * Bilateral cataract removal and prescription of glasses * Reassurance of the parents and advice to come for bilateral cataract extraction after 3 years of age * Advise mydriatic eye drops in both eyes till the age of 03 years. **73.** All of the following are indications for removal of cataract except: * Phacoanaphylactic glaucoma * Phacolytic glaucoma * Phacomorphic glaucoma * Visual impairment * Acute hydrops **74.** Primary open angle glaucoma (POAG) is generally bilateral disease. The common risk factors are * Elderly patient, above the age of 40 years * Diabetic patients * Patients with family history of POAG * Hypertension * Immunocompromised patients **75.** Neovascular glaucoma can be associated with the following conditions except: * Ischaemic central retinal vein occlusion * Central retinal artery occlusion * Choroidal tumours * Long standing retinal detachment * Ectopia lentis **76.** A seventy years old farmer presents with a firm nodular lesion on the lateral border of right lower eve lid. Lesion is slowly growing for the last five years. There are dilated vessels on the lesion and there is a small ulcerated area in the middle with rolled edges. What is the most likely diagnosis? * Squamous cell carcinoma * Keratoacanthoma * Basal Cell papilloma * Capillary hemangioma * Basal cell carcinoma ## PAPER CODE U **77.** In case of having both left & right changes [same level] in a case of Cranial Nerve palsy, what can be the combination of nerve(s) involvement? * Both 3rd & 7th * Both 3rd & 6th * Both 6th & 7th * Both 4th & 6th * Both 6th & 9th **78.** A 10 year old child is having medial rectus muscle restriction. His left eye is showing the restriction since early childhood. Restriction is maximum in left gaze and restriction is less in its downward and upward gaze. What is the most likely diagnosis? * Congenital fibrosis of medial rectus * Duane's retraction syndrome * Myasthenia gravis * Diabetic neuropathy * Orbital haematoma **79.** Choose the incorrect statement regarding "ptosis"! * Most common cause is Aponeurotic palsy * Congenital ptosis is associated with blepharophimosis * Ptosis restricts the field of vision * Horner's syndrome can lead to ptosis * Most common cause is myasthenia gravis **80.** A 60 years old lady presents with recent onset (3-4 weeks) difficulty in producing involuntary movements of her right upper extremity and right side of her face. She has difficulty in buttoning her clothes. Also, she has a significant difficulty in copying a drawing. Which of the following is the most likely diagnosis? * Corticospinal tract lesion * Cerebellar lesion * Hypothalamic lesion * Basal ganglia lesion * Thalamic lesion **81.** An eye is considered to be ambiopia when there is * Normal vision in the affected eye with the least acuity being 6/18 * Loss of vision in the affected eye due to cataract * A unilateral condition with the normal eye having the following deficiency- 1) Strabismus 2) High astigmatism * One eye is more dominant than the other one * A bilateral condition with the least acuity in each eye of 6/18 **82.** Weakness is a condition of the face which usually affects * Eyelid closure * Chewing * Facial expression * Speaking * All of the above **83.** Large tumours of the pituitary gland are usually associated with * Bilateral temporal hemianopia * Bitemporal hemianopia * Homonymous hemianopia * Quadrantanopia * None of the above **84.** Choose the correct answer from the following: * Tracheitis is a cause of hoarseness. * Accumulation of fluid under the skin is called * "Strabismus" is a condition of the eyes * Paralysis of the superior oblique muscle is called "Hypothermia" * None of the above **85.** Ulcer mouth is associated with a stimulation of which ganglia * Submandibular ganglia * Otic ganglia * Pterigopalatine ganglion * All of the above * None of the above **86.** Upper motor neurone lesion is characterized by which of the following * Hypertonia * Clonus * Babinski Sign * All of the above * None of the above **87.** Disorders associated with "upper motor neurone lesion" are all of the following except * Cerebral palsy * Spastic paraplegia * Spinal muscular atrophy * Disuse atrophy * None of the above **88.** Choose the incorrect statement regarding "hypoglossal nerve"! * It supplies all the intrinsic muscles of the tongue and stylohyoid * It is associated with the following system- endocrine, escape, autonomic * It is affected by polio virus * It is associated with the following system disorder: dysphagia * It is associated with the following symptom: fasciculation, atrophy **89.** Choose the correct answer: * Prostaglandin analogues are * The term "Hypersomnia" is associated with * Hypothalamus controls * A drug which increases sweating * None of the above **90.** The term is called * Spinal muscular atrophy * Spastic paraplegia * Hyperprolactinemia * Hypersomnia * Amyotrophic lateral sclerosis ## PAPER CODE U **91.** In the case of a patient having a spinal cord lesion, the following are the features of upper motor neuron lesion except * Hypertonia * Hyperreflexia * Clonus * Babinski's sign * Fasciculation's **92.** All of the following can be used to relieve muscle spasticity except * Baclofen * Benzodiazepines * Dantrolene Sodium * Botulinum Toxin * Anticholinergics **93.** All are features of lower motor neuron legion except: * Muscle atrophy * Weakness * Hyporeflexia * Fasciculation's * Hyperreflexia **94.** A 25 year old male presents with a history of generalized tremors of the body and slow movement. On examination, he has cog-wheel rigidity in both upper extremities. Where is the lesion located? * Thalamus * Cerebellum * Basal ganglia * Motor cortex * Spinal cord **95.** "Myasthenia gravis" is associated with * Antibodies against acetylcholine receptors * Antibodies aganist voltage-gated calcium channels * Antibodies against sodium channels * Antibodies against neurotransmitter release proteins * All of the above **96.** All of the following are features of Horner's syndrome except * Miosis * Ptosis * Enophthalmos * Anhidrosis * Proptosis **97.** A 5 years old child presents with left eye deviation. On examination the eye is deviated inwards and the child has difficulty converging both the eyes. What is the most likely diagnosis? * Esotropia * Exotropia * Hypertropia * Hypotropia * None of the above **98.** The medial rectus muscle is supplied by which Cranial Nerve: * IIIrd * IVth * VIth * VIIth * None of the above **99.** A 50 year old male presented with gradual loss of vision in left eye since the surgery. He was operated for cataract extraction in the left eye. He reported the following: * His vision is better when light is * His visual acuity is 6/18 in left eye. He is complaining of poor night vision in the left * Left eye is red and watering. He has difficulty seeing the colors clearly. * On examination, his left eye reveals a slightly * With the above scenario, what are the possible * Posterior capsular opacification * Macular edema * Glaucoma * Vitreous hemorrhage * Endophthalmitis **100.** A patient with the history of multiple sclerosis has recent onset of difficulty in speaking and swallowing. On examination he has diminished gag reflex. What is the most likely diagnosis? * Dysarthria * Aphasia * Dysphasia * Dysphagia * None of the above **101.** Choose the incorrect statement regarding "Bell's palsy": * It is the paralysis of Facial nerve * It is a common cause of facial nerve palsy * It usually affects one side of the face * It is usually associated with drooping of eyelid on the affected side * It is usually associated with diminished hearing on the affected side **102.** A patient develops sudden onset of severe pain in right eye with decreased vision and associated nausea. Examination of the right eye shows corneal edema, mid-dilated pupil and raised intraocular pressure. What is the immediate next step of management? * Intravenous mannitol, oral acetazolamide and Pilocarpine 4% * Laser iridotomy in right eye * Topical antibiotics * Surgical peripheral iridectomy in right eye * Trabeculectomy in right eye **103.** All of the following are the features of diabetic neuropathy except: * Sensory disturbances * Motor disturbances * Autonomic disturbances * Painful extremities * Proptosis **104.** The most common cause of unilateral facial nerve palsy is * Bell's palsy * Acoustic neuroma * Ramsay Hunt syndrome * Brainstem stroke * None of the above **105.** In normal circumstances, any lesion that is located in the left cerebellar hemisphere * The patient will have difficulty with the left hand * The patient will have difficulty with the right hand * The patient will have difficulty with speech * The patient will have difficulty with swallowing * The patient will have difficulty with gaze and the affected eye will deviate to the left side **106.** The term "hemiparesis" is most commonly used to describe the loss of power of * One side of the body * Two sides of the body * Both upper extremities * Both lower extremities * None of the above **107.** A patient presents with the complaint of difficulty in swallowing after a stroke. The difficulty occurs * When he tries to swallow any food * When he tries to swallow only solid food * When he tries to swallow only liquid * Only while drinking water * None of the above **108.** A patient presents with right sided numbness in the body. On examination there is loss of sensation on the right side of the body and on the right side of the face. This could be due to the lesion present in * Left hemisphere * Right hemisphere * Left side of the brain stem * Right side of the brain stem * None of the above **109.** A 60 years old male presents to the physician with a sudden onset of weakness in the right upper and lower extremities with associated slurred speech and facial droop. What are the possible differentials? * Right middle cerebral artery occlusion * Left middle cerebral artery occlusion * Right internal carotid artery occlusion * Left internal carotid artery occlusion * All of the above **110.** All of the following can be the cause of involuntary movements in case of "right upper extremity" except * Corticospinal tract lesion * Cerebellar lesion * Hypothalamic lesio * Basal ganglia lesion * Thalamic lesion **111.** "Asymmetrical weakness" of the face with deviation of the mouth towards the * Cerebellar lesion * Hypothalamic lesio * Basal ganglia lesion * Thalamic lesion * Brainstem lesion **112.** All of the conditions can be the cause of difficulty in recognizing faces in a person * Cerebral palsy * Spastic paraplegia * Prosopagnosia * Parkinson's disease * Amyotrophic lateral sclerosis ## PAPER CODE U **113.** Choose the incorrect statement: * "Prosopagnosia" is a condition of the brain where the patient cannot recognize the familiar people. * "Agnosia" is a deficit in recognition and it can be due to the lesion in the parietal lobe * "Aphasia" is a deficit in speech and it can be due to the lesion in the temporal lobe * "Dysarthria" is a deficit in language comprehension and it can be due to the lesion in the frontal lobe * "Ataxia" is a deficit in coordination and it can be due to the lesion in the cerebellum **114.** A patient presents with the history of difficulty performing his daily activities, the difficulty is specifically in fine motor movements and his gait is wide based. What is the most likely diagnosis? * Cerebellar lesion * Hypothalamic lesio * Basal ganglia lesion * Thalamic lesion * Brainstem lesion **115.** A 28 years old lady presented with the complaint of difficulty in walking for the last 4 days. She is having bilateral lower limb weakness and difficulty in standing without support. She is also complaining of numbness in both her feet. She had a history of intermittent episodes of similar weakness in past which resolved spontaneously. What is the most likely diagnosis? * Guillain Barre syndrome * Multiple sclerosis * Myasthenia gravis * Amyotrophic lateral sclerosis * Spina bifida **116.** A 60 years old man presents with history of chronic low back pain with tingling sensation in the lower limbs. On examination, his right lower limb is weak and there is diminished sensation in right lower leg and foot. What is the most likely diagnosis? * Spinal cord compression * Lumbar disc prolapse * Peripheral neuropathy * Spinal stenosis * All of the above **117.** All of the following are the causes of the "difficulty in swallowing" Except: * Mechanical problems * Neurologic disorders * Diseases of the esophagus * Dysphasia * None of the Above **118.** All of the following are the causes of the "poor articulation of speech" except: * Dysarthria * Aphasia * Dysphagia * Broca’s Aphasia * None of the Above **119.** All of the following are associated with the following system except: * Autonomic Nervous System * Endocrine System * Escape System * Muscle system * None of the above **120.** All of the following are the causes of the "difficulty in controlling bowel movements" except: * Diabetic Neuropathy * Polymyositis * Spinal stenosis * Multiple sclerosis * None of the above