mock questions for neet pg, usmle, plab, fmge (mci screening exam) on crao

Q:1 Painless loss of vision is seen in all, EXCEPT:

A: PapilledemaB: PapillitisC: Angle closure glaucomaD: CRAO

Correct Ans:C

Explanation

Acute angleclosure glaucoma is an ophthalmic emergency thatcauses severe visual loss without treatment. Symptoms includeocular pain, blurred vision, lacrimation, halos around lights,frontal headache, nausea, and vomiting.

Causes of Sudden Painless Loss of Vision:

1. Retinal detachment2. Vitreous haemorrhage3. Retinal vein occlusion4. Retinal artery occlusion5. Wet age related macular degeneration6. Anterior ischemic optic neuropathy7. Optic neuritis8. Cerebrovascular accident9. Papillitis10. Papilledema

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Q:2 Sudden loss of vision is seen in following, except:

A: CRAOB: CRVOC: Optic neuritisD: Papilledema

Correct Ans:D

ExplanationPapilledema (choked disk) is usually a symptom of increased intracranial pressurecaused by a mass, such as a brain tumor. The increased pressure is transmitted to theoptic disk through the extension of the subarachnoid space around the optic nerve.Papilledema caused by a sudden increase in intracranial pressure develops within 24 to48 hours. Visual acuity is not affected in papilledema, although the blind spot may be

enlarged. Ref :Chang D.F. (2011). Chapter 2. Ophthalmologic Examination. In P. RiordanEva,E.T. Cunningham, Jr. (Eds), Vaughan & Asbury's General Ophthalmology, 18e.


Q:3 Fundus examination of a patient presenting with loss of vision revealed a Cherry red spot on the macula. What is he most likely suffering from?

A: Retinitis pigmentosaB: RetinoblastomaC: CRAOD: CRVO

Correct Ans:C

Explanation

Cherry red spot on the retina is seen in central retinal artery occlusion. Other retinal signs in this condition includes retinal oedema and segmentation of blood column in the retinal vein (cattle tracking sign). Patients often presents with sudden painless loss of vision.

Reference:Comprehensive Ophthalmology By A K Khurana, 4th Edition, Page255.


Q:4Which of the following condition is associated with Macular edema?

A: CRAOB: PapilledemaC: Diabetes mellitusD: Age related macular degeneration

Correct Ans:C

Explanation

Cystoid macular edema occur following retinal vascular disorders such as diabeticretinopathy caused by diabetes mellitus and central retinal vein occlusion. It can alsooccur as a post operative complication following cataract extraction and penetratingkeratoplasty, following intraocluar inflammation, as a side effect of adrenaline eyedropsand in retinal dystrophies.

Must know:

Cystoid macular edema:

It refers to collection of fluid in the outer plexiform layer (Henle’s layer) andinner nuclear layer of the retina centred around the foveola.It occur due to leakage of fluid following breakdown of inner blood retinal barrier.Ophthalmoscopy in this case shows honey comb appearence.Fundus fluorescein angiography shows flower petal appearence.

Ref: Comprehensive Ophthalmology By AK Khurana, 4th edn, page 273


Q:5 Rubeosis iridis is NOT COMMONLY seen in:

A: CRVOB: CRAOC: Diabetic retinopathyD: Neovascularization

Correct Ans:B

ExplanationRubeosis iridis or neovascularization of iris is a medical condition of the iris in whichnew blood vessels are found on the surface of the iris. It is associated with conditionswhich cause ischemia of the retina. Conditions commonly associated with rubeosisiridis are central retinal vein occlusion, proliferative diabetic retinopathy, ocularischemic syndrome, ocular surgery complication and chronic retinal detachment.Rubeosis iridis may also be associated with CRAO but is less common than with CRVO. Ischemic diseases of the retina causes the release of VEGF which in turn stimulateangiogenesis. They can be seen on the iris, and it can also grow into the angle of theeye resulting in an increase in intra ocular pressure. Ref: Glaucoma Surgery edited by Ashok Garg, page 350, Ocular Angiogenesis:Diseases, Mechanisms, and Therapeutics edited by Joyce TombrainTink, PAGE 128.


Q:6 Cherry red spot is seen in all of the following conditions, EXCEPT:

A: CRAOB: Tay Sach’s diseaseC: Niemman pick’s diseaseD: Central retinal vein occlusion

Correct Ans:D

ExplanationCherry red spots of the macula are produced when ganglion cells filled with lipiddegenerate thereby exposing the vascular choroidal tissue behind these cells. Centralretinal vein occlusion is not associated with cherry red spot. In CRVO retina appearscongested with large areas of flame hemorrhages.

Conditions associated with cherry red spot:

Central retinal artery occlusionTay sachs diseaseFarber’s diseaseSandhoff’s diseaseNeimann Pick diseaseGoldberg’s syndromeGaucher’s diseaseGangliosidase GM1 type 2Hurler’s syndrome

Ref: Ophthalmology edited by Myron Yanoff, 3rd edn page 590


Q:7 Clinical examination of a patient shows ring scotoma. It is seen in the followingcondition:

A: PapilloedemaB: Macular edemaC: CRAOD: Retinitis pigmentosa

Correct Ans:D

ExplanationAnnular or ringshaped scotoma is a typical feature of retinitis pigmentosa whichcorresponds to the degenerated equatorial zone of retina. As the disease progresses,scotoma increases anteriorly and posteriorly and ultimately only central vision is left(tubular vision). Eventually even this is also lost and the patient becomes blind. Ref: Comprehensive Ophthalmology by AK Khurana, 4th edition, Page 268269.


Q:8A female presented with progressive loss of vision during night since few months.Fundoscopy shows "bonespicule formation". Her two brothers and mother arealso suffering with the same problem. Diagnosis is:

A: PapilledemaB: Macular edemaC: CRAOD: Retinitis pigmentosa

Correct Ans:D

Explanation

Retinitis pigmentosa is a group of heterogeneous hereditary retinal degenerationscharacterized by progressive dysfunction of the photoreceptors, associated withprogressive cell loss and eventual atrophy of several retinal layers. Inheritance of thetypical form can be autosomal recessive, autosomal dominant, or Xlinked recessive.

The hallmark symptoms of retinitis pigmentosa are nightblindness (nyctalopia) and gradually progressive peripheralvisual field loss as a result of increasing and coalescing ringscotomas. The most characteristic fundoscopic findings areattenuated retinal arterioles, waxy pale optic disk, mottling ofthe retinal pigment epithelium, and peripheral retinal pigmentclumping, referred to as "bonespicule formation". Ref: Fletcher E.C., Chong N., Augsburger J.J., Corrêa Z.M. (2011). Chapter 10. Retina.In P. RiordanEva, E.T. Cunningham, Jr. (Eds), Vaughan & Asbury's GeneralOphthalmology, 18e.


Q:9 Cattle track appearance in fundoscopy is due to?

A: CRAOB: CRVOC: Retinitis pigmentosaD: Diabetic retinopathy

Correct Ans:A

Explanation

CRAO REF: Elsevier Comprehensive Guide, page 628 Common fundoscopy findings:

Condition FindingOptic disc coloboma Morning glory appearanceCRAO Cattle track appearanceCRVO Blood and thunder fundusChloroquine toxicity Bull's eye maculopathyQuinine toxicity Cherry red spotRetinitis pigmentosa Waxy pallor of optic disc

Bone spicule pigmentationCongenital syphilis/ Rubella Salt and pepper fundusSickle cell anemia Rising sun signCMV retinitis Mozzarella pizza fundusAIDS Cotton wool spots


Q:10 Cattle track appearance in fundoscopy is due to?

A: CRAOB: CRVOC: Retinitis pigmentosaD: Diabetic retinopathy

Correct Ans:A

Explanation

CRAO REF: Elsevier Comprehensive Guide, page 628 Common fundoscopy findings:

Condition FindingOptic disc coloboma Morning glory appearanceCRAO Cattle track appearanceCRVO Blood and thunder fundusChloroquine toxicity Bull's eye maculopathyQuinine toxicity Cherry red spotRetinitis pigmentosa Waxy pallor of optic disc

Bone spicule pigmentationCongenital syphilis/ Rubella Salt and pepper fundusSickle cell anemia Rising sun signCMV retinitis Mozzarella pizza fundusAIDS Cotton wool spots


Q:11 Which of the following is not an ophthalmic emergency?

A: Macular holeB: Retinal detachmentC: CRAOD: Acute primary angle closure glaucoma

Correct Ans:A

Explanation

Macular hole REF: Yanoff Ophthalmology 2nd edition

"A Macular hole is a break in the central part of the retina (macula), causing blurredand distorted vision. While this can occur after trauma, it usually presentsspontaneously. The treatment of macular hole involves surgery. While the repair of amacular hole is not an emergency there is a general consensus that repair should occurwithin 612 months after onset to maximize visual recovery"

"Eye injury, retinal detachment, and central retinal artery occlusion (CRAO) areamong the most common ocular emergencies"

Following are ocular emergencies:

1. Acute infectious endophthalmitis2. Acute primary angleclosure glaucoma3. Infectious keratitis4. Orbital hemorrhage5. Retinal detachment6. Foreign body7. Orbital fractures8. Corneal abrasions, lacerations, ulcers9. Chemical burns 10. Ruptured globe11. CRAO12. Retrobulbar hematoma


Q:12 Roth's spot is seen in?

A: Infective endocarditis B: TyphoidC: CRAOD: Rheumatic carditis

Correct Ans:A

Explanation

Infective endocarditis REF: Harrison's Principles of Internal Medicine 17th edchapter 118

"Roth spots are flame shaped hemorrhages with central cotton wool spots. They arecaused by immune complex deposition and are seen in subacute bacterialendocarditis"

"In the case of leukemia, the Roth spot is composed of a hemorrhage with a centralaggregation of white blood cells"

Feature of infective endocarditis:

Fever Chills and sweatsAnorexia, Weight loss, Malaise, Myalgias, arthralgias, Back painHeart murmur, New/worsened regurgitant murmurArterial emboliSplenomegalyClubbingPeripheral manifestations (Osler's nodes, subungual hemorrhages, Janewaylesions, Roth's spots)PetechiaeLaboratory manifestations: Anemia, Leukocytosis, Microscopic hematuria,Elevated erythrocyte sedimentation rate >90, Elevated Creactive protein level

>90, Rheumatoid factor, Circulating immune complexes, Decreased serumcomplement

Causes of Roth spots:

Subacute bacterial endocarditisAcute leukemiaPernicious anemiaScurvyCO poisoningPost cardiac bypass surgery


Q:13 Painless loss of vision is seen in all except:

A: PappilodemaB: PappilitisC: CRAOD: Angle closure glaucoma

Correct Ans:D

Explanation

Angle closure glaucoma


mock questions for neet pg, usmle, plab, fmge (mci screening exam) on crao

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