DAMS CALICUT POST TEST – OPHTHALMOLOGY + MICROBIOLOGY

Questions : 50 Time: 35 minutes

Correct answer : 4 marks Negative : -1
1)Identify the sign shown in image ?

a)Enroth sign
b)Munsen sign
c)Gifford’s sign
d)Stellwag’s sign

2)Identify

a)Pterygium

[email protected] Page 1
 DAMS CALICUT

b)Pinguecula
c)Episcleritis
d)Bitot’s spots

33)The following ocular finding can be a part of which syndrome ?

a)Moebius syndrome
b)Alagille syndrome
c)Treacher Collins syndrome
d)Goldenhar syndrome

4)Which of the following conditions can produce the fundus picture shown below ?

[email protected] Page 2
 DAMS CALICUT

a)Sickle cell anemia

b)Pseudoxanthoma elasticum
c)Paget’s disease
d) All

5)Identify the instrument?

[email protected] Page 3
 DAMS CALICUT

a)Chalazion clamp
b)Snellen entropion clamp
c)Jameson’s muscle forceps
d)Colibri forceps

6)Study the image of the pupillary pathway.Lesion at which of these sites produces Argyll
Robertson Pupil ?

a)1
b)2
c)3
d)4

[email protected] Page 4
 DAMS CALICUT

7)What could be the ocular finding in this child?

a)Glaucoma
b)Ectopia lentis
c)Choroidal hemangioma
d)Both a and c

8)Which of the following conditions can produce the typical appearance of cataract shown in
image?

[email protected] Page 5
 DAMS CALICUT

a)Diabetes mellitus
b)Trauma
c)Myotonic dystrophy
d)Galactosemia

9)Which corneal degenerative corneal change produces the characteristic change seen below?

a)Arcus senilis
b)Terrien degeneration
c)Band shaped keratopathy
d)Climatic droplet keratopathy

10)The characteristic fundus appearance is seen in?

[email protected] Page 6
 DAMS CALICUT

a)Stargardt disease
b)Best disease
c)Fundus flavimaculatus
d)Stickler syndrome

11)A 40 year old female is on long term treatment for Rheumatoid arthritis.Fundus
examination was done on follow up visit.See image below.What is the most probable drug
responsible for this ?

a)Leflunomide
b)Chloroquine
c)Ibuprofen
d)Methotrexate

12)A 35 year old male presents with sudden onset blurring of vision in both eyes.History
taking reveals similar episode 4 months back.He has also been having a ringing sensation in
his ears for past few weeks.Findings are shown below.What is your diagnosis?
[email protected] Page 7
 DAMS CALICUT

a)Behcet syndrome
b)Vogt-Koyanagi-Harada syndrome
c)Fuch’sheterochromic iridocyclitis
d)Eale’s disease

13)A 55 year old cardiac patient who was on long term treatment comes for follow up
visit.The physician observes the following finding on opthalmological examination.Which

[email protected] Page 8
 DAMS CALICUT

drug prescribed by the physician would most probably be responsible for this?

a)Digoxin
b)Verapamil
c)Amiodarone
d)Propranolol

14)A 3 year old male presents with a sudden onset visual loss in left eye.Ophthalmological
examination reveals strabismus and white pupillary reflex.Fundus finding is shown
below.What is your diagnosis?

a)Retinoblastoma
b)Sickle cell retinopathy
c)Toxoplasmosis
d)Coats disease

[email protected] Page 9
 DAMS CALICUT

15)Given below is the fundus picture of a myopic patient.What does the arrow point to?

a)Foster-Fuchs spot
b)Lacquer cracks
c)Arlt line
d)Myopic crescent

16)A 25 year old male presents with decreased vision in right eye.Fluorecein angiography
finding is shown in image below.What is your diagnosis?

[email protected] Page 10
 DAMS CALICUT

a)Cystoid macular edema

b)CRVO
c)Central Serous Retinopathy
d)CRAO

17)A 27 year old male has been complaints of difficulty in vision in dim light for past 2
years.Fundus finding is shown below.What is the most characteristic feature of this
condition?

[email protected] Page 11
 DAMS CALICUT

a)Ring scotoma
b)Chronic Progressive External Ophthalmoplegia
c)Peripheral field defect
d)Central scotoma

18)The fundus picture is most likely that of a patient with ?

a)Lupus erythematous retinopathy

[email protected] Page 12
 DAMS CALICUT

b)Sicke cell retinopathy

c)Retinopathy of prematurity
d)Diabetic retinopathy

19)Identify this chart used for visual acuity testing?

a)Pelli-robson chart
b)Snellen chart
c)Jaeger’s chart
d)Bailey Lovie chart

20)What ophthalmological imaging technique is shown in the image below ?

[email protected] Page 13
 DAMS CALICUT

a)Specular microscopy
b)Indocyanine green angiography
c)Optical Coherence Tomography
d)Heidelberg Retinal Tomograph

21) Study the image given below.What condition could the patient be suffering from?

[email protected] Page 14
 DAMS CALICUT

a)Marfan’s syndrome
b)Alport’s syndrome
c)Lowe’s syndrome
d)Weil-Marchesani syndrome

32)A 5 month old baby was admitted in the pediatrics ward with failure to gain weight and
recurrent episodes of vomiting.Clinical examination revealed hepatosplenomegaly.Lab
investigations show decreased blood glucose level.Ocular finding is shown below.What is the
most probable diagnosis?

[email protected] Page 15
 DAMS CALICUT

a)Von Gierke’s disease

b)Galactosemia
c)Hereditary Fructose Intolerance
d)Fructosuria

23)Correlate the two images.Which intrauterine infection can cause these defects in the
newborn?

[email protected] Page 16
 DAMS CALICUT

a)Toxoplasmosis
b)Rubella
c)Cytomegalovirus
d)Herpes simplex

24)A 60 year old female presents with a lesion in her left upper eyelid,as shown in image
below.Biopsy reveals malignant change.She also has a past history of removal of chalazion
two times in the same eye.What is the most likely diagnosis?

[email protected] Page 17
 DAMS CALICUT

a)Squamous cell carcinoma

b)Basal cell carcinoma
c)Sebaceous cell carcinoma
d)Malignant melanoma

25)Study the image below.The patient is most probably suffering from ?

a)Diabetes mellitus
b)Wilson’s disease
c)Down’s syndrome
d)Myotonic dystrophy

26)From the fundus picture,what is the grading as per Keith Wagner Barker classification ?

[email protected] Page 18
 DAMS CALICUT

a)Grade 1
b)Grade 2
c) Grade 3
d)Grade 4

27)The Fundus Fluorescein Angiography finding shown below is typical of ?

[email protected] Page 19
 DAMS CALICUT

a)High myopia
b)Central Serous Retinopathy
c)Retinal pigment epithelial detachment
d)Cystoid Macular Edema

28)A 60 year old male presents with sudden painless loss of vision in his left eye.Fundus
finding is shown below.What is the diagnosis?

a)Optic neuritis
b)Central Retinal Artery Occlusion
c)Central Retinal Vein Occlusion
d)Age related macular degeneration

[email protected] Page 20
 DAMS CALICUT

29)Given below is the fundus finding of a systemic disease.What is the most common organ
involved in this disease?

a)Skin
b)Liver
c)Lung
d)Brain

30)What is the most probable diagnosis from the fundus picture ?

[email protected] Page 21
 DAMS CALICUT

a)Purtscher’s retinopathy
b)Eale’s disease
c)Central Retinal Artery Occlusion
d)Central Retinal Vein Occlusion

31)What is the most probable diagnosis from the fundus picture?

[email protected] Page 22
 DAMS CALICUT

a)Central Retinal Artery Occlusion

b)Central Retinal Vein Occlusion
c)Morning glory anomaly
d)Retinal detachment

32)An 70 year old male complaints of foreign body sensation,irritation and watering from his
right eye.Which of the following is not a surgical method for this patient ?

a)Byron Smith modification of Kuhnt-Szymanowski procedure

b)Bick’s procedure with Reeh’s modification
c)Jone’s procedure
d)Wies procedure

33)Correlate the images and give your diagnosis?

[email protected] Page 23
 DAMS CALICUT

a)Choroidal melanoma
b)Coats disease
c)Choroidalhemangioma
d)Retinoblastoma

34)What is the most probable diagnosis in this patient?

[email protected] Page 24
 DAMS CALICUT

a)Mooren’s ulcer
b)ArcusSenilis
c)Reis-Buckler dystrophy
d)Schnyder crystalline dystrophy

35)What is the most likely diagnosis?

a)CRVO
b)CMV retinitis
c)Toxoplasma choroiditis
d)CRAO

[email protected] Page 25
 DAMS CALICUT

ANSWERS DAMS CALICUT IMAGE BASED QUESTIONS OPHTHALMOLOGY

1)B
Munsen sign refers to the acute bulge of the lower eyelid when the patient looks down.It is
seen in Keratoconus.

Some useful points on Keratoconus from Parson’s and Kanski Clinical Ophthalmology.

 It refers to a congenital weakness of cornea.Butremember,it usually manifests only

after puberty.However,it can also occur secondary to certain conditions like:
i)Trauma
ii)Patients with Vernal Keratoconjunctivitis and Down syndrome due to repeated
rubbing of eye.
 The cornea thins near the centre and progressively bulges forwards,with the apex of
the cone always being slightly below the centre of the cornea.
 Clinical presentation-Progressive myopia and astigmatism
 Other signs in Keratoconus are:
i)Oil droplet reflex on direct ophthalmoscopy
ii)Irregular scissor reflex on retinoscopy
iii)Vogt lines-Fine,vertical deep stromal striae
iv)Fleischer ring-Epithelial iron deposits surrounding the base of the cone
v)Acute hydrops caused by rupture of Basement membrane
vi)Stromal scarring following resolution of hydrops.

2)D
Bitot’s spots are patches of foamy,keratinized epithelium in the inter-palpebral zone seen in
Xeropthalmia.The foamy spots are due to gas production by Corynebacteriumxerosis.The
term Xerophthalmia comprises all the ocular manifestations of Vitamin A deficiency ranging
from nightblindness to keratomalacia.

Prevalence Criteria for determining Xerophthalmia problem (Ref:Park)

CRITERIA PREVALENCE IN POPULATION AT

RISK (6 months to 6 years)
Nightblindness More than 1%
Bitot’s spot More than 0.5 %
Corneal xerosis/Corneal More than 0.01 %
ulceration/Keratomalacia
Corneal ulcer More than 0.05 %
Serum retinol (less than 10 mcg/dl) More than 5 %

EXTRA EDGE(Ref:Parson 21sted)

[email protected] Page 26
 DAMS CALICUT

 In keratomalcia,inflammation is characteristically ABSENT.

3)D
Limbaldermoids can be a part of Goldenhar’ssyndrome.They are yellow tumors consisting of
epidermoid epithelium with sebaceous glands and hair.

Goldenhar’s syndrome

 Synonym- Oculo-auriculo-vertebral dysplasia

 Ocular features-Limbal/Epibulbardermoid,upper lid
coloboma,microphthalmos,ptosis,nasolacrimalobstruction,disccoloboma.
 Systemic fetures-Mandibular hypoplasia,facialasymmetry,microtia,pre-auricular
appendeges,hemivertebrae.

4)D
The arrow in the image shows angioid streaks.

 Angioid streaks are crack like dehiscences in thickened , calcified, and abnormally
brittle collagenous and elastic portions of Bruch membrane.They are dark red or grey
linear lesions with irregular serrated edges that intercommunicate around the optic
disc.
 Visual loss can occur in 70% of cases due to
choroidalneovascularisation,traumaticchoroidal rupture or foveal involvement by a
streak.
 Systemic association is seen in 50% of patients with conditions like:
a)PseudoxanthomaElasticum
b)EhlerDanlos syndrome
c)Paget’s disease of bone
d)Sickle cell anemia

5)A
The chalazion clamp is used for holding the lid during incision and curettage of a chalazion
and achieving hemostasis during surgery.See image below,where the lid is held by
chalazionclamp and the chalazion is removed with the help of a curette.

[email protected] Page 27
 DAMS CALICUT

6)C
Argyll Robertson pupil(ARP) is due to a lesion in the pretectal nucleus.

Other features of ARP are:

 The pupils are small,constricted and do not react to light ,but react to
accommodation.(Accomodation Reflex Present,Pupillary Reflex Absent)
 It is a characteristic feature of neurosyphilis.
 There is absence of dilatation in response to mydriatics like atropine.
 Vision is unaffected

7)D
The child is having facial portwinestain.Mostprobably,it is a case of Sturge Weber syndrome.

EXTRA EDGE(Ref:Parsons’)

Ocular features of inherited disorders

Inherited disorder Ocular features

Down syndrome Mongoloid slant of
eyes,epicanthicfolds,keratoconus,cataract,brushfield
iris spots
Sturge –Weber syndrome Arteriovenous malformation of
episclera,choroidalhemangioma,glaucoma
Neurofibromatosis Ptosis,pulsatingexophthalmos,optic nerve
glioma,Lisch iris nodules,neurofibromas of
iris,choroid and retina.
Albinism Nystagmus,translucentiris,albinoticfundus,foveal

[email protected] Page 28
 DAMS CALICUT

hypoplasia
Marfan syndrome Ectopialentis,myopia,retinal detachment
Von HippelLindau syndrome Retinal angiomas
Tuberous Sclerosis Retinal astrocytomas

8)B
The image shows “Rosette cataract” seen in blunt trauma.

Type of Cataract Condition

Christmas tree cataract Myotonic dystrophy
Oil drop cataract Galactosemia
Sunflower cataract Wilson’s disease/Chalcosis
Shield like cataract Atopic dermatitis
Polychromatic lustre/Bread crump Complicated cataract
appearance/Rainbow cataract
Snow flake/Snow storm cataract Diabetes mellitus
Morgagnian cataract Hypermature senile cataract

9)B
Terrien Marginal Degeneration(Ref:Parsons’)

 Slow progressive thinning of the peripheral cornea,sparing the limbus.

 Typically manifest on the superior aspect of cornea
 Males are more affected
 Usually bilateral,may be unilateral.
 Ocular findings:
a)Fine vascularised pannus over the thinned involved area with a yellow deposit of
lipid in the affected part.
b)Eye is typically quiet with no redness or inflammation.
c)The lesion may slowly extend circumferentially and lead to either myopic or
irregular astigmatism.
d)The epithelium over the thinned cornea usually remains intact but perforation can
occur with minor trauma.

10)B
The image shows “Egg yolk lesion” of macula seen in Best disease.

Best disease

 It is the vitelliform dystrophy of the fovea.

 Visual acuity usually remains good and neuroepithelium is unaffected.
 Serious loss of vision occurs only when there is a transition of the egg yolk lesion to
a scrambed egg appearance.See image below

[email protected] Page 29
 DAMS CALICUT

 Definitive diagnosis is based on abnormal Electro-oculogram(EOG)

findings.Electroretinography(ERG) shows a reduced C wave,but otherwise is normal.
 Remember that this is the only disease with normal electroretinographic results
associated with abnormal electrooculographic findings.

11)B
When high doses of Chloroquine are used for prolonged duration,it can result in Bull’s eye
maculopathy.

EXTRA EDGE
Factors predisposing to chloroquine toxicity:
a)Duration of use more than 5 years
b)Cumulative dose more than 100 grams
c)Daily dose more than 250mg or more than 3mg/kg

12)B
Correlating the history with examination finding of vitiligo,poliosis and Sunset glow
fundus,the diagnosis is VKH syndrome
Vogt-Koyanagi-Harada syndrome

 Bilateral condition affecting young adults

 Etiology-Autoimmune response causing inflammation of melanocyte containing
tissue.(uvea,meninges,skin,ear)
 HLA-DR4,DW15 association

[email protected] Page 30
 DAMS CALICUT

 Patient can have ocular,dermatological,otological and neurological features.

 Ocular features-Bilateral granulomatous anterior or multifocal posterior
uveitis,Exudative retinal detachment,Sunset glow fundus(due to retinal pigment
epithelium atrophy),Saguira sign(depigmentedlimbal lesions)
 Dermatological features-Vitiligo,poliosis,alopecia.
 Otological features-Tinnitus,vertigo,deafness
 Neurological features-Meningitis,Encephalopathy
 Treatment-Steroids.If no response,may require Cyclophosphamide,Cyclosporine.

13)C
The image shows “vortex keratopathy”.Here,there is a whorl-like pattern of epithelial
deposits in the cornea.

 Causes(Ref:Parsons’)
a)Drugs-Amiodarone,Chloroquine,Phenothiazines,Indomethacin
b)Fabry’s disease and its carrier state
 The whorl like pattern shows the direction of migration of corneal epithelial cells.

14)D
The clinical history along with fundus finding of telangiectatic vessels and hard exudates
points towards a diagnosis of Coats disease.

Coats disease

 Idiopathic non-hereditary,retinal telangiectasia.

 Age group-1st decade of life (average 5 years)
 Clinical features-Unilateral visual loss,strabismus,leukokoria.
 It is characterised by retinal angiomas and massive subretinal exudation from the
angiomas.This exudation produces retinal detachment.Cataract and angle closure
glaucoma may also occur in late stages.

EXTRA EDGE(Ref:Harrison)

 Facioscapulohumeralmuscular dystrophy can have Coats disease as a

manifestation.

15)A
In myopic degeneration,choroidal thrombosis may give rise to the sudden formation of a
circular deep purplish red or black coloured spot at the fovea.This is called Foster-Fuchs
spot.

 Lacquer cracks are seen in myopic degeneration.These fine lines occur due to
ruptures in the Retinal pigment epithelium-Bruch membrane-Choriocapillaris
complex.

[email protected] Page 31
 DAMS CALICUT

 Myopic crescents are seen in cases of moderate myopia,where there is a white

crescent usually at the temporal border of the disc.It may be absent in high
myopia.

16)C
The Fluorecein angiography in the image shows hyperfuorecent spot which ascends vertically
like a smock stack and gradually spreads laterally to take a mushroom or
umbrellaconfiguration.This pattern is seen in Central Serous Retinopathy.Also remember
that some cases of CSR may show Inkblot appearance on FFA,where the hyperfluorescent
spot enlarges centrifugally.

Central Serous Retinopathy

 Spontaneous serous detachment of neurosensory retina in the macular region, with

or without retinal pigment epithelium detachment.
 Age group-young or middle aged adult males with Type A personality
 Clinical features
-Unilateral blurring of vision
-Positive relative scotoma
-Micropsia,Metamorphopsia and occasionally macropsia
-The visual acuity is correctable by using a convex lens
 Clinical course-Reassurance is all what is required in majority of cases as in most
cases visual acuity returns to normal within 3-6 months.Argon lase burns may be
used to coagulate the leak if the edema has persisted for 3 months or longer

17)A
The fundus picture is that of Retinitis Pigmentosa.Ringscotoma or annular scotoma is
characterisitic.

 Nightblindness in Retinitis pigmentosa is due to the degeneration of rods,which are

primarily responsible for vision in dim light.
 The classic triad of Retinitis Pigmentosa is :
a)Arteriolar attenuation
b)Retinal bony spicule pigmentation
c)Waxy disc pallor

[email protected] Page 32
 DAMS CALICUT

EXTRA EDGE(Ref:Parsons’)

 There may be some variants of Retinitis pigmentosa,which may have similar

symptoms,but certain atypical features.They are:
a)Retinitis pigmentosa sine pigmento-There are NO VISIBLE pigmentary changes
in the retina.
b)Retinitis punctate albescens-Retina shows hundreds of small white dots
distributed fairly uniformly over the whole fundus.

18)B
The image shows “Sea-fan neovascularization” seen in proliferative sickle cell
retinopathy.Correlate it with the original sea fan image shown below.

[email protected] Page 33
 DAMS CALICUT

EXTRA EDGE(Ref:Parsons’ 21sted)

 Important features of non- proliferative sickle cell retinopathy are:

a)Salmon patch haemorrhages-Peripheral pre-retinal or superficial intra-retinal
haemorrhages
b)Sunburst spots-Patches of peripheral retinal pigment epithelial hyperplasia.
 Sickle cell C disease (HbSC) is the most important hemoglobinopathy in
ophthalmology,because its clinical manifestation is predominantly in the
eye,consisting of retinopathy,angioidstreaks,papilloedema,cataract,glaucoma and
circumscribed dilatation and constriction of conjunctival capillaries.

19)D
This is the Bailey-Lovie chart.
Peculiarities

 There are five letters in each row and the chart has a constant geometric
progression,with the size of letters in each row decreasing by a factor of log1010.
 The distance between each letter is equal to the width of the letter.

EXTRA EDGE(Ref:Parsons’)

 Tests for recording visual acuity in children are:

a)Cardiff acuity cards-for children 2-4 years of age

[email protected] Page 34
 DAMS CALICUT

b)Teller acuity cards-for children below 3 years of age

c)Sheridan-Gardiner test-for children 4-6 years of age

20)C
The image shows Optical Coherence Tomography (OCT)

Optical Coherence Tomography

 Non-invasive test that uses light waves to take cross-sectional images of retina.

[email protected] Page 35
 DAMS CALICUT

 Indications
a)Macular pathology
b)To monitor preogression of disease processes and response to treatment
c)Analysis of optic nerve head and retinal nerve fiber layer thickness.

21)B
Anterior lenticonus is a feature of Alport’ssyndrome.Also remember that posterior
lenticonus can occur in Lowe’s syndrome.

EXTRA EDGE(Ref:Harrison)

 Dot and fleck retinopathy is seen in Alport syndrome

22)B
The clinical history along with the ocular finding of bilateral cataract points towards the
diagnosis of Galactosemia.Hereditary fructose intolerance also has similar clinical
manifestations,but cataract is not a usual feature.

EXTRA EDGE(Ref:O.P.Ghai)

 E.Coli sepsis is an important cause of mortality in galactosemic patients in the

neonatal period.

23)B
Congenital cataract and Salt and pepper retinopathy correlates with Congenital Rubella
Syndrome.

EXTRA EDGE(Ref:Williams 22nded)

[email protected] Page 36
 DAMS CALICUT

 Neonates with congenital rubella may shed the virus for many months and thus be a
threat to other infants, as well as to susceptible adults who come in contact with them.

24)C
Recurrent chalazion in an elderly patient should always raise the suspicion of Sebaceous
cell carcinoma.
EXTRA EDGE(Ref:Parsons’)

 Sebaceous cell carcinoma usually affects upper lid > lower lid and females > males.

25)B
Sunflower cataract is a feature of Wilson’s disease as well as Chalcosis.

26)D
Keith Wagner Barker classification is for Hypertensive Retinopathy.

Keith Wagner Barker grading Features

Grade 1 Mild to moderate narrowing or sclerosis of
the smaller arterioles.
Grade 2 Moderate to marked narrowing of the retinal
arterioles,exaggeration of the light
reflex,changes at the arterio-venous
crossings.
Grade 3 Retinal arteriolar narrowing and focal
constriction,prominentarteriovenous crossing
changes,retinaledema,cotton wool
spots,flame shaped haemorrhages.
Grade 4 All the features of Grade 3 are seen as well as
papilloedema.

The fundus picture in question is that of Grade 4 Hypertensive Retinopathy.

Also,see the fundus picture below.See if you can identify what the arrows correspond to:

[email protected] Page 37
 DAMS CALICUT

Blue arrow-Cotton wool spots

White arrow-Haemorrhages
Green arrow-Macular star (exudates in a ring like manner).It can be seen in advanced
hypertensive retinopathy as well as optic neuritis.

27)D
The “Flower Petal” pattern of hyperfluorescence in Fluorescein angiography is seen in
Cystoid Macular Edema.

28)C
The clinical history along with the fundus finding of splashed tomato or blood and
thunderappearance is suggestive of ischaemic Central Retinal Vein Occlusion

EXTRA EDGE

 Rubeosisiridis develops in 50 % cases of Ischaemic CRVO, resulting in neovascular

glaucoma in 2-4 months.It is also called “100 day glaucoma”

29)C
The exudates form “Candle wax drippings” in Sarcoidosis.The most common organ
involved in Sarcoidosis is Lung,followed by skin.

EXTRA EDGE (Ref:Harrison)

 On Gallium-67 scan,Sarcoidosis shows increased activity in the parotids and lacrimal

glands (Panda sign) or in the right para-tracheal and left hilar area (Lambda sign)

[email protected] Page 38
 DAMS CALICUT

30)A
Purtscher’s Retinopathy

 Etiopathogenesis-Microvascular occlusion associated with conditions like:

a)Trauma
b)Embolism
c)Acute pancreatitis
d)Connective tissue diseases
e)Thrombotic thrombocytopenic purpura
f)Bone marrow transplantation

 Fundus shows multiple unilateral or bilateral,superficial,white retinal

patches,resembling large cotton wool spots,often associated with superficial
peripapillary haemorrhages.

31)C
Morning Glory Anomaly (Ref:Parsons’)

 The disc resembles morning glory flower.There is a central excavation surrounded by

an elevated rim of pink neuroretinal tissue with vessels emerging radially from the
disc as spokes in all directions.
 Systemic associations-Frontonasal dysplasia,NF-2,PHACE syndrome (Posterior fossa
brain
malformations,facialHemangiomas,Arterialanomalies,Cardiacdefects,Eyeabnormaltie
s)
 Complication-Serous retinal detachment can occur in 30% of cases.

32)A
The patient in question has senile entropion of right eyelid.Byron-Smith modification of
Kuhnt-Szymanowski procedure is used for surgical management of senile ectropion.

33)D
The diagnosis is Retinoblastoma of left eye.
Image A-Leukocoria in the left eye
Image B-Macular endophytic retinoblastoma with another small tumor nasal to the optic disc.
Image C-Flexner-Wintersteiner rosette: Central lumen surrounded by tall columnar cells, the
nuclei of which lie away from the lumen.
Image D-Fleurettes:Clusters of cells with long cytoplasmic processes resembling a bouquet
of flowers.Presence of fleurette indicates well differentiated tumor.

EXTRA EDGE(Ref:Parsons’)

 Retinoblastoma was the first cancer found to be directly associated with a genetic
abnormality(deletions or mutations of the q14 band of chromosome 13)

[email protected] Page 39
 DAMS CALICUT

34)A
The image shows peripheral circumferential ulcer extending the whole of
cornea,suggestive of Mooren’s ulcer.

Mooren’s ulcer

 Synonyms- Chronic serpiginousulcer,Rodent ulcer

 Etiology-Exact etiologyunknown.Most probably due to autoimmune process directed
against a specific target protein antigen in the corneal stroma.
 Ophthalmic signs in chronological order are:
i)progressive circumferential stromal ulceration with an undermined and infiltrated
leading edge.
ii)central stromal thinning,opacification and vascularization
iii)healing stage

35)B
This is the Pizza pie retinopathy or Cheese-pizza appearance seen in CMV retinitis.There is
a mixture of cotton wool spots, infiltrates, and hemorrhages.

[email protected] Page 40