Clinical Examination Of Eye

CLINICAL EXAMINATION OF EYE

Q. 1

Tonography is useful in:

 A

Total facility of aqueous outflow

 B

Reflecting the uveo scleral outflow of aqueous

 C

Monitoring the IOP in different states

 D

Detecting the formation of aqueous humour

Q. 1

Tonography is useful in:

 A

Total facility of aqueous outflow

 B

Reflecting the uveo scleral outflow of aqueous

 C

Monitoring the IOP in different states

 D

Detecting the formation of aqueous humour

Ans. A

Explanation:

[Total facility of aqueous outflow]

Tonography – is a noninvasive technique for determining the facility of aqueous outflow

Tonometry – is the assessment of the IOP of the eye and is one of the pillar stones of diagnosis of glaucoma


Q. 2

Tonography helps you to determine:

 A

The rate of formation of aqueous

 B

The facility of outflow of aqueous

 C

The levels of intraocular pressure at different times.

 D

None of the above

Q. 2

Tonography helps you to determine:

 A

The rate of formation of aqueous

 B

The facility of outflow of aqueous

 C

The levels of intraocular pressure at different times.

 D

None of the above

Ans. B

Explanation:

Tonography is a noninvasive technique for determining the facility of aqueous outflow.

Ref: Parson’s Diseases of The Eye, 18th Edition, Page 7226


Q. 3

What is the area of retina visualised under direct ophthalmoscope?

 A

1DD

 B

2DD

 C

3DD

 D

4DD

Q. 3

What is the area of retina visualised under direct ophthalmoscope?

 A

1DD

 B

2DD

 C

3DD

 D

4DD

Ans. B

Explanation:

Area of retina visualised under direct ophthalmoscope is 2DD. Image formed is virtual, erect and magnified 15 times.

Area of retina visualised under indirect ophthalmoscope is 8DD. Image formed is real, inverted and magnified 4-5 times.

Quiz In Between


Q. 4

Image in indirect ophthalmoscopy is :

 A

Enlarged, virtual, erect

 B

Enlarged, virtual, inverted

 C

Enlarged, real, erect

 D

Enlarged, real, inverted

Q. 4

Image in indirect ophthalmoscopy is :

 A

Enlarged, virtual, erect

 B

Enlarged, virtual, inverted

 C

Enlarged, real, erect

 D

Enlarged, real, inverted

Ans. D

Explanation:

  • Direct ophthalmoscopy one that produces an upright, or unreversed, image of approximately 15 times magnification.
  • Indirect ophthalmoscopy one that produces an inverted, or reversed, direct image of 2 to 5 times magnification.
Indirect ophthalmoscopy is used preoperatively and intraoperatively in the evaluation and surgical repair of retinal detachments.
 
Ref : Chang D.F. (2011). Chapter 2. Ophthalmologic Examination. In P. Riordan-Eva, E.T. Cunningham, Jr. (Eds), Vaughan & Asbury’s General Ophthalmology, 18e.

Q. 5

All of the following are features of fundus examination using direct ophthalmoscope, EXCEPT:

 A

Less useful in myopic patients

 B

Image formed is erect and virtual

 C

Field of vision is about 35 degrees

 D

Provides a magnification of 15 times

Q. 5

All of the following are features of fundus examination using direct ophthalmoscope, EXCEPT:

 A

Less useful in myopic patients

 B

Image formed is erect and virtual

 C

Field of vision is about 35 degrees

 D

Provides a magnification of 15 times

Ans. C

Explanation:

Field of vision with a direct ophthalmoscope is about 10-15 degrees, whereas with an indirect ophthalmoscope it is 35 degrees. 
 
Characteristics of direct and indirect ophthalmoscopy:

 

 

Direct ophthalmoscopy

Indirect ophthalmoscopy

Magnification

About 15 x

About 2.5 x

Depth of field

Small

Large

Field of vision

10 – 15 degree

35 degree

Stereopsis

Absent

Present

Type of image

Erect and virtual

Inverted and reversed real

View of periphery

Not clear

Clear

Value in myopia and other ametropias

Less

More

 
REF: Textbook of Ophthalmology edited by Sunita Agarwal, PAGE 199

Q. 6

Gonioscopy is used to study

 A

Ant. Chamber

 B

Post chamber

 C

Angle of anterior chamber

 D

Retina

Q. 6

Gonioscopy is used to study

 A

Ant. Chamber

 B

Post chamber

 C

Angle of anterior chamber

 D

Retina

Ans. C

Explanation:

C i.e. Angle of anterior chamber 

Gonioscopy is examination of angle of anterior chamber Q.

Quiz In Between


Q. 7

Fluorescein angiography is used to identify lesions in all EXCEPT:

 A

Retina

 B

Lens

 C

Optic nerve head

 D

Iris

Q. 7

Fluorescein angiography is used to identify lesions in all EXCEPT:

 A

Retina

 B

Lens

 C

Optic nerve head

 D

Iris

Ans. B

Explanation:

B i.e. Lens 

Lens and cornea are avascular structures of eye Q that’s why fluorescein angiography can’t be used to identify lesions.

While fluorescein angiography (FA) is an excellent method of showing the retinal circulation against the uniform dark background of retinal pigmentary epithelium. It is not helpful in delineating choroidal circulation. In contrast Indocyanine green angiography is excellent in studying choroidal circulation & is a useful adjunct in investigation of macular disease.


Q. 8

Inverted Purkinje image is seen on:

 A

Anterior surface of cornea

 B

Anterior surface of lens

 C

Posterior surface of cornea

 D

Posterior surface of lens

Q. 8

Inverted Purkinje image is seen on:

 A

Anterior surface of cornea

 B

Anterior surface of lens

 C

Posterior surface of cornea

 D

Posterior surface of lens

Ans. D

Explanation:

D i.e. Posterior surface of lens 


Q. 9

Magnification in Indirect ophthalmoscopy:

 A

Depends on power of lens used

 B

Depends on refractive error of pt

 C

Independent of refractive error of pt

 D

All

Q. 9

Magnification in Indirect ophthalmoscopy:

 A

Depends on power of lens used

 B

Depends on refractive error of pt

 C

Independent of refractive error of pt

 D

All

Ans. B

Explanation:

B i.e. 2DD

Quiz In Between


Q. 10

Indirect ophthalmoscopy is done for:

 A

Central retina

 B

Periphery of retina

 C

Sclera

 D

Angle of ant. Chamber

Q. 10

Indirect ophthalmoscopy is done for:

 A

Central retina

 B

Periphery of retina

 C

Sclera

 D

Angle of ant. Chamber

Ans. B

Explanation:

B i.e. Periphery of retina

Indirect ophthalmoscopy is done for examination of periphery of retina upto ora serrata Q where as direct ophthalmoscopy can show slightly beyond equator.


Q. 11

Corneal endothelial cell count is done by:

 A

Specular microscopy

 B

Keratometry

 C

Gonioscopy

 D

Slit lamp

Q. 11

Corneal endothelial cell count is done by:

 A

Specular microscopy

 B

Keratometry

 C

Gonioscopy

 D

Slit lamp

Ans. A

Explanation:

Ans. Specular microscopy


Q. 12

The aqueous flare is best demonstrated by:

 A

Biomicroscope

 B

Keratoscope

 C

Pentoscope

 D

Ophthalmoscope

Q. 12

The aqueous flare is best demonstrated by:

 A

Biomicroscope

 B

Keratoscope

 C

Pentoscope

 D

Ophthalmoscope

Ans. A

Explanation:

Ans. Biomicroscope

Quiz In Between


Q. 13

In indirect ophthalmoscopy the examining eye is made:

 A

Myopic

 B

Hypermetropic

 C

Emmetropic

 D

None of the above

Q. 13

In indirect ophthalmoscopy the examining eye is made:

 A

Myopic

 B

Hypermetropic

 C

Emmetropic

 D

None of the above

Ans. A

Explanation:

Ans. Myopic


Q. 14

Thickness of cornea is best measured by:

 A

Keratometer

 B

Pachymeter

 C

Optometer

 D

Pentoscope

Q. 14

Thickness of cornea is best measured by:

 A

Keratometer

 B

Pachymeter

 C

Optometer

 D

Pentoscope

Ans. B

Explanation:

Ans. Pachymeter


Q. 15

Angiography is the investigation of choice in:

 A

Posterior vitreous detachment

 B

Rhegmatogenous retinal detachment

 C

Retinoschisis

 D

Central serous retinopathy

Q. 15

Angiography is the investigation of choice in:

 A

Posterior vitreous detachment

 B

Rhegmatogenous retinal detachment

 C

Retinoschisis

 D

Central serous retinopathy

Ans. D

Explanation:

Ans. Central serous retinopathy

Quiz In Between


Q. 16

Distance of distant direct ophthalmoscopy is:

March 2013 (a, b, c, d, g, h)

 A

22 cm

 B

50 cm

 C

75 cm

 D

100 cm

Q. 16

Distance of distant direct ophthalmoscopy is:

March 2013 (a, b, c, d, g, h)

 A

22 cm

 B

50 cm

 C

75 cm

 D

100 cm

Ans. A

Explanation:

Ans. A i.e. 22 cm

Distant direct ophthalmoscopy

  • Used to get a preliminary idea about the status of the ocular media and fundu
  • This should be done routinely before doing a direct ophthalmoscopy
  • Equipment needed – self illuminated ophthalmoscope or plane mirror with a hole in centre
  • Procedure

Should be performed in a semi dark room

The ophthalmoscope should be kept at a distance of 20-25 cm from the patient’s eye Normally a red reflex is seen at the pupillary area

  • Uses
  • Opacities in the ocular media are seen as dark spots in the red glow at the pupillar area
  • The plane of the opacities can be assessed by asking the patient to move the eye from side to side while the examiner is observing the pupillary glow (based on parallax principle)
  • opacities in front of the pupil move in the direction of eye movement
  • opacities in the pupillary plane do not move
  • opacities behind the pupillary plane move opposite the direction of eye movement
  • To differentiate between a mole on the iris and a hole in the iris in oblique illumination, both appear dark in distant direct ophtalmoscopy
  • mole – appears dark
  • hole – red glow is seen
  • To detect a retinal detachment or fundal mass

Both of them are visible as a grayish reflex

It is not possible to differentiate them in distant direct ophthalmoscopy


Q. 17

Using a lens of +14D, magnification of fundus of an emmetropic eye in indirect ophthalmoscopy is:

March 2013 (e)

 A

5 times

 B

10 times

 C

15 times

 D

25 times

Q. 17

Using a lens of +14D, magnification of fundus of an emmetropic eye in indirect ophthalmoscopy is:

March 2013 (e)

 A

5 times

 B

10 times

 C

15 times

 D

25 times

Ans. D

Explanation:

Ans. D i.e. 5 times


Q. 18

In direct ophthalmoscopy, image is magnified by:

March 2005 & March 2013 (h)

 A

5 times

 B

10 times

 C

15 times

 D

20 times

Q. 18

In direct ophthalmoscopy, image is magnified by:

March 2005 & March 2013 (h)

 A

5 times

 B

10 times

 C

15 times

 D

20 times

Ans. C

Explanation:

Ans. C: 15 times

The direct ophthalmoscope gives a magnification of approximately 15 times and a field of view of 6.5 to 10 degrees, This 15 times magnification makes the 1.5 mm disc appear much larger than it really is.

The image formed in direct ophthalmoscopy is always erect.

Quiz In Between


Q. 19

All are true regarding direct ophthalmoscopy except:

March 2008

 A

Image is erect

 B

Magnification is more than indirect ophthalmoscopy

 C

Wide area of fundus with least magnification can be seen in hypermetropics

 D

It has a large field of view.

Q. 19

All are true regarding direct ophthalmoscopy except:

March 2008

 A

Image is erect

 B

Magnification is more than indirect ophthalmoscopy

 C

Wide area of fundus with least magnification can be seen in hypermetropics

 D

It has a large field of view.

Ans. D

Explanation:

Ans. D: It has a large field of view

Direct ophthalmoscopy allows visualization of the posterior pole of retina upto the equator. In comparison to this, indirect ophthalmoscopy has large field of view.

The image is erect and magnified about 15 times (more magnified than that of indirect ophthalmoscopy)

The area of the fundus which can be seen by the direct method varies with the distance of the observer from the eye and with the refraction. It increases as the eye is approached, is greatest in hypermetropia, least in myopia and intermediate in emmetropia.

Thus the largest area, least magnified, is seen in hypermetropia, and the least area, most magnified, in myopia.


Q. 20

Corneal curvature measured by ‑

 A

Keratometry

 B

Pachymetry

 C

Gonioscopy

 D

Perimetry

Q. 20

Corneal curvature measured by ‑

 A

Keratometry

 B

Pachymetry

 C

Gonioscopy

 D

Perimetry

Ans. A

Explanation:

Ans. is ‘a’ i.e., Keratometry

The `Keratometry’ or `ophthalmometry’ is an objective mehod of estimating the corneal astigmatism by measuring the curvature of central cornea.

Gonioscopy – Biomicroscopic examination of the angle of anterior chamber.

Perimetry – Procedure of estimating the extent of visual fields.

Tonography – Non – invasive technique for determining the facility of aqeous outflow (C – value).


Q. 21

Increased intraocular tension can be diagnosed by ‑

 A

Tonometer

 B

Pachymeter

 C

Placido’s disc

 D

Keratometer

Q. 21

Increased intraocular tension can be diagnosed by ‑

 A

Tonometer

 B

Pachymeter

 C

Placido’s disc

 D

Keratometer

Ans. A

Explanation:

Ans. is ‘a’ i.e., Tonometer

The exact measurement of intraocular pressure is done by an instrument called tonometer. Indentation (Schiotz tonometer) and applanation (e.g., Goldmann’s tonometer) tonometers are frequently used.

Quiz In Between


Q. 22

Objective methods for checking the refractive error are all except

 A

Ophthalmoscopy

 B

Retinoscopy

 C

Refractometry

 D

Keratometry

Q. 22

Objective methods for checking the refractive error are all except

 A

Ophthalmoscopy

 B

Retinoscopy

 C

Refractometry

 D

Keratometry

Ans. A

Explanation:

Ans. is ‘a’ i.e., Ophthalmoscopy

The procedure of determining and correcting refractive errors is termed as refraction. The refraction comprises two complementary methods : ‑

A) Objective methods : Objective methods of refraction include :- (i) Retinoscopy, (ii) Refractometry, (iii) Keratometry.

B) Subjective methods : These are :- (i) Subjective verification of refraction, (ii) Subjective refining of refraction, (iii) Subjective binocular balancing.


Q. 23

Quantification of corneal sensation is done by ‑

 A

Pachymeter

 B

Keratometer

 C

Aesthesiometer

 D

Tonometer

Q. 23

Quantification of corneal sensation is done by ‑

 A

Pachymeter

 B

Keratometer

 C

Aesthesiometer

 D

Tonometer

Ans. C

Explanation:

Ans. is ‘c’ i.e., Aesthesiometer

Measurement of Corneal Sensitivity

  • Corneal sensitivity may be tested by touching it in various places with a wisp of cotton-wool twisted to a fine point and comparing the effect with that on the other, normal cornea. There is in general a brisk reflex closure of the lids.
  • Corneal sensations are often diminished after any gross disorder, but the change is of diagnostic significance in certain cases, particularly herpes keratitis where minimal corneal changes are accompanied by a gross diminution of sensation.
  • Quantification of the corneal sensation is possible to some degree by the use of a corneal aesthesiometer in which a single horse hair of varying length is used instead of a wisp of cotton-wool. The longest length which induces blinking is a measure of the threshold of corneal sensitivity.

Q. 24

Advantage of indirect over direct ophthalmoscopy ‑

 A

Erect image

 B

No stereopsis

 C

Hypermagnification

 D

Useful in hazy media

Q. 24

Advantage of indirect over direct ophthalmoscopy ‑

 A

Erect image

 B

No stereopsis

 C

Hypermagnification

 D

Useful in hazy media

Ans. D

Explanation:

Ans. is ‘d’ i.e., Useful in hazy media

Quiz In Between


Q. 25

Corneal endothelium seen by ‑

 A

Pachymeter

 B

Keratometer

 C

Tonometer

 D

Slit lamp bio-microscope

Q. 25

Corneal endothelium seen by ‑

 A

Pachymeter

 B

Keratometer

 C

Tonometer

 D

Slit lamp bio-microscope

Ans. D

Explanation:

Ans. is ‘d’ i.e., Slit lamp bio-microscope

Corneal Endothelium:

  • It consists of single layer of polygonal (mainly hexagonal cells).
  • They are visualized by slit lamp bio-microscope and appear like mosaic.
  • The cell density is 3000 cells/ mm2 in young adults and deceases with age.
  • These cells contain active pump mechanism.

Note: Confocal microscope can be used to study all layers of retina.


Q. 26

Fluoresciene stain is used in the eye to stain ‑

 A

Cornea

 B

Retina

 C

Choroid

 D

Iris

Q. 26

Fluoresciene stain is used in the eye to stain ‑

 A

Cornea

 B

Retina

 C

Choroid

 D

Iris

Ans. A

Explanation:

Ans. is ‘a’ i.e., Cornea

Important corneal examinations

  • Keratometry, Corneal topography
  • Specular microscopy
  • Slit lamp
  • Pachymeter
  • Placido’s disc
  • Fluorescein, Alacian blue & Bengal rose stain
  • Window reflex, slit lamp biomicroscopy, Placidos’ disc

Used for

  • Curvature of cornea
  • Corneal endothelial density
  • Corneal opacity
  • Thickness of cornea
  • Corneal sheen
  • Corneal staining
  • Corneal surface

Q. 27

The Instrument shown in the diagram is used for ?

 A

Gonioscopy

 B

Perimetry

 C

Retinoscopy

 D

Keratometry

Q. 27

The Instrument shown in the diagram is used for ?

 A

Gonioscopy

 B

Perimetry

 C

Retinoscopy

 D

Keratometry

Ans. A

Explanation:

The Instrument shown is a Gonioscope 

Quiz In Between


Q. 28

Identify the Instrument shown in the Photograph 

 A

Direct Ophthalmoscope

 B

Indirect Ophthalmoscope

 C

Retinoscope

 D

Otoscope

Q. 28

Identify the Instrument shown in the Photograph 

 A

Direct Ophthalmoscope

 B

Indirect Ophthalmoscope

 C

Retinoscope

 D

Otoscope

Ans. B

Explanation:

Ans:B.)Indirect Ophthalmoscope

Ophthalmoscopy, also called fundoscopy

  • It is a test that allows to see inside the fundus of the eye and other structures using an ophthalmoscope (or fundoscope). It is crucial in determining the health of the retina, optic disc, and vitreous humor.
  • It is of two major types:
    • Direct ophthalmoscopy : produces an upright, or unreversed, image of approximately 15 times magnification.
    • Indirect ophthalmoscopy: produces an inverted, or reversed, direct image of 2 to 5 times magnification.
Features Direct ophthalmoscopy Indirect ophthalmoscopy
Condensing lens Not Required Required
Examination distance As close to patient’s eye as possible At an arm’s length
Image Virtualerect Real, inverted
Illumination Not as bright; not useful in hazy media Bright; useful for hazy media
Area of field in focus About 2 disc diameters About 8 disc diameters
Stereopsis Absent Present
Accessible fundus view Slightly beyond equator Up to Ora serrata i.e. peripheral retina
Examination through hazy media Not possible Possible
  • Each type of ophthalmoscopy has a special type of ophthalmoscope:
    • The direct ophthalmoscope is an instrument about the size of a small flashlight (torch) with several lenses that can magnify up to about 15 times. This type of ophthalmoscope is most commonly used during a routine physical examination.
    • An indirect ophthalmoscope, on the other hand, constitutes a light attached to a headband, in addition to a small handheld lens. It provides a wider view of the inside of the eye.
      •  It allows a better view of the fundus of the eye, even if the lens is clouded by cataracts.
      •  An indirect ophthalmoscope can be either monocular or binocular. It is used for peripheral viewing of the retina.

Q. 29

Fundus flouoscien angiography is least useful in

 A

Diabetic retinopathy

 B

 Central serous retinopathy

 C

Cystoids macular edema

 D

None of the above

Q. 29

Fundus flouoscien angiography is least useful in

 A

Diabetic retinopathy

 B

 Central serous retinopathy

 C

Cystoids macular edema

 D

None of the above

Ans. D

Explanation:

Ans. is ‘d’ i.e., None of the above

  • Fluorescein angiography is useful in all conditions.

 Fluorescein angiography is used in :‑

  1. Diabetic retinopathy
  2. Neoplasm
  3. Papilloedema
  4. Central serous retinopathy
  5. Retinitis pigmentosa and other retinal degeneration
  6. Choroidal diseases : Choroidal neovascularization
  7. Vascular occlusions (CRVO, CRAO)
  8. Eale’s disease
  9. Cystoid macular edema

Q. 30

Methods to measure error of refraction are all except‑

 A

Retinoscopy

 B

Refractometry

 C

Keratometry

 D

Binocular balancing

Q. 30

Methods to measure error of refraction are all except‑

 A

Retinoscopy

 B

Refractometry

 C

Keratometry

 D

Binocular balancing

Ans. D

Explanation:

Ans. is ‘d’ i.e., Binocular balancing

Refraction

  • The procedure of determining and correcting refractive errors is termed as refraction. The refraction comprises two complementary methods : ‑

Objective methods

  • These are used to measure the error of refraction.
  1. These tests are :-
  2. Retinoscopy
  3. Keratometry
  4. Refractometry

Subjective refraction

  • Subjective refraction is meant for finding out the most suitable lenses to be prescribed. The proper subjective
  1. refraction includes three steps.
  2. Subjective verification of refraction
  3. Subjective refining of refraction
  4. Subjective binocular balancing

Quiz In Between



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