FMGE Ophthalmology previous year questions

1. Q1. A patient with a painful red eye, photophobia and blurred vision has cells and flare in the anterior chamber with deposits on the corneal endothelium. What is the diagnosis?

   • A. Acute angle-closure glaucoma
   • B. Bacterial conjunctivitis
   • C. Central retinal vein occlusion
   • D. Acute anterior uveitis

   Answer: D. Acute anterior uveitis

2. Q2. A child with multiple cafe-au-lait macules and axillary freckling develops painless proptosis with reduced vision in one eye. Which tumour is most likely?

   • A. Vestibular schwannoma
   • B. Optic nerve glioma
   • C. Retinoblastoma
   • D. Sphenoid wing meningioma

   Answer: B. Optic nerve glioma

1. Q1. A patient cannot close the right eye fully and develops corneal drying and punctate erosions. Which nerve is affected, and which muscle has failed?

   • A. Oculomotor nerve, with weakness of levator palpebrae superioris
   • B. Facial nerve, with weakness of orbicularis oculi
   • C. Trigeminal nerve, with loss of corneal sensation
   • D. Sympathetic supply, with weakness of Muller's muscle

   Answer: B. Facial nerve, with weakness of orbicularis oculi

2. Q2. A patient with raised intracranial pressure develops horizontal diplopia and cannot abduct either eye. Why is this nerve affected early, and what does it tell you about the site of the lesion?

   • A. It has the shortest intracranial course, so it localises the lesion to the pons
   • B. It lies in the cavernous sinus wall, so it localises the lesion there
   • C. It is compressed at the tentorial edge, so it localises to the uncus
   • D. Its long intracranial course makes it vulnerable to stretch, so it is a false localising sign

   Answer: D. Its long intracranial course makes it vulnerable to stretch, so it is a false localising sign

1. Q1. The WHO SAFE strategy for trachoma elimination has four components. What does the S stand for, and which stage of disease does it address?

   • A. Screening, for active infection among schoolchildren
   • B. Surgery, for trichiasis, to prevent corneal blindness
   • C. Spectacles, for refractive error after scarring
   • D. Sanitation, to reduce fly breeding sites

   Answer: B. Surgery, for trichiasis, to prevent corneal blindness

2. Q2. In chronic hyperglycaemia the lens takes up water, swells and opacifies. Which pathway is responsible, and which product accumulates?

   • A. Glycolysis, with lactate accumulating anaerobically
   • B. The pentose phosphate pathway, with ribose-5-phosphate accumulating
   • C. The polyol pathway, with sorbitol accumulating because lens sorbitol dehydrogenase activity is low
   • D. Glycogenolysis, with glucose-1-phosphate accumulating

   Answer: C. The polyol pathway, with sorbitol accumulating because lens sorbitol dehydrogenase activity is low

1. Q1. Three weeks after uncomplicated cataract surgery a man reports flashes and floaters, then a curtain descending over his vision from above. What has happened, and what is the mechanism?

   • A. Endophthalmitis, from intraocular bacterial contamination
   • B. Posterior capsular opacification, from lens epithelial proliferation
   • C. Cystoid macular oedema, from prostaglandin release
   • D. Rhegmatogenous retinal detachment, from a retinal tear allowing fluid beneath the retina

   Answer: D. Rhegmatogenous retinal detachment, from a retinal tear allowing fluid beneath the retina

2. Q2. In with-the-rule astigmatism the vertical corneal meridian is steeper than the horizontal. Which cylindrical correction is therefore appropriate?

   • A. A plus cylinder with its axis at 90 degrees
   • B. A minus cylinder with its axis at 90 degrees
   • C. A minus cylinder with its axis at 180 degrees
   • D. A plus cylinder placed at any axis

   Answer: B. A minus cylinder with its axis at 90 degrees

1. Q1. A woman has chronic watering and mucopurulent regurgitation from the left eye with a swelling below the medial canthus. Sac syringing shows a blocked nasolacrimal duct. What is the definitive treatment?

   • A. Dacryocystorhinostomy, creating a bypass between sac and nasal cavity
   • B. Dacryocystectomy, removing the sac
   • C. Probing of the nasolacrimal duct
   • D. Topical antibiotics alone

   Answer: A. Dacryocystorhinostomy, creating a bypass between sac and nasal cavity

2. Q2. An elderly man has sudden painless total loss of vision in one eye. Fundoscopy shows a pale oedematous retina with a cherry-red spot at the fovea. What has occurred, and why is the fovea red?

   • A. Central retinal vein occlusion, with venous congestion
   • B. Vitreous haemorrhage, obscuring the retina
   • C. Central retinal artery occlusion, with the intact choroidal circulation showing through the thin fovea
   • D. Optic neuritis, with disc swelling

   Answer: C. Central retinal artery occlusion, with the intact choroidal circulation showing through the thin fovea

1. Q1. A young man has recurrent unilateral acute anterior uveitis. Which HLA allele is associated, and which systemic diseases should be sought?

   • A. HLA-B51, with Behcet disease
   • B. HLA-B27, with ankylosing spondylitis, reactive arthritis and inflammatory bowel disease
   • C. HLA-DR3, with Sjogren syndrome
   • D. HLA-A29, with birdshot retinochoroidopathy

   Answer: B. HLA-B27, with ankylosing spondylitis, reactive arthritis and inflammatory bowel disease

2. Q2. A patient has ptosis, a constricted pupil that fails to dilate in the dark, and reduced sweating on the same side of the face. Which pathway is interrupted, and which muscle causes the ptosis?

   • A. The parasympathetic supply, with levator palpebrae weakness
   • B. The oculomotor nerve, with levator palpebrae weakness
   • C. The facial nerve, with orbicularis oculi weakness
   • D. The sympathetic pathway, with weakness of the superior tarsal muscle of Muller

   Answer: D. The sympathetic pathway, with weakness of the superior tarsal muscle of Muller

1. Q1. A squash ball strikes the eye and blood collects in the anterior chamber. Which vessels usually bleed?

   • A. The major arterial circle of the iris at the ciliary body
   • B. The central retinal artery
   • C. The short posterior ciliary arteries
   • D. The episcleral venous plexus

   Answer: A. The major arterial circle of the iris at the ciliary body

2. Q2. A man with Bell's palsy cannot close one eye and has punctate corneal erosions from exposure. What is the correct order of management?

   • A. Immediate permanent tarsorrhaphy in all cases
   • B. Topical steroids, then corneal grafting
   • C. Intensive lubricants and taping at night, escalating to a bandage contact lens or temporary tarsorrhaphy if the cornea deteriorates
   • D. Refractive surgery to reduce corneal exposure

   Answer: C. Intensive lubricants and taping at night, escalating to a bandage contact lens or temporary tarsorrhaphy if the cornea deteriorates

1. Q1. Parasympathetic secretomotor fibres to the lacrimal gland relay in which ganglion, and by which nerve do they reach the gland?

   • A. Ciliary ganglion, via the short ciliary nerves
   • B. Otic ganglion, via the auriculotemporal nerve
   • C. Submandibular ganglion, via the lingual nerve
   • D. Pterygopalatine ganglion, via the zygomatic and lacrimal nerves

   Answer: D. Pterygopalatine ganglion, via the zygomatic and lacrimal nerves

2. Q2. Under WHO categories, a person whose better eye has a best-corrected acuity of 6/60 but worse than 6/18 falls into which group?

   • A. Blindness
   • B. Moderate visual impairment
   • C. Severe visual impairment
   • D. Normal vision

   Answer: B. Moderate visual impairment

1. Q1. What is the commonest cause of blindness in India, and why is it considered avoidable?

   • A. Cataract, because it is reversible by surgery
   • B. Refractive error, because spectacles correct it
   • C. Glaucoma, because drops arrest it
   • D. Trachoma, because antibiotics cure it

   Answer: A. Cataract, because it is reversible by surgery

2. Q2. A head-injured patient with rising intracranial pressure develops a fixed dilated pupil. On which side, and which structure is compressed?

   • A. Contralateral to the lesion, from optic nerve compression
   • B. Ipsilateral to the lesion, from uncal herniation compressing the oculomotor nerve
   • C. Contralateral, from midbrain shift
   • D. Ipsilateral, from sympathetic interruption

   Answer: B. Ipsilateral to the lesion, from uncal herniation compressing the oculomotor nerve

1. Q1. Which laser is used for peripheral iridotomy in angle-closure glaucoma, and what is its mechanism?

   • A. Argon laser, by thermal coagulation
   • B. Nd-YAG laser, by photodisruption creating a full-thickness opening
   • C. Excimer laser, by photoablation
   • D. CO2 laser, by vaporisation

   Answer: B. Nd-YAG laser, by photodisruption creating a full-thickness opening

2. Q2. In dacryocystorhinostomy, an opening is created between the lacrimal sac and which part of the nose?

   • A. Inferior meatus
   • B. Middle meatus
   • C. Superior meatus
   • D. Sphenoethmoidal recess

   Answer: B. Middle meatus

Every FMGE session paper, all 19 subjects together, is on our previous year questions page.