LU 5 Ophthalmic Emergency

1. Which chemical injury penetrates deeper and causes more extensive damage to ocular tissues?
A. Sulphuric acid
B. Hydrochloric acid
C. Sodium hydroxide
D. Acetic acid
Answer: C

2. A patient presents with severe pain, photophobia, and corneal opacity after accidental exposure to cleaning chemicals. The first immediate intervention is:
A. Instillation of topical antibiotics
B. Application of cycloplegic drops
C. Irrigation with copious normal saline
D. Administering IV steroids
Answer: C

3. Which condition is characterized by sudden painless loss of vision with visual floaters and photopsia?
A. Central retinal vein occlusion
B. Retinal detachment
C. Acute angle-closure glaucoma
D. Corneal ulcer
Answer: B

4. The mechanism of damage in acid burns is primarily due to:
A. Protein coagulation acting as a barrier
B. Lipid dissolution leading to necrosis
C. Rapid penetration through tissues
D. Direct thermal injury
Answer: A

5. Which of the following is least likely to be a complication of corneal ulcers?
A. Corneal scarring
B. Endophthalmitis
C. Cataracts
D. Retinal detachment
Answer: D

6. A corneal foreign body is deeply embedded and metallic. What is the preferred removal method?
A. 25-gauge needle under slit lamp
B. Magnetic removal
C. Forceps removal under general anesthesia
D. High-pressure saline jet
Answer: B

7. The most common cause of traumatic hyphaema is:
A. Blunt trauma
B. Acid injury
C. Alkali injury
D. Thermal burn
Answer: A

8. In an intraocular foreign body injury, the most important management priority is:
A. Delayed removal to reduce inflammation
B. Immediate removal within 24 hours
C. Topical steroid therapy only
D. Eye patching without intervention
Answer: B

9. Which is a common causative organism for fungal corneal ulcers among contact lens wearers?
A. Staphylococcus aureus
B. Herpes simplex
C. Fusarium
D. Pseudomonas aeruginosa
Answer: C

10. What is the initial sign in acute angle-closure glaucoma?
A. Halos around light
B. Total vision loss
C. Sudden eye rupture
D. Eyelid laceration
Answer: A

11. What type of trauma does ultraviolet ray exposure fall under?
A. Thermal trauma
B. Chemical trauma
C. Radiation trauma
D. Physical trauma
Answer: C

12. The purpose of cycloplegic eye drops in corneal ulcers is to:
A. Treat bacterial infection
B. Reduce intraocular pressure
C. Paralyze ciliary muscle and relieve pain
D. Enhance epithelial regeneration
Answer: C

13. In lid laceration involving nasal to punctum area, there is risk of injury to:
A. Superior rectus muscle
B. Nasolacrimal drainage system
C. Optic nerve
D. Ciliary body
Answer: B

14. Which of these injuries is considered a true ophthalmic emergency?
A. Subconjunctival hemorrhage
B. Alkali chemical burn
C. Hordeolum
D. Pinguecula
Answer: B

15. Perilimbal ischaemia is a physical manifestation of:
A. Retinal detachment
B. Central retinal artery occlusion
C. Chemical injury
D. Corneal abrasion
Answer: C

16. Which procedure aids clot dislodgement in central retinal artery occlusion?
A. Cyclocryotherapy
B. Ocular massage
C. Nd:YAG laser iridotomy
D. Vitrectomy
Answer: B

17. The goal of IOFB management is best described as:
A. Preserving intraocular pressure
B. Reconstructing the eye and removing object
C. Preventing secondary cataracts
D. Reducing corneal astigmatism
Answer: B

18. Which contact lens practice increases risk of corneal ulcers the most?
A. Using daily disposable lenses
B. Overnight wear of lenses
C. Cleaning with prescribed solutions
D. Wearing lenses for <6 hours
Answer: B

19. Which nerve palsy increases corneal ulcer risk by exposure?
A. Oculomotor nerve
B. Trochlear nerve
C. Facial nerve
D. Abducens nerve
Answer: C

20. In chemical burns, why is early irrigation critical?
A. To reduce pain sensation
B. To restore ocular pH rapidly
C. To sterilize the cornea
D. To reduce eyelid swelling
Answer: B

21. Which medication is used to reduce intraocular pressure in CRAO?
A. IV mannitol
B. Topical NSAIDs
C. IV methylprednisolone
D. Oral antihistamines
Answer: A

22. Photocoagulation is a treatment modality for:
A. Retinal detachment
B. Corneal ulcer
C. Acute glaucoma
D. IOFB
Answer: A

23. Which is NOT a causative agent for corneal ulcers?
A. Herpes simplex
B. Varicella zoster
C. Streptococcus pneumoniae
D. Mycobacterium tuberculosis
Answer: D

24. Intraocular pressure elevation is most typical in:
A. CRAO
B. Retinal detachment
C. Acute angle-closure glaucoma
D. Corneal abrasion
Answer: C

25. The classic finding in CRAO fundoscopy is:
A. Cherry red spot at macula
B. Cup-to-disc ratio increase
C. Cotton wool spots
D. Flame-shaped hemorrhages
Answer: A

26. Which surgical management is used in acute angle-closure glaucoma?
A. Cyclocryotherapy
B. Corneal transplantation
C. Ocular massage
D. Pneumatic retinopexy
Answer: A

27. The risk of infection in lid laceration is minimized by:
A. Application of topical steroids
B. Systemic broad-spectrum antibiotics
C. Saline irrigation alone
D. Covering with eye pad only
Answer: B

28. Thyroid eye disease predisposes to corneal ulcer through:
A. Increased tear secretion
B. Decreased blinking reflex
C. Exposure keratopathy
D. Direct bacterial infection
Answer: C

29. Amniotic membrane transplantation is beneficial in:
A. CRAO
B. Alkali chemical burns
C. Acute glaucoma
D. IOFB removal
Answer: B

30. Anterior chamber paracentesis in CRAO is done to:
A. Increase aqueous humor production
B. Reduce intraocular pressure
C. Remove corneal foreign body
D. Enhance retinal perfusion by vasoconstriction
Answer: B

31. The most common cause of IOFB injuries is:
A. Explosion debris
B. Hammering metal on metal
C. Assault with sharp object
D. Agricultural injury
Answer: B

32. The pathophysiology of corneal ulcer involves:
A. Only superficial epithelial defect
B. Underlying stromal inflammation and necrosis
C. Lens capsule rupture
D. Ciliary body inflammation
Answer: B

33. Nd:YAG laser iridotomy is used in management of:
A. Retinal detachment
B. Acute angle-closure glaucoma
C. CRAO
D. Corneal ulcer
Answer: B

34. Which symptom distinguishes CRAO from retinal detachment?
A. Sudden painless vision loss
B. Floaters and photopsia
C. Halos around light
D. Headache and nausea
Answer: B

35. The reason alkali burns are more severe than acid burns is because:
A. Alkali causes immediate coagulation
B. Alkali penetrates rapidly due to lipid solubility
C. Acid burns reach deeper layers
D. Alkali neutralizes tears
Answer: B

36. Hyperbaric oxygen therapy in CRAO serves to:
A. Dissolve retinal emboli
B. Increase blood oxygen tension
C. Reduce intraocular pressure
D. Relieve pain
Answer: B

37. In traumatic lid laceration, what indicates oculoplastic referral?
A. Laceration not involving lid margin
B. Laceration lateral to punctum
C. Laceration involving lid margin
D. Laceration <5 mm
Answer: C

38. Which drug acts as a carbonic anhydrase inhibitor in glaucoma?
A. Timolol
B. Acetazolamide
C. Pilocarpine
D. Latanoprost
Answer: B

39. Endophthalmitis risk in IOFB is reduced by:
A. Delaying surgical removal
B. Topical NSAIDs
C. Concurrent intravitreal antibiotics
D. Only oral antibiotics
Answer: C

40. A patient presents with sudden onset severe eye pain, blurred vision, and mid-dilated pupil. Likely diagnosis?
A. Retinal detachment
B. Corneal abrasion
C. Acute angle-closure glaucoma
D. CRAO
Answer: C