AMC MCQ Ophthalmology and ENT — Questions and Answers

Question 1: A 65-year-old presents with gradual painless vision loss. Fundoscopy shows a cup-to-disc ratio of 0.8 and intraocular pressure is 28 mmHg bilaterally. What is the most likely diagnosis?

Cataracts
Primary open-angle glaucoma (Correct answer)
Age-related macular degeneration
Central retinal vein occlusion

Correct answer: Primary open-angle glaucoma

Primary open-angle glaucoma presents with elevated IOP, increased cup-to-disc ratio, and gradual painless peripheral vision loss due to progressive optic nerve damage.

Question 2: A 50-year-old presents with sudden severe eye pain, nausea, vomiting, and halos around lights. The eye is red with a mid-dilated fixed pupil and corneal haze. What is the immediate first-line management?

Topical antibiotics and eye patching
Oral acetazolamide and topical beta-blockers (Correct answer)
Systemic corticosteroids
Topical antihistamines

Correct answer: Oral acetazolamide and topical beta-blockers

Acute angle-closure glaucoma is an emergency requiring immediate IOP reduction with systemic acetazolamide and topical agents such as beta-blockers and pilocarpine to prevent permanent vision loss.

Question 3: A 72-year-old complains of central vision distortion and sees straight lines as wavy (metamorphopsia). Fundoscopy reveals drusen deposits and pigmentary changes in the macula. What is the most likely diagnosis?

Diabetic maculopathy
Optic neuritis
Age-related macular degeneration (Correct answer)
Retinal detachment

Correct answer: Age-related macular degeneration

Age-related macular degeneration presents with central vision distortion, metamorphopsia, and drusen deposits on fundoscopy, predominantly affecting patients over 60 years.

Question 4: A 38-year-old with recurrent sinusitis presents with nasal polyps, bronchial asthma, and develops bronchospasm after taking aspirin for a headache. What is this triad called?

Kartagener syndrome
Churg-Strauss syndrome
Wegener's granulomatosis
Samter's triad (aspirin-exacerbated respiratory disease) (Correct answer)

Correct answer: Samter's triad (aspirin-exacerbated respiratory disease)

Samter's triad (aspirin-exacerbated respiratory disease) consists of asthma, nasal polyps, and aspirin/NSAID sensitivity caused by aberrant arachidonic acid metabolism.

Question 5: A 2-year-old presents with fever, ear pain, and a bulging erythematous tympanic membrane. There is no perforation. What is the most appropriate first-line management?

Observation alone for 48-72 hours
Amoxicillin for 10 days (Correct answer)
Ciprofloxacin ear drops
Urgent myringotomy

Correct answer: Amoxicillin for 10 days

Children under 2 years with acute otitis media should receive antibiotics (amoxicillin) because they have a higher risk of complications and less ability to mount an adequate immune response.

Question 6: A 55-year-old presents with sudden painless monocular vision loss described as a 'curtain descending from above.' There is no pain or redness. What is the most likely diagnosis?

Central retinal vein occlusion
Vitreous haemorrhage
Optic neuritis
Retinal detachment (Correct answer)

Correct answer: Retinal detachment

Retinal detachment classically presents as a shadow or 'curtain' advancing across the visual field, representing progressive separation of the retina from the underlying retinal pigment epithelium.

Question 7: A 28-year-old presents with unilateral progressive sensorineural hearing loss, constant tinnitus, and mild vertigo. MRI reveals an enhancing lesion at the right cerebellopontine angle. What is the most likely diagnosis?

Vestibular schwannoma (acoustic neuroma) (Correct answer)
Meniere's disease
Labyrinthitis
Cholesteatoma

Correct answer: Vestibular schwannoma (acoustic neuroma)

Vestibular schwannoma presents with unilateral progressive sensorineural hearing loss, tinnitus, and vertigo, and appears as an enhancing cerebellopontine angle mass on gadolinium-enhanced MRI.

Question 8: A 58-year-old with poorly controlled diabetes presents with new retinal vessels and a recent vitreous haemorrhage. What stage of diabetic retinopathy does this represent?

Mild non-proliferative retinopathy
Severe non-proliferative retinopathy
Proliferative diabetic retinopathy (Correct answer)
Diabetic maculopathy

Correct answer: Proliferative diabetic retinopathy

Proliferative diabetic retinopathy is defined by neovascularization (new vessel formation) on the retina or disc, which can rupture and cause vitreous haemorrhage or lead to tractional retinal detachment.

Question 9: A 70-year-old with atrial fibrillation develops sudden painless monocular vision loss. Fundoscopy shows a pale, oedematous retina with a 'cherry red spot' at the fovea. What is the diagnosis?

Central retinal vein occlusion
Anterior ischaemic optic neuropathy
Central retinal artery occlusion (Correct answer)
Vitreous haemorrhage

Correct answer: Central retinal artery occlusion

Central retinal artery occlusion causes inner retinal ischaemia, producing a pale retina with a cherry red spot at the fovea where the choroidal circulation preserves the thinner foveal tissue.

Question 10: A 32-year-old with ankylosing spondylitis presents with a painful red eye, photophobia, blurred vision, and lacrimation. Slit-lamp examination reveals keratic precipitates and a hypopyon. What is the diagnosis?

Bacterial conjunctivitis
Corneal ulcer
Acute anterior uveitis (iritis) (Correct answer)
Scleritis

Correct answer: Acute anterior uveitis (iritis)

Anterior uveitis presents with a painful red eye, photophobia, and keratic precipitates on slit-lamp examination; it is commonly associated with HLA-B27-positive conditions such as ankylosing spondylitis.

Question 11: A 3-year-old child is brought in after parents notice a white reflex (leukocoria) in the left eye in photographs. What is the most critical diagnosis to exclude urgently?

Congenital cataract
Retinoblastoma (Correct answer)
Coloboma
Persistent hyperplastic primary vitreous

Correct answer: Retinoblastoma

Leukocoria in a child must prompt urgent ophthalmological referral to exclude retinoblastoma, the most common intraocular malignancy in children, which is life-threatening if diagnosis is delayed.

Question 12: A 48-year-old presents with a 2-month history of unilateral nasal obstruction, blood-stained nasal discharge, and a firm cervical lymph node. There is unilateral serous otitis media. CT shows a nasopharyngeal mass. What is the most likely diagnosis?

Juvenile nasopharyngeal angiofibroma
Nasal polyposis
Nasopharyngeal carcinoma (Correct answer)
Inverted papilloma

Correct answer: Nasopharyngeal carcinoma

Nasopharyngeal carcinoma presents with unilateral nasal obstruction, epistaxis, cervical lymphadenopathy, and unilateral serous otitis media due to Eustachian tube obstruction; it is strongly associated with EBV.

Question 13: A 42-year-old presents with recurrent episodes of vertigo lasting 2-3 hours, accompanied by fluctuating low-frequency sensorineural hearing loss, tinnitus, and aural fullness in the left ear. What is the most likely diagnosis?

Benign paroxysmal positional vertigo
Vestibular schwannoma
Meniere's disease (Correct answer)
Vestibular neuritis

Correct answer: Meniere's disease

Meniere's disease is characterized by the classic tetrad of episodic vertigo, fluctuating sensorineural hearing loss, tinnitus, and aural fullness due to endolymphatic hydrops.

Question 14: A 55-year-old presents with brief episodes of intense vertigo triggered by rolling over in bed, lasting less than one minute. The Dix-Hallpike test is positive. What is the most effective first-line treatment?

Long-term meclizine (vestibular suppressant)
Canalith repositioning procedure (Epley maneuver) (Correct answer)
Intratympanic gentamicin injection
Surgical posterior semicircular canal occlusion

Correct answer: Canalith repositioning procedure (Epley maneuver)

Benign paroxysmal positional vertigo is caused by displaced otoliths in the posterior semicircular canal and is effectively treated with the Epley canalith repositioning maneuver.

Question 15: A 5-year-old is found on routine screening to have best corrected visual acuity of 6/6 in the right eye and 6/60 in the left eye with no structural abnormality. What is the most effective treatment for the left eye?

Corrective lenses alone
Surgery on the left eye
Patching the right (good) eye for several hours per day (Correct answer)
Atropine drops to both eyes

Correct answer: Patching the right (good) eye for several hours per day

Amblyopia is treated by patching the stronger eye to force use of the amblyopic eye, stimulating visual cortex development during the critical period of visual plasticity.

Question 16: A 45-year-old presents with a drooping left upper eyelid, a constricted left pupil that reacts poorly in dim light, and reduced sweating on the left side of the face. What is the diagnosis?

Left third cranial nerve palsy
Left Horner syndrome (Correct answer)
Myasthenia gravis
Left Bell's palsy

Correct answer: Left Horner syndrome

Horner syndrome consists of ipsilateral ptosis, miosis, and anhidrosis resulting from interruption of the sympathetic supply to the eye and face, and requires urgent investigation for underlying causes such as Pancoast tumor or carotid dissection.

Question 17: A 52-year-old smoker presents with a firm, painless 3 cm neck mass that has been present for 8 weeks. Fine needle aspiration cytology reveals squamous cell carcinoma. What is the most important next investigative step?

Immediate radical neck dissection
Panendoscopy to identify the primary tumour (Correct answer)
PET-CT scan only
Empirical radiotherapy to the neck

Correct answer: Panendoscopy to identify the primary tumour

Metastatic SCC in the neck requires panendoscopy (examination of the nasopharynx, oropharynx, hypopharynx, larynx, and oesophagus) with biopsies to identify the primary tumour before definitive treatment planning.

Question 18: A 61-year-old smoker presents with 8 weeks of progressive hoarseness. Flexible laryngoscopy reveals a lesion on the left true vocal cord with impaired mobility. What is the single most important next step in management?

Voice rest for 4 weeks and reassessment
Microlaryngoscopy and biopsy under general anaesthesia (Correct answer)
Proton pump inhibitors for suspected laryngopharyngeal reflux
Antifungal therapy for presumed candidiasis

Correct answer: Microlaryngoscopy and biopsy under general anaesthesia

Persistent hoarseness beyond 3 weeks in a smoker with a laryngeal lesion requires urgent microlaryngoscopy and biopsy to obtain histological diagnosis and exclude laryngeal carcinoma.

Question 19: A 35-year-old presents with recurrent anterior epistaxis originating from the Kiesselbach plexus (Little's area). The bleeding is moderate and the patient is haemodynamically stable. What is the correct initial management?

Immediate anterior nasal packing with ribbon gauze
Firm pinching of the soft part of the nose for 10-15 minutes while leaning forward (Correct answer)
Posterior nasal packing
Urgent sphenopalatine artery ligation

Correct answer: Firm pinching of the soft part of the nose for 10-15 minutes while leaning forward

First-line management of anterior epistaxis is direct pressure by pinching the soft cartilaginous part of the nose for 10-15 minutes while the patient leans forward; this compresses the Kiesselbach plexus effectively.

Question 20: Parents of a 6-year-old ask about tonsillectomy after their child had 7 documented episodes of streptococcal tonsillitis in the past year, each requiring antibiotics. According to the Paradise criteria, is this child a candidate for tonsillectomy?

No — requires 10 episodes in one year
No — tonsillectomy is not indicated before age 7
Yes — 7 episodes in one year meets the threshold for tonsillectomy consideration (Correct answer)
Yes — but only if adenoidectomy is performed simultaneously

Correct answer: Yes — 7 episodes in one year meets the threshold for tonsillectomy consideration

The Paradise criteria recommend tonsillectomy for 7 or more documented tonsillitis episodes in one year, 5 or more per year for two consecutive years, or 3 or more per year for three consecutive years.

Question 21: A 63-year-old heavy smoker and drinker presents with progressive hoarseness, odynophagia, referred otalgia, and a palpable neck mass. Laryngoscopy reveals a supraglottic mass. Which investigation is most important for staging?

Plain chest radiograph alone
CT scan of the neck, chest, and upper abdomen with contrast (Correct answer)
MRI of the brain only
Ultrasound of the neck

Correct answer: CT scan of the neck, chest, and upper abdomen with contrast

Contrast-enhanced CT of the neck, chest, and abdomen is essential for staging laryngeal carcinoma, assessing local tumour extent, regional lymph node involvement, and distant metastases to guide treatment planning.

AMC MCQ Ophthalmology and ENT

A 65-year-old presents with gradual painless vision loss.
Fundoscopy shows a cup-to-disc ratio of 0.8 and intraocular pressure is 28 mmHg bilaterally.
What is the most likely diagnosis?

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