AMC MCQ Ophthalmology and ENT 2 — Questions and Answers
Question 1: 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 2: 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 3: 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 4: 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 5: 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 6: 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 7: 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.
AMC MCQ Ophthalmology and ENT 2
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?