Free PD-CET Ophthal MCQs

1. 1

   Which statement about prostaglandins is FALSE?

   • ACOX pathway produces prostaglandins, prostacyclin, and thromboxane
   • BIn general, prostaglandins cause mydriasis
   • CCorticosteroids inhibit both COX and LOX pathways
   • DLow-dose prostaglandins decrease IOP; high doses may increase IOP
   • EProstacyclin is a vasodilator; thromboxane is a vasoconstrictor
   Show answer and explanationHide answer

   Answer: B — In general, prostaglandins cause mydriasis

   Topical PGE and PGF cause miosis, not mydriasis. Steroids inhibit phospholipase A2 → block both COX and LOX pathways.

2. 2

   All methods increase ocular absorption of topical medications EXCEPT:

   • AAdding a second eye drop immediately after the first
   • BWaiting 5–10 min between medications
   • CNasolacrimal occlusion
   • DClosing eyes after administration
   • EPrior topical anesthetic
   Show answer and explanationHide answer

   Answer: A — Adding a second eye drop immediately after the first

   Second drop may wash out the first. One drop (~50 µL) exceeds conjunctival sac capacity (~10 µL).

3. 3

   Factors increasing corneal penetration EXCEPT:

   • AHigher drug concentration
   • BHigher vehicle viscosity
   • CHigher pH of the drug
   • DHigher lipid solubility
   • EBenzalkonium chloride
   Show answer and explanationHide answer

   Answer: C — Higher pH of the drug

   Extreme pH causes reflex tearing and dilution. BAK disrupts corneal epithelium and increases penetration.

4. 4

   NSAIDs block formation of all EXCEPT:

   • AThromboxane
   • BLeukotrienes
   • CProstaglandins
   • DProstacyclin
   Show answer and explanationHide answer

   Answer: B — Leukotrienes

   NSAIDs block COX. Leukotrienes are produced through LOX pathway.

5. 5

   Aminoglycoside most commonly causing topical hypersensitivity?

   • AGentamicin
   • BTobramycin
   • CKanamycin
   • DAmikacin
   • ENeomycin
   Show answer and explanationHide answer

   Answer: E — Neomycin

   Most frequent topical allergic reactions among aminoglycosides. Hypersensitivity occurs in ~6–8%.

6. 6

   Which statement about vancomycin is FALSE?

   • AInhibits cell wall synthesis
   • BEmpiric use in neutropenia is recommended for prophylaxis
   • CDrug of choice in filtering bleb-related endophthalmitis
   • DUseful in pseudomembranous colitis
   • ENephrotoxicity increased with aminoglycosides
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   Answer: B — Empiric use in neutropenia is recommended for prophylaxis

   CDC recommends avoiding routine empiric vancomycin due to resistance concerns.

7. 7

   All statements are true of diclofenac-class drugs EXCEPT:

   • ACan cause corneal melt/perforation
   • BUsed for postoperative inflammation
   • CIncrease thromboxane production
   • DDecrease prostaglandin synthesis
   Show answer and explanationHide answer

   Answer: C — Increase thromboxane production

   NSAIDs decrease prostaglandins, prostacyclin, and thromboxane.

8. 8

   Ways to increase ocular absorption EXCEPT:

   • APrior topical anesthetic
   • BNasolacrimal occlusion
   • CEye closure after drop instillation
   • DIncreased hydrophilicity of the drug
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   Answer: D — Increased hydrophilicity of the drug

   Increased lipid solubility improves corneal penetration.

9. 9

   Higher uptake as ointment rather than drops EXCEPT:

   • ATetracycline
   • BChloramphenicol
   • CFluorometholone
   • DPenicillin
   Show answer and explanationHide answer

   Answer: D — Penicillin

   Penicillin penetrates ocular tissues poorly.

10. 10

    Mitomycin-C has been used in all EXCEPT:

    • AProliferative vitreoretinopathy after vitrectomy
    • BConjunctival fibrosis after trabeculectomy
    • CPterygium recurrence
    • DStromal haze after PRK
    Show answer and explanationHide answer

    Answer: A — Proliferative vitreoretinopathy after vitrectomy

    MMC is primarily used on external ocular surfaces.

11. 11

    Natamycin may be effective against all EXCEPT:

    • AAspergillus
    • BCandida albicans
    • CFusarium
    • DMucor
    Show answer and explanationHide answer

    Answer: D — Mucor

    Mucor responds better to Amphotericin B.

12. 12

    Amphotericin B alone may be effective against all EXCEPT:

    • AAspergillus
    • BCandida
    • CCryptococcus
    • DMucor
    Show answer and explanationHide answer

    Answer: D — Mucor

    Mucor generally requires Amphotericin B plus surgical debridement.

13. 13

    Effective agents for Acanthamoeba EXCEPT:

    • ANeomycin
    • BPolyhexamethylene biguanide (PHMB)
    • CPropamidine
    • DTrifluridine
    Show answer and explanationHide answer

    Answer: D — Trifluridine

    Trifluridine is antiviral. PHMB + diamidines are classic therapy.

14. 14

    Side effects of systemic corticosteroids include all EXCEPT:

    • AAseptic necrosis of hip
    • BHypoglycemia
    • CHypertension
    • DGastric ulceration
    Show answer and explanationHide answer

    Answer: B — Hypoglycemia

    Steroids cause hyperglycemia, not hypoglycemia.

15. 15

    Side effects of prostaglandin analogues EXCEPT:

    • AConjunctival hyperemia
    • BCystoid macular edema
    • CDecrease in iris pigmentation
    • DHypertrichosis
    Show answer and explanationHide answer

    Answer: C — Decrease in iris pigmentation

    Prostaglandin analogues increase iris pigmentation.

16. 16

    Best topical beta-blocker for mild bronchoconstrictive disease?

    • ATimolol
    • BBetaxolol
    • CMetipranolol
    • DLevobunolol
    Show answer and explanationHide answer

    Answer: B — Betaxolol

    Betaxolol is β1-selective. Preferred in mild pulmonary disease.

17. 17

    Least suitable IOP-lowering drug in mild bronchoconstrictive disease?

    • ATimolol
    • BBetaxolol
    • CLatanoprost
    • DBrimonidine
    Show answer and explanationHide answer

    Answer: A — Timolol

    Non-selective β-blockers can cause bronchospasm.

18. 18

    Which statement about carbonic anhydrase inhibitors is FALSE?

    • A>90% inhibition required before significant reduction in aqueous production
    • BReduced urinary citrate/magnesium predisposes to kidney stones
    • CCan cause acute transient myopia
    • DMetabolic acidosis is greater with oral than IV acetazolamide
    Show answer and explanationHide answer

    Answer: D — Metabolic acidosis is greater with oral than IV acetazolamide

    Metabolic acidosis is greater with IV acetazolamide.

19. 19

    Dipivefrin is converted to epinephrine in:

    • ATears
    • BConjunctiva
    • CCornea
    • DAqueous humor
    • EIris stroma
    Show answer and explanationHide answer

    Answer: C — Cornea

    Corneal esterases cleave dipivefrin to epinephrine.

20. 20

    Best single medication for POAG in an aphakic patient with chronic bronchitis, labile hypertension and depression on MAO inhibitors?

    • AEpinephrine
    • BDipivefrin
    • CPilocarpine
    • DTimolol
    • EAcetazolamide
    Show answer and explanationHide answer

    Answer: C — Pilocarpine

    Epinephrine/dipivefrin: risk of CME in aphakia.; Timolol: bronchospasm.; Acetazolamide: caution in depression.; Pilocarpine becomes safest option.

21. 21

    Main Site of Resistance to Aqueous Outflow?

    • AUveal trabecular meshwork
    • BCorneoscleral trabecular meshwork
    • CJuxtacanalicular trabecular meshwork
    • DSchlemm's canal
    Show answer and explanationHide answer

    Answer: C — Juxtacanalicular trabecular meshwork

    Trabecular meshwork layers: uveal meshwork, corneoscleral meshwork, juxtacanalicular meshwork (cribriform layer) ← greatest resistance. Most common glaucoma board question.

22. 22

    Glaucoma Laser Trial (GLT)?

    • ABetter visual field score with laser first
    • BLower IOP with laser first
    • CMost laser-treated eyes did not require medication
    • DLaser trabeculoplasty ≈ timolol efficacy
    Show answer and explanationHide answer

    Answer: C — Most laser-treated eyes did not require medication

    After 2 years: ~56% still required medications. ALT comparable to timolol.

23. 23

    Infantile Glaucoma Progression?

    • AIncreasing axial length
    • BAmblyopia
    • CIncreasing horizontal diameter
    • DIncreasing myopia
    Show answer and explanationHide answer

    Answer: B — Amblyopia

    Increasing axial length, buphthalmos, increased corneal diameter, increasing myopia.

24. 24

    Late Bleb-Associated Endophthalmitis?

    • AStaph epidermidis
    • BStreptococcus pneumoniae
    • CPseudomonas
    • DPropionibacterium acnes
    Show answer and explanationHide answer

    Answer: B — Streptococcus pneumoniae

    Late bleb infection → Streptococcus species or H. influenzae. Early postop cataract endophthalmitis → Staph epidermidis.

25. 25

    Superior Visual Field Defect?

    • AGlaucoma
    • BLens rim artifact
    • CHigh false-positive rate
    • DPtosis
    Show answer and explanationHide answer

    Answer: C — High false-positive rate

    High false-positive VF: "trigger-happy" patient, artificially better sensitivity, white scotomas.

26. 26

    Most Urgent Post-Trabeculectomy Problem?

    • AChoroidal hemorrhage
    • BChoroidal effusion
    • CShallow AC with lens-cornea touch
    • DShallow AC with iris-cornea touch
    Show answer and explanationHide answer

    Answer: C — Shallow AC with lens-cornea touch

    Lens-cornea touch causes corneal decompensation and cataract progression. Needs immediate intervention.

27. 27

    Elevated IOP After Heavy PRP?

    • ACycloplegic
    • BLaser iridotomy
    • CLaser iridoplasty
    • DTrabeculectomy
    Show answer and explanationHide answer

    Answer: A — Cycloplegic

    PRP → ciliary body edema → forward rotation of ciliary body → angle closure.

28. 28

    Earlier Detection of Glaucoma?

    • ASuprathreshold testing
    • BOCT
    • CCSLO
    • DFrequency-doubling technology (FDT)
    Show answer and explanationHide answer

    Answer: D — Frequency-doubling technology (FDT)

    FDT targets magnocellular ganglion cells and can detect early glaucomatous damage.

29. 29

    Infantile Glaucoma with Corneal Clouding?

    • ATrabeculectomy
    • BTrabeculotomy
    • CCyclophotocoagulation
    • DGoniotomy
    Show answer and explanationHide answer

    Answer: B — Trabeculotomy

    | Cornea | Surgery | | Clear | Goniotomy | | Cloudy | Trabeculotomy |

30. 30

    Apraclonidine (Iopidine)?

    • AAlpha-1 agonist
    • BMay cause transient lid retraction
    • CCommonly causes hypotension
    • DCauses CME in aphakia
    Show answer and explanationHide answer

    Answer: B — May cause transient lid retraction

    Apraclonidine: alpha-2 agonist, conjunctival blanching, lid retraction, allergic blepharoconjunctivitis.

31. 31

    Pilocarpine in Young Myope?

    • ASmall pupil
    • BIncreased myopia
    • CRetinal detachment
    • DIncreased hyperopia
    Show answer and explanationHide answer

    Answer: B — Increased myopia

    Pilocarpine: accommodative spasm, lens thickening, forward lens movement, increased myopia.

32. 32

    Goldmann Applanation Tonometry?

    • A3.06 mm
    • B3.16 mm
    • C3.10 mm
    • D3.01 mm
    Show answer and explanationHide answer

    Answer: A — 3.06 mm

    At 3.06 mm, corneal rigidity and tear-film surface tension cancel each other.

33. 33

    Medication Causing Most Dermatitis?

    • ALatanoprost
    • BBrimonidine
    • CDorzolamide
    • DApraclonidine
    Show answer and explanationHide answer

    Answer: D — Apraclonidine

    Apraclonidine: allergic dermatitis ≈ 40%, limits chronic use.

34. 34

    Herpetic Keratitis and Glaucoma Therapy?

    • ALatanoprost
    • BTimolol
    • CBrimonidine
    • DMethazolamide
    Show answer and explanationHide answer

    Answer: A — Latanoprost

    Prostaglandin analogs may reactivate HSV keratitis, uveitis, CME. Avoid in these settings.

35. 35

    Visual Field Artifact and Pupil Size?

    • A1.5 mm
    • B2.5 mm
    • C3.5 mm
    • D4.5 mm
    Show answer and explanationHide answer

    Answer: B — 2.5 mm

    Pupil <2.5 mm → generalized depression artifact on Humphrey VF.

36. 36

    Substance That Lowers IOP?

    • AAlcohol
    • BLSD
    • CCaffeine
    • DKetamine
    Show answer and explanationHide answer

    Answer: A — Alcohol

    ↓ IOP: Alcohol, Cannabis, Heroin; ↑ IOP: Ketamine, LSD

37. 37

    Image Question: Gray-White Lens Deposits?

    • AAcute angle-closure glaucoma
    • BChronic angle closure glaucoma
    • CUveitic glaucoma
    • DPseudoexfoliation glaucoma
    Show answer and explanationHide answer

    Answer: A — Acute angle-closure glaucoma

    Glaukomflecken = anterior subcapsular lens epithelial necrosis caused by a previous acute angle-closure attack.

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