Q.1 Which of the following is the most common type of strabismus in children?
Esotropia
Exotropia
Hypertropia
Hypotropia
Explanation - Esotropia, inward deviation of the eye, is the most common form of strabismus in children, especially congenital or infantile forms.
Correct answer is: Esotropia
Q.2 A 5-year-old child presents with sudden onset double vision and ptosis. Which cranial nerve is most likely involved?
Oculomotor nerve (III)
Trochlear nerve (IV)
Abducens nerve (VI)
Optic nerve (II)
Explanation - The oculomotor nerve controls most extraocular muscles and the levator palpebrae superioris; its dysfunction can cause ptosis and diplopia.
Correct answer is: Oculomotor nerve (III)
Q.3 Which test is used to differentiate between paralytic and non-paralytic strabismus?
Cover test
Hirschberg test
Prism cover test
Krimsky test
Explanation - The prism cover test quantitatively measures the angle of deviation and helps distinguish paralytic from non-paralytic strabismus.
Correct answer is: Prism cover test
Q.4 Which ocular motility disorder is characterized by a vertical deviation of the eye that worsens on contralateral gaze?
Superior oblique palsy
Inferior rectus palsy
Lateral rectus palsy
Medial rectus palsy
Explanation - Superior oblique palsy (fourth nerve palsy) causes hypertropia that increases on contralateral gaze and head tilt to the opposite side.
Correct answer is: Superior oblique palsy
Q.5 Duane retraction syndrome primarily involves which cranial nerve anomaly?
Abducens nerve agenesis
Oculomotor nerve hypoplasia
Trochlear nerve paralysis
Optic nerve dysplasia
Explanation - Duane retraction syndrome is caused by congenital absence or hypoplasia of the abducens nerve, leading to restricted abduction and globe retraction.
Correct answer is: Abducens nerve agenesis
Q.6 Which condition is most likely if a child has an inward turning eye and a strong family history of strabismus?
Accommodative esotropia
Intermittent exotropia
Hypertropia
Congenital nystagmus
Explanation - Accommodative esotropia often presents in children with hypermetropia and a positive family history, causing inward deviation when focusing.
Correct answer is: Accommodative esotropia
Q.7 Which motility disorder is commonly associated with thyroid eye disease?
Restrictive myopathy of the inferior rectus
Lateral rectus palsy
Congenital esotropia
Superior oblique overaction
Explanation - Thyroid eye disease commonly causes fibrosis of the inferior rectus, leading to restricted elevation and hypotropia.
Correct answer is: Restrictive myopathy of the inferior rectus
Q.8 Which of the following is a hallmark of intermittent exotropia?
Occasional outward deviation of one eye
Constant inward deviation
Vertical deviation
Nystagmus
Explanation - Intermittent exotropia presents with outward eye deviation that occurs intermittently, often with fatigue or inattention.
Correct answer is: Occasional outward deviation of one eye
Q.9 Which head posture is typically adopted in superior oblique palsy?
Head tilt to opposite side
Head tilt to same side
Chin down
Chin up
Explanation - Patients tilt their head to the contralateral side to reduce diplopia caused by hypertropia from superior oblique palsy.
Correct answer is: Head tilt to opposite side
Q.10 A 6-year-old child shows a small-angle esotropia only when fatigued. This is most consistent with:
Microtropia
Phoria
Paralytic strabismus
Intermittent exotropia
Explanation - Phorias are latent deviations that appear only under certain conditions such as fatigue or stress, unlike constant tropias.
Correct answer is: Phoria
Q.11 Which condition is characterized by involuntary, rhythmic oscillations of the eyes?
Nystagmus
Strabismus
Ptosis
Lagophthalmos
Explanation - Nystagmus involves involuntary rhythmic eye movements, either congenital or acquired, and affects visual acuity.
Correct answer is: Nystagmus
Q.12 A child presents with hypertropia in primary gaze and worse on ipsilateral head tilt. This is indicative of:
Inferior oblique palsy
Superior oblique palsy
Medial rectus overaction
Lateral rectus palsy
Explanation - Superior oblique palsy causes hypertropia that increases on ipsilateral head tilt due to the Bielschowsky head tilt test.
Correct answer is: Superior oblique palsy
Q.13 Which diagnostic test measures ocular deviation in prism diopters?
Prism cover test
Hirschberg test
Worth 4-dot test
Lang stereotest
Explanation - The prism cover test quantifies the angle of strabismus in prism diopters and helps in treatment planning.
Correct answer is: Prism cover test
Q.14 Which ocular motility disorder is associated with Duane retraction syndrome type I?
Limited abduction
Limited adduction
Ptosis
Nystagmus
Explanation - Duane retraction syndrome type I primarily presents with limited abduction, sometimes with globe retraction on adduction.
Correct answer is: Limited abduction
Q.15 Which cranial nerve is most commonly involved in isolated paralytic strabismus?
Abducens nerve (VI)
Oculomotor nerve (III)
Trochlear nerve (IV)
Facial nerve (VII)
Explanation - The abducens nerve is most susceptible to microvascular or traumatic injury, causing lateral rectus palsy and horizontal diplopia.
Correct answer is: Abducens nerve (VI)
Q.16 Which type of strabismus is often associated with high hyperopia in children?
Accommodative esotropia
Intermittent exotropia
Hypertropia
Congenital nystagmus
Explanation - Hyperopic children over-accommodate to focus, leading to convergence and inward deviation of the eyes.
Correct answer is: Accommodative esotropia
Q.17 A patient shows horizontal diplopia that worsens when looking to the right. Which muscle is likely affected?
Right lateral rectus
Right medial rectus
Left lateral rectus
Left medial rectus
Explanation - The lateral rectus abducts the eye. Weakness causes diplopia that worsens when attempting gaze toward the affected side.
Correct answer is: Right lateral rectus
Q.18 Which of the following is a common cause of acquired restrictive strabismus in adults?
Thyroid eye disease
Congenital esotropia
Infantile exotropia
Superior oblique overaction
Explanation - Fibrosis of extraocular muscles due to thyroid eye disease restricts ocular motility, leading to restrictive strabismus.
Correct answer is: Thyroid eye disease
Q.19 Which test evaluates binocular single vision and suppression?
Worth 4-dot test
Hirschberg test
Cover-uncover test
Krimsky test
Explanation - The Worth 4-dot test is used to assess binocular vision, fusion, and suppression in strabismus patients.
Correct answer is: Worth 4-dot test
Q.20 Which surgical procedure is commonly performed for intermittent exotropia?
Lateral rectus recession
Medial rectus resection
Inferior oblique myectomy
Superior rectus recession
Explanation - Recession of the lateral rectus weakens the muscle to correct outward deviation in intermittent exotropia.
Correct answer is: Lateral rectus recession
Q.21 A child with congenital esotropia usually presents at what age?
Before 6 months
1–2 years
3–5 years
After 6 years
Explanation - Congenital (infantile) esotropia typically manifests within the first 6 months of life with large-angle inward deviation.
Correct answer is: Before 6 months
Q.22 Which of the following is a feature of Brown syndrome?
Limited elevation in adduction
Limited abduction
Limited depression
Ptosis
Explanation - Brown syndrome is characterized by mechanical restriction of the superior oblique tendon, leading to limited elevation in adduction.
Correct answer is: Limited elevation in adduction
Q.23 Which ocular motility disorder can be secondary to orbital fractures?
Inferior rectus entrapment
Lateral rectus palsy
Superior oblique overaction
Congenital esotropia
Explanation - Orbital floor fractures can trap the inferior rectus muscle, causing restriction in elevation and vertical diplopia.
Correct answer is: Inferior rectus entrapment
Q.24 A 7-year-old child shows intermittent outward deviation of the eye when tired. The best initial management is:
Observation and glasses if needed
Immediate surgery
Botulinum injection
Patch therapy only
Explanation - Intermittent exotropia in children with good control is often initially managed conservatively with observation and refractive correction.
Correct answer is: Observation and glasses if needed