Q.1 Which of the following is the most common type of strabismus in children?
Esotropia
Exotropia
Hypertropia
Hypotropia
Explanation - Esotropia, an inward deviation of the eye, is the most common form of strabismus seen in children, especially congenital types.
Correct answer is: Esotropia
Q.2 A 4-year-old child has inward turning of one eye that appears intermittently. What is the most likely diagnosis?
Intermittent exotropia
Accommodative esotropia
Congenital hypertropia
Nystagmus
Explanation - Accommodative esotropia is an inward deviation of the eye associated with focusing efforts, often appearing intermittently in children around 2–5 years of age.
Correct answer is: Accommodative esotropia
Q.3 Which cranial nerve is primarily responsible for innervating the lateral rectus muscle?
Oculomotor nerve (CN III)
Trochlear nerve (CN IV)
Abducens nerve (CN VI)
Optic nerve (CN II)
Explanation - The lateral rectus muscle, which abducts the eye, is innervated by the abducens nerve (cranial nerve VI). Dysfunction leads to esotropia due to unopposed medial rectus action.
Correct answer is: Abducens nerve (CN VI)
Q.4 Which test is most appropriate for detecting small-angle strabismus?
Cover-uncover test
Visual acuity test
Tonometry
Fundoscopy
Explanation - The cover-uncover test helps identify manifest or latent deviations, including small-angle strabismus that may not be obvious on casual observation.
Correct answer is: Cover-uncover test
Q.5 Which type of strabismus is more likely to lead to amblyopia if untreated?
Intermittent exotropia
Accommodative esotropia
Comitant hypertropia
Cyclotropia
Explanation - Accommodative esotropia in children can cause the brain to suppress input from the deviated eye, leading to amblyopia if not corrected early.
Correct answer is: Accommodative esotropia
Q.6 What is the primary goal of strabismus surgery?
Improve visual acuity
Restore ocular alignment
Correct refractive error
Treat glaucoma
Explanation - Strabismus surgery aims to restore proper alignment of the eyes, improving binocular vision and cosmesis; visual acuity may improve indirectly if amblyopia therapy is also applied.
Correct answer is: Restore ocular alignment
Q.7 Which of the following is a common sign of esotropia in infants?
Outward deviation of the eyes
Inward deviation of the eyes
Upward deviation of the eyes
Downward deviation of the eyes
Explanation - Esotropia presents as inward deviation of one or both eyes, noticeable when the infant is trying to focus or fixate.
Correct answer is: Inward deviation of the eyes
Q.8 A patient has a constant outward deviation of the right eye. What type of strabismus is this?
Esotropia
Exotropia
Hypertropia
Hypotropia
Explanation - Exotropia is defined as an outward deviation of the eye. Constant exotropia is more likely to disrupt binocular vision than intermittent forms.
Correct answer is: Exotropia
Q.9 Which of the following is NOT typically a cause of strabismus?
Refractive error
Cranial nerve palsy
Amblyopia
Myopia alone
Explanation - While refractive errors can contribute to accommodative strabismus, simple myopia without hyperopic or accommodative demand usually does not cause strabismus.
Correct answer is: Myopia alone
Q.10 Which test helps distinguish between a phoria and a tropia?
Cover-uncover test
Snellen chart
Slit-lamp examination
Tonometry
Explanation - The cover-uncover test identifies manifest (tropia) versus latent (phoria) deviations by covering one eye and observing movement in the other eye.
Correct answer is: Cover-uncover test
Q.11 Which factor is most important in deciding the timing of strabismus surgery in children?
Age of the child
Severity of refractive error
Presence of amblyopia
Cosmetic appearance only
Explanation - Early detection and treatment of amblyopia are crucial; surgery is timed to optimize binocular vision development and prevent permanent vision loss.
Correct answer is: Presence of amblyopia
Q.12 Which type of strabismus is typically associated with a 'crossed eyes' appearance?
Esotropia
Exotropia
Hypertropia
Hypotropia
Explanation - Esotropia presents as inward deviation of the eyes, giving the appearance of crossed eyes, especially noticeable in children.
Correct answer is: Esotropia
Q.13 Which of the following is the most appropriate initial treatment for accommodative esotropia?
Glasses with hyperopic correction
Prism therapy
Botulinum toxin injection
Immediate surgery
Explanation - Accommodative esotropia often improves with correction of hyperopia using glasses, reducing accommodative effort and associated eye deviation.
Correct answer is: Glasses with hyperopic correction
Q.14 Which condition is characterized by vertical misalignment of the eyes?
Hypertropia
Exotropia
Esotropia
Phoria
Explanation - Hypertropia refers to a vertical deviation in which one eye is positioned higher than the other. Hypotropia is the downward equivalent.
Correct answer is: Hypertropia
Q.15 Which is a hallmark of infantile esotropia?
Onset before 6 months
Intermittent exotropia
Vertical deviation only
Normal stereopsis
Explanation - Infantile esotropia typically presents within the first 6 months of life and often requires early surgical intervention to prevent amblyopia.
Correct answer is: Onset before 6 months
Q.16 Which of the following describes intermittent exotropia?
Eye deviates outward only sometimes
Eye is constantly turned inward
Eye is constantly turned upward
No deviation observed
Explanation - Intermittent exotropia involves outward deviation of the eye that occurs only under certain conditions, such as fatigue or inattention.
Correct answer is: Eye deviates outward only sometimes
Q.17 Which condition is most likely to cause diplopia in adults?
Acute onset strabismus
Infantile esotropia
Mild phoria
Congenital exotropia
Explanation - Acute onset strabismus in adults often leads to double vision (diplopia) because the brain has no established suppression mechanism.
Correct answer is: Acute onset strabismus
Q.18 Which imaging modality is most useful in evaluating suspected cranial nerve palsy causing strabismus?
MRI
X-ray
Ultrasound
Fundoscopy
Explanation - MRI is used to detect lesions or compressions affecting cranial nerves III, IV, or VI, which can lead to secondary strabismus.
Correct answer is: MRI
Q.19 Which type of strabismus surgery involves weakening a muscle?
Recession
Resection
Transposition
Cycloplegia
Explanation - Recession surgery involves moving the insertion of an extraocular muscle posteriorly to weaken its action and correct ocular deviation.
Correct answer is: Recession
Q.20 Which type of strabismus is often associated with a compensatory head tilt?
Vertical strabismus
Exotropia
Esotropia
Intermittent phoria
Explanation - Vertical deviations (hypertropia or hypotropia) may lead patients to adopt a head tilt to maintain single binocular vision and reduce diplopia.
Correct answer is: Vertical strabismus
Q.21 Which eye muscle is primarily responsible for inward rotation (intorsion)?
Superior oblique
Inferior oblique
Medial rectus
Lateral rectus
Explanation - The superior oblique muscle primarily causes intorsion (inward rotation) of the eye and contributes to depression and abduction as well.
Correct answer is: Superior oblique
Q.22 Which of the following is true regarding congenital esotropia?
Typically appears after 1 year of age
Frequently associated with amblyopia
Never requires surgery
Always intermittent
Explanation - Congenital esotropia often leads to amblyopia if untreated due to suppression of the deviated eye during critical visual development.
Correct answer is: Frequently associated with amblyopia
Q.23 Which test evaluates binocular single vision in strabismus patients?
Worth 4-dot test
Snellen chart
Tonometry
Slit-lamp exam
Explanation - The Worth 4-dot test assesses fusion and suppression, helping determine the presence and degree of binocular single vision in strabismus.
Correct answer is: Worth 4-dot test
Q.24 Which of the following is a risk factor for developing strabismus?
Premature birth
Hyperopia
Family history
All of the above
Explanation - Prematurity, hyperopia, and a family history of strabismus are all established risk factors for developing ocular misalignment.
Correct answer is: All of the above