HEENT Practice Questions: 700+ Solved
Exam Questions with Verified Solutions
(2026/2027)
1. A 70-year-old man presents with a gradual, painless loss of central vision in
both eyes. He reports that straight lines appear wavy. What is the most likely
diagnosis?
A. Cataracts
B. Open-angle glaucoma
C. Age-related macular degeneration (AMD)
D. Diabetic macular edema
Answer: C. Age-related macular degeneration (AMD)
Rationale: AMD is a leading cause of vision loss in older adults. The "wet" form is
characterized by choroidal neovascularization, which can cause metamorphopsia (wavy
lines) and rapid central vision loss. The "dry" form is more gradual.
2. Which cranial nerve is primarily responsible for the afferent limb of the
pupillary light reflex?
,A. CN II (Optic)
B. CN III (Oculomotor)
C. CN IV (Trochlear)
D. CN V (Trigeminal)
Answer: A. CN II (Optic)
Rationale: The afferent limb of the pupillary light reflex is mediated by the optic nerve (CN
II), which senses the light. The efferent limb is mediated by the oculomotor nerve (CN III),
which constricts the pupil.
3. A 65-year-old patient presents with a sudden, painless loss of vision in the right
eye that lasted for a few minutes and has now resolved. This episode is most
consistent with:
A. Retinal detachment
B. Acute angle-closure glaucoma
C. Amaurosis fugax
D. Vitreous hemorrhage
Answer: C. Amaurosis fugax
Rationale: Amaurosis fugax, or transient monocular blindness, is described as a "curtain
coming down" over the vision. It is often caused by a transient ischemic attack (TIA) of the
ophthalmic artery, frequently due to an embolus from the carotid artery. The key features
are its sudden onset, painlessness, and complete resolution.
4. A patient presents with a "cherry-red spot" in the macula and a history of
sudden, painless vision loss. What is the most likely diagnosis?
A. Central retinal vein occlusion (CRVO)
B. Central retinal artery occlusion (CRAO)
C. Macular degeneration
D. Diabetic retinopathy
Answer: B. Central retinal artery occlusion (CRAO)
,Rationale: In CRAO, the opacification of the ischemic retina contrasts with the normally
perfused choroid, which is visible through the thin fovea, creating a "cherry-red spot." It is
an ophthalmologic emergency.
5. A 24-year-old patient complains of a severe, deep, aching pain in the eye,
accompanied by nausea, vomiting, and seeing halos around lights. The eye is red,
and the pupil is fixed and mid-dilated. What is the most likely diagnosis?
A. Conjunctivitis
B. Uveitis
C. Acute angle-closure glaucoma
D. Corneal abrasion
Answer: C. Acute angle-closure glaucoma
Rationale: This is a classic presentation of acute angle-closure glaucoma. The increased
intraocular pressure causes severe pain, nausea/vomiting (due to vagal stimulation), and
corneal edema leading to halos. The fixed, mid-dilated pupil is a key finding.
6. Which of the following is the most common cause of preventable blindness in
the United States?
A. Glaucoma
B. Cataracts
C. Diabetic retinopathy
D. Macular degeneration
Answer: C. Diabetic retinopathy
Rationale: Diabetic retinopathy is the leading cause of blindness in working-age adults in
the US. While cataracts are a common cause of reversible vision loss, diabetic retinopathy
is a major cause of preventable, often irreversible, blindness if not managed.
, 7. A patient is diagnosed with papillitis. This condition is most commonly
associated with which of the following?
A. Glaucoma
B. Multiple sclerosis
C. Hypertension
D. Diabetes mellitus
Answer: B. Multiple sclerosis
Rationale: Papillitis is an inflammation of the optic disc, a form of optic neuritis. Optic
neuritis is strongly associated with Multiple Sclerosis (MS) and is often the initial
presenting symptom in many MS patients.
8. A patient is unable to abduct the right eye. Which cranial nerve is most likely
affected?
A. CN III (Oculomotor)
B. CN IV (Trochlear)
C. CN VI (Abducens)
D. CN VII (Facial)
Answer: C. CN VI (Abducens)
Rationale: The abducens nerve (CN VI) innervates the lateral rectus muscle, which is
responsible for abduction of the eye. Damage to this nerve results in an inability to abduct
the affected eye.
9. A 45-year-old patient presents with a red, painful eye and a vesicular rash on
the tip of their nose. What is the most likely diagnosis?
A. Herpes simplex keratitis
B. Herpes zoster ophthalmicus
Exam Questions with Verified Solutions
(2026/2027)
1. A 70-year-old man presents with a gradual, painless loss of central vision in
both eyes. He reports that straight lines appear wavy. What is the most likely
diagnosis?
A. Cataracts
B. Open-angle glaucoma
C. Age-related macular degeneration (AMD)
D. Diabetic macular edema
Answer: C. Age-related macular degeneration (AMD)
Rationale: AMD is a leading cause of vision loss in older adults. The "wet" form is
characterized by choroidal neovascularization, which can cause metamorphopsia (wavy
lines) and rapid central vision loss. The "dry" form is more gradual.
2. Which cranial nerve is primarily responsible for the afferent limb of the
pupillary light reflex?
,A. CN II (Optic)
B. CN III (Oculomotor)
C. CN IV (Trochlear)
D. CN V (Trigeminal)
Answer: A. CN II (Optic)
Rationale: The afferent limb of the pupillary light reflex is mediated by the optic nerve (CN
II), which senses the light. The efferent limb is mediated by the oculomotor nerve (CN III),
which constricts the pupil.
3. A 65-year-old patient presents with a sudden, painless loss of vision in the right
eye that lasted for a few minutes and has now resolved. This episode is most
consistent with:
A. Retinal detachment
B. Acute angle-closure glaucoma
C. Amaurosis fugax
D. Vitreous hemorrhage
Answer: C. Amaurosis fugax
Rationale: Amaurosis fugax, or transient monocular blindness, is described as a "curtain
coming down" over the vision. It is often caused by a transient ischemic attack (TIA) of the
ophthalmic artery, frequently due to an embolus from the carotid artery. The key features
are its sudden onset, painlessness, and complete resolution.
4. A patient presents with a "cherry-red spot" in the macula and a history of
sudden, painless vision loss. What is the most likely diagnosis?
A. Central retinal vein occlusion (CRVO)
B. Central retinal artery occlusion (CRAO)
C. Macular degeneration
D. Diabetic retinopathy
Answer: B. Central retinal artery occlusion (CRAO)
,Rationale: In CRAO, the opacification of the ischemic retina contrasts with the normally
perfused choroid, which is visible through the thin fovea, creating a "cherry-red spot." It is
an ophthalmologic emergency.
5. A 24-year-old patient complains of a severe, deep, aching pain in the eye,
accompanied by nausea, vomiting, and seeing halos around lights. The eye is red,
and the pupil is fixed and mid-dilated. What is the most likely diagnosis?
A. Conjunctivitis
B. Uveitis
C. Acute angle-closure glaucoma
D. Corneal abrasion
Answer: C. Acute angle-closure glaucoma
Rationale: This is a classic presentation of acute angle-closure glaucoma. The increased
intraocular pressure causes severe pain, nausea/vomiting (due to vagal stimulation), and
corneal edema leading to halos. The fixed, mid-dilated pupil is a key finding.
6. Which of the following is the most common cause of preventable blindness in
the United States?
A. Glaucoma
B. Cataracts
C. Diabetic retinopathy
D. Macular degeneration
Answer: C. Diabetic retinopathy
Rationale: Diabetic retinopathy is the leading cause of blindness in working-age adults in
the US. While cataracts are a common cause of reversible vision loss, diabetic retinopathy
is a major cause of preventable, often irreversible, blindness if not managed.
, 7. A patient is diagnosed with papillitis. This condition is most commonly
associated with which of the following?
A. Glaucoma
B. Multiple sclerosis
C. Hypertension
D. Diabetes mellitus
Answer: B. Multiple sclerosis
Rationale: Papillitis is an inflammation of the optic disc, a form of optic neuritis. Optic
neuritis is strongly associated with Multiple Sclerosis (MS) and is often the initial
presenting symptom in many MS patients.
8. A patient is unable to abduct the right eye. Which cranial nerve is most likely
affected?
A. CN III (Oculomotor)
B. CN IV (Trochlear)
C. CN VI (Abducens)
D. CN VII (Facial)
Answer: C. CN VI (Abducens)
Rationale: The abducens nerve (CN VI) innervates the lateral rectus muscle, which is
responsible for abduction of the eye. Damage to this nerve results in an inability to abduct
the affected eye.
9. A 45-year-old patient presents with a red, painful eye and a vesicular rash on
the tip of their nose. What is the most likely diagnosis?
A. Herpes simplex keratitis
B. Herpes zoster ophthalmicus
