KMU Past Paper Practice

Question:

A 68-year-old man has no perception of light in his left eye after an old ocular injury. His presenting visual acuity in the right eye is 6/24. When his overall distance-vision impairment is classified according to WHO criteria, which category best applies?

Options:

Correct Answer: Moderate distance-vision impairment

Explanation: WHO distance-vision classification is based on the better eye. A better-eye acuity of 6/24 lies within the moderate impairment range despite profound loss in the fellow eye.

Question:

A patient with profound visual loss cannot identify the largest optotype and cannot count the examiner’s fingers at one metre. He can, however, correctly identify movement of the examiner’s hand. How should this level of vision be documented?

Options:

Correct Answer: Hand movements

Explanation: When fingers cannot be counted but hand motion can still be detected, visual acuity is recorded as hand movements rather than counting fingers or light perception.

Question:

A patient with severe visual loss cannot detect hand movements but can detect a bright light and correctly indicate whether the light is coming from above, below, right, or left. Which finding best describes this residual visual function?

Options:

Correct Answer: Perception of light with accurate projection

Explanation: Detecting light confirms perception of light, while correctly identifying its direction demonstrates preserved projection of rays.

Question:

A 46-year-old man has complete interruption of the right optic nerve following trauma. The oculomotor nerves and pupillary sphincters are intact bilaterally. Which pattern is expected during the pupillary light examination?

Options:

Correct Answer: Right-eye illumination causes no constriction; left-eye illumination constricts both pupils

Explanation: The right optic nerve cannot carry afferent light input, but illumination of the normal left eye activates both Edinger-Westphal nuclei and both intact efferent pathways.

Question:

A 10-year-old child has variable visual acuity during refraction because strong accommodation interferes with accurate measurement. The ophthalmologist wants temporary paralysis of accommodation to obtain a reliable refraction. Which drug is most appropriate?

Options:

Correct Answer: Cyclopentolate

Explanation: Cyclopentolate blocks muscarinic activity in the ciliary muscle and produces cycloplegia, allowing refraction without excessive accommodative influence.

Question:

A 64-year-old woman has been using a prostaglandin analogue for long-term control of glaucoma. At follow-up, she notices gradual darkening of the treated iris and increased eyelash growth. Which drug is most consistent with this history?

Options:

Correct Answer: Latanoprost

Explanation: Prostaglandin analogues such as latanoprost may increase iris pigmentation and eyelash growth during long-term topical therapy.

Question:

A patient with glaucoma is started on brimonidine. The ophthalmologist explains that the drug lowers intraocular pressure through more than one effect on aqueous humour. Which mechanism best describes its action?

Options:

Correct Answer: Reduces aqueous production and enhances aqueous outflow

Explanation: Brimonidine is an alpha-2 agonist that lowers intraocular pressure mainly by reducing aqueous formation while also promoting aqueous outflow.

Question:

A 55-year-old woman has required prolonged topical corticosteroid therapy for ocular inflammation. Months later, her inflammation is controlled but she develops gradually progressive painless blurring of vision due to a new lens opacity. Which treatment-related complication best explains this change?

Options:

Correct Answer: Corticosteroid-associated cataract

Explanation: Prolonged ocular corticosteroid exposure can promote cataract formation in addition to raising intraocular pressure and increasing susceptibility to infection.

Question:

A 44-year-old office worker reports bilateral burning, irritation and a persistent foreign-body sensation. Examination suggests an unstable tear film without evidence of ocular infection. Which treatment most directly supports the affected ocular surface?

Options:

Correct Answer: Artificial tears

Explanation: Artificial tears supplement the tear film, reduce friction over the ocular surface and relieve burning and foreign-body sensation associated with dry-eye disease.

Question:

A patient is diagnosed with a herpetic ocular infection. The clinician avoids treating it as a routine bacterial conjunctival infection because the responsible organism requires a different pharmacological approach. Which treatment category is appropriate?

Options:

Correct Answer: Antiviral therapy

Explanation: Herpetic ocular disease requires antiviral treatment because antibacterial drugs do not act against the viral cause.

Question:

Fundus examination reveals a localized lesion involving the inferior retina of the right eye. If the lesion disrupts visual function in the corresponding retinal area, which part of that eye’s visual field is expected to be affected?

Options:

Correct Answer: Superior visual field

Explanation: The retinal image is vertically inverted, so the inferior retina receives information from the superior visual field.

Question:

During revision of the visual pathway, a student traces retinal ganglion-cell axons through the optic chiasm. Which group of fibres continues on the same side rather than decussating at the chiasm?

Options:

Correct Answer: Temporal retinal fibres

Explanation: Nasal retinal fibres decussate at the chiasm, while temporal retinal fibres remain uncrossed and continue into the ipsilateral optic tract.

Question:

A lesion is identified at the principal thalamic relay through which most visual fibres pass after leaving the optic tract but before entering the optic radiations. Which structure is involved?

Options:

Correct Answer: Lateral geniculate nucleus

Explanation: Most optic-tract fibres synapse in the lateral geniculate nucleus before second-order visual information continues through the optic radiations.

Question:

Imaging shows a small lesion confined to the lower bank of the right calcarine fissure. Which region of visual space is represented in this part of the primary visual cortex?

Options:

Correct Answer: Left superior visual field

Explanation: The right visual cortex represents the left visual hemifield, and the lower bank of the calcarine cortex receives superior-field information.

Question:

A 32-year-old woman notices a persistent blurred spot at the centre of vision in her left eye. The peripheral visual field of that eye is relatively preserved, and the right eye is unaffected. Which anatomical site is most compatible with this monocular central scotoma?

Options:

Correct Answer: Left optic nerve

Explanation: A monocular central scotoma may occur with partial optic-nerve dysfunction; post-chiasmal lesions instead affect corresponding areas of both eyes.

Question:

A hospitalized patient suddenly reports difficulty seeing objects on one side. The doctor wants an immediate bedside screening test to determine whether a major hemifield defect is present before arranging formal testing. Which assessment is most appropriate?

Options:

Correct Answer: Confrontation visual-field testing

Explanation: Confrontation testing is a rapid bedside method for detecting major visual-field defects, while automated perimetry provides detailed quantitative assessment later.

Question:

A patient undergoes an intravenous dye-based retinal vascular investigation. Shortly afterward she notices temporary yellow-orange discoloration of her urine but remains otherwise well. Which investigation was most likely performed?

Options:

Correct Answer: Fundus fluorescein angiography

Explanation: Intravenous fluorescein used during FFA is excreted in urine and may temporarily discolor it; nausea and hypersensitivity reactions are other recognized effects.

Question:

A 73-year-old man has a dense cataract that prevents visualization of the fundus. The ophthalmologist is concerned about a possible posterior-segment mass and wants a two-dimensional assessment of structures behind the opaque lens. Which investigation is most useful?

Options:

Correct Answer: B-scan ultrasonography

Explanation: B-scan uses sound waves and does not require transparent ocular media, allowing two-dimensional evaluation of posterior structures and selected intraocular masses.

Question:

During ocular ultrasonography of an eye with opaque media, the examiner needs to distinguish a true membranous posterior-segment structure from freely mobile vitreous echoes. Which feature of B-scan examination is particularly useful for this distinction?

Options:

Correct Answer: Dynamic assessment of echo movement

Explanation: Dynamic B-scan assessment shows how internal echoes move with eye movement, helping distinguish structured retinal tissue from more mobile vitreous echoes.

Question:

A 60-year-old patient with central visual distortion requires high-resolution cross-sectional imaging of the retinal layers. She is anxious about intravenous injections and asks whether the required investigation needs an injected dye. Which investigation best meets the clinical requirement without intravenous contrast?

Options:

Correct Answer: Optical coherence tomography

Explanation: OCT is a non-contact optical imaging technique that provides high-resolution retinal cross-sections without intravenous fluorescein dye.