KMU Past Paper Practice

Question:
A 28-year-old man is struck forcefully in the eye by a cricket ball. Visual acuity is markedly reduced. No external wound is clearly visible, but there is extensive subconjunctival hemorrhage extending posteriorly and the anterior chamber appears asymmetric compared with the fellow eye. Which interpretation is most appropriate?

Options:

Correct Answer: Occult scleral rupture

Explanation: Severe blunt trauma with major visual loss, extensive subconjunctival hemorrhage and abnormal chamber depth should raise suspicion of a hidden eyewall rupture even when no wound is obvious.

Question:
A metal particle is removed from the peripheral cornea of a factory worker. Slit-lamp examination afterward shows a brown deposit surrounding the previous site of impaction. Vision is preserved, but irritation persists. What is the most appropriate interpretation?

Options:

Correct Answer: Residual corneal rust ring

Explanation: Metallic corneal foreign bodies can oxidize and leave a rust ring after removal; persistent material may require careful ophthalmic removal and review.

Question:
A high-velocity projectile enters through the cornea and exits through the posterior sclera. Imaging confirms that no foreign material remains within the globe. How should this injury be classified?

Options:

Correct Answer: Perforating globe injury

Explanation: A single object producing separate full-thickness entry and exit wounds creates a perforating injury; penetration has an entry wound without an exit wound.

Question:
Following blunt ocular trauma, a patient develops monocular diplopia. Slit-lamp examination shows an abnormal lens position and a visibly unstable iris-lens diaphragm. Which structural injury best explains these findings?

Options:

Correct Answer: Disruption of the lens zonules

Explanation: Blunt force can tear the zonular fibers supporting the lens, producing lens subluxation or dislocation and resulting optical disturbance.

Question:
A teenager is struck in the eye with a tennis ball. The globe remains intact. The affected pupil is larger than the fellow pupil and reacts poorly to light, while there is no relative afferent pupillary defect. Which lesion is most likely responsible?

Options:

Correct Answer: Iris sphincter tear

Explanation: Blunt trauma can tear the iris sphincter, producing traumatic mydriasis with a poorly reactive enlarged pupil despite preserved afferent pupillary function.

Question:
A patient with traumatic hyphema is reviewed several hours after blunt eye injury. Intraocular pressure has increased despite an intact globe. Which mechanism most directly explains this pressure rise?

Options:

Correct Answer: Obstruction of aqueous outflow by blood

Explanation: Blood cells and clot within the anterior chamber can interfere with trabecular aqueous drainage, causing an acute rise in intraocular pressure.

Question:
Three days after significant blunt ocular trauma, a patient reports new flashes and floaters followed by a curtain-like loss of part of the visual field. Which complication should now be suspected?

Options:

Correct Answer: Retinal detachment

Explanation: Trauma can produce retinal tears; subsequent separation of the retina characteristically causes flashes, floaters and a progressive curtain-like field defect.

Question:
A patient develops dense vitreous hemorrhage after blunt ocular trauma. The globe has been confirmed to be intact, but the fundus cannot be visualized. Which investigation is most useful for determining whether an associated retinal detachment is present?

Options:

Correct Answer: B-scan ocular ultrasonography

Explanation: When opaque media prevent direct fundus visualization and globe integrity is established, B-scan ultrasonography can demonstrate posterior-segment abnormalities such as retinal detachment.

Question:
Six months after ocular trauma, a patient has gradually worsening visual acuity. Examination shows a dense lens opacity, while retinal examination demonstrates good visual potential. Which rehabilitation strategy is most likely to improve vision substantially?

Options:

Correct Answer: Surgical treatment of the traumatic cataract

Explanation: When post-traumatic visual loss results from a surgically correctable lens opacity and posterior visual potential is preserved, cataract surgery can restore useful vision.

Question:
A welder works without protective eyewear and feels well immediately afterward. Several hours later he develops severe bilateral ocular pain, photophobia and watering. Which mechanism best explains the delayed onset of symptoms?

Options:

Correct Answer: Evolution of corneal epithelial injury

Explanation: Ultraviolet exposure damages corneal epithelial cells, but symptomatic epithelial disruption develops after a latent period, explaining delayed pain and photophobia.

Question:
Two workers sustain ocular chemical burns of comparable concentration and duration. One is exposed to an acid and the other to an alkali. The acid injury remains relatively more superficial. Which tissue effect best explains this difference?

Options:

Correct Answer: Coagulation of surface proteins

Explanation: Many acids coagulate superficial tissue proteins, creating a barrier that can limit further penetration compared with the deeper tissue penetration produced by alkalis.

Question:
A restaurant worker sustains a splash of very hot liquid to the eye. After removal from the heat source, examination suggests superficial eyelid and ocular-surface injury without globe penetration. Which immediate management principle is most appropriate?

Options:

Correct Answer: Cool and irrigate the affected ocular surface

Explanation: Initial care of superficial thermal injury includes removing the heat source, cooling or irrigating the ocular surface and then assessing epithelial and deeper damage.

Question:
Several weeks after penetrating injury to one eye, a patient develops bilateral intraocular inflammation and reduced vision. OCT demonstrates accumulation of fluid beneath the neurosensory retina. Which pathological process best accounts for this imaging finding?

Options:

Correct Answer: Inflammatory choroidal leakage

Explanation: Posterior inflammation in sympathetic ophthalmia can disrupt the choroid-retinal interface, producing subretinal fluid and exudative retinal detachment on OCT.

Question:
A man with irreversible visual loss after severe bilateral trauma has difficulty adjusting emotionally and has become increasingly dependent on family members despite having completed mobility training. Which additional rehabilitation service is most appropriate?

Options:

Correct Answer: Psychological counseling with family support

Explanation: Sudden permanent blindness affects mood, independence and family roles; counseling and family education are important components of comprehensive rehabilitation.

Question:
A school-aged child has permanent severe visual impairment following ocular trauma. Medical treatment is complete, but the child cannot use ordinary classroom textbooks effectively. Which service best supports continued education?

Options:

Correct Answer: Special educational support with accessible material

Explanation: Children with lasting visual impairment may require special-education services, large-print or Braille material and other accessible learning formats.

Question:
A patient retains limited vision after bilateral ocular trauma. He can recognize print when it is enlarged but struggles in poorly illuminated rooms and with low-contrast text. Which rehabilitation approach would most directly improve his functional vision?

Options:

Correct Answer: Improved lighting and contrast enhancement

Explanation: Environmental modification is a key low-vision strategy; better illumination and stronger contrast can make residual vision substantially more useful.

Question:
Following ocular trauma, the fundus can be visualized clearly, but an ophthalmologist needs to evaluate abnormal retinal circulation and determine whether a suspicious retinal area is leaking dye. Which investigation is most appropriate?

Options:

Correct Answer: Fundus fluorescein angiography

Explanation: FFA documents retinal and choroidal vascular filling patterns and dye leakage, helping evaluate retinal vascular abnormalities when the fundus is visible.

Question:
A patient develops sudden floaters and marked haziness of vision after blunt ocular trauma. The cornea and lens are clear, but the red reflex is reduced and the fundus is poorly visible. Which ocular lesion best explains this combination?

Options:

Correct Answer: Vitreous hemorrhage

Explanation: Blood within the vitreous produces floaters, hazy visual loss and impaired fundus visualization despite a clear cornea and lens.

Question:
A child presents shortly after wind-blown dust enters the eye. Visual acuity is normal, the globe is intact and examination shows a loose superficial particle lying on the bulbar conjunctiva without epithelial penetration. What is the most appropriate initial treatment?

Options:

Correct Answer: Gentle ocular irrigation

Explanation: A loose superficial conjunctival particle can commonly be removed safely by gentle irrigation when there is no evidence of penetration or deeper injury.

Question:
A man with permanent severe bilateral visual impairment has completed low-vision and mobility training. His family now requests assistance with disability-related social support and access to available community services. Which referral is most appropriate?

Options:

Correct Answer: Social-welfare and disability-support services

Explanation: Blindness rehabilitation includes linkage with locally available social-welfare and disability-support pathways to improve long-term social and functional independence.