KMU Past Paper Practice

Question:

A 52-year-old man with no visual complaints attends an eye assessment because his father and elder brother were treated for glaucoma. His visual acuity is normal and the anterior segments are clear. Which feature in his history most increases concern for future primary open-angle glaucoma?

Correct Answer:
Strong family history of glaucoma

Explanation: A first-degree family history is an important risk factor for POAG and increases the need for careful long-term glaucoma assessment.

Question:

A 45-year-old woman is found to have large optic cups in both eyes. The neuroretinal rims are healthy, retinal nerve-fibre imaging and visual fields are normal, and the appearance remains unchanged on serial review. Which interpretation is most appropriate?

Correct Answer:
Physiological optic disc cupping

Explanation: Cup size alone does not diagnose glaucoma. A healthy rim with normal structural and functional testing and stability over time supports physiological cupping.

Question:

Serial examination of a patient with glaucoma shows progressive enlargement of the optic cup and loss of neuroretinal rim tissue. Which cellular event most directly produces these structural changes?

Correct Answer:
Loss of retinal ganglion-cell axons

Explanation: Glaucoma damages retinal ganglion-cell axons at the optic-nerve head, producing neuroretinal rim loss and progressive optic disc cupping.

Question:

A patient has an open anterior chamber angle and definite glaucomatous optic-nerve damage. Examination also identifies another ocular disorder that is responsible for impaired aqueous drainage. How should the glaucoma be classified?

Correct Answer:
Secondary glaucoma

Explanation: Glaucoma is classified as secondary when another identifiable ocular or systemic process is responsible for the pressure or outflow abnormality.

Question:

An infant is found to have glaucoma resulting from abnormal development of the aqueous drainage structures. Which category best describes this condition?

Correct Answer:
Developmental glaucoma

Explanation: Developmental or congenital glaucomas arise from abnormalities in development of the aqueous drainage system.

Question:

Two patients with primary open-angle glaucoma have the same measured intraocular pressure. One has mild stable disease, while the other has advanced damage and documented progression. Why may their desired treatment pressures differ?

Correct Answer:
Target pressure is individualized to progression and risk

Explanation: The required IOP reduction depends on baseline pressure, severity, rate of progression and individual susceptibility rather than one universal target.

Question:

A 29-year-old woman develops reduced vision in one eye over several days. The eye is externally white, but she reports pain when moving it and notices that colours appear less vivid than with the other eye. Which diagnosis best fits this pattern?

Correct Answer:
Optic neuritis

Explanation: Pain with eye movement, reduced colour perception and visual loss in an externally quiet eye localize the problem to an inflamed optic nerve.

Question:

A 72-year-old patient develops sudden painless monocular visual loss. The cornea, lens and vitreous are clear, and examination does not show retinal detachment or widespread retinal hemorrhage. The abnormality is localized clinically to the optic nerve. Which cause is most likely?

Correct Answer:
Ischemic optic neuropathy

Explanation: Sudden painless loss localized to the optic nerve is consistent with ischemic optic neuropathy rather than an anterior optical or vitreoretinal cause.

Question:

Three days after intraocular surgery, a 67-year-old woman develops rapidly worsening ocular pain and marked reduction of vision. Which clinical possibility requires the most urgent ophthalmic assessment?

Correct Answer:
Severe intraocular infection

Explanation: Severe pain and major visual loss following intraocular surgery are sight-threatening warning features requiring urgent specialist evaluation for intraocular infection.

Question:

A 40-year-old man has gradually reduced vision in one eye following a previous healed corneal infection. Examination shows a dense central corneal scar, while the lens and fundus are otherwise normal. Which mechanism best explains his reduced vision?

Correct Answer:
Impaired transmission of light through the cornea

Explanation: A central corneal scar is an anterior-segment optical opacity that reduces the quantity and quality of light reaching the retina.

Question:

A 63-year-old man with longstanding diabetes reports slowly worsening vision. The cornea and lens are sufficiently clear, but fundus examination reveals retinal vascular disease with involvement near the macula. Which anatomical category best explains his visual impairment?

Correct Answer:
Posterior-segment visual loss

Explanation: Retinal vascular and macular disease arises behind the lens and therefore represents posterior-segment visual loss.

Question:

During a physiology demonstration, aqueous humor is shown leaving the anterior chamber by passing through tissues around the ciliary muscle toward the suprachoroidal region. Which drainage route is being demonstrated?

Correct Answer:
Uveoscleral pathway

Explanation: Uveoscleral drainage allows aqueous to pass through the ciliary muscle region toward the suprachoroidal space rather than through Schlemm canal.

Question:

Aqueous humor enters Schlemm canal through the conventional drainage route. Where does this fluid ultimately pass as it leaves the eye through this pathway?

Correct Answer:
Episcleral venous circulation

Explanation: After Schlemm canal, aqueous travels through collector channels and eventually enters the episcleral venous circulation.

Question:

A patient with ocular hypertension has no current optic-nerve or field damage, but repeated assessment shows several features that place him at relatively high risk of developing glaucoma. Which management principle is most appropriate?

Correct Answer:
Consider pressure-lowering treatment based on risk

Explanation: OHT management is risk based. Higher-risk patients may benefit from IOP-lowering therapy before definite glaucomatous damage develops.

Question:

A 65-year-old man is diagnosed with primary open-angle glaucoma. Both eyes show glaucomatous changes, but the right eye has markedly greater rim loss and field damage than the left. Which interpretation best fits the expected clinical pattern?

Correct Answer:
Bilateral disease with asymmetrical severity

Explanation: POAG commonly affects both eyes but the degree of optic-nerve and visual-field damage may differ considerably between them.

Question:

A patient with longstanding glaucoma has progressive enlargement and merging of previously localized visual-field defects. Which functional pattern is most consistent with very advanced disease?

Correct Answer:
Severe field constriction with small remaining islands

Explanation: Progressive glaucomatous defects enlarge and coalesce, eventually leaving severe field constriction and only small residual islands of vision.

Question:

During assessment of two patients with glaucomatous optic neuropathy, one has an open drainage angle while the other has iris obstruction of the trabecular angle. The examiner also determines whether another disease is responsible for the glaucoma. Which features are therefore central to clinical classification?

Correct Answer:
Angle configuration and primary or secondary cause

Explanation: Glaucoma is classified importantly by whether the anterior chamber angle is open or closed and whether the disease is primary or secondary.

Question:

A patient recently diagnosed with glaucoma asks whether pressure-lowering treatment will restore the portion of his visual field that has already been lost. Which counselling statement best reflects the purpose of treatment?

Correct Answer:
Treatment mainly aims to preserve remaining vision by limiting progression

Explanation: Established glaucomatous neural and field loss is generally irreversible; lowering IOP aims to slow or prevent further optic-nerve damage.

Question:

A 70-year-old patient has slowly progressive visual impairment. The cornea and lens are clear, retinal examination does not identify a macular cause, and the clinician concludes that chronic optic-nerve damage rather than an optical opacity is responsible. Which listed cause of gradual visual loss best fits this localization?

Correct Answer:
Optic atrophy

Explanation: Optic atrophy represents chronic optic-nerve dysfunction and is an important posterior neural cause of gradual visual loss when the optical media are clear.

Question:

A patient describes several episodes in which vision in one eye becomes temporarily reduced and then returns completely to baseline. When classifying the visual complaint before determining its cause, which description is most appropriate?

Correct Answer:
Transient unilateral visual loss

Explanation: Complete recovery between brief episodes classifies the disturbance as transient, while involvement of one eye makes it unilateral.