KMU Past Paper Practice

Question:

A 68-year-old hypermetropic woman has progressively shallower anterior chambers on serial ophthalmic examinations. Her crystalline lenses have become thicker with age. Which anatomical effect most directly increases her risk of primary angle closure?

Options:

Correct Answer:
Increased crowding of the anterior segment

Explanation: Age-related lens thickening reduces available anterior-segment space and brings the peripheral iris closer to the trabecular meshwork, increasing the tendency to angle closure.

Question:

A 59-year-old woman with previously unrecognized narrow angles develops severe ocular pain and blurred vision shortly after receiving dilating eye drops. Which change most likely precipitated the attack?

Options:

Correct Answer:
Peripheral iris crowding during mydriasis

Explanation: Pupillary dilatation can bunch the peripheral iris within an anatomically narrow angle, obstructing trabecular drainage and precipitating acute closure.

Question:

A 63-year-old woman presents with a severe high-pressure ocular attack. Slit-lamp examination shows marked corneal edema, making detailed visualization of the anterior chamber angle difficult. Which approach is most appropriate for confirming the angle abnormality?

Options:

Correct Answer:
Lower the pressure and repeat gonioscopy after corneal clearing

Explanation: Corneal edema can prevent adequate gonioscopic visualization during a severe attack. Angle assessment becomes more reliable after initial IOP reduction and corneal clearing.

Question:

After successful treatment of an acute angle-closure episode, an ophthalmologist notes suspicious optic-disc changes and wants to determine whether functional glaucomatous damage is present. Which test is most appropriate?

Options:

Correct Answer:
Visual-field assessment

Explanation: Visual-field testing assesses the functional consequence of glaucomatous optic-nerve damage and is particularly useful after the acute episode has stabilized.

Question:

A patient undergoing treatment for an acute angle-closure attack has improving intraocular pressure but persistent anterior-segment inflammation. Which adjunctive treatment most directly addresses this inflammatory component?

Options:

Correct Answer:
Topical corticosteroid therapy

Explanation: Acute angle closure can produce significant anterior-segment inflammation. Topical corticosteroids reduce this inflammatory response while pressure-lowering treatment addresses the IOP elevation.

Question:

During management of a patient with acute angle closure, visual acuity is recorded at presentation and again after treatment. What is the main clinical value of these measurements?

Options:

Correct Answer:
Document functional visual loss and subsequent recovery

Explanation: Visual acuity provides a functional baseline and allows assessment of improvement after corneal clearing and pressure control.

Question:

A 72-year-old man develops ocular pain and raised intraocular pressure several weeks after severe unilateral visual loss. Fundus examination shows widespread retinal hemorrhages, venous congestion and marked retinal ischemia. Which underlying disorder most likely initiated his secondary glaucoma?

Options:

Correct Answer:
Ischemic central retinal vein occlusion

Explanation: Severe ischemic central retinal vein occlusion is an important cause of retinal ischemia and can drive anterior-segment neovascularization with secondary glaucoma.

Question:

A patient with neovascular glaucoma has ocular pain, active anterior-segment inflammation and markedly elevated intraocular pressure. Which medical strategy is most appropriate for initial pressure control?

Options:

Correct Answer:
Aqueous-suppressing antiglaucoma therapy

Explanation: Beta-blockers, alpha-2 agonists and carbonic anhydrase inhibitors reduce aqueous production and are useful for pressure control in neovascular glaucoma. Miotics do not correct its fibrovascular mechanism.

Question:

A diabetic patient is found to have fine new vessels on the iris and abnormal vessels within the anterior chamber angle. Gonioscopy shows that much of the angle remains open. Which interpretation is most appropriate?

Options:

Correct Answer:
Neovascular glaucoma can begin before permanent synechial closure develops

Explanation: Early neovascular glaucoma may have an anatomically open angle with abnormal angle vessels. Later fibrovascular contraction produces permanent synechial closure.

Question:

A patient with suspected neovascular glaucoma has widespread retinal vascular disease on fundus examination. The ophthalmologist wants to define areas of retinal non-perfusion more clearly. Which investigation is most appropriate when adequate fundus visualization is possible?

Options:

Correct Answer:
Fundus fluorescein angiography

Explanation: Fundus fluorescein angiography can demonstrate retinal vascular perfusion and help define areas of non-perfusion driving ocular neovascularization.

Question:

A 74-year-old woman with a dense cataract and secondary glaucoma is being prepared for definitive lens management. The cataract prevents visualization of the fundus, but posterior-segment information is required before surgery. Which investigation is most appropriate?

Options:

Correct Answer:
Ocular ultrasonography

Explanation: When a dense cataract prevents direct fundus visualization, ocular ultrasonography can assess important posterior-segment structures behind the opaque lens.

Question:

A patient with lens-related secondary glaucoma has significant cells and flare in the anterior chamber in addition to raised intraocular pressure. Pressure-lowering therapy has been started. Which adjunct most directly treats the inflammatory component?

Options:

Correct Answer:
Topical corticosteroid therapy

Explanation: Lens proteins or lens material can provoke significant anterior-segment inflammation. Topical corticosteroids suppress this inflammatory response while the causative lens problem is addressed.

Question:

A patient with chronic open-angle glaucoma begins a once-daily topical medication that lowers intraocular pressure mainly by facilitating an alternative aqueous drainage pathway rather than suppressing its production. Which mechanism best explains the drug effect?

Options:

Correct Answer:
Enhancement of uveoscleral aqueous outflow

Explanation: Prostaglandin analogues lower intraocular pressure predominantly by increasing uveoscleral outflow rather than by reducing aqueous production.

Question:

A patient with glaucoma is prescribed topical timolol. Intraocular pressure falls without a significant change in pupil size. Which physiological effect accounts for the pressure reduction?

Options:

Correct Answer:
Reduced aqueous humor production

Explanation: Topical beta-blockers lower intraocular pressure by reducing aqueous production from the ciliary epithelium rather than by altering pupil size.

Question:

A patient using an additional topical glaucoma medication develops dry mouth, fatigue and occasional light-headedness. Which drug class is most consistent with this adverse-effect pattern?

Options:

Correct Answer:
Alpha-2 adrenergic agonists

Explanation: Alpha-2 agonists may cause dry mouth, fatigue and systemic hypotensive effects in addition to ocular allergy.

Question:

A patient with chronic glaucoma needs an additional medication that reduces aqueous secretion. The ophthalmologist prefers a topical drug for long-term adjunctive use rather than repeated systemic acetazolamide. Which class is most appropriate?

Options:

Correct Answer:
Topical carbonic anhydrase inhibitors

Explanation: Topical carbonic anhydrase inhibitors reduce aqueous production and are suitable adjuncts for chronic pressure control without the systemic exposure of oral acetazolamide.

Question:

A patient with open-angle glaucoma is being considered for selective laser trabeculoplasty. Gonioscopy shows that the trabecular meshwork is clearly visible throughout the treatment area. Why is this anatomy important for the planned procedure?

Options:

Correct Answer:
The trabecular drainage tissue must be accessible to treatment

Explanation: Laser trabeculoplasty acts on the trabecular meshwork to improve aqueous outflow, so it is suitable when the angle is open and the drainage tissue is accessible.

Question:

A patient with progressive glaucoma requires substantial pressure lowering despite appropriate medication and laser therapy. Trabeculectomy is planned. Which principle explains how this operation lowers intraocular pressure?

Options:

Correct Answer:
It creates an alternative drainage route to a filtering bleb

Explanation: Trabeculectomy bypasses the conventional outflow pathway by allowing aqueous to drain from the anterior chamber into a subconjunctival filtering bleb.

Question:

A patient with refractory secondary glaucoma undergoes implantation of a glaucoma drainage device. Which mechanism best describes how the device controls intraocular pressure?

Options:

Correct Answer:
Aqueous is diverted through a tube toward an external plate

Explanation: A glaucoma drainage device uses a tube to divert aqueous from the anterior chamber to an external plate, providing an alternative pathway for pressure control.

Question:

A patient with refractory glaucoma and limited visual potential undergoes a procedure designed to reduce aqueous production rather than create a new drainage pathway. Which ocular structure is the therapeutic target?

Options:

Correct Answer:
Ciliary body

Explanation: Cyclodestructive procedures treat part of the ciliary body to reduce aqueous production and are reserved for selected refractory glaucomas.