KMU Past Paper Practice

Question:

An 18-month-old child is brought with unilateral leukocoria. Initial examination suggests a posterior-segment mass, but the child is distressed and does not permit adequate examination of either fundus. What is the most appropriate next step to complete the ocular assessment?

Options:

Correct Answer:
Examination under anaesthesia with dilated fundus examination

Explanation: A young uncooperative child with suspected serious intraocular disease may require examination under anaesthesia so both eyes can be examined completely and accurately.

Question:

A 2-year-old child is evaluated for a recently noticed convergent squint. Fundus examination reveals a retinal tumour involving the central retina. The parents had not noticed leukocoria. What best explains the ocular deviation in this child?

Options:

Correct Answer:
Loss of central visual fixation from tumour involvement

Explanation: A retinal tumour affecting central vision can impair fixation in the involved eye, allowing ocular misalignment and strabismus to develop.

Question:

A child with retinoblastoma has several intraocular tumours in an eye with useful visual potential. Systemic chemotherapy is started and subsequent examination shows substantial reduction in tumour size. What is the principal purpose of this approach?

Options:

Correct Answer:
To reduce tumour volume and facilitate focal treatment

Explanation: Chemotherapy may shrink retinoblastoma and make residual disease suitable for focal eye-preserving treatment such as laser or cryotherapy.

Question:

A child with hereditary retinoblastoma is being considered for different tumour-control strategies. The team wishes to restrict radiotherapy when effective alternatives are available. Which long-term concern most strongly supports this decision?

Options:

Correct Answer:
Increased risk of radiation-associated second malignancy

Explanation: Children with hereditary RB1 abnormalities have increased susceptibility to additional malignancies, making unnecessary radiation exposure particularly undesirable.

Question:

A 3-year-old child with known retinoblastoma was lost to follow-up. He now returns with marked forward displacement of the affected eye and deterioration in vision. What does this new finding most strongly suggest?

Options:

Correct Answer:
Progression to advanced extraocular disease

Explanation: Proptosis in a child with untreated retinoblastoma is a serious sign suggesting tumour extension beyond the globe into the orbit.

Question:

During routine examination of a 6-month-old infant, a small localized opacity is seen at the front pole of the crystalline lens. The remainder of the lens is clear. Which morphological type is present?

Options:

Correct Answer:
Anterior polar cataract

Explanation: An anterior polar cataract is a localized opacity at the anterior pole of the lens and may have limited visual effect when small.

Question:

A 4-year-old child undergoing eye examination is found to have fine opacities following the normal Y-shaped lines within the lens. Visual acuity is only mildly affected. Which type of congenital cataract best matches this appearance?

Options:

Correct Answer:
Sutural cataract

Explanation: Sutural cataracts follow the characteristic Y-shaped sutures formed by the arrangement of lens fibres.

Question:

An infant develops congenital lens opacity despite an otherwise structurally normal anterior segment. Which alteration most directly converts the normally transparent lens into an opaque optical medium?

Options:

Correct Answer:
Disruption of the orderly arrangement of lens fibres and proteins

Explanation: Lens transparency depends on highly ordered fibres and proteins; disruption increases light scattering and produces cataract.

Question:

A child treated surgically for congenital cataract has a clear visual axis during follow-up. One year later, visual acuity has fallen and the child’s previous spectacle correction no longer provides a clear image. What is the most appropriate next step?

Options:

Correct Answer:
Repeat refraction and update optical correction

Explanation: Refractive requirements change as the child’s eye develops, so long-term cataract follow-up includes repeated refraction and appropriate optical rehabilitation.

Question:

An infant with congenital glaucoma has progressive enlargement of the optic-disc cup during follow-up. Which pathological process most directly accounts for this change?

Options:

Correct Answer:
Pressure-related injury to retinal ganglion-cell axons

Explanation: Persistently raised intraocular pressure damages retinal ganglion-cell axons at the optic nerve and produces glaucomatous disc cupping.

Question:

A 5-month-old infant has primary congenital glaucoma with markedly raised intraocular pressure. Corneal clouding prevents adequate visualization of the anterior chamber angle. Which procedure can open the trabecular outflow pathway through an external approach?

Options:

Correct Answer:
Trabeculotomy

Explanation: Trabeculotomy opens the abnormal trabecular pathway externally and is useful when corneal haze prevents adequate visualization for an internal angle procedure.

Question:

An infant with primary congenital glaucoma is started on pressure-lowering medication while arrangements are made for definitive treatment. How should the role of this medical therapy be interpreted?

Options:

Correct Answer:
It serves mainly as an adjunct while surgery is planned

Explanation: Primary congenital glaucoma is principally a surgical disease; medication can temporarily reduce pressure but does not correct developmental outflow obstruction.

Question:

A 7-month-old infant is being assessed for suspected congenital glaucoma. The ophthalmologist wants to document both the chronic structural effect of raised pressure on the developing eye and evidence of neural damage. Which combination is most useful?

Options:

Correct Answer:
Corneal diameter measurement and optic-disc examination

Explanation: Increased corneal diameter reflects pressure-related stretching of the infant eye, while optic-disc examination assesses glaucomatous neural damage.

Question:

A 7-year-old child has reduced visual acuity despite a structurally normal eye. Refraction reveals significant uncorrected astigmatism that has been present since early childhood. There is no manifest squint. Which form of amblyopia best explains the deficit?

Options:

Correct Answer:
Meridional amblyopia

Explanation: Persistent uncorrected astigmatic blur during visual development can selectively impair vision in affected meridians, producing meridional amblyopia.

Question:

A 6-year-old child has persistent reduction in best-corrected visual acuity. Amblyopia is suspected after refraction and alignment assessment. Why is a dilated fundus examination still essential before confirming the diagnosis?

Options:

Correct Answer:
To exclude retinal or optic-nerve pathology

Explanation: Amblyopia should not be diagnosed until structural causes capable of explaining reduced vision, particularly retinal and optic-nerve disease, have been excluded.

Question:

A 6-year-old child had longstanding ocular deviation with reduced acuity in one eye. Alignment is later corrected successfully, but visual acuity in that eye remains reduced. What is the most appropriate interpretation and management principle?

Options:

Correct Answer:
Amblyopia therapy should continue despite corrected alignment

Explanation: Correcting strabismus removes the alignment problem but does not automatically reverse established abnormal visual development, so visual rehabilitation remains necessary.

Question:

A child receiving occlusion therapy for unilateral amblyopia returns for follow-up. Vision in the treated eye has improved, but acuity in the previously better eye has started to decline. What is the most appropriate management principle?

Options:

Correct Answer:
Adjust occlusion therapy and reassess vision in both eyes

Explanation: Amblyopia treatment requires regular monitoring because excessive penalization of the better eye can itself reduce its visual function.

Question:

A premature infant is clinically stable and ready for follow-up after neonatal care. The eyes appear externally normal and the parents ask why retinal examinations are still required. What is the main purpose of this surveillance?

Options:

Correct Answer:
To detect retinopathy of prematurity before severe retinal damage develops

Explanation: Appropriate retinal surveillance of at-risk premature infants allows retinopathy of prematurity to be recognized before progression to irreversible tractional retinal damage.

Question:

A child-eye health programme identifies several children with permanent visual impairment from corneal scarring related to ocular injury, infection and nutritional problems. Which strategy best addresses the preventable component of this blindness?

Options:

Correct Answer:
Prevent ocular injury and address infectious and nutritional causes early

Explanation: Preventing injury and addressing treatable infectious or nutritional contributors can reduce avoidable corneal scarring and childhood visual loss.

Question:

A 3-year-old child is referred after an abnormal white pupillary reflex is noted. Examination shows a clear cornea, clear anterior chamber and transparent crystalline lens. Which examination is now most important for localizing the source of the abnormal reflex?

Options:

Correct Answer:
Dilated fundus examination

Explanation: When the anterior segment and lens are clear, the source of leukocoria is likely posterior, making dilated retinal examination the key next localization step.