glaucoma previous year questions

Q:1Which of the following drug is not used in Acute Angle closure Glaucoma?

A: PilocarpineB: ClozapineC: FluphenazineD: Duloxetine

Correct Ans:B

Explanation

Clozapine will precipitate acute angle closure glaucoma.

Reference:1. KDT 6th Edition, Pages 429, 4422. Atlas of Psychiatric Pharmacotherapy, 2nd Edition, Page 423. Medicinal Natural Products: A Biosynthetic Approach By Paul M. Dewick, Page 4004. Modell's Essential Drugs in Current Use and New Drugs By Milagros Fernandez, Walter Modell, Lydia Calix, 85. Clinical Pharmacy By Jeff Hughes, William Hughes, Page 156. Kaplan and Sadock's Psychiatry, 10th Edition, Page 10837. American Psychiatric Association Practice Guidelines for The Treatment of Psychiatric Disorders By American Psychiatric Association, 2006, Page 654

Want To Solve More Such Question on Mobile without connecting to internetDownload Our FREE Subjectwise Mobile Apps at www.medicoapps.org

Q:2Which of the following arachidonic acid derivative is used in treatment ofglaucoma?

A: LatanoprostB: IloprostC: AlprostadilD: None of the above

Correct Ans:A

ExplanationLatanoprost, a stable longacting PGF2derivative, was the first prostanoid used forglaucoma. The success of latanoprost has stimulated development of similarprostanoids with ocular hypotensive effects, and bimatoprost, travoprost, andunoprostone are now available. These drugs act at the FP receptor and areadministered as drops into the conjunctival sac once or twice daily. Adverse effectsinclude irreversible brown pigmentation of the iris and eyelashes, drying of the eyes,and conjunctivitis.

Ref: Katzung 11th edition Chapter 18.


Q:3Which of the following is NOT correct regarding glycopyrrolate?

A: Inhibitory action on salivary glandsB: Heart rate usually increases after intravenous administrationC: Should be avoided in glaucomaD: Longer duration of action than atropine

Correct Ans:C

ExplanationBecause of its quaternary structure, glycopyrrolate cannot cross the blood–brain barrierand is almost devoid of central nervous system and ophthalmic activity. Potentinhibition of salivary gland and respiratory tract secretions is the primary rationale forusing glycopyrrolate as a premedication. Heart rate usually increases after intravenous—but not intramuscular—administration. Glycopyrrolate has a longer duration of actionthan atropine (2–4 h vs 30 min after intravenous administration). Ref: Butterworth IV J.F., Butterworth IV J.F., Mackey D.C., Wasnick J.D., Mackey D.C.,Wasnick J.D. (2013). Chapter 13. Anticholinergic Drugs. In J.F. Butterworth IV, J.F.Butterworth IV, D.C. Mackey, J.D. Wasnick, D.C. Mackey, J.D. Wasnick (Eds), Morgan &Mikhail's Clinical Anesthesiology, 5e.


Q:4Which of the following is the indication for using phenylsubstituted prostaglandinF2 alpha, Latanoprost:

A: Maintenance of ductus arteriosusB: Pulmonary hypertensionC: Gastric mucosal protectionD: Glaucoma

Correct Ans:D

Explanation

Latanoprost is a derivative of PGF2 alpha that reduces intraocular pressure (IOP) byincreasing uveoscleral outflow without effects on aqueous flow. It is indicated inreduction of elevated IOP in patients with open angle glaucoma, ocular hypertensionand capsular glaucoma. The only apparent side effect is darkening of the pigment of theeyes, such as hazel, that are made up of multiple colors.

Ref: Clinical Ophthalmology: Contemporary Perspectives By Gupta, 2009, Page 80;Desk Reference of Clinical Pharmacology, Second Edition By Manuchair S. Ebadi, 2008,Page 381; Goodman and Gillman's 11th edition, Page 1103.


Q:5A 41yearold woman with glaucoma is treated with acetazolamide. Several weekslater the woman has an arterial pH of 7.34, an arterial PCO2 of 29mmHg, and aplasma HCO3− of 15 mEq/L. Which of the following abnormalities has this womenmost likely developed?

A: Metabolic acidosisB: Metabolic alkalosisC: Mixed acidosisD: Mixed alkalosis

Correct Ans:A

Explanation

The laboratory results indicate that the arterial pH, arterial PCO2, and plasma HCO3concentrations are all low. These changes clearly demonstrate metabolic acidosis,which occurs commonly when a carbonic anhydrase inhibitor is administered. Thecarbonic anhydrase enzyme attached to the brush border of the tubular epithelial cellsnormally catalyzes the dissociation of carbonic acid into water and carbon dioxide.

Inhibition of carbonic anhydrase prevents the removal of bicarbonate ions from thetubular fluid, which initially increases urine pH. The result is heavy spillage ofbicarbonate in the urine, which is the hallmark of type 2 RTA (renal tubular acidosis).However, once the plasma levels of bicarbonate have decreased sufficiently, thebicarbonaturia ceases and the plasma HCO3 levels stabilize at a lower than normallevel. Consequently, the urine pH falls typically to 4.55.0.


Q:6Acetazolamide is administered to a glaucoma patient. Given that this drug inhibitscarbonic anhydrase in the renal proximal tubule, which of the followingsubstances will be excreted at a lower rate?

A: Na+B: H2OC: HCO3D: NH4

Correct Ans:D

ExplanationThe primary effect of carbonic anhydrase inhibitors such as acetazolamide is to inhibitboth H+ secretion and NaHCO3 reabsorption, making the urine alkaline. NH4+excretion is reduced as a result of the diminished H+ secretion. Carbonic anhydraseinhibitors restrict H+ secretion by inhibiting the intracellular hydration of CO2, aprimary source of intracellular H+. The decline in H+ secretion inhibits the Na+H+exchange at the luminal membrane of the proximal tubule, which is the primary site ofNaHCO3 diuresis. Carbonic anhydrase inhibitors also block the dehydration of H2CO3formed in the tubular lumen. Chronic doses of such drugs can lead to hyperchloremicacidosis (metabolic acidosis). Ref: McNamara J.O. (2011). Chapter 21. Pharmacotherapy of the Epilepsies. In L.L.

Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman's ThePharmacological Basis of Therapeutics, 12e.


Q:7 A 30 year old female, presents with episodic throbbing headache associated withnausea and vomiting for past 4 yrs. What will be the most likely diagnosis is:

A: MigraineB: Cluster headacheC: Angle closure glaucomaD: Temporal arteritis

Correct Ans:A

Explanation

Migraine is the second most common form of headaches affecting ~15% of woman and~6% of men. It is an episodic headache associated with sensitivity to light, sound andmovement. Often accompanied by nausea and vomiting. Migraine is a benign andrecurring syndrome of headache recognized by its activators, termed as triggers.

Ref: Harrison’s Principle of Internal Medicine, 16th Edition, Pages 8889


Q:8

A 20 year old unmarried girl complaining of visual aura lasting for 20 minutesdescribed as a small central disturbance in the field of vision marches towards theperiphery, leaving a transient scotoma in its wake. The expanding border of that has a scintillating, dancing, or zigzag edge. This phenomena also remain visible inthe dark or with the eyes closed. After the visual symptoms recede, headachedevelops. She gives a long standing history of stereotypic attacks. What is themost likely diagnosis?

A: GlaucomaB: Classic migraineC: Transient ischemic attacksD: Non organic visual loss

Correct Ans:B

Explanation

This is the classical description of classic migraine. No other diagnosis would fit in thisscenario.

Ref: Harrisons Principles of Internal Medicine, 18th Edition, Page 234


Q:9 Painless loss of vision is seen in all, EXCEPT:

A: PapilledemaB: PapillitisC: Angle closure glaucomaD: CRAO

Correct Ans:C

Explanation

Acute angleclosure glaucoma is an ophthalmic emergency thatcauses severe visual loss without treatment. Symptoms includeocular pain, blurred vision, lacrimation, halos around lights,frontal headache, nausea, and vomiting.

Causes of Sudden Painless Loss of Vision:

1. Retinal detachment2. Vitreous haemorrhage3. Retinal vein occlusion4. Retinal artery occlusion5. Wet age related macular degeneration6. Anterior ischemic optic neuropathy7. Optic neuritis8. Cerebrovascular accident9. Papillitis10. Papilledema


Q:10 All of the following can be seen in patients with accelerated hypertension whichcan lead to visual loss, EXCEPT:

A: Vitreous haemorrhageB: GlaucomaC: Cotton wool spotsD: Retinal detachment

Correct Ans:B

Explanation

In young patients with accelerated malignant hypertension, an extensive retinopathy isseen, with hemorrhages, retinal infarcts (cottonwool spots), choroidal infarcts, andoccasionally serous detachment of the retina.

Severe disk edema is a prominent feature and may be accompanied by a macular starof hard exudates. Vision may be impaired and may deteriorate further if blood pressureis reduced too quickly. Ref: Pringle E., Graham E.M. (2011). Chapter 15. Ocular Disorders Associated withSystemic Diseases. In P. RiordanEva, E.T. Cunningham, Jr. (Eds), Vaughan & Asbury'sGeneral Ophthalmology, 18e.


Q:11 Ring scotoma is seen in:

A: Macular edemaB: Night blindnessC: Severe myopiaD: Angle closure glaucoma

Correct Ans:C

Explanation

Ring scotoma involves the point of fixation. Conditions resulting in ring scotoma arepigmentary retinopathies, retinitis, choroiditis, myopia, open angle glaucoma and opticneuropathies.

Bilateral annular scotomas occur due to bilateral retinal or optic nerve disease but mayalso occur with bilateral occipital pole damage or occur on a functional basis.

Scotomas are abnormal blind spots in visual fields.

Types of scotomas:Central scotomas: In this the point of fixation is involved and central visual acuity isimpaired.Centrocecal scotoma: It involve the point of fixation and extend to the normal blindspot.Paracentral scotoma: It involves the area adjacent to the point of fixation.Scintillating scotoma: They are subjective experiences of bright colorless and coloredlights in the line of vision. They are often reported by patients as part of the aurapreceding migraine headache.

Ref: Waxman S.G. (2010). Chapter 15. The Visual System. In S.G. Waxman(Ed),Clinical Neuroanatomy, 26e. Clinical Pathways in NeuroOphthalmology: AnEvidenceBased Approach By Andrew Lee, Paul Brazis page 2018.


Q:12 Dalen Fuch nodules are seen in:

A: Sympathetic opthalmitisB: Anterior uveitisC: Eye injuryD: Glaucoma

Correct Ans:A

ExplanationDalen Fuchs nodules are seen in patients with sympathetic ophthalmia, a bilateral,granulomatous panuveitis that follows penetrating ocular injury, intraocular surgery orlaser cyclo coagulation. Dalen Fuchs nodules are small, discrete, yellow elevated infiltrates commonly seen inthe midperipheral fundus of patients with sympathetic uveitis. They consist oflymphocytes and epithelioid cell collections between bruch membrane and RPE. Ref: Clinical Pathways In Vitreoretinal Disease edited by Scott M Steidl, page 77


Q:13Which type of senile cataract is notorious for glaucoma formation?

A: Incipient cataractB: Hypermature morgagniC: Intumescent cataractD: Nuclear cataract

Correct Ans:C

ExplanationIn intumescent cataract, the lens may take up fluid during cataractous change,increasing markedly in size. It may then encroach upon the anterior chamber,producing both pupillary block and angle crowding and resulting in acute angle closure.Treatment consists of lens extraction once the intraocular pressure has been controlledmedically. Ref: Salmon J.F. (2011). Chapter 11. Glaucoma. In P. RiordanEva, E.T. Cunningham,Jr. (Eds), Vaughan & Asbury's General Ophthalmology, 18e.


Q:14 The mode of action of Lanatoprost in glaucoma:

A: Increasing trabecular outflowB: Releasing pupillary blockC: Decreasing aqueous humour formationD: Increasing uveoscleral outflow

Correct Ans:D

Explanation

Lantanoprost is prastoglandin in nature and decrease the intraocular pressure byincreasing uveoscleral outflow of aqueous humour. It is very good adjunctive therapyalong with betablockers, dorzolamide and pilocarpine.

Ref: A.K KHURANA (2005), Chapter 9, “Glaucoma”, In the book, “Opthalmology”, 3rdEdition, Newdelhi, Page 229 ; KDT 5th Edition, 8


Q:15 A patient having glaucoma develops blepharoconjunctivitis after instilling someantiglaucoma drug. Which of the following drug can be responsible for it:

A: TimololB: LatanosprostC: DipiverineD: Pilocarpine

Correct Ans:A

Explanation

Allergic blepharoconjunctivitis is a side effect of beta blockers.

Ref: Essentials of Medical Pharmacology By K D Tripathi, 4th Edition, Page 95


Q:16 Kusumlata presents with acute painful red eye and mild dilated vertically ovalpupil. Most likely diagnosis is:

A: Acute retrobulber neuritisB: Acute angle closure glaucomaC: Acute anterior uveitisD: Severe keratoconjunctivitis

Correct Ans:B

Explanation

Acute painful red eye and mild dilated vertically oval pupil give the diagnosis of acuteangle closure glaucoma.

Ref: Comprehensive Ophthalmology By AK Khurana, 2nd Edition, Page 232


Q:17 Babloo a 5 yrs old child presents with large cornea, lacrimation and photophobia;Diagnosis is:

A: MegalocorneaB: Congenital glaucoma

C: Congenital cataractD: Anterior uveitis

Correct Ans:B

Explanation

In this scenario signs and symptoms occur as a result of congenital glaucoma.

Ref: Comprehensive Ophthalmology A K Khurana 4th Edition, Pages 21112 ; Textbookof Ophthalmology By Neema, 3rd Edition, Page 190


Q:18 A woman complains of coloured halos around lights in the evening, with nauseaand vomiting, IOP is normal; Diagnosis is:

A: Incipient stage glaucoma open angleB: Prodromal stage, closed angle glaucomaC: MigraineD: Raised ICT

Correct Ans:B

Explanation

The patient in question presents with symptoms suggestive of glaucoma, but a normalIOP on examination. This is therefore most likely a case of Prodromal stage ofGlaucoma.

Ref: Concise Textbook Of Ophthalmology By Sharma, Page119 ; Clinical OphthalmologyBy Kanski, 3rd Edition, Page 255 and 4th Edition, Page 213 ; ComprehensiveOphthalmology A K Khurana 4th Edition, Page 225


Q:19Which of the following antiglaucoma medications can cause drowsiness?

A: TimololB: LatanoprostC: BrimonidineD: Dorzolamide

Correct Ans:C

Explanation

Among the anti glaucoma medications given in the question, brimonidine can causedrowsiness.

Brimonidine is a selective alpha 2 adrenergic agonist that lowers intra ocular pressure

by decreasing aqueous humor production and enhancing uveoscleral outflow. Mostcommon adverse effects associated with its use are dry mouth, ocular hyperemia,ocular burning, headache, blurred vision, foreign body sensation and drowsiness.

Ref: Mastering the Tech. of Glaucoma Diagnosis and Management By Garg, Page161; Comprehensive Ophthalmology By A K Khurana, 4th Edition, Pages 425, 427.


Q:20Which of the following drugs is not used topically for treatment of open angleglaucoma?

A: LatanoprostB: BrimonidineC: AcetazolamideD: Dorzolamide

Correct Ans:C

Explanation

Acetazolamide is a carbonic anhydrase inhibitor used orally and not topically fortreatment of open angle glaucoma. It acts by inhibiting carbonic anhydrase enzymeinvolved in the synthesis of aqueous humor.

Ref: Comprehensive Ophthalmology By A K Khurana, 4th Edition, Pages 4257.


Q:21

A 64yearold woman in otherwise excellent health is referred by her optician toophthalmology outpatients. The optician has noticed cupping of the optic disc andenlargement of the blind spot. Tonometry confirms the diagnosis of chronicsimple (open angle) glaucoma. Choose the most appropriate drug from thechoices below.

A: BrimonidineB: TropicamideC: TimololD: Hypromellose

Correct Ans:C

Explanation

Chronic simple (open angle) glaucoma is one of the major causes of blindness. Incontrast to acute (closed angle) glaucoma, its onset is insidious and painless. Initialtreatment is with a topical betablocker, such as timolol, with the provison thatsignificant systemic absorption may occur; the usual cautions and contraindications tobetablockers should be observed. If initial treatment does not reduce intraocularpressure sufficiently, additional treatments may include parasympathomimetics (e.g.pilocarpine); selective alpha2adrenoceptor agonists (e.g. brimonidine); carbonicanhydrase inhibitors (e.g. dorzolamide) and prostaglandin analogues (e.g. latanoprost).

If medical treatment fails, surgical trabeculectomy or laser trabeculoplasty may benecessary.


Q:22

A 55yearold woman presents to her physician complaining of acute pain andredness in her right eye, with nausea and vomiting. She reports seeing halosaround lights. On examination, lacrimation, lid edema, conjunctival injection, asteamy cornea, and a fixed middilated pupil are seen. She has markedlyelevated intraocular pressure (IOP), and a visual acuity of 20/200 in her righteye. She has no family history of eye diseases. Which of the following is the mostlikely diagnosis?

A: Acute closedangle glaucomaB: Corneal lacerationC: Ocular hypertension without glaucomaD: Open angle glaucoma

Correct Ans:A

Explanation

This patient has acute closedangle glaucoma, as evidenced by the pain and redness ofher eye, the steamy cornea, her description of halos around lights, and her markedlyelevated intraocular pressure. The fixed middilated pupil indicates ischemia to the iris.Unlike open angle glaucoma, closedangle glaucoma (also called narrowangle orangleclosure glaucoma) is a medical emergency, and requires immediate diagnosisand treatment to prevent permanent visual impairment.

The anterior and posterior chambers of the eye are filled with aqueous humor, whichflows from the posterior chamber, through the pupil, into the anterior chamber, into thetrabecular network, and then exits the eye via the canal of Schlemm.

Individuals with a shallow or narrow anterior chamber or thickened lens may bepredisposed to this type of glaucoma because their iris is in close opposition to thechamber angle and cornea (narrow angle). If the aqueous humor is produced at agreater rate than it can be drained, intraocular pressure rises. Any stimulus that causespupillary dilation (e.g., anticholinergic medications, sympathomimetics, emotionalupset, dim lighting) can precipitate an attack.

The cornea may look hazy because of edema, but corneal laceration is produced bytrauma. There is no history of trauma in this patient and the symptoms exhibited bythis patient strongly suggest acute closedangle glaucoma.

Intraocular hypertension is a condition in which IOP is higher than normal (greaterthan 21 mm Hg), but there is no damage to the optic nerve or visual loss. About 90% ofpeople with elevated IOP never develop glaucoma. There is no associated pain or visualsymptoms associated with this. Known as the "sneak thief of sight," openangle glaucoma has no early warning signsor symptoms, and accounts for 90% of all glaucoma cases. It is a slow progressivecondition, usually affecting both eyes, in which there is an increase in resistance to theoutflow of aqueous humor. This resistance is associated with a normal rate ofproduction of the fluid and normal anterior chamber angle. Elevated IOP is the mostcommon finding and agerelated changes in the trabecular region are the most likelyexplanation of this disease.


Q:23

A 45 year old male presents to the clinic with insidious onset of loss of vision,mild headache and eye ache. He also gives a history of frequent change inreading glass. On examination he was found to glaucomatous visual field defectsbut his intraocular pressure was normal. Fundus examination showed pale discwith a large cup.

Assertion: Betaxolol is the drug of choice for this condition.

Reason: Lowering the intraocular pressure and increasing the optic nerve blood flow arehelpful in this condition.

A: Both Assertion and Reason are true, and Reason is the correct explanation forAssertion

B: Both Assertion and Reason are true, and Reason is not the correct explanationfor AssertionC: Assertion is true, but Reason is falseD: Assertion is false, but Reason is true

Correct Ans:A

Explanation

Patient is suffering from normal tension glaucoma. It is said to occur when typicalglaucomatous disc changes with or without visual field defects are associated with anIOP below 21 mmHg. It is believed to result from chronic low vascular perfusion whichmakes the optic nerve head susceptible to normal intraocular pressure. Betaxolol is thedrug of choice for this condition, because in addition to lowering the intraocularpressure, it also increases the optic nerve blood flow.

Ref: Comprehensive Ophthalmology By A K Khurana, 4th Edition, Page 224


Q:24 A patient who is on long term steroid developed certain ocular symptoms sincefew weeks. Which of the following condition is caused by chronic steroid use?

A: Open angle glaucomaB: Conjunctival papillomatosisC: UveitisD: None of the above

Correct Ans:A

Explanation

Topical, periocular, and intraocular corticosteroids may produce a type ofglaucoma that simulates primary openangle glaucoma, particularly in individualswith a family history of the disease, and will exaggerate the intraocular pressureelevation in those with established primary openangle glaucoma. Systemic steroid therapy is less likely to cause a rise in intraocular pressure.

Ref: Salmon J.F. (2011). Chapter 11. Glaucoma. In P. RiordanEva, E.T. Cunningham,Jr. (Eds), Vaughan & Asbury's General Ophthalmology, 18e.


Q:25A 56 year old female is brought to casualty with acute narrow angle glaucoma.She has severe pain in her eye and it spreads. The radiation of pain in acutenarrow angle glaucoma is in the distribution of:

A: Ill nerveB: V nerveC: VII nerveD: II nerve

Correct Ans:B

Explanation

Acute primary angle glaucoma:

It occurs due to a sudden total angle closure leading to severe rise in intraocularpressure (IOP). Typically acute attack is characterized by sudden onset of very severe pain in the eyewhich radiates along the branches of 5th nerve.

Nausea, vomiting and prostrations are frequently associated with pain. Ref: Comprehensive Ophthalmology by A K Khurana, 4th edition, Page 229.


Q:26A patient presents with h/o evening halos and occasional headache for somemonths. His examination shows normal IOP but shallow AC. He is in which stageof glaucoma?

A: AcuteB: AbsoluteC: ProdromeD: Constant instability

Correct Ans:C

Explanation

Five clinical stages are discernable in primary angle closure glaucoma (PACG):

Prodromal stage: Patient sees coloured haloes due to high intraocular pressure

(IOP) with some obscuration of visionChronic instability stage: The intermittency of the prodromal stage is replaced bythe regularity of attacks.Acute ACG stage: Acute attacks glaucomaChronic ACG stage: The recurrent attacks of angle closure eventually lead toperipheral anterior synechiae that may permanently block the exit pathwaysAbsolute glaucoma: It is the end result of untreated attacks ACG or chronic ACG.It results in a stony hard, painful, blind eye.

Ref: Concise Textbook Of Ophthalmology By Sharma, 2006, Page 118.


Q:27 All of the following can predispose to development of angle closure glaucoma,EXCEPT:

A: Small corneaB: Smaller diameter of lensC: Shallow ACD: Small eyeball

Correct Ans:B

Explanation

Anatomical risk factors for developing primary angle closure glaucoma are:

Hypermetropic eyes with shallow anterior chamberEyes in which irislens diaphragm is placed anteriorlyEyes with narrow angle of anterior chamber, which may be due to: small eyeball,relatively large size of the lens and smaller diameter of the cornea or bigger sizeof the ciliary bodyPlateau iris configuration

Ref: Comprehensive Ophthalmology by AK Khurana, 4th edition, Page 225.


Q:28Which of the following type of glaucoma is treated by Argon LaserTrabeculoplasty?

A: Open angle glaucomaB: Secondary glaucomaC: Angle recession glaucomaD: Angle closure glaucoma

Correct Ans:A

Explanation

Laser trabeculoplasty is effective in the initial treatment of primary openangle

glaucoma. Application of laser (either argon or frequencydoubled Qswitched Nd:YAG)burns via a goniolens to the trabecular meshwork facilitates aqueous outflow by virtueof its effects on the trabecular meshwork and Schlemm's canal or cellular events thatenhance the function of the meshwork. The pressure reduction usually allows decreaseof medical therapy and postponement of glaucoma surgery.

Ref: Salmon J.F. (2011). Chapter 11. Glaucoma. In P. RiordanEva, E.T. Cunningham,Jr. (Eds), Vaughan & Asbury's General Ophthalmology, 18e.


Q:29Which among the following is the indication for using Fincham's test?

A: To diagnose congenital glaucomaB: To diagnose acute congestive glaucomaC: For differential diagnosis of acute congestive glaucoma from cataractD: To diagnose congenital cataract

Correct Ans:C

ExplanationThe coloured halos in glaucoma must be differentiated from those found in acutepurulent conjunctivitis and early cataractous changes. In conjunctivitis, the halos canbe eliminated by irrigating the discharge. The halos of glaucoma and immature cataractmay be differentiated by Fincham’s test in which a stenopaic slit is passed across thepupil. During this test glaucomatous halo remains intact, while a halo due to cataract isbroken up into segments. Ref: Comprehensive Ophthalmology by AK Khurana, 4th edition, Page 228.


Q:30 Following anatomic factors predispose to glaucoma, EXCEPT:

A: Flat corneaB: Increased length of eyeballC: Shallow anterior chamberD: Big size of ciliary body

Correct Ans:B

ExplanationAnatomic risk factors for the development of acute angle closure glaucoma are smalleyes with shallow anterior chamber, short axial length, small corneal diameter, shallowlimbal chamber depth and thick, relatively anteriorly positioned lens. Risk factors for primary open angle glaucoma:

AgeRaceFamily historyDiabetes mellitusThin central corneaSystemic hypertension

REF: Pearls of Glaucoma Management edited by JoAnn A. Giaconi, page 415.


Q:31A 30 days old neonate presented with excessive lacrimation and photophobia. Hehas a large and hazy cornea. I lis both lacrimal duct systems arc normal. Thediagnosis is:

A: MegalocorneaB: KeratoconusC: Congenital glaucomaD: Hunter's syndrome

Correct Ans:C

ExplanationCongenital glaucoma is often bilateral. The most striking symptom is extremephotophobia. Early signs are corneal haze or opacity, increased corneal diameter, andincreased intraocular pressure. Since the outer coats of the eyeball are not as rigid inthe child, the increased intraocular pressure expands the corneal and scleral tissues,producing an eye that is larger than normal (buphthalmos). Early recognition isessential to prevent permanent blindness. Ref: Fredrick D.R. (2011). Chapter 17. Special Subjects of Pediatric Interest. In P.RiordanEva, E.T. Cunningham, Jr. (Eds), Vaughan & Asbury's General Ophthalmology,18e.


Q:32Cholinergic drugs such as pilocarpine are routinely used to treat glaucoma. Whatis their mechanism of action in the eye that accounts for this ophthalmologicuse?

A: Reduction in the formation of aqueous humorB: Blockade of adrenergic receptors to potentiate cholinergic effectsC: Alkalinization of aqueous humorD: Improved drainage of aqueous humor

Correct Ans:D

ExplanationLike other cholinergics with muscarinic action, pilocarpine improves the drainage ofaqueous humor from the anterior chamber angle of the eye. The cholinomimetic effectresults in contraction of the ciliary body and causes a change in its position. Thisaltered position increases flow of aqueous humor through the trabecular network andinto the canal of Schlemm, thus decreasing the intraocular pressure of glaucoma.

Ref: Brown J.H., Laiken N. (2011). Chapter 9. Muscarinic Receptor Agonists andAntagonists. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman'sThe Pharmacological Basis of Therapeutics, 12e.


Q:33 Von Recklinghausen disease is associated with:

A: GlaucomaB: Optic Nerve gliomaC: Neurofibroma of the lidsD: All the above

Correct Ans:D

Explanation

Glaucoma, Optic nerve glioma and Neurofibroma of the lids are all seen inNeurofibromatosisi 1.

Ref: Comprehensive Manual of Ophthalmology, By E. Ahmed, Page 148; OcularPathology, By Myron Yanoff, Joseph W. Sassani, Page 33; Kanski 6th Edition, Page 917


Q:34Which of the following will not cause pupillary white reflex?

A: RetinoblastomaB: GlaucomaC: CataractD: Retrolental fibroplasia

Correct Ans:B

Explanation

Glaucoma is not a cause of white pupillary reflex (cat’s eye reflex). The patient shouldbe evaluated immediately as an important differential diagnosis is retinoblastoma.

Ref: A.K KHURANA (2005), In the book, “Opthalmology”, 3rd Edition, Newdelhi, Page23, 170, 269


Q:35Which statement regarding glaucoma is true?

A: If recognized early, the optic neuropathy of glaucoma is reversible

B: Topical Badrenergic antagonists have few if any side effect due to theirsystemic absorption

C: The initial symptom oh optic neuropathy due to glaucoma is loss of centralvisionD: None of the above

Correct Ans:D

Explanation

Glaucoma is the leading cause of irreversible blindness in the world. Whensufficient axinal loss occurs, peripheral vision declines. Loss of central vision occursmuch later in the disease process. Retinopathy due to glaucoma is irreversible.Treatment is focused on lowering intraocular pressure. Reduction in intracecularpressure has been demonstrated to protect against further damage to the opticnerve. Primary openangle is by far the most common type of glaucoma in the UnitedStates. Closedangle glaucoma is more common among Asians. The Schijltztonometer, due to the fact that it is inexpensive, is the most frequently used device tomeasure intraoccular pressure in the United States. It is used in both hospitals andoutpatient clinics. βAdrenergic antagonists are one of the more commonly used drugsand are initially started as a topical agent. Unfortunately, excess drug drains throughthe nasolacrimal duct into the nose and is absorbed into the systemic circulation.Therefore systemic side effects can occur and may be severe. It is not unusual forpatients to be treated with a bronchodilater drug for newonset bronchospasmswithout the physician considering the use of topical βadrenergic antagonist, used forglaucoma treatment, which may have contributed to the condition.


Q:36 Circumcorneal congestion is not seen in?

A: Acute bacterial conjunctivitisB: Acute iritis C: Acute glaucomaD: Scleritis

Correct Ans:D

Explanation

Scleritis

REF: khurana 4th ed p. 147

"Scleritis usually presents as diffuse erythema of the conjunctiva and sclera ratherthan circumcorneal congestion"


Q:37 In Acute angle closure glaucoma all are seen EXCEPT:

A: Cupping of discB: Bayonetting signC: Snow bankingD: Oval cup

Correct Ans:C

Explanation

Snow banking REF: Khurana 4th ed p. 216

"Snow banking is seen in pars planitis not acute angle closure glaucoma"

Optic disc changes in POAG include:

High cup:disc ratioCup:disc ratio asymmetry between eyes (usually considered significant if greaterthan 0.2)Vertical elongation of cupFocal neuroretinal rim thinning or notchingVessel bayonetingBetazone peripapillary atrophyDisc hemorrhage


glaucoma previous year questions

Health & Medicine