Glaucoma

1. The following visual field defects are typically seen in primary open angle glaucoma:

a. centrocecal scotoma

b. nasal step

c. central scotoma

d. paracentral scotoma

e. altitudinal field loss
 

answer1.    a.F    b.T    c.F    d.T    e.FCentrocecal scotoma is seen in toxic amblyopiaCentral scotoma occurs in optic nerve or macular diseasesAltitudinal field loss is seen in ischaemic optic neuropathyor retinal vascular disorder

2. Early signs of glaucomatous damage include:

a. splinter haemorrhage of the optic disc

b. glaucoflecken

c. vertical elongation of the cup

d. loss nerve fibre layer

e. peripapillary atrophy

answer2.    a.T    b.F    c.T    d.T    e.FEarly signs of glaucomatous damage include:splinter haemorrhages of  the optic discloss of nerve fibre layervertical elongation of the optic cupglaucoflecken is a sign of acute glaucomaperipapillary atrophy may predispose a patient to glaucomatous damage but is not a sign of glaucomatous damage

3. Static perimetry include:

a. Lister perimeter

b. Goldmann perimeter

c. tangent screen

d. Octopus

e. Humphrey

answer3.    a.T    b.T    c.T    d.F    e.FGoldmann perimeter can be used as static as well kinetic perimetryOctopus and Humphrey are automated instruments used for static perimetry

4. The following are direct gonio lenses:

a. Koeppe

b. Goldmann

c. Thorpe

d. Zeiss

e. Barkan
 

answer4.   a.T    b.F    c.T    d.F    e.TDirect gonio lenses include Koeppe, Swan-Jacob, Thorpe and Medical Workshop prismaticIndirect gonio lenses include Goldmann and Zeiss

5. In pigmentary dispersion syndrome:

a. the pigments is caused by the release of melanin from
    the anterior surface of the iris

b. the incidence of affected male to female is 5:1

c. peripupillary retroillumination is a feature

d. heterochromia can occur

e. latanoprost should be avoided as it increases the release
    of pigments
 

answer5.    a.F    b.T    c.F    d.T    e.FPigmentary dispersion syndrome:the ratio of male to female is 5:1 and most affected patientsare young myopicthe pigments is caused by shedding of the melanin from the posterior surface of the iris as the iris rubbed against the anterior surface of the zonular fibrilsmidpupillary retroillumination is a feature and in severe cases can lead to heterochromiapilocarpine is avoided as it is poorly tolerated by young people and can increase the myopia
 

6. Blood in Schlemm's canal is seen in:

a. Sturge-Weber's syndrome

b. carotid-cavernous fistula

c. angle recession glaucoma

d. hypotony

e. neurofibromatosis

answer6.    a.T    b.T   c.F    d.T    e.F
 

7. The following are true about lens induced glaucoma:

a. laser iridotomy is ineffective against pharcomorphic
    glaucoma

b. phacolytic glaucoma is characterized by blockage of the
    trabecular meshwork by protein laden marcophages

c. phacolytic glaucoma typically occurs following cataract
    extraction

d. phacolytic glaucoma is associated with Morgagnian
    cataract

e. phacoanaphylactic glaucoma is associated with
    granulomatous inflammation

answer7.    a.F    b.T    c.F    d.T    e.TGlaucoma associated with lens:pharcomorphic glaucoma requires cataract extraction but while waiting for this laser iridotomy is effective in lowering the pressurephacolytic glaucoma is caused by leakage of lens protein through an intact capsule, it is seen in hypermature and Morgagnian cataract.  The trabecular meshwork is clogged by protein laden marcophages.phacoanaphylactic glaucoma occurs when there is rupture of the lens capsule, it is an autoimmune granulomatous reaction to lens protein.
 

8. In a patient with angle recession glaucoma, gonioscopy may reveal:

a. separation of the ciliary body from its attachment to the
    scleral spur

b. increased visibility of the scleral spur

c. torn iris process

d. marked variation in the ciliary body width in different
    quadrant of the same eye

e. new vessels at the angle

answer8.    a.F    b.T    c.T    d.T    e.FAngle recession glaucoma:is caused by tear between the longitudinal and circular muscles of the ciliary bodygonioscopy will reveal torn iris process, widened ciliary body and marked variation in the ciliary body width in different quadrant of the same eyeSeparation of the ciliary body from its attachment to the scleral spur is seen in cyclodialysis

9. In primary congenital glaucoma:

a. the incidence is 1:12,500 births

b. the corneal diameter is usually greater than 8 mm

c. gonioscopy reveals iris hypoplasia

d. the cup: disc ratio is greater than 0.3

e. males are more commonly affected than females

answer9.    a.T    b.F    c.F    d.T    e.TPrimary congenital glaucoma:has an incidence of 1:12,500 birthsmost affected individuals are malethe corneal diameter is typically greater than 12.5mmthe cup disc ratio is greater than 0.3gonioscopy reveals anterior insertion of the iris
 

10. Sampaolesi's line:

a. is a pigmented line anterior to Schwalbe's line

b. occurs in pseudoexfoliation syndrome

c. is seen in pigment dispersion syndrome

d. occurs in iris melanoma

e. is seen in siderosis bulbi

answer10.    a.T    b.T    c.T    d.T    e.FSampaolesi's line:occurs in pseudoexfoliation syndrome, pigment dispersion syndrome, trauma and iris melanoma
 

11. In uveitic glaucoma:

a. pilocarpine is the treatment of choice in patient who can
    not take beta blockers

b. girls with pauciarticular juvenile rheumatoid arthritis are
    more likely to develop glaucoma than their male
    counterpart

c. simple trabeculectomy is associated with high failure
    rate

d. iridocyclitis is often associated with low rather than high
    intraocular pressure

e. iris bombe is a common complication of
    Posner-Schlossman syndrome

answer11.    a.F    b.T    c.T    d.T    e.FPilocarpine can lead to increased breakdown of the blood aqueous barrier and exacerbate the inflammationTrabeculectomy should be performed with anti-metaboliteInflammation of the ciliary body is associated with decreased aqueous productionPosterior synechiae is rare in Posner-Schlossman syndrome
 

12. In Humphrey automated perimeter, the following definition are true:

a. a false-negative response: failure to respond to a
    suprathreshold stimulus at a location that the patient
    would be expected to see

b. fixation loss: occurs when the patient responds to a
    target shown at his blind spot

c. high positive rate is seen in trigger happy patient

d. short term variation is greater in glaucomatous than
    normal population

e. short term variation refers to change in sensitivity when
    the same area is retested.
 

answer12.    a.T    b.T    c.T    d.T    e.T

13. The following glaucoma are associated with bilateral primary abnormalities of the corneal endothelium:

a. Axenfeld's anomaly

b. Peter's anomaly

c. Cogan-Reese syndrome

d. posterior polymorphous membraneous dystrophy

e. essential iris atrophy

answer13.    a.F    b.F    c.F    d.T    e.FAxenfeld's anomaly and Peter's anomaly are iridocorneal dysgenesis which affects both eyes but the primary disorders are not in the endotheliumCogen-Reese syndrome and essential iris atrophy are iridocorneal endothelial (ICE) syndrome which occur unilaterallyposterior polymorphous membraneous dystrophy is an inherited disorders of the endothelium which may be associated with glaucoma
 

14. True statements about topical beta blockers include:

a. 10% of patients do not show therapeutic response

b. therapeutic response is reduced in patients on systemic
    beta-blockers use

c. the additive effect on glaucoma is increased if it is
    combined with topical adrenaline than with topical
    acetazolamide

d. betaxolol is more effective than timolol in lowering
    intraocular pressure

e. bradycardia is less with carteolol than timolol

answer14.    a.T    b.T    c.F    d.F    e.TTopical beta blockers:the additive effect is stronger with topical acetazolamide than topical adrenalinebetaxolol is a selective blocker but less effective than timololcarteolol contains intrinsic sympathomimetic action and therefore causes less bradycardia than timolol
 

15. The risk of developing steroid-induced glaucoma is increased in the following conditions:

a. myopes

b. patients with a history of primary open angle glaucoma

c. history of angle closure glaucoma

d. diabetes mellitus

e. posterior synechiae

answer15.    a.T    b.T    c.F    d.T    e.FRisk of steroid-induced glaucoma is increased in:patients with open-angle glaucoma or a family history of primary open angle glaucomamyopesdiabetics
 

16. The following are true about laser peripheral iridotomies:

a. Nd:YAG laser requires fewer application compared
    with argon laser

b. bleeding is less common with argon than Nd:YAG laser

c. late closure of the iridotomies is commoner with argon
    than Nd:YAG laser

d. iris oedema is commoner with argon than Nd:YAG
    laser

e. pupillary distortion is commoner with argon than
    Nd:YAG laser

answer16.    a.T    b.T    c.T    d.T    e.TCompared with argon laser, Nd:YAG laser:requires less energycauses less iris oedema, iritis and pupillary distortioncauses less late closurebleeding is more common
 

17. True statements about systemic acetazolamide include:

a. it should be avoided in patients allergic to sulphonamides

b. it is associated with metabolic acidosis

c. it is associated with renal calculi

d. it causes transient myopia

e. it should be avoided in patient with hepatic
    encephalopathy

answer17.    a.T    b.T    c.T    d.T    e.TSystemic acetazolamide:contains sulfa groups and should be avoided in patients allergic to sulphonamidescauses metabolic acidosis and is associated with increased incidence of renal calculicauses transient acute myopiacan precipitate hepatic coma
 

18. The following are true about aqueous drainage devices:

a. all contain a silicone tube attached to a synthetic plate

b. corneal decompensation is a known complication

c. Molteno's tube contains pressure sensitive device

d. post-operative hypotony is commoner with Ahmed's
    valve than Molteno's tube

e. Krupin's valve contains pressure sensitive valve

answer18.    a.T    b.T    c.F    d.F   e.TAqueous drainage devices:all contains a silicone tube attached to a synthetic platecorneal decompensation can occur if the tube touches the corneaMolteno's tube and Baerveldt implant do not have a pressure sensitive valveAhmed valve and Krupin implant contain pressure sensitive valve and therefore less likely to cause post-operative hypotony.
 

19. Regarding anti-metabolites:

a. they are applied to the scleral flap during trabeculectomy

b. they increase the incidence of post-operative
    endophthalmitis

c. they inhibit DNA synthesis and therefore cellular
    proliferation

d. 5-fluorouracil is more likely to cause hypotony than
    mitomycin C

e. mitomycin C is associated with a higher incidence of
    wound leak than 5-fluorouracil

answer19.    a.F    b.T    c.T    d.F    e.TAnti-metabolites:are applied to the subconjunctiva and the scleral surfaceincrease the incidence of endophthalmitismitomycin C is more potent than 3-fluorouracil and therefore more likely to cause hypotony and wound leak
 

20. Apraclonidine:

a. is an alpha 2 agonist

b. causes conjunctival hyperaemia

c. causes increased uveoscleral outflow

d. produces miosis

e. causes lid retraction

answer20.    a.T    b.F    c.F    d.F    e.TApraclonidine:is an alpha 2 agonistcauses blanching of the conjunctivadecreases intraocular pressure via reduction of aqueous productioncauses lid retraction and mydriasis
 

Return to the main page