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Ophthalmology, glaucoma

  Part 1, glaucoma anatomy and introduction

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MCQ

1- Glaucoma means:

 a-Increased I.O.P.

 b-Changes of the field of vision 

 c-Changes of the optic nerve disc

 d-All

2- Aqueous humour is produced by: 

 a) Trabecular meshwork 

 b) Ciliary body 

 c) Iris

 d) Schlemm’s canal

 e) Zonules

3- The aqueous humor is drained through:

 a-the trabecular meshwork 

 b-the iris crypts

 c-the suprachoroidal space

 d-all of the above

4- Gonioscopy allows examination of:

 a-IOP 

 b-the fundus of the eye

 c-the angle of ant chamber

 d-the field of vision

5- Regarding the IOP measurement, which of the following can lead to high false reading by Goldman applanation tonometer (GAT): 

 a) Too much fluorescein stain.

 b) Associated conjunctivitis. 

 c) Corneal edema. 

 d) Repeated measurement over short period.

 e) thin cornea. 

6- A non-contact method for IOP measurement is : 

a. Indentation tonometry. 

b. Goldman applanation. 

c. Digital method.

 d. Air puff.

 e. Perkins method. 

 7- IOP is can be measured by:

 a-the digital method

 b-indentation tonometry

 c-applanation tonometry

 d-all of the above

8- Best Investigation for follow up of Glaucoma: 

a. Pentacam 

b. Visual Field

c. OCT macula 

d. Refraction 

e. B scan 

9- Central field extends for ……… degrees in all directions from the fixation point :

 A-15 

 B-20 

 C-30

 D-40

 E-45 

10- Perimetry is done by

a-Arc perimeter 

b-Goldman perimeter 

c-Automated perimeter 

d-All of the above

11- Optic nerve axons emerge from: 

a-Ganglion cells

b-Rods and cones

c-Amacrine cells 

d-Bipolar cells 

 e-Inner nuclear layer 

12- Which of the following is a method to assess anterior chamber angle? 

a. visual field. 

b. B scan.

c. UBM. 

d. FFA. 

e. slit lamp  

13- Which of the following is TRUE concerning the intraocular pressure

a) It varies during the day with a peak in the early morning

b) Normal value is 9-21 mmHg

c) It can be normal in patients with glaucoma

d) A and B only

e) All of the above

Answers

1. D

2. B

3. D

4. C

5. A

6. D

7. D

8. B

9. C

10. D

11. A

12. C

13. E

Part 2,congenital glaucoma

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MCQ

1- One of the following is a differential diagnosis of congenital glaucoma:

 a- Keratoconus

 b- Megalocornea

 c- Trachomatous pannus

 d- Keratomalacia 

e- ROP 

2. In congenital glaucoma management, which is correct?

a: Medical treatment may be enough. 

b. Laser PI is an available option. 

c. Drainage device is the best initial management. 

d. Subscleral trabeculectomy may be an option. 

e. Trabeculotomy requires a clear cornea

3- Regarding congenital glaucoma which of the following statement is true:

 a) Refraction will show hypermetropia. 

 b) Usually, unilateral.

 c) Anterior chamber is shallow.

 d) Haab’s striae represent vertical lines

 e) corneal diameter increased.

4- Treatment of buphthalmos is :

  a-Medical 

  b-Surgical after 2 years

  c-As early as possible surgical

  d-Mannitol 

  e-enucleation at time of diagnosis 

5- In subscleral trabeculectomy, a fistulous traction is created to drain the aqueous between which structures:

 a) Vitreous cavity and episcleral space.

 b) Suprachoroidal space and episcleral space. 

c) Anterior chamber and posterior chamber.

 d) Anterior chamber and episcleral/subconjunctival space. 

e) Anterior chamber and suprachoroidal space.

6- A one-month old baby is brought with complaints of photophobia and watering. Clinical examination shows normal tear passages and clear but large cornea. The most likely diagnosis is: 

 a) Congenital dacryocystitis 

 b) Interstitial keratitis

 c) Keratoconus

 d) Buphthalmos 

 e) Neonatal conjunctivitis

7- A newly born presented with big hazy cornea and watering with photophobia. The initial management will be: 

a-Electrophysiologic investigations 

 b-Syringing of NLD 

 c-Fluorescein staining

 d-Measuring the IOP

 e-Pediatric consultation

8- The best line of treatment of buphthalmousis 

 a-Pilocarpine eye drops.

 b-B-Adrenergic blocker eye drops. 

 c-Periphraliridectomy. 

 d-Gonitomy

9- Buphthalmos is usually associated with the following Except 

a-Opaque cornea 

 b-Corneal diameter more than 12mm 

 c-Hypermetropia

 d-Deep anterior chamber

10- Diagnosis of buphthalmos is based on all of the following except:

a) Field changes

b) Corneal diameter

c) IOP

d) Fundus changes

11- In case of buphthalmos we usually find

a) Shallow Anterior Chamber

b) Large Hazy cornea  > 13mm.

c) Leukocoria,

d) Oclusio pupillae.

Answers

1. B

2. D

3. E

4. C

5. D

6. D

7. D

8. D

9. C

10.A

11. B

Glaucoma part3 (POAG), primary open angle glaucoma, ophthalmology

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1-Primary open angle glaucoma is not treated by : 

a-PG analogue

b-Carbonic anhydrase 

c-Betablockers 

d-Atropine 

e-Glaucoma Filtering surgery

2-Systemic carbonic anhydrase inhibitors have the following effect: 

a-Paresthesia; tingling of fingers, hands & toes

b-Bronchospasm 

c-Bradycardia

d-HTN

e-Hyperlipidemia

3. One of specific sign of optic nerve head change in glaucoma;

a. Laminal dot sign 

b. Nasal shift of blood vessels 

c. Peripapillary atrophy

d. Bayontting of blood vessels 

e. Focal notching of rim

4. Which of the following is not related to glaucomatous visual field changes:

 a. Paracentral sctoma

 b. Siedle scotoma

 c. Arcuate scotoma 

 d. Respecting vertical meridian

 e. Tubular vision

5. A primary open angle glaucoma patient on medical treatment complaining of increased iris and lash pigmentation, which of the following drug is accused?

 a. Beta blocker.

 b. Alpha 2 agonist. 

 c. Miotics. 

 d. Prostaglandin analogue. 

 e. Carbonic anhydrase inhibitior.

6. Beta blockers help to decrease IOP by 

a. Increase aqueous outflow. 

b. Decrease aqueous secretion.

c. Increase uveoscleral outflow. 

d. Vitreous shrinkage. 

e. Iris blood vessels dilatation.

7. Which of the following clinical features are associated with ocular hypertension: 

 a) Increased IOP, abnormal optic disc and abnormal visual field.

 b) Increased IOP, normal optic disc and normal visual field.

 c) Normal IOP, abnormal optic disc, normal visual field.

 d) Normal IOP, abnormal optic disc and abnormal visual field.

 e) Normal IOP, normal optic disc and normal visual field.

8. Specific signs of optic disc changes in glaucomatous optic neuropathy include: 

 a) Optic disc swelling. 

 b) Nasal shift of blood vessels. 

 c) Diffuse pallor of the neuro-retinal rim.

 d) asymmetrical increase of C/D ratio.

 e) Laminar dot sign. 

9. Fixation loss in the visual field of glaucomatous patient represent affection of which part of the retinal nerve fiber layer: 

a) Upper temporal fibers.

b) Lower temporal fibers. 

c) Macular fibers. 

d) Lower nasal fibers. 

e) Upper nasal fibers.

10. Prostaglandin analogues reduce the IOP by the following mechanism:

a) Decreased aqueous humor production. 

b) Withdrawal of fluid from the vitreous cavity with vitreous shrinkage. 

c) Increase aqueous drainage through the trabecular meshwork. 

d) Increase aqueous drainage through the uveoscleral pathway.

e) Reduction of episcleral venous pressure. 

11. In subscleral trabeculectomy, a fistulous traction is created to drain the aqueous between which structures:

a) Vitreous cavity and episcleral space. 

b) Suprachoroidal space and episcleral space.

c) Anterior chamber and posterior chamber.

 d) Anterior chamber and episcleral/subconjunctival space. 

e) Anterior chamber and suprachoroidal space. 

12. The 1st line for treating 1ry OAG (IOP:26 mmhg) in a asthmatic patient is :

a-Timolol E.D. b-Acetazolamide tablet

c-Latanoprost E.D. 

d-Flurometholone E.D.

e-Dexamethasone E.D. 

13. Glaucoma suspected by :

 a-deep anterior chamber. 

 b-hemianopia 

 c-Edema of the optic nerve disc. 

 d-optic disc rim vertical notching.

 e-Large Optic disc.

14. The earliest visual field defect in POAG is 

a. Isolated paracentral nasal scotoma 

b. Bjerrums scotoma 

c. Arcuate scotoma 

d. Altitudinal Scotoma

e. Centrocecal scotoma 

15. Best Investigation for follow up of Glaucoma:

 a. Pentacam 

 b. Visual Field

 c. OCT macula

 d. Refraction

 e. B scan

Answers

1. D

2. A

3. E

4. D

5. D

6. B

7. B

8. D

9. C

10. D

11. D

12. C

13. D

14. A

15. B


Glaucoma part 4 (primary angle closure)

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MCQ and Answers

1- In acute congestive glaucoma the pupil is:
a) Miotic non-reactive.
b) Festooned, non-reactive.
c) Mid-dilated, non-reactive. 
d) D shaped, reactive.


answer c


2- A female aged 50 years old suddenly developed severe headache, drop of vision and redness of one eye. We should search for diagnostic sign in:
a) The cornea
b) The pupil
c) The lens
d) The fundus


answer b


3- In acute congestive glaucoma we usually find:
a) Miotic pupil
b) Comeal edema
c) Cyclitic membrane
d) keratic perceptiates


answer b


4- Which of the following conditions need immediate hospitalization:
a) Central retinal vein occlusion
b) Open angle glaucoma
c) Denderitic ulcer
d) Acute angle closure glaucoma


answer d


5- Management of primary acute congestive glaucoma is by:
a) Miotics for life
b) Urgent surgery after medical control of IOP
c) Surgery if medical treatment failed


answer b


6- Treatment of Acute attack of 1% angle closure glaucoma include all the following except:
a) Cycloplegics.
b) Carbonic anhydrase inhibitors.
c) Pilocarpine eye drops.
d) Beta-blockers


answer a


7-Cases of neovascular glaucoma get worse after the application of:
a) Corticosteroids.
b) Miotics.
c) Antibiotics.
d) Mydriatics


answer b


8-Glaucoma inversus is found with:
a) Anterior lens dislocation.
b) Posterior lens dislocation.
c) Central retinal vein occlusion.
d) Post cataract vitreous prolapse.


answer a


9- Pupillary block glaucoma is found with:
a) Anterior tens dislocation.
b) Posterior lens dislocation.
c) Primary open angle glaucoma.
d) High myopia.


answer a


10-Lens induced glaucoma occur in the following conditions except:
a) Intumescent cataract.
b) Anterior polar cataract.
c) Hypermature cataract.
d) Subluxation of the lens


answer b


11- All of the following are lens induced glaucoma except Pepp
a) Phacomorphic glaucoma
b) Phacoanaphlactic glaucoma
c) Phacolytic glaucoma
d) Neovascular glaucoma


answer d


12- Which of the following drugs can lead to rise of intraocular pressure
a) Steroids
b) Beta blockers
c) Brimonidine
d) Mannitol


answer a


13-Glaucoma inversus is found with:
a) Anterior lens dislocation.
b) Posterior lens dislocation.
c) Central retinal vein occlusion.
d) Post cataract vitreous prolapse.


answer a


L27,28 glaucoma part 5, secondary glaucoma, ophthalmology

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MCQ as part 4

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