Primary Angle-Closure Glaucoma Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Primary Angle-Closure Glaucoma. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Primary Angle-Closure Glaucoma Indian Medical PG Question 1: Pilocarpine is used in all of the following except:
- A. Primary, Open Angle Glaucoma
- B. Acute Angle Closure Glaucoma
- C. Malignant Glaucoma (Correct Answer)
- D. Chronic Synechial Angle Closure Glaucoma
Primary Angle-Closure Glaucoma Explanation: ***Malignant Glaucoma***
- **Pilocarpine** is contraindicated in **malignant glaucoma** because it can worsen the condition by causing **ciliary body edema** and anterior displacement of the lens-iris diaphragm.
- This form of glaucoma requires treatment aimed at posterior displacement of the lens-iris diaphragm, often involving **cycloplegics**, **hyperosmotic agents**, or surgical interventions.
*Primary, Open Angle Glaucoma*
- **Pilocarpine** is an effective **miotic agent** that increases aqueous humor outflow through the **trabecular meshwork**, thereby lowering intraocular pressure.
- It can be used as a treatment for **primary open-angle glaucoma**, although it is less commonly used due to its side effects and the availability of better-tolerated medications.
*Acute Angle Closure Glaucoma*
- **Pilocarpine** is typically used in the management of **acute angle-closure glaucoma** after the intraocular pressure has been acutely lowered by other agents.
- It works by inducing **miosis**, which pulls the iris away from the **trabecular meshwork**, opening the angle and facilitating aqueous outflow.
*Chronic Synechial Angle Closure Glaucoma*
- In **chronic synechial angle-closure glaucoma**, **pilocarpine** can be used to break or prevent the formation of new **peripheral anterior synechiae** by constricting the pupil.
- However, its effectiveness is limited if extensive synechiae have already formed, as these physically block the outflow pathway.
Primary Angle-Closure Glaucoma Indian Medical PG Question 2: Select the diuretic that is most effective in acute angle-closure glaucoma.
- A. Furosemide
- B. Amiloride
- C. Indapamide
- D. Mannitol (Correct Answer)
Primary Angle-Closure Glaucoma Explanation: ***Mannitol***
- **Mannitol** is an osmotic diuretic that creates an osmotic gradient, drawing fluid from the eye into the bloodstream, thereby **rapidly reducing intraocular pressure (IOP)**.
- Its quick onset of action and potent IOP-lowering effect make it the **drug of choice for acute angle-closure glaucoma** when rapid pressure reduction is critical.
*Furosemide*
- **Furosemide** is a loop diuretic that primarily acts on the renal tubules to increase urine output, with **minimal direct effect on intraocular pressure**.
- While it can lower systemic blood pressure, its efficacy in **rapidly reducing elevated IOP in acute glaucoma is limited** compared to osmotic agents.
*Amiloride*
- **Amiloride** is a potassium-sparing diuretic that works in the collecting ducts of the kidneys and is primarily used for **hypertension and heart failure**, often in combination with other diuretics.
- It does not have a significant or rapid effect on **intraocular pressure**, making it ineffective for acute angle-closure glaucoma.
*Indapamide*
- **Indapamide** is a thiazide-like diuretic that acts on the distal convoluted tubule and is primarily used for the treatment of **hypertension and edema**.
- It has a slower onset of action and **does not effectively reduce intraocular pressure** in acute settings, making it unsuitable for acute angle-closure glaucoma.
Primary Angle-Closure Glaucoma Indian Medical PG Question 3: Sudden painful loss of vision seen in
- A. Angle closure glaucoma (Correct Answer)
- B. Endophthalmitis
- C. Acute uveitis
- D. Central retinal artery occlusion
Primary Angle-Closure Glaucoma Explanation: ***Angle closure glaucoma***
- This is the **classic presentation** of sudden, painful vision loss in ophthalmology
- Characterized by **acute increase in intraocular pressure** (often >40 mmHg) causing severe eye pain, headache, nausea, and vomiting
- Vision loss is rapid due to damage to the **optic nerve** and corneal edema
- The pain is intense and sharp due to stretching of ocular structures
- **Key distinguishing feature**: Mid-dilated fixed pupil, corneal edema, shallow anterior chamber
*Endophthalmitis*
- Also causes **sudden painful vision loss** and is a sight-threatening emergency
- Pain is severe with rapid onset of vision loss, redness, and hypopyon
- **Differentiating features**: History of recent ocular surgery, trauma, or intravitreal injection; presence of hypopyon (layered pus in anterior chamber)
- While both can present similarly, endophthalmitis typically has **obvious intraocular inflammation** and relevant preceding history
*Acute uveitis*
- Presents with **ocular pain**, **redness**, **photophobia**, and blurred vision
- Vision loss is usually **gradual**, not sudden and complete
- Pain is moderate, described as dull aching rather than severe acute pain
- Rarely causes sudden severe vision loss unless complicated
*Central retinal artery occlusion*
- Causes **sudden, painless loss of vision** - this is the key distinguishing feature
- Described as "curtain coming down" or sudden blackout of vision
- **Absence of pain** differentiates it from acute angle-closure glaucoma
- Cherry-red spot on fundoscopy is pathognomonic
Primary Angle-Closure Glaucoma Indian Medical PG Question 4: Sudden loss of vision without pain - Which of the following is NOT a cause?
- A. CRAO
- B. CSR
- C. Acute congestive glaucoma (Correct Answer)
- D. Vitreous Hemorrhage
Primary Angle-Closure Glaucoma Explanation: ***Acute congestive glaucoma***
- This condition is characterized by **sudden, severe eye pain** along with blurred vision, redness, and a fixed, mid-dilated pupil.
- The pain arises from abrupt elevation of **intraocular pressure**, which differentiates it from painless vision loss.
*CRAO*
- **Central Retinal Artery Occlusion** (CRAO) typically presents as **sudden, profound, painless monocular vision loss**.
- Funduscopic examination often reveals a **cherry-red spot** in the fovea with generalized retinal whitening.
*CSR*
- **Central Serous Retinopathy** (CSR) causes **sudden, painless blurred vision** or a scotoma, often described as a "watery" or "shimmering" effect.
- It involves leakage of fluid under the retina, typically in the macula.
*Vitreous Hemorrhage*
- Presents as **sudden, painless loss of vision** or a shower of floaters, often described as cobwebs or clouds.
- It results from bleeding into the **vitreous cavity**, which can obscure the retina.
Primary Angle-Closure Glaucoma Indian Medical PG Question 5: Which of the following statements is false about phacolytic glaucoma?
- A. Open angle glaucoma
- B. Lens induced glaucoma
- C. Primarily caused by iris-lens contact (Correct Answer)
- D. Seen in hypermature stage of cataract
Primary Angle-Closure Glaucoma Explanation: ***Primarily caused by iris-lens contact***
- This statement is **FALSE** because **phacolytic glaucoma** is caused by the leakage of **lens proteins** from a **hypermature cataract** into the **anterior chamber**, not by iris-lens contact.
- **Iris-lens contact** is the mechanism in **pupillary block glaucoma** and **acute angle-closure glaucoma**, not in phacolytic glaucoma.
- The pathophysiology involves **macrophages** engulfing leaked lens proteins and obstructing the **trabecular meshwork**.
*Open angle glaucoma*
- This statement is true because **phacolytic glaucoma** is definitively an **open-angle glaucoma**.
- It involves obstruction of the **trabecular meshwork** by **macrophages** laden with **lens proteins**, which is an open-angle mechanism.
- The angle remains anatomically open but functionally blocked.
*Seen in hypermature stage of cataract*
- This statement is true because **phacolytic glaucoma** develops when the **lens capsule** of a **hypermature (Morgagnian) cataract** becomes permeable.
- This permeability allows **high-molecular-weight lens proteins** to leak into the **aqueous humor**.
*Lens induced glaucoma*
- This statement is true as **phacolytic glaucoma** is a specific type of **lens-induced glaucoma**, arising from the toxic effects of **leaked lens material**.
- Other forms of **lens-induced glaucoma** include **phacomorphic glaucoma**, **lens-particle glaucoma**, and **phacoanaphylactic glaucoma**.
Primary Angle-Closure Glaucoma Indian Medical PG Question 6: Vogt's triad is indicative of:
- A. Past attack of acute iridocyclitis
- B. Vogt-Koyanagi-Harada syndrome
- C. Past attack of acute angle-closure glaucoma (Correct Answer)
- D. Past attack of herpes zoster ophthalmicus
Primary Angle-Closure Glaucoma Explanation: ***Past attack of acute-angle closure glaucoma***
- Vogt's triad refers to three specific signs observed in the eye after an episode of **acute angle-closure glaucoma**.
- The triad includes **glaukomflecken** (anterior subcapsular lens opacities), **iris stromal atrophy**, and **pupil dilation or distortion**.
*Vogt-Koyanagi-Harada syndrome*
- This is a **multisystem inflammatory disease** primarily affecting pigmented structures, not characterized by Vogt's triad.
- It involves **uveitis**, dermatological manifestations (e.g., poliosis, vitiligo), neurological symptoms (e.g., tinnitus, meningitis), and auditory symptoms.
*Past attack of acute iridocyclitis*
- While iridocyclitis involves **inflammation of the iris and ciliary body**, it does not typically lead to the specific triad of signs seen in Vogt's triad.
- Complications of severe iridocyclitis might include synechiae or cataract, but not glaukomflecken or specific iris atrophy described by Vogt.
*Past attack of herpes zoster ophthalmicus*
- This condition is caused by the **reactivation of the varicella-zoster virus** in the ophthalmic division of the trigeminal nerve.
- Ocular manifestations include keratitis, uveitis, and neurotrophic keratopathy, but not the specific changes of Vogt's triad.
Primary Angle-Closure Glaucoma Indian Medical PG Question 7: Which of the following is most likely to cause bilateral angle closure glaucoma?
- A. Sulfonamide medications
- B. Adrenergic agonists
- C. Topiramate (Correct Answer)
- D. Anticholinergic drugs
Primary Angle-Closure Glaucoma Explanation: ***Topiramate can cause bilateral angle closure glaucoma***
- **Topiramate** is known to cause a unique form of **bilateral angle closure glaucoma** due to ciliary body edema and anterior displacement of the iris-lens diaphragm, leading to acute myopia and angle closure.
- This reaction typically occurs within the first few weeks of starting the drug, is **bilateral**, and is not related to angle anatomy.
*Sulfonamide medications*
- While some **sulfonamides** can cause acute myopia and secondary angle closure, similar to topiramate, this is a less consistently reported and less recognized association compared to topiramate.
- The mechanism involves **ciliary body edema** leading to anterior displacement of the iris-lens diaphragm, but topiramate is a more classic example.
*Adrenergic agonists*
- **Adrenergic agonists** typically cause **mydriasis** (pupil dilation), which can precipitate acute angle closure in eyes with an already **narrow angle**.
- However, they usually trigger **unilateral** angle closure and do not cause the same ciliary body edema mechanism seen with topiramate that results in bilateral involvement.
*Anticholinergic drugs*
- **Anticholinergic drugs** also cause **mydriasis** and can lead to **acute angle closure glaucoma** by widening the pupil and potentially blocking aqueous outflow in susceptible individuals.
- Similar to adrenergic agonists, this is usually a **unilateral** event and does not involve the characteristic ciliary body edema and resultant bilateral acute myopia associated with topiramate.
Primary Angle-Closure Glaucoma Indian Medical PG Question 8: Intumescent cataract is associated with which type of glaucoma?
- A. Phacolytic glaucoma
- B. Phacotopic glaucoma
- C. Pseudophakic glaucoma
- D. Phacomorphic glaucoma (Correct Answer)
Primary Angle-Closure Glaucoma Explanation: ***Phacomorphic glaucoma***
- **Intumescent cataract** refers to a mature or hypermature cataract that has absorbed water, leading to a swollen lens.
- This swelling can cause the lens to push the iris forward, leading to secondary **angle closure glaucoma** due to pupillary block, which is characteristic of phacomorphic glaucoma.
*Phacolytic glaucoma*
- This type of glaucoma is caused by leakage of **high-molecular-weight lens proteins** from a mature or hypermature cataract into the aqueous humor, triggering a macrophagic response and obstruction of the trabecular meshwork.
- It results in an **open-angle glaucoma** and anterior chamber inflammation, unlike the angle closure seen with intumescent cataracts.
*Phacotopic glaucoma*
- This is a rare term and not a recognized distinct category of glaucoma related to lens swelling. It may refer loosely to glaucoma associated with **lens dislocation** or subluxation.
- It does not specifically describe glaucoma caused by an **intumescent cataract**.
*Pseudophakic glaucoma*
- This refers to glaucoma that develops in patients who have undergone **cataract surgery** and have an **intraocular lens (IOL)** implant (pseudophakia).
- It can be caused by various mechanisms post-surgery, such as inflammation, steroid response, or IOL-related issues, but it is not directly associated with the presence of an intumescent natural lens.
Primary Angle-Closure Glaucoma Indian Medical PG Question 9: A patient presents with eye ache and difficulty in vision after watching a movie. What will be the first line of management?
- A. Mannitol with Moxifloxacin
- B. Mannitol with Atropine
- C. Mannitol with lubricating eye drops
- D. Mannitol with Pilocarpine (Correct Answer)
Primary Angle-Closure Glaucoma Explanation: ***Mannitol with Pilocarpine***
- This combination is appropriate for **acute angle-closure glaucoma (AACG)**, which can be triggered by pupillary dilation (e.g., in a dark movie theater). **Mannitol** is an osmotic diuretic that rapidly reduces intraocular pressure.
- **Pilocarpine** is a miotic agent that constricts the pupil, pulling the iris away from the trabecular meshwork and opening the drainage angle to facilitate aqueous humor outflow.
*Mannitol with Moxifloxacin*
- While mannitol helps with intraocular pressure, **Moxifloxacin is an antibiotic** used to treat bacterial infections.
- There is no indication of an ocular infection in this scenario, so an antibiotic would not be the first-line treatment for sudden eye pain and vision difficulty after watching a movie.
*Mannitol with Atropine*
- Adding **Atropine, a cycloplegic agent**, would cause further pupillary dilation, which would worsen acute angle-closure glaucoma and increase intraocular pressure.
- Atropine is contraindicated in AACG and would exacerbate the patient's condition.
*Mannitol with lubricating eye drops*
- While mannitol helps with intraocular pressure, **lubricating eye drops** are used for dry eyes or surface irritation, not for acute angle-closure glaucoma.
- Lubricating drops do not address the underlying pathology of increased intraocular pressure due to angle closure.
Primary Angle-Closure Glaucoma Indian Medical PG Question 10: Which of the following statements regarding glaucoma and its management is true?
- A. Latanoprost is used with caution in patients of bronchial asthma
- B. Central scotoma is seen in open angle glaucoma
- C. Topiramate can cause bilateral angle closure glaucoma (Correct Answer)
- D. Methazolamide causes decrease in ocular blood flow
Primary Angle-Closure Glaucoma Explanation: ***Topiramate can cause bilateral angle closure glaucoma***
- **Topiramate**, a sulfonamide derivative, can cause acute **myopia** and **ciliary body swelling**, leading to anterior displacement of the lens-iris diaphragm and subsequent **bilateral angle closure glaucoma**.
- This adverse effect typically occurs within the first few weeks of starting the drug, and prompt discontinuation can often resolve the condition.
*Latanoprost is used with caution in patients of bronchial asthma*
- **Latanoprost** is a **prostaglandin analog** and is generally safe for patients with bronchial asthma as it does not affect pulmonary function.
- Beta-blockers, rather than latanoprost, are the class of glaucoma medications that require caution in patients with bronchial asthma due to their potential to cause **bronchospasm**.
*Central scotoma is seen in open angle glaucoma*
- **Central scotoma** is more characteristic of conditions affecting the **macula** or optic nerve pathologies other than typical open-angle glaucoma.
- The classic visual field defect in **open-angle glaucoma** is a **paracentral scotoma** or **nasal step**, often progressing to peripheral field loss.
*Methazolamide causes decrease in ocular blood flow*
- **Methazolamide**, a carbonic anhydrase inhibitor (CAI), primarily acts by reducing aqueous humor production, which can **lower intraocular pressure**.
- Although CAIs can cause systemic side effects, they are not known to significantly decrease **ocular blood flow**; in fact, some studies suggest they may even have a mild beneficial effect on optic nerve head blood flow.
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