Secondary Angle-Closure Glaucomas Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Secondary Angle-Closure Glaucomas. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Secondary Angle-Closure Glaucomas Indian Medical PG Question 1: 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
Secondary Angle-Closure Glaucomas 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.
Secondary Angle-Closure Glaucomas Indian Medical PG Question 2: Which of the following conditions is least likely to be associated with neovascular glaucoma?
- A. Diabetes
- B. Open angle glaucoma (Correct Answer)
- C. CRVO
- D. Eale's disease
Secondary Angle-Closure Glaucomas Explanation: ***Open angle glaucoma*** ✓
- **Open-angle glaucoma** is a primary **neurodegenerative disease** of the optic nerve, characterized by progressive loss of **retinal ganglion cells** and their axons, leading to characteristic **optic neuropathy** and visual field defects.
- It does **NOT** directly cause **neovascularization** or increased VEGF production, which are the underlying mechanisms for **neovascular glaucoma**.
- This is the **least likely** association among the given options.
*Diabetes*
- **Diabetic retinopathy** is a **major cause** of **neovascularization** due to retinal ischemia and increased production of **vascular endothelial growth factor (VEGF)**, which can lead to **neovascular glaucoma**.
- **Neovascularization** on the iris (rubeosis iridis) and angle can block aqueous outflow, causing a severe, rapidly progressing form of secondary glaucoma.
*CRVO (Central Retinal Vein Occlusion)*
- **CRVO** leads to significant retinal ischemia and subsequent release of **VEGF**, which prompts the growth of new, fragile blood vessels.
- These new vessels (neovascularization) can grow in the iris and angle, obstructing aqueous humor outflow and causing **neovascular glaucoma**.
- **Ischemic CRVO** is one of the **most common causes** of neovascular glaucoma.
*Eale's disease*
- **Eale's disease** is an **idiopathic occlusive vasculitis** primarily affecting the **peripheral retinal veins**, leading to **retinal ischemia**.
- This ischemia stimulates **neovascularization** and the production of **VEGF**, increasing the risk of **neovascular glaucoma** due to the formation of new blood vessels in the anterior chamber.
Secondary Angle-Closure Glaucomas Indian Medical PG Question 3: Recurrent anterior uveitis with increased intraocular tension is seen in which of the following conditions?
- A. Posner-Schlossman syndrome (Correct Answer)
- B. Foster-Kennedy syndrome
- C. Vogt-Koyanagi-Harada syndrome
- D. Fuchs heterochromic iridocyclitis
Secondary Angle-Closure Glaucomas Explanation: ***Posner-Schlossman syndrome***
- Characterized by **recurrent, unilateral, non-granulomatous anterior uveitis** associated with markedly **elevated intraocular pressure (IOP)**.
- The condition is also known as **glaucomatocyclitic crisis**, highlighting the episodic inflammation and glaucoma.
- Key features include **acute attacks** lasting hours to weeks with **dramatic IOP elevation** (often >40 mmHg).
*Foster-Kennedy syndrome*
- This syndrome is defined by ipsilateral **optic atrophy**, contralateral **papilledema**, and often **anosmia**, typically due to a frontal lobe tumor.
- It does not involve anterior uveitis or primary elevated intraocular tension.
- This is a neuro-ophthalmologic syndrome, not an inflammatory ocular condition.
*Vogt-Koyanagi-Harada syndrome*
- An autoimmune disorder affecting pigmented tissues, leading to **bilateral granulomatous panuveitis**, often with hearing loss, vitiligo, poliosis, and neurological symptoms.
- While it involves uveitis, it is typically **bilateral and panuveitis**, not recurrent unilateral anterior uveitis.
- IOP may be elevated but not the defining feature with dramatic episodic rises.
*Fuchs heterochromic iridocyclitis*
- A chronic, **unilateral, low-grade anterior uveitis** with characteristic iris heterochromia.
- May have mild IOP elevation but **not recurrent episodic attacks** with marked pressure spikes.
- Inflammation is typically **quiet and chronic** rather than acute and recurrent.
Secondary Angle-Closure Glaucomas Indian Medical PG Question 4: Secondary glaucoma associated with angle recession is seen in:
- A. Penetrating injury
- B. Concussion injury (Correct Answer)
- C. Chemical injury
- D. Radiation injury
Secondary Angle-Closure Glaucomas Explanation: ***Concussion injury***
- **Concussion injuries** (blunt trauma) to the eye lead to shearing forces between the ciliary body and sclera, causing a tear in the ciliary body and trabecular meshwork.
- This anatomical alteration, known as **angle recession**, impairs aqueous humor outflow over time, leading to secondary open-angle glaucoma.
*Penetrating injury*
- **Penetrating injuries** breach the globe and can cause direct damage to ocular structures, but angle recession leading to glaucoma is more characteristic of blunt trauma.
- Such injuries often lead to other forms of glaucoma, like **pupillary block** or **phacolytic glaucoma**, depending on the extent of damage and inflammation.
*Chemical injury*
- **Chemical injuries** (e.g., acid or alkali burns) cause severe inflammation, tissue necrosis, and scarring within the anterior segment.
- Glaucoma following chemical injury is typically due to **trabecular meshwork damage** from inflammation and scarring, or **peripheral anterior synechiae formation**, rather than angle recession.
*Radiation injury*
- **Radiation injury** to the eye is rare but can occur with radiation therapy for tumors, causing damage to vascular structures and contributing to neovascularization.
- Glaucoma associated with radiation injury is usually secondary to **neovascularization** of the angle or **inflammatory processes**, not angle recession.
Secondary Angle-Closure Glaucomas Indian Medical PG Question 5: Which diagnostic procedure is not done in a dilated pupil?
- A. Laser interferometry
- B. Electroretinography
- C. Gonioscopy (Correct Answer)
- D. Fundus examination
Secondary Angle-Closure Glaucomas Explanation: ***Gonioscopy***
- **Gonioscopy** is the examination of the **anterior chamber angle**, where the **iris** meets the **cornea**.
- It is crucial for assessing **glaucoma** and is typically performed with a **nondilated pupil** to allow the iris to lie in its natural anatomical position, which helps visualize the angle structures accurately.
*Laser interferometry*
- **Laser interferometry** is used to assess **potential visual acuity** in patients with **media opacities** such as cataracts.
- This procedure benefits from a **dilated pupil** as it allows more light to pass through existing clear areas of the lens, improving the measurement.
*Electroretinography*
- **Electroretinography (ERG)** measures the **electrical responses of the retina** to light stimulation.
- **Pupil dilation** is generally performed to maximize the amount of light reaching the retina, ensuring a comprehensive assessment of retinal function.
*Fundus examination*
- A **fundus examination** visualizes the **retina, optic disc, macula, and retinal blood vessels**.
- **Dilation of the pupil** is a standard practice for a thorough fundus examination, as it allows for a wider and more complete view of the posterior segment of the eye, facilitating detection of various retinal pathologies.
Secondary Angle-Closure Glaucomas Indian Medical PG Question 6: A patient presents with superior quadrant vision loss since one week. Patient has Rheumatic Heart Disease (RHD) and is not taking medications. What is the most likely diagnosis?
- A. CRAO
- B. CRVO
- C. BRAO (Correct Answer)
- D. BRVO
Secondary Angle-Closure Glaucomas Explanation: ***BRAO***
- **Branch retinal artery occlusion** (BRAO) presents with **sudden, painless sectoral or quadrant visual field loss** corresponding to the distribution of the occluded arterial branch.
- Superior quadrant vision loss indicates **inferior retinal involvement** (visual field is inverted on retina).
- **Rheumatic heart disease** not on anticoagulation poses high risk for **cardiac emboli** from valvular vegetations or atrial fibrillation, which preferentially cause **arterial occlusions** (BRAO/CRAO).
- Fundoscopy shows **retinal whitening** in the affected area with a clear demarcation line.
*BRVO*
- **Branch retinal vein occlusion** causes quadrant vision loss but is **NOT typically embolic** in nature.
- BRVO is associated with systemic **vascular risk factors** (hypertension, diabetes, hyperlipidemia), not cardiac emboli.
- Fundoscopy shows **flame-shaped hemorrhages** and cotton-wool spots in a wedge distribution.
*CRAO*
- **Central retinal artery occlusion** presents with **complete, sudden painless monocular vision loss** affecting the entire visual field.
- Shows classic **"cherry-red spot"** at the fovea due to diffuse retinal ischemia.
- Would not present with isolated quadrant vision loss.
*CRVO*
- **Central retinal vein occlusion** causes **complete monocular vision loss** with "blood and thunder" appearance on fundoscopy.
- Presents with diffuse retinal hemorrhages throughout the retina, not isolated to one quadrant.
Secondary Angle-Closure Glaucomas Indian Medical PG Question 7: Sudden painful loss of vision seen in
- A. Angle closure glaucoma (Correct Answer)
- B. Endophthalmitis
- C. Acute uveitis
- D. Central retinal artery occlusion
Secondary Angle-Closure Glaucomas 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
Secondary Angle-Closure Glaucomas Indian Medical PG Question 8: 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)
Secondary Angle-Closure Glaucomas 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.
Secondary Angle-Closure Glaucomas Indian Medical PG Question 9: Intumescent cataract is associated with which type of glaucoma?
- A. Phacolytic glaucoma
- B. Phacotopic glaucoma
- C. Pseudophakic glaucoma
- D. Phacomorphic glaucoma (Correct Answer)
Secondary Angle-Closure Glaucomas 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.
Secondary Angle-Closure Glaucomas Indian Medical PG Question 10: 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
Secondary Angle-Closure Glaucomas 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.
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