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Quiz me on glaucoma Mcq type

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I now have rich content from Kanski's Clinical Ophthalmology and Wills Eye Manual to build a solid MCQ quiz. Let me construct it.

Glaucoma MCQ Quiz

Here are 10 MCQs covering classification, pathophysiology, clinical features, investigations, and treatment. Try each one, then check the answer and explanation below.
Q1. Which of the following is the MOST common form of glaucoma in people of European and African descent?
  • A) Primary angle-closure glaucoma
  • B) Normal-tension glaucoma
  • C) Primary open-angle glaucoma (POAG)
  • D) Congenital glaucoma
Answer & Explanation
Answer: C - Primary open-angle glaucoma (POAG)
POAG is the most prevalent glaucoma type in White and Black individuals. In those older than 70, prevalence is ~6% in White and ~16% in Black populations. Primary angle-closure has a particularly high prevalence in people of Asian descent. (Kanski's Clinical Ophthalmology 10e)
Q2. The ISNT rule in glaucoma assessment refers to the normal neuroretinal rim width. Which of the following correctly describes it?
  • A) Inferior = Superior = Nasal = Temporal
  • B) Inferior > Superior > Nasal > Temporal
  • C) Superior > Inferior > Temporal > Nasal
  • D) Nasal > Temporal > Inferior > Superior
Answer & Explanation
Answer: B - Inferior > Superior > Nasal > Temporal
The inferior rim is the broadest, followed by superior, nasal, and temporal ("ISNT" rule). This has high sensitivity (81%) for glaucoma detection but low specificity (32%), meaning eyes without glaucoma often don't follow this rule either. (Kanski's Clinical Ophthalmology 10e)
Q3. A 65-year-old patient is found to have an IOP of 32 mmHg on routine examination. The optic disc and visual fields are entirely normal. Gonioscopy shows an open angle. The MOST likely diagnosis is:
  • A) Primary open-angle glaucoma
  • B) Low-tension glaucoma
  • C) Ocular hypertension
  • D) Acute angle-closure glaucoma
Answer & Explanation
Answer: C - Ocular hypertension
Ocular hypertension is defined as raised IOP with a normal optic nerve and normal visual fields. In the Ocular Hypertension Treatment Study (OHTS), untreated patients had a 9.5% cumulative risk of developing POAG over 5 years. Treatment targeting a 20% IOP reduction reduced this to 4.4%. (Kanski's Clinical Ophthalmology 10e)
Q4. Which visual field defect pattern is MOST characteristic of primary open-angle glaucoma?
  • A) Central scotoma respecting the vertical midline
  • B) Bitemporal hemianopia
  • C) Arcuate scotoma extending from the blind spot nasally
  • D) Homonymous hemianopia
Answer & Explanation
Answer: C - Arcuate scotoma extending from the blind spot nasally
Characteristic POAG visual field patterns include: nasal step, paracentral scotoma, arcuate scotoma extending from the blind spot nasally (defects typically respect the horizontal midline), altitudinal defect, or generalized depression. Central scotoma respecting the vertical midline suggests intracranial pathology. (Wills Eye Manual; Kanski's Clinical Ophthalmology 10e)
Q5. A Drance hemorrhage on the optic disc is MOST associated with which condition?
  • A) Diabetic retinopathy
  • B) Primary open-angle glaucoma (especially normal-tension)
  • C) Central retinal vein occlusion
  • D) Hypertensive retinopathy
Answer & Explanation
Answer: B - Primary open-angle glaucoma (especially normal-tension)
A Drance hemorrhage is a splinter/nerve fiber layer hemorrhage that crosses the disc margin. It is a characteristic sign of POAG and is particularly associated with normal-tension glaucoma. It indicates active glaucomatous damage and is a marker of poor prognosis. (Wills Eye Manual)
Q6. Which of the following glaucoma medications is CONTRAINDICATED in a pregnant woman?
  • A) Timolol (beta-blocker)
  • B) Brimonidine (alpha-2 agonist)
  • C) Latanoprost (prostaglandin agonist)
  • D) Dorzolamide (carbonic anhydrase inhibitor)
Answer & Explanation
Answer: C - Latanoprost (prostaglandin agonist)
Prostaglandin agonists (latanoprost, bimatoprost, travoprost, tafluprost) are contraindicated in pregnant women or women wishing to become pregnant due to their uterotonic effects. They also require caution in active uveitis or cystoid macular edema. (Wills Eye Manual)
Q7. In pseudoexfoliation glaucoma, the Early Manifest Glaucoma Trial (EMGT) found the mean rate of visual field change WITHOUT treatment to be:
  • A) -0.36 dB/year
  • B) -1.31 dB/year
  • C) -3.13 dB/year
  • D) -5.0 dB/year
Answer & Explanation
Answer: C - -3.13 dB/year
The EMGT provided prospective natural history data:
  • High-tension glaucoma (HTG): -1.31 dB/year
  • Normal-tension glaucoma (NTG): -0.36 dB/year
  • Pseudoexfoliation glaucoma (PXEG): -3.13 dB/year - the most rapidly progressive
This underlines the aggressive nature of pseudoexfoliation glaucoma. (Kanski's Clinical Ophthalmology 10e)
Q8. Glaucoma in Sturge-Weber syndrome is thought to be caused by which mechanism in OLDER patients (adults)?
  • A) Trabeculodysgenesis
  • B) Elevated episcleral venous pressure from arteriovenous communication in episcleral haemangioma
  • C) Pupillary block
  • D) Pigment dispersion from the iris
Answer & Explanation
Answer: B - Elevated episcleral venous pressure from arteriovenous communication in episcleral haemangioma
In Sturge-Weber syndrome, glaucoma occurs ipsilateral to the facial haemangioma in ~30% of cases. In infants (60% of these), the mechanism is likely trabeculodysgenesis. In older patients, raised episcleral venous pressure from an arteriovenous communication in an episcleral haemangioma is the putative mechanism. (Kanski's Clinical Ophthalmology 10e)
Q9. Which of the following is the FIRST-LINE medical treatment for primary open-angle glaucoma?
  • A) Oral acetazolamide
  • B) Topical beta-blockers (e.g., timolol)
  • C) Topical prostaglandin agonists (e.g., latanoprost)
  • D) Topical alpha-2 agonists (e.g., brimonidine)
Answer & Explanation
Answer: C - Topical prostaglandin agonists
Prostaglandin agonists (latanoprost, bimatoprost, travoprost) are the preferred first-line agents for POAG due to their once-daily dosing, efficacy, and good tolerability. Beta-blockers (e.g., timolol) are commonly used but have more systemic contraindications. Treatment should be started with one drop in one eye (monocular therapeutic trial) unless IOP >35 mmHg or fixation is threatened. (Wills Eye Manual; Kanski's Clinical Ophthalmology 10e)
Q10. C/D ratio asymmetry between the two eyes of what value should raise suspicion for glaucoma (in the absence of a difference in overall disc size)?
  • A) > 0.1
  • B) > 0.2
  • C) > 0.3
  • D) > 0.5
Answer & Explanation
Answer: B - > 0.2
A cup-to-disc (C/D) ratio asymmetry of 0.2 or more between the two eyes is suspicious for glaucoma, provided there is no corresponding difference in overall disc diameter. Only 2% of the general population has a C/D ratio greater than 0.7. An asymmetric C/D ratio is one of the key signs prompting further glaucoma workup. (Kanski's Clinical Ophthalmology 10e; Wills Eye Manual)
How to use: Read each question, pick your answer, then expand the dropdown to check. Let me know your score or if you want more questions on a specific topic - angle-closure, congenital glaucoma, drug mechanisms, surgical options, or investigations!
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