AANP AGPCNP PRACTICE QUESTIONS AND ANSWERS GRADED A+

AANP AGPCNP PRACTICE QUESTIONS AND ANSWERS 2022/2023| GRADED A An 88-year-old presents with right-side weakness after being unable to rise unassisted following a fall to the bathroom floor. History includes aphasia and noncompliance with hypertension medication regimen. What is the most likely diagnosis? Left-sided or right-sided CVA? Correct Answer: LEFT-SIDED CVA Which of the following signs/symtpoms are often associated with headahces due to intracranial tumor? 1) pain worse laying down, focal neurological signs 2) Hyperflexia, personality change 3) acute onset: hours to days 4) pupillary constriction; stupor Correct Answer: 1) pain worse laying down, focal neurological signs Which of the following pharmacotherapeutics would be most important to administer to a patient who has a corneal abrasion? 1) Timolol 2) Gentamicin ophthalmic 3) Cromolyn optha 4) Olopatadine Correct Answer: 2) Gentamicin ophthalmic (Genoptic) A 25-year-old presents with the chief complaint of decreased mobility and pain of the right shoulder exacerbated by movement. The patient reports that he participated in extensive house painting 24 hours prior to the onset of pain. He denies any trauma. Passive ROM is intact. No redness or ecchymosis is present. What is the next step to be taken in order to make a diagnosis? 1) Xray of shoulder 2) Palpate structures around the shoulder. 3) MRI of shoulder 4) EMG Correct Answer: 2) palpate structures A 16-year-old female in the first month of taking Ortho-Novum 7/7/7 complains of midcycle spotting. She has not missed any doses and uses no other medication. Which of the following is appropriate? 1) Changing to Ortho-Novum 1/35 2) Discontinue use 3) Providing reassurance 4) Double dose-for two days Correct Answer: 3) provide reassurance According to the Report of the U.S. Preventive Services Task Force, which of the following is NOT a current recommendation guideline for preventive care in elderly female patients? 1) Mammogram and clinical breast exams 2) Fecal Occult blood test and/or sig 3) Rubella serology or vaccination history 4) Pnuemo and influenza vaccines Correct Answer: 3) Rubella serology or vaccination history 87 y/o NH patient is drowsy and barely responsive. Temp 95, BP: 110/70, Pulse 60, R 10. The best action is to: 1) initiate passive warming 2) apply a rebreather 3) Perform fluid replacement 4) initiate active warming Correct Answer: 1) initiate passive rewarming A patient is referred with DM, HTN and CAD. He is on insulin and a beta blocker. How would you educate this patient on recognizing the signs and symptoms of hypoglycemia? 1) Edema 2) Tachycardia 3) palpitations 4) sweating Correct Answer: 4) sweating A 65-year-old overweight patient is diagnosed with plantar fasciitis. Initial therapy of NSAIDs, stretching, ice, and rest has proven ineffective after 3 weeks. The best follow-up plan of care would be to: 1) stop NSAID, apply a heel cup and encourage exercise and wt loss. 2) continue NSAID, apply an arch support and encourage wt loss and exercise 3) continue NSAID, xray and add a short-leg night splint 4) COntinue NSAID, xray and add a metatarsal bar Correct Answer: 2) continue NSAID, apply an arch support and encourage wt loss and exercise Fundoscopic exam of Hypertensive patient. 1) nicking of arteriols and viens, and small retinol hemorrages 2) drusen bodies and pale retina 3) pale macula and swollen disk margins 4) microaneurysms and optic disc cupping Correct Answer: 1) nicking of arteriols and viens, and small retinol hemorrages Which of the following is a common presenting feature of hyperthyroidism in the elderly? 1) elevated TSH 2) Thyroid enlargement 3) atrial fibrillation 4) abnormal T3 suppression Correct Answer: 3) atrial fibrillation A 35-year-old lawn maintenance worker presents reporting "something in my eye" since the previous day. The eye was rinsed with over-the-counter eyewash, without relief. The patient denies visual disturbances or drainage. In formulating a plan of care, the nurse practitioner would FIRST: 1) send to ophthalmologists 2) florescreen staining 3) test visual field 4) prescribe eyedrops Correct Answer: 3) test visual field A 72-year-old patient presents with dry, itchy eyes. During the course of the physical examination, the nurse practitioner notes the presence of a gray band of opacity in the cornea that encircles the iris. The band is 1.0-1.5 mm wide. This finding is most consistent with a diagnosis of a/an: 1. corneal abrasion 2. arcus senilis 3. corneal ulcer 4. herpetic infection of the eye Correct Answer: 2) arcus senilis A 26-year-old presents with reports of anorexia, fatigue, weight loss, malaise, fever, night sweats, and a cough that has been present for 4 weeks. The diagnostic study to perform first would be: 1) xray 2) pulmonary function test 3) bronchoscopy 4) H & H Correct Answer: 1) xray (tb-night sweats) A 44-year-old female is complaining of frequent anxiety attacks with chest discomfort and fatigue. On physical examination, her lungs are clear bilaterally. There are a midsystolic click and a grade II/VI systolic murmur at the apex. Further evaluation would include which of the following? 1) EKG, flat plate of the abdomen, lipid profile 2) Echocardiogram, Doppler, EKG 3) Labs and benzo's 4) EEG, Anxiety Scale, and electrolytes Correct Answer: 2) Echocardiogram, Doppler, EKG A healthy 84 y/o would like to start an exercise program, what would you do before this takes place? 1) physical exam 2) EKG 3) knee xrays 4) PT Stress test Correct Answer: 1) Physical Exam 29 y/o has uncomplicated Chlamydia infection will exhibit: 1) green penile discharge 2) uticartia 3) unremarkable symtpoms 4) penile ulcer Correct Answer: 3) unremarkable symptoms 37 has suspected PE. c/o anxiety and cough, CXR normal, the next test should be: 1) spirometry 2) MRI 3) COntract venogra[hy 4) helical CT pulmonary angiograph Correct Answer: 4) helical CT pulmonary angiography. A 12-lead EKG shows an undulating baseline with no visible P waves and an irregularly irregular R-R interval. This arrhythmia is: 1) atrial flutter 2) atrial fibrillation 3) second degree heart block 4) Wolff-White Syndrome Correct Answer: 2) atrial fibrillation After a 3-week camping trip, a 17-year-old is seen for a target lesion with central clearing, located in the inguinal area. The patient has had a severe headache, malaise, fatigue, and generalized musculoskeletal pain for several days. Pharmacologic management of this condition includes: 1) Bactrim 2) azithromycin 3) doxycycline (Doryx). 4) metronidazole Correct Answer: 3) doxycycline (Doryx). Rocky Mountain spotted fever (Lyme disease-test with WEstern Blot) According to the American Diabetes Association, the newest standard for determining the presence of diabetes mellitus based on fasting plasma sugar level is a value equal to or greater than: 1) 110 mg/dL. 2) 126 mg/dL. 3) 135 4) whatever Correct Answer: 2) 126 mg/dl In the elderly, one pathophysiologic mechanism of isolated systolic hypertension involves: 1) decreased cardiac output. 2) loss of vascular tissue elasticity. 3) hyperactive baroreceptors Correct Answer: 2) loss of vascular tissue elasticity A 58-year-old female presents with shoulder and pelvic girdle pain for the past 6 months. She reports recent unintentional weight loss. On physical examination, there is pain on ROM, with no weakness noted. Laboratory studies show a low hemoglobin and an elevated sedimentation rate. Which of the following is the most likely diagnosis? 1) Polymyalgia rheumatica 2) polymyositis 3) osteoarthritis 4) Fibromyalgia Correct Answer: 1) polymyalgia rheumatica An 85-year-old male relates that on the way to his annual physical examination, he suffered a sudden loss of vision in his right eye characterized by "a bunch of lights" and a feeling that "a curtain came down." All of the following would be included in the differential diagnosis EXCEPT: 1) opthalmolic migraine 2) retinal detachment. 3) diabetic retinopathy. 4) TIA Correct Answer: 3) diabetic retinopathy A patient with diabetes mellitus who is on NPH and regular insulin split-dosing presents with complaints of early morning rise in fingerstick blood glucose. A review of self blood glucose monitoring reveals increased morning levels. After an increase in the evening insulin dose, the problem worsens. This is most likely an example of: 1) insulin resistance 2) the Somogyi effect. 3) needing more insulin in the mornings 4) Need to increase insulin at night Correct Answer: 2) Somogyi effect In a healthy elder, which of the following TRADITIONALLY defines a positive urine culture? 1) ≥100,000 colonies/mL of a single organism 2) ≥10,000 colonies/mL of a single organism 3) ≥100,000 colonies/mL of a two or more organisms Correct Answer: ≥100,000 colonies/mL of a single organism A 55-year-old patient exhibits a verified serum calcium level of 13 mg/dL [normal = 8.9-10.2 mg/dL]. The next step in determining the presence of pathology is to order a: 1) BUN and serum creatinine. 2) 24 hour urine 3) parathyroid hormone level. 4) thyroid panel Correct Answer: 3) parathyroid hormone level An 88-year-old female presents with a 3-day history of vertigo. The patient has a past medical history of hypertension controlled with metoprolol, 50 mg daily. She reports that the presenting symptoms are constant, severe, and accompanied by nausea and vomiting. She denies experiencing diplopia, slurring of speech, chest pain, dyspnea, or diaphoresis. She exhibits mild anxiety and reluctance to change position or turn the head. BP = 126/76; P = 78; R = 16/min; and T = 98.2°F (36.8°C). HEENT examination reveals 17 beats of horizontal nystagmus on right lateral gaze; the nystagmus stops after several repetitions of the maneuver. Funduscopic, cardiac, pulmonary, abdominal, and neurologic examination results are normal. The most likely diagnosis is: 1) acoustic neuroma 2) vestibular neuritis. 3) vertibailar insufficiency 4) TIA Correct Answer: 2) vestibular neuritis When initiating thyroid hormone replacement in the older adult, care must be taken to evaluate the patient's: 1) coronary status. 2) weight 3) renal function 4) mental state Correct Answer: 1) coronary status Which of the following would be most appropriate to perform in the initial evaluation of a patient with symptoms of acute prostatitis? 1) Prostate-specific antigen (PSA) 2) Urinalysis and urine culture 3) Scrotal massage and urine sample 4) CBC with diff Correct Answer: 2) urinalysis and urine culture Which of the following wet-mount results confirms a preliminary diagnosis of bacterial vaginosis? 1) Organisms about the size of white blood cells with undulating flagellum, occasional lactobacillus, many white blood cells 2) Squamous epithelial cells with stippling appearance and indistinct borders, no lactobacillus rods, many white blood cells 3) Squamous epithelial cells with stippling appearance and indistinct borders, many lactobacillus rods, few white blood cells Correct Answer: 2) Squamous epithelial cells with stippling appearance and indistinct borders, no lactobacillus rods, many white blood cells Which of the following physical findings would best alert a nurse practitioner to the probability of a herniated lumbar disc? 1) Positive Patrick's sign, decreased thoracolumbar ROM, positive straight-leg raise at 90° 2) Decreased thoracolumbar ROM, positive crossed straight-leg raise, positive straight-leg raise at 30° 3) Negative Patrick's sign, decreased thoracolumbar ROM, positive straight-leg raise at 80° Correct Answer: 2) Decreased thoracolumbar ROM, positive crossed straight-leg raise, positive straight-leg raise at 30° An 87-year-old obese female presents with complaints of calf pain in her right leg. The patient reports that the pain is increased with ambulation and has been increasing over the past 24 to 48 hours. The patient denies the following: any recent injury to the leg, smoking, or recent surgery. To assess this patient's symptoms, you would initially assess: 1) calf circumference and perform Doppler studies. 2) popliteal pulses and Doppler studies 3) Femoral pulses and skin temperature 4) Patrick's signs and popliteal pulses Correct Answer: 1) calf circumference and perform Doppler studies What type of exercise would you recommend for a 74-year-old patient with hypertension and degenerative joint disease (DJD)? 1) Stationary bike 2) Aqua exercises 3) aerobic walking Correct Answer: 2) Aqua exercises Trigeminal neuralgia 1) electric shock like unilateral pain 2) jaw pain extending to the neck 3) Bilateral burning pain Correct Answer: 1) electric shock like unilateral pain A manifestation of autonomic neuropathy in a 70-year-old patient with diabetes mellitus is: 1) tremors. 2) orthostatic hypotension. 3) hypertension 4) color blindness Correct Answer: 2) orthostatic hypotension The most common fluid and electrolyte imbalance in patients over 65 years of age is: 1) hypokalemia 2) due to dehydration. 3) Hypercalcemia 4) due to fluid overload Correct Answer: 2) due to dehydration Office spirometry performed with an albuterol nebulizer treatment can confirm a diagnosis of asthma because it indicates: 1) a patient has pulmonary fibrosis 2) chronic carbon dioxide retension 3) if a patient has reversible airway obstruction. Correct Answer: 3) if a patient has reversible airway obstruction. To assess ability to reason abstractly, you would ask the patient to: 1) the meaning of a common proverb 2) ask what they would do if there was a fire in the house 3) count backwards by 7's Correct Answer: 1) the meaning of a common proverb A 66-year-old patient presents with bilateral otitis media with effusion and white patches in the mouth that do not rub off when wiped with a 4 × 4. The patient should be evaluated for: 1) lichen planus 2) HIV infection. 3) lymphoma 4) Candida lingua Correct Answer: 2) HIV infection (hairy luekaplakia-immune) A 70-year-old patient presents with complaints of vague epigastric pain occurring at night, causing early morning awakening, and decreased appetite with early satiety. Significant history includes recent use of ibuprofen for headaches. Rectal examination was negative. While awaiting the results of ordered diagnostic tests, the practitioner should recommend all of the following EXCEPT: 1) starting H2 blockers. 2) taking off from work until the work-up is complete. 3) Reporting nausea/vomiting 4) Discontinue NSAIDS Correct Answer: 2) taking off work until the work-up is complete A 32-year-old patient reports a 6-month history of intermittent symmetrical swelling of the wrists and daily morning stiffness lasting 1 hour or more in and around other joints. What is the most likely diagnosis? 1) Rheumatoid arthritis 2) Osteoarthritis 3) Gouty arthritis Correct Answer: 1) Rheumatoid arthritis An 18-year-old college student presents for an athletic physical. When asked about current medications, she mentions she takes "some herb" she bought at the health food store for migraines and menstrual cramps. Which of the following herbal remedies has been commonly used for these conditions? 1) Echinacea 2) St. JOhn's Wort 3) ginko biloba 4) Feverfew Correct Answer: 4) Feverfew The most common bacterial agents responsible for pneumonia in older adults residing in the community are: 1) Streptococcus pneumoniae and Haemophilus influenzae. 2) staphylococcus aureas and Haemophilus influenzae. 3) Psuedomonas aeruginosa and Klebsiella pneumonae 4) Legionnaires and streptococcus pneumoniae Correct Answer: 1) Streptococcus pneumoniae and Haemophilus influenzae. Which cranial nerves test the oculomotor eye movement and strabismus? 1) CN I III, IV 2) CV III, IV and VI 3) CN III, V, VII Correct Answer: 2) CV III, IV and VI The management of COPD in the elderly is best guided by: 1) pulse oximetry 2) arterial blood gases 3) radiographic images 4) symptomology Correct Answer: 4) symptomology Which of the following is the most serious outcome of Barrett's esophagus? 1) Esophageal adenocarcinoma 2) esophageal varices 3) GERD 4) Stricture Correct Answer: 1) Esophageal adenocarcinoma Which of the following is most important in enhancing a nurse practitioner's clinical assessment when promoting health behaviors in young adults? 1) Personality 2) Include the parents with the pateint 3) Taking developmental stages into consideration 4) Provide a chart of growth physical changes Correct Answer: 3) Taking developmental stages into consideration Pulmonary status findings of increased total lung capacity and residual volume in a 74-year-old patient are indicative of: 1) emphysema. 2) COPD 3) chronic bronchitis 4) Asthma Correct Answer: 1) emphysema A 65-year-old patient with hypertension and associated angina requests a flu vaccine. The patient had a pneumococcal vaccine 10 years ago. The most appropriate plan of care would include: 1) influenza vaccine, 0.5 mL IM, 2) influenza vaccine, 0.5 mL IM, and pneumococcal vaccine, 0.5 mL IM. 3) pneumococcal vaccine, 0.5 mL IM. Correct Answer: 2) influenza vaccine, 0.5 mL IM, and pneumococcal vaccine, 0.5 mL IM. An 87-year-old patient is being treated for major depression with a selective serotonin reuptake inhibitor. Which of the following would have the greatest probability of remaining in the serum long after being discontinued? 1) Celexa 2) Prozac 3) Paxil 4) Zoloft Correct Answer: 2) Fluoxetine (Prozac) Age-related macular degeneration leads to which of the following? 1) Loss of central vision 2) Loss of peripheral vision 3) hemianopsia bilateral Correct Answer: 1) loss of central vision The approved therapeutic International Normalized Ratio (INR) for a patient on warfarin (Coumadin) therapy for atrial fibrillation is: 1) 1.0-2.0 2) 2.0-3.0 3) 2.5-3.5 Correct Answer: 2) 2.0-3.0 A 57-year-old patient presents for a physical examination. The patient has been in good health, takes no medications, has a family history of hypertension and heart disease, denies alcohol use, and has never smoked. The patient's last tetanus booster was 9 years ago. Which of the following vaccines is indicated at this time? 1) TD 2) Influenza 3) PNA 4) Hep B Correct Answer: 2) Influenza A patient with a diagnosis of diverticulosis presents with localized left lower quadrant discomfort, a palpable mass, mild leukocytosis, and T = 100° (37.8°C). The patient does not appear toxic and can tolerate fluids. An appropriate plan should include: 1) NPO, BARIUM enema 2) low fiber diet and referral to GI 3) clear liquids and oral antibiotics. 4) admit to hospital Correct Answer: 3) clear liquids and oral antibiotics. A frail elder who is on total bed rest suddenly develops urinary and fecal incontinence. This condition is frequently an indication of: 1) dementia. 2) fecal impaction. 3) cholecystitis. 4) parkinsons. Correct Answer: 2) fecal impaction. A 65-year-old female with diabetes mellitus presents for a routine follow up. BP is 142/88, Hgb A1c is 8.4%, fasting blood glucose is 160 mg/dL, and microalbumin is 60 mg/L (normal 30 mg/L). In addition to changing the diabetes medications, the nurse practitioner would also ensure that the patient is taking: 1) nifedipine 12.5mg daily 2) Amlodipine 10mg daily 3) benazepril, 10 mg daily. 4) atenolol 25mg BID Correct Answer: 3) benazepril, 10 mg daily. A 67-year-old patient with type 2 diabetes mellitus, congestive heart failure (CHF), and mild coronary artery disease is currently taking digoxin, 0.25 mg daily; hydrochlorothiazide, 25 mg daily; glipizide, 10 mg daily; and atorvastatin (Lipitor), 20 mg h.s. Which of the following is an accurate statement regarding this regimen? 1) Glipizide will deplete potassium stores 2) The hydrochlorothiazide will predispose the patient to digoxin toxicity. 3) atorvastatin will worsen the diabetes Correct Answer: 2) The hydrochlorothiazide will predispose the patient to digoxin toxicity. An 18-year-old patient presents with complaints of maxillary facial pain and yellow nasal discharge for 14 days. What is the appropriate initial pharmacologic intervention? 1) Amoxicillin 2) Diphenhydramine 3) Doxycycline 4) erythromycin Correct Answer: 1) Amoxicillin Therapy for temporal arteritis would include: 1) Tylenol with codiene 2) ibuprofen 800mg TID 3) prednisone, 60 mg daily PO and re-evaluate in 1 month. Correct Answer: 3) prednisone, 60 mg daily PO and re-evaluate in 1 month. In addressing suspected domestic violence in an adult relationship, it is appropriate to: 1) just do a physical assessment, not social 2) make an assessment of battering. 3) avoid making a battering assessment, it is legal Correct Answer: 2) make an assessment of battering. Over the past 6 months, a nurse practitioner has been treating a 62-year-old construction worker for chronic/recurrent right biceps tendonitis. He has had good and bad days, but seems to respond well to NSAIDs and muscle relaxants. Today he returns to the clinic after feeling a "snapping" sensation in his right upper arm while lifting a cinder block. To aid in diagnosis, the nurse practitioner would evaluate: 1) Right shoulder ROM, and strength 2) for the presence of right upper arm bulge ("Popeye muscle") and biceps strength. 3) radial pulses and right biceps tendon 4) right supination/pronation Correct Answer: 2) for the presence of right upper arm bulge ("Popeye muscle") and biceps strength. Which of the following accurately describes the phenomenon of isolated systolic hypertension, as opposed to isolated diastolic or combined systolic/diastolic hypertension, in the elderly? 1) Considered a significant risk factor for MI or stroke 2) demonstrated to be related to smoking 3) Occurs primarily in men 4) Not considered to be a major risk Correct Answer: 1) Considered a significant risk factor for MI or stroke An 87-year-old long-term care facility resident was hospitalized for an abdominal surgery procedure, and the incision has become infected with methicillin-resistant Staphylococcus aureus (MRSA). The hospital is planning to return the patient to the same facility, which has no private rooms. According to CDC guidelines, the alternative placement would be to: 1) inform the hospital that the patient will have to go to another facility. 2) have the patient share a room with a resident who also has MRSA. 3) have the patient share a room with a resident who has VRSA. 4) Delay discharge until the wound is clear Correct Answer: 2) have the patient share a room with a resident who also has MRSA. Which of the following laboratory tests are most widely accepted as indicators of the progression of HIV infection? 1) CD4 count and viral load 2) CD4 and Western Blot 3) CD4 and ELISA 4) WBC count and viral load Correct Answer: 1) CD4 count and viral load Which class of antihypertensive agents has been associated with acute renal failure, and is absolutely CONTRAINDICATED in patients with bilateral renal artery stenosis? 1) Thiazide diuretics 2) Angiotensin-converting enzyme (ACE) inhibitors 3) Calcium channel blockers 4) Potassium sparing diuretics Correct Answer: 2) Angiotensin-converting enzyme (ACE) inhibitors In geriatric patients, the polyvalent pneumococcal vaccine: 1) prevents or lessens the severity of 60%-70% of pneumococcal infections. 2) has no affect on immunocompromised patients 3) prevents pneumonia 100% of the time Correct Answer: 1) prevents or lessens the severity of 60%-70% of pneumococcal infections A 39-year-old patient was diagnosed with acute bronchitis in the emergency department and treated with acetaminophen, dextromethorphan, and metaproterenol (Alupent). The patient's history reveals a smoking habit of 1 pack per day. He now presents to your office with a fever of 101.2°F (39.4°C) and a cough productive of thick, yellow-green, foul-smelling sputum. You would encourage smoking cessation and prescribe: 1) a penicillin antibiotic 2) a macrolide antibiotic. 3) theophylline 4) inhalors Correct Answer: 2) macrolide antibiotic A 68-year-old female presents with a 3-week history of itching that increases in intensity at night. Red papules with scale crusts are noted on the axilla, groin, and interdigital webs of the hands. The most likely diagnosis is: 1) xerosis 2) herpes zoster 3) eczema 4) scabies. Correct Answer: 4) scabies A 68-year-old male with Parkinson's disease was placed on haloperidol (Haldol), 1 mg PO t.i.d. after presenting in the emergency department with visual and auditory hallucinations. On a visit to the office 2 days later for follow-up, the immediate course of action should be to: 1) decrease the dose of haloperidol. 2) prescribe a more potent neroleptic 3) discontinue the haloperidol. 4) add SSRI Correct Answer: 3) discontinue the halperidol A 70-year-old farmer was hit in the eye with a tree branch. The first step in the assessment of a possible corneal abrasion is to: 1) check for pupillary reaction. 2) measure visual acuity. 3) irrigate the eye 4) perform a fundoscopic exam Correct Answer: 2) check for visual acuity Which of the following is considered the most important factor in understanding and predicting an individual's health across the life span? 1) Psychological profile 2) Body habitus 3) Family history 4) diet history Correct Answer: 3) family history A 68-year-old patient with a recent diagnosis of mild transient ischemic attack has been placed on aspirin, 325 mg PO daily with food. The patient develops an aspirin allergy. You would discontinue aspirin and: 1) change to clopidogrel (Plavix). 2) change to valproic acid 3) refer for endoarectomy 4) change to bulibital Correct Answer: 1) change to clopidorel An 85-year-old female presents with a 2-hour history of diminished vision and severe pain in the right eye, plus nausea and vomiting. Visual acuity is decreased, the left pupil reacts to light, the right pupil does not react to light, and the conjunctiva is injected. The nurse practitioner would: 1) immediately refer to an ophthalmologist. 2) administer steroids 3) complete a comprehensive eye vision test 4) administer pilotarpine eye drops Correct Answer: 1) immediately refer to an ophthalmologist. (acute angle closure glaucoma)