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Central line-associated bloodstream infection prevention — USMLE Step 3 MCQ

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HardEthics, Patient Safety, Quality Improvement, Systems-Based PracticeCentral line-associated bloodstream infection preventionUSMLE Step 3

A 61-year-old develops severe unilateral eye pain, halos, nausea and a fixed mid-dilated pupil after receiving nebulized ipratropium. Intraocular pressure is 54 mm Hg and the cornea is cloudy. What is the best immediate plan?

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Correct answer: B — Use timolol, apraclonidine, and acetazolamide before laser peripheral iridotomy

The best answer is “Use timolol, apraclonidine, and acetazolamide before laser peripheral iridotomy”. This is acute angle closure. Aqueous production and pressure are reduced immediately with topical and systemic agents; pilocarpine is less effective while the iris sphincter is ischemic at very high pressure and is added after pressure begins to fall. Laser peripheral iridotomy provides definitive relief of pupillary block.

Reference: AAO 2026 Preferred Practice Pattern: Primary Angle-Closure Disease: https://pubmed.ncbi.nlm.nih.gov/41665581/