COA Flashcards - Exam Review Manual
A history is obtained by:
a - asking a series of organized and specific questions
b - observing the patient’s actions n the exam room
c - allowing the patient to discuss anything he or she wishes
d - asking the same questions of each patient during every exam
a - asking a series of organized and specific questions
- The questions should be organized and specific, directing the patient’s narrative and tailored to the problems at hand.
The history should be recorded:
a - by writing down the patient’s entire story, word-for-word
b - by condensing the patient’s story, including pertinent information
c - by interpreting the patient’s story and suggesting a diagnosis
d - by copying patient information from a questionnare
b - by condensing the patient’s story, including pertinent information
- The assistant should avoid writing down the patient’s every word or trying to interpret. Diagnosis is the physician’s realm. Questionnaires have their place but cannot be used for an entire history because each patient is different.
When taking a history on a school-aged child, it is important to:
a - listen only to the parent’s account of the illness
b - listen only to the child’s account of the illness
c - talk to the parent outside of the child’s hearing
d - get an account of the illness from both the parent and the child
d - get an account of the illness from both the parent and the child
- A normal school-aged child is usually able to give a fairly good history, with the parent affirming the information
Which of the following is false?
a - A thorough history can direct a physician toward a final diagnosis
b - all information given by the patient can be shared with insurance companies without patient permission
c - statements made by the patient should lead the assistant into additional questions that can be asked
d - all patient information is private unless a consent release form is signed
b - all information given by the patient can be shared with insurance companies without patient permission
- The patient must sign a consent to release information, even to insurance companies.
Which of the following is NOT part of a history?
a - presenting complaint
b - medications currently used
c - family eye disease
d - visual acuity
d - visual acuity
- Visual acuity is part of the examination, not the history
The “presenting complaint” is:
a - the main reason that the patient has come to the office
b - always the most serious of the patient’s many complaints
c - the only item with which the history is really concerned
d - the main reason the patient should be dilated
a - the main reason that the patient has come to the office
- The presenting complaint is the patient’s main reason for coming in. An accurate history might include other complaints as well, however.
An example of a question relating to onset would be:
a - “can you still function at work?”
b - “when did you first notice the problem?”
c - “what treatment have you tried?”
d - “has the problem worsened?”
b - “when did you first notice the problem?”
- Onset relates to when the patient first noticed the problem
The question “Does your head hurt so badly that you have to leave school early?” relates to:
a - onset
b - duration
c - progression
d - severity
d - severity
- The severity of the problem relates to the amount of disability a patient suffers
To obtain the most important information about the presenting complaint, you should ask questions relating to:
a - location, timing, aggravating and alleviating factors, and family history
b - location, quality, severity, timing, and aggravating/alleviating factors
c - location, severity, timing, drug allergies, and past surgical procedures
d - present illness, past ocular history, family history, and description of pain
b - location, quality, severity, timing, and aggravating/alleviating factors
- The above are all pertinent questions regarding the presenting complaint. Family history, drug allergies, past surgical procedures and past ocular history are all important parts of the history, but not the most important regarding the presenting complaint.
A symptom is:
a - something you notice when you look at the patient
b - something that can always be tested and proven
c - a change noticed by the patient
d - any change that results from injury
c - a change noticed by the patient
- A symptom is a change that the patient notices, whether from injury, illness, or another situation. It cannot always be proven (e.g. pain) or seen by looking (e.g. pressure sensation)
An example of a sign is:
a - the patient tells you what part of the eye hurts
b - an elevated intraocular pressure reading
c - the patient complaint of blurred vision
d - the patient complains of a pressure sensation behind the eyes
b - an elevated intraocular pressure reading
- A sign is something you can observe in the patient, such as an intraocular pressure reading. The other answers are symptoms.
A 56-year-old patient complains of a sudden onset of double vision. It is most important to ask:
a - “Does the doubling go away if you cover one eye?”
b - “Are the eyes also red?”
c - “Do the eyes ache?”
d - “Does anyone in your family have a lazy eye?”
a - “Does the doubling go away if you cover one eye?”
- Double vision in an adult is potentially serious. If vision is single with one eye covered, this indicates a muscle balance problem, which could indicate a possible brain tumor or nerve disorder. If vision is double in one eye only, the eye itself has a problem. The other answers are irrelevant to the situation.
An old photograph of the patient will be most useful to the physician if the patient complains of or exhibits:
a - eye protrusion, double vision, or floaters
b - lid droop, pupil abnormality, or head tilt
c - redness, pain, halos around lights at night, and decreased vision
d - headache, rash, or lid droop
b - lid droop, pupil abnormality, or head tilt
- If any of the conditions listed in this answer are present in the photograph, this indicates that the problem is longstanding
Your patient has a cut eyelid. It is important to know what caused the injury because:
a - this will determine how the doctor will repair the lid
b - if the object was organic (plant or animal), there is a greater risk of infection
c - if the object was metal, there is a greater risk of infection
d- the injury needs to be reported to the National Ocular Injury Registry (NOIR)
b - if the object was organic (plant or animal), there is a greater risk of infection
- Any laceration that was caused by or infused with organic matter has a much greater likelihood of becoming infected. The physician might choose to give an oral antibiotic.
(There is no such thing as the NOIR!)
A patient presents with a corneal foreign body, and your supervisor asks how the foreign body got into the eye. This is an important question because:
a - if the patient was not wearing safety glasses, Workers’ Compensation will not pay
b - if the particle was under high speed, there might be internal ocular damage
c - this determines whether or not you should check the patient’s vision
d - this determines whether or not you should irrigate the eye
b - if the particle was under high speed, there might be internal ocular damage
- a foreign body a high speed might cause serious internal damage. The patient’s vision is checked regardless of how the injury occurred. While it is true that you should not irrigate an eye if you suspect the globe has been penetrated (nor is irrigation usually used for a corneal foreign body)
The patient is not wearing contacts but would like to be fit for them. The most important question is:
a - “have you tried contact lenses before?”
b - “are you interested in disposable lenses?”
c - “do you have trouble seeing to read?”
d - “are you allergic to thimerosal?”
a - “have you tried contact lenses before?”
- It is most important to know a patient’s past experience with contacts. Answers b and c are not wrong, but they are not best. Thimerosal is a preservative that was formerly used in contact lens solutions but was largely discontinued when many people developed a sensitivity to it.
A 52-year-old patient hands you his single-vision glasses, the only glasses he has. Which of the following is the most important question in determining the patient’s refractive status?
a - “how long have you had these?”
b - “do these help you see better?”
c - “do you wear these for driving or for reading?”
d - “do the frames hurt your ears?”
c - “do you wear these for driving or for reading?”
- While all questions are good ones, you can determine the patient’s refractive status only if you know how he uses the glasses. At his age, he has been presbyopic for a number of years. If the glasses are for driving, he is myopic. If the glasses are for reading, he is probably emmetropic withe presbyopia.
A patient reports that he sleeps in his contact lenses. An important question would be:
a - “what type of lenses are they?”
b - “do you have astigmatism?”
c - “why haven’t you had LASIK?”
d - “are you legally blind without the contacts?”
a - “what type of lenses are they?”
- You need to know about the lens material. It may be okay to sleep in a disposable extended-wear lens, for example, but some contact should bever be left in during sleep, and the patient is doing something potentially harmful.
The patient gives a history of having a cataract removed with a laser. You should:
a - record the cataract surgery without mentioning the laser, because the patient does not know what he or she is talking about.
b - use this as a “teachable moment” and inform the patient that cataracts cannot be removed with a laser
c - ask the patient if the surgery was done in a hospital while lying down or sitting up in a chair (to an instrument like a slit lamp)
d - not record this, because the patient is obviously confused
c - ask the patient if the surgery was done in a hospital while lying down or sitting up in a chair (to an instrument like a slit lamp)
- When a patient says something that does not make ophthalmic sense, ask more questions before writing it in the history. She may be referring to having a laser capsulotomy for a so-called “secondary cataract”.
The patient gives a history of having a laser treatment but is not sure what it was for. You might discover more by asking:
a - “have you had cataract surgery?”
b - “do you have diabetes?”
c - “do you have glaucoma?”
d - all of the above
d - all of the above
- Laser treatment might be used after cataract surgery (laser capsulotomy), in the case of diabetes (photocoagulation), or glaucoma (trabeculectomy or iridotomy)
The patient states she used to wear contact lenses but went back to her glasses. A pertinent question would be:
a - “do you have astigmatism?”
b - “do you think the lenses were improperly fit?”
c - “why did you stop wearing them?”
d - “do you have dry eyes?”
c - “why did you stop wearing them?”
- Answers a and d are not bad questions, but they are not the best. Answer b could imply a judgment on the patient’s past care, which is not ethical as it calls into question the competency of another practitioner
A 76-year-old new patient tells you that he caught astigmatism from his brother when they were both children. You should:
a - tell him he is wrong because astigmatism is not a disease
b - agree with him because astigmatism can run in families
c - ask him what he means by “astigmatism”
d - explain that astigmatism is a refractive error
c - ask him what he means by “astigmatism”
- The patient obviously has a misconception about the origin of astigmatism, or he may have misapplied the term to some type of infection. Ask him.
Knowledge of a past ocular injury is needed because:
a - it might help explain current complaints and findings
b - it might indicate a reason why the patient’s vision should not be checked
c - it might indicate the reason for an allergy to eye drops
d - a careless, accident-prone patient is likely to be noncompliant
a - it might help explain current complaints and findings
- A patient’s current problems may stem from past injury (such as recurrent erosion syndrome).
The patient states she has prism in her glasses. Which of the following is the most important question to ask?
a - “have you ever had surgery to straighten your eyes?”
b - “does anyone in your family have a lazy eye?”
c - “have you recently tried glasses without prism?”
d - “were you dilated during your last eye exam?”
a - “have you ever had surgery to straighten your eyes?”
- Prism is usually prescribed to overcome motility disorders; hence, asking about surgery to straighten the eyes is in order.
A mother brings in her 4-year-old son. The mother says he has a lazy eye. What do you need to find out?
a - was the birth premature?
b - who else in the family has a lazy eye?
c - does the child rub one eye frequently?
d - what does she mean by “lazy eye”?
d - what does she mean by “lazy eye”?
- She may mean an eye that “looks weak” or crosses. Or she might mean amblyopia. Answers b and c are good but are not key. Answer a is irrelevant in this case.
An example of a systemic illness is:
a - down syndrome
b - senility
c - past surgical procedures
d - cardiac problems
d - cardiac problems
- “Cardiac problems” is the only systemic illness listed. Down syndrome may have systemic effects, but it is a genetic condition, not an illness.
Questions asked of a hypertensive patient should include:
a - method of blood pressure control, sensation of pressure in the eyes, last blood pressure reading
b - weight loss, last blood gases reading, visual stability
c - method of blood pressure control, decrease in vision, last blood pressure reading
d - method of blood pressure control, onset of double vision, last blood sugar reading
c - method of blood pressure control, decrease in vision, last blood pressure reading
- You need to know how a hypertensive patient controls the blood pressure (medications can affect the eyes), any decrease in vision (possible symptoms of hypertensive retinopathy), and the last blood pressure reading (to compare with the one obtained today).
Questions asked of a diabetic patient should include:
a - loss of depth perception, visual stability, type of insulin used
b - method of sugar control, visual stability, last blood sugar reading
c - weight loss, last blood gases reading, type of insulin used
d - injection sites used, increased floaters, frequent urination
b - method of sugar control, visual stability, last blood sugar reading
- A diabetic patient should tell you how he or she is controlling his or her blood sugar (diet, pills or injections), whether or not vision seems stable (fluctuations indicate uncontrolled blood sugar and may affect the refractometric measurement), and his or her last blood sugar reading (preferably the A1C, a single test that evaluates levels over a 90-day period).
A patient with heart problems:
a - may need to eat something during an eye exam
b - cannot be dilated
c - may have hardening of the arteries in the eye
d - always has high cholesterol
c - may have hardening of the arteries in the eye
- Ocular disorders associated with heart problems include hardening of the arteries and/or blood vessel blockage. Patients can be safely dilated in most cases. Answer d is wrong because of the word “always.”
Knowledge of a patient’s breathing or lung problems would be important if the patient also has:
a - dry eye
b - glaucoma
c - macular degeneration
d - oxygen deficiency color blindness
b - glaucoma
- Certain glaucoma medications are contraindicated in patients with lung disease
Your patient states that he has rheumatoid arthritis. You should not ask symptom related questions to find out if he has:
a - dry eye
b - angle-closure glaucoma
c - decreased central vision
d - a visual field loss
a - dry eye
- Dry eye is strongly associated with rheumatoid arthritis
Sickle cell disease:
a - is hereditary and occurs primarily in the black population
b - is hereditary and occurs primarily in the white population
c - is hereditary and occurs equally in all populations
d - is hereditary and occurs primarily in the Latino population
a - is hereditary and occurs primarily in the black population
- Sickle cell disease occurs mainly in the black population and is hereditary
Sickle cell disease may affect the eye:
a - by causing a paralysis of the extraocular muscles
b - by causing posterior subcapsular cataracts
c - because the abnormally shaped cells can block the optic nerve
d - because the abnormally shaped cells can block the eye’s blood vessels
d - because the abnormally shaped cells can block the eye’s blood vessels
- These blockages can happen anywhere in the body, including the eye
Knowing a patient’s past history of surgical procedures is important because:
a - it may reveal precautions needed before eye surgery is undertaken
b - it reveals whether or not the patient is likely to be compliant
c - it may reveal whether or not the patient is a hypochondriac
d - it reveals whether or not the patient may be reluctant to have future surgery
a - it may reveal precautions needed before eye surgery is undertaken
- A patient’s reaction to prior surgery (e.g. excessive bleeding or panic) can be a good indicator f how he or she will tolerate future procedures
Major infections that can affect the eye include:
a - Human immunodeficiency virus (HIV), gonorrhea, tuberculosis and herpes simplex
b - gonorrhea, tuberculosis, Down syndrome and leukemia
c - sickle cell disease, HIV, tuberculosis and toxemia
d - herpes simplex, herpes zoster, anemia and gonerrhia
a - Human immunodeficiency virus (HIV), gonorrhea, tuberculosis and herpes simplex
- Each item in answer a is an infection. Down syndrome, leukemia, sickle cell disease, toxemia and anemia are not infections; they are conditions or disorders.
Your patient is a 4-month-old who was born prematurely. Which question will be most important in predicting the occurrence of eye disorders related to prematurity?
a - how much did the baby weigh?
b - was the mother exposed to measles during pregnancy?
c - did the baby receive oxygen after birth?
d - has the baby steadily gained weight since birth?
c - did the baby receive oxygen after birth?
- Oxygen therapy after a premature birth has been linked to retinopathy of prematurity. Answers a and d are good, but not related to the question.
In which of the following ocular disorders would it be most important to know what eye drops a new patient is using?
a - cataracts
b - glaucoma
c - macular degeneration
d - retinitis pigmentosa
b - glaucoma
- A new patient who states they have glaucoma should be asked what eye drops they are using to control their pressure. Conditions in answers a, c and d do not require medication.
Which situation poses a potential problem in a patient taking aspirin-containing medications?
a - the patient with a cataract who will be having surgery
b - the patient with migraine headaches
c - the patient with headaches from convergence insufficiency
d - the patient with diplopia
a - the patient with a cataract who will be having surgery
- Aspirin and aspirin-containing medications thin the blood. Thus, the patient taking them runs a greater risk of hemorrhage during or after surgery.
While taking the ocular history of a new patient, she mentions that her last ophthalmologist told her she has macular degeneration. This should trigger you to specifically ask about which of the following?
a - aspirin use
b - steroid use
c - vitamin use
d - artificial tear use
c - vitamin use
- Patients with diagnosed macular degeneration have probably been put on a vitamin regimen of some kind.
Patients taking a diuretic might have which special need during the exam?
a - frequent trips to the bathroom
b - an increase in the amount of oxygen they are receiving
c - frequent stops to use an inhaler for breathing
d - an early appointment because they tire easily
a - frequent trips to the bathroom
- Diuretics act to reduce the body’s fluids.
A patient taking a diuretic probably has which health problem?
a - asthma
b - heart trouble
c - emphysema
d - diabetes
b - heart trouble
- Heart patients are placed on diuretics to reduce excess fluid in the body, thereby reducing heart strain. Asthma and emphysema are breathing problems. Diabetes is related to blood sugar.
High blood pressure is frequently treated by:
a - nonsteroidal anti-inflammatory drugs (NSAIDs)
b - oral steroids
c - beta-blockers
d - analgesics
c - beta-blockers
- Beta-blockers are frequently used to treat hypertension. NSAIDs and steroids are used to treat inflammation. Analgesics are for pain.
If a patient with glaucoma is to be treated using beta-blockers, it would be most important to know if the patient is currently being treated for:
a - diabetes
b - gout
c - sinus
d - high blood pressure
d - high blood pressure
- If the patient is already taking beta-blockers for hypertension, the physician may not want to prescribe an additional beta-blocker for the glaucoma.
It is important to know if a patient is taking birth control pills because:
a - an overdose can cause blindness
b - these hormones can cause loss of depth perception
c - these hormones can cause changes in the retina
d - forgetting to take them can cause loss of depth perception
c - these hormones can cause changes in the retina
- These changes can include damage such as retinal artery and vein occlusion
A patient who has been taking oral steroids for long periods should be evaluated for possible development of:
a - dry eye
b - cataracts
c - iris cysts
d - macular degeneration
b - cataracts
- Cataract formation has been associated with the long-term use of oral steroids
Conditions for which a person might take oral steroids include:
a - rheumatoid arthritis
b - diabetes
c - hypertension
d - hypoglycema
a - rheumatoid arthritis
- Steroids are anti-inflammatory drugs and, thus, are used in treatment of rheumatoid arthritis
Patients often fail to report the use of over-the-counter medications because:
a - they consider them to be unimportant and unrelated to eye care
b - over-the-counter medications have no ocular side effects
c - only prescription medications are important because they are stronger
d - patients do not want to admit they use them
a - they consider them to be unimportant and unrelated to eye care
- Patients tend to think that over-the-counter medications are not important (or they would be regulated), nor have an effect on the eye
The patient has said he has no heart problems, but you notice that he is taking two heart medications. For the most complete history, you should:
a - simply record the medications
b - not record the medications because the patient must be mistaken
c - ask the patient what he takes the medication for
d - confront the patient with his misinformation
c - ask the patient what he takes the medication for
- When in doubt, ask. In some cases, a drug is prescribed for a condition other than its “usual” use. Recording the medicine without delving a little further, or not recording it at all, would be irresponsible. Confronting the patient is unnecessary
Diabetes medication includes:
a - diuretics and beta-blockers
b - insulin injections and “sugar pills”
c - steroids and analgesics
d - antibiotics and NSAIDs
b - insulin injections and “sugar pills”
- Diabetes is treated with oral medication (“sugar pills”) and injectable insulin. (These pills are not actually made out of sugar, but many patients call their oral medication “sugar pills”)
An example of an analgesic is:
a - insulin
b - aspirin
c - sulfa
d - nitroglycerin
b - aspirin
- An analgesic is a pain reliever
Which patient is most likely to be using hormone replacement therapy?
a - a woman who has not yet reached menopause
b - a woman who has had a hysterectomy/oophorectomy
c - a pregnant woman
d - a woman who has had a mastectomy
b - a woman who has had a hysterectomy/oophorectomy
- Hormones are generally contraindicated in women who are pregnant or who have had a mastectomy for breast cancer. A woman who has not reached menopause presumably still has functioning ovaries.
A male patient is going to be scheduled for cataract surgery. Which of the following medications is of the most concern?
a - sildenafil citrate
b - hydroxychloroquine
c - amiodarone
d - testosterone patch
a - sildenafil citrate
- Medications for erectile dysfunction, such as Viagra, have been implicated in intraoperative floppy iris syndrome, a complication of cataract surgery. Plaquenil is an antimalarial drug sometimes used in the treatment of arthritis. It’s side effects include disturbances of the macula. Amiodarone is used for irregular heartbeat and can have ocular side effects (eg, corneal deposits). The testosterone patch is a male hormone replacement therapy.
Your patient says she is allergic to something common but cannot remember the name. You suggest:
a - penicillin, sulfa or codeine
b - niacin, sulfa or caffeine
c - penicillin, sulfa or caffeine
d - penicillin, sulfur or codeine
a - penicillin, sulfa or codeine
- An allergy to niacin or caffeine is possible, but not common. Sulfur is a mineral.
Your patient says that beta-blockers make him nauseated. This is:
a - an allergy
b - a side effect
c - an unrelated occurrence
d - unimportant
b - a side effect
- Side effects should still be recorded in the patient’s chart
Your patient says that erythromycin makes her break out in a rash. This is:
a - an allergy
b - a side effect
c - an unrelated occurance
d - unimportant
a - an allergy
- Allergic reactions always need to be recorded in the patient’s chart
Your patient is scheduled to have a chalazion excision. It is most important to know his previous reactions to:
a - general anesthesia
b - local anesthesia
c - neomycin
d - fluorescein
b - local anesthesia
- Chalazion excisions are done under local. The exception to this is for small children, where they will use general.
Your patient is unsure if she has ever had any local anesthesia. You could ask if she:
a - has ever had a numbing injection for a dental procedure
b - has ever been put to sleep for any surgery
c - has ever had an applanation tension test
d - has ever had drops to numb the eye
a - has ever had a numbing injection for a dental procedure
- This is an example of a local anesthetic.
Your patient reports an adverse reaction to dye injected for a kidney evaluation. This could affect:
a - performing applanation tonometry
b - performing a fluorescein angiogram
c - testing tear function
d - dilating the pupil
b - performing a fluorescein angiogram
- Dye is injected into the vein during an FA. The fluorescein used during a and c would be topical.
Knowing a patient’s occupation may be important in:
a - prescribing bifocals or trifocals
b - deciding what type of medication to prescribe
c - knowing the patient’s risk of eye surgery
d - all of the above
d - all of the above
- A patient’s occupation may affect the prescribing of bifocals or trifocals (because of work distance), medications (eg. those causing blurred vision or drowsiness), and the types of ocular risks to which the patient is exposed (eg, the need for safety glasses).
A patient’s social history would include all of the following except:
a - tobacco use
b - living arrangements
c - hobbies
d - therapeutic drug use
d - therapeutic drug use
- “Therapeutic” implies that the medication/drug is used as a treatment for an illness or condition. Use of “recreational” drugs would be part of the patient’s social history.
Your patient has been referred to your practice for cataract surgery. You ask if there is anyone at home who can help the patient instill eye drops. This is part of the patient’s:
a - family history
b - ocular history
c - social history
d - medical history
c - social history
- This is only one component of social history
The most common ocular disorders that run in families are:
a - cataracts, macular degeneration, and color blindness
b - strabismus, myopia and glaucoma
c - glaucoma, color blindness and albinism
d - retinitis pigmentosa, strabismus and albinism
b - strabismus, myopia and glaucoma
- All of the disorders listed are hereditary, the others just aren’t as common
25-year-old white woman comes in as a new patient because her mother has just been diagnosed with glaucoma. This information:
a - is unimportant because the patient is under the age of 45
b - is unimportant because glaucoma less prevalent among whites
c - is good reason for a full eye exam
d - is insignificant because glaucoma is passed through the father, not the mother
c - is good reason for a full eye exam
- Family history of glaucoma is always a reason for a full eye exam, regardless of the patient’s age or race or which family member has it.
A mother brings in a 2-year-old child with esotropia. Which of the following is significant for the history?
a - does anyone in the family have crossed eyes?
b - is anyone in the family blind?
c - does anyone in the family have down syndrome?
d - has anyone in the family been born prematurely
a - does anyone in the family have crossed eyes?
- Strabismus tends to be familial
Examples of hereditary systemic disease include:
a - shingles, diabetes, hypertension and gout
b - diabetes, hypertension, arthritis and cancer
c - cancer, diabetes, arthritis and meningitis
d - hypertension, acquired immune deficiency syndrome (AIDS) and shingles
b - diabetes, hypertension, arthritis and cancer
- The other conditions listed (except gout) are infectious diseases
Which of the following is NOT potentially a hereditary disorder?
a - keratoconus
b - secondary glaucoma
c - migraine headaches
d - nystagmus
b - secondary glaucoma
- Secondary implies it was caused by something else (steroid use, trauma, etc)
Any pupil smaller than what size is considered miotic?
a - 1 mm
b - 2 mm
c - 3 mm
d - 4 mm
b - 2 mm
Any pupil larger than what size is considered mydriatic?
a - 3 mm
b - 4 mm
c - 5 mm
d - 6 mm
d - 6 mm
Which of the following groups tend to have smaller pupils?
a - children
b - myopes
c - people with light blue eyes
d - older people
d - older people
- Children, myopes and people with light blue eyes tend to have larger pupils.
Unequal pupil size is termed:
a - anisocoria
b - anisometropia
c - anisochromia
d - aniseikonia
a - anisocoria
- The other answers are all real terms that you should be familiar with as well
The pupil evaluation includes:
a - size, shape, and reaction to light
b - iris color, roundness, and reaction to light
c - angle depth, iris diameter, reaction to light
d - reaction to cycloplegia, light and accommodation
a - size, shape, and reaction to light
- Evaluation of pupils includes checking each pupil for its size, shape, and reaction to light (and sometimes accommodation). After that is done, one pupil is compared to the other. Are they the same size? shape? do they respond to light (or accommodation) to the same degree?
An iris coloboma usually causes a pupillary shape defect:
a - at 12 o’clock
b - at 3 o’clock
c - at 6 o’clock
d - at 9 o’clock
c - at 6 o’clock
- Iris coloboma is a congenital defect where the iris fails to fuse, usually inferiorly
Constriction of the pupil can be accomplished by any of the following except:
a - shining a bright light into the eye
b - having the patient focus on a near object
c - using miotics
d - dimming the room lights
d - dimming the room lights
- Dimming the room lights would make the pupil enlarge
Dilation of the pupil can be accomplished by any of the following except:
a - shining a bright light into the eye
b - pinching the patient’s neck
c - having the patient focus on a distant object
d - dimming the room lights
a - shining a bright light into the eye
- Shining a bright light into the eye would cause the pupils to constrict, not dilate
Direct pupillary response refers to:
a - the reaction of both pupils to light
b - the reaction of one pupil to light
c - the reaction of both pupils to near
d - the reaction of one pupil to near
b - the reaction of one pupil to light
Testing the consensual light response in healthy eyes is possible because:
a - each pupil reacts to light independently
b - if one pupil reacts to light, the other reacts with it
c - the pupils react to light in reverse order
d - the pupils react to near stimuli independently
b - if one pupil reacts to light, the other reacts with it
- The consensual light response compares the response (to light) of one pupil to the response of the other pupil. This is possible because healthy pupils are innervated to do the same thing at the same time, regardless of which eye has the light shining into it.
When checking consensual pupil responses to light, all of the following should be done except:
a - dim the room lights
b - have the patient look at a distant object
c - shine the light source from the side
d - cover the eye not being tested
d - cover the eye not being tested
- Consensual light response testing requires you to able to see both pupils at the same time.
To test pupillary response to accommodation:
a - observe the pupils as the patient looks from a distant object to a close-up object
b - observe the pupils as the patient looks from a close-up object to a light source
c - observe the pupils as the patient reads the near card
d - observe the pupils as the patient reads the distant chart
a - observe the pupils as the patient looks from a distant object to a close-up object
To evaluate a patient for tonic pupil (or Adie’s tonic pupil), one would use which method?
a - pupilometer
b - slit-lamp evaluation
c - cycloplegia
d - accommodation response test
d - accommodation response test
- In Adie’s tonic pupil, there is a rapid/normal reaction of pupillary constriction when looking at a near object, but dilation is markedly slow when the patient shifts to look at a distant object. The pupil is also slow in its reaction to light. A pupillometer is used to measure the pupil’s diameter
Each pupil constricts to direct light. This indicates:
a - there is no relative afferent pupillary defect (RAPD) present
b - the pupils react equally
c - light is passing through each optic nerve
d - equal reaction to accommodation
c - light is passing through each optic nerve
- The direct test evaluates each pupil on its own and is not meant to compare the reaction the optic nerve of each eye. In order to find a RAPD, you would need to additionally perform the swinging flashlight test. Testing pupillary reaction to accommodation would involve having the patient look at a near then distant object and back, watching the pupillary response as he or she does this; a light is not used.
Testing that reveals normal-appearing pupils that react appropriately is documented as:
a - PERRLA
b - RAPD
c - CSM
d - PEAR
a - PERRLA
- PERRLA stands for “pupils equally round and reactive to light and accommodation”
The most common cause of a false-positive pupillary defect is:
a - glaucoma
b - papilledema
c - RAPD
d - weak flashlight batteries
d - weak flashlight batteries
- You probably will not see this question on the test, but it does make an important point. Any time you detect a pupillary defect, double-check with another penlight.
Each of the following could cause abnormal pupil shape except:
a - surgery
b - trauma
c - birth defect
d - Marcus Gunn
d - Marcus Gunn
- The Marcus Gunn pupillary defect affects the pupil’s reaction, not its shape. An example of a congenitally abnormal pupil shape is the coloboma.
Each of the following disorders can cause a change in pupil size except:
a - iritis
b - angle-closure glaucoma attack
c - drug reactions
d - open-angle glaucoma
d - open-angle glaucoma
- Open-angle glaucoma has no effect on pupil size. Some medications for glaucoma do (the miotics). Iritis causes a smaller pupil. angle-closure causes a larger pupil. Drug reactions can go either way.
Argyll Robertson pupils are often:
a - unreactive to direct or consensual light
b - unreactive to accommodation
c - reactive to light
d - sluggishly reactive to accommodation
a - unreactive to direct or consensual light
You discover that your patient has Argyll Robertson pupil. This pupillary defect is associated with:
a - acquired immune deficiency syndrome (AIDS)
b - syphilis
c - gonorrhea
d - rubella
b - syphilis
Which of the following is associated with ptosis, miosis, and lack of perspiration (anhidrosis) on the affected side?
a - Adie’s tonic pupil
b - Horner’s syndrome
c - Argyll Robertson pupil
d - Marcus Gunn pupil
b - Horner’s syndrome
Horner’s syndrome is caused by:
a - nerve damage
b - keratoconjunctivitis
c - syphilis
d - Herpes zoster
a - nerve damage
- This nerve damage specifically affects eyelid position, pupil size and facial perspiration to varying degrees
Adie’s tonic pupil (or tonic pupil) is caused by:
a - systemic rubella
b - sympathetic ophthalmia
c - gonorrhea
d - nerve damage
d - nerve damage
- Specifically, to the short posterior ciliary nerves
You might first suspect that the patient has a tonic pupil when:
a - the response to direct light is slow
b - the pupil enlarges in direct light
c - that eye also has a ptotic lid
d - the patient is photophobic
a - the response to direct light is slow
- A tonic pupil will have a slow reaction to direct light. A pupil that enlarges in direct light most likely has Marcus Gunn, or RAPD defect. Horner’s syndrome exhibits ptosis on that same side.
A relative afferent pupillary defect (RAPD) is identified by using the:
a - cross cover test
b - pupillometer
c - swinging flashlight test
d - direct flashlight test
c - swinging flashlight test
The presence of a RAPD:
a - demonstrates a totally blind eye
b - indicates a problem in the optic nerve
c - indicates a defect in the facial nerve
d - indicates a problem in the cerebral cortex
b - indicates a problem in the optic nerve
- The Marcus Gunn pupil can be identified by shining the light in one eye, then the other, also known as the swinging flashlight test. An eye with March Gunn pupil usually has poorer vision than a normal eye,but is not necessarily blind.
An eye with a RAPD usually has:
a - redness and pain
b - subnormal visual acuity
c - delayed extraocular muscle responses
d - irregular astigmatism
b - subnormal visual acuity
Another name for a RAPD is:
a - Argyll Robertson pupils
b - Adie’s syndrome
c - Marcus Gunn pupil
d - tonic pupil
c - Marcus Gunn pupil
You are performing a swinging flashlight test. The right pupil does not react at all when you shine the light in it. When you swing it over to the left eye, the left pupil constricts rapidly. When you swing back to the right eye, there is again no reaction. This indicates:
a - a normal reaction
b - RAPD OD by reverse
c - RAPD OS by reverse
d - a tonic pupil
b - RAPD OD by reverse
- Usually, RAPD is identified when the unaffected eye constricts rapidly, and the affected eye dilates when you swing back to it. But one can still identify a RAPD in a fixed pupil by the reaction of the other (reverse), reactive eye, as in this scenario.
In order to determine the base curve for a patient’s contact lens, one must perform:
a - keratometry
b - lensometry
c - refractometry
d - slit-lamp exam
a - keratometry
- The keratometer measures the curvature of the cornea. The base curve of the lens is then selected to complement this measurement.
Soft contact lens diameter can be selected by measuring the patient’s:
a - pupillary distance
b - vertex distance
c - visible iris diameter
d - corneal curvature
c - visible iris diameter
- A soft lens should extend beyond the limbus, so one needs this measurement.
For most contact lens fitting purposes, it is acceptable to measure corneal diameter:
a - using an ophthalmoscope set on +10.0 and a millimeter rule
b - by measuring the visible iris with a millimeter rule
c - by using a pachymeter
d - by anesthetizing the eye and using calipers
b - by measuring the visible iris with a millimeter rule
Which of the following is NOT a factor in determining the appropriate power of a contact lens?
a - pupil diameter
b - refractive error
c - vertex distance
d - astigmatism
a - pupil diameter
- Pupil diameter couple possibly figure in on the design of a rigid contact lens but is not a factor in the power of either soft or rigid lenses.
Your patient, a 63-year-old woman, wants to try contact lenses. Which of the following should be done?
a - tear evaluation
b - pachymetry
c - glare test
d - conjunctival biopsy
a - tear evaluation
- Tear production and quality is an important consideration when fitting a woman of menopausal age or anyone in whom dry eye might be a concern. A Schirmer’s tear test is a good option.
Your patient is going to be fit with rigid gas permeable (RGP) lenses. In addition to the usual parameters, you should also measure:
a - corneal thickness
b - palpebral fissures
c - axial length
d - contrast senstivity
b - palpebral fissures
- RGP’s are more dependent on eyelid structure than soft lenses because it is critical that they move with each blink. The distance between the upper and lower lids (the palpebral fissure) should be measured with a simple millimeter rule.
A good rule of thumb when instructing patients regarding contact lenses is to:
a - provide a training session offering oral and written instructions
b - provide written instructions and tell the patient to call with questions
c - provide a training session and oral instructions
d - develop a support group where successful lens wearers teach others
a - provide a training session offering oral and written instructions
The first rule to teach patients about handling contact lenses is:
a - always use a mirror
b - work over a clean surface
c - always wash hands first
d - never touch the lens itself
c - always wash hands first
Before inserting a soft lens, the patient should make sure it is not inverted. This can be done by:
a - visual inspection or the taco test
b - visual inspection of the jelly roll test
c - inserting the lens in an inversion tester
d - viewing the lens’ reverse image in the mirror
a - visual inspection or the taco test
- The taco test involves holding the lens on thumb and forefinger and gently squeezing. If the lens edges flip inward, like a taco shell, then it is NOT inverted.
(There is no such thing as the jelly roll test of an inversion tester.)
To insert a soft lens:
a - the lens should be dry and the finger wet
b - the lens and finger should be dry
c - the lens should be wet and the finger dry
d - the lens and finger should be wet
c - the lens should be wet and the finger dry
- The lens being wet, and the finger dry helps to keep the lens from sticking to the finger instead of the eye
The patient should be instructed to place a contact lens:
a - directly on the cornea
b - on the inferior sclera, then slide it up
c - on the margin of the lower lid
d - on the nasal sclera, then slide it over
a - directly on the cornea
- The lens should be placed directly on the cornea, bull’s-eye style.
Sliding is not a good idea with rigid lenses, as this can cause a corneal abrasion. A lens on the lid margin is almost sure to be blinked out.
Use of lotion or moisturizer before handling lenses or use of makeup, hair spray, or face cream after inserting contact lenses can cause:
a - lens film
b - corneal edema
c - degradation of the lens
d - giant papillary conjunctivitis
a - lens film
- To prevent a filmy build-up on the lens, only hand soap that is free of moisturizers and other additives should be used.
Makeup, face creams and hair spray should be used before insertion.
Hand lotions should be used after.
The patient asks what he or she should do if the contact lens drops into the sink while trying to insert the lens. You tell the patient:
a - rinse the lens with saline and insert
b - rinse the lens with rewetting drops and insert
c - clean and disinfect the lens as per solution instructions
d - replace the lens
c - clean and disinfect the lens as per solution instructions
- A dropped lens should be cleaned and disinfected prior to insertion, every time, no matter what.
Soft contact lenses are most easily removed by:
a - using a plunger cup
b - blinking them out
c - squeezing them out
d - pinching them out
d - pinching them out
- Soft lenses are pinched out with thumb and forefinger at the 9 and 3 o’clock position.
A plunger could tear a soft lens.
Blinking and squeezing will not work.
Damage to soft contact lenses is frequently caused by:
a - enzymatic cleaners
b - rolling them between the fingers
c - long fingernails
d - defective materials
c - long fingernails
Rigid contact lenses are often removed by blinking them out. For this technique to work:
a - the lens should be moved onto the sclera first
b - the lens must be centered on the eye
c - the patient must flip the edge of the lens with the finger
d - the patient must squint and look up
b - the lens must be centered on the eye
- Blinking out a rigid lens requires the patient to look down, open both eyes wide, and pull the temporal canthus with thumb or finger. If the lens is not centered, this will not work.
All of the following are helpful/proper techniques for using a plunger to remove a rigif lens except:
a - locate the lens on the eye before applying the plunger
b - wet the plunger with wetting solution first
c - run the plunger over the cornea and sclera to locate a “lost” lens
d - carry an extra plunger in your pocket or purse for emergency removal
c - run the plunger over the cornea and sclera to locate a “lost” lens
- Teach your patients to never apply the plunger to the eye unless they know exactly where the contact is. “Fishing” for a lost lens with a plunger is painful and can be damaging to the eye.
Soft lenses should be cleaned immediately after removal because:
a - grunge is easier to remove at body temperature
b - the patient might forget to do it later
c - grunge is harder to remove once the lens has dried out
d - otherwise enzymes are needed
a - grunge is easier to remove at body temperature
- A soft lens should never be allowed to dry out
The difference between cleaning and disinfecting is:
a - cleaning is mandatory; disinfecting is optional
b - cleaning removes film and debris; disinfecting kills germs
c - cleaning kills germs; disinfecting removes film and debris
d - cleaning is optional; disinfecting is mandatory
b - cleaning removes film and debris; disinfecting kills germs
- Neither cleaning not disinfecting is optional. Disinfectant cannot reach all the surfaces of a dirty lens.
When using a one-step contact lens solution, what should one do upon removing a lens from the eye?
a - put the lens directly into the case with fresh solution
b - place the lens in the palm, add solution, and gently rub with fingertip
c - rinse lens with solution and rub vigorously between the thumb and index finger
d - rinse the lens under the water faucet and gently rub with fingertip
b - place the lens in the palm, add solution, and gently rub with fingertip
- This is still true even if the solution says it is “no rub”
Enzymatic cleaners may be used weekly for daily-wear soft lenses and gas-permeable lenses in order to:
a - sterile the lenses
b - prolong the life of the lens material
c - remove protein deposits
d - reduce splitting and chipping
c - remove protein deposits
- They do not provide the advantages listed in answers a, b, or d
When not being worn, even rigid lenses should be stored in soaking solution because:
a - this prevents warping
b - this reduces the chances of chipping the lenses
c - this maintains the power of the lens
d - this maintains the integrity of the plastic
a - this prevents warping
If a gas-permeable lens dries out:
a - it must be replaced
b - it can still be worn immediately
c - it should be soaked for at least 4 hours
d - it should be soaked for a week before wearing
c - it should be soaked for at least 4 hours
If soft contact lenses are not going to be worn for a few days:
a - add more soaking solution periodically to keep the lenses covered
b - screw the case lid on tight to prevent evaporation
c - use only non-preserved saline as a soak
d - change the soaking solution every day to maintain disinfection
d - change the soaking solution every day to maintain disinfection
Which of the following regarding “topping off” cleaning/disinfecting solutions is false? (“topping off” refers to the practice of adding a little fresh solution to what was left in the case from the last cleaning.)
a - it weakens the lens material
b - it contaminates the solution
c - it dilutes the solution
d - disinfection is compromised
a - it weakens the lens material
Wetting solutions are used to:
a - keep lenses sterile while stored in the case
b - enable tears to spread evenly on the lens surface
c - make the lens resistant to deposit build-up
d - prevent scratches on the lens surface
b - enable tears to spread evenly on the lens surface
Rewetting solutions are used to:
a - disinfect the lenses while on the eye
b - remove deposits
c - rehydrate the lenses while on the eye
d - treat ocular redness
c - rehydrate the lenses while on the eye
- This increases lens movement and comfort
Which of the following is the least sterile of these unapproved, ill-advised, and dangerous rewetting fluids?
a - saliva
b - tap water
c - urine
d - water from a swimming pool
a - saliva
- Gross as it may be urine is more sterile than saliva. (Telling your patients this may discourage the terrible habit of wetting a rigid lens in their mouth!) Saliva harbors all kinds of nasty, infection-causing bacteria. Tap water and pool water (although “cleaner” thank saliva) are not the right solutions either and can cause the lens to adhere to the cornea, as well as cause corneal edema.
Every patient who wears extended-wear contact lenses should be told to:
a - remove the lenses and clean them daily
b - allow the lenses to remain in the eye for up to 1 month
c - use lubricating drops every morning and during the day
d - endure occasional pain and redness as a matter of course
c - use lubricating drops every morning and during the day
All of the following are true regarding a contact lens case except:
a - it can be boiled in water
b - it should be washed weekly with hot water and soap
c - it should be rinsed daily with fresh lens solution
d - the interior is disinfected along with the contacts
b - it should be washed weekly with hot water and soap
- The case should NOT be washed with soap because the residue could interfere with the disinfectant or cause a film on the lenses. The entire case should be replaced every couple of months.
Patients who work around smoke, dust, and chemical fumes should be told:
a - they are not good candidates for contact lenses
b - they should wear rigid lenses, which will not absorb fumes
c - they should not wear contacts at work
d - they should change jobs if they want to wear contacts
c - they should not wear contacts at work
The contact lens patient should be told that if they eye ever becomes red or painful:
a - try another lens
b - irrigate the eye
c - bear with it
d - remove the lens
d - remove the lens
Corneal vascularization can result from chronic:
a - hypoxia
b - solution sensitivity
c - conjunctival injection
d - giant papillary conjunctivitis
a - hypoxia
- This is a lack of oxygen
The area of the cornea that most commonly becomes vascularized is the:
a - inferior limbal area
b - superior limbal area
c - 9 o’clock limbal area
d - 3 o’clock limbal area
b - superior limbal area
- (Under the upper lid)
Corneal edema is caused by:
a - excess oxygen permeability
b - insufficient oxygen
c - excess carbon monoxide
d - excess tear production
b - insufficient oxygen
Symptoms of corneal edema include:
a - blurred vision
b - rainbows around lights
c - injection and burning
d - all of the above
d - all of the above
Which of the following has been associated with Acanthamoeba infections in contact lens wearers?
a - non-preserved saline
b - thimerosal-preserved solution
c - homemade saline
d - sample bottles of solution
c - homemade saline
- Generally made with salt tablets and distilled water
Patients who remove his or her extended-wear lenses only once a month experience a higher percentage of all of the following except:
a - decreased need for artificial lubrication
b - redness
c - corneal anesthesia
d - exposure keratitis when lenses are removed
a - decreased need for artificial lubrication
- Every patient who wears contact lenses on an extended basis needs to lubricate the lenses regularly, especially every morning.
Corneal anesthesia is a loss of sensation.
Giant papillary conjunctivitis is suspected to be:
a - an allergic response
b - an infection
c - a response to mechanical irritation
d - a sign of overwear
a - an allergic response
- A response to the protein deposits on a contact lens (usually soft). As the deposits break down, an allergic response is triggered.
In addition to mucus formation, itching, and lens intolerance, the hallmark of giant papillary conjunctivitis is:
a - corneal ulcers
b - inflamed pinguecula
c - papillae on the palpebral conjunctiva of the upper lid
d - papillae on the bulbar conjunctiva under the upper lid
c - papillae on the palpebral conjunctiva of the upper lid
- The signs and symptoms of Giant Papillary Conjunctivitis include itching, mucus, lens intolerance, and the formation of the papillae on the inner surface of the upper eyelid.
The patient with excess tear secretion may experience:
a - “sucked on” lens syndrome
b - increased risk of neovascularization
c - excessive lens movement
d - circumcorneal indentation
c - excessive lens movement
- Excessive tears equal excessive movement as the lens floats around on the surplus fluid
Patients using the monovision technique might experience problems:
a - taking the driver’s license vision test
b - in very bright light
c - looking from the desk to the board in a classroom situation
d - when peripheral vision is checked by confrontation
a - taking the driver’s license vision test
- The test for the driver’s exam is a distance vision test. Often, the eye fit for near will fail to see the required distance figures. In this case, a letter or form may be required from the physician, explaining the situation.
The advantages of soft lenses include all of the following except:
a - they are more comfortable than rigid lenses
b - they provide crisper vision than rigid lenses
c - there is less lens displacement
d - there is less lens loss
b - they provide crisper vision than rigid lenses
- As a rule, soft lenses (being very flexible) do not provide the crisp, sharp vision of rigid lenses
One of the main disadvantages of soft lenses is:
a - frequent lens loss
b - poor durability
c - low oxygen permeability
d - corneal injury on insertion
b - poor durability
- The soft lens’ flexible nature also makes it vulnerable to problems of durability. The lens can be torn easily. (Non-disposable types may also crack or split with age. The life expectancy of a non-disposable soft lens is generally considered to be only about 1 year.) However, there is less lens loss, better oxygen permeability, and a lower risk of injury on insertion because the edges are soft.
The characteristic of soft lens material that is responsible for most of the lens’ advantages (and disadvantages) is its:
a - tear exchange under the lens
b - ability to absorb water
c - resistance to deposits
d - larger diameter
b - ability to absorb water
- The soft lens is hydrophilic, which means “loves water”. The fact that is absorbs water is responsible for its entire nature. This includes comfort, flexibility, and oxygen transmission. There is very little tear exchange under a soft lens (as opposed to a rigid lens). These lenses are not resistant to deposits. A larger diameter is possible because of the oxygen transmissibility, but the diameter in and of itself is not responsible for the lens’ advantages and disadvantages.
One of the main risks of wearing soft contact lenses is:
a - modifications are impossible
b - residual astigmatism
c - infection
d - lens discoloration
c - infection
- The pores of soft lens material generally are too small for bacteria to penetrate. However, once the lens forms deposits, there is a rough surface on which bacteria may grow. In addition, the removal of a deposit may create a pit in the lens large enough to harbor bacteria.
Which patient is a poor candidate for soft lenses?
a - a patient with dry eye
b - a patient with a spherical refractive error
c - an infant or child
d - a recreational basketball player
a - a patient with dry eye
- If a hydrophilic lens does not get the water it “wants” from the tear film, its thickness (and, thus, optics) can change, making the patient with dry eye a less-than-ideal contact lens patient. Soft lenses usually correct spherical errors quite well. An infant and child are good candidates because the soft lens provide more comfort and a low rate of lens loss on impact. Rigid lenses may pop out on impact, which makes the soft lens a good choice for the recreational basketball player as well.
Fitting a dry eye with a soft lens can be difficult because:
a - tear supplements cannot be used with soft lenses
b - the lens will move excessively
c - the diameter of the lens will change as it dries
d - the optical properties of the lens will change as it dries
d - the optical properties of the lens will change as it dries
- As it dries out, its base curve (not diameter) changes, altering its optical qualities and producing blurred vision. Selected tear supplement drops can be used with soft contact lenses in place. The dry lens moves little if at all.
All of the following are poor candidates for extended-wear lenses except:
a - those who work in a dusty environment
b - those with chronic blepharitis
c - those taking blood thinners
d - those with pre-existing giant papillary conjunctivitis
c - those taking blood thinners
- There is no connection between taking blood thinners and wearing contact lenses
Which of the following probably would be a poor candidate for monovision technique?
a - a public speaker
b - a teacher
c - a bookkeeper
d - an actor
c - a bookkeeper
- Anyone who continuously works up close and requires “perfect” near vision all the time (such as a bookkeeper or an accountant) probably is not a good candidate for monovision. Monovision involves a trade-off. Both distance and near vision are somewhat compromised, and binocular vision is sacrificed, but the patient does not have to cope with bifocals (glasses or contacts).
Monovision contact lens fitting for presbyopia involves:
a - fitting both eyes for distance and using reading glasses for near
b - fitting one eye (usually the dominant eye) for distance and the other eye for near
c - fitting one eye (usually the dominant eye) for near and the other eye for distance
d - wearing a contact lens for near in one eye and leaving the other eye uncorrected
b - fitting one eye (usually the dominant eye) for distance and the other eye for near
The lower the water content of a soft lens:
a - the more durable the lens
b - the greater oxygen permeability
c - the less frequently it needs to be cleaned
d - the smaller the diameter
a - the more durable the lens
- The lower the water content, the more rigid it is and thus more durable. Still the soft lens does not approach the rigidity in the sense that a hard or gas-permeable lens does. A low water content lens is less oxygen transmissible.
A soft contact lens with a high-water content will:
a - be more stable if lens dehydration occurs
b - allow for greater oxygen transmission
c - need to be disinfected by thermal methods only
d - be more durable if it made of hydroxyethyl methacrylate (HEMA)
b - allow for greater oxygen transmission
- Unfortunately, these lenses are sensitive to dehydration if the environment changes. They also are heat sensitive, and some types may not be disinfected using thermal methods. Given the same water content, the non-HEMA lenses are more durable.
The “Dk value” of a contact lens refers to its:
a - carbon dioxide permeability
b - oxygen permeability
c - carbon monoxide permeability
d - deciliter per kilogram value
b - oxygen permeability
*The Dk value of a contact lens is a laboratory measurement of the oxygen permeability of a material. That is not to say, however, that the Dk is a measurement of how much oxygen actually reaches the cornea.
The oxygen supply to the cornea can be increased by selecting a lens:
a - with a high Dk value or reduced thickness
b - with a low Dk value or reduced thickness
c - with a high Dk value or increased thickness
d - with a low Dk value or increased thickness
a - with a high Dk value or reduced thickness
Selecting the power of a spherical soft contact lens is based on:
a - the spherical element found on refractometry
b - the cylindrical element found on refractometry
c - the spherical equivalent of the refractometric measurement
d - the refractometric and keratometric measurements
c - the spherical equivalent of the refractometric measurement
- The power of a spherical soft contact is chosen by the spherical equivalent of the refractometric measurement. The K readings are not used for calculating the power.
To obtain the spherical equivalent:
a - add half of the sphere to the cylinder algebraically, keeping the cylinder
b - add half of the cylinder to the sphere algebraically, keeping the cylinder
c - add half of the sphere to the cylinder algebraically, deleting the cylinder
d - add half of the cylinder to the sphere algebraically, deleting the cylinder
d - add half of the cylinder to the sphere algebraically, deleting the cylinder
You want to fit a spherical soft contact. The refractometric measurement is -3.00 + 1.00 X 180. Your lens choice is:
a - -3.00 sphere
b - -3.50 sphere
c - -2.00 sphere
d - -2.50 sphere
d - -2.50 sphere
- Half of the cylinder is +0.50. Add this to the sphere power: -3.00 +0.50 = -2.50
With spherical soft lenses, a small amount of corneal astigmatism is:
a - increased
b - eliminated
c - tolerated
d - a reason to fit Toric lenses
c - tolerated
- As long as a patient tolerates it, there is no reason to rush into fitting a toric lens.
The amount of astigmatism that is present after the patient is fitted with lenses is referred to as:
a - residual astigmatism
b - corneal astigmatism
c - lenticular astigmatism
d - irregular astigmatism
a - residual astigmatism
The most common source of residual astigmatism in contact lens wearing is:
a - the tear lens
b - the cornea
c - the crystalline lens
d - the retina
c - the crystalline lens
- Residual astigmatism is most often caused by lenticular astigmatism, or irregular curvature of the crystalline lens (which does not show up on K readings)
The patient with astigmatism may tolerate spherical soft contact lenses up to the point that the astigmatism is:
a - less than one-third of the total refractive error
b - less than half of the total refractive error
c - lenticular
d - with the rule
a - less than one-third of the total refractive error
You plan to fit a soft Toric contact lens. Which of the following is true regarding the refractometric measurements?
a - it must be converted to plus cylinder
b - you will use the spherical equivalent
c - you want the patient to accept the most cylinder power possible
d - you want the patient to accept the least cylinder power possible
d - you want the patient to accept the least cylinder power possible
- When fitting a soft Toric, you want the least amount of cylinder correction that the patient will accept, because the lens will rotate a bit on the eye. The higher the amount of cylinder, the more pronounced the visual problems caused by this rotation.
The major difficulty with fitting Toric lenses is:
a - patient discomfort
b - lens stability on the eye
c - arriving at the correct prescription
d - obtaining accurate over-refractions
b - lens stability on the eye
- Keeping the cylinder properly aligned means keeping the lens aligned. A spherical lens is normally pushed around and rotates during blinking. This spells disaster for a Toric lens fit.
An aid in evaluating the stability of a soft Toric lenses is:
a - the movement gauge
b - etch or laser marks on the lens
c - a protractor in the slit-lamp ocular
d - the contact lens gauge
b - etch or laser marks on the lens
- Soft Toric lenses have etc marks or dots either at the base or at the horizontal meridian. These can be observed with the slit lamp. The examiner looks for lens rotation as the patient blinks.
Most practitioners would prefer to fit a gas-permeable contact lens instead of a traditional hard polymethylmethacrylate (PMMA) lens because:
a - vision with a gas-permeable lens is better
b - gas-permeable lenses are easier to handle
c - gas-permeable lenses are available for astigmatism
d - corneal warpage is less with gas-permeable lenses
d - corneal warpage is less with gas-permeable lenses
- Because a PMMA lens is not oxygen permeable, nearly all PMMA lenses cause some degree of corneal anoxia (an- means without and -oxia means oxygen). This, in turn, is responsible for corneal warpage. Because gas-permeable lenses do allow oxygen to reach the cornea, the incidence (and risk) of corneal warpage is much less. In the absence of corneal complications, both rigid lens types should provide crisp vision, are equally easy to handle, and can be ground to correct astigmatism.
Which of the following makes a patient a poor candidate for gas-permeable contact lenses:
a - history of giant papillary conjunctivitis
b - exophthalmos
c - corneal irregularity
d - neovascularization from soft lenses
b - exophthalmos
- A bulging eye is best fit with a soft lens, which is more stable on the eye and doesn’t interfere with the lids
The fact that gas-permeable contact lens material allows more oxygen to the eye means that:
a - the lens can be larger than a PMMA lens
b - the lens is more comfortable than a PMMA lens
c - lens movement is not an important factor
d - the lens can be allowed to rest on the lower lid margin
a - the lens can be larger than a PMMA lens
- Because a gas-permeable contact lens allows more oxygen to get to the cornea, the eye can tolerate a larger lens. True, it is more comfortable than a PMMA lens, but this is due to the fit (sliding under the upper lid versus bumping into it), not permeability. Lens movement still is important. The properly fit gas-permeable lens does not sit on the lower lid.
The average life of a rigid gas-permeable lens is:
a - 6 to 9 months
b - 12 months
c - 18 to 24 months
d - 36 months
c - 18 to 24 months
Over-refractometry of a contact lens is useful in fine tuning:
a - lens power
b - lens diameter
c - lens centration
d - lens base curve
a - lens power
When taking a refractometric measurement over a contact lens of a patient over 40-years-old:
a - first find out how the patient is corrected for presbyopia
b - measure each eye for distance only
c - measure each eye for near only
d - measure the right eye for distance and the left for near
a - first find out how the patient is corrected for presbyopia
- If the patient is presbyopic, find out how the lenses are fit before pulling the refractor forward. Are they monfit? Bifocals? Maybe distance in both eyes with reading glasses? Knowing what to expect before you get started will make your job easier.
Bandage contact lenses are routinely used for all of the following except:
a - correcting a refractive error
b - promoting healing and protection
c - patient comfort
d - drug reservoir
a - correcting a refractive error
- While a bandage lens of a specific power may be chosen, correcting the refractive error is not the priority in a bandage lens. In fact, a plano lens usually is preferred because it is thinner (in the center for a plus lens and the edges for a minus lens) and thus more oxygen permeable.
They key in selecting a bandage contact lens is:
a - the patient’s refractive error
b - the patient’s ability to handle the lens
c - oxygen permeability
d - the patient’s corneal curvature
c - oxygen permeability
- Getting oxygen to the cornea is key in selecting a bandage lens. A bandage lens is generally not handled by the patient.
Even if a patient has a hyperopic refractive error, it is best to try a plano bandage lens first because:
a - refractive correction may trigger ciliary spasms
b - a plan lens is thinner
c - a plan lens has a higher water content
d - the patient should avoid using the eye anyway
b - a plan lens is thinner
All of the following are suitable bandage contact lenses except:
a - a collagen disintegrating lens
b - a disposable soft lens
c - a low water content lens
d - a thin, soft lens
c - a low water content lens
- High water content lens versus low water content is preferred because it is more oxygen permeable.
Acuity projector slides can be cleaned by:
a - washing with soap and water
b - spraying with commercial cleaner
c - wiping with dry lens wipe
d - wiping with wet lens wipe
c - wiping with dry lens wipe
- Liquids can dissolve the paint and ruin the slides
Which of the following will help prevent dust build-up on the lenses of a direct ophthalmoscope?
a - the direct ophthalmoscope has no built-in lenses
b - cleaning daily with cleanser
c - removing the instrument facing for direct access to the lenses
d - storing the instrument with the lens setting on zero
d - storing the instrument with the lens setting on zero
- With the setting at zero, there are no exposed lenses in the instrument’s aperture
Which of the following is NOT appropriate when cleaning an indirect ophthalmoscope?
a - cleaning the front surface mirror with a brush
b - rubbing debris off the bulb with finger
c - cleaning the bulb contacts by scraping with a file
d - wiping the headband with an alcohol wipe
b - rubbing debris off the bulb with finger
- Oil from the fingers is transferred to the bulb if you touch it.
Unless the manufacturer’s instructions indicate otherwise, the perimeter bowl surface may be cleaned with:
a - mild detergent and water
b - lighter fluid
c - contact lens solution
d - lens cleaner
a - mild detergent and water
When brushing or wiping the perimeter bowl surface, it is important to avoid:
a - any moisture at all
b - excessive pressure/friction
c - fibrous cotton balls
d - using a soft brush or cloth
b - excessive pressure/friction
*Putting too much pressure on an area inside the bowl might change the reflective properties of the bowl in that area or scratch the finish
Dirty tangent screen test objects should be cleaned with:
a - cleanser
b - an alcohol wipe
c - soap and water
d - acetone
c - soap and water
Discolored tangent screen white test objects should be:
a - replaced
b - painted with correction liquid
c - used as is
d - wiped with an alcohol wipe
a - replaced
- If the test objects are discolored, they should be replaced, not “repaired”. If they are too dingy, they can affect the accuracy of the test.
The tangent screen itself can be cleaned:
a - by gentle whisking with a very soft brush
b - by brushing with a wire brush
c - with a commercial dry-cleaning product
d - with soap and water
a - by gentle whisking with a very soft brush
To prevent dirt from collecting on the back surface of the refractor/phoroptor lenses:
a - use the widest pupillary distance possible
b - adjust the forehead rest to avoid lash/lens contact
c - make sure the refractor is level
d - request that patients remove mascara before refractometry
b - adjust the forehead rest to avoid lash/lens contact
- Oil and makeup can accumulate on the lenses when there is contact between the lids and lenses.
Keep in mind that adjusting the forehead rest changes the vertex distance.
If the internal lenses of the refractor are dirty:
a - spray them through the aperture with lens cleaner
b - open the refractor and clean the lenses one at a time
c - add one line of acuity to everyone’s measurements
d - have the instrument professionally cleaned
d - have the instrument professionally cleaned
- The refractor (phoroptor) is a complicated instrument and should be cleaned only by a trained professional. Never spray anything into the instrument.
To clean the friction plate under the joystick:
a - wipe with alcohol wipe
b - remove the plate, and put it in the autoclave
c - rub with bathroom cleanser
d - spray with lens cleaner
a - wipe with alcohol wipe
- The slit-lamp will not move smoothly if the friction plate is dirty.
To lubricate the friction plate under the joystick:
a - lightly coat with cooking oil and wipe it almost dry
b - lightly coat with automotive oil and wipe it almost dry
c - lightly coat with silicone oil and wipe it away
d - lightly sprinkle with graphite
c - lightly coat with silicone oil and wipe it away
- Alcohol will dissolve oil and grease, so lubricate the clean friction plate with silicone oil or WD-40
Solid ultrasound probes should be cleaned:
a - only if an infectious disease is suspected
b - once a week
c - once each day
d - between each patient exam
d - between each patient exam
- Because the probe makes direct contact with eye tissues, it needs to be cleaned between each patient
All of the following tend to loosen the glue of a mounted lens except:
a - drying out over time
b - heat
c - cool water
d - alcohol or acetone
c - cool water
Unless the manufacturer’s instructions state otherwise, a glass lens (non-bloomed) may be cleaned by any of the following except:
a - 4:1 ratio of ether and alcohol
b - commercial chrome cleaner
c - 1:1 ratio of ammonia and isopropyl alcohol
d - commercial glass or lens cleaner
b - commercial chrome cleaner
Do not use commercial glass cleaner on plastic lenses because:
a - this can scratch the surface
b - this can remove lens coatings
c - this can cloud the lens
d - this can cause crazing
c - this can cloud the lens
Besides soap and cool water, which of the following can be used to clean plastic lenses?
a - contact lens solution
b - lighter fluid
c - bathroom cleanser
d - baking soda
a - contact lens solution
- Because contact lenses are plastic, it makes sense that you can use contact lens solution to clean plastic lenses.
Which of the following will remove the coating on a bloomed lens (such as the indirect ophthalmoscope lens)?
a - gently wiping the dry lens with a tissue
b - wiping the lens with ethyl or methyl alcohol
c - blowing the lens with compressed air
d - heavily rubbing the lens to remove fingerprints
d - heavily rubbing the lens to remove fingerprints
When cleaning a lens that is fixed into an instrument:
a - spray lens cleaner on the lens in the instrument
b - use a stream bottle to irrigate the lens in the instrument
c - spray lens cleaner on a wipe, and clean the lens with the wipe
d - fixed lenses cannot be cleaned
c - spray lens cleaner on a wipe, and clean the lens with the wipe
- Never spray cleaner into an instrument!
The best way to remove dust from a fundus camera lens is to first:
a - dust it with a camel’s hairbrush
b - blow off dust with air
c - wipe dust off with dry cloth
d - clean dust off with isopropyl alcohol
b - blow off dust with air
Which surface of an exophthalmometer might require disinfection?
a - the mirrors
b - the gauges
c - the prisms
d - the points of patient contact
d - the points of patient contact
Which surface of an ophthalmodynamometer might require disinfection?
a - the tip
b - the gauge
c - the lens
d - the watch glass
a - the tip
Which of the following is untrue regarding front surface mirrors?
a - the silver coating can be rubbed off over time
b - the coating can be scratched by mishandling
c - they produce a faint double image of the reflection
d - they reflect 100% light transmission
c - they produce a faint double image of the reflection
Prior to cleaning a front surface mirror, one should:
a - rub with cotton ball to remove loose dust
b - use canned air to remove loose dust
c - blow on it to remove loose dust
d - spray it with water
b - use canned air to remove loose dust
- Prior to cleaning the mirror, use canned air or an air bulb to remove loose debris, which could scratch the mirror when it is being wiped. If you use canned air, be sure it is approved for use on mirrors and lenses; the type usually used for general office use sometimes has a liquid additive that can coat the surface.
Which of the following can be used to clean a front surface mirror?
a - a paper towel and commercial glass cleaner
b - a cotton-tipped applicator and dry baking soda
c - a fingertip to rub off smudges
d - a lens wipe with a :1 ratio of ether and alcohol
d - a lens wipe with a :1 ratio of ether and alcohol
- A front surface mirror can be scratched easily, and a little bit of the silver is rubbed off every time it is cleaned. Clean it with a lens wipe moistened with ether and alcohol, gently moving the wipe in down-strokes. Do not rub the mirror.
A mirror surface should be dried by:
a - patting with a lint-free lens wipe
b - wiping with a lint-free lens wipe
c - rubbing with a tissue or cotton ball
d - patting with a paper towel
a - patting with a lint-free lens wipe
- To avoid scratching, do not rub the mirror and do not use an abrasive wipe
Which surface is NOT affected by friction during cleaning?
a - front surface mirrors
b - bloomed lenses
c - projector screens
d - glass trial lenses
d - glass trial lenses
A projector screen is cleaned by:
a - wiping with an alcohol wipe
b - scrubbing with cleanser
c - a solution of mild detergent
d - commercial glass cleaner
c - a solution of mild detergent
One of the easiest and least expensive ways to prolong the life of ophthalmic/optometric equipment is to:
a - wipe it daily with an alcohol wipe
b - have it serviced every 6 months
c - change bulbs and batteries every 6 months
d - cover or store it when note in use
d - cover or store it when note in use
- Covering or storing equipment prevents dust build-up and reduces breakage
Turning a screw counterclockwise (to the left) will cause it to:
a - tighten
b - loosen
c - strip out
d - fall out
b - loosen
- Remember: “Righty tighty, lefty loosey”
The first several turns inserting a screw are difficult. You should:
a - force it
b - use a hammer
c - stop and try resetting the screw
d - spray lubricant on the instrument
c - stop and try resetting the screw
- Forcing a screw may strip it, making it nearly impossible to remove later. It could also cause the instrument housing to crack.
To extend the life of a slit-lamp bulb:
a - use the lowest voltage setting as much as possible
b - scrape the contact points weekly
c - turn it 180 degrees weekly
d - use the lowest illumination as much as possible
a - use the lowest voltage setting as much as possible
If he filament of a bulb is aligned incorrectly in the housing:
a - the bulb will blow out
b - chromatic aberration will occur in the light field
c - the light will be deviated from prismatic power
d - the projected light will not illuminate the entire field
d - the projected light will not illuminate the entire field
If the light in a piece of electrical equipment begins to flicker or does not come on, the first and easiest thing to check is:
a - the filament
b - the bulb’s seating
c - the instrument’s plug
d - the instrument’s fuse
c - the instrument’s plug
When changing light bulbs in a piece of equipment, all of the following are important except:
a - turn off and unplug the instrument
b - allow the old bulb to cool, if it is hot
c - remove the old bulb with pliers
d - do not touch the glass of the new bulb
c - remove the old bulb with pliers
If the bulb contacts become corroded, one may remedy this problem by unplugging the instrument and:
a - replacing the contacts
b - wiping the contacts with alcohol
c - scraping with a metal file
d - blowing with compressed air
c - scraping with a metal file
The projector bulb has a build-up of oxidation on one side, decreasing its illumination. You should:
a - replace the bulb
b - turn the bulb 180 degrees to use the other side (without the build-up)
c - remember that nothing needs to be done as long as all patients are checked in the same illumination
d - scrape off the contacts in the bulb housing
b - turn the bulb 180 degrees to use the other side (without the build-up)
Which is true of rechargeable batteries and recharging units?
a - the battery will last 10 years or more
b - the rechargers cannot be left on indefinitely
c - batteries can lose the ability to recharge
d - all batteries can be installed in either direction
c - batteries can lose the ability to recharge
An instrument operating on rechargeable NiCad batteries:
a - should be placed in the charger after each use during the day
b - should be placed in the charge only at the end of the day
c - will not operate if more than 25 feet away from the charger
d - works best if the batteries are cooler than room temperature
b - should be placed in the charge only at the end of the day
Regular cell batteries should be stored:
a - in a heated room
b - in the refrigerator
c - in the freezer
d - at room temperature
d - at room temperature
If a particular fuse repeatedly burns out, one should:
a - replace the fuse as needed
b - use a fuse with a lower ampere (AMP) rating
c - get professional assistance
d - replace the instrument
c - get professional assistance
One might adjust the concave mirror in a acuity projector in order to:
a - change the size of the letters to fit a shorter room
b - increase the clarity of the letters
c - improve faulty illumination
d - change the place where the target is projected
c - improve faulty illumination
To calibrate the size of the target of an acuity projector, one must:
a - have a 20-foot test distance
b - use a template and adjust the projection tube until the letter fits into the correct bracket
c - use a table to convert every patient’s measurement if the test distance is not 20 feet
d - use a template, and adjust the concave mirror until the letter fits into the correct bracket
b - use a template and adjust the projection tube until the letter fits into the correct bracket
If the vertical alignment of an indirect ophthalmoscope is misaligned:
a - adjust the headband
b - make sure the mirror is clean
c - adjust the mirror
d - have the instrument professionally serviced
d - have the instrument professionally serviced
A bent, or C-shaped streak in a streak retinoscope is caused by:
a - a weak bulb
b - a bent bulb filament
c - a weak battery
d - using it with the sleeve down
b - a bent bulb filament
- This is caused by lying the instrument on its side
During a normal workday, when not in immediate use, the retinoscope should be stored:
a - by lying it on its side on the table
b - by leaving it turned on
c - by placing it upright
d - by lying it in a protected drawer
c - by placing it upright
If the retinoscope light flickers and the bulb placement is solid, the flickering is probably due to:
a - a loose bulb filament
b - inadequate charge
c - internal wiring problems
d - weak batteries
c - internal wiring problems
Which of the following is NOT true regarding fluid-filling ultrasound probes?
a - the membrane tip is fragile and lasts only a few days
b - the probe is filled with sterile saline solution
c - air bubbles must be removed from the probe before use
d - the crystal in the probe can lose sensitivity over time
b - the probe is filled with sterile saline solution
- Water filled probes contain distilled water, not saline solution
Ultrasound units are calibrated by:
a - touching the probe to a test block specific for that machine
b - touching the probe to a flat surface
c - routinely measuring the same person’s eye as a standard
d - pressing the calibration button on the instrument
a - touching the probe to a test block specific for that machine
Care of the noncontact tonometer includes all of the following except:
a - firing it at the beginning of each day to blow dust from the air nozzle
b - checking calibration by firing the air burst against your finger
c - covering it when not in use
d - cleaning the objective lens and aperture
b - checking calibration by firing the air burst against your finger
The muscle light (transilluminator) might require the following maintenance:
a - brightness calibration
b - bulb and battery replacement
c - sterilization
d - tip and casing replacement
b - bulb and battery replacement
The prescription of a lens is written in the following order:
a - cylinder power, sphere power, sphere axis
b - sphere power, cylinder axis, cylinder power
c - sphere power, cylinder power, cylinder axis
d - sphere power, sphere axis, cylinder axis
c - sphere power, cylinder power, cylinder axis
(By the way, there is no such thing as sphere axis)
In a glasses prescription reading +1.25 -3.75 X082, the -3.75 refers to:
a - sphere power
b - cylinder power
c - cylinder axis
d - add power
b - cylinder power
In a glasses prescription reading -2.25 +1.50 X173, which of the following is true?
a - the prescription is written in minus cylinder
b - the sphere power is “plus”
c - the cylinder power is written in “plus”
d - the cylinder axis is a multiplier
- the cylinder power is written in “plus”
(this is the second number in the prescription)
In a glasses prescription reading +1.00 +1.00 X180 | 1.25/2.50, the number 1.25 refers to:
a - the trifocal power
b - the bifocal power
c - the total add power
d - the cylinder power
a - the trifocal power
(the 1.25 will be the trifocal (intermediate distance) and the 2.50 will be the bifocal (closest distance)).
Which of the following glasses prescriptions would definitely be questioned by an optician?
a - +1.50 +2.25 X181
b - Plano -9.25 X072
c - +11.75 -1.75 X175
d - -2.50 + 6.50 X018
a - +1.50 +2.25 X181
(while any prescription can earn a call from an optician to verify; the first one most definitely would due to the axis. Axis numbers should only every fall between 001 and 180)
When using an automated lensometer, it is important to designate:
a - lens material
b - lens manufacturer
c - desired cylinder type
d - desired base curve type
c - desired cylinder type
An advantage of the automated lensometer is the ease with which it:
a - detects Fresnel prism
b - reads progressive add lenses
c - identifies lens material
d - identified polarized lenses
b - reads progressive add lenses
(Fresenel prisms can be detected without a machine, they have a ridged texture. Lens material and polarization are not detected by any lensometer).
An automated lensometer may be disadvantageous in identifying:
a - optical centers
b - add powers
c - prisms
d - warped lenses
d - warped lenses
A key advantage of automated lensometer is that is:
a - eliminates math errors
b - converts the glasses prescription to a contact lens prescription
c - takes vertex distance into account
d - identifies photosensitive lenses
a - eliminates math errors
All of the following are true regarding automated lensometers except:
a - they should be set on an antistatic mat
b - they should not be placed and used in direct sunlight
c - the internal lenses and mirrors can be cleaned by removing the instrument housing
d - the computer components are sensitive to dust
c - the internal lenses and mirrors can be cleaned by removing the instrument housing
The first step in reading a pair of glasses with the manual lensometer is to:
a - position the glasses in the holder with the temples away from you
b - position the glasses in the holder with the temples toward you
c - clean the lenses before reading
d - adjust the eye piece of the instrument
d - adjust the eye piece of the instrument
When adjusting the lensometer eye piece:
a - you should wear your own habitual correction
b - the lensometer’s power dial should be set to your prescription
c - the lensometer’s axis indicator should be set to 180
d - the lensometer’s axis indicator should be set to match your own astigmatism
a - you should wear your own habitual correction
Before adjusting the lensometer eye piece:
a - turn the eye piece to the most minus position
b - turn the eye piece to the most plus position
c - turn the eye piece to an axis of 180
d - turn the eye piece to the axis of your astigmatism
b - turn the eye piece to the most plus position
(rotating to minus will trigger your accommodative reflex)
When adjusting the lensometer eye piece, the eye piece is slowly rotated until:
a - the target just begins to blur
b - the target is first seen to be clear
c - the target has turned 90 degrees
d - the target clears then begins to blur again
b - the target is first seen to be clear
(If you continue to turn it, you will add unneeded minus and your own accommodation will interfere)
Failure to properly adjust the lensometer eye piece before reading lenses may result in:
a - missing ground-in prism
b - a misaligned cylinder axis
c - reading in plus instead of minus cylinder
d - an inaccurate reading
d - an inaccurate reading
A lens can be read in a lensometer in plus or minus form:
a - by changing the axis 180 degrees
b - by changing the axis 90 degrees
c - by changing the axis 360 degrees
d - by changing the axis 45 degrees
b - by changing the axis 90 degrees
Which is the name of this item?
Direct Ophthalmoscope Slit Lamp (Biomicroscope)
Indirect Ophthalmoscope Ultrasound (A-scan)
Retinoscope Keratometer (Ophthalmometer)
Lensmeter (Lensometer) Trial Lens Set
Perimeter Schiotz Tonometer
Tangent Screen Goldman Tonometer
Phoropter (refractor) Muscle Light
Muscle Light
Which is the name of this item?
Direct Ophthalmoscope Slit Lamp (Biomicroscope)
Indirect Ophthalmoscope Ultrasound (A-scan)
Retinoscope Keratometer (Ophthalmometer)
Lensmeter (Lensometer) Trial Lens Set
Perimeter Schiotz Tonometer
Tangent Screen Goldman Tonometer
Phoropter (refractor) Muscle Light
Tangent Screen
Which is the name of this item?
Direct Ophthalmoscope Slit Lamp (Biomicroscope)
Indirect Ophthalmoscope Ultrasound (A-scan)
Retinoscope Keratometer (Ophthalmometer)
Lensmeter (Lensometer) Trial Lens Set
Perimeter Schiotz Tonometer
Tangent Screen Goldman Tonometer
Phoropter (refractor) Muscle Light
Keratometer (Ophthalmometer)
Which is the name of this item?
Direct Ophthalmoscope Slit Lamp (Biomicroscope)
Indirect Ophthalmoscope Ultrasound (A-scan)
Retinoscope Keratometer (Ophthalmometer)
Lensmeter (Lensometer) Trial Lens Set
Perimeter Schiotz Tonometer
Tangent Screen Goldman Tonometer
Phoropter (refractor) Muscle Light
Indirect Ophthalmoscope
Which is the name of this item?
Direct Ophthalmoscope Slit Lamp (Biomicroscope)
Indirect Ophthalmoscope Ultrasound (A-scan)
Retinoscope Keratometer (Ophthalmometer)
Lensmeter (Lensometer) Trial Lens Set
Perimeter Schiotz Tonometer
Tangent Screen Goldman Tonometer
Phoropter (refractor) Muscle Light
Retinoscope
Which is the name of this item?
Direct Ophthalmoscope Slit Lamp (Biomicroscope)
Indirect Ophthalmoscope Ultrasound (A-scan)
Retinoscope Keratometer (Ophthalmometer)
Lensmeter (Lensometer) Trial Lens Set
Perimeter Schiotz Tonometer
Tangent Screen Goldman Tonometer
Phoropter (refractor) Muscle Light
Direct Ophthalmoscope
Which is the name of this item?
Direct Ophthalmoscope Slit Lamp (Biomicroscope)
Indirect Ophthalmoscope Ultrasound (A-scan)
Retinoscope Keratometer (Ophthalmometer)
Lensmeter (Lensometer) Trial Lens Set
Perimeter Schiotz Tonometer
Tangent Screen Goldman Tonometer
Phoropter (refractor) Muscle Light
Trial Lens Set
Which is the name of this item?
Direct Ophthalmoscope Slit Lamp (Biomicroscope)
Indirect Ophthalmoscope Ultrasound (A-scan)
Retinoscope Keratometer (Ophthalmometer)
Lensmeter (Lensometer) Trial Lens Set
Perimeter Schiotz Tonometer
Tangent Screen Goldman Tonometer
Phoropter (refractor) Muscle Light
Phoropter (Refractor)
Which is the name of this item?
Direct Ophthalmoscope Slit Lamp (Biomicroscope)
Indirect Ophthalmoscope Ultrasound (A-scan)
Retinoscope Keratometer (Ophthalmometer)
Lensmeter (Lensometer) Trial Lens Set
Perimeter Schiotz Tonometer
Tangent Screen Goldman Tonometer
Phoropter (refractor) Muscle Light
Ultrasound (A-scan)
Which is the name of this item?
Direct Ophthalmoscope Slit Lamp (Biomicroscope)
Indirect Ophthalmoscope Ultrasound (A-scan)
Retinoscope Keratometer (Ophthalmometer)
Lensmeter (Lensometer) Trial Lens Set
Perimeter Schiotz Tonometer
Tangent Screen Goldman Tonometer
Phoropter (refractor) Muscle Light
Lensmeter (Lensometer)
Which is the name of this item?
Direct Ophthalmoscope Slit Lamp (Biomicroscope)
Indirect Ophthalmoscope Ultrasound (A-scan)
Retinoscope Keratometer (Ophthalmometer)
Lensmeter (Lensometer) Trial Lens Set
Perimeter Schiotz Tonometer
Tangent Screen Goldman Tonometer
Phoropter (refractor) Muscle Light
Slit Lamp
Which is the name of this item?
Direct Ophthalmoscope Slit Lamp (Biomicroscope)
Indirect Ophthalmoscope Ultrasound (A-scan)
Retinoscope Keratometer (Ophthalmometer)
Lensmeter (Lensometer) Trial Lens Set
Perimeter Schiotz Tonometer
Tangent Screen Goldman Tonometer
Phoropter (refractor) Muscle Light
Schiotz Tonometer
Which is the name of this item?
Direct Ophthalmoscope Slit Lamp (Biomicroscope)
Indirect Ophthalmoscope Ultrasound (A-scan)
Retinoscope Keratometer (Ophthalmometer)
Lensmeter (Lensometer) Trial Lens Set
Perimeter Schiotz Tonometer
Tangent Screen Goldman Tonometer
Phoropter (refractor) Muscle Light
Perimeter
Which part of the Lensometer is: A
Axis Wheel Lens Holder Frame Stage
Eye Piece Lens Stop Power Wheel
Table Control Lever
Eye Piece
Which part of the Lensometer is: B
Axis Wheel Lens Holder Frame Stage
Eye Piece Lens Stop Power Wheel
Table Control Lever
Lens Holder
Which part of the Lensometer is: C
Axis Wheel Lens Holder Frame Stage
Eye Piece Lens Stop Power Wheel
Table Control Lever
Lens Stop
Which part of the Lensometer is: D
Axis Wheel Lens Holder Frame Stage
Eye Piece Lens Stop Power Wheel
Table Control Lever
Frame Stage
Which part of the Lensometer is: E
Axis Wheel Lens Holder Frame Stage
Eye Piece Lens Stop Power Wheel
Table Control Lever
Axis Wheel
Which part of the Lensometer is: F
Axis Wheel Lens Holder Frame Stage
Eye Piece Lens Stop Power Wheel
Table Control Lever
Table Control Lever
Which part of the Lensometer is: G
Axis Wheel Lens Holder Frame Stage
Eye Piece Lens Stop Power Wheel
Table Control Lever
Power Wheel
The proper position of glasses on the manual lensometer is:
a. bottom edge of frame against the frame stage, temples facing away
b. top edge of frame against the frame stage, temples facing away
c. bottom edge of frame against the frame stage, temples facing toward you
d. top edge of frame against the frame stage, temples facing toward you
a. bottom edge of frame against the frame stage, temples facing away
When beginning to read the right lens, the first step is to:
a. try to center the target by moving the stage
b. move the stage so the target is in the uppermost part of the field
c. move the stage so the target is in the lower part of the field
d. change the eye piece again to refocus
a. try to center the target by moving the stage
Which target is analyzed first?
a. the instrument makes this selection
b. the circular mires
c. the wide/triple lines
d. the narrow/single lines
d. the narrow/single lines
If all the lines of the lensometer target clear at the same time, the lens is:
a. monocentric
b. spherical
c. cylindrical
d. spherocylindrical
b. spherical
If the narrow/single line and the wide/triple lines of the lensometer target do not clear at the same time, the lens is:
a. bicentric
b. spherical
c. plano
d. spherocylindrical
d. spherocylindrical
If the lens is determined to by spherocylindrical, one can deduce that the patient has:
a. myopia
b. hyperopia
c. astigmatism
d. presbyopia
c. astigmatism
You are reading the right lens, and the narrow lines appear broken. This means you need to adjust the:
a. eye piece
b. lens table
c. axis wheel
d. power whell
c. axis wheel
If the narrow/single lines are clear and you wish to read the lens in minus cylinder form, you should:
a. turn the power-focusing wheel toward yourself
b. turn the power-focusing wheel away from yourself
c. change the axis 90 degrees
d. focus the triple lines first instead
b. turn the power-focusing wheel away from yourself
The narrow/single lines are clear. You wish to read the glasses in plus cylinder. Turning the power wheel toward yourself does not bring the wide/triple lines into focus. What should you do?
a. read the lenses in minus cylinder instead
b. subtract the reading for the narrow/single lines from the reading for the wide/triple lines
c. add the reading for the narrow/single lines to the reading for the wide/triple lines
d. rotate the axis 90 degrees
d. rotate the axis 90 degrees
You have taken the following lensometer reading: The narrow/single lines clear at -2.00. The wide/triple lines clear at -3.00. Axis is on 083. The prescription is:
a. -2.00 -3.00 x 083
b. -2.00 -1.00 x 083
c. -2.00 -1.00 x 173
d. -3.00 +1.00 x 083
b. -2.00 -1.00 x 083
You have taken the following lensometer reading: The narrow/single lines clear at +6.25. The wide/triple lines clear at +8.00. Axis is on 132. The prescription is:
a. +8.00 -6.28 x 042
b. +6.25 +8.00 x 132
c. +6.25 +1.75 x 042
d. +6.25 +1.75 x 132
d. +6.25 +1.75 x 132
You have taken the following lensometer reading: The narrow/single lines clear at -1.50. The wide/triple lines clear at +1.25. Axis is on 097. The prescription is:
a. -1.50 +1.25 x 097
b. -1.50 +2.75 x 007
c. -1.50 +2.75 x 097
d. -0.25 -1.25 x 097
c. -1.50 +2.75 x 097
You have taken the following lensometer reading: The narrow/single lines clear at +2.25. The wide/triple lines clear at -0.25. Axis is on 178. The prescription is:
a. +2.25 -0.25 x 178
b. +2.00 -0.25 x 178
c. -0.25 +2.50 x 088
d. +2.25 -2.50 x 088
c. -0.25 +2.50 x 088
You have centered and read the distant portion of the right lens of a pair of bifocals. What is the next step?
a. move the stage up to read the bifocal segment
b. switch to the left lens, center, and read its distant portion
c. switch to the left lens and note the position of the target
d. turn the glasses over and read the front power of the right lens
c. switch the left lens and note the position of the target
(It is very important to go from distance, right lens, to distance, left lens, without moving the stage. Otherwise, you could miss induced vertical prism.)
To read the power of bifocal or trifocal segments, you should:
a. move the frame table upward until the segment mires appear in the center
b. Slide the glasses down until the segment mires appear in the center
c. Slide the glasses up and hold them there by hand
d. always turn the glasses around to read the back of the lens
a. move the frame table upward until the segment mires appear in the center
The power of a bifocal will be the difference between:
a. the axes of the distant and bifocal portions of the lens
b. the point where the wide lines clear on the distant part of the lens and where the thin lines clear on the bifocal
c. the point where the narrow/single lines clear on the distant part of the lens and where they clear on the bifocal
d. the point where the narrow/single lines clear on the distant part of the lens and where the wide lines clear on the bifocal
c. the point where the narrow/single lines clear on the distant part of the lens and where they clear on the bifocal
The distance portion of the lens prescription is -1.25 sphere. You are now reading the bifocal add, and the lensometer dial reads +1.50. The add should be recorded as:
a. +1.50
b. +0.25
c. +0.75
d. +2.75
d. +2.75
The distant portion of the lens prescription is +1.25 (narrow/single lines) -1.25 (wide/triple lines) x180. You are now reading the bifocal add, and the narrow lines clear at +3.00. The add should be recorded as:
a. +3.00
b. plano
c. +1.75
d. +4.25
c. +1.75
The distance portion of the lens is -2.00 +2.00 x 072. You are now reading the bifocal add, and the wide lines clear at +3.00. The add is:
a. plano
b. +1.00
c. +2.00
d. +3.00
d. +3.00
The best method for reading the add on a no-line progressive lens using a manual lensometer is to:
a. mark the lens first using the template from that manufacturer
b. use the least plus reading for the distance and the most plus reading for the add
c. take the distant lensometry reading at a point between the laser marks on the lens
d. center the target on the lensometer
a. mark the lens first using the template from that manufacturer
(Most companies who manufacture no-line progressives have a template for their lens. The lens is laid on the template, and a wax pencil is used to trace the markings onto the lens. A circle indicates where the reading should be taken.)
To read the bifocal portion of an aphakic spectacle lens:
a. the distance and bifocal spherical power should be read with the temples toward the technician
b. the distance and bifocal spherical power should be read with the temples away from the technician
c. one need only read the distance spherical power, because all aphakic lenses have a +3.50 add
d. one must adjust the eye piece to compensate for the high amount of plus power
a. the distance and bifocal spherical power should be read with the temples toward the technician
Regarding the power of the midlevel trifocal lens segment:
a. it is impossible to read the power on the lensometer
b. it is always half the power of the bifocal
c. it is always twice the power of the bifocal
d. it can be read using the lensometer
d. it can be read using the lensometer
Lenses that are not correctly centered on the visual axis result in:
a. off-axis prescriptions
b. extra edge thickness
c. unwanted prism
d. accurate prescriptions
c. unwanted prism
Prism diopters are measured using a lensometer by:
a. the rings in the reticle
b. the number of lines in the target
c. the position of the target
d. the position of the glasses on the stage
a. the rings in the reticle
Prism direction is indicated in the lensometer by:
a. the rings in the reticle
b. the number of lines in the target
c. the position of the target
d. the position of the glasses on the stage
c. the position of the target
If the target can be centered in the lensometer, how does one determine whether or not there is induced prism due to decentration?
a. by marking the centers
b. by marking the centers and measuring the distance between them
c. by marking the centers and observing the glasses on the patient
d. decentered lenses cannot be centered in the lensometer
c. by marking the centers and observing the glasses on the patient
The target of the right lens is displaced to the right, and the lines cross at the third ring. The prism power and direction is:
a. 3 prism diopters, base out
b. 3 prism diopters, base in
c. 1.5 prism diopters, base out
d. 1.5 prism diopters, base in
b. 3 prism diopters, base in
The target of the left lens is displaced to the right, and the lines cross between the first and second rings. The prism power and direction is:
a. 1 prism diopter, base in
b. 2 prism diopters. base out
c. 1.5 prism diopters, base in
d. 1.5 prism diopters, base out
d. 1.5 prism diopters, base out
Base-out prism is induced when:
a. the optical center separation is greater than the pupillary distance with minus lenses
b. the optical center separation is less than the pupillary distance with minus lenses
c. the optical center separation is less than the pupillary distance with plus lenses
d. the optical separation is offset vertically with plus or minus lenses
b. the optical center separation is less than the pupillary distance with minus lenses
To check a manual lensometer for accuracy:
a. adjust the eye piece then read a trial lens
b. set the target lines for your refractive error, then see if they are clear
c. set the eye piece at zero, then read a trial lens
d. set the eye piece at zero, and see if the target lines clear at plano
a. adjust the eye piece then read a trial lens
True or False; the following pertains to maintenance of a manual lensometer:
resetting the eye piece to zero after each use
False
True or False; the following pertains to maintenance of a manual lensometer:
turning off the instrument when not being used
True
True or False; the following pertains to maintenance of a manual lensometer:
covering the instrument when not in use
True
True or False; the following pertains to maintenance of a manual lensometer:
not putting too much ink on the ink pad
True
The structure of the eye with the most refractive power is the:
a. lens
b. cornea
c. vitreous/aqueous
d. retina
b. cornea
(While the lens, cornea, and vitreous/aqueous each have refractive power, and in spite of the fact that the lens can adjust and focus, the cornea is the strongest refracting structure of the eye.)
Corneal curvature is measured (quantified) using the:
a. Placido’s disk
b. slit lamp
c. vertexometer
d. keratometer
d. keratometer
(the keratometer is the only device listed that measures corneal curvature. Placido’s disk is used to evaluate corneal shape and topography, but it does not give measurement. Vertexometer is used to measure vertex distance (the distance between a corrective lens and the front surface of the cornea.))
Corneal curvature can be recorded as:
a. millimeters/diopters
b. milliliters/diopters
c. millimeters/cylinders
d. centimeters/decibels
a. millimeters/diopters
Unequal corneal curvature where the flattest and steepest curves are 90 degrees apart is known as:
a. myopia
b. presbyopia
c. astigmatism
d. hyperopia
c. astigmatism
(Astigmatism occurs when the cornea is more curved in one direction and less in the other. Think of the back of a spoon or the surface of an eggshell; these curves are almost always 90 degrees from each other.)
The average power of the human cornea is:
a. 30 to 32 D
b. 35 to 36 D
c. 43 to 44 D
d. 45 to 47 D
c. 43 to 44 D
Average thickness of the central cornea is:
a. 0.8mm
b. 0.5mm
c. 0.2mm
d. 1.0mm
b. 0.5mm
The following prescription, Plano -2.00 x 180, is an example of:
a. with-the-rule astigmatism
b. against-the-rule astigmatism
c. oblique astigmatism
d. irregular astigmatism
a. with-the-rule astigmatism
(in with-the-rule astigmatism, the strongest corneal axis is vertical; this translates to approximately 180 degrees in minus cylinder and approximately 90 degrees in plus cylinder. Against-the-rule is the opposite, with the strongest corneal axis in the horizontal, approximately 90 degrees in minus cylinder and approximately 180 degrees in plus. Irregular astigmatism does not have a single axis because the flattest and steepest meridians are not at 90 degree angles from each other.)
Which of the following is an example of oblique astigmatism?
a. -2.00 + 1.25 x 093
b. -0.75 -1.25 x003
c. -4.25 + 2.75 x 046
d. Plano
c. -4.35 + 2.75 x 046
(An oblique astigmatism means the axes are not vertical, or horizontal, but at an angle in between. Note that the axes do not have to be “on the dot” at 90,180,45 or 135 to qualify.)
If the axis of astigmatism are not 90 degrees from each other, this is termed:
a. irregular astigmatism
b. compound astigmatism
c. dry eye syndrome
d. astigmatism of vitreous face
a. irregular astigmatism
(Irregular astigmatism occurs when the steepest and flattest curves are not 90 degrees from each other. Compound astigmatism is a type of regular astigmatism.)
Of the following, which patient is most likely to have irregular astigmatism?
a. postoperative cataract
b. aphakic
c. surface ocular trauma
d. postoperative LASIK
c. surface ocular trauma
The steepest part of the cornea is the:
a. periphery
b. inferior one-fourth
c. stroma
d. center
d. center
The diameter of the cornea’s optic zone, or cap, measures:
a. 4.0 mm
b. 0.5 mm
c. 20 mm
d. 3.06 um
a. 4.0 mm
Manual keratometry would not be the most appropriate method for reliable measurements in which of the following cases?
a. fitting contact lenses
b. monitoring keratoconus
c. calculating intraocular lens (IOL) power
d. evaluating after cataract surgery
b. monitoring keratoconus
Keratometry would be useful in evaluating all of the following except:
a. keratoconus
b. preoperative cataract surgery
c. contact lens fitting
d. corneal ulcer
d. corneal ulcer
Which Part of the Keratometer is A:
barrel Lock Vertical barrel adjustment
chin rest occluder vertical mires adjustment
chin rest adjustment eye piece horizontal mires adjustment
focus adjustment forehead adjustment
occluder
Which Part of the Keratometer is B:
barrel Lock Vertical barrel adjustment
chin rest occluder vertical mires adjustment
chin rest adjustment eye piece horizontal mires adjustment
focus adjustment forehead adjustment
barrel
Which Part of the Keratometer is C:
barrel Lock Vertical barrel adjustment
chin rest occluder vertical mires adjustment
chin rest adjustment eye piece horizontal mires adjustment
focus adjustment forehead adjustment
eye piece
Which Part of the Keratometer is D:
barrel Lock Vertical barrel adjustment
chin rest occluder vertical mires adjustment
chin rest adjustment eye piece horizontal mires adjustment
focus adjustment forehead adjustment
vertical mires adjustment
Which Part of the Keratometer is E:
barrel Lock Vertical barrel adjustment
chin rest occluder vertical mires adjustment
chin rest adjustment eye piece horizontal mires adjustment
focus adjustment forehead adjustment
horizontal mires adjustment
Which Part of the Keratometer is F:
barrel Lock Vertical barrel adjustment
chin rest occluder vertical mires adjustment
chin rest adjustment eye piece horizontal mires adjustment
focus adjustment forehead adjustment
focus adjustment
Which Part of the Keratometer is G:
barrel Lock Vertical barrel adjustment
chin rest occluder vertical mires adjustment
chin rest adjustment eye piece horizontal mires adjustment
focus adjustment forehead adjustment
chin rest adjustment
Which Part of the Keratometer is H:
barrel Lock Vertical barrel adjustment
chin rest occluder vertical mires adjustment
chin rest adjustment eye piece horizontal mires adjustment
focus adjustment forehead adjustment
vertical barrel adjustment
Which Part of the Keratometer is I:
barrel Lock Vertical barrel adjustment
chin rest occluder vertical mires adjustment
chin rest adjustment eye piece horizontal mires adjustment
focus adjustment forehead adjustment
lock
Which Part of the Keratometer is J:
barrel Lock Vertical barrel adjustment
chin rest occluder vertical mires adjustment
chin rest adjustment eye piece horizontal mires adjustment
focus adjustment forehead adjustment
forehead adjustment
Which is step 1 in using a Keratometer in chronological order:
- occlude the eye not being tested
- turn the drum so that the horizontal plus signs are aligned exactly tip-to-tip
- turn the dials to superimpose the horizontal plus and vertical minus signs
- position the patient
- focus the mires, and center the cross-hairs in the lower right hand circle
- focus the eye piece
focus the eyepiece
Which is step 2 in using a Keratometer in chronological order:
- occlude the eye not being tested
- turn the drum so that the horizontal plus signs are aligned exactly tip-to-tip
- turn the dials to superimpose the horizontal plus and vertical minus signs
- position the patient
- focus the mires, and center the cross-hairs in the lower right hand circle
- focus the eye piece
position the patient
Which is step 3 in using a Keratometer in chronological order:
- occlude the eye not being tested
- turn the drum so that the horizontal plus signs are aligned exactly tip-to-tip
- turn the dials to superimpose the horizontal plus and vertical minus signs
- position the patient
- focus the mires, and center the cross-hairs in the lower right hand circle
- focus the eye piece
occlude the eye not being tested
Which is step 4 in using a Keratometer in chronological order:
- occlude the eye not being tested
- turn the drum so that the horizontal plus signs are aligned exactly tip-to-tip
- turn the dials to superimpose the horizontal plus and vertical minus signs
- position the patient
- focus the mires, and center the cross-hairs in the lower right hand circle
- focus the eye piece
focus the mires, and center the cross-hairs in the lower right hand circle
Which is step 5 in using a Keratometer in chronological order:
- occlude the eye not being tested
- turn the drum so that the horizontal plus signs are aligned exactly tip-to-tip
- turn the dials to superimpose the horizontal plus and vertical minus signs
- position the patient
- focus the mires, and center the cross-hairs in the lower right hand circle
- focus the eye piece
turn the drum so that the horizontal plus signs are aligned exactly tip-to-tip
Which is step 6 in using a Keratometer in chronological order:
- occlude the eye not being tested
- turn the drum so that the horizontal plus signs are aligned exactly tip-to-tip
- turn the dials to superimpose the horizontal plus and vertical minus signs
- position the patient
- focus the mires, and center the cross-hairs in the lower right hand circle
- focus the eye piece
turn the dials to superimpose the horizontal plus and vertical minus signs
Occluding the eye not being measured is helpful because it:
a. reduces reflections
b. aids in fixation
c. eliminates lenticular astigmatism
d. reduces irregular astigmatism
b. aids in fixation
(the occluder forces the patient to fixate with the eye that is being measured. This helps hold that eye steady for being measured.)
You are attempting a K reading and do no see both horizontal plus signs. This might be due to:
a. a drooped upper lid
b. the patient closing his or her eye
c. a keratometer occluder in the way
d. improper focusing
c. a keratometer occluder in the way
(the plus sign is projected on the side, and the main thing that might obstruct the mires from the side is the occluder. A common vertical obstruction (which would obstruct the minus signs) is the patient’s upper lid.)
With a flat cornea, how will the keratometer mires appear:
a. small b. round c. elliptical d. very large
e. clear, then quickly blur f. wavy, blurred, discontinuous
g. distorted, small, cannot superimpose
d. very large
With corneal warpage, how will the keratometer mires appear:
a. small b. round c. elliptical d. very large
e. clear, then quickly blur f. wavy, blurred, discontinuous
g. distorted, small, cannot superimpose
f. wavy, blurred, discontinuous
With keratoconus, how will the keratometer mires appear:
a. small b. round c. elliptical d. very large
e. clear, then quickly blur f. wavy, blurred, discontinuous
g. distorted, small, cannot superimpose
g. distorted, small, cannot superimpose
With a spherical cornea, how will the keratometer mires appear:
a. small b. round c. elliptical d. very large
e. clear, then quickly blur f. wavy, blurred, discontinuous
g. distorted, small, cannot superimpose
b. round
With a steep cornea, how will the keratometer mires appear:
a. small b. round c. elliptical d. very large
e. clear, then quickly blur f. wavy, blurred, discontinuous
g. distorted, small, cannot superimpose
a. small
With dry eye, how will the keratometer mires appear:
a. small b. round c. elliptical d. very large
e. clear, then quickly blur f. wavy, blurred, discontinuous
g. distorted, small, cannot superimpose
e. clear, then quickly blur
With an astigmatism, how will the keratometer mires appear:
a. small b. round c. elliptical d. very large
e. clear, then quickly blur f. wavy, blurred, discontinuous
g. distorted, small, cannot superimpose
c. elliptical
If the cross-hairs of the keratometer are not centered during the initial reading for contact lens fitting:
a. the fit may be inaccurate
b. lens diameter may be incorrect
c. lenses will be difficult to handle
d. the lens will not transmit oxygen
a. the fit may be inaccurate
(If the cross-hairs are not centered, you are not reading the corneal apex. Because the corneal periphery is flatter, the resulting fit will be too loose when placed on the steeper corneal apex.)
True or False:
K readings in a contact lens-wearing patient may be used to evaluate
progressive corneal steepening
True
True or False:
K readings in a contact lens-wearing patient may be used to evaluate
lens fit
True
True or False:
K readings in a contact lens-wearing patient may be used to evaluate
lens coverage
False
True or False:
K readings in a contact lens-wearing patient may be used to evaluate
corneal warpage
True
The patient’s keratometry mires are very oval-shaped. This means that there is:
a. no astigmatism
b. high emmetropia
c. significant astigmatism
d. inaccurate alignment
c. significant astigmatism
(actually, this makes the reading easier, as even a tiny turn of barrel or dial makes an obvious difference. An eye with no astigmatism would have very round mires. Emmetropia is lack of refractive error, so it cannot be classified as high, low, or in between. Inaccurate alignment is evident when the cross-hair is not centered in the lower right circle.)
The patient’s keratometry mires are squiggly looking and change when the patient blinks. You should try:
a. instilling topical anesthetic
b. instilling artificial tears
c. re-explaining the procedure
d. realigning the patient
b. instilling artificial tears
(“squiggly” mires that change when the patient blinks indicate a problem with the tear film. Instill some artificial tears, have the patient blink a lot, and blot gently with a tissue. Then, try the readings again. There is no need to use an anesthetic.)
No matter how you rotate the keratometer drum, the “plus signs” remain aligned. This indicates that there is:
a. irregular astigmatism
b. poor tear film
c. poorly focused eye piece
d. no astigmatism
d. no astigmatism
(this is because the curve is the same in every meridian)
Which of the following types of astigmatism is not obvious when measuring with the keratometer?
a. astigmatism at 180 degrees
b. irregular astigmatism
c. lenticular astigmatism
d. oblique astigmatism
c. lenticular astigmatism
You are taking a K reading. The power drum is at 52.00 D (the upper limit of the scale), and the mires are still not aligned. To extend the range of the keratometer, you should:
a. affix a -1/00 D trial lens over the aperture
b. affix a +1.25 D trial lens over the aperture
c. affix a +2.25 D trial lens over the eye piece
d. it is not possible to extend the range of a keratometer
b. affix a +1.25 D lens over the aperture
You have taken a K reading by extending the instrument’s range. To get the correct value, you can:
a. use a conversion chart
b. subtract the power of the extending lens
c. add the power of the extending lens
d. simply record the drum reading
a. use a conversion chart
You are adjusting the keratometer eye piece by looking at the occluder through the ocular: The mires are distorted. You should:
a. calibrate with metal balls
b. spray cleaner into the instrument
c. clean the instrument with compressed air
d. return to the manufacturer for cleaning
d. return to the manufacturer for cleaning
When calibrating the keratometer with metal balls, all of the following are done except:
a. using chrome balls of known radius
b. placing holder on the headrest
c. setting the eye piece for your refractive error
d. placing the chrome ball in the holder with your fingers
d. placing the chrome ball in the holder with your fingers
If calibration of the keratometer reveals a discrepancy:
a. adjust the drums
b. tighten the headrest
c. loosen the top screw
d. have the manufacturer repair it
d. have the manufacturer repair it
If the keratometer’s occluder is loose:
a. simply remove it
b. rebend or replace the washer
c. tape it up out of the way
d. adjust the headrest appropriately
b. rebend or replace the washer
Current procedural terminology (CPT) codes are used to:
a. communicate between providers
b. communicate with insurance companies
c. provide legal documentation
d. inform patients regarding their health care
b. communicate with insurance companies
CPT has a direct impact on:
a. clinical clarification
b. presenting evidence in court
c. patient feedback
d. reimbursement
d. reimbursement
(Coding, be it proper or improper, directly affects the reimbursement that the practice gets from third-party payers.)
A procedure might carry a different charge, depending on who performs it. This may mean that the procedure code needs an additional code called a(n):
a. service number
b. qualifier
c. modifier
d. HIPAA code
c. modifier
(modifiers provide more explicit information about a procedure. Thus, a modifier might be called for when a procedure carries an additional element, such as being performed by a technician or by a mid-level practitioner.)
The International Classification of Diseases (ICD) codes of nuclear cataract 366.16 and astigmatism 367.21 are examples of:
a. AMA codes
b. procedure codes
c. diagnosis codes
d. encounter codes
c. diagnoses codes
(ICD codes are numeric codes that identify disorders, diseases, conditions, etc.)
A reviewer is looking over an encounter form for a patient visit to your practice to make sure that diagnosis codes and procedure codes match up. Which of the following would be marked as unacceptable?
a. CPT: incise and drain ICD: chalazion
b. CPT: epilation ICD: trichiasis
c. CPT: probe and irrigation ICD: cataract
d. CPT: biopsy ICD: lesion of the eyelid
c. CPT: probe and irrigation ICD: cataract
(it is vital that procedure codes have an appropriate diagnosis code to justify them.)
A patient who had a blepharoplasty is upset because now she has dry eyes. They court determined that the patient was not told about this risk prior to surgery. This is an example of:
a. failure to disclose
b. breach of promise
c. failure to perform
d. intentional harm
a. failure to disclose
(“failure to disclose” occurs when a patient has not been informed about the risks of a particular procedure. This “duty of disclosure” is part of the informed consent process.)
A patient who is moving to another state has stopped by the office requesting his records. He would like you to hand over the chart so he can take it with him. Your response to this is to:
a. make copies for the office and give him the original
b. tell the patient you will mail the original to his new provider
c. give the patient lab work reports from his chart
d. make copies for the patient and keep the original for the office
d. make copies for the patient and keep the original for the office
(the physical chart belongs to the practice; the information belongs to the patient. Prior to providing the copies, you must get a signed release of information form. Some clinics have further rules that govern how medical records are to be handled.)
True of False; the following is a legal regulation?
An eye care practitioner must fit any patient who desires it with contact lenses
False
True of False; the following is a legal regulation?
The patient who has a refractive eye exam must be provided with a copy of the glasses prescription
True
True of False; the following is a legal regulation?
A prescription for glasses is only good for 6 months
False
True of False; the following is a legal regulation?
K readings must be included on every glasses prescription in case the patient decides to get contact lenses
False
An ophthalmic assistant who measures a patient’s refractive error and then writes the patient a glasses prescription, where the physician does not see the patient or review the record, is:
a. breaking the law
b. violating patient privacy
c. doing the patient a favor
d. in accordance with current practice
a. breaking the law
(the procedure described is a refraction, which involves clinical judgement allowed only by a licensed professional. Ophthalmic technicians may perform refractometry, where the refractive error is measured but the prescribing/clinical judgement is left to the licensed practitioner.)
The right of a patient to protection of his or her personal health information is a federal law known as:
a. Health Insurance Portability and Accountability Act (HIPAA)
b. Occupational Safety and Health Administration (OSHA)
c. Joint Commission on Accreditation of Health Care Organizations (JCAHO)
d. American Academy of Ophthalmology (AAO)
a. Health Insurance Portability and Accountability Act (HIPAA)
OSHA has developed laws regarding:
a. standard for safety lenses
b. eye protection in the workplace
c. privacy laws
d. scope of practice
b. eye protection in the workplace
(OSHA deals with employee safety and has rules regarding eye protection in the workplace (such as safety goggles worn when assisting with laser surgery)
Which of the following is true?
a. an eye care practitioner may charge a fee to release a patient’s glasses prescription
b. an eye care practitioner may restrict eye exams only to those who agree to purchase eyewear from the practice’s optical shop
c. an eye care practitioner may refuse to release a patient’s glasses prescription until the patient has paid for the eye exam, if it is customary to require payment at the time of the service
d. an eye care practitioner who has fit a patient for contacts may require that the patient buy the first year’s supply of lenses from the practitioner’s practice
c. an eye care practitioner may refuse to release a patient’s glasses prescription until the patient has paid for the eye exam, if it is customary to require payment at the time of the service
The federal Trade Commission (FTC) has regulations affecting all of the following except:
a. the “intraocular lens implant rule”
b. advertising for refractive surgery
c. the “eyeglass rule”
d. the “contact lens rule”
a. the “intraocular lens implant rule”
OSHA regulations regarding medical practices require all of the following except:
a. every new hire is to be trained in infection control practices
b. all contact lenses must be fit by a licensed eye care practitioner
c. the employer must provide personal protective equipment to employees
d. OSHA regulations must be posted in the workplace
b. all contact lenses must be fit by a licensed eye care practitioner
The “Red Flags Rule” was developed by the FTC in order to prevent:
a. employee injuries
b. identity theft
c. insurance fraud
d. sexual harassment in the workplace
b. identity theft
(the rule requires businesses (including medical practices) to develop a plan of identifying “relevant patterns, practices, and specific forms of activity - the ‘red flags’ - that signal possible identity theft”)
All of the following are true regarding the Patient Protection and Affordable Care Act (PPACA) except:
a. it affects insurance coverage for pre-existing conditions
b. it is concerned with health insurance reform
c. it enforces health care privacy laws
d. it was signed into law by President Barack Obama
c. it enforces health care privacy laws
Quality assurance (QA) depends upon:
a. opinions of caregivers
b. patient compliance
c. being able to measure something
d. having favorable surgical results
c. being able to measure something
(QA requires that something be measured, regardless of whether the data come from a patient survey, patient records, checklists, etc.)
Which of the following does not apply to QA?
a. one characteristic of QA is to minimize problems and poor outcome
b. one characteristic of QA is to identify procedures that need to be changed
c. one characteristic of QA is to be a once-and-done procedure
d. one characteristic of QA is that it can lead to better patient care
c. one characteristic of QA is to be a once-and-done procedure
(the intent of QA is to monitor routine procedures so that problems can be identified and corrected, resulting in better patient care. To be effective, QA is an ongoing process, not something done once to qualify for a certification or to pass an inspection.)
An example of data collected for QA purposes regarding outcomes would be:
a. employee turnover
b. visual acuity after cataract surgery
c. number of patients seen daily
d. number of referral patients
b. visual acuity after cataract surgery
Which of the following is true?
a. QA is the responsibility only of the practitioner
b. QA helps hold health care workers accountable
c. QA is only an issue if the practice is to be inspected
d. QA is not concerned with access to health care
b. QA helps to hold health care workers accountable
(a practice’s QA system helps to set minimum standards to which all in the clinic (not just the practitioner) are held. QA is generally focused on outcome (e.g. vision after cataract surgery), the relationship of cost to benefit (e.g. time, money, and effort put into patient care versus benefit to patient). While a viable QA system may be required for certain clinical certifications, every patient needs to have such a system.)
Your practice is developing a QA program. One area to be addressed is strabismus surgery. Which of the following would not fit into the list of logical assessments?
a. preoperative and postoperative prism measurements of the deviation
b. patient or parental survey of satisfaction with the process as a whole
c. data concerning postoperative complications
d. putting strategies into place that will prevent alterations to the process
d. putting strategies into place that will prevent alterations to the process
The standards that govern moral conduct, especially of a person/group with some type of power in issues regarding conduct, rights, and actions is:
a. informed consent
b. patient rights
c. ethics
d. medicolegal code
c. ethics
(ethics are the standards that govern our personal and professional behavior. In medicine, these are the standards that help us make moral judgements regarding such things as how we treat our patients (both personally and medically), how we treat our peers, what kind of employee we are, and much more. It includes providing the best and most intelligent care of which we are capable and maintaining honest relationships with others.)
The basis for medical ethics is:
a. the Oath of Hammurabi
b. the Hippocratic Oath
c. the Mayflower Compact
d. the Constitution of the United States
b. the Hippocratic Oath
(Hippocrates lived in the fifth century BC. He was a Greek physician who held himself to a strict code of behavior and quality of care, which included conduct, confidentiality, and scope of practice. From this grew the concept of medical ethics, and the Hippocratic Oath (which speaks to those same virtues) is named after him.
You have just seated your patient and ask if she’s having any problems with her eyes. She states that she would like to discuss that only with the physician. You explain your role in gathering information and assure her of confidentiality, but she insists that she will speak only to the doctor. You should:
a. explain that it is office policy that she speak to you first
b. offer to appoint her for another day when she may feel more cooperative
c. affirm her right to speak only to the physician and acquiesce
d. recommend that the physician dismiss her from the practice
c. affirm her right to speak only to the physician and acquiesce
(it is the patient’s right to discuss her case with the physician only; be sure to document in the chart that the patient has made this choice. You might ask if you can go ahead and do a “few tests” so that the doctor will have some information when she speaks to the patient, such as visual acuity, lensometry, pupil evaluation, slit-lamp evaluation, and perhaps noncontact tonometry. Without a history, it is inadvisable to instill drops or perform any type of contact test (tonometry, schirmer’s, etc.). In addition, while the patient may not wish to discuss his or her eye problems, he or she may be willing to give other information about his or her history)
The physician is out of the office, and a patient comes by on his way to an optical shop. He has broken his glasses and asks you to “test me for glasses” and give him a new, updated prescription to take to the optician. For you, as an ophthalmic assistant, this is a question of:
a. patient rights
b. scope of practice
c. confidentiality
d. moral obligation
b. scope of practice
(“Scope of practice” relates to what you are allowed to do in the performance of your job. Because ophthalmic/optometric technicians are not permitted to “Refract” (ie, measure refractive error and then apply clinical judgment to write the prescription), this request would be beyond your scope of practice.
Your new patient had cataract surgery at another practice in town 6 months ago and is unhappy with her vision. She states that she was nearsighted before, but now she cannot read anything up close without glasses. Your refractometric measurement of the eye is +3.75 sphere for distance, with a +2.25 add for near. Which of the following is a potentially libelous thing to say?
a. “You’re the second patient in a month from that practice who has this problem!”
b. “We’ll know more after Dr. Davis looks at you.”
c. “Unfortunately, measuring for the power of an implant is an inexact science.”
d. “Has the surgeon suggested anything that might help?”
a. “You’re the second patient in a month from that practice who has this problem!”
(the comment in answer a suggests that there is a problem with the surgeon, who has made the same mistake twice in just a few weeks. Discussing another doctor, practice, or even someone in your own clinic in a negative fashion is not good ethics… even if they are at fault.)
Which of the following does not carry with it the “duty to report”?
a. incompetence
b. child abuse
c. data collection
d. impaired eye care professional
c. data collection
Which of the following is true regarding certifications for eye care paraprofessionals?
a. certification is required in order to be employed
b. certification acknowledges that a person has attained specific professional standards
c. certification legally permits the individual to evaluate and interact with patients
d. certification is required in order to perform certain functions, such as refractions
b. certification acknowledges that a person has attained specific professional standards
(certifications attests to a person’s ability to meet a specific professional standard. It is not required to work in the field of eye care, but it is a statement to patients, to other professionals, and to the community at large that a person has attained those standards. It is not licensure, a legal instruments that allows the bearer certain privileges.
Compliance with the American National Standards Institute (ANSI) standards is:
a. required by federal law
b. required by state statutes
c. relative to the type of industry involved
d. voluntary
d. voluntary
Which of the following is true regarding the ANSI standards concerning eyeglasses?
a. the ANSI standards apply only to prescription eyewear
b. the ANSI standards designate allowable variance between the power of the menses ordered and the lenses dispensed
c. the ANSI standards apply to safety lenses, but not to any type of lens coating
d. the ANSI standards apply only to safety lenses and frames
b. the ANSI standards designate allowable variance between the power of the menses ordered and the lenses dispensed
(the stronger the lens power, the smaller the allowable variance)
Which of the following is true regarding the ANSI standards concerning contact lenses?
a. the ANSI standards apply to contact lens materials but not to the care products
b. the ANSI standards apply to rigid contact lenses, but not to soft contact lenses
c. the ANSI standards dictate what information must appear on the contact lens label
d. the ANSI standards do not mention disinfection of multiuse trial contact lenses
c. the ANSI standards dictate what information must appear on the contact lens label
Regarding intraocular lens implants, which of the following is not covered by the ANSI standards?
a. phakic IOLs
b. optical properties and biocompatibility
c. sterility and shelf-life
d. patient selection
d. patient selection
At its most basic, the duty of the scribe is:
a. personal assistant to the practitioner
b. patient educator and advocate
c. coding and charting coordinator
d. patient flow coordinator
a. personal assistant to the practitioner
(scribing is essentially being the practitioner’s right hand. While the main duty may be documentation, the scribe also performs other duties at the physician’s discretion, including patient education, coordinating patient flow, and overseeing billing forms and chart work.)
Which of the following is not a function of scribing?
a. documenting what the practitioner tells the patient about his or her diagnosis
b. writing and signing a prescription for the patient’s glaucoma drops
c. remaining after the physician and teaching the patient how to do lid scrubs
d. recording exam findings as the doctor dictates them
b. writing and signing a prescription for the patient’s glaucoma drops
(a scribe may write out the prescriptions, but they may not sign them - only physicians can do this)
You are scribing for the physician, and he tells the patient that while he expects her vision to improve, it will not be 20/20 after cataract surgery because of macular degeneration. Which of the following notations best illustrates the scribe’s function as a witness in this case?
a. that cataract surgery has been recommended
b. that the patient has cataracts and macular degeneration
c. that the physician told the patient that cataract surgery would improve vision
d. that the physician explained the effects of macular degeneration on postoperative vision
d. that the physician explained the effects of macular degeneration on postoperative vision
You are functioning as a scribe in a practice that uses paper charts. At first, the doctor describes a cataract as 3+. You write this in the chart. Later, the physician changes that rating to 2+. Which of the following is the right way to make the correction?
a. scratching out the first entry so it cannot be read
b. using a commercial product that covers errors
c. completely erasing the fist entry
d. drawing one line through the error and writing the correction above it
d. drawing one line through the error and writing the correction above it
You may discuss a patient’s case with another technician if:
a. you do so only in front of the patient
b. it is pertinent to the patient’s care
c. the patient was difficult to handle and you need to unload
d. the patient has symptoms of communicable disease
b. it is pertinent to the patient’s care
It is permissible to ask a patient questions related to his or her health:
a. in the reception area, if all the exam rooms are full and you’re running behind
b. in a group if everyone has gathered for the same purpose, such as surgical counseling
c. in front of someone whom the patient has brought into the exam room
d. in a multipurpose room where other patient’s are having tests run
c. in front of someone whom the patient has brought into the exam room
Which of the following is a breach of confidentiality?
a. Leaning across the front desk and saying, “Here are your glaucoma drops, Mrs. Smith”
b. Discussing the exam results of a minor with a parent over the phone
c. Telling the operating room nurse what a surgery patient’s drug allergies are
d. Telling your boss that the patient has recently lost her spouse and is very upset today
a. Leaning across the front desk and saying, “Here are your glaucoma drops, Mrs. Smith”
Regarding minor surgery and informed consent:
a. informed consent is not required if the procedure has minimal risk
b. informed consent is not required if general anesthesia is not used
c. informed consent is not required if intravenous injection is not used
d. informed consent is required prior to any surgical procedure
d. informed consent is required prior to any surgical procedure
Each of the following is a key element of informed consent except:
a. potential risks and benefits
b. description of procedure
c. watching a video about the procedure
d. optional treatments
c. watching a video about the procedure
Which of the following statements regarding informed consent is true?
a. the physician may have a technician do the patient education
b. it only involves having the patient sign papers
c. it is necessary only if the patient is a minor
d. only the patient can sign
a. the physician may have a technician do the patient education
You have just finished counseling an alert 87-year-old man who needs cataract surgery, and you ask him to sign the informed consent. “I understand what you’ve told me,” he says, “but I’m just not sure.” His 62-year-old daughter has accompanied him and says “Oh, come on, Dad! Just sign it and let’s go!” An appropriate response from you would be:
a. “You’ll be very happy with your vision after surgery”
b. “Why don’t you discuss this at home and give me a call later?”
c. “Dr. Snyder thinks this is the best thing for you”
d. “This is a very common surgery, nothing bad ever happens”
b. “Why don’t you discuss this at home and give me a call later?”
Which of the following is appropriate wording on an informed consent regarding the description of the procedure?
a. “The recommended procedure is a lateral rectus recession”
b. “The recommended procedure is laser trabeculoplasty”
c. “The recommended procedure is removal of redundant skin from both upper lids”
d. “The recommended procedure is CE with IOL”
c. “The recommended procedure is removal of redundant skin from both upper lids”
Which of the following is not appropriate when explaining the risks of cataract surgery?
a. “A person is more likely to be in a car accident than to go blind from having a cataract removed”
b. “The risk of developing glaucoma after surgery is so miniscule that you don’t have to worry about it”
c. “While very unlikely, you do run a slightly higher risk of retinal detachment because you’re so nearsighted”
d. “The chances of you developing a severe infection after cataract surgery are less than one-fourth of 1%”
b. “The risk of developing glaucoma after surgery is so miniscule that you don’t have to worry about it”
Which of the following would not be allowed due to informed consent?
a. a vitrectomy when vitreous suddenly comes forward during cataract surgery
b. An unplanned arcuate keratectomy during cataract surgery to reduce the patient’s astigmatism
c. cryotherapy to seal a scleral hole caused inadvertently during extraocular muscle surgery
d. exploratory surgery to locate a “dropped” extraocular muscle during strabismus surgery
b. An unplanned arcuate keratectomy during cataract surgery to reduce the patient’s astigmatism
Prior to disinfection or sterilization, contaminated instruments must be:
a. soaked in instrument milk
b. boiled
c. cleaned
d. wiped with ether
c. cleaned
Disinfection involves:
a. the reduction of microorganisms on inanimate surfaces
b. the destruction of microorganisms on inanimate surfaces
c. the destruction and inhibition of microorganisms on any surface
d. the reduction of microorganisms on any surface
c. the destruction and inhibition of microorganisms on any surface
Sterilization involves:
a. the reduction of microorganisms on inanimate surfaces
b. the destruction of microorganisms on inanimate surfaces
c. the destruction and inhibition of microorganisms on any surface
d. the reduction of microorganisms on any surface
b. the destruction of microorganisms on inanimate surfaces
The effectiveness of a sterilization method is based on:
a. temperature
b. destruction of bacteria
c. destruction of bacterial spores
d. destruction of viral spores
c. destruction of bacterial spores
(spores are tougher to kill than the organisms themselves. Viruses do not produce spores.)
Sanitation can be described as:
a. destruction of bacteria and bacterial spores
b. reduction of bacteria and bacterial spores
c. destruction of viruses and viral spores
d. “clean enough to be healthy”
d. “clean enough to be healthy”
If a sterile package falls to the floor:
a. it may be wiped with alcohol and used
b. it must be removed from use
c. it may be used if the floor is clean
d. it may be used if the wrapping is linen
b. it must be removed from use
The presence of even one bacterium on an object in the sterile field means that the object is:
a. bactericidal
b. antiseptic
c. contaminated
d. bacteriostatic
c. contaminated
A chemical used to disinfect inanimate objects is a(n):
a. germicide
b. antiseptic
c. antibiotic
d. ester
a. germicide
A chemical used to disinfect living tissue is a(n):
a. germicide
b. antiseptic
c. antibiotic
d. alcohol
b. antiseptic
To test the effectiveness of any sterilization method, one may:
a. attempt to culture bacteria from “sterilized” instruments
b. visually inspect the “sterilized” instruments
c. use heat-activated testing tape
d. keep records of any ensuing patient infections
a. attempt to culture bacteria from “sterilized” instruments
The organism that may contaminate ophthalmic solutions, including fluorescein, and can destroy an eye in 48 hours is:
a. herpes simplex
b. haemophilus influenzae
c. mycobacterium tuberculosis
d. pseudomonas aeruginosa
d. pseudomonas aeruginosa
Which of the following might be least susceptible to contracting an eye infection?
a. a patient with human immunodeficiency virus (HIV)
b. a patient with recurrent erosion syndrome
c. a patient wearing contact lenses
d. a patient working in the public sector
d. a patient working in the public sector
The organization involved with ensuring employee health and safety is:
a. JCAHPO
b. EOE
c. OSHA
d. HIPAA
c. OSHA
The Bloodborne Pathogens Standard involves all of the following except:
a. use and disposal of sharps
b. one-time employee education
c. provision of personal protective equipment
d. provision of hepatitis B vaccines
b. one-time employee education
Universal precautions are:
a. a method of infection control regulated by OSHA
b. a set of standards regulated by ANSI
c. a set of safety standards set by each clinic
d. a method of evaluating infection control
a. a method of infection control regulated by OSHA
Universal precautions would include all of the following except:
a. use of personal protective equipment
b. method of cleaning contaminated spills
c. method of disposing contaminated materials
d. regarding some body fluids as always “safe”
d. regarding some body fluids as always “safe”
Examples of bloodborne pathogens include all of the following except:
a. hepatitis B virus
b. HIV
c. herpes simplex virus
d. hepatitis C virus
c. herpes simplex virus
Which of the following is true?
a. one need not wash hands after removing gloves
b. gloves may be washed and reused if not contaminated
c. hand washing is necessary only if there is visible soil
d. hand washing protocol is 15 to 20 seconds with soap and water
d. hand washing protocol is 15 to 20 seconds with soap and water
The single most effective method of preventing the spread of germs is:
a. use of a mask
b. hand washing
c. disinfection of surfaces
d. covering coughs and sneezes
b. hand washing
Personal protective equipment would include all of the following except:
a. eye shields
b. gloves and masks
c. tonopen covers
d. gowns
c. tonopen covers
Universal precautions generally apply to tears (lacrimal secretions):
a. in every case
b. if they are bloody
c. if the patient is known to have tuberculosis
d. if the patient has glaucoma
b. if they are bloody
Use of eye drops would be advantageous:
a. if the drug needs to stay on the eye for a long time
b. if exterior parts of the eye are being treated
c. in case of systemic infection
d. if the condition being treated is not very serious
b. if exterior parts of the eye are being treated
(topical drops are best used to treat external eye problems. That is not to say that they do not have a place in treating intraocular problems)
A disadvantage of eye drops is that:
a. they are expensive
b. they do not have prolonged contact with the eye
c. they must be refrigerated
d. they penetrate too deeply into the eye’s structures
b. they do not have prolonged contact with the eye
(eye medications in drop form are prone to run out the lacrimal drainage system)
Use of eye ointments is advantageous because:
a. they are less expensive than drops
b. they penetrate more quickly than drops
c. they are easier to apply than drops
d. they remain in contact with the eye longer than drops
d. they remain in contact with the eye longer than drops
(because ointments are in a petroleum-type base, they do not drain off the eye as rapidly as drops)
A patient might complain about using eye ointment because:
a. it has to be used more often than drops
b. it is more expensive than drops
c. it blurs the vision
d. it is less effective than drops
c. it blurs the vision
(ointment creates a film in the tears, causing blurry vision. Ointment is generally used less often (ie, fewer doses) than drops.)
All of the following are characteristics of locally injected drugs except:
a. a greater concentration of the drug can be given versus topical
b. the drug can be delivered directly to the site where it is needed
c. the drug takes effect quickly
d. the drug is absorbed through the digestive tract
d. the drug is absorbed through the digestive tract
(Locally injected drugs have all the advantages listed except being absorbed through the digestive tract (which would describe medication given orally, not injected)
Systemic drugs are those administered by:
a. applying the drug to the surface
b. injection or mouth
c. mouth only
d. injection only
b. injection or mouth
All of the following are examples of systemically administered drugs except:
a. acetazolamide pills of glaucoma
b. glycerol liquid drink to reduce intraocular pressure
c. mannitol intravenous injection to reduce intraocular pressure
d. timolol eye drops for glaucoma
d. timolol eye drops for glaucoma
(eye drops as topical, not systemic)
When a child is to be given anesthetic drops, the assistant should:
a. give the drops without warning to avoid hassles
b. tell the child that the drops will not sting
c. let the physician do it
d. briefly explain what is to be done, then do it quickly
d. briefly explain what is to be done, then do it quickly
(you could tell the child that the drops might sting for a second, but do not lie, and do not drag it out. Surprises are unpleasant, too. The physician needs a good rapport with the child in order to complete the exam and render treatment, so it is better if the doctor does not give the drops.)
A topical ophthalmic drug preparation is considered unsterile:
a. once it is opened
b. only if it touches the lashes or lids
c. only if bacteria can be cultured from it
d. none of the above
a. once it is opened
(while the drug may not be contaminated (ie, no bacteria or other organisms have gotten into it), it is no longer considered sterile once opened.)
The physician has asked you to dilate a patient’s eyes. The drops used to do this will have:
a. a purple cap
b. a green cap
c. a white cap
d. a red cap
d. a red cap
Having the patient look down when you instill topical anesthetics might be advantageous because:
a. the drop will sting less
b. the drop will be distributed over the cornea
c. the drop will stay on the eye longer
d. the tears will not dilute the solution
b. the drop will be distributed over the cornea
(the theory is that if the patient looks down when the drop is instilled, afterwards when he or she blinks, the eye will automatically roll up, giving better coverage over the cornea. This would be true for most topical dyes (eg, rose bengal) as well.)
Dilating and medicinal topical drops/ointments are most easily instilled by:
a. having the patient look to one side
b. dropping directly on the cornea
c. using a cotton-tipped applicator
d. having that patient look up
d. having that patient look up
(Have the patient look up, and gently pull down the lower lid. The medication is then instilled in the lower cul-de-sac (pocket between the lid and eyeball)
You are instilling cycloplegic drops, and the dropper tip touches the patient’s eye-lashes. You should:
a. wipe the dropper tip with alcohol
b. soak the tip in bleach solution
c. cap the bottle
d. discard the bottle and drops
d. discard the bottle and drops
Regarding the recapping of multiple-use ophthalmic drops:
a. it is unnecessary and inconvenient
b. it helps to prevent contamination
c. it needs to be done only at the end of the day
d. only single-use dispensers should be used
b. it helps to prevent contamination
All of the following should be done prior to pupil dilation except:
a. swinging flashlight test
b. keratometry
c. refractometry in a patient over the age of 45
d. pressure check
b. keratometry
Which of the following bottle cap colors are coded for glaucoma medications?
a. yellow, blue, red
b. purple, blue, yellow, green
c. yellow, white, red, purple
d. green, yellow, purple, white
b. purple, blue, yellow, green
After installation of topical anesthetic, the patient should be told:
a. “be sure to wear sunglasses when you go outside”
b. “your vision may be blurry for several hours”
c. “do not rub your eyes”
d. “do not drive until it has worn off”
c. “do not rub your eyes”
(because of the numbness induced by topical anesthetics, the patient should be reminded not to rub his or her eyes. The danger is that he or she will accidently rub and abrade the cornea while it cannot feel anything)
A patient who has undergone routine dilation for an eye exam can expect:
a. better night vision
b. better vision in bright light
c. blurred near vision
d. light sensitivity for 24 hours
c. blurred near vision
(routine dilation “freezes” accommodation. There is generally some light sensitivity too, but generally not for a full 24 hours)
A disadvantage of drops used to reverse routine office dilation is:
a. it takes a long time to act
b. the patient is still light sensitive
c. it clears near but blurs distance vision
d. it can cause headaches
d. it can cause headaches
Home use of anesthetic eye drops is never prescribed because:
a. it causes a breakdown of the corneal surface
b. a patient in pain will schedule a return visit
c. it decreases the efficacy of other drugs
d. it is too expensive to justify home use
a. it causes a breakdown of the corneal surface
(repeated use of topical anesthetic drops causes corneal melting, which can interfere with healing)
A patient has had a piece of metal removed from him cornea one morning. That afternoon he calls the office and asks the doctor to prescribe numbing drops. You tell him:
a. the doctor will call it in as soon as possible
b. come by the office and pick some up
c. that medication is not prescribed because it interferes with healing
d. that medication is not prescribed because it can elevate eye pressure
c. that medication is not prescribed because it interferes with healing
Patients who use nonpreserved artificial tears supplied in “bullets” should be told to:
a. use them only once a day
b. discard the leftover solution at the end of the day
c. use them only at night
d. make their own saline because it is cheaper
b. discard the leftover solution at the end of the day
(because there is no preservative to retard the bacterial growth, any solution remaining in the bullet at the end of the day should be discarded. These drops may be used many times throughout the day. No one should use homemade saline in the eye because of the risk of contamination)
Dry eye patients should be told to use artificial tears:
a. morning and night
b. only when the eyes water
c. four times daily
d. as often as needed to control symptoms
d. as often as needed to control symptoms
The first choice of medicinal treatment for open-angle glaucoma is usually:
a. oral
b. topical
c. subconjunctival injection
d. intravenous
b. topical
The patient should be told that his or her glaucoma medications:
a. need not be used on the day of the appointment
b. will cure the condition
c. do not need to be refilled
d. should be continued until told otherwise
d. should be continued until told otherwise
(patient education is key to successful treatment of glaucoma using medications. The patient should be told to continue the medication (including refilling it before it runs out) until instructed otherwise. In addition, the medication should be used on schedule, even (especially) when the patient has an appointment that day; otherwise, it is more difficult to assess the treatment’s efficacy)
Reasons that a patient fails to take his or her glaucoma medications properly include all the following except:
a. lack of symptoms suggesting the patient has a disease
b. side effects of glaucoma medications
c. he or she understands the serious nature of the disease
d. lack of visual improvement from the medication
c. he or she understands the serious nature of the disease
(if the patient understands the gravity of the disease, he or she will be more motivated to use the medication)
If the patient is given oral antibiotics following surgery, he or she should be told to:
a. discontinue the pills once the danger of infection is over
b. take half of the prescription, then discontinue if no infection develops
c. take all the medication until its gone
d. take the pills only if infection seems to be developing
c. take all the medication until its gone
(oral antibiotics should be taken until gone; otherwise, its effectiveness may be reduced or nil)
The patient is going to be using an ophthalmic medication that is labeled “suspension”. You tell the patient to:
a. keep the bottle refrigerated
b. shake the bottle prior to use
c. use twice the prescribed dose
d. warm the drops prior to use
b. shake the bottle prior to use
(a suspension means the actual medication is in the form of particles, which may settle to the bottom of the bottle. Mixing is necessary to “suspend” the particles throughout the carrier solution. Otherwise, the patient may instill a drop full of “carrier” that has no medication in it)
The doctor has diagnosed iritis and has asked you to explain the use of cyclopentolate drops to the patient. You tell the patient:
a. “this will numb your eye and make you more comfortable”
b. “this will dilate your pupil to make your eye more comfortable”
c. “don’t miss a single dose or your eye pressure may go up”
d. “this will minify your pupil to make you more comfortable”
b. “this will dilate your pupil to make your eye more comfortable”
(dilating/cyclopleging an eye with inflammation decreases discomfort by temporarily paralyzing accommodation and iris movement. This is analogous to putting a splint on a sprained wrist to limit movement. It also helps to prevent the iris from adhering to the corneal endothelium or to the lens)
All of the following can be complications of eye drop use except:
a. the patient may have an allergic reaction
b. the patient may develop irritation of the eye or lids
c. the drops can become contaminated
d. the patient may develop a fever
d. the patient may develop a fever
(fever is a sign of infection, not allergy or drug reaction)
Abnormal drug reactions may occur:
a. in patients who are debilitated
b. in the presence of other drugs
c. as toxic or chemical reactions
d. all of the above
d. all of the above
Common signs and symptoms of a topic allergic reaction to ocular medications include:
a. rash, itching, redness, and swelling
b. pain, redness, discharge
c. pain, photophobia, and mid-dilated pupil
d. rash, redness, and anterior chamber reaction
a. rash, itching, redness, and swelling
Which of the following suggests a drug allergy in the skin?
a. redness and itching
b. increased perspiration
c. a feeling of heat in the skin
d. a prickling sensation
a. redness and itching
Which of the following suggests a drug allergy in the conjunctiva?
a. a deep aching
b. a pus-like discharge
c. swelling and redness
d. decreased tearing
c. swelling and redness
If a patient has a localized allergic reaction to a topical medication instilled in the office, one should:
a. irrigate the eye immediately
b. call 911
c. administer oxygen, cortisone, and epinephrine
d. check the pH of the eye and neutralize appropriately
a. irrigate the eye immediately
Over a period of time, use of steroid drops can cause all of the following, except:
a. an increase in intraocular pressure
b. accelerated growth of certain organisms
c. iris cysts
d. slow wound healing
c. iris cysts
Which of the following has the highest risk of complications?
a. a drug given in drop form
b. a drug given in ointment form
c. a drug given in topical sustained-release form
d. a drug given via injection or oral form
d. a drug given via injection or oral form
(these medications enters the entire body, thus has a higher risk of complications)
All of the following have potentially serious side effects or may cause allergy with long-term usage except:
a. topical anesthetic
b. topical steroid
c. topical neomycin
d. topical preservative-free lubrication
d. topical preservative-free lubrication
Severe drug reaction may include:
a. nausea
b. dizziness
c. airway obstruction
d. rash
c. airway obstruction
A patient having an allergic reaction involving shallow respiration should be given:
a. mouth-to-mouth resuscitation
b. mouth-to-nose resuscitation
c. oxygen from a portable unit
d. resuscitation through a mask
c. oxygen from a portable unit
Positioning the eyes so that an object’s image is placed on the macula is known as:
a. fixation
b. binocular vision
c. stereo vision
d. depth perception
a. fixation
(in fixation, the eyes are positioned so that each macula is receiving the same image (albeit at a slightly different angle))
The coordinating process by which the two images (one received by each eye) are blended into a single image is known as:
a. stereo vision
b. depth perception
c. binocular vision
d. fusion
d. fusion
(the brain merges the slightly different images coming from each eye to create a single three-dimensional image)
Coordinated movement of both eyes in the same direction is known as:
a. ductions
b. versions
c. rotations
d. saccades
b. versions
(versions are movements of both eyes in the same directions. ductions are movements of one eye alone)
Which of the following are not considered cardinal position of gaze?
a. down and left, or up and left
b. up and right, or down and right
c. straight ahead, or straight up and down
d. directly left, or directly right
c. straight ahead, or straight up and down
(in any of these positions, the action of one muscle can be masked by the action of another, so these positions are not considered diagnostic)
When testing a patient’s versions, it is important to:
a. test in dim lighting
b. keep the patient’s head still
c. use an opaque occluder to break fusion
d. keep the patient’s eyes in primary position
b. keep the patient’s head still
(if the patient moves their head to follow the target, you are not able to test the full motion of the eyes, but rather the range of motion of the neck)
Versional movements are those that:
a. result in fusion
b. move one eye
c. move both eyes in the same direction
d. move both eyes in different directions
c. move both eyes in the same direction
(versions move both eyes in the same direction. fusion does not necessarily occur; for example, the muscles in a blind eye are still innervated and linked to those of the other (seeing) eye)
