COA Flashcards - Exam Review Manual

Question 1

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

Answer 1

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.

Question 2

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

Answer 2

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.

Question 3

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

Answer 3

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

Question 4

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

Answer 4

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.

Question 5

Which of the following is NOT part of a history?
a - presenting complaint
b - medications currently used
c - family eye disease
d - visual acuity

Answer 5

d - visual acuity

• Visual acuity is part of the examination, not the history

Question 6

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

Answer 6

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.

Question 7

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?”

Answer 7

b - “when did you first notice the problem?”

• Onset relates to when the patient first noticed the problem

Question 8

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

Answer 8

d - severity

• The severity of the problem relates to the amount of disability a patient suffers

Question 9

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

Answer 9

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.

Question 10

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

Answer 10

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)

Question 11

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

Answer 11

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.

Question 12

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?”

Answer 12

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.

Question 13

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

Answer 13

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

Question 14

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)

Answer 14

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!)

Question 15

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

Answer 15

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)

Question 16

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?”

Answer 16

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.

Question 17

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?”

Answer 17

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.

Question 18

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?”

Answer 18

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.

Question 19

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

Answer 19

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”.

Question 20

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

Answer 20

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)

Question 21

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?”

Answer 21

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

Question 22

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

Answer 22

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.

Question 23

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

Answer 23

a - it might help explain current complaints and findings

• A patient’s current problems may stem from past injury (such as recurrent erosion syndrome).

Question 24

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?”

Answer 24

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.

Question 25

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”?

Answer 25

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.

Question 26

An example of a systemic illness is:
a - down syndrome
b - senility
c - past surgical procedures
d - cardiac problems

Answer 26

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.

Question 27

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

Answer 27

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).

Question 28

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

Answer 28

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).

Question 29

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

Answer 29

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.”

Question 30

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

Answer 30

b - glaucoma

• Certain glaucoma medications are contraindicated in patients with lung disease

Question 31

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

Answer 31

a - dry eye

• Dry eye is strongly associated with rheumatoid arthritis

Question 32

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

Answer 32

a - is hereditary and occurs primarily in the black population

• Sickle cell disease occurs mainly in the black population and is hereditary

Question 33

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

Answer 33

d - because the abnormally shaped cells can block the eye’s blood vessels

• These blockages can happen anywhere in the body, including the eye

Question 34

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

Answer 34

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

Question 35

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

Answer 35

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.

Question 36

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?

Answer 36

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.

Question 37

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

Answer 37

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.

Question 38

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

Answer 38

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.

Question 39

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

Answer 39

c - vitamin use

• Patients with diagnosed macular degeneration have probably been put on a vitamin regimen of some kind.

Question 40

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

Answer 40

a - frequent trips to the bathroom

• Diuretics act to reduce the body’s fluids.

Question 41

A patient taking a diuretic probably has which health problem?
a - asthma
b - heart trouble
c - emphysema
d - diabetes

Answer 41

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.

Question 42

High blood pressure is frequently treated by:
a - nonsteroidal anti-inflammatory drugs (NSAIDs)
b - oral steroids
c - beta-blockers
d - analgesics

Answer 42

c - beta-blockers

• Beta-blockers are frequently used to treat hypertension. NSAIDs and steroids are used to treat inflammation. Analgesics are for pain.

Question 43

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

Answer 43

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.

Question 44

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

Answer 44

c - these hormones can cause changes in the retina

• These changes can include damage such as retinal artery and vein occlusion

Question 45

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

Answer 45

b - cataracts

• Cataract formation has been associated with the long-term use of oral steroids

Question 46

Conditions for which a person might take oral steroids include:
a - rheumatoid arthritis
b - diabetes
c - hypertension
d - hypoglycema

Answer 46

a - rheumatoid arthritis

• Steroids are anti-inflammatory drugs and, thus, are used in treatment of rheumatoid arthritis

Question 47

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

Answer 47

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

Question 48

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

Answer 48

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

Question 49

Diabetes medication includes:
a - diuretics and beta-blockers
b - insulin injections and “sugar pills”
c - steroids and analgesics
d - antibiotics and NSAIDs

Answer 49

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”)

Question 50

An example of an analgesic is:
a - insulin
b - aspirin
c - sulfa
d - nitroglycerin

Answer 50

b - aspirin

• An analgesic is a pain reliever

Question 51

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

Answer 51

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.

Question 52

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

Answer 52

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.

Question 53

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

Answer 53

a - penicillin, sulfa or codeine

• An allergy to niacin or caffeine is possible, but not common. Sulfur is a mineral.

Question 54

Your patient says that beta-blockers make him nauseated. This is:
a - an allergy
b - a side effect
c - an unrelated occurrence
d - unimportant

Answer 54

b - a side effect

• Side effects should still be recorded in the patient’s chart

Question 55

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

Answer 55

a - an allergy

• Allergic reactions always need to be recorded in the patient’s chart

Question 56

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

Answer 56

b - local anesthesia

• Chalazion excisions are done under local. The exception to this is for small children, where they will use general.

Question 57

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

Answer 57

a - has ever had a numbing injection for a dental procedure

• This is an example of a local anesthetic.

Question 58

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

Answer 58

b - performing a fluorescein angiogram

• Dye is injected into the vein during an FA. The fluorescein used during a and c would be topical.

Question 59

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

Answer 59

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).

Question 60

A patient’s social history would include all of the following except:
a - tobacco use
b - living arrangements
c - hobbies
d - therapeutic drug use

Answer 60

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.

Question 61

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

Answer 61

c - social history

• This is only one component of social history

Question 62

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

Answer 62

b - strabismus, myopia and glaucoma

• All of the disorders listed are hereditary, the others just aren’t as common

Question 63

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

Answer 63

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.

Question 64

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

Answer 64

a - does anyone in the family have crossed eyes?

• Strabismus tends to be familial

Question 65

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

Answer 65

b - diabetes, hypertension, arthritis and cancer

• The other conditions listed (except gout) are infectious diseases

Question 66

Which of the following is NOT potentially a hereditary disorder?
a - keratoconus
b - secondary glaucoma
c - migraine headaches
d - nystagmus

Answer 66

b - secondary glaucoma

• Secondary implies it was caused by something else (steroid use, trauma, etc)

Question 67

Any pupil smaller than what size is considered miotic?
a - 1 mm
b - 2 mm
c - 3 mm
d - 4 mm

Answer 67

b - 2 mm

Question 68

Any pupil larger than what size is considered mydriatic?
a - 3 mm
b - 4 mm
c - 5 mm
d - 6 mm

Answer 68

d - 6 mm

Question 69

Which of the following groups tend to have smaller pupils?
a - children
b - myopes
c - people with light blue eyes
d - older people

Answer 69

d - older people

• Children, myopes and people with light blue eyes tend to have larger pupils.

Question 70

Unequal pupil size is termed:
a - anisocoria
b - anisometropia
c - anisochromia
d - aniseikonia

Answer 70

a - anisocoria

• The other answers are all real terms that you should be familiar with as well

Question 71

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

Answer 71

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?

Question 72

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

Answer 72

c - at 6 o’clock

• Iris coloboma is a congenital defect where the iris fails to fuse, usually inferiorly

Question 73

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

Answer 73

d - dimming the room lights

• Dimming the room lights would make the pupil enlarge

Question 74

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

Answer 74

a - shining a bright light into the eye

• Shining a bright light into the eye would cause the pupils to constrict, not dilate

Question 75

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

Answer 75

b - the reaction of one pupil to light

Question 76

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

Answer 76

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.

Question 77

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

Answer 77

d - cover the eye not being tested

• Consensual light response testing requires you to able to see both pupils at the same time.

Question 78

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

Answer 78

a - observe the pupils as the patient looks from a distant object to a close-up object

Question 79

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

Answer 79

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

Question 80

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

Answer 80

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.

Question 81

Testing that reveals normal-appearing pupils that react appropriately is documented as:
a - PERRLA
b - RAPD
c - CSM
d - PEAR

Answer 81

a - PERRLA

• PERRLA stands for “pupils equally round and reactive to light and accommodation”

Question 82

The most common cause of a false-positive pupillary defect is:
a - glaucoma
b - papilledema
c - RAPD
d - weak flashlight batteries

Answer 82

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.

Question 83

Each of the following could cause abnormal pupil shape except:
a - surgery
b - trauma
c - birth defect
d - Marcus Gunn

Answer 83

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.

Question 84

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

Answer 84

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.

Question 85

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

Answer 85

a - unreactive to direct or consensual light

Question 86

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

Answer 86

b - syphilis

Question 87

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

Answer 87

b - Horner’s syndrome

Question 88

Horner’s syndrome is caused by:
a - nerve damage
b - keratoconjunctivitis
c - syphilis
d - Herpes zoster

Answer 88

a - nerve damage

• This nerve damage specifically affects eyelid position, pupil size and facial perspiration to varying degrees

Question 89

Adie’s tonic pupil (or tonic pupil) is caused by:
a - systemic rubella
b - sympathetic ophthalmia
c - gonorrhea
d - nerve damage

Answer 89

d - nerve damage

• Specifically, to the short posterior ciliary nerves

Question 90

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

Answer 90

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.

Question 91

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

Answer 91

c - swinging flashlight test

Question 92

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

Answer 92

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.

Question 93

An eye with a RAPD usually has:
a - redness and pain
b - subnormal visual acuity
c - delayed extraocular muscle responses
d - irregular astigmatism

Answer 93

b - subnormal visual acuity

Question 94

Another name for a RAPD is:
a - Argyll Robertson pupils
b - Adie’s syndrome
c - Marcus Gunn pupil
d - tonic pupil

Answer 94

c - Marcus Gunn pupil

Question 95

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

Answer 95

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.

Question 96

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

Answer 96

a - keratometry

• The keratometer measures the curvature of the cornea. The base curve of the lens is then selected to complement this measurement.

Question 97

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

Answer 97

c - visible iris diameter

• A soft lens should extend beyond the limbus, so one needs this measurement.

Question 98

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

Answer 98

b - by measuring the visible iris with a millimeter rule

Question 99

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

Answer 99

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.

Question 100

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

Answer 100

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.

Question 101

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

Answer 101

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.

Question 102

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

Answer 102

a - provide a training session offering oral and written instructions

Question 103

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

Answer 103

c - always wash hands first

Question 104

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

Answer 104

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.)

Question 105

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

Answer 105

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

Question 106

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

Answer 106

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.

Question 107

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

Answer 107

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.

Question 108

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

Answer 108

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.

Question 109

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

Answer 109

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.

Question 110

Damage to soft contact lenses is frequently caused by:
a - enzymatic cleaners
b - rolling them between the fingers
c - long fingernails
d - defective materials

Answer 110

c - long fingernails

Question 111

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

Answer 111

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.

Question 112

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

Answer 112

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.

Question 113

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

Answer 113

a - grunge is easier to remove at body temperature

• A soft lens should never be allowed to dry out

Question 114

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

Answer 114

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.

Question 115

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

Answer 115

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”

Question 116

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

Answer 116

c - remove protein deposits

• They do not provide the advantages listed in answers a, b, or d

Question 117

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

Answer 117

a - this prevents warping

Question 118

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

Answer 118

c - it should be soaked for at least 4 hours

Question 119

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

Answer 119

d - change the soaking solution every day to maintain disinfection

Question 120

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

Answer 120

a - it weakens the lens material

Question 121

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

Answer 121

b - enable tears to spread evenly on the lens surface

Question 122

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

Answer 122

c - rehydrate the lenses while on the eye

• This increases lens movement and comfort

Question 123

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

Answer 123

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.

Question 124

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

Answer 124

c - use lubricating drops every morning and during the day

Question 125

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

Answer 125

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.

Question 126

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

Answer 126

c - they should not wear contacts at work

Question 127

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

Answer 127

d - remove the lens

Question 128

Corneal vascularization can result from chronic:
a - hypoxia
b - solution sensitivity
c - conjunctival injection
d - giant papillary conjunctivitis

Answer 128

a - hypoxia

• This is a lack of oxygen

Question 129

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

Answer 129

b - superior limbal area

• (Under the upper lid)

Question 130

Corneal edema is caused by:
a - excess oxygen permeability
b - insufficient oxygen
c - excess carbon monoxide
d - excess tear production

Answer 130

b - insufficient oxygen

Question 131

Symptoms of corneal edema include:
a - blurred vision
b - rainbows around lights
c - injection and burning
d - all of the above

Answer 131

d - all of the above

Question 132

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

Answer 132

c - homemade saline

• Generally made with salt tablets and distilled water

Question 133

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

Answer 133

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.

Question 134

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

Answer 134

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.

Question 135

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

Answer 135

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.

Question 136

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

Answer 136

c - excessive lens movement

• Excessive tears equal excessive movement as the lens floats around on the surplus fluid

Question 137

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

Answer 137

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.

Question 138

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

Answer 138

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

Question 139

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

Answer 139

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.

Question 140

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

Answer 140

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.

Question 141

One of the main risks of wearing soft contact lenses is:
a - modifications are impossible
b - residual astigmatism
c - infection
d - lens discoloration

Answer 141

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.

Question 142

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

Answer 142

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.

Question 143

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

Answer 143

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.

Question 144

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

Answer 144

c - those taking blood thinners

• There is no connection between taking blood thinners and wearing contact lenses

Question 145

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

Answer 145

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).

Question 146

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

Answer 146

b - fitting one eye (usually the dominant eye) for distance and the other eye for near

Question 147

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

Answer 147

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.

Question 148

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)

Answer 148

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.

Question 149

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

Answer 149

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.

Question 150

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

Answer 150

a - with a high Dk value or reduced thickness

Question 151

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

Answer 151

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.

Question 152

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

Answer 152

d - add half of the cylinder to the sphere algebraically, deleting the cylinder

Question 153

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

Answer 153

d - -2.50 sphere

• Half of the cylinder is +0.50. Add this to the sphere power: -3.00 +0.50 = -2.50

Question 154

With spherical soft lenses, a small amount of corneal astigmatism is:
a - increased
b - eliminated
c - tolerated
d - a reason to fit Toric lenses

Answer 154

c - tolerated

• As long as a patient tolerates it, there is no reason to rush into fitting a toric lens.

Question 155

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

Answer 155

a - residual astigmatism

Question 156

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

Answer 156

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)

Question 157

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

Answer 157

a - less than one-third of the total refractive error

Question 158

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

Answer 158

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.

Question 159

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

Answer 159

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.

Question 160

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

Answer 160

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.

Question 161

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

Answer 161

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.

Question 162

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

Answer 162

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

Question 163

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

Answer 163

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.

Question 164

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

Answer 164

c - 18 to 24 months

Question 165

Over-refractometry of a contact lens is useful in fine tuning:
a - lens power
b - lens diameter
c - lens centration
d - lens base curve

Answer 165

a - lens power

Question 166

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

Answer 166

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.

Question 167

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

Answer 167

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.

Question 168

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

Answer 168

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.

Question 169

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

Answer 169

b - a plan lens is thinner

Question 170

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

Answer 170

c - a low water content lens

• High water content lens versus low water content is preferred because it is more oxygen permeable.

Question 171

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

Answer 171

c - wiping with dry lens wipe

• Liquids can dissolve the paint and ruin the slides

Question 172

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

Answer 172

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

Question 173

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

Answer 173

b - rubbing debris off the bulb with finger

• Oil from the fingers is transferred to the bulb if you touch it.

Question 174

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

Answer 174

a - mild detergent and water

Question 175

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

Answer 175

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

Question 176

Dirty tangent screen test objects should be cleaned with:
a - cleanser
b - an alcohol wipe
c - soap and water
d - acetone

Answer 176

c - soap and water

Question 177

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

Answer 177

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.

Question 178

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

Answer 178

a - by gentle whisking with a very soft brush

Question 179

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

Answer 179

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.

Question 180

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

Answer 180

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.

Question 181

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

Answer 181

a - wipe with alcohol wipe

• The slit-lamp will not move smoothly if the friction plate is dirty.

Question 182

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

Answer 182

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

Question 183

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

Answer 183

d - between each patient exam

• Because the probe makes direct contact with eye tissues, it needs to be cleaned between each patient

Question 184

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

Answer 184

c - cool water

Question 185

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

Answer 185

b - commercial chrome cleaner

Question 186

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

Answer 186

c - this can cloud the lens

Question 187

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

Answer 187

a - contact lens solution

• Because contact lenses are plastic, it makes sense that you can use contact lens solution to clean plastic lenses.

Question 188

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

Answer 188

d - heavily rubbing the lens to remove fingerprints

Question 189

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

Answer 189

c - spray lens cleaner on a wipe, and clean the lens with the wipe

• Never spray cleaner into an instrument!

Question 190

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

Answer 190

b - blow off dust with air

Question 191

Which surface of an exophthalmometer might require disinfection?
a - the mirrors
b - the gauges
c - the prisms
d - the points of patient contact

Answer 191

d - the points of patient contact

Question 192

Which surface of an ophthalmodynamometer might require disinfection?
a - the tip
b - the gauge
c - the lens
d - the watch glass

Answer 192

a - the tip

Question 193

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

Answer 193

c - they produce a faint double image of the reflection

Question 194

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

Answer 194

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.

Question 195

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

Answer 195

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.

Question 196

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

Answer 196

a - patting with a lint-free lens wipe

• To avoid scratching, do not rub the mirror and do not use an abrasive wipe

Question 197

Which surface is NOT affected by friction during cleaning?
a - front surface mirrors
b - bloomed lenses
c - projector screens
d - glass trial lenses

Answer 197

d - glass trial lenses

Question 198

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

Answer 198

c - a solution of mild detergent

Question 199

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

Answer 199

d - cover or store it when note in use

• Covering or storing equipment prevents dust build-up and reduces breakage

Question 200

Turning a screw counterclockwise (to the left) will cause it to:
a - tighten
b - loosen
c - strip out
d - fall out

Answer 200

b - loosen

• Remember: “Righty tighty, lefty loosey”

Question 201

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

Answer 201

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.

Question 202

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

Answer 202

a - use the lowest voltage setting as much as possible

Question 203

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

Answer 203

d - the projected light will not illuminate the entire field

Question 204

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

Answer 204

c - the instrument’s plug

Question 205

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

Answer 205

c - remove the old bulb with pliers

Question 206

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

Answer 206

c - scraping with a metal file

Question 207

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

Answer 207

b - turn the bulb 180 degrees to use the other side (without the build-up)

Question 208

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

Answer 208

c - batteries can lose the ability to recharge

Question 209

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

Answer 209

b - should be placed in the charge only at the end of the day

Question 210

Regular cell batteries should be stored:
a - in a heated room
b - in the refrigerator
c - in the freezer
d - at room temperature

Answer 210

d - at room temperature

Question 211

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

Answer 211

c - get professional assistance

Question 212

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

Answer 212

c - improve faulty illumination

Question 213

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

Answer 213

b - use a template and adjust the projection tube until the letter fits into the correct bracket

Question 214

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

Answer 214

d - have the instrument professionally serviced

Question 215

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

Answer 215

b - a bent bulb filament

• This is caused by lying the instrument on its side

Question 216

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

Answer 216

c - by placing it upright

Question 217

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

Answer 217

c - internal wiring problems

Question 218

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

Answer 218

b - the probe is filled with sterile saline solution

• Water filled probes contain distilled water, not saline solution

Question 219

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

Answer 219

a - touching the probe to a test block specific for that machine

Question 220

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

Answer 220

b - checking calibration by firing the air burst against your finger

Question 221

The muscle light (transilluminator) might require the following maintenance:
a - brightness calibration
b - bulb and battery replacement
c - sterilization
d - tip and casing replacement

Answer 221

b - bulb and battery replacement

Question 222

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

Answer 222

c - sphere power, cylinder power, cylinder axis

Question 223

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

Answer 223

b - cylinder power

Question 224

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

Answer 224

c - the cylinder power is written in “plus”

Question 225

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

Answer 225

a - the trifocal power

Question 226

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

Answer 226

a - +1.50 +2.25 X181

Question 227

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

Answer 227

c - desired cylinder type

Question 228

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

Answer 228

b - reads progressive add lenses

Question 229

An automated lensometer may be disadvantageous in identifying:
a - optical centers
b - add powers
c - prisms
d - warped lenses

Answer 229

d - warped lenses

Question 230

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

Answer 230

a - eliminates math errors

Question 231

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

Answer 231

c - the internal lenses and mirrors can be cleaned by removing the instrument housing

Question 232

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

Answer 232

d - adjust the eye piece of the instrument

Question 233

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

Answer 233

a - you should wear your own habitual correction

Question 234

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

Answer 234

b - turn the eye piece to the most plus position

Question 235

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

Answer 235

b - the target is first seen to be clear

Question 236

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

Answer 236

d - an inaccurate reading

Question 237

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

Answer 237

b - by changing the axis 90 degrees