exam2 Flashcards
Mrs. Alden is a 29-year-old pregnant patient in her third trimester. She tells you that her vision has been a little blurred, and she thinks she needs to get new contact lenses. You should
advise her to
a. get new lenses as soon as possible to avoid complications.
b. wait until several weeks after delivery to get new lenses.
c. go to the nearest emergency department for evaluation.
d. change her diet to include more yellow vegetables.
b. wait until several weeks after delivery to get new lenses.
Because of the increased level of lysozyme in the tears during pregnancy, a blurred sensation may occur but will subside several weeks after pregnancy. The blurred vision is a normal occurrence during pregnancy. It is not an emergency, nor is it diet-dependent
A condition that typically develops by the age of 45 years is
a. presbyopia.
b. hyperopia.
c. myopia.
d. astigmatism.
a. presbyopia.
By 45 years of age, a condition known as presbyopia develops; presbyopia involves a weakening of accommodation. Hyperopia occurs in early infancy. Myopia and astigmatism
can occur at any time
Which finding, when seen in the infant, is ominous?
a. Difficulty tracking objects with the eyes
b. Appearing to have better peripheral than central vision
c. Blinking when bright light is directed at the face
d. White pupils on photographs
ANS: D
The absence of a red reflex, determined by physical examination or the appearance of white
pupils on a photograph, is indicative of retinoblastoma, a serious retinal tumor.
d. White pupils on photographs
Mr. C’s visual acuity is 20/50. This means that he
a. can see 50% of what the average person sees at 20 feet.
b. has perfect vision when tested at 50 feet.
c. can see 20% of the letters on the chart’s 20/50 line.
d. can read letters while standing 20 feet from the chart that the average person could read at 50 feet
d. can read letters while standing 20 feet from the chart that the average person could read at 50 feet
The criterion for determining the adequacy of a patient’s visual field is
a. the ability to discriminate primary colors.
b. the ability to discriminate details.
c. correspondence with the visual field of the examiner.
d. distance vision equal to that of an average person.
c. correspondence with the visual field of the examiner.
The examiner compares his or her own peripheral vision to that of the patient while performing the confrontation test, so unless the examiner is aware of a problem with his or her own vision, the examiner could assume that the fields are full if they match.
. Mrs. S. is a 69-year-old woman who presents for a physical examination. On inspection of her eyes, you note that the left upper eyelid droops, covering more of the iris than does the right.
This is recorded as
a. exophthalmos on the right.
b. ptosis on the left.
c. nystagmus on the left.
d. astigmatism on the right.
ANS: B
Ptosis is when one of the upper eyelids covers more of the iris than the other lid, possibly extending over the pupil
A condition in which the eyelids do not completely meet to cover the globe is called
a. glaucoma.
b. lagophthalmos.
c. exophthalmos.
d. hordeolum.
ANS: B
Lagophthalmos is a term used to describe the condition in which eyelids do not completely
meet when closing. Glaucoma involves elevated pressure in the eye. Exophthalmus involves
bulging eyes. A hordeolum is better known as a stye
Mr. Morris is a 38-year-old patient who presents to the clinic with complaints of allergies. An allergy can cause the conjunctiva to have a
a. cobblestone pattern.
b. dry surface.
c. subconjunctival hemorrhage.
d. rust-colored pigment.
ANS: A
A red or cobblestone pattern, especially to the upper conjunctiva, indicates allergic
conjunctivitis. Allergies also cause itchy, watery eyes rather than dry surfaces, hemorrhage, or rust-colored pigment
A pterygium is more common in people heavily exposed to
a. high altitudes.
b. tuberculosis.
c. ultraviolet light.
d. cigarette smoke.
ANS: C
Persons heavily exposed to ultraviolet light are more susceptible to the development of a pterygium.
Mr. Brown was admitted from the emergency department, and you are completing his physical examination. His pupils are 2 mm bilaterally, and you notice that they fail to dilate when the penlight is moved away. This is characteristic in patients who are or have been
a. in a coma.
b. taking sympathomimetic drugs (cocaine).
c. taking opioid drugs (morphine).
d. treated for head trauma.
ANS: C
Pupil constriction to less than 2 mm is called miosis. With miosis, the pupils fail to dilate in the dark, a common result of opioid ingestion or the use of drops for glaucoma. Pupils are usually dilated greater than 6 mm in a patient described in the other choices.
When testing corneal sensitivity controlled by cranial nerve V, you should expect the patient to respond with
a. brisk blinking.
b. copious tearing.
c. pupil dilation.
d. reflex smiling
ANS: A
Brisk blinking is an expected response to corneal sensitivity testing, which involves gently touching the cornea with a piece of cotton
You observe pupillary response as the patient looks at a distant object and then at an object held 10 cm from the bridge of the nose. You are assessing for
a. confrontation reaction.
b. accommodation.
c. pupillary light reflex.
d. nystagmus
ANS: B
Testing for accommodation involves asking the patient to look at an object at a distance (pupils dilate) and then to look at another, much closer object (pupils constrict).
When inspecting the region of the lacrimal gland, palpate
a. the lower orbital rim, near the inner canthus.
b. in the area between the arch of the eyebrow and upper lid.
c. beneath the lower lid, adjacent to the inner canthus.
d. adjacent to the lateral aspect of the eye, just beneath the upper lid.
ANS: A
The lacrimal gland is located at the lower orbital rim near the inner canthus of the eye
Examination to assess for extraocular muscle imbalance is conducted by
a. comparing pupillary responses to different shapes.
b. having the patient follow your finger through planes.
c. inspecting slightly closed lids for fasciculations.
d. transilluminating the cornea with tangential light.
ANS: B
The test for extraocular muscle function is to have the patient follow an object as you move it through planes of vision while observing for nystagmus.
Mr. Older is a 40-year-old patient who presents to the office for a follow-up eye examination after the diagnosis of myopia. To see retinal details in a myopic patient, you will need to
a. adjust your ophthalmoscope into the plus lens.
b. move your ophthalmoscope backward.
c. move your hand farther forward.
d. turn your ophthalmoscope to a minus lens.
ANS: D
The myopic patient (nearsighted) has longer eyeballs, so that light rays focus in front of the retina. To see the retina, use the minus (red) numbers by moving the diopter wheel counterclockwise; to assess a hyperopic patient, use a plus lens.
Ask the patient to look directly at the light of the ophthalmoscope when you are ready to examine the
a. retina.
b. optic disc.
c. retinal vessels.
d. macula.
ANS: D
The macula is the site of central vision and is observed when the patient looks directly at the ophthalmoscope light.
Opacities of the red reflex may indicate the presence of
a. hypertension.
b. hydrocephalus.
c. cataracts.
d. myopia.
ANS: C
Opacities or dark spots of the red reflex may indicate the presence of congenital cataracts in the newborn.
If a patient has early papilledema, using an ophthalmoscope, the examiner will be able to detect
a. dilated retinal veins.
b. retinal vein pulsations.
c. sharply defined optic discs.
d. visual defects.
ANS: A
Papilledema is caused by increased intracranial pressure along the optic nerve, pushing the vessels forward (cup protrudes forward) and dilating the retinal veins. Retinal vein pulsations and visual defects are not visible with an ophthalmoscope. On examination, papilledema is characterized by loss of definition of the optic disc.
Cupping of the optic disc may be a result of
a. migraine headaches.
b. diabetes.
c. glaucoma.
d. dehydration
ANS: C
Cupping is seen with causes of increased intraocular pressure, such as glaucoma. Migraine headaches, diabetes, and dehydration do not cause cupping of the optic disc. Diabetes results in cotton wool patches and hemorrhages.
When drusen bodies are noted to be increasing in number or in intensity of color, the patient should be further evaluated with a(n)
a. Amsler grid.
b. Snellen E chart.
c. litmus test.
d. confrontation test
ANS: A
Drusen bodies, when they increase in number or intensity of color, may indicate a precursor state of macular degeneration. When this happens, the patient’s central vision should be
assessed using the Amsler grid. The Snellen E chart measures visual acuity, the litmus test is used for testing pH, and a confrontation test examines peripheral vision.
Cotton wool spots are most closely associated with
a. glaucoma.
b. normal aging processes.
c. hypertension.
d. eye trauma
ANS: C
Cotton wool spots actually represent infarcts of the retina and are associated with hypertension or diabetes.
Which may be suggestive of Down syndrome?
a. Drusen bodies
b. Papilledema
c. Narrow palpebral fissures
d. Prominent epicanthal folds
ANS: D
Prominent epicanthal folds, or slanting of the eyes, may be normal in Asian infants, but in other ethnic groups it may indicate Down syndrome.
To differentiate between infants who have strabismus and those who have pseudostrabismus, use the
a. confrontation test.
b. corneal light reflex.
c. E chart.
d. Amsler grid
ANS: B
The corneal light reflex is used with infants to differentiate between strabismus and
pseudostrabismus by noting an asymmetric versus symmetric light reflex.
You are attempting to examine the eyes of a newborn. To facilitate eye opening, you would first
a. dim the room lights.
b. elicit pain.
c. place him in the supine position.
d. shine the penlight in his or her eyes.
ANS: A
The best way to assess the eyes of a newborn is to start by dimming the lights because it encourages infants to open their eyes.
Dot hemorrhages, or microaneurysms, in the retina and the presence of hard and soft exudates are most commonly seen in those with
a. Down syndrome.
b. diabetic retinopathy.
c. systemic lupus.
d. glaucoma.
ANS: B
Dot hemorrhages or tiny aneurysms are characteristics of background retinopathy. A trapping of lipids within incompetent capillaries causes the hemorrhages.
Which maneuver can be done to reduce the systemic absorption of cycloplegic and mydriatic agents when examining a pregnant woman if the examination is mandatory?
a. Have the woman keep her eyes closed for several minutes.
b. Instill half the usual dosage.
c. Keep the patient supine, with her head turned and flexed.
d. Use nasolacrimal occlusion after instillation
ANS: D
To reduce absorption systemically, the examiner may use nasolacrimal occlusion after applying, which involves pinching the upper bridge of the nose.
Changes seen in proliferative diabetic retinopathy are the result of
a. anoxic stimulation.
b. macular damage.
c. papilledema.
d. minute hemorrhages.
ANS: A
New vessels are a characteristic seen in proliferative retinopathy resulting from anoxic stimulation. An insufficient blood supply from failing capillaries causes new vessel growth
Which are the signs and symptoms of infant retinoblastoma? (Select all that apply.)
a. White reflex
b. Red reflex
c. Corneal light reflex
d. Absence of a blink reflex
e. Autosomal dominant trait
f. Drainage from the affected eye
g. Visual acuity of 20/500
ANS: A, E
Retinoblastoma in an infant is marked by a characteristic white reflex, also called cat’s eye reflex or leukocoria. Red reflex and corneal light reflex are expected findings. Absence of the blink reflex is not associated with retinoblastoma
Contraction or relaxation of the ciliary body:
a. allows voluntary blinking.
b. changes lens thickness.
c. regulates peripheral vision.
d. sends light impulses to the brain.
e. regulates tear production.
ANS: B
The lens is circularly supported by a framework of fibers from the ciliary body, and contraction or relaxation of this structure results in a change in the thickness of the lens, allowing for accommodation as needed. Voluntary blinking, peripheral vision, tear production, and impulses to the brain are not controlled by the ciliary body.
Term infants have a visual acuity of about:
a. 20/20.
b. 20/100.
c. 20/200.
d. 20/300.
e. 20/400
ANS: E
Term infants are hyperopic, with a visual acuity of less than 20/400.
At what age does an infant usually develop the ability to distinguish color?
a. At birth
b. 2 months
c. 6 months
d. 12 months
e. 16 months
ANS: C
By 6 months of age, vision has developed so that colors can be differentiated.
Xanthelasma may suggest that the patient has an abnormality of:
a. lipid metabolism.
b. cognitive function.
c. renal metabolism.
d. bone marrow function.
e. thyroid disease.
ANS: A
Small, odd-shaped, yellow-colored plaques around the eyes are actually lipid deposits and are characteristics of a lipid metabolism problem. The other conditions are not associated with eye plaques.
An acute suppurative inflammation of the follicle of an eyelash can cause an erythematous or yellow lump.
generally caused by a staphylococcal infection
hordeolum, or stye,
