History Taking

Question 1

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 1

A
A patients reaction to prior surgery (eg, excessive bleeding or panic can be a good indicator of how he pr she will tolerate future procedures.

Question 2

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 Gonorrhea

Answer 2

A
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 3

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 3

C
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 4

In which of the following ocular disorders would it be most important to know, what eye drops a new patient is using?
A. Cataract
B. Glaucoma
C. Macular Degeneration
D. Retinitis Pigmentosa

Answer 4

B
A new patient who states he or she has glaucoma should be asked what eye drops he or she is using to control the pressure. Conditions in answer a, c, and d do not require medication.

Question 5

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 5

A
Aspirin and aspirin-containing medications thin the blood. Thus, the patient taking them runs a greater risk for hemorrhage during or after surgery.

Question 6

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 6

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

Question 7

Patients taking a diuretic might have which special need during the exam?
A. frequent trips to the restroom
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 7

A
Diuretics act to reduce the body’s fluids. Thus, the patient may need to a break to go to the restroom during the exam.

Question 8

A patient taking a diuretic probably has which health problem?
A. asthma
B. heart trouble
C. emphysema
D. diabetes

Answer 8

B
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 9

High blood pressure is frequently treated by:
A. nonsteroidal anti-inflammatory drugs (NSAIDs)
B. oral steroids
C. beta-blockers
D. analgesics

Answer 9

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

Question 10

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 10

D
If the patient is already taking a beta-blocker for hypertension, the physician may not want to prescribe an additional beta-blocker for the glaucoma.

Question 11

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 11

C
Birth control pills can cause changes in the retina, including retinal artery and vein occlusion.

Question 12

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 12

B
Cataract formation has been associated with the long term use of steroids.

Question 13

Conditions for which a person might take oral steroids include:
A. rheumatoid arthritis
B. diabetes
C. hypertension
D. hypoglycemia

Answer 13

A
Steroids are anti-inflammatory drugs and , thus, are used in the treatment of rheumatoid arthritis.

Question 14

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 14

A
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 15

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 15

C
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 16

Diabetes medication includes:
A. diuretics and beta-blockers
B. insulin injections and “sugar pills”
C. steroids and analgesics
D. antibiotics and NSAIDs

Answer 16

B
Diabetes is treated with oral medication (“sugar pills”) and injectable insulin. (Of course, a diabetic does not take pills made out of sugar, but many patients call oral diabetic medicine a “sugar pill.”) Do not feel bad if you missed this one!

Question 17

An example of an analgesic is:
A. insulin
B. aspirin
C. sulfa
D. nitroglycerin

Answer 17

B
An analgesic is a pain reliever, such as aspirin.

Question 18

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 18

B
A woman who has had her ovaries removed is most likely on a hormone replacement therapy. 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 19

A male patient is going to be scheduled for cataract surgery. Which of the following medications is of most concern?
A. Sildenafil Citrate (for erectile dysfunction)
B. hydroxychloroquine
C. amiodarone
D. testosterone patch

Answer 19

A
Medication for erectile dysfunction, such as Viagra (sildenafil citrate), have been implicated in intraoperative floppy iris syndrome, a complication of cataract surgery. Plaquenil (hydroxychloroquine) is an antimalarial drug sometimes used in the treatment of arthritis. Its side effects can include disturbance of the macula. Amiodarone is used for irregular heartbeat and can have ocular side effects (ex. corneal deposits). The testosterone patch is a male hormone replacement therapy.

Question 20

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 codeine
C. penicillin, sulfa, or caffeine
D. penicillin, sulfur, or codeine

Answer 20

A
The most common drug allergies are to penicillin, sulfa, and codeine. An allergy to niacin or caffeine is possible, but not common. Sulfur is a mineral.

Question 21

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 21

B
Nausea is a side effect and should be recorded in the patient’s chart. (Examples of an allergy are rash, itching, and shortness of breath.)

Question 22

Your patient says that erythromycin makes her break out in a rash. This is:
A. an allergy
B. a side effect
C. an unrelated occurrence
d. unimportant

Answer 22

A
Rash (urticaria) is a common allergic response.

Question 23

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 23

B
A chalazion excision is done under local anesthesia. An exception might be general anesthesia for a small child, but the question does not gibe you this kind of detail.

Question 24

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 24

A
A numbing injection prior to dental work is local anesthesia. Answer b refers to general anesthesia. Answers c and d refer to topical anesthesia.

Question 25

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 pupils

Answer 25

B
Dye is injected into a vein during a fluorescein angiogram. Fluorescein involved in procedures a and c would be topical.

Question 26

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 26

D
A patient’s occupation may affect the prescription of a bifocal or trifocal (because of work distance), medications (eg, those causing blurred vision or drowsiness), and they types of ocular risks to which the patient is exposed (eg, the need for safety glasses).

Question 27

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 27

D
“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 28

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 28

C
A patient’s living situation is one component of social history. (Note: Family history covers hereditary disorders.)

Question 29

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 29

B
While all the disorders listed may be hereditary, strabismus, myopia, and glaucoma are the most common.

Question 30

A 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 is less prevalent among whites
C. is a good reason for a full eye exam
D. is insignificant because glaucoma is passed through the father, not the mother

Answer 30

C
A family history of glaucoma is reason for a full exam, regardless of the patient’s age or race. There is no evidence that glaucoma is linked to the X chromosome.

Question 31

A mother brings in a 2-year-old 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 31

A
Strabismus tends to be familial.

Question 32

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 32

B
The tendency to develop diabetes, hypertension, arthritis, and cancer can be linked to heredity. The other conditions (except gout) are infectious diseases.

Question 33

Which of the following is not potentially a hereditary disorder?
A. keratoconus
B. secondary glaucoma
C. migraine headaches
D. nystagmus

Answer 33

B
The term secondary was your clue that the glaucoma was caused by something (eg, steroid use, injury, etc.) and not inherited. The others can be hereditary or not.