History Taking

Question 1

A history is obtained by:
A. asking a series of organized and specific questions
B. observing the patient’s actions in 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
The question 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 facts
C. by interpreting the patient’s story and suggesting a diagnosis
D. by copying patient information from a questionnaire

Answer 2

B
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 to only the parent’s account of the illness
B. listen to only the child’s account of the illness
C. talk to the parent outside the the child’s hearing
D. get an account of the illness from both the parent and child

Answer 3

D
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 statements 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 form is signed.

Answer 4

B
The patient must sign a consent to release information, even to insurance companies.

Question 5

Which of the following is “not” a part of history?
A. presenting a complaint
B. medications currently used
C. family eye disease
D. visual acuity

Answer 5

D
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 presenting complaint is the patient’s main reason for coming in. An accurate history might include other complaints 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
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
The severity of a 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 and 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 and alleviating factors 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 a 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 symptom is a change that the patient notices, whether from injury, illness, or other situation. It cannot always be proven (eg, pain) or seen by looking (eg, pressure sensations).

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 complains of blurred vision
D. the patient complains of a pressure sensation behind the eyes

Answer 11

B
A sign is something that 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 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
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 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
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 matter), 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
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
A foreign body at 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), B is still the best answer.

Question 16

The patient is not wearing contacts, but would like to be fit for them. The most relevant question is:
A. “Have you tried contacts 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
It is most important to know a patient’s past experience with contacts. Answers B and C are not wrong, but they are not the 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 you ears?”

Answer 17

C
While all the 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 with presbyopia.

Question 18

A patient reports that he sleeps in his contact lenses. An important question to ask 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 contacts?”

Answer 18

A
You need to know about the lens material. It may be ok to sleep in a disposable extended-wear lens, for example, but some contacts should never 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 and instrument like a slit lamp)
D. not record this. because the patient is obviously confused

Answer 19

C
When a patient says something that does not make ophthalmic sense, ask more questions before writing it in the history. They 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
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 eye?”

Answer 21

C
Answers A and D are not bad questions, but they are not the best. Answer B could imply a judgement 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 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
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
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 eye?”
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 exam?”

Answer 24

A
Prism is usually prescribed to overcome motility disorders; hence, asking about surgery to straighten the eye 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 the mother 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 mostly 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” is the only systemic illness listed. Down syndrome may have systemic effects, but it is a genetic condition not an illness

Question 27

Question 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
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

C
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 level (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
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
Certain glaucoma medications are contraindicated in patients with lung disease.

Question 31

Your patient states that he has rheumatoid arthritis. You should now 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 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 Latina population

Answer 32

A
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
The abnormally shaped cells in sickle cell disease can block blood vessels in any part of the body, including the eye.

Question 34

Knowing the 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 hypochondriac
D. it reveals whether or not the patient may be reluctant to have future surgery

Answer 34

A
A patient’s reaction to prior surgery (eg, excessive bleeding or panic) can be a good indicator of how he or she will tolerate future problems.

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 gonorrhea

Answer 35

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 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
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. cataract
B. glaucoma
C. macular degeneration
D. retinitis pigmentosa

Answer 37

B
A new patient who states he or she has glaucoma should be asked what eye drops he or she is using to control 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
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
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 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 40

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

Question 41

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

Answer 41

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 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 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
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 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
Birth control pills can cause changes in the retina, including 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
Cataract formation has been associated with the long-term use or oral steroids.

Question 46

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

Answer 46

A
Steroids are anti-inflammatory drugs and, thus, are used in the 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 don’t want to admit they use them

Answer 47

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 48

The patient has said that he has no heart problems, but you notice that he is taking two heart medications. For the 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
When in doubt, ask. In some cases, a drug is prescribed for condition other than it’s “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
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 50

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

Answer 50

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

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 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 yet 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 most concern?
A. sildenafil citrate
B. hydroxychloroquine
C. amiodarone
D. testosterone patch

Answer 52

A
Medications 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 (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 codeine
C. penicillin, sulfa, or caffeine
D. penicillin, sulfur, or codeine

Answer 53

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 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
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 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 occurrence
D. unimportant

Answer 55

A
Rash (urticaria) is a common allergic response.

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

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
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 58

Your patient reports an adverse reaction to dye injected for kidney evaluation. This could affect:
A. performing applanation tonometry
B. performing a fluorescein angiogram
C. testing tear function
D. dilating pupils

Answer 58

B
Dye is injected into a vein during a fluorescein angiogram. Fluorescein involved in procedures 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 injury
D. all of the above

Answer 59

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

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