Ophthalmic Patient Services and Education CH12

Question 1

A patient who has an upper blepharoplasty has been treated for:
a) chalazion
b) epicanthal folds
c) dermatochalasis
d) brow ptosis

Answer 1

c) An upper blepharoplasty (“lid lift”) is the procedure used to treat dermatochalasis or
redundant skin of the eyelids.

Question 2

Ptosis surgery is done to repair which of the following?
a) strabismus
b) drooping upper lid
c) lax lower lid
d) redundant skin and fat

Answer 2

b) Ptosis is a drooping upper lid.

Question 3

The procedure for removing a growth from the eyelid is:

a) excision
b) incision
c) decompression
d) biopsy

Answer 3

a) A procedure to remove a growth or other tissue is an excision. An incision is cutting into, but not necessarily removing, anything. A biopsy is when tissue is removed and sent to a lab for identification. A biopsy might be done once tissue is excised.

Question 4

The most common surgical treatment for a chalazion is:

a) cautery
b) electrolysis
c) incise and drain
d) probe and irrigate

Answer 4

c) A chalazion is often incised (cut into) and drained. Although not mentioned here, curet-
tage may also be performed, where the exposed tissue is scraped.

Question 5

A patient wants to have an upper blepharoplasty to improve his looks. This type of surgery is termed:
a) functional
b) cosmetic
c) mandatory
d) sight-threatening

Answer 5

b) Surgery to improve appearance is cosmetic. Insurance is not likely to pay for it.

Question 6

The main purpose of a biopsy is to:

a) determine the type of lesion
b) determine the effectiveness of surgery
c) determine the expected outcome of surgery
d) identify malingerers

Answer 6

a) In a biopsy, tissue is sent to a lab for identification. Usually, the concern is whether or not the tissue is malignant (cancerous).

Question 7

The surgical procedure where skin or other tissue is transplanted from one part of the
body to another is a(n):
a) flap
b) incision
c) graft
d) implant

Answer 7

c) Removing tissue (such as skin) from one part of the body and transplanting it onto
another area is a graft. (Note: When a flap is performed, the tissue to be transplanted is not totally removed, but left partially attached and rotated to cover the adjacent area needing repair.)

Question 8

The surgery to fix an in-turned eyelid is:
a) epilation
b) frontalis sling
c) blepharoplasty
d) entropion repair

Answer 8

d) An inward-turned eyelid is called an entropion; thus, the surgery is an entropion repair.

Question 9

The surgery to fix an out-turned eyelid is:
a) ptosis repair
b) trichiasis repair
c) ectropion repair
d) iridotomy

Answer 9

c) An outward-turned eyelid is called an ectropion, so this surgery is an ectropion repair.

Question 10

When repairing a lower lid laceration in the area of the punctum, tissue alignment is
especially critical because:

a) the lacrimal drainage system is involved
b) the tear-producing ducts are involved
c) infection may set in
d) eyelash alignment may be affected

Answer 10

a) If a laceration involves the lower lid, next to the nose, the tear drainage system is
involved. Permanent tearing may result if the drainage ducts are not properly aligned.

Question 11

An infant with a blocked nasolacrimal duct might initially need which of the following
procedures?
a) dacryocystorhinostomy
b) removal of the tear gland
c) punctal dilation
d) probe and irrigation

Answer 11

d) During fetal development, there is a membrane covering the nasolacrimal duct in the tear drainage system. This membrane usually disappears before birth, but sometimes remains. In this case, tears do not drain properly, and an infection can easily develop. The treatment is to open the membrane with a probe (thin wire) and then flush the drainage system with saline.

Question 12

A patient with dry eyes might have which of the following procedures?
a) lacrimectomy
b) cyclocryo
c) punctal occlusion
d) punctal dilation

Answer 12

c) Punctal occlusion is sometimes used to prevent tears from draining off the eye’s surface. Occlusion keeps the tears that are produced (not much, in a patient with dry eye) on the eye.

Question 13

The grafting of corneal tissue from one human eye to another is a(n):
a) enucleation
b) keratoplasty
c) dacryocystorhinostomy
d) corneal topography

Answer 13

b) Another name for a corneal graft or transplant is a keratoplasty.

Question 14

Each of the following might be associated with a corneal transplant except:
a) follow-up radiation treatment
b) tissue rejection
c) irregular astigmatism
d) 12-month recovery time

Answer 14

a) Radiation is not used with a corneal transplant.

Question 15

Which of the following might need to be surgically removed because it is growing
across the cornea?
a) pingueculum
b) punctal plug
c) pterygium
d) xanthelasma

Answer 15

c) A pterygium is a piece of fleshy tissue that grows from the conjunctiva onto the cornea.
An “active” pterygium continues to grow and may need to be removed before it gets to the
center and obscures vision.

Question 16

Recurrent corneal erosion might be treated by:
a) corneal scraping
b) punctal occlusion
c) enucleation
d) corneal transplant

Answer 16

a) In the case of recurrent corneal erosion, the eroded area is carefully scraped. The idea is to create a smooth surface so the cornea will be able to heal normally.

Question 17

Surgery that is performed in order to correct hyperopia, myopia, and/or astigmatism
is classified as:
a) amniotic membrane transplant
b) refractive surgery
c) corneal transplant
d) corneal endothelial correction

Answer 17

b) Logically, refractive errors are corrected using refractive surgery. Technically, any sur-
gery that purposely alters the eye’s refractive status could be considered refractive surgery,
making cataract extraction with intraocular lens implant the most-performed refractive
surgery.

Question 18

A popular technique for correcting refractive errors using laser technology is:

a) laser-assisted in situ keratomileusis (LASIK)
b) radial keratotomy (RK)
c) astigmatic keratotomy (AK)
d) corneal implants

Answer 18

a) RK and AK are performed with blades, not laser. Corneal implants are done by conven-
tional surgery.

Question 19

Which of the following refractive surgeries does not involve creating a corneal flap?
a) epi-LASIK
b) photorefractive keratectomy (PRK)
c) laser-assisted subepithelial keratomileusis (LASEK)
d) LASIK

Answer 19

b) PRK involves removing the corneal epithelium (compared to creating a flap that is later replaced) and shaping the underlying corneal layer.

Question 20

Which laser is most commonly used in refractive surgery?
a) yttrium-aluminum-garnet (YAG)
b) argon
c) krypton
d) excimer

Answer 20

d) The excimer laser is used in refractive surgery. The YAG is a cutting laser, used for capsulotomy, adhesions, and iridotomy. The argon and krypton lasers are used in retinal vascular disease and in glaucoma procedures.

Question 21

Anesthesia for laser refractive surgery is usually:
a) local
b) general
c) topical
d) not needed

Answer 21

c) Topical anesthesia is used for refractive surgery.

Question 22

A person with esotropia might have what kind of surgery?
a) trabeculectomy
b) recession and resection
c) blepharoplasty
d) ptosis repair

Answer 22

b) In strabismus (esotropia, exotropia), the condition is often corrected by moving the location where the extraocular muscles attach to the eye and/or shortening a muscle. One muscle is recessed (its insertion moved farther back on the eyeball) and the other resected (part of it removed, making it shorter).

Question 23

The purpose of extraocular muscle (EOM) surgery as a child might include all of the
following except:
a) prevention/resolution of amblyopia
b) cosmesis
c) correction of anisometropia
d) establish stereo vision

Answer 23

c) Anisometropia is a refractive problem where the refractive difference between the two eyes is 2.00 D or more. Strabismus surgery cannot change this; it must be resolved with optical correction. It is generally recommended that EOM surgery be done prior to a child’s entering kindergarten so that the “crossed eyes” are no longer noticed (ie, for cosmetic reasons). The main hope, however, is that by aligning the eyes, they will quickly learn to “lock” together, resulting in stereo vision. This, in turn, can help prevent or resolve amblyopia.

Question 24

A cataract is a:
a) growth on the lens
b) clouding of the cornea
c) lens opacity
d) growth on the retina

Answer 24

c) By definition, a cataract is an opacity of the crystalline lens; it is not a growth.

Question 25

Symptoms of cataract include:
a) halos
b) floaters
c) flashes
d) foreign-body sensation

Answer 25

a) Light entering an eye with a cataract is scattered and may result in halos around lights because the light is broken into its component colors.

Question 26

Symptoms of cataract include:
a) becoming more nearsighted
b) becoming more farsighted
c) early presbyopia
d) discharge

Answer 26

a) As the lens opacity gets denser, the eye generally becomes more nearsighted or myopic. This can happen even in a farsighted/hyperopic eye and is known as a myopic shift. A person who needed glasses to read may now find he or she no longer needs them. This phenomenon is known as “second sight” or the “honeymoon” stage of cataracts.

Question 27

Symptoms of cataract include:
a) ghost image
b) vertical diplopia
c) stabbing pains
d) lid twitch

Answer 27

a) See answer 25. The scattered light can cause objects to appear doubled, although “ghost image” is usually a better description.

ANSWER 25: Light entering an eye with a cataract is scattered and may result in halos around lights because the light is broken into its component colors.

Question 28

Symptoms of cataract include:
a) tearing
b) ptosis
c) increased contrast sensitivity
d) change in color vision

Answer 28

d) Cataracts tend to cause a yellowing to a person’s color vision. Often, after cataract surgery, a patient will notice that colors are more vivid.

Question 29

Symptoms of cataract include:

a) granulated eyelids
b) looking through a fog
c) dull ache
d) pressure sensation

Answer 29

b) A cataract may cause a general haze to the vision, as if looking through waxed paper.

Question 30

The most common cause of cataract is:
a) smoking
b) aging
c) hypertension
d) eye strain

Answer 30

b) It is current theory that every person will get cataracts if he or she lives long enough. It
is just that mine may be ready to be removed when I am 57 (which I am not…yet!), and
you may be 91 and not need yours removed yet.

Question 31

Cataracts can be caused by all of the following except:

a) exposure to ultraviolet light
b) injury
c) open-angle glaucoma
d) diabetes

Answer 31

c) Having open-angle glaucoma does not predispose one to cataracts.

Question 32

A cataract that occurs due to some other condition or medication is known as:
a) secondary
b) subcapsular
c) congenital
d) lenticular

Answer 32

a) A secondary cataract is caused by something else, such as trauma (including ultraviolet light), disease (eg, diabetes), or medication (eg, steroids).

Question 33

Current, accepted treatment of a cataract is:
a) “eye vitamins”
b) laser ablation
c) homeopathic eye drops
d) surgical extraction

Answer 33

d) Surgical extraction is the only current method of treating cataracts. Generally, a small opening is made in the eye just at the limbus. The cataract is broken into pieces using ultrasound, and the pieces are drawn out with suction. A clear plastic lens implant is then put in the place of the crystalline lens that was removed. Stitches are generally not needed.

Question 34

Your patient says his neighbor had her cataracts removed with laser and wants to
know if his will be taken off in the same way. You tell him:

a) “Yes, we use only the latest technology.”
b) “No, she’s probably referring to the way we use ultrasound to break the cataract into
tiny pieces. It’s not actually a laser.”
c) “Yes, it’s called the YAG laser.”
d) “No, she doesn’t know what she’s talking about.”

Answer 34

b) Because laser is used to treat postoperative capsule opacity, people often think that the cataract is removed that way as well. Answer d is not recommended; you can educate the patient without implying that someone is ignorant! (By the way, the length of answer b should have clued you in that it was probably the correct answer!)

Question 35

The vision a patient may have after cataract surgery can be estimated with:

a) potential acuity meter (PAM; Marco Technologies Inc, Jacksonville, FL)
b) brightness acuity tester (BAT)
c) pinhole
d) accurate refractometry

Answer 35

a) A PAM is used to estimate what vision will be once the cataract is removed. For other
questions regarding the BAT, see Chapter 16, the section titled Glare Testing.

Question 36

Postoperative cataract surgery vision might not be substantially improved in a patient
with:
a) ptosis
b) small pupils
c) macular degeneration
d) strabismus

Answer 36

c) A patient who has macular degeneration may not notice much improvement after cataract surgery; the PAM may be able to help predict this. Explain it to the patient like this: If you have a great camera but the film is not good, you will not get a good picture regardless of the quality of the lens. The eye is like that. The lens is the implant, and the film is the retina. If the retina is diseased, having cataract surgery with a lens implant will not help much. (Exception: Sometimes, cataract surgery is performed for a patient with macular degeneration to improve his or her “getting around” vision, rather than the central vision.)

Question 37

A preoperative B-scan might be required in which cataract patient?
a) diabetic retinopathy
b) macular degeneration
c) extremely dense cataract
d) pterygium

Answer 37

c) A dense cataract makes it difficult for the physician to see inside the eye to judge the
health of the retina. A B-scan ultrasound might be done to make sure that the retina is not detached nor has any gross abnormality that might prevent vision improvement if the cataract was removed.

Question 38

Prior to cataract surgery, an A-scan is used to:
a) measure the length of the eye
b) establish postoperative vision
c) evaluated the corneal endothelium
d) evaluate retinal health

Answer 38

a) The A-scan ultrasound is used to measure the axial length of the eye prior to cataract surgery. It is one of several variables in determining the power of an IOL implant to be used once the cataract has been removed (see Chapter 16, the section titled IOL Power Calculation).

Question 39

Specular microscopy (“cell count”) might be needed prior to cataract surgery if the
patient has:
a) corneal dystrophy
b) Graves’ disease
c) astigmatism
d) dry eye

Answer 39

a) Cataract surgery invariably “bumps” the single-cell-layered corneal endothelium, which is already diseased in corneal dystrophy. Specular microscopy (also known as a cell count) may be done to evaluate the corneal endothelium prior to attempting cataract surgery to make sure it is healthy enough to withstand the operation.

Question 40

Which gives the most accurate idea of a cataract patient’s visual disability?
a) pinhole vision
b) standard Snellen vision chart
c) PAM
d) BAT

Answer 40

d) Of the tests listed, the BAT gives the best evaluation of what a patient with cataracts
actually sees now. The results can indicate a level of disability that is not evident on testing with the regular Snellen eye chart. Cataracts that are dense in the center can often cause vision to worsen in bright light because the pupil constricts. The BAT gives an actual measurement of how much worse the vision is in such bright conditions.

Question 41

A cataract is often removed when:

a) vision is reduced below 20/200
b) the cataract is “ripe”
c) the patient fails a color vision test
d) the patient notes impairment of daily living

Answer 41

d) Years ago, a cataract was not removed until it was “ripe.” But with modern technology a cataract can be removed whenever the patient notices that his vision decrease is interfering with his activities of daily living.

Question 42

Preoperative cataract surgery measurement of a patient’s corneal curvature is known
as:
a) keratometry (“K reading”)
b) exophthalmometry
c) interferometry
d) tonometry

Answer 42

a) Keratometry is used to measure the curvature of the cornea prior to cataract surgery. It is one of several variables used in determining the power of IOL implant to be used once the cataract has been removed. (See Chapter 6, Keratometry, as well as Chapter 16, the section titled IOL Power Calculation.)

Question 43

Each of the following is used in intraocular lens implant (IOL) calculation except:
a) K reading
b) desired postoperative refraction
c) A-scan
d) intraocular pressure

Answer 43

d) The patient’s intraocular pressure does not figure into the formula used to determine the
power of an IOL implant.

Question 44

Medications of concern for the preoperative cataract patient include all of the follow-
ing except:
a) those containing aspirin
b) those for erectile dysfunction
c) estrogen-based hormones
d) blood thinners

Answer 44

c) Estrogen-based medications do not have any known effects on cataract surgery. Aspirin and blood thinners can cause operative and postoperative bleeding. Some treatments for erectile dysfunction have been known to cause the intraoperative complication of floppy iris syndrome.

Question 45

Your patient wants to know if she will have stitches in her eye after cataract surgery.
You tell her:
a) “No, cataract surgery is always ‘stitchless’ now.”
b) “No, cataract surgery is done with laser.”
c) “No, unless something changes during surgery.”
d) “Yes, stitches are a safeguard against wound gape.”

Answer 45

c) Answer a might be tempting, but it sounds too much like a guarantee. Although unlikely,
there could be some type of intraoperative complication where the surgeon will suture the wound.

Question 46

Currently, the most commonly used type of anesthesia for cataract surgery is:
a) topical
b) retrobulbar injection
c) intravitreal injection
d) general

Answer 46

a) The most commonly used type of anesthesia for cataract surgery is topical.

Question 47

Reducing a cataract into small pieces by use of ultrasonic energy is termed:
a) can-opener method
b) open sky technique
c) phacoemulsification
d) intracapsular extraction

Answer 47

c) Phacoemulsification uses sound waves to break the cataract into small pieces, which are then removed by suction through a small tube.

Question 48

Your patient asks if he will still need glasses after cataract surgery. You tell him:

a) “No, the intraocular lens implant will allow you to see normally.”
b) “No, everyone gets specialty implants now so you don’t need glasses.”
c) “Probably, just to fine-tune either distance or near vision.”
d) “No, all patients having cataract surgery see 20/20 after the procedure.”

Answer 48

c) Answers a and d are patently incorrect and sound like a (dangerous) guarantee that the
patient will see perfectly without correction once the cataract has been removed. Answer b is incorrect as well, because not everyone gets a “specialty” IOL (ie, multifocal or toric).
Answer c is the only “safe” answer. (Note: While the use of “specialty” IOLs and monovision IOLs may obviate the need for glasses, that was not given as an option here.)

Question 49

Which of the following are general restrictions immediately following cataract surgery?
a) No bathing.
b) Do not bend over or lift anything heavy.
c) Keep the eye patched at all times.
d) Keep the head elevated when reclining.

Answer 49

b) Patients are generally told not to bend over (ie, bending at the waist so that the head is dangling down). Inclining the head to read is okay, and it is fine to kneel to pick something up. Patients are also told not to lift anything heavy. Bathing is allowed, although the patient is cautioned not to get any water in the eye.

Question 50

Symptoms of a posterior subcapsular opacity:
a) mimic those of a cataract
b) mimic those of angle-closure glaucoma
c) include flashes and floaters
d) can be alleviated with artificial tears

Answer 50

a) When a cataract is removed, the back part of the capsule that encloses the eye’s natural
lens is left in place to support the IOL. The capsule membrane is polished, but sometimes gets cloudy after surgery (a few months to a few years). The symptoms of a posterior subcapsular opacity are pretty much the same as those of a cataract: blurred/foggy vision, ghost images, and problems with glare.

Question 51

The term “secondary cataract” is a misnomer because:
a) most cataracts are congenital
b) once removed, a cataract cannot grow back
c) it actually occurs in the IOL implant
d) it is actually an opacity of the cornea

Answer 51

b) Another name for a posterior capsule opacity is “secondary cataract,” but this is a misnomer. Once removed, a cataract cannot grow back.

Question 52

A posterior capsule opacity is treated by performing a:
a) cryo-capsulotomy
b) laser iridotomy
c) surgical capsulotomy
d) laser capsulotomy

Answer 52

d) Posterior capsule opacity is treated with a YAG laser, which is used to make an opening
in the center of the capsule. This clears the visual axis, improving acuity.

Question 53

Insertion of a phakic IOL would be done for the purpose of:
a) cataract removal
b) correction of refractive error
c) preventing cataracts
d) intraocular medication

Answer 53

b) A “phakic IOL” is inserted into the eye without removing the natural crystalline lens. It is done for the purpose of correcting refractive errors.

Question 54

In which of the following surgical procedures might a drainage implant be placed in
the eye?
a) cataract surgery
b) nasolacrimal surgery
c) strabismus surgery
d) glaucoma surgery

Answer 54

d) The aim of all glaucoma treatment is to decrease intraocular pressure. This is generally done in one of two ways: increasing drainage/outflow or decreasing production/inflow of aqueous humor. Thus, glaucoma surgery might involve placing an implant devised to drain aqueous fluid out of the eye.

Question 55

The aim of most types of glaucoma surgery is to:
a) increase aqueous production
b) improve optic nerve health
c) increase aqueous outflow
d) avoid medication use

Answer 55

c) See answer 54.

ANSWER 54: The aim of all glaucoma treatment is to decrease intraocular pressure. This is generally
done in one of two ways: increasing drainage/outflow or decreasing production/inflow of aqueous humor. Thus, glaucoma surgery might involve placing an implant devised to drain aqueous fluid out of the eye.

Question 56

Laser treatment for primary/chronic open-angle glaucoma is a(n):
a) valve implant
b) iridotomy
c) iridectomy
d) trabeculoplasty

Answer 56

d) The laser surgery for open-angle glaucoma is trabeculoplasty. The laser beam is aimed
into the angle of the eye (between the cornea and iris root). The theory is that when the
tissue heals, the scarring pulls the trabecular meshwork open, increasing aqueous outflow.

Question 57

A surgically created, conjunctiva-covered, external opening through which aqueous
can drain is a:
a) bleb
b) seton
c) drainage implant
d) sebaceous cyst

Answer 57

a) In glaucoma surgery using a valve, a “bubble” or bleb is created between the conjunctiva and sclera as a site for venting aqueous from the eye.

Question 58

Angle-closure glaucoma is most often treated by performing a:
a) surgical trabeculectomy
b) valve implant
c) laser iridotomy
d) surgical iridectomy

Answer 58

c) In angle-closure glaucoma, the iris butts up against the anterior lens surface and is then
pushed into the angle of the eye, blocking the drainage of aqueous from the eye. A laser
iridotomy is done to create an opening in the iris to allow the aqueous to drain even when
the angle is blocked.

Question 59

The removal of the jelly-like substance in the back of the eye is a(n):
a) centesis
b) vitrectomy
c) evisceration
d) enucleation

Answer 59

b) Removal of the vitreous is a vitrectomy (the suffix –ectomy refers to removal).

Question 60

Laser photocoagulation might commonly be used to treat all of the following except:
a) hypertensive retinopathy
b) hyphema
c) diabetic retinopathy
d) macular degeneration

Answer 60

b) Laser photocoagulation is frequently used to seal, especially blood vessels. Answers a,
c, and d are all retinal conditions that may respond well to photocoagulation. A hyphema is blood in the anterior chamber, which is not treated with laser.

Question 61

Laser, scleral buckle, and intravitreal gas or air bubble are all treatments for:
a) diabetic retinopathy
b) retinal hemorrhage
c) retinal detachment
d) macular degeneration

Answer 61

c) A retinal detachment might be treated with laser (photocoagulation, to “fuse” tissue), a
scleral buckle (a device that pushes the tissues together), or a “bubble” of gas or air (which puts internal pressure on the area of concern).

Question 62

The intent behind intravitreal injections for macular degeneration is to:
a) inhibit the growth of new, abnormal retinal blood vessels
b) seal off leaking blood vessels
c) reattach the macula
d) create a drainage bleb

Answer 62

a) The medication given via intravitreal injection for macular degeneration is intended to interfere with neovascularization, or the growth of new, abnormal, fragile blood vessels.

Question 63

Removal of the entire eyeball is an:
a) evisceration
b) exenteration
c) ectropion
d) enucleation

Answer 63

d) An enucleation is the procedure for removal of the eyeball. Evisceration is removal of the contents of the globe but not the globe itself. Exenteration is removal of the globe and all associated muscles, fat, and tissue (including the eyelids). Ectropion is an out-turned eyelid.

Question 64

In the event that the eyeball is removed, an implant is placed into the orbit. The pur-
pose of this implant is to:

a) provide an attachment for electronic vision devices
b) maintain the shape of the orbit
c) cosmetically look like a natural eye
d) keep the eye shut

Answer 64

b) After an eyeball is enucleated, an implant is placed into the eye socket to maintain the
shape of the orbit. Without the implant, the orbit would tend to shrink, making it difficult
to fit a prosthetic eye.

Question 65

Diabetes is a condition resulting from:

a) increased thirst and urination
b) an imbalance in the insulin-glucose levels of the body
c) an imbalance in the calcium content of the blood
d) fluctuations in vision

Answer 65

b) Diabetes results when the insulin-glucose (sugar) levels of the body are imbalanced.
Answers a and d are symptoms of diabetes, but do not cause it.

Question 66

When seeing a diabetic patient for a routine eye exam, it is important to know how
stable her sugar level has been recently because fluctuations:

a) can change the refractometric measurement
b) can cause extraocular muscle palsies
c) can cause diplopia
d) can cause eye pain

Answer 66

a) A stable sugar level for about 6 weeks prior to refractometry is desirable for a good
measurement. The refractometric measurement often varies as the sugar level fluctuates.

Question 67

The hallmark of proliferative diabetic retinopathy is:
a) fluctuating vision
b) resistance to dilation
c) increased intraocular pressure
d) growth of new retinal blood vessels

Answer 67

d) The word proliferative indicates that something is growing or spreading. Proliferative diabetic retinopathy occurs when new, abnormal blood vessels begin to spread into the retina of the diabetic. This is called neovascularization.

Question 68

Diabetic retinopathy is currently treated with:

a) topical medication
b) oral medication
c) insulin injections
d) laser

Answer 68

d) Diabetes itself is treated with answers b and c. Retinopathy is treated with laser.

Question 69

Hypertension mainly affects which eye structure?
a) cornea
b) lens
c) retina
d) optic nerve

Answer 69

c) High blood pressure (hypertension) affects mainly the retina.

Question 70

Hypertension is when, most of the time, the blood pressure is equal to or greater than:

a) 140 systolic and/or 90 diastolic
b) 120 systolic and/or 80 diastolic
c) 180 diastolic and/or 95 systolic
d) 200 systolic and/or 100 diastolic

Answer 70

a) Currently, the designation of hypertension starts when a person’s blood pressure is consistently 140 to 159 systolic (or higher) and/or 90 to 99 diastolic (or higher). There is also a category known as “prehypertension,” which ranges from 120 to 139 systolic and 80 to 89 diastolic. If the systolic is 180 or higher and/or the diastolic is higher than 110, emergency care is called for.

Question 71

Which of the following is most commonly used in the treatment of retinal disease
caused by hypertension?
a) topical medication
b) periodic injections
c) conventional surgery
d) laser surgery

Answer 71

d) As in diabetes, retinopathy caused by hypertension is treated with laser.

Question 72

The main ocular concern in a patient with cancer is:
a) accelerated presbyopia
b) decreased blood supply to the eye
c) spread of cancer to the eye’s tissues
d) decreased nerve response

Answer 72

c) Cancer can spread to any organ or tissue, including the eye.

Question 73

Atherosclerosis is characterized by fatty deposits along the walls of the:
a) arteries
b) veins
c) capillaries
d) atrium

Answer 73

a) The condition of fatty deposits on the walls of the arteries is known as atherosclerosis.
(Atherosclerosis is actually a form of arteriosclerosis, or hardening of the arteries.)

Question 74

Which of the following can occur in the eye as a result of atherosclerosis?
a) posterior vitreous detachment
b) macular edema
c) central retinal artery occlusion
d) corneal dystrophy

Answer 74

c) If a fatty plaque dislodges, travels through the bloodstream, and gets stuck in the central retinal artery, an occlusion can occur.

Question 75

Leukemia and sickle cell disease both produce abnormal blood cells. These cells can:
a) clump together and clog retinal blood vessels
b) cause retinal detachment
c) cause spasms of the extraocular muscles
d) interfere with nerve transmission

Answer 75

a) Any foreign material in the bloodstream has the potential for blocking blood vessels.

Question 76

All of the following are infections that can be present at birth except:
a) toxoplasmosis
b) herpes simplex
c) siderosis
d) gonorrhea

Answer 76

c) If the mother is infected with toxoplasmosis, herpes simplex, or gonorrhea (Neisseria gonorrhoeae), the infant is at risk. Toxoplasmosis would occur in utero, herpes simplex and N. gonorrhoeae during birth. Siderosis refers to iron deposits in the tissues, which is not something that would be transmitted from mother to child.

Question 77

Shingles is a systemic infection that can also affect the eye and is caused by:
a) Toxocara canis
b) Pseudomonas aeruginosa
c) herpes simplex
d) herpes zoster

Answer 77

d) Herpes zoster is the virus that causes shingles.

Question 78

Herpes zoster occurs in patients:
a) who have had malaria
b) who have had a tetanus booster
c) who have had tuberculosis
d) who have had chicken pox

Answer 78

d) Herpes zoster, or shingles, occurs in those who have been previously infected with the
chicken pox (varicella).

Question 79

One of the more common viruses seen in acquired immune deficiency syndrome
(AIDS) patients is:

a) herpes simplex
b) herpes zoster
c) Adenovirus
d) Streptococcus

Answer 79

a) The AIDS patient, with a lowered immunity, is subject to infection. One of the more
common is herpes simplex.

Question 80

All of the following are often seen in the patient with AIDS except:
a) dry eye
b) recurrent blepharitis
c) xanthelasma
d) optic neuritis

Answer 80

c) Of course an AIDS patient can develop xanthelasma (yellowish lid lesions related to
cholesterol), but in general this is not directly associated with AIDS. In addition to a, b, and
d, recurrent conjunctivitis is also common.

Question 81

The most likely route of human immunodeficiency virus (HIV) infection from patient to ophthalmic medical personnel would be:
a) contaminated tears during applanation tonometry
b) needle stick during minor surgery
c) being in the same room with an HIV-positive patient
d) shaking hands with an HIV-positive patient

Answer 81

b) Needle sticks remain the main source of transmission to medical personnel. The AIDS
virus has been isolated from human tears, but there have been no known cases of transmission due to contact with contaminated tears.

Question 82

Which of the following systemic disorders is most commonly associated with dry eye?
a) hypertension
b) rheumatoid arthritis
c) osteoporosis
d) diabetes

Answer 82

b) Rheumatoid arthritis is commonly associated with dry eye, sometimes severe (keratitis sicca).

Question 83

Which of the following might be done on a patient with thyroid eye disease?
a) exophthalmometry
b) B-scan ultrasound
c) glare test
d) duochrome test

Answer 83

a) Exophthalmos, where the eye(s) bulge abnormally, is associated with thyroid eye disease. The instrument used to measure ocular protrusion is the exophthalmometer.

Question 84

Smoking can cause all of the following except:
a) dry eye and tobacco amblyopia
b) ptosis, trichiasis, and retinoblastoma
c) increased risk of diabetic and hypertensive retinopathy
d) increased risk of macular degeneration

Answer 84

b) Smoking pretty much affects the entire body. Externally, the smoke can contribute to dry eye. Smoking also increases the risk of retinal diseases, including diabetic and hypertensive retinopathy and macular degeneration. Tobacco amblyopia is visual decrease in an otherwise healthy eye, related to smoking.

Question 85

All of the following are usually noncancerous skin and lid growths except:
a) xanthelasma
b) molluscum contagiosum
c) milia (skin tags)
d) basal cell tumors

Answer 85

d) Basal cell tumors are also known as basal cell carcinomas. This is a malignant tumor that should be removed and biopsied promptly.

Question 86

Sagging and eversion of the lower eyelid is termed:
a) entropion
b) ectropion
c) epiphora
d) trichiasis

Answer 86

b) A sagging, everted (out-turned) lid is known as ectropion.

Question 87

Entropion is defined as:
a) lids that turn inward
b) lids that have inward-turned hairs
c) upper lids that droop
d) lids that turn outward

Answer 87

a) An inverted lid is termed entropion.

Question 88

Infection of the lash follicle is a:
a) chalazion
b) hordeolum
c) xanthelasma
d) blepharitis

Answer 88

b) An infected lash follicle produces a sty or hordeolum. (A chalazion is an infected mei-
bomian gland.)

Question 89

A condition in which eyelashes grow inward, toward the eye is:
a) lash ptosis
b) blepharitis
c) trichiasis
d) keratitis

Answer 89

c) The condition of having inward-growing lashes—patients sometimes calls these “wild
hairs”—is known as trichiasis.

Question 90

An infected meibomian gland causes a(n):
a) blepharochalasis
b) obstructed nasolacrimal duct
c) chalazion
d) hordeolum

Answer 90

c) An infected meibomian gland produces a chalazion.

Question 91

Blepharitis is a common:
a) lid infection
b) corneal infection
c) lid droop
d) retinal disorder

Answer 91

a) Blepharitis is a common lid infection (blephar- referring to eyelids and –itis meaning an inflammation).

Question 92

Which of the following refers to a drooped upper lid?
a) ptosis
b) exophthalmos
c) trachoma
d) blepharospasm

Answer 92

a) Ptosis refers to the drooping of an organ or structure. When speaking of the eye, the term refers to the drooping of the upper lid. Blepharoptosis would be even more descriptive and accurate.

Question 93

Redundant skin of the lids is referred to as:
a) blepharoptosis
b) subluxation
c) ectropion
d) dermatochalasis

Answer 93

d) The prefix dermato- indicates a condition involving the skin; the suffix –chalasis means
relaxation. Thus, the combined term is dermatochalasis. (Note: Some references make a distinction between blepharochalasis, which is a rarer problem involving intermittent swelling of the upper lids, and dermatochalasis, which is the common relaxing of the lid’s skin.)

Question 94

Infection of the lacrimal sac is termed:
a) canaliculitis
b) lacrimitis
c) lacrimal cystitis
d) dacryocystitis

Answer 94

d) Dacryocystitis is the term for an infected tear sac. Canaliculitis is an infection of the
canaliculus. Answers b and c are bogus.

Question 95

The condition where the lacrimal gland slips down under the conjunctiva is known as
a(n):
a) obstructed tear gland
b) conjunctival bleb
c) prolapse
d) pinguecula

Answer 95

c) A prolapse occurs when a structure slides out of place. The lacrimal gland can “fall” into
the space between the globe and the conjunctiva, appearing as a yellowish, moveable mass under the conjunctiva on the superior area of the globe.

Question 96

Which of the following is not a symptom of dry eye?
a) burning
b) epiphora (streaming tears)
c) gritty, foreign-body sensation
d) extreme itching

Answer 96

d) Extreme itching is more often associated with allergies and infections, not dry eye.

Question 97

The standard test for diagnosis of dry eye is:
a) rose bengal test
b) Schirmer’s test
c) fluorescein
d) nasolacrimal irrigation

Answer 97

b) Schirmer’s tear test measures the amount of tears produced in a 5-minute test period.

Question 98

A blockage of the nasolacrimal duct might result in any of the following except:
a) recurrent erosion syndrome
b) epiphora
c) chronic infections
d) tearing in an infant

Answer 98

a) Recurrent erosion syndrome is not related to a blocked nasolacrimal duct. Epiphora
(tears streaming down the cheeks) and tearing in infants as well as chronic infections
(occurring because microorganisms are not being flushed out of the system) are frequent
hallmarks of this condition.

Question 99

Your physician has told the patient that she has a subconjunctival hemorrhage (SCH)
and has left you to educate the patient. You should:

a) warn her that she may later have a retinal detachment
b) tell her to leave the pressure patch on for 24 hours
c) reassure her that it will dissipate in 1 to 3 weeks
d) impress her with the serious nature of the condition

Answer 99

c) An SCH in and of itself is not serious. The patient can be reassured. The exception would be if the SCH was the result of trauma, in which case answer a would be appropriate. But do not read into the question!

Question 100

Slit-lamp examination of your patient reveals a yellowish nodule on the conjunctiva
just nasal of the cornea. Most likely this is a(n):
a) pterygium
b) xanthelasma
c) episcleritis
d) pinguecula

Answer 100

d) A pinguecula appears as a yellow nodule, usually on the nasal side of the eyeball. A pterygium crosses onto the cornea, and the nodule associated with episcleritis generally is seen in a red eye. Xanthelasma appears on the lids.

Question 101

All of the following are common indications of viral conjunctivitis except:

a) photophobia
b) recent sore throat
c) moderate redness
d) yellow crusting

Answer 101

d) Crusting is usually associated with bacterial conjunctivitis.

Question 102

All of the following are true regarding epidemic keratoconjunctivitis (EKC) except:

a) it is highly contagious
b) it is caused by a bacterium
c) the cornea is usually involved
d) it is also known as “shipyard eye”

Answer 102

b) EKC is caused by a virus. The conjunctiva and usually the cornea are involved.

Question 103

The type of conjunctivitis caused by constant irritation (such as a contact lens) is:

a) giant papillary
b) seasonal
c) bacterial
d) viral

Answer 103

a) Giant papillary conjunctivitis is thought to be caused by constant irritation from contact lenses or other physical irritants such as a prosthesis or exposed suture.

Question 104

An inflammation of the white of the eye that can be very painful is:
a) episcleritis
b) scleritis
c) uveitis
d) iritis

Answer 104

b) The sclera is the white of the eye, so the inflammation is known as scleritis. Episcleritis is an inflammation of the episclera and, in general, is not very painful (if at all). Uveitis is an inflammation of the uvea which includes the iris, ciliary body, and choroid; iritis is an
inflammation of the iris.

Question 105

Protrusion of the eyeball is known as:
a) exophthalmos
b) keratoconus
c) buphthalmos
d) ptosis

Answer 105

a) Exophthalmos is the abnormal protrusion of an eye, also called proptosis. Buphthalmos is abnormal enlargement of the infant eye due to congenital glaucoma.

Question 106

A cream-colored arc in the cornea at the limbus that may be related to cholesterol is:
a) toxic pemphigoid
b) keratoconus
c) drug reaction
d) arcus

Answer 106

d) Arcus senilis is a creamy white deposit in the corneal tissue at the limbus. It is a cholesterol accumulation and may encircle the entire cornea or just part of it.

Question 107

Neovascularization of the cornea is generally related to:

a) lack of blood supply
b) lack of adequate tears
c) enucleation
d) lack of oxygen

Answer 107

d) Neovascularization (in any part of the body) is the growth of new blood vessels. In the cornea, this is due to anoxia, or lack of oxygen. It is commonly associated with contact lens
wear.

Question 108

Trachoma, a leading cause of world blindness, is seen in populations with poor diet and hygiene. This devastating disease causes:
a) scarring of lids, conjunctiva, and cornea
b) retinal detachment
c) hemorrhagic keratoconjunctivitis
d) sympathetic ophthalmia

Answer 108

a) Trachoma is a contagious chlamydial (bacterial) infection that causes severe scarring, which often results in blindness.

Question 109

On slit-lamp examination, a corneal lesion caused by herpes simplex typically appears:
a) as a small, round, ulcerated area
b) as a branched-looking erosion
c) as a raised red nodule
d) as a fleshy encroachment on the cornea

Answer 109

b) The corneal dendrite typical of herpes simplex has a branched, tree-like appearance best
seen with the cobalt blue light and fluorescein stain.

Question 110

Slit-lamp examination of your patient reveals bulging, centrally thinned corneas. Refractometry shows an increase in astigmatism. The patient probably has:
a) pathologic astigmatism
b) keratoconjunctivitis
c) keratoconus
d) exophthalmos

Answer 110

c) The hallmark of keratoconus is a bulging, cone-shaped cornea that thins at the center. This induces astigmatism. The condition can be progressive.

Question 111

Your patient has an abrasion of the corneal epithelium. All of the following are true except:
a) the abraded area will be evident with fluorescein and a blue light
b) there will likely be a corneal scar
c) it may heal as quickly as overnight
d) there may continue to be a foreign-body sensation until fully healed

Answer 111

b) If only the corneal epithelium is involved, there will be no scarring. Corneal scarring generally occurs if the abrasion reaches the deeper stromal tissue.

Question 112

When asked about previous eye surgery, your patient says that she once had “a piece
of skin removed that was growing onto the clear part of my eye.” Most likely she is describing a:
a) pinguecula
b) cataract
c) corneal dystrophy
d) pterygium

Answer 112

d) A pterygium is a flesh-colored growth that extends from the conjunctiva and onto the cornea. If it grows far enough out onto the cornea, it will impair vision.

Question 113

You are eliciting the patient’s chief complaint, and he says, “I wake up in the middle of the night, and my right eyelid seems stuck shut. Then, when I get it open, it’s like it pulled part of my eye with it. My eye hurts, and I can hardly stand the light.” An ocular condition that can cause these types of symptoms is:
a) recurrent erosion syndrome
b) keratoconus
c) corneal dystrophy
d) chemical splash

Answer 113

a) Recurrent erosion syndrome (RES) usually occurs in an eye that has had a previous corneal injury, maybe even years before. The weakened area adheres to the palpebral conjunctiva—which lines the inner lid—and is literally peeled off when the lid is opened, resulting in a new corneal abrasion with the typical foreign body sensation and light sensitivity.

Question 114

Blood in the anterior chamber (AC) of the eye is a(n):
a) hypopyon
b) aqueous humor
c) rubeosis
d) hyphema

Answer 114

d) Hyphema (-hema referring to blood) denotes the presence of blood in the AC. It is usually graded by the amount of the AC that is involved. A 50% hyphema would mean that half of the AC is filled with blood. A 100% hyphema is sometimes called an 8-ball hyphema, because the filled AC looks like a black 8-ball.

Question 115

Which of the following refers to a layer of inflammatory cells/pus in the AC?
a) hypopyon
b) leuko-aqueous
c) hypophema
d) eosinophilosis

Answer 115

a) An hypopyon is the presence of white blood cells in the AC. It generally signals the presence of an infection. The other 3 answers are all bogus.

Question 116

Prior to dilating a patient, one should evaluate:
a) the space between the iris and lens
b) the iridocorneal angle
c) for cataracts
d) the cup-to-disc ratio

Answer 116

b) Prior to dilating patients, you should check the angles (the space in the AC where the cornea meets the iris). Dilating an eye with narrow angles could result in an angle-closure glaucoma attack.

Question 117

An inflammation of the iris (only) is termed:
a) posterior uveitis
b) uveitis
c) iritis
d) retinitis

Answer 117

c) Uveitis refers to inflammation of any part of the uvea: the iris, ciliary body, and choroid. Iritis indicates that the inflammation is limited to the iris. It is sometimes called anterior uveitis, which distinguishes it as being the “front” of the uvea (ie, not involving the choroid).

Question 118

Which of the following indicates a risk for open-angle glaucoma?
a) a pressure sensation in the eyes
b) red, painful eyes
c) a family history of glaucoma
d) halos around lights at night

Answer 118

c) Open-angle glaucoma has no physical symptoms and tends to be hereditary. Halos around lights at night are sometimes associated with angle-closure glaucoma.

Question 119

Glaucoma is classically characterized by increased intraocular pressure, visual field loss, and:

a) pigment in the trabecular meshwork
b) headaches at bedtime
c) fluctuating visual acuity
d) optic nerve head damage

Answer 119

d) Most ophthalmologists agree that, in order for glaucoma to be diagnosed, there must be damage to the optic disc (head). Not mentioned here but also important is central corneal thickness. See also answer 127.

ANSWER 127: The classic hallmarks of glaucoma are increased IOP (tested with tonometry), loss of
peripheral vision (evaluated with formal perimetry), and damage to the optic nerve head (as seen on ophthalmoscopy). Because a thin cornea is also associated with increased risk of glaucoma, a central—not peripheral—corneal thickness measurement is also taken.

Question 120

Because of elevated intraocular pressure, a child born with glaucoma has:
a) buphthalmos
b) exophthalmos
c) proptosis
d) lid lag

Answer 120

a) An infant’s eye is more elastic than an adult’s, so elevated intraocular pressure tends to distort and distend the globe. This causes buphthalmos, or “ox eye,” in which the cornea takes up most of the palpebral fissure.

Question 121

What are the symptoms of angle-closure glaucoma?
a) redness, pain, blurred vision, and halos around lights
b) redness, tearing, blurred vision, and pain from bright lights
c) discharge, redness, and pain from bright lights
d) redness, small pupil, and halos around lights

Answer 121

a) The symptoms of angle-closure glaucoma are redness, pain, blurred vision, and halos around lights.

Question 122

Symptoms and signs for acute angle-closure glaucoma include all of the following except:
a) severe pain
b) decreased vision
c) vomiting/nausea
d) miotic pupil

Answer 122

d) The pupil in an angle-closure attack is mid-dilated. The pain can be severe to the point of nausea and vomiting.

Question 123

Secondary glaucoma can be caused by all of the following except:
a) trauma
b) extended use of topical steroids
c) blood in the AC
d) strabismus

Answer 123

d) Strabismus does not cause glaucoma.

Question 124

Risk factors for glaucoma include all of the following except:
a) rheumatoid arthritis
b) positive family history
c) African-American heritage
d) ocular trauma

Answer 124

a) There is no indication that a patient with rheumatoid arthritis is at a higher risk of developing glaucoma. Answers b through d do indicate an increased risk.

Question 125

All of the following are problems common to public glaucoma screening programs except:
a) air-puff tonometry, commonly used for screening, is not the most accurate method
b) a single, normal pressure reading does not necessarily indicate the absence of glaucoma
c) it generates public interest in the disorder and its treatment
d) some normal pressures register as high and some high pressures read normal

Answer 125

c) The fact that glaucoma screening generates public interest is not a plague, but a benefit. The other answers are problems inherent to screening programs.

Question 126

The most common type of glaucoma is:
a) congenital
b) secondary
c) open-angle
d) angle-closure

Answer 126

c) Open-angle glaucoma is the most common type of glaucoma. Some sources identify more than 40 different types of glaucoma.

Question 127

The diagnosis of glaucoma may be based on which set of the following tests?
a) tactile pressures, slit-lamp exam, confrontation fields
b) slit-lamp exam, glare test, A-scan
c) tonometry, perimetry, ophthalmoscopy, central corneal thickness
d) slit-lamp exam, gonioscopy, peripheral corneal thickness, cup-to-disc ratio

Answer 127

c) The classic hallmarks of glaucoma are increased IOP (tested with tonometry), loss of peripheral vision (evaluated with formal perimetry), and damage to the optic nerve head (as seen on ophthalmoscopy). Because a thin cornea is also associated with increased risk of
glaucoma, a central—not peripheral—corneal thickness measurement is also taken.

Question 128

Vision lost by glaucoma damage:
a) can be recovered if the intraocular pressure (IOP) is brought under control
b) can be recovered if laser treatment is used
c) can be recovered with certain topical or oral medications
d) generally cannot be recovered

Answer 128

d) Unfortunately, vision lost due to glaucoma is not recoverable even once the condition is controlled or treated.

Question 129

The appearance of halos around lights during an attack of angle-closure glaucoma is due to:
a) lens edema
b) corneal edema
c) vitreous hemorrhage
d) optic nerve damage

Answer 129

b) Corneal edema has a prismatic effect, breaking light into its component colors, and thus creating halos around lights. Pressure build-up during an attack causes a breakdown in the pumping function of the corneal endothelium, and edema results.

Question 130

All of the following are true regarding open-angle glaucoma except:
a) the patient generally has no sensation of eye pressure
b) it can be cured
c) optic nerve damage cannot be reversed
d) it might be controlled with a single medication

Answer 130

b) Open-angle glaucoma cannot be cured; it can only be controlled. In this respect, it resembles diabetes and high blood pressure. Answers a, c, and d are true.

Question 131

The dangerous element of open-angle glaucoma is:
a) pain
b) rapid, irreversible visual loss
c) lack of symptoms
d) lack of signs

Answer 131

c) Because open-angle glaucoma has no physical symptoms, the patient is not driven to seek attention. The loss of peripheral vision occurs over a long period of time, often escaping the patient’s notice. Signs are perceptible to the examiner, such as optic disc cupping or an elevated IOP reading.

Question 132

In open-angle glaucoma:
a) the iris blocks off the angle structures
b) the pressure damages the ciliary body
c) the angle allows too much aqueous to drain out
d) the angle looks normal

Answer 132

d) As its name implies, the angle structure in open-angle glaucoma is open. Generally, it looks normal.

Question 133

A patient known to have open-angle glaucoma:
a) should not be dilated
b) should have his pressure checked with an air-puff tonometer
c) should be checked annually with confrontation fields
d) needs annual dilation, gonioscopy, and formal visual fields

Answer 133

d) A patient with open-angle glaucoma needs an annual full exam including dilation, gonioscopy, and formal visual fields testing. Of course, he also needs periodic IOP checks during the year. The air-puff tonometer is not accurate enough to monitor glaucoma. Likewise, confrontation fields are not sensitive enough to monitor for field loss in glaucoma. Generally, it is safe to dilate a patient with open-angle glaucoma. Many practitioners also want an annual OCT.

Question 134

A patient in the end stages of open-angle glaucoma:
a) may have a small temporal island of vision
b) may have a small central island of vision
c) may have a small nasal island of vision
d) still has enough peripheral vision to get around

Answer 134

a) In advanced open-angle glaucoma, the patient often retains a small temporal island of vision. Eventually, that is lost as well.

Question 135

A patient with open-angle glaucoma has missed an appointment for a pressure check. The practice should:

a) wait for the patient to call and reschedule, then emphasize the importance of IOP checks
b) inform the patient’s relatives, and stress the importance of having IOP checks
c) have the pharmacist ask the patient to call the office when medication needs to be refilled
d) contact the patient to reschedule, emphasizing the importance of IOP checks

Answer 135

d) A patient with glaucoma who misses a pressure check undoubtedly should be contacted to reschedule. The importance of the exam and the gravity of the disease should be stated. Answer b is a breach of patient confidentiality.

Question 136

The total absence of a crystalline lens is termed:
a) phako-dislocation
b) pseudophakia
c) aphakia
d) phacoemulsification

Answer 136

c) The prefix a- means without, and –phakia refers to the lens. So, the condition of having no lens, generally due to surgical removal, is aphakia. In the term pseudophakia, pseudo means false, referring to an intraocular lens implant (eg, a “false lens”).

Question 137

A dislocation of the crystalline lens is termed:
a) iridodonesis
b) phako-prolapse
c) lacrimation
d) luxated

Answer 137

d) A luxated lens is dislocated; a subluxated lens is only partially dislocated. Lens dislocation may cause iridodonesis, where the iris seems to vibrate or shake because its support, the lens, has shifted or been lost.

Question 138

Signs and symptoms of uveitis include all of the following except:
a) perilimbal redness
b) sensitivity to light (photophobia)
c) dizziness and nausea
d) smaller, sluggish pupil on the affected side

Answer 138

c) Dizziness and nausea are not associated with uveitis. Redness is generally more marked at the limbus. Light sensitivity may be severe, and the pupil is generally smaller.

Question 139

Spontaneous retinal detachments are more common in patients with:
a) myopia
b) hyperopia
c) astigmatism
d) presbyopia

Answer 139

a) The longer eye of the myope predisposes him to retinal detachment.

Question 140

Usual symptoms of retinal detachment include all of the following except:
a) curtain over the vision
b) floaters
c) pain
d) light flashes

Answer 140

c) Retinal detachment is generally painless.

Question 141

Most cases of floaters and flashes are caused by:
a) posterior vitreous detachment (PVD)
b) retinal detachment
c) retinitis
d) vitreous hemorrhage

Answer 141

a) PVD and retinal detachment can both be accompanied by floaters and flashes. However, PVD is more common.

Question 142

A progressive breakdown of the macular tissue usually associated with age is:
a) retinitis pigmentosa
b) presumed ocular histoplasmosis
c) cystic macular edema
d) macular degeneration

Answer 142

d) Macular degeneration is an inclusive term meaning any degeneration of the macular tissue, the most common cause of which is aging. Years ago, it was called senile macular degeneration, but is now more often referred to as age-related macular degeneration (AMD).

Question 143

The physician has asked you to educate a patient with macular degeneration regarding home care. This will most likely include:
a) instillation of eye drops and punctal occlusion
b) Amsler grid, UV protection, and vitamin therapy
c) cleansing techniques and physical therapy
d) vision exercises and home color vision testing

Answer 143

b) Standard home care for patients with macular degeneration is Amsler grid (patient is shown how to use it and how often), UV protection (sunglasses and a hat with a brim), and vitamin therapy (often one of the “eye vitamins” now available on the market).

Question 144

Intravitreal injections and laser treatments may sometimes be used in which type of macular degeneration?
a) wet
b) dry
c) congenital
d) tobacco-related

Answer 144

a) Treatment for macular degeneration (other than vitamin therapy) is for the wet form of the disease, where new abnormal blood vessels grow and leak fluid into the macular tissues.

Question 145

A patient has had a sudden, painless loss of vision. She should be seen immediately as an emergency because these are the symptoms of a(n):
a) intravitreal infection
b) sympathetic ophthalmia
c) endophthalmitis
d) retinal artery occlusion

Answer 145

d) A sudden, painless loss of vision (especially in just one eye) is the hallmark of a retinal artery occlusion. In this situation, the artery in the retina becomes blocked, cutting off the blood supply to the retina. Immediate treatment, within 30 minutes, is necessary.

Question 146

All of the following are true regarding a retinal vein occlusion except:
a) the symptoms are easily distinguished from a retinal artery occlusion
b) it occurs most often in patients with hypertension
c) there is still blood flow into the retinal tissues
d) there may be a visual field change

Answer 146

a) Because the symptoms of a retinal vein occlusion are so similar to those of a retinal artery occlusion, the patient with sudden, painless loss of vision should always be triaged as if it were a retinal artery occlusion. If a vein is occluded, blood can still come into the eye via the arteries, but blood drainage from the retina is blocked or slowed. This happens most often in patients with high blood pressure. There may be a generalized blurring of
vision or a field loss in an area related to the part of the retina that is affected.

Question 147

Toxoplasmosis is a protozoan-caused infection that can damage the choroid and retina. It is most often passed to humans by means of:
a) contaminated water
b) heterosexual contact
c) contaminated drug paraphernalia
d) cat feces

Answer 147

d) Toxoplasmosis is passed in cat feces, thus the warnings for pregnant women to avoid cleaning the litter box and for children to play only in sand boxes that have been covered.

Question 148

Histoplasmosis is a fungus-caused infection that can attack the choroid. A human gets histoplasmosis by:
a) drinking contaminated water
b) eating contaminated meat
c) contact with dog feces
d) inhaling the spores

Answer 148

d) The spores of histoplasmosis infect a human via inhalation.

Question 149

Which of the following is commonly seen in open-angle glaucoma?
a) optic nerve edema
b) optic neuritis
c) optic nerve pinching
d) optic nerve cupping

Answer 149

d) The classic optic nerve sign of open-angle glaucoma is optic nerve cupping, where the high IOP has killed axons, leaving empty space.

Question 150

An infection of the internal ocular tissues occurring after surgery or penetrating injury is:
a) retinitis
b) orbititis
c) endophthalmitis
d) cellulitis

Answer 150

c) Endophthalmitis is a most serious infection of an eye following penetrating injury or surgery and can lead to loss of the eye.

Question 151

A rare condition in which one eye is injured and the fellow, non-injured eye develops an inflammation that can destroy the eye is:
a) endophthalmitis
b) blow-out
c) sympathetic ophthalmia
d) syncope

Answer 151

c) Sympathetic ophthalmia is a rare but severe inflammation that develops in a noninjured eye in response to an injury in the other, generally weeks later.

Question 152

Treatment for sympathetic ophthalmia is:

a) enucleation of the inflamed, uninjured eye
b) enucleation of the injured eye
c) enucleation of both eyes
d) emergency lens extraction

Answer 152

b) The injured eye is enucleated in order to prevent or resolve inflammation from setting up in (and perhaps destroying) the uninjured eye.

Question 153

All of the following are hereditary except:
a) albinism
b) retinitis pigmentosa
c) trachoma
d) coloboma

Answer 153

c) Trachoma is a disease. The other answers all have a genetic basis.

Question 154

Match the organ or tissue to the correct system:

Organ/Tissue
a) pancreas b) auricles and ventricles c) lungs
d) pituitary gland e) brain f) spinal cord g) carotid artery
h) alveoli i) aorta j) parathyroid k) bronchi l) thyroid
m) neuron n) capillaries o) cerebellum p) veins
q) trachea r) cranial nerves I to XII

System
cardiovascular
respiratory
endocrine
nervous

Answer 154

cardiovascular - b, g, i, n, p
respiratory - c, h, k, q
endocrine - a, d, j, l
nervous - e, f, m, o, r

Question 155

Which blood cell carries oxygen in the blood?
a) platelets
b) macrophages
c) white blood cells
d) red blood cells

Answer 155

d) Oxygen is carried by the red blood cells, which contain hemoglobin.

Question 156

Which order represents human circulation?
a) capillaries, arteries, heart, lungs, heart, veins, capillaries
b) capillaries, veins, heart, lungs, heart, arteries, capillaries
c) veins, arteries, capillaries, heart, lungs, heart, veins
d) arteries, heart, veins, lungs, capillaries, heart, arteries

Answer 156

b) Human circulation could be conceived to start and end at any number of points, because it is a cycle. The body’s cells dump waste products into the capillaries, which lead to the veins, which lead to the heart. The heart pumps the blood to the lungs to get rid of carbon dioxide and to take on oxygen. The blood goes back to the heart where it is pumped through the arteries and then to the capillaries, where the cells have access to the now oxygen-rich
blood.

Question 157

Human respiration follows which order?
a) pharynx, esophagus, diaphragm, arteries
b) trachea, bronchus/bronchioles, alveoli, capillaries
c) trachea, bronchial filaments, gill arch, arterioles, arteries
d) alveoli, bronchus/bronchioles, trachea, arterioles

Answer 157

b) As we breathe in, air enters the trachea (“windpipe”) and goes to the lungs. In the lungs, the air enters the bronchus/bronchioles, alveoli, and then the capillaries. Humans do not have a gill arch!

Question 158

What occurs as a result of respiration?
a) The blood gives up carbon and takes on dioxide.
b) The blood gives up ammonia and takes on oxygen.
c) The blood gives up carbon dioxide and takes on oxygen.
d) The blood gives up oxygen and takes on carbon dioxide.

Answer 158

c) During respiration, the blood gives up carbon dioxide, a waste product, and takes in oxygen.

Question 159

Endocrine glands synthesize and release chemicals known as:
a) oxidizers
b) hormones
c) neurotransmitters
d) stimulants

Answer 159

b) Endocrine glands synthesize and release hormones.

Question 160

Chemicals from the endocrine glands travel to the target organ through the:
a) muscle fibers
b) bone marrow
c) bloodstream
d) nerve fibers

Answer 160

c) Hormones are released into the bloodstream and are carried to the target organ.

Question 161

Nerve cells release chemicals known as:
a) antioxidants
b) inhibitors
c) stimulants
d) neurotransmitters

Answer 161

d) Nerve cells release neurotransmitters, which are chemicals that transmit impulses from one nerve cell to another.

Question 162

A predictable, involuntary motor response to a specific stimulus is a(n):
a) stimulus
b) extension
c) flexion
d) reflex

Answer 162

d) A reflex is the predictable, involuntary motor response to a stimulus.

Question 163

The human nervous system is divided into which two structural parts?
a) central and peripheral
b) cardiac and visceral
c) sensory and motor
d) cranial and spinal

Answer 163

a) The nervous system is structurally composed of the central and peripheral systems. (There are other divisions, but this is the structural division.)

Question 164

The human nervous system is divided into which two functional parts?
a) central and peripheral
b) cardiac and visceral
c) sensory and motor
d) cranial and spinal

Answer 164

c) Functionally, the nervous system is divided into the sensory and motor systems.

Question 165

Label the following (Figure 12-1):

Answer 165

A) anterior segment
B) posterior segment

Question 166

Label the following (Figure 12-2):
bulbar, conjunctiva, eyebrow, iris, eyelashes, pupil palpebral fissure, lateral canthus, plica (semilunaris), sclera, caruncle, eyelids, medial canthus

Answer 166

C or F - bulbar conjunctiva
L - eyelashes
B - lateral canthus
H - caruncle
K - eyebrow
E - pupil
I - plica (semilunaris)
A - eyelids
D - iris
J - palpebral fissure
F or C - sclera
G - medial canthus

Question 167

Label the following (Figure 12-3):
optic nerve, vitreous, anterior chamber,
posterior chamber

Answer 167

D - optic nerve
A - anterior chamber
C - vitreous
B - posterior chamber

Question 168

Label the following (Figure 12-4):
nasolacrimal duct, nasolacrimal sac, lacrimal gland, punctum, canaliculus

Answer 168

D - nasolacrimal duct
A - lacrimal gland
C - canaliculus
E - nasolacrimal sac
B - punctum

Question 169

Label the following (Figure 12-5):
stroma, endothelium, Descemet’s membrane
precorneal tear film, epithelium, Bowman’s layer

Answer 169

F - stroma
A - precorneal tear film
D - endothelium
B - epithelium
E - Descemet’s membrane
C - Bowman’s layer

Question 170

Label the following (Figure 12-6):
vitreous humor, lens, aqueous humor

Answer 170

C - vitreous humor
A - aqueous humor
B - lens

Question 171

Label the following (Figure 12-7):
lens, zonules, ciliary body, angle, cornea, iris

Answer 171

E - lens
C - angle
A - zonules
F - cornea
B - ciliary body
D - iris

Question 172

Label the following (Figure 12-8):
optic nerve, blood vessels, macula

Answer 172

A - optic nerve
C - macula
B - blood vessels

Question 173

Label the following (Figure 12-9):
macula, iris, retina, cornea, sclera, optic nerve, lens

Answer 173

F - macula
C - cornea
A - optic nerve
E - iris
B - sclera
D - lens
G - retina

Question 174

The primary goal of the eye’s components is to:
a) interpret what is seen
b) focus incoming light onto the lens
c) focus incoming light onto the retina
d) maintain proper intraocular pressure

Answer 174

c) Incoming light is ideally focused on the retina. (Interpretation occurs in the occipital cortex of the brain.)

Question 175

The term for the eye socket, which consists of parts of seven bones, is:
a) globe
b) orbit
c) bony chamber
d) orbital fissure

Answer 175

b) The orbit (or bony orbit) is the socket in which the globe (eyeball) is situated.

Question 176

Most of the blood supply directly to the eye is supplied by the:
a) internal carotid artery
b) external carotid artery
c) ophthalmic artery
d) ophthalmic vein

Answer 176

c) The ophthalmic artery is the main blood source that enters the eye directly. (By the way, a vein conducts blood out of an organ.)

Question 177

How many extraocular muscles are attached to each eye?
a) 4
b) 5
c) 6
d) 7

Answer 177

c) The movement of each eye is controlled by 6 extraocular muscles.

Question 178

The “plate” of connective tissue that serves as the underlying structure of the eyelids is the:
a) tarsus
b) Tenon’s capsule
c) conjunctiva
d) meibomian glands

Answer 178

a) The tarsus, or tarsal plate, is a tough fibrous connective tissue that gives form to the eyelids.

Question 179

Asians and some children have a small vertical fold of skin nasally between the upper and lower lids. This is called a(n):
a) ptosis fold
b) epicanthal fold
c) ectropion
d) entropion

Answer 179

b) The epicanthal fold is a small vertical fold of skin next to the nose. It is genetic in Asians and may appear in some children (who may later outgrow it).

Question 180

The main lacrimal (tear) gland is located:
a) under the brow
b) near the nose
c) in the lower lid
d) in the conjunctiva

Answer 180

a) The main tear gland is under the brow. There are accessory glands in the conjunctiva.

Question 181

Which of the following is not a component of the tear film layer?
a) mucin
b) water
c) oil
d) plasma

Answer 181

d) The tear film layer is made up of mucin, water, and oil.

Question 182

Which is the correct route of tears as they are drained off the eye?
a) punctum, canaliculi, lacrimal sac, nasolacrimal duct
b) nasolacrimal duct, canaliculi, lacrimal sac, punctum
c) canaliculi, punctum, lacrimal sac, nasolacrimal duct
d) punctum, canaliculi, nasolacrimal duct, lacrimal sac

Answer 182

a) Tears drain off the eye through the punctum into the canaliculi. From there, they go into the lacrimal sac and out the nasolacrimal duct.

Question 183

Which tear film layer acts to prevent or retard evaporation of tears from the eye?
a) lipid (oily) layer
b) aqueous (watery) layer
c) mucus layer
d) epithelium

Answer 183

a) The oily film that makes up the outer surface of the tear layer helps prevent evaporation of the underlying watery layer.

Question 184

The ocular media consists of:
a) the lens correction for ametropia
b) contact lenses and intraocular lenses
c) the eyelid, sclera, uvea, and optic nerve
d) the tear film, cornea, aqueous, vitreous, and lens

Answer 184

d) The ocular media are the transparent structures of the eye through which light passes. Some references might not include the tear film.

Question 185

Which of the following is not a part of the optical media?
a) cornea
b) aqueous/vitreous
c) lens
d) retina

Answer 185

d) The retina is not considered a part of the optical media.

Question 186

Which ocular structure refracts light the most?
a) tear film
b) cornea
c) aqueous
d) lens

Answer 186

b) Light entering the eye is refracted three-fourths by the cornea and one-fourth by the remaining optical structures. The average crystalline lens has about 20 D of plus power. The cornea has 43.0 D.

Question 187

The average adult corneal diameter, in millimeters, is:
a) 12 mm
b) 10 mm
c) 15 mm
d) 8 mm

Answer 187

a) The average adult cornea is 12 mm in diameter.

Question 188

Which corneal layer generally regenerates rapidly without scarring?
a) endothelium
b) stroma
c) Bowman’s layer
d) epithelium

Answer 188

d) If only the epithelium is abraded, the cornea almost always heals without scarring.

Question 189

Which corneal layer acts to limit corneal hydration (edema)?
a) endothelium
b) stroma
c) Bowman’s layer
d) epithelium

Answer 189

a) The endothelial layer of the cornea acts as a “pump” to keep the cornea dehydrated and clear.

Question 190

How many muscles make up the iris?
a) 1
b) 2
c) 3
d) each strand is a muscle

Answer 190

b) The two muscles of the iris are the dilator (which opens the pupil) and the sphincter (which closes the pupil).

Question 191

Which of the following structures is responsible for aqueous production?
a) ciliary muscle
b) ciliary body
c) trabecular meshwork
d) islets of Langerhans

Answer 191

b) Aqueous humor is formed by the ciliary body, which joins the iris and the sclera. The ciliary muscle controls the shape of the crystalline lens via accommodation. The islets of Langerhans are in the pancreas.

Question 192

The hard, central core (nucleus) of the crystalline lens:
a) is present in its adult form at birth
b) is produced by the capsular envelope
c) is formed from the inside out as fiber layers are produced at the center
d) is formed as lens fiber layers are produced and compacted together

Answer 192

d) An infant’s lens is soft throughout, like putty. The hard central core forms as layers laminate over time as we age.

Question 193

Which of the following is not true regarding the crystalline lens?
a) It lies behind the pupil.
b) It is suspended by zonules.
c) It lies in the anterior chamber.
d) It is encased in a capsular bag.

Answer 193

c) The crystalline lens is in the posterior chamber, which lies behind the iris. (Do not con-
fuse the posterior chamber with the posterior segment.) The zonules connect the lens—which is enclosed in a capsule—to the ciliary muscle.

Question 194

The physiological process by which one focuses on a near object is:
a) phakomorphosis
b) accommodation
c) fixation
d) stereopsis

Answer 194

b) Accommodation enables near vision by causing the pupils to constrict (miosis), the eyes
to converge, and the ciliary muscle to contract. (See answer 196.)

ANSWER 196: We need more “plus” power to view close-up objects. When the circular ciliary muscle
contracts, the zonules are allowed to relax. This takes the tension off the lens, which also
“relaxes” and thickens, making the lens “more plus.”

Question 195

Which of the following does not automatically occur when a patient focuses on a close-up object?

a) narrowing of palpebral fissures
b) pupils get smaller (miosis)
c) eyes converge
d) lens thickens (accommodates)

Answer 195

a) A person might squint (narrow the palpebral fissures) when looking at a close object, but it is not an element of accommodation.

Question 196

When a person looks at a near object:

a) the ciliary muscle contracts, causing the zonules to relax, causing the lens to thicken
b) the ciliary muscle relaxes, causing the zonules to relax, causing the lens to thicken
c) the ciliary muscle contracts, causing the zonules to pull tight, causing the lens to thin
d) the ciliary muscle relaxes, causing the zonules to pull tight, causing the lens to thicken

Answer 196

a) We need more “plus” power to view close-up objects. When the circular ciliary muscle contracts, the zonules are allowed to relax. This takes the tension off the lens, which also “relaxes” and thickens, making the lens “more plus.”

Question 197

Which of the following is not a part of the uvea?
a) choroid
b) iris
c) retina
d) ciliary body

Answer 197

c) The uvea is comprised of the choroid, iris, and ciliary body.

Question 198

The major function of the choroid is:
a) aqueous production
b) accommodation
c) blood supply to the retina
d) blood supply to the cornea

Answer 198

c) The choroid is the blood vessel-rich layer that underlies and nourishes the retina. The retinal pigment epithelium is the inner-most layer of the retina and overlies the choroid. Rhodopsin (“visual purple”) is a visual pigment. Carotene is a pigment as well, but is not synthesized in the eye.

Question 199

The retinal photoreceptor cells is/are known as:
a) pigment epithelium
b) rods and cones
c) rhodopsin
d) carotene

Answer 199

b) The light-receptor cells of the retina are the rods and cones.

Question 200

Which of the following is not true regarding cone cells?
a) They are concentrated in the foveal area.
b) They outnumber the rods 20 to 1.
c) They are responsible for color and central vision.
d) They function best in daylight.

Answer 200

b) The rods actually outnumber the cones by about 20:1.

Question 201

Fibers from the retina travel through the optic chiasm in the following manner:
a) nasal fibers cross, temporal fibers do not cross
b) temporal fibers cross, nasal fibers do not cross
c) the upper half of all fibers cross, the lower half do not cross
d) all fibers cross to the opposite side

Answer 201

a) As the nerve fibers exit the optic nerve and enter the chiasm, the nasal fibers cross from one side to the other. The temporal fibers stay on their original side.

Question 202

Because of the crossing of retinal fibers after leaving the optic nerve, an object in the patient’s right field of view:

a) is perceived by the patient to be on the left
b) is projected to the left optic tract
c) is projected to the right optic tract
d) is perceived by the patient to be closer than it actually is

Answer 202

b) An object to the patient’s right would be perceived by the temporal retina of the left eye and the nasal retina of the right eye. Temporal retinal fibers stay on the side of origin; nasal retinal fibers cross to the other side. Hence, an object to the right would be projected to the left optic tract.

Question 203

Your patient complains that he cannot see objects on his left with his left eye. Confrontation visual fields confirms this. You suspect a retinal detachment. What part of the
retina would be affected if you are correct?
a) left eye, nasal side
b) left eye, temporal side
c) left eye, upper hemisphere
d) right eye, temporal side

Answer 203

a) Objects on a patient’s left are projected onto the nasal portion of the retina in the left eye.

Question 204

The head of the optic nerve, visible with the ophthalmoscope, is called the:
a) optic radiation
b) optic disc
c) macula
d) lamina cribrosa

Answer 204

b) The optic disc is the head of the optic nerve and is visible with the ophthalmoscope.

Question 205

The group that accredits standards in safety glasses and lenses is the:
a) American National Standards Institute (ANSI)
b) American Optical Association (AOA)
c) Council on Eye Safety (CES)
d) National Eye Institute (NEI)

Answer 205

a) ANSI accredits the standards for a number of industries, products, and processes. The standards themselves must go through a specific accreditation process including, among other things, a consensus by experts in the field and input from the public sector.

Question 206

The main features of safety frames include all of the following except:
a) they are impact-resistant
b) extended side protection required in some cases
c) do not conduct electricity
d) approved products are marked

Answer 206

c) Frames approved for safety glasses must be resistant to high impact and marked to identify them. If the temples are thin, extra side shields are required.

Question 207

Standard safety glasses are intended to be used:
a) only in industry
b) by adults only
c) on the job and on the street
d) when welding

Answer 207

c) Safety glasses are appropriate for use as street wear and on the job.

Question 208

Which of the following should always be prescribed safety lenses?
a) children and adults
b) postoperative cataract patients
c) health care workers
d) children and monocular patients

Answer 208

d) This is one case where the world “always” is acceptable! Children (who are more prone to impact) and monocular patients (who must protect his or her one good eye) should always have safety lenses.

Question 209

The key feature of safety lenses is that they:
a) are completely shatterproof
b) splinter under impact
c) are shatter-resistant
d) protect against radiation

Answer 209

c) No lens is completely shatterproof, but a safety lens resists shattering on impact.

Question 210

The thinnest allowable width for a general wear, impact-resistant glass safety lens is:
a) 1.5 mm
b) 2.2 mm
c) 3.0 mm
d) 3.7 mm

Answer 210

b) A glass safety lens for general use may be no thinner than 2.2 mm in any part of the lens. The standard for an industrial-use lens is 3 mm.

Question 211

The standard spectacle lens material used for safety in streetwear is:
a) impact-resistant glass
b) heat-treated glass
c) polycarbonate
d) aspheric

Answer 211

c) “Polycarb” is the safety lens usually prescribed for average streetwear in adults and children. Glass safety lenses are used primarily in industry.

Question 212

Occupational Safety and Health Administration (OSHA) standards require that a health care employer provide safety glasses and/or face shields for employees at risk
for biological or chemical splashes. These safety glasses fall under the category of:
a) EOE regulations
b) personal protective equipment
c) incident reporting
d) unsafe work practices

Answer 212

b) The necessary personal protective equipment must be supplied by the employer and includes face shields, goggles, masks, gloves, and gowns.

Question 213

Welders must wear safety glasses or shields that will protect them from:
a) chemical splashes
b) laser radiation
c) infrared radiation burns
d) ultraviolet radiation burns

Answer 213

d) The welding arc is ultraviolet radiation and can cause very painful corneal burns.

Question 214

To reduce systemic absorption of an eye drop, the patient should be instructed to:
a) use only half the prescribed dose and close his eyes
b) avoid getting eye drops on his fingers
c) put pressure over the punctum after instilling the drops
d) blink rapidly after instilling the drops

Answer 214

c) Placing a finger at the medial corner of the closed eye helps keep the drop on the eye and reduces drainage through the lacrimal system, and from there, to the body.

Question 215

The patient should be told that the first step in applying any type of topical eye medication is to:
a) rinse the eyes with warm water
b) perform lid hygiene
c) wash the hands
d) occlude the punctum

Answer 215

c) Hands should always be washed prior to touching the eye area.

Question 216

Ophthalmic ointment is usually applied:
a) to the lower cul de sac
b) to the cornea
c) into the vitreous
d) to the eyelashes

Answer 216

a) To apply ophthalmic ointment, the lower lid is pulled down and ointment is placed in the “pocket” (cul de sac).

Question 217

When using eye drops, the patient should do all of the following except:
a) use 2 drops at a time to ensure effectiveness
b) avoid touching the lids or eye with the bottle tip
c) allow several minutes between instilling different types of drops
d) avoid touching the bottle tip with the fingers

Answer 217

a) The eye will not usually hold more than one drop, so using two at a time is a waste.

Question 218

If someone else is to instill eye drops for the patient, he can be told it is easiest to instill eye drops if the patient will:
a) close one eye
b) open both eyes and look up
c) hold her breath
d) focus on the dropper tip

Answer 218

b) If one eye closes, the other eye wants to close as well. Also, it is more difficult to close the eyes when looking up.

Question 219

A glare test might be indicated in a patient with:
a) glaucoma
b) macular degeneration
c) hypertensive retinopathy
d) posterior capsular cataracts

Answer 219

d) A patient with posterior capsular cataracts might have a problem with a decrease in vision when bright light causes the pupil to constrict. A glare test would assist in documenting this.

Question 220

Your patient is a 10-year-old boy whose mother thinks he is having a problem with color vision. You evaluate him with the Ishihara pseudoisochromatic plates, which test
for:
a) red/green color vision defects
b) blue/yellow color vision defects
c) red/yellow color vision defects
d) green/blue color vision defects

Answer 220

a) The Ishihara pseudoisochromatic plates evaluate for red/green color defects. This type of defect occurs almost exclusively in males.

Question 221

Your patient complains that he cannot see anything to his left. Which of the following will give the most detailed analysis of this problem?
a) Amsler grid
b) cover testing
c) automated visual field
d) visual acuity

Answer 221

c) A patient with a visual field loss would be most benefited by an automated visual field, which can help determine where in the visual pathway the problem is. An Amsler grid tests only the central 10 degrees to 20 degrees of vision, which is not enough in this case.

Question 222

Your patient sees 20/20, yet complains of “not being able to see.” Which of the following tests might help in documenting the problem?
a) pinhole test
b) tonometry
c) color vision test
d) contrast sensitivity

Answer 222

d) The standard “eye chart” is of high contrast, but the real world is full of shadows and low contrast. A contrast sensitivity test evaluates a person’s ability to discern detail as the contrast becomes lower and lower.

Question 223

A test done to estimate how much of a vision loss is due to cataracts and how much to
retinal disease is:
a) glare testing
b) brightness acuity testing
c) potential acuity testing
d) OCT

Answer 223

c) The PAM gives a visual acuity that bypasses media opacities. For example, a patient with
cataracts and macular degeneration has 20/100 acuity and a PAM of 20/40. One might
expect that if there was no media opacity, the patient would have 20/40 vision, which is
subnormal due to the macular degeneration.

Question 224

Exophthalmometry reveals that your patient has bulging eyes. Which of the following
is the eye care practitioner probably going to want tested?
a) cholesterol levels
b) heart function
c) glucose levels
d) thyroid function

Answer 224

d) Exophthalmos—or bulging of the eye, measured with an exophthalmometer—can be a sign of thyroid eye disease.

Question 225

Your diabetic patient has decreased vision, but says he or she does not want to be
dilated. You tell the patient that you will not do anything he or she does not want you
to, but:
a) you cannot get an accurate IOP without it
b) it is the best way for the doctor to get a good look at the back of the eye
c) you can take nonmydriatic fundus photos instead
d) the optic nerve is not visible without it

Answer 225

b) I often tell patients that dilation is like the difference between looking into a room
through a window versus a keyhole. With dilation, we have opened the pupil in order to get a broader view of the eye’s interior. I also frequently say that the dilated exam is the most important part of a diabetic eye exam.

Question 226

Which of the following would be a way to explain a Schirmer’s test to a patient?
a) “This will help us learn what is causing your floaters.”
b) “This will help us learn what is causing your eyes to feel gritty.”
c) “This will help us learn if your cataract is ready to be removed.”
d) “This will help us learn why you are having headaches.”

Answer 226

b) Schirmer’s is a test that evaluates tear output. Dry eye is a common cause of a gritty or sandy sensation. For more on tear testing, see Chapter 16, the section titled Tear Tests.

Question 227

A “dye test” to evaluate the retina’s blood vessels is:
a) retinal photography
b) rose bengal angiography
c) fluorescein slit-lamp test
d) fluorescein angiography

Answer 227

d) In fluorescein angiography, fluorescein dye is injected into a vein. Photographs (using a
special filter) are taken as the dye enters the bloodstream of the eye, showing any areas of
leaking and blockage.

Question 228

You are about to perform an A-scan on a patient with a suspected intraocular foreign
body. You explain to the patient that:

a) the test involves use of laser technology
b) the test uses a strong magnet to create an image
c) the test uses ultrasound waves
d) the test uses ultraviolet rays

Answer 228

c) The A-scan uses ultrasound. A retained intraocular foreign body will reflect the waves, revealing its presence as a “blip” on the scan.

Question 229

The doctor has asked you to measure a patient’s central corneal thickness. You might
explain this to the patient using any of the following except:
a) “Corneal thickness can be related to how we interpret your eye pressure readings.”
b) “This measurement uses ultrasound to measure your cornea.”
c) “This reading is just one aspect in determining if glaucoma is present.”
d) “This measurement is essential in fitting your contact lenses.”

Answer 229

d) Corneal thickness is not usually a factor in contact lens selection. The other statements
are true.

Question 230

The physician has ordered an OCT and left you in the room to explain the procedure
to the patient. You tell her that the test:
a) uses ultrasound to image all the structures in the eye
b) is used to further evaluate the patient’s vision
c) shows the layers of the retina
d) determines aqueous outflow

Answer 230

c) The OCT uses low coherence light (not ultrasound) to image the layers of the retina. The results may indicate why a patient has subnormal vision, but that is not the best response of those given.

Question 231

Your patient complains of a foreign body sensation. Which of the following would be
most useful?
a) tonometry
b) corneal topography
c) keratometry
d) topical fluorescein

Answer 231

d) Instilling topical fluorescein dye and looking at the eye with a cobalt blue filter will
cause any corneal abrasions to be visible when the dye pools in the defect.

Question 232

Which of the following helps determine the cause of an eye infection?
a) biopsy
b) culture
c) rose bengal
d) complete blood count

Answer 232

b) A culture generally involves taking some material from the infected area (usually just
rubbing the area with a cotton swab) and placing the sample on a culture plate to see what type of organism is causing the infection. Once this is determined, specific treatment can be given; certain bacteria respond better to certain types of antibiotics.

Question 233

An established patient returns every 6 months or so complaining of decreasing vision. Refractometry has shown a gradual increase in astigmatism. The most helpful test to determine the cause of this would be a(n):
a) keratometry
b) pachymetry
c) corneal topography
d) A-scan

Answer 233

c) Corneal topography will generate a map of the corneal curvature and, if repeated over
time, may reveal that this patient has keratoconus. The keratometer does not “read” a large enough area of the cornea to be the best answer in this scenario.

Question 234

A patient returns for a 2-year exam, and her vision today with her glasses is 20/70. Two years ago, she was 20/25– with the same prescription. You perform a pinhole test,
which improves her vision to 20/50+. This most likely indicates:
a) the glasses were filled incorrectly
b) a new refraction should improve her back up to 20/25–
c) she has dry eye
d) there is some type of ocular pathology present

Answer 234

d) The pinhole only improves decreased vision caused by a refractive error, so a score of less than 20/20 pinhole vision generally indicates that some pathology is present, preventing the eye from having optimal vision.

Question 235

Each of the following tests is standard in determining the cause of a red painful eye
except:
a) pachymetry
b) pupil check
c) slit-lamp exam
d) IOP check

Answer 235

a) The standard three causes of a red, painful eye are angle-closure glaucoma, iritis, and
infection. In angle-closure glaucoma, the pupil is generally mid-dilated; in iritis, it is
smaller than the fellow pupil; and in an infection, the pupil size is unaffected. Slit-lamp exam of the angles (for closure), anterior chamber (for inflammatory cells), the pattern of redness, the condition of the cornea, and any discharge also help differentiate between the three. IOP is elevated in angle closure, but normal in the other two.

Question 236

Your patient had 20/20 vision OD 9 months ago. Today, it is 20/60, without pinhole
improvement. In the absence of obvious pathology, the eye care provider may want
which of the following tests to help diagnose the problem?
a) BAT
b) PAM
c) fluorescein angiogram
d) OCT of macula

Answer 236

d) The macular scan using the OCT may reveal underlying macular pathology that is not readily visible with the ophthalmoscope. While the fluorescein angiogram has its uses, it is not the best choice of the options given.

Question 237

A patient complaining of floaters and flashes will need which of the following?
a) B-scan ultrasound
b) dilated fundus exam
c) specular microscopy
d) macular photostress test

Answer 237

b)The dilated fundus exam (preceded, of course, by visual acuity, pupil check, IOP, and
slit-lamp exam to check the angles) is standard procedure in the patient with floaters and flashes. Either of these can be caused by a benign vitreous detachment or the more ominous retinal detachment. There is no way to tell the difference without a fundus exam.

Question 238

A procedure done to help alleviate dry eye by keeping the tears on the eye is:
a) tarsorrhaphy
b) epilation
c) punctal occlusion
d) tear inserts

Answer 238

c) In punctal occlusion, the puncti—usually just the lower—are plugged with punctal plugs or sealed with laser or cautery. The idea is to keep whatever tears are made on the eye by blocking the drainage route.

Question 239

The eye care provider has determined that an infant’s nasolacrimal duct is blocked.
The procedure to rectify this problem is:
a) probe and irrigate
b) Quickert-Dryden tube insertion
c) dacryocystectomy
d) punctal dilation

Answer 239

a) To open a blocked nasolacrimal duct, a thin wire probe is inserted into the lower punctum
and pushed through the obstructing membrane. The punctum is usually dilated first, but dilation alone will not open the duct.

Question 240

Which of the following is used to remove an embedded metallic corneal foreign body?
a) spud or drill
b) cotton-tipped applicator
c) speculum
d) anesthesiometer

Answer 240

a) A foreign body spud or a small drill may be used to remove a metallic foreign body that
has lodged in the cornea. Any rust in the tissue around the foreign body must also be
removed.

Question 241

Botulinum toxin injection, or Botox (Allergan Inc, Irvine, CA), is used to relieve:
a) accommodative esotropia
b) accommodative spasms
c) blepharospasms
d) migraine headaches

Answer 241

c) Botulinum toxin is used to relieve chronic lid twitching, or blepharospasm. It also is used in some cases of nonaccommodative strabismus.

Question 242

Removal of an eyelash is called:
a) trichiasis
b) epilation
c) incision
d) indentation

Answer 242

b) Removal of an eyelash is called epilation. Trichiasis is the term for the condition where
the lashes grow back toward the eye.

Question 243

A procedure done to resolve angle-closure glaucoma is:
a) goniotomy
b) laser trabeculoplasty
c) laser iridotomy
d) glaucoma valve

Answer 243

c) A laser iridotomy is a procedure in which a hole is punched into the iris so that aqueous
can still exit the eye, even if the angle is occluded.

Question 244

A procedure performed to clear a posterior capsule opacity is:
a) laser capsulotomy
b) laser posteriotomy
c) laser capsulorrhexis
d) laser iridectomy

Answer 244

a) A cloudy posterior capsule is cleared in minutes using a laser to blast away the glazed-over center of the capsule, restoring vision. This is known as a capsulotomy.

Question 245

Treatment of wet macular degeneration includes:
a) removal of diseased tissue
b) retinal tissue transplant
c) intravitreal injections
d) laser to open drainage sites

Answer 245

c) Wet macular degeneration is treated by injecting anti-VEGF agents, or antivascular endothelial growth factor, which discourages the growth of new, abnormal blood vessels, into the vitreal cavity of the eye.

Question 246

The post-surgical patient should be told to report the following symptoms, which may
indicate wound infection:
a) itching, scaling, and redness
b) redness, swelling, and pain
c) tenderness and slight oozing
d) bruising, swelling, and itching

Answer 246

b) The symptoms of infection are redness, swelling, and pain. Itching and scaling are usually associated with allergy; mild tenderness and oozing are probably normal, as are bruising and swelling.

Question 247

All of the following are true regarding care of skin sutures except:
a) do not get them wet
b) if a suture falls out, call the doctor’s office
c) all sutures are absorbable and do not need to be removed
d) antibiotic ointment can be applied directly to the sutures

Answer 247

c) Not all sutures are absorbable; some need to be removed.

Question 248

If the patient is to use warm compresses, she should be told to:
a) test the compress for excessive heat before applying
b) wet an electric pad to provide moist heat
c) use boiling water to make the cloth hot enough
d) use boiling water to sterilize the cloth

Answer 248

a) If the compress is too hot, the patient’s skin may be burned. Answers b through d are
dangerous or unnecessary.

Question 249

A hot compress is generally used to:
a) sterilize the area to prevent infection
b) increase patient comfort
c) increase the effectiveness of oral antibiotics
d) increase circulation to the area

Answer 249

d) Heat increases circulation in the area, promoting healing.

Question 250

An ice pack is generally used to:
a) increase circulation to the area
b) increase patient comfort
c) decrease bruising and swelling
d) decrease redness and discharge

Answer 250

c) Cold is used to minimize or reduce bruising and swelling.

Question 251

The basic treatment for blepharitis is:
a) steroid ointment at night
b) antibiotic ointment and lid scrubs
c) antibiotic ointment
d) lid scrubs and steroid drops

Answer 251

b) Lid scrubs and antibiotic ointment are commonly used to treat blepharitis. Steroids are usually avoided.

Question 252

A patient with which of the following might be taught how to perform lid scrubs?
a) blepharitis
b) blepharoptosis
c) blepharochalasis
d) exophthalmos

Answer 252

a) Blepharitis is treated, at least in part, by cleansing (“scrubbing”) the lid margin daily to
prevent build-up of oil and debris. This technique may also be termed “lid hygiene.”

Question 253

A patient with dry eye syndrome needs to be made aware that:
a) the condition will go away after a few days of treatment
b) the condition will require indefinite treatment
c) the condition is contagious
d) the condition will get worse before it gets better

Answer 253

b) I often tell patients that dry eye is rather like high blood pressure. You cannot get rid of it, but you can control it. Dry eye is not, of course, contagious.

Question 254

A parent whose infant probably has a nasolacrimal duct obstruction should be told
to:
a) apply the occluding patch as directed
b) instill artificial tears every 2 hours
c) massage the eyeball several times daily
d) massage the nasolacrimal duct area several times a day

Answer 254

d) Some eye care practitioners advocate external nasolacrimal duct massage. The massage is started in the nasal canthus and worked downward toward the fold in the nose.

Question 255

Standard instructions for a patient with conjunctivitis include all of the following
except:
a) if another family member develops symptoms, give him or her your eye drops
b) do not share washcloths with anyone
c) wash your hands before and after touching the eye
d) do not share pillows with anyone

Answer 255

a) Treating a family member with another’s medication is not wise. For one thing, there are many types of conjunctivitis, and treatment varies according to the cause.

Question 256

A patient who has had a corneal foreign body removed in the office should be told to:
a) expect a foreign body sensation for the rest of the day
b) use “numbing drops” as needed for pain
c) expect the eye to feel better right away
d) avoid heavy lifting

Answer 256

a) Once a corneal foreign body is removed, an abrasion remains. The patient needs to be
told this, and that the eye might still feel as though there is something in it. Such abrasions usually heal within 24 hours. Topical anesthetics (“numbing drops”) are never prescribed for home use, as repeated instillation interferes with the healing process.

Question 257

After removal of a corneal foreign body, the patient should be warned that the eye
may again have a foreign body sensation once the topical anesthetic wears off. This is
because:
a) it is impossible to remove the entire foreign body
b) rust forms from metallic foreign bodies
c) there is an abrasion at the removal site
d) there is decreased corneal sensation at the site

Answer 257

c) A corneal abrasion causes a foreign body sensation because every time the patient blinks, the lids rub over the raw spot. There is commonly an abrasion at the site where a foreign body was removed.

Question 258

A postoperative cataract patient is told to:
a) protect the eye from bright light
b) sleep facedown
c) avoid heavy lifting
d) rub ointment vigorously into the eye

Answer 258

c) Following cataract surgery, the patient is told to avoid heavy lifting and straining, as this can cause a sudden rise in intraocular pressure.16 Bright light may be uncomfortable, but it will not damage anything. The patient is generally told to sleep on the side opposite the operated eye, not facedown. Rubbing the eye is also to be avoided.

Question 259

The postoperative cataract surgery patient is generally sent home with:
a) an eye shield
b) oral medications to lower intraocular pressure
c) topical numbing drops
d) a home IOP monitor

Answer 259

a) The operative eye is usually patched, and a shield is applied. IOP-lowering medications
will be topical, not oral. Topical anesthetics (“numbing drops”) are never prescribed for
home use, as repeated instillation interferes with the healing process. And, did you know
that there is such a thing as a home IOP monitor?17 Postoperative cataract patients, however, are not sent home with these.

Question 260

A postoperative cataract patient should be warned that:
a) the cataract can grow back
b) intraocular pressure may rise a year later
c) the intraocular lens implant can dislocate
d) the membrane behind the IOL can get cloudy

Answer 260

d) Many patients hear that cataracts “can grow back.” By the time a post-cataract surgery patient is dismissed (generally at 4 to 6 weeks), she should understand that the membrane behind the implant can cloud over, causing the same symptoms as a cataract. The patient should then contact the office, as this problem is usually dealt with easily and in minutes by a YAG laser capsulotomy.

Question 261

Following cataract surgery, the patient may notice:
a) a visual improvement in the fellow eye
b) vision has a bluish tinge
c) vertical diplopia
d) decreased depth perception

Answer 261

b) The cataract has the effect of causing vision to become dingy and yellowed. When the cataract is removed, objects are restored to their normal color. However, the patient often perceives this as being “bluer” than his or her preoperative vision.

Question 262

Following cataract surgery, the final refraction will usually take place:
a) 1 week after surgery
b) 4 to 6 weeks after surgery
c) once the intraocular pressure is normal
d) 6 months after surgery

Answer 262

b) A final postoperative examination, including refractometry (and probably IOP and dilated exam), is generally done 4 to 6 weeks after surgery.

Question 263

The parent of a child who is being patched for amblyopia asks how the patch is going
to help. You respond:
a) the patch prevents secondary infections
b) the weak eye is patched to relieve eye strain
c) the strong eye is patched to force the weaker eye to work harder
d) the patch prevents the eyes from crossing

Answer 263

c) In patching (occlusion) therapy for amblyopia, the strong eye is patched to force the weaker eye to work harder. The hope is that the visual pathway will then develop normally, with an increase in visual acuity in the “lazy” amblyopic eye.

Question 264

A patient with which of the following might be taught how to do “pencil push-up” eye
exercises?
a) amblyopia
b) convergence insufficiency
c) divergence insufficiency
d) exotropia

Answer 264

b) “Pencil push-ups” (convergence training) involves training the eyes to increase and hold convergence.

Question 265

265. Your patient is given an Amsler grid for home use. She would be told all of the following except:
     a) cover one eye at a time, checking each
     b) post the grid on a wall, and stand 10 feet away
     c) focus on the central dot
     d) evaluate for missing or distorted areas

Answer 265

b) The Amsler grid is held at normal reading range, about 16 inches.

Question 266

A patient using an Amsler grid at home should be told to contact the office if:
a) the lines appear to be straight
b) the lines appear to be wavy
c) there is any change in the way the grid looks
d) a dot appears in the middle of the grid

Answer 266

c) Did you get this one? Or did answer b fool you? Of course, the real COA® exam will not
be intentionally tricky, but the point here is that the first time the patient looks at the grid, there may be wavy lines, distortions, and areas missing. The thing the patient is told to look for is any changes from the initial viewing. And yes, there is a dot in the middle of the grid!

Question 267

A properly applied pressure patch should:
a) prevent the patient from moving his or her eye
b) prevent the patient from opening his or her eye
c) eliminate pain
d) improve the patient’s vision

Answer 267

b) The purpose of a pressure patch is to keep the eye closed.

Question 268

To secure a pressure patch, it may be necessary to:
a) shave the patient’s eyebrows
b) shave the patient’s facial hair
c) shave the patient’s forehead
d) shave the patient’s eyelashes

Answer 268

b) You may have to shave some facial hair to get the tape to stick to the cheek. If the tape
is not tight enough to keep the eye shut, pressure patching is useless.

Question 269

When a pressure patch is properly applied, the tape:
a) will prevent the patient from eating
b) will prevent the patient from speaking
c) will angle away from the edge of the mouth
d) will go beyond the hairline of the forehead

Answer 269

c) Angle the tape away from the lips. There is no need to extend tape beyond the hairline;
it will not stick.

Question 270

If the tape of the pressure patch will not stick because the patient’s skin is oily, the
assistant may:
a) use extra tape
b) cleanse the skin with alcohol
c) use an eye shield instead
d) ask the physician for help

Answer 270

b) Alcohol will cleanse away skin oil so the tape will stick.

Question 271

Use of a pressure patch in superficial corneal defects is generally indicated because:
a) it helps create a smooth surface for healing
b) it keeps light from entering the cornea
c) the pressure makes healing faster
d) the patch keeps the medicine on the eye

Answer 271

a) Answers b through d sound good, but answer a is the best. If the cornea heals smoothly, there is less chance of developing recurrent erosion, where the eyelid pulls off the new cells.

Question 272

The patient should be told all of the following after application of a pressure patch except:

a) to call the office if the eye opens under the patch
b) to leave the patch on until told to remove it
c) that the purpose of the patch is to promote healing
d) to remove the patch if it is uncomfortably tight

Answer 272

d) If the pressure patch is put on correctly, it probably will be a little uncomfortable.

Question 273

An eye patch is commonly used after ocular surgery for all of the following except:
a) to prevent infection and absorb discharge
b) to protect the eye
c) to stop bleeding and reduce swelling
d) to improve visual acuity

Answer 273

d) The role of the patch is to accomplish answers a through c.

Question 274

The edges of an eye shield should:
a) rest on the eyeball
b) rest on the bones surrounding the eye
c) fit over the nose
d) permit no light to enter

Answer 274

b) The shield edges should rest on the orbital bones to prevent pressure on the globe.

Question 275

The purpose of the eye shield is:
a) to keep the eye shut
b) to prevent light from entering the eye
c) to protect the eye from physical injury
d) to keep the eye from moving

Answer 275

c) The shield provides a rigid barrier to protect the eye.

Question 276

A good rule of thumb when accompanying a patient with a physical disability is to:

a) try to anticipate his or her needs and give the appropriate help without being told
b) offer no help even if he or she is struggling in order to support his or her independence
c) ask if he or she wants or needs your assistance first
d) automatically request that the patient ride in a wheelchair

Answer 276

c) Always ask a disabled person if he or she wants help.

Question 277

A patient can often be transferred from the wheelchair to the exam chair most easily
by:
a) having the assistant physically lift him or her from one chair to the other
b) removing the arms of both chairs so the patient can slide from one to the other
c) transferring the patient first to a stretcher and from there to the exam chair
d) using a step-stool

Answer 277

b) Wheelchair transfers are easiest by removing the armrest of both chairs, enabling the patient to slide over. This avoids lifting.

Question 278

To best assist a blind patient in the office, the assistant should:
a) use a wheelchair to move the patient
b) offer the patient a cane
c) offer his or her arm, and move slightly ahead of the patient
d) gently guide the patient from behind

Answer 278

c) Proper sighted-guide technique requires the guide to walk slightly ahead of the patient, with the patient’s hand on your arm. Never push the patient. Some blind patients are not skilled with a cane. For some, the wheelchair option would be degrading.

Question 279

When speaking to a blind patient, one should do all of the following except:
a) speak directly to the patient
b) speak in a louder voice
c) tell the patient when you leave and enter the room
d) tell the patient what you are doing as the exam progresses

Answer 279

b) A blind person is not deaf! The other answers are good rules of etiquette.

Question 280

Your patient has a guide dog. You should guide the patient by:
a) taking the dog’s halter and guiding it to the exam room
b) taking the patient’s arm and directing him to the exam room
c) requesting that the patient and dog follow you
d) walking behind the dog and patient, telling them where to go

Answer 280

c) Never touch a guide dog! You need not touch the patient, either. Just tell him where you are going and lead the way.

Question 281

Patient flow can be expedited by all of the following except:
a) chart preview
b) scheduling fewer patients
c) template-style exam forms
d) protocol for handling phone calls

Answer 281

b) It is not necessarily how many patients you see, but how you handle the ones you do see.
Chart preview involves looking over a patient’s record prior to his or her visit to be sure you are aware of the reason for the visit, any special patient concerns (eg, allergy to latex, claustrophobia), and any notes the physician left “for next time” (eg, dilation, pachymetry, A-scan). Template-style exam forms can expedite the exam and help ensure that you do not forget something. A phone call protocol should help minimize intra-exam interruptions as well.18

Question 282

The act of briefly assessing a patient’s injury or illness in order to determine the
urgency of treatment is:
a) first aid
b) patient flow
c) triage
d) first response

Answer 282

c) Triage is a cursory evaluation of a patient’s needs and then categorizing them as emergent, urgent, or routine.

Question 283

In the case that there is more than one patient needing attention, triage enables the
screener to:
a) determine the order in which the patients need care
b) determine who is malingering and does not need care
c) make sure the least serious condition is treated first
d) make sure patients are seen in order of arrival

Answer 283

a) In the case of multiple patients, triage helps determine whose injuries or illness is most
urgent. The more urgent the case, the sooner the patient is slated to be seen.

Question 284

Urgent ocular situations generally need to be seen:
a) at the practice’s convenience
b) the same day
c) within 24 to 48 hours
d) within minutes

Answer 284

c) Urgent cases are seen within 24 to 48 hours.

Question 284

Which of the following is not one of the 3 highly emergent ocular situations that
requires treatment within minutes?

a) corneal transplant patient with symptoms of rejection
b) sudden, painless loss of vision in one eye
c) chemical burns
d) penetrating injuries

Answer 284

a) Of the conditions listed, the corneal transplant rejection is the least emergent, although it probably warrants a same-day appointment. The situations in b, c, and d are highly emergent. Sudden, painless loss of vision in one eye (symptoms of central retinal artery occlusion) might be reversed with rapid treatment. Chemical burns should be irrigated immediately. Because a penetrating injury involves exposure of the ocular tissues to contamination, it is also a high-level emergency.

Question 284

Which of the following is an example of an emergent condition?
a) sudden onset of diplopia
b) globe perforation
c) chalazion
d) obstructed nasolacrimal duct

Answer 284

b) See answer 284. Sudden onset of diplopia in an adult is usually considered urgent, not
emergent.

ANSWER 284: a) Of the conditions listed, the corneal transplant rejection is the least emergent, although it probably warrants a same-day appointment. The situations in b, c, and d are highly emergent. Sudden, painless loss of vision in one eye (symptoms of central retinal artery occlusion) might be reversed with rapid treatment. Chemical burns should be irrigated immediately. Because a penetrating injury involves exposure of the ocular tissues to contamination, it is also a high-level emergency.

Question 285

Which of the following is an emergency?
a) a 42-year-old patient who has just noticed an inability to read at near
b) a 4-year-old with a crossed eye since birth
c) a construction worker with a foreign body sensation
d) a –1.00 myope who broke her glasses

Answer 285

c) The construction worker should be seen immediately. The 42-year-old probably has
presbyopia, the 4-year-old has been waiting for 4 years, and the –1.00 myope can cope to
some degree until being seen.

Question 286

Which of the following constitutes the most emergent complaint?
a) gradual loss of vision in one eye
b) flashes and floaters of 4 months’ duration
c) sudden, painless loss of vision in one eye
d) painful red eye

Answer 286

c) The most emergent of the conditions listed is the sudden, painless loss of vision in one
eye. These can be the symptoms of central retinal artery occlusion, and there is a small
window of opportunity during which treatment must start if there is to be any hope of regaining vision.

Question 287

All of the following could be considered elective except:
a) diabetic eye exam
b) refractive exam
c) foreign body
d) nonpainful lid lesions

Answer 287

c) A foreign body is usually seen the same day (emergent/urgent). Conditions a, b, and d
can be seen in a next available slot.

Question 288

A patient phones in with a loss of vision. Which of the following is the most important
set of questions from a triage point of view?

a) One eye or both? Was this sudden or gradual? Is there any pain?
b) When was your last eye exam? Did they see anything they were concerned about?
c) Is there any discharge? Does the eye feel gritty?
d) Have you used any eye drops to try to relieve the symptoms? Did that help?

Answer 288

a) When a patient calls in with vision loss, you must first rule out the most emergent situation that can cause this: central retinal artery occlusion (CRAO). A symptom of CRAO is
sudden, painless loss of vision in one eye.

Question 289

Which of the following is most likely to have a disastrous visual outcome if not treated
immediately?
a) conjunctivitis
b) subconjunctival hemorrhage
c) angle-closure glaucoma
d) iritis

Answer 289

c) Vision loss in angle-closure glaucoma can be permanent. Immediate treatment is imperative. Of course, iritis should be treated as soon as possible, but is not quite as crucial as a glaucoma attack.

Question 290

A patient phones in complaining of a red eye. From a triage standpoint, which is the
most important question?
a) When did this start?
b) Is there any pain?
c) Are you seeing double?
d) Do you have glaucoma?

Answer 290

b) Triage is the process of deciding how serious a condition is, and, thus, how soon it needs treatment. Generally speaking, a painful red eye is higher on the triage scale than a non-painful red eye. Double vision is not associated with redness. Usually, a person who knows he has glaucoma has the open-angle type.

Question 291

All of the following can cause a painful red eye except:
a) angle-closure glaucoma
b) conjunctivitis
c) subconjunctival hemorrhage
d) iritis

Answer 291

c) A subconjunctival hemorrhage is red, but generally painless. Viral conjunctivitis can be
particularly painful.

Question 292

Which of the following does not cause a red eye?
a) iritis
b) conjunctivitis
c) open-angle glaucoma
d) angle-closure glaucoma

Answer 292

c) Open-angle glaucoma, in and of itself, does not cause an eye to be red. The other answers are classically accompanied by a red eye.

Question 293

Symptoms and signs for acute angle-closure glaucoma may include all of the following
except:
a) severe pain
b) decreased vision
c) vomiting/nausea
d) miotic pupil

Answer 293

d) An attack of angle-closure glaucoma can include signs and symptoms as follows: redness, hazy cornea, mid-dilated pupil (not miotic), pain, vomiting, nausea, headache, eye
ache, halos around lights, and decreased vision.

Question 294

All of the following may trigger an angle-closure glaucoma attack except:
a) being dilated in the office
b) being in a dark room
c) sudden exposure to bright light
d) sitting in a movie theater

Answer 294

c) Answers a, b, and d all act to dilate the pupil, creating a potential for the iris to block the angle. A sudden bright light would cause the pupil to constrict, which is not associated with angle closure.

Question 295

In angle-closure glaucoma:
a) the iris closes off the anterior chamber angle
b) there is a sudden surge of aqueous production
c) a miotic pupil prevents aqueous passage
d) corneal edema closes off the anterior chamber angle

Answer 295

a) When angle-closure glaucoma occurs, the iris is pushing against the lens and angle.
Aqueous production continues, but the fluid is not drained out, causing a rise in IOP. If the
pupil were miotic, as suggested in answer c, the iris would be pulled away from the angle,
increasing drainage.

Question 296

Which of the following conditions gives a higher risk for developing an angle-closure
glaucoma attack?
a) high hyperopia
b) high myopia
c) aphakia
d) keratoconus

Answer 296

a) The eye of a high hyperope is short, meaning there is not much room for the angle. This increases the chances of iris obstruction. It is also the reason that we check angle depth prior to dilation, to make sure the angle is not going to occlude during mydriasis or cycloplegia.

Question 297

The appearance of halos around lights during an attack of angle-closure glaucoma is
due to:
a) lens edema
b) corneal edema
c) vitreous hemorrhage
d) optic nerve damage

Answer 297

b) Corneal edema has a prismatic effect, breaking light into its component colors and thus creating halos around lights. Pressure build-up during an attack causes a breakdown in the pumping function of the corneal endothelium, and edema results.

Question 298

Emergency treatment during an angle-closure glaucoma attack includes pressure-
lowering medications and:
a) miotics
b) mydriatics
c) antibiotics
d) corticosteroids

Answer 298

a) The pupil in angle-closure glaucoma is mid-dilated. Miotics are used in an effort to con-
strict the pupil and pull the iris out of the angle. Mydriatics would keep the pupil dilated. Antibiotics would have no effect, nor would corticosteroids. Steroids can actually elevate the pressure when used for a period of time.

Question 299

In examining the pupil of a painful red eye, which would most likely be seen in iritis?

a) The affected eye would have a smaller pupil.
b) The affected eye would have a larger pupil.
c) The affected eye would have an oval shaped pupil.
d) Iritis does not affect the pupil size or shape.

Answer 299

a) In iritis, the affected pupil is often smaller.

Question 300

A 60-year-old patient calls with flashes and floaters in one eye, which started 2 days ago. You should:
a) schedule him or her for a routine eye exam in a month
b) schedule him or her for a dilated exam in a week
c) schedule him or her for an urgent visit right away
d) reassure the patient that this is normal as one ages

Answer 300

c) Flashes and floaters can be symptoms of a retinal detachment and should be seen on an
urgent basis.

Question 301

Which of the following symptoms could indicate a retinal detachment?
a) painful red eye
b) curtain or veil over part of the vision
c) halos around lights
d) sticky discharge

Answer 301

b) In addition to flashes and floaters, a retinal detachment can cause the appearance of a
curtain or veil over part of the vision.

Question 302

The classic symptoms for posterior vitreous detachment are:
a) sudden, painless loss of vision
b) painful red eye
c) flashes and floaters
d) foreign body sensation

Answer 302

c) The classic symptoms of posterior vitreous detachment are floaters and flashes. These
are also the symptoms of retinal detachment, however, and must be evaluated, usually the
same day.

Question 303

Any eye injury is considered:
a) a reason to irrigate the eye
b) a reason to apply a pressure patch
c) vision-threatening until proven otherwise
d) able to wait until the patient’s turn in the exam room

Answer 303

c) It is always better to overestimate the potential of an injury to threaten vision. Certain injuries should not be irrigated or pressure patched. A patient’s ability to wait must be determined on a case-by-case basis. (The key to this question is the word any.)

Question 304

A patient comes to the office after getting chemicals in his eye. The first step is to:
a) assess vision
b) apply a pressure patch
c) instill topical anesthetic
d) irrigate

Answer 304

d) The first step in a chemical splash to the eye is irrigation.

Question 305

Which of the following causes the most severe chemical injury?
a) acetic acid
b) hydrochloric acid
c) nitric acid
d) ammonia

Answer 305

d) Ammonia is a base. Bases bind to lipids (fats) in the tissues and, thus, penetrate deeply. Acids cause surface burns, but do not adhere to the tissue or penetrate.

Question 306

Before any treatment is started on a patient who presents with a foreign body in the
eye, the most important question to ask is:
a) “Were you wearing safety glasses?”
b) “Does the eye hurt?”
c) “Does your vision seem to be affected?”
d) “What were you doing when this happened?”

Answer 306

d) It is important to know how a foreign body got into the eye. If the foreign material was
at a high velocity, the eye might have been penetrated.

Question 307

Which of the following best indicates the severity of a deep, penetrating injury?
a) the patient’s vision
b) the ophthalmoscopic evaluation
c) the external appearance of the eye
d) the amount of pain the patient has

Answer 307

b) A penetrating injury may have surprisingly little immediate effect on the patient’s vision,
the appearance of the eye, or the amount of pain. Looking inside the eye with the ophthalmoscope gives the best idea of the injury’s severity.

Question 308

If a patient has a perforated globe, the technician must:
a) apply a pressure patch
b) irrigate the eye
c) perform a tactile tension
d) cover lightly and inform the physician

Answer 308

d) If the globe is perforated, you do not want to put pressure on it or apply any drops, solutions, or ointments. Cover lightly with a sterile dressing and tell the doctor at once.

Question 309

Your patient complains of a foreign body sensation about an hour after grinding metal
at work. The physician is in surgery and will not be available for over an hour. You
should:
a) instill ointment for comfort
b) dilate the pupil
c) cover lightly
d) give the patient oral pain medication

Answer 309

c) A foreign body under high velocity could have penetrated the eye (see answers 284 and 308 to 310). The physician is the one who would decide to give oral pain medication, not the assistant.

Question 310

It is best to remove a metallic corneal foreign body during the first 6 to 8 hours to
prevent:
a) sympathetic ophthalmia
b) formation of a rust ring
c) epidemic conjunctivitis
d) endophthalmitis

Answer 310

b) A rust ring forms around a metallic corneal foreign body in 6 to 8 hours. The rust stains
the corneal tissue and must be removed with a drill or burr, or a foreign body spud.

Question 311

Painful corneal burns due to ultraviolet light might occur (if one fails to protect the eyes) in all of the following situations except:
a) tanning booth
b) direct viewing of a lunar eclipse
c) welding
d) snow skiing

Answer 311

b) A lunar eclipse does not emit significant ultraviolet light to damage the eye and may be viewed directly. A solar eclipse, however, should never be directly viewed.

Question 312

A patient has been hit in the eye with a tennis ball. Your best action is to:
a) ask him to come right in before the eye swells shut
b) explain the symptoms of retinal detachment and have him call back if they appear
c) make him an appointment for next week so the swelling has a chance to go down
d) tell him to use an ice pack and call back if he has any problems

Answer 312

a) A patient who has had a blow to the eye should be seen as soon as possible, before swelling makes it impossible to examine the globe. A dilated exam will be needed to determine if there is a detachment or any other retinal complications.

Question 313

All of the following can result from blunt trauma to the eye except:
a) blow out fracture
b) traumatic hyphema
c) retinal detachment
d) trachoma

Answer 313

d) Trachoma is an infection, not an injury.

Question 314

A blow out fracture involves:
a) bones of the orbit and sinuses
b) globe rupture
c) airborne particles
d) bones of the cheek and forehead

Answer 314

a) A blowout fracture involves the bones in the floor of the orbit, which actually separate
the orbit from the sinuses.

Question 315

A hemorrhage in the anterior chamber is:
a) a subconjunctival hemorrhage
b) cells and flare
c) a hyphema
d) a vitreous hemorrhage

Answer 315

c) A hyphema is blood in the AC.

Question 316

Which of the following is the wrong thing to say to an injured patient?
a) “Dr. Pelham will do her best to help you.”
b) “I am sorry this happened to you.”
c) “I am sure you will be just fine.”
d) “Is there anyone I can call for you?”

Answer 316

c) Never tell a patient that everything will be all right. If the outcome is not satisfactory (a
distinct possibility), the patient can claim that you guaranteed a successful outcome and sue your boss, and you, too.

Question 317

The organization involved with ensuring employee health and safety is:
a) Joint Commission on Allied Health Personnel in Ophthalmology (JCAHPO®)
b) Exempt Organization Entity (EOE)
c) Occupational Safety and Health Administration (OSHA)
d) Health Insurance Portability and Accountability Act (HIPAA)

Answer 317

c) OSHA is part of the United States Department of Labor. It was created in 1970 for the purpose of ensuring safety (including health safety) in the workplace.

Question 318

The “OSHA poster” must be displayed in the workplace and explains:
a) employee rights to a safe workplace and how to report problems
b) hand washing requirements
c) employee rights to a work environment free of harassment
d) fire escape routes

Answer 318

a) OSHA is concerned with employee safety. The poster tells employees about their rights
and how to report problems.

Question 319

An employer’s written plan regarding employee exposure to bloodborne pathogens is a(n):
a) Exposure Incident Report
b) Report of Employee Hazards
c) Exposure Control Plan
d) Hepatitis B Vaccine Report

Answer 319

c) The Exposure Control Plan is part of OSHA’s requirement for employee safety in the
workplace where there is potential exposure to bloodborne pathogens.

Question 320

You are concerned about the possible toxicity of the lens cleaner you use. Where can
you look for information?
a) The office’s Material Safety Data Sheet (MSDS) file.
b) The office’s Exposure Incident Report file.
c) The office’s exposure control plan.
d) The office’s employee handbook.

Answer 320

a) MSDS sheets give information regarding a substance’s ingredients, flash-point, storage
requirements, handling requirements, and first aid for exposures. Your office should maintain a readily accessible file that contains MSDSs for materials used by employees in the performance of their jobs.

Question 321

An employer’s written plan detailing expectations and procedures for the clinic would be the office’s:
a) Exposure Control Plan
b) Manual of Clinic Safety
c) Standard Operating Procedures
d) Job Descriptions

Answer 321

c) The practice’s Standard Operating Procedures is a manual that usually includes job descriptions, provisions for training and evaluation of employees, office practices (vacation and sick-leave), code of conduct, and handling of personnel issues.

Question 322

A patient falls in your clinic. The practice will fill out a(n):
a) Safety Data Sheet
b) Exposure Incident Report
c) Incident Report
d) Worker’s Compensation Form

Answer 322

c) An Incident Report (ie, for non-employees) would be used to document any accidents on
the property.

Question 323

An assessment that makes a statement about a patient’s ability/inability to perform tasks that he or she needs and wants to do is an evaluation of:
a) impairment
b) disability
c) qualification
d) vision loss

Answer 323

b) Statements regarding how a visual or other impairment has affected a person’s quality of
life evaluate the presence of a disability. The disability is “what’s wrong,” backed up by
medical testing. The impairment is the effect that the disability has on the patient’s life (eg,
professionally, socially, and personally).

Question 324

A medical report of a patient’s ophthalmic status (including vision assessment and
documentation of ocular diseases/disorders) is an evaluation of that patient’s:
a) quality of life
b) disability
c) impairment
d) culpability

Answer 324

c) An assessment of a person’s impairment includes medical data: the results of testing as well as a report of ocular disease.

Question 325

The purpose of government-required forms regarding ocular health is generally to:
a) determine fault
b) determine eligibility
c) eliminate malingering
d) justify legal prosecution

Answer 325

b) See questions 325 and 326. The awarding of services and funds to disabled persons relies on determining eligibility.

Question 326

Inaccuracy or errors made on a form for government benefits and services may:
a) deprive the patient of services he or she is actually qualified for
b) accuse the patient of self-inflicted harm
c) result in an OSHA citation to the practice
d) result in a freeze on the practice’s insurance reimbursements

Answer 326

a) Errors may mean that the patient is denied services for which he or she is eligible. Such
a mistake can make a profound difference in a person’s quality of life, or at the very least
further delay such assistance.

Question 327

In order to qualify for many governmental benefits, acuity testing for the visually
impaired commonly includes:
a) potential acuity testing
b) uncorrected and best-corrected vision
c) vision uncorrected and with current correction
d) pinhole vision

Answer 327

b) Agencies generally want to know uncorrected and best-corrected acuity. (Vision with current correction might potentially be improved with a new refraction.)

Question 328

A person with 20/20 acuity in both eyes and normal visual fields:
a) would never qualify as having a visual disability
b) is not eligible for any type of assistance
c) may still be visually disabled
d) does not have a visual impairment

Answer 328

c) Surprisingly enough, a person who has 20/20 vision and normal fields can still be dis-
abled if one or both eyes is totally paralyzed (ophthalmoplegia) and/or there is severe diplopia. (Note: This explanation is simplified, but the point is to be aware that there is more to visual disability and impairment than acuity and fields.)

Question 329

Your patient hands you a form to qualify him for a commercial driver’s license (CDL).
The main visual components in such an exam generally include:
a) IOP, confrontation fields, and central corneal thickness
b) visual acuity, glare test, and stereo vision
c) visual acuity, pupil evaluation, and dilated fundus exam
d) visual acuity, visual fields, and color vision

Answer 329

d) The minimum visual requirements for such a license would include visual acuity (usually uncorrected and best-corrected) visual fields, and color vision.

Question 330

A patient usually presents with a form for a vision test related to obtaining a driver’s
license when:
a) getting a license for the first time
b) getting a driving citation for the first time
c) failing the acuity test at the license bureau
d) failing the driving test at the license bureau

Answer 330

c) Visual acuity is generally tested at the licensing bureau. If the patient does not pass this test, then he is referred for a more formal eye exam.

Question 331

As a result of vision testing, the eye care practitioner has written “daytime driving
only” on the patient’s drivers license form. This is an example of a(n):
a) restriction
b) impairment
c) allowance
d) conviction

Answer 331

a) Examples of such restrictions might include daytime driving only, must wear correction
when driving, may not drive on interstates, or driving only within a specific radius from
home.

Question 332

Insurance that covers an employee who is injured on the job or develops a job-related
illness is:
a) HIPAA
b) Employee Incident Insurance
c) Workers’ Compensation
d) Medicaid

Answer 332

c) Workers’ Compensation is insurance paid by an employer to be used in the event that an employee is injured on the job or incurs a job-related illness.

Question 333

A Workers’ Compensation form for a patient with a job-related eye injury will probably include:
a) nature and length of any disability
b) statement regarding whether or not the worker was careless
c) citations to the employer for unsafe environment
d) citations to the employee for unsafe practices

Answer 333

a) As with any type of insurance claim, Workers’ Compensation wants to know what type of disability the employee has suffered and how long that disability is likely to last, along with how soon (if ever) the employee can return to work, and whether or not rehabilitation will be required.

Question 334

Which of the following might be covered under Workers’ Compensation?
a) any eye injury
b) an eye injury sustained while working on one’s own car
c) an eye injury sustained while on the job
d) an eye injury sustained while working on a friend’s house

Answer 334

c) Workers’ Compensation covers only on-the-job injuries.

Question 335

The United States government’s health insurance plan for citizens over the age of 65 is:
a) Medicare
b) Medicaid
c) HIPAA
d) Social Security

Answer 335

a) Medicare is the federal insurance program that helps pay the cost of medical care for
citizens 65 and older, as well as those with certain disabilities.

Question 336

A refraction is usually ruled by Medicare as:
a) an essential part of the routine eye exam
b) a noncovered procedure
c) covered at 50%
d) covered if the physician can show need

Answer 336

b) Medicare does not cover the cost of a refraction, nor does it usually cover certain special testing (eg, corneal topography or endothelial cell count), contact lenses, or fittings.

Question 337

In order to be able to file Medicare for a patient, the patient must sign a(n):
a) informed consent
b) assignment of benefits
c) opt-out form
d) financial statement

Answer 337

b) The Assignment of Benefits form allows the practice to file the patient’s Medicare and
other insurance and allows the practice to release pertinent medical information in pursuit of these payments.

Question 338

Federal- and state-supported health insurance for those who cannot afford insurance is:
a) supplemental insurance
b) Medicare
c) Medicaid
d) secondary insurance

Answer 338

c) Medicaid is supported by both state and federal funding (Medicare is federal only) and
is designed to provide health insurance to the indigent of any age.

Question 339

A federal law that includes a patient’s right to protection of his or her personal health
information is:
a) the Miranda Law
b) OSHA
c) HIPAA
d) Amber Alert

Answer 339

c) HIPAA was made law in 1996. One of its main features is the protection of personal
health information. It also establishes regulations regarding electronic medical records.

Question 340

Patient forms pertaining to HIPAA would include:
a) release of information and privacy disclosure
b) restriction of information and incident report
c) assignment of benefits and financial statement
d) health history and insurance information

Answer 340

a) A release of information form, as well as information regarding privacy, are standard
office forms revolving around the HIPAA standards.

Question 341

The group of tests collectively known as “vital signs” include:
a) temperature, blood pressure, pulse, and respirations
b) height, weight, and body mass index
c) vision, pupils, and confrontation fields
d) mental status, physical status, and psychological status

Answer 341

a) Vital signs include body temperature, blood pressure, pulse rate, and respiration rate.

Question 342

Which of the following is considered the “normal” human body temperature?
a) 89.6 ̊ F
b) 96.8 ̊ F
c) 98.6 ̊ F
d) 99.6 ̊ F

Answer 342

c) Normal body temperature is 98.6 ̊ F, with some slight variation found between
individuals.

Question 343

If taking an oral temperature, accuracy depends upon:
a) when the patient last had something warm or cool in his or her mouth
b) whether the patient is sitting or standing
c) the patient having a normal pulse rate
d) the time of day

Answer 343

a) It is recommended to wait 20 to 30 minutes before taking an oral temperature if the
patient has had something warm or cold to drink or has been smoking.

Question 344

Before taking an oral temperature with a standard (nonelectronic) thermometer, one
must first:
a) rinse the thermometer in hot water
b) have the patient rinse her mouth
c) tap the thermometer sharply on the table
d) shake the mercury down into the bulb

Answer 344

d) The mercury must be shaken down into the thermometer bulb before use.

Question 345

When checking temperature with a standard oral thermometer, the probe tip is placed:
a) between cheek and gum
b) on top of the tongue
c) under the tongue
d) between the molars

Answer 345

c) An oral thermometer is placed under the tongue.

Question 346

When using a standard oral thermometer, how long is the thermometer left in place
before taking the reading?
a) 1 to 2 minutes
b) 3 to 4 minutes
c) 5 to 6 minutes
d) until the probe “beeps”

Answer 346

b) Leave the thermometer in the patient’s mouth for 3 to 4 minutes before reading.

Question 347

A temperature that is above normal generally indicates the presence of a(n):
a) infectious process somewhere in the body
b) inaccurate method
c) overheated patient
d) swelling and pain

Answer 347

a) A fever generally indicates that an infection exists somewhere in the body.

Question 348

When checking pulse, one should:
a) apply gentle pressure with the thumb
b) apply the firmest pressure the patient can tolerate
c) apply gentle pressure
d) watch for the pulse-beat through the skin

Answer 348

c) Apply only gentle pressure, using the first two fingers. (The thumb has a pulse of its own, which might confuse things!) Heavy pressure might obstruct blood flow, so you will not feel a pulse.

Question 349

The usual place for checking pulse is:
a) in the arch of the foot
b) in the soft tissue in front of the ear
c) in the arm pit
d) in the soft tissue of the wrist above the thumb

Answer 349

d) The usual place to take a pulse is in the soft tissue of the wrist, above the thumb. There
are pulses in other places, however, such as the neck, in the bend of the elbow, behind the
knee, and next to the ankle.

Question 350

Heart rate is generally recorded as:
a) systolic and diastolic
b) beats per minute
c) beats per second
d) normal/abnormal

Answer 350

b) Heart rate is measured as beats per minute.

Question 351

Average heart rate in a human adult is:
a) 39 beats per minute
b) 72 beats per minute
c) 3 beats per second
d) 100 beats per minute

Answer 351

b) The average human heart rate is 70 to 80 beats per minute.

Question 352

Pulse can additionally be evaluated by noting:
a) the ratio of breaths to pulse beats
b) the amount of pressure applied until the pulse stops
c) if the patient is in pain
d) any irregularities in beat or strength

Answer 352

d) In addition to the basic count of the heart rate, the pulse is also evaluated for patterns
such as skipping or changes in speed and strength.

Question 353

The average adult human respiration rate is:
a) 1 breath per second
b) 18 breaths per minute
c) 30 breaths per minute
d) 50 breaths per minute

Answer 353

b) The average human respiration rate is 12 to 20. Eighteen is given as an average.20

Question 354

The best way to check respiration rate is to:
a) covertly evaluate it after the pulse has been checked
b) place a hand on the patient’s back and time the breaths
c) ask the patient to breathe normally
d) ask the patient to breathe once every 2.5 seconds

Answer 354

a) Respirations are usually counted “on the sly”; after checking pulse, leave the fingers in
place but count breaths instead of heart beats. If the patient knows you are counting breaths, it is difficult to breathe normally.

Question 355

Respiration can additionally be evaluated by noting:
a) if pinching the ankle causes an increase
b) the ratio of pulse to breaths
c) any unusual sounds or irregularities
d) the patient’s reaction to additional oxygen

Answer 355

c) Are the breaths shallow or deep? Easy or labored? Quiet or is there some sort of noise
such as wheezing or crackling? Is breathing even or irregular?

Question 356

In a blood pressure of 120/80, the number 80 is:
a) the time length of the measurement
b) the average of the measurement
c) the diastolic pressure
d) the systolic pressure

Answer 356

c) The lower of the 2 numbers in a BP reading is the diastolic pressure.

Question 357

The best time to take the patient’s blood pressure is:
a) immediately after he or she enters the exam room
b) right before dilation
c) a few minutes after he or she has been seated
d) when he or she is lying down

Answer 357

c) Any exertion can alter the patient’s “normal” BP reading, so wait several minutes before taking the reading. There is no need to have the patient lie down. After you have announced that you will be putting drops into his or her eyes is also not a good time to take the BP, as the patient’s apprehension may cause a false elevation in the reading!

Question 358

Blood pressure (BP) is measured using a(n):
a) sphygmomanometer
b) exophthalmometer
c) electrocardiograph
d) examiner’s fingers

Answer 358

a) A sphygmomanometer is used to evaluate BP.

Question 359

The BP cuff is positioned:
a) above the knee
b) around the wrist
c) around the neck
d) above the elbow

Answer 359

d) The cuff is placed on the patient’s arm above the elbow. Shirt sleeves should be loosely pushed up above the BP cuff.

Question 360

When checking BP with a manual (nonelectronic) sphygmomanometer, the examiner
holds the membrane of the stethoscope:
a) against the skin and inside the elbow
b) against the neck at the carotids
c) at the site of the radial pulse
d) against the cuff

Answer 360

a) The stethoscope is held on the inside of the elbow, just below the cuff.

Question 361

The bulb of the sphygmomanometer is used to:
a) regulate the patient’s heart rate
b) keep the gauge visible
c) pump air into the cuff
d) measure pulse rate

Answer 361

c) The bulb is used to pump air into the cuff. At some point, the heartbeat will be audible
in the stethoscope. Continue to pump until the heartbeat disappears again.

Question 362

Air is released from the cuff by:
a) barely turning the screw on the bulb
b) releasing pressure on the bulb
c) asking the patient to exhale
d) removing the cuff

Answer 362

a) Turn the screw on the bulb until the air just starts to escape, but not so fast that the cuff
deflates rapidly.

Question 363

As the cuff initially deflates, the examiner must note the:
a) number of seconds before the heartbeat is heard
b) gauge reading when the heartbeat is first heard
c) gauge reading when the pulse stops
d) reaction of the patient

Answer 363

b) You must listen for the heartbeat to start and note the reading on the gauge when this
occurs.

Question 364

366. The BP cuff continues to deflate, and the heartbeat sound is lost. At this point, the
     examiner notes the:
     a) time of the reading
     b) length of the reading
     c) gauge reading when the heartbeat is again heard
     d) gauge reading when the heartbeat fades

Answer 364

d) The point where the heartbeat fades is when you note the second of the 2 readings that make up the BP measurement.

Question 365

In addition to the numeric measurement of BP, one also documents:
a) the length of the reading
b) characteristics of the pulse
c) which arm was used
d) the patient’s reaction

Answer 365

c) BP can actually vary from one arm to the other; patients can often tell you which arm is
usually used.

Question 366

Normal BPs fall into which range?
a) 110 to 140 systolic, 70 to 90 diastolic
b) both systolic and diastolic over 100 but less than 150
c) 120/80 to 150/100
d) varies according to the patient’s body mass index

Answer 366

a) Consistent readings somewhat lower than 120/80 are considered normal blood pressure.

Question 367

BP might be especially important in each of the following patients except:
a) the patient with a cataract
b) the patient who is being prepped for a chalazion excision
c) the patient who is using beta-blocker drops for glaucoma
d) the patient who feels dizzy

Answer 367

a) The patient scenarios in answers b, c, and d especially warrant a BP reading. If the cataract patient is about to have surgery, the BP would be needed then as well, but that was not part of the given answers.

Question 368

A BP of 120 to 139 systolic and 80 to 89 diastolic is considered:
a) normotensive
b) hypotensive
c) prehypertensive
d) hypertensive

Answer 368

c) Prehypertension is defined by the American Heart Association as consistent readings of 120 to 139 systolic and 80 to 89 diastolic.

Question 369

Which group is at most risk for developing cardiopulmonary arrest?
a) those with cardiovascular problems
b) those with diabetes
c) those with emphysema
d) those with cancer

Answer 369

a) People with heart problems are most at risk for cardiopulmonary arrest.

Question 370

If breathing and pulse are not present, brain death will usually occur:
a) in 2 to 4 minutes
b) in 4 to 6 minutes
c) in 6 to 10 minutes
d) in 10 to 14 minutes

Answer 370

b) Brain death occurs approximately 4 to 6 minutes after pulse and breathing cease.

Question 371

The most common airway obstruction in an unconscious adult is:
a) food
b) the tongue
c) displaced dentures
d) ice

Answer 371

b) The victim’s own tongue is the most common obstruction to the airway. This occurs after the victim loses consciousness. (It is common for a person to choke on food, but not on his own tongue.)

Question 372

How many people survive cardiac arrest if someone performs chest compressions or
CPR?
a) 1 in 5
b) 1 in 10
c) 1 in 20
d) 1 in 25

Answer 372

b) Approximately 1 in 10 victims will survive cardiac arrest if chest compressions or CPR
is performed.

Question 373

What is the first step in the rescue/CPR process?
a) Activate 911 or an emergency response system.
b) Assess responsiveness.
c) Position patient.
d) Check for pulse and breathing.

Answer 373

b) The first step is always to assess responsiveness. The classic method is to gently shake or tap the victim’s arm and shout “Are you okay? Are you okay?” (Consider the alternatives: 911 arrives, and the “victim” is only sleeping; you attempt to “position” a “victim,” and he or she awakens, thinking he or she is being attacked!)

Question 374

The correct rescuer position for performing chest compressions on an adult is:
a) straddling the victim, hands interlaced, elbows straight
b) at the victim’s side, both hands on chest, elbows bent
c) at the victim’s head, heel of one hand on chest, elbow straight
d) at the victim’s side, hands interlaced, elbows straight

Answer 374

d) When performing compressions on an adult, the rescuer is kneeling at the victim’s side, hands interlaced and placed on the victim’s chest (two finger-widths above the xiphoid process), elbows straight. The rescuer’s shoulders, elbows, and hands should be in line. Compressions originate from the shoulders and arms, not by bending the elbows or rocking the body.

Question 375

The correct depth for chest compressions in an adult is:
a) 1 to 1.5 inches
b) at least 2 inches
c) 4 inches
d) until the rib cage crackles

Answer 375

b) In order for the compressions in an adult to be effective, they must be at least 2 inches
deep.

Question 376

“Hands-only” CPR has been introduced to the public because:
a) few people take CPR training
b) previously only health care workers could perform CPR
c) bystanders are reluctant to administer mouth-to-mouth breathing
d) many areas are remote, and EMS is more than 15 minutes away

Answer 376

c) In 2010, a report was released that found hands-only (or compression-only) CPR to be
about as effective as CPR that includes emergency breathing on adults.22 This is good news because bystanders are increasingly reluctant to perform mouth-to-mouth breathing on a person whose medical background (especially HIV status) is unknown. Rescue breathing is still indicated in children and infants.23

Question 377

The rate of compressions in hands-only CPR is:
a) 30 per minute
b) one per second
c) 100 per minute
d) 120 per minute

Answer 377

c) The compression rate in hands-only CPR is the same as in CPR that includes rescue
breathing: 100 per minute. (Someone told me that if you pump to the tune of the song
“Stayin’ Alive” from the movie Saturday Night Fever, that you will be delivering 100 com-
pressions per minute.)

Question 378

All of the following are true regarding automated external defibrillators except:
a) they can be used by any bystander
b) they are appropriate to use on adults and children
c) they provide a shock to restart the heart
d) they are used until EMS arrives

Answer 378

a) While many automated external defibrillators actually tell you what to do step-by-step, they are to be used only by trained personnel. There are now pediatric-sized pads, and some automated external defibrillators have a switch to deliver a pediatric-appropriate shock.