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.