Seidel's ch 12

Question 1

A structure that protects the eye from foreign bodies is the a.conjunctiva. b.cornea. c.eyelid. d.sclera. e.lens.

Answer 1

ANS: C The eyelid distributes tears over the surface of the eye, limits the amount of light entering it, and protects the eye from foreign bodies.

Question 2

Tears flow over the cornea and drain via the lacrimal sac into the a. lacrimal gland. b. posterior pharynx. c. nasal meatus. d. thyroglossal duct. e. anterior fossa.

Answer 2

ANS: C Anatomically, the eye is closest to the nose, so tears drain from the lacrimal sac into the nasal lacrimal duct. The pharynx is the throat, and the thyroglossal duct deals with the tongue. The anterior fossa is the hollow bone that holds the lacrimal gland, which produces tears.

Question 3

Contraction of which eye structure controls the amount of light that reaches the retina? a. Retina b. Medial rectus muscle c. Sclera d. Lens e. Iris

Answer 3

ANS: E The iris is able to dilate and contract, allowing light to reach the retina. The retina is deep within the eye. The sclera is not able to dilate and contract, and the lens is merely a transparent disc that acts as a focus for the retina.

Question 4

Contraction or relaxation of the ciliary body a. allows voluntary blinking. b. changes lens thickness. c. regulates peripheral vision. d. sends light impulses to the brain. e. regulates tear production.

Answer 4

ANS: B The lens is circularly supported by a framework of fibers from the ciliary body, and contraction or relaxation of this structure results in a change in the thickness of the lens, allowing for accommodation as needed. Voluntary blinking, peripheral vision, tear production, and impulses to the brain are not controlled by the ciliary body.

Question 5

The sensory network of the eye is the a. cornea. b. iris. c. pupil d. retina. e. vitreous body

Answer 5

ANS: D The retina acts as the sensory network of the eye in that it sends electric impulses to the brain transformed from light. The cornea, iris, and pupil act together as an opening for light to pass through the lens. The vitreous body is the gelatinous mass posterior to the lens that gives shape to the globe.

Question 6

Term infants have a visual acuity of about a. 20/20. b. 20/100. c. 20/200. d. 20/300. e. 20/400.

Answer 6

ANS: E Term infants are hyperopic, with a visual acuity of less than 20/400.

Question 7

At what age does an infant usually develop the ability to distinguish color? a. At birth b. 2 months c. 6 months d. 12 months e. 16 months

Answer 7

ANS: C By 6 months of age, vision has developed so that colors can be differentiated.

Question 8

An increased level of lysozyme in the tears will occur normally during which life stage? a. Adolescence b. Childhood c. Infancy d. Pregnancy e. Older adults

Answer 8

ANS: D Because of rising hormonal levels, lysozyme is present in an increased amount in the tears during pregnancy. Tears are not affected by increased lysozyme at any other stage in life.

Question 9

A pregnant woman in her third trimester tells you that her vision has been a little blurred and she thinks she needs to get new contact lenses. You should advise her to a. get new lenses as soon as possible to avoid complications. b. wait until several weeks after delivery to get new lenses. c. go to the nearest emergency department for evaluation. d. change her diet to include more yellow vegetables. e. decrease her water intake.

Answer 9

ANS: B Because of the increased level of lysozyme in the tears during pregnancy, a blurred sensation may occur, but this subsides several weeks after pregnancy. This is a normal occurrence during pregnancy and is not diet- dependent, nor is it an emergency or urgent need.

Question 10

Which of the following is a relatively benign condition that may occur during pregnancy or labor? a. Macular degeneration b. Papilledema c. Subconjunctival hemorrhage d. Cupping of the optic disc e. Presbyopia

Answer 10

ANS: C Because of falling intraocular pressure during the late stages of pregnancy, hemorrhages may occur in the conjunctiva and resolve spontaneously. Papilledema is never a benign condition, and presbyopia, macular degeneration, and cupping of the optic disc occur in older adults.

Question 11

When does the lens usually become more rigid and the ciliary muscle of the iris become weaker? a. Adolescence b. Around 25 years of age c. Around 35 years of age d. Around 45 years of age e. Older than 65 years of age

Answer 11

ANS: D Starting at around 45 years of age, the lens starts to change and become more rigid, and the ciliary muscles begin to weaken.

Question 12

A condition that typically develops by the age of 45 years is a. presbyopia. b. hyperopia. c. myopia. d. astigmatism. e. cataracts.

Answer 12

ANS: A By 45 years of age, a condition known as presbyopia develops that involves a weakening of accommodation. Hyperopia occurs in early infancy; myopia and astigmatism can occur at any time. Cataracts generally develop in older adults.

Question 13

Which of the following findings, when seen in an infant, is most ominous? a. Difficulty tracking objects with the eyes b. Appearing to have better peripheral than central vision c. Blinking when bright light is directed at face d. White pupils on photographs e. The appearance of convergence

Answer 13

ANS: D The absence of a red reflex, either by physical examination or by white pupils with flash photography, is indicative of retinoblastoma, a serious retina tumor. The other choices are expected at this age.

Question 14

Which of the following is a genetic eye disorder that should be included in the history and physical examination, under family history, for all members of the affected family? a. Constrictive iritis b. Retinoblastoma c. Oval pupils d. Retinal hemorrhages e. Maculates

Answer 14

ANS: B Retinal cancer, or retinoblastoma, is a tumor originating from the retina and often occurs during the first 24 months of life. It has been found to be caused by an autosomal trait or a mutation of the chromosomes. Constrictive iritis, maculates, oval pupils, and retinal hemorrhages are not autosomal dominant disorders.

Question 15

A Rosenbaum card is used to measure a. distance perception. b. near vision. c. peripheral distortion. d. the ability to identify colors. e. extraocular movements.

Answer 15

ANS: B A Rosenbaum card is best used to measure nearsightedness because the patient holds the card a comfortable distance away and reads from the card. Distance perception cannot be accurately measured with a card held close. Peripheral vision and extraocular movements are assessed by an examiner by hand movements, and color identification can be measured with color cards.

Question 16

When measuring visual acuity, you are assessing cranial nerve a. I. b. II. c. IV. d. VI. e. VIII.

Answer 16

ANS: B Visual acuity is controlled by cranial nerve II. Cranial nerve I is designated for sense of smell, cranial nerve IV is designated for accommodation, and cranial nerve VI deals with lateral eye muscle movements. Cranial nerve VIII deals with hearing and balance.

Question 17

Measurement of near vision should be tested a. in each eye separately. b. with the head at a 45-degree angle. c. with the use of primary colors. d. using the Snellen chart. e. with the confrontation test.

Answer 17

ANS: A Near vision is measured by the Rosenbaum card and should be tested in each eye separately holding the card about 35 cm in front of the eye. Color identification is not measured by this test, and the Snellen chart tests visual acuity at 20 feet. The confrontation test is an imprecise way of testing peripheral vision.

Question 18

Mr. C’s visual acuity is 20/50. This means that he a. can see 50% of what the average person sees at 20 feet. b. has perfect vision when tested at 50 feet. c. can see 20% of the letters on the chart’s 20/50 line. d. can read letters while standing 20 feet from the chart that the average person could read at 50 feet. e. is legally blind.

Answer 18

ANS: D Visual acuity is measured as a fraction in which the top number is the distance that the patient is standing from the chart and the bottom number is the distance that an average person can stand and still read the line. Vision not correctable to better than 20/200 is considered legal blindness.

Question 19

Peripheral vision can be estimated by means of which test? a.Confrontation b.Pupillary reaction c. Accommodation d. Snellen chart e. Swinging flashlight

Answer 19

ANS: A The confrontation test measures peripheral vision. The examiner sits or stands across from the patient and asks the patient to close one eye while the examiner closes the opposite eye. The examiner then proceeds to wave the fingers while moving the extended arms from a lateral to a central position along both the temporal and the nasal fields. The pupillary reaction test is done by observing the pupil’s response to light. The accommodation test deals with pupil reaction to light, and the Snellen chart measures visual acuity. The swinging flashlight test evaluates the health of the optic nerve by looking for an afferent pupillary defect.

Question 20

The criterion for adequacy of a patient’s visual field is a. the ability to discriminate primary colors. b. the ability to discriminate details. c. correspondence with the visual field of the examiner. d. distance vision equal to that of an average person. e. pupillary constriction when an object is moved close to the nose.

Answer 20

ANS: C The examiner continuously compares his or her own peripheral vision with that of the patient while performing the confrontation test, so unless the examiner is aware of a problem with his or her own vision, the examiner could assume that the fields are full if they match. The confrontation test does not assess colors, details, or distance vision. Having a patient look at a distant object and then one held 10 cm from the nose tests the pupillary response to accommodation.

Question 21

Periorbital edema is a. an abnormal sign. b. expected with aging. c. more common in males. d. present in children. e. an abnormality of lipid metabolism.

Answer 21

ANS: A A clinical finding of periorbital edema should always be regarded as an abnormal finding until ruled otherwise.

Question 22

Xanthelasma may suggest that the patient has an abnormality of a. lipid metabolism. b. cognitive function. c. renal metabolism. d. bone marrow function. e. thyroid disease.

Answer 22

ANS: A Small, odd-shaped, yellow-colored plaques around the eyes are actually lipid deposits and are characteristic of a lipid metabolism problem. The other conditions are not associated with eye plaques.

Question 23

Mrs. S. is a 69-year-old woman who presents for a physical examination. On inspection of her eyes, you note that the left upper eyelid droops, covering more of the iris than does the right. This is recorded as _____ on the _____. a. exophthalmos; left b. ptosis; left c. nystagmus; left d. astigmatism; right e. ectropion; left

Answer 23

ANS: B Ptosis is when one of the upper eyelids covers more of the iris than the other eyelid, possibly extending over the pupil. Exophthalmos, nystagmus, and astigmatism are not conditions of the eyelid. Ectropion is an eversion of the lower eyelid.

Question 24

Ptosis may be secondary to a. blepharitis. b. hyperthyroidism c. psoriasis. d. paresis of a branch of cranial nerve III. e. entropion.

Answer 24

ANS: D Ptosis is caused by a congenital defect of the muscle around the eye controlled by cranial nerve III. Hyperthyroidism causes exophthalmos, psoriasis is a skin condition, and blepharitis is a crusting of the eyelashes. Entropion is an inversion of the lower eyelid.

Question 25

What is the condition called when the eyelid is turned away, or everted, from the globe? a. Ectropion b. Entropion c. Exophthalmos d. Ptosis e. Acute hordeolum

Answer 25

ANS: A Ectropion describes an everted lower eyelid that is turned away from the eye. Entropion describes the lower eyelid turning inward. Ptosis refers to a drooping of the upper eyelid. Exophthalmos is when the eye globe bulges. Acute hordeolum is an inflammation of the follicle of an eyelash.

Question 26

Entropion implies that the eyelid is a. drooping. b. everted. c. edematous. d. turned inward. e. inflamed.

Answer 26

ANS: D Entropion of the lower eyelid does not imply drooping, eversion, inflammation, or edema but is a slight inward turn of the lower eyelid.

Question 27

A condition in which the eyelids do not completely meet to cover the globe is called a. glaucoma. b. lagophthalmos. c. exophthalmos. d. hordeolum. e. blepharitis.

Answer 27

ANS: B Lagophthalmos is a term used to describe the condition in which the eyelids do not completely meet when closing. Glaucoma involves the optic nerve, exophthalmos involves bulging eyes, and hordeolum is better known as a sty. Blepharitis is crusting along the eyelashes, which can have several causes.

Question 28

Inspection of the tarsal conjunctiva should be performed a. with every eye examination. b. in eye examinations in patients older than 45 years of age. c. when a foreign body may be present. d. for the patient with glaucoma. e. with the patient looking upward.

Answer 28

ANS: C Inspecting the tarsal conjunctiva involves asking the patient to look down and pull the top eyelid down and up while everting the eyelid. This maneuver is reserved for inspection of a foreign body, as indicated.

Question 29

An allergy can cause the conjunctiva to have a a. cobblestone pattern. b. dry surface. c. subconjunctival hemorrhage. d. rust-colored pigment. e. pale appearance

Answer 29

ANS: A A red or cobblestone pattern, especially to the upper conjunctiva, indicates an allergic conjunctivitis. Allergies also cause itchy, watery eyes rather than dry surfaces, hemorrhage, or rust-colored pigment.

Question 30

An abnormal growth of conjunctiva extending over the cornea from the limbus is known as a. a cataract. b. erythematous. c. glaucoma. d. conjunctivitis. e. a pterygium.

Answer 30

ANS: E An abnormal growth of the conjunctiva that extends over the cornea is called a pterygium. Cataracts and glaucoma do not affect the conjunctiva, and erythematous means that the area is red and irritated. Conjunctivitis is an inflammation of the conjunctiva.

Question 31

A pterygium is more common in people heavily exposed to a. high altitudes. b. tuberculosis. c. ultraviolet light. d. cigarette smoke. e. lead.

Answer 31

ANS: C Persons heavily exposed to ultraviolet light are more susceptible to pterygium developments. High altitudes, tuberculosis, lead, and cigarette smoke do not cause an overgrowth of the conjunctiva.

Question 32

Mr. B was admitted from the emergency department, and you are completing his physical examination. His pupils are 2 mm bilaterally, and you notice that they fail to dilate when the penlight is moved away. This is characteristic in patients who are or have been a. in a coma. b. taking sympathomimetic drugs (e.g., cocaine). c. taking opioid drugs (e.g., morphine). d. treated for head trauma. e. atropine overdosed.

Answer 32

ANS: C Pupil constriction to less than 2 mm is called miosis. With miosis, the pupils fail to dilate in the dark, a common result of opioid ingestion or drops for glaucoma. Pupils are usually dilated greater than 6 mm in a coma and with sympathomimetic drugs, atropine, and head trauma.

Question 33

When testing corneal sensitivity controlled by cranial nerve V, you should expect the patient to respond by a. blinking. b. copious tearing. c. pupil dilation. d. reflex smiling. e. pupil constriction.

Answer 33

ANS: A Blinking is an expected response to corneal sensitivity testing, which involves gently touching the cornea with a piece of cotton. Copious tearing, pupil dilation, constriction, and reflex smiling do not involve cranial nerve V.

Question 34

You observe a pupillary response as the patient looks at a distant object and then at an object held 10 cm from the bridge of the nose. You are assessing for a. confrontation reaction. b. accommodation. c. pupillary light reflex. d. nystagmus. e. corneal circus senilis

Answer 34

ANS: B Testing for accommodation involves asking the patient to look at an object at a distance (pupils dilate) and then look at another object much closer (pupils constrict). The other choices do not test for accommodation.

Question 35

Mydriasis accompanies a. coma. b. diabetes. c. hyperopia. d. astigmatism. e. morphine administration.

Answer 35

ANS: A Coma patients always have mydriasis, which occurs when the pupils are dilated more than 6 mm. Diabetes may cause a coma but not mydriasis. Hyperopia is a condition of infants, describing their visual acuity as at or worse than 20/400. Astigmatism affects the shape of the lens, not the pupils. Opiates cause miosis.

Question 36

An inequality of pupillary size is called a. hyperopia. b. diopter. c. ptosis. d. anisocoria. e. mydriasis.

Answer 36

ANS: D Anisocoria is when the pupil sizes are not the same when compared together but the reflexes remain normal. Hyperopia is visual acuity equal to or worse than 20/400 in infants. Mydriasis is when the pupil sizes are large and even. Ptosis is droopy eyelid, and diopter is a unit of measurement used to focus a lens.

Question 37

When inspecting the region of the lacrimal gland, palpate a. the lower orbital rim near the inner canthus. b. in the area between the arch of the eyebrow and the upper eyelid. c. beneath the lower eyelid adjacent to the inner canthus. d. adjacent to the lateral aspect of the eye, just beneath the upper eyelid. e. medially above the eyebrow.

Answer 37

ANS: A The lacrimal gland is located in the area between the arch of the eyebrow and the upper lid. The lacrimal sac is located in the corner of the eye closest to the nose near the inner canthus.

Question 38

You note a dark, slate gray pigment just anterior to the insertion of the medial rectus muscle in an 80-year-old woman. Which action is appropriate? a. Record the finding in the patient’s record. b. Refer the patient to an ophthalmologist. c. Attribute the finding to type II hyperlipidemia. d. Ask the patient if she remembers being hit in the eye. e. Test the patient immediately for liver disease.

Answer 38

ANS: A This finding is consistent with senile hyaline plaque and does not indicate an emergency or disease process, but should be charted as a finding. With hyperlipidemia, yellow plaques are seen. Liver disease may produce a diffuse, yellow-green pigment in the sclera.

Question 39

An examination to assess for extraocular muscle imbalance is conducted by a. comparing pupillary responses to different shapes. b. everting the upper and lower eyelids. c. inspecting slightly closed lids for fasciculations. d. transilluminating the cornea with tangential light. e. having the patient follow your finger through different planes.

Answer 39

ANS: E The test for extraocular muscle function is to have the patient follow an object as you move it through the planes of vision while observing for nystagmus.

Question 40

When there is an imbalance found with the corneal light test, you should then perform the _____ test. a. confrontation b. accommodation c. cover–uncover d. visual acuity e. pupillary light reflex

Answer 40

ANS: C If the corneal light reflex demonstrates an imbalance, the next test to perform is the cover–uncover test. The confrontation test measures peripheral vision, the pupillary light reflex, the accommodation test assesses pupillary reaction to light, and the visual acuity test measures vision, all of which will not help to assess eye muscle imbalance further.

Question 41

To see retinal details in a patient with myopia, the examiner will need to a. adjust the ophthalmoscope into the plus lenses. b. move the ophthalmoscope backward. c. move the hand farther forward. d. examine the patient in a well-lighted room. e. turn the ophthalmoscope to a minus lens.

Answer 41

ANS: E A patient with myopia (nearsighted) has longer eyeballs, so light rays focus in front of the retina. To see the retina, the examiner should use the minus (red) numbers by moving the diopter wheel counterclockwise; to assess a patient with hyperopia, a plus lens should be used.

Question 42

The unit of measurement in describing lesion size and location on the fundus is the a. disc diameter. b. macular diameter. c. pupillary diameter. d. centimeter. e. diopter

Answer 42

ANS: A When examining the eye and the fundus comes into focus, the branching of blood vessels becomes apparent. These always branch away from the optic disc and can be used as landmarks to locate the optic disc. The disc itself measures about 1.5 mm in diameter and the disc diameter is therefore the unit of measurement used to describe lesion size and location on the fundus.

Question 43

Ask the patient to look directly at the light of the ophthalmoscope when you are ready to examine the a. retina. b. lens. c. retinal vessels. d. macula. e. optic disc.

Answer 43

ANS: D The macula is the site of central vision and is observed when the patient looks directly at the ophthalmoscope light.

Question 44

After focusing on a blood vessel in the retina with your ophthalmoscope, you attempt to locate the optic disc. You should a. follow the vessel as it branches out. b. have the patient move his or her eye laterally. c. have the patient move his or her eye up. d. have the patient move his or her eye down. e. follow the vessel as it converges into larger vessels.

Answer 44

ANS: E When you locate a vessel, follow it in the direction of the optic disc. Vessels nearer the disc are directionally toward the nose, are larger, and have less branching.

Question 45

After completion of your ophthalmoscopic examination, you record that the arteriole-to-venule ratio is 1:2 This indicates that the a. arterioles are narrowed. b. venules are narrowed. c. ratio is normal for a child. d. ratio is normal for an adult. e. arterioles are dilated.

Answer 45

ANS: A The expected ratio of arterioles to venules is 3:5 to 2:3. A 1:2 ratio indicates that the arterioles are narrower than normal.

Question 46

If a patient has early papilledema, the examiner will be able to detect a. dilated retinal veins. b. retinal vein pulsations. c. sharply defined optic discs. d. visual defects. e. narrowed retinal veins.

Answer 46

ANS: A Papilledema is cause by increased intracranial pressure along the optic nerve, pushing the vessels forward (cup protrudes forward) and dilating the retinal veins. On examination, papilledema is characterized by loss of definition of the optic disc. Vein pulsations and visual defects are not visible with an ophthalmoscope.

Question 47

Cupping of the optic disc may be a result of a. migraine headaches b. diabetes. c. glaucoma. d. dehydration. e. cataracts

Answer 47

ANS: C Cupping is seen with causes of increased intraocular pressure such as glaucoma. Migraine headaches and dehydration do not cause cupping of the optic disc. Diabetes results in cotton-wool patches and hemorrhages. Cataracts are clouding of the lens.

Question 48

Drusen bodies are most commonly a consequence of a. glaucoma. b. aging. c. presbyopia. d. papilledema. e. hypertension.

Answer 48

ANS: B Drusen bodies, or lesions or spots on the retina, are part of the aging process. Glaucoma, presbyopia, and papilledema do not present with spots on the retina. Retinal hemorrhages and cotton wool spots are associated with hypertensive retinopathy.

Question 49

When drusen bodies are noted to be increasing in number or in intensity of color, the patient should be further evaluated with a(n) a. Amsler grid. b. Snellen E chart. c. litmus test. d. confrontation test. e. Keith-Wagner-Barker (KWB) system.

Answer 49

ANS: A Drusen bodies, when they increase in number or intensity of color, may indicate a precursor state of macular degeneration. When this happens, the patient’s central vision should be assessed using the Amsler grid. The Snellen chart measures visual acuity, the litmus test is used for determining testing pH, and the confrontation test examines peripheral vision. The KWB system is a way of classifying retinal changes associated with hypertension.

Question 50

Cotton wool spots are most closely associated with a. glaucoma. b. normal aging processes. c. hypertension. d. eye trauma. e. hyperthyroidism.

Answer 50

ANS: C Cotton wool spots actually represent infarcts of the retina and are associated with hypertension or diabetes. Hyperthyroidism, glaucoma, and eye trauma do not present with cotton wool spots.

Question 51

The Keith-Wagner-Barker system group IV is characterized by the development of a. an increased light reflex in the arterioles. b. crossing defects. c. cotton wool spots. d. papilledema. e. retinal hemorrhages.

Answer 51

ANS: D The Keith-Wagner-Barker system is used to classify changes to the eyes caused by hypertension. Group IV is the class that represents evidence of papilledema. Increased light reflex is in group I, crossing defects are in group II, and cotton wool spots and retinal hemorrhages are in group III.

Question 52

Which of the following may be suggestive of Down syndrome? a. Drusen bodies b. Papilledema c. Narrow palpebral fissures d. Prominent epicanthal folds e. Entropion

Answer 52

ANS: D Prominent epicanthal folds, or slanting of the eyes, may be normal in Asian infants, but in other ethnic groups, it may indicate Down syndrome. Drusen bodies, papilledema, entropion, and narrow palpebral fissures are not associated with Down syndrome.

Question 53

To differentiate between infants who have strabismus and those who have pseudostrabismus, use the a. confrontation test. b. corneal light reflex. c. E chart. d. Amsler grid. e. cover–uncover test.

Answer 53

ANS: B The corneal light reflex is used with infants to differentiate between strabismus and pseudostrabismus by noting an asymmetric versus symmetric light reflex. The confrontation test, Amsler grid, cover–uncover test, and “E” chart do not assess strabismus.

Question 54

You are attempting to examine the eyes of a newborn. To facilitate eye opening, you would first a. dim the room lights. b. elicit pain. c. place the newborn in the supine position. d. shine the penlight in the newborn’s eyes. e. apply mydriatics.

Answer 54

ANS: A The best way to assess the eyes of a newborn is to start by dimming the lights because it encourages infants to open their eyes.

Question 55

White specks scattered in a linear pattern around the entire circumference of the iris are called a. drusen bodies. b. cotton wool spots. c. rust spots. d. Brushfield spots. e. band keratopathy.

Answer 55

ANS: D Brushfield spots strongly suggest Down syndrome or mental retardation and are characterized by white specks that align perfectly around the circumference of the iris. Drusen bodies, cotton wool spots, band keratopathy, and rust spots are not associated with mental retardation

Question 56

Opacities of the red reflex may indicate the presence of a. hypertension. b. hydrocephalus. c. cataracts. d. myopia. e. diabetes.

Answer 56

ANS: C Opacities or dark spots of the red reflex may indicate the presence of congenital cataracts in newborns. Opacities or dark spots of the red reflex are not associated with hypertension, diabetes, hydrocephalus, or myopia.

Question 57

The Snellen E chart is appropriate for initial visual acuity in a child of which age? a. Newborn b. 6 months c. 18 months d. 3 years e. 8 years

Answer 57

ANS: D For the Snellen chart to be accurate, the child must be cooperative, and usually by age 3 years, visual acuity can be assessed. Newborns and infants 6 and 18 months of age are much too young to assess visual acuity, and age 8 years is too late to test for it initially.

Question 58

You normally expect a child to achieve 20/20 vision by age ____ years. a. 3 b. 4 c. 5 d. 6 e. 8

Answer 58

ANS: A At 3 years of age, children are expected to achieve 20/20 visual acuity.

Question 59

What maneuver can be done to reduce the systemic absorption of cycloplegic and mydriatic agents when examining a pregnant woman if the examination is mandatory? a. Have the woman keep her eyes closed for several minutes. b. Instill half the usual dosage. c. Keep the patient supine. d. Use nasolacrimal occlusion after instillation. e. Have the patient keep her head turned and flexed.

Answer 59

ANS: D To reduce absorption systemically, the examiner may use the nasolacrimal occlusion after application, which involves pinching the upper bridge of the nose. Keeping the eyes closed, instilling half of the usual dosage, and having the patient position her head a certain way will not prevent absorption through the nasal membranes.

Question 60

Episcleritis may indicate a. lipid abnormalities. b. an autoimmune disorder. c. an anaphylactoid reaction. d. severe anemia. e. thyroid disease.

Answer 60

ANS: B Episcleritis is an inflammation of the sclera, involves purplish bumps, and is commonly associated with autoimmune disorder. Lipid abnormalities, anaphylactoid reactions, anemia, and thyroid disease are not associated with these symptoms.

Question 61

The most common cause of exophthalmos is a. Graves disease. b. diabetes. c. hypertension. d. glaucoma. e. Crohn disease.

Answer 61

ANS: A Graves disease is the most common cause of exophthalmos, which is an increase in the eye tissue resulting in the characteristic bulging eyes. However, if exophthalmos only involves one eye, suspect a tumor as the cause. Diabetes, hypertension, glaucoma, and Crohn disease do not cause eye tissue to increase in size.

Question 62

Horner syndrome is manifested by a. proptosis and contralateral mydriasis. b. excessive watering of the eyes. c. blurring of vision when glucose levels fall. d. ipsilateral miosis and mild ptosis. e. band keratopathy and miosis.

Answer 62

ANS: D Horner syndrome is characterized by mild pupil constriction and drooping of the upper eyelid of the same eye. Horner syndrome is a result of a break in the sympathetic nerve supply to that eye. Mydriasis involves enlarged pupils. Watering of the eyes and blurred vision are not affected by a disruption in the sympathetic nervous system. Band keratopathy is a result of chronic corneal disease and is not associated with Horner syndrome

Question 63

Dot hemorrhages, or microaneurysms, and the presence of hard and soft exudates are most commonly seen in a. Down syndrome. b. diabetic retinopathy. c. systemic lupus. d. glaucoma. e. retinitis pigmentosa.

Answer 63

ANS: B Dot hemorrhages or tiny aneurysms are characteristic of background retinopathy. A trapping of lipids within incompetent capillaries causes the hemorrhages. Aneurysms in the retina are not symptoms of Down syndrome, lupus, glaucoma, or retinitis pigmentosa.

Question 64

Changes seen in proliferative diabetic retinopathy are the result of a. anoxic stimulation. b. macular damage. c. papilledema. d. minute hemorrhages. e. chorioretinal scarring.

Answer 64

ANS: A New vessels are a characteristic seen in proliferative retinopathy resulting from anoxic stimulation. An insufficient blood supply because of failing capillaries causes new vessel growth. Macular damage, papilledema, chorioretinal inflammation, and resultant scarring do not involve new inadequate vessel growth.

Question 65

Bone spicule pigmentation is a hallmark of a. chorioretinal pigmentosa. b. cytomegalovirus infection. c. lipemia retinalis. d. retinitis pigmentosa. e. choroidal nevus.

Answer 65

ANS: D Retinitis pigmentosa is inherited night blindness, characterized by the hallmark pigmentation of the peripheral fields or bone spicules.

Question 66

An initial sign of retinoblastoma in an infant is a. the cat’s eye reflex. b. the red reflex. c. the corneal light reflex. d. the absence of a blink reflex. e. Brushfield spots.

Answer 66

ANS: A Retinoblastoma in an infant is marked by a characteristic white reflex, also called cat’s eye reflex. Red reflex and corneal light reflex are expected findings. Absence of the blink reflex is not associated with retinoblastoma. Brushfield spots on the iris strongly suggest Down syndrome or mental retardation.

Question 67

Retinal hemorrhages in an infant require investigation for a. retinoblastoma. b. retrolental fibroplasia. c. pituitary tumor. d. child abuse. e. strabismus.

Answer 67

ANS: D Beyond newborn age, any hemorrhages to the retina indicate infection, allergy, or trauma and should be further investigated. Retinoblastoma, retrolental fibroplasia, pituitary tumors, and strabismus are not associated with retinal hemorrhages.