1. Contraction or relaxation of the ciliary body: a. allows voluntary blink- ing. b. changes lens thickness. c. regulates peripheral vi- sion. d. sends
... [Show More] light impulses to the brain. e. regulates tear produc- tion. 2. Term infants have a visual acuity of about: a. 20/20. b. 20/100. c. 20/200. d. 20/300. e. 20/400 3. 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 4. An increased level of lysozyme in the tears will occur normally during which life stage? a. Adolescence b. Childhood ANS: B The lens is circularly supported by a framework of fibers from the ciliary body, and contrac- tion 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 impuls- es to the brain are not controlled by the ciliary body. ANS: E Term infants are hyperopic, with a visual acuity of less than 20/400. ANS: C By 6 months of age, vision has developed so that colors can be differentiated. 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. c. Infancy d. Pregnancy e. Older adults 5. Which of the following is a relatively benign condition that may occur during preg- nancy or labor? a. Macular degeneration b. Papilledema c. Subconjunctival hemor- rhage d. Cupping of the optic disc e. Presbyopia 6. A condition that typically develops by the age of 45 years is: a. presbyopia. b. hyperopia. c. myopia. d. astigmatism. e. cataracts. 7. Which of the following find- ings, when seen in an in- fant, is most ominous? a. Difficulty tracking ob- jects with the eyes b. Appearing to have better peripheral than central vi- sion c. Blinking when bright light is directed at face d. White pupils on pho- tographs ANS: C Because of falling intraocular pressure dur- ing the late stages of pregnancy, hemorrhages may occur in the conjunctiva and resolve spon- taneously. Papilledema is never a benign con- dition, and presbyopia, macular degeneration, and cupping of the optic disc occur in older adults. 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. ANS: D The absence of a red reflex, either by phys- ical examination or by white pupils with flash photography, is indicative of retinoblastoma, a serious retina tumor. The other choices are ex- pected at this age e. The appearance of con- vergence 8. Which of the following is a genetic eye disorder that should be included in the history and physical exami- 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 nation, under family history, found to be caused by an autosomal trait or for all members of the af- fected family? a. Constrictive iritis b. Retinoblastoma c. Oval pupils d. Retinal hemorrhages e. Maculates 9. 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 per- son could read at 50 feet. e. is legally blind. 10. Peripheral vision can be es- timated by means of which test? a. Confrontation b. Pupillary reaction a mutation of the chromosomes. Constrictive iritis, maculates, oval pupils, and retinal hemor- rhages are not autosomal dominant disorders. ANS: D Visual acuity is measured as a fraction in which the top number is the distance that the pa- tient 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. 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 c. Accommodation d. Snellen E chart e. Swinging flashligh 11. The criterion for adequacy fingers while moving the extended arms from a lateral to a central position along both the temporal and the nasal fields. The pupillary re- action test is done by observing the pupil's re- sponse to light. The accommodation test deals with pupil reaction to light, and the Snellen E chart measures visual acuity. The swinging flashlight test evaluates the health of the optic nerve by looking for an afferent pupillary defect ANS: C of a patient's visual field is: The examiner continuously compares his or her own peripheral vision with that of the pa- 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. 12. 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. 13. Xanthelasma may suggest that the patient has an ab- normality of: a. lipid metabolism. tient 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 ANS: A A clinical finding of periorbital edema should always be regarded as an abnormal finding until ruled otherwise. ANS: A Small, odd-shaped, yellow-colored plaques around the eyes are actually lipid deposits and are characteristics of a lipid metabolism prob- b. cognitive function. c. renal metabolism. d. bone marrow function. e. thyroid disease. 14. Ptosis may be secondary to: a. blepharitis. b. hyperthyroidism. c. psoriasis. d. paresis of a branch of cranial nerve III. e. entropion. 15. Entropion implies that the eyelid is: a. drooping. b. everted. c. edematous. d. turned inward. e. inflamed. 16. 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 17. An allergy can cause the conjunctiva to have a: a. cobblestone pattern. b. dry surface. lem. The other conditions are not associated with eye plaques. ANS: D Ptosis is caused by a congenital defect of the muscle around the eye controlled by cranial nerve III. Hyperthyroidism causes exophthal- mos, psoriasis is a skin condition, and blephar- itis is a crusting of the eyelashes. Entropion is an inversion of the lower eyelid. 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. ANS: B Lagophthalmos is a term used to describe the condition in which the eyelids do not completely meet when closing. Glaucoma involves the op- tic nerve, exophthalmos involves bulging eyes, and hordeolum is better known as a sty. Ble- pharitis is crusting along the eyelashes, which can have several causes ANS: A A red or cobblestone pattern, especially to the upper conjunctiva, indicates an allergic con- junctivitis. Allergies also cause itchy, watery c. subconjunctival hemor- rhage. d. rust-colored pigment. e. pale appearance. 18. A pterygium is more com- mon in people heavily ex- posed to: a. high altitudes. b. tuberculosis. c. ultraviolet light. d. cigarette smoke. e. lead. 19. Mr. B was admitted from eyes rather than dry surfaces, hemorrhage, or rust-colored pigment. 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 con- junctiva. ANS: C the emergency department, Pupil constriction to less than 2 mm is called 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 char- acteristic 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. 20. You observe a pupillary re- sponse as the patient looks at a distant object and then 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 sympa- thomimetic drugs, atropine, and head trauma ANS: B Testing for accommodation involves asking the patient to look at an object at a distance (pupils at an object held 10 cm from dilate) and then look at another object much the bridge of the nose. You are assessing for: a. confrontation reaction. b. accommodation. c. pupillary light reflex. d. nystagmus. e. corneal arcus senilis. 21. Mydriasis accompanies: a. coma. b. diabetes. c. hyperopia. d. astigmatism. e. morphine administration. 22. When inspecting the region of the lacrimal gland, pal- pate: 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 can- thus. d. adjacent to the lateral as- pect of the eye, just beneath the upper eyelid. e. medially above the eye- brow. 23. To see retinal details in a patient with myopia, the ex- aminer will need to: closer (pupils constrict). The other choices do not test for accommodation. 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 ANS: A The lacrimal gland is located in the area be- tween 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. 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 a. adjust the ophthalmo- scope into the plus lenses. b. move the ophthalmo- scope backward. c. move the hand farther forward. d. examine the patient in a well-lighted room. e. turn the ophthalmoscope to a minus lens. 24. 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. 25. Ask the patient to look di- rectly at the light of the oph- thalmoscope when you are ready to examine the: a. retina. b. lens. c. retinal vessels. d. macula. e. optic disc. 26. After focusing on a blood vessel in the retina with your ophthalmoscope, you attempt to locate the optic disc. You should: the minus (red) numbers by moving the diopter wheel counterclockwise; to assess a patient with hyperopia, a plus lens should be used ANS: A When examining the eye and the fundus comes into focus, the branching of blood vessels be- comes apparent. These always branch away from the optic disc and can be used as land- marks to locate the optic disc. The disc itself measures about 1.5 mm in diameter and the disc diameter is therefore the unit of measure- ment used to describe lesion size and location on the fundus. ANS: D The macula is the site of central vision and is observed when the patient looks directly at the ophthalmoscope light. ANS: E When you locate a vessel, follow it in the direc- tion of the optic disc. Vessels nearer the disc are directionally toward the nose, are larger, and have less branching. 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 ves- sels 27. If a patient has early pa- pilledema, 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 28. Cupping of the optic disc may be a result of: a. migraine headaches. b. diabetes. c. glaucoma. d. dehydration. e. cataracts. 29. Drusen bodies are most commonly a consequence of: a. glaucoma. b. aging. c. presbyopia. ANS: A Papilledema is caused by increased intracra- nial pressure along the optic nerve, pushing the vessels forward (cup protrudes forward) and dilating the retinal veins. On examination, pa- pilledema is characterized by loss of definition of the optic disc. Vein pulsations and visual defects are not visible with an ophthalmoscope. ANS: C Cupping is seen with causes of increased in- traocular pressure such as glaucoma. Migraine headaches and dehydration do not cause cup- ping of the optic disc. Diabetes results in cotton wool patches and hemorrhages. Cataracts are clouding of the lens. ANS: B Drusen bodies, or lesions or spots on the reti- na, 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 hy- pertensive retinopathy. d. papilledema. e. hypertension. 30. Cotton wool spots are most closely associated with: a. glaucoma. b. normal aging processes. c. hypertension. d. eye trauma. e. hyperthyroidism. 31. 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. 32. Opacities of the red reflex may indicate the presence of: a. hypertension. b. hydrocephalus. c. cataracts. d. myopia. e. diabetes. 33. What maneuver can be done to reduce the sys- temic absorption of cyclo- plegic and mydriatic agents when examining a pregnant patient if the examination is mandatory? 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. ANS: D Brushfield spots strongly suggest Down syn- drome or mental retardation and are character- ized 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 retarda- tion. 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. ANS: D To reduce absorption systemically, the exam- iner 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 a. Have the woman keep her membranes. eyes closed for several min- utes. b. Instill half the usual dosage. c. Keep the patient supine. d. Use nasolacrimal occlu- sion after instillation. e. Have the patient keep her head turned and flexed. 34. Episcleritis may indicate: a. lipid abnormalities. ANS: B Episcleritis is an inflammation of the sclera, in- volves purplish bumps, and is commonly asso- b. an autoimmune disorder. ciated with autoimmune disorder. Lipid abnor- c. an anaphylactoid reac- tion. d. severe anemia. e. thyroid disease. 35. Horner syndrome is mani- fested by: a. proptosis and contralat- eral 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. 36. Dot hemorrhages, or mi- croaneurysms, and the presence of hard and soft exudates are most com- malities, anaphylactoid reactions, anemia, and thyroid disease are not associated with these symptoms. 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. ANS: B Dot hemorrhages or tiny aneurysms are char- acteristics of background retinopathy. A trap- ping of lipids within incompetent capillaries monly seen in: causes the hemorrhages. Aneurysms in the retina are not symptoms of Down syndrome, a. Down syndrome. lupus, glaucoma, or retinitis pigmentosa b. diabetic retinopathy. c. systemic lupus. d. glaucoma. e. retinitis pigmentosa. 37. Changes seen in prolifer- ANS: A ative diabetic retinopathy New vessels are a characteristic seen in prolif- are the result of: erative retinopathy resulting from anoxic stim- ulation. An insufficient blood supply because a. anoxic stimulation. of failing capillaries causes new vessel growth. b. macular damage. Macular damage, papilledema, chorioretinal in- c. papilledema. flammation, and resultant scarring do not in- d. minute hemorrhages. volve new inadequate vessel growth. e. chorioretinal scarring. 38. Bone spicule pigmentation ANS: D is a hallmark of: Retinitis pigmentosa is inherited night blind- ness, characterized by the hallmark pigmenta- a. chorioretinal pigmen- tion of the peripheral fields or bone spicules. tosa. b. cytomegalovirus infec- tion. c. lipemia retinalis. d. retinitis pigmentosa. e. choroidal nevus. 39. Retinal hemorrhages in an ANS: D infant require investigation Beyond newborn age, any hemorrhages to for: the retina indicate infection, allergy, or trauma and should be further investigated. Retinoblas- a. retinoblastoma. toma, retrolental fibroplasia, pituitary tumors, b. retrolental fibroplasia. and strabismus are not associated with retinal c. pituitary tumor. hemorrhages. d. child abuse. e. strabismus. 40. ANS: A. Narrowed retinal arteries Which finding during an ophthalmoscopic examina- tion suggests the patient has hypertension? a. Narrowed retinal arteries b. Presence of the red reflex c. Crossing of arterioles and venules d. Absence of cones and rods in the optic disc 41. Which condition of the eye is associated with impaired vision? a. Anisocoria b. Blepharitis c. Arcus senilis d. Corneal scar 42. An increased number of drusen in the macular area are noted on ophthalmo- scopic examination. What action should follow? a. Refer for cataract extrac- tion surgery. b. Measure the intraocular pressure. c. Check for the presence of the corneal reflex. d. Ask the patient to self-test using the Amsler grid. 43. Which test assesses a pa- tient's peripheral vision? ANS: D. Corneal scar ANS: D. Ask the patient to self-test using the Amsler grid. ANS: B. Confrontation test a. Cover test b. Confrontation test c. Reading from a Jaeger card d. Reading from a Snellen chart 44. Which instruction is given to a patient for the Snellen test? a. Each eye is tested sep- arately and then with both eyes. b. Testing will be done with and without the corrective lens. c. The patient advances to the next row if 75% of the letters are correct. d. Apply slight pressure on the covered eye to assist vi- sion in eye being tested. 45. Which patient concern sug- gests the development of a cataract? a. Poor night vision b. Inability to focus close up c. Having blind spots in vi- sion d. Gradual loss of peripher- al vision 46. What is the common cause of a hordeolum? ANS: B. Testing will be done with and without the corrective lens. ANS: A. Poor night vision ANS: D. Infection due to Staphylococcus au- reus a. Error in lipid metabolism b. Increased intraocular pressure c. Prolonged exposure to ultraviolet light d. Infection due to Staphy- lococcus aureus [Show Less]