COA Flashcards - Exam Review Manual

Question 1

A history is obtained by:
a - asking a series of organized and specific questions
b - observing the patient’s actions n the exam room
c - allowing the patient to discuss anything he or she wishes
d - asking the same questions of each patient during every exam

Answer 1

a - asking a series of organized and specific questions

• The questions should be organized and specific, directing the patient’s narrative and tailored to the problems at hand.

Question 2

The history should be recorded:
a - by writing down the patient’s entire story, word-for-word
b - by condensing the patient’s story, including pertinent information
c - by interpreting the patient’s story and suggesting a diagnosis
d - by copying patient information from a questionnare

Answer 2

b - by condensing the patient’s story, including pertinent information

• The assistant should avoid writing down the patient’s every word or trying to interpret. Diagnosis is the physician’s realm. Questionnaires have their place but cannot be used for an entire history because each patient is different.

Question 3

When taking a history on a school-aged child, it is important to:
a - listen only to the parent’s account of the illness
b - listen only to the child’s account of the illness
c - talk to the parent outside of the child’s hearing
d - get an account of the illness from both the parent and the child

Answer 3

d - get an account of the illness from both the parent and the child

• A normal school-aged child is usually able to give a fairly good history, with the parent affirming the information

Question 4

Which of the following is false?
a - A thorough history can direct a physician toward a final diagnosis
b - all information given by the patient can be shared with insurance companies without patient permission
c - statements made by the patient should lead the assistant into additional questions that can be asked
d - all patient information is private unless a consent release form is signed

Answer 4

b - all information given by the patient can be shared with insurance companies without patient permission

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

Question 5

Which of the following is NOT part of a history?
a - presenting complaint
b - medications currently used
c - family eye disease
d - visual acuity

Answer 5

d - visual acuity

• Visual acuity is part of the examination, not the history

Question 6

The “presenting complaint” is:
a - the main reason that the patient has come to the office
b - always the most serious of the patient’s many complaints
c - the only item with which the history is really concerned
d - the main reason the patient should be dilated

Answer 6

a - the main reason that the patient has come to the office

• The presenting complaint is the patient’s main reason for coming in. An accurate history might include other complaints as well, however.

Question 7

An example of a question relating to onset would be:
a - “can you still function at work?”
b - “when did you first notice the problem?”
c - “what treatment have you tried?”
d - “has the problem worsened?”

Answer 7

b - “when did you first notice the problem?”

• Onset relates to when the patient first noticed the problem

Question 8

The question “Does your head hurt so badly that you have to leave school early?” relates to:
a - onset
b - duration
c - progression
d - severity

Answer 8

d - severity

• The severity of the problem relates to the amount of disability a patient suffers

Question 9

To obtain the most important information about the presenting complaint, you should ask questions relating to:
a - location, timing, aggravating and alleviating factors, and family history
b - location, quality, severity, timing, and aggravating/alleviating factors
c - location, severity, timing, drug allergies, and past surgical procedures
d - present illness, past ocular history, family history, and description of pain

Answer 9

b - location, quality, severity, timing, and aggravating/alleviating factors

• The above are all pertinent questions regarding the presenting complaint. Family history, drug allergies, past surgical procedures and past ocular history are all important parts of the history, but not the most important regarding the presenting complaint.

Question 10

A symptom is:
a - something you notice when you look at the patient
b - something that can always be tested and proven
c - a change noticed by the patient
d - any change that results from injury

Answer 10

c - a change noticed by the patient

• A symptom is a change that the patient notices, whether from injury, illness, or another situation. It cannot always be proven (e.g. pain) or seen by looking (e.g. pressure sensation)

Question 11

An example of a sign is:
a - the patient tells you what part of the eye hurts
b - an elevated intraocular pressure reading
c - the patient complaint of blurred vision
d - the patient complains of a pressure sensation behind the eyes

Answer 11

b - an elevated intraocular pressure reading

• A sign is something you can observe in the patient, such as an intraocular pressure reading. The other answers are symptoms.

Question 12

A 56-year-old patient complains of a sudden onset of double vision. It is most important to ask:
a - “Does the doubling go away if you cover one eye?”
b - “Are the eyes also red?”
c - “Do the eyes ache?”
d - “Does anyone in your family have a lazy eye?”

Answer 12

a - “Does the doubling go away if you cover one eye?”

• Double vision in an adult is potentially serious. If vision is single with one eye covered, this indicates a muscle balance problem, which could indicate a possible brain tumor or nerve disorder. If vision is double in one eye only, the eye itself has a problem. The other answers are irrelevant to the situation.

Question 13

An old photograph of the patient will be most useful to the physician if the patient complains of or exhibits:
a - eye protrusion, double vision, or floaters
b - lid droop, pupil abnormality, or head tilt
c - redness, pain, halos around lights at night, and decreased vision
d - headache, rash, or lid droop

Answer 13

b - lid droop, pupil abnormality, or head tilt

• If any of the conditions listed in this answer are present in the photograph, this indicates that the problem is longstanding

Question 14

Your patient has a cut eyelid. It is important to know what caused the injury because:
a - this will determine how the doctor will repair the lid
b - if the object was organic (plant or animal), there is a greater risk of infection
c - if the object was metal, there is a greater risk of infection
d- the injury needs to be reported to the National Ocular Injury Registry (NOIR)

Answer 14

b - if the object was organic (plant or animal), there is a greater risk of infection

• Any laceration that was caused by or infused with organic matter has a much greater likelihood of becoming infected. The physician might choose to give an oral antibiotic.
  (There is no such thing as the NOIR!)

Question 15

A patient presents with a corneal foreign body, and your supervisor asks how the foreign body got into the eye. This is an important question because:
a - if the patient was not wearing safety glasses, Workers’ Compensation will not pay
b - if the particle was under high speed, there might be internal ocular damage
c - this determines whether or not you should check the patient’s vision
d - this determines whether or not you should irrigate the eye

Answer 15

b - if the particle was under high speed, there might be internal ocular damage

• a foreign body a high speed might cause serious internal damage. The patient’s vision is checked regardless of how the injury occurred. While it is true that you should not irrigate an eye if you suspect the globe has been penetrated (nor is irrigation usually used for a corneal foreign body)

Question 16

The patient is not wearing contacts but would like to be fit for them. The most important question is:
a - “have you tried contact lenses before?”
b - “are you interested in disposable lenses?”
c - “do you have trouble seeing to read?”
d - “are you allergic to thimerosal?”

Answer 16

a - “have you tried contact lenses before?”

• It is most important to know a patient’s past experience with contacts. Answers b and c are not wrong, but they are not best. Thimerosal is a preservative that was formerly used in contact lens solutions but was largely discontinued when many people developed a sensitivity to it.

Question 17

A 52-year-old patient hands you his single-vision glasses, the only glasses he has. Which of the following is the most important question in determining the patient’s refractive status?
a - “how long have you had these?”
b - “do these help you see better?”
c - “do you wear these for driving or for reading?”
d - “do the frames hurt your ears?”

Answer 17

c - “do you wear these for driving or for reading?”

• While all questions are good ones, you can determine the patient’s refractive status only if you know how he uses the glasses. At his age, he has been presbyopic for a number of years. If the glasses are for driving, he is myopic. If the glasses are for reading, he is probably emmetropic withe presbyopia.

Question 18

A patient reports that he sleeps in his contact lenses. An important question would be:
a - “what type of lenses are they?”
b - “do you have astigmatism?”
c - “why haven’t you had LASIK?”
d - “are you legally blind without the contacts?”

Answer 18

a - “what type of lenses are they?”

• You need to know about the lens material. It may be okay to sleep in a disposable extended-wear lens, for example, but some contact should bever be left in during sleep, and the patient is doing something potentially harmful.

Question 19

The patient gives a history of having a cataract removed with a laser. You should:
a - record the cataract surgery without mentioning the laser, because the patient does not know what he or she is talking about.
b - use this as a “teachable moment” and inform the patient that cataracts cannot be removed with a laser
c - ask the patient if the surgery was done in a hospital while lying down or sitting up in a chair (to an instrument like a slit lamp)
d - not record this, because the patient is obviously confused

Answer 19

c - ask the patient if the surgery was done in a hospital while lying down or sitting up in a chair (to an instrument like a slit lamp)

• When a patient says something that does not make ophthalmic sense, ask more questions before writing it in the history. She may be referring to having a laser capsulotomy for a so-called “secondary cataract”.

Question 20

The patient gives a history of having a laser treatment but is not sure what it was for. You might discover more by asking:
a - “have you had cataract surgery?”
b - “do you have diabetes?”
c - “do you have glaucoma?”
d - all of the above

Answer 20

d - all of the above

• Laser treatment might be used after cataract surgery (laser capsulotomy), in the case of diabetes (photocoagulation), or glaucoma (trabeculectomy or iridotomy)

Question 21

The patient states she used to wear contact lenses but went back to her glasses. A pertinent question would be:
a - “do you have astigmatism?”
b - “do you think the lenses were improperly fit?”
c - “why did you stop wearing them?”
d - “do you have dry eyes?”

Answer 21

c - “why did you stop wearing them?”

• Answers a and d are not bad questions, but they are not the best. Answer b could imply a judgment on the patient’s past care, which is not ethical as it calls into question the competency of another practitioner

Question 22

A 76-year-old new patient tells you that he caught astigmatism from his brother when they were both children. You should:
a - tell him he is wrong because astigmatism is not a disease
b - agree with him because astigmatism can run in families
c - ask him what he means by “astigmatism”
d - explain that astigmatism is a refractive error

Answer 22

c - ask him what he means by “astigmatism”

• The patient obviously has a misconception about the origin of astigmatism, or he may have misapplied the term to some type of infection. Ask him.

Question 23

Knowledge of a past ocular injury is needed because:
a - it might help explain current complaints and findings
b - it might indicate a reason why the patient’s vision should not be checked
c - it might indicate the reason for an allergy to eye drops
d - a careless, accident-prone patient is likely to be noncompliant

Answer 23

a - it might help explain current complaints and findings

• A patient’s current problems may stem from past injury (such as recurrent erosion syndrome).

Question 24

The patient states she has prism in her glasses. Which of the following is the most important question to ask?
a - “have you ever had surgery to straighten your eyes?”
b - “does anyone in your family have a lazy eye?”
c - “have you recently tried glasses without prism?”
d - “were you dilated during your last eye exam?”

Answer 24

a - “have you ever had surgery to straighten your eyes?”

• Prism is usually prescribed to overcome motility disorders; hence, asking about surgery to straighten the eyes is in order.

Question 25

A mother brings in her 4-year-old son. The mother says he has a lazy eye. What do you need to find out? a - was the birth premature? b - who else in the family has a lazy eye? c - does the child rub one eye frequently? d - what does she mean by "lazy eye"?

Answer 25

d - what does she mean by "lazy eye"? * She may mean an eye that "looks weak" or crosses. Or she might mean amblyopia. Answers b and c are good but are not key. Answer a is irrelevant in this case.

Question 26

An example of a systemic illness is: a - down syndrome b - senility c - past surgical procedures d - cardiac problems

Answer 26

d - cardiac problems * "Cardiac problems" is the only systemic illness listed. Down syndrome may have systemic effects, but it is a genetic condition, not an illness.

Question 27

Questions asked of a hypertensive patient should include: a - method of blood pressure control, sensation of pressure in the eyes, last blood pressure reading b - weight loss, last blood gases reading, visual stability c - method of blood pressure control, decrease in vision, last blood pressure reading d - method of blood pressure control, onset of double vision, last blood sugar reading

Answer 27

c - method of blood pressure control, decrease in vision, last blood pressure reading * You need to know how a hypertensive patient controls the blood pressure (medications can affect the eyes), any decrease in vision (possible symptoms of hypertensive retinopathy), and the last blood pressure reading (to compare with the one obtained today).

Question 28

Questions asked of a diabetic patient should include: a - loss of depth perception, visual stability, type of insulin used b - method of sugar control, visual stability, last blood sugar reading c - weight loss, last blood gases reading, type of insulin used d - injection sites used, increased floaters, frequent urination

Answer 28

b - method of sugar control, visual stability, last blood sugar reading * A diabetic patient should tell you how he or she is controlling his or her blood sugar (diet, pills or injections), whether or not vision seems stable (fluctuations indicate uncontrolled blood sugar and may affect the refractometric measurement), and his or her last blood sugar reading (preferably the A1C, a single test that evaluates levels over a 90-day period).

Question 29

A patient with heart problems: a - may need to eat something during an eye exam b - cannot be dilated c - may have hardening of the arteries in the eye d - always has high cholesterol

Answer 29

c - may have hardening of the arteries in the eye * Ocular disorders associated with heart problems include hardening of the arteries and/or blood vessel blockage. Patients can be safely dilated in most cases. Answer d is wrong because of the word "always."

Question 30

Knowledge of a patient's breathing or lung problems would be important if the patient also has: a - dry eye b - glaucoma c - macular degeneration d - oxygen deficiency color blindness

Answer 30

b - glaucoma * Certain glaucoma medications are contraindicated in patients with lung disease

Question 31

Your patient states that he has rheumatoid arthritis. You should not ask symptom related questions to find out if he has: a - dry eye b - angle-closure glaucoma c - decreased central vision d - a visual field loss

Answer 31

a - dry eye * Dry eye is strongly associated with rheumatoid arthritis

Question 32

Sickle cell disease: a - is hereditary and occurs primarily in the black population b - is hereditary and occurs primarily in the white population c - is hereditary and occurs equally in all populations d - is hereditary and occurs primarily in the Latino population

Answer 32

a - is hereditary and occurs primarily in the black population * Sickle cell disease occurs mainly in the black population and is hereditary

Question 33

Sickle cell disease may affect the eye: a - by causing a paralysis of the extraocular muscles b - by causing posterior subcapsular cataracts c - because the abnormally shaped cells can block the optic nerve d - because the abnormally shaped cells can block the eye's blood vessels

Answer 33

d - because the abnormally shaped cells can block the eye's blood vessels * These blockages can happen anywhere in the body, including the eye

Question 34

Knowing a patient's past history of surgical procedures is important because: a - it may reveal precautions needed before eye surgery is undertaken b - it reveals whether or not the patient is likely to be compliant c - it may reveal whether or not the patient is a hypochondriac d - it reveals whether or not the patient may be reluctant to have future surgery

Answer 34

a - it may reveal precautions needed before eye surgery is undertaken * A patient's reaction to prior surgery (e.g. excessive bleeding or panic) can be a good indicator f how he or she will tolerate future procedures

Question 35

Major infections that can affect the eye include: a - Human immunodeficiency virus (HIV), gonorrhea, tuberculosis and herpes simplex b - gonorrhea, tuberculosis, Down syndrome and leukemia c - sickle cell disease, HIV, tuberculosis and toxemia d - herpes simplex, herpes zoster, anemia and gonerrhia

Answer 35

a - Human immunodeficiency virus (HIV), gonorrhea, tuberculosis and herpes simplex * Each item in answer a is an infection. Down syndrome, leukemia, sickle cell disease, toxemia and anemia are not infections; they are conditions or disorders.

Question 36

Your patient is a 4-month-old who was born prematurely. Which question will be most important in predicting the occurrence of eye disorders related to prematurity? a - how much did the baby weigh? b - was the mother exposed to measles during pregnancy? c - did the baby receive oxygen after birth? d - has the baby steadily gained weight since birth?

Answer 36

c - did the baby receive oxygen after birth? * Oxygen therapy after a premature birth has been linked to retinopathy of prematurity. Answers a and d are good, but not related to the question.

Question 37

In which of the following ocular disorders would it be most important to know what eye drops a new patient is using? a - cataracts b - glaucoma c - macular degeneration d - retinitis pigmentosa

Answer 37

b - glaucoma * A new patient who states they have glaucoma should be asked what eye drops they are using to control their pressure. Conditions in answers a, c and d do not require medication.

Question 38

Which situation poses a potential problem in a patient taking aspirin-containing medications? a - the patient with a cataract who will be having surgery b - the patient with migraine headaches c - the patient with headaches from convergence insufficiency d - the patient with diplopia

Answer 38

a - the patient with a cataract who will be having surgery * Aspirin and aspirin-containing medications thin the blood. Thus, the patient taking them runs a greater risk of hemorrhage during or after surgery.

Question 39

While taking the ocular history of a new patient, she mentions that her last ophthalmologist told her she has macular degeneration. This should trigger you to specifically ask about which of the following? a - aspirin use b - steroid use c - vitamin use d - artificial tear use

Answer 39

c - vitamin use * Patients with diagnosed macular degeneration have probably been put on a vitamin regimen of some kind.

Question 40

Patients taking a diuretic might have which special need during the exam? a - frequent trips to the bathroom b - an increase in the amount of oxygen they are receiving c - frequent stops to use an inhaler for breathing d - an early appointment because they tire easily

Answer 40

a - frequent trips to the bathroom * Diuretics act to reduce the body's fluids.

Question 41

A patient taking a diuretic probably has which health problem? a - asthma b - heart trouble c - emphysema d - diabetes

Answer 41

b - heart trouble * Heart patients are placed on diuretics to reduce excess fluid in the body, thereby reducing heart strain. Asthma and emphysema are breathing problems. Diabetes is related to blood sugar.

Question 42

High blood pressure is frequently treated by: a - nonsteroidal anti-inflammatory drugs (NSAIDs) b - oral steroids c - beta-blockers d - analgesics

Answer 42

c - beta-blockers * Beta-blockers are frequently used to treat hypertension. NSAIDs and steroids are used to treat inflammation. Analgesics are for pain.

Question 43

If a patient with glaucoma is to be treated using beta-blockers, it would be most important to know if the patient is currently being treated for: a - diabetes b - gout c - sinus d - high blood pressure

Answer 43

d - high blood pressure * If the patient is already taking beta-blockers for hypertension, the physician may not want to prescribe an additional beta-blocker for the glaucoma.

Question 44

It is important to know if a patient is taking birth control pills because: a - an overdose can cause blindness b - these hormones can cause loss of depth perception c - these hormones can cause changes in the retina d - forgetting to take them can cause loss of depth perception

Answer 44

c - these hormones can cause changes in the retina * These changes can include damage such as retinal artery and vein occlusion

Question 45

A patient who has been taking oral steroids for long periods should be evaluated for possible development of: a - dry eye b - cataracts c - iris cysts d - macular degeneration

Answer 45

b - cataracts * Cataract formation has been associated with the long-term use of oral steroids

Question 46

Conditions for which a person might take oral steroids include: a - rheumatoid arthritis b - diabetes c - hypertension d - hypoglycema

Answer 46

a - rheumatoid arthritis * Steroids are anti-inflammatory drugs and, thus, are used in treatment of rheumatoid arthritis

Question 47

Patients often fail to report the use of over-the-counter medications because: a - they consider them to be unimportant and unrelated to eye care b - over-the-counter medications have no ocular side effects c - only prescription medications are important because they are stronger d - patients do not want to admit they use them

Answer 47

a - they consider them to be unimportant and unrelated to eye care * Patients tend to think that over-the-counter medications are not important (or they would be regulated), nor have an effect on the eye

Question 48

The patient has said he has no heart problems, but you notice that he is taking two heart medications. For the most complete history, you should: a - simply record the medications b - not record the medications because the patient must be mistaken c - ask the patient what he takes the medication for d - confront the patient with his misinformation

Answer 48

c - ask the patient what he takes the medication for * When in doubt, ask. In some cases, a drug is prescribed for a condition other than its "usual" use. Recording the medicine without delving a little further, or not recording it at all, would be irresponsible. Confronting the patient is unnecessary

Question 49

Diabetes medication includes: a - diuretics and beta-blockers b - insulin injections and "sugar pills" c - steroids and analgesics d - antibiotics and NSAIDs

Answer 49

b - insulin injections and "sugar pills" * Diabetes is treated with oral medication ("sugar pills") and injectable insulin. (These pills are not actually made out of sugar, but many patients call their oral medication "sugar pills")

Question 50

An example of an analgesic is: a - insulin b - aspirin c - sulfa d - nitroglycerin

Answer 50

b - aspirin * An analgesic is a pain reliever

Question 51

Which patient is most likely to be using hormone replacement therapy? a - a woman who has not yet reached menopause b - a woman who has had a hysterectomy/oophorectomy c - a pregnant woman d - a woman who has had a mastectomy

Answer 51

b - a woman who has had a hysterectomy/oophorectomy * Hormones are generally contraindicated in women who are pregnant or who have had a mastectomy for breast cancer. A woman who has not reached menopause presumably still has functioning ovaries.

Question 52

A male patient is going to be scheduled for cataract surgery. Which of the following medications is of the most concern? a - sildenafil citrate b - hydroxychloroquine c - amiodarone d - testosterone patch

Answer 52

a - sildenafil citrate * Medications for erectile dysfunction, such as Viagra, have been implicated in intraoperative floppy iris syndrome, a complication of cataract surgery. Plaquenil is an antimalarial drug sometimes used in the treatment of arthritis. It's side effects include disturbances of the macula. Amiodarone is used for irregular heartbeat and can have ocular side effects (eg, corneal deposits). The testosterone patch is a male hormone replacement therapy.

Question 53

Your patient says she is allergic to something common but cannot remember the name. You suggest: a - penicillin, sulfa or codeine b - niacin, sulfa or caffeine c - penicillin, sulfa or caffeine d - penicillin, sulfur or codeine

Answer 53

a - penicillin, sulfa or codeine * An allergy to niacin or caffeine is possible, but not common. Sulfur is a mineral.

Question 54

Your patient says that beta-blockers make him nauseated. This is: a - an allergy b - a side effect c - an unrelated occurrence d - unimportant

Answer 54

b - a side effect * Side effects should still be recorded in the patient's chart

Question 55

Your patient says that erythromycin makes her break out in a rash. This is: a - an allergy b - a side effect c - an unrelated occurance d - unimportant

Answer 55

a - an allergy * Allergic reactions always need to be recorded in the patient's chart

Question 56

Your patient is scheduled to have a chalazion excision. It is most important to know his previous reactions to: a - general anesthesia b - local anesthesia c - neomycin d - fluorescein

Answer 56

b - local anesthesia * Chalazion excisions are done under local. The exception to this is for small children, where they will use general.

Question 57

Your patient is unsure if she has ever had any local anesthesia. You could ask if she: a - has ever had a numbing injection for a dental procedure b - has ever been put to sleep for any surgery c - has ever had an applanation tension test d - has ever had drops to numb the eye

Answer 57

a - has ever had a numbing injection for a dental procedure * This is an example of a local anesthetic.

Question 58

Your patient reports an adverse reaction to dye injected for a kidney evaluation. This could affect: a - performing applanation tonometry b - performing a fluorescein angiogram c - testing tear function d - dilating the pupil

Answer 58

b - performing a fluorescein angiogram * Dye is injected into the vein during an FA. The fluorescein used during a and c would be topical.

Question 59

Knowing a patient's occupation may be important in: a - prescribing bifocals or trifocals b - deciding what type of medication to prescribe c - knowing the patient's risk of eye surgery d - all of the above

Answer 59

d - all of the above * A patient's occupation may affect the prescribing of bifocals or trifocals (because of work distance), medications (eg. those causing blurred vision or drowsiness), and the types of ocular risks to which the patient is exposed (eg, the need for safety glasses).

Question 60

A patient's social history would include all of the following except: a - tobacco use b - living arrangements c - hobbies d - therapeutic drug use

Answer 60

d - therapeutic drug use * "Therapeutic" implies that the medication/drug is used as a treatment for an illness or condition. Use of "recreational" drugs would be part of the patient's social history.

Question 61

Your patient has been referred to your practice for cataract surgery. You ask if there is anyone at home who can help the patient instill eye drops. This is part of the patient's: a - family history b - ocular history c - social history d - medical history

Answer 61

c - social history * This is only one component of social history

Question 62

The most common ocular disorders that run in families are: a - cataracts, macular degeneration, and color blindness b - strabismus, myopia and glaucoma c - glaucoma, color blindness and albinism d - retinitis pigmentosa, strabismus and albinism

Answer 62

b - strabismus, myopia and glaucoma * All of the disorders listed are hereditary, the others just aren't as common

Question 63

25-year-old white woman comes in as a new patient because her mother has just been diagnosed with glaucoma. This information: a - is unimportant because the patient is under the age of 45 b - is unimportant because glaucoma less prevalent among whites c - is good reason for a full eye exam d - is insignificant because glaucoma is passed through the father, not the mother

Answer 63

c - is good reason for a full eye exam * Family history of glaucoma is always a reason for a full eye exam, regardless of the patient's age or race or which family member has it.

Question 64

A mother brings in a 2-year-old child with esotropia. Which of the following is significant for the history? a - does anyone in the family have crossed eyes? b - is anyone in the family blind? c - does anyone in the family have down syndrome? d - has anyone in the family been born prematurely

Answer 64

a - does anyone in the family have crossed eyes? * Strabismus tends to be familial

Question 65

Examples of hereditary systemic disease include: a - shingles, diabetes, hypertension and gout b - diabetes, hypertension, arthritis and cancer c - cancer, diabetes, arthritis and meningitis d - hypertension, acquired immune deficiency syndrome (AIDS) and shingles

Answer 65

b - diabetes, hypertension, arthritis and cancer * The other conditions listed (except gout) are infectious diseases

Question 66

Which of the following is NOT potentially a hereditary disorder? a - keratoconus b - secondary glaucoma c - migraine headaches d - nystagmus

Answer 66

b - secondary glaucoma * Secondary implies it was caused by something else (steroid use, trauma, etc)

Question 67

Any pupil smaller than what size is considered miotic? a - 1 mm b - 2 mm c - 3 mm d - 4 mm

Answer 67

b - 2 mm

Question 68

Any pupil larger than what size is considered mydriatic? a - 3 mm b - 4 mm c - 5 mm d - 6 mm

Answer 68

d - 6 mm

Question 69

Which of the following groups tend to have smaller pupils? a - children b - myopes c - people with light blue eyes d - older people

Answer 69

d - older people * Children, myopes and people with light blue eyes tend to have larger pupils.

Question 70

Unequal pupil size is termed: a - anisocoria b - anisometropia c - anisochromia d - aniseikonia

Answer 70

a - anisocoria * The other answers are all real terms that you should be familiar with as well

Question 71

The pupil evaluation includes: a - size, shape, and reaction to light b - iris color, roundness, and reaction to light c - angle depth, iris diameter, reaction to light d - reaction to cycloplegia, light and accommodation

Answer 71

a - size, shape, and reaction to light * Evaluation of pupils includes checking each pupil for its size, shape, and reaction to light (and sometimes accommodation). After that is done, one pupil is compared to the other. Are they the same size? shape? do they respond to light (or accommodation) to the same degree?

Question 72

An iris coloboma usually causes a pupillary shape defect: a - at 12 o'clock b - at 3 o'clock c - at 6 o'clock d - at 9 o'clock

Answer 72

c - at 6 o'clock * Iris coloboma is a congenital defect where the iris fails to fuse, usually inferiorly

Question 73

Constriction of the pupil can be accomplished by any of the following except: a - shining a bright light into the eye b - having the patient focus on a near object c - using miotics d - dimming the room lights

Answer 73

d - dimming the room lights * Dimming the room lights would make the pupil enlarge

Question 74

Dilation of the pupil can be accomplished by any of the following except: a - shining a bright light into the eye b - pinching the patient's neck c - having the patient focus on a distant object d - dimming the room lights

Answer 74

a - shining a bright light into the eye * Shining a bright light into the eye would cause the pupils to constrict, not dilate

Question 75

Direct pupillary response refers to: a - the reaction of both pupils to light b - the reaction of one pupil to light c - the reaction of both pupils to near d - the reaction of one pupil to near

Answer 75

b - the reaction of one pupil to light

Question 76

Testing the consensual light response in healthy eyes is possible because: a - each pupil reacts to light independently b - if one pupil reacts to light, the other reacts with it c - the pupils react to light in reverse order d - the pupils react to near stimuli independently

Answer 76

b - if one pupil reacts to light, the other reacts with it * The consensual light response compares the response (to light) of one pupil to the response of the other pupil. This is possible because healthy pupils are innervated to do the same thing at the same time, regardless of which eye has the light shining into it.

Question 77

When checking consensual pupil responses to light, all of the following should be done except: a - dim the room lights b - have the patient look at a distant object c - shine the light source from the side d - cover the eye not being tested

Answer 77

d - cover the eye not being tested * Consensual light response testing requires you to able to see both pupils at the same time.

Question 78

To test pupillary response to accommodation: a - observe the pupils as the patient looks from a distant object to a close-up object b - observe the pupils as the patient looks from a close-up object to a light source c - observe the pupils as the patient reads the near card d - observe the pupils as the patient reads the distant chart

Answer 78

a - observe the pupils as the patient looks from a distant object to a close-up object

Question 79

To evaluate a patient for tonic pupil (or Adie's tonic pupil), one would use which method? a - pupilometer b - slit-lamp evaluation c - cycloplegia d - accommodation response test

Answer 79

d - accommodation response test * In Adie's tonic pupil, there is a rapid/normal reaction of pupillary constriction when looking at a near object, but dilation is markedly slow when the patient shifts to look at a distant object. The pupil is also slow in its reaction to light. A pupillometer is used to measure the pupil's diameter

Question 80

Each pupil constricts to direct light. This indicates: a - there is no relative afferent pupillary defect (RAPD) present b - the pupils react equally c - light is passing through each optic nerve d - equal reaction to accommodation

Answer 80

c - light is passing through each optic nerve * The direct test evaluates each pupil on its own and is not meant to compare the reaction the optic nerve of each eye. In order to find a RAPD, you would need to additionally perform the swinging flashlight test. Testing pupillary reaction to accommodation would involve having the patient look at a near then distant object and back, watching the pupillary response as he or she does this; a light is not used.

Question 81

Testing that reveals normal-appearing pupils that react appropriately is documented as: a - PERRLA b - RAPD c - CSM d - PEAR

Answer 81

a - PERRLA * PERRLA stands for "pupils equally round and reactive to light and accommodation"

Question 82

The most common cause of a false-positive pupillary defect is: a - glaucoma b - papilledema c - RAPD d - weak flashlight batteries

Answer 82

d - weak flashlight batteries * You probably will not see this question on the test, but it does make an important point. Any time you detect a pupillary defect, double-check with another penlight.

Question 83

Each of the following could cause abnormal pupil shape except: a - surgery b - trauma c - birth defect d - Marcus Gunn

Answer 83

d - Marcus Gunn * The Marcus Gunn pupillary defect affects the pupil's reaction, not its shape. An example of a congenitally abnormal pupil shape is the coloboma.

Question 84

Each of the following disorders can cause a change in pupil size except: a - iritis b - angle-closure glaucoma attack c - drug reactions d - open-angle glaucoma

Answer 84

d - open-angle glaucoma * Open-angle glaucoma has no effect on pupil size. Some medications for glaucoma do (the miotics). Iritis causes a smaller pupil. angle-closure causes a larger pupil. Drug reactions can go either way.

Question 85

Argyll Robertson pupils are often: a - unreactive to direct or consensual light b - unreactive to accommodation c - reactive to light d - sluggishly reactive to accommodation

Answer 85

a - unreactive to direct or consensual light

Question 86

You discover that your patient has Argyll Robertson pupil. This pupillary defect is associated with: a - acquired immune deficiency syndrome (AIDS) b - syphilis c - gonorrhea d - rubella

Answer 86

b - syphilis

Question 87

Which of the following is associated with ptosis, miosis, and lack of perspiration (anhidrosis) on the affected side? a - Adie's tonic pupil b - Horner's syndrome c - Argyll Robertson pupil d - Marcus Gunn pupil

Answer 87

b - Horner's syndrome

Question 88

Horner's syndrome is caused by: a - nerve damage b - keratoconjunctivitis c - syphilis d - Herpes zoster

Answer 88

a - nerve damage * This nerve damage specifically affects eyelid position, pupil size and facial perspiration to varying degrees

Question 89

Adie's tonic pupil (or tonic pupil) is caused by: a - systemic rubella b - sympathetic ophthalmia c - gonorrhea d - nerve damage

Answer 89

d - nerve damage * Specifically, to the short posterior ciliary nerves

Question 90

You might first suspect that the patient has a tonic pupil when: a - the response to direct light is slow b - the pupil enlarges in direct light c - that eye also has a ptotic lid d - the patient is photophobic

Answer 90

a - the response to direct light is slow * A tonic pupil will have a slow reaction to direct light. A pupil that enlarges in direct light most likely has Marcus Gunn, or RAPD defect. Horner's syndrome exhibits ptosis on that same side.

Question 91

A relative afferent pupillary defect (RAPD) is identified by using the: a - cross cover test b - pupillometer c - swinging flashlight test d - direct flashlight test

Answer 91

c - swinging flashlight test

Question 92

The presence of a RAPD: a - demonstrates a totally blind eye b - indicates a problem in the optic nerve c - indicates a defect in the facial nerve d - indicates a problem in the cerebral cortex

Answer 92

b - indicates a problem in the optic nerve * The Marcus Gunn pupil can be identified by shining the light in one eye, then the other, also known as the swinging flashlight test. An eye with March Gunn pupil usually has poorer vision than a normal eye,but is not necessarily blind.

Question 93

An eye with a RAPD usually has: a - redness and pain b - subnormal visual acuity c - delayed extraocular muscle responses d - irregular astigmatism

Answer 93

b - subnormal visual acuity

Question 94

Another name for a RAPD is: a - Argyll Robertson pupils b - Adie's syndrome c - Marcus Gunn pupil d - tonic pupil

Answer 94

c - Marcus Gunn pupil

Question 95

You are performing a swinging flashlight test. The right pupil does not react at all when you shine the light in it. When you swing it over to the left eye, the left pupil constricts rapidly. When you swing back to the right eye, there is again no reaction. This indicates: a - a normal reaction b - RAPD OD by reverse c - RAPD OS by reverse d - a tonic pupil

Answer 95

b - RAPD OD by reverse * Usually, RAPD is identified when the unaffected eye constricts rapidly, and the affected eye dilates when you swing back to it. But one can still identify a RAPD in a fixed pupil by the reaction of the other (reverse), reactive eye, as in this scenario.

Question 96

In order to determine the base curve for a patient's contact lens, one must perform: a - keratometry b - lensometry c - refractometry d - slit-lamp exam

Answer 96

a - keratometry * The keratometer measures the curvature of the cornea. The base curve of the lens is then selected to complement this measurement.

Question 97

Soft contact lens diameter can be selected by measuring the patient's: a - pupillary distance b - vertex distance c - visible iris diameter d - corneal curvature

Answer 97

c - visible iris diameter * A soft lens should extend beyond the limbus, so one needs this measurement.

Question 98

For most contact lens fitting purposes, it is acceptable to measure corneal diameter: a - using an ophthalmoscope set on +10.0 and a millimeter rule b - by measuring the visible iris with a millimeter rule c - by using a pachymeter d - by anesthetizing the eye and using calipers

Answer 98

b - by measuring the visible iris with a millimeter rule

Question 99

Which of the following is NOT a factor in determining the appropriate power of a contact lens? a - pupil diameter b - refractive error c - vertex distance d - astigmatism

Answer 99

a - pupil diameter * Pupil diameter couple possibly figure in on the design of a rigid contact lens but is not a factor in the power of either soft or rigid lenses.

Question 100

Your patient, a 63-year-old woman, wants to try contact lenses. Which of the following should be done? a - tear evaluation b - pachymetry c - glare test d - conjunctival biopsy

Answer 100

a - tear evaluation * Tear production and quality is an important consideration when fitting a woman of menopausal age or anyone in whom dry eye might be a concern. A Schirmer's tear test is a good option.

Question 101

Your patient is going to be fit with rigid gas permeable (RGP) lenses. In addition to the usual parameters, you should also measure: a - corneal thickness b - palpebral fissures c - axial length d - contrast senstivity

Answer 101

b - palpebral fissures * RGP's are more dependent on eyelid structure than soft lenses because it is critical that they move with each blink. The distance between the upper and lower lids (the palpebral fissure) should be measured with a simple millimeter rule.

Question 102

A good rule of thumb when instructing patients regarding contact lenses is to: a - provide a training session offering oral and written instructions b - provide written instructions and tell the patient to call with questions c - provide a training session and oral instructions d - develop a support group where successful lens wearers teach others

Answer 102

a - provide a training session offering oral and written instructions

Question 103

The first rule to teach patients about handling contact lenses is: a - always use a mirror b - work over a clean surface c - always wash hands first d - never touch the lens itself

Answer 103

c - always wash hands first

Question 104

Before inserting a soft lens, the patient should make sure it is not inverted. This can be done by: a - visual inspection or the taco test b - visual inspection of the jelly roll test c - inserting the lens in an inversion tester d - viewing the lens' reverse image in the mirror

Answer 104

a - visual inspection or the taco test * The taco test involves holding the lens on thumb and forefinger and gently squeezing. If the lens edges flip inward, like a taco shell, then it is NOT inverted. (There is no such thing as the jelly roll test of an inversion tester.)

Question 105

To insert a soft lens: a - the lens should be dry and the finger wet b - the lens and finger should be dry c - the lens should be wet and the finger dry d - the lens and finger should be wet

Answer 105

c - the lens should be wet and the finger dry * The lens being wet, and the finger dry helps to keep the lens from sticking to the finger instead of the eye

Question 106

The patient should be instructed to place a contact lens: a - directly on the cornea b - on the inferior sclera, then slide it up c - on the margin of the lower lid d - on the nasal sclera, then slide it over

Answer 106

a - directly on the cornea * The lens should be placed directly on the cornea, bull's-eye style. Sliding is not a good idea with rigid lenses, as this can cause a corneal abrasion. A lens on the lid margin is almost sure to be blinked out.

Question 107

Use of lotion or moisturizer before handling lenses or use of makeup, hair spray, or face cream after inserting contact lenses can cause: a - lens film b - corneal edema c - degradation of the lens d - giant papillary conjunctivitis

Answer 107

a - lens film * To prevent a filmy build-up on the lens, only hand soap that is free of moisturizers and other additives should be used. Makeup, face creams and hair spray should be used before insertion. Hand lotions should be used after.

Question 108

The patient asks what he or she should do if the contact lens drops into the sink while trying to insert the lens. You tell the patient: a - rinse the lens with saline and insert b - rinse the lens with rewetting drops and insert c - clean and disinfect the lens as per solution instructions d - replace the lens

Answer 108

c - clean and disinfect the lens as per solution instructions * A dropped lens should be cleaned and disinfected prior to insertion, every time, no matter what.

Question 109

Soft contact lenses are most easily removed by: a - using a plunger cup b - blinking them out c - squeezing them out d - pinching them out

Answer 109

d - pinching them out * Soft lenses are pinched out with thumb and forefinger at the 9 and 3 o'clock position. A plunger could tear a soft lens. Blinking and squeezing will not work.

Question 110

Damage to soft contact lenses is frequently caused by: a - enzymatic cleaners b - rolling them between the fingers c - long fingernails d - defective materials

Answer 110

c - long fingernails

Question 111

Rigid contact lenses are often removed by blinking them out. For this technique to work: a - the lens should be moved onto the sclera first b - the lens must be centered on the eye c - the patient must flip the edge of the lens with the finger d - the patient must squint and look up

Answer 111

b - the lens must be centered on the eye * Blinking out a rigid lens requires the patient to look down, open both eyes wide, and pull the temporal canthus with thumb or finger. If the lens is not centered, this will not work.

Question 112

All of the following are helpful/proper techniques for using a plunger to remove a rigif lens except: a - locate the lens on the eye before applying the plunger b - wet the plunger with wetting solution first c - run the plunger over the cornea and sclera to locate a "lost" lens d - carry an extra plunger in your pocket or purse for emergency removal

Answer 112

c - run the plunger over the cornea and sclera to locate a "lost" lens * Teach your patients to never apply the plunger to the eye unless they know exactly where the contact is. "Fishing" for a lost lens with a plunger is painful and can be damaging to the eye.

Question 113

Soft lenses should be cleaned immediately after removal because: a - grunge is easier to remove at body temperature b - the patient might forget to do it later c - grunge is harder to remove once the lens has dried out d - otherwise enzymes are needed

Answer 113

a - grunge is easier to remove at body temperature * A soft lens should never be allowed to dry out

Question 114

The difference between cleaning and disinfecting is: a - cleaning is mandatory; disinfecting is optional b - cleaning removes film and debris; disinfecting kills germs c - cleaning kills germs; disinfecting removes film and debris d - cleaning is optional; disinfecting is mandatory

Answer 114

b - cleaning removes film and debris; disinfecting kills germs * Neither cleaning not disinfecting is optional. Disinfectant cannot reach all the surfaces of a dirty lens.

Question 115

When using a one-step contact lens solution, what should one do upon removing a lens from the eye? a - put the lens directly into the case with fresh solution b - place the lens in the palm, add solution, and gently rub with fingertip c - rinse lens with solution and rub vigorously between the thumb and index finger d - rinse the lens under the water faucet and gently rub with fingertip

Answer 115

b - place the lens in the palm, add solution, and gently rub with fingertip * This is still true even if the solution says it is "no rub"

Question 116

Enzymatic cleaners may be used weekly for daily-wear soft lenses and gas-permeable lenses in order to: a - sterile the lenses b - prolong the life of the lens material c - remove protein deposits d - reduce splitting and chipping

Answer 116

c - remove protein deposits * They do not provide the advantages listed in answers a, b, or d

Question 117

When not being worn, even rigid lenses should be stored in soaking solution because: a - this prevents warping b - this reduces the chances of chipping the lenses c - this maintains the power of the lens d - this maintains the integrity of the plastic

Answer 117

a - this prevents warping

Question 118

If a gas-permeable lens dries out: a - it must be replaced b - it can still be worn immediately c - it should be soaked for at least 4 hours d - it should be soaked for a week before wearing

Answer 118

c - it should be soaked for at least 4 hours

Question 119

If soft contact lenses are not going to be worn for a few days: a - add more soaking solution periodically to keep the lenses covered b - screw the case lid on tight to prevent evaporation c - use only non-preserved saline as a soak d - change the soaking solution every day to maintain disinfection

Answer 119

d - change the soaking solution every day to maintain disinfection

Question 120

Which of the following regarding "topping off" cleaning/disinfecting solutions is false? ("topping off" refers to the practice of adding a little fresh solution to what was left in the case from the last cleaning.) a - it weakens the lens material b - it contaminates the solution c - it dilutes the solution d - disinfection is compromised

Answer 120

a - it weakens the lens material

Question 121

Wetting solutions are used to: a - keep lenses sterile while stored in the case b - enable tears to spread evenly on the lens surface c - make the lens resistant to deposit build-up d - prevent scratches on the lens surface

Answer 121

b - enable tears to spread evenly on the lens surface

Question 122

Rewetting solutions are used to: a - disinfect the lenses while on the eye b - remove deposits c - rehydrate the lenses while on the eye d - treat ocular redness

Answer 122

c - rehydrate the lenses while on the eye * This increases lens movement and comfort

Question 123

Which of the following is the least sterile of these unapproved, ill-advised, and dangerous rewetting fluids? a - saliva b - tap water c - urine d - water from a swimming pool

Answer 123

a - saliva * Gross as it may be urine is more sterile than saliva. (Telling your patients this may discourage the terrible habit of wetting a rigid lens in their mouth!) Saliva harbors all kinds of nasty, infection-causing bacteria. Tap water and pool water (although "cleaner" thank saliva) are not the right solutions either and can cause the lens to adhere to the cornea, as well as cause corneal edema.

Question 124

Every patient who wears extended-wear contact lenses should be told to: a - remove the lenses and clean them daily b - allow the lenses to remain in the eye for up to 1 month c - use lubricating drops every morning and during the day d - endure occasional pain and redness as a matter of course

Answer 124

c - use lubricating drops every morning and during the day

Question 125

All of the following are true regarding a contact lens case except: a - it can be boiled in water b - it should be washed weekly with hot water and soap c - it should be rinsed daily with fresh lens solution d - the interior is disinfected along with the contacts

Answer 125

b - it should be washed weekly with hot water and soap * The case should NOT be washed with soap because the residue could interfere with the disinfectant or cause a film on the lenses. The entire case should be replaced every couple of months.

Question 126

Patients who work around smoke, dust, and chemical fumes should be told: a - they are not good candidates for contact lenses b - they should wear rigid lenses, which will not absorb fumes c - they should not wear contacts at work d - they should change jobs if they want to wear contacts

Answer 126

c - they should not wear contacts at work

Question 127

The contact lens patient should be told that if they eye ever becomes red or painful: a - try another lens b - irrigate the eye c - bear with it d - remove the lens

Answer 127

d - remove the lens

Question 128

Corneal vascularization can result from chronic: a - hypoxia b - solution sensitivity c - conjunctival injection d - giant papillary conjunctivitis

Answer 128

a - hypoxia * This is a lack of oxygen

Question 129

The area of the cornea that most commonly becomes vascularized is the: a - inferior limbal area b - superior limbal area c - 9 o'clock limbal area d - 3 o'clock limbal area

Answer 129

b - superior limbal area * (Under the upper lid)

Question 130

Corneal edema is caused by: a - excess oxygen permeability b - insufficient oxygen c - excess carbon monoxide d - excess tear production

Answer 130

b - insufficient oxygen

Question 131

Symptoms of corneal edema include: a - blurred vision b - rainbows around lights c - injection and burning d - all of the above

Answer 131

d - all of the above

Question 132

Which of the following has been associated with Acanthamoeba infections in contact lens wearers? a - non-preserved saline b - thimerosal-preserved solution c - homemade saline d - sample bottles of solution

Answer 132

c - homemade saline * Generally made with salt tablets and distilled water

Question 133

Patients who remove his or her extended-wear lenses only once a month experience a higher percentage of all of the following except: a - decreased need for artificial lubrication b - redness c - corneal anesthesia d - exposure keratitis when lenses are removed

Answer 133

a - decreased need for artificial lubrication * Every patient who wears contact lenses on an extended basis needs to lubricate the lenses regularly, especially every morning. Corneal anesthesia is a loss of sensation.

Question 134

Giant papillary conjunctivitis is suspected to be: a - an allergic response b - an infection c - a response to mechanical irritation d - a sign of overwear

Answer 134

a - an allergic response * A response to the protein deposits on a contact lens (usually soft). As the deposits break down, an allergic response is triggered.

Question 135

In addition to mucus formation, itching, and lens intolerance, the hallmark of giant papillary conjunctivitis is: a - corneal ulcers b - inflamed pinguecula c - papillae on the palpebral conjunctiva of the upper lid d - papillae on the bulbar conjunctiva under the upper lid

Answer 135

c - papillae on the palpebral conjunctiva of the upper lid * The signs and symptoms of Giant Papillary Conjunctivitis include itching, mucus, lens intolerance, and the formation of the papillae on the inner surface of the upper eyelid.

Question 136

The patient with excess tear secretion may experience: a - "sucked on" lens syndrome b - increased risk of neovascularization c - excessive lens movement d - circumcorneal indentation

Answer 136

c - excessive lens movement * Excessive tears equal excessive movement as the lens floats around on the surplus fluid

Question 137

Patients using the monovision technique might experience problems: a - taking the driver's license vision test b - in very bright light c - looking from the desk to the board in a classroom situation d - when peripheral vision is checked by confrontation

Answer 137

a - taking the driver's license vision test * The test for the driver's exam is a distance vision test. Often, the eye fit for near will fail to see the required distance figures. In this case, a letter or form may be required from the physician, explaining the situation.

Question 138

The advantages of soft lenses include all of the following except: a - they are more comfortable than rigid lenses b - they provide crisper vision than rigid lenses c - there is less lens displacement d - there is less lens loss

Answer 138

b - they provide crisper vision than rigid lenses * As a rule, soft lenses (being very flexible) do not provide the crisp, sharp vision of rigid lenses

Question 139

One of the main disadvantages of soft lenses is: a - frequent lens loss b - poor durability c - low oxygen permeability d - corneal injury on insertion

Answer 139

b - poor durability * The soft lens' flexible nature also makes it vulnerable to problems of durability. The lens can be torn easily. (Non-disposable types may also crack or split with age. The life expectancy of a non-disposable soft lens is generally considered to be only about 1 year.) However, there is less lens loss, better oxygen permeability, and a lower risk of injury on insertion because the edges are soft.

Question 140

The characteristic of soft lens material that is responsible for most of the lens' advantages (and disadvantages) is its: a - tear exchange under the lens b - ability to absorb water c - resistance to deposits d - larger diameter

Answer 140

b - ability to absorb water * The soft lens is hydrophilic, which means "loves water". The fact that is absorbs water is responsible for its entire nature. This includes comfort, flexibility, and oxygen transmission. There is very little tear exchange under a soft lens (as opposed to a rigid lens). These lenses are not resistant to deposits. A larger diameter is possible because of the oxygen transmissibility, but the diameter in and of itself is not responsible for the lens' advantages and disadvantages.

Question 141

One of the main risks of wearing soft contact lenses is: a - modifications are impossible b - residual astigmatism c - infection d - lens discoloration

Answer 141

c - infection * The pores of soft lens material generally are too small for bacteria to penetrate. However, once the lens forms deposits, there is a rough surface on which bacteria may grow. In addition, the removal of a deposit may create a pit in the lens large enough to harbor bacteria.

Question 142

Which patient is a poor candidate for soft lenses? a - a patient with dry eye b - a patient with a spherical refractive error c - an infant or child d - a recreational basketball player

Answer 142

a - a patient with dry eye * If a hydrophilic lens does not get the water it "wants" from the tear film, its thickness (and, thus, optics) can change, making the patient with dry eye a less-than-ideal contact lens patient. Soft lenses usually correct spherical errors quite well. An infant and child are good candidates because the soft lens provide more comfort and a low rate of lens loss on impact. Rigid lenses may pop out on impact, which makes the soft lens a good choice for the recreational basketball player as well.

Question 143

Fitting a dry eye with a soft lens can be difficult because: a - tear supplements cannot be used with soft lenses b - the lens will move excessively c - the diameter of the lens will change as it dries d - the optical properties of the lens will change as it dries

Answer 143

d - the optical properties of the lens will change as it dries * As it dries out, its base curve (not diameter) changes, altering its optical qualities and producing blurred vision. Selected tear supplement drops can be used with soft contact lenses in place. The dry lens moves little if at all.

Question 144

All of the following are poor candidates for extended-wear lenses except: a - those who work in a dusty environment b - those with chronic blepharitis c - those taking blood thinners d - those with pre-existing giant papillary conjunctivitis

Answer 144

c - those taking blood thinners * There is no connection between taking blood thinners and wearing contact lenses

Question 145

Which of the following probably would be a poor candidate for monovision technique? a - a public speaker b - a teacher c - a bookkeeper d - an actor

Answer 145

c - a bookkeeper * Anyone who continuously works up close and requires "perfect" near vision all the time (such as a bookkeeper or an accountant) probably is not a good candidate for monovision. Monovision involves a trade-off. Both distance and near vision are somewhat compromised, and binocular vision is sacrificed, but the patient does not have to cope with bifocals (glasses or contacts).

Question 146

Monovision contact lens fitting for presbyopia involves: a - fitting both eyes for distance and using reading glasses for near b - fitting one eye (usually the dominant eye) for distance and the other eye for near c - fitting one eye (usually the dominant eye) for near and the other eye for distance d - wearing a contact lens for near in one eye and leaving the other eye uncorrected

Answer 146

b - fitting one eye (usually the dominant eye) for distance and the other eye for near

Question 147

The lower the water content of a soft lens: a - the more durable the lens b - the greater oxygen permeability c - the less frequently it needs to be cleaned d - the smaller the diameter

Answer 147

a - the more durable the lens * The lower the water content, the more rigid it is and thus more durable. Still the soft lens does not approach the rigidity in the sense that a hard or gas-permeable lens does. A low water content lens is less oxygen transmissible.

Question 148

A soft contact lens with a high-water content will: a - be more stable if lens dehydration occurs b - allow for greater oxygen transmission c - need to be disinfected by thermal methods only d - be more durable if it made of hydroxyethyl methacrylate (HEMA)

Answer 148

b - allow for greater oxygen transmission * Unfortunately, these lenses are sensitive to dehydration if the environment changes. They also are heat sensitive, and some types may not be disinfected using thermal methods. Given the same water content, the non-HEMA lenses are more durable.

Question 149

The "Dk value" of a contact lens refers to its: a - carbon dioxide permeability b - oxygen permeability c - carbon monoxide permeability d - deciliter per kilogram value

Answer 149

b - oxygen permeability *The Dk value of a contact lens is a laboratory measurement of the oxygen permeability of a material. That is not to say, however, that the Dk is a measurement of how much oxygen actually reaches the cornea.

Question 150

The oxygen supply to the cornea can be increased by selecting a lens: a - with a high Dk value or reduced thickness b - with a low Dk value or reduced thickness c - with a high Dk value or increased thickness d - with a low Dk value or increased thickness

Answer 150

a - with a high Dk value or reduced thickness

Question 151

Selecting the power of a spherical soft contact lens is based on: a - the spherical element found on refractometry b - the cylindrical element found on refractometry c - the spherical equivalent of the refractometric measurement d - the refractometric and keratometric measurements

Answer 151

c - the spherical equivalent of the refractometric measurement * The power of a spherical soft contact is chosen by the spherical equivalent of the refractometric measurement. The K readings are not used for calculating the power.

Question 152

To obtain the spherical equivalent: a - add half of the sphere to the cylinder algebraically, keeping the cylinder b - add half of the cylinder to the sphere algebraically, keeping the cylinder c - add half of the sphere to the cylinder algebraically, deleting the cylinder d - add half of the cylinder to the sphere algebraically, deleting the cylinder

Answer 152

d - add half of the cylinder to the sphere algebraically, deleting the cylinder

Question 153

You want to fit a spherical soft contact. The refractometric measurement is -3.00 + 1.00 X 180. Your lens choice is: a - -3.00 sphere b - -3.50 sphere c - -2.00 sphere d - -2.50 sphere

Answer 153

d - -2.50 sphere * Half of the cylinder is +0.50. Add this to the sphere power: -3.00 +0.50 = -2.50

Question 154

With spherical soft lenses, a small amount of corneal astigmatism is: a - increased b - eliminated c - tolerated d - a reason to fit Toric lenses

Answer 154

c - tolerated * As long as a patient tolerates it, there is no reason to rush into fitting a toric lens.

Question 155

The amount of astigmatism that is present after the patient is fitted with lenses is referred to as: a - residual astigmatism b - corneal astigmatism c - lenticular astigmatism d - irregular astigmatism

Answer 155

a - residual astigmatism

Question 156

The most common source of residual astigmatism in contact lens wearing is: a - the tear lens b - the cornea c - the crystalline lens d - the retina

Answer 156

c - the crystalline lens * Residual astigmatism is most often caused by lenticular astigmatism, or irregular curvature of the crystalline lens (which does not show up on K readings)

Question 157

The patient with astigmatism may tolerate spherical soft contact lenses up to the point that the astigmatism is: a - less than one-third of the total refractive error b - less than half of the total refractive error c - lenticular d - with the rule

Answer 157

a - less than one-third of the total refractive error

Question 158

You plan to fit a soft Toric contact lens. Which of the following is true regarding the refractometric measurements? a - it must be converted to plus cylinder b - you will use the spherical equivalent c - you want the patient to accept the most cylinder power possible d - you want the patient to accept the least cylinder power possible

Answer 158

d - you want the patient to accept the least cylinder power possible * When fitting a soft Toric, you want the least amount of cylinder correction that the patient will accept, because the lens will rotate a bit on the eye. The higher the amount of cylinder, the more pronounced the visual problems caused by this rotation.

Question 159

The major difficulty with fitting Toric lenses is: a - patient discomfort b - lens stability on the eye c - arriving at the correct prescription d - obtaining accurate over-refractions

Answer 159

b - lens stability on the eye * Keeping the cylinder properly aligned means keeping the lens aligned. A spherical lens is normally pushed around and rotates during blinking. This spells disaster for a Toric lens fit.

Question 160

An aid in evaluating the stability of a soft Toric lenses is: a - the movement gauge b - etch or laser marks on the lens c - a protractor in the slit-lamp ocular d - the contact lens gauge

Answer 160

b - etch or laser marks on the lens * Soft Toric lenses have etc marks or dots either at the base or at the horizontal meridian. These can be observed with the slit lamp. The examiner looks for lens rotation as the patient blinks.

Question 161

Most practitioners would prefer to fit a gas-permeable contact lens instead of a traditional hard polymethylmethacrylate (PMMA) lens because: a - vision with a gas-permeable lens is better b - gas-permeable lenses are easier to handle c - gas-permeable lenses are available for astigmatism d - corneal warpage is less with gas-permeable lenses

Answer 161

d - corneal warpage is less with gas-permeable lenses * Because a PMMA lens is not oxygen permeable, nearly all PMMA lenses cause some degree of corneal anoxia (an- means without and -oxia means oxygen). This, in turn, is responsible for corneal warpage. Because gas-permeable lenses do allow oxygen to reach the cornea, the incidence (and risk) of corneal warpage is much less. In the absence of corneal complications, both rigid lens types should provide crisp vision, are equally easy to handle, and can be ground to correct astigmatism.

Question 162

Which of the following makes a patient a poor candidate for gas-permeable contact lenses: a - history of giant papillary conjunctivitis b - exophthalmos c - corneal irregularity d - neovascularization from soft lenses

Answer 162

b - exophthalmos * A bulging eye is best fit with a soft lens, which is more stable on the eye and doesn't interfere with the lids

Question 163

The fact that gas-permeable contact lens material allows more oxygen to the eye means that: a - the lens can be larger than a PMMA lens b - the lens is more comfortable than a PMMA lens c - lens movement is not an important factor d - the lens can be allowed to rest on the lower lid margin

Answer 163

a - the lens can be larger than a PMMA lens * Because a gas-permeable contact lens allows more oxygen to get to the cornea, the eye can tolerate a larger lens. True, it is more comfortable than a PMMA lens, but this is due to the fit (sliding under the upper lid versus bumping into it), not permeability. Lens movement still is important. The properly fit gas-permeable lens does not sit on the lower lid.

Question 164

The average life of a rigid gas-permeable lens is: a - 6 to 9 months b - 12 months c - 18 to 24 months d - 36 months

Answer 164

c - 18 to 24 months

Question 165

Over-refractometry of a contact lens is useful in fine tuning: a - lens power b - lens diameter c - lens centration d - lens base curve

Answer 165

a - lens power

Question 166

When taking a refractometric measurement over a contact lens of a patient over 40-years-old: a - first find out how the patient is corrected for presbyopia b - measure each eye for distance only c - measure each eye for near only d - measure the right eye for distance and the left for near

Answer 166

a - first find out how the patient is corrected for presbyopia * If the patient is presbyopic, find out how the lenses are fit before pulling the refractor forward. Are they monfit? Bifocals? Maybe distance in both eyes with reading glasses? Knowing what to expect before you get started will make your job easier.

Question 167

Bandage contact lenses are routinely used for all of the following except: a - correcting a refractive error b - promoting healing and protection c - patient comfort d - drug reservoir

Answer 167

a - correcting a refractive error * While a bandage lens of a specific power may be chosen, correcting the refractive error is not the priority in a bandage lens. In fact, a plano lens usually is preferred because it is thinner (in the center for a plus lens and the edges for a minus lens) and thus more oxygen permeable.

Question 168

They key in selecting a bandage contact lens is: a - the patient's refractive error b - the patient's ability to handle the lens c - oxygen permeability d - the patient's corneal curvature

Answer 168

c - oxygen permeability * Getting oxygen to the cornea is key in selecting a bandage lens. A bandage lens is generally not handled by the patient.

Question 169

Even if a patient has a hyperopic refractive error, it is best to try a plano bandage lens first because: a - refractive correction may trigger ciliary spasms b - a plan lens is thinner c - a plan lens has a higher water content d - the patient should avoid using the eye anyway

Answer 169

b - a plan lens is thinner

Question 170

All of the following are suitable bandage contact lenses except: a - a collagen disintegrating lens b - a disposable soft lens c - a low water content lens d - a thin, soft lens

Answer 170

c - a low water content lens * High water content lens versus low water content is preferred because it is more oxygen permeable.

Question 171

Acuity projector slides can be cleaned by: a - washing with soap and water b - spraying with commercial cleaner c - wiping with dry lens wipe d - wiping with wet lens wipe

Answer 171

c - wiping with dry lens wipe * Liquids can dissolve the paint and ruin the slides

Question 172

Which of the following will help prevent dust build-up on the lenses of a direct ophthalmoscope? a - the direct ophthalmoscope has no built-in lenses b - cleaning daily with cleanser c - removing the instrument facing for direct access to the lenses d - storing the instrument with the lens setting on zero

Answer 172

d - storing the instrument with the lens setting on zero * With the setting at zero, there are no exposed lenses in the instrument's aperture

Question 173

Which of the following is NOT appropriate when cleaning an indirect ophthalmoscope? a - cleaning the front surface mirror with a brush b - rubbing debris off the bulb with finger c - cleaning the bulb contacts by scraping with a file d - wiping the headband with an alcohol wipe

Answer 173

b - rubbing debris off the bulb with finger * Oil from the fingers is transferred to the bulb if you touch it.

Question 174

Unless the manufacturer's instructions indicate otherwise, the perimeter bowl surface may be cleaned with: a - mild detergent and water b - lighter fluid c - contact lens solution d - lens cleaner

Answer 174

a - mild detergent and water

Question 175

When brushing or wiping the perimeter bowl surface, it is important to avoid: a - any moisture at all b - excessive pressure/friction c - fibrous cotton balls d - using a soft brush or cloth

Answer 175

b - excessive pressure/friction *Putting too much pressure on an area inside the bowl might change the reflective properties of the bowl in that area or scratch the finish

Question 176

Dirty tangent screen test objects should be cleaned with: a - cleanser b - an alcohol wipe c - soap and water d - acetone

Answer 176

c - soap and water

Question 177

Discolored tangent screen white test objects should be: a - replaced b - painted with correction liquid c - used as is d - wiped with an alcohol wipe

Answer 177

a - replaced * If the test objects are discolored, they should be replaced, not "repaired". If they are too dingy, they can affect the accuracy of the test.

Question 178

The tangent screen itself can be cleaned: a - by gentle whisking with a very soft brush b - by brushing with a wire brush c - with a commercial dry-cleaning product d - with soap and water

Answer 178

a - by gentle whisking with a very soft brush

Question 179

To prevent dirt from collecting on the back surface of the refractor/phoroptor lenses: a - use the widest pupillary distance possible b - adjust the forehead rest to avoid lash/lens contact c - make sure the refractor is level d - request that patients remove mascara before refractometry

Answer 179

b - adjust the forehead rest to avoid lash/lens contact * Oil and makeup can accumulate on the lenses when there is contact between the lids and lenses. Keep in mind that adjusting the forehead rest changes the vertex distance.

Question 180

If the internal lenses of the refractor are dirty: a - spray them through the aperture with lens cleaner b - open the refractor and clean the lenses one at a time c - add one line of acuity to everyone's measurements d - have the instrument professionally cleaned

Answer 180

d - have the instrument professionally cleaned * The refractor (phoroptor) is a complicated instrument and should be cleaned only by a trained professional. Never spray anything into the instrument.

Question 181

To clean the friction plate under the joystick: a - wipe with alcohol wipe b - remove the plate, and put it in the autoclave c - rub with bathroom cleanser d - spray with lens cleaner

Answer 181

a - wipe with alcohol wipe * The slit-lamp will not move smoothly if the friction plate is dirty.

Question 182

To lubricate the friction plate under the joystick: a - lightly coat with cooking oil and wipe it almost dry b - lightly coat with automotive oil and wipe it almost dry c - lightly coat with silicone oil and wipe it away d - lightly sprinkle with graphite

Answer 182

c - lightly coat with silicone oil and wipe it away * Alcohol will dissolve oil and grease, so lubricate the clean friction plate with silicone oil or WD-40

Question 183

Solid ultrasound probes should be cleaned: a - only if an infectious disease is suspected b - once a week c - once each day d - between each patient exam

Answer 183

d - between each patient exam * Because the probe makes direct contact with eye tissues, it needs to be cleaned between each patient

Question 184

All of the following tend to loosen the glue of a mounted lens except: a - drying out over time b - heat c - cool water d - alcohol or acetone

Answer 184

c - cool water

Question 185

Unless the manufacturer's instructions state otherwise, a glass lens (non-bloomed) may be cleaned by any of the following except: a - 4:1 ratio of ether and alcohol b - commercial chrome cleaner c - 1:1 ratio of ammonia and isopropyl alcohol d - commercial glass or lens cleaner

Answer 185

b - commercial chrome cleaner

Question 186

Do not use commercial glass cleaner on plastic lenses because: a - this can scratch the surface b - this can remove lens coatings c - this can cloud the lens d - this can cause crazing

Answer 186

c - this can cloud the lens

Question 187

Besides soap and cool water, which of the following can be used to clean plastic lenses? a - contact lens solution b - lighter fluid c - bathroom cleanser d - baking soda

Answer 187

a - contact lens solution * Because contact lenses are plastic, it makes sense that you can use contact lens solution to clean plastic lenses.

Question 188

Which of the following will remove the coating on a bloomed lens (such as the indirect ophthalmoscope lens)? a - gently wiping the dry lens with a tissue b - wiping the lens with ethyl or methyl alcohol c - blowing the lens with compressed air d - heavily rubbing the lens to remove fingerprints

Answer 188

d - heavily rubbing the lens to remove fingerprints

Question 189

When cleaning a lens that is fixed into an instrument: a - spray lens cleaner on the lens in the instrument b - use a stream bottle to irrigate the lens in the instrument c - spray lens cleaner on a wipe, and clean the lens with the wipe d - fixed lenses cannot be cleaned

Answer 189

c - spray lens cleaner on a wipe, and clean the lens with the wipe * Never spray cleaner into an instrument!

Question 190

The best way to remove dust from a fundus camera lens is to first: a - dust it with a camel's hairbrush b - blow off dust with air c - wipe dust off with dry cloth d - clean dust off with isopropyl alcohol

Answer 190

b - blow off dust with air

Question 191

Which surface of an exophthalmometer might require disinfection? a - the mirrors b - the gauges c - the prisms d - the points of patient contact

Answer 191

d - the points of patient contact

Question 192

Which surface of an ophthalmodynamometer might require disinfection? a - the tip b - the gauge c - the lens d - the watch glass

Answer 192

a - the tip

Question 193

Which of the following is untrue regarding front surface mirrors? a - the silver coating can be rubbed off over time b - the coating can be scratched by mishandling c - they produce a faint double image of the reflection d - they reflect 100% light transmission

Answer 193

c - they produce a faint double image of the reflection

Question 194

Prior to cleaning a front surface mirror, one should: a - rub with cotton ball to remove loose dust b - use canned air to remove loose dust c - blow on it to remove loose dust d - spray it with water

Answer 194

b - use canned air to remove loose dust * Prior to cleaning the mirror, use canned air or an air bulb to remove loose debris, which could scratch the mirror when it is being wiped. If you use canned air, be sure it is approved for use on mirrors and lenses; the type usually used for general office use sometimes has a liquid additive that can coat the surface.

Question 195

Which of the following can be used to clean a front surface mirror? a - a paper towel and commercial glass cleaner b - a cotton-tipped applicator and dry baking soda c - a fingertip to rub off smudges d - a lens wipe with a :1 ratio of ether and alcohol

Answer 195

d - a lens wipe with a :1 ratio of ether and alcohol * A front surface mirror can be scratched easily, and a little bit of the silver is rubbed off every time it is cleaned. Clean it with a lens wipe moistened with ether and alcohol, gently moving the wipe in down-strokes. Do not rub the mirror.

Question 196

A mirror surface should be dried by: a - patting with a lint-free lens wipe b - wiping with a lint-free lens wipe c - rubbing with a tissue or cotton ball d - patting with a paper towel

Answer 196

a - patting with a lint-free lens wipe * To avoid scratching, do not rub the mirror and do not use an abrasive wipe

Question 197

Which surface is NOT affected by friction during cleaning? a - front surface mirrors b - bloomed lenses c - projector screens d - glass trial lenses

Answer 197

d - glass trial lenses

Question 198

A projector screen is cleaned by: a - wiping with an alcohol wipe b - scrubbing with cleanser c - a solution of mild detergent d - commercial glass cleaner

Answer 198

c - a solution of mild detergent

Question 199

One of the easiest and least expensive ways to prolong the life of ophthalmic/optometric equipment is to: a - wipe it daily with an alcohol wipe b - have it serviced every 6 months c - change bulbs and batteries every 6 months d - cover or store it when note in use

Answer 199

d - cover or store it when note in use * Covering or storing equipment prevents dust build-up and reduces breakage

Question 200

Turning a screw counterclockwise (to the left) will cause it to: a - tighten b - loosen c - strip out d - fall out

Answer 200

b - loosen * Remember: "Righty tighty, lefty loosey"

Question 201

The first several turns inserting a screw are difficult. You should: a - force it b - use a hammer c - stop and try resetting the screw d - spray lubricant on the instrument

Answer 201

c - stop and try resetting the screw * Forcing a screw may strip it, making it nearly impossible to remove later. It could also cause the instrument housing to crack.

Question 202

To extend the life of a slit-lamp bulb: a - use the lowest voltage setting as much as possible b - scrape the contact points weekly c - turn it 180 degrees weekly d - use the lowest illumination as much as possible

Answer 202

a - use the lowest voltage setting as much as possible

Question 203

If he filament of a bulb is aligned incorrectly in the housing: a - the bulb will blow out b - chromatic aberration will occur in the light field c - the light will be deviated from prismatic power d - the projected light will not illuminate the entire field

Answer 203

d - the projected light will not illuminate the entire field

Question 204

If the light in a piece of electrical equipment begins to flicker or does not come on, the first and easiest thing to check is: a - the filament b - the bulb's seating c - the instrument's plug d - the instrument's fuse

Answer 204

c - the instrument's plug

Question 205

When changing light bulbs in a piece of equipment, all of the following are important except: a - turn off and unplug the instrument b - allow the old bulb to cool, if it is hot c - remove the old bulb with pliers d - do not touch the glass of the new bulb

Answer 205

c - remove the old bulb with pliers

Question 206

If the bulb contacts become corroded, one may remedy this problem by unplugging the instrument and: a - replacing the contacts b - wiping the contacts with alcohol c - scraping with a metal file d - blowing with compressed air

Answer 206

c - scraping with a metal file

Question 207

The projector bulb has a build-up of oxidation on one side, decreasing its illumination. You should: a - replace the bulb b - turn the bulb 180 degrees to use the other side (without the build-up) c - remember that nothing needs to be done as long as all patients are checked in the same illumination d - scrape off the contacts in the bulb housing

Answer 207

b - turn the bulb 180 degrees to use the other side (without the build-up)

Question 208

Which is true of rechargeable batteries and recharging units? a - the battery will last 10 years or more b - the rechargers cannot be left on indefinitely c - batteries can lose the ability to recharge d - all batteries can be installed in either direction

Answer 208

c - batteries can lose the ability to recharge

Question 209

An instrument operating on rechargeable NiCad batteries: a - should be placed in the charger after each use during the day b - should be placed in the charge only at the end of the day c - will not operate if more than 25 feet away from the charger d - works best if the batteries are cooler than room temperature

Answer 209

b - should be placed in the charge only at the end of the day

Question 210

Regular cell batteries should be stored: a - in a heated room b - in the refrigerator c - in the freezer d - at room temperature

Answer 210

d - at room temperature

Question 211

If a particular fuse repeatedly burns out, one should: a - replace the fuse as needed b - use a fuse with a lower ampere (AMP) rating c - get professional assistance d - replace the instrument

Answer 211

c - get professional assistance

Question 212

One might adjust the concave mirror in a acuity projector in order to: a - change the size of the letters to fit a shorter room b - increase the clarity of the letters c - improve faulty illumination d - change the place where the target is projected

Answer 212

c - improve faulty illumination

Question 213

To calibrate the size of the target of an acuity projector, one must: a - have a 20-foot test distance b - use a template and adjust the projection tube until the letter fits into the correct bracket c - use a table to convert every patient's measurement if the test distance is not 20 feet d - use a template, and adjust the concave mirror until the letter fits into the correct bracket

Answer 213

b - use a template and adjust the projection tube until the letter fits into the correct bracket

Question 214

If the vertical alignment of an indirect ophthalmoscope is misaligned: a - adjust the headband b - make sure the mirror is clean c - adjust the mirror d - have the instrument professionally serviced

Answer 214

d - have the instrument professionally serviced

Question 215

A bent, or C-shaped streak in a streak retinoscope is caused by: a - a weak bulb b - a bent bulb filament c - a weak battery d - using it with the sleeve down

Answer 215

b - a bent bulb filament * This is caused by lying the instrument on its side

Question 216

During a normal workday, when not in immediate use, the retinoscope should be stored: a - by lying it on its side on the table b - by leaving it turned on c - by placing it upright d - by lying it in a protected drawer

Answer 216

c - by placing it upright

Question 217

If the retinoscope light flickers and the bulb placement is solid, the flickering is probably due to: a - a loose bulb filament b - inadequate charge c - internal wiring problems d - weak batteries

Answer 217

c - internal wiring problems

Question 218

Which of the following is NOT true regarding fluid-filling ultrasound probes? a - the membrane tip is fragile and lasts only a few days b - the probe is filled with sterile saline solution c - air bubbles must be removed from the probe before use d - the crystal in the probe can lose sensitivity over time

Answer 218

b - the probe is filled with sterile saline solution * Water filled probes contain distilled water, not saline solution

Question 219

Ultrasound units are calibrated by: a - touching the probe to a test block specific for that machine b - touching the probe to a flat surface c - routinely measuring the same person's eye as a standard d - pressing the calibration button on the instrument

Answer 219

a - touching the probe to a test block specific for that machine

Question 220

Care of the noncontact tonometer includes all of the following except: a - firing it at the beginning of each day to blow dust from the air nozzle b - checking calibration by firing the air burst against your finger c - covering it when not in use d - cleaning the objective lens and aperture

Answer 220

b - checking calibration by firing the air burst against your finger

Question 221

The muscle light (transilluminator) might require the following maintenance: a - brightness calibration b - bulb and battery replacement c - sterilization d - tip and casing replacement

Answer 221

b - bulb and battery replacement

Question 222

The prescription of a lens is written in the following order: a - cylinder power, sphere power, sphere axis b - sphere power, cylinder axis, cylinder power c - sphere power, cylinder power, cylinder axis d - sphere power, sphere axis, cylinder axis

Answer 222

c - sphere power, cylinder power, cylinder axis (By the way, there is no such thing as sphere axis)

Question 223

In a glasses prescription reading +1.25 -3.75 X082, the -3.75 refers to: a - sphere power b - cylinder power c - cylinder axis d - add power

Answer 223

b - cylinder power

Question 224

In a glasses prescription reading -2.25 +1.50 X173, which of the following is true? a - the prescription is written in minus cylinder b - the sphere power is "plus" c - the cylinder power is written in "plus" d - the cylinder axis is a multiplier

Answer 224

- the cylinder power is written in "plus" (this is the second number in the prescription)

Question 225

In a glasses prescription reading +1.00 +1.00 X180 | 1.25/2.50, the number 1.25 refers to: a - the trifocal power b - the bifocal power c - the total add power d - the cylinder power

Answer 225

a - the trifocal power (the 1.25 will be the trifocal (intermediate distance) and the 2.50 will be the bifocal (closest distance)).

Question 226

Which of the following glasses prescriptions would definitely be questioned by an optician? a - +1.50 +2.25 X181 b - Plano -9.25 X072 c - +11.75 -1.75 X175 d - -2.50 + 6.50 X018

Answer 226

a - +1.50 +2.25 X181 (while any prescription can earn a call from an optician to verify; the first one most definitely would due to the axis. Axis numbers should only every fall between 001 and 180)

Question 227

When using an automated lensometer, it is important to designate: a - lens material b - lens manufacturer c - desired cylinder type d - desired base curve type

Answer 227

c - desired cylinder type

Question 228

An advantage of the automated lensometer is the ease with which it: a - detects Fresnel prism b - reads progressive add lenses c - identifies lens material d - identified polarized lenses

Answer 228

b - reads progressive add lenses (Fresenel prisms can be detected without a machine, they have a ridged texture. Lens material and polarization are not detected by any lensometer).

Question 229

An automated lensometer may be disadvantageous in identifying: a - optical centers b - add powers c - prisms d - warped lenses

Answer 229

d - warped lenses

Question 230

A key advantage of automated lensometer is that is: a - eliminates math errors b - converts the glasses prescription to a contact lens prescription c - takes vertex distance into account d - identifies photosensitive lenses

Answer 230

a - eliminates math errors

Question 231

All of the following are true regarding automated lensometers except: a - they should be set on an antistatic mat b - they should not be placed and used in direct sunlight c - the internal lenses and mirrors can be cleaned by removing the instrument housing d - the computer components are sensitive to dust

Answer 231

c - the internal lenses and mirrors can be cleaned by removing the instrument housing

Question 232

The first step in reading a pair of glasses with the manual lensometer is to: a - position the glasses in the holder with the temples away from you b - position the glasses in the holder with the temples toward you c - clean the lenses before reading d - adjust the eye piece of the instrument

Answer 232

d - adjust the eye piece of the instrument

Question 233

When adjusting the lensometer eye piece: a - you should wear your own habitual correction b - the lensometer's power dial should be set to your prescription c - the lensometer's axis indicator should be set to 180 d - the lensometer's axis indicator should be set to match your own astigmatism

Answer 233

a - you should wear your own habitual correction

Question 234

Before adjusting the lensometer eye piece: a - turn the eye piece to the most minus position b - turn the eye piece to the most plus position c - turn the eye piece to an axis of 180 d - turn the eye piece to the axis of your astigmatism

Answer 234

b - turn the eye piece to the most plus position (rotating to minus will trigger your accommodative reflex)

Question 235

When adjusting the lensometer eye piece, the eye piece is slowly rotated until: a - the target just begins to blur b - the target is first seen to be clear c - the target has turned 90 degrees d - the target clears then begins to blur again

Answer 235

b - the target is first seen to be clear (If you continue to turn it, you will add unneeded minus and your own accommodation will interfere)

Question 236

Failure to properly adjust the lensometer eye piece before reading lenses may result in: a - missing ground-in prism b - a misaligned cylinder axis c - reading in plus instead of minus cylinder d - an inaccurate reading

Answer 236

d - an inaccurate reading

Question 237

A lens can be read in a lensometer in plus or minus form: a - by changing the axis 180 degrees b - by changing the axis 90 degrees c - by changing the axis 360 degrees d - by changing the axis 45 degrees

Answer 237

b - by changing the axis 90 degrees

Question 238

Which is the name of this item? Direct Ophthalmoscope Slit Lamp (Biomicroscope) Indirect Ophthalmoscope Ultrasound (A-scan) Retinoscope Keratometer (Ophthalmometer) Lensmeter (Lensometer) Trial Lens Set Perimeter Schiotz Tonometer Tangent Screen Goldman Tonometer Phoropter (refractor) Muscle Light

Answer 238

Muscle Light

Question 239

Which is the name of this item? Direct Ophthalmoscope Slit Lamp (Biomicroscope) Indirect Ophthalmoscope Ultrasound (A-scan) Retinoscope Keratometer (Ophthalmometer) Lensmeter (Lensometer) Trial Lens Set Perimeter Schiotz Tonometer Tangent Screen Goldman Tonometer Phoropter (refractor) Muscle Light

Answer 239

Tangent Screen

Question 240

Which is the name of this item? Direct Ophthalmoscope Slit Lamp (Biomicroscope) Indirect Ophthalmoscope Ultrasound (A-scan) Retinoscope Keratometer (Ophthalmometer) Lensmeter (Lensometer) Trial Lens Set Perimeter Schiotz Tonometer Tangent Screen Goldman Tonometer Phoropter (refractor) Muscle Light

Answer 240

Keratometer (Ophthalmometer)

Question 241

Which is the name of this item? Direct Ophthalmoscope Slit Lamp (Biomicroscope) Indirect Ophthalmoscope Ultrasound (A-scan) Retinoscope Keratometer (Ophthalmometer) Lensmeter (Lensometer) Trial Lens Set Perimeter Schiotz Tonometer Tangent Screen Goldman Tonometer Phoropter (refractor) Muscle Light

Answer 241

Indirect Ophthalmoscope

Question 242

Which is the name of this item? Direct Ophthalmoscope Slit Lamp (Biomicroscope) Indirect Ophthalmoscope Ultrasound (A-scan) Retinoscope Keratometer (Ophthalmometer) Lensmeter (Lensometer) Trial Lens Set Perimeter Schiotz Tonometer Tangent Screen Goldman Tonometer Phoropter (refractor) Muscle Light

Answer 242

Retinoscope

Question 243

Which is the name of this item? Direct Ophthalmoscope Slit Lamp (Biomicroscope) Indirect Ophthalmoscope Ultrasound (A-scan) Retinoscope Keratometer (Ophthalmometer) Lensmeter (Lensometer) Trial Lens Set Perimeter Schiotz Tonometer Tangent Screen Goldman Tonometer Phoropter (refractor) Muscle Light

Answer 243

Direct Ophthalmoscope

Question 244

Which is the name of this item? Direct Ophthalmoscope Slit Lamp (Biomicroscope) Indirect Ophthalmoscope Ultrasound (A-scan) Retinoscope Keratometer (Ophthalmometer) Lensmeter (Lensometer) Trial Lens Set Perimeter Schiotz Tonometer Tangent Screen Goldman Tonometer Phoropter (refractor) Muscle Light

Answer 244

Trial Lens Set

Question 245

Which is the name of this item? Direct Ophthalmoscope Slit Lamp (Biomicroscope) Indirect Ophthalmoscope Ultrasound (A-scan) Retinoscope Keratometer (Ophthalmometer) Lensmeter (Lensometer) Trial Lens Set Perimeter Schiotz Tonometer Tangent Screen Goldman Tonometer Phoropter (refractor) Muscle Light

Answer 245

Phoropter (Refractor)

Question 246

Which is the name of this item? Direct Ophthalmoscope Slit Lamp (Biomicroscope) Indirect Ophthalmoscope Ultrasound (A-scan) Retinoscope Keratometer (Ophthalmometer) Lensmeter (Lensometer) Trial Lens Set Perimeter Schiotz Tonometer Tangent Screen Goldman Tonometer Phoropter (refractor) Muscle Light

Answer 246

Ultrasound (A-scan)

Question 247

Which is the name of this item? Direct Ophthalmoscope Slit Lamp (Biomicroscope) Indirect Ophthalmoscope Ultrasound (A-scan) Retinoscope Keratometer (Ophthalmometer) Lensmeter (Lensometer) Trial Lens Set Perimeter Schiotz Tonometer Tangent Screen Goldman Tonometer Phoropter (refractor) Muscle Light

Answer 247

Lensmeter (Lensometer)

Question 248

Which is the name of this item? Direct Ophthalmoscope Slit Lamp (Biomicroscope) Indirect Ophthalmoscope Ultrasound (A-scan) Retinoscope Keratometer (Ophthalmometer) Lensmeter (Lensometer) Trial Lens Set Perimeter Schiotz Tonometer Tangent Screen Goldman Tonometer Phoropter (refractor) Muscle Light

Answer 248

Slit Lamp

Question 249

Which is the name of this item? Direct Ophthalmoscope Slit Lamp (Biomicroscope) Indirect Ophthalmoscope Ultrasound (A-scan) Retinoscope Keratometer (Ophthalmometer) Lensmeter (Lensometer) Trial Lens Set Perimeter Schiotz Tonometer Tangent Screen Goldman Tonometer Phoropter (refractor) Muscle Light

Answer 249

Schiotz Tonometer

Question 250

Which is the name of this item? Direct Ophthalmoscope Slit Lamp (Biomicroscope) Indirect Ophthalmoscope Ultrasound (A-scan) Retinoscope Keratometer (Ophthalmometer) Lensmeter (Lensometer) Trial Lens Set Perimeter Schiotz Tonometer Tangent Screen Goldman Tonometer Phoropter (refractor) Muscle Light

Answer 250

Perimeter

Question 251

Which part of the Lensometer is: A Axis Wheel Lens Holder Frame Stage Eye Piece Lens Stop Power Wheel Table Control Lever

Answer 251

Eye Piece

Question 252

Which part of the Lensometer is: B Axis Wheel Lens Holder Frame Stage Eye Piece Lens Stop Power Wheel Table Control Lever

Answer 252

Lens Holder

Question 253

Which part of the Lensometer is: C Axis Wheel Lens Holder Frame Stage Eye Piece Lens Stop Power Wheel Table Control Lever

Answer 253

Lens Stop

Question 254

Which part of the Lensometer is: D Axis Wheel Lens Holder Frame Stage Eye Piece Lens Stop Power Wheel Table Control Lever

Answer 254

Frame Stage

Question 255

Which part of the Lensometer is: E Axis Wheel Lens Holder Frame Stage Eye Piece Lens Stop Power Wheel Table Control Lever

Answer 255

Axis Wheel

Question 256

Which part of the Lensometer is: F Axis Wheel Lens Holder Frame Stage Eye Piece Lens Stop Power Wheel Table Control Lever

Answer 256

Table Control Lever

Question 257

Which part of the Lensometer is: G Axis Wheel Lens Holder Frame Stage Eye Piece Lens Stop Power Wheel Table Control Lever

Answer 257

Power Wheel

Question 258

The proper position of glasses on the manual lensometer is: a. bottom edge of frame against the frame stage, temples facing away b. top edge of frame against the frame stage, temples facing away c. bottom edge of frame against the frame stage, temples facing toward you d. top edge of frame against the frame stage, temples facing toward you

Answer 258

a. bottom edge of frame against the frame stage, temples facing away

Question 259

When beginning to read the right lens, the first step is to: a. try to center the target by moving the stage b. move the stage so the target is in the uppermost part of the field c. move the stage so the target is in the lower part of the field d. change the eye piece again to refocus

Answer 259

a. try to center the target by moving the stage

Question 260

Which target is analyzed first? a. the instrument makes this selection b. the circular mires c. the wide/triple lines d. the narrow/single lines

Answer 260

d. the narrow/single lines

Question 261

If all the lines of the lensometer target clear at the same time, the lens is: a. monocentric b. spherical c. cylindrical d. spherocylindrical

Answer 261

b. spherical

Question 262

If the narrow/single line and the wide/triple lines of the lensometer target do not clear at the same time, the lens is: a. bicentric b. spherical c. plano d. spherocylindrical

Answer 262

d. spherocylindrical

Question 263

If the lens is determined to by spherocylindrical, one can deduce that the patient has: a. myopia b. hyperopia c. astigmatism d. presbyopia

Answer 263

c. astigmatism

Question 264

You are reading the right lens, and the narrow lines appear broken. This means you need to adjust the: a. eye piece b. lens table c. axis wheel d. power whell

Answer 264

c. axis wheel

Question 265

If the narrow/single lines are clear and you wish to read the lens in minus cylinder form, you should: a. turn the power-focusing wheel toward yourself b. turn the power-focusing wheel away from yourself c. change the axis 90 degrees d. focus the triple lines first instead

Answer 265

b. turn the power-focusing wheel away from yourself

Question 266

The narrow/single lines are clear. You wish to read the glasses in plus cylinder. Turning the power wheel toward yourself does not bring the wide/triple lines into focus. What should you do? a. read the lenses in minus cylinder instead b. subtract the reading for the narrow/single lines from the reading for the wide/triple lines c. add the reading for the narrow/single lines to the reading for the wide/triple lines d. rotate the axis 90 degrees

Answer 266

d. rotate the axis 90 degrees

Question 267

You have taken the following lensometer reading: The narrow/single lines clear at -2.00. The wide/triple lines clear at -3.00. Axis is on 083. The prescription is: a. -2.00 -3.00 x 083 b. -2.00 -1.00 x 083 c. -2.00 -1.00 x 173 d. -3.00 +1.00 x 083

Answer 267

b. -2.00 -1.00 x 083

Question 268

You have taken the following lensometer reading: The narrow/single lines clear at +6.25. The wide/triple lines clear at +8.00. Axis is on 132. The prescription is: a. +8.00 -6.28 x 042 b. +6.25 +8.00 x 132 c. +6.25 +1.75 x 042 d. +6.25 +1.75 x 132

Answer 268

d. +6.25 +1.75 x 132

Question 269

You have taken the following lensometer reading: The narrow/single lines clear at -1.50. The wide/triple lines clear at +1.25. Axis is on 097. The prescription is: a. -1.50 +1.25 x 097 b. -1.50 +2.75 x 007 c. -1.50 +2.75 x 097 d. -0.25 -1.25 x 097

Answer 269

c. -1.50 +2.75 x 097

Question 270

You have taken the following lensometer reading: The narrow/single lines clear at +2.25. The wide/triple lines clear at -0.25. Axis is on 178. The prescription is: a. +2.25 -0.25 x 178 b. +2.00 -0.25 x 178 c. -0.25 +2.50 x 088 d. +2.25 -2.50 x 088

Answer 270

c. -0.25 +2.50 x 088

Question 271

You have centered and read the distant portion of the right lens of a pair of bifocals. What is the next step? a. move the stage up to read the bifocal segment b. switch to the left lens, center, and read its distant portion c. switch to the left lens and note the position of the target d. turn the glasses over and read the front power of the right lens

Answer 271

c. switch the left lens and note the position of the target (It is very important to go from distance, right lens, to distance, left lens, without moving the stage. Otherwise, you could miss induced vertical prism.)

Question 272

To read the power of bifocal or trifocal segments, you should: a. move the frame table upward until the segment mires appear in the center b. Slide the glasses down until the segment mires appear in the center c. Slide the glasses up and hold them there by hand d. always turn the glasses around to read the back of the lens

Answer 272

a. move the frame table upward until the segment mires appear in the center

Question 273

The power of a bifocal will be the difference between: a. the axes of the distant and bifocal portions of the lens b. the point where the wide lines clear on the distant part of the lens and where the thin lines clear on the bifocal c. the point where the narrow/single lines clear on the distant part of the lens and where they clear on the bifocal d. the point where the narrow/single lines clear on the distant part of the lens and where the wide lines clear on the bifocal

Answer 273

c. the point where the narrow/single lines clear on the distant part of the lens and where they clear on the bifocal

Question 274

The distance portion of the lens prescription is -1.25 sphere. You are now reading the bifocal add, and the lensometer dial reads +1.50. The add should be recorded as: a. +1.50 b. +0.25 c. +0.75 d. +2.75

Answer 274

d. +2.75

Question 275

The distant portion of the lens prescription is +1.25 (narrow/single lines) -1.25 (wide/triple lines) x180. You are now reading the bifocal add, and the narrow lines clear at +3.00. The add should be recorded as: a. +3.00 b. plano c. +1.75 d. +4.25

Answer 275

c. +1.75

Question 276

The distance portion of the lens is -2.00 +2.00 x 072. You are now reading the bifocal add, and the wide lines clear at +3.00. The add is: a. plano b. +1.00 c. +2.00 d. +3.00

Answer 276

d. +3.00

Question 277

The best method for reading the add on a no-line progressive lens using a manual lensometer is to: a. mark the lens first using the template from that manufacturer b. use the least plus reading for the distance and the most plus reading for the add c. take the distant lensometry reading at a point between the laser marks on the lens d. center the target on the lensometer

Answer 277

a. mark the lens first using the template from that manufacturer (Most companies who manufacture no-line progressives have a template for their lens. The lens is laid on the template, and a wax pencil is used to trace the markings onto the lens. A circle indicates where the reading should be taken.)

Question 278

To read the bifocal portion of an aphakic spectacle lens: a. the distance and bifocal spherical power should be read with the temples toward the technician b. the distance and bifocal spherical power should be read with the temples away from the technician c. one need only read the distance spherical power, because all aphakic lenses have a +3.50 add d. one must adjust the eye piece to compensate for the high amount of plus power

Answer 278

a. the distance and bifocal spherical power should be read with the temples toward the technician

Question 279

Regarding the power of the midlevel trifocal lens segment: a. it is impossible to read the power on the lensometer b. it is always half the power of the bifocal c. it is always twice the power of the bifocal d. it can be read using the lensometer

Answer 279

d. it can be read using the lensometer

Question 280

Lenses that are not correctly centered on the visual axis result in: a. off-axis prescriptions b. extra edge thickness c. unwanted prism d. accurate prescriptions

Answer 280

c. unwanted prism

Question 281

Prism diopters are measured using a lensometer by: a. the rings in the reticle b. the number of lines in the target c. the position of the target d. the position of the glasses on the stage

Answer 281

a. the rings in the reticle

Question 282

Prism direction is indicated in the lensometer by: a. the rings in the reticle b. the number of lines in the target c. the position of the target d. the position of the glasses on the stage

Answer 282

c. the position of the target

Question 283

If the target can be centered in the lensometer, how does one determine whether or not there is induced prism due to decentration? a. by marking the centers b. by marking the centers and measuring the distance between them c. by marking the centers and observing the glasses on the patient d. decentered lenses cannot be centered in the lensometer

Answer 283

c. by marking the centers and observing the glasses on the patient

Question 284

The target of the right lens is displaced to the right, and the lines cross at the third ring. The prism power and direction is: a. 3 prism diopters, base out b. 3 prism diopters, base in c. 1.5 prism diopters, base out d. 1.5 prism diopters, base in

Answer 284

b. 3 prism diopters, base in

Question 285

The target of the left lens is displaced to the right, and the lines cross between the first and second rings. The prism power and direction is: a. 1 prism diopter, base in b. 2 prism diopters. base out c. 1.5 prism diopters, base in d. 1.5 prism diopters, base out

Answer 285

d. 1.5 prism diopters, base out

Question 286

Base-out prism is induced when: a. the optical center separation is greater than the pupillary distance with minus lenses b. the optical center separation is less than the pupillary distance with minus lenses c. the optical center separation is less than the pupillary distance with plus lenses d. the optical separation is offset vertically with plus or minus lenses

Answer 286

b. the optical center separation is less than the pupillary distance with minus lenses

Question 287

To check a manual lensometer for accuracy: a. adjust the eye piece then read a trial lens b. set the target lines for your refractive error, then see if they are clear c. set the eye piece at zero, then read a trial lens d. set the eye piece at zero, and see if the target lines clear at plano

Answer 287

a. adjust the eye piece then read a trial lens

Question 288

True or False; the following pertains to maintenance of a manual lensometer: resetting the eye piece to zero after each use

Answer 288

False

Question 289

True or False; the following pertains to maintenance of a manual lensometer: turning off the instrument when not being used

Answer 289

True

Question 290

True or False; the following pertains to maintenance of a manual lensometer: covering the instrument when not in use

Answer 290

True

Question 291

True or False; the following pertains to maintenance of a manual lensometer: not putting too much ink on the ink pad

Answer 291

True

Question 292

The structure of the eye with the most refractive power is the: a. lens b. cornea c. vitreous/aqueous d. retina

Answer 292

b. cornea (While the lens, cornea, and vitreous/aqueous each have refractive power, and in spite of the fact that the lens can adjust and focus, the cornea is the strongest refracting structure of the eye.)

Question 293

Corneal curvature is measured (quantified) using the: a. Placido's disk b. slit lamp c. vertexometer d. keratometer

Answer 293

d. keratometer (the keratometer is the only device listed that measures corneal curvature. Placido's disk is used to evaluate corneal shape and topography, but it does not give measurement. Vertexometer is used to measure vertex distance (the distance between a corrective lens and the front surface of the cornea.))

Question 294

Corneal curvature can be recorded as: a. millimeters/diopters b. milliliters/diopters c. millimeters/cylinders d. centimeters/decibels

Answer 294

a. millimeters/diopters

Question 295

Unequal corneal curvature where the flattest and steepest curves are 90 degrees apart is known as: a. myopia b. presbyopia c. astigmatism d. hyperopia

Answer 295

c. astigmatism (Astigmatism occurs when the cornea is more curved in one direction and less in the other. Think of the back of a spoon or the surface of an eggshell; these curves are almost always 90 degrees from each other.)

Question 296

The average power of the human cornea is: a. 30 to 32 D b. 35 to 36 D c. 43 to 44 D d. 45 to 47 D

Answer 296

c. 43 to 44 D

Question 297

Average thickness of the central cornea is: a. 0.8mm b. 0.5mm c. 0.2mm d. 1.0mm

Answer 297

b. 0.5mm

Question 298

The following prescription, Plano -2.00 x 180, is an example of: a. with-the-rule astigmatism b. against-the-rule astigmatism c. oblique astigmatism d. irregular astigmatism

Answer 298

a. with-the-rule astigmatism (in with-the-rule astigmatism, the strongest corneal axis is vertical; this translates to approximately 180 degrees in minus cylinder and approximately 90 degrees in plus cylinder. Against-the-rule is the opposite, with the strongest corneal axis in the horizontal, approximately 90 degrees in minus cylinder and approximately 180 degrees in plus. Irregular astigmatism does not have a single axis because the flattest and steepest meridians are not at 90 degree angles from each other.)

Question 299

Which of the following is an example of oblique astigmatism? a. -2.00 + 1.25 x 093 b. -0.75 -1.25 x003 c. -4.25 + 2.75 x 046 d. Plano

Answer 299

c. -4.35 + 2.75 x 046 (An oblique astigmatism means the axes are not vertical, or horizontal, but at an angle in between. Note that the axes do not have to be "on the dot" at 90,180,45 or 135 to qualify.)

Question 300

If the axis of astigmatism are *not* 90 degrees from each other, this is termed: a. irregular astigmatism b. compound astigmatism c. dry eye syndrome d. astigmatism of vitreous face

Answer 300

a. irregular astigmatism (Irregular astigmatism occurs when the steepest and flattest curves are not 90 degrees from each other. Compound astigmatism is a type of regular astigmatism.)

Question 301

Of the following, which patient is *most* likely to have irregular astigmatism? a. postoperative cataract b. aphakic c. surface ocular trauma d. postoperative LASIK

Answer 301

c. surface ocular trauma

Question 302

The steepest part of the cornea is the: a. periphery b. inferior one-fourth c. stroma d. center

Answer 302

d. center

Question 303

The diameter of the cornea's optic zone, or cap, measures: a. 4.0 mm b. 0.5 mm c. 20 mm d. 3.06 um

Answer 303

a. 4.0 mm

Question 304

Manual keratometry would *not* be the most appropriate method for reliable measurements in which of the following cases? a. fitting contact lenses b. monitoring keratoconus c. calculating intraocular lens (IOL) power d. evaluating after cataract surgery

Answer 304

b. monitoring keratoconus

Question 305

Keratometry would be useful in evaluating all of the following *except*: a. keratoconus b. preoperative cataract surgery c. contact lens fitting d. corneal ulcer

Answer 305

d. corneal ulcer

Question 306

Which Part of the Keratometer is A: barrel Lock Vertical barrel adjustment chin rest occluder vertical mires adjustment chin rest adjustment eye piece horizontal mires adjustment focus adjustment forehead adjustment

Answer 306

occluder

Question 307

Which Part of the Keratometer is B: barrel Lock Vertical barrel adjustment chin rest occluder vertical mires adjustment chin rest adjustment eye piece horizontal mires adjustment focus adjustment forehead adjustment

Answer 307

barrel

Question 308

Which Part of the Keratometer is C: barrel Lock Vertical barrel adjustment chin rest occluder vertical mires adjustment chin rest adjustment eye piece horizontal mires adjustment focus adjustment forehead adjustment

Answer 308

eye piece

Question 309

Which Part of the Keratometer is D: barrel Lock Vertical barrel adjustment chin rest occluder vertical mires adjustment chin rest adjustment eye piece horizontal mires adjustment focus adjustment forehead adjustment

Answer 309

vertical mires adjustment

Question 310

Which Part of the Keratometer is E: barrel Lock Vertical barrel adjustment chin rest occluder vertical mires adjustment chin rest adjustment eye piece horizontal mires adjustment focus adjustment forehead adjustment

Answer 310

horizontal mires adjustment

Question 311

Which Part of the Keratometer is F: barrel Lock Vertical barrel adjustment chin rest occluder vertical mires adjustment chin rest adjustment eye piece horizontal mires adjustment focus adjustment forehead adjustment

Answer 311

focus adjustment

Question 312

Which Part of the Keratometer is G: barrel Lock Vertical barrel adjustment chin rest occluder vertical mires adjustment chin rest adjustment eye piece horizontal mires adjustment focus adjustment forehead adjustment

Answer 312

chin rest adjustment

Question 313

Which Part of the Keratometer is H: barrel Lock Vertical barrel adjustment chin rest occluder vertical mires adjustment chin rest adjustment eye piece horizontal mires adjustment focus adjustment forehead adjustment

Answer 313

vertical barrel adjustment

Question 314

Which Part of the Keratometer is I: barrel Lock Vertical barrel adjustment chin rest occluder vertical mires adjustment chin rest adjustment eye piece horizontal mires adjustment focus adjustment forehead adjustment

Answer 314

lock

Question 315

Which Part of the Keratometer is J: barrel Lock Vertical barrel adjustment chin rest occluder vertical mires adjustment chin rest adjustment eye piece horizontal mires adjustment focus adjustment forehead adjustment

Answer 315

forehead adjustment

Question 316

Which is step 1 in using a Keratometer in chronological order: - occlude the eye not being tested - turn the drum so that the horizontal plus signs are aligned exactly tip-to-tip - turn the dials to superimpose the horizontal plus and vertical minus signs - position the patient - focus the mires, and center the cross-hairs in the lower right hand circle - focus the eye piece

Answer 316

focus the eyepiece

Question 317

Which is step 2 in using a Keratometer in chronological order: - occlude the eye not being tested - turn the drum so that the horizontal plus signs are aligned exactly tip-to-tip - turn the dials to superimpose the horizontal plus and vertical minus signs - position the patient - focus the mires, and center the cross-hairs in the lower right hand circle - focus the eye piece

Answer 317

position the patient

Question 318

Which is step 3 in using a Keratometer in chronological order: - occlude the eye not being tested - turn the drum so that the horizontal plus signs are aligned exactly tip-to-tip - turn the dials to superimpose the horizontal plus and vertical minus signs - position the patient - focus the mires, and center the cross-hairs in the lower right hand circle - focus the eye piece

Answer 318

occlude the eye not being tested

Question 319

Which is step 4 in using a Keratometer in chronological order: - occlude the eye not being tested - turn the drum so that the horizontal plus signs are aligned exactly tip-to-tip - turn the dials to superimpose the horizontal plus and vertical minus signs - position the patient - focus the mires, and center the cross-hairs in the lower right hand circle - focus the eye piece

Answer 319

focus the mires, and center the cross-hairs in the lower right hand circle

Question 320

Which is step 5 in using a Keratometer in chronological order: - occlude the eye not being tested - turn the drum so that the horizontal plus signs are aligned exactly tip-to-tip - turn the dials to superimpose the horizontal plus and vertical minus signs - position the patient - focus the mires, and center the cross-hairs in the lower right hand circle - focus the eye piece

Answer 320

turn the drum so that the horizontal plus signs are aligned exactly tip-to-tip

Question 321

Which is step 6 in using a Keratometer in chronological order: - occlude the eye not being tested - turn the drum so that the horizontal plus signs are aligned exactly tip-to-tip - turn the dials to superimpose the horizontal plus and vertical minus signs - position the patient - focus the mires, and center the cross-hairs in the lower right hand circle - focus the eye piece

Answer 321

turn the dials to superimpose the horizontal plus and vertical minus signs

Question 322

Occluding the eye not being measured is helpful because it: a. reduces reflections b. aids in fixation c. eliminates lenticular astigmatism d. reduces irregular astigmatism

Answer 322

b. aids in fixation (the occluder forces the patient to fixate with the eye that is being measured. This helps hold that eye steady for being measured.)

Question 323

You are attempting a K reading and do no see both horizontal plus signs. This might be due to: a. a drooped upper lid b. the patient closing his or her eye c. a keratometer occluder in the way d. improper focusing

Answer 323

c. a keratometer occluder in the way (the plus sign is projected on the side, and the main thing that might obstruct the mires from the side is the occluder. A common vertical obstruction (which would obstruct the minus signs) is the patient's upper lid.)

Question 324

With a flat cornea, how will the keratometer mires appear: a. small b. round c. elliptical d. very large e. clear, then quickly blur f. wavy, blurred, discontinuous g. distorted, small, cannot superimpose

Answer 324

d. very large

Question 325

With corneal warpage, how will the keratometer mires appear: a. small b. round c. elliptical d. very large e. clear, then quickly blur f. wavy, blurred, discontinuous g. distorted, small, cannot superimpose

Answer 325

f. wavy, blurred, discontinuous

Question 326

With keratoconus, how will the keratometer mires appear: a. small b. round c. elliptical d. very large e. clear, then quickly blur f. wavy, blurred, discontinuous g. distorted, small, cannot superimpose

Answer 326

g. distorted, small, cannot superimpose

Question 327

With a spherical cornea, how will the keratometer mires appear: a. small b. round c. elliptical d. very large e. clear, then quickly blur f. wavy, blurred, discontinuous g. distorted, small, cannot superimpose

Answer 327

b. round

Question 328

With a steep cornea, how will the keratometer mires appear: a. small b. round c. elliptical d. very large e. clear, then quickly blur f. wavy, blurred, discontinuous g. distorted, small, cannot superimpose

Answer 328

a. small

Question 329

With dry eye, how will the keratometer mires appear: a. small b. round c. elliptical d. very large e. clear, then quickly blur f. wavy, blurred, discontinuous g. distorted, small, cannot superimpose

Answer 329

e. clear, then quickly blur

Question 330

With an astigmatism, how will the keratometer mires appear: a. small b. round c. elliptical d. very large e. clear, then quickly blur f. wavy, blurred, discontinuous g. distorted, small, cannot superimpose

Answer 330

c. elliptical

Question 331

If the cross-hairs of the keratometer are not centered during the initial reading for contact lens fitting: a. the fit may be inaccurate b. lens diameter may be incorrect c. lenses will be difficult to handle d. the lens will not transmit oxygen

Answer 331

a. the fit may be inaccurate (If the cross-hairs are not centered, you are not reading the corneal apex. Because the corneal periphery is flatter, the resulting fit will be too loose when placed on the steeper corneal apex.)

Question 332

True or False: K readings in a contact lens-wearing patient may be used to evaluate progressive corneal steepening

Answer 332

True

Question 333

True or False: K readings in a contact lens-wearing patient may be used to evaluate lens fit

Answer 333

True

Question 334

True or False: K readings in a contact lens-wearing patient may be used to evaluate lens coverage

Answer 334

False

Question 335

True or False: K readings in a contact lens-wearing patient may be used to evaluate corneal warpage

Answer 335

True

Question 336

The patient's keratometry mires are very oval-shaped. This means that there is: a. no astigmatism b. high emmetropia c. significant astigmatism d. inaccurate alignment

Answer 336

c. significant astigmatism (actually, this makes the reading easier, as even a tiny turn of barrel or dial makes an obvious difference. An eye with no astigmatism would have very round mires. Emmetropia is lack of refractive error, so it cannot be classified as high, low, or in between. Inaccurate alignment is evident when the cross-hair is not centered in the lower right circle.)

Question 337

The patient's keratometry mires are squiggly looking and change when the patient blinks. You should try: a. instilling topical anesthetic b. instilling artificial tears c. re-explaining the procedure d. realigning the patient

Answer 337

b. instilling artificial tears ("squiggly" mires that change when the patient blinks indicate a problem with the tear film. Instill some artificial tears, have the patient blink a lot, and blot gently with a tissue. Then, try the readings again. There is no need to use an anesthetic.)

Question 338

No matter how you rotate the keratometer drum, the "plus signs" remain aligned. This indicates that there is: a. irregular astigmatism b. poor tear film c. poorly focused eye piece d. no astigmatism

Answer 338

d. no astigmatism (this is because the curve is the same in every meridian)

Question 339

Which of the following types of astigmatism is *not* obvious when measuring with the keratometer? a. astigmatism at 180 degrees b. irregular astigmatism c. lenticular astigmatism d. oblique astigmatism

Answer 339

c. lenticular astigmatism

Question 340

You are taking a K reading. The power drum is at 52.00 D (the upper limit of the scale), and the mires are still not aligned. To extend the range of the keratometer, you should: a. affix a -1/00 D trial lens over the aperture b. affix a +1.25 D trial lens over the aperture c. affix a +2.25 D trial lens over the eye piece d. it is not possible to extend the range of a keratometer

Answer 340

b. affix a +1.25 D lens over the aperture

Question 341

You have taken a K reading by extending the instrument's range. To get the correct value, you can: a. use a conversion chart b. subtract the power of the extending lens c. add the power of the extending lens d. simply record the drum reading

Answer 341

a. use a conversion chart

Question 342

You are adjusting the keratometer eye piece by looking at the occluder through the ocular: The mires are distorted. You should: a. calibrate with metal balls b. spray cleaner into the instrument c. clean the instrument with compressed air d. return to the manufacturer for cleaning

Answer 342

d. return to the manufacturer for cleaning

Question 343

When calibrating the keratometer with metal balls, all of the following are done *except*: a. using chrome balls of known radius b. placing holder on the headrest c. setting the eye piece for your refractive error d. placing the chrome ball in the holder with your fingers

Answer 343

d. placing the chrome ball in the holder with your fingers

Question 344

If calibration of the keratometer reveals a discrepancy: a. adjust the drums b. tighten the headrest c. loosen the top screw d. have the manufacturer repair it

Answer 344

d. have the manufacturer repair it

Question 345

If the keratometer's occluder is loose: a. simply remove it b. rebend or replace the washer c. tape it up out of the way d. adjust the headrest appropriately

Answer 345

b. rebend or replace the washer

Question 346

Current procedural terminology (CPT) codes are used to: a. communicate between providers b. communicate with insurance companies c. provide legal documentation d. inform patients regarding their health care

Answer 346

b. communicate with insurance companies

Question 347

CPT has a direct impact on: a. clinical clarification b. presenting evidence in court c. patient feedback d. reimbursement

Answer 347

d. reimbursement (Coding, be it proper or improper, directly affects the reimbursement that the practice gets from third-party payers.)

Question 348

A procedure might carry a different charge, depending on who performs it. This may mean that the procedure code needs an additional code called a(n): a. service number b. qualifier c. modifier d. HIPAA code

Answer 348

c. modifier (modifiers provide more explicit information about a procedure. Thus, a modifier might be called for when a procedure carries an additional element, such as being performed by a technician or by a mid-level practitioner.)

Question 349

The International Classification of Diseases (ICD) codes of nuclear cataract 366.16 and astigmatism 367.21 are examples of: a. AMA codes b. procedure codes c. diagnosis codes d. encounter codes

Answer 349

c. diagnoses codes (ICD codes are numeric codes that identify disorders, diseases, conditions, etc.)

Question 350

A reviewer is looking over an encounter form for a patient visit to your practice to make sure that diagnosis codes and procedure codes match up. Which of the following would be marked as unacceptable? a. CPT: incise and drain ICD: chalazion b. CPT: epilation ICD: trichiasis c. CPT: probe and irrigation ICD: cataract d. CPT: biopsy ICD: lesion of the eyelid

Answer 350

c. CPT: probe and irrigation ICD: cataract (it is vital that procedure codes have an appropriate diagnosis code to justify them.)

Question 351

A patient who had a blepharoplasty is upset because now she has dry eyes. They court determined that the patient was not told about this risk prior to surgery. This is an example of: a. failure to disclose b. breach of promise c. failure to perform d. intentional harm

Answer 351

a. failure to disclose ("failure to disclose" occurs when a patient has not been informed about the risks of a particular procedure. This "duty of disclosure" is part of the informed consent process.)

Question 352

A patient who is moving to another state has stopped by the office requesting his records. He would like you to hand over the chart so he can take it with him. Your response to this is to: a. make copies for the office and give him the original b. tell the patient you will mail the original to his new provider c. give the patient lab work reports from his chart d. make copies for the patient and keep the original for the office

Answer 352

d. make copies for the patient and keep the original for the office (the physical chart belongs to the practice; the information belongs to the patient. Prior to providing the copies, you must get a signed release of information form. Some clinics have further rules that govern how medical records are to be handled.)

Question 353

True of False; the following is a legal regulation? An eye care practitioner must fit any patient who desires it with contact lenses

Answer 353

False

Question 354

True of False; the following is a legal regulation? The patient who has a refractive eye exam must be provided with a copy of the glasses prescription

Answer 354

True

Question 355

True of False; the following is a legal regulation? A prescription for glasses is only good for 6 months

Answer 355

False

Question 356

True of False; the following is a legal regulation? K readings must be included on every glasses prescription in case the patient decides to get contact lenses

Answer 356

False

Question 357

An ophthalmic assistant who measures a patient's refractive error and then writes the patient a glasses prescription, where the physician does not see the patient or review the record, is: a. breaking the law b. violating patient privacy c. doing the patient a favor d. in accordance with current practice

Answer 357

a. breaking the law (the procedure described is a *refraction*, which involves clinical judgement allowed only by a licensed professional. Ophthalmic technicians may perform *refractometry*, where the refractive error is measured but the prescribing/clinical judgement is left to the licensed practitioner.)

Question 358

The right of a patient to protection of his or her personal health information is a federal law known as: a. Health Insurance Portability and Accountability Act (HIPAA) b. Occupational Safety and Health Administration (OSHA) c. Joint Commission on Accreditation of Health Care Organizations (JCAHO) d. American Academy of Ophthalmology (AAO)

Answer 358

a. Health Insurance Portability and Accountability Act (HIPAA)

Question 359

OSHA has developed laws regarding: a. standard for safety lenses b. eye protection in the workplace c. privacy laws d. scope of practice

Answer 359

b. eye protection in the workplace (OSHA deals with employee safety and has rules regarding eye protection in the workplace (such as safety goggles worn when assisting with laser surgery)

Question 360

Which of the following is true? a. an eye care practitioner may charge a fee to release a patient's glasses prescription b. an eye care practitioner may restrict eye exams only to those who agree to purchase eyewear from the practice's optical shop c. an eye care practitioner may refuse to release a patient's glasses prescription until the patient has paid for the eye exam, if it is customary to require payment at the time of the service d. an eye care practitioner who has fit a patient for contacts may require that the patient buy the first year's supply of lenses from the practitioner's practice

Answer 360

c. an eye care practitioner may refuse to release a patient's glasses prescription until the patient has paid for the eye exam, if it is customary to require payment at the time of the service

Question 361

The federal Trade Commission (FTC) has regulations affecting all of the following *except*: a. the "intraocular lens implant rule" b. advertising for refractive surgery c. the "eyeglass rule" d. the "contact lens rule"

Answer 361

a. the "intraocular lens implant rule"

Question 362

OSHA regulations regarding medical practices require all of the following *except*: a. every new hire is to be trained in infection control practices b. all contact lenses must be fit by a licensed eye care practitioner c. the employer must provide personal protective equipment to employees d. OSHA regulations must be posted in the workplace

Answer 362

b. all contact lenses must be fit by a licensed eye care practitioner

Question 363

The "Red Flags Rule" was developed by the FTC in order to prevent: a. employee injuries b. identity theft c. insurance fraud d. sexual harassment in the workplace

Answer 363

b. identity theft (the rule requires businesses (including medical practices) to develop a plan of identifying "relevant patterns, practices, and specific forms of activity - the 'red flags' - that signal possible identity theft")

Question 364

All of the following are *true* regarding the Patient Protection and Affordable Care Act (PPACA) *except*: a. it affects insurance coverage for pre-existing conditions b. it is concerned with health insurance reform c. it enforces health care privacy laws d. it was signed into law by President Barack Obama

Answer 364

c. it enforces health care privacy laws

Question 365

Quality assurance (QA) depends upon: a. opinions of caregivers b. patient compliance c. being able to measure something d. having favorable surgical results

Answer 365

c. being able to measure something (QA requires that something be measured, regardless of whether the data come from a patient survey, patient records, checklists, etc.)

Question 366

Which of the following does *not* apply to QA? a. one characteristic of QA is to minimize problems and poor outcome b. one characteristic of QA is to identify procedures that need to be changed c. one characteristic of QA is to be a once-and-done procedure d. one characteristic of QA is that it can lead to better patient care

Answer 366

c. one characteristic of QA is to be a once-and-done procedure (the intent of QA is to monitor routine procedures so that problems can be identified and corrected, resulting in better patient care. To be effective, QA is an ongoing process, not something done once to qualify for a certification or to pass an inspection.)

Question 367

An example of data collected for QA purposes regarding outcomes would be: a. employee turnover b. visual acuity after cataract surgery c. number of patients seen daily d. number of referral patients

Answer 367

b. visual acuity after cataract surgery

Question 368

Which of the following is true? a. QA is the responsibility only of the practitioner b. QA helps hold health care workers accountable c. QA is only an issue if the practice is to be inspected d. QA is not concerned with access to health care

Answer 368

b. QA helps to hold health care workers accountable (a practice's QA system helps to set minimum standards to which all in the clinic (not just the practitioner) are held. QA is generally focused on outcome (e.g. vision after cataract surgery), the relationship of cost to benefit (e.g. time, money, and effort put into patient care versus benefit to patient). While a viable QA system may be required for certain clinical certifications, every patient needs to have such a system.)

Question 369

Your practice is developing a QA program. One area to be addressed is strabismus surgery. Which of the following would *not* fit into the list of logical assessments? a. preoperative and postoperative prism measurements of the deviation b. patient or parental survey of satisfaction with the process as a whole c. data concerning postoperative complications d. putting strategies into place that will prevent alterations to the process

Answer 369

d. putting strategies into place that will prevent alterations to the process

Question 370

The standards that govern moral conduct, especially of a person/group with some type of power in issues regarding conduct, rights, and actions is: a. informed consent b. patient rights c. ethics d. medicolegal code

Answer 370

c. ethics (ethics are the standards that govern our personal and professional behavior. In medicine, these are the standards that help us make moral judgements regarding such things as how we treat our patients (both personally and medically), how we treat our peers, what kind of employee we are, and much more. It includes providing the best and most intelligent care of which we are capable and maintaining honest relationships with others.)

Question 371

The basis for medical ethics is: a. the Oath of Hammurabi b. the Hippocratic Oath c. the Mayflower Compact d. the Constitution of the United States

Answer 371

b. the Hippocratic Oath (Hippocrates lived in the fifth century BC. He was a Greek physician who held himself to a strict code of behavior and quality of care, which included conduct, confidentiality, and scope of practice. From this grew the concept of medical ethics, and the Hippocratic Oath (which speaks to those same virtues) is named after him.

Question 372

You have just seated your patient and ask if she's having any problems with her eyes. She states that she would like to discuss that only with the physician. You explain your role in gathering information and assure her of confidentiality, but she insists that she will speak only to the doctor. You should: a. explain that it is office policy that she speak to you first b. offer to appoint her for another day when she may feel more cooperative c. affirm her right to speak only to the physician and acquiesce d. recommend that the physician dismiss her from the practice

Answer 372

c. affirm her right to speak only to the physician and acquiesce (it is the patient's right to discuss her case with the physician only; be sure to document in the chart that the patient has made this choice. You might ask if you can go ahead and do a "few tests" so that the doctor will have some information when she speaks to the patient, such as visual acuity, lensometry, pupil evaluation, slit-lamp evaluation, and perhaps noncontact tonometry. Without a history, it is inadvisable to instill drops or perform any type of contact test (tonometry, schirmer's, etc.). In addition, while the patient may not wish to discuss his or her eye problems, he or she may be willing to give other information about his or her history)

Question 373

The physician is out of the office, and a patient comes by on his way to an optical shop. He has broken his glasses and asks you to "test me for glasses" and give him a new, updated prescription to take to the optician. For you, as an ophthalmic assistant, this is a question of: a. patient rights b. scope of practice c. confidentiality d. moral obligation

Answer 373

b. scope of practice ("Scope of practice" relates to what you are allowed to do in the performance of your job. Because ophthalmic/optometric technicians are not permitted to "Refract" (ie, measure refractive error and then apply clinical judgment to write the prescription), this request would be beyond your scope of practice.

Question 374

Your new patient had cataract surgery at another practice in town 6 months ago and is unhappy with her vision. She states that she was nearsighted before, but now she cannot read anything up close without glasses. Your refractometric measurement of the eye is +3.75 sphere for distance, with a +2.25 add for near. Which of the following is a potentially libelous thing to say? a. "You're the second patient in a month from that practice who has this problem!" b. "We'll know more after Dr. Davis looks at you." c. "Unfortunately, measuring for the power of an implant is an inexact science." d. "Has the surgeon suggested anything that might help?"

Answer 374

a. "You're the second patient in a month from that practice who has this problem!" (the comment in answer a suggests that there is a problem with the surgeon, who has made the same mistake twice in just a few weeks. Discussing another doctor, practice, or even someone in your own clinic in a negative fashion is not good ethics... even if they are at fault.)

Question 375

Which of the following does *not* carry with it the "duty to report"? a. incompetence b. child abuse c. data collection d. impaired eye care professional

Answer 375

c. data collection

Question 376

Which of the following is *true* regarding certifications for eye care paraprofessionals? a. certification is required in order to be employed b. certification acknowledges that a person has attained specific professional standards c. certification legally permits the individual to evaluate and interact with patients d. certification is required in order to perform certain functions, such as refractions

Answer 376

b. certification acknowledges that a person has attained specific professional standards (certifications attests to a person's ability to meet a specific professional standard. It is not required to work in the field of eye care, but it is a statement to patients, to other professionals, and to the community at large that a person has attained those standards. It is not licensure, a legal instruments that allows the bearer certain privileges.

Question 377

Compliance with the American National Standards Institute (ANSI) standards is: a. required by federal law b. required by state statutes c. relative to the type of industry involved d. voluntary

Answer 377

d. voluntary

Question 378

Which of the following is *true* regarding the ANSI standards concerning eyeglasses? a. the ANSI standards apply only to prescription eyewear b. the ANSI standards designate allowable variance between the power of the menses ordered and the lenses dispensed c. the ANSI standards apply to safety lenses, but not to any type of lens coating d. the ANSI standards apply only to safety lenses and frames

Answer 378

b. the ANSI standards designate allowable variance between the power of the menses ordered and the lenses dispensed (the stronger the lens power, the smaller the allowable variance)

Question 379

Which of the following is *true* regarding the ANSI standards concerning contact lenses? a. the ANSI standards apply to contact lens materials but not to the care products b. the ANSI standards apply to rigid contact lenses, but not to soft contact lenses c. the ANSI standards dictate what information must appear on the contact lens label d. the ANSI standards do not mention disinfection of multiuse trial contact lenses

Answer 379

c. the ANSI standards dictate what information must appear on the contact lens label

Question 380

Regarding intraocular lens implants, which of the following is *not* covered by the ANSI standards? a. phakic IOLs b. optical properties and biocompatibility c. sterility and shelf-life d. patient selection

Answer 380

d. patient selection

Question 381

At its most basic, the duty of the scribe is: a. personal assistant to the practitioner b. patient educator and advocate c. coding and charting coordinator d. patient flow coordinator

Answer 381

a. personal assistant to the practitioner (scribing is essentially being the practitioner's right hand. While the main duty may be documentation, the scribe also performs other duties at the physician's discretion, including patient education, coordinating patient flow, and overseeing billing forms and chart work.)

Question 382

Which of the following is *not* a function of scribing? a. documenting what the practitioner tells the patient about his or her diagnosis b. writing and signing a prescription for the patient's glaucoma drops c. remaining after the physician and teaching the patient how to do lid scrubs d. recording exam findings as the doctor dictates them

Answer 382

b. writing and signing a prescription for the patient's glaucoma drops (a scribe may write out the prescriptions, but they may not sign them - only physicians can do this)

Question 383

You are scribing for the physician, and he tells the patient that while he expects her vision to improve, it will not be 20/20 after cataract surgery because of macular degeneration. Which of the following notations *best* illustrates the scribe's function as a witness in this case? a. that cataract surgery has been recommended b. that the patient has cataracts and macular degeneration c. that the physician told the patient that cataract surgery would improve vision d. that the physician explained the effects of macular degeneration on postoperative vision

Answer 383

d. that the physician explained the effects of macular degeneration on postoperative vision

Question 384

You are functioning as a scribe in a practice that uses paper charts. At first, the doctor describes a cataract as 3+. You write this in the chart. Later, the physician changes that rating to 2+. Which of the following is the right way to make the correction? a. scratching out the first entry so it cannot be read b. using a commercial product that covers errors c. completely erasing the fist entry d. drawing one line through the error and writing the correction above it

Answer 384

d. drawing one line through the error and writing the correction above it

Question 385

You may discuss a patient's case with another technician if: a. you do so only in front of the patient b. it is pertinent to the patient's care c. the patient was difficult to handle and you need to unload d. the patient has symptoms of communicable disease

Answer 385

b. it is pertinent to the patient's care

Question 386

It is permissible to ask a patient questions related to his or her health: a. in the reception area, if all the exam rooms are full and you're running behind b. in a group if everyone has gathered for the same purpose, such as surgical counseling c. in front of someone whom the patient has brought into the exam room d. in a multipurpose room where other patient's are having tests run

Answer 386

c. in front of someone whom the patient has brought into the exam room

Question 387

Which of the following is a breach of confidentiality? a. Leaning across the front desk and saying, "Here are your glaucoma drops, Mrs. Smith" b. Discussing the exam results of a minor with a parent over the phone c. Telling the operating room nurse what a surgery patient's drug allergies are d. Telling your boss that the patient has recently lost her spouse and is very upset today

Answer 387

a. Leaning across the front desk and saying, "Here are your glaucoma drops, Mrs. Smith"

Question 388

Regarding minor surgery and informed consent: a. informed consent is not required if the procedure has minimal risk b. informed consent is not required if general anesthesia is not used c. informed consent is not required if intravenous injection is not used d. informed consent is required prior to any surgical procedure

Answer 388

d. informed consent is required prior to any surgical procedure

Question 389

Each of the following is a key element of informed consent *except*: a. potential risks and benefits b. description of procedure c. watching a video about the procedure d. optional treatments

Answer 389

c. watching a video about the procedure

Question 390

Which of the following statements regarding informed consent is *true*? a. the physician may have a technician do the patient education b. it only involves having the patient sign papers c. it is necessary only if the patient is a minor d. only the patient can sign

Answer 390

a. the physician may have a technician do the patient education

Question 391

You have just finished counseling an alert 87-year-old man who needs cataract surgery, and you ask him to sign the informed consent. "I understand what you've told me," he says, "but I'm just not sure." His 62-year-old daughter has accompanied him and says "Oh, come on, Dad! Just sign it and let's go!" An appropriate response from you would be: a. "You'll be very happy with your vision after surgery" b. "Why don't you discuss this at home and give me a call later?" c. "Dr. Snyder thinks this is the best thing for you" d. "This is a very common surgery, nothing bad ever happens"

Answer 391

b. "Why don't you discuss this at home and give me a call later?"

Question 392

Which of the following is appropriate wording on an informed consent regarding the description of the procedure? a. "The recommended procedure is a lateral rectus recession" b. "The recommended procedure is laser trabeculoplasty" c. "The recommended procedure is removal of redundant skin from both upper lids" d. "The recommended procedure is CE with IOL"

Answer 392

c. "The recommended procedure is removal of redundant skin from both upper lids"

Question 393

Which of the following is *not* appropriate when explaining the risks of cataract surgery? a. "A person is more likely to be in a car accident than to go blind from having a cataract removed" b. "The risk of developing glaucoma after surgery is so miniscule that you don't have to worry about it" c. "While very unlikely, you do run a slightly higher risk of retinal detachment because you're so nearsighted" d. "The chances of you developing a severe infection after cataract surgery are less than one-fourth of 1%"

Answer 393

b. "The risk of developing glaucoma after surgery is so miniscule that you don't have to worry about it"

Question 394

Which of the following would *not* be allowed due to informed consent? a. a vitrectomy when vitreous suddenly comes forward during cataract surgery b. An unplanned arcuate keratectomy during cataract surgery to reduce the patient's astigmatism c. cryotherapy to seal a scleral hole caused inadvertently during extraocular muscle surgery d. exploratory surgery to locate a "dropped" extraocular muscle during strabismus surgery

Answer 394

b. An unplanned arcuate keratectomy during cataract surgery to reduce the patient's astigmatism

Question 395

Prior to disinfection or sterilization, contaminated instruments must be: a. soaked in instrument milk b. boiled c. cleaned d. wiped with ether

Answer 395

c. cleaned

Question 396

Disinfection involves: a. the reduction of microorganisms on inanimate surfaces b. the destruction of microorganisms on inanimate surfaces c. the destruction and inhibition of microorganisms on any surface d. the reduction of microorganisms on any surface

Answer 396

c. the destruction and inhibition of microorganisms on any surface

Question 397

Sterilization involves: a. the reduction of microorganisms on inanimate surfaces b. the destruction of microorganisms on inanimate surfaces c. the destruction and inhibition of microorganisms on any surface d. the reduction of microorganisms on any surface

Answer 397

b. the destruction of microorganisms on inanimate surfaces

Question 398

The effectiveness of a sterilization method is based on: a. temperature b. destruction of bacteria c. destruction of bacterial spores d. destruction of viral spores

Answer 398

c. destruction of bacterial spores (spores are tougher to kill than the organisms themselves. Viruses do not produce spores.)

Question 399

Sanitation can be described as: a. destruction of bacteria and bacterial spores b. reduction of bacteria and bacterial spores c. destruction of viruses and viral spores d. "clean enough to be healthy"

Answer 399

d. "clean enough to be healthy"

Question 400

If a sterile package falls to the floor: a. it may be wiped with alcohol and used b. it must be removed from use c. it may be used if the floor is clean d. it may be used if the wrapping is linen

Answer 400

b. it must be removed from use

Question 401

The presence of even one bacterium on an object in the sterile field means that the object is: a. bactericidal b. antiseptic c. contaminated d. bacteriostatic

Answer 401

c. contaminated

Question 402

A chemical used to disinfect inanimate objects is a(n): a. germicide b. antiseptic c. antibiotic d. ester

Answer 402

a. germicide

Question 403

A chemical used to disinfect living tissue is a(n): a. germicide b. antiseptic c. antibiotic d. alcohol

Answer 403

b. antiseptic

Question 404

To test the effectiveness of any sterilization method, one may: a. attempt to culture bacteria from "sterilized" instruments b. visually inspect the "sterilized" instruments c. use heat-activated testing tape d. keep records of any ensuing patient infections

Answer 404

a. attempt to culture bacteria from "sterilized" instruments

Question 405

The organism that may contaminate ophthalmic solutions, including fluorescein, and can destroy an eye in 48 hours is: a. herpes simplex b. haemophilus influenzae c. mycobacterium tuberculosis d. pseudomonas aeruginosa

Answer 405

d. pseudomonas aeruginosa

Question 406

Which of the following might be *least* susceptible to contracting an eye infection? a. a patient with human immunodeficiency virus (HIV) b. a patient with recurrent erosion syndrome c. a patient wearing contact lenses d. a patient working in the public sector

Answer 406

d. a patient working in the public sector

Question 407

The organization involved with ensuring employee health and safety is: a. JCAHPO b. EOE c. OSHA d. HIPAA

Answer 407

c. OSHA

Question 408

The Bloodborne Pathogens Standard involves all of the following *except*: a. use and disposal of sharps b. one-time employee education c. provision of personal protective equipment d. provision of hepatitis B vaccines

Answer 408

b. one-time employee education

Question 409

Universal precautions are: a. a method of infection control regulated by OSHA b. a set of standards regulated by ANSI c. a set of safety standards set by each clinic d. a method of evaluating infection control

Answer 409

a. a method of infection control regulated by OSHA

Question 410

Universal precautions would include all of the following *except*: a. use of personal protective equipment b. method of cleaning contaminated spills c. method of disposing contaminated materials d. regarding some body fluids as always "safe"

Answer 410

d. regarding some body fluids as always "safe"

Question 411

Examples of bloodborne pathogens include all of the following *except*: a. hepatitis B virus b. HIV c. herpes simplex virus d. hepatitis C virus

Answer 411

c. herpes simplex virus

Question 412

Which of the following is *true*? a. one need not wash hands after removing gloves b. gloves may be washed and reused if not contaminated c. hand washing is necessary only if there is visible soil d. hand washing protocol is 15 to 20 seconds with soap and water

Answer 412

d. hand washing protocol is 15 to 20 seconds with soap and water

Question 413

The single most effective method of preventing the spread of germs is: a. use of a mask b. hand washing c. disinfection of surfaces d. covering coughs and sneezes

Answer 413

b. hand washing

Question 414

Personal protective equipment would include all of the following *except*: a. eye shields b. gloves and masks c. tonopen covers d. gowns

Answer 414

c. tonopen covers

Question 415

Universal precautions generally apply to tears (lacrimal secretions): a. in every case b. if they are bloody c. if the patient is known to have tuberculosis d. if the patient has glaucoma

Answer 415

b. if they are bloody

Question 416

Use of eye drops would be advantageous: a. if the drug needs to stay on the eye for a long time b. if exterior parts of the eye are being treated c. in case of systemic infection d. if the condition being treated is not very serious

Answer 416

b. if exterior parts of the eye are being treated (topical drops are best used to treat external eye problems. That is not to say that they do not have a place in treating intraocular problems)

Question 417

A disadvantage of eye drops is that: a. they are expensive b. they do not have prolonged contact with the eye c. they must be refrigerated d. they penetrate too deeply into the eye's structures

Answer 417

b. they do not have prolonged contact with the eye (eye medications in drop form are prone to run out the lacrimal drainage system)

Question 418

Use of eye ointments is advantageous because: a. they are less expensive than drops b. they penetrate more quickly than drops c. they are easier to apply than drops d. they remain in contact with the eye longer than drops

Answer 418

d. they remain in contact with the eye longer than drops (because ointments are in a petroleum-type base, they do not drain off the eye as rapidly as drops)

Question 419

A patient might complain about using eye ointment because: a. it has to be used more often than drops b. it is more expensive than drops c. it blurs the vision d. it is less effective than drops

Answer 419

c. it blurs the vision (ointment creates a film in the tears, causing blurry vision. Ointment is generally used less often (ie, fewer doses) than drops.)

Question 420

All of the following are characteristics of locally injected drugs *except*: a. a greater concentration of the drug can be given versus topical b. the drug can be delivered directly to the site where it is needed c. the drug takes effect quickly d. the drug is absorbed through the digestive tract

Answer 420

d. the drug is absorbed through the digestive tract (Locally injected drugs have all the advantages listed except being absorbed through the digestive tract (which would describe medication given orally, not injected)

Question 421

Systemic drugs are those administered by: a. applying the drug to the surface b. injection or mouth c. mouth only d. injection only

Answer 421

b. injection or mouth

Question 422

All of the following are examples of systemically administered drugs *except*: a. acetazolamide pills of glaucoma b. glycerol liquid drink to reduce intraocular pressure c. mannitol intravenous injection to reduce intraocular pressure d. timolol eye drops for glaucoma

Answer 422

d. timolol eye drops for glaucoma (eye drops as topical, not systemic)

Question 423

When a child is to be given anesthetic drops, the assistant should: a. give the drops without warning to avoid hassles b. tell the child that the drops will not sting c. let the physician do it d. briefly explain what is to be done, then do it quickly

Answer 423

d. briefly explain what is to be done, then do it quickly (you could tell the child that the drops might sting for a second, but do not lie, and do not drag it out. Surprises are unpleasant, too. The physician needs a good rapport with the child in order to complete the exam and render treatment, so it is better if the doctor does not give the drops.)

Question 424

A topical ophthalmic drug preparation is considered unsterile: a. once it is opened b. only if it touches the lashes or lids c. only if bacteria can be cultured from it d. none of the above

Answer 424

a. once it is opened (while the drug may not be contaminated (ie, no bacteria or other organisms have gotten into it), it is no longer considered sterile once opened.)

Question 425

The physician has asked you to dilate a patient's eyes. The drops used to do this will have: a. a purple cap b. a green cap c. a white cap d. a red cap

Answer 425

d. a red cap

Question 426

Having the patient look down when you instill topical anesthetics might be advantageous because: a. the drop will sting less b. the drop will be distributed over the cornea c. the drop will stay on the eye longer d. the tears will not dilute the solution

Answer 426

b. the drop will be distributed over the cornea (the theory is that if the patient looks down when the drop is instilled, afterwards when he or she blinks, the eye will automatically roll up, giving better coverage over the cornea. This would be true for most topical dyes (eg, rose bengal) as well.)

Question 427

Dilating and medicinal topical drops/ointments are most easily instilled by: a. having the patient look to one side b. dropping directly on the cornea c. using a cotton-tipped applicator d. having that patient look up

Answer 427

d. having that patient look up (Have the patient look up, and gently pull down the lower lid. The medication is then instilled in the lower cul-de-sac (pocket between the lid and eyeball)

Question 428

You are instilling cycloplegic drops, and the dropper tip touches the patient's eye-lashes. You should: a. wipe the dropper tip with alcohol b. soak the tip in bleach solution c. cap the bottle d. discard the bottle and drops

Answer 428

d. discard the bottle and drops

Question 429

Regarding the recapping of multiple-use ophthalmic drops: a. it is unnecessary and inconvenient b. it helps to prevent contamination c. it needs to be done only at the end of the day d. only single-use dispensers should be used

Answer 429

b. it helps to prevent contamination

Question 430

All of the following should be done prior to pupil dilation *except*: a. swinging flashlight test b. keratometry c. refractometry in a patient over the age of 45 d. pressure check

Answer 430

b. keratometry

Question 431

Which of the following bottle cap colors are coded for glaucoma medications? a. yellow, blue, red b. purple, blue, yellow, green c. yellow, white, red, purple d. green, yellow, purple, white

Answer 431

b. purple, blue, yellow, green

Question 432

After installation of topical anesthetic, the patient should be told: a. "be sure to wear sunglasses when you go outside" b. "your vision may be blurry for several hours" c. "do not rub your eyes" d. "do not drive until it has worn off"

Answer 432

c. "do not rub your eyes" (because of the numbness induced by topical anesthetics, the patient should be reminded not to rub his or her eyes. The danger is that he or she will accidently rub and abrade the cornea while it cannot feel anything)

Question 433

A patient who has undergone routine dilation for an eye exam can expect: a. better night vision b. better vision in bright light c. blurred near vision d. light sensitivity for 24 hours

Answer 433

c. blurred near vision (routine dilation "freezes" accommodation. There is generally some light sensitivity too, but generally not for a full 24 hours)

Question 434

A disadvantage of drops used to reverse routine office dilation is: a. it takes a long time to act b. the patient is still light sensitive c. it clears near but blurs distance vision d. it can cause headaches

Answer 434

d. it can cause headaches

Question 435

Home use of anesthetic eye drops is never prescribed because: a. it causes a breakdown of the corneal surface b. a patient in pain will schedule a return visit c. it decreases the efficacy of other drugs d. it is too expensive to justify home use

Answer 435

a. it causes a breakdown of the corneal surface (repeated use of topical anesthetic drops causes corneal melting, which can interfere with healing)

Question 436

A patient has had a piece of metal removed from him cornea one morning. That afternoon he calls the office and asks the doctor to prescribe numbing drops. You tell him: a. the doctor will call it in as soon as possible b. come by the office and pick some up c. that medication is not prescribed because it interferes with healing d. that medication is not prescribed because it can elevate eye pressure

Answer 436

c. that medication is not prescribed because it interferes with healing

Question 437

Patients who use nonpreserved artificial tears supplied in "bullets" should be told to: a. use them only once a day b. discard the leftover solution at the end of the day c. use them only at night d. make their own saline because it is cheaper

Answer 437

b. discard the leftover solution at the end of the day (because there is no preservative to retard the bacterial growth, any solution remaining in the bullet at the end of the day should be discarded. These drops may be used many times throughout the day. No one should use homemade saline in the eye because of the risk of contamination)

Question 438

Dry eye patients should be told to use artificial tears: a. morning and night b. only when the eyes water c. four times daily d. as often as needed to control symptoms

Answer 438

d. as often as needed to control symptoms

Question 439

The first choice of medicinal treatment for open-angle glaucoma is usually: a. oral b. topical c. subconjunctival injection d. intravenous

Answer 439

b. topical

Question 440

The patient should be told that his or her glaucoma medications: a. need not be used on the day of the appointment b. will cure the condition c. do not need to be refilled d. should be continued until told otherwise

Answer 440

d. should be continued until told otherwise (patient education is key to successful treatment of glaucoma using medications. The patient should be told to continue the medication (including refilling it before it runs out) until instructed otherwise. In addition, the medication should be used on schedule, even (especially) when the patient has an appointment that day; otherwise, it is more difficult to assess the treatment's efficacy)

Question 441

Reasons that a patient fails to take his or her glaucoma medications properly include all the following *except*: a. lack of symptoms suggesting the patient has a disease b. side effects of glaucoma medications c. he or she understands the serious nature of the disease d. lack of visual improvement from the medication

Answer 441

c. he or she understands the serious nature of the disease (if the patient understands the gravity of the disease, he or she will be more motivated to use the medication)

Question 442

If the patient is given oral antibiotics following surgery, he or she should be told to: a. discontinue the pills once the danger of infection is over b. take half of the prescription, then discontinue if no infection develops c. take all the medication until its gone d. take the pills only if infection seems to be developing

Answer 442

c. take all the medication until its gone (oral antibiotics should be taken until gone; otherwise, its effectiveness may be reduced or nil)

Question 443

The patient is going to be using an ophthalmic medication that is labeled "suspension". You tell the patient to: a. keep the bottle refrigerated b. shake the bottle prior to use c. use twice the prescribed dose d. warm the drops prior to use

Answer 443

b. shake the bottle prior to use (a suspension means the actual medication is in the form of particles, which may settle to the bottom of the bottle. Mixing is necessary to "suspend" the particles throughout the carrier solution. Otherwise, the patient may instill a drop full of "carrier" that has no medication in it)

Question 444

The doctor has diagnosed iritis and has asked you to explain the use of cyclopentolate drops to the patient. You tell the patient: a. "this will numb your eye and make you more comfortable" b. "this will dilate your pupil to make your eye more comfortable" c. "don't miss a single dose or your eye pressure may go up" d. "this will minify your pupil to make you more comfortable"

Answer 444

b. "this will dilate your pupil to make your eye more comfortable" (dilating/cyclopleging an eye with inflammation decreases discomfort by temporarily paralyzing accommodation and iris movement. This is analogous to putting a splint on a sprained wrist to limit movement. It also helps to prevent the iris from adhering to the corneal endothelium or to the lens)

Question 445

All of the following can be complications of eye drop use *except*: a. the patient may have an allergic reaction b. the patient may develop irritation of the eye or lids c. the drops can become contaminated d. the patient may develop a fever

Answer 445

d. the patient may develop a fever (fever is a sign of infection, not allergy or drug reaction)

Question 446

Abnormal drug reactions may occur: a. in patients who are debilitated b. in the presence of other drugs c. as toxic or chemical reactions d. all of the above

Answer 446

d. all of the above

Question 447

Common signs and symptoms of a topic allergic reaction to ocular medications include: a. rash, itching, redness, and swelling b. pain, redness, discharge c. pain, photophobia, and mid-dilated pupil d. rash, redness, and anterior chamber reaction

Answer 447

a. rash, itching, redness, and swelling

Question 448

Which of the following suggests a drug allergy in the skin? a. redness and itching b. increased perspiration c. a feeling of heat in the skin d. a prickling sensation

Answer 448

a. redness and itching

Question 449

Which of the following suggests a drug allergy in the conjunctiva? a. a deep aching b. a pus-like discharge c. swelling and redness d. decreased tearing

Answer 449

c. swelling and redness

Question 450

If a patient has a localized allergic reaction to a topical medication instilled in the office, one should: a. irrigate the eye immediately b. call 911 c. administer oxygen, cortisone, and epinephrine d. check the pH of the eye and neutralize appropriately

Answer 450

a. irrigate the eye immediately

Question 451

Over a period of time, use of steroid drops can cause all of the following, *except*: a. an increase in intraocular pressure b. accelerated growth of certain organisms c. iris cysts d. slow wound healing

Answer 451

c. iris cysts

Question 452

Which of the following has the highest risk of complications? a. a drug given in drop form b. a drug given in ointment form c. a drug given in topical sustained-release form d. a drug given via injection or oral form

Answer 452

d. a drug given via injection or oral form (these medications enters the entire body, thus has a higher risk of complications)

Question 453

All of the following have potentially serious side effects or may cause allergy with *long-term* usage *except*: a. topical anesthetic b. topical steroid c. topical neomycin d. topical preservative-free lubrication

Answer 453

d. topical preservative-free lubrication

Question 454

Severe drug reaction may include: a. nausea b. dizziness c. airway obstruction d. rash

Answer 454

c. airway obstruction

Question 455

A patient having an allergic reaction involving shallow respiration should be given: a. mouth-to-mouth resuscitation b. mouth-to-nose resuscitation c. oxygen from a portable unit d. resuscitation through a mask

Answer 455

c. oxygen from a portable unit

Question 456

Positioning the eyes so that an object's image is placed on the macula is known as: a. fixation b. binocular vision c. stereo vision d. depth perception

Answer 456

a. fixation (in fixation, the eyes are positioned so that each macula is receiving the same image (albeit at a slightly different angle))

Question 457

The coordinating process by which the two images (one received by each eye) are blended into a single image is known as: a. stereo vision b. depth perception c. binocular vision d. fusion

Answer 457

d. fusion (the brain merges the slightly different images coming from each eye to create a single three-dimensional image)

Question 458

Coordinated movement of both eyes in the same direction is known as: a. ductions b. versions c. rotations d. saccades

Answer 458

b. versions (versions are movements of both eyes in the same directions. ductions are movements of one eye alone)

Question 459

Which of the following are *not* considered cardinal position of gaze? a. down and left, or up and left b. up and right, or down and right c. straight ahead, or straight up and down d. directly left, or directly right

Answer 459

c. straight ahead, or straight up and down (in any of these positions, the action of one muscle can be masked by the action of another, so these positions are not considered diagnostic)

Question 460

When testing a patient's versions, it is important to: a. test in dim lighting b. keep the patient's head still c. use an opaque occluder to break fusion d. keep the patient's eyes in primary position

Answer 460

b. keep the patient's head still (if the patient moves their head to follow the target, you are not able to test the full motion of the eyes, but rather the range of motion of the neck)

Question 461

Versional movements are those that: a. result in fusion b. move one eye c. move both eyes in the same direction d. move both eyes in different directions

Answer 461

c. move both eyes in the same direction (versions move both eyes in the same direction. fusion does not necessarily occur; for example, the muscles in a blind eye are still innervated and linked to those of the other (seeing) eye)

Question 462

If the eyes have normal version movements, all of the following will exist *except*: a. each eye will move with equal speed b. each eye will move smoothly c. the eyes will diverge equally d. each eye will be in the same position relative to the other

Answer 462

c. the eyes will diverge equally

Question 463

To test the right inferior rectus (RIR) and the left superior oblique (LSO) muscles, the patient must look: a. directly right b. down and to the right c. up and to the right d. down and to the left

Answer 463

b. down and to the right

Question 464

Your patient is looking down and to the left. Which muscles are pulling the eyes into this position? a. RIR and LSO b. right superior oblique (RSO) and left inferior rectus (LIR) c. right superior rectus (RSR) and left inferior oblique (LIO) d. right inferior oblique (RIO) and left superior rectus (LSR)

Answer 464

b. right superior oblique (RSO) and left inferior rectus (LIR)

Question 465

You want to check the action of the right lateral rectus (RLR) muscle. Where do you direct the patient to look? a. to the left b. to the right c. down and right d. up and left

Answer 465

b. to the right

Question 466

You want to check the action of the LIO muscle. Where do you direct the patient to look? a. to the left b. down and right c. up and left d. up and right

Answer 466

d. up and right

Question 467

Ductions refer to: a. muscles that work against each other during eye movements b. movements of one eye c. movements of both eyes in the same direction d. movements of both eyes in the opposite direction

Answer 467

b. movements of one eye

Question 468

Testing ductions is useful in differentiating cases of: a. restrictive strabismus b. accommodative strabismus c. congenital esotropia d. pseudostrabismus

Answer 468

a. restrictive strabismus

Question 469

If one eye is obviously turned in, out, up or down when you perform a simple external evaluation of the patient, this deviation is a: a. ptosis b. phoria c. tropia d. vergence

Answer 469

c. tropia

Question 470

A phoria is exhibited when: a. the patient is malingering b. fusion is disrupted c. the patient is fusing d. the patient has diplopia

Answer 470

b. fusion is disrupted (a phoria is evident only when you disrupt fusion

Question 471

The difference between a phoria and an intermittent tropia is: a. the patient experiences diplopia with the phoria but not with the intermittent tropia b. the phoria rarely is controlled, and the intermittent tropia always is controlled c. the phoria usually is controlled, and the intermittent tropia always is uncontrolled d. the phoria usually is controlled, and the intermittent tropia sometimes is controlled

Answer 471

d. the phoria usually is controlled, and the intermittent tropia sometimes is controlled (a phoria usually is controlled unless fusion is disrupted. When the disruption is removed, the eyes will fuse again. An intermittent tropia comes and goes; sometimes the patient is fusing, and sometimes he or she is not. When the patient is not fusing, the deviation appears)

Question 472

An adult patient with a tropia has either: a. amblyopia or anisometropia b. prism or slab-off lens c. diplopia or suppression d. fusion or stereopsis

Answer 472

c. diplopia or suppression (an adult with a crossed eye either has learned to suppress the image from the eye that is not fixating or has double vision. Usually, suppression is learned in childhood as the visual system is developing; the brain learns to ignore the image from a crossed eye. In cases where the strabismus occurs as an adult, diplopia occurs because the brain does not know how to suppress a second image. It is not a given that amblyopia or anisometropia exist, although they might. Fusion and stereopsis can occur only when both eyes are working together, looking at the same object.)

Question 473

Which of the following is A: esotropia hypotropia exotropia orthophoria hypertropia

Answer 473

orthophoria

Question 474

Which of the following is B: esotropia hypotropia exotropia orthophoria hypertropia

Answer 474

esotropia

Question 475

Which of the following is C: esotropia hypotropia exotropia orthophoria hypertropia

Answer 475

exotropia

Question 476

Which of the following is D: esotropia hypotropia exotropia orthophoria hypertropia

Answer 476

hypertropia

Question 477

Which of the following is E: esotropia hypotropia exotropia orthophoria hypertropia

Answer 477

hypotropia

Question 478

An intermittent horizontal tropia might be aggravated by all the following *except*: a. inattention b. dry eye c. illness d. fatigue

Answer 478

b. dry eye

Question 479

Vertical deviations are conventionally described by indicating: a. the higher (up-turned) eye b. the lower (down-turned) eye c. the preferred eye d. the eye with best vision

Answer 479

a. the higher (up-turned) eye (conventionally, vertical deviations are described as a hypertropia of the higher eye. Thus, if the patient was fixating with the right eye and the left eye was deviated downward, the right eye is higher. So this situation would be designated as a right hypertropia (RHT))

Question 480

In pseudostrabismus: a. the eye turns only if fusion is disrupted b. the eyes are straight, but there is amblyopia c. the eyes are straight, but the patient has diplopia d. the eyes look crossed, but actually are straight

Answer 480

d. the eyes look crossed, but actually are straight (the prefix "pseudo" means false. Thus, pseudostrabismus is false strabismus, the eyes falsely appear to be crossed although they are straight)

Question 481

The most common patient complaint in a *new* nerve palsy is: a. decreased vision b. diplopia c. an ache in the affected muscle(s) d. an inability to read at near

Answer 481

b. diplopia

Question 482

Nerve palsies cause the affected muscle(s) to become: a. overactive b. underactive c. spasmodic d. responsive

Answer 482

b. underactive (if the muscle is not getting a full nerve supply, it will not be able to react properly (if at all). It will thus be underactive. This might manifest itself as an overaction of the muscle's antagonist (the muscle in the same eye that has the opposite action)

Question 483

The purpose of covering one eye with an occluder for strabismus screening is to: a. determine if the patient is suppressing b. perform monocular testing c. disrupt fusion d. determine if the patient is malingering

Answer 483

c. disrupt fusion (the occluder is used in strabismus cover tests to disrupt fusion (ie, to prevent the eyes from being locked onto the same target). Fusion will hold a phoria and often an intermittent deviation in check, so fusion must be disrupted in order to determine if these deviations exist)

Question 484

Cover testing can be performed even on an infant because: a. it is nonthreatening b. it is painless c. it is objective d. it is brief

Answer 484

c. it is objective (the cover tests are objective; they are based on the observations of the examiner rather than on the responses of the subject. Thus, they can performed on an infant or any other patient who cannot or will not give a verbal response)

Question 485

Cover testing can be useful in all of the following patients *except*: a. bilateral aphake b. bilateral pseudophake c. the patient with suppression d. the monocular patient

Answer 485

d. the monocular patient (there is no point in doing cover tests on a monocular patient because there is no vision in the second eye with which to fuse. The patient must always fixate with the single, seeing eye)

Question 486

The cover/uncover test is used to determine the presence of: a. phoria versus tropia b. amblyopia c. suppression d. stereopsis

Answer 486

a. phoria versus tropia

Question 487

The cover/uncover test can also reveal the presence of: a. esotropia versus exotropia b. vergence insufficiency c. depth perception d. visual acuity

Answer 487

a. esotropia versus exotropia

Question 488

You have covered the patient's right eye. When you uncover it, the right eye moves inward. Now, you cover the left eye. When you uncover it, the left eye moves inward. At this point, you can only deduce that the patient has an: a. exophoria b. exotropia c. exodeviation d. esodeviation

Answer 488

c. exodeviation (the eye must have drifted out (toward the temple) under the cover if they make inward movements when uncovered, so an exodeviation is present. You were not given enough information to differentiate between a phoria and tropia. For that, you need to know what the uncovered eye is doing, as well)

Question 489

The patient's vision is 20/20 in both eyes. You cover the patient's right eye and note that when you do so, the left eye moves outward. When you uncover the right eye, neither eye moves. When you cover the left eye, the right eye moves outward. When you uncover the left eye, neither eye moves. This indicates: a. alternating exotropia b. esophoria c. intermittent esotropia d. alternating esotropia

Answer 489

d. alternating esotropia (an outward motion upon uncovering indicates that the eye has drifted in, denoting an esodeviation. In this case, regardless of which eye is covered, the covered eye drifts in. When the eye is uncovered, it does not move to take up fixation (indicating a tropia). This further indicates that the patient is willing to use either eye to fix, revealing an alternating esotropia)

Question 490

During the cover/uncover test, if a patient has a phoria, the response of the eye that is *not* covered is to: a. take up fixation b. move in the same direction as the covered eye c. remain straight d. deviate in or out

Answer 490

c. remain straight (in a phoria, the under the cover drifts. The eye that is not covered is fixating. When you remove the cover, the resulting diplopia causes the deviated eye to move in order to pick up fixation. The eye that was not covered is fixating already, so it does not need to move. Be sure to read the questions carefully; the answer would have been different if this had been a *cross cover* test)

Question 491

The alternate (cross) cover test does *not* reveal: a. exodeviations b. esodeviations c. hyper deviations d. a phoria versus a tropia

Answer 491

d. a phoria versus a tropia (the alternate (or cross) cover test will reveal horizontal and vertical deviations, but does not differentiate between phoria and tropia)

Question 492

When performing the alternate (cross) cover test, it is important to: a. momentarily remove the cover from one eye before covering the other b. move the cover rapidly from one eye to the other c. allow the patient to look at the target with both eyes before covering again d. move the cover from one eye to the next every half-second

Answer 492

b. move the cover rapidly from one eye to the other (when performing the alternate (cross) cover test, move the cover rapidly from one eye to the other, but every half-second is too fast. The important thing is to prevent the patient from seeing with both eyes at once and thus regaining focus)

Question 493

If there is no movement of either eye during any part of the alternate (cross) cover test, one has determined that: a. the patient is amblyopic in one eye b. the eyes are orthophoric c. the patient has stereo vision d. the patient has equal vision in both eyes

Answer 493

b. the eyes are orthophoric (if no motion is seen during the alternate (cross) cover test, it is logical to assume that the patient is orthophoric. You cannot, however, assume that amblyopia does or does not exist, that the patient has stereopsis, or that vision is equal in both eyes)

Question 494

You have performed the alternate (cross) cover test and notice that each eye moves inward when uncovered. What is you next step? a. record exodeviation in the chart b. record exotropia in the chart c. record esodeviation in the chart d. perform a cover/uncover test

Answer 494

d. perform a cover/uncover test (the only thing you know at this point is that there is some type of exodeviation. (For the eye to move inward when it is uncovered, it must have drifted outward under the cover.) Once you have found movement on the alternate (cross) cover test, use the cover/uncover test to determine if it is a tropia or phoria)

Question 495

The alternate (cross) cover test can be used to measure the size of a deviation if: a. the patient can fuse b. the corneal reflex can be seen c. it is combined with prisms d. polarized glasses are used

Answer 495

c. it is combined with prisms (the alternate (cross) cover test combined with prisms to measure the size of a deviation (phoria or tropia) becomes the "prism and cover test." The deviation can be measured in a patient with fusion because the test itself disrupts fusion. The corneal reflex and polarized glasses are not used in prism and cover test)

Question 496

Which of the following is *not* a component of binocular vision? a. clear vision in each eye b. alignment of the eyes c. overlapping visual fields d. identical images on each retina

Answer 496

d. identical images on each retina (binocular vision depends on slightly different images coming from each retina)

Question 497

Depth perception: a. requires two eyes b. requires overlapping visual fields c. is absent in monocular patients d. uses environmental "clues"

Answer 497

d. uses environmental "clues" (depth perception is not the same as binocular, or stereo, vision. A person with one eye can develop depth perception by learning to use "clues" from the environment, such as overlap, grayness, or merging)

Question 498

Stereopsis is recorded in: a. Snellen fractions b. degrees of arc c. seconds of arc d. degrees of field

Answer 498

c. seconds of arc

Question 499

Which of the following indicates the better stereo vision? a. 50 degrees of arc b. 25 degrees of arc c. 50 seconds of arc d. 25 seconds of arc

Answer 499

d. 25 seconds of arc

Question 500

Stereopsis can be elicited and measured in which of the following patients? a. 60 diopter esotropia b. 45 diopter exotropia c. 8 diopter intermittent exotropia d. monocular

Answer 500

c. 8 diopter intermittent exotropia (a patient with a constant esotropia or exotropia over 10 diopters will not have stereo vision, nor will a monocular patient. A binocular patient with an intermittent deviation, a phoria, or a deviation of 10 diopters or less should have a stereo acuity test performed)

Question 501

Stereopsis differs from depth perception in that: a. depth perception is monocular or binocular b. stereo vision involves judging spatial relationships c. depth perception involves seeing in three dimensions d. stereopsis is a learned experience

Answer 501

a. depth perception is monocular or binocular (stereopsis is only present in binocular individuals. Depth perception is not)

Question 502

While it does not give a measurement, a simple stereo test that can be done at bedside is the: a. Hirschberg test b. confrontation stereo test c. pencil point to pencil point test d. Amsler grid stereo test

Answer 502

c. pencil point to pencil point test (having the patient touch one pencil point to another is an indicator of gross stereopsis)

Question 503

The Titmus/Wirt test, Randot test and fly test all use: a. polarized glasses b. glasses with one red and one green lens c. dissociating prisms d. a red filter

Answer 503

a. polarized glasses

Question 504

You ask a cooperative 3-year-old girl to touch the wings of the Titmus fly. She recoils and refuses. You can assume that most likely: a. she is tired and cranky b. she has impaired mental ability c. she has at least gross fusion d. she has an intermittent deviation

Answer 504

c. she has at least gross fusion (the fly was chosen as a test object because it is repulsive. An otherwise cooperative child may refuse to touch the fly because it is ugly and appears to be real. When the child sees it, the huge fly seems to be standing on the page. Refusal is generally considered a positive indication that gross stereopsis exists, but further testing is indicated)

Question 505

You are testing an intelligent 12-year-old boy with the Titmus/Wirt circles and suspect that he is either a good guesser or a cheater. You should: a. turn the test 90 degrees b. turn the test 180 degrees c. switch the glasses around d. record the patient's responses regardless

Answer 505

b. turn the test 180 degrees (turning the test around 180 degrees will change the location of the stereo rings and make them appear sunken instead of elevated. If you turn the test 90 degrees, it will not be stereopic. Polarized glasses are usually designed to be worn only one way. It is in the patient's best interest to get the most accurate measurements possible)

Question 506

An advantage of the Random Dot E test over the Titmus test is that the Random Dot E: a. does not require special glasses b. offers monocular clues c. does not offer monocular clues d. does not require color vision

Answer 506

c. does not offer monocular clues (the first 3 rings of the Titmus/Wirt test can be guessed correctly by a nonfussing patient because the dot looks off-center. The Random Dot E test offers no such clues. Neither test requires accurate color vision)

Question 507

Rhythmic jerking motions of the eyes are known as: a. versions b. ductions c. nystagmus d. end-point/gaze-induced

Answer 507

c. nystagmus (this movement may be horizontal, vertical, or torsional)

Question 508

When evaluating congenital nystagmus, all of the following might be noted *except*: a. binocular or monocular b. direction c. magnitude d. head position

Answer 508

a. binocular or monocular (because of the laws of extraocular muscle innervation, the eyes of a patient with congenital nystagmus will both jerk. The direction of the jerking should be noted as well as the magnitude (eg, small, fine movements, versus large ones). In some patients, the jerking is lessened when the eyes are in a specific position, so the patient may adopt a head tilt or turn to quiet the eyes)

Question 509

A patient with nystagmus might find that which of the following decreases the magnitude of the jerking? a. closing/covering one eye b. squinting c. positioning the head d. wearing sunglasses

Answer 509

c. positioning the head (In some cases, occluding one eye makes the nystagmus worse)

Question 510

A head position in which the nystagmus is quietest (least) is known as the: a. null point b. near point c. angle of deviation d. cyclic amplitude

Answer 510

a. null point

Question 511

During visual acuity testing and refractometry, it is important to remember that which of the following might cause a worsening of nystagmus? a. fogging b. occluding one eye c. cross cylinder d. astigmatic dial

Answer 511

b. occluding one eye (occluding one eye can make the nystagmus worse. Use a +6.00 to "occlude" (fog) the eye not being examined in visual acuity testing and refractometry)

Question 512

Your physician plans to prescribe glasses for a patient with nystagmus. Which method will give her the best information? a. autorefractor alone b. retinoscopy alone c. phoropter measurements d. trial frames and lenses

Answer 512

d. trial frames and lenses (Using a trial frame for refractometry will allow the patient to easily adopt his or her null-point head position. This is not as easily done using the phoroptor. Subjective refractometry (versus autorefractor or retinoscopy alone) will provide the best information from which the practitioner might prescribe)

Question 513

A type of nystagmus that a normal patient might exhibit in far right or far left gaze is: a. ductional nystagmus b. versional nystagmus c. acquired nystagmus d. gaze-induced nystagmus

Answer 513

d. gaze-induced nystagmus

Question 514

Adult onset nystagmus will frequently cause the patient to complain of: a. diplopia b. "vibrating" vision c. photophobia d. extraocular muscle pain

Answer 514

b. "vibrating" vision (vibrating vision (properly termed oscillopsia) is where objects of regard seem to move, jerk, or wiggle when the patient concentrates on them. This phenomenon occurs only in acquired nystagmus; patients with congenital nystagmus do not have this syndrome)

Question 515

Which of the following is *not* true regarding congenital nystagmus? a. it is often associated with maternal infections b. the child may adopt a specific head position c. the child will frequently outgrow the condition d. it is often associated with visual impairment

Answer 515

c. the child will frequently outgrow the condition (in some cases, the nystagmus will resolve as the child grows; however, that is not the case with most types of nystagmus)

Question 516

The term *minor surgery* can be defined as: a. a simple procedure with minimal risk b. any surgery that is done using only local anesthetic c. any surgery that is not required to be performed in a hospital d. a simple procedure that can be performed by an assistant

Answer 516

a. a simple procedure with minimal risk

Question 517

Which of the following could be considered minor surgery? a. cataract extraction b. corneal transplant c. chalazion removal d. enucleation

Answer 517

c. chalazion removal (the rest are not minor and have at least moderate risk)

Question 518

"Incision" refers to: a. cutting out tissue b. cutting into tissue c. suturing tissue d. giving an injection

Answer 518

b. cutting into tissue

Question 519

"Excision" is defined as: a. cutting out tissue b. cutting into tissue c. suturing tissue d. giving an injection

Answer 519

a. cutting out tissue

Question 520

The procedure that corrects the inversion of the lower eyelid is: a. chalazion removal b. ptosis correction c. entropion repair d. ectropion repair

Answer 520

c. entropion repair (an inverted lower eyelid is an entropion. It is corrected to prevent corneal irritation and scarring from constant rubbing by the eyelashes)

Question 521

A surgical schedule would describe the procedure to correct drooping of the upper eyelid as: a. ptosis correction b. chalazion removal c. scleral buckling d. trabeculectomy

Answer 521

a. ptosis correction (ptosis is a drooped eyelid. It might be repaired for cosmetic or visual reasons)

Question 522

The procedure for removal of a fleshy encroachment into the cornea is a/an: a. ectropion repair b. pterygium excision c. hordeolum excision d. scleral buckling

Answer 522

b. pterygium excision (pterygium is a fleshy growth that extends from the conjunctiva onto the cornea. It is removed because it can grow across the front of the cornea, impeding sight)

Question 523

All of the following might be done after the excision of a possible skin cancer *except*: a. placing disposable needles and blades in an approved sharps container b. placing the removed tissue in a specimen bottle for biopsy c. proper disposal of contaminated disposables d. proper disposal of all removed tissue

Answer 523

d. proper disposal of all removed tissue (any tissue that might be cancerous is sent for biopsy, not disposed of)

Question 524

An ungloved person sets up a sterile tray by carefully "dumping" sterile instruments and materials onto the tray without contacting them. This preparation is knows as: a. the "no touch" method b. unacceptable, as it is not sterile technique c. standard precautions d. the sterile method

Answer 524

a. the "no touch" method (the "no touch" method of setting up a sterile tray for minor surgery is acceptable as long as there is strictly no contact with anything that touches the tray)

Question 525

A sterile tray for a chalazion removal might include: a. chalazion clamp, blade, forceps, and curette b. eyelid speculum, blade, and forceps c. chalazion clamp, needle holder, and cannula d. eyelid speculum, blade, forceps, and curette

Answer 525

a. chalazion clamp, blade, forceps, and curette (eyelid speculum, cannula, and/or needle holder are not generally required for this procedure)

Question 526

A sterile tray for a lacrimal evaluation might include: a. lid speculum, punctal dilator, and lacrimal stint b. clamp, needle holder, and curette c. forceps, punctal dilator, curette, and lacrimal cannula d. medicine glass, punctal dilator, syringe, and lacrimal cannula

Answer 526

d. medicine glass, punctal dilator, syringe, and lacrimal cannula (medicine glass is for saline)

Question 527

In addition to the sterile tray for a lacrimal evaluation, the setup for a procedure to open a blocked tear duct would include: a. blunt needle b. set of probes c. cautery unit d. electrolysis unit

Answer 527

b. set of probes (a probe is the wire-like instrument that is passed through the punctum and canaliculus, then pushed through the blockage)

Question 528

A sterile tray for any growth removal will probably include: a. lid speculum, forceps, curette, and suture material b. scalpel, scissors, forceps, needle holder, and sutures c. curette, chalazion clamp, forceps, and scalpel d. probe, forceps, scissors, and needle holder

Answer 528

b. scalpel, scissors, forceps, needle holder, and sutures (a lid speculum might be used, but the other instruments listed are not used in this procedure)

Question 529

Match the following: cryo, cautery, electrolysis and laser a. uses focused amplified light b. uses electrical impulses c. uses cold d. uses heat

Answer 529

cryo - c. uses cold cautery - d. uses heat electrolysis - b. uses electrical impulses laser - a. uses focused amplified light

Question 530

All of the following can cause stains on surgical instruments *except*: a. failure to rinse off detergents b. residue from sutures c. minerals in the water source d. dried blood

Answer 530

b. residue from sutures

Question 531

Surgical instruments should be lubricated: a. only when they seems to stick b. only if cleaned in an ultrasonic unit c. after every use d. after every fifth use

Answer 531

d. after every fifth use

Question 532

Which of the following is true regarding ultrasonic cleaners? a. they effectively sterilize surgical instruments b. scrub instruments before placing them in the unit c. instruments should not touch while in the unit d. glass cannot be placed in the unit

Answer 532

c. instruments should not touch while in the unit (ultrasonic cleaners do not sterilize, you do not scrub first, and you can put glass in them. But, the instruments should not touch)

Question 533

The premise behind refractive surgery is to change the refractive power of the eye by: a. changing the eye's refractive index b. eliminating astigmatism c. altering the eye's focal length d. transposing the refractive error

Answer 533

c. altering the eye's focal length (the focal length of the eye (or any lens/lens system) is the distance from the lens system to the focal point, where light is focused. Refractive surgery seeks to alter this in order to put the focal point directly on the retina (i.e. macula))

Question 534

Laser refractive surgery seeks to correct a refractive error by: a. altering the shape of the cornea b. altering the shape of the retina c. improving the tear film d. inserting a retinal implant

Answer 534

a. altering the shape of the cornea (the cornea accounts for most of the refractive power of the eye. It is also accessible, as opposed to the other parts of the ocular media, except for the tear film. Changing the cornea's shape (flattening or steepening) alters the refractive error)

Question 535

To correct myopia with laser refractive surgery, the goal is to: a. steepen the corneal center b. flatten the corneal center c. eliminate minus power in the eye d. eliminate astigmatism

Answer 535

b. flatten the corneal center (flattening the cornea's center moves the eye's focal point back toward the retina. In myopia, the focal point falls somewhere in the vitreous)

Question 535

In which of the following refractive procedures is a corneal flap created and laser used to sculpt the underlying tissue? a. intrastromal rings b. radial keratotomy (RK) c. laser-assisted in-situ keratomileusis (LASIK) d. photorefractive keratectomy (PRK)

Answer 535

c. laser-assisted in-situ keratomileusis (LASIK) (in LASIK surgery, a microkeratome (a keratome is a surgical knife/blade used to incise the cornea; a microkeratome is small and capable of making very precise incisions) is used to cut a thin flap in the top-most corneal layers. The excimer laser is then used to sculpt the underlying tissue to correct the refractive error. The flap is then put back into place, over the ablated area)

Question 536

Laser refractive surgery is performed with which type of laser? a. argon b. excimer c. YAG d. krypton

Answer 536

b. excimer (the name excimer is derived from "excited dimer". This laser uses ultraviolet radiation that breaks or photoevaporates chemical bonds between tissues and is ideally suited for work on the cornea)

Question 537

All of the following are forms of laser refractive surgery *except*: a. RK b. PRK c. LASIK d. laser-assisted subepithelial keratomileusis (LASEK)

Answer 537

a. RK (in RK, the surgeon uses a diamond blade to alter the cornea's shape)

Question 537

In LASIK, which corneal layers are excised as part of the flap? a. epithelium b. epithelium and Bowman's layer c. epithelium and Descemet's membrane d. endothelium and stroma

Answer 537

b. epithelium and Bowman's layer

Question 538

Which of the following allows the surgeon to customize laser refractive surgery during the procedure? a. wavefront LASIK b. aberration-free LASIK c. LASIK IOLMaster (Carl Zeiss, Jena, Germany) software d. LASIK corneal keratometry

Answer 538

a. wavefront LASIK (wavefront technology creates a rough map of the patient's eye, allowing very precise control and treatment during the refractive procedure. The idea is to reduce aberrations, thus reducing side effects such as glare, haloes, and blur. The other answers are bogus)

Question 539

Postoperative instructions following LASIK surgery would include all of the following *except*: a. do not bend over b. shower from the neck down c. wear a shield over the operated eye at bedtime d. do not rub the eye

Answer 539

a. do not bend over (there is no restriction on bending over after LASIK surgery. Otherwise, patients are told to avoid water/sweat in the eye, do not rub the eye, wear the shield at bedtime, avoid smoke, and not to wear make-up. The duration of these restrictions vary)

Question 540

Which of the following describe PRK? a. used to treat corneal scars e. very thin corneal flap b. involves use of keratome f. treats some corneal dystrophy c. corneal epithelium removed g. corneal flap includes some stroma d. corneal flap h. routine use of a postop BCL

Answer 540

c. corneal epithelium removed h. routine use of a postop BCL

Question 541

Which of the following describe LASIK? a. used to treat corneal scars e. very thin corneal flap b. involves use of keratome f. treats some corneal dystrophy c. corneal epithelium removed g. corneal flap includes some stroma d. corneal flap h. routine use of a postop BCL

Answer 541

b. involves use of keratome d. corneal flap g. corneal flap includes some stroma

Question 542

Which of the following describe LASEK? a. used to treat corneal scars e. very thin corneal flap b. involves use of keratome f. treats some corneal dystrophy c. corneal epithelium removed g. corneal flap includes some stroma d. corneal flap h. routine use of a postop BCL

Answer 542

c. corneal epithelium removed d. corneal flap e. very thin corneal flap

Question 543

Which of the following describe Phototherapeutic keratectomy (PTK)? a. used to treat corneal scars e. very thin corneal flap b. involves use of keratome f. treats some corneal dystrophy c. corneal epithelium removed g. corneal flap includes some stroma d. corneal flap h. routine use of a postop BCL

Answer 543

a. used to treat corneal scars c. corneal epithelium removed f. treats some corneal dystrophy h. routine use of a postop BCL

Question 544

The sterile field is an area that is considered to be: a. disinfected b. free of chemicals c. free of microbes d. sanitized

Answer 544

c. free of microbes (the sterile field is considered to be free of microorganisms. Disinfection is not sterility; it does not remove the most resistant microbes. Sanitization means that the number of microbes has been reduced to a "safe" level)

Question 545

The sterile field would include all of the following *except*: a. sterile, gloved hands b. eye drop bottles c. the drape around the surgical site d. the instrument tray

Answer 545

b. eye drop bottles (while many minor ophthalmic procedures would include the use of eye drops before, during, or after the surgery, the bottles are not sterile. The sterile gloved hands of the surgical team, the exterior of the eye drape, and the instrument tray (with sterile instruments on a sterile drape or towel of some sort) are each part of the sterile field)

Question 546

If an unsterile object touches anything in the sterile field, the field is: a. immediately covered with another drape b. immediately rescrubbed c. considered contaminated d. still adequate and surgery may continue

Answer 546

c. considered contaminated (there is no such thing as "almost" sterile; if an unsterile item contacts the sterile field, the field is considered contaminated)

Question 547

Techniques used to prevent preoperative, intraoperative, and postoperative microbial infection are collectively termed: a. clean b. aseptic c. sanitary d. health standard

Answer 547

b. aseptic (aseptic technique is used to prevent contamination by infectious microorganisms. The level of asepsis varies according to the procedure, ranging from clean to aseptic to sterile. Clean technique is used for noninvasive procedures such as tonometry. Aseptic technique is applied to minor surgical procedures. Sterile technique is used in major surgery, where exposure of tissues might be more deep and lengthy)

Question 548

The purpose of aseptic technique is to: a. reduce the number of chemicals present b. ensure proper safety measures c. reduce the chances of wound infection d. ensure proper ventilation

Answer 548

b. ensure proper safety measures (to eliminate microorganisms that could potentially cause infection)

Question 549

Steps in a minor surgery procedure include all of the following *except*: a. disinfection of the patient's skin b. setting up a sterile tray c. administering topical or local anesthetic d. sterile gowning of surgical personnel

Answer 549

d. sterile gowning of surgical personnel

Question 550

In minor surgery, the assistant might remain ungloved. In this case he or she: a. must not disinfect the patient's skin b. must not touch any nonsterile area c. must not touch the sterile field d. must not apply eye drops

Answer 550

c. must not touch the sterile field (if an ungloved assistant touches the sterile field, the field becomes contaminated)

Question 551

"Laser" stands for: a. light amplification to stimulate emission of radioactivity b. light amplification to stimulate emergence of radiation c. light absorption to simulate effective radiation d. light amplification by stimulated emission of radiation

Answer 551

d. light amplification by stimulated emission of radiation

Question 552

The basic function of any laser is: a. tissue destruction b. tissue sculpting c. creation of an opening d. to decrease pressure

Answer 552

a. tissue destruction (regardless of laser type, mode of action, or treatment type, a laser is used to destroy tissue. The purpose may be to open (as in laser capsulotomy), cause scarring (the theorized action of laser trabeculectomy), or seal (as in punctoplasty or diabetic retinopathy). Each of these involves tissue destruction, whether by heat (photocoagulation), vaporization, cutting (photodisruption), or breaking down the chemical bonds of tissues (photoablation).

Question 553

Which laser is commonly used to remove a cloudy capsule following cataract surgery? a. argon b. CO2 c. YAG d. microendolaser

Answer 553

c. YAG (laser capsulotomy is usually performed with the YAG laser. The argon is used for photocoagulation, the CO2 for skin lesions, and the microendolaser for internal treatments)

Question 554

Phototherapeutic keratectomy (PTK) might be performed on which of the following? a. high myopia b. presbyopia c. corneal scar d. pterygium

Answer 554

c. corneal scar (PTK is a laser treatment for surface corneal disease such as shallow scars, recurrent erosion, and some types of corneal dystrophy. The goal is to create a smooth corneal surface that will heal evenly)

Question 555

The argon laser is commonly used in all of the following disease states *except*: a. diabetic retinopathy b. hypertensive retinopathy c. cataract d. glaucoma

Answer 555

c. cataract (a cataract cannot be removed with a laser at this time)

Question 556

Laser surgery for open-angle glaucoma mainly involves: a. treating the trabecular meshwork b. treating the ciliary body c. treating the canal of Schlemm d. sealing the puncta

Answer 556

a. treating the trabecular meshwork (an ALT, the current most popular laser treatment for open-angle glaucoma, is directed at the trabecular meshwork in an attempt to increase aqueous drainage)