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Ophthalmic Techniques exam

Terms in this set (270)

The confidentiality of the patient's symptoms and medical history is most important.
True
Which of the following are eight (8) elements for a complete history present illness (HPI) in medical ocular history?
Onset, Location, Duration, Severity, Associated Sx, Context, Quality, and Modifying factors
Which of the following is not the best direction for the interviewing technician to handle to history taking experience with the patient?
The interviewing technician allows patients to ramble in a disconnected way.
Which of the following is not an ocular condition that causes diplopia?
RD (retinal detachment)
Which of the following systemic disease (Dz) is proptosis a sign?
Thyroid Dz
A patient visual acuity is recorded as Va sc 20/100 what does this mean?
Vision is checked without glasses Pt is able to see at 20 feet what normal vision patient can see at 100 feet right eye and sees at 20 ft what is normal vision at 80 ft.
List 5 different methods available to check a patients visual acuity (vision).
Snellen Charts, E-chart, Allen cards, Lebenshon reading chart, Sheridan-Gardiner test
Normal children between the ages of 2 and 3 can usually identify the pictures at ----------- feet.
2 and 3 is 12-15ft
Children between ages 3 and 4 can usually identify them at --------- feet.
3 and 4 is 15-20ft
Which of the following is the abbreviation used to record the visual assessment of a preverbal child with no nystagums, good straight-ahead fixation and no preference for either eye?
CSM
At what difference between a child's two eyes is probable cause for a more detailed exam?
5 feet
Vision should be tested with and without the patient's glasses so that a comparison between the two can be made.
True
A true visual acuity will be obtained if the patient partially closes an eye or squints.
False
Which of the following can vision be tested in most preverbal children?
HOTV chart
In children, visual acuity should be prolonged and fatiguing to achieve an accurate reading.
False
The patient should be observed during testing to prevent peeking around the occluder.
True
In all visual acuity testing the AOP should never note any consistent pattern in the letters missed by the patient.
False
Which of the following tools is helpful in differentiate visual loss due to refractive error verse a medical condition.
pinhole
At what distance are near vision charts are designed to be held by the patient?
14 -16 inches
A system of readable print and arbitrarily assigned numbers mostly common used for near vision testing is the :
Jaeger system
The term N5 refers to the Jaeger system.
False
Near vision for normal individuals may be recorded by all the following except?
J10
Shining a light in the eye not being examined is a valid way of doing a pinhole assessment of vision.
False
Which of the following two (2) types of patients are commonly seen in the ophthalmologist office?
Routine ocular exam combined with refraction, and
Patient with symptoms of an ocular disorder
When recording visual acuity as a ratio, which of the following does the second number represent?
distance where optoype subtends 5 minutes of arc on retina
The Snellen charts consist of letters carefully designed to subtend at which of the following?
a 5 minute angle to the eye at certain specified distances
Which of the following is indicated when improving the visual acuity by using a multiple pinhole?
refractive error
Which of the following is not a True statement regarding the Amsler grid?
It is a binocular test
Which of the following visual acuity (Va) charts was developed in a study for early detection of diabetic retinopathy?
ETDRS
Which of the following is the most common patient chief complaint with a new ocular nerve palsy?
diplopia
Which of the following is appropriate when testing a preschooler for amblyopia?
a full line of figures
Which of the following is not considered a cardinal gaze position?
straight ahead, or straight up or down
Which of the following is stereopsis recorded?
seconds or arc
Stereopsis differs from depth perception in that:
depth perception is monocular or binocular
Which of the following is required for depth perception?
you need to have binocular vision, which means you have vision in both of your eyes. Those with monocular vision (vision only in one eye) lack strong eye depth perception.
You ask a cooperative, 2 year old girl to touch the wings of the Titmus fly, She recoiled and refuses. Which of the following can you assume is the most likely reason
she does fuse
Which of the following indicates the better stereo vision?
25 seconds of arc
While it does not give a measurement, a simple stereo test that can be done at bedside is the:
pencil point to pencil point test
You are testing an intelligent 12 year old boy with the Titmus dots and suspect that he is either a good guesser or a cheater. What should you do?
turn the test 180 degree
The NPC (near point convergence) occurs when with which of the following?
a test object gets so close that one eye deviates outward
Which of the following units of measurements is used to record the NPC (near point convergence) test?
cm
Which of the following is required in order to perform the NPC test?
normal fusion
In NPC, Children may measure from ---------------, but adults may be more remote and tend to move further back with age.
5 to 10 cm
Which of the following does the near point of accommodation (NPA) test measure?
diopters available for accommodation
To test NPA:
small print is brought closer until it blurs
Which of the following is the most accurate way to measure NPA?
have the patient wear full distance correction
NPA should be measured:
separately for each eye
Which of the following is not a true statement regarding confrontation field (CVF)?
It cannot be performed on a patient laying down
What is the given assumption in CVF testing?
the examiner's field is normal
Which of the following is not true regarding the CVF test?
Only the examiner's fingers should be used as target
A patient can read the 20/20 line on the Snellen chart but still c/o (complain of) poor vision, Which of the following test would help resemble the real-life vision?
contrast sensitivity
When drawing / plotting your CVF the patient's right eye is shown on the right
True
All of the following are glare test devices available on the market except?
PAM
Aging changes or opacities the natural lens is a cataract which of the following ancillary test would be used to check with problems of headlights being to bright when driving at night?
BAT
All of the following are a series of questions that should be asked when performing an Amsler grid except?
While looking a my open eye, can you tell me how many fingers I am showing you?
All of the following are ways to check a patients color vision except?
Worth 4 dot (W4D)
All of the following test are performed with the patient's best corrected vision (BCVA) except?
CVF
An amsler grid can detect abnormalities in the central 20 degrees in the field of vision.
True
Congenital color defects occur in about 10% of females and 0.4% of males
True
Which of the following devices or instruments is used to determine retinal function using a red laser light to pass through a lens opacity?
interferometer
Which of the following devices developed by local Ophthalmologist, Jack Holladay, can stimulate three degrees of light as well perform a macular photostress test?
BAT
When performing a macular photostress test, using a BAT or other bright light, which of the following is the normal recovery time?
0 - 30 seconds
The macular photostress test is a sensitive test for detecting all of the following except?
cataract
The PAM and an interferometer are similar testing devices or instruments.
True
Ishihara test plates consist of 15 caps in different colors and hues for the patient to place in an order.
False
Which of the following test, does the examiner compares the range of the patient's field with the their (examiner) own, which is presumed normal?
CVF
If a Patient fails the Ishihara color test which of the following might be ordered by the Physcian?
Farnsworth D-15
Defects in color vision is only congenital
False
Judging the NPC by having the patient report diplopia may not always be accurate because the patient might be
suppressing
Which of the following groups is pseudostrabismus usually seen?
infants
Which of the following situation is Normal retinal correspondence (NRC)?
the brain can fuse the images from each fovea
Which of the following is the difference between a phoria and an intermittent tropia?
The phoria usually is controlled and the intermittent tropia sometimes is controlled.
All of the following are stereo tests except?
Stereogram cards
Which of the following is the Hirchberg corneal light reflex test notation of deviation based?
1mm decentration = 7o = 15 ^
All of the following can make finding the blind spot in visual field testing difficulty except?
enlarged blind spot due to glaucoma
All of the following are interferometers except?
BAT
Cataracts cause diffuse visual field loss
True
When performing a HVF, a correcting lens is required to test which of the following?
on a patient - by-patient basis
Explain what you should do when neutralizing a pair of glasses in a Plus (+) cylinder power when you fat lines (cylinder) come in first.
Rotate your axis wheel to 90 degrees to make the fat lines = skinny (sphere) lines.
Roll wheel away from you to double check that you are still moving in the plus direction for the cylinder fat lines.
The add power (addition) to a glasses Rx is to correct which of the following?
presbyopia
All of the following are signs/symptoms associated with an acute angle-closure glaucoma except?
no pain or discomfort
veil or curtain over vision
RD (retinal detachment)
sandy, gritty, foreign body sensation
sandy, gritty, foreign body sensation
child c excessive tearing OD
NLO ( naso-lacrimal duct obstruction)
halos or rainbow around lights
NAG / ACG
glare causing problems driving at night
cataract
infant with a white pupil
retinoblastoma (cancer in the eye)
double vision
3rd CN palsy
red eye c discharge
conjunctivitis
blurred, foggy or hazy vision
refractive error
distorted vision, wavy or crooked objects
macular edema or degeneration
What is a slit lamp?
A biomicroscope that enables the viewer to examine the anteror 1/3 of the eye starting with the lashes to the lens (natural or IOL)
List the 4 slit lamp starting techniques.
1. Make sure patient is comfortable and stable
2. Place the tower on the left side, with a narrow, tall slit beam
3. Grossly focus beam on center of cornea or eyelid, keeping the joystick back
4. Use the joystick to fine tune the slit beam
List the order of viewing the eye beginning anteriorly.
1. Lashes
2. Lids
3. Conjuctuctiva
4. cornea
5. Anterior chamber and angles
6. iris
7. lens
All of the following are items used to achieve all types of illumination except?
filters are adjusted
During the slit lamp exam, the examiner concentrates one using one one illumination during the complete exa
False
Which illumination is the primary method used in biomcroscopy?
direct focal
Which illumination is used in photography?
diffuse
Which of the following is not a correct statement when viewing the cornea at the slit lamp?
Use the red reflex of the fundus as a background
All of the following cornea layers can be distinguished using the parallelepiped illumination except?
bowman's membrane
Which type of direct focal illumination would be used to view an iris lesion?
tangential
At what angle should the slit beam be when observing the cornea, anterior chamber and angle?
45 - 60 degrees
Which of the following describes viewing the anterior chamber on the slit lamp?
The space seen between the parallelepiped beams (first beam) and 2nd beam hitting the iris
Tyndall's phenomenon reveals cells and flare in the posterior chamber.
False
Cells seen in the anterior chamber (a/c) are:
WBC (white blood cells) caused by inflammation or infection and appear as dust particules during a SLE
What is flare on a slit lamp exam ?
An increase of protein in the A/C caused by inflammation or infection appears as smoke or fog swirling through the SL beam
Mr. Brown has a sliver (piece) of metal in his eye, Which illumination would be used to observe the size, shape and location of the object?
indirect
Which illumination would be used to study the texture of refletive surfaces such as the corneal endothelium?
specular reflection
Which of the following is observed using sclerotic scatter illumination?
integrity of the cornea
Which of the following is not a commonly used accessories to the slit lamp?
tonopen tonometer
TA
Goldmann Applanation
TS
Schiotz
TP
Tonopen
TPn
Pneumatonometer
T appl
Goldmann Applanation
T pen
Tonopen
What diagnostic dye aids in performing Goldmann applanation ?
fluorescein
Which of the following is the most common type of glaucoma?
Primary open angle glaucoma
What are you measuring with the Goldmann applanation tonometer?
intraocular pressure (IOP) to aid in diagnosing glaucoma
Which of the following is a dangerous element of open angle glaucoma?
the lack of symptoms
Which of the following determines how the IOP (intraocular pressure) can be measured?
The rate of aqueous production and resistance to outflow
IOP is measured by which of the following two tonometry principles?
1.applanation
2.indentation
Applanation tonometry is based on which law of physics?
Imbert-Flick Law
Which of the following describes the physiologic cup of the optic nerve?
Represents the normal opening in the sclera
All Patients with a high IOP (greater than 21 mm Hg) have glaucoma
False
Aqueous humor leaves the eye by filtering through the trabecular meshwork.
True
This patient has a pteryium seen on the SLE, which of the following areas would it be documented in the chart?
Conjunctiva
Which of the following is the most accurate and reliable method of measuring intraocular pressure (IOP)?
Applanation tonometer
Which of the following is the most important and easiest way to keep instruments protected?
Covering instrument with a dust cover when not in use
It always necessary to touch an ophthalmic bulb(s) with your bare hands when changing a burned out bulb.
False
The last ring on the goldmann applanation calibration rod is 20 mm Hg.
False
If the slit lamp becomes difficult to move the joystick you may do all of the following except?
spray WD40 on the joystick
In calibration of Goldmann applanation tonmeter, at each measure the tonometer head should move how much with each settting?
+/ - 0.5 mm Hg
Before the Schiotz tonometer is used it must be calibrated by which of the following methods?
Holding and checking the instrument on a factory metal test block
In properly aligned Schiotz tonometry:
the needle may pulsate slightly with the heartbeat
Which of the following describes the Patient's position for Schiotz tonometry?
lying back in the exam chair
When the Schiotz needle pulsates, the IOP:
is at midpoint between the two readings
Which of the following is one advantage of Schiotz tonometer?
It can be used at bedside
Which of the following statements is not true?
IOP can be read directly off the Schiotz tonometer's scale
The Schiotz tonometer is applied to the eye:
perpendicular to the central cornea
Which of the following may result in false low readings in Schiotz tonometry?
young or highly myopic eyes
Which of the following is a disadvantage of the Schiotz tonometer?
scleral rigidity can cause inaccuracy
If the mires are unequal, larger mire circle on the bottom, indicates the tonometer is:
too high
The diurnal curve of IOP in a glaucoma patient:
may vary up to 10mm
In glaucoma, the term 'cupping' refers to:
an enlargement and 'caving in' of the physiologic cup
A patient in the end stages of POAG / COAG:
may have a small island of vision temporally
In addition to tonometry, the diagnosis of glaucoma may be based on all of the following test completed by the AOP except?
topography
Indentation tonometry measures IOP by measuring the force:
it takes to indent the cornea
The applanation tonometer is preferred in cases of low scleral rigidity because:
it does not displace an appreciable amount of aqueous
All of the following are risk factors for glaucoma except?
HTN
Which of the following is the first area of the optic nerve to be damaged by elevated IOP?
the upper and lower portions of the rim
The areas of optic nerve damage directly relate to:
the visual field pattern
Which of the following conditions gives a higher risk for developing an angle-closure glaucoma attack?
high hyperopia
All of the following may trigger an angle-glaucoma attack except?
sudden exposure to light
Scleral rigidity refers to:
the amount of distensibility or "give" of the sclera
Which of the following is a potential complication or side effect following a LASER treatment?
elevated IOP
Which of the following is the basis for reduction and control of elevated IOP?
decreasing aqueous production and / or increasing the outflow
The Goldmann applanation tonometer flattens a circle of which of the following?
3.06 mm in diameter of the cornea
The Goldmann applanation tonometer is the "gold" standard method used in ophthalmology.
True
A disadvantage to Goldmann applanation is that it requires a relatively normal corneal shape for accurate measurements.
True
All of the following are true statements regarding Goldmann applanation except?
Four measurements are taking on point of contact with the cornea.
Calibration of the Goldmann applanation tonometer is important, the measuring rod is set at 0, 2, and 6, the tonometer head should move only ----- of these settings.
0.05 - 0.1g
What two handheld instruments are used in the same manner as the applanation instrument?
Perkins
Kowa
Which of the following tonometry methods is attached to the biomcroscope?
Goldmann applanation
When using the applanation tonometer, if the corneal astigmatism is greater than 3 diopters, the prism axis of the minus cylinder at the red mark of the prism holder.
True
Which of the following measurement notation are Goldmann applanation readings expressed?
mmHg
Patients who hold their breath or wear tight collars during the tonometry may produce which of the following?
false high reading
In applanation tonometer if the mires are to wide due to too much fluorescien what type of reading will result?
high and errouneous reading
Lesions in what area of the brain result in defects that respect the vertical meridian?
posterior to the optic chiasm
The Hirschberg and Krimsky corneal light reflex test are accurate test and should always be used to measure for surgery.
False
The binocular visual field equals how many degrees?
120 degrees
Which of the following signs seen during a SLE is the most commonly caused by Iritis?
posterior synechiae
A and V patterns are types of horizontal deviations that:
vary in up and down gaze
FL (fixation loss) rates exceeding 20% may suggest compromised test results during a HVF II-i.
True
The visual field patient should be told all of the following except?
be sure and look at the light once you see it
The validity of all visual field testing depends on:
The patient's ability to maintain fixation
Retinal sensitivity does not diminish with age.
False
Which of the following is a relative term and represents the level where a stimulus can be seen 50% of the time?
Threshold
To provide for patient comfort and rest during an automated visual field (HVF), the patient should be:
encouraged periodicaly to continue, the allowed to rest between testing eyes
The OCT stands for:
optical coherence tomography
All of the following can be scanned by the OCT except?
IOL power
A red or white color on the OCT image indicates which of the following?
high reflectivity
Which of the following situation is Normal retinal correspondence (NRC)?
the brain can fuse the images from each fovea
Which of the following two are used to describe an abnormal protrusion of one or both eyes?
exophthalmos
proptosis
Which of the following is not a retrobulbar, space-occupying condition an exophthalmometry measurement would aid in the diagnose?
Epiphora
Which of the following is not a brand or type of exophthalmomenter?
Placido's disc
Under normal conditions, what is the normal distance between the corneal apex and the orbital wall when taking exophthalmometry measurements?
18mm
What will help to reduce errors in exophthlamometry readings?
Being on the same level, eye to eye, with your patient.
Found in the document titled Hertel in the Exophthalmometry folder
Physiologic anisocoria is common and occurs in what percentage of the population?
20%
Which pupillary defect constricts to accommodation but not to light?
Argyll Robertson Pupil
Younger people tend to have ______ pupils
larger
Which of the following innervation leads to pupillary dilation?
Sympathetic
A wide fluorescein pattern will produce a pressure reading that will be much ____ than the actual pressure.
Higher
Abnormal retinal correspondence (ARC) may evolve:
as an adaptation to strabismus
All of the following factors could cause erroneous readings during applanation tonometry except?
The astigmatic correction properly set on the applanation prism.
All of the following pupil defects where the problem lies in the efferent system except?
Marcus-Gunn (is an afferent defect)
Eye drops penetrate the eye directly through the cornea and into the anterior chamber. T/F
True
During a Humphrey visual field, which of the following parameter attempts to quantfy the patient's allertness during the test?
False negatives
Threshold
point where a stimulus is seen 50% of the time
Mydriatic agents are used in children to paralyze the ciliary muscle to stop accommodation. T/F
False (cycloplegic agents are used in children for the CR)
On the numeric printout of an automated field (as the Humphrey), the number zero indicates that:
The brightest stimulus was not seen by patient
The term amaurosis fugax means?
A temporary monocular vision loss
The threshold level in kinetic perimetry is affected by:
The fact that the target is moving
Which of the following is the tear outflow sequence?
punctum →canaliculi → lacrimal sac → nasolacrimal duct
Which of the following are not Quantitative values of an OCT analysis?
Reflectivity (is a measure of signal strength)
Which of the following corneal conditions is rose bengal used as a diagnostic tool?
Keratoconjunctivitis sicca
Which of the following detects tear deficiency?
Schirmer's
Which of the following indicates an unilateral exophthalmos?
The difference of more than 2 mm between the eyes.
Which of the following is the cause of the pulsation of the semi-circle (mires) in Goldmann applanation?
Heartbeat
Which of the following is the correct time after pushing the button on the Tonopen to measure the pressure?
15 seconds
Which of the following is used to describe an abnormal protrusion of one or both eyes?
Exophthalmos, and proptosis
Which of the following occurs in the OD if an APD is present in the OD when the light shines in the OS?
Dilates
Which of the following two reasons is topical fluorescien used?
To stain the K epithelium for defects or abrasions, and to obtain IOP by Goldmann applanation
All of the following are correct statements when viewing the cornea except?
It uses the red reflex of the fundus as a background (Retro illumination used the red reflex.)
Which of the following is reduction and/ or control of elevated IOP based upon?
Decreasing aqueous production and / or increasing the outflow
Which muscle is responsible for puillary constriction?
Iris sphincter
Which of the following IOP readings indicates hypotony?
6 mm Hg
Which of the following is pupil defects is caused by syphilis?
Argyll - Robertson
Which of the following is the most rapid-developing and most damaging ocular injuries caused by?
Alkaki
Which of the following would the occur when Goldmann applanation is being applied to a patient with a Rx of - 3.00 + 4.00 x 160 at of astigmatism?
Rotate the bi-prism to 070 on red line
Which of the following is used to dilate the pupil in Horner's sydrome?
Paredrine
For what condition is BAT testing most often done?
Cataracts
What five points are required when taking history on a diabetic patient?
1. Type
2. Insulin Dependency
3. Duration of Dx
4. A1c
5. Fasting Blood Sugar
Which of the following will occur when a patient holds their breath or wear tight collars during the tonometry process?
false high reading
Which of the following is a correctly preparing to perform Goldmann applanation tonometry on the Slit Lamp?
The power should be set on 10 volts
Which of the following field defects is not commonly seen in patients with POAG?/COAG (open angle glaucoma)?
Central scotoma
Normal pupil size
4-6mm
A patient with light constriction at near but as distance on pupil check had which type of pupil defect?
Argyll-Robertson pupil
Keratoconus
occurs when the cornea becomes irregular and cone-shaped, causing blurring and distortion of vision
Mires that are too narrow?
Low and erroneous reading
What occluder to you use on a child?
Adhesive patch
Slit beam angle should be?
45-65
What is a good A1C#
5.9
Efferent pupillary defect?
Adie pupil
Hyphema
blood in the anterior chamber of the eye
Two Drops:
ii gHS
Non-proliferative diabetic rentiopathy:
NPDR
Bedtime:
Hs
High blood pressure:
HTN
Prescription:
Rx
Three times a day:
t.i.d
Pupils equal round reactive to light:
PERRLA
Ointment:
ung
Tonometry goldmann applanation:
GAT
Which of the following two questions should be addressed when the Patient's CC is floaters?
Do you have a veil or curtain blocking your vision? and Do you have any flashes of light?
Which of the following two tonometry principles is used in measuring intraocular pressure?
Applanation, and indentation
In calibration of Goldmann applanation tonmeter which drum position is the most important?
2
Which of the following is not part of the Social History (Hx)?
Spouse occupation
Which of the following is not a true eye emergency?
Blurred vision without glasses
Judging the NPC by having the patient report diplopia may not always be accurate because the patient might be:
suppressing
Which of the following is the most commonly used stereo tests in clinical setting?
Titmus House Fly, Circles and Animals
Which of the following cornea layers can not be seen using the parallelepiped illumination?
Bowman's membrane
When recording visual acuity as a ratio, which of the following does the second number (denominator) represent?
Distance where optoype subtends 5 minutes of arc on retina
Which the following instruments is used for checking the patient's visual potential?
PAM
Which of the following refractive errors is correct with the add power (addition) in a glasses Rx?
Presbyopia
Which of the following three questions should be addressed when the Patient's CC is double vision?
-Are the two objects side by side or up & down from each other?
-Are there true two objects or is the second image ghosty?
-Does the second image go away when you cover one eye?
If a Patient fails the Ishihara color test which of the following might be ordered by the Phyiscian?
Farnsworth D-15
Which of the following illumination would best to observe the size, shape and location of the piece of metal (FB = foreign body) in Mr. Brown's OS?
indirect
Which of the following is the best way to measure visual acuity when vision is less than 5/200?
Isolated 20/200 E care from - to 5 feet
Shining a light in the eye not being examined is a valid way of doing a pinhole assessment of vision. T/F
False
Which of the following is not an outcome scenerio with measuring Near Point of Convergence?
30 mm
Of the following, which two are used to describe an abnormal protrusion of one or both eyes?
Exophthalmos, and proptosis
All of the following are commonly used accessories to the slit lamp except?
Tonopen tonometer
All Patients with a high IOP (greater than 21 mm Hg) have glaucoma. T/F
False
How many degrees of the visual field does the Amsler Grid test?
10° centrally
Which of the following is an increase of protein in the A/C caused by inflammation or infection, appears as smoke or fog swirling through the SL beam?
Flare
Which of the following test would help resemble the real-life vision for a patient who complains of poor, blurred vision with 20/20 vision OU?
Contrast sensitivity
The confidentiality of the patient's sysmptoms and medical history is most important. T/F
True
Cataracts cause diffuse visual field loss. T/F
True
Which of the following does the near point of accommodation (NPA) measure?
Diopters available for accommodation
Sets found in the same folder