1. When viewing the optic disc with the ophthalmoscope, one should remember that:
a. The optic disc is actually the natural lens of the eye.
b. The optic disc is generally examined last since it is the most light sensitive area of the retina.
c. The disc is approximately 15 degrees nasal to the fovea in each eye.
d. A healthy optic disc is elevated and has blurred margins.
2. Important things to inquire about when taking an ophthalmic family history include:
a. Strabismus.
b. Retinal detachment.
c. Glaucoma.
d. All of the above.
3. Confrontation visual fields are useful for detecting:
a. Gross constriction of the visual field.
b. Bitemporal hemianopsia due to a pituitary tumor.
c. Homonymous hemianopsia.
d. All of the above.
4. If the patient has to be at 20 feet to read what a "normal" person can read at 30 feet, the visual acuity would be recorded as:
a. 30/20.
b. 20/30.
c. 5/50.
d. 10/100.
5. When testing visual acuity at the bedside with the near card, one should remember to:
a. Tape the card to the far wall of the room, at least 6 feet away.
b. Hold the card as close to the patient as possible.
c. Keep the room lights as dim as possible.
d. Hold the card at a distance of 14 inches from the patient.
6. During pupillary testing, you notice that when you shine your light into the right eye, both the right and left pupils constrict normally. However, when you shine your light into the left eye, neither pupil constricts. The "swinging flashlight test" shows a paradoxical dilation of the left pupil when the light is swung back to the left side.
a. This is a normal variant.
b. The right eye is abnormal.
c. The findings indicate an afferent pathway defect involving the left side (Marcus Gunn pupil).
d. This is a common finding in conjunctivitis.
7. Regarding ocular anatomy:
a. The conjunctiva is the thin membrane which covers the optic nerve.
b. The natural lens is anterior to the iris.
c. The foveola is the area of the retina where the blood vessels enter the eye.
d. The limbus is the area where the cornea meets the sclera.
8. When adducting the right eye:
a. The eye turns outward (away from the nose).
b. The lateral rectus muscle is employed.
c. The eye turns inward (toward the nose).
d. Cranial nerve VIII must be inhibited.
9. While examining the cornea with your penlight, you notice the corneal light reflex. What is the value of this phenomenon?
a. It is helpful in assessing the integrity of the corneal epithelium and tear film.
b. The reflex has no value.
c. The reflex is absent in adults.
d. The normal reflex is very irregular and jagged.
10. While illuminating the anterior chamber tangentially with your penlight, you notice a pronounced shadow on the far side of the iris (away from your light source). You conclude:
a. This is normal.
b. It is safe to dilate this patient.
c. This patient has a cataract.
d. The anterior chamber is probably shallow.
11. Nerve fibers originating from the nasal retina:
a. Cross at the optic chiasm.
b. Contain no visual information.
c. Contain pupillary fibers only.
d. Contain visual information for black and white vision only.
12. Efferent nerve fibers for pupillary constriction:
a. Make up a small part of the vagal nerve.
b. Join up with Cranial nerve III after leaving the Edinger-Westphal nucleus.
c. Are largely sympathetic.
d. Also innervate the tongue.
13. During your fundus exam with the ophthalmoscope, you should:
a. Have the patient keep his glasses on.
b. Use your right eye with the patient's right eye and use your left eye with the patient's left eye.
c. Keep the room lights turned all the way up.
d. Turn the ophthalmoscope upside down when examining the left eye.
14. To find the macula during ophthalmoscopy, you might:
a. Ask the patient to look up to the ceiling.
b. Swing your light 15 degrees temporal to the optic disc or simply ask the patient to look directly at your light.
c. Follow a blood vessel - They all originate from the macula.
d. The macula cannot be visualized with the ophthalmoscope.
15. When trying to differentiate retinal arterioles from veins, it is helpful to remember that:
a. Arterioles are not visible without special radiographic studies.
b. Retinal veins carry freshly oxygenated blood.
c. Veins are larger than arterioles and are darker in color.
d. Normal arterioles have a pronounced "copper wire" or "silver wire" appearance.
16. Common fundus changes in diabetic retinopathy include:
a. Retinal tumors.
b. Dot/blot hemorrhages, hard exudates, retinal neovascularization.
c. Extreme enlargement of the physiologic cup in the optic disc.
d. None of the above.
17. Hard exudates:
a. Are deposits of lipid and protein that signify retinal leakage.
b. Are calcium deposits within the retina.
c. Have a white, fluffy appearance.
d. Are also called cotton-wool spots (CWS).
18. In glaucoma:
a. The optic disc may show progressive enlargement of the cup and pallor of the rim tissue.
b. You will find enlarged, tender pre-auricular lymph nodes.
c. The natural lens of the eye becomes opaque.
d. The upper eyelid droops on the involved side.
19. While performing an external exam on a patient with hyperthyroidism, you notice that the eyes seem to be bulging outward. The lids appear retracted and the conjunctiva seems mildly hyperemic. Your first diagnostic consideration would be:
a. Amblyopia (lazy eye).
b. A congenital anomaly of the bones in the skull.
c. A large brain tumor.
d. Graves' ophthalmopathy.
20. Checking visual acuity is the first step in performing an eye exam except in cases of:
a. Acute chemical exposure, e.g., a caustic liquid being splashed in the eyes.
b. Blunt ocular trauma.
c. "Routine" exams in which the patient has no complaints.
d. Diabetic retinopathy.