Ophthalmic Assistant Exam Review

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Questions and Answers

What is sildenafil citrate commonly known as?

Amiodarone

Hydroxychloroquine

Viagra (correct)

Testosterone patch

Your patient says she is allergic to something common, but cannot remember the name. You suggest:

Penicillin, sulfa, or codeine (correct)

Penicillin, sulfa, or caffeine

Penicillin, sulfur, or codeine

Niacin, sulfa, or codeine

Your patient says that beta-blockers make him nauseated. This is:

An unrelated occurrence

A side effect (correct)

An allergy

Unimportant

Your patient says that erythromycin makes her break out in a rash. This is:

An allergy Signup and view all the answers

Your patient is scheduled to have a chalazion excision. It is most important to know his previous reaction to:

Local anesthesia Signup and view all the answers

Your patient is unsure if she has ever had any local anesthesia. You could ask if she:

Has ever had a numbing injection for a dental procedure Signup and view all the answers

Your patient reports an adverse reaction to dye injected for a kidney evaluation. This could affect:

Performing a fluorescein angiogram Signup and view all the answers

Knowing a patient's occupation may be important in:

All of the above Signup and view all the answers

A patient's social history would include all of the following except:

Therapeutic drug use Signup and view all the answers

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:

Social history Signup and view all the answers

The most common ocular disorders that run in families are:

Strabismus, myopia, and glaucoma Signup and view all the answers

A 25-year-old white woman comes in as a new patient because her mother has just been diagnosed with glaucoma. This information:

Is a good reason for a full eye exam Signup and view all the answers

A mother brings in a 2-year-old child with esotropia. Which of the following is significant for the history?

Does anyone in the family have crossed eyes? Signup and view all the answers

Examples of hereditary systemic disease include:

Diabetes, hypertension, arthritis, and cancer Signup and view all the answers

Which of the following is not potentially a hereditary disorder?

Secondary glaucoma Signup and view all the answers

Any pupil smaller than what size is considered miotic?

2 mm Signup and view all the answers

Any pupil larger than what size is considered mydriatic?

6 mm Signup and view all the answers

Which of the following groups tend to have smaller pupils?

Older people Signup and view all the answers

Unequal pupil size is termed?

Anisocoria Signup and view all the answers

The pupil evaluation includes:

Size, shape, and reaction to light Signup and view all the answers

An iris coloboma usually causes a pupillary shape defect:

At 6 o'clock Signup and view all the answers

Constriction of the pupil can be accomplished by any of the following except:

Dimming the room lights Signup and view all the answers

Dilation of the pupil can be accomplished by any of the following except?

Shining a bright light into the eye Signup and view all the answers

Direct pupillary response refers to:

The reaction of one pupil to light Signup and view all the answers

Testing of the consensual light response in healthy eyes is possible because:

If one pupil reacts to light, the other reacts with it Signup and view all the answers

When checking consensual pupil responses to light, all of the following should be done except:

Cover the eye not being tested Signup and view all the answers

To test pupillary response to accommodation:

Observe the pupils as the patient looks from a distant object to a close-up object Signup and view all the answers

To evaluate a patient for tonic pupil (or Adie's tonic pupil), one would use which method?

Accommodation response test Signup and view all the answers

Each pupil constricts to direct light. This indicates:

Light is passing through each optic nerve Signup and view all the answers

Testing that reveals normal-appearing pupils that react appropriately is documented by the acronym:

PERRLA Signup and view all the answers

The most common cause of a false-positive pupillary defect is:

Weak flashlight batteries Signup and view all the answers

Each of the following could cause abnormal pupil shape except:

Marcus Gunn Signup and view all the answers

Each of the following disorders can cause a change in pupil size except:

Open-angle glaucoma Signup and view all the answers

Argyll Robertson pupils are often:

Unreactive to direct or consensual light Signup and view all the answers

You discover that your patient has an Argyll Robertson pupil. This pupillary defect is associated with:

Syphilis Signup and view all the answers

Which of the following is associated with ptosis, miosis, and lack of perspiration (anhydrosis) on the affected side?

Horner's syndrome Signup and view all the answers

Horner's syndrome is caused by:

Nerve damage Signup and view all the answers

Adie's tonic pupil (or tonic pupil) is caused by:

Nerve damage Signup and view all the answers

You might first suspect that the patient has a tonic pupil when:

The response to direct light is slow Signup and view all the answers

A relative afferent pupillary defect (RAPD) is identified by using the:

Swinging flashlight test Signup and view all the answers

The presence of a RAPD:

Indicates a problem in the optic nerve Signup and view all the answers

An eye with a RAPD usually has:

Subnormal visual acuity Signup and view all the answers

Another name for a RAPD is:

Marcus Gunn pupil Signup and view all the answers

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 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:

RAPD OD by reverse Signup and view all the answers

In order to determine the base curve for a patient's contact lens, one must perform:

Keratometry Signup and view all the answers

Soft contact lens diameter can be selected by measuring the patient's:

Visible iris diameter Signup and view all the answers

For most contact lens fitting purposes, it is acceptable to measure corneal diameter:

By measuring the visible iris with a millimeter rule Signup and view all the answers

Which of the following is not a factor in determining the appropriate power of a contact lens?

Pupil diameter Signup and view all the answers

Your patient, a 63-year-old woman, wants to try contact lenses. Which of the following should be done?

Tear evaluation Signup and view all the answers

A history is obtained by:

Asking a series of organized & specific questions Signup and view all the answers

The history should be recorded:

By condensing the patient's story, including pertinent facts Signup and view all the answers

When taking a history on a school-aged child, it is important to:

Get an account of the illness from both the parent & child Signup and view all the answers

Which of the following statements is false?

All information given by the patient can be shared with insurance companies without patient permission. Signup and view all the answers

Which of the following is not a part of a history?

Visual acuity Signup and view all the answers

The 'presenting complaint' is:

The main reason that the patient has come to the office Signup and view all the answers

An example of a question relating to onset would be:

'When did you first notice the problem?' Signup and view all the answers

The question 'Does your head hurt so badly that you have to leave school early?' relates to:

Severity Signup and view all the answers

To obtain the most important information about the presenting complaint, you should ask questions relating to:

Location, quality, severity, timing, & aggravating & alleviating factors Signup and view all the answers

A symptom is:

A change noticed by the patient Signup and view all the answers

An example of a sign is:

An elevated intraocular pressure reading Signup and view all the answers

A 56-year-old patient complains of a sudden onset of double vision. It is most important to ask:

'Does the doubling go away if you cover one eye?' Signup and view all the answers

An old photograph of the patient will be most useful to the physician if the patient complains of or exhibits:

Lid droop, pupil abnormality, or head tilt Signup and view all the answers

Your patient has a cut eyelid. It is important to know what caused the injury because:

If the object was organic (plant or animal matter), there is a greater risk of infection Signup and view all the answers

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:

If the particle was under high speed, there might be internal ocular damage Signup and view all the answers

The patient is not wearing contacts, but would like to be fit for them. The most relevant question is:

'Have you tried contact lenses before?' Signup and view all the answers

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?

'Do you wear these for driving or for reading?' Signup and view all the answers

A patient reports that he sleeps in his contact lenses. An important question would be:

'What type of lenses are they?' Signup and view all the answers

The patient gives a history of having a cataract removed with a laser. You should:

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) Signup and view all the answers

The patient gives a history of having a laser treatment, but is not sure what it was for. You might discover more by asking:

All of the above Signup and view all the answers

The patient states she used to wear contact lenses, but went back to her glasses. A pertinent question would be:

'Why did you stop wearing them?' Signup and view all the answers

A 76-year old new patient tells you that he caught astigmatism from his brother when they were both children. You should:

Ask him what he means by 'astigmatism' Signup and view all the answers

Knowledge of a past ocular injury is needed because:

It might help explain current complaints and findings Signup and view all the answers

The patient states she has prism in her glasses. Which of the following is the most important question to ask?

'Have you ever had surgery to straighten your eye?' Signup and view all the answers

A mother brings in her 4-year old son. The mother says he has a lazy eye. What do you need to find out?

What does she mean by 'lazy eye?' Signup and view all the answers

An example of a systemic illness is:

Cardiac problems Signup and view all the answers

Questions asked of a hypertensive patient should include:

Method of blood pressure control, decrease in vision, last blood pressure reading Signup and view all the answers

Questions asked of a diabetic patient should include:

Method of sugar control, visual stability, last blood sugar reading Signup and view all the answers

A patient with heart problems:

May have hardening of the arteries in the eye Signup and view all the answers

Knowledge of a patient's breathing or lung problems would be important if the patient also has:

Glaucoma Signup and view all the answers

Your patient states that he has rheumatoid arthritis. You should now ask symptom-related question to find out if he has:

Dry eye Signup and view all the answers

Sickle cell disease:

Is hereditary and occurs primarily in the black population Signup and view all the answers

Sickle cell disease may affect the eye:

Because the abnormally shaped cells can block the eye's blood vessels Signup and view all the answers

Knowing a patient's past history of surgical procedures is important because:

It may reveal precautions needed before eye surgery is undertaken Signup and view all the answers

Major infections that can affect the eye include:

Human immunodeficiency virus (HIV), gonorrhea, tuberculosis, and herpes simplex Signup and view all the answers

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?

Did the baby receive oxygen after birth? Signup and view all the answers

In which of the following ocular disorders would it be most important to know what eye drops a new patient is using?

Glaucoma Signup and view all the answers

Which situation poses a potential problem in a patient taking aspirin-containing medications?

The patient with a cataract who will be having surgery Signup and view all the answers

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?

Vitamin use Signup and view all the answers

Patients taking a diuretic might have which special need during the exam?

Frequent trips to the restroom Signup and view all the answers

A patient taking a diuretic probably has which health problem?

Heart trouble Signup and view all the answers

High blood pressure is frequently treated by:

Beta-blockers Signup and view all the answers

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:

High blood pressure Signup and view all the answers

It is important to know if a patient is taking birth control pills because:

These hormones can cause changes in the retina Signup and view all the answers

A patient who has been taking oral steroids for long periods should be evaluated for possible development of:

Cataracts Signup and view all the answers

Conditions for which a person might take oral steroids include:

Rheumatoid arthritis Signup and view all the answers

Patients often fail to report the use of over-the-counter medications because:

They consider them to be unimportant and unrelated to eye care Signup and view all the answers

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:

Ask the patient what he takes the medication for Signup and view all the answers

Diabetes medication includes:

Insulin injections and 'sugar pills' Signup and view all the answers

An example of an analgesic is:

Aspirin Signup and view all the answers

Which patient is most likely to be using hormone replacement therapy?

A woman who has had a hysterectomy/oophorectomy Signup and view all the answers

Study Notes

Patient History and Examination

Obtaining a patient history involves asking organized and specific questions to gather relevant information about their symptoms and history.
Accurate recording of patient history should condense the patient's narrative while emphasizing pertinent facts rather than transcribing it verbatim.
For school-aged children, both the parent and the child should be interviewed to understand the full context of the child's health issue.

Presenting Complaints and Associated Symptoms

The "presenting complaint" refers to the primary reason a patient visits the office, critical for guiding the examination.
Symptoms are changes reported by the patient, while signs are observable conditions, such as elevated intraocular pressure.
Important questions around symptoms include onset, duration, severity, and triggers to accurately assess the situation.

Understanding Patient Conditions

Conditions such as diabetes and hypertension require specific inquiries regarding their management and how they might affect ocular health.
A thorough history of past ocular injuries is essential for understanding current symptoms or conditions.

Medications and Their Implications

The use of medications, including over-the-counter drugs, can significantly affect eye health, yet patients often neglect to disclose this information.
Knowledge of any medications, particularly those impacting vision or eye conditions (like beta-blockers for glaucoma), is crucial during history-taking.
Allergies to medications, and understanding their implications, is vital before prescribing new treatments or conducting procedures.

Special Considerations in Pediatric and Elderly Patients

Information about a child’s ‘lazy eye’ or parents’ concerns should be clarified, as interpretations may vary within the family context.
In elderly patients, especially those with multiple illnesses, it's important to correlate medication use with specific health issues to prevent adverse effects.

Surgical History and Reactions

Past surgical procedures may necessitate special precautions for future eye surgeries, and patient reactions to anesthesia should be carefully documented.
The significance of knowing previous reactions, such as to local anesthesia, is paramount for informing surgical risk assessments.

Systemic Diseases and their Ocular Effects

Systemic conditions like rheumatoid arthritis and sickle cell disease can lead to specific ocular issues, such as dry eyes or vascular blockages.
Eye examinations must consider how conditions like hypertension might complicate procedures, particularly in patients with glaucoma.

Additional Patient Querying

Questions related to lifestyle (like occupation) can provide insight into potential risks for ocular injuries or the need for specific visual aids, like glasses.
Comprehensive understanding of patients’ history regarding systemic illnesses, treatments, and lifestyle factors ensures a more thorough approach to eye care.

Communication and Clarity

Clear communication around patients’ understanding of their conditions or treatments, such as what they mean by terms like "lazy eye," is crucial for accurate assessment.
Patients may misinterpret medical terminology, highlighting the need for sensitivity and clarity in interviews.

Conclusion

Overall, an eye care assistant should be diligent in collecting a comprehensive and clear medical history, understanding the relevance of symptoms, medications, and past medical interventions to provide optimal patient care.### Social History in Patients
Social history includes tobacco use, living arrangements, and hobbies.
Therapeutic drug use is not typically considered part of social history.

Patient Care and Eye Drops

Assessing if someone at home can help with eye drops is part of a patient’s social history, especially for pre-operative assessments like cataract surgery.

Family Relation to Ocular Disorders

Common hereditary ocular disorders include strabismus, myopia, and glaucoma.
A family history of glaucoma is significant, warranting a full eye exam even in younger patients.

Pediatric Vision Concerns

In a child with esotropia, assessing family history of crossed eyes is crucial for a comprehensive medical history.

Hereditary Systemic Diseases

Hereditary systemic diseases include diabetes, hypertension, arthritis, and cancer.

Pupil Size Classifications

A pupil smaller than 2 mm is classified as miotic; larger than 6 mm is mydriatic.
Older individuals tend to have smaller pupils compared to other groups.

Pupil Evaluation

Pupil evaluation includes assessing size, shape, and reaction to light.
Unequal pupil size is known as anisocoria.

Pupil Reaction to Light

Direct pupillary response is the reaction of one pupil to light.
The consensual light response tests how both pupils react simultaneously to a light stimulus.

Testing for Pupil Response

To test accommodation response, observe pupils transitioning between distant and near objects.
The swinging flashlight test is used to identify a relative afferent pupillary defect (RAPD).

Common Pupillary Defects

Argyll Robertson pupils are unreactive to light but may react to accommodation and are often associated with syphilis.
Horner's syndrome features ptosis, miosis, and anhidrosis caused by nerve damage.

Contact Lens Fitting

Determining contact lens base curve requires keratometry.
Soft contact lens diameter is selected based on visible iris diameter.

Factors in Contact Lens Power

Key factors for appropriate contact lens power include refractive error, vertex distance, and astigmatism, excluding pupil diameter.
Tear evaluation is important for older patients seeking contact lenses.

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Prepare for the Certified Ophthalmic Assistant exam with these flashcards. The questions focus on key practices and procedures related to gathering patient history and conducting examinations. Test your knowledge and readiness for the exam with this targeted study aid.