Ch 11 Eyes Questions PDF

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Ch 11 Multiple Choice Identify the choice that best completes the statement or answers the question. ____ a. b. c. d. e.

1.

A structure that protects the eye from foreign bodies is the conjunctiva. cornea. eyelid. sclera. lens.

____ a. b. c. d. e.

2.

Tears flow over the cornea and drain via the lacrimal sac into the lacrimal gland. posterior pharynx. nasal meatus. thyroglossal duct. anterior fossa.

3. Contraction of which eye structure controls the amount of light that reaches the retina? a. Retina b. Medial rectus muscle c. Sclera d. Lens e. Iris

____

____ a. b. c. d. e.

4.

Contraction or relaxation of the ciliary body allows voluntary blinking. changes lens thickness. regulates peripheral vision. sends light impulses to the brain. regulates tear production.

____ a. b. c. d. e.

5.

The sensory network of the eye is the cornea. iris. pupil. retina. vitreous body.

____ a. b. c. d.

6.

Term infants have a visual acuity of about 20/20. 20/100. 20/200. 20/300.

20/400.

e. ____

7.

At what age does an infant usually develop the ability to distinguish

color? a. b. c. d. e.

At birth 2 months 6 months 12 months 16 months

8. An increased level of lysozyme in the tears will occur normally during which life stage? a. Adolescence b. Childhood c. Infancy d. Pregnancy e. Older adults

____

9. A pregnant woman in her third trimester tells you that her vision has been a little blurred and she thinks she needs to get new contact lenses. You should advise her to a. get new lenses as soon as possible to avoid complications. b. wait until several weeks after delivery to get new lenses. c. go to the nearest emergency department for evaluation. d. change her diet to include more yellow vegetables. e. decrease her water intake.

____

____ 10. Which of the following is a relatively benign condition that may occur during pregnancy or labor? a. Macular degeneration b. Papilledema c. Subconjunctival hemorrhage d. Cupping of the optic disc e. Presbyopia ____ 11. When does the lens usually become more rigid and the ciliary muscle of the iris become weaker? a. Adolescence b. Around 25 years of age c. Around 35 years of age d. Around 45 years of age e. Older than 65 years of age

____ a. b. c. d. e.

12.

A condition that typically develops by the age of 45 years is presbyopia. hyperopia. myopia. astigmatism. cataracts.

____

13.

Which of the following findings, when seen in an infant, is most

ominous? Difficulty tracking objects with the eyes Appearing to have better peripheral than central vision Blinking when bright light is directed at face White pupils on photographs The appearance of convergence

a. b. c. d. e.

14. Which of the following is a genetic eye disorder that should be included in the history and physical examination, under family history, for all members of the affected family? a. Constrictive iritis b. Retinoblastoma c. Oval pupils d. Retinal hemorrhages e. Maculates

____

____ a. b. c. d. e.

15.

A Rosenbaum card is used to measure distance perception. near vision. peripheral distortion. the ability to identify colors. extraocular movements.

____ a. b. c. d. e.

16.

When measuring visual acuity, you are assessing cranial nerve I. II. IV. VI. VIII.

____ a. b. c. d.

17.

Measurement of near vision should be tested in each eye separately. with the head at a 45-degree angle. with the use of primary colors. using the Snellen chart.

with the confrontation test.

e. 18.

Mr. C’s visual acuity is 20/50. This means that he can see 50% of what the average person sees at 20 feet. has perfect vision when tested at 50 feet. can see 20% of the letters on the chart’s 20/50 line. can read letters while standing 20 feet from the chart that the average person could read at 50 feet. is legally blind.

____ a. b. c. d. e.

19.

Peripheral vision can be estimated by means of which test? Confrontation Pupillary reaction Accommodation Snellen E chart Swinging flashlight

____ a.

20.

The criterion for adequacy of a patient’s visual field is the ability to discriminate primary colors. the ability to discriminate details. correspondence with the visual field of the examiner. distance vision equal to that of an average person. pupillary constriction when an object is moved close to the nose.

____ a. b. c. d. e.

21.

Periorbital edema is

____ a. b. c. d. e.

22.

Xanthelasma may suggest that the patient has an abnormality of lipid metabolism. cognitive function. renal metabolism. bone marrow function. thyroid disease.

____

23.

Mrs. S. is a 69-year-old woman who presents for a physical

____ a. b. c. d.

e.

b. c. d. e.

an abnormal sign. expected with aging. more common in males. present in children. an abnormality of lipid metabolism.

examination. On inspection of her eyes, you note that the left upper eyelid droops, covering more of the iris than does the right. This is recorded as _____ on the _____. a. exophthalmos; left b. ptosis; left c. nystagmus; left d. astigmatism; right e. ectropion; left ____ a. b. c. d. e.

24.

Ptosis may be secondary to blepharitis. hyperthyroidism. psoriasis. paresis of a branch of cranial nerve III. entropion.

What is the condition called when the eyelid is turned away, or everted, from the globe? a. Ectropion b. Entropion c. Exophthalmos d. Ptosis e. Acute hordeolum ____

25.

____ a. b. c. d. e.

26.

Entropion implies that the eyelid is drooping. everted. edematous. turned inward. inflamed.

____ 27. A condition in which the eyelids do not completely meet to cover the globe is called a. glaucoma. b. lagophthalmos. c. exophthalmos. d. hordeolum. e. blepharitis. ____ a. b. c. d. e.

28.

Inspection of the tarsal conjunctiva should be performed with every eye examination. in eye examinations in patients older than 45 years of age. when a foreign body may be present. for the patient with glaucoma. with the patient looking upward.

____ a. b. c. d. e.

29.

An allergy can cause the conjunctiva to have a cobblestone pattern. dry surface. subconjunctival hemorrhage. rust-colored pigment. pale appearance.

An abnormal growth of conjunctiva extending over the cornea from the limbus is known as a. a cataract. b. erythematous. c. glaucoma. d. conjunctivitis. e. a pterygium.

____

30.

____ a. b. c. d. e.

31.

A pterygium is more common in people heavily exposed to high altitudes. tuberculosis. ultraviolet light. cigarette smoke. lead.

____ 32. Mr. B was admitted from the emergency department, and you are completing his physical examination. His pupils are 2 mm bilaterally, and you notice that they fail to dilate when the penlight is moved away. This is characteristic in patients who are or have been a. in a coma. b. taking sympathomimetic drugs (e.g., cocaine). c. taking opioid drugs (e.g., morphine). d. treated for head trauma. e. atropine overdosed. 33. When testing corneal sensitivity controlled by cranial nerve V, you should expect the patient to respond by a. blinking. b. copious tearing. c. pupil dilation. d. reflex smiling. e. pupil constriction.

____

____ 34. You observe a pupillary response as the patient looks at a distant object and then at an object held 10 cm from the bridge of the nose. You are assessing for a. confrontation reaction. b. accommodation.

pupillary light reflex. nystagmus. corneal circus senilis.

c. d. e.

Mydriasis accompanies

____ a. b. c. d. e.

35.

____ a. b. c. d. e.

36.

An inequality of pupillary size is called hyperopia. diopter. ptosis. anisocoria. mydriasis.

____ a.

37.

When inspecting the region of the lacrimal gland, palpate the lower orbital rim near the inner canthus. in the area between the arch of the eyebrow and the upper eyelid. beneath the lower eyelid adjacent to the inner canthus. adjacent to the lateral aspect of the eye, just beneath the upper eyelid. medially above the eyebrow.

coma. diabetes. hyperopia. astigmatism. morphine administration.

b. c. d. e.

____ 38. You note a dark, slate gray pigment just anterior to the insertion of the medial rectus muscle in an 80-year-old woman. Which action is appropriate? a. Record the finding in the patient’s record. b. Refer the patient to an ophthalmologist. c. Attribute the finding to type II hyperlipidemia. d. Ask the patient if she remembers being hit in the eye. e. Test the patient immediately for liver disease. ____

39.

An examination to assess for extraocular muscle imbalance is

conducted by a. b.

comparing pupillary responses to different shapes. everting the upper and lower eyelids.

inspecting slightly closed lids for fasciculations. transilluminating the cornea with tangential light. having the patient follow your finger through different planes.

c. d. e.

____ 40. When there is an imbalance found with the corneal light test, you should then perform the _____ test. a. confrontation b. accommodation c. cover–uncover d. visual acuity e. pupillary light reflex ____

41.

To see retinal details in a patient with myopia, the examiner will

need to a. b. c. d. e.

adjust the ophthalmoscope into the plus lenses. move the ophthalmoscope backward. move the hand farther forward. examine the patient in a well-lighted room. turn the ophthalmoscope to a minus lens.

____ 42. The unit of measurement in describing lesion size and location on the fundus is the a. disc diameter. b. macular diameter. c. pupillary diameter. d. centimeter. e. diopter. ____ 43. Ask the patient to look directly at the light of the ophthalmoscope when you are ready to examine the a. retina. b. lens. c. retinal vessels. d. macula. e. optic disc. 44. After focusing on a blood vessel in the retina with your ophthalmoscope, you attempt to locate the optic disc. You should a. follow the vessel as it branches out. b. have the patient move his or her eye laterally.

____

have the patient move his or her eye up. have the patient move his or her eye down. follow the vessel as it converges into larger vessels.

c. d. e.

____ 45. After completion of your ophthalmoscopic examination, you record that the arteriole-to-venule ratio is 1:2 This indicates that the a. arterioles are narrowed. b. venules are narrowed. c. ratio is normal for a child. d. ratio is normal for an adult. e. arterioles are dilated. ____

46.

If a patient has early papilledema, the examiner will be able to

detect dilated retinal veins. retinal vein pulsations. sharply defined optic discs. visual defects. narrowed retinal veins.

a. b. c. d. e. ____ a. b. c. d. e.

47.

Cupping of the optic disc may be a result of migraine headaches. diabetes. glaucoma. dehydration. cataracts.

____ a. b. c. d. e.

48.

Drusen bodies are most commonly a consequence of glaucoma. aging. presbyopia. papilledema. hypertension.

____ 49. When drusen bodies are noted to be increasing in number or in intensity of color, the patient should be further evaluated with a(n) a. Amsler grid. b. Snellen E chart. c. litmus test. d. confrontation test. e. Keith-Wagner-Barker (KWB) system. ____ a.

50.

Cotton wool spots are most closely associated with glaucoma.

normal aging processes. hypertension. eye trauma. hyperthyroidism.

b. c. d. e.

51. The Keith-Wagner-Barker system group IV is characterized by the development of a. an increased light reflex in the arterioles. b. crossing defects. c. cotton wool spots. d. papilledema. e. retinal hemorrhages.

____

____ a. b. c. d. e.

52.

Which of the following may be suggestive of Down syndrome? Drusen bodies Papilledema Narrow palpebral fissures Prominent epicanthal folds Entropion

53. To differentiate between infants who have strabismus and those who have pseudostrabismus, use the a. confrontation test. b. corneal light reflex. c. E chart. d. Amsler grid. e. cover–uncover test.

____

____ 54. You are attempting to examine the eyes of a newborn. To facilitate eye opening, you would first a. dim the room lights. b. elicit pain. c. place the newborn in the supine position. d. shine the penlight in the newborn’s eyes. e. apply mydriatics.

White specks scattered in a linear pattern around the entire circumference of the iris are called a. drusen bodies. b. cotton wool spots. c. rust spots. d. Brushfield spots. e. band keratopathy. ____

55.

____ a. b. c. d. e.

56.

Opacities of the red reflex may indicate the presence of hypertension. hydrocephalus. cataracts. myopia. diabetes.

The Snellen E chart is appropriate for initial visual acuity in a child of which age? a. Newborn b. 6 months c. 18 months d. 3 years e. 8 years ____

57.

____

58.

You normally expect a child to achieve 20/20 vision by age ____

years. 3 4 5 6 8

a. b. c. d. e.

____ 59. What maneuver can be done to reduce the systemic absorption of cycloplegic and mydriatic agents when examining a pregnant woman if the examination is mandatory? a. Have the woman keep her eyes closed for several minutes. b. Instill half the usual dosage. c. Keep the patient supine. d. Use nasolacrimal occlusion after instillation. e. Have the patient keep her head turned and flexed. ____ a. b. c. d. e.

60.

____ a. b. c.

61.

Episcleritis may indicate lipid abnormalities. an autoimmune disorder. an anaphylactoid reaction. severe anemia. thyroid disease. The most common cause of exophthalmos is Graves disease. diabetes. hypertension.

glaucoma. Crohn disease.

d. e. ____ a. b. c.

62.

d. e.

Horner syndrome is manifested by proptosis and contralateral mydriasis. excessive watering of the eyes. blurring of vision when glucose levels fall. ipsilateral miosis and mild ptosis. band keratopathy and miosis.

____ 63. Dot hemorrhages, or microaneurysms, and the presence of hard and soft exudates are most commonly seen in a. Down syndrome. b. diabetic retinopathy. c. systemic lupus. d. glaucoma. e. retinitis pigmentosa. ____ a. b. c. d. e.

64.

Changes seen in proliferative diabetic retinopathy are the result of anoxic stimulation. macular damage. papilledema. minute hemorrhages. chorioretinal scarring.

____ a. b. c. d. e.

65.

Bone spicule pigmentation is a hallmark of chorioretinal pigmentosa. cytomegalovirus infection. lipemia retinalis. retinitis pigmentosa. choroidal nevus.

____ a. b. c. d. e.

66.

An initial sign of retinoblastoma in an infant is the cat’s eye reflex. the red reflex. the corneal light reflex. the absence of a blink reflex. Brushfield spots.

____ a. b. c. d. e.

67.

Retinal hemorrhages in an infant require investigation for retinoblastoma. retrolental fibroplasia. pituitary tumor. child abuse. strabismus.

Ch 11 Answer Section MULTIPLE CHOICE 1.

ANS: C

The eyelid distributes tears over the surface of the eye, limits the amount of light entering it, and protects the eye from foreign bodies. PTS: 1 REF: p. 205 MSC: Organ System: Nervous 2. ANS: C

TOP: Discipline: Physiology

Anatomically, the eye is closest to the nose, so tears drain from the lacrimal sac into the nasal lacrimal duct. The pharynx is the throat, and the thyroglossal duct deals with the tongue. The anterior fossa is the hollow bone that holds the lacrimal gland, which produces tears. PTS: 1 REF: p. 206 MSC: Organ System: Nervous 3. ANS: E

TOP: Discipline: Physiology

The iris is able to dilate and contract, allowing light to reach the retina. The retina is deep within the eye. The sclera is not able to dilate and contract, and the lens is merely a transparent disc that acts as a focus for the retina. PTS: 1 REF: p. 206 MSC: Organ System: Nervous 4. ANS: B

TOP: Discipline: Physiology

The lens is circularly supported by a framework of fibers from the ciliary body, and contraction or relaxation of this structure results in a change in the thickness of the lens, allowing for accommodation as needed. Voluntary blinking, peripheral vision, tear production, and impulses to the brain are not controlled by the ciliary body. PTS: 1 REF: p. 206 MSC: Organ System: Nervous 5. ANS: D

TOP: Discipline: Physiology

The retina acts as the sensory network of the eye in that it sends electric impulses to the brain transformed from light. The cornea, iris, and pupil act together as an opening for light to pass through the lens. The vitreous body is the gelatinous mass posterior to the lens that gives shape to the globe. PTS: 1 REF: p. 206 MSC: Organ System: Nervous 6. ANS: E

TOP: Discipline: Physiology

Term infants are hyperopic, with a visual acuity of less than 20/400. PTS: 1

REF: p. 206

TOP: Discipline: Physiology

MSC: Organ System: Nervous 7. ANS: C

By 6 months of age, vision has developed so that colors can be differentiated. PTS: 1 REF: p. 206 MSC: Organ System: Nervous 8. ANS: D

TOP: Discipline: Physiology

Because of rising hormonal levels, lysozyme is present in an increased amount in the tears during pregnancy. Tears are not affected by increased lysozyme at any other stage in life. PTS: 1 REF: p. 206 MSC: Organ System: Nervous 9. ANS: B

TOP: Discipline: Physiology

Because of the increased level of lysozyme in the tears during pregnancy, a blurred sensation may occur, but this subsides several weeks after pregnancy. This is a normal occurrence during pregnancy and is not diet- dependent, nor is it an emergency or urgent need. PTS: 1 REF: p. 206 MSC: Organ System: Nervous 10. ANS: C

TOP: Discipline: Physiology

Because of falling intraocular pressure during the late stages of pregnancy, hemorrhages may occur in the conjunctiva and resolve spontaneously. Papilledema is never a benign condition, and presbyopia, macular degeneration, and cupping of the optic disc occur in older adults. PTS: 1 REF: p. 211 MSC: Organ System: Nervous 11. ANS: D

TOP: Discipline: Pathophysiology

Starting at around 45 years of age, the lens starts to change and become more rigid, and the ciliary muscles begin to weaken. PTS: 1 REF: p. 206 MSC: Organ System: Nervous 12. ANS: A

TOP: Discipline: Physiology

By 45 years of age, a condition known as presbyopia develops that involves a weakening of accommodation. Hyperopia occurs in early infancy; myopia and astigmatism can occur at any time. Cataracts generally develop in older adults. PTS: 1 REF: p. 206 MSC: Organ System: Nervous 13. ANS: D

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