Ohp II Mt 1 (Excluding Red Eye)

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  • 1/61 Questions

    Indicate all of the 'classic signs' of angle closure.

    • Pain
    • Redness
    • Aqueous discharge
    • Halos
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About This Quiz

OHP II MT 1 focuses on ophthalmic procedures excluding red eye conditions. It assesses knowledge on signs of angle closure, contraindications and indications for gonioscopy, and the use of different lenses in eye exams. Essential for learners in ophthalmology to understand diagnostic techniques and their applications.

Ohp II Mt 1 (Excluding Red Eye) - Quiz

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  • 2. 

    Indicate all the contraindications for gonio.

    • Hyphema

    • Compromised cornea

    • Neovascularization of the iris

    • Perforation/lacerations

    • Hypopyon

    • Hyphema

    • Any history of refractive surgery

    Correct Answer(s)
    A. Hyphema
    A. Compromised cornea
    A. Perforation/lacerations
    A. Hyphema
    Explanation
    refractive surgery is only a contraindication if it was performed in the last 6 months

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  • 3. 

    Indicate all the indications for gonio.

    • History of blunt trauma

    • Evaluation of iris contour changes

    • Lacerations

    • Determine presence of angle closure or open angle glc

    • Rule out neovascularization of the iris

    • Ciliary body spasms

    Correct Answer(s)
    A. History of blunt trauma
    A. Evaluation of iris contour changes
    A. Determine presence of angle closure or open angle glc
    A. Rule out neovascularization of the iris
    Explanation
    Gonio is a short form for gonioscopy, which is a diagnostic procedure used to examine the drainage angle of the eye. It involves using a special lens to visualize the angle between the cornea and the iris. The indications for gonio include a history of blunt trauma, as it can help assess any damage to the angle caused by the trauma. It is also used to evaluate iris contour changes, which can indicate certain eye conditions. Gonio is performed to determine the presence of angle closure or open angle glaucoma, as it helps assess the drainage of fluid from the eye. Lastly, it can be used to rule out neovascularization of the iris, which is the abnormal growth of new blood vessels.

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  • 4. 

    Compression gonio should NOT be performed on a pt that you suspect has synechiae because the excess force of this procedure could worsen the situation

    • True

    • False

    Correct Answer
    A. False
    Explanation
    You SHOULD do compression gonio to evaluate synechiae and also to brea an angle closure attack

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  • 5. 

    What type of lens and what type of pt is direct gonio most often used for?

    • 4 mirror; children

    • 3 mirror; children

    • Koeppe Lens; geriatrics

    • Koeppe Lens; children

    Correct Answer
    A. Koeppe Lens; children
    Explanation
    Koeppe lens has no involves direct viewing with a light source and viewing microscope (no mirrors involved)

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  • 6. 

    How does compression/indentation gonio affect IOP in angle closure attack?

    • Lowers IOP

    • Raises IOP

    • May or may not affect IOP

    Correct Answer
    A. Lowers IOP
    Explanation
    directs aqueous towards the peripheral AC and pushes the peripheral iris back to view the angle

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  • 7. 

    Your pt has a phacomorphic lens and a bowed iris.  You want to evaluate the SUPERIOR angle but your view is very limited.  What would you do to get a better view?

    • Tilt/slide lens inferiorly

    • Tilt/slide lens superiorly

    • Have pt look up

    • Have pt look down

    • A and c

    • B and d

    Correct Answer
    A. B and d
    Explanation
    tilt/slide lens toward angle being viewed -or- have pt look into the mirror

    --> This is DYNAMIC GONIO

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  • 8. 

    The ciliary body is generally _____ wide. 

    Correct Answer
    0.5 mm
    Explanation
    The ciliary body is generally 0.5 mm wide.

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  • 9. 

    If the ciliary body is wider than normal, what might this indicate?

    • Angle closure

    • Peripheral synechiae

    • Angle recession

    • Neovascularization of the CB

    Correct Answer
    A. Angle recession
    Explanation
    In angle recession, trauma often leads to tearing of the CB resulting in a wider/larger CB

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  • 10. 

    What structure is considered the filtering portion of the angle?

    • Scleral spur

    • Non-pigmented trabecular meshwork

    • Pigmented trabecular meshwork

    • Ciliary body

    Correct Answer
    A. Pigmented trabecular meshwork
    Explanation
    The pigmented trabecular meshwork is considered the filtering portion of the angle. This structure is located in the anterior chamber angle of the eye and plays a crucial role in regulating the outflow of aqueous humor. It consists of a network of pigmented cells and connective tissue beams that help filter and drain the fluid from the eye. The pigmented trabecular meshwork acts as a sieve, allowing the aqueous humor to flow out of the eye while preventing the passage of larger particles or cells.

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  • 11. 

    The pigmented trabecular meshwork is more posterior than the non-pigmented

    • True

    • False

    Correct Answer
    A. True
    Explanation
    The pigmented trabecular meshwork is indeed more posterior than the non-pigmented trabecular meshwork. The trabecular meshwork is a specialized tissue in the eye that helps regulate the outflow of aqueous humor, which is important for maintaining proper intraocular pressure. It is located in the anterior chamber angle of the eye, where the cornea and iris meet. The pigmented trabecular meshwork is located deeper within the angle, closer to the iris, while the non-pigmented trabecular meshwork is located more superficially, closer to the cornea. This anatomical arrangement allows for efficient drainage of aqueous humor from the eye.

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  • 12. 

    Indicate what circumstances will result in DECREASED pigmentation of the trabecular meshwork.

    • Aging

    • Pregnancy

    • Ligher irises

    Correct Answer
    A. Ligher irises
    Explanation
    Lighter irises can result in decreased pigmentation of the trabecular meshwork. The trabecular meshwork is responsible for regulating the outflow of aqueous humor from the eye. Darker pigmentation in the iris is associated with a higher density of melanocytes, which produce pigments. These pigments can accumulate in the trabecular meshwork, leading to increased resistance to aqueous humor outflow and potentially causing glaucoma. In contrast, individuals with lighter irises have fewer melanocytes and less pigmentation in the trabecular meshwork, which may result in decreased resistance to outflow and a lower risk of glaucoma.

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  • 13. 

    Schwalbe's Line can be defined by:

    • Termination of Descemet's

    • Posterior limit of the angle wall

    • Anterior limit of the angle wall

    • Aka Sampaolesi's Line

    • More than one of the above

    Correct Answer
    A. More than one of the above
    Explanation
    Schwalbe's = termination of Descemet's + anterior limit of angle wall

    --> Sampolesi's Line = wavy line of pigment seen in exfoliation pts (pigment has settled on Schwalbe's Line which acts as a shelf for the loose pigment)

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  • 14. 

    What is the term for an anteriorly displaced Schwalbe's Line?

    • Mackenzie Dase

    • Zetmeyer's Line

    • Posterior embryotoxin

    • Anterior embryotoxin

    Correct Answer
    A. Posterior embryotoxin
    Explanation
    Posterior embryotoxin refers to the anterior displacement of Schwalbe's line, which is the termination of Descemet's membrane in the cornea. This displacement is commonly seen in conditions like Axenfeld-Rieger syndrome and can be identified through various imaging techniques. The term "Posterior embryotoxin" is used to describe this anatomical variation.

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  • 15. 

    The CB and TM can be differentiated by the fact that the TM has a more homogenous pigmentation

    • True

    • False

    Correct Answer
    A. False
    Explanation
    CB --> homogenous pigmentation
    TM --> speckled pigmentation

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  • 16. 

    Your staff doc wants you to do gonio on your patient and to report back using the Becker-Shaffer grading scale.  The most posterior structure that you see is the anterior TM.  What grade do you give this angle?

    • 4

    • 3

    • 2

    • 1

    • 0

    Correct Answer
    A. 2
    Explanation
    4 - CB
    3 - SS
    2- ant TM
    1- ant TM/Shwalbe's Line
    0 - no structures visible

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  • 17. 

    Name the 4 things that must be recorded for gonio.

  • 18. 

    If you view through the gonio lens is steamy, what is this likely due to?

    • Ocular sex per Dr. Sendrowski

    • Not enough fluid

    • Too much fluid

    • Corneal inflammation

    Correct Answer
    A. Not enough fluid
    Explanation
    If the view through the gonio lens is steamy, it is likely due to not enough fluid. The steamy view may indicate that there is not enough fluid between the lens and the cornea, causing the lens to fog up. This can make it difficult to see clearly and may require the addition of more fluid to improve visibility.

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  • 19. 

    What central AC depth is a concern for angle closure? ____ mm

    Correct Answer
    1.8
    Explanation
    The central AC depth of 1.8 mm is a concern for angle closure. This means that the depth of the anterior chamber (AC) in the eye is 1.8 mm, and this measurement is considered to be a potential issue for angle closure. Angle closure refers to the narrowing or closing of the drainage angle in the eye, which can lead to increased intraocular pressure and potential damage to the optic nerve. Therefore, a central AC depth of 1.8 mm raises concerns about the risk of angle closure.

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  • 20. 

    Indicate what features are at higher risk for angle closure.

    • Larger corneal diameter

    • Thick lens

    • Flat anterior lens

    • Short axial lengths

    • Hyperopes

    Correct Answer(s)
    A. Thick lens
    A. Short axial lengths
    A. Hyperopes
    Explanation
    Higher risk for angle closure:
    - small corneal diameter
    - shallow AC (1.8 mm)
    - thick lens
    - steep anterior lens
    - short axial lengths
    - hyperopes

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  • 21. 

    What angles are the best to evluate for chronic angle closure?

    • Superior

    • Inferior

    • Temporal/nasal

    • 'corner's (45 deg)

    Correct Answer
    A. 'corner's (45 deg)
    Explanation
    the corner angles tend to be the most shallow

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  • 22. 

    Wher does chronic angle closure occur first?

    • Superior

    • Inferior

    • Temporal/nasal

    • Corners

    Correct Answer
    A. Superior
    Explanation
    Chronic angle closure refers to a condition where the drainage angle in the eye gradually becomes blocked, leading to increased eye pressure. In this context, the term "superior" refers to the upper part of the eye. The explanation for the correct answer, "superior," is that chronic angle closure tends to occur first in the upper part of the eye, specifically in the superior region. This is because the superior angle is more prone to narrowing due to anatomical factors, such as the position of the iris and the shape of the eye.

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  • 23. 

    What is the most common cause of angle closure glc?

    • Miotic drugs

    • Pupil block

    • Peripheral synechiae

    • Trauma

    Correct Answer
    A. Pupil block
    Explanation
    Angle closure glaucoma is a condition where the drainage angle of the eye becomes blocked, leading to increased intraocular pressure. Pupil block is the most common cause of angle closure glaucoma. In this condition, the iris gets pushed forward and blocks the drainage angle, preventing the aqueous humor from draining properly. This can occur due to various factors such as a shallow anterior chamber or a large lens pushing against the iris. Miotic drugs, peripheral synechiae (adhesions between the iris and other structures), and trauma can also contribute to angle closure glaucoma, but pupil block is the most common cause.

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  • 24. 

    A 'bumpy' iris is indicative of what?

    • Kruckenberg's spindle

    • Pupil block

    • Plateau iris

    • Chronic angle closure

    Correct Answer
    A. Plateau iris
    Explanation
    plateau iris bunches up at the angle

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  • 25. 

    Name the 3 components of the classic triad for pigment dispersion syndrome (PDS).

  • 26. 

    Angle recession will almost always present 360 deg

    • True

    • False

    Correct Answer
    A. False
    Explanation
    this would only occur if there were multiple traumatic events (e.g. boxer)

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  • 27. 

    _____ is the most common cause of peripheral anterior synechiae (PAS).

    Correct Answer
    uveitis
    Explanation
    Uveitis is the most common cause of peripheral anterior synechiae (PAS). Uveitis refers to the inflammation of the uvea, which is the middle layer of the eye that includes the iris, ciliary body, and choroid. When uveitis occurs, it can lead to the formation of adhesions between the iris and the cornea, known as peripheral anterior synechiae. This condition can result in a variety of complications, such as increased intraocular pressure and impaired drainage of aqueous humor, which can lead to further eye problems.

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  • 28. 

    What is a cause of iris neovascularization

    • Diabetes

    • Carotid dz

    • Vein occlusion

    • All of the above

    Correct Answer
    A. All of the above
    Explanation
    The correct answer is "all of the above". Iris neovascularization can be caused by various factors including diabetes, carotid dz (disease), and vein occlusion. These conditions can lead to the abnormal growth of new blood vessels in the iris, which can cause vision problems and other complications.

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  • 29. 

    Indicate what signs/symptoms would be present if there's an increase in episcleral venous pressure.

    • Constricted episcleral veins

    • Engorged episcleral veins

    • Low IOP

    • High IOP

    Correct Answer(s)
    A. Engorged episcleral veins
    A. Low IOP
    Explanation
    An increase in episcleral venous pressure can lead to engorged episcleral veins and low intraocular pressure (IOP). Engorged episcleral veins occur when there is increased pressure in the veins, causing them to become dilated and visible. Low IOP can result from the impaired outflow of aqueous humor due to the increased pressure in the episcleral veins. This can lead to decreased fluid production and accumulation, resulting in lower pressure within the eye.

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  • 30. 

    You notice staining in Zone 5 of the Van Bijstervald grading scale.  Where is this stain located?

    • Superior temporal

    • Nasal

    • Inferior nasal

    • Temporal

    • Inferior temporal

    Correct Answer
    A. Inferior nasal
    Explanation
    The staining in Zone 5 of the Van Bijstervald grading scale is located in the inferior nasal area.

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  • 31. 

    You measure an average TBUT of 7 sec on you pt.  How do you interpret these results?

    • Normal

    • Abnormal

    Correct Answer
    A. Abnormal
    Explanation
    TBUT Interpretation: < 10 seconds = abnormal

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  • 32. 

    How does temperature and humidity affect TBUT?

    • Increases TBUT

    • Decreases TBUT

    • No effect

    Correct Answer
    A. No effect
    Explanation
    Temperature and humidity do not have a direct effect on TBUT (Tear Break-Up Time). TBUT is a measure of the time it takes for a tear film to break up on the surface of the eye. It is primarily influenced by tear quality and quantity, as well as the health of the ocular surface. While environmental factors like temperature and humidity can impact overall eye comfort and dryness, they do not directly affect the tear film stability measured by TBUT.

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  • 33. 

    Indicate what circumstances/products will INCREASE TBUT.

    • Ointments

    • Preservatives

    • Anesthesia

    • ATs

    • Estrogen phase of menstrual cycle

    Correct Answer
    A. ATs
    Explanation
    all others will DECREASE TBUT

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  • 34. 

    You measure your pt's interblink period as 5 seconds.  You measure their TBUT as 10 seconds.  What is their Ocular Protection Index?

    Correct Answer
    2
    Explanation
    The Ocular Protection Index (OPI) is calculated by dividing the Tear Break-Up Time (TBUT) by the Interblink Period (IBP). In this case, the TBUT is 10 seconds and the IBP is 5 seconds. Therefore, the Ocular Protection Index would be 10/5, which equals 2.

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  • 35. 

    Schirmer I Test measures ______ amount of tear production

    • Basal

    • Maximum

    • Minimum

    • Reflex

    Correct Answer
    A. Maximum
    Explanation
    Basal + Reflex

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  • 36. 

    You perform Schirmer I on your pt and record 7 mm of wetting.  How do you interpret this?

    • Abnormal

    • Severe KCS

    • Mild-Mod KCS

    • Normal

    Correct Answer
    A. Mild-Mod KCS
    Explanation
    Schirmer I Interpretation:
    10 mm: normal

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  • 37. 

    If you are working in Las Vegas, how do you expect Shirmer I test results to be affected compared to people living in Hawaii?

    • Less wetting in Vegas

    • Less wetting in Hawaii

    • No difference; schirmer I unaffected by temp + humidity

    Correct Answer
    A. Less wetting in Vegas
    Explanation
    Schirmer I is affected by temp/humidity (evaporation)

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  • 38. 

    Jones Basal Secretion evaluates the minimum amount of tear secretion and requires an anesthetic

    • True

    • False

    Correct Answer
    A. True
    Explanation
    Jones Basal Secretion evaluates the minimum amount of tear secretion and requires an anesthetic. This statement is true because Jones Basal Secretion is a test used to measure the baseline tear production in an individual. It involves placing a small strip of filter paper in the lower eyelid to absorb tears for a certain period of time. Anesthetic eye drops are used to numb the eye during the test to minimize any discomfort. By measuring the amount of tear secretion, this test helps in diagnosing conditions such as dry eye syndrome.

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  • 39. 

    You want to measure REFELX secretion ONLY.  What test should you choose?

    • Schirmer I

    • Schirmer II

    • Lactoplate

    • Sno Strips

    Correct Answer
    A. Schirmer II
    Explanation
    Schirmer II --> tickle/iritate the nasal mucosa for 10-15 seconds

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  • 40. 

    What is considered impaired reflex tearing based on Schrimer II test?

    • < 10 mm after 5 minutes

    • < 5 mm after 5 minutes

    • < 10 mm after 2 minutes

    • < 5 mm after 2 minutes

    Correct Answer
    A. < 10 mm after 2 minutes
    Explanation
    Impaired reflex tearing based on the Schrimer II test is considered when the measurement is less than 10 mm after 2 minutes. This test is used to evaluate tear production and assess tear film stability. A measurement of less than 10 mm indicates a decreased tear production, which can be indicative of dry eye syndrome or other ocular surface disorders. The shorter time frame of 2 minutes allows for a more accurate assessment of tear production compared to the longer time frame of 5 minutes.

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  • 41. 

    What is the normal range for phenol red thread test?

    • 5-10 mm

    • 7-14 mm

    • 9-18 mm

    • 10-20 mm

    Correct Answer
    A. 9-18 mm
    Explanation
    The normal range for the phenol red thread test is 9-18 mm. This test is used to measure tear production and assess the quality of tears. The test involves placing a thread impregnated with phenol red dye in the lower eyelid for a certain amount of time. The length of the thread that changes color indicates the amount of tears produced. A range of 9-18 mm is considered normal, indicating adequate tear production.

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  • 42. 

    Indicate what the Lactoplate Test directly tests for. Check all that apply

    • Tear quality

    • Level of lactoferrin

    • Lacrimal gland secretory activity

    • Tear lysozyme

    Correct Answer(s)
    A. Tear quality
    A. Level of lactoferrin
    A. Lacrimal gland secretory activity
    Explanation
    Lactoplate test correlates with tear lysozyme (doesn't directly test for it..i think...)

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  • 43. 

    For the Sno-Strips, at what point does the test terminate?

    • After 10 minutes

    • After 5 mm of wetting

    • After 1 minute (then multiply by 3)

    • After 10 mm of wetting

    Correct Answer
    A. After 10 mm of wetting
    Explanation
    Sno Strips test are timed until there is 10 mm of wetting.

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  • 44. 

    You perform a Sno-Strip test on your patient and the test is complete in 7 minutes.  How do you interpret this?

    • Sufficient secretion

    • Borderline

    • Insufficient secretion

    Correct Answer
    A. Borderline
    Explanation
    3-5 mins = sufficient secretion
    5-10 mins = borderline
    > 10 mins = insufficient secretion

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  • 45. 

    For the Lactoplate Test, less than ___mg/mL is considered abnormal

    Correct Answer
    0.9
    Explanation
    In the Lactoplate Test, a concentration of less than 0.9 mg/mL is considered abnormal. This means that if the concentration of lactoplate in the test is below 0.9 mg/mL, it indicates an abnormal result. This cutoff value is used to determine the presence of certain substances or conditions being tested for in the Lactoplate Test.

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  • 46. 

    The Touch Tear Microassay is good for determining______

    • Aqueous deficiency

    • Lipid deficiency

    • Mucin deficiency

    • Abrasions

    Correct Answer
    A. Aqueous deficiency
    Explanation
    The Touch Tear Microassay is a reliable method for determining the presence of aqueous deficiency in the eye. This assay helps to measure the quantity and quality of tears produced, specifically focusing on the aqueous component. Aqueous deficiency refers to a condition where there is a lack of an adequate amount of watery fluid in the tear film. By using this assay, healthcare professionals can accurately diagnose and assess the severity of aqueous deficiency, allowing for appropriate treatment and management strategies to be implemented.

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  • 47. 

    What grade is considere abnormal for the NaFL Dye Disapperance Test?

    • 1+

    • 2+

    • 3+

    • 4+

    Correct Answer
    A. 4+
    Explanation
    4+ = maximal retention = prolonged presence due to poor drainage

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  • 48. 

    A negative Jone's I Test is when dye is visible/retrieved from the inferior nasal turbinate.

    • True

    • False

    Correct Answer
    A. False
    Explanation
    Visible/retrieved dye = Positive Jones I test

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  • 49. 

    If no dye apperas in Jones I or Jones II, how would you interpret this type of block?

    • Functional

    • Anatomical

    • No block

    Correct Answer
    A. Anatomical
    Explanation
    If dye does NOT appear in Jones I, but appears in Jones II --> functional block

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  • Oct 09, 2023
    Quiz Edited by
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  • Apr 05, 2012
    Quiz Created by
    Tseemore

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