Clin Med - Practice Quiz for Eye Condtions

Question 1 of 55

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Melissa is a 7-year-old girl who is brought to her pediatrician by her mother for evaluation of a 2-day history of fever (temperature, 101 ° F), sore throat, and redness and tearing in both eyes. She denies any cough, nasal congestion, or any pain or photophobia in her eyes. Melissa has been taking swimming lessons 2 days a week for the past month. Findings on physical examination include copious watery discharge and scanty exudate in both eyes, prominent follicles present on both her conjunctiva and pharyngeal mucosa, and nontender preauricular lymphadenopathy. The most appropriate treatment for Melissa at this time is which of the following?

Select one of the following:

  • penicillin to be taken four times a day by mouth

  • topical or systemic antiviral such as acyclovir

  • only symptomatic treatment required

  • instillation of a mast cell stabilizer to each eye

  • culture of ocular exudate

Question 2 of 55

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A 35-year-old man presents to your office complaining of a painless, localized swelling of his left lower eyelid that has developed over a period of weeks. He comes in today because it is now producing a foreign body sensation in his left eye. On physical examination, his visual acuity is normal and there is no evidence of injection or discharge. There is a nontender, localized nodule on the lower eyelid. What is the likely diagnosis?

Select one of the following:

  • Hordeolum

  • chalazion

  • pterygium

  • dacrocystitis

  • blepharitis

Question 3 of 55

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A 50-year-old man presents with an acute and painless onset of a bright red blood patch along the lateral part of his sclera. His visual acuity is normal and blood pressure is within normal limits. He has had a cough, which is getting better. What is your diagnosis and the most appropriate treatment?

Select one of the following:

  • Subconjunctival hemorrhage - no treatment is needed

  • Subconjunctival hemorrhage - CT scan to rule out intracranial hemorrhage

  • Hyphema - complete blood cell count and bleeding studies

  • Hyphema - emergent consultation with an ophthalmologist

Question 4 of 55

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A 43-year-old man presents with complaint of a 3-day history of localized pain, redness, and swelling of his upper eyelid. He denies fever, visual changes, or photophobia. On physical examination, the patient's eyelid is diffusely red, with a tender, localized area of swelling, which points outward. He appears to have an infection of the glands of the upper eyelid. The most common pathogen associated with this infection is which of the following?

Select one of the following:

  • Staphylococcus aureus

  • Streptococcus pneumoniae

  • Haemophilus influenzae

  • Candida albicans

  • Aspergillus species

Question 5 of 55

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A 38-year-old man presents to the emergency department complaining of persistent double vision after being hit in the left eye during a fistfight the night before. On physical examination, his left perioribital area is markedly edematous and ecchymotic. On the basis of his history, what other abnormal finding might you expect to find as you complete your ophthalmic examination, and what diagnostic study would you order to best confirm your diagnosis?

Select one of the following:

  • hyphema; Schiotz tonometer

  • hyphema; plain radiograph

  • restricted ocular movement; CT scan

  • restricted ocular movement; plain radiograph

  • ruptured globe; retinal angiography

Question 6 of 55

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A 45-year-old woman presents with sudden onset of excruciating pain in the right eye, blurred vision, nausea, and vomiting. Physical examination reveals decreased visual acuity, intraocular pressure of 70 mm Hg, shallow anterior chamber, steamy cornea, and a moderately dilated right pupil that does not react to light. Which of the following is the most likely diagnosis?

Select one of the following:

  • retinal detachment

  • retinal artery occlusion

  • uveitis

  • primary open angle glaucoma

  • primary acute angle closure glaucoma

Question 7 of 55

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What is the leading cause of permanent vision loss in people older than 65 years in the United States?

Select one of the following:

  • Diabetic Retinopathy

  • Glaucoma

  • Hypertensive retinopathy

  • cataracts

  • age-related macular degeneration

Question 8 of 55

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A 75-year-old man presents with painless, sudden loss of vision in one eye. A careful history reveals previous episodes of vision loss that resolved spontaneously. A workup for these previous episodes included a carotid ultrasound, which confirmed a diagnosis of bilateral carotid stenosis. Given this patient's current symptoms and medical history, which of the following findings would be expected on funduscopic examination?

Select one of the following:

  • retinal lines that have the appearance of a “ripple on a pond” or a “billowing sail”

  • a pale or milky retina with a cherry-red fovea

  • enlarged physiologic cup, occupying more than half of the disc's diameter

  • swollen disc with blurred margins; physiologic cup is not visible

  • yellowish-orange to creamy-pink disc with sharp margins and a centrally located physiologic cup

Question 9 of 55

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A 35-year-old woman presents with a history of a self-limited upper respiratory illness 3 weeks prior to this clinic visit. She now complains of persistent weakness and malaise, which worsens near the end of the day. She complains that she has a difficult time keeping her right eye open during the later part of the day. Taking a nap often helps. You notice that her right eyelid covers the top portion of her pupil. Pupillary reactions are normal. A complete neurological evaluation is otherwise negative. Based on these findings, what is your diagnosis?

Select one of the following:

  • Ptosis

  • Multiple Sclerosis

  • Brain stem lesion

  • None of the above

Question 10 of 55

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A 40-year-old man presents with a history of having a fleck of metal getting into the eye while the patient was pounding on a piece of metal scrap. The patient is complaining of extreme pain, photophobia, and his eyes are tearing like a faucet. How would you proceed with this patient?

Select one of the following:

  • Local anesthetic eye drops, fluorescein dye to visualize corneal foreign body, remove FB with needle, and apply polymyxin-B ointment.

  • Provide local anesthetic eye drops that the patient can continue to use to relieve the pain at home

  • Have the patient flush their eye with water until the metal comes out

  • None of the above is effective

Question 11 of 55

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A 65-year-old woman fell down and bumped her head earlier in the evening. She now presents with a sensation of flashing lights and floaters in her right eye. She has a history of diabetic retinopathy. She now has decreased visual acuity and feels that there is a curtain over her visual field. Funduscopic examination is difficult and, therefore, nondiagnostic since the patient is on eye drops for glaucoma. What is the most appropriate disposition for this patient?

Select one of the following:

  • emergency referral to an ophthalmologist

  • fasting blood glucose level

  • CT scan of the head

  • neurologic evaluation

  • admission to the hospital for head injury observation

Question 12 of 55

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A 24-year-old man is working in a factory and felt a speck of material get into his eye, which was quite painful. He flushed out his eye at work but still complains of pain. He states that blinking makes the pain worse. The eye is very red. What is your next step?

Select one of the following:

  • patch the eye and refer to the ophthalmologist

  • flourescein staining

  • cycloplegics to reduce the patient's pain

  • slit-lamp examination

  • evert the upper eyelid

Question 13 of 55

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A 10-year-old boy presents with a fibrous nodule under his upper eyelid. It has been present for a couple of months. There is no drainage or pain. What is the most likely diagnosis?

Select one of the following:

  • Chalazion

  • Stye

  • Chronic dacryocystitis

  • dacryocystocele

  • foreign body reaction

Question 14 of 55

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A 60-year-old man presents with long-standing poorly controlled hypertension. Which of the following is/ are generally not associated with hypertensive retinopathy?

Select one of the following:

  • AV nicking with focal arteriolar damage

  • copper wire arterioles

  • decreased AV ratio

  • microaneurysms and hard exudates

  • papilledema

Question 15 of 55

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A 65-year-old man with a history of diabetes mellitus presents with an acute episode of left facial paralysis. He is still able to wrinkle and elevate both sides of his forehead. He denies recent viral illness or ear pain. His diabetes has been well controlled. Examination of the tympanic membranes and the external pinnae are normal. The Weber and Rinné tuning fork assessments are normal. Visual acuity, extraocular movement, and pupillary responses are all normal and equal bilaterally. Which of the following is the most likely diagnosis?

Select one of the following:

  • Bell palsy

  • Ramsay– Hunt syndrome

  • cerebrovascular accident

  • peripheral facial nerve palsy

  • diabetic neuropathy

Question 16 of 55

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An elderly patient presents with slurred speech. You have her protrude her tongue and it deviates to the right. Which cranial nerve (CN) is involved?

Select one of the following:

  • Left CN XII

  • Right CN XII

  • Left CN X

  • Right CN X

  • Left CN IX

Question 17 of 55

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Your patient is a 28 year old male who presents with severely injected eyes with copious purulent drainage (buckets of pus). He admits to being very sexually active. What is the most likely diagnosis and etiology?

Select one of the following:

  • Bacterial Conjunctivitis - Gonococcal

  • Bacterial Conjunctivitis - MRSA

  • Viral Conjunctivitis - Adenovirus

  • Viral Conjunctivitis - Gonococcal

Question 18 of 55

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You just diagnosed your patient with gonococcal conjunctivitis. Which of the following is the most appropriate treatment plan?

Select one of the following:

  • Refer immediately to Ophthalmologist and treat with both topical and oral antibiotics

  • This condition is self-limiting and requires no treatment

  • Prescribe topical antibiotics and see if condition resolves

  • None of the above

Question 19 of 55

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Your patient presents with a severely injected right eye with copious purulent discharge. Based on this presentation, which of the following is your diagnosis?

Select one of the following:

  • Viral Conjunctivitis

  • Bacterial Conjunctivitis

  • Allergic Conjunctivitis

  • Chlamydial Keratoconjunctivitis

Question 20 of 55

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Your patient is a 16 year old girl complaining of itchy watery eyes. P/E findings include ropy discharge and cobblestoning of the eyelid. What is your diagnosis?

Select one of the following:

  • Viral Conjunctivitis

  • Allergic Conjunctivitis

  • Chlamydial Keratoconjunctivitis

  • Bacterial Conjunctivitis

Question 21 of 55

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Your patient is a 10 year old boy who presents with bilateral collicular conjunctivitis, epithelial keratitis, and corneal vascularization (pannus). What is your diagnosis and treatment choice?

Select one of the following:

  • Chlamydial Keratoconjunctivitis - azithromycin and improvements in hygiene and living conditions

  • Viral Conjunctivitis - topical sulfonamide and cold compresses

  • Bacterial Conjunctivitis - topical sulfonamide or oral antibiotic

  • Allergic Conjunctivitis - H1 receptor antagonists

Question 22 of 55

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Your patient complains of a red, swollen, tender area on the upper eyelid. What is your diagnosis and treatment plan?

Select one of the following:

  • Pterygium - artificial tears

  • Dacrocystitis - systemic antibiotics

  • Chalizion - incision and curettage

  • Blepharitis - clean the lid margins

  • Hordoleum - antibiotic ointment

Question 23 of 55

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Your patient is an avid surfer and is frequently exposed to wind, sun, and sand. He comes into your office presenting with a fleshy, triangular encroachment of the conjunctiva onto the nasal side of the cornea. What is your diagnosis?

Select one of the following:

  • Pterygium

  • Dacrocystitis

  • Chalzion

  • Blepharitis

  • Hordoleum

Question 24 of 55

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You just diagnosed your patient with ptyergium, which of the following would you use in your treatment plan?

Select one of the following:

  • artificial tears

  • short course of topical NSAIDs or weak corticosteroids

  • Excision if the growth threatens vision, induced astigmatism, or severe ocular irritation

  • All of the above should be used/considered in your treatment plan

Question 25 of 55

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Your patient presents with a hard, nontender swelling on the upper eyelid of the right eye. The adjacent conjunctiva is edematous and erythematous. What is your diagnosis?

Select one of the following:

  • Pterygium

  • Dacrocystitis

  • Chalazion

  • Blepharitis

  • Hordeleum

Question 26 of 55

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You patient presents with scales (seborrhea) around the base of the eyelashes and redness of the eyelids. Based on this presentation, what is your diagnosis?

Select one of the following:

  • Blepharitis

  • Dacrocysitits

  • Ectropion

  • Keratoconjunctivitis

Question 27 of 55

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A 6 month old infant was taken into an urgent care clinic because the mother noticed swelling, redness and pus coming out of the infant's tear sac area. The infant seemed very agitated. What is your diagnosis and treatment plan?

Select one of the following:

  • Congenital Dacrocystitis - probing of the nasolacrimal system

  • Chronic Dacrocystitis - systemic antibiotics

  • Blepharitis - baby shampoo to cleanse eye

  • Ectropion - surgical correction

Question 28 of 55

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Your patient is a 50 year old woman complaining of pain, swelling, and redness near the tear sac of her right eye. She also complains of tearing and purulent discharge. You diagnose her with chronic dacryocystitis. What pathogens are likely causing this condition and how would you treat it?

Select one of the following:

  • S. epidermidis, anaerobic streptococci, or candidida albicans - recommend dacryocystorhinostomy (surgical correction)

  • S. epidermidis, anaerobic streptococci, or candidida albicans - systemic antibiotics will cure this condition

  • Staphylococcus aureus, or beta-hemolytic streptococci - recommend dacryocystorhinostomy (surgical correction)

  • Staphylococcus aureus, or beta-hemolytic streptococci - systemic antibiotics will cure this condition

Question 29 of 55

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Your patient is an 80 year old male complaining of excessive tearing, dryness, and general irritation of his left eye. P/E findings include the outward turning of the lower eyelid on the affected eye only. What is your diagnosis?

Select one of the following:

  • Ectropion

  • Blepharitis

  • Dacryocystitis

  • Keratoconjunctivitis

Question 30 of 55

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Your patient is a 27 year old female who wears contact lenses and frequently forgets to take them out before going to sleep. She is now presenting with a hazy cornea, central ulcer with adjacent stromal abscess and hypopyon. You scraped the ulcer for culture and found Pseudomonas aeurginosa. What is your diagnosis and treatment plan?

Select one of the following:

  • Bacterial Keratitis - high concentration topical antibiotic drops (tobramycin)

  • Corneal Ulcer - emergent referral to ophthalmologist

  • Dacryocysitis - systemic oral antibiotics

  • Conjunctivitis - self-limiting condition, no treatment necessary

  • Blepharitis - use baby shampoo for eye hygiene

Question 31 of 55

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Your patient is complaining of pain, photophobia, tearing, and reduced vision. P/E findings include circumcorneal injection. What is your diagnosis and treatment plan?

Select one of the following:

  • Corneal Ulcer - emergent referral to ophthamologist

  • Dacryocystitis - systemic antibiotics

  • Bacterial Keratitis - levofloxacin antibiotic drops

  • Viral Conjunctivitis - no treatment necessary

Question 32 of 55

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Your patient presents with a pool of blood at the bottom of the iris which appears to be contained by the cornea. What is your diagnosis?

Select one of the following:

  • Hypopyon

  • Hyphema

  • Conjunctivitis

  • Uveitis

Question 33 of 55

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You just diagnosed your patient with hyphema, what is the most appropriate treatment option?

Select one of the following:

  • No treatment is needed, the body with reabsorb the hemorrhage

  • Emergent referral to ophthalmologist because this condition may lead to intractable glaucoma with permanent visual loss

  • Excise and drain the blood

  • None of the above

Question 34 of 55

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Your patient presents with peri-limbic irritation (around the iris), pain, ciliary flush (inflamed ciliary body), severe photophobia, vision loss, and hypopyon in the left eye. The pupil of the left eye is smaller than the right eye and is irregular in shape. What is your diagnosis?

Select one of the following:

  • Anterior Uveitis

  • Acute Glaucoma

  • Bacterial Corneal Ulcer

  • Keratitis

  • Bacterial Conjunctivitis

Question 35 of 55

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Your patient recently had cataract surgery and is now complaining of redness, swelling, blurred vision, and photophobia. P/E findings include decreased visual acuity and hypopyon. What is the most likely diagnosis?

Select one of the following:

  • Endophthalmitis

  • Keratitis

  • Uveitis

  • Hyphema

  • Conjunctivitis

Question 36 of 55

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Which of the following is true regarding the cranial nerves that innervate the eye muscles?

Select one of the following:

  • CN IV (trochlear) innervates the superior oblique muscle

  • CN VI (abducens) innervates the lateral rectus muscle

  • CN III (oculomotor) controls all eye muscles except the ones mentioned above

  • All of the above are true

  • None of the above are true

Question 37 of 55

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Your patient presents with malaise, fever, headache, and periorbital burning and itching for the past two days. Today they developed a vesicular rash. P/E findings include conjunctivitis, keratitis, episcleritis, anterior uveitis and increased intraocular pressure. What is your diagnosis and treatment plan?

Select one of the following:

  • Herpes Zoster Opthalmicus - high-dose oral acylcovir and emergent referral to ophthalmologist

  • Herpes Zoster Opthalmicus - viral cause that will resolve on its own

  • Herpes Simplex Keratitis - high-dose oral acylcovir and emergent referral to ophthalmologist

  • Herpes Simplex Keratitis - viral cause that will resolve on its own

Question 38 of 55

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Your patient complains of vision loss and has 20/20 visual acuity in the left eye and 20/200 in the right eye. Using fluorescein dye, you see a dendritic ulcer over the cornea. What is your diagnosis?

Select one of the following:

  • Herpes Simplex (Viral) Keratitis

  • Herpes Zoster Opthalmicus

  • Anterior Uveitis

  • Acute glaucoma

Question 39 of 55

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Patient complains of rapid loss of vision in the right eye due to a "curtain-like" covering of visual field. This occurrence lasted for a few minutes and then subsided. What is the most likely diagnosis?

Select one of the following:

  • Amaurosis Fugax (ocular TIA)

  • Retinal Detachment

  • Branch retinal artery occlusion

  • Acute angle closure glaucoma

Question 40 of 55

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Your patient is a 70 year old male complaining of rapid loss of vision in the left eye due to a “curtain-like” covering of visual field. Patient also notes a sudden onset of floaters and photopsia. Pt history includes cataract surgery and myopia (nearsightedness). P/E findings include the retina hanging in the vitreous, appearing as a gray cloud. What is your diagnosis?

Select one of the following:

  • Retinal Detachment

  • Open Angle Glaucoma

  • Amaurosis Fugax

  • Retinal artery occlusion

Question 41 of 55

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Which of the following would predispose someone to a retinal detachment?

Select one of the following:

  • Myopia (nearsightedness)

  • Diabetic Retinopathy

  • Cataract Surgery

  • Neovascular age-related macular degeneration

  • Retinal vein occlusion

  • All of the above

Question 42 of 55

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Your patient is complaining of sudden onset of unilateral facial paralysis and post auricular pain. You diagnose your patient with Bell's Palsy. Which of the following best represents the pathophysiology of this condition?

Select one of the following:

  • CN 7 (facial) nerve compression likely due to herpes simplex virus

  • CN 7 (facial) nerve blockage due to stroke

  • Guillain-Barré syndrome

  • basilar meningitis

Question 43 of 55

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Your patient presents with ptosis, divergent and slightly depressed left eye. Extra ocular movements are restricted in all directions except laterally. The pupil is dialed and does not respond to light. What is your diagnosis?

Select one of the following:

  • CN III Palsy (oculomotor)

  • CN IV Palsy (trochlear)

  • CN VI Palsy (abducens)

  • None of the above

Question 44 of 55

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Your patient recently experienced head trauma and is now presenting with an upward deviation of the left eye with failure of depression on adduction. Based on this presentation what is the most likely diagnosis?

Select one of the following:

  • CN III Palsy (oculomotor)

  • CN IV Palsy (trochlear)

  • CN VI palsy (abducens)

  • None of the above

Question 45 of 55

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Your patient recently experienced head trauma and is now presenting with a convergent squint in the right eye with failure of abduction, producing horizontal diplopia that increases on gaze and looking into the distance. The patient has increased intraocular pressure. Based on this presentation what is the most likely diagnosis?

Select one of the following:

  • CN III Palsy (oculomotor)

  • CN IV Palsy (trochlear)

  • CN VI Palsy (abducens)

  • None of the above

Question 46 of 55

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Which of the following are true about lesions of the optic tract?

Select one of the following:

  • A lesion in the left optic tract will cause right-sided homonymous hemianopsia

  • A lesion in the right optic tract will cause left-sided homonymous hemianopsia

  • Stroke, congenital defects, tumors, infection, and surgery are all possible causes of optic tract damage

  • All of the above are true

Question 47 of 55

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You diagnose your patient with acute angle glaucoma. Which of the following is the best treatment plan for this condition?

Select one of the following:

  • Reduce intraocular pressure with IV acetazolamide, apply topical pilocarpine, and recommend peripheral iridotomy in both eyes

  • Reduce intraocular pressure with IV acetazolamide, apply topical pilocarpine, and recommend peripheral iridotomy in the affected eye only

  • once a day dose of a prostaglandin analog (bimatoprost)

  • Topical beta-adrenergic blocking agent (timolol)

Question 48 of 55

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Which of the following may predispose a patient to acute angle-closure glaucoma?

Select one of the following:

  • shallow anterior chamber depth

  • farsightedness or short stature

  • enlargement of crystalline lens with age

  • Inheritance (usually in Inuit and Asian populations)

  • All of the above

Question 49 of 55

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Your patient is a 65 year old male complaining of progressive bilateral loss of peripheral vision (tunnel vision). P/E findings include cupping of the optic discs, and increased intraocular pressure. What is your diagnosis and treatment plan?

Select one of the following:

  • Chronic (open angle) Glaucoma - prescribe a prostaglandin analog, recommend laser trabeculoplasty and refer to an ophthalmologist

  • Chronic (open angle) Glaucoma - reduce intraocular pressure with IV acetazolamide, apply topical pilocarpine, and recommend peripheral iridotomy in both eyes

  • Acute angle closure glaucoma - no treatment is necessary at this time

  • Acute angle closure glaucoma - urgent referral to an ophthalmologist

Question 50 of 55

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Your patient is complaining of sudden visual loss and abrupt onset of floaters. The eye is not injected and the patient denies any pain. Fundoscopic exam findings include a collection of blood in front of the retina. What is your diagnosis?

Select one of the following:

  • Vitreous Hemorrhage

  • Cerebrovascular accident

  • Retinal detachment

  • Diabetic retinopathy

  • Macular degeneration

Question 51 of 55

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Your patient has diabetes mellitus and during their annual physical you perform an eye exam. Fundoscopic exam findings of your patient include microaneruisyms, retinal hemorrhages, venous beading, retinal edema, and hard exudates. What is your diagnosis?

Select one of the following:

  • Diabetic retinopathy

  • Macular Degeneration

  • Hypertensive Retinopathy

  • Central retinal artery occlusion

Question 52 of 55

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Your patient is a 65 year old female complaining of progressive, bilateral central vision loss. She denies any pain and her eyes are non-injected. Based on this presentation, what is your diagnosis?

Select one of the following:

  • Retinal detachment

  • Macular degeneration

  • Cerebrovascular accident

  • Diabetic Retinopathy

Question 53 of 55

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You suspect your patient has a corneal abrasion, using a slit-lamp and fluorescein dye, you inspect the cornea and notice there is damage into Bowman's layer. What is your diagnosis?

Select one of the following:

  • Corneal erosion

  • Corneal abrasion

  • Retinal detachment

  • Macular degeneration

Question 54 of 55

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Your patient is a 65 year old female with a Hx of diabetes and smoking. She is complaining of gradually progressive blurred vision with monocular diplopia. Patient denies any pain, and the eyes are non-injected. P/E findings include an absent red reflex in both eyes and white-looking pupils. What is your diagnosis and treatment plan?

Select one of the following:

  • Cataracts - refer to ophthalmologist for surgical correction

  • Corneal abrasion - prescribe antibiotic ointment

  • Acute Glaucoma - decrease intraocular pressure with IV acetazolamide

  • None of the above

Question 55 of 55

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Your patient has papilledema (optic disc swelling due to increased intracranial pressure). Which of the following would be included in your differential diagnosis?

Select one of the following:

  • Optic neuritis

  • Optic disc drusen

  • central retinal vein occlusion

  • posterior uveitis

  • all of the above

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Clin Med - Practice Quiz for Eye Condtions

claire.p.larkin
Quiz by , created about 1 year ago

Practice quiz based on the focused review points

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claire.p.larkin
Created by claire.p.larkin about 1 year ago
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