1.
Which of the following is an example of a consultation
Correct Answer
A. Jim, you suspect Jim may have the early stage primary open angle glaucoma. unfortunately you do not have the appropriate diagnostic equipment at your clinic. you send jim to another pHysician to have an evaluation for glaucoma with notes for Jim to return to your office for continued care.
Explanation
This scenario is an example of a consultation because the optometrist refers Jim to another physician for further evaluation and care. The optometrist suspects that Jim may have glaucoma but does not have the necessary equipment to make a definitive diagnosis. Therefore, they send Jim to another physician who can provide the appropriate diagnostic evaluation. The optometrist also provides notes for Jim to return to their office for continued care, indicating that the consultation is part of an ongoing treatment plan.
2.
If there is a suspected problem. when should a baby's first eye exam be done?
Correct Answer
A. 6 months or earlier
Explanation
Babies should have their first eye exam done at 6 months or earlier. This is because early detection of any potential eye problems is crucial for their overall visual development. By examining a baby's eyes at this age, any issues such as refractive errors or eye diseases can be identified and treated promptly, ensuring that the baby's vision develops properly.
3.
Which of the following age ranges is the ONLY age range in which its ok for a patient to go 3 years without an eye exam (according to the lectures)
Correct Answer
D. 18-40 YOA
Explanation
According to the lectures, the only age range in which it is okay for a patient to go 3 years without an eye exam is 18-40 years old.
4.
Which of the following parts of a routine wellness exam would NOT be covered by medical insurance (select all that apply)
Correct Answer(s)
A. Refraction with Rx given to pt
B. Binocular vision screening
Explanation
this question is really asking what vision insurance would cover (but that's too easy) vision insurance will cover "routine Vison related" tests. i like to think of it as, if the patient is benefiting/ getting something from the test somehow, then vision insurance will likely cover it (with an appropriate diagnosis ie. myopia, astigmatism etc). for a diagnostic refraction; you can do a refraction whenever the heck you want to: you dont always have to give the final Rx to the patient. when a refraction is done and no Rx is given, all the information still goes into the chart. so you may refer back at a later date to determine pertinent changes. But if the patient wants the Rx to get glasses, someone has to pay for that. gotta make that monayyy!
5.
In the course of an eye wellness exam of an established pt. you do a refraction and/or pertinent related tests, in which the patient really wants to buy new glasses. you should bill the following CPT code
Correct Answer
A. 92015, 92014
Explanation
The correct answer is 92015, 92014. This is because during an eye wellness exam, the optometrist or ophthalmologist may perform a refraction test to determine the patient's prescription for glasses or contact lenses (CPT code 92015). They may also perform other pertinent related tests, such as a comprehensive eye exam (CPT code 92014), to evaluate the overall health of the patient's eyes. Therefore, both CPT codes 92015 and 92014 are appropriate to bill for this scenario.
6.
True or false? there is a higher insurance reimbursement for including dilation as part of an eye wellness examination
Correct Answer
B. False
Explanation
you get paid for it regardless of if it is done or not. the reimbursement amount does not change.
however, it is best practice to complete a dilated fundus exam for quality patient care
7.
Regarding the eye wellness examination @ Ketchum health
your very first patient, here for a new eye wellness examination is following you down the hall. during the trek to the exam room, you completed autorefractometry/keratometry. in the exam room, you completed a thoroughly detailed history of the patient (PMH, POH, meds, allergies, etc.). after your completed refraction, you find that the patient would benefit from spectacles for both far and near. Goldmann applanation tonometry was 15/16mmHg. the patient then consented to dilation. once dilated, you proceed to find that this patient has unremarkable eyes. you hand over the new prescription and send the patient to optical to pick out some shiny new frames
assuming that everything mentioned was documented correctly...
does it meet the minimum requirements for Ketchum health
Correct Answer
A. NOOOOOO!
Explanation
this exam would be unacceptable; NO preliminary/entrance tests were completed. entrance testing consists of EOMS, NPC, CVF, pupils BP/HR, Cover test etc.
an AR/AK does not count as entrance testing (even though it was done at the beginning)
8.
Karen comes into your office and states the following complaint
"my right eye is red and irritated"
you start a problem-focused exam in the health record
during your FOLDARS she explains intermittent frequency. symptoms started 3 days ago. when to occurs it seems to last for the whole day. looking at the computer makes it worse. closing her eyes makes it better. and when it occurs it is about an 8 of 10 on the pain scale.
which of the following would be the MOST appropriate chief complaint to document
Correct Answer
A. OD red and irritated
Explanation
you want to try to keep your CC as close to what the patient says, as close to their own words as you can. its ok to use abbreviations where appropriate. in this example, the patient did not elaborate on history of present illness until prompted, so including FOLDARS in the CC would be inappropriate.
9.
According to the lectures, what is the minimum number of HPI categories that you need to cover/ask in order to bill 92004/92014
Correct Answer
A. 4
Explanation
According to the lectures, in order to bill for 92004/92014, a minimum of 4 HPI (History of Present Illness) categories need to be covered/asked.
10.
In terms of disc diameters, how large is the FOV of a direct ophthalmoscope
Correct Answer
A. 2dd
Explanation
The FOV (Field of View) of a direct ophthalmoscope is 2dd in terms of disc diameters. This means that when looking through the ophthalmoscope, the field of vision will cover an area that is equivalent to two disc diameters.
11.
In general, what is the percentage of the fundus we can see with DO
Correct Answer
A. 50-70%
Explanation
The correct answer is 50-70%. This means that when using direct ophthalmoscopy (DO), we are able to visualize approximately 50-70% of the fundus. Direct ophthalmoscopy involves using a handheld instrument called an ophthalmoscope to examine the back of the eye, including the retina, optic nerve, and blood vessels. While DO provides a limited view compared to other imaging techniques, it is still a valuable tool for assessing the health of the eye and detecting certain eye conditions.
12.
You can maximize the FOV of DO by all of the following except
Correct Answer
A. Increasing working distance
Explanation
Increasing working distance can actually help maximize the field of view (FOV) of depth of field (DO). When the working distance is increased, the area that can be seen in focus expands, allowing for a larger FOV. Therefore, this option is not an exception and can help maximize the FOV of DO.
13.
High myopia will ______________ the FOV of DO
Correct Answer
A. Decrease
Explanation
High myopia refers to severe nearsightedness, where distant objects appear blurry. In this context, the question is asking how high myopia affects the field of view (FOV) of depth of field (DO). The FOV refers to the extent of the visual area that can be seen without moving the eyes or head. Since high myopia causes blurry vision, it means that the individual's ability to see clearly and sharply within their FOV is reduced. Therefore, high myopia will decrease the FOV of DO.
14.
For fundus biomicroscopy, decreasing slit lamp mag or increasing the dioptric power of the condensing lense will _______________ the FOV
Correct Answer
A. Increase
Explanation
Increasing the dioptric power of the condensing lens or decreasing the slit lamp magnification will result in an increase in the field of view (FOV) during fundus biomicroscopy. This is because a higher dioptric power or lower magnification allows for a wider area of the fundus to be seen, increasing the overall FOV.
15.
For fundus biomicroscopy, which condensing lens will give the best balance between magnification and FOV
Correct Answer
A. 78D
Explanation
The 78D condensing lens would give the best balance between magnification and field of view (FOV) for fundus biomicroscopy. This lens provides a moderate level of magnification while still allowing a wide enough FOV to capture a sufficient amount of the fundus. The 90D lens may provide a larger FOV but at the expense of magnification, while the 60D and 20D lenses may offer higher magnification but with a narrower FOV.
16.
For SL biomicroscopy, increasing the power of the condensing lens will _____________ FOV and _____________ magnification
Correct Answer
A. Increase, decrease
Explanation
Increasing the power of the condensing lens in SL biomicroscopy will increase the field of view (FOV) because a higher power lens allows for a wider area to be viewed. However, it will decrease the magnification because a higher power lens spreads out the light rays, resulting in a smaller image size.
17.
According to the lecture material, the focal point of a 90D condensing lens is approximately
Correct Answer
A. 8mm
Explanation
however, when you do math it should be around 11mm 1/90=0.011
18.
A red-free filter will accentuate all of the following EXCEPT
Correct Answer
D. Choroidal nevi
Explanation
A red-free filter is used in ophthalmology to enhance the visibility of certain structures in the eye by blocking out red light. It accentuates the contrast between different components of the eye, making them easier to distinguish. Choroidal melanoma, retinal nerve fiber layer, and blood vessels are all structures that can be accentuated by a red-free filter. However, choroidal nevi are not accentuated by this filter, meaning they do not stand out as much compared to the other structures.
19.
You are evaluating your patients left eye using your DO, which of the following directions would direct your patient to fixate to center the ONH in your view
Correct Answer
A. Up and to the right
Explanation
the reason why up and towards your nose is incorrect is because... we have two eyes, our nose is in the middle of said eyes. when you tell a patient to look towards their nose, they dont know which direction to look, its left for the right eye but right form the left eye, its just confusing. much easier to just tell the patient to look in a direction
20.
Approximately how much power should you dial into the DO to start evaluating the eyelids
Correct Answer
A. +20.0D
Explanation
To start evaluating the eyelids, approximately +20.0D of power should be dialed into the DO.
21.
You are evaluating the anterior segment with your DO, starting at the lids and lashes (assuming it is clear), in order to visualize the cornea/conjunctiva --> iris --> lens --> vitreous --> retina, how would you adjust your DO compensating lenses
Correct Answer
A. Decrease plus
Explanation
When evaluating the anterior segment, the DO uses compensating lenses to adjust the focus and clarity of the different structures. Since the DO is starting at the lids and lashes and moving towards the retina, decreasing the plus power of the compensating lenses would be the appropriate adjustment. Decreasing the plus power helps to bring the focal point closer to the DO, allowing for a clearer visualization of the cornea, conjunctiva, iris, lens, vitreous, and retina.
22.
Jim is evaluating his patient's right eye for a PSC. Jim knows from the patient's record that he has a large central opacity which was last examined 1 week ago (he knows it's there). he has dialed in +3.00 into the DO, he is 1-2cm from the patient's eye, and moving around to examine all quadrants but he is failing to see anything. what is Jim doing wrong
Correct Answer
A. Jim is way too close
Explanation
to examine the lens you would need to dial in ~+3.00D in compensation lenses and stand around arms length away.
23.
Which of the following filters would allow the BEST visualization of ONH drusen
Correct Answer
A. Red free
Explanation
The red free filter allows the best visualization of ONH drusen. This filter enhances the contrast between the drusen and the surrounding tissue, making it easier to identify and visualize the drusen. The red free filter blocks red light, which can interfere with the visualization of drusen, while allowing other wavelengths of light to pass through, resulting in a clearer and more detailed image of the drusen.
24.
The appearance of this ONH is likely due to which of the following
Correct Answer
A. Idiopathic intracranial hypertension
Explanation
ill try not to focus on disease in this one (even though most of the lectures a HEAVILY disease based) but what im trying to convey is that pathologic causes of indistinct ONH margins look feathery. compared to non pathologic indistinct margins.
25.
This is a fundus image of
Correct Answer
A. OS RPE crescent
Explanation
The fundus image shows a crescent-shaped area in the left eye (OS) that corresponds to the retinal pigment epithelium (RPE). The RPE is a layer of cells located between the retina and the choroid, responsible for supporting the retina and maintaining its function. This crescent-shaped area indicates a specific abnormality or change in the RPE layer in the left eye.
26.
The indistinct appearance of this ONH is due to
Correct Answer
A. Degeneration of the short posterior ciliary artery
Explanation
The indistinct appearance of the optic nerve head (ONH) is likely due to the degeneration of the short posterior ciliary artery. The ONH is supplied by the ciliary arteries, which provide the necessary blood flow to the optic nerve. When the short posterior ciliary artery degenerates, it can lead to a decrease in blood flow to the ONH, resulting in an indistinct appearance. This can affect the visual function and potentially lead to vision problems.
27.
Which of the following is the correct order of optic nerve head rim tissue from thinnest to thickest (in general)
Correct Answer
A. Temporal < nasal < superior < inferior
Explanation
The correct answer is "temporal < nasal < superior < inferior". This order is based on the general thickness of the optic nerve head rim tissue. The temporal region is usually the thinnest, followed by the nasal region, then the superior region, and finally the inferior region, which is generally the thickest.
28.
Which of the following characteristics would you NOT expect to find associated with ONH pallor
Correct Answer
F. Ptosis
Explanation
ONH pallor refers to the pale appearance of the optic nerve head, which can be indicative of optic nerve damage. Ptosis, or drooping of the eyelid, is not typically associated with ONH pallor. The other characteristics listed, such as reduced BVCA (best visual corrected acuity), APD (afferent pupillary defect), VF (visual field) defect, color desaturation, and compromised circulation, are all commonly associated with ONH pallor.
29.
Pathological symmetrical thinning of the Optic nerve head rim is only due to
Correct Answer
A. Glaucoma
Explanation
glaucoma is the best answer here, question asked about pathological (reason why large nerve is not correct)
Ocular hypertension does not mean glaucoma, yes high IOP put you at greater risk of developing glaucoma but high IOP is not glaucoma
high myopia goes along with large nerve
30.
In this fundus photo, which of the following would best describe the eye and the appearance
Correct Answer
A. OS ONH notch @ 6:00
Explanation
The correct answer is OS ONH notch @ 6:00. This means that in the fundus photo, the left eye (OS) has an optic nerve head (ONH) notch located at the 6 o'clock position.
31.
Spontaneous venous pulsation is visible when
Correct Answer
A. Intraocular Pressure is higher than central retinal venous pressure
Explanation
Spontaneous venous pulsation is visible when the Intraocular Pressure (IOP) is higher than the central retinal venous pressure. This means that when the pressure inside the eye (IOP) is greater than the pressure in the veins of the retina, the veins will pulsate and become visible.
32.
For DO, which aperture could you use to measure your patient's disc size?
Correct Answer
A. Medium
Explanation
A medium aperture would be suitable for measuring the patient's disc size. This is because a medium aperture allows for a balance between a narrow and wide opening, providing a moderate amount of light to enter the eye. This aperture size would enable the examiner to accurately assess the size of the patient's disc without overwhelming or insufficient light entering the eye.
33.
True or false? tilted discs usually occur bilaterally
Correct Answer
A. True
Explanation
usually a bilateral congenital anomaly
34.
Malinsertion of ONH through the scleral canal at an angle usually greater than 15o. can present unilateral or bilateral. associated with elevation of the nasal rim tissue. the disk appears stretched and flattened temporally. commonly seen in myopes and astigmatics.
this is a description of which of the following
Correct Answer
A. Oblique insertion
Explanation
The description provided in the question matches the condition known as oblique insertion. This condition refers to the malinsertion of the optic nerve head (ONH) through the scleral canal at an angle usually greater than 15 degrees. It can present unilaterally or bilaterally and is associated with elevation of the nasal rim tissue. The optic disk appears stretched and flattened temporally. Oblique insertion is commonly seen in individuals with myopia and astigmatism.
35.
When evaluating the c/d of a patient with an obliquely inserted ONH, what would you use to judge the c/d ratio
Correct Answer
A. The vertical limits
Explanation
To judge the c/d (cup-to-disc) ratio of a patient with an obliquely inserted optic nerve head (ONH), one would use the vertical limits. The vertical limits refer to the upper and lower boundaries of the cup, which can be assessed by comparing the height of the cup to the height of the disc. This is important in determining the extent of cupping and evaluating for possible glaucoma. The horizontal limits and the apexes of the "kidney bean" shape may also provide valuable information, but the vertical limits specifically help in assessing the c/d ratio.
36.
You are using your DO, and notice a lesion that seems elevated, you focus on the apex of the lesion then dial in 4 clicks to focus on the base of the lesion. what is the approximate relative height of this lesion
Correct Answer
A. 1.33mm
Explanation
The question describes using a DO (dental operating microscope) to examine a lesion. The examiner first focuses on the apex (top) of the lesion and then adjusts the focus by dialing in 4 clicks to focus on the base (bottom) of the lesion. The question asks for the approximate relative height of the lesion. Since the examiner adjusted the focus by 4 clicks, it suggests that each click corresponds to a specific measurement. Therefore, the approximate relative height of the lesion would be 4 times the measurement of each click. The answer provided, 1.33mm, is the closest option to this calculation.
37.
Which of the following would be a "normal" c/d ratio for a caucasian
Correct Answer
A. 0.3h x 0.3v
38.
True or false? retinal arteries lie above retinal veins.
Correct Answer
A. True
Explanation
Retinal arteries do indeed lie above retinal veins. This is due to the difference in blood flow direction. Arteries carry oxygenated blood away from the heart and towards the tissues, while veins carry deoxygenated blood back to the heart. In the retina, the arteries bring oxygenated blood into the tissue, and they are positioned above the veins, which carry the deoxygenated blood out of the retina.
39.
Arterial sclerosis with associated venous deflection at a right angle. the vein appears tapered adjacent to the artery and the underlying vein is concealed
Correct Answer
A. Gunn's sign
Explanation
Gunn's sign refers to the presence of arterial sclerosis with associated venous deflection at a right angle. This means that there is a narrowing of the artery and the adjacent vein appears tapered. Additionally, the underlying vein is concealed. This sign is named after Dr. Robert Gunn, who first described it.
40.
In general, when evaluating a retinal hemorrhage, which of the following are matched correctly? (select 2)
Correct Answer(s)
A. Bright red blood --> likely arterial
B. Dark red blood --> likely venous
Explanation
Bright red blood is likely arterial because arterial blood is oxygenated and has a higher oxygen content, giving it a brighter red color. Dark red blood is likely venous because venous blood has a lower oxygen content and appears darker in color.
41.
Which of the following plaques is most common
Correct Answer
A. Hollenhorst plaque
Explanation
Hollenhorst plaque is the most common plaque among the options given. It is a small, cholesterol-rich plaque that is typically found in the retinal artery. These plaques are often composed of cholesterol crystals and are known to cause blockages in the blood vessels, leading to decreased blood flow and potential damage to the surrounding tissues. This type of plaque is commonly associated with atherosclerosis and can be a significant risk factor for cardiovascular diseases.
42.
This reflective plaque is a __________________, and a common indicator of _______________
Correct Answer
A. Hollenhorst plaque; impending stroke
Explanation
A Hollenhorst plaque is a type of plaque that is commonly found in the retinal artery. It is composed of cholesterol and other fatty substances that can break off and travel to smaller blood vessels in the brain, leading to a blockage. This blockage can cause an impending stroke, as the blood flow to the brain is compromised. Therefore, the presence of a Hollenhorst plaque is a common indicator of an impending stroke.
43.
Talc retinopathy apparently is due to which of the following
Correct Answer
A. Snorting of talcum powder laced cocaine
Explanation
i know, i know supposedly there is no pathology on the final but there really isnt much else from Dr. Tong
44.
Which of the following hemorrhages would obscure your view of the posterior pole (select 2)
Correct Answer(s)
A. Vitreal hemorrhage
G. Pre-retinal hemorrhage
Explanation
Vitreal hemorrhage and pre-retinal hemorrhage are the two types of hemorrhages that can obscure the view of the posterior pole. Vitreal hemorrhage refers to bleeding into the vitreous humor, the gel-like substance that fills the space between the lens and the retina. Pre-retinal hemorrhage, on the other hand, refers to bleeding that occurs between the retina and the vitreous humor. Both of these hemorrhages can obstruct the visual pathway and make it difficult to see the posterior pole of the eye, which includes the optic nerve head and the macula.
45.
You look into Bob's eye and notice the following.
severe arteriole narrowing with severe focal constriction, abnormal A/V crossing, macular star-patterned hard exudates, cotton wool spots, retinal edema, and flame heme
which stage of hypertensive retinopathy does Bob have
Correct Answer
A. Stage 3
Explanation
Bob has stage 3 hypertensive retinopathy based on the presence of severe arteriole narrowing with severe focal constriction, abnormal A/V crossing, macular star-patterned hard exudates, cotton wool spots, retinal edema, and flame heme. These findings indicate significant damage to the blood vessels in the retina, including narrowing, constriction, and abnormal crossing of arteries and veins. Additionally, the presence of hard exudates, cotton wool spots, retinal edema, and flame heme suggests the presence of retinal ischemia and hemorrhage, which are characteristic of stage 3 hypertensive retinopathy.
46.
An individual with stage 4 hypertensive retinopathy has a life expectancy of about
Correct Answer
A. 1yr
Explanation
An individual with stage 4 hypertensive retinopathy has a life expectancy of about 1 year. This is because stage 4 hypertensive retinopathy is a severe form of the condition, indicating significant damage to the blood vessels in the retina caused by high blood pressure. If left untreated, this can lead to complications such as retinal detachment and vision loss. Therefore, the prognosis for individuals with stage 4 hypertensive retinopathy is generally poor, with a limited life expectancy of approximately 1 year.
47.
Which fundus photos shows grade II hypertensive retinopathy
Correct Answer
A. C
Explanation
so the major indicator here is papilledema A,B, & D all have disc edema (fuzzy margins) so right away you should know at least grade IV. A,B,D all also have flame hemorrhages and CWS or hard exudates
C shows AV nicking (focal constriction) and arteriolar narrowing
48.
Hard exudates can be all of the following EXCEPT
Correct Answer
A. RBC
Explanation
Hard exudates are yellowish-white deposits that can be seen in the retina of the eye. They are typically caused by leaking blood vessels and are composed of lipids, proteins, and cellular debris. While red blood cells (RBCs) can be present in hard exudates, they are not typically a major component. Therefore, the correct answer is RBC.
49.
In this photo, which grade of arteriosclerotic retinopathy is present in the superior arcade
Correct Answer
A. Stage IV
Explanation
In arteriosclerotic retinopathy, the stages indicate the severity of the condition. Stage IV is the most advanced stage, indicating severe arteriosclerosis and significant narrowing of the blood vessels in the superior arcade of the retina. This narrowing can lead to decreased blood flow and potential damage to the retina. Hence, stage IV is the correct answer as it suggests the highest level of severity in arteriosclerotic retinopathy in the superior arcade.
50.
You look into your patient's eye with your BIO and notice this. which of the following is correct
Correct Answer
A. OS inferior Branch retinal vein occlusion
Explanation
The correct answer is OS inferior Branch retinal vein occlusion because the question states that the examiner noticed a specific finding in the patient's eye using a BIO (binocular indirect ophthalmoscope). Based on this finding, the examiner identified an occlusion in the inferior branch of the retinal vein in the left eye (OS). This indicates a blockage of the blood flow in the retinal vein, specifically in the inferior branch, leading to potential vision problems in the affected area.