Eye quiz page – The Emergency Medicine Manual

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Eyes

This is a 10 question quiz about eyes.

The questions are randomly drawn from a bank of 52 questions so will be different each time you take it.

1 / 10

1. A patient presents to the emergency department with a chemical burn to the eye. After instilling topical anaesthetic, what is the appropriate order of further treatment?

a) Assess visual acuity, irrigate the eye, check conjunctival pH

b) Check conjunctival pH, irrigate the eye, assess visual acuity

c) Irrigate the eye, check conjunctival pH, assess visual acuity

d) Irrigate the eye, assess visual acuity, check conjunctival pH

The correct sequence is to irrigate the eye, check conjunctival pH, assess visual acuity. Irrigation until the pH is no longer alkali is the priority.

The correct sequence is to irrigate the eye, check conjunctival pH, assess visual acuity. Irrigation until the pH is no longer alkali is the priority.

2 / 10

2. A 25-year-old man complains of persistent blurring to his left eye one day after sustaining a blow to the area in an altercation.
VAR is 6/6, VAL 6/60, correcting to 6/6 with pin hole. Pupils are equal, round, and reactive.
Fundoscopy is normal at -12 diopters. Slit lamp examination is unremarkable.
Which one of the following is the most likely cause?

a) Retinal detachment

b) Macular oedema

c) Lens dislocation

d) Hyphema

3 / 10

3. The feature most specific for iritis at 8 hours since onset is

a) Consensual photophobia

b) Increased intraocular pressure

c) Hypopyon

d) Episcleral vascular injection

In iritis there is early episcleral injection from associated keratitis, however this may be difficult to differentiate from conjunctivitis (but most prominent around the limbus). There is photophobia, and consensual photophobia is a key finding (i.e. pain in the symptomatic eye when the unaffected eye is exposed to light). Visual acuity may be mild to moderately decreased and the pupil may be small, normal, or irregular. There is a muddy appearance of the iris and cell and flare in the anterior chamber. The intraocular pressure is initially < 15 mmHg but may be increased later due to synechiae. A hypopyon may develop, but usually only after 2-3 days of symptoms.

In iritis there is early episcleral injection from associated keratitis, however this may be difficult to differentiate from conjunctivitis (but most prominent around the limbus). There is photophobia, and consensual photophobia is a key finding (i.e. pain in the symptomatic eye when the unaffected eye is exposed to light). Visual acuity may be mild to moderately decreased and the pupil may be small, normal, or irregular. There is a muddy appearance of the iris and cell and flare in the anterior chamber. The intraocular pressure is initially < 15 mmHg but may be increased later due to synechiae. A hypopyon may develop, but usually only after 2-3 days of symptoms.

4 / 10

4. Which one of the following slit lamp settings would be best to obtain a good optical section?

a) illumination source at 45 degrees to the cornea, slit width 1.00 mm, slit height 15 mm

b) illumination source at 45 degrees to the cornea, slit width 0.25 mm, slit height 8 mm

c) illumination source at 70 degrees to the cornea, slit width 0.25 mm, slit height 8 mm

d) illumination source at 70 degrees to the cornea, slit width 1.0 mm, slit height 15 mm

The preferred slit lamp settings to obtain an optical section are:

illumination source at 45 degrees

slit width 0.25 mm

slit height 8 mm

initial low to medium magnification (7-10X)

increase to 16-20 X once a section obtained

move the illumination source to the opposite side when crossing the mid-line of the cornea

The preferred slit lamp settings to obtain an optical section are:

illumination source at 45 degrees

slit width 0.25 mm

slit height 8 mm

initial low to medium magnification (7-10X)

increase to 16-20 X once a section obtained

move the illumination source to the opposite side when crossing the mid-line of the cornea

5 / 10

5. When performing fundoscopy it is best to set the opthalmoscope brightness to

a) 90% and the aperture to the large circle

b) 70% and the aperture to the small circle

c) 80-90% and the aperture to the small or medium circle

d) 100% and the aperture to the medium circle

When performing fundoscopy it is usually best to set the ophthalmoscope brightness to 80-90% and the aperture to the small or medium circle to prevent pupillary constriction.

When performing fundoscopy it is usually best to set the ophthalmoscope brightness to 80-90% and the aperture to the small or medium circle to prevent pupillary constriction.

6 / 10

6. Normal intraocular pressure

a) Does not vary during the day, but tonometry accuracy may change with diurnal changes in corneal compliance

b) Is usually maximal at 1800 in the evening

c) Does not normally vary during the day

d) May normally vary during the day by up to 5mmHg

Normal intraocular pressure may normally vary by up to 5mmHg with the maximum IOP usually at around 0600.

Normal intraocular pressure may normally vary by up to 5mmHg with the maximum IOP usually at around 0600.

7 / 10

7. The specificity of an IOP of 26mmHg for glaucoma is approximately

a) 40%

b) 80%

c) 100%

d) 60%

The specificity of an IOP of 26mmHg for glaucoma is approximately 100%. Significant optic nerve damage can occur despite a relatively low intraocular pressure (low-tension glaucoma). Others may have little optic nerve damage despite high IOP (ocular hypertension). The sensitivity of IOP >20mmHg on its own for the diagnosis of glaucoma may be as low as 25%. The specificity of IOP for glaucoma increases significantly once IOP reaches 24mmHg and is close to 100% when IOP reaches 26mmHg.

The specificity of an IOP of 26mmHg for glaucoma is approximately 100%. Significant optic nerve damage can occur despite a relatively low intraocular pressure (low-tension glaucoma). Others may have little optic nerve damage despite high IOP (ocular hypertension). The sensitivity of IOP >20mmHg on its own for the diagnosis of glaucoma may be as low as 25%. The specificity of IOP for glaucoma increases significantly once IOP reaches 24mmHg and is close to 100% when IOP reaches 26mmHg.

8 / 10

8. A 47 year-old man with long standing insulin dependent diabetes complains of the sudden onset of painless loss of vision in the right eye one day earlier.
You note normal vision on the left and "light perception only" on the right. There is an afferent pupillary defect on the right and an absent red reflex.
Slit lamp examination is normal.
What is the most likely diagnosis?

a) Central retinal vein occlusion

b) Central retinal artery occlusion

c) Macular retinal detachment

d) Vitreous haemorrhage

9 / 10

9. When moving towards the eye at the start of performing fundoscopy it is best to turn the ophthalmoscope dial

a) clockwise to increase the diopter setting and focus

b) anti-clockwise to reduce the diopter setting and focus

c) clockwise to reduce the diopter setting and focus

d) anti-clockwise to increase the diopter setting and focus

When moving towards the eye at the start of performing fundoscopy it is best to turn the ophthalmoscope dial clockwise to reduce the diopter setting and focus.

When moving towards the eye at the start of performing fundoscopy it is best to turn the ophthalmoscope dial clockwise to reduce the diopter setting and focus.

10 / 10

10. Tropicamide is a

a) Carbonic anhydrase inhibitor

b) Mydriatic agent

c) Miotic agent

d) Cycloplegic

Tropicamide is a mydriatic.

Tropicamide is a mydriatic.

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The average score is 52%
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