COT Patient History and Ophthalmic Examination Techniques 4 — Questions and Answers
Question 1: A patient reports seeing halos around lights at night. Which historical finding would most increase concern for acute angle-closure glaucoma?
- Recent change in eyeglass prescription
- Episodes of severe headache and nausea accompanying the visual symptoms (Correct answer)
- History of dry eye syndrome
- Use of antihistamine eye drops
Correct answer: Episodes of severe headache and nausea accompanying the visual symptoms
Acute angle-closure glaucoma classically presents with halos around lights accompanied by severe headache, nausea, and eye pain due to a sudden rise in intraocular pressure.
Question 2: When performing confrontation visual field testing, the technician covers the patient's left eye and asks them to look at the technician's nose. What is the technician's corresponding eye doing?
- Both of the technician's eyes remain open
- The technician covers their own right eye (Correct answer)
- The technician covers their own left eye
- The technician closes both eyes briefly between targets
Correct answer: The technician covers their own right eye
In confrontation fields, the technician covers the eye mirrored to the patient's covered eye — patient's left eye covered, technician covers their own right eye — so each tests the same field quadrant.
Question 3: A patient with diabetes reports fluctuating vision that worsens after meals. The technician should note this as likely related to:
- Dry macular degeneration
- Osmotic lens changes from blood glucose fluctuations (Correct answer)
- Increased tear film instability
- Early posterior vitreous detachment
Correct answer: Osmotic lens changes from blood glucose fluctuations
Fluctuating blood glucose levels cause osmotic shifts in the crystalline lens, temporarily altering its refractive index and producing transient blurred vision.
Question 4: During slit-lamp examination, the technician uses a narrow slit beam directed obliquely to evaluate the anterior chamber depth. This technique is called:
- Specular reflection
- Van Herick grading (Correct answer)
- Sclerotic scatter
- Retro-illumination
Correct answer: Van Herick grading
The Van Herick technique uses a narrow oblique slit beam at the limbus to estimate the peripheral anterior chamber depth as a ratio of corneal thickness, helping screen for occludable angles.
Question 5: A patient is unable to read the 20/400 letter on the Snellen chart. The next step in assessing visual acuity should be:
- Immediately record vision as NLP (no light perception)
- Test counting fingers at progressively shorter distances (Correct answer)
- Switch to the Jaeger chart
- Perform pinhole testing
Correct answer: Test counting fingers at progressively shorter distances
When a patient cannot see the largest Snellen optotype, vision is tested by counting fingers (CF), then hand motion (HM), then light perception (LP) to characterize the level of visual function.
Question 6: Which medication class in a patient's history most directly requires documentation because it can cause a pigmentary retinopathy detectable on examination?
- Topical beta-blockers
- Hydroxychloroquine (Plaquenil) (Correct answer)
- Oral corticosteroids
- ACE inhibitors
Correct answer: Hydroxychloroquine (Plaquenil)
Hydroxychloroquine can cause a bull's-eye maculopathy and must be documented so baseline and annual retinal screening can be performed per dosing guidelines.
Question 7: A patient reports a sudden painless loss of vision in one eye described as 'a curtain coming down.' This history is most consistent with:
- Central serous chorioretinopathy
- Rhegmatogenous retinal detachment (Correct answer)
- Optic neuritis
- Vitreous hemorrhage
Correct answer: Rhegmatogenous retinal detachment
A 'curtain' or 'shadow' descending over the visual field is the classic description of a rhegmatogenous retinal detachment as it progresses to involve the macula.
COT Patient History and Ophthalmic Examination Techniques 4
A patient reports seeing halos around lights at night.
Which historical finding would most increase concern for acute angle-closure glaucoma?