COT Patient History and Ophthalmic Examination Techniques 5 — Questions and Answers
Question 1: When recording pupil reactions in a patient's chart, 'PERRL' means:
- Pupils Equal, Round, Reactive to Light (Correct answer)
- Pupils Examined, Reactive, Round, and Level
- Pupils Equal, Responsive, Round, and Luminous
- Pupils Elevated, Reactive, Reflective, and Light-sensitive
Correct answer: Pupils Equal, Round, Reactive to Light
PERRL stands for Pupils Equal, Round, and Reactive to Light, and is a standard notation confirming normal direct and consensual pupillary light responses.
Question 2: A patient taking tamsulosin (Flomax) for benign prostatic hyperplasia is scheduled for cataract surgery. The technician should flag this history because of the risk of:
- Elevated intraocular pressure intraoperatively
- Intraoperative floppy iris syndrome (IFIS) (Correct answer)
- Corneal endothelial decompensation
- Increased risk of posterior capsule rupture from lens hardness
Correct answer: Intraoperative floppy iris syndrome (IFIS)
Alpha-1 adrenergic antagonists like tamsulosin cause intraoperative floppy iris syndrome, where the iris billows and prolapses, significantly complicating cataract surgery.
Question 3: The Amsler grid is primarily used to detect defects in which area of the visual field?
- Peripheral visual field beyond 30 degrees
- Central 20 degrees of vision, particularly the macula (Correct answer)
- Superior arcuate region associated with glaucoma
- Nasal step defects near the blind spot
Correct answer: Central 20 degrees of vision, particularly the macula
The Amsler grid tests the central 20 degrees of vision and is most sensitive for detecting metamorphopsia and scotomas caused by macular disease.
Question 4: During cover-uncover testing, the examiner observes that the uncovered eye moves to pick up fixation when the other eye is covered. This finding indicates:
- Orthophoria
- A tropia (manifest strabismus) (Correct answer)
- A phoria (latent strabismus only)
- Normal fusional vergence
Correct answer: A tropia (manifest strabismus)
Movement of the uncovered eye during the cover-uncover test indicates that it was not fixing on the target, confirming a manifest deviation (tropia).
Question 5: A patient presents with a red eye and purulent discharge since waking. The most important historical question to help differentiate bacterial from viral conjunctivitis is:
- Does the redness worsen outdoors?
- Is there a recent history of upper respiratory infection or exposure to a person with similar symptoms? (Correct answer)
- Does the patient wear contact lenses overnight?
- Has the patient ever had LASIK surgery?
Correct answer: Is there a recent history of upper respiratory infection or exposure to a person with similar symptoms?
Viral conjunctivitis is often associated with a preceding upper respiratory infection or sick contact, while bacterial conjunctivitis typically presents with mucopurulent discharge without these associations.
Question 6: When using a non-contact tonometer (NCT or air-puff tonometer), the technician should obtain at least how many readings per eye to report a reliable average?
- 1 reading only
- 2 readings
- 3 readings (Correct answer)
- 5 readings
Correct answer: 3 readings
Standard practice is to obtain a minimum of three readings per eye with the NCT and average them, as single readings have greater variability.
Question 7: A patient with a history of herpes simplex virus (HSV) keratitis reports a recurrence of eye pain and photophobia. The technician should specifically note in the history whether the patient is currently taking:
- Vitamin C supplements
- Oral acyclovir or valacyclovir (antiviral prophylaxis) (Correct answer)
- Artificial tears
- Topical antihistamines
Correct answer: Oral acyclovir or valacyclovir (antiviral prophylaxis)
Oral antiviral prophylaxis with acyclovir or valacyclovir significantly reduces HSV ocular recurrences, and current use or non-compliance is critical history for managing an acute episode.
COT Patient History and Ophthalmic Examination Techniques 5
When recording pupil reactions in a patient's chart, 'PERRL' means: