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OEBC OSCE Component study materials
OEBC OSCE Component study resources

OEBC OSCE Component practice questions

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Question 1Case history and patient communication

A patient attends with a new complaint of low back pain. Which opening question best elicits a full history?

  1. Tell me what has been happening with your back. Correct answer.
  2. Is the pain worse in the morning or the evening?
  3. Does the pain travel down your leg at all?
  4. Have you tried ibuprofen for this pain?

Explanation

Open-ended questions invite the patient to describe the problem in their own words and often reveal concerns the clinician had not anticipated. Narrow, closed questions are valuable later for clarifying specific details, but used first they truncate the narrative and hide the patient's main worry.

Question 2Case history and patient communication

During the history a patient pauses and looks away after mentioning a recent bereavement. Which response best demonstrates active listening?

  1. Let us move on now to your medications.
  2. Bereavement is a normal part of life for most people.
  3. It sounds as though that has been hard for you. Correct answer.
  4. Can you tell me how many units of alcohol you drink in a typical week?

Explanation

Active listening means noticing and reflecting the patient's emotional cue so that they feel heard, which encourages disclosure of psychosocial detail relevant to the case. Ignoring the cue, or normalising it with a platitude, closes the conversation down and may lead the patient to withhold important information.

Question 3Case history and patient communication

At the end of a long and complicated history you want to confirm that you have understood the patient's concerns. Which technique is most appropriate?

  1. I have written everything down, so we do not need to go over it again.
  2. I will read back what I have heard and you can correct me. Correct answer.
  3. Let us leave it there for now and start the physical examination.
  4. Do you have any questions before we finish?

Explanation

Summarising the history back to the patient confirms that the clinician's understanding matches the patient's meaning and gives the patient a chance to add or correct information. It also provides a natural bridge from history taking into the examination or the discussion of a plan.

Question 4Case history and patient communication

A patient presents with three separate problems and the clinic is already running behind schedule. What is the best approach?

  1. We can only deal with one problem today, so choose the most important one.
  2. Let me list all three concerns, then we can agree what to cover today. Correct answer.
  3. I will address all three concerns fully today even if the appointment runs over time.
  4. Please book separate appointments for the other two without discussing them.

Explanation

Naming all of the patient's concerns early and then negotiating priorities prevents the last-minute revelation of a serious issue as the patient reaches for the door. The negotiation respects the patient's agenda while acknowledging honestly the practical limits of the appointment.

Question 5Case history and patient communication

A patient who smokes says he knows he should quit but enjoys it and is not ready to stop. Which response is most consistent with motivational interviewing?

  1. You must stop now; there is no safe level of smoking for you.
  2. Most people find that a combination of patches and gum makes quitting much easier.
  3. You enjoy smoking, and you are also aware it affects your health. Correct answer.
  4. I will refer you to the smoking cessation clinic today.

Explanation

Motivational interviewing uses reflective statements that hold both sides of the patient's ambivalence, allowing the patient to voice the arguments for change in their own words. Confrontation, warning or unsolicited advice tends to provoke resistance and makes behaviour change less likely.

Question 6Case history and patient communication

Before performing an intimate examination, which action best supports valid informed consent?

  1. Ask a chaperone to be present and then proceed with the examination.
  2. Ask the patient to sign the consent form at the front desk before the visit.
  3. Explain the reason, what it involves, and obtain agreement before proceeding. Correct answer.
  4. Give the patient an information leaflet about the examination at reception.

Explanation

Consent is a process rather than a signature: the clinician must explain the purpose and nature of the examination, confirm the patient understands, and obtain voluntary agreement, which may be withdrawn at any point. A chaperone or a leaflet can support that process but never replaces it.

Question 7Case history and patient communication

You must tell a patient that recent imaging suggests a malignancy. Which opening is most appropriate?

  1. There is a shadow on the lung, which means you have lung cancer.
  2. I have some news that may be difficult; is now a good time to talk? Correct answer.
  3. Your results are back; would you prefer to read the report yourself first?
  4. The scan shows something serious, but I want you to try not to worry about it yet.

Explanation

A warning shot prepares the patient for difficult information and lets them choose the moment, which supports autonomy and softens the impact of the news. Announcing a diagnosis baldly, or handing the report over, removes that preparatory step and the offer of support that should follow.

Question 8Case history and patient communication

A patient nods while you explain how to use a newly prescribed inhaler. Which action best confirms that the technique has been understood?

  1. Ask whether the patient has understood everything you have said.
  2. Ask the patient to repeat back the brand name of the medication.
  3. Give a printed leaflet and ask the patient to read it carefully at home later.
  4. Ask the patient to show you how they would use the inhaler. Correct answer.

Explanation

The teach-back or show-me method asks the patient to demonstrate or explain the technique in their own words, which reveals genuine understanding rather than polite agreement. A nod, or a general question about understanding, frequently produces false reassurance.

Question 9Case history and patient communication

A patient with limited English attends with her 12-year-old child, who offers to interpret. What is the most appropriate action?

  1. Continue with the child interpreting but avoid discussing sensitive topics.
  2. Arrange a trained professional interpreter and speak directly to the patient. Correct answer.
  3. Use the child for simple questions and a professional interpreter for sensitive ones.
  4. Speak slowly and loudly in English, using gestures to make yourself understood.

Explanation

Clinical interpreting should be done by a trained professional who is bound by confidentiality and can convey nuance accurately, and children must never be placed in that role. The clinician should address the patient directly in short segments rather than speaking to the interpreter.

Question 10Case history and patient communication

While taking a sexual history, a patient says firmly, 'I do not want to talk about that.' What is the best response?

  1. Record the refusal in the notes and move on without comment or explanation.
  2. Explain why the question matters and ask permission before continuing. Correct answer.
  3. Tell the patient the information is mandatory for the appointment to continue.
  4. Ask the questions again in a different order to obtain the information indirectly.

Explanation

When a patient declines a sensitive question, the clinician should explain why the information matters and seek permission to continue, which preserves trust and autonomy. Issuing an ultimatum, or extracting the information by stealth, damages the therapeutic relationship and may cause the patient to disengage from care altogether.

Question 11Case history and patient communication

You are about to take a history from a new patient in a busy clinic. You prefer to type brief notes during the consultation. What is the most appropriate action before you begin?

  1. Type quietly without mentioning it so the patient is not distracted.
  2. Ask permission to take notes and explain their purpose. Correct answer.
  3. Record the conversation on your phone to avoid typing during the consultation.
  4. Ask the patient to write their own history on a form before you start.

Explanation

Note-taking supports accurate recall but should be transparent. Seeking permission and explaining why notes are made maintains trust and respects the patient's expectation of confidentiality. Covert recording or unexplained typing can make patients uneasy and may breach consent requirements.

Question 12Case history and patient communication

You need to ask a new patient about their alcohol intake during a routine history. Which approach best prepares the patient for this question?

  1. Start with 'How much do you drink?' so the question is direct and efficient.
  2. Say 'I ask all patients about alcohol as part of the routine history' before asking. Correct answer.
  3. Ask the patient's partner about their drinking while the patient is present.
  4. Wait until the patient mentions alcohol themselves before asking about it.

Explanation

Signposting normalises a potentially sensitive question, reduces any sense of being judged, and improves the likelihood of an honest answer. An abrupt direct question can feel intrusive, while waiting for the patient to raise the topic may mean important risk information is never gathered.

Question 13Case history and patient communication

A patient says they take 'two tablets for the pain' but cannot remember the strength. Which question best clarifies the prescribed dose?

  1. Why are you taking two tablets?
  2. What strength is each tablet, and how many times a day do you take them? Correct answer.
  3. Do you think your pain is well controlled?
  4. Tell me about your pain medication.

Explanation

Specific closed questions are appropriate when confirming factual details such as tablet strength and frequency. Broad open questions are useful for exploring the patient's experience but may not produce the precise numerical information needed to check the prescription and avoid dosing errors.

Question 14Case history and patient communication

A patient has described intermittent chest discomfort. Before moving to examination, which question best explores their perspective?

  1. How many times has this happened in the past week?
  2. Does the discomfort spread to your arm or jaw?
  3. What do you think might be causing this, and what worries you most? Correct answer.
  4. Have you had an ECG before?

Explanation

Exploring ideas, concerns and expectations helps the clinician understand the meaning the patient attaches to the symptom and what they fear most. This information shapes the explanation, investigation plan and shared decision-making, and can reveal concerns that a purely biomedical history would miss.

Question 15Case history and patient communication

An older patient attends with her adult son, who repeatedly answers questions that are directed at his mother. What is the most appropriate response?

  1. Direct all further questions to the son because he is likely to know the full history.
  2. Continue the history without acknowledging either the son's answers or the patient's attempts to speak.
  3. Ask the son to leave the room immediately so the patient can speak freely.
  4. Thank the son, then turn to the patient and say, 'I would like to hear from you first, Mrs X.' Correct answer.

Explanation

The patient remains the primary source of their own history, and the clinician should politely restore their voice while acknowledging the companion's supportive role. Excluding the relative without discussion may remove valuable support, while relying on the relative undermines the patient's autonomy and may produce an inaccurate account.

Question 16Case history and patient communication

A patient says, 'I have just been feeling really poorly lately.' What is the best next question?

  1. Can you tell me what 'poorly' means for you and what you have noticed? Correct answer.
  2. Do you feel depressed?
  3. Have you taken any medication for it?
  4. How long has this been going on?

Explanation

Vague terms should be clarified before the clinician interprets them, because 'feeling poorly' may mean pain, fatigue, low mood or something else entirely. Asking the patient to describe what they have noticed invites a detailed account without prematurely narrowing the differential.

Question 17Case history and patient communication

As you are concluding a consultation and reaching for the prescription pad, the patient says, 'There is one more thing I have been worried about.' What is the best response?

  1. Tell the patient that the clinic is running late and they should have mentioned it earlier.
  2. Pretend not to hear and finish the prescription so the clinic stays on time.
  3. Ask the patient to book another appointment before they say anything more.
  4. Acknowledge the concern, ask briefly what it is, then agree how and when it will be addressed. Correct answer.

Explanation

A concern raised at the end of a consultation may be the patient's most important issue. Acknowledging it and briefly screening its nature allows the clinician to judge urgency and negotiate a safe plan, rather than dismissing it or letting it prolong the interview without structure.

Question 18Case history and patient communication

A patient arrives 40 minutes late and is angry about the time spent in the waiting room. Which opening response is most appropriate?

  1. I am sorry you have waited so long. What has brought you in today? Correct answer.
  2. The delay is not my fault because the clinic is short-staffed today.
  3. You were late yourself, so you cannot really complain about waiting.
  4. If you calm down, I will speak to you.

Explanation

Acknowledging the patient's frustration briefly and then moving to the clinical agenda demonstrates respect without dwelling on blame. Defensive explanations or conditional reassurance tend to escalate anger, whereas a clear apology for the experience helps restore the working relationship.

Question 19Case history and patient communication

You need to explain that a screening test carries a 1 in 1,000 risk of a serious complication. Which explanation best supports understanding for a patient with low numeracy?

  1. One in a thousand means there is a 99.9% chance of no problem at all.
  2. The risk is 0.1%, which is very low.
  3. Serious complications are rare with this test.
  4. Out of 1,000 people who have the test, one will have a serious complication. Correct answer.

Explanation

Natural frequencies using a consistent denominator are easier to grasp than percentages or vague descriptors, especially for people with low numeracy. Presenting the same denominator for both outcomes, where relevant, further reduces framing effects and supports informed decisions.

Question 20Case history and patient communication

You are taking a history by telephone from a patient with abdominal pain. Which action best compensates for the absence of visual cues?

  1. Rely mainly on the patient's tone of voice to judge how severe the pain is.
  2. Signpost each step, screen for red flags with structured questions, and check understanding. Correct answer.
  3. Ask the patient to photograph their abdomen and send the image during the call.
  4. Ask only a few questions so that the telephone call can be kept short.

Explanation

Telephone consultations remove visual information, so the clinician must compensate with clear signposting, systematic screening for serious features, and explicit checks that the patient has understood the advice. Relying on vocal tone alone is unreliable, and a photograph of the abdomen cannot substitute for a structured clinical history.

Question 21Case history and patient communication

At the beginning of a new-patient consultation, which statement best illustrates signposting?

  1. I am running very late today, so please keep your answers as brief as possible.
  2. Why have you come to the clinic today, and what would you like help with?
  3. Your notes say you have diabetes and asthma, so I will focus on those first.
  4. I will ask some questions, examine you, and then we agree a plan. Correct answer.

Explanation

Signposting tells the patient what will happen next and in what order, which reduces uncertainty and supports a collaborative consultation. It is not a substitute for an open opening question or for acknowledging the patient's agenda.

Question 22Case history and patient communication

Which question best invites a patient to share their own explanation for their symptoms?

  1. How has this affected your daily activities?
  2. What were you hoping we would do today?
  3. What do you think is causing this problem? Correct answer.
  4. What worries you most about these symptoms?

Explanation

Exploring the patient's ideas means asking what they believe is causing the problem, which reveals attributions, fears, and possible unmet information needs. Worries, expectations, and functional impact are separate components of the patient's perspective.

Question 23Case history and patient communication

A patient with hearing loss attends without hearing aids. Which adjustment is most appropriate for taking the history?

  1. Write every question on paper and avoid spoken communication entirely.
  2. Speak loudly and directly into the patient's ear from the side.
  3. Ask the accompanying family member to answer questions on the patient's behalf.
  4. Face the patient, speak clearly, and reduce background noise. Correct answer.

Explanation

Facing the patient, speaking clearly at a normal pace, and reducing background noise improves lip-reading cues and audibility. Shouting distorts speech, and relying on a relative removes the patient's own voice from the history.

Question 24Case history and patient communication

At the end of the history you want to summarize. Which statement is the best example of summarizing?

  1. I will now examine your abdomen and then we can discuss the results.
  2. You seem to be finding this difficult; would you like to take a break?
  3. So the pain started Monday, is worse at night, and eases with rest. Correct answer.
  4. Can you repeat for me, from the beginning, everything that you have told me so far?

Explanation

A summary condenses the key elements of the history and offers the patient a chance to correct or add details. It differs from stating a plan, requesting full repetition, or responding only to emotion.

Question 25Case history and patient communication

A patient stops mid-sentence and looks down. Which response best encourages them to continue?

  1. Can you give me a yes or no answer?
  2. Take your time; I am listening. Correct answer.
  3. I think we should move on to the examination.
  4. Is this something you would rather not discuss?

Explanation

Silence with a brief permission statement gives the patient space to gather thoughts and signals that the clinician is listening. It is preferable to changing topic or demanding a closed answer.

Question 26Case history and patient communication

A patient says, 'I take a water tablet for my heart.' Which question best clarifies the medication?

  1. Why do you call it a water tablet?
  2. Are you sure it is for your heart?
  3. Do you mean furosemide?
  4. What name and dose are on the packet? Correct answer.

Explanation

The safest clarification is to ask the patient to read the exact name and dose from the packet, avoiding leading suggestions. Guessing a drug name can produce inaccurate medication reconciliation.

Question 27Case history and patient communication

A patient with low mood says, 'I have had enough.' Which question best assesses suicidal ideation?

  1. Have you thought about ending your life or harming yourself? Correct answer.
  2. Do you think this is just stress?
  3. You would not do anything silly, would you?
  4. Would you like me to refer you to a counsellor?

Explanation

Asking directly and specifically about thoughts of ending life or self-harm is safe, non-judgmental, and more likely to elicit an honest answer. Indirect or dismissive phrasing can miss significant risk.

Question 28Case history and patient communication

An adult patient's daughter telephones and asks for her mother's test results. What is the most appropriate response?

  1. I can tell you the results if you promise to keep them confidential.
  2. I will post the results to your mother, and she can share them with you.
  3. Your mother's results are not your concern.
  4. I cannot share results without her consent; may I contact her directly? Correct answer.

Explanation

Confidentiality means results belong to the patient, so information should not be shared with a relative without the patient's consent. Offering to contact the patient directly respects autonomy and safety.

Question 29Case history and patient communication

A patient shouts that staff have ignored him and that nobody listens. Which opening response is most appropriate?

  1. I can see you are angry; help me understand what happened. Correct answer.
  2. Please lower your voice or I will end the consultation.
  3. The staff are very busy, so some delay is unavoidable.
  4. You will need to make a formal complaint if you are unhappy.

Explanation

Acknowledging anger and inviting the patient's account can de-escalate the situation and uncover the underlying concern. Threatening, defending staff, or redirecting to complaints may intensify the conflict.

Question 30Case history and patient communication

A patient mentions taking herbal remedies alongside prescribed warfarin. Which response best supports safe care?

  1. Herbal products are natural, so they cannot affect your warfarin.
  2. You should stop all herbal remedies immediately; they are dangerous.
  3. Please do not mention this to the prescriber unless asked.
  4. Thank you; which remedies do you use, and how often? Correct answer.

Explanation

A non-judgmental, specific enquiry about which remedies and how often they are used supports safe medication review and detection of interactions. Abrupt cessation or reassurance without details can be unsafe.

Question 31Case history and patient communication

You are beginning a history with a new patient who has not yet said why they have attended. Which opening question is most appropriate?

  1. How long have you had the pain?
  2. Have you had this problem before?
  3. What would you like to discuss today? Correct answer.
  4. Are you taking any regular medicines?

Explanation

An opening question should be broad and open so the patient can raise whatever is uppermost in their mind in their own words. Closed questions about duration, medicines, or previous episodes are useful later, but used first they narrow the agenda before the patient has had a chance to set it.

Question 32Case history and patient communication

A patient who speaks limited English attends with their 12-year-old child, who offers to interpret. What is the most appropriate approach to taking the history?

  1. Arrange a trained interpreter and address questions to the patient rather than to the interpreter. Correct answer.
  2. Use the child for straightforward questions and switch to a professional interpreter only for sensitive topics.
  3. Speak more loudly and slowly in English and rely on gestures rather than interpreting.
  4. Accept the child's offer because it keeps the consultation running smoothly and avoids delay.

Explanation

History taking must remain accurate and confidential, and children should not be placed in the position of carrying clinical information for a parent. A trained interpreter protects accuracy and allows the patient to disclose sensitive matters freely, and speaking directly to the patient preserves the rapport.

Question 33Case history and patient communication

A patient with recurrent headaches says, 'My father had a brain tumour, so I know what this means.' Which response best explores the patient's concerns?

  1. Reassure the patient immediately that most headaches have a benign cause.
  2. Explain that a brain tumour is very unlikely given such a young age.
  3. That sounds frightening. What have you been thinking this might be? Correct answer.
  4. Ask how long each headache lasts and whether it is throbbing or constant.

Explanation

Naming the emotion and inviting the patient to describe their own interpretation reveals the ideas, fears, and expectations driving the consultation. Premature reassurance or a rapid move to symptom detail can leave the real worry unexplored and unaddressed.

Question 34Case history and patient communication

A 15-year-old attends alone and asks about contraception, requesting that her parents not be told. How should you respond while taking the history?

  1. Say that you cannot discuss contraception with her until a parent or guardian is present in the room.
  2. Promise that nothing discussed will be shared with anyone, including her parents, so that she feels able to be honest.
  3. Tell her that her parents must be informed before any advice about contraception can be given.
  4. Explain the limits of confidentiality, then explore her situation and her understanding of the issues involved. Correct answer.

Explanation

A young person should be told honestly how confidentiality works, including its limits where there is risk of harm, before being invited to talk. Assessing their understanding and circumstances allows a judgment about whether they can consent to their own care, rather than assuming incapacity or promising absolute secrecy.

Question 35Ocular health assessment techniques (biomicroscopy, ophthalmoscopy, gonioscopy, tonometry)

During slit-lamp examination, which illumination method is used to obtain an optical section of the cornea?

  1. A broad diffuse beam with the room lights on
  2. A narrow beam directed at an angle to the cornea Correct answer.
  3. A beam directed at the limbus with the microscope offset
  4. A cobalt blue beam after fluorescein instillation

Explanation

An optical section is produced by narrowing the slit beam and directing it obliquely so that the illuminated plane cuts through the cornea, allowing depth, thickness and layer-by-layer assessment. Reducing beam width to about 1 mm and widening the angle between illumination and observation improves the section.

Question 36Ocular health assessment techniques (biomicroscopy, ophthalmoscopy, gonioscopy, tonometry)

What are the characteristics of the retinal image seen with direct ophthalmoscopy?

  1. Inverted and reversed, magnified about 2.5 times
  2. Upright and real, with magnification set by the lens
  3. Inverted and virtual, with magnification that varies
  4. Upright and virtual, magnified about 15 times Correct answer.

Explanation

The direct ophthalmoscope forms an upright, virtual image of the fundus, with magnification of roughly 15 times in an emmetropic eye and less in myopia. Because the image is not inverted, vessels and the optic disc appear in their anatomical orientation.

Question 37Ocular health assessment techniques (biomicroscopy, ophthalmoscopy, gonioscopy, tonometry)

When performing Goldmann applanation tonometry, the scale reading is taken at the point where:

  1. The mires overlap and the fluorescent semicircles merge
  2. The inner edges of the two mires just touch Correct answer.
  3. The mires are separated by about one mire width
  4. The outer edges of the mires align with the slit beam

Explanation

Applanation is correct at the endpoint where the inner borders of the superior and inferior fluorescein semicircles just touch, corresponding to a flattened area of 3.06 mm diameter and a scale value in mmHg. The endpoint is approached with the fine control drum so that contact is just complete.

Question 38Ocular health assessment techniques (biomicroscopy, ophthalmoscopy, gonioscopy, tonometry)

A faint, diffuse corneal scar is barely visible under direct focal illumination. Which slit-lamp technique best highlights it?

  1. Specular reflection from the corneal endothelium
  2. Cobalt blue illumination after fluorescein
  3. Retroillumination with the beam through the pupil
  4. Sclerotic scatter with the beam at the limbus Correct answer.

Explanation

With sclerotic scatter, light entering the limbus is internally reflected through the cornea, so any disruption of corneal transparency glows brightly against a dark background. The microscope is kept out of the beam path and the room darkened to maximise contrast, making faint scars and oedema easier to detect.

Question 39Ocular health assessment techniques (biomicroscopy, ophthalmoscopy, gonioscopy, tonometry)

On slit-lamp examination with a narrow beam at the temporal limbus, the peripheral anterior chamber depth is judged to be one quarter of the corneal thickness. How should this be interpreted?

  1. The finding is uninterpretable without a corneal thickness reading
  2. The angle is open and no further assessment is needed
  3. The angle is likely narrow and gonioscopy is indicated Correct answer.
  4. The angle is closed and the patient needs urgent referral

Explanation

A peripheral chamber depth of one quarter corneal thickness corresponds roughly to a Shaffer grade 2 angle of about 15 to 20 degrees, which is considered narrow. Such eyes warrant gonioscopy because the Van Herick method only estimates depth and may miss a closure-prone angle.

Question 40Ocular health assessment techniques (biomicroscopy, ophthalmoscopy, gonioscopy, tonometry)

The fundus image seen with a 20-diopter condensing lens during binocular indirect ophthalmoscopy is:

  1. Inverted, virtual and located behind the patient's eye
  2. Erect and real, forming between the lens and the eye
  3. Inverted, laterally reversed and formed in air Correct answer.
  4. Erect, virtual and magnified relative to the direct view

Explanation

The condensing lens produces a real image in the air between the lens and the observer, and that image is inverted and laterally reversed, which the examiner learns to reinterpret. A 20 D lens gives about 3 times magnification with a wide field, at a working distance of roughly 50 cm.

Question 41Ocular health assessment techniques (biomicroscopy, ophthalmoscopy, gonioscopy, tonometry)

Why is a contact goniolens necessary to view the anterior chamber angle?

  1. It replaces the air-tear interface that reflects light from the angle Correct answer.
  2. It illuminates the angle with an internal light source
  3. It flattens the cornea so the angle opens for viewing
  4. It magnifies the angle so a slit lamp can resolve it

Explanation

Light from the angle would otherwise meet the curved air-tear interface beyond the critical angle and undergo total internal reflection, so the angle cannot be seen directly. The goniolens provides an interface of refractive index similar to the cornea, allowing light to leave and be viewed through a mirror or prism.

Question 42Ocular health assessment techniques (biomicroscopy, ophthalmoscopy, gonioscopy, tonometry)

During Goldmann applanation, the examiner sees the superior and inferior mires overlapping, with the fluorescent semicircles partially merged. What is the likely consequence and the appropriate correction?

  1. Artifact from too little fluorescein; instil more dye
  2. Overestimation of IOP; reduce the applanation force Correct answer.
  3. A valid reading; slight overlap is acceptable at any pressure
  4. Underestimation of IOP; press the prism harder

Explanation

Overlapping mires mean the flattened area has exceeded 3.06 mm because the prism is being pressed too firmly, so the scale reads higher than the true pressure. The force should be reduced with the control drum, or the prism withdrawn slightly, until the inner edges of the semicircles just touch.

Question 43Ocular health assessment techniques (biomicroscopy, ophthalmoscopy, gonioscopy, tonometry)

Gonioscopy shows a narrow angle with apparent iridocorneal contact. Gentle indentation with the lens opens the angle so that the trabecular meshwork becomes visible. What does this indicate?

  1. The finding is an artifact and the angle should be regraded
  2. The angle is synechially closed and laser is required
  3. The lens has deepened the angle by compressing the crystalline lens
  4. The closure is appositional rather than synechial Correct answer.

Explanation

If the angle opens during indentation, peripheral iris is merely apposed to the meshwork and can be pushed away, which defines appositional closure. Synechial closure, in which permanent peripheral anterior synechiae have formed, remains closed despite indentation and carries a different prognosis and management.

Question 44Ocular health assessment techniques (biomicroscopy, ophthalmoscopy, gonioscopy, tonometry)

A 90-diopter lens is used with the slit lamp to examine the fundus. How does the resulting image appear?

  1. Inverted and laterally reversed, with a wide field Correct answer.
  2. Inverted and virtual, with magnification higher than direct
  3. Erect and virtual, similar to the direct ophthalmoscope
  4. Erect and real, located between the lens and the examiner

Explanation

A condensing lens held in front of the eye forms a real, inverted and laterally reversed image that the slit-lamp microscope then views, giving a wide stereoscopic field. Higher-power lenses such as the 90 D provide a wider field with lower magnification, whereas lower-power lenses such as 60 D magnify more.

Question 45Ocular health assessment techniques (biomicroscopy, ophthalmoscopy, gonioscopy, tonometry)

Which slit-lamp illumination technique is best for viewing the corneal endothelial mosaic?

  1. Sclerotic scatter
  2. Diffuse illumination
  3. Retroillumination
  4. Specular reflection Correct answer.

Explanation

Specular reflection aligns the illumination beam and the microscope at equal angles on opposite sides of the corneal normal, so light reflected from the endothelial surface reveals the mosaic. Retroillumination uses light returning from deeper structures to silhouette opacities rather than resolve endothelial cells. Sclerotic scatter and diffuse illumination give a broad overview but do not provide the specular view needed for endothelial detail.

Question 46Ocular health assessment techniques (biomicroscopy, ophthalmoscopy, gonioscopy, tonometry)

Which tonometric method uses a controlled air pulse and does not require topical anesthesia?

  1. Noncontact tonometry Correct answer.
  2. Dynamic contour tonometry
  3. Goldmann applanation tonometry
  4. Schiotz tonometry

Explanation

Noncontact tonometry estimates intraocular pressure by detecting the air pulse that temporarily flattens the cornea, so it avoids corneal contact and does not require anesthetic or fluorescein. Goldmann and dynamic contour tonometry both require contact with the anesthetized cornea. Schiotz tonometry also contacts the cornea and requires anesthesia.

Question 47Ocular health assessment techniques (biomicroscopy, ophthalmoscopy, gonioscopy, tonometry)

Which aperture of a direct ophthalmoscope is most appropriate for assessing the red reflex?

  1. The large circular spot Correct answer.
  2. The slit beam
  3. The fixation target
  4. The small circular spot

Explanation

A large circular beam illuminates a broad area of the retina and produces an easily observed red reflex when viewed from a working distance. The small spot is intended for macular examination, while the slit beam helps assess retinal elevation and the fixation target is used for fixation. Choosing a broad beam improves detection of opacities that obscure the red reflex.

Question 48Ocular health assessment techniques (biomicroscopy, ophthalmoscopy, gonioscopy, tonometry)

On gonioscopy, which structure is located immediately anterior to the scleral spur?

  1. Ciliary body band
  2. Trabecular meshwork Correct answer.
  3. Schwalbe line
  4. Iris root

Explanation

Moving anteriorly from the iris insertion, the ciliary body band and scleral spur are followed by the trabecular meshwork and then Schwalbe line. The trabecular meshwork therefore lies directly anterior to the scleral spur. The iris root and ciliary body band are posterior to the spur, while Schwalbe line is anterior to the meshwork.

Question 49Ocular health assessment techniques (biomicroscopy, ophthalmoscopy, gonioscopy, tonometry)

A patient has a corneal laceration and a shallow anterior chamber. Which slit-lamp technique is used to look for aqueous leakage?

  1. Van Herick technique at the temporal limbus
  2. Specular reflection of the endothelium
  3. Seidel test with fluorescein and cobalt blue light Correct answer.
  4. Sclerotic scatter with a broad beam

Explanation

In a Seidel test, concentrated fluorescein is applied and viewed with cobalt blue light; a dark stream that dilutes the fluorescent tear film indicates aqueous leakage from the wound. Van Herick technique estimates anterior chamber depth, while specular reflection and sclerotic scatter are used to examine corneal structure rather than wound leakage.

Question 50Ocular health assessment techniques (biomicroscopy, ophthalmoscopy, gonioscopy, tonometry)

During binocular indirect ophthalmoscopy, what is the main purpose of scleral depression?

  1. To increase the magnification of the posterior pole
  2. To stabilize the condensing lens in front of the eye
  3. To view the peripheral retina and ora serrata Correct answer.
  4. To reduce corneal astigmatism during the examination

Explanation

Scleral depression pushes the peripheral retina toward the observer so that the ora serrata and anterior retina, which otherwise lie out of view, can be examined. It does not change the magnification of the posterior pole, correct corneal astigmatism, or hold the condensing lens. The technique is especially useful for detecting peripheral retinal breaks.