I85PREP
⌘ K
MOC PQA Optometrist study materials
MOC PQA Optometrist study resources

MOC PQA Optometrist practice questions

One question at a time. Build your MOC PQA Optometrist understanding.

First 50 of 200 questions. Each one lists the choices, the correct answer, and an explanation. The checker at the top of this page saves progress in this browser when it is available.

Continue in the practice tool above to load more questions, 50 at a time.

Question 1Patient Care and Clinical Management

A 54-year-old patient reports gradual loss of near vision and holds reading material farther away. Distance acuity is unchanged and the anterior segment is normal. What is the most likely diagnosis?

  1. Convergence insufficiency
  2. Myopic shift from nuclear sclerosis
  3. Accommodative esotropia
  4. Presbyopia Correct answer.

Explanation

Presbyopia is the age-related decline in accommodative amplitude that begins in the fifth decade and produces difficulty with near tasks while distance acuity remains intact. Normal anterior segment findings and preserved distance vision fit this diagnosis.

Question 2Patient Care and Clinical Management

Which finding on confrontation testing most strongly suggests an afferent pupillary defect in one eye?

  1. Anisocoria greater in bright light than in dim light
  2. Bilateral pupils that react sluggishly to both light and near targets
  3. A pupil that constricts more briskly when light swings from the affected eye to the normal eye
  4. A pupil that dilates when light is swung from the normal eye to the affected eye Correct answer.

Explanation

In a relative afferent pupillary defect, the affected eye transmits less light signal, so the pupil dilates when the light swings from the healthy eye to the affected eye. This is the classic Marcus Gunn sign and indicates asymmetric optic nerve or severe retinal dysfunction.

Question 3Patient Care and Clinical Management

A patient with known open-angle glaucoma reports new onset of painless, progressive loss of peripheral vision in one eye. Which test best quantifies this functional loss and guides treatment decisions?

  1. Pachymetry
  2. Gonioscopy
  3. Optical coherence tomography of the macula
  4. Standard automated perimetry Correct answer.

Explanation

Standard automated perimetry measures the visual field and quantifies the extent and depth of glaucomatous field loss, which is the functional endpoint used to judge progression and adequacy of therapy. Structural tests support but do not replace field testing.

Question 4Patient Care and Clinical Management

A 6-year-old is brought in for a school vision screening failure. Which finding most warrants urgent referral for possible amblyopia management?

  1. Intermittent exophoria at near with good fusion
  2. Mild bilateral allergic conjunctivitis
  3. Anisometropia of 1.50 D spherical equivalent between eyes Correct answer.
  4. Visual acuity of 20/20 in each eye with normal alignment

Explanation

Significant anisometropia in a young child can produce amblyopia in the more ametropic eye and is a recognized reason for prompt evaluation and possible refractive correction. Early detection preserves the critical period for visual development.

Question 5Patient Care and Clinical Management

Which instruction is most appropriate for a patient beginning treatment with a prostaglandin analog for open-angle glaucoma?

  1. Instill only when eye pressure feels high
  2. Instill once nightly and expect a gradual increase in iris pigmentation and lash length Correct answer.
  3. Instill once weekly to reduce systemic absorption
  4. Instill four times daily and avoid all contact lens wear

Explanation

Prostaglandin analogs such as latanoprost are dosed once daily in the evening and are associated with iris darkening and eyelash lengthening, which patients should be counseled about. Once-daily dosing maximizes efficacy and minimizes adverse effects.

Question 6Patient Care and Clinical Management

A patient presents with a painful, red eye, photophobia, and a dendritic corneal lesion staining with fluorescein. What is the most appropriate management?

  1. Topical antibiotic and patching
  2. Topical antiviral therapy and referral as needed Correct answer.
  3. Topical corticosteroid alone
  4. Immediate rigid contact lens fitting

Explanation

A dendritic epithelial lesion with pain and photophobia indicates herpes simplex keratitis, which is treated with topical antiviral agents. Corticosteroids without antiviral cover can worsen the infection and are avoided in active epithelial disease.

Question 7Patient Care and Clinical Management

Which systemic medication class is most strongly associated with cataract formation and should be documented in the ocular history?

  1. Thiazide diuretics
  2. Beta blockers
  3. Systemic corticosteroids Correct answer.
  4. Proton pump inhibitors

Explanation

Long-term systemic corticosteroid use is associated with posterior subcapsular cataract formation, so it is an important part of the medication history in any patient with lens changes. Recognizing this association helps in counseling and monitoring.

Question 8Patient Care and Clinical Management

During a routine examination a patient mentions occasional flashes and new floaters. Which action is most appropriate?

  1. Perform dilated fundus examination to evaluate for retinal tear or detachment Correct answer.
  2. Refer for cataract surgery evaluation
  3. Reassure and schedule a routine follow-up in one year
  4. Prescribe artificial tears and recheck in six months

Explanation

New flashes and floaters raise concern for posterior vitreous detachment with possible retinal tear or detachment, which requires prompt dilated fundus examination. Missing a retinal tear risks vision loss.

Question 9Patient Care and Clinical Management

Which test is most useful for detecting a relative afferent pupillary defect when a patient has a dense cataract in one eye?

  1. Worth four-dot test
  2. Swinging flashlight test Correct answer.
  3. Cover-uncover test
  4. Titmus stereoacuity test

Explanation

The swinging flashlight test compares the pupillary response between eyes and identifies asymmetric afferent conduction, though a dense cataract can confound interpretation because it reduces light reaching the retina. The other listed tests assess binocular function or stereopsis rather than afferent conduction.

Question 10Patient Care and Clinical Management

A 68-year-old with diabetes reports fluctuating vision that is worse in the morning. Which diagnosis best fits this pattern?

  1. Corneal abrasion
  2. Open-angle glaucoma
  3. Posterior vitreous detachment
  4. Diabetic macular edema Correct answer.

Explanation

Diabetic macular edema often causes vision that fluctuates with fluid shifts and can be worse after overnight recumbency. Diabetes history plus variable central vision points to macular edema as the leading concern.

Question 11Patient Care and Clinical Management

A patient using timolol eyedrops for glaucoma has a history of asthma. What is the most important counseling point?

  1. The drops may cause bronchospasm and should be discussed with the prescriber Correct answer.
  2. The drops are safe because beta blockade is cardioselective
  3. The drops should be stopped only when eye pressure normalizes
  4. The drops should be used more frequently to compensate for systemic absorption

Explanation

Timolol is a nonselective beta blocker that can be systemically absorbed and trigger bronchospasm in patients with reactive airway disease. Punctal occlusion and discussion of alternatives with the prescriber are appropriate.

Question 12Patient Care and Clinical Management

A patient reports sudden painless loss of vision in one eye described as a curtain descending over the field. What is the most appropriate next step?

  1. Arrange urgent evaluation for possible retinal detachment or vascular occlusion Correct answer.
  2. Perform a routine glaucoma screening in one month
  3. Schedule a routine refraction in two weeks
  4. Prescribe reading glasses and reassure

Explanation

A curtain-like visual loss is a classic description of retinal detachment and can also occur with vascular occlusion, both of which require urgent assessment. Prompt referral protects the chance of visual recovery.

Question 13Patient Care and Clinical Management

A child with intermittent exotropia is being evaluated. Which measurement is most important to document at the initial visit?

  1. The corneal endothelial cell count
  2. The amplitude of accommodation only
  3. The size of the deviation at distance and near with and without accommodative targets Correct answer.
  4. The axial length of each eye

Explanation

In intermittent exotropia the deviation size and control vary with fixation distance and accommodative demand, so documenting distance and near measurements with and without accommodative targets guides management. Other listed measurements are not central to strabismus decision-making.

Question 14Patient Care and Clinical Management

A patient with a known corneal ulcer returns with worsening pain and a hypopyon. What is the most appropriate action?

  1. Start a topical corticosteroid and observe
  2. Continue current drops and recheck in one week
  3. Obtain urgent ophthalmologic evaluation for possible microbial keratitis Correct answer.
  4. Patch the eye and prescribe oral antihistamines

Explanation

A hypopyon with worsening pain suggests severe microbial keratitis that requires urgent ophthalmologic evaluation and likely corneal scraping with intensive antimicrobial therapy. Delay risks corneal perforation and permanent vision loss.

Question 15Patient Care and Clinical Management

Which patient instruction best reduces systemic absorption of topical ophthalmic medication?

  1. Apply punctal occlusion for one to two minutes after instillation Correct answer.
  2. Use a larger drop volume to ensure coverage
  3. Instill drops while lying flat without closing the eyes
  4. Blink rapidly immediately after instillation

Explanation

Punctal occlusion or eyelid closure after instillation reduces drainage into the nasolacrimal system and systemic absorption. This is particularly important for beta blockers and other agents with systemic effects.

Question 16Patient Care and Clinical Management

A patient with type 2 diabetes has no visual symptoms and a normal dilated fundus examination. How should follow-up be managed?

  1. Immediate referral for vitrectomy
  2. No further examinations unless symptoms develop
  3. Annual dilated retinal examination Correct answer.
  4. Examination every five years

Explanation

Patients with diabetes without retinopathy generally require annual dilated retinal examinations to detect asymptomatic retinopathy and macular edema early. Symptom-driven screening would miss treatable disease.

Question 17Patient Care and Clinical Management

A patient reports diplopia that is worse at distance and resolves at near, with an esodeviation on cover testing. Which diagnosis is most consistent?

  1. Basic exophoria
  2. Divergence insufficiency Correct answer.
  3. Convergence excess
  4. Accommodative insufficiency

Explanation

Divergence insufficiency produces an esodeviation that is greater at distance and often symptomatic for distance diplopia while near function is preserved. The pattern of distance-limited symptoms with esodeviation supports this diagnosis.

Question 18Patient Care and Clinical Management

Which finding in a patient with acute anterior uveitis most strongly supports an association with an underlying systemic inflammatory disease?

  1. Mild photophobia responding to cycloplegia
  2. Small keratic precipitates in one eye
  3. A single unilateral episode with no other findings
  4. Bilateral recurrent episodes with HLA-B27 positivity Correct answer.

Explanation

Bilateral, recurrent anterior uveitis, especially with HLA-B27 positivity, raises suspicion for a systemic association such as an HLA-B27-related spondyloarthropathy. Isolated unilateral episodes are more often idiopathic.

Question 19Patient Care and Clinical Management

A patient with a long history of contact lens wear presents with a red eye and a ring-shaped corneal infiltrate. Which condition should be suspected?

  1. Acanthamoeba keratitis Correct answer.
  2. Blepharitis
  3. Episcleritis
  4. Pingueculitis

Explanation

Acanthamoeba keratitis is associated with contact lens wear and can produce ring-shaped stromal infiltrates with pain out of proportion to findings. Prompt recognition and specialized culture or confocal evaluation are important.

Question 20Patient Care and Clinical Management

An older adult reports reading difficulty despite an accurate distance refraction. Which additional measurement is most useful in planning management?

  1. Axial length measurement
  2. Amplitude of accommodation and near addition determination Correct answer.
  3. Corneal topography only
  4. Tear film breakup time only

Explanation

When distance refraction is accurate but near vision is impaired, measuring accommodative amplitude and determining the appropriate near addition guides presbyopic correction. Other tests do not directly address the near-vision complaint.

Question 21Patient Care and Clinical Management

A patient with known keratoconus reports sudden decrease in vision and increasing discomfort with a previously well-tolerated rigid lens. What is the most likely explanation?

  1. Posterior vitreous detachment
  2. Acute corneal hydrops Correct answer.
  3. Simple conjunctivitis
  4. Optic neuritis

Explanation

Acute hydrops occurs when a break in Descemet membrane allows aqueous into the stroma, causing sudden visual decline, discomfort, and corneal edema in keratoconus. It is managed supportively with monitoring for resolution.

Question 22Patient Care and Clinical Management

A patient on chronic topical steroid therapy for ocular inflammation develops raised intraocular pressure. Which mechanism best explains this finding?

  1. Reduced episcleral venous drainage
  2. Increased trabecular meshwork outflow resistance Correct answer.
  3. Pupillary block with iris bombé
  4. Increased aqueous production by the ciliary body

Explanation

Steroid-induced ocular hypertension results primarily from increased resistance to aqueous outflow at the trabecular meshwork. Recognizing this mechanism guides monitoring of intraocular pressure during chronic steroid use.

Question 23Patient Care and Clinical Management

A patient with thyroid eye disease presents with diplopia and exposure symptoms. Which management principle is most appropriate initially?

  1. High-dose topical antibiotics
  2. Supportive lubrication with monitoring and deferral of rehabilitative surgery until disease is inactive Correct answer.
  3. Immediate orbital decompression for all patients
  4. Immediate strabismus surgery during active inflammation

Explanation

In active thyroid eye disease, initial management focuses on lubrication, monitoring, and control of risk factors, with rehabilitative surgery deferred until the disease is stable. Operating during active inflammation risks poor outcomes.

Question 24Patient Care and Clinical Management

A patient presents with a painful red eye, decreased vision, and a mid-dilated pupil that reacts poorly to light. Which diagnosis should be considered first?

  1. Central serous chorioretinopathy
  2. Chronic open-angle glaucoma
  3. Acute angle-closure glaucoma Correct answer.
  4. Vitreous hemorrhage

Explanation

Acute angle closure produces a painful red eye with blurred vision, a mid-dilated poorly reactive pupil, and raised intraocular pressure. It is an emergency requiring immediate pressure-lowering treatment and definitive angle management.

Question 25Patient Care and Clinical Management

A patient with a history of recurrent oral and genital ulcers reports eye pain and hypopyon. Which systemic condition is most likely?

  1. Giant cell arteritis
  2. Multiple sclerosis
  3. Behçet disease Correct answer.
  4. Sarcoidosis

Explanation

Recurrent oral and genital ulceration with hypopyon uveitis is characteristic of Behçet disease, which can cause severe occlusive retinal vasculitis. Early systemic immunosuppression is important to preserve vision.

Question 26Patient Care and Clinical Management

A patient with open-angle glaucoma is prescribed a prostaglandin analogue. Which counseling point is most important to give at the first dispensing?

  1. It may gradually darken the iris and lengthen the lashes Correct answer.
  2. It typically causes a dry mouth and urinary retention
  3. It must be stored frozen until the day of first use
  4. It should be instilled only once weekly to avoid toxicity

Explanation

Prostaglandin analogues commonly cause iris and periocular skin hyperpigmentation and eyelash lengthening, which are cosmetic but often permanent, so patients should be told before starting. They are dosed once nightly, not weekly, and are not associated with systemic anticholinergic effects.

Question 27Patient Care and Clinical Management

A patient reports that a topical drop stings and produces a bad taste immediately after instillation. Which technique change is most likely to reduce this complaint?

  1. Increasing the interval between the two eyes to one hour
  2. Punctal occlusion for one to two minutes after instilling Correct answer.
  3. Instilling the drop onto the closed lid margin
  4. Shaking the bottle vigorously for a full minute before use

Explanation

Closing the eyelids and applying pressure over the nasolacrimal sac reduces drainage into the nasopharynx, limiting both the bitter taste from systemic absorption and some stinging. The other maneuvers do not address nasolacrimal drainage and may reduce therapeutic effect.

Question 28Patient Care and Clinical Management

A patient with a suspected bacterial conjunctivitis has copious purulent discharge and matted lashes. Which action is most appropriate before instilling diagnostic drops?

  1. Schedule the patient for a same-day punctal plug placement
  2. Instill a topical anesthetic and wait thirty minutes
  3. Irrigate and gently clear the discharge from the conjunctival sac Correct answer.
  4. Apply a firm pressure patch over the closed eyelids

Explanation

Purulent discharge obscures the ocular surface and can inactivate or dilute diagnostic agents, so the cul-de-sac should be irrigated or gently cleaned first. Patching a purulent eye is contraindicated, and the other options do not improve the examination.

Question 29Patient Care and Clinical Management

A patient's recorded visual acuity is 20/40 in the right eye and 20/20 in the left eye. How should this be documented in the clinical record?

  1. Visual acuity 20/40 OD and 20/20 OS Correct answer.
  2. Visual acuity 20/40 right eye only, left not tested
  3. Visual acuity 20/40 OS and 20/20 OD
  4. Visual acuity 20/40 OU and 20/20 OU

Explanation

OD denotes the right eye and OS the left eye, so the right eye value is recorded first with OD and the left with OS. Using OU would imply both eyes together, and omitting the left eye would misrepresent the examination.

Question 30Patient Care and Clinical Management

A patient with mild dry eye reports symptoms that are worse late in the day and after prolonged screen use. Which initial management step is most appropriate?

  1. Recommend lubricant drops and scheduled blinking breaks Correct answer.
  2. Start oral corticosteroids for one month
  3. Refer urgently for penetrating keratoplasty
  4. Prescribe a topical antibiotic course for two weeks

Explanation

Mild evaporative dry eye related to screen use is initially managed with lubricants and blink breaks to reduce tear film instability. Antibiotics, surgery, and systemic steroids are not indicated for mild symptoms without other findings.

Question 31Patient Care and Clinical Management

A patient asks how often a healthy adult with no ocular symptoms and no risk factors should have a comprehensive eye examination. Which schedule is most consistent with general guidance?

  1. Every six months from age twenty
  2. Every five years
  3. Only when symptoms begin
  4. Every one to two years Correct answer.

Explanation

For asymptomatic adults without risk factors, a comprehensive examination every one to two years is generally recommended, with frequency adjusted for age and risk. Waiting for symptoms may allow silent disease to progress, and six-month intervals are more frequent than needed for low-risk adults.

Question 32Patient Care and Clinical Management

A patient with diabetes is scheduled for a dilated fundus examination. Which counseling point about dilation is most accurate?

  1. Vision may be blurry and light sensitivity increased for several hours Correct answer.
  2. Pupils will remain dilated permanently after the examination
  3. Driving should be avoided for at least one week afterward
  4. Dilation is unsafe in patients with well-controlled diabetes

Explanation

Mydriatic effects typically last several hours, causing blurred near vision and photophobia, so patients should be advised accordingly. The effect is temporary, and diabetes is a key reason to dilate rather than a contraindication.

Question 33Patient Care and Clinical Management

During case history, a patient reports a new medication started two weeks ago. Which action best supports safe clinical decision-making?

  1. Omit the medication because it is unrelated to the eye
  2. Ask the patient to bring the information at a later visit
  3. Note only the drug name in the margin
  4. Record the drug, dose, duration, and indication in the chart Correct answer.

Explanation

A complete medication record including dose, duration, and indication allows the clinician to identify ocular side effects and drug interactions. Partial or deferred documentation risks missing relevant associations.

Question 34Patient Care and Clinical Management

A patient reports intermittent blur at distance that clears with blinking and a foreign body sensation over several weeks. Which finding on the external examination is most consistent with this history?

  1. A fixed dilated pupil unresponsive to light
  2. A dense white cataract visible without dilation
  3. A tear film break-up time under ten seconds Correct answer.
  4. A restriction of upgaze on forced duction testing

Explanation

Blur that clears with blinking plus irritation suggests an unstable tear film, reflected in a short break-up time. A fixed pupil, cataract, and gaze restriction produce different symptom patterns and would not typically clear with a blink.

Question 35Patient Care and Clinical Management

A patient with known hypertension reports a sudden onset of blurred vision in one eye with no pain. Which historical detail is most important to clarify next?

  1. Whether the patient has seasonal allergies
  2. Whether the visual loss was transient and how long it lasted Correct answer.
  3. Whether the patient wears reading glasses
  4. Whether the patient prefers daily or monthly contact lenses

Explanation

Transient monocular visual loss suggests a vascular or embolic cause and requires urgent evaluation, so duration and recurrence are critical. The other details do not influence the urgency of the visual symptom.

Question 36Patient Care and Clinical Management

A patient with a known allergy to sulfonamide antibiotics requires topical therapy. Which prescribing consideration is most relevant?

  1. Double the dose to overcome the allergy
  2. Use any topical antibiotic because allergy does not apply to eye drops
  3. Avoid sulfonamide-containing agents and document the allergy clearly Correct answer.
  4. Substitute an oral sulfonamide for the topical form

Explanation

Drug allergy history applies to topical formulations as well, and sulfonamide-containing ophthalmic agents should be avoided and the allergy documented prominently. Topical application does not eliminate the risk, and dose changes do not prevent hypersensitivity.

Question 37Patient Care and Clinical Management

A patient with a long-standing history of angle-closure risk asks about over-the-counter cold remedies. Which counseling point is most appropriate?

  1. Only nasal sprays carry ocular risk
  2. Cold remedies should be doubled during allergy season
  3. All cold remedies are safe because they are sold without prescription
  4. Some decongestants and antihistamines can precipitate angle closure Correct answer.

Explanation

Systemic sympathomimetics and anticholinergics in cold preparations can dilate the pupil and precipitate angle closure in susceptible eyes. Nonprescription status does not confer ocular safety, and doubling doses increases risk.

Question 38Patient Care and Clinical Management

A patient with moderate myopia is being counseled about refractive surgery. Which statement best reflects appropriate informed consent?

  1. Guarantee 20/20 vision without correction after surgery
  2. Describe the procedure as risk-free for all patients
  3. State that refractive surgery eliminates the need for future eye examinations
  4. Discuss the risk of undercorrection, dry eye, and night vision symptoms Correct answer.

Explanation

Informed consent requires disclosure of realistic risks such as residual refractive error, dry eye, and night vision disturbances. Guarantees of perfect vision and claims of no risk misrepresent outcomes and are inappropriate.

Question 39Patient Care and Clinical Management

A patient with a history of migraines reports visual disturbance that precedes headache and lasts about twenty minutes. Which action is most appropriate?

  1. Schedule immediate laser iridotomy
  2. Refer emergently for retinal detachment repair
  3. Document the pattern and correlate with the headache history Correct answer.
  4. Prescribe topical antibiotics

Explanation

Visual aura that precedes a migraine and resolves within about an hour is characteristic of migraine and should be documented and correlated with the headache history. Surgical or antibiotic interventions are not indicated based on this pattern alone.

Question 40Patient Care and Clinical Management

A patient with a known diagnosis of keratoconus reports that a rigid contact lens is now uncomfortable and vision is no longer clear. Which action is most appropriate?

  1. Increase lens wearing time despite the discomfort
  2. Switch to over-the-counter reading glasses
  3. Reassess lens fit and corneal topography before making changes Correct answer.
  4. Recommend immediate corneal transplantation

Explanation

Changing comfort and acuity in a keratoconic lens wearer may indicate fit instability or disease progression, so lens fit and topography should be reassessed before altering the regimen. Increasing wear time or using reading glasses does not address the underlying fit problem.

Question 41Patient Care and Clinical Management

A patient with a history of herpes simplex keratitis reports new eye pain and photophobia. Which management step is most appropriate?

  1. Start a course of oral antibiotics
  2. Prescribe a topical steroid without antiviral cover
  3. Recommend a pressure patch and return in one week
  4. Refer for prompt evaluation and avoid initiating topical steroids Correct answer.

Explanation

Recurrent herpes simplex keratitis requires prompt evaluation, and topical steroids without antiviral coverage can worsen the infection. Antibiotics and patching do not treat the viral process and may delay appropriate care.

Question 42Patient Care and Clinical Management

A patient with a history of amblyopia in the left eye is scheduled for a vision screening. Which consideration is most important when interpreting the results?

  1. Compare the result with prior documented acuity for that eye Correct answer.
  2. Use only the right eye result to judge binocular function
  3. Assume the left eye should match the right eye exactly
  4. Disregard the left eye result entirely

Explanation

Amblyopic eyes may have reduced acuity at baseline, so comparison with that patient's prior documented acuity distinguishes stable from new change. Assuming symmetry or ignoring the affected eye would misclassify a change.

Question 43Patient Care and Clinical Management

A patient with a history of uveitis reports new floaters and decreased vision. Which action is most appropriate?

  1. Arrange prompt dilated examination to assess for inflammation Correct answer.
  2. Reassure the patient and schedule a routine annual visit
  3. Recommend tinted glasses for light sensitivity
  4. Prescribe artificial tears and advise rest

Explanation

New floaters and decreased vision in a patient with prior uveitis may indicate recurrent inflammation or complications and warrant prompt dilated evaluation. Reassurance, lubricants, and tinted lenses do not address the possibility of active disease.

Question 44Patient Care and Clinical Management

A patient with a history of diabetic retinopathy is due for follow-up. Which factor most strongly influences the recommended follow-up interval?

  1. The color of the patient's iris
  2. The severity of retinopathy and presence of macular edema Correct answer.
  3. The patient's preferred appointment day
  4. Whether the patient wears glasses for reading

Explanation

Follow-up intervals in diabetic retinopathy are driven by disease severity and the presence of macular edema, which determine risk of progression and need for treatment. Scheduling preferences and unrelated ocular features do not guide interval selection.

Question 45Patient Care and Clinical Management

A patient with a known allergy to topical anesthetics reports that a previous eye examination was painful. Which approach best supports the examination?

  1. Skip documentation to avoid alarming the patient
  2. Administer the anesthetic without informing the patient
  3. Instill a higher dose of the same anesthetic
  4. Use alternative comfort measures and document the reaction Correct answer.

Explanation

When a topical anesthetic allergy is reported, alternative comfort measures should be used and the reaction documented to prevent re-exposure. Giving the same agent at a higher dose or withholding information would be unsafe and unethical.

Question 46Patient Care and Clinical Management

A patient with a history of angle-closure glaucoma is scheduled for a routine examination. Which preparatory step is most appropriate?

  1. Schedule the visit without any review of the medication list
  2. Review the medication list for agents that may dilate the pupil Correct answer.
  3. Instill a strong mydriatic without further consideration
  4. Advise the patient to stop all eye drops before the visit

Explanation

Reviewing medications for anticholinergic or sympathomimetic agents helps anticipate and avoid precipitating angle closure. Instilling a strong mydriatic without planning is risky, and stopping prescribed drops without guidance is inappropriate.

Question 47Patient Care and Clinical Management

A patient with a history of corneal transplant reports a sudden decrease in vision and redness. Which action is most appropriate?

  1. Prescribe artificial tears and a warm compress
  2. Arrange urgent evaluation for possible graft rejection Correct answer.
  3. Recommend observation at home for two weeks
  4. Schedule a routine visit in six months

Explanation

Sudden visual decline and redness in a corneal graft may signal rejection, which is time-sensitive and requires urgent evaluation. Observation, lubricants, and delayed follow-up risk irreversible graft failure.

Question 48Patient Care and Clinical Management

A patient with a history of recent eye surgery reports increasing pain and decreased vision. Which finding would most strongly suggest a need for immediate referral?

  1. A mild reduction in tear break-up time
  2. A small pinguecula on the conjunctiva
  3. A marked rise in intraocular pressure with a hazy cornea Correct answer.
  4. A refractive error change of half a diopter

Explanation

Postoperative pain with rising pressure and corneal haze may indicate a serious complication such as a suprachoroidal hemorrhage or malignant glaucoma and requires immediate referral. The other findings are common and not emergent.

Question 49Patient Care and Clinical Management

A patient with a history of chronic topical steroid use for ocular inflammation presents with elevated pressure and a normal-appearing optic disc. Which management principle is most appropriate?

  1. Stop all ocular medications abruptly without guidance
  2. Coordinate with the prescriber to taper steroids and monitor pressure Correct answer.
  3. Continue the same steroid dose indefinitely
  4. Reassure the patient that steroid-related pressure rise is harmless

Explanation

Steroid-induced ocular hypertension requires coordination with the prescribing clinician to taper the offending agent while monitoring pressure and the optic nerve. Continuing the same dose perpetuates the risk, and abrupt cessation without guidance can cause rebound inflammation.

Question 50Patient Care and Clinical Management

A patient with a history of thyroid eye disease reports new double vision and eyelid swelling. Which management principle is most appropriate?

  1. Coordinate with the care team and address exposure and motility symptoms Correct answer.
  2. Reassure the patient that the symptoms will resolve without review
  3. Prescribe a topical antibiotic for the eyelid swelling
  4. Recommend patching both eyes continuously

Explanation

Active thyroid eye disease with new diplopia and soft tissue signs warrants coordinated multidisciplinary management addressing exposure and motility. Reassurance without review, antibiotics for noninfectious swelling, and bilateral patching are not appropriate.