Initial Assessment of the Eye

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Question 1 of 10

1. Question
When considering the presentation of patients with eye problems to the emergency department (ED), which one of the following statements is true?
- Eye problems account for less than 1 % of all attendances to the ED in the UK
- The most common presenting problem is the red eye
- Approximately two-thirds of patients can be managed in the ED without involvement of an ophthalmologist
- Slit lamps can be found in the vast majority of all EDs
- Junior doctors are better at assessing and managing eye problems than Emergency Nurse Practitioners (ENP)
Question 2 of 10

2. Question
It is important to take a comprehensive history from a patient with an acute eye problem. Which one of the following statements is true regarding the history?
- A history of 'a curtain coming down' across the vision is a typical finding in retinal artery occlusion
- A patient with a hemianopia commonly describes visual loss in one eye
- Viral and bacterial conjunctivitis can easily be differentiated on the history alone
- A complaint of flashes of light in the vision is commonly seen in acute iritis
- Angle grinding is an activity typically associated with blunt injury to the eye
Question 3 of 10

3. Question
Which one of the following statements is true regarding the measurement of visual acuity in the ED?
- The acuity is usually documented in the form of a fraction with the distance of the chart from the patient as the denominator
- The eye chart should be placed at a distance of 6 m from the patient in a room with at least two windows
- Studies have shown that visual acuity measurement is reliably performed in almost all patients attending the ED with an eye problem
- The numbers next to each line of letters on a Snellen chart indicate the font size and are used to enable consistent documentation of acuity
- The LogMAR chart is a more accurate measurement of acuity than the Snellen chart, as it has the same number of letters on each line and avoids errors associated with visual crowding
Question 4 of 10

4. Question
Although measurement of the visual acuity is usually straightforward, occasionally problems arise. Considering these problems, which one of the following statements is true?
- In a patient with reduced visual acuity, a refractive error can be corrected by a pinhole occluder
- Visual acuity cannot be accurately measured in an illiterate patient
- If the patient is unable to see any letters on the chart at 6 m, the ability to perceive light and dark should be assessed next
- If a patient has come to the ED without his/her glasses, they should be sent home immediately to retrieve them
- The eyelids should be forced apart to assess initial acuity in a patient with blepharospasm from a chemical splash in the eye, prior to any treatment taking place
Question 5 of 10

5. Question
Having checked the visual acuity of the patient, an external examination of the eyes and face is the next step. Which one of the following statements correctly describes an abnormal examination finding?
- Lymphadenopathy of the pre-auricular and submandibular lymph nodes may occur as these nodes receive drainage from the eyelids and conjunctiva
- A protruding globe is a sign of Horner’s syndrome
- Loss of infraorbital nerve sensation is commonly found in assaulted patients due to the nerve’s location immediately above the eye
- Perilimbal conjunctival injection is found in acute episcleritis
- Blood in the anterior chamber always appears as a horizontal fluid level
Question 6 of 10

6. Question
When considering the assessment of the size and symmetry of the pupils, which one of the following statements is correct?
- An abnormally dilated pupil measures more than 7 mm in size in a brightly lit room
- The Haab scale is commonly used to measure the pupil size
- Unequal pupil sizes is always a pathological finding
- The pupil may be dilated in unilateral acute inflammatory processes of the eye
- The normal cornea is 16 mm in diameter and this can be used to provide a rough estimate of pupillary size
Question 7 of 10

7. Question
The triage nurse calls you over to see a patient as she is worried that her pupils aren’t reacting. Which one of the following statements is true regarding your findings?
- The patient’s pupils fail to react to light but do react to accommodation. Argyll-Robertson pupil is a possible diagnosis.
- The swinging light test must be performed to look for the presence of Horner’s syndrome.
- The patient’s pupils fail to react to light and accommodation. Holmes-Adie syndrome is a possible diagnosis.
- Failure to react to both light and accommodation is seen in third nerve palsy and following administration of mydriatic drugs.
- The patient’s pupils react to light but not to accommodation in oculomotor nerve palsy.
Question 8 of 10

8. Question
A 43-year-old woman presents to the ED complaining of double vision. After taking a history and assessing her visual acuity, you assess her eye movements. In respect to this assessment, which one of the following statements is correct?
- At rest, the affected eye usually lies in a lower position relative to the other eye in trochlear nerve palsy
- The inferior oblique muscle pulls the eye upwards and inwards
- In sixth nerve palsy the eye is adducted at rest
- Internuclear ophthalmoplegia is identified by a failure of one or both eyes to abduct
- The superior oblique muscle is innervated by the sixth cranial nerve
Question 9 of 10

9. Question
A 56 year old patient presents to the ED complaining of visual loss. You decide to check the visual fields by performing a confrontation test. Which one of the following statements accurately describes your potential findings?
- A lesion affecting the optic chiasm typically produces a homonymous quadrantopia
- Bitemporal hemianopia is found in lesions affecting the optic radiation
- A bilateral peripheral defect may be found in temporal lobe problems
- A homonymous hemianopia with macular sparing is typical of an occipital cortex lesion
- A field deficit limited to one eye is usually due to an infarct in the optic radiation
Question 10 of 10

10. Question
When contemplating the use of topical drugs in the eye for diagnostic purposes, which of the following statements are true? (Select all that apply)
- Fluorescein 2 % is the optimum preparation for diagnostic use in the eye
- The pain associated with local anaesthetic instillation is reduced if a buffered preparation is used
- Proxymetacaine is the least painful local anaesthetic agent when instilled into the eye
- Tropicamide should not be used routinely to dilate the pupil for fundoscopy as there is a high chance that it will precipitate acute glaucoma
- There is little diagnostic benefit from dilating a pupil with tropicamide

Initial Assessment of the Eye – Post Test

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