Maryville University NURS 621 - HEENT
Exam #1
Section 1: Ophthalmic Assessment & Disorders
1. A 68-year-old patient reports sudden, painless loss of vision in the right eye described
as "a black curtain being drawn down." What is the most likely diagnosis?
A. Acute angle-closure glaucoma
B. Central retinal artery occlusion
C. Retinal detachment
D. Senile cataract progression
Option C is correct because a dark shadow or "curtain" falling across the visual field is the classic
presentation of retinal detachment. Option A presents with severe eye pain and halos around lights,
while Option D causes gradual, painless blurring over months or years.
2. Which physical examination finding distinguishes acute angle-closure glaucoma from
open-angle glaucoma?
A. Severe ocular pain, mid-dilated non-reactive pupil, and cloudy cornea
B. Gradual loss of peripheral vision without physical eye appearance changes
C. Bilateral purulent discharge with eyelid matted shut in the morning
D. Painless central scotoma with drusen on fundoscopic exam
Option A is correct because acute angle-closure is an emergency causing rapid pressure spikes, pupil
dilation, corneal edema, and intense pain. Open-angle glaucoma (Option B) develops slowly and
painlessly over years.
3. When assessing visual acuity using a Snellen chart, a patient's vision is recorded as
20/50. How should the clinician interpret this result?
A. The patient reads at 50 feet what a normal person reads at 20 feet
B. The patient reads at 20 feet what a person with normal vision can read at 50 feet
C. The patient has 50 percent loss of total visual acuity in both eyes
D. The patient can read line 20 with 50 percent accuracy
Option B is correct because the top number represents testing distance (20 feet) and the bottom
number represents the distance a person with standard vision sees the same line. Option A reverses
, the numerator and denominator meanings.
4. On fundoscopic examination, yellow-white extracellular deposits concentrated in the
macula are identified as drusen. Which condition does this finding indicate?
A. Diabetic retinopathy
B. Hypertensive retinopathy
C. Age-related macular degeneration
D. Open-angle glaucoma
Option C is correct because drusen beneath the retinal pigment epithelium are the hallmark sign of dry
age-related macular degeneration. Option A is characterized by cotton wool spots and
microaneurysms.
5. An 8-year-old child presents with purulent discharge from the left eye, conjunctival
injection, and eyelids glued shut upon awakening. What is the most common bacterial
pathogen responsible?
A. Streptococcus pneumoniae
B. Pseudomonas aeruginosa
C. Chlamydia trachomatis
D. Neisseria gonorrhoeae
Option A is correct because Streptococcus pneumoniae, Haemophilus influenzae, and
Staphylococcus aureus are the primary bacterial causes of pediatric conjunctivitis. Option B is typically
associated with contact lens wearers.
6. A patient presents with a painful, erythematous, localized nodule on the margin of the
upper eyelid. What is the initial recommended treatment?
A. Immediate surgical incision and drainage
B. Topical corticosteroid ophthalmic drops
C. Warm compresses applied for 10-15 minutes 3 to 4 times daily
D. Oral fluoroquinolone antibiotics for 14 days
Option C is correct because a hordeolum (stye) responds well to conservative warm moist heat, which
promotes spontaneous drainage. Option B is contraindicated because steroids can worsen localized
infections.
7. How does a chalazion differ clinically from a hordeolum?
A. A chalazion is extremely painful and located on the outer eyelash line
, B. A chalazion is a painless, chronic granulomatous swelling of a meibomian gland
C. A chalazion represents an acute staphylococcal abscess of a lash follicle
D. A chalazion requires systemic oral antibiotic therapy immediately
Option B is correct because a chalazion is a non-infectious, chronic granuloma that is painless and
firmer than a hordeolum. Option C describes an acute hordeolum.
8. Which cranial nerve is evaluated when assessing direct and consensual pupillary light
reflexes?
A. Cranial Nerve II only
B. Cranial Nerve III only
C. Cranial Nerves II and III
D. Cranial Nerves III, IV, and VI
Option C is correct because CN II (Optic) senses incoming light (afferent limb) and CN III
(Oculomotor) mediates pupillary constriction (efferent limb). Option D tests extraocular muscle
movement rather than pupillary reflexes.
9. A patient with a history of hypertension displays AV nicking and copper wiring during
a fundoscopic exam. What diagnosis do these findings support?
A. Proliferative diabetic retinopathy
B. Hypertensive retinopathy
C. Increased intracranial pressure
D. Cytomegalovirus retinitis
Option B is correct because arteriolar sclerotic changes like AV nicking and copper wiring result from
chronic high arterial pressure. Option C causes papilledema with optic disc swelling.
10. What diagnostic test should be performed to confirm a suspected corneal abrasion in
a patient presenting with eye pain and foreign body sensation?
A. Tonometry testing
B. Schirmer test
C. Fluorescein staining under Wood's lamp examination
D. Direct ophthalmoscopy with red free filter
Option C is correct because fluorescein dye collects in epithelial defects, glowing bright green under
ultraviolet light. Option A measures intraocular pressure, while Option B evaluates tear production.
11. A 72-year-old patient reports progressive blurring of vision, difficulty driving at night
due to glare from headlights, and faded color perception. What is the most likely
Exam #1
Section 1: Ophthalmic Assessment & Disorders
1. A 68-year-old patient reports sudden, painless loss of vision in the right eye described
as "a black curtain being drawn down." What is the most likely diagnosis?
A. Acute angle-closure glaucoma
B. Central retinal artery occlusion
C. Retinal detachment
D. Senile cataract progression
Option C is correct because a dark shadow or "curtain" falling across the visual field is the classic
presentation of retinal detachment. Option A presents with severe eye pain and halos around lights,
while Option D causes gradual, painless blurring over months or years.
2. Which physical examination finding distinguishes acute angle-closure glaucoma from
open-angle glaucoma?
A. Severe ocular pain, mid-dilated non-reactive pupil, and cloudy cornea
B. Gradual loss of peripheral vision without physical eye appearance changes
C. Bilateral purulent discharge with eyelid matted shut in the morning
D. Painless central scotoma with drusen on fundoscopic exam
Option A is correct because acute angle-closure is an emergency causing rapid pressure spikes, pupil
dilation, corneal edema, and intense pain. Open-angle glaucoma (Option B) develops slowly and
painlessly over years.
3. When assessing visual acuity using a Snellen chart, a patient's vision is recorded as
20/50. How should the clinician interpret this result?
A. The patient reads at 50 feet what a normal person reads at 20 feet
B. The patient reads at 20 feet what a person with normal vision can read at 50 feet
C. The patient has 50 percent loss of total visual acuity in both eyes
D. The patient can read line 20 with 50 percent accuracy
Option B is correct because the top number represents testing distance (20 feet) and the bottom
number represents the distance a person with standard vision sees the same line. Option A reverses
, the numerator and denominator meanings.
4. On fundoscopic examination, yellow-white extracellular deposits concentrated in the
macula are identified as drusen. Which condition does this finding indicate?
A. Diabetic retinopathy
B. Hypertensive retinopathy
C. Age-related macular degeneration
D. Open-angle glaucoma
Option C is correct because drusen beneath the retinal pigment epithelium are the hallmark sign of dry
age-related macular degeneration. Option A is characterized by cotton wool spots and
microaneurysms.
5. An 8-year-old child presents with purulent discharge from the left eye, conjunctival
injection, and eyelids glued shut upon awakening. What is the most common bacterial
pathogen responsible?
A. Streptococcus pneumoniae
B. Pseudomonas aeruginosa
C. Chlamydia trachomatis
D. Neisseria gonorrhoeae
Option A is correct because Streptococcus pneumoniae, Haemophilus influenzae, and
Staphylococcus aureus are the primary bacterial causes of pediatric conjunctivitis. Option B is typically
associated with contact lens wearers.
6. A patient presents with a painful, erythematous, localized nodule on the margin of the
upper eyelid. What is the initial recommended treatment?
A. Immediate surgical incision and drainage
B. Topical corticosteroid ophthalmic drops
C. Warm compresses applied for 10-15 minutes 3 to 4 times daily
D. Oral fluoroquinolone antibiotics for 14 days
Option C is correct because a hordeolum (stye) responds well to conservative warm moist heat, which
promotes spontaneous drainage. Option B is contraindicated because steroids can worsen localized
infections.
7. How does a chalazion differ clinically from a hordeolum?
A. A chalazion is extremely painful and located on the outer eyelash line
, B. A chalazion is a painless, chronic granulomatous swelling of a meibomian gland
C. A chalazion represents an acute staphylococcal abscess of a lash follicle
D. A chalazion requires systemic oral antibiotic therapy immediately
Option B is correct because a chalazion is a non-infectious, chronic granuloma that is painless and
firmer than a hordeolum. Option C describes an acute hordeolum.
8. Which cranial nerve is evaluated when assessing direct and consensual pupillary light
reflexes?
A. Cranial Nerve II only
B. Cranial Nerve III only
C. Cranial Nerves II and III
D. Cranial Nerves III, IV, and VI
Option C is correct because CN II (Optic) senses incoming light (afferent limb) and CN III
(Oculomotor) mediates pupillary constriction (efferent limb). Option D tests extraocular muscle
movement rather than pupillary reflexes.
9. A patient with a history of hypertension displays AV nicking and copper wiring during
a fundoscopic exam. What diagnosis do these findings support?
A. Proliferative diabetic retinopathy
B. Hypertensive retinopathy
C. Increased intracranial pressure
D. Cytomegalovirus retinitis
Option B is correct because arteriolar sclerotic changes like AV nicking and copper wiring result from
chronic high arterial pressure. Option C causes papilledema with optic disc swelling.
10. What diagnostic test should be performed to confirm a suspected corneal abrasion in
a patient presenting with eye pain and foreign body sensation?
A. Tonometry testing
B. Schirmer test
C. Fluorescein staining under Wood's lamp examination
D. Direct ophthalmoscopy with red free filter
Option C is correct because fluorescein dye collects in epithelial defects, glowing bright green under
ultraviolet light. Option A measures intraocular pressure, while Option B evaluates tear production.
11. A 72-year-old patient reports progressive blurring of vision, difficulty driving at night
due to glare from headlights, and faded color perception. What is the most likely
