MSN 620 Primary care Quiz Questions and Answers (100% Graded)

MSN 620 Primary care Quiz During an eye examination, the provider notes a red light reflex in one eye but not the other. What is the significance of this finding? Ocular disease requiring referr al Potential infection in the “red” eye Normal physiologic variant Potential vision loss in one eye The red reflex should be elicited in normal eyes. Any asymmetry or opacity suggests ocular disease, potentially retinoblastoma, and should be evaluated immediately.REF: Posterior Segment A provider performs an eye examination during a health maintenance visit and notes a difference of 0.5 mm in size between the patient’s pupils. What does this finding indicate? Probable benign, physiologic anisocoria A relative afferent pupillary defect Likely underlying neurological abnormality Indication of a difference in intraocular pressure A difference in diameter of less than 1 mm is usually benign. Afferent pupillary defects are paradoxical dilations of pupils in response to light. This does not indicate differences in intraocular pressure. A difference of more than 1 mm is more likely to represent an underlying neurological abnormality.REF: Pupil Response A primary care provider may suspect cataract formation in a patient with which finding? Corneal opacification Injection of conjunctiva Excessive tearing Asymmetric red reflex An asymmetric red reflex may be a finding in a patient with cataracts. Corneal opacification, excessive tearing, and corneal injection are not symptoms of cataracts.REF: Physical Examination A patient has a gradually enlarging nodule on one upper eyelid and reports that the lesion is painful. On examination, the lesion appears warm and erythematous. The provider knows that this is likely to be which type of lesion? Meibomian Blepharitis Chalazion Hordeolum Although hordeolum and chalazion lesions both present as gradually enlarging nodules, a hordeolum is usually painful, while a chalazion generally is not. Blepharitis refers to generalized inflammation of the eyelids. Meibomian is a type of gland near the eye.REF: Clinical Presentation A patient reports has been using artificial tears for comfort because of burning and itching in both eyes, but reports worsening symptoms. The provider notes redness and discharge along the eyelid margins with clear conjunctivae. What is the recommended treatment? Oral antibiotics given prophylactically for several months Reassurance that this is a self-limiting condition Compresses, lid scrubs, and antibiotic ointment Antibiotic solution drops four times daily This patient has symptoms of blepharitis without conjunctivitis. Initial treatment involves lid hygiene and antibiotic ointment may be applied after lid scrubs. Antibiotic solution is used if conjunctivitis is present. Oral antibiotics are used for severe cases. This disorder is generally chronic.REF: Clinical Presentation/Management A patient reports bilateral reports burning and itching eyes for several days. The provider notes a boggy appearance to the conjunctivae, along with clear, watery discharge. The patient’s eyelids are thickened and discolored. There are no other symptoms. Which type of conjunctivitis is most likely? Allergic Viral Chemical Bacterial Allergic conjunctivitis generally presents simultaneously in both eyes with itching as a predominant feature. Discharge is generally clear or stringy and white and the patient will have lid discoloration, thickening, and erythema. Bacterial conjunctivitis is characterized by acute inflammation of the conjunctivae along with purulent discharge. Chemical conjunctivitis will not have purulent discharge. Viral conjunctivitis is usually in association with a URI.REF: Clinical Presentation/Acute Allergic Conjunctivitis A patient with allergic conjunctivitis who has been using a topical antihistamine-vasoconstrictor medication reports worsening symptoms. What is the provider’s next step in managing this patient’s symptoms? Refer the patient to an ophthalmologist for further care Determine the duration of treatment with this medication Prescribe a non-sedating oral antihistamine Consider prescribing a topical mast cell stabilizer Antibiotic-vasoconstrictor agents can have a rebound effect with worsening symptoms if used longer than 3 to 7 days, so the provider should determine whether this is the cause. Topical mast cell stabilizers are useful as prophylaxis for recurrent or persistent allergic conjunctivitis and results do not occur for several weeks. Oral antihistamines may be the next step if it is determined that the cause of worsening symptoms is related to the allergy. It is not necessary to refer to ophthalmology at this time.REF: Management A patient who works in a furniture manufacturing shop reports a sudden onset of severe eye pain while sanding a piece of wood and now has copious tearing, redness, and light sensitivity in the affected eye. On examination, the conjunctiva appears injected, but no foreign body is visualized. What is the practitioner’s next step? Administration of antibiotic eye drops Irrigation of the eye with normal saline Application of topical fluorescein dye Instillation of cyclopegic eye drops The practitioner must determine if there is a corneal abrasion and will instill fluorescein dye in order to examine the cornea under a Wood’s lamp. Antibiotic eye drops are not indicated as initial treatment. Cyclopegic drops are used occasionally for pain control, but should be used with caution. Irrigation of the eye is indicated for chemical burns.REF: Management A patient has chronically dry eyes, sometimes with a foreign body sensation, burning, and itching. A Schirmer test is abnormal. What is the suspected cause of this patient’s symptoms based on this test finding? Poor eyelid closure Corneal abrasion Aqueous-deficiency Evaporative disorder An abnormal Schirmer test, which assesses aqueous production, indicates aqueous-deficient dry eye. A corneal abrasion usually causes excessive tearing. An evaporative disorder is determined by an evaluation of tear breakup time. Poor eyelid closure causes increased corneal exposure and increased evaporation of tears.REF: Diagnostics A patient has dacryocystitis. The provider notes a painful lacrimal sac abscess that appears to be coming to a head. Which treatment will be useful initially? Incision and drainage Topical antibiotic ointment Eyelid scrubs with baby shampoo Lacrimal bypass surgery When an abscess is present and coming to a head, incision and drainage may be useful. Definitive treatment with lacrimal bypass surgery will be performed once the acute episode has resolved. Eyelid scrubs and topical ointments are not effective.REF: Management An adult patient with a history of recurrent sinusitis and allergic rhinitis reports chronic tearing in one eye, ocular discharge, and eyelid crusting. The provider suspects nasolacrimal duct obstruction. Which initial treatment will the provider recommend? Antibiotic eye drops Systemic antibiotics Warm compresses Nasolacrimal duct probing This is most likely acquired nasolacrimal duct obstruction. Initial treatment should include warm compresses. Antibiotics are only used if infection is present. Nasolacrimal duct probing is not useful for acquired conditions; definitive treatment usually requires surgery.REF: Clinical Presentation/Management Which is the most common cause of orbital cellulitis in all age groups? Inoculation from lo