OCANZ ACTUAL EXAM 2024 LATEST WITH QUESTIONS AND ANSWERS/GRADED A+

1 OCANZ ACTUAL EXAM 2024 LATEST WITH QUESTIONS AND ANSWERS/GRADED A+ Diabetic recently diagnosed unstable. Refraction reveals significant myopic shift compared to last visit 12 months ago. Which is the most appropriate course of action: a/ prescribe specs & report to GP b/ Refer to Ophthalmologist, c/ Discuss findings with GP before prescribing Rx, d/ Obtain info on current blood glucose levels - ANSWER c/ Discuss findings with GP before prescribing Rx, The main cause of amblyopia in a child: anisometropia >2, accommodative eso, intermittent exo - ANSWER anisometropia >2, Which of the following can match Illuminant c: Incandescent, Halogen, Flourescent, sodium - ANSWER Fluorescent 25 years old enquiring her suitability for laser refractive surgery. Which of the following is NOT essential pre- operatively: a/ Tonometry, b/ Tear film stability c/ pupil size, d/ Gonio - ANSWER d/ Gonio 2 What is Kolleners rule in relation to colour vision? - ANSWER outer retinal diseases and media changes result in blue-yellow color defects inner retina, optic nerve, visual pathway, and visual cortex will result in red-green defects. (increased susceptibility of S-cones and rods to ischaemia and oxidative damage, although S-cone loss is more noticeable due to their lower density and their higher metabolic rate) (Kollners rule, retinal disease will give a blue yellow defect and optic nerve disease will give a red green defect but the exceptions are glaucoma which will give a blue yellow defect and central cone degeneration which will give a red green defect) Which causes a red defect- red cap test: optic neuritis, Amd - ANSWER Optic neuritis Lissamine green; what does it stain? - ANSWER Lissamine green stains dead and degenerate cells, yet does not stain healthy epithelial cells. (NaFl permeates into the intercellular space associated with any epithelial cellular disruption) Is gonio indicated with Hyphaema? - ANSWER no What is prenticies rule? - ANSWER P (prism dioptres =c (decentration in cm) x F(power of lens in dioptres) 3 What is the most preventable cause of AMD? - ANSWER Smoking 15 years old attends eye examination, best Va's R6/6, L 6/24 (told ambloypic). Which occuptation should he NOT pursue: a/ Train driver, B/ construction worker, c/ Electrician, d/ Dentist - ANSWER a/ Train driver RGP fit with lens riding high and bubbles underneath. What is the bubbles underneath- name? What is the cause? How would you change the fit? Rewrite the prescription, base curve/power/diameter according to change in fit. 0.05 base curve change the rx by 0.25, 0.5mm diam change etc...all the rules of thumb - ANSWER DimpleVeil RGP too steep - reduce total diameter, flatten Change BOZR by 0.1mm then change power of 0.50D to keep NaFL pattern? Increase TD by 0.1mm then flatten BOZR by 0.05mm Picture of GPC, differential diagnosis, treatment Treatment method for GPC? - ANSWER improve lens hygeine Increase lens replacement frequency DD if possible Reduce modulus of lens material (Swap to hydrogel lens, be aware more difficult to handle) 4 Manage lid margin disease If sever - topical Mast cell stabalisers Colour vision: What careers can you do if you have a defect? What is the fail criterion for D15. What test would you do to confirm ishihara? - ANSWER Fail criterion is 2 or more diagonal crossings D15 can classify but not grade severity 63 year old elderly woman with purple loss in vision for past 3 weeks, she is experiencing jaw claudication. a) What is your diagnosis? b) What is your systemic and optometric management? c) Patients prognosis? - ANSWER GCA evaluating visual acuity, pupils (looking for a relative afferent defect), intraocular pressures, anterior segment examination, motility examination (looking for ocular misalignment and/or evidence of cranial neuropathies), and a dilated fundus examination (evaluating for signs of optic nerve or retinal ischemia) Visual fields testing ESR (erythrocyte sedimentation rate), high then indicated inflamation CRP (C reactive protein) - produced by liver with inflamation platelets temporal artery biopsy 5 prog good if no CRAO or AAION, better prognosis the sooenr steroids are started Patient burnt with laser. Management - ANSWER NSAID or Anti VEGF depending on severity Name of drops post cataract and percentages post op. - ANSWER Different ophthals do different things. Ideally you want an antibiotic eg chloramphenicol for 1 month qid and a steroid eg maxidex for 1 month qid start tapering after 1 week ie 4 then 3 then 2 then 1 drop then an NSAID eg voltaren bid for a month Visual fields: inferior nasal step, what other defects cause this effect, management. - ANSWER Glaucaom or disc druse, if arcuate consider BRVO Tree branch hit the patient in the eye, diagnosed as RCE which is failing to heal and is uncomfortable. What to do? (Bandage contact lens, debridement and 2 others) - ANSWER Punctal occlusion>bandage contact lens> Patient with a prescription of +4.50, PD of 60mm, seg height of 20mm each eye. Spectacles arrive from the lab with optical centers cut at 62mm and a seg height in the right eye of 21mm. What would be the prismatic effect and in what direction? - ANSWER 6 How many times a day would you dose a prostaglandin for glaucoma? (One a day, twice a day, three times a day or four times a day) - ANSWER od Tear film calculation. Given a contact lens (RGP) of -2.00D, the patient needs -3.50D, the over-refraction is -0.50D. What is the fit? - ANSWER 0.2 too flat? Same contact lens as above in question as above, What would you order if the BC is 7.5mm and the over-refraction is -0.50D? - ANSWER What is the most contagious condition of the conditions listed below? (Adenovirus, chlamydia and two others) - ANSWER Adenovirus Given a monovision presbyope of +5.00D (OU). The patient wants to be able to see the computer at 67cm, what would the contact lens script be for this patient? - ANSWER +6.50 one eye How do you manage convergence excess, accomodative spasm? - ANSWER Issue plus RX vision therapy, dot card Leukocoria is one sign of retinoblastoma in children, what is the next most indicative sign? (Strabismus, cataract and two others) - ANSWER Strabismus 7 An 85 year old patient wants to see the TV better, this patient has ARMD, what would you advise? (Move 2x closer to the TV, move 2x further away from the TV, 2x telescope or 2x reverse telescope) - ANSWER Move 2x closer to the TV Which low vision device offers the largest working distance? (Microscope, hand held telescope, stand magnifier or telemicroscope) - ANSWER hand held telescope Treatment for pseudomonas? - ANSWER Which is the following occurs due to the normal ageing process of the eye? (ILM thinning, ILM thickening, cell loss in the retina, cell proliferation) - ANSWER What is bests disease and what colour vision defect may it cause? - ANSWER Vitelliform dystrophy, or Best disease, is a hereditary retinal dystrophy involving the retinal pigment epithelium (RPE), and leads to a characteristic bilateral yellow "egg-yolk" appearance of the macula Blue/yellow Lateral temporal visual field restriction occurs as a result of which extra ocular muscle palsy? - ANSWER 6th nerve (abducens affecting the lateral rectus) What is the most prominent side effect of suddenly stopping a steroid eye drop? - ANSWER You can get rebound inflammation 8 What is not required to be done at every follow up with Glaucoma? Iops Visual fields Goniscopy Corneal thickness - ANSWER Pachymetry (as it is for diagnosis not management) When referring for glaucoma, what is the least important test? (Visual acuity, IOP, CCT and one other) - ANSWER ????? VA A contact lens wearer that is 25 years old, what is the most likely cause of SPK? (Mucin balls, solution toxicity, tear film stability and one other) - ANSWER Tear film instability What is Ketotifen used for? - ANSWER antihistamine and mast cell stabilizer Patient is a +2.50 hyperope with a +1.00D add, what is the least likely prescription for this patient? (Multifocal, bifocal, 2 separate pairs and one other) - ANSWER ??????? Baseball hit in the eye, limited elevation of the eyes, what would the cause be? - ANSWER Blow out fracture Which of the following is a dry eye sign? Hyperosmolarity, lysozyme decrease - ANSWER Hyperosmorality 9 What can tear film hyperosmorality cause? - ANSWER hyperosmolarity can induce tear film instability by modifying the interaction between tear film lipids and proteins, damaging the epithelial cell membranes, triggering inflammation, and stimulating corneal nerves Who is most appropriate to refer a px with a conjunctival lymphoid tumour to Ophthalmologist Oncologist Haematologist GP - ANSWER ophthalmologist What is Hutchinson's sign and what is it a sign of? - ANSWER nasociliary skin lesions for ocular inflammation and corneal sensory denervation in acute herpes zoster ophthalmicus. Pressures of 22mmHg in each eye, what else is needed in order to manage the patient? (Pachymetry, gonioscopy, visual fields and OCT) - ANSWER Pachymetry One pupil (OD) bigger than the other, what is wrong? (Sympathetic pathway of OD, sympathetic pathway of OS, parasympathetic pathway of OD and parasympathetic pathway of OS) - ANSWER one or both pupils to be abnormally dilated with delayed constriction disorder of the parasympathetic nervous system innervation to the iris sphincter and ciliary muscle 10 Causes include viral infection, trauma, vasospasm due to migraine, ocular surgery, tumors, and possibly chronic cough Hypersensitivity to pilocarpine What is the most common cause of proptosis? - ANSWER Graves disease 45. What is the biggest complication of thyroid eye disease? - ANSWER Exposure keratitis In which patient is diabetic retinopathy more common? (Type 1 for 4 years, type 2 non-insulin for 4 years, type 2 insulin defendant for 10 years and one other? - ANSWER All the following cause vortex keratopathy except for? (Wilsons disease, chloroquine, fabry's disease and amiodarone) - ANSWER What is Fabrys disease? - ANSWER Fabry disease is a lysosomal enzyme (alpha-galactosidase A) deficienc causing Cornea verticillata, the most typical ocular sign in Fabry disease What is Wilsons disease? - ANSWER Wilson's disease is a genetic disorder in which copper builds up in the body and cause fleichers ring 11 Which would be the most common cause of amblyopia? (Accommodative eso, alternating eso, anisometropia of more than 2D and one other) - ANSWER anisometropia 49. Which colour vision test determines the type and severity? - ANSWER Farnsworth Munsell Fm100 25 year old with stargardts disease requests assistance with reading tasks, lighting at work and travel, which of the following professional below will assist him- occuptational therapist, orientation instructor, phsycologist & GMP, Physiotherapist & Rehab, Social worker & Ophthalmologist - ANSWER What is Stargardt disease - ANSWER is the most common form of inherited juvenile macular degeneration. Patient is a pilot, VA is 6/6 and 6/9 do they meet standards? a) What tests you do to determine is patient is pass or fail? b) What visual field test required if fails Ishihara? - ANSWER 6/9 corrected, 6/6 or better when tested with both eyes, no greater than +/-5D, N5 with correction, N14 without correction OCcupational lantern test. 12 What does BRÜCKNER TEST allow? and how is it done? - ANSWER Early detection of amblyopia in very young children that is not possible to perform other tests on. Looking at the difference in retinal transillumination using a direct ophthalmosocope at a distance ~0.5m Describe Hirchberg Test - ANSWER using pupil reflexes to determine if strabismus is present Describe Kappa test? - ANSWER using monocular pupil reflex to determine if eccentric fixation present A 50 year old myope presents to you. She mainly wears contact lenses - RE -3.50 and LE -3.75. Her spectacle prescription is as follows: RE -3.50 LE -3.50 Add +1.00 R+L Discuss four different ways to correct her spectacle prescription. List one advantage and one disadvantage of each. - ANSWER 1. monvision contact lenses (stereo, price) 2. RR over contact lenses (glasses and lenses, price) 3. multifocal contact lenses (price, no glasses) 4. varifocal (wearing glasses, all distances) 5. bifocal (cosmesis + jump, corrects Reading and distance) What is most important to check following a px coming into your practice with pressures of 22mmhg r+l? A time of day reading taken 13 B type of machinery used C central corneal thickness D family history of Glaucoma - ANSWER Which is the following would be irresponsible to allow optical assistants to carry out A look through a px's file to get their spec rx B triage red eyes and advice pxs on medical aids they can take C answer phone calls and organise clinic - ANSWER B triage red eyes and advice pxs on medical aids they can take Which of the following would be considered unprofessional A calling a px by their first name amongst a crowded waiting area B showing them a photo of their fundus and discussing it w them C showing an abnormal finding on their file to a practitioner outside of the clinic/store - ANSWER ???? What is the leading cause of blindness in Australia A cataract B DR C ARMD D RP - ANSWER ARMD Which part of the optic nerve is thinnest A temporal B superior C inferior 14 D nasal - ANSWER Temporal Recent onset of Diplopia suspected 4th nerve palsy. Action required Immediate referral to ophthalmologist Treat with prism Review in 1 month Refer for squint surgery - ANSWER Immediate referral to ophthalmologist 4th nerve (trochlear)- superior oblique 6. Slight Diplopia on R lateral gaze and restriction of RE looking temporally. Which nerve is affected? II VII VI III - ANSWER VI What is most likely in children Astigmatism is likely to increase over 3yrs Moves to against astigmatism with development Is likely to have oblique axis Astigmatism reduces in children over 3 - ANSWER Optic disc pathology is most likely to cause colour vision problems with Red green Blue yellow 15 Atypical - ANSWER Red/Green Type 2 D15 colour vision does the following Classifies type and severity of congenital types Classifies type and not severity of congenital type - ANSWER Classifies type and not severity of congenital type Corneal brown swirl like deposits noted what is least likely to be cause Amiodarone Fabrys Wilsons Chloroquine - ANSWER Chloroquine If px is non-responsive to cold compress with allergic conjunctivitis what is next option? Chloramphenicol Antihistamine Antiviral - ANSWER Anti histamine What is with the rule astigmatism - ANSWER When the steepers meridian is vertical - the minus cyl axis is @180 degrees Child, watery hyperaemic eye started In 1 eye and 2 days later went to the other. Follicles seen on lid eversion and white fine stromal opacities noted nasal cornea. A) what is this 16 B) what is differential diagnosis C) what is your management D) what non optical management do you need to consider? - ANSWER Follicular viral conjunctivitus GPC, allergic conj, bacterial due to corneal involvement (lymphoid reaction to virus) refer to ophthalmology cool compesses, not sharing towels, time of school due to adenovirus Wife calls requesting details on husbands eye test. Do you: get verbal consent, refuse call, get written consent - ANSWER get written consent Signs of primary open angle glaucoma - ANSWER IOP High cup:disc ratio Cup:disc ratio asymmetry between eyes (usually considered significant if greater than 0.2) Vertical elongation of cup Focal neuro-retinal rim thinning or notching Vessel bayonetingBeta-zone peripapillary atrophy Disc hemorrhage 17 6 week post cataract op, visual acuity has decreased. What could the cause be? - ANSWER CMO Patient bumping into things and has ARMD, what would be the most appropriate referral? (Orientation and mobility, ophthalmologist, occupational therapist and one other) - ANSWER Orientation and mobility Prostaglandin analogues have what possible side effects to the eye? - ANSWER eyelash growth, eye color and eyelid skin, stinging, blurred vision, eye redness, itching, burning. What is an advantage of positive cylinder form? - ANSWER 4year old with patching 2hrs a day not improving VA on last 2 consecutive visits. What is most urgent requirement cIncrease to 6hrs Start suppression therapy Start atropine penalisation Rule out underlying pathology - ANSWER Side effects of glaucoma medications - ANSWER Prostaglandin Analogs: possible changes in eye color and eyelid skin, stinging, blurred vision, eye redness, itching, burning. Beta Blockers: low blood pressure, reduced pulse rate, fatigue, shortness of breath; rarely: reduced libido, depression. 18 Alpha Agonists: burning or stinging, fatigue, headache, drowsiness, dry mouth and nose, relatively higher likelihood of allergic reaction. Carbonic Anhydrase Inhibitors: in eye drop form: stinging, burning, eye discomfort; in pill form: tingling hands and feet, fatigue, stomach upset, memory problems, frequent urination. K-readings are too high to record, what to do to help? (Minus lens over it, plus lens over it and two others) - ANSWER Plus lens Picture of an everted top lid with huge papillae, case history of s contact lens wearer given. What is your diagnosis, what are the differential diagnoses and how would you manage this condition? - ANSWER GPC Infectious conjunctivitis Blepharitis Dry Eyes Syndrome Toxic conjunctivitis Ocular rosacea Keratitis Episcleritis/scleritis Angle Closure glaucoma Phlyctenular conjunctivitis 19 improve lens hygeine Increase lens replacement frequency DD if possible Reduce modulus of lens material (Swap to hydrogel lens, be aware more difficult to handle) Manage lid margin disease If sever - topical Mast cell stabalisers 6. Patient presents for a cataract check up. Cataracts were notes 12 months ago. The prescription is now 2D more minus and cataracts were observed using a slitlamp. Visual acuities are 6/12 (OD) and 6/9 (OS) with the new prescription. What would you consider when referring to an ophthalmologist, what type of cataract is this according to the history given, explain cataract surgery in lay mans terms, what are the post surgical complications to look out for? - ANSWER Cataract Cause of visual complaint Compramising Lifestyle Driver Anisometropia Visual Acuity Other Ocular Pathology General Health and Medications Patient wants to have operation Year old with high plus anisometropia. Explain 5 reasons why contact lenses are a better option than spectacles. In spectacles - RE +0.50DS LE +7.50DS in contact lenses RE +1.00DS LE +9.00DS - ANSWER 1. cosmesis/comfort/weight 20 2. spectacle magnification 3. field of view (no ring scotoma) 4. Less convergence needed in contact lenses (opposite of myope) 5 Less accomodation neeed in contact lenses ((opposite of myope)) 8. Picture of an eye with blepharitis (collorettes along the lashes and mucous discharge). What would you diagnose, give differential diagnoses, what is the general cause of this condition and what is the management of this condition? - ANSWER Lid hygiene Warm compresses avoidance of cosmetics, especially eye liner and mascara Weak evidence to suggest antibacterials help. DD- conjunctivitus's, eyelid traumas Given a visual field plot indicating a left temporal quadrantic defect. Asked whether the test was reliable or not, asked what the scientific name for the defect would be, name 2 conditions that would cause this type of defect, management of these conditions? - ANSWER left superior homonymous quadrantanoipa indicating legion in optical radiations (meyers loop) Female presents with a dilated pupil (OD) which doesn't respond to direct or consensual pupil tests. The deep tendon reflex is also absent. What pupil abnormality would you 21 diagnose, give differential diagnoses, what additional tests would you want to perform to confirm the diagnosis. - ANSWER one or both pupils to be abnormally dilated with delayed constriction disorder of the parasympathetic nervous system innervation to the iris sphincter and ciliary muscle Causes include viral infection, trauma, vasospasm due to migraine, ocular surgery, tumors, and possibly chronic cough Hypersensitivity to pilocarpine Photo of inferior BRVO, explain what has happened (4marks) Explain patients prognosis (6marks). - ANSWER 13. Obese patient experiencing headaches and blurred vision. Fundus photographs show papilloedema. What is the diagnosis, what other screening tests would you do, what would you ever this patient for? - ANSWER 14. 27 year old male experiencing pain behind the eye, vision is slightly reduced, no systemic issues to take note of, optic nerve is slightly hyperaemic. What is your diagnosis, what additional tests would you perform, what systemic treatment would be necessary? - ANSWER 22 15. A patient has a BCVA of OD plano 6/6 OS -0.75 6/9 and wants to be a pilot. What are the requirements he would need to meet to be a pilot and what other options does he have? - ANSWER Patient has a laser burn from working in a chemistry lab. What color vision defect would this patient present with? How would you diagnose this? What causes acquired colour vision defects What is the most common acquired colour vision defect? - ANSWER Use Ishihara to screen, 122 year old male with itchy eyes and stringy mucopurelent discharge for the past 1 week. Patient says that this has also happened before once. There is a picture of the lids which show moderate crusting of upper and lower lids/lashes that extends slightly onto lids. a) What is your diagnosis? b) What is your differential diagnosis? c) What caused this to occur? d) What is your management? - ANSWER Recurrent Bacterial Conjunctivitis DD - epidemic keratoconjunctivitis (e.g. adenovirus) Herpes (simplex or zoster) Chlamydial infection, allergy Contamination of the conjunctival surface with bacteria Bleph 23 Bathing lids and lid hygiene Low evidence to suggest antibacterials can help. If corneal involvement or no resolution refer to ophthalmology. 2) Photo of bilateral swollen discs a) What is it? b) What tests would you do? c) What is your management? looked like papilloedema - ANSWER Visual fields Pupils Colour Vision Motility Stereo Disc images Primary concern Papilloedema due to raised intercranial pressure, caused by sub arachnoid haemorrhage or space occupying legion, Refer emergency HES tests - Urgent neuro imaging (MRI CT) and CBC count, blood sugar, angiotensin-converting enzyme, erythrocyte sedimentation rate 24year old male with reduced VA in LE to 6/24 and RE 6/6. there is pain behind LE and disc appears slightly hyperaemic. a) What is your diagnosis? b) What tests would you do? c) What is your management? 24 I thought it was Optic neuritis - ANSWER a - optic neuritis b - RAPD?, Colour vision, VF, Motility, contrast c - Refer urgent to Ophthalmolgy for MRI and MS investigations ON more likely in males 3:2, 20 to 40 yo RGP lens with bubbles centrally and pooling and peripheral bubbles. Appears large diameter and lid attached. What is wrong and what would you change? patient has 7.40/- 4.00/10.0 over refraction is -0.75DS Write new order for RGP - ANSWER