HHPD midterm 2 Practice Questions and Answers
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A 29-year-old physical therapist presents for evaluation of an eyelid problem. On observation,
the right eyeball appears to be protruding forward. Based on this description, what is the most
likely diagnosis?
A. Ptosis
B. Exophthalmos
C. Ectropion
D. Epicanthus - CORRECT ANSWER-B. Exophthalmos
Exophthalmos is the condition when the eyeball protrudes forward. If it is bilateral, it suggests
the presence of Graves' disease. If it is unilateral, it could still be caused by Graves' disease.
Alternatively, it could be caused by a tumor or inflammation in the orbit.
A 12-year-old presents to the clinic with his father for evaluation of a painful lump in the left
eye. It started this morning. He denies any trauma or injury. There is no visual disturbance. Upon
physical examination, there is a red raised area at the margin of the eyelid that is tender to
palpation; no tearing occurs with palpation of the lesion. Based on this description, what is the
most likely diagnosis?
A. Dacryocystitis
B. Chalazion
C. Hordeolum
D. Xanthelasma - CORRECT ANSWER-C. Hordeolum
A hordeolum, or sty, is a painful, tender, erythematous infection in a gland at the margin of the
eyelid.
A 15-year-old high school sophomore presents to the emergency room with his mother for
evaluation of an area of blood in the left eye. He denies trauma or injury but has been coughing
forcefully with a recent cold. He denies visual disturbances, eye pain, or discharge from the eye.
On physical examination, the pupils are equal, round, and reactive to light, with a visual acuity of
20/20 in each eye and 20/20 bilaterally. There is a homogeneous, sharply demarcated area at the
lateral aspect of the base of the left eye. The cornea is clear. Based on this description, what is
the most likely diagnosis?
A) Conjunctivitis
B) Acute iritis
,C) Corneal abrasion
D) Subconjunctival hemorrhage - CORRECT ANSWER-D) Subconjunctival hemorrhage
A subconjunctival hemorrhage is a leakage of blood outside of the vessels, which produces a
homogenous, sharply demarcated bright red area; it fades over several days, turning yellow, then
disappears. There is no associated eye pain, ocular discharge, or changes in visual acuity; the
cornea is clear. Many times it is associated with severe cough, choking, or vomiting, which
increase venous pressure. It is rarely caused by a serious condition, so reassurance is usually the
only treatment necessary.
A 67-year-old lawyer comes to your clinic for an annual examination. He denies any history of
eye trauma. He denies any visual changes. You inspect his eyes and find a triangular thickening
of the bulbar conjunctiva across the outer surface of the cornea.
He has a normal pupillary reaction to light and accommodation. Based on this description, what
is the most likely diagnosis?
A. Corneal arcus
B. Cataracts
C. Corneal scar
D. Pterygium - CORRECT ANSWER-D. Pterygium
A pterygium is a triangular thickening of the bulbar conjunctiva that grows slowly across the
outer surface of the cornea, usually from the nasal side. Reddening may occur, and it may
interfere with vision as it encroaches on the pupil. Otherwise, treatment is unnecessary.
A sudden, painless unilateral vision loss may be caused by which of the following?
A. Retinal detachment
B. Corneal ulcer
C. Acute glaucoma
D. Uveitis - CORRECT ANSWER-A. Retinal detachment
Corneal ulcer, acute glaucoma, and uveitis are almost always accompanied by pain. Retinal
detachment is generally painless, as is chronic glaucoma
Sudden, painful unilateral loss of vision may be caused by which of the following conditions?
A. Vitreous hemorrhage
B. Central retinal artery occlusion
C. Macular degeneration
,D. Optic neuritis - CORRECT ANSWER-D. Optic neuritis
In multiple sclerosis, sudden painful loss of vision may accompany optic neuritis. The other
conditions are usually painless.
Diplopia, which is present with one eye covered, can be caused by which of the following
problems?
A. Weakness of CN III
B. Weakness of CN IV
C. A lesion of the brainstem
D. An irregularity in the cornea or lens - CORRECT ANSWER-D. An irregularity in the cornea
or lens
Double vision in one eye alone points to a problem in "processing" the light rays of an incoming
image. The other causes of diplopia result in a misalignment of the two eyes.
A patient complains of epistaxis. Which other cause should be considered?
A. Intracranial hemorrhage
B. Hematemesis
C. Intestinal hemorrhage
D. Hematoma of the nasal septum - CORRECT ANSWER-B. Hematemesis
Although the source of epistaxis may seem obvious, other bleeding locations should be on the
differential. Hematemesis can mimic this and cause delay in life-saving therapies if not
considered. Intracranial hemorrhage and septal hematoma are instances of contained bleeding.
Intestinal hemorrhage may cause hematemesis if there is obstruction distal to the bleeding, but
this is unlikely.
Glaucoma is the leading cause of blindness in African-Americans and the second leading cause
of blindness overall. What features would be noted on funduscopic examination?
A. Increased cup-to-disc ratio
B. AV nicking
C. Cotton wool spots
D. Microaneurysms - CORRECT ANSWER-A. Increased cup-to-disc ratio
It is important to screen for glaucoma on fundoscopic examination. The cup and disc are among
the easiest features to find. AV nicking and cotton wool spots are seen in hypertension.
Microaneurysms are seen in diabetes.
, Very sensitive methods for detecting hearing loss include which of the following?
A. The whisper test
B. The finger rub test
C. T he tuning fork test
D. Audiometric testing - CORRECT ANSWER-D. Audiometric testing
While it is important to screen for hearing complaints with methods available to you, it should be
realized that some physical examination techniques are limited. Nonetheless, you should be
comfortable performing these tests, as audiometric testing is not always available.
Which area of the fundus is the central focal point for incoming images?
A. The fovea
B. The macula
C. The optic disk
D. The physiologic cup - CORRECT ANSWER-A. The fovea
The fovea is the area of the retina which is responsible for central vision. It is surrounded by the
macula, which is responsible for more peripheral vision. The optic disc and physiologic cup are
where the optic nerve enters the eye.
A light is pointed at a patient's pupil, which contracts. It is also noted that the other pupil
contracts as well, though it is not exposed to bright light. Which of the following terms describes
this latter phenomenon?
A. Direct reaction
B. Consensual reaction
C. Near reaction
D. Accommodation - CORRECT ANSWER-B. Consensual reaction
The constriction of the contralateral pupil is called the consensual reaction. The response of the
ipsilateral eye is the direct response. The dilation of the pupil when focusing on a close object is
the near reaction. Accommodation is the changing of the shape of the lens to sharply focus on an
object.
A patient is assigned a visual acuity of 20/100 in her left eye. Which of the following is true?
A. She obtains a 20% correct score at 100 feet.
