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Glaucoma.

1 CET POINT Assessment of optic nerve head appearance, knowledge of gonioscopic landmarks, visual field interpretation and an understanding of factors affecting IOP measurement are all required to successfully complete this glaucoma-themed clinical recognition test.

Course code: C-39407 Deadline: April 3, 2015

LEARNING OBJECTIVES

To be able to interpret visual field defects (Group 3.1.5)

To understand the factors affecting intraocular pressure measurements (Group 3.1.6)

To be able to recognise cases of glaucoma (Group 6.1.8)

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LEARNING OBJECTIVES

To be able to recognise and understand the natural progress and severity of glaucoma (Group 1.1.1)

To understand the techniques used to identify cases of glaucoma (Group 2.1.2)

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01 Which of the following statements in relation to this optic nerve head image is incorrect?

a/ The neuro-retinal rim appears healthy and without any notches

b/ There are new vessels growing at the superotemporal rim

c/ The vertical cup to disc ratio is approximately 0.3

d/ There is a splinter haemorrhage on the superotemporal rim

02 With regard to examining the optic nerve head which of the following statements is incorrect?

a/ The blood vessels provide good clues as to the boundary of the neuro-retinal rim

b/ Measurement of the vertical disc height is not significant

c/ It is important to check the neuro-retinal rim for localised thinning

d/ If the disc is tilted, analysis of the neuro-retinal rim becomes more difficult

03 In relation to splinter haemorrhages which of the following statements is incorrect?

a/ They are often a pre-cursor to pseudo-exfoliation glaucoma

b/ Recording/photographing this finding is a good idea for future follow-up

c/ These are strongly associated with normal tension glaucoma

d/ They most often occur on the supero- or inferotemporal rim

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04 In relation to the green mires shown in this tonometry image, which of the following statements is correct?

a/ This is a non-contact method of IOP measurement

b/ The mires are perfectly lined up

c/ The dial of the tonometer needs to be reduced in order to line up the inner edge of the mires

d/ The dial needs to be increased to line up the inner edges of the mires

05 Which of the following statements in relation to tonometry measurement is incorrect?

a/ Too much fluorescein while undertaking applanation tonometry may lead to an overestimation of the IOP

b/ Massaging the eye will increase the IOP

c/ Too little fluorescein while undertaking tonometry can lead to an underestimate of IOP

d/ Patients holding their breath during measurement can increase the IOP

06 When considering corneal thickness and IOP measurement by applanation tonometry which of the following statements is incorrect?

a/ This technique assumes that all corneas are of a similar thickness

b/ Thicker than average corneas may result in an overestimation of IOP

c/ IOP may be underestimated following laser refractive surgery

d/ Corneal thickness has no bearing at all on the IOP measurement

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07 Considering this gonioscopic image with the scleral spur visible, which of the following statements is incorrect?

a/ This is an open angle

b/ The ciliary body can be seen below the scleral spur

c/ The trabecular meshwork is visible

d/ This is a narrow angle

08 In relation to gonioscopy which of the following statements is incorrect?

a/ The inferior quadrant of the anterior angle is often the most open

b/ If the angle is wide open all structures, including the ciliary body, are visible

c/ The trabecular meshwork is visible in very shallow angles

d/ No structures are visible in a closed anterior angle

09 With regard to undertaking gonioscopy which of the following statements is incorrect?

a/ It should not be performed if the van Herick test suggests a narrow angle

b/ Gonisocopy assessment should be undertaken in all cases of significantly raised IOP by those with suitable experience

c/ Gonioscopy can help to detect secondary conditions such as pigment dispersion

d/ Gonioscopy can be used to find out whether pupil dilation can be carried out safely

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10 Which of the following statements best describes the visual field defect shown?

a/ Superior para-central scotoma

b/ Superior temporal quadrantanopia

c/ Inferior nasal step

d/ Superior arcuate defect

11 Which of the following conditions is most likely to be responsible for causing this visual field defect?

a/ Optic neuritis

b/ Retinitis pigmentosa

c/ Primary open angle glaucoma

d/ A lesion of the optic chiasm

12 In relation to visual field defects which of the following statements is incorrect?

a/ Inferior defects are less likely to cause difficulties for the patient than superior defects

b/ Arcuate defects are a typical finding in glaucoma

c/ Near vision function tends to be less affected by arcuate defects than paracentral defects

d/ A binocular Esterman test is used to ensure the visual field is adequate for driving

//REFLECTIVE LEARNING

Having completed this CET exam, consider whether you feel more confident in your clinical skills--how will you change the way you practice? How will you use this information to improve your work for patient benefit?

Exam questions

Under the enhanced CET rules of the G0C, MCQs for this exam appear online at www.optometry.co.uk/cet/exams. Please complete online by midnight on April 3, 2015. You will be unable to submit exams after this date. Answers will be published on www.optometry.co.uk/cet/exam-archive and CET points will be uploaded to the GOC every two weeks. You will then need to log into your CET portfolio by clicking on 'MyGOC' on the GOC website (www.optical.org) to confirm your points.

References

Visit www.optometry.co.uk/clinical, click on the article title and then on 'references' to download

Stanley Keys BSc (Hons), FCOptom, Dip Glauc, Dip Tp (IP)

Stanley Keys is principal optometrist and clinical teacher at Ninewells Hospital in Dundee. He also works in private optometric practice and has gained independent prescribing status, as well as the College of Optometrists Diploma in Glaucoma. He is active in optometric education through his work with NHS Education Scotland and works with Optometry Scotland on professional development.
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Title Annotation:VRICS: GLAUCOMA
Author:Keys, Stanley
Publication:Optometry Today
Geographic Code:4EUUK
Date:Feb 7, 2015
Words:1025
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