21 General Medical Knowledge & History Practice Questions & Answers

1. 1. A patient arriving for an eye examination says, "Everything looks smoky when I drive at night." How should the assistant record the chief complaint?

   • A.The patient's own words, quoted exactly as spoken✓ Answer
   • B.The assistant's summary of the likely lens problem
   • C.The reason for the visit as the referring notes state it
   • D.A diagnosis of cataract with night glare, both eyes

   The chief complaint belongs to the subjective part of the record and is the patient's own stated reason for the visit, so it is quoted verbatim. Converting "smoky" vision into a diagnosis such as cataract is an interpretation, which is outside the assistant's role and can steer the physician toward a conclusion the findings may not support.

   Source: IJCAHPO Core Examination Content Areas — History and Documentation (chief complaint)Report a problem with this question

2. 2. During the workup a patient asks, "Do you think I have glaucoma? My father went blind from it." What is the assistant's best response?

   • A.Say the doctor will probably order a visual field test
   • B.Record the question and refer it to the ophthalmologist✓ Answer
   • C.Reassure the patient that the pressure reading looked normal
   • D.Explain the differences between the two main types of glaucoma

   Allied ophthalmic personnel work under the supervising ophthalmologist's direction and are not independent practitioners, so they do not diagnose, interpret findings for the patient, or offer reassurance about a possible disease. Charting the question preserves it for the physician and keeps the assistant inside the delegated scope.

   Source: IJCAHPO scope-of-practice statement for Allied Ophthalmic PersonnelReport a problem with this question

3. 3. A visual acuity was written on the wrong line of a paper chart. What is the correct way to fix the entry?

   • A.Erase the entry completely and rewrite the correct value there
   • B.Write the correct value on top of the original, on the same line
   • C.Draw one line through it, write the correction, and initial and date it✓ Answer
   • D.Cover the entry with correction fluid, then write the correct value

   The medical record is a legal document, so a correction must leave the original entry readable and must show who changed it and when. A single strike-through with the correction, initials and date preserves that trail, while correction fluid, erasure or overwriting obliterates the original and makes the whole chart look altered.

   Source: Medical record documentation standards for correcting entries in paper chartsReport a problem with this question

4. 4. A patient says she "cannot take penicillin" because it once gave her an upset stomach, with no rash or swelling. How should this be documented?

   • A.As "no known drug allergies," because nausea is not serious
   • B.As a drug allergy, since the patient calls it one
   • C.As an allergy to all antibiotics, to be safe
   • D.As an intolerance, with the drug and the reaction named✓ Answer

   A true allergy is an immune reaction such as rash, hives, swelling, wheezing or anaphylaxis, whereas nausea or stomach upset is a side effect and does not carry the same risk. Recording the agent together with the actual reaction lets the physician judge the risk instead of ruling out useful drugs on a label alone.

   Source: IJCAHPO history content — allergies and adverse drug reactionsReport a problem with this question

5. 5. A man scheduled for cataract surgery lists tamsulosin among his medications. Why does this entry matter to the surgical team?

   • A.It raises intraocular pressure after many years of use
   • B.It causes deposits in the corneal epithelium over time
   • C.It is associated with floppy iris during cataract surgery✓ Answer
   • D.It produces a bull's-eye change at the macula with long use

   Alpha-1 blockers such as tamsulosin relax the iris dilator muscle, so the iris can billow and the pupil constrict during surgery, a pattern known as intraoperative floppy iris syndrome. Because the effect persists long after the drug is stopped, the surgeon needs the exposure documented in advance to plan for it.

   Source: Ophthalmic medical assisting practice — medication history and intraoperative floppy iris syndromeReport a problem with this question

6. 6. A new patient mentions that "someone in the family had glaucoma." What should the assistant do next?

   • A.Tell the patient that glaucoma is usually inherited
   • B.Ask which relative it was and at what age it began✓ Answer
   • C.Schedule the patient for more frequent follow-up visits
   • D.Record "positive family history of glaucoma" and move on

   Family history carries different weight depending on how close the relative is and how early the disease appeared, so a first-degree relative affected young means far more than a distant one. Narrowing an open statement with follow-up questions is exactly how the structured history moves from general to specific; setting the follow-up interval is the physician's decision.

   Source: IJCAHPO history content — family historyReport a problem with this question

7. 7. A patient telephones the office reporting a red, watery eye. After relaying the call to the physician and giving the physician's instructions, what must the assistant do?

   • A.Chart the call with the time, symptoms, and advice given✓ Answer
   • B.Chart the call only if the patient is later seen in the office
   • C.Keep a personal note in case the physician asks about it
   • D.Note the call in the appointment book rather than the chart

   A telephone encounter is patient care and belongs in the chart with the date and time, the caller, the symptoms in the caller's words, the advice given, and who reviewed it. Care that is not documented in the record cannot be relied on later, so a personal note or an appointment-book jotting does not protect the patient or the practice.

   Source: IJCAHPO patient services content — responding to and documenting telephone callsReport a problem with this question

8. 8. A man walks in saying a cleaning solution splashed into his eye a few minutes ago. What should happen first?

   • A.Complete the full history and medication list before treating
   • B.Instill a topical anesthetic and wait for the physician
   • C.Measure visual acuity in both eyes before touching the eye
   • D.Start irrigating at once, asking which chemical while it runs✓ Answer

   A chemical injury keeps damaging tissue for as long as the agent stays on the eye, and alkalis in particular penetrate deeper the longer they sit, so dilution cannot wait. This is the one situation in which treatment precedes the history; only the identity of the chemical and the time of exposure are gathered while irrigation runs.

   Source: Ocular chemical injury first response — standard emergency ophthalmic practiceReport a problem with this question

9. 9. Four patients call the office on the same morning. Which report should be escalated for a same-day appointment?

   • A.Reading glasses that no longer feel strong enough
   • B.New floaters with a shadow in the side vision✓ Answer
   • C.A few floaters that have been unchanged for years
   • D.Morning crusting on the lashes for the past week

   A sudden burst of new floaters with a shadow or curtain in the peripheral field suggests a retinal tear or detachment, which threatens central vision if the macula becomes involved. Long-standing unchanged floaters, a weakening near correction and lid crusting are chronic and can be scheduled routinely.

   Source: Ophthalmic triage of retinal detachment symptoms — standard clinical practiceReport a problem with this question

10. 10. While taking the past ocular history before a cataract evaluation, the patient reports laser vision correction years ago. Why is that entry important?

    • A.It prevents accurate acuity testing from then on
    • B.It makes the patient ineligible for cataract surgery later
    • C.It changes the corneal measurements used for lens calculations✓ Answer
    • D.It removes the need for a dilated fundus examination

    Refractive surgery reshapes the front corneal surface, so the usual relationship between the measured front curvature and the cornea's true refracting power no longer holds and standard lens calculations become unreliable. Prior refractive surgery is one of the items patients most often forget to mention, which is why it is asked directly.

    Source: Past ocular history — prior refractive surgery and corneal measurement interpretationReport a problem with this question

11. 11. A child is brought in by his grandfather, and a qualified interpreter is used for the interview. What must the record show?

    • A.Only the answers the child gave, since the child is the patient
    • B.That the grandfather gave the history and an interpreter was used✓ Answer
    • C.That the parents will confirm the history at a later visit
    • D.The interpreter's summary of what the symptoms probably mean

    Whoever supplied the information changes how the history should be weighed later, so the record names the historian rather than implying the patient gave it. Documenting that a qualified interpreter was used shows the exchange was understood by both sides, and an interpreter relays what is said rather than offering an opinion.

    Source: Medical record standards — identifying the historian and documenting use of a qualified interpreterReport a problem with this question

12. 12. Aqueous humor is produced by the ciliary body. Which route does it normally follow before leaving the eye?

    • A.Vitreous cavity, then forward through the lens to the angle
    • B.Anterior chamber, pupil, then back into the vitreous cavity
    • C.Lacrimal gland, the puncta, then the nasolacrimal duct
    • D.Posterior chamber, pupil, anterior chamber, trabecular meshwork✓ Answer

    Aqueous is secreted into the posterior chamber behind the iris, passes through the pupil into the anterior chamber, and drains mainly through the trabecular meshwork at the angle into Schlemm's canal. Because production continues regardless of drainage, anything that obstructs this path raises intraocular pressure; the lacrimal route carries tears, not aqueous.

    Source: Ocular anatomy and physiology — aqueous humor production and outflowReport a problem with this question

13. 13. The corneal endothelium is the single cell layer lining the back surface of the cornea. What is its main function?

    • A.Regenerating fast after an abrasion to reseal the surface
    • B.Extracting fluid from the stroma to keep the cornea clear✓ Answer
    • C.Bringing blood to the cornea from the limbal vessels
    • D.Producing the mucin layer that wets the ocular surface

    The endothelium continuously pumps fluid out of the stroma, and that dehydrated, regularly arranged stroma is what makes the cornea transparent. These cells do not replace themselves, so once enough are lost the stroma swells and the cornea clouds; mucin comes from conjunctival goblet cells and the cornea is normally avascular.

    Source: Corneal anatomy and physiology — endothelial pump functionReport a problem with this question

14. 14. A patient cannot turn the right eye outward past the midline and has horizontal double vision that worsens on right gaze. Which nerve is most likely involved?

    • A.The sixth cranial nerve on the right✓ Answer
    • B.The fourth cranial nerve on the right
    • C.The seventh cranial nerve on the right
    • D.The third cranial nerve on the right

    The sixth cranial nerve supplies only the lateral rectus, the muscle that abducts the eye, so its weakness limits outward movement and the images separate most when the patient looks toward the affected side. The fourth nerve serves the superior oblique, the third the remaining recti and inferior oblique, and the seventh closes the lids rather than moving the globe.

    Source: Cranial nerve innervation of the extraocular musclesReport a problem with this question

15. 15. A relative afferent pupillary defect is detected with the swinging flashlight test. Which condition can actually produce one?

    • A.A dense cataract in the eye being tested
    • B.Optic nerve damage worse in one eye✓ Answer
    • C.Uncorrected high myopia in one eye
    • D.A drooping upper lid on one side

    The test compares how strongly each eye carries the light signal along the afferent limb, the optic nerve, so it is positive only when one nerve or a large area of retina conducts less well than the other side. A cataract scatters light but still transmits the signal, refractive error does not affect it at all, and a drooping lid is an eyelid problem, not a pupil pathway problem.

    Source: Pupillary light reflex and the swinging flashlight testReport a problem with this question

16. 16. A patient has lost the outer half of the visual field in both eyes. Where is the lesion most likely located?

    • A.In one optic nerve
    • B.In the right optic tract
    • C.In the occipital cortex
    • D.At the optic chiasm✓ Answer

    Fibres from the nasal half of each retina, which carry the temporal field, cross at the chiasm, so a lesion pressing there from below or above knocks out both temporal fields and produces a bitemporal defect. A lesion in front of the chiasm affects one eye only, and anything behind it produces a matching defect on the same side of both fields.

    Source: Visual pathway anatomy and visual field defect localizationReport a problem with this question

17. 17. A patient with a history of an overactive thyroid presents with irritated eyes. Which combination of findings fits thyroid eye disease?

    • A.Sunken eyes with heavy discharge and matted lashes
    • B.Enlarged corneas with tearing and marked light sensitivity
    • C.Small pupils with drooping lids and reduced sweating
    • D.Bulging eyes with lid retraction, lid lag, and surface drying✓ Answer

    In thyroid eye disease the orbital tissues and muscles swell, pushing the globe forward, while the upper lid retracts and lags behind the eye on downgaze. Because more of the surface stays exposed and blinking no longer covers it, the cornea dries; miosis with ptosis and anhidrosis instead describes a sympathetic pathway lesion.

    Source: Ocular manifestations of thyroid diseaseReport a problem with this question

18. 18. Which retinal change makes a diabetic patient's retinopathy proliferative rather than nonproliferative?

    • A.Refraction that shifts with blood sugar
    • B.Small red dots from microaneurysms
    • C.Growth of new abnormal blood vessels✓ Answer
    • D.Yellow hard exudates near the macula

    Chronic capillary closure starves the retina of oxygen, and the ischaemic tissue responds by growing fragile new vessels; that neovascularization is what the word proliferative names. Microaneurysms and hard exudates are damage within the existing vessel bed, and fluctuating refraction reflects lens hydration changing with blood sugar.

    Source: Diabetic retinopathy classification — nonproliferative versus proliferative diseaseReport a problem with this question

19. 19. Before a patient begins a topical beta-blocker such as timolol, which history question matters most?

    • A.Whether the patient has ever had a corneal abrasion
    • B.Whether the patient wears soft contact lenses daily
    • C.Whether the patient has asthma or a slow heart rate✓ Answer
    • D.Whether the patient has seasonal pollen allergies

    Drops drain through the nasolacrimal system and are absorbed into the circulation without passing through the liver first, so a topical beta-blocker can slow the heart and narrow the airways just as an oral one would. Asthma, chronic lung disease and bradycardia are therefore the history items that must reach the physician before the drug is started.

    Source: Systemic effects of topical beta-blockers in ophthalmic practiceReport a problem with this question

20. 20. A chart entry reads "pseudophakic OS." What does this tell you about the patient?

    • A.The right eye has an implanted intraocular lens
    • B.The left eye has no lens of any kind in it
    • C.The left eye has an implanted intraocular lens✓ Answer
    • D.The left eye still has a clouded natural lens

    The root phak- refers to the lens, so aphakia means no lens at all while pseudophakia means the natural lens has been replaced by an implant, and OS designates the left eye. Misreading OS as the right eye or pseudophakia as aphakia are the two classic abbreviation errors, and both put the wrong eye or the wrong status into the record.

    Source: Ophthalmic medical terminology and standard chart abbreviationsReport a problem with this question

21. 21. After the physician finishes an in-office injection, how should the used needle be handled?

    • A.Drop it in the red bag used for soiled dressings
    • B.Place it uncapped in a sharps container at once✓ Answer
    • C.Recap it carefully before carrying it to the container
    • D.Bend the needle so it cannot be reused, then discard it

    Most needlestick injuries happen while recapping, bending or carrying a used needle, so the exposure is removed by discarding it uncapped into a rigid, puncture-resistant container at the point of use. A red biohazard bag holds soft contaminated waste and will not stop a needle from penetrating it.

    Source: Standard precautions and sharps disposal in the ophthalmic office (OSHA bloodborne pathogens practice)Report a problem with this question

Practice questions based on the IJCAHPO core certification content areas for the Certified Ophthalmic Assistant and on standard ophthalmic clinical practice references. COA, COT, and COMT are marks of the International Joint Commission on Allied Health Personnel in Ophthalmology; this site is not affiliated with or endorsed by IJCAHPO. Ophthalmic assistants work under the delegation of a supervising ophthalmologist and permitted tasks vary by state and by practice — confirm your own scope, and check the current exam requirements and content outline with IJCAHPO before testing. About IJCAHPO certification →