Selfassessment by peirongw

VIEWS: 31 PAGES: 15

									2009 AACO Self Assessment Exam

Attached is the 2009 AACO Self Assessment Exam, consisting of 60 multiple-choice questions based on 12 journal articles. **You need only read 10 articles and answer 50 of the 60 questions. ** An answer sheet is included. Please make sure you are placing your answer by the appropriate number on the answer sheet! A minimum score of 70% is required to receive the 5 continuing education credits from the AOC. Proof of credits and receipt of payment will be mailed to you once your exam is received and scored.

Please send your answer sheet, along with a check for $50 (U.S.) payable to AACO, Inc. to: Claire Hennessey, C.O. 136 E. Oakview Place San Antonio, TX 78209

For questions or more information please contact: Jorie Jackson, CO joriejackson@yahoo.com (281) 362 5554 Co-Coordinator Self Assessment Exam Claire Hennessey, CO clairechennessey@yahoo.com (210) 340-6633 Co-Coordinator Self Assessment Exam

Please note: You are only required to read 10 articles and answer 50 questions
Decreased postoperative drift in intermittent exotropia associated with A and V patterns. Pineles SL, et al. J AAPOS 2009; 13: 127-131 The influence of head tilt on ocular torsion in patients with superior oblique muscle palsy Kushner BJ. J AAPOS 2009; 13: 132-35. Quality of life in intermittent exotropia: child and parent concerns Hatt SR, et al. Arch Ophthalmol. 2008 November, 126(11): 1525-1529. Sutured protective occlude for severe amblyopia Arnold RW, et al. Arch Ophthalmol. 2008; 126(7): 891-895. Bupivacaine injection of the lateral rectus muscle to treat esotropia Scott AB, et al. J AAPOS 2009; 13: 119-122 Surgical treatment of strabismus secondary to glaucoma drainage device. Roizen A, et al. Arch Ophthalmol. 2008; 126(4): 480-486 Community-Based Trial of Peripheral Prism Visual Field Expansion Device for Hemianopia. Bowers, A. et al. Arch Ophthalmol. May 2008.; Vol 126 (5): 657-664. Adjustable suture strabismus surgery in infants and children. Awadein, Ahmed et al. J AAPOS 2008; 12: 585-590. The effect of Bangerter filters on optotype acuity, Vernier acuity, and contrast sensitivity. Odell, N. V. et al. J AAPOS 2008; 12: 555-559. Occlusion Properties of prosthetic contact lenses for the treatment of amblyopia. Collins, R. S. et al. J AAPOS 2008; 12: 565-568. Orbital magnetic resonance imaging of extraocular muscles in chronic progressive external ophthalmoplegia: specific diagnostic findings. Ortube MC, Bhola R, Demer JL. JAAPOS . 2006 Oct;10(5):414-8 Stereoacuity and ocular associations at age 12 years: findings from a population-based study. Robaei D, Huynh SC, Kifley A, Gole GA, Mitchell P. JAAPOS. 2007 Aug; 11(4):356-61. Epub 2007 Mar 13

Decreased postoperative drift in intermittent exotropia associated with A and V patterns. Pineles SL, et al. J AAPOS 2009; 13: 127-131 1. Patients with pattern X(T) drifted ___ diopters at approximately 6 months postop. a. 7.4 b. 2.6 c. 8.2 d. 4.3 Patients with pattern X(T) whose patterns were “sufficiently collapsed” postoperatively . . . a. Appeared to drift more than those whose patterns were not collapsed b. Appeared to drift less than those whose patterns were not collapsed c. Had the same amount of XT) in primary position as was measured preoperatively d. Had the best surgical results in the patient cohort Which of the following is a potential explanation of why postoperative drift is less in pattern X(T)? a. Pattern strabismus may be the result of mechanical and orbital factors not seen in patients with comitant strabismus b. Comitant exotropia is caused by a central disorder of vergence control and will not respond to surgery similarly to pattern X(T) c. Patients with pattern X(T) may adopt a compensatory head posture to aid with fusion, and as a result will fuse more preoperatively d. All of the above

2.

3.

4. Which of the following statements is true? a. In the study, postoperative drift in patients with comitant strabismus was less than patients with A- or V- pattern X(T) b. In the study, the presence of an A vs. V pattern did significantly correlate with postoperative drift c. Although the trend was insignificant, there was a larger exotropic drift in those patients who underwent rectus muscle transposition than oblique weakening procedures d. Earlier studies suggested that initial overcorrections of >20 diopters following bilateral lateral rectus recessions yielded the best long-term results 5. Patients were defined as having an A-pattern if the amount of XT in downgaze exceeded that in upgaze by at least ___ diopters a. 5 b. 10 c. 15 d. 20

The influence of head tilt on ocular torsion in patients with superior oblique muscle palsy Kushner BJ. J AAPOS 2009; 13: 132-35. 6. The Cervical Range of Motion (CROM) device used in the study is . . . a. A way to accurately measure torsion b. A way to measure the hypertropia present in contralateral head tilt c. Measures head tilts with a reproducibility and accuracy of 1 degree d. Determines the presence of a masked bilateral superior oblique palsy

7. According to the study, which of the following statements does not explain why patients with a superior oblique palsy adopt a compensatory head posture to the contralateral side? a. Tilting to the contralateral side sends innervation to the inferior oblique and inferior rectus muscles of the involved eye b. The hypertropia will decrease with a contralateral head tilt c. A head tilt to the contralateral side may aid in maintaining fusion d. A compensatory head posture serves to decrease the excyclotropia, particularly if the tilt is large 8. The mean decrease in the excyclotropia from the head-erect measurement to that found on contralateral head tilt was ___ degrees. a. 0.25 b. 0.50 c. 0.75 d. 1.0 9. Which statement is false a. In patients with unilateral superior oblique muscle palsy, the ipsilateral inferior oblique muscle is unopposed and becomes overacting b. The decrease in the hypertropia from the head-erect position to that found on contralateral head tilt was not significant c. The data in this study suggests that a compensatory head posture in unilateral superior oblique muscle palsy is to minimize the vertical deviation d. The author feels that when the patient’s head is tilted, he has an easier time orienting the Maddox rod vertically (e.g., from floor to ceiling) than trying to assess the true horizontal plane 10. According to the author, in unilateral superior oblique palsy, which of the following is the driving force when deciding which muscle(s) to operate on a. Magnitude of the head tilt b. Size of the hypertropia c. Amount of excyclotropia d. Both b and c e. All of the above

Quality of life in intermittent exotropia: child and parent concerns Hatt SR, et al. Arch Ophthalmol. 2008 November, 126(11): 1525-1529. 11. When interviewing children with X(T), the topic areas mentioned in order of most frequently mentioned to least were: a. Troubled by blurriness, Worry, Self consciousness b. Worry, Troubled by blurriness, Comments from others c. Comments from others, Worry, Troubled by blurriness d. Comments from others, Troubled by blurriness, Worry 12. Upon interviewing the parents of children with X(T), the most frequently mentioned topic of concern regarding their child’s health related quality of life (HRQOL) was: a. Comments from others b. The child’s appearance to others c. Concerns regarding reading d. The child’s self-consciousness 13. This study suggests that: a. A child’s own HRQOL concerns will most likely differ from his/her parent’s concerns b. The parents interviewed for the study mentioned that “worry regarding possible deterioration” as their number one HRQOL concern c. Only ¼ of the children interviewed expressed worry related to their eye condition d. 63% of the parents interviewed mentioned “comments from others” as a HRQOL concern 14. According to a study by Paysse et al, the age at which children may become aware of strabismus in others is approximately: a. 4 years b. 5 years c. 6 years d. 7 years 15. Experiencing “blurry vision” was a HRQOL concern mentioned by several of the interviewed children. An explanation for this could be: a. Recruiting accommodative convergence to help control the exodeviation b. Children might be describing diplopia as “blurry vision” c. Children describe as “blur” the change in visual experience noticed when suppression occurs d. All of the above

Sutured protective occluder for severe amblyopia Arnold RW, et al. Arch Ophthalmol. 2008; 126(7): 891-895. 16. Before suturing the plastic occluder to a patient’s orbital rim, the authors first sewed it to the nondominant forearm of one of the investigators. Which type of suture was the best tolerated? a. 4-0 monofilament nylon suture b. 2 large staples with 4-0 braided silk thread c. 3-0 monofilament polypropylene suture d. Vicryl sutures 17. Which of the following statements is false? a. In all 10 cases, parents and patients were satisfied with the appearance of the scars once the shields were removed b. One patient had a skin infection that required antibiotics c. No patient was injured secondary to a fall while occluded d. There were no cases of reverse amblyopia 18. After one month of the sewn-on patch in place, the amblyopic eyes included in the study improved from a mean visual acuity of ___ to ___. a. 20/119 to 20/57 b. 20/200 to 20/50 c. 20/117 to 20/44 d. 20/214 to 20/37 19. The authors compared sewn-on occlusion to which relatively common practice in today’s society? a. Body piercing because the level of discomfort during both procedures is comparable b. Tattooing because the complications are similar c. The authors only compared sewn-on occlusion to the frontalis suspension sling surgery d. Body piercing because the complications are similar 20. Which data finding is similar to what was found by PEDIG in several of their recent studies on amblyopia treatment(s)? a. The age of the patients did not correlate with the degree of visual acuity gained b. Only those patients with strabismic amblyopia responded to full time occlusion c. Early detection does not improve treatment adherence d. Adolescent patients with amblyopia who adhered to extended full-time occlusion did not realize substantial acuity gains

Bupivacaine injection of the lateral rectus muscle to treat esotropia Scott AB, et al. J AAPOS 2009; 13: 119-122 21. Bupivacaine is a common form of anesthesia used in what type of ocular surgery? a. Eye muscle surgery b. Corneal transplantation c. Cataract extraction d. Refractive surgeries such as LASIK 22. Bupivacaine effects eye alignment in what way? a. An eye muscle exposed to Bupivacaine will decrease in contractility b. The eye will deviate towards the injected muscle c. They eye will deviate away from the injected muscle d. Bupivacaine has no effect on the contractility of eye muscles 23. How was bupivacaine guided into the lateral rectus muscle a. By using an MRI with a standard head coil b. By using the electromyogram recorded from the needle tip c. By using a CT scan d. By using a VEP machine 24. The enlargement of the injected muscle reached its maximum around ___ days after injection a. 60 b. 76 c. 200 d. 540 25. The following statement is true a. A small injection volume of Bupivacaine will adequately expose even the posterior third of the muscle b. The incidence of strabismus from orbital anesthetic injection decreases with increasing injection volume c. The greater initial correction of strabismus after bupivacaine injection was seen in primary position, not in abduction or adduction d. The study showed a positive correlation between improved alignment and increased volume of the injected muscle

Surgical treatment of strabismus secondary to glaucoma drainage device. Roizen A, et al. Arch Ophthalmol. 2008; 126(4): 480-486 26. What type of strabismus does implantation of a glaucoma drainage device in the superonasal quadrant cause? a. Pseudo-Brown Syndrome b. Pseudo-sixth nerve palsy c. Esotropia d. Exotropia 27. What was the size of the target the subject was asked to fixate on while motor alignment was determined at 6 meters? a. 20/200 b. 20/40 c. 20/70 d. 20/100 28. How many patients in the study reported both vertical and horizontal diplopia? a. 8 b. 6 c. 9 d. 1 29. Which of the following statements is false? a. 5 out of 9 patients needed elimination of the restriction caused by the fibrous capsule surrounding the implant b. The main concern when operating on an eye with a drainage device is the risk of damaging the patient’s ability to control the IOP. c. Potential complications such as a cataract and a decentered IOL make strabismus surgery secondary to a glaucoma drainage device a complex procedure d. The scar tissue was removed until the restriction on forced-generation testing was released 30. It is prudent to involve a glaucoma specialist in the strabismus surgery for the following reason a. They can help manage changes in the aqueous flow once the fibrous capsule is opened b. They can aid in trimming or replacing the glaucoma drainage device c. They can help in reforming the anterior chamber d. All of the above

Community-Based Trial of Peripheral Prism Visual Field Expansion Device for Hemianopia. Bowers, A. et al. Arch Ophthalmol. May 2008.; Vol 126 (5): 657-664. 31. What is the prevalence of homonymous visual field defects in the general population older than 49 years? A. 1% B. 0.8% C. 0.4% D. 2% 32. The prisms were fitted on which side? A. The side with no field loss. B. The examiner’s right side. C. The side of the field loss. D. The patient’s left side. 33. Toleration was defined as A. Comfortable single central vision with no change in head posture between walking without and with the prisms. B. Single vision in the peripheral. C. Comfortable double vision with no change in head posture between walking without and with the prisms. D. Single vision in down gaze with a head posture. 34. How long was the upper prism worn before the lower prism was fitted? A. 4 weeks B. 1 week C. 2 weeks D. 3 weeks 35. What was the mean daily wearing time of the prism in the 20 participants who continued prism wear at the long-term interview? A. 8 hours B. 6 hours C. 5 hours D. 12 hours

Adjustable suture strabismus surgery in infants and children. Awadein, Ahmed et al. J AAPOS 2008; 12: 585-590. 36. What kind of patients were included in this study? A. All children who had unilateral or bilateral horizontal muscle surgery. B. All adults with horizontal muscle surgery on an adjustable suture. C. All children with vertical muscle surgery D. All adults with vertical muscle surgery on an adjustable suture. 37. All of the following excluded a patient from this study except. A. Restrictive Strabismus B. Myasthenia Gravis C. Vertical strabismus D. Paralytic Strabismus 38. How much was added to the intended amount of a resection? A. 3 mm B. 1.5 mm C. 2 mm D. 3.5 mm 39. How long after surgery was the alignment of the eyes assessed in the adjustable group? A. 4-6 hours B. 1 to 2 hours C. 24-48 hours D. 3-4 hours 40. What was the general goal of the adjustment in exotropic patients? A. To leave the patient under corrected in the distance by 3-6 PD. B. To leave the patient orthotropic in the distance. C. To leave the patient overcorrected in the distance by 3-6 PD. D. To leave the patient over corrected at near by 3-6 PD.

The effect of Bangerter filters on optotype acuity, Vernier acuity, and contrast sensitivity. Odell, N. V. et al. J AAPOS 2008; 12: 555-559. 41. How were the Bangerter filters applied to the lenses? A. With water to the inner surface of the lens. B. With water to the outer surface of the lens. C. With heat to the inner surface of the lens. D. With heat to the outer surface of the lens. 42. In what order were the filters tested on the patients. A. In random order. B. The patient got to choose the order. C. From the most dense to the least dense. D. From the least dense to the most dense. 43. How was the contrast sensitivity measured in all subjects? A. Rock-McClain Chart B. Pelli-Robson Chart C. The Near Visual Acuity Test D. The GEE method. 44. Which filter degraded the distance optotype acuity more then vernier acuity? A. 0.3 filter B. 0.8 filter D. <0.1 filter D. 0.2 filter 45. What was the mean degraded optotype acuity by the 0.4 filter? A. 20/38 B. 20/42 C. 20/60 D. 20/36

Occlusion Properties of prosthetic contact lenses for the treatment of amblyopia. Collins, R. S. et al. J AAPOS 2008; 12: 565-568. 46. What was one the objects of this study? A. To determine the degree of vision penalization produced by the contact lenses tested in this study. B. To determine the cosmetic appearance of the contact lenses tested in the study. C. To determine if the patient’s amblyopia got better by using the contacts tested in this study. D. To determine if the patient liked wearing the contacts tested in this study. 47. How were contact lenses applied to the eye of the volunteer? A. From the most dense to the least dense. B. The patient got to choose the order. C. In random order D. From the least dense to the most dense 48. What was the mean visual acuity with the blue iris, light under print in the 3 mm opaque pupil? A. 20/200 B. 20/100 C. 20/320 D. 20/400 49. How much peripheral fusion was preserved in the subjects when the 8 lenses with 3 mm and 4 mm opaque pupils were placed on their eye? A. 25% B. 75% C. 30% D. 50% 50. What was the age range of the volunteers in this study? A. 30-42 B. 16-18 C. 18 to 30 D. 18-26

Orbital magnetic resonance imaging of extraocular muscles in chronic progressive external ophthalmoplegia: specific diagnostic findings. Ortube MC, Bhola R, Demer JL. JAAPOS . 2006 Oct;10(5):414-8

51. What statement is correct regarding CPEO? a) b) c) d) Slow bilateral loss of extraocular muscles function with blepharoptosis Congenital abnormally causing imprecise and uncoordinated movement of a voluntary muscle Adduction abnormalities with contralateral nystagmus attributed to a brainstem lesion Vascular disorder with severe headaches presented with ocular motor nerve palsies

52. The best alternative to diagnose CPEO is: a) b) c) d) Molecular tests to detect mitochondrial DNA deletions Family history, clinical findings and MRI Clinical findings, observation of deviation and diplopia stability Stability of the saccadic velocity within periods of 3 months

53. CPEO presents with signs and symptoms similar to all of the following diagnoses below except: a) b) c) d) Disorder of neuromuscular junction Orbital myositis Goldenhar Syndrome Thyroid orbitopathy

54. The muscles will be found in a patient with CPEO as: a) b) c) d) Fibrotic and increased volume Normal appearance Inflammation and enlargement of one or more extraocular muscle Increased number of red fibers

55. All of the following symptoms fit the CPEO diagnosis except: a) b) c) d) Progressive blepharoptosis Non-fluctuating diplopia Fatigue Family history

Stereoacuity and ocular associations at age 12 years: findings from a population-based study. Robaei D, Huynh SC, Kifley A, Gole GA, Mitchell P. JAAPOS. 2007 Aug; 11(4):356-61. Epub 2007 Mar 13

56. What is the most common cause for reduced stereoacuity? a) b) c) d) Anisometropia Strabismus Amblyopia Monocular visual impairment

57. What is the prevalence of reduced stereopsis in the general population? a) b) c) d) 50% 3% 10-15% No study was ever done in this matter

58. All of the statements below are correct except: a) A common tool used for stereo acuity assessment is TNO, with normal acuity defined as 120 arc/sec b) Most of children with anisometropia have normal stereo acuity regardless of the amount of anisometropia. c) A significant ethnic difference is found among the population with reduced stereoacuity d) Most of the children with “super-normal” stereoacuity had no history of amblyopia, but some of them presented strabismus

59. Which one of the statements below is correct? a) Studies on the amblyopia population have showed a significant negative effect on the development of children. b) Stereo perception is important for short distance work since monocular cues don’t provide sufficient information on depth c) Stereopsis applies beyond 500 m of distance d) Amblyopic people account for the majority of the population with reduced stereoacuity

60. Which one of these will most likely show a 120 sec/arc stereo acuity on the TNO test/ a) b) c) d) X(T) Mod. ET Amblyopia Monofixation syndrome

American Association of Certified Orthoptists 2009 Self Assessment Exam 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. 56. 57. 58. 59. 60.

NAME: ________________________________


								
To top