Special tests for sensory and motor anomalies

1. Special tests for sensory and motor
anomalies
By - Krishna Banjade
Consultant optometrist
M. Optom
FLVPEI - Pediatrics and BSV

2. Which statement is wrong about Hirschberg's
test
a. It is also called corneal reflection test
b. Each 1 mm of decentration of the corneal reflection
corresponds to 7degrees of deviation of the visual axis
c. If the reflection is on the iris between the pupillary margin
and the limbus, angle of 20 to 45 degrees may be present
d. It cannot measure angle of deviation when the reflection is
from the conjunctiva
If the reflection appears on the conjunctiva, a
deviation of 45 or more exists

3. Which of the following statement is true about
Modified Krimsky’s test
a. It is based on the principle of Hering’s law of equal innervation
b. Prism is placed in front of the fixating eye
c. The examiner places himself on the side of the deviated eye to
avoid parallax errors in observation
d. It is performed if the deviated eye is blind or has low visual acuity
or, in young children, is unable to maintain fixation for longer than
a moment
e. All the the above statements are true

4. Which of the following statement is wrong
about Bruckner’s test
a. It is used to diagnose strabismus in infants based on judgment of
the position of the corneal light reflex and the color of the light
reflected from the fundus
b. A bright coaxial light source emitted by a direct ophthalmoscope
illuminates both eyes of the patient simultaneously from a distance
of 25cm in a semidarkened room
c. In the presence of strabismus the reflex of the fixating eye is darker
than in the deviated eye
d. This reflex is in the lower part in myopes and in the upper part in
hyperope

5. Which of the following is a clinical sign of
pseudo strabismus in infants ?
a. Prominent epicanthal fold
b. Telecanthus
c. Broad nasal bridge
d. All of the above
Gives impression to
pseudoesotropia

6. Which of the following stament is wrong about
angle kappa
a. An angle kappa is caused by failure of the pupillary and visual
axes of the eye to coincide
b. Position of angle kappa is slightly nasal to the center of the
cornea
c. A sufficiently large positive angle kappa may simulate an
exodeviation and produce pseudostrabismus.
d. A negative angle kappa may simulate an exodeviation and
produce a pseudostrabismus

7. What is the average value of angle kappa in
emmetropes ?
a. 3 degrees
b. 5.0 degrees
c. 10 degrees
d. 15 degrees
In hypermetropes the angle
varies from 6.0 to 9.0 degrees
and In myopic eyes the angle is
around 2.0 degrees and may
even be negative

8. Which of the following test is used to establish
heterophoria ?
a. Cover test
b. Uncover test
c. Prism bar cover test
d. All of the above

9. Which of the following test is based on the
principle of dissociation/diplopia?
a. Red filter
b. Maddox Rod
c. Maddox Wing
d. Heterophorometer
e. All of the above

10. Which of the following test is used to diagnose
suppression ?
a. Worth’s four dot test
b. Red filter test
c. Bagollini striated glasses
d. Amsler grid
e. 4 prism base out test
f. All of above

11. In Worth’s four dot test if red filter is placed over right eye
and green over left eye. Which color is appreciated while
seeing red target with right eye ?
a. Red
b. Green
c. White
d. Black
Red + Red = White
Green + Green = White
Red + Green = Black (Complementary colors)

12. a. Red
b. Green
c. White
d. Black
In W4DT if red filter is placed over right eye and green
over left eye. Which color is appreciated by right eye if
the background of W4DT is changed to white ?
Red + Red = White which cannot be
perceived with the white background.
Hence right eye sees green colors as black
(R+G=Black)

13. Which statement is false about measurement of
NPC ?
a. The NPC should be at 8 to 10 cm
b. A distance closer than 5 cm is excessive and NPC farther
away than 10 cm is defective or remote
c. The eye that maintains fixation at the NPC is generally
considered to be the dominant eye, and the deviated one is
the nondominant eye.
d. It is performed monocularly and then binocularly

14. During NPC measurement why we use vertical line not
horizontal ?
• Because diplopia is perceived more vertically than horizontally

15. A patient has AC/A ratio of 6:1. On examination he has
4X’. What is the deviation when +1.0D lens is placed in
front of the eye?
a. 2 PD E’
b. 2PD X’
c. 10 PD X’
d. 5 PD X’

16. True statements about microtropia include:
a. it may result from operation for congenital esotropia
b. the angle of deviation is typically between 15 and 20 prism
dioptres
c. stereopsis is usually absent
d. anisometropia is a common feature
e. a base out 4 dioptre prism can be used to detect central
scotoma

17. Which of the following test is not preferred in
diagnosing microtropia ?
a. Bagolllini striated glasses
b. 4PBO test
c. W4DT
d. Maddox rod

18. Double maddox rod is used to measure
a. Heterophoria
b. Heterotropia
c. Cyclotropia
d. None of the above

19. Accommodative components
• Acc. amplitude is better binocularly
• Acc. facility is better monocularly

20. While performing MEM retinoscopy the normal value is
considered to be +0.50 to +0.75
 when performed at 40cm pupils constrict and depth of focus
increases
 Depth of focus manages the lag upto +0.75D
 If one gets MEM value of +2.25 when performed at 40 cm
then the examiner is wrong (Because at 40 cm
accommodation required is 100/40 = 2.5D. For this 2.5D,
0.75D already provided by depth of focus then the required
amount is only 1.75D)

21. You perform MEM retinoscopy on a patient and find -
0.50 OD and OS. Which of the following diagnoses
would you suspect?
a. accommodative excess, convergence excess
b. accommodative excess, convergence insufficiency
c. accommodative insufficiency, convergence insufficiency
d. accommodative insufficiency, convergence exces

22. NRA/PRA
• Always measured binocularly
• Relative accommodation – they are relative to vergence
• NRA always measured before PRA

23. In a clinical setting, fixation is best examined
using
a. Ophthalmoscope
b. Red filter test
c. Bagollini striated glasses
d. Amblyoscope