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Question 40 One cause of nasal septum perforation may be: a. nasal polyps. b. intranasal use of cocaine. c. cystic fibrosis. d. chronic sinusitis. Explanation: Perforation of the nasal septum could be caused by trauma, surgery, and intranasal use of cocaine or amphetamines. Nasal polyps obstruct air flow but there is no relationship to nasal septum perforation. Cystic fibrosis or chronic sinusitis are not associated with nasal perforation. Question 41 A 30-year-old patient presents with a moderate "aching" in his right eye. Findings reveal a small and irregular shaped right pupil. The cornea appears cloudy with a slight erythematous area around the corneal limbus. There is no ocular discharge noted. These findings are consistent with: a. acute iritis. b. corneal injury. c. corneal infection. d. acute angle closure glaucoma. Explanation: Acute iritis presents with a moderate aching deep within the eye. The pupils are small and irregular and vision is decreased and photophobia is present. The cornea is clear or slightly cloudy with injection confined to the corneal limbus. This is considered an emergency and is usually related to Herpes zoster infection or tuberculosis. Corneal injury or infection usually presents with watery or purulent ocular discharge and severe eye pain. With acute angle closure glaucoma, the pain is severe, aching, and deep, but the pupils are dilated and fixed and the cornea appears steamy or cloudy. If an increase in intraocular pressure is present in conjunction with these findings, this would be an emergency situation. Question 42 Sudden bilateral and painless visual loss is rare but can be associated with all the following except: a. cholinergics. b. anticholinergics. c. steroids. d. chemical exposure. Explanation: Certain medications are associated with sudden bilateral, painless visual loss. These medication classesinclude cholinergic, anticholinergics, and steroids. Exposure to chemical