11. Anatomy/Physiology of the Eye/Ocular Exam

Question 1

orbicularis oculi innervation

Answer 1

CN VII

Question 2

levator palpebrae innervation

Answer 2

CN III

Question 3

muller’s muscle innervation

Answer 3

sympathetic

Question 4

ciliary body, posterior chamber, anterior chamber, cornea, pupil, iris, zonules, sclera, lens, vitreous body, optic disc, retina, fovea centralis, central retinal artery, central retinal vein, optic nerve

Answer 4

anatomical structures of the eye

Question 5

epithelium, bowman’s membrane, stroma, descemet’s membrane, endothelium

Answer 5

anatomy of the cornea

Question 6

minor arterial circle of the iris, major arterial circle of the iris, anterior ciliary artery, long posterior ciliary artery, vorticose vein, short posterior ciliary artery

Answer 6

vascular supply to the uveal tract

Question 7

ciliary body, zonular fibrils, anterior chamber, trabecular meshwork

Answer 7

relevant anatomy for drainage of aqueous humor

Question 8

red reflex

Question 9

scotoma, hemianopia, homonymous

Answer 9

visual field defects

Question 10

reduced or absent vision

Answer 10

scotoma

Question 11

loss of half of visual field

Answer 11

hemnianopia

Question 12

either a right or left sided visual defect

Answer 12

homonymous

Question 13

lesion anterior to optic chiasm

Answer 13

monocular loss

Question 14

lesion at the optic chiasm

Answer 14

bitemporal hemniaopia

Question 15

lesion posterior to chiasm

Answer 15

homonymous hemianopia

Question 16

unilateral field loss

Answer 16

left or right optic nerve compression

Question 17

chiasmal compression from pituitary tumor

Answer 17

bitemporal hemianopia

Question 18

left cerebrovascular event

Answer 18

homonymous hemianopia

Question 19

optic nerve swelling

Answer 19

papilledema

Question 20

rhodopsin, anaerobic glycolysis, aerobic glucose metabolism, hexose monophosphate shunt, sorbitol pathway, galactosemia-dulcitol

Answer 20

biochemical pathways used by the eye

Question 21

metabolism directed towards maintaining transparency of the lens epithelium, glucose enters the lens from the aqueous humor and is rapidly metabolized, hyperglycemia shunts glucose to the sorbitol pathway causing lens edema and acute refractive error changes such as blurred vision which may take 4-6 weeks to equilibrate after stabilization of blood sugars, chronically can lead to cell rupture and early cataract development in diabetics

Answer 21

lens metabolism

Question 22

cornea and lens, cornea is 2/3 of refractive power, lens is 1/3 of refractive power

Answer 22

refractive surface of the eye

Question 23

refractive power of the cornea and lens being different in one meridian versus the other

Answer 23

astigmatism

Question 24

ability of the ciliary muscle to contract or relax the zonules allowing lens to focus at near objects

Answer 24

accommodation

Question 25

farsighted, axial length too short

Answer 25

hyperopia

Question 26

nearsighted, axial length too long

Answer 26

myopia

Question 27

distorted vision

Answer 27

astigmatism

Question 28

decreased ability to focus at near objects with age, cannot be corrected with refractive surgery

Answer 28

presbyopia

Question 29

good and equal vision in both eyes, monocular or binocular, central or peripheral, acute or gradual, variation throughout the day, pain, metamorphopsia, diplopia both monocular and binocular

Answer 29

history of ocular chief complaints

Question 30

diabetes mellitus, hypertension, thyroid disease, autoimmune disease like collagen vascular or inflammatory bowel disease, glaucoma, malignancy

Answer 30

past medical history for ocular complaints

Question 31

trauma, refractive surgery, cataract surgery

Answer 31

past surgical history for ocular complaints

Question 32

employment, living situation, activities/hobbies, smoking, alcohol, illicit drugs, spectacles/contact lenses, last ocular exam

Answer 32

social history for ocular complaints

Question 33

retinoblastoma, amblyopia, strabismus, glaucoma, macular degeneration, diabetes, hypertension, color blindness, retinitis pigmentosa

Answer 33

family history for ocular complaints

Question 34

disturbances of vision, pain or discomfort in or about the eyes, abnormal eye secretions

Answer 34

review of systems for ocular complaints

Question 35

blurred or decreased vision, loss of vision either monocular/binocular/amaurosis, color vision abnormalities, decreased peripheral vision, iridescent vision like halos or rainbows

Answer 35

disturbances in vision

Question 36

lacrimation, epiphora -overflow tearing-. purulent/mucous/serous exudate

Answer 36

abnormal eye secretions

Question 37

superficial foreign body sensation, deep pain in iritis/glaucoma, burning, itching generally pointing to allergy, photophobia generally pointing to iritis, headaches

Answer 37

pain or discomfort with ocular complaints

Question 38

best corrected visual acuity problem

Answer 38

monocular vision`

Question 39

about 1 meter apart, monocular, test from peripheral to central, gross visual field testing, formal testing is available

Answer 39

confrontation visual fields

Question 40

orbit, eyebrows for thinning in hypothyroidism, eyelids, eyelashes, lacrimal gland, lymph nodes, proptosis/exopthlamos

Answer 40

external exam for eye

Question 41

patient looks down, grasp upper lashes & lid, cotton tipped applicated placed in lid crease, pull lid up over applicator, examine for foreign bodies

Answer 41

upper lip eversion

Question 42

direct, consensual not performed instead swinging flashlight, swinging flashlight/afferent reflex

Answer 42

pupillary testing

Question 43

direct examination including size, equal, anisocoria, round, central, reactivity to light, rapid swinging flashlight test, light-near association

Answer 43

pupil exam

Question 44

important if patient is complaining of diplopia, check cardinal positions of gaze, check for diplopia monocular/binocular, paresis/palsy, nystagmus

Answer 44

extraocular muscle testing

Question 45

corneal sensitivity, cranial nerve 5, inspect for epithelial defects, such as ulcer/abrasion, active/old opacifications, peripheral changes like arcus corneae

Answer 45

cornea exam

Question 46

is able to detect epithelial defects, flouresces with cobalt blue filter, use strips to avoid contamination, remove soft contact lenses first

Answer 46

fluorescein staining of the corne

Question 47

corneal abrasion

Question 48

assessed by side penlight test

Answer 48

anterior chamber assessing depth

Question 49

red reflex, optic nerve cup/disc/blurriness, retinal circulation including the artery/vein/av crossing, retinal background, and macula

Answer 49

opthalmoscopy

Question 50

normal 10 10-21 mmHg anesthetize cornea with proparacaine, separate lids without pressure, schiotz tonometer is lowered on cornea/record the scale reading and convert to IOP, tonopen can be connected to an electric device and is less cumbersome, pneumotonmetry is an air puff, icare, goldman is the current gold standard

Answer 50

tonometry

Question 51

psychiatric, functional, drugs/toxins, vasculaer, infectious, traumatic, autoimmune/allergy, metabolic, endocrine, idiopathic/iatrogenic, neoplastic, congenital

Answer 51

categories of systemic diseases necessary for ophthalmic examination