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Simmons NURP 503 Exam 2 > 5: Decreased Vision/Neuro > Flashcards

5: Decreased Vision/Neuro Flashcards

1
Q

How do you tell the difference between decreased vision and a refractive error?

A

Check both distance and near vision. If a refractive error, only 1 of the 2 is reduced.

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2
Q

If a refractive error, vision will improve while looking through a _____.

A

Pinhole occluder

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3
Q

Sudden, painless, transient blurring of vision that improves with blink.

A

Dry eye syndrome

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4
Q

Sudden, painless, transient blurring of vision that affects parts of field of vision. Lasts 10-60 minutes.

A

Migraine (visual aura)

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5
Q

Sudden, painless, transient blurring of vision that lasts a few seconds and is bilateral. Medical emergency!

A

Papilledema. Increased ICP is always bilateral. Look for absence of spontaneous venous pulsation.

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6
Q

Sudden, painless, transient blurring of vision that lasts a few minutes and is caused by hypoperfusion of the globe. It is usually unilateral (except for vertebrobasilar artery insufficiency).

A

Amaurosis fugax

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7
Q

With amarousis fugax, you check for _____ symptoms.

A

TIA

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8
Q

When is amarousis fugax urgent?

A

With TIA symptoms

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9
Q

What is management for amarousis fugax (3)?

A
  1. Carotid artery evaluation
  2. Hypercoagulable blood work
  3. Cardiac evaluation
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10
Q

A “curtain” in the vision that is sometimes preceded by flashes/floaters.

A

Retinal detachment

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11
Q

Which type of retinal detachment is more urgent and why?

A

If central vision is intact, as this indicates the macula is still attached and can be saved. If central vision is lost, then the macula is not attached and the damage is already done.

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12
Q

Usually d/t an embolus.

A

Retinal artery occlusion

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13
Q

What would you expect to find with a central artery occlusion?

A

Cherry red spot

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14
Q

There is a _____ window to dislodge the embolus in retinal artery occlusions.

A

24-hour window

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15
Q

What is treatment for retinal artery occlusion (2)?

A
  1. Decrease IOP.

2. Dilate blood vessels.

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16
Q

Patients 50 and older with retinal artery occlusions need what?

A

Urgent giant cell arteritis workup (stat CRP/ESR, platelets, temporal artery biopsy).

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17
Q

This type of occlusion is “blood and thunder.”

A

Central Occlusion

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18
Q

This type of occlusion has only a partial loss of field of vision.

A

Branch Occlusion

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19
Q

Is central or branch occlusion more urgent?

A

Central. Will only treat branch if macular edema or neovascularization.

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20
Q

Why do you have regular eye exams for the first 6 months with retinal vein occlusion?

A

Check for neovascularization.

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21
Q

What do you check with retinal vein occlusion (2)?

A
  1. BP

2. Cholesterol

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22
Q

Patients 50 and older with retinal vein occlusions need what?

A

Urgent giant cell arteritis workup (stat CRP/ESR, platelets, temporal artery biopsy).

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23
Q

If retinal occlusions are caused by giant cell arteritis, irreversible loss of vision in the other eye can occur within _____ days.

A

1-7 days

24
Q

What are signs of giant cell arteritis (4)?

A
  1. Jaw claudication
  2. Scalp tenderness
  3. Simultaneous headache
  4. Tender temporal artery
25
Q

List differentials of sudden PAINLESS decreased vision (10).

A
  1. Dry eye syndrome
  2. Migraines
  3. Papilledema
  4. Amaurosis fugax
  5. Retinal detachment
  6. Retinal occlusion
  7. Cataracts
  8. Refractive error
  9. Open angle glaucoma
  10. Retinal diseases (diabetic retinopathy, macular hole, etc.)
26
Q

Open angle glaucoma usually starts with _____ vision.

A

Side vision

27
Q

If you suspect cataracts, refractive error, open angle glaucoma, or retinal diseases, what is the management?

A

For non-emergent causes, advise patient to have eye exam within 1 week.

28
Q

Pain on eye movement that has loss of vision over days and decreased color perception.

A

Optic neuritis

29
Q

Optic neuritis can be the first manifestation of _____ in those age 18-45.

A

MS

30
Q

T/F Nerve can look normal in optic neuritis.

A

True. It can look swollen or normal. 2/3 cases are retrobulbar.

31
Q

List differentials of sudden PAINFUL decreased vision (5).

A
  1. Optic neuritis
  2. Narrow angle glaucoma
  3. Uveitis
  4. Endophthalmitis
  5. Central corneal ulcer
32
Q

What is management of optic neuritis (2)?

A
  1. Neuro-ophthalmology consultation

2. MRI with gadolinium

33
Q

How can you check for malinger/hysterical cause of vision loss?

A

Pupil reaction must match visual loss. Does the visual loss correspond to actions? Can they walk to exam room, shake hand, tell time?

34
Q

If pupil reacts to light, there is at least _____ with visual loss.

A

Light perception

35
Q

If there is unilateral severe visual loss, what should be present?

A

Relative afferent pupillary defect (RAPD). RAPD or Marcus Gunn pupil is a medical sign observed during the swinging-flashlight test whereupon the patient’s pupils constrict less (therefore appearing to dilate) when a bright light is swung from the unaffected eye to the affected eye. The affected eye still senses the light and produces pupillary sphincter constriction to some degree, albeit reduced.

36
Q

How do you manage non-organic causes of vision loss (3)?

A
  1. Visual field testing at different distances.
  2. Optokinetic drum (low-power lenses).
  3. If hx not consistent with exam, go back and examine hx for other possible causes.
37
Q

If there are only 1-2 new floaters, this is an indication of _____. Needs eye exam to r/o concurrent retinal tears.

A

Detached vitreous.

38
Q

A sudden retinal detachment will have sudden increase of _____.

A

Multiple floaters.

39
Q

A bright flash on the side of vision means _____.

A

Traction between vitreous and retina.

40
Q

T/F Retinal flashes indicate retinal detachment.

A

False. Retinal flashes will not necessarily lead to retinal detachment.

41
Q

Migraine-related flashes can last minutes to hours and are usually _____ with more than 1 “flicker.”

A

Bilateral

42
Q

T/F Migraine flashes can start in the center of vision with or without headache.

A

True

43
Q

If suspect flashes/floaters of retinal origin, arrange eye exam within _____.

A

24 hours.

44
Q

Double vision can be neurological in origin. What signs do you check and why (4)?

A
  1. Pain with extraocular movement indicates thyroid eye disease or MS.
  2. Pupil reaction. Pupil involvement suggest 3rd nerve palsy (emergency).
  3. Intermittent or constant diplopia. Intermittent suggests myasthenia gravis (with fatigue), thyroid eye disease, or MS.
  4. Present when covering an eye. This is reassuring, as monocular diplopia is rarely urgent.
45
Q

How do you check for RAPD?

A

Look for dilation lag by holding light in front of each eye for at least 2-3 seconds. Check with lights off. Have patient focus on something far away.

46
Q

Anisocoria is a sign of RAPD.

A

False. There is a lag in dilation, but pupils are the same size.

47
Q

What can cause RAPD (7)?

A
  1. Large retinal detachment
  2. Central retinal artery occlusion
  3. Ischemic central retinal vein occlusion
  4. Optic nerve ischemia
  5. Optic neuritis
  6. Compression
  7. Asymmetric glaucoma
48
Q

T/F RAPD is associated with cataracts, vitreous hemorrhage, and amblyopia (lazy eye).

A

False. It is not associated with cataracts or vitreous hemorrhage. If associated with amblyopia, it is only mild/borderline.

49
Q

Does hyper or hypothyroidism usually cause thyroid eye disease?

A

Hyperthyroidism. Only 10% have hypothyroidism (Hashimoto).

50
Q

What is the first eye muscle involved with thyroid eye disease?

A

Inferior rectus

51
Q

Associated with exophthalmos, dry eyes, lid retraction.

A

Thyroid eye disease

52
Q

Diplopia that is worst at the end of the day. Can have ptosis, but never pupil involvement.

A

Myasthenia gravis

53
Q

When does ptosis get worse in myasthenia gravis?

A

With sustained up gaze.

54
Q

Ptosis in myasthenia gravis will improve with _____.

A

Ice

55
Q

When are headaches related to the eye (4)?

A

If the headache:

  1. Occurs toward afternoon.
  2. Is associated with a visual task.
  3. Mostly frontal or on the temples.
  4. If patient squints to see objects.

Simmons NURP 503 Exam 2 (17 decks)

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