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PCM III Midterm > Eye Exam Competency > Flashcards

Eye Exam Competency Flashcards

1
Q

The red reflex should be examined using the ophthalmoscope, look at pts eyes as they look straight ahead. You should see an equal reddish color reflection bilaterally. _____ colored eyes or different ethnic groups, e.g., ______ , may have lighter red reflex that may appear yellow, orange, or even pink. Abnormalities should always be _______

A

Lighter; AA; referred to ophthalmology

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2
Q

_______, aka white reflex, indicates a serious pathology in the eye, most commonly a congenital cataract; can also be an indicator of RB, retinal detachment, or other more serious condition

A

Leukocoria

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3
Q

Neuroectodermal malignancy arising from embryonic retinal cells; rare cause of childhood blindness, most often dx by the age of 5

A

Retinoblastoma

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4
Q

Most common presenting sign of retinoblastoma

A

Leukocoria

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5
Q

What nerves are tested by cardinal signs of gaze?

A

III, IV, VI

Remember SO4-LR6-AR3

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6
Q

What is strabismus?

A

Misalignment of the eyes

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7
Q

Strabismus can result in ____ (lazy eye) with resultant blindness in that eye

A

Amblyopia

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8
Q

Types of strabismus

A

Exotropia (lateral)

Esotropia (medial)

Hypotropia (caudad)

Hypertropia (cephalad)

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9
Q

What is the point of the cover/uncover test?

A

Used to identify weakness of EOM

Eyes should remain synchronous regardless of being covered; watch for drift as eye is uncovered

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10
Q

According to _____ law, secondary deviation of the eyes is greater than primary deviation

A

Hering’s

[Example: Right LR palsy— while looking straight ahead, the right eye is deviated medially d/t no opposition from LR. To look to one side, both the MR and LR must receive the same amount of stimulation, which causes “overshoot” of the non-paretic muscle]

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11
Q

Causes of infantile vs. adult nystagmus

A

Infantile — 90% caused by functional or anatomical sensory defect

Adults — may have nystagmus from dysfunctional labyrinth/vestibular system while turning head, intoxication (e.g., alcohol or PCP), or neurological dysfunction

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12
Q

Nystagmus is ocular ataxia or rhythmical oscillation of the eyes. Testing involves _____ movement of the eyes

What are the 3 types of nystagmus?

A

Horizontal

Horizontal; vertical; rotary

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13
Q

_____ = unequal size of the pupils

A

Anisocoria

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14
Q

Average pupil size

A

4 mm

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15
Q

Pupils should ______ as object becomes close to eyes (convergence test)

A

Constrict

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16
Q

When doing visual field confrontation testing, the ____ fields can be tested simultaneously while the ___ require testing each eye separately and covering the other

A

Temporal; nasal

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17
Q

When examining patient’s left eye, doc should be holding instrument in ____ hand and using their ____ eye

A

Left; left

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18
Q

During fundoscopic exam, start just lateral of midline to identify _______, then move forward to identify structures in posterior chamber

A

Red reflex (retina)

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19
Q

What structures of posterior chamber should be identified on fundoscopic exam?

A

Optic disc (nasal and inferior)

Arterioles (2 lateral, 2 nasal)

Macula (temporal)

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20
Q

When is fluorescein stain used on eye exams?

A

Used to identify epithelial defect — performed AFTER complete screening including acuity, EOM, etc

Fluorescein has high affinity for basement membrane of epithelium and fluoresces w/cobalt blue or woods lamp — can identify corneal abrasion

21
Q

Describe procedure for eyelid eversion

A

Patient looks downward

Fingers pull lid down, and index finger or cotton tip is placed on upper tarsal border

The lid is pulled up over finger

Lid is everted

22
Q

Benign growth of fibroblastic tissue on eye d/t chronic UV exposure; typically located on medial side and more likely to develop and progress if pt has dry eyes

A

Pterygium

23
Q

Most common pathogens implicated in bacterial conjunctivitis

A

S.aureus (most common in adults)

M.catarrhalis (most common in kids)

Others: S.pneumoniae, H.influenzae

24
Q

Most common cause of viral conjunctivitis

A

Adenovirus

25
Q

Compare/contrast bacterial vs. viral conjunctivitis

A

Both spread by direct contact

Bacterial: commonly unilateral, can become matted shut during sleep, purulent discharge through the day

Viral: may or may not have prodrome of URI sxs, pt may complain of gritty or sandy feeling of eye(s), initially unilateral but becomes bilateral, clear discharge and may have follicular appearance on tarsal conjunctiva

26
Q

Allergic conjunctivitis has airborne allergen association with IgE response and mast cell degranulation

What are some symptoms?

A

Bilateral redness, watery discharge, itching

Associated with allergy symptoms of nasal congestion, sneezing, etc.

27
Q

Acute painful inflammation of the eyelid margins or Meibomianglands

A

Hordeolum (stye)

28
Q

Hordeolum can be sterile when a duct is plugged, or infectious which is most commonly caused by _____

A

S.aureus

29
Q

A ______ hordeolum is caused by Meibomian gland acutely plugged, while a ______ hordeolum is caused by eyelash follicle or lid margin tear gland

Tx is with warm compress; these are more common on the _____ eyelid

A

Internal; external; lower

30
Q

Painless, rubbery, nodular lesion caused by obstruction of Meibomian tear gland

A

Chalazion

31
Q

How should chalazions be managed?

A

No abx are necessary bc they are granulomatous processes

Failure to resolve may require incision and drainage by ophthalmology

32
Q

Chalazions are often associated with ____ and _____

They are more comon on the ____ eyelid

A

Blepharitis; roseacea

Upper

33
Q

Conditions associated with xanthelasma

A

Dyslipidemia (only found in 50% of pts)

Classic for primary biliary cholangitis associated with hypercholesterolemia

34
Q

____ =blood in anterior chamber of the eye; commonly from trauma, but may also be caused by clotting disturbances, vascular abnormalities, or mass effect from neoplasms

A

Hyphema

35
Q

Ophthalmologic emergency likely caused by trauma leading to retrobulbar hematoma — blood collection within bony confines of the orbit leading to increased intraocular pressure

A

Orbital compartment syndrome

36
Q

How does orbital compartment syndrome present?

A

Progressive pain, diplopia, proptosis, diffuse subconjunctival hemorrhage, and chemosis

Delay in tx may lead to permanent vision loss!

37
Q

During fundoscopic exam, _____ can be used to improve visualization

A

Mydriasis/pupillary dilation

38
Q

During fundoscopic exam, how are arterioles differentiated from venules?

A

Arterioles are brighter and smaller than venules

39
Q

Describe findings on normal funduscopic exam

A

Color of fundus is brown or orange. A slightly dark spot in the middle is the macula. At the portion 15 degrees nasally from the center on the horizontal axis is the papilla of the optic nerve, which appears slightly brighter.

The border between the papilla and surrounding retina is clearly defined. The center of the papilla is indented and brighter than the periphery, and appears pale yellow.

The arteries are bright red and the veins are darker, and int he center of the arteries appears a white linear reflection about 40-45% of the artery in width

40
Q

The following description of a funduscopic exam represents what pathologic condition:

Arterial vasoconstriction grade 3, arteriosclerosis grade 1, hemorrhages, cotton wool spots, and simple vein concealment. The diameter of the constricted arteries is irregular and less than half that of the corresponding veins. Spotty hemorrhages are scattered. Soft exudates (cotton wool spots) exhibit localized insufficient blood supply of the optic nerve tissue.

A

Hypertensive retinopathy

41
Q

The following description of a funduscopic exam represents what pathologic condition:

Small red microaneurysms, scattered spotty hemorrhages, and hard exudates

A

Simple/background diabetic retinopathy

42
Q

The following description of a funduscopic exam represents what pathologic condition:

The papilla of the optic nerve swells and protrudes into vitreous body. The apical indentation disappears, and the boundary between papilla and surrounding retina becomes unclear. The amount of bleeding and exudation is smaller with less degree of venous engorgement

A

Chronic phase papilledema

[contrast to acute — which has more bleeding and exudation, more venous engorgement]

43
Q

The following description of a funduscopic exam represents what pathologic condition:

Optic disc cupping (indentation of optic papilla becomes pale/enlarged and diameter becomes over 60% of the total diameter of the papilla); normal coloration of margin of papilla, and border between papilla and surrounding retina is distinct. Nerve fiber bundle defect appears in a radiating pattern from the papilla

A

Glaucomatous optic atrophy

44
Q

The following description of a funduscopic exam represents what pathologic condition:

Flame-shaped hemorrhages and cotton wool spots; in areas without hemorrhages, crossing phenomena by arteriosclerosis can be observed

A

Retinal vein occlusion (acute phase)

[occurs at venous/arterial crossings where veins are pressed by sclerotic arteries]

45
Q

The following description of a funduscopic exam represents what pathologic condition:

Series of whitish spots; white lines replace retinal veins

A

Retinal vein occlusion (after retinal laser photocoagulation)

46
Q

The following description of a funduscopic exam represents what pathologic condition:

Localized exudative retinochoroiditis, usually in posterior area of the retina; may appear as white/gray lump seen at the macula

A

Toxoplasmosis

47
Q

The following description of a funduscopic exam represents what pathologic condition:

Macular exudate and subretinal hemorrhage, typically in pts over age 60

A

Age-related macular degeneration

48
Q

The following description of a funduscopic exam represents what pathologic condition:

Papilla swells and protrudes into vitreous body. The apical indentation disappears. The boundary between the papilla and the surrounding retina becomes unclear, and the retinal veins become engorged. Splinter hemorrages appear in the retina

A

Acute phase papilledema

PCM III Midterm (10 decks)

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