Eyes

Question 1

How do you encourage an infant to open their eyes?

Answer 1

1. dimly lit room
2. hold infant upright, suspended under its arms
3. have parent hold infant over a shoulder

Question 2

In a newborn, eyelids may be swollen or edematous, accompanied by conjunctival inflammation and drainage as a consequence or what?

Answer 2

routinely administered antibiotics

Question 3

What would redness, hemorrhage, discharge, or granular appearance indicate?

Answer 3

1. infx
2. allergy
3. trauma

Question 4

What is hypertelorism?

Answer 4

Widely spaced eyes

Question 5

What is another name for Coloboma?

Answer 5

Keyhole pupil

Question 6

What are the symptoms of a coloboma?

Answer 6

Loss of pupil function and often associated with other congenital abnormalities

Question 7

What are white specks in a linear pattern around the circumference of the iris called?

Answer 7

Brushfield spots

Question 8

What do brushfield spots suggest?

Answer 8

downs syndrome

Question 9

What two types of strabismus’ are there?

Answer 9

1. Exoptropic = eye deviated outward

2. Esotropic = eye deviated inward

Question 10

How can a strabismus be corrected?

Answer 10

proper lens’

Question 11

What tests do you perform to find out it is a stabismus?

Answer 11

1. corneal light reflex (hirschbergs test)
2. cross-cover test
3. cover-uncover test

Question 12

When performing a corneal light reflex aka hirschberg’s test how far away is the penlight when looking for symmetrical reflection from each cornea?

Answer 12

30 cm

Question 13

What is the result of a corneal light reflex with a pseudostrabismus?

Answer 13

symmetrical

Question 14

Who arre pseudostrabismus’ most commonly found in?

Answer 14

Asian and african american populations

Question 15

When do pseudostrabismus’ usually disappear by?

Answer 15

1 year old

Question 16

What condition has an asymmetrical light reflex?

Answer 16

strabismus

Question 17

What test is being performed when the pt. stares at penlight and doctor covers one eye and observes the uncovered eye for movement?

Answer 17

Cross-cover test

Question 18

What are the possible findings for the cross-cover test:

1. Normal = ?
2. Exotropic eye = ?
3. Esotropic eye = ?

Answer 18

1. Normal = no movement
2. Exotropic eye = Moves lateral to midline
3. Esotropic eye = Moves medial to lateral

Question 19

What test is being performed with pt. stares at the penlight and the doctor covers one eye and then observes as it is uncovered?

Answer 19

cover-uncover test

Question 20

What are the findings for the cover-uncover test:

1. normal = ?
2. Exotropic = ?
3. Esotropic= ?

Answer 20

1. normal = no movement (remains fixed on light)
2. Exotropic eye = moves lateral
3. Esotropic eye = Moves medial

Question 21

What is paralytic Strabismus?

Answer 21

Impairment of extraocular muscles or their nerve supply

Question 22

What is nonparalytic strabisumus?

Answer 22

no muscle weakness, and pt. can focus with either eye but not both simultaneously

Question 23

What is a concern with nonparalytic strabismus?

Answer 23

developing amblyopia

Question 24

What is amblyopia?

Answer 24

reduced vision in an eye that appears strucurally normal

Question 25

What is characterized by congenital non-progressive horizontal ophthalmoplegia (inability to move the eyes)?

Answer 25

Duane's syndrome

Question 26

What is primarily affected with duane syndrome?

Answer 26

1. abducens nerve 2. abducens nucleus 3. lateral rectus muscle

Question 27

What is absent or hypoplastic in pts. with duane syndrome?

Answer 27

the abducens nucleus and nerve

Question 28

Which type of Duane syndrome is there an absent to markedly restricted abduction and adduction and retraction of the globe and narrowing of the palpebral fissure on attempted adduction?

Answer 28

Type 3

Question 29

Pt. with what type of Duane syndrome more commonly have upshoot and downshoot of affected globe on attempt to adduct the eye?

Answer 29

Type 1 and 2

Question 30

Upon shining a bright light at the infant's eyes (optical blink reflex) what should be the reaction?

Answer 30

quick closure of eyes and dorsiflexion of the head

Question 31

Through what degrees can you expect an infant to focus and track through?

Answer 31

60 degrees

Question 32

How do you assess visual acuity of an infant?

Answer 32

grossly examine by observing infant's preference for looking at certain objects

Question 33

How do you assess visual acuity of a child?

Answer 33

Observe playing with toys (stacking, building, or placing objects inside of others) if performed well visual difficulties are unlikely

Question 34

At what age are children usually able to cooperate with a snellen chart exam?

Answer 34

3 years old

Question 35

What does a snellen E chart result of 20/25 + 2 mean?

Answer 35

Child can read all on the 20/25 line plus two letters from the 20/20 more difficult line

Question 36

What is a good way to explain the snellen E chart to kids?

Answer 36

point which way the legs are pointing

Question 37

What could a difference (even slight) on visual acuity between eyes indicate?

Answer 37

amblyopia

Question 38

``` What is the anticipated visual acuity of the following ages: 3 y/o = 4 y/o = 5 y/o = 6 y/o = ```

Answer 38

3 y/o = 20/50 4 y/o = 20/40 5 y/o =20/30 6 y/o =20/20

Question 39

When should the red reflex be elicited?

Answer 39

in every newborn, performed from birth on

Question 40

What does the red reflex test observe for?

Answer 40

1. opacities 2. dark spots 3. whit spots w/in the circle of red glow

Question 41

What does an abnormal or "white" reflex indicate?

Answer 41

1. congenital cataracts | 2. retinoblastoma

Question 42

What eye condition requires a full metabolic, infectious, systematic and genetic workup?

Answer 42

Congenital cataracts

Question 43

What are some common causes of congenital cataracts?

Answer 43

1. infectioius diseases (toxoplasmosis, rubella (MC), cytomegalovirus, and herpes 2. hypoglycemia 3. trisomies 4. prematurity

Question 44

What is the MC infectious disease to cause congenital cataracts?

Answer 44

Rubella

Question 45

What is a congenital malignant tumor in a child <2 y/o?

Answer 45

Retinoblastoma

Question 46

What is the initial sign of a retinoblastoma?

Answer 46

"white" reflex

Question 47

What is seen on a fundoscopic exam with a pt. that has a retinoblastomoa?

Answer 47

1. ill defined mass arising from the retina | 2. chalky-white areas of calcification

Question 48

You should defer a fundoscopic examination until the child is __ - __ old unless patient presentation suggests a need.

Answer 48

2-6 months

Question 49

In what condition are blood vessels straightened and diverted temporally and cicatrical changes may be severe?

Answer 49

Retinopathy of prematurity

Question 50

With a retinopathy of prematurity what is there and increased risk of?

Answer 50

1. retinal detachment 2. Glaucoma 3. Blindness

Question 51

Retinal findings on a supine fundoscopic exam appear "upside down" T/F

Answer 51

True

Question 52

What are the 3 screening methods for newborns to 3 months and what would require further evaluation?

Answer 52

1. red reflex; asymmetric 2. corneal light reflex; Asymmetric 3. inspection; structurally abnormality

Question 53

What are the 5 screening methods for a pt. 6 months old - 1 year, and what findings would require further evaluations with these screenings?

Answer 53

1. Red reflex; Evaluation Abnormal or Asymmetric 2. Corneal light reflex; Asymmetric 3. Differential occlusion; Failure to object equally to covering each eye 6. Fix and follow with each eye; Failure to fix and follow 7. Inspection; Structural abnormality

Question 54

What are the 5 screening methods for a pt. ~3 years old, and what findings would require further evaluations with these screenings?

Answer 54

1. Visual acuity; <20/50; 2 lines of difference between the eyes 2. Red reflex; Abnormal or asmmetric 3. Corneal light reflex; Cover-uncover; Asymmetric/ocular refixation movements 4. Stereoacuity; Failure to appreciate random dot stereogram 5. Inspection; structural abnormality

Question 55

What are the 5 screening methods for a pt. ~5 years old, and what findings would require further evaluations with these screenings?

Answer 55

1. Visual acuity; 20/30 or worse 2. Red reflex; Abnormal or asymmetric 3. Corneal light reflex; cover -uncover; Asymmetric; ocular refixation movements 4. Sftereoacuity; Failure to appreciate random dot stereogram 5. Inspection; structural abnormality