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Clin Med 3 > Eyes - Lab > Flashcards

Eyes - Lab Flashcards

1
Q

measurement of the smallest object a person can see at a given distance (tests CNII, measurement of central vision)

A

visual acuity

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2
Q

What test would be used if a patient has complaints regarding near vision?

A

Rosenbaum pocket eye chart

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3
Q

At what distance should a patient hold the Rosenbaum pocket eye chart from?

A

no closer than 14 inches

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4
Q

What test could be used to check patient’s distance vision, central vision, and CNII?

A

Snellen chart

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5
Q

At what distance should a patient stand from the Snellen chart?

A

20 feet

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6
Q

The results of vision test using a Snellen chart is reported in fractions, what does the numerator indicate? Denominator?

A

numerator is the distance between the patient and the eye chart (20)
denominator is the distance at which a person with normal acuity reads

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7
Q

If the result of a Snellen chart is 20/100, what does this mean?

A

the patient can read at 20 feet what the average person reads at 100 feet.

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8
Q

What is the range of a normal adult visual acuity?

A

20/12 to 20/25

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9
Q

What is the near normal range when using a Snellen chart to assess visual acuity?

A

20/30 to 20/70

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10
Q

What is the moderate low range when using a Snellen chart to assess visual acuity?

A

20/80 to 20/160

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11
Q

What is the severe low range when using a Snellen chart to assess visual acuity?

A

20/200 to 20/400

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12
Q

What do you inspect on eyebrows?

A

size, extension and texture

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13
Q

A patient has short eyebrows that do not extend beyond temporal canthus and are coarse, what should you be thinking?

A

hypothyroidism

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14
Q

What do you inspect in the orbital area?

A

ptosis, edema, sagging, drainage, or lesions

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15
Q

Periorbital edema is abnormal, what are some causes?

A

it varies: thyroid disease, allergies, or renal disease

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16
Q

yellow-tinted flat to slightly raised, irregularly shaped lesions

A

xanthelasma

abnormal lipid metabolism

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17
Q

Would you see inflammation or drainage in the eyelids of a newborn?

A

NO, newborn eyelids can be swollen or edematous due to birth trauma, but inflammation or drainage are abnormal

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18
Q

What are some things you would inspect for eyelids and eyelashes?

A

symmetry, color, quantity, blinking patterns, ptosis, tremors, flakiness, lesions, inflammation, and edema

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19
Q

What kind of eyelid movements can be seen in a patient with hyperthyroidism?

A

fasciculations or tremors

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20
Q

What test can be performed if you suspect a patient has foreign object or polyps in the eyelid?

A

eyelid eversion

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21
Q

What test do you use to evaluate a patient’s peripheral visual fields?

A

confrontation test

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22
Q

What tests for hemianopia’s and quadrantanopia’s?

A

confrontation test

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23
Q

Briefly describe how to perform the confrontation test

A

1) stand about one meter away from the patient
2) ask the patient to close their left eye, you close your right eye
3) have the patient look directly at you
4) very slowly move your fingers into the visual field halfway between you and the patient, this is done in four quadrants at 45 degrees
5) ask patient to tell you when they see your finger
6) compare the time your patient see your finger with the time you see your finger
7) repeat in the other eye

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24
Q

Will a normal test result from a confrontation test rule out a visual field deficit?

A

NO, an abnormal result is significant, a normal result is not

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25
Q

Name the eye muscles involved with the following eye movement: right and up

A

right superior rectus

left inferior oblique

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26
Q

Name the eye muscles involved with the following eye movement: right

A

right lateral rectus

left medial rectus

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27
Q

Name the eye muscles involved with the following eye movement: right and down

A

right inferior rectus

left superior oblique

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28
Q

Name the eye muscles involved with the following eye movement: left and up

A

left superior rectus

right inferior oblique

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29
Q

Name the eye muscles involved with the following eye movement: left

A

left lateral recuts

right medial rectus

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30
Q

Name the eye muscles involved with the following eye movement: left and down

A

left inferior rectus

right superior oblique

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31
Q

Briefly describe how to test for convergence. What could difficulty with convergence suggestive of?

A

ask the patient to follow your finger as you bring it closer to their nose
hyperthyroidism

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32
Q

What should be inspected regarding the pupils?

A

shape, size and equality

**Record pupil size in each eye in the SOAP note (for SPAL)

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33
Q

What is direct pupil response?

A

when a light source is held in front of one eye and you watch for ipsilateral constriction (the same eye)

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34
Q

What is consensual pupil response?

A

when a light source is held in front of one eye and you watch for contralateral constriction (the opposite eye)

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35
Q

What results would you expect for a normal light reaction reflex?

A

pupils will constrict equally in both pupils (due to identical signals from the midbrain)

36
Q

What are abnormal results for a light reaction reflex?

A

constriction of one pupil but not the other

slow or no reaction to light

37
Q

What reflex grading would you use if a patient has brisk, hyperactive, with intermittent or transient clonus response to light reaction reflex?

A

4+ (hyperresponsive actions are rare)

38
Q

What reflex grading would you use if a patient has sluggish or diminished response to light reaction reflex?

A

1+

39
Q

What reflex grading would you use if a patient has more brisk than expected, slightly hyperactive response to light reaction reflex?

A

3+

40
Q

What reflex grading would you use if a patient has no response to light reaction reflex?

A

0

41
Q

What reflex grading would you use if a patient has active or expected response to light reaction reflex?

A

2+

42
Q

What cranial nerve is involved with near reaction?

A

oculomotor nerve (CN III)

43
Q

What are the three phases of a near reaction?

A

1) constriction of the pupils
2) convergence of the eyes
3) accommodation of the lens (cannot visualize)

44
Q

Briefly describe how to perform a near reaction

A

the patient shifts gaze from a far object to a near object approximately 10 cm away from their eyes
Normal: constriction and convergence are observed

45
Q

What abnormality can be detected using the swinging flashlight test?

A

relative afferent pupillary defect (Marcus Gunn pupil)

*remember afferent is sensory (CN II)

46
Q

What is indicative of an abnormal result for the swinging flashlight test?

A

slow dilation without initial constriction, may indicate lesion of the optic nerve or retinal lesion

47
Q

Will dense cataracts affect the results of a swinging flashlight test?

A

no

48
Q

What do you look for in a visual inspection of the eye?

A

gross abnormalities, scars, opacities, cloudiness

49
Q

What is the purpose of a lateral penlight test?

A

to observe anterior chamber depth, tests for glaucoma

**this test MUST be don before instilling mydriatics

50
Q

Briefly describe how to perform a lateral penlight test

A

stand in front of patient and shine light from temporal side of head across front of the eye parallel to plane of iris

51
Q

What are you looking for once you shine the light into the patient’s eye during a lateral penlight test?

A

you’re looking for a shadow in nasal aspect of iris

more than 2/3 of nasal iris in shadow (may indicate shallow chamber)

52
Q

What does the corneal light reflex tests for?

A

ocular alignment

presence of esotropia, exotropia, hypertropia or hypotropia (uneven gaze between the two eyes)

53
Q

Briefly describe how to perform the corneal light reflex

A

1) the patient is staring at a distant object (15 feet away)
2) shine penlight directly in front of the patient at a distance of two feet
3) compare where the light is reflecting in both eyes
Normal: symmetry is observed

54
Q

esotropia

A

eye is inward from the light reflection (medially)

55
Q

exotropia

A

eye is outward from the light reflection (laterally)

56
Q

hypertropia

A

eye is above from the light reflection

57
Q

hypotropia

A

eye is below from the light reflection

58
Q

What test is used to detect tropias?

A

cover test

**patients over age of 6 or 7 months

59
Q

What test is used to test CN V1 & V2 and the CN VII?

A

corneal reflex to touch

60
Q

What test is used to detect present of phorias?

A

cover-uncover test

61
Q

Which eye are you observing when performing the cover test?

A

the uncovered eye

62
Q

Which eye are you observing when performing the cover-uncover test?

A

the covered eye as it is being uncovered

63
Q

During the cover test the patient’s eye moved outward, what type of tropia is this?

A

esotropic

the eye was originally inward and now it moved outward

64
Q

During the cover test the patient’s eye moved inward, what type of tropia is this?

A

exotropic

the eye was originally outward and now it moved inward

65
Q

During the cover test the patient’s eye moved upward, what type of tropia is this?

A

hypotropic

eye was originally downward and now it moved upward

66
Q

During the cover test the patient’s eye moved downward, what type of tropia is this?

A

hypertropic

eye was originally upward and now it moved downward

67
Q

During the cover-uncover test the patient’s eye moved outward, what type of phoria is this?

A

exophoria

68
Q

During the cover-uncover test the patient’s eye moved inward, what type of phoria is this?

A

esophoria

69
Q

When performing the corneal reflex to touch, you provided a gentle stimulation to one cornea, what should be expected as a normal result?

A

both eyes will blink

70
Q

When performing the ophthalmoscopic inspection, when should you use the small light source? What about the large light source?

A

small light source should be used for undilated pupils

large light source should be used for dilated pupils and better illumination

71
Q

What do you use the green light for on the opthalmoscope?

A

drusen bodies, nerve fiber defects or blood

72
Q

What do you used the grid for on the opthalmoscope?

A

to identify size of lesions

73
Q

When would you use the slit of the opthalmoscope?

A

to examine the anterior chamber and to determine elevation of lesions

74
Q

If your patient is myopic (near-sighted), what lens should you use to focus on the retina?

A

minus (red) lens

75
Q

If your patient is hyperopic (far-sighted), what lens should you use to focus on the retina?

A

plus (black) lens

- this is also used for those who are lacking a lens

76
Q

What would obscure the red reflex?

A

opacities such as corneal scars, cataract, and vitreous hemorrhage

77
Q

A-V nicking is seen in what type of patients?

A

hypertensive

78
Q

When examining a patient’s optic disc, you find it to be pale and clearly demarcated, is this normal? If not, what could it be?

A

No, it is not normal, this is optic atrophy

79
Q

What does pathological cupping indicative of?

A

glaucoma

80
Q

What is the most common cause for new vessels on the optic disc?

A

proliferative diabetic retinopathy

81
Q

If the optic disc is observed to have blurred margins with or without hemorrhages, what could it be indicative of?

A

papilledema-bilateral

82
Q

When observing blood vessels in the eye, what should you be looking for?

A

look at the mid-periphery for scars (inflammatory, laser), hemorrhages, exudates, pigment (white, black) and pigmented lesions

83
Q

Where will you find the macula in relation to the optic disc?

A

temporal/ lateral to the disc (about two disc diameters away)

84
Q

The foveal reflex is seen better using which color filter?

A

green

85
Q

What are some common things you ill see in the macula?

A

circinate ring of hard exudates, hemorrhage (dot, blot, or flame), or pigment deposition

Clin Med 3 (11 decks)

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