Internal Eye

Question 1

At what distance do we hold the ophthalmoscope when assessing the red retinal reflex?

Answer 1

6 inches away from patient’s eye

Question 2

What does it mean when the red retinal reflex is created without any dark shadows?

Answer 2

No opacities of the cornea (scars), lens (cataracts), nor blood or pus in the aqueous or vitreous fluids

Question 3

What are cataracts?

Answer 3

Abnormal progressive loss of lens transparency

Question 4

What causes cataracts?

Answer 4

Degenerative changes usually occurring after age 50

Question 5

What is the eventual appearance of cataracts?

Answer 5

Gray-white opacity

Question 6

What is the vision like in a patient with cataracts?

Answer 6

Progressively blurry vision as if looking into frosted glass

Question 7

What is unique about the tendency to develop cataracts?

Answer 7

Inherited

Question 8

What should be the shape and color of the optic nerve head, and the ratio between the opt disc and the physiologic cup?

Answer 8

Shape = disc-shaped/round
Color = yellow-orange
Ratio = cup usually less than 1/2 the entire disc area

Question 9

Where is a choroidal crescent located?

Answer 9

On the optic nerve head

Question 10

Choroidal crescents are especially common among what population?

Answer 10

Near-sighted individuals (myopic patients)

Question 11

What is unique about the vascularization of the physiologic cup?

Answer 11

Lack a capillary bed (appears as a small light yellow area for this reason)

Question 12

What is the physiologic cup?

Answer 12

Small indentation of the optic nerve head from which blood vessels emerge from

Question 13

What are the four layers of the eye before the retina that are assed via the red retinal reflex?

Answer 13

1 cornea
2 aqueous humor
3 lens
4 vitreous humor

Question 14

Which are usually fatter: arteries or veins?

Answer 14

Veins

Question 15

Which border of the optic disc is often not as sharp as the rest?

Answer 15

Nasal border

Question 16

What should be the overall general appearance of a normal and healthy retina?

Answer 16

Uniform red color and texture

Question 17

Describe the appearance of both the macula and fovea.

Answer 17

Macula - darker pigmented area in retina

Fovea - pinhole dot of light in the macula

Question 18

What is the most sensitive part of the retina?

Answer 18

Macula/fovea

Question 19

Why is the macula/fovea region difficult to inspect?

Answer 19

1 most sensitive part of retina
2 pupil will further constrict
3 patient won’t hold still

Question 20

Where is the macula located in relation to the optic disc?

Answer 20

2 disc diameters lateral

Question 21

If papilledema is observed, what must be ruled out as a cause?

Answer 21

Intracranial pressure

Question 22

Is an atypical, deep, and escalating headache present in all cases of papilledema?

Answer 22

No, about 25%

Question 23

How is visual acuity affected by papilledema?

Answer 23

Only affected in advanced stages

Question 24

What is the most consistent funduscopic finding associated with space occupying intracranial lesions?

Answer 24

Papilledema

Question 25

What is the funduscopic appearance of papilledema?

Answer 25

Distorted optic disc with blurry borders

Question 26

What are the signs and symptoms of chronic glaucoma?

Answer 26

1 headaches originates near eyes 2 tunnel vision 3 increased physiologic cup size

Question 27

What is the cause of the increased physiologic cup size seen with chronic glaucoma?

Answer 27

Atrophy (whitening) of nerve fibers leading to blindness

Question 28

What are the general symptoms of diabetes mellitus?

Answer 28

Frequent urination and thirst

Question 29

What is the most frequent form of diabetic neuropathy?

Answer 29

Bilateral sensory loss in the feet

Question 30

What is the most common symptoms of neuropathy in 50-60% of males with diabetes mellitus?

Answer 30

Impotence with gradual firmness of erections over 6-12 months

Question 31

What diagnostic test is used in suspected cases of diabetes as the "gold standard"?

Answer 31

Glucose tolerance test

Question 32

When are funduscopic signs of diabetic retinopathy usually first detected?

Answer 32

5 or more years after diagnosis

Question 33

Funduscopic signs of diabetic retinopathy may only be present in 50% of patients to some degree how many years post diagnosis?

Answer 33

10

Question 34

What are the funduscoptic signs of diabetic retinopathy in order of earliest to latest stages?

Answer 34

1 microaneurysms 2 hard exudates 3 soft exudates 4 neovascularization

Question 35

Are there any obvious signs of hypertension?

Answer 35

No

Question 36

What kinds of funduscopic signs may be seen with hypertensive retinopathy?

Answer 36

1 arteriole constriction/A-V tapering 2 flame-shaped hemorrhages 3 silver-wiring

Question 37

Is retinal detachment always due to trauma?

Answer 37

No (can be age-related)

Question 38

Shrinkage of which fluid of the eye occurs in retinal detachment?

Answer 38

Vitreous

Question 39

What population is especially at risk for retinal detachment?

Answer 39

Near-sighted people over 50 years old

Question 40

What are symptoms of retinal detachment?

Answer 40

1 new vitreous floaters 2 flashing lights 3 loss of peripheral vision in the area of detachment

Question 41

What kind of eye condition is associated with an adult with a narrow corneal angle?

Answer 41

Acute glaucoma

Question 42

What is the genetic eye condition where night blindness occurs followed by progressive tunnel vision starting during youth and appears as a "bone spicule" retinopathy?

Answer 42

Retinitis pigmentosa

Question 43

Which eye condition is often due to atherosclerosis and usually precedes a vascular event like a stroke?

Answer 43

Amaurosis fugax

Question 44

What are the physical findings of amaurosis fugax?

Answer 44

Small embolus or thrombus in retinal artery, possible carotid bruit

Question 45

What are the symptoms of central cataract?

Answer 45

Central blurred vision progressing into a central scotoma

Question 46

What are the symptoms of macular degeneration?

Answer 46

Slowly progressive central vision loss with distorted images

Question 47

What are the physical exam findings involved with macular degeneration?

Answer 47

Altered color and configuration of the macula/fovea