Lab Final Flashcards
1
Q
Small pupils
A
Old, dark eyes, pilocarpine, heroin, allergies, alcoholism
2
Q
Big Pupils
A
Young, light eyes, antihistamine, steroid, scopalamide
3
Q
CN III
A
- MR-add
- SR-eleve
- IR-dep
- IO-ext
4
Q
CN IV
A
- SO-int
5
Q
CN VI
A
- LR-Abd
6
Q
Addies Tonic Pupil
A
Efferent pathway. Affected eye is big. POOR direct. Near response is slow but prolonged. will dilate with 0.125% pilocarpine. Veriform movement
7
Q
Addie’s Syndrome
A
Decreased corneal sensitivity, deep tendon reflex, tonic pupil
8
Q
Argyll-Robertson
A
Tectum. Pupil normal or small and irregular. NO direct. GOOD near. Can be unilateral–>bilateral
9
Q
APD
A
Afferent. Normal pupil. Pupil dilates with direct.
10
Q
Horner’s Syndrome
A
Sympathetic. Anisocornia in dark. Small pupil. POOR direct and near. Hydroxymethamine 1. One eye-post 1. both-pre
11
Q
CN III palsy
A
Eye is down and out. No direct or near response. An emergency
12
Q
Normal exophathalmous readings
A
12-21. Up to 24 if black
13
Q
Diff. in exophathalmous
A
1-2 mm
14
Q
Pachymetery
A
Measures the corneal thickness
15
Q
Normal corneal thickness
A
550 nm. Must be within 5 of each other. 570 for white.
16
Q
Thin cornea
A
Will have decreased pressures. More at risk of glaucoma as abnormally low
17
Q
IOP and Pachy
A
Must adjust IOP by 4 mm hg for every 80 micrometers off average
18
Q
Insurance and cataract
A
Must be worse then 20/40
19
Q
PAM
A
PT. is dilated. On the SLAMP. Dial in ES. NO rxn. Improvement means good candidate. Smallest line is PA.
20
Q
BAT
A
Pt. NOT dialted. Habitual rxn. Acuity will get worse with light if have cataracts.
21
Q
Super pinhole
A
Pt. is dilated. Habitual RXN. 5 ft. test distance. Vas should improve.
22
Q
Interferometer
A
When they get half right this is their PA. No Rxn. Dilated. For amblyopes and dense cataracts
23
Q
Cataract test where you are NOT dilated
A
BAT
24
Q
Cataract test where you do not wear glasses
A
PAM, interformeter
25
Cataract test where you wear glasses
pinhole and bat
26
+ sidel sign
If you put fluoroscene on and it leaks out. The cornea has ruptured
27
Loupe and magnet
Superficial FBs
28
Spud
Mini golf club. Good for embedded FBs
29
Polytome
swiss army knife
30
Needle
Sterile cheap
31
Alger brush
Use to clear up metabolic FB. Leave rust deeper than bowman's.
32
Line 1 of Rxn
Med and amount and form
33
Line 2 of rxn
How many to disp
34
Line 3
Instructions for pt.
35
When to do stromal puncture
Pt. with RCE
36
Care after FB removal
AB, patch, tell them they loose 1/2 field
37
Patch rule
Patch never sees sunset twice.
38
OCT
Ocular Coherence Tomography
39
AS-OCT useful with...
Keratoconus, corneal degenerations, recurrent micro cysts, corneal scars, cornea transplant, angle closure
40
5-line raster
Series of scans. 2D image
41
Cube
Horizontal and vertical. Lower resolution but 3D. Good for macula and ON.
42
Time domain
Old, low resole, slow
43
Spectral domain
Exact change in wavelength between lasers, high res, faster
44
Luminescence
Decay in light
45
How does fluoroscene work
Light is absorbed by luminescent material that causes the light to lose energy and be re-emmited. Absorbs 490 (blue) and emits 520 (green)
46
Excitation filter
Transmits 490 nm which is the peak absorption
47
Barrier filter
Transmits 520 which is the emitted peak
48
Fluorescein solution
Eliminiated by liver and kidneys for 24 hours. Normally use 5 mL at 10%.
49
If cannot inject dye
30 mg/kg of oral fluoroscene taken 30-60 min after ingestion
50
When to avoid angiography
Pregnant women. esp in first trimester
51
Moderately severe reactions
1%. Urticaria, SOB, vasovagal rxn, skin necrosis
52
Life threatening cond
.0001%. Anaphylactic shock, seizure, cardio collapse
53
Predmeds with fluoro.
Can use antihistamine or corticosteroids
54
Scalp needle vein
Makes sure extravasation of fluorescein doesn't occur.
55
Set up for procedures
Maximal dilation (6 mm or more is best), color and red free photos
56
Transient eye
Eye of interest
57
Procedure
Establish a venous line. Start time and inject dye rapidly (10 sec). Appear in eyes in 8-12 sec. Take photos every 1.5-2 sec in transient eye for 30 sec. Wait for 3-5 minutes and take more photos.
58
How long to get to eye
8-12 sec
59
Choroidal Flush
8-12 sec. Choriocapillaris leaks dye freely. Usually little detail as RPE filtures. Will see dye in cilioretinal artery.
60
Arterial phase
2s after choroidal. Retinal arteries fill. Fills from lumen out. choroid can get patchy
61
Arteriovenous phase
retinal arteries, capilaries and veins contain fluoroscene. Early part of phase is lamellar phase when fluoroscene is visualized in larger veins.
62
Venous phase
30 sec after injection. Fluorescein leaves the arteries and veins have increased fluoroscene. Perifoveal capillary network is best visualized here.
63
Normal macula color
Macula will by hypo fluorescent (taller more pigment RPE, xanthophyll pigment, absence of retinal capillaries)
64
Mid phase
Recirculation occurs 2-4 min. after injections. The arteries and veins are roughly equal brightness
65
Late phase
Gradual elimination of dye from retina and choroid. Staining of the optic disc is normal. Late hyper fluorescence is abnormal. Photos normally taken 7-15 min after injection.
66
Retinal circulation
Supplies inner 2/3 of retina. Non-fenestrated. Blood-retinal barrier via tight junctions. Autoregulation, perfusion pressure has negligible effect on blood flow
67
Choroidal circulation
Supplies the outer 1/3 of the retina. Fenestrated, low resistance. Blood retinal barrier via tight junction. No autoregulation
68
Cause of hypofluorescence
Blockage or vascular filling defect
69
Is it blockage or vascular filling defect
If size/shape/location is same as funds photo-->blockage.
70
Pre-retinal Hemmorhage
Pre-retinal hemmorhage cause blockage of all retinal and choroid. Will be same as funds photo.
71
Intraretinal hemmorhage
bleeding stops at 180. Will be blockage. Will see some vasculature.
72
Subretinal hemmorhage
Will see retinal vasculature.
73
CHRPE
Subretinal hypertrophy of the RPE. Blocked chroidal fluorescence and normal retinal fluorscene. Blockage.
74
Choroidal nevus
Blockage at AV stage. Will see vascu.
75
Non-filling of an artery
Will eventually see back flow so this is why it is important to see whole picture
76
Retinal capillary nonperfusion
choroidal fluorescene blocked by opaque retina.
77
CRAO
Blood flow will not get through here quickly. Will tai 30 sec to 1 min instead of 8-12 sec.
78
Preinjection fluorescence
Autofluorescence or pseduofluorescence
79
Autofluorescence
Occurs with optic disc drusen and astrocytic hamartomas
80
Psuedofluorescence
When barrier and excitation filters aren't well matched.
81
Early hyperfluorescence
Vascular. Retinal or choroidal.
82
Microanyeursms
Early hyperflur.
83
Neovascularization
Will have early hyperfluorecence and late leakage.
84
Window defect
Early hyper. Transmission of hyper is seen in the choroid due to damage of RPE. Size is uniform. Borders are well defined. Can also be due to macula hole.
85
Choroid subretinal neovascularization
hyper early. Early fine lacy hyperflur in the sub retinal neovascular. Late=leakage.
86
Leakage
Dye leaks from an intravascular space into an extravascular space. A and size changes with time.
87
Pooling
Dye fills an anatomical space with a defined border.
88
Staining
Deposits of dye in tissue. Normal staining (ON and sclera) Pathological (scars)
89
How long until fluorescein empties from eye
10-15 min
90
Normal staining
1. hyper of disc margins
2. fluor of lamina cribs
3. fluor of the sclera at the disc margin (sclera crescent)
4. fluor of the scleral in lightly pigment fundus
91
Cystoid macula edema
Will have petaloid appearance late. Can also have diffuse leakage (late picture)
92
Central serous retinopathy
Choroidal leakage and pooling into sub retinal space. Early phase shows small hyper fluorescent spot. Late phase shows pooling. Will have borders. Can be smoke stack or ink blot
93
Pigment epithelial detachment
Pooling of luis between bruch and RPE. Early hyper from area of detached RPE. Late phase showing well demarcated hyperfluo. borders. Will get brighter with time!
94
Drusenoid PED
Between RPE and bruch. Drusen stains more in late angio
95
Fibrous scar
Most common location is sub retinal. Will pick up stain as angiogram progresses.
96
Tumors
early hyperfluor and lake leakage
97
Widefiled FA
Difficult as take picture at different time
98
OPTOS
See everything happening at once
99
OCT angiography
Can perform without fluoroscene
