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PPO 5 > Lec 2: Fundus BIO > Flashcards

Lec 2: Fundus BIO Flashcards

1
Q

Dilated exam IS part of a comprehensive exam in order to bill what two codes?

A

92004 (new)

92014 (established)

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2
Q

Refraction and binocular assessment alone does not complete a comprehensive eye examination. The patient MUST have a fundus assessment. This can be done dilated or not, with the preference of dilation. (T/F)

A

true

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3
Q

whats the difference b/w direct and indirect ophthalmoscopy?

A

direct: upright, non inverted image
indirect; anatomically in correct position

indirect: inverted, aerial image b/w examiner’s eye and condensing lens

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4
Q

techniques using direct views

A

goldmann 3 mirror with Hruby lens

direct ophthalmoscope

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5
Q

technique using indirect view

A

hand held condensing lens (inverted and reversed)

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6
Q

Preferred technique of posterior pole examination

A

fundus biomicroscopy

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7
Q

! Lens diameter > 90D
! Magnification >90D
! FOV <90D
! 8mm working distance

A

78 D

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8
Q

! Good with small pupil
! Small, ring design
! Fov ~30 – 40 degrees
! 7mm working distance

A

90 D

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9
Q

! Good “work horse” lens for biomicroscopy

! Preferred lens for undilated views

A

90D

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10
Q

! Preferred lens for glaucoma suspects and diabetic retinopathy

A

78D

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11
Q

! Small, diameter, >90D
! Designed to provide same mag as the 90D with >fov
! 7mm working distance

A

super 90

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12
Q
  • specially designed for high res of posterior pole
  • lens diamter > 78D
  • Mag > 78D but designd to give same fov as 78D
  • 11mm wd
A

super 66

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13
Q

pt with deep set eye

what lens should u use?

A

78D b/c it has a longer wd (super 66 would be great too)

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14
Q

! Ideal for posterior pole
! Diameter similar to 78D
! Fov similar to 78D with more mag than 78D
! 13mm working distance

A

digital high mag

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15
Q

! “Ultimate” 90, similar mag and much wider filed of view

! Working distance VERY SHORT at 5-6mm

A

digital wide field

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16
Q

The proper _____________ allows the back focus of the lens to be fixed right at the pupil, permitting the examiner to move the joystick and effectively scan the full field the lens provides

A

working distance

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17
Q

condensing lens

SET-UP:

A

! Medium - High illumination in click position
! 10x
Using 90D or Superfield start with 10x-16x
Using 78D stay 10x
! Parallelepiped beam height 5-6mm
! For HS BQ900 use Polaroid filter ON and aperture 1-3

18
Q
  1. Focus on pupil (iris in focus)
  2. Put lens in place holding it perpendicular to light
  3. From outside of scope SEE the light go thru the pupil
  4. While looking thru oculars pull the scope back [holding hand very still] until see image
  5. Continue to pull back until image in focus
A

musts for how to fundus biomicrosopy

19
Q

You are examining OS and superior-temporal arcades. The view is lost as you reach the outer limit of the 90D lens. Your corrective maneuver is to move where?

A

examiner’s left

Why does this work?
Ans: your views are inverted and reversed

20
Q

o Macula and optic nerve
o Superior and inferior vessel arcades
o Temporal vessels arc around the fovea on their way to the periphery
o Nasal vessels radiate straight from the disc to equator

A

posterior pole

21
Q

It is important to keep your views CENTERED in the lens. Accomplish this by doing what?

A

moving your lens and/or asking the patient to make slight fixation adjustments

22
Q

if you want optic nerve to move to your left, where do we tell the patient to look?

A

slightly to their right

23
Q

If you are scanning across and reach the outer limit of your lens diameter, the corrective maneuver is to do waht?

A

move your lens IN the direction of your scans

24
Q

o Long posterior ciliary nerves at 3 & 9 o’clock represent the anatomical horizontal meridians
o Divides the retina into superior/inferior

A

horizontal meridian

25
Q

o Short ciliary nerves seen between 10 and 2 as well as 4 and 6 o’clock represent the anatomical verHcal meridians
o Divides the retina into nasal/temporal

A

vertical meridian

26
Q

– Vortex ampulla are located just posterior (~3mm) to the
ORA
– There are at least 4 to 6 vortex veins (ampulla) – Located in the 1, 5, 7, 11 o’clock meridians

A

anterior/posterior retina

27
Q

anterior/posterior retina is divided by what?

A

the equator

28
Q

– The junction between the retina and ciliary body – Nasal ora appears “serrated”

A

ora serrata

29
Q

layers towards the choroid/sclera

A

outer

30
Q

layers towards the vitreous

A

inner

31
Q

near the front of eye, closer to ora serrata

A

anterior

32
Q

near the back of eye, closer to posterior pole

A

posterior

33
Q

if pt looks up, where do we tilt lens?

A

bottom of lens towards pt

34
Q

All views are inverted and represent the view of an angle or area of retina 180 degrees away

A

all mirrors in 3 mirror goldmann (not Hruby lens)

35
Q
  • stereoscopic exam of retina
  • stable view of post pole
  • magnified view of peripheral ret
  • performed AFTER PERIPH RET EXAM WITH BIO
A

3 MIRROR fundus indications

36
Q 
!  Severe corneal surface disease 
!  Recent eye surgery
!  Complications of trauma
   ◦ Hyphema 
   ◦ Corneal Laceration
    ◦ Globe perforation
A

contraindications of 3 mirror

37
Q

posterior pole (PP) views

A

central lens (hruby)

38
Q

equator to PP (“mid-periphery”)

A

trapezoid

39
Q

equator to ora (‘Periphery”)

A

rectangle

40
Q

CB, pars plana

A

gonio mirror

41
Q

The D-shaped/thumbnail mirror may be used to view what?

A

pars plana with widely dilated pupils

42
Q
  1. Focus on iris around pupil
  2. Move light into mirror of interest
  3. find orange glow
  4. push in and scope v. pull back
A

slit lamp set up same as gonio and 78/90D

PPO 5 (3 decks)

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