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II. Diagnosing and Prescribing > Midterm I > Flashcards

Midterm I Flashcards

1
Q

What is the widely accepted format for documentation of medical and allied health patient records?

A
  1. Subjective
  2. Objective
  3. Assessment
  4. Plan
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2
Q

What are the three categories of a chief complaint?

A
  1. blur/vision loss
  2. discomfort/pain/irritation
  3. routine vision check
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3
Q

What are the uncorrected spherical errors associated with the following snellen VA’s: 1. 20/20; 2. 20/30; 3. 20/40; 4. 20/60; 5. 20/80; 6. 20/120; 7. 20/200

A
  1. 0.25
  2. 0.50
  3. 0.75
  4. 1.00
  5. 1.50
  6. 2.00
  7. 2.00-3.00
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4
Q

What are the uncorrected cylindrical errors associated with the following snellen VA’s: 1. 20/20; 2. 20/30; 3. 20/40; 4. 20/60; 5. 20/80; 6. 20/120; 7. 20/200

A
  1. 0.25
  2. 1.00
  3. 1.50
  4. 2.00
  5. 3.00
  6. 4.00
  7. 5.00 or greater
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5
Q

What is a complete and thorough listing of all the patient’s health care problems called?

A

diagnosis

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6
Q

What should the first line of the body of a letter contain?

A

purpose of the letter

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7
Q

What is a measurement of the fusion free position of the eye?

A

distance phoria

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8
Q

If someone is not orthophoric at distance what is this abnormality related to?

A
  1. fusional adaptation abnormality
  2. position of eyes in orbit
  3. relative lengths of EOMs
  4. position of muscle insertions
  5. genetic abnormality of EOM
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9
Q

If a person has excessive convergence per 1.00D of accommodation do they have a high or low AC/A? 1. Eso or exo? 2

A
  1. high AC/A

2. eso

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10
Q

If a person has deficient convergence per 1.00D of accommodation do they have a high or low AC/A? 1. Eso or exo? 2

A
  1. low AC/A

2. exo

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11
Q

What type of fusional convergence (and what type of prism) accommodates for a deficit in tonic or accommodative convergence?

A

positive (BO) fusional vergence

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12
Q

What type of fusional convergence (and what type of prism) accommodates for a excess in tonic or accommodative convergence?

A

negative (BI) fusional vergence

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13
Q

What are Morgan’s expected for BI at distance?

A

x/7/4

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14
Q

What are Morgan’s expected for BO at distance?

A

9/19/10

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15
Q

What are Morgan’s expected for BI at near?

A

13/21/13

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16
Q

What are Morgan’s expected for BO at near?

A

17/21/11

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17
Q

What is an abnormal value for NPC?

A

> 6cm

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18
Q

Do myopes accommodate more in contacts or glasses?

A

contacts

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19
Q

Do hyperopes accommodate more in contacts or glasses?

A

glasses

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20
Q

What does stereo acuity test for?

A

quality of fusion

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21
Q

What are the conditions that can lead to reduced stereo acuity?

A
  1. central suppression
  2. peripheral suppression
  3. high phoria with poor vergences
  4. uncorrected refractive error
  5. reduced VA from disease, amblyopia, etc
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22
Q

What are the treatment options for convergence insufficiency?

A
  1. VT to inc BO

2. near BI prism

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23
Q

What are the treatment options for convergence excess?

A
  1. VT to inc BI

2. near add

24
Q

What are the symptoms of binocular vision dysfunctions?

A
  1. inc symptoms at end of day
  2. blurred vision
  3. intermittent diplopia
  4. pulling sensation
  5. asthenopia
  6. headaches
  7. burning or tearing
  8. inability to sustain concentration
25
Q

What is the rule that positive relative convergence (BO to blur from demand) should be at least two times the phoria?

A

Sheard’s Criterion

26
Q

What is the rule that neither vergence value should be more than twice the other?

A

Percival’s Criterion

27
Q

What is the procedure to use an add to meet Percival’s or Sheard’s criterion?

A
  1. determine amount of prism using Sheard’s or Percivals
  2. determine AC/A
  3. divide prism by AC/A to determine add and round up to nearest 0.25
28
Q

When do you prescribe for binocular vision problems?

A
  1. has symptoms (current or anticipated)

2. performance problems (current or anticipated)

29
Q

What are vertical phorias more likely to be related to then horizontal?

A

physical/mechanical factors

30
Q

What is the epidemiology of a vertical phoria?

A
  1. 20% of population (9% significant)
  2. congenital
  3. congenital or acquired 4th nerve paulsy
31
Q

What is the progression of a vertical phoria like for each epidemiology:

  1. congenital
  2. vascular/ischemic events
  3. trauma
  4. neoplastic
A
  1. stable
  2. improvement over time
  3. stable
  4. worsen over time
32
Q

What are key feature of a vertical phoria that can be observed by the doctor?

A
  1. head tilt
  2. facial muscle tension
  3. reduced lateral vergences
  4. reduced stereo acuity
33
Q

What are methods to analyze vertical phorias?

A
  1. cover test
  2. Von Graefe
  3. Maddox rod
  4. Borish card
  5. vertical vergences
  6. fixation disparity
    7, occlusion (takes long time)
34
Q

How much prism should be prescribed to a vertical phoria patient?

A

1/2 to full amount

35
Q

What are the symptoms of accommodative dysfunction?

A
  1. near blur
  2. irritability
  3. poor concentration
  4. headaches
36
Q

What is the equation to find the normal amplitude values?

A

18.5 - 0.3x(age)

37
Q

What is the equation to find the minimum amplitude values?

A

15 - 0.25x(age)

38
Q

What is an abnormal PRA value?

A

1.50 or less

39
Q

What minimum monocular accommodative facility (flipper)? 1. Minimum binocular? 2

A
  1. 12 cycles/min

2. 10 cycles/min

40
Q

What are the theories to explain presbyopia?

A
  1. lenticular
  2. ciliary muscle
  3. geometric (not accepted)
41
Q

At what ages do accommodative amplitudes begin to fall? 1. When do they reach zero? 2

A
  1. 6 years

2. 50 years old

42
Q

Do myopes or hyperopes need an add earlier? 1. At what age do these become similar? 2

A
  1. hyperopes

2. 45 yo

43
Q

What conditions make presbyopia symptoms worse for a patient?

A
  1. reduced illumination
  2. fatigued
  3. illness
44
Q

What are the amplitudes of accommodation like for a presbyope?

A

below 3.00 D

45
Q

Is the AC/A for presbyopes increasing, decreasing, or staying the same?

A

increasing

46
Q

What are the tests used for the assessment and plan for a presbyope?

A
  1. demo of age expected add
  2. dynamic retinoscopy
  3. amplitude of accommodation
  4. bionocular cross cyl
  5. near duochrome
  6. NRA/PRA
47
Q

What were found to be the worst tests to use to determine an add power of a presbyope?

A
  1. dynamic retinoscopy

2. amps of accom

48
Q

What were found to be the best tests to use to determine an add power of a presbyope?

A
  1. age expected

2. most other acceptable

49
Q

What are common first add powers for presbyopes?

A

+0.75 to +1.25

50
Q

What is the equation for calculating the actual near add a patient is receiving with uncorrected or under-corrected distance refractive error?

A

EA = Rx(near) - (U(fp) - Rx(spec))

51
Q

Why is a phoropter not a good demonstration for an add power?

A
  1. too dark

2. patient cannot choose where to hold the material

52
Q

What is one of the most common causes of unhappiness with a new Rx and why?

A

error in add because loss of intermediate or adaptation

53
Q

What issues could lead to problems with the acceptance of a bifocal?

A
  1. 4th nerve palsy

2. exophoria (low AC/A) so may have to do VT before bifocal

54
Q

If the patient leans forward during seg height measurement will the segs be too high or too low?

A

too high

55
Q

Are seg heights higher or lower with longer vertex distance?

A

higher

II. Diagnosing and Prescribing (2 decks)

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