Ophthalmology - exam and Dx (150pp) Flashcards
(141 cards)
1
Q
Eleven causes of transient vision loss
A
Vascular - Migraine, embolus, carotid, central ret. aa., GCA,Takayasu,APL/SLE CNII - Papilledema Early tumor Glaucoma Viral neuroretinitis
2
Q
Three types of floaters
A
physiologic
hemorrhage
retinal detachments
3
Q
Two causes of light flashes
A
traction of the vitreous on the retina
Ischemic insults to occipital cortex
4
Q
Five causes of night blindness
A
Refractive error aging cataracts retinitis pigmentosa Vitamin A deficiency
5
Q
Five causes of photophobia
A
CNS inflammation Lightly pigmented mucous lens or corneal opacities retinal degeneration
6
Q
Seven types of HA pertinent to ophtho
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Blurred vision/ tension imbalace Tension Migraine SInusitis Menstraul Nerve irritation (sharp) Those that have focal neuro defecits.
7
Q
Five Causes of persistent vision loss
A
Focusing Diabetes Macular Degeneration Cataracts Glaucoma
8
Q
What is the Van Herick Test and how do you perform it ?
A
Estimates angle width
Bring narrow beam in temporally at 60 and compare corneal width vs. anterior chamber width
9
Q
5 changes that can be seen in diabetes /sign of
A
large change in refraction cataracts retinopathy rubeosis (neovascularization of iris) CN II, IV, and VI palsies
10
Q
Cause of Bull’s Eye maculpathy
A
Hydroxyxhloroquine ( Plaquenil) think about in SLE patients etc.
11
Q
Four retinotoxic medications
A
phenothiazines
Niacin
Tomxifen
IFNs
12
Q
Drug that can cause optic neuritis
A
Ethambutol ( TB tx)
13
Q
Corticosteroids can increase risk of what 3 things
A
herpes keratitis
glaucoma
cataract
14
Q
Pilocarpine can cause what ?
A
cataracts (used to treat glaucoma)
15
Q
Durg that thins the iris dilator mm.
A
Flomax (tamsulosin (complication in cataract surgery)
16
Q
Xaltan, Lumigan, and travatan for glaucoma can cause what three things
A
increase lash number
darken iris
darken peri-orbital skin
17
Q
what does Latisse do ?
A
Increases lashes
18
Q
Drugs suspect in NAION
A
Viagra,Cialis, Amiodarone,Levitra
19
Q
What Abx can cause conjuctivitis ?
A
Neomycin
20
Q
What fundus exam finding can be helpful to indicate likely ICP when the pts. optic disc is of normal morphology.
A
Presence of Spontaneous Venous Pulsations
21
Q
A patient’s visual acuity is less than 20/20 what technique do you then preform ?
A
Pinhole to confirm need for spectacles.
22
Q
What level of vision do you need in at least one eye to drive in most states ?
A
20/50
23
Q
What is legally blind ?
A
20/200
24
Q
Patient cannot read chart at appropriate distance then what?
A
NUmerator becomes distance at which they can see first line (x/400)
CF/2ft then HM/3ft
25
What does NLP mean in terms of visual acuity
no light perception
26
Define Emmetropia
light is focused on the retina
27
Define Ametropia
light is not focused on the retina
28
Define hyperopia
farsighted = sees more clearly at a distance need convex positive lens
29
Define Myopia
nearsighted = sees more clearly up close needs concave lense
30
Two types of myopia
axial (longer eye) and refractive (increased curvature of cornea)
31
define astigmatism
rays of light are not being refracted uniformly in all meridians
32
what does a keratometer do ?
measures curvature of cornea
33
Pachymeter
thickness of cornea
34
Three types of refractive surgery
LASIK - Laser in situ keratomileusis
PRK = photorefractive keratectomy
epi-LASIK
35
What diopter range is appropriate for LASIK,epi-lasik and PRK
4-8 if outside range then IO lens is indicated
36
advantage to epi-lask
does not take any stroma with it but this causes slower healing time
37
advantage to PRK and 2 disadvantages
painful and slower to heal but more natural as flap is not needed because an artificial abrasion is created.
38
advantage to LASIK and one disadvantage
most popular, quick healing but dry eye is common
39
EOM of CN III and their action
Medial rectus - adducts
Inferior rectus - depresses, slightly extorts and adducts
superior rectus - elevates, slightly intorts and adducts
Inferior oblique - extorts, elevates and abducts slightly
40
PANS of CNIII
```
pupil constrictor (light and near focus)
Ciliary muscle (focuses lens for near
```
41
EOM of CNIV
Superior oblique - mainly intorts, depresses and abducts slightly
42
EOM of CNVI
lateral rectus - abducts
43
3 Roles of SANS in eye
Mullers muscle - elevates upper lid
pupil dilator
skin of lid (sweat glands)
44
phorias can become
tropias
45
two types of ambylopia and by what age should they be corrected ?
refractive and strabismic
| by age 5 , after 8 years nearly impossible to correct
46
What is NPC and when is considered insuffficient
Near Point Convergence - considered abnormal if the NPC is >8cm
47
what do you need to measure tropias
prism
48
Visualize six cardinal fields of vision beginning in the superomedial field
inferior oblique --> medial rectus --> superior oblique --> inferior rectus --> lateral rectus --> superior rectus
49
Three causes of a CNIII palsy and what does exam reveal
pupil down and out with mydriasis (except DM)
| DM, Uncal herniation, PCA aneurysm
50
CN most susceptible to trauma and what exam would show
CN IV , head tilt towards opposite should to "mechanically intort the eye"
51
What is spasmus nutans
pendular nystagmus that begins around 6mo and ends at 2 yrs
52
Horner's in kid, r/o what ?
Neuroblastoma
53
3 orders of neurons of horner's syndrome and 4 causes of each
1- C8-T2 from hypothalm - syringomyelia, demyelination,tumor,trauma
2- superior cervical gang. - Pancoasts tumor, goiter, neck injury, surgery
3- to mullers and eye from above - dissection, migraine, cavernous sinus, orbital disease
54
Three general causes of miosis
increased cholinergic tone (pilocarpine and morphine)
decreased sympathetic tone (Horner's, aldomet, reserpine)
Constrictor mm. irritation ( Iritis, HISTAMINE)
55
Three general causes of mydriasis
decreased cholinergic tone (atropine,CNIII palsy,Adie's,Anti-hist)
increased sympathetic tone (phenylephrine,epi,anxiety,cocaine,decongestants)
damaged constrictor - >40 IOP, trauma (hyphemas)
56
Home test for patients with mild or suspected macular degeneration
Amsler Grid central 20 degrees
57
What is metamorphopsia
wrinkled retina in macular disease, wavi lines
58
What is a tangent screen
using small balls tests central 60
59
What does a perimeter test
the full 170 horizontal and 130 of the vertical
60
define scotoma
loss of part of the field relative equals small things , absolute is total blindness
61
A scotoma test is unreliable if...
you can't find the physiologic scotoma 15degrees temporal
62
generally an easy way to localize a visual field cut to the chiasm or posterior to it ...
cut in both eyes.
63
how long does homonymous hemianopsia last in a migraine spasm
15-20 minutes
64
pulsating exolphthalmos
carotid-cavernous fistula
65
non-pulsating exolphthalmos
cavernous sinus thrombosis
66
what are the four L's of the external exam ?
Lymphnodes, Lids, Lashes, lacrimal gland
67
lymph drainage of eye , 2 sites
lateral conjuctiva --> preauricular
| nasal conj --> submandibular
68
3 components of tear film and their source
oils (miebum) --> meibomian glands
water --> lacrimal gland
mucous conj goblet cells
69
What percent of dry eye cases is caused by meibomian gland dysfunction
86%
70
Proper way to admin. eye drops
close eyes for 60 seconds while pressing on puncta
71
blinking occurrs how often and how does it move tear film
q4seconds (15/min) moves film nasally
72
fancy name for dry eye and tearing
keratoconjunctivits sicca, epiphora
73
Rx causes of dry eye and one other general cause
anticholinergics, antihistamines, tranquilizers
diuretics, vitamin A def.
Autoimmune diseases
74
What is cyclosporine
Restasis BID, increases tear production
75
Two causes of epiphora
emotion/irritation
| improper drainage
76
What is an infection of the nasolacrimal duct
dacryocystitis (think actinomyces israelii etc.
77
Three causes of wrinkled/droopy lids (not neuromuscularptosis)
Floppy eye syndrome (increased risk of sleep apnea)
Dermatochalasis (aging)
Allergies (edema stretches skin)
78
two causes of ectropion
CNVII palsy, aging
79
Define ptosis
drooping of the lid with narrowing of the palpebral fissure
80
Can ptosis be caused by aging ?
yes because the levator can degenerate
81
how long should a patient look up for MG etc
5 minutes
82
Define trichiasis and madarosis
Trich is inturned lash causing irritaion
| madarosis is loss of eye lashes or loss of eyebrows
83
squamos ceel carcinoma on the eye lid could also be...
keratoacanthoma which is benign
84
Tuberous sclerosis 4 possible findings
sebaceous adenomas, mental deficiencies, seizures, retinal astrocytoma (looks like a white mulberry)
85
Two things to monitor in sturge-weber syndrome
glaucoma
| hemangiomas in the CNS or choroid
86
Finding in NF on the iris
Lisch nodules (94% of patients) circular tan spots with clear borders.
87
6 sequelae of belpharitis
conjuctivitis, sties, chalazions, dry eye, corneal ulcers, lid cellulitis.
88
How many times do you blink a day ?
about 50k
89
General tx for blepharitis
baby shampoo and warm compress
90
Stie vs. chalazion
Stie is infection of glands of Zeis and moll around lashes that point externally
Chalazion is a cystic enlargement of the meibomian glands that point internally
91
Three borders of the orbit
periosteum, orbital septum to tarsal plate
92
CT scans may be responsible for what percent of all future cancers in the US
1.5-2%
93
Serious signs of periorbital cellulitis and possibly orbital cellulitis
exophthalmos or enophthalmos, swollen and/or chemosis, ophthalmoplegia is very ominous
94
most common cause of exophthlamos in adults and kids, what else should you also consider/r/o
thyroid disease u/l or b/l
orbital cellulitis in kids
r/o solid mass, hemorrhage or thrombosis
95
Four signs of an orbital blow out fracture
Enophtalmos, hypesthesia over maxilla, inferior rectus entrapment, conjuctiva hemorrhage
96
Where are corneal stem cells located
Limbua, within 24 hours 40% of the cornea can regenerate
97
Most densely packed sensory nerve fiber location
stroma of the cornea. (between bowman's and the posterior Descemet's membrane)
98
What are guttata
seen in Fuch's Dystrophy, round spots of thickening of Descemet's membrane
99
What is keratoconus and 2 things about it
central thinning and subsequent bulgin go the central epithelium.
Munson's sign when looking down the inferior led bulges due to the chape of the cornea. Often genetic
100
Wilson's disease where is the Cu
descemet's membrane, Kayser-Fleischer ring
101
bulging/swelling of the conjuctiva or chemosis is seen in what 2 things
orbital venous congestion and allergies
102
Pterygium from wind/UV light vs. Pinguecula
Pterygium is wing shape extending from the medial canthus and possibly covering part of cornea
Pinguecula is benign and a yellowish elevation on conj.
103
You lift a patients eyelideand you see the upper or lower fornix....
Floppy-Eyelid syndrome (associated with sleep apnea)
104
What is trichiasis
Inward growing eyelash
105
What is a trachoma
seen in chlamydia, pannus (superior to cornea, vascularized), essentially severe keratoconjunctivits
106
scleritis vs. episcleritis
pain vs tender but not painful
107
Then sclera = and seen in ....
blue d/t choroidal pigment shine through. seen in RA or OI
108
bilirubin binds to what in the sclera
elastin, often first sign of increased levels (>12 tbili is toxic in adults
109
Glaucoma normal ranges and name for each (2)
10-20 = nl 21-27 glaucoma suspect/ ocular htn, >28 glaucoma
110
One reason for falsely elevated pressures
thick cornea
111
5 stages of optic nerve damage in glaucoma
C/D ration increased normal is
112
half of the nfl layer may be lost when what happens in glaucoma
visual changes
113
Four pathognomonic visual field signs of glaucoma
bjerrum's scotoma arc extending nasally from blind spot
Island scotomas
constricted firlds before loss of central vission
Ronne's is loss of peripheral nasal field above or below the horizontal meridian
114
5 classes of medications for Glaucoma management
BB, CAI, Alpha agonist, PG analogues, Cholinergic
115
sogns of angle closure glaucoma and 4 drug classes to avoid
pain,halos,mid-dialted pupil,nausea
| anticholinergics,antihistamines, phenothiazenes, adrenergics.
116
primary open angle should be monitored during use of what medication
corticosteroids (high dose and long term)
117
How could trauma cause glaucoma
hyphema and ciliary body is torn from iris
118
One type of juvenile glaucoma associated with 3 other findings
Sturge-Weber, angiomatosis of face and meninges with cerebral calcification in seizures
119
What is the uvea
ciliary body, iris and choroid
120
Morning Glory sign =
Moya Moya
121
What do you use to dilate pupils and what should you have just in case this happens...
2.5 % Phenylephrin +/- .5-1% Tropicamide to dilate to >6mm. If acute angle closure occurs use pilocarpine
122
What are the three components of the uvea
choroid, iris, and ciliary body
123
Type of cancer common to the uveal structures
malignant melanoma (choroid 85% of the time)
124
Three causes of rubeosis iridis and what could it lead to ? ?
Central retinal vein occlusion, DM, carotid stenosis
| could lead to glaucoma
125
5 anticholinergics used to dilate the eye , their action time and primary use
Atropine - 2 weeks - prolonged/severe ant. uveitis
Scopolamine - 4 days - alt. to above
Homatropine - 2 days - ant. uveitis
Cyclopentoate - 1 day - iritis usually combined with ster.
Tropicamide - 6 hours - used with phenyl 2.5 %
126
Three causes of inflamed eye and how the look .
Iritis - inflammation that is centrifugal
Conjuctivits - inflammation that is centripetal
Angle closure - inflmmation that is rapid and diffuse
127
5 conditions associated with iritis
```
Ankylosing spondylitis
juvenile RA
IBD
Psoriatic Arthritis
Reactive arthritis
```
128
3 conditions associated with band keratopahty
juveinile RA
Sarcoid
Hyypervitamanosis D
129
Toxo vs. hisot on retinal exam
toxo had black rings with sclera showing.
| histo are small punched out spots
130
2 signs of choroiditis
White exudates on the retina, cell in the vitreous
131
5 causes of choroiditis
Bacterial - syph. TB
Viral - HSV, CMV (AIDS esp.)
Fungal - Toxoplasma and toxocara
Immunosupression - predisposed to the above
Autiimmune - Behcet's (mouth/genital ulcers)
132
what should be examined last to minimize miosis and discomfort with ophth.
macula
133
5 signs of papilledema
blurred disc margins, engorged veins, lack of SVPs, flame hemorrhages, enlarging blind spot.
134
what type of CN palsy can you get with papilledema
CN VI
135
Three non mechanical causes of papilledema
tetracycline, retinoids used for severe acne/psoriasis, vitamin a toxicity
136
Causes of pseudopapilledema
malignant HTN
CRVO
Drusen
137
Whats a quick thing to due in retinal artery occlusion
breath into bag to induce hypercapnia to dilate arteries , ocular message too.
138
type of vision loss in macular degeneration
central
139
type of vision loss in retinitis pgimentosa
peripheral and night vision
140
what visual symptoms does a patient report with PVD ?
flashing lights
141
what visual symptoms does a patient report with RD ?
flashes, floaters, and curtain-like visual loss
