Pupillary Assessment CH2 Flashcards
(29 cards)
Any pupil smaller than what size is considered miotic?
a) 1 mm
b) 2 mm
c) 3 mm
d) 4 mm
b) If a pupil is 2 mm or smaller, it is considered miotic.
Any pupil larger than what size is considered mydriatic?
a) 3 mm
b) 4 mm
c) 5 mm
d) 6 mm
d) A pupil that is 6 mm or larger is considered mydriatic.
Which of the following groups tend to have smaller pupils?
a) children
b) myopes
c) people with light blue eyes
d) older people
d) Children, myopes, and those with light blue eyes tend to have larger pupils. Older people
tend to have smaller pupils.
Unequal pupil size is termed:
a) anisocoria
b) anisometropia
c) anisochromia
d) aniseikonia
a) Anisocoria is the term for unequal pupil size. (The other answers are all real terms that you might want to look up if you do not know them.)
The pupil evaluation includes:
a) size, shape, and reaction to light
b) iris color, roundness, and reaction to light
c) angle depth, iris diameter, reaction to light
d) reaction to cycloplegia, light, and accommodation
a) Evaluation of pupils includes checking each pupil for its size, shape, and reaction to light
(and sometimes to accommodation). After that is done, one pupil is compared to the other. Are they the same size? Shape? Do they respond to light (or accommodation) to the same degree?
An iris coloboma usually causes a pupillary shape defect:
a) at 12 o’clock
b) at 3 o’clock
c) at 6 o’clock
d) at 9 o’clock
c) Iris coloboma is a congenital defect where the iris fails to fuse, usually inferiorly (ie, at
6 o’clock).
Constriction of the pupil can be accomplished by any of the following except:
a) shining a bright light into the eye
b) having the patient focus on a near object
c) using miotics
d) dimming the room lights
d) Dimming the room lights would make the pupils enlarge.
Dilation of the pupil can be accomplished by any of the following except:
a) shining a bright light into the eye
b) pinching the patient’s neck
c) having the patient focus on a distant object
d) dimming the room lights
a) Shining a bright light into the eye causes the pupil to constrict, not dilate.
Direct pupillary response refers to:
a) the reaction of both pupils to light
b) the reaction of one pupil to light
c) the reaction of both pupils to near
d) the reaction of one pupil to near
b) The reaction of a single pupil to light is a direct pupillary response.
Testing of the consensual light response in healthy eyes is possible because:
a) each pupil reacts to light independently
b) if one pupil reacts to light, the other reacts with it
c) the pupils react to light in reverse order
d) the pupils react to near stimuli independently
b) The consensual light response compares the response (to light) of one pupil to the
response of the other pupil. This is possible because healthy pupils are innervated to do the same thing at the same time, regardless of which eye has the light shining into it.
When checking consensual pupil responses to light, all of the following should be done
except:
a) dim the room lights
b) have the patient look at a distant object
c) shine the light source from the side
d) cover the eye not being tested
d) Consensual light response testing requires that you be able to see both pupils, so covering is not appropriate. Covering either eye during any type of pupil check is unnecessary.
To test pupillary response to accommodation:
a) observe the pupils as the patient looks from a distant object to a close-up object
b) observe the pupils as the patient looks from a close-up object to a light source
c) observe the pupils as the patient reads the near card
d) observe the pupils as the patient reads the distant chart
a) To see the pupillary change that occurs in accommodation, have the patient look into the distance (accommodation relaxed), then at something up close (accommodation stimulated), or vice versa.
To evaluate a patient for tonic pupil (or Adie’s tonic pupil), one would use which
method?
a) pupillometer
b) slit-lamp evaluation
c) cycloplegia
d) accommodation response test
d) In Adie’s tonic pupil, there is a rapid/normal reaction of pupillary constriction when looking at a near object, but dilation is markedly slow when the patient shifts to look at a distant object. The pupil is also slow in its reaction to light. A pupillometer is used to measure the pupil’s diameter. (Note: Do not confuse a pupillometer with the instrument that measures pupillary distance, which should properly be called an interpupillometer.)
Each pupil constricts to direct light. This indicates:
a) there is no relative afferent pupillary defect (RAPD) present
b) the pupils react equally
c) light is passing through each optic nerve
d) equal reaction to accommodation
c) The direct test evaluates each pupil on its own and is not meant to compare the reaction of one pupil to the other. All you can say at this point is that at least some light is traversing the optic nerve of each eye. In order to find a RAPD, you would need to additionally perform the swinging flashlight test. Testing pupillary reaction to accommodation would involve having the patient look at a near then distant object and back, watching the pupillary response as he or she does this; a light is not used.
Testing that reveals normal-appearing pupils that react appropriately is documented
by the acronym:
a) PERRLA
b) RAPD
c) CSM
d) PEAR
a) PERRLA stands for “pupils equally round and reactive to light and accommodation.”
The most common cause of a false-positive pupillary defect is:
a) glaucoma
b) papilledema
c) RAPD
d) weak flashlight batteries
d) You probably will not see this question on the test, but it does make an important point. Any time you detect a pupillary defect, double-check with another penlight.
Each of the following could cause abnormal pupil shape except:
a) surgery
b) trauma
c) birth defect
d) Marcus Gunn
d) The Marcus Gunn pupillary defect affects the pupil’s reaction, not its shape. An example
of a congenitally abnormal pupil shape is the coloboma.
Each of the following disorders can cause a change in pupil size except:
a) iritis
b) angle-closure glaucoma attack
c) drug reactions
d) open-angle glaucoma
d) Open-angle glaucoma has no effect on pupil size. Some medications for glaucoma do
(the miotics), but that was not the way the question was worded. Iritis causes a smaller
pupil, angle-closure causes a larger pupil, and drug reactions can go either way.
Argyll Robertson pupils are often:
a) unreactive to direct or consensual light
b) unreactive to accommodation
c) reactive to light
d) sluggishly reactive to accommodation
a) The hallmark of Argyll Robertson pupils is their lack of response to direct or consensual light.
You discover that your patient has an Argyll Robertson pupil. This pupillary defect is
associated with:
a) acquired immune deficiency syndrome (AIDS)
b) syphilis
c) gonorrhea
d) rubella
b) The Argyll Robertson pupil is a sign of syphilis.
Which of the following is associated with ptosis, miosis, and lack of perspiration
(anhydrosis) on the affected side?
a) Adie’s tonic pupil
b) Horner’s syndrome
c) Argyll Robertson pupil
d) Marcus Gunn pupil
b) Horner’s syndrome is identified by the triad of ptosis, miosis, and anhydrosis on the
affected side.
Horner’s syndrome is caused by:
a) nerve damage
b) keratoconjunctivitis
c) syphilis
d) Herpes zoster
a) Horner’s syndrome is caused by nerve damage that specifically affects eyelid position, pupil size, and facial perspiration to varying degrees.
Adie’s tonic pupil (or tonic pupil) is caused by:
a) systemic rubella
b) sympathetic ophthalmia
c) gonorrhea
d) nerve damage
d) Damage to the short posterior ciliary nerves is the cause of Adie’s tonic pupil.
You might first suspect that the patient has a tonic pupil when:
a) the response to direct light is slow
b) the pupil enlarges in direct light
c) that eye also has a ptotic lid
d) the patient is photophobic
a) A tonic pupil will have a slow reaction to direct light. A pupil that enlarges in direct light
most likely has a Marcus Gunn, or RAPD defect. Horner’s syndrome exhibits ptosis on that same side.
