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PPO5 > Quiz 1 > Flashcards

Quiz 1 Flashcards

1
Q

What is the purpose of BIO?

A

To evaluate the peripheral retina in search of “rhegmatogenous” conditions

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2
Q

What is a rhegmatogenous condition?

A

Retinal separation associated with a break, hole, or tear in the sensory retina

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3
Q

What are the two big advantages of BIO over MO or DO?

A

Quick assessment of entire vitreous and retina

Stereo exam of entire retina and vitreous - large FOV, independent of patient’s refractive effor

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4
Q

What are the disadvantages of BIO?

A

Lower magnification that SLE with lenses, as well as direct scope
Requires a dilated pupil
Light is very bright for the patient

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5
Q

What is the mag of a 20D lens?

A

About 3X

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6
Q

What are the 4 indications for BIO?

A

Part of a comprehensive exam
Complaints of newly onset flashes and floaters
Myopia of greater than 4.00D
Systemic diseases

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7
Q

What are the contraindications for BIO?

A

Extremely narrow angles (can’t dilate)

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8
Q

What is the relative contraindication for BIO?

A

Down’s Syndrome - sensitivity to tropicamide

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9
Q

What is the order of pupil dilation protocols?

A
  1. Review history for changes
  2. Optometry vitals - VAs, pupils, EOMs, CF
  3. SLE of cornea + Van Herick
  4. IOP
  5. Gonio - as needed
  6. Patient education of need, confirm allergies, explain side effects of drops
  7. Drop instillation
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10
Q

What is the mechanism of action for phenylephrine?

A

Sympathomimetic

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11
Q

What does phenylephrine cause?

A 
Some mydriasis (no cyclo)
Vasoconstriction
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12
Q

Why isn’t phenylephrine a good dilator on its own?

A

Weak and slow acting

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13
Q

What is the usual percentage of phenylephrine used?

A

2.5%

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14
Q

When is 10% phenylephrine used?

A

To break synechiae

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15
Q

What are common names of phenylephrine?

A

AK-Dilate
Mydfrin
Neo-synephrine
Neofrin

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16
Q

What effects can a sympathomimetic drug have on the body?

A 
Dizziness
Fast, irregular, pounding heartbeat
Increased sweating
Increased BP
Paleness
Trembling
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17
Q

Why does a sympathomimetic cause high blood pressure?

A

It has vasoconstricting properties that can increase BP bu 10%

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18
Q

You should be concerned about using a sympathomimetic drug on a patient with what issue?

A

High BP

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19
Q

Patients with which characteristics might make using 0.5% tropicamide more beneficial?

A

Shallow angles

Blue/green eyes

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20
Q

Which patients always need 1% tropicamide?

A

Dark brown eyes

Diabetics

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21
Q

What is the mechanism of action for tropicamide?

A

Anticholinergic

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22
Q

What effects does an anticholinergic drug have on the eye?

A

Blocks the iris sphincter

Blocks the ciliary muscle

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23
Q

Which system does an anticholinergic drug block?

A

Parasympathetic

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24
Q

What is the “lab dilation cocktail”?

A

Proparacaine
Phenylephrine
Tropicamide

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25
Q

What should be recorded when giving drops?

A 
Which drop
Which eye
How much
What time
Patient education about the drops
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26
Q

Increasing the diopteric power of a condensing lens does what to FOV, mag, and working distance?

A

Increases FOV
Decreases mag
Decreases WD

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27
Q

What is the working distance of a 20D lens?

A

50mm or 5cm

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28
Q

A 15D condensing lens gives how much mag?

A

4X

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29
Q

About how big is the FIV with a 20D lens?

A

8 disc diameters

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30
Q

Which side of the lens should be pointed toward the patient?

A

Side with the silver ring or the more reflective side

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31
Q

What is the correct distance from the lens to the examiner?

A

About 16-20 inches or 50cm

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32
Q

What is the critical element in obtaining a BIO view?

A

Tromboning

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33
Q

You should always be ___ degrees from the patients fixation.

A

180

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34
Q

When examining the superior retina, your arms should reach up at what angle?

A

45 degrees

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35
Q

When examining the inferior retina, your arms should reach down at what angle?

A

30-45 degrees

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36
Q

What are the required elements for BIO of the posterior pole?

A

Dim the rheostat
Sit eye level with patient
OD first, then OS
Make sure the optic nerve moves to a new location with each view
Take hand away before redirecting the patient’s gaze

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37
Q

If you are having trouble with a temporal views, how should you direct the patient?

A

Have them turn their head in the opposite direction of their gaze

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38
Q

Where is the long ciliary artery found?

A

Nasally

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39
Q

Where is the long ciliary nerve found?

A

Temporally

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40
Q

Where are the short ciliary nerves found?

A

Superior and inferior

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41
Q

What should be recorded when doing a DFE?

A

Which eye
Anatomical location - by clock position or quadrant
Size and shape
Contour - flat vs elevated

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42
Q

Where should you find long posterior ciliary nerves?

A

3:00 and 9:00 position

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43
Q

Where should you find short ciliary nerves?

A

Between 10:00 and 2:00, as well as between 4:00 and 6:00

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44
Q

Where is the vortex ampulla located?

A

3mm posterior to the ora

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45
Q

How many vortex veins stem from the ampulla?

A

4-6

46
Q

Where are the ampullae located?

A

1:00, 5:00, 7:00, and 11:00

47
Q

What things must be done before dilating drops are instilled?

A 
BP
BCVA
Pupils
EOM
SLE of cornea and angles
Tonometry
48
Q

When is tropicamide contraindicated?

A

Gonio evidence of at risk angles
Iris fixated IOLs
Plateau iris
Hypersensitivity

49
Q

What is the one absolute contraindication to dilation?

A

Iris fixated IOLs

50
Q

What conditions require caution when dilating?

A

Hyphema
Pregnancy/lactating
Down’s syndrome

51
Q

What orientation are the views given by direct viewing techniques?

A

Upright

52
Q

What are the two direct viewing techniques that we can use?

A

DO

Goldmann 3-mirror Hruby lens

53
Q

What are the characteristics of an indirect view of the fundus?

A

Inverted, arial image

54
Q

What is the clinical standard for posterior pole examination?

A

High plus condensing lens with slitlamp

55
Q

What are the advantages of fundus biomicroscopy over DO?

A

Stereo views

Variable mag and FOV

56
Q

What is the FOV with a 90D lens?

A

30-40 degrees

57
Q

What is the working distance with a 90D lens?

A

7mm

58
Q

Which has a larger FOV, 79D or 90D?

A

90D

59
Q

What is the working distance of a 78D?

A

8mm

60
Q

When is a 78D lens preferred over a 90?

A

For glaucoma suspects and diabetic retinopathy

61
Q

Which has more mag, a 79D or a 90D?

A

78D

62
Q

The 78D lens has a longer focal length, so the slitlamp must be (closer, farther) from the patient?

A

Farther

63
Q

The proper working distance allows the back focus of the lens to be fixed where?

A

Right at the pupil

64
Q

What is the correct set-up for fundus biomicroscopy?

A

Medium-high illumination, in click
Mag starting with 10X, maybe 16X
Parallelepiped beam with 5-6mm height
Polaroid filter on, aperture 1-3

65
Q

What anatomical landmarks are located in the posterior pole?

A

Macula
Optic nerve
Superior and inferior vessel arcades
Nasal Vessels

66
Q

If you scan across and reach the outer limit of your lens, what is the corrective measure that you take?

A

Move the lens in the direction of your scans

67
Q

When the patient is looking up, which direction should you have your lens tilted?

A

Top down

68
Q

When the patient is looking down, which direction should your lens be tilted?

A

Bottom up

69
Q

If your patient is looking down and left, and you have an ampulla in view, in which direction is the posterior pole?

A

Posterior pole will be near the bottom of the lens

70
Q

If your patient is looking down and left, and you have an ampulla in view, in which direction is the ora?

A

Ora will be toward the top of the lens

71
Q

Which Goldmann mirror is most inclined?

A

Trapezoid

72
Q

Which Goldmann mirror is least inclined?

A

D-mirror

73
Q

What are the advantages to 3-mirror fundus exams?

A

Provides a stable view of the posterior pole

Provides a magnified view of the peripheral retina

74
Q

When would 3-mirror fundus be performed?

A

After peripheral retina exam with BIO

75
Q

What are the contraindications for 3-mirror?

A

Corneal surface disease
Recent eye surgery
Complications of trauma: hyphema, corneal laceration, globe perforation

76
Q

What view does the contact Hruby lens provide?

A

Direct upright view of the fundus with a larger field of view than the direct scope

77
Q

What view do the rectangular mirror and trapezoid mirror allow?

A

Views of the retina

78
Q

The D mirror may be used to view what structure with widely dilated pupils?

A

Pars plana

79
Q

The trapezoid mirror is for viewing what?

A

Mid-periphery

Equator to posterior pole

80
Q

The rectangular mirror is for viewing what?

A

Periphery

Equator to ora

81
Q

What is the average size of the optic nerve?

A

1.5mm or 1500 microns

82
Q

When measuring the optic nerve with the slit lamp, what are the conversion factors to use with the 90D and 78D lenses?

A
  1. 33 - 90D

1. 2 - 78D

83
Q

A larger than average optic disc is often associated with what?

A

High myopia

84
Q

What is the order of optic nerve size from large to small among the various races?

A

African-American
Asian
Hispanic
Caucasian

85
Q

What are the characteristics of a malinserted optic nerve?

A

Nasal side is indistinct, but temporal is clear

Tilted along vertical axis

86
Q

A “heaped up” nerve is associated with what?

A

A tilted disc

87
Q

Tilted disc are tilted along which axis?

A

Horizontal

88
Q

What things may cause papilledema?

A

Increased ICP due to brain lesion
Idiopathic intracranial hypertension
Hypertensive crisis

89
Q

What may cause pseudopapilledema?

A

Congenital disc anomalies like:
Optic nerve head drusen
Congenitally full disc
Malinserted disc

90
Q

What is optic nerve head type I?

A

Flat nerve heads
C/D 0-0.2
Cupping less than or equal to 1D

91
Q

What is optic nerve head type II?

A 
Nerve has sharp temporal rim
Vessels flow over the cup's rim and into the vertical cup's edge
Bifurcation of central vessels visible
C/D from 0.15 - 0.65
1-5D of dupping
92
Q

What is ONH type III?

A 
Very little to no sharp temporal rim
Vessels follow slope of the cup
Looks somewhat like a saucer
Cupping from 1-3D
Looks like a saucer
93
Q

What is ONH type IV?

A

Little to no sharp temporal rim
Vessels are in the nasal hook
May not see vessel bifurcation
C/D from 0.2-0.7

94
Q

Nasal hooks are commonly seen in which type of patient?

A

Moderate to hight myopes

95
Q

What is Elschnig type I ONH?

A

Flat

96
Q

What is Elschnig type II ONH?

A

Cylindrical

97
Q

What is Elschnig Type III

A

Sloping

98
Q

What is Elschnig Type IV?

A

Sloping with hook

99
Q

What is the average C/D for caucasians?

A

0.4

100
Q

What is the average C/D for asians/latinos?

A

0.5

101
Q

What is the average C/D for african americans?

A

0.6

102
Q

When do you get suspicious concerning ON size?

A

When it is about 0.1 bigger than it should be

103
Q

What are the five R’s of glaucoma?

A 
Scleral ring
Rim size and color
Retinal nerve fiber layer
Region of peripapillary atrophy
Retinal/optic nerve hemorrhages
104
Q

C/D asymmetry is ok if within ___.

A

0.15

105
Q

What filter is used to better visualize the NFL?

A

Red-free

106
Q

Where is the NFL thickest?

A

Vertical poles

107
Q

If fundus veins are too wide, what disease is common?

A

Diabetes

108
Q

If fundus arteries are too narrow, what disease is common?

A

Hypertension

109
Q

What is an abnormal A/V ratio?

A

1/4 - 1/3

110
Q

What are the side effects of tropicamide?

A 
Sting
Blurred vision
Photophobia
Decreased sweating
Fast heart rate
111
Q

What are the side effects of phenylephrine?

A 
Rapid heart rate
Photophobia
Dizziness
Paleness
High BP
Sweating
112
Q

How does the image appear when using 3-mirror for a fundus exam?

A

Inverted, but not reversed

PPO5 (3 decks)

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