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PCMI > 2.6 Eye Exam > Flashcards

2.6 Eye Exam Flashcards

1
Q

General History for patient’s presenting with eye complaints

A
  • Age
  • Pregnant?
  • Glasses/contacts
  • Injuries/trauma
  • Surgeries
  • Eye infections
  • Recent travel/activities
  • Current eye issue (OLD CAAARTS)
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2
Q

What are examples of associated symptoms with eye complaints?

A
  • Pain
  • Drainage
  • Itching/burning
  • Vision change
  • Blurry vision
  • Flashing lights
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3
Q

What are some examples of relevant past medical hx with eye complaints?

A

Glaucoma

DM

Thyroid disease

ASCD

Collagen Vascular Disease

HIV

Inflammatory bowel disease

***All of these are associated with some form of eye involvement

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4
Q

What are some classes of medications that can have ocular side effects?

A
  • Steroids
  • Plaquenil
  • Antihistamines
  • Antidepressants
  • Antipsychotics
  • Antiarrhythmics
  • Beta blockers
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5
Q

What do we ALWAYS do first during the physical exam?

A

INSPECT

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6
Q

What are you looking for on external examination of the eyes?

A
  • Symmetry
  • Plucking?
  • “Falling out”
  • Scaly skin -aka seborrheic dermatitis
  • Scars
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7
Q

What do you look for in the periorbital area?

A

General:

  • Edema
  • Bruising
  • Injury
  • Rash

Specific:

  • Change in elasticity
  • Allergic shiners (look like low on sleep, brusing under eyes)
  • Xanthelasma (check cholesterol level)
  • Proptosis/Exophtalmos (eyes buldging out)
  • Dacrocystitis (infection in tear duct)
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8
Q

What do you always want to do when you are inspecting the eyelids/eyelashes?

A

Remove glasses

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9
Q

What are you looking for when inspecting the eyelids/eyelashes?

A
  • Do the lids close completly?
  • Do lids invert/evert?
  • Flakiness/crustiness
  • Erythema
  • Swelling
  • Scabs/new skin lesions
  • Ptosis (drooping of eye)
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10
Q

What is the picture on the LEFT revealing?

A

Entropion

Lash line is INVERTED

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11
Q

What is the picture on the RIGHT revealing?

A

Ectropion

Lash line is facing outward

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12
Q

What is this called?

Where is it found?

A

Hordeloum

ALONG THE LASHLINE

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13
Q

What is this called?

Where do you find it?

A

Chalazion

IN THE LID

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14
Q

What is a similarity between hordeolum and chalazions?

A

Both blocked meibomian gland

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15
Q

What are the differences between hordeolum and chalazion?

A

Hordeloum: Tender/painful, located along lash line

Chalazion: Non painful (unless becomes inflammed), located in the lid

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16
Q

What is this called?

A

Blepharitis

inflammation at base of hair follicle, from S. anreus and allergies, difficult to treat

(right side=chronic)

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17
Q

Lacrimal apparatus:

What do you want to look for?

What can deformations of this strucure indicate?

A

Look at the punctae

Could indicate skin lesions/cancer or autoimmune diseases

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18
Q

How do you inspect the conjunctiva?

What should it look like?

A

Lower the lower eyelid and have patient look up

Raise the upper eyelid and have patient look down

Should be clear

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19
Q

Conjunctiva

If you see:

  1. Erythema
  2. Purulence

What could they indicate?

A
  1. Erythema = subconjunctival hemorrhage
  2. Purulence = “pink eye”, conjunctivitis
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20
Q

What is pterygium?

A

Overgrowth of the conjunctiva

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21
Q

The cornea should be:

A

Clear and equal

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22
Q

How do you test for corneal sensitivity?

What CNs does this test for?

A

Cotton

*Tests cranial nerve V (trigeminal) : Sensory to “feel the cotton

*test cranial nerve VII (facial) motor to “blink

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23
Q

What is this?

Are these common?

Are they painful?

A

Corneal abrasion/ulcer

VERY common in ER

Very painful

24
Q

What is this called?

Who is this common in?

A

Arcus senilis

Common in older adult population

If under <40yrs consider checking cholesterol level

25
Q

When examining for the “red reflex”, what are abnormal findings?

A

-Reflex is NOT equal in both eyes

(*note, reflex does not have to be red to be normal “red reflex”)

-Brown speckles

26
Q

What is this?

A

Cataract

27
Q

Sclera

What do brown or gray spots in the sclera mean?

A

–> Birthmarks

  • There could be an increased amount of melanin in sclera
  • Can have incresed risk for glaucoma
28
Q

Sclera

What does a blue sclera mean?

A

Inherited

Seen frequently in brittle bone disease

29
Q

Sclera

What does a yellow sclera mean?

What is the medical term for a yellow sclera?

A

Neonatal liver disease

Pancreatic cancer

Gallbladder disease

“Icterus”

30
Q

What is this presentation called?

A

Nevus of Ota

31
Q

How would you document fully functional extraocular muscles in your SOAP note?

A

EOMI

“Extraocular muscles intact”

32
Q

Defects in extraocular muscles can cause?

A

Diplopia

Nystagmus

33
Q

What are the cranial nerves that are associated with each extraocular muscle?

A

LR6SO4AR3

Lateral rectus m.= CN 6

Superior oblique m. = CN 4

“All the rest”= CN 3

34
Q

What test to you do to check for extraocular muscle function?

A

H test

35
Q

What is the abnormal movement of the child’s left eye called?

A

Esotropia

“eye turns in”

36
Q

What is the abnormal movement of the pts left eye called?

A

Exotropia

“Eye turns out”

37
Q

How do you perform a cover/uncover test?

A

Have pt. stare ahead at a near fixed point

Cover one eye and observe uncovered eye as it focuses on point

Remove cover and watch for movement of newly uncovered eye as it fixes on point

Repeat on other side

38
Q

How do you treat strabismus in young children?

A

Patching

If patching fails, surgery

39
Q

What happens if strabismus goes untreated?

A

Brain will choose to focus with unaffected eye and the other eye will lose vision

40
Q

How do you document normal iris/pupil in your SOAP note?

A

PERRLA

Pupils equal round reactive to light and accomodation

41
Q

NEVER dilate the eyes until you have checked for..

A

A shallow anterior chamber

42
Q

What does mydriasis mean?

A

Dilating of the pupil

43
Q

How do you hold the opthalmoscope and perform an eye exam?

A

Your right hand holds opthalmoscope to look with right eye in patient’s right eye

Your left hand holds opthalmoscope to look with left eye in the patient’s left eye

44
Q

With a funduscopic exam, what are the structures you are looking at?

A

Optic disc

Veins

Arteries

Macula

45
Q

What is this?

What causes it?

A

Papilledema

Increased intracranial pressure

46
Q

What is this?

What causes it?

A

Cotton Wool Spots

Vascular disease from HTN or DM

47
Q

What is this?

A

Glaucomatous Cupping

48
Q

What is this?

What causes this?

A

Retinal proliferation

HTN or DM

49
Q

What are these?

Precursor to?

A

Drusen bodies

Precursor to macular degeneration

50
Q

When performing a visual acuity test, how far does pt. stand away from chart?

A

20 ft

51
Q

What does the first and second number in a visual acuity test indicate?

(eg. 20/20)

A

First number = distance from chart

Second number = distance at which a normal eye can read the line of letters

52
Q

what does lipoatrophy or lipohypertrophy mean?

A

change in elasticity from topical meds

53
Q

pterygium

A

abnormal finding of conjunctiva, redness/opaque area that starts midline normally and moves toward pupil

-caused from excessive sun exposure

54
Q

When you cover the good eye, what does the bad eye do in a patient with esotropia?

A

eye turns out

(Still confused, but repeated her lecture like 5x to hear it)

55
Q

When you cover the good eye, what does the bad eye do in a patient with exotropia?

A

the bad eye turns in

PCMI (15 decks)

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