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Motility > B12 > Flashcards

B12 Flashcards

1
Q

Is a nystagmus voluntary or involuntary?

A

Involuntary

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2
Q

An involuntary rhythmic oscillation of one or both eyes

A

Nystagmus

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3
Q

The shaking, dancing, jerking, or wobbling of the eyes

A

Nystagmus

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4
Q

A type of nystagmus that has both quick corrective saccade and slow movements away from fixation

A

Jerk nystagmus

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5
Q

This phase brings the eyes back to the target during a jerk nystagmus

A

Fast corrective saccade

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6
Q

A type of nystagmus with to and fro movements of equal velocity in each direction

A

Pendular

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7
Q

The type of nystagmus has a sinusoidal movement without a fast phase

A

Pendular

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8
Q

What phase is a jerk nystagmus characterized by?

A

Fast phase

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9
Q

The slow phase in a jerk nystagmus reflects what?

A

There is an abnormality/pathology

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10
Q

A left jerk nystagmus has a slow movement to the ____ and a fast corrective jerk movement to the ____

A

Slow to the right and fast to the left

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11
Q

What are the 4 different directions/movements of a nystagmus?

A
  • Horizontal (side to side)
  • vertical (up and down)
  • torsional (rotary)
  • combination
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12
Q

size/extent of movement between the start of the drift away from fixation to the start of the corrective movement (in the opposite direction)

A

Nystagmus amplitude

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13
Q

The number of oscillations per unit time

A

Frequency

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14
Q

This means a waveform completes a full rotation in 1 sec

A

One hertz (cycle/sec)

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15
Q

The greater the number of beats, the ___ the frequency

A

Higher

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16
Q

What is considered a fast nystagmus?

A

> 2Hz

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17
Q

What is considered a slow nystagmus?

A

<2 Hz

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18
Q

Where the intensity of the nystagmus diminished and the VA improves

A

Null point

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19
Q

If someone has a null point in L gaze, how will they move their head?

A

To the right

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20
Q

For someone with a latent nystagmus (changes with occlusion), the fast phase is towards the _____ eye

A

Uncovered

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21
Q

For a latent nystagmus will the amplitude and frequency increase or decrease?

A

Increase

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22
Q

A latent component usually indicates a ____ condition

A

Congenital

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23
Q

Amplitude may ____ with convergence

A

Decrease

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24
Q

T/F: nystagmus is a sign of a problem

A

True

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25
Q

What are the 3 etiologies of nystagmus?

A
  • genetics
  • developmental abnormalities
  • ocular pathology/conditions
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26
Q

What are the 3 anterior segment conditions associated with nystagmus?

A
  • congenital cataract
  • congenital glaucoma
  • iridocorneal dysgenesis
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27
Q

This type of foveal condition is associated with a nystagmus

A

Foveal hypoplasia

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28
Q

What are the 3 optic nerve disorders associated with nystagmus?

A
  • optic nerve hypoplasia
  • optic nerve coloboma
  • optic atrophy
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29
Q

What are the 3 primary sensory retinal abnormalities associated with a nystagmus?

A
  • leber congenital amaurosis
  • achromatopsia
  • congenital station also night blindness
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30
Q

What are the 4 vitreoretinal abnormalities associated with a nystagmus?

A
  • coloboma involving the macula
  • familial exudate vitreoretinopathy
  • retinal dysplasia
  • retinoblastoma
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31
Q

What are the 3 type of foveal hypoplasia’s that are associated with a nystagmus?

A
  • albinism
  • aniridia
  • isolated
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32
Q

What are the 4 infectious diseases associated with a nystagmus?

A
  • congenital toxoplasmosis
  • cytomegalovirus
  • rubella
  • syphillis
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33
Q

What are the 4 types of physiological nystagmus’?

A
  • endpoint
  • rotational
  • caloric
  • optokinetic
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34
Q

Name the 9 types of pathological nystagmus’?

A
  • congenital
  • latent/manifest
  • acquired
  • spasmus nutans
  • vestibular
  • gaze paretic
  • see-saw
  • convergence-retraction
  • downbeat
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35
Q

T/F: children with congenital nystagmus will complain about the problem

A

False. They seldom complain

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36
Q

What are some neurological signs or symptoms you should ask about?

A
  • dizziness
  • pain
  • numbness
  • poor balance
  • ringing in the ears
  • seizure
  • weakness
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37
Q

Can a nystagmus be better in certain gazes, tilts or turns?

A

Yes

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38
Q

Nystagmus from motor coordination problems result in a ____ VA loss than nystagmus with sensory issues

A

Less

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39
Q

Decreased VA is more likely in motor or sensory?

A

Sensory

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40
Q

Should you do VA’s mono only, bino only, or both at D and N for someone with a nystagmus?

A

Do mono and bino at D and N

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41
Q

Can near VA’s be better than distance vision in someone with a nystagmus?

A

Yep

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42
Q

T/F: when testing for a nystagmus the patient should be sitting straight up with head positioned straight

A

False. They should be in their preferred head position at D and N to assess true functional vision

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43
Q

If there is an objection to occlusion, how should test for a nystagmus?

A

Assess their visual behavior

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44
Q

Do you want to assess eye movements in all 9 positions of gaze?

A

Yes

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45
Q

These 3 tests can be valuable to determine if the corneal reflex appears symmetrical in both eyes

A
  • hirschberg
  • krimsky
  • Bruckners
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46
Q

Since cover test is difficult in someone with a latent nystagmus what can be used in place of a paddle?

A

A +5.00 lens

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47
Q

What type of test will allow you to determine if a patient has a phoria

A

Stereo

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48
Q

What test can be used for suppression testing for someone with a nystagmus?

A

W4D

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49
Q

If the patient has a very small nystagmus what can you do to get a better view?

A

Look in the slit lamp

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50
Q

If there is no cooperation with the slit lamp, what can you use to assess the nystagmus?

A

A 20D lens or a hand held slit lamp

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51
Q

Do you want to dilate a patient with a nystagmus?

A

Yes, so you can get a completely evaluation of the retina and periphery

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52
Q

What can help identify lebers or congenital retinal blindness?

A

ERG

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53
Q

What should you do if the MRI is normal, fundus appears normal, but there is decreased VA and nystagmus.

A

Order an ERG

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54
Q

When should you run a CT and MRI for someone with a nystagmus?

A

If it is acquired

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55
Q

If someone has a recent onset or/and nystagmus that has not been diagnosed, what should you do?

A

Refer to neuro

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56
Q

Sensation of the environment moving

A

Oscillopsia

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57
Q

A feeling of being off balance

A

Vertigo

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58
Q

The position of gaze where the eyes are quiet for someone with a nystagmus

A

Null point

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59
Q

Someone with this type of nystagmus, you should always warn them to not drink and drive

A

Endpoint nystagmus

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60
Q

A nystagmus with small amplitude and variable frequency that has an intermittent conjugate jerk, worse when tired, and symmetrical in R and L gaze

A

Endpoint nystagmus

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61
Q

Someone with an endpoint nystagmus will have a nystagmus seen in both eye when an extreme ___ gaze (greater than ___ degrees of midline) is held for a prolonged amount of time

A

Extreme lateral gaze and greater than 30 degrees

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62
Q

Type of nystagmus: jerk nystagmus due to head or body rotation.

A

Rotational nystagmus

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63
Q

A rotational nystagmus is related to ____ in the semicircular canals

A

Endolymph

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64
Q

In rotational nystagmus, the normal response is slow conjugate eye movement then fast phase in the _____ direction of the rotation

A

Opposite

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65
Q

Type of nystagmus: Conjugate, jerk nystagmus produced during the caloric testing of the vestibular system.

A

Caloric nystagmus

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66
Q

In a normal caloric response,

For cold water: nystagmus with fast phase towards the ____ ear

For warm water: nystagmus with fast phase towards the ____ ear

A

Cold: opposite
Warm: same

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67
Q

Type of nystagmus: Slow pursuit eye movement followed by a fast corrective saccade because a visual field moves over the retina (determined with a drum)

A

Optokinetic nystagmus

68
Q

When will you see a fast corrective saccade in an optokinetic nystagmus

A

When fixating on a new stripe

69
Q

Is the head still or moving in the OKN?

A

Still

70
Q

When does an optokinetic nystagmus develop?

A

3-5 months of age

71
Q

OKN can be used for what type of patients?

A

Malingering and uncooperative patients

72
Q

How is someone with a congenital nystagmus going to react to an OKN?

A

They will show a reverse OKN response and could show a preserved vertical OKN response

73
Q

Name the 4 physiological types of nystagmus?

A

Endpoint
Rotational
Caloric
Optokinetic

74
Q

Physiological or pathological nystagmus: Dissociated movements with excessive oscillations in the presence of other ocular motor abnormalities.

A

Pathological

75
Q

When will will a congenital nystagmus present? And who is more prone boys or girls?

A

At or shortly after birth, boys

76
Q

Will someone with a congenital nystagmus have a strabismus?

A

Could be present

77
Q

Is conjugate, horizontal, oscillopsia present in congenital nystagmus?

A

No

78
Q

Is the etiology of congenital nystagmus more motor or sensory?

A

Motor (60%)

79
Q

Will someone with congenital nystagmus have a horizontal or vertical nystagmus?

A

Horizontal

80
Q

When will someone with congenital nystagmus have a head turn or tilt?

A

If the null point is not in primary

81
Q

With congenital nystagmus, the nystagmus ___ with fixation and __ with convergences

A

Increases with fixation and dampens with convergence

82
Q

Can a congenital nystagmus improve with age?

A

Yes

83
Q

Is a latent nystagmus seen in someone with a congenital nystagmus?

A

Yeah usually when one eye is covered

84
Q

Type of congenital etiology: inadequate image formation that results in a failure of development or normal fixation, poorer vision/bad VAs

A

Afferent etiology

85
Q

Type of congenital etiology: fixation and or motor issues that has a better VA and has cosmesis concerns

A

Efferent

86
Q

A patient with congenital nystagmus that later develops an ET with a head turn

A

Nystagmus blocking syndrome

87
Q

Convergence usually ___ congenital nystagmus

A

Dampens

88
Q

Type of nystagmus: a congenital, jerk nystagmus after occlusion of one eye

A

Latent nystagmus

89
Q

Is a latent nystagmus horizontal or vertical?

A

Horizontal

90
Q

In latent nystagmus the fast phase is towards the __ eye

A

Uncovered

91
Q

A latent nystagmus is associated with what 2 conditions?

A

Strabismus and amblyopia

92
Q

When a latent nystagmus occurs with both eyes open but one eye suppresses

A

Manifest latent nystagmus

93
Q

In mono VA increased or reduced with a latent nystagmus?

A

Reduced

94
Q

In bino VA better or reduced with a latent nystagmus?

A

Better

95
Q

A left jerk latent nystagmus is when the __ is covered

A

OD

96
Q

Type of nystagmus: starts shortly after birth, pendular, usually bilateral, ad should be sent to neuro

A

Spasmus nutans

97
Q

When does spasmus nutans usually reduce by?

A

Age 5-8

98
Q

Spasmus nutans can be associated with what 3 things?

A

Strabismus, amblyopia, and developmental delays

99
Q

Type of nystagmus: small/fine amplitude with high frequency, head nodding and possibilities torticollis

A

Spasmus nutans

100
Q

Type of nystagmus: pendular nystagmus where one eye elevates and intorts while the other depresses and extorts

A

See-saw nystagmus

101
Q

Someone with a see-saw nystagmus probable has a lesion in the ___ or a ___ in children

A

Lesion in Supra stellar area or craniopharyngioma in children

102
Q

See saw nystagmus is seen in what type of syndrome?

A

Joubert syndrome

103
Q

Type of nystagmus: a jerk vertical nystagmus in primary, that has a fast phase that beats down

A

Downbeat nystagmus

104
Q

A downbeat nystagmus is due to what type of abnormalities?

A

Cranio-cervical junction

Medications can also cause this

105
Q

Type of nystagmus: a jerk vertical nystagmus, with the fast phase up

A

Upbeat nystagmus

106
Q

What causes an upbeat nystagmus?

A

brainstem abnormalities or drugs

107
Q

Type of nystagmus: horizontal nystagmus with a jerk with a rotary element

A

Vestibular nystagmus

108
Q

This type of nystagmus is associated with an inner ear or vestibular abnormality

A

Vestibular nystagmus

109
Q

What 3 symptoms can someone have with a vestibular nystagmus?

A
  • oscillopsia
  • nausea
  • vertigo
110
Q

A rhythmic convergence and retraction of the eyes when attempting upgaze movement

A

Convergence-retraction syndrome

111
Q

Convergence-retraction is found in what syndrome?

A

Parinaud syndrome

112
Q

Name 4 characteristics of parinaud syndrome

A
  • dorsal minbrain syndrome
  • pretectal dysfunction
  • excess convergence
  • paralysis of upward gaze
113
Q

What are 4 accompanying neurological signs in parinaud syndrome?

A
  • palsy in upgaze
  • eyelid retraction
  • pupillary light-near dissociation
  • convergence-retraction
114
Q

What is the hallmark sings in periodic alternating nystagmus?

A

Shifting null point

115
Q

Type of nystagmus: horizontal nystagmus that changes directions every 90 seconds with rest of about 10 secs

A

Periodic alternating nystagmus

116
Q

What might a patient with periodic alternating nystagmus do to adapt to the nystagmus?

A

Alternating head turnings

117
Q

Type of nystagmus: a rapid with small amplitude and short duration nystagmus that is pendular and only maintained for a few secs because of fatigue

A

Voluntary nystagmus

118
Q

Is a voluntary nystagmus horizontal or vertical?

A

Horizontal

119
Q

What induces a voluntary nystagmus?

A

Convergence

120
Q

Is oscillopsia present in voluntary nystagmus?

A

Yes

121
Q

What are the 5 goals to improve nystagmus?

A
  • VA
  • Ocular motor control
  • binocularity
  • cosmesis
  • comfort
122
Q

What are 5 options to manage a nystagmus?

A
  • glasses or contacts
  • prism
  • vision therapy
  • surgery
  • medication
123
Q

Why would you give someone prism for their nystagmus?

A
  • to improve fusion
  • to induce convergence
  • to reduce head turn
124
Q

____ prism can be also used to move the null point

A

Yoked

125
Q

Why would you want to give someone correction for their nystagmus?

A

To improve the clarity of the retinal image and to lessen the nystagmus

126
Q

What is the first type of management you would give someone with a nystagmus?

A

Correction

127
Q

When would you rx for hyperope with nystagmus?

A

1 to 2D

128
Q

When would you rx for a myope with nystagmus?

A

0.50D or more

129
Q

When would you rx for someone with a nystagmus?

A

0.50D or more

130
Q

What 2 types of lenses could be considered for higher refractive errors for someone with a nystagmus?

A
  • rigid-gas permeable lens

- soft contact lenses

131
Q

Why might you use plus adds for someone with a nystagmus?

A
  • valuable at near for improved VA and clarity for near point demands
  • aid in accommodation at near
132
Q

Why might you use minus adds for someone with a nystagmus?

A

To induce convergence since nystagmus can decrease with convergence

133
Q

What type of prism would you use to induce convergence in a nystagmus patient

A

Use BO prism

134
Q

What type of prisms can be used to improve VA and slow down the nystagmus by improving abnormal head postures?

It also shifts the retinal image towards the null point

A

Yoked

135
Q

How should the prism be placed for some with a nystagmus to lessen the head turn?

A

To be placed in the same direction as the head turn

136
Q

If you put a BO over the OD and BI over the OS the image will shift to the ____ improving the small gift head/face turn

A

Left

137
Q

This types of prism are used for large amounts of prism

A

Fresnel and ground

138
Q

The apex of the prism is towards the ___ and the base is towards the ___

A

Apex towards the null point and base towards the turn

139
Q

If someone has a left head turn, the patient has the null point in the right face and you use a base to the _____over each eye

A

Left..this will shift the image to the right and reduce the head turn

140
Q

Why is vision therapy used in some nystagmus patients?

A
  • fusional vergences
  • improve motor control
  • suppression that could lead to manifest latent nystagmus
141
Q

When do you need to rx medication for someone with a nystagmus?

A

When there is a systemic problem (infection, metabolic, or vascular problem) or if they have oscillopsia and vertigo

142
Q

What type of medication has been shown to help reduce the severity of nystagmus?

A

Gabapentin

143
Q

This technique is used to shift the null point closer to the primary position and eliminates the head turn

A

Kestenbaum technique

144
Q

When is the best age to do surgery on someone with a nystagmus? And why?

A

Oder than 4 because there is a higher change of over correction in younger children

145
Q

A spontaneous upward movement of one or both eyes when tired, when fusion is broke, or inattentive

A

Dissociated vertical deviation (DVD)

146
Q

For someone with a DVD, will they have a hypo deviation in the other eye?

A

No, they will have a hyper deviation in one or both eyes

147
Q

At what age does DVD start?

A

2-3 years

148
Q

Do you usually treat someone with a DVD?

A

No, unless its huge then you can do surgery

149
Q

If someone has an IO overaction will they have a deviation in the primary gaze?

A

Probably not

150
Q

When do you usually see a IO overaction?

A

In children with infantile strabismus mainly

151
Q

In what gaze will you see an overaction of the IO?

A

When the eye is elevated in adduction

152
Q

This is present when a horizontal deviation changes in magnitude between upgaze and downgaze

A

Pattern strabismus

153
Q

Is a pattern strabismus comitant or non-comitant?

A

Non-comitant

154
Q

Is a pattern strabismus considered horizontal or vertical?

A

Vertical

155
Q

T/F: a pattern strabismus can be seen in an XT or ET

A

True

156
Q

Pattern strabismus: horizontal deviation is more divergent in upgaze than in downgaze

A

V pattern

157
Q

Pattern strabismus: horizontal deviation is more divergent in downgaze than in upgaze

A

A pattern

158
Q

How do you determine A and V pattern strabismus?

A

Measure alignment in primary at distance and then about 25 degrees from primary in upgaze and downgaze

159
Q

When is the V pattern considered significant?

A

When the difference in measurement between upgaze and downgaze is at least 15pd

160
Q

What is the most common pattern deviation?

A

V

161
Q

In what type of ET is a V pattern present?

A

Infantile

162
Q

Will someone have a head posture with a V pattern strabismus?

A

Yes they may adopt a chin up compensatory head posture

163
Q

What kind of palsy can a V pattern strabismus be seen in?

A

SO palsy (especially if bilateral)

164
Q

When is an A pattern considered clinically significant?

A

When there is a difference in measurement between upgaze and down gaze is at least 10pd

165
Q

This pattern is seen more frequently in patients with XT

A

A pattern

166
Q

Will someone with an A pattern strabismus have a head posture?

A

They may adopt a chin down compensatory head posture

167
Q

This pattern strabismus is more common in patients with infantile strabismus associated with craniofacial malformations, down’s.

A

A pattern

Motility (6 decks)

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