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Opthalmology > Clinical Examination and Signs > Flashcards

Clinical Examination and Signs Flashcards

1
Q

When inspecting the eye, what things are you looking for?

A
  • Facial asymmetry - VII nerve palsy – upper neuron / lower neuron
  • Rashes - rosacea – blepharitis; Malar rash (SLE)– Vasculitis; Shingles - Uveitis
  • Lid position abnormalities - ptosis, entropion, ectropion
  • Globe position abnormalities - proptosis, enophthalmos
  • Pupil asymmetry - anisocoria
  • Lumps, bumps, redness/discharge
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2
Q

What is the following?

A

Ptosis - Droppy eyelid

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3
Q

What is the following?

A

Entropian - eyelid turns inwards - bottom eyelid is turned inwards in this picture

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4
Q

What is the following?

A

Ectropian - Eyelid turns outwards

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5
Q

What is the following?

A

Proptosis - forward displacement of the globe

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6
Q

What is the following?

A

Enopthalmos - posterior displacement of the globe

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7
Q

What is the following?

A

Anisocoria - difference in pupil size

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8
Q

What is the following?

A

Episcleritis - benign, self-limiting inflammatory disease affecting part of the eye called the episclera.

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9
Q

What is the following?

A

Scleritis - a serious inflammatory disease that affects the white outer coating of the eye, known as the sclera

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10
Q

How would you distinguish between scleritis and episcleritis?

A

Episcleritis typically presents with little to no pain and is most often idiopathic. It is generally a self-limiting inflammatory process affecting only the conjunctival and superficial episcleral vascular plexuses.

Scleritis manifests as a very painful red eye—but it sometimes suggests that something deeper than the eye is involved.

If you touch sclera and vessels move, this is episcleritis

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11
Q

What is the following?

A

Subconjunctival haemorrhage - bleeding underneath the conjunctiva. The conjunctiva contains many small, fragile blood vessels that are easily ruptured or broken. When this happens, blood leaks into the space between the conjunctiva and sclera.

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12
Q

What is the following?

A

Pterygium - growth of the conjunctiva or mucous membrane that covers the white part of your eye over the cornea

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13
Q

What is the following?

A

Hypopyon - ¨level of inflammatory cells / pus in the AC

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14
Q

What is the following?

A

Hyphaema - ¨level of blood in the AC

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15
Q

What is the following?

A

Lens subluxation/dislocation

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16
Q

What is aphakia?

A

No lens in the eye

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17
Q

What is the following?

A

Cataracts - a clouding of the lens in the eye which leads to a decrease in vision. Cataracts often develop slowly and can affect one or both eyes

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18
Q

What field defect would someone have if they had a lesion at 1 (in the following image)/

A

Blindness - Right uniocular VF defect

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19
Q

What visual field defect would someone have if they had a lesion at 3 (in the attached image)?

A

Bitemporal hemianopia

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20
Q

What visual field defect would you get in someone with a lesion at 4 (on the attached diagram)?

A

Left homonimous hemianopia

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21
Q

What visual field defect would be present if there was a lesion at 8 (in the attached diagram)?

A

Left homonimous hemianopia

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22
Q

What visual field defects would be present in someone with a lesion in the superior optic radiation (F or I in the diagram attached)?

A

Left inferior homonimous quadrantanopia

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23
Q

When examining the pupils, what is important to look at?

A
  1. Iris colour, pupil size and shape in ambient light
  2. Assess pupil size in light/dark and comment on anisocoria
  3. Check pupil reactions
  • Direct & Consensual response to light
  • Response to accommodation
  • Relative afferent pupillary defect (RAPD)
24
Q

What visual field defects would be present in someone with a lesion in the inferior optic radiation (E or J in the diagram attached)?

A

Left superior homonimous quadrantanopia

25
Q

If there was a relative afferent pupillary defect, what might this suggest?

A

An abnormality of the optic nerve or generalised retinal abnormality

26
Q

What is the following?

A

Myadriasis - dilation of the pupil

27
Q

What are central causes of horner’s syndrome?

A
  • MS
  • Spondylosis
  • SOL
  • Syringomyelia
  • Stroke/lateral medullary syndrome
28
Q

What is the following?

A

Miosis - constriction of the pupil

29
Q

What are causes of bilateral miosis (pinpoint pupils)?

A
  • Opioid – morphine, heroin
  • Senile miosis
  • Pontine haemorrhage
  • Cholinergic toxicity – organophosphate poisoning
  • Upward transtentorial herniation
  • Central α-2 agonist – clonidine, dexmedetomidine
  • Beta-adrenergic antagonist – carvedilol, timolol
30
Q

If someone presented with bitemporal hemianopia, where might you suspect the lesion to be?

A

Optic chiasm lesion e.g. pituitary tumour

31
Q

If someone presented with blindness in their right eye, where might the lesion causing the VF defect be?

A

Right optic nerve

32
Q

Lesions in which locations can cause homonimous hemianopias?

A
  • Optic cortex lesion
  • Superior and inferior optic radiations lesion
  • LGN, thalamus lesion
  • Optic tract lesion (least common)
33
Q

What is the following?

A

Chemosis - oedema in the conjunctiva

34
Q

What is the following?

A

Blepharitis - inflammed eyelids

35
Q

What is a scotoma?

A

Defect causing the part of field of view to go missing

36
Q

What is strabismus?

A

Eyes look in different directions - squint

37
Q

What is papillitis?

A

Inflammation of the optic nerve head

38
Q

What is myopia?

A

Nearsightedness - eye focusses in front of the retina

39
Q

What is hyperopia?

A

Farsightedness - Images focus past the retina

40
Q

What is emmetropia?

A

Normal refractive index

41
Q

What is astigmatism?

A

Condition where the cornea is not perfectly spherical (i.e. more egg/rugby ball shaped) and therefore light is focused in two different focus points which overlap, resulting in blurred vision

42
Q

What is presbiopia?

A

Condition where the eye gradually loses its focusing ability for near objects (accommodation) in particular as a result of age (loss of elasticity of crystalline lens capsule and weakening of the ciliary muscles)

43
Q

What lens would you use to correct the vision of someone who is myopic?

A

Concave lens

44
Q

What lens would you use to correct the vision of someone who had hypermetropia?

A

Convex lens

45
Q

What is the following?

A

Synechiae - iris adheres to either the cornea (i.e. anterior synechia) or lens (i.e. posterior synechia)

46
Q

What is the following?

A

Dacrocystitis - acute inflammation of the tear sac medial the the medial canthus

47
Q

How would you remeber when the upper and lower optic radiations are?

A

TISO

Temporal inferior, Superior Occipital

48
Q

What are causes of a monocular visual field loss?

A

Ipsilateral retinal/optic nerve lesion

  • Retinal - Central retinal artery/vein occlusion, retinal detachement
  • Optic nerve - Optic neuritis, optic atropy, glaucoma
49
Q

What are causes of a lesion at point C, causing bitemporal hemianopia?

A
  • Pituitary tumour
  • Craniopharyngioma
50
Q

What are causes of a lesion at point D - resulting in homonymous hemianopia?

A

Middle cerebral artery occlusion

51
Q

What are causes of a lesion at E - resulting in a Left superior quadrantanopia?

A

Contralateral Temporal (lower) optic radiation

  • Temporal tumour
  • MCA occlusion - superior branch
52
Q

What are causes of a lesion at F - resulting in a Left inferior quadrantanopia?

A

Contralateral parietal upper optic radiation

  • Parietal tumour
  • MCA occlusion - inferior branch
53
Q

What are causes of a lesion at H - resulting in a homonymous hemianopia with macular sparing?

A

Contralateral occipital visual cortex lesion

  • Posterior cerebral artery occlusion
54
Q

What are pre-ganglionic causes of horner’s syndrome?

A
  • Pancoast tumour
  • Cervical rib
  • Thyroid carcinoma/goitre
55
Q

What are post-ganglionic causes of horner’s syndrome?

A
  • Carotid artery dissection
  • Radical neck dissection

Opthalmology (12 decks)

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