Clinical Skills Flashcards
perimetry
visual field testing
FOLDARS
F- Frequency O - Onset L - Location D - Duration A - Associated signs/symptoms R - Relief S - Severity Note - do for every chief complaint
DEA
Drug Enforcement Administration
CSA
Controlled Substances Act
ROI
Release of Information
AIDET
Model of Patient Satisfaction A - Acknowledge I - Introduce D - Duration E - Explanation T - Thank you.
PII
Personally Identifiable Information eg) name, address
PHI
Protected Health Information
HIPAA
Health Insurance Portability & Accountability Act - sets standards for protecting patient data)
Symptoms of Eye Problems
- reported by patient; story
eg) visual symptoms, visual disturbances, physical discomfort, physical changes
Signs of Eye Problems
abnormalities of the eye directly observed
Dose
quantity of medication ie) 500 mg
Dosage
size or frequency of dose ie) 3 times a day
emergent
- immediate attention
urgent
- seen with a day
routine
- longer standing problem
optical infinity
- distance where light rays are virtually parallel
visual acuity
- ie) 20/70 - the greater the denominator, the worse the vision
- 3 phenomena: detection, recognition & resolution
snellen chart
- for visual acuity
- optotype: letters
sloan chart
- for visual acuity
- letters with standard spacing, upside down pyramid
ETDRS
- early treatment diabetic retinopathy study chart
- inverted pyramid with 5 optotypes
- for low vision patients
Lea numbers
- numbers 5, 6, 8 & 9 blur into nondescript once past limits of recognition ability
allen pictures
- objects universally recognized
- ie) hand, truck, horse
Lea symbols
- four: square, circle, house, apple
- all are blurry circles beyond acuity
tumbling E’s
- resolution test
Landolt’s Broken Rings
- resolution test
one minute of arc
- amount of angle where a normal eye can detect the separation of two points
- one degree = 60 min of arc
ie) person with 20/20 can distinguish an object that subtends 5 min of arc
crowding phenomenon
- patient sees smaller letters if shown one at a time vs. a row of letters
pinhole
- opaque disk with a tiny hole in center to look through
- allows only direct light rays (not scattered) into eye
- increased acuity through pinhole if refractive error causing reduced far vision
Teller acuity cards
- for babies
- gratings of various frequencies (babies prefer pattern over blank)
- peep hole in card for examiner to watch babies response
Photostress Recovery test
- how quickly pigments in cone cells regenerate after being depleted of ligth sensitive pigments with white light
Pelli Robson Chart
- for contrast sensitivity
- letters same size but decrease in contrast
Brightness Acuity Test (BAT)
- testing glare
- look through an illuminated half globe & read eye chart
S.A.F.E
- range of motion of eyes into 9 positions of gaze S - smooth A - accurate F - fast E - equal
PERRLA
- pupils equal, round & reactive to light
- (A) accomodation normal
Oblique Flashlight Test
- for angle evaluation
- if temporal & nasal iris appear illuminated, then angle open
saccades
- rapid eye movements to quickly change point of fixation
smooth pursuits
- slower eye movements to follow moving object
vergence
- moving both eyes
- convergence - inward, looking closer
- divergence - outward, looking farther
vestibulo-ocular reflex
- eyes move opposite to head movement
- want this in emergency to lessen brainstem damage
prism diopter
- unit of measure for refractive power
- ## 1 diopter = deflection of light ray by 1 cm at a distance of 1 m
abduction
lateral movement of one eye away from midline
adduction
medial movement of one eye toward midline
supraduction
upward movement of one eye
infraduction
downward movement of one eye
dextroelevation
movement up and to the right of one eye
laevoelevation
movement up and to the left of one eye
incycloduction
nasal rotation of one eye of one eye
excycloduction
temporal rotation of one eye
dextroversion
binocular movement to the right
laevoversion
binocular movement to the left
supraversion
binocular movement up
infraversion
binocular movement down
dextroinfraversion
binocular movement down & to the right
laevoinfraversion
binocular movement down & to the left
fusional convergence
eyes move inward to avoid double vision
tonic convergence
inherent reflex to reposition our eyes from a divergent position
convergence
- both eye move inward
- near focus
- 20 to 35 diopters
divergence
- both eyes outward
- far focus
- 6 to 10 diopters
AC/A
accommodative convergence/accommodation ratio
= amount of convergence for each diopter accomodation
- normal 3-5 diopters convergence / 1 diopter accommodation
- esodeviations (+), exo (-)
near point convergence
- closest point a person can converge both eyes
- normal 3-4 inches (8-10 cm)
Cover Testing
- detects & quantifies strabismus and assesses control
1) Cover/Uncover
2) Alternate Cross/Cover
3) Repeat Cover/Uncover
deviation measurements
- use prisms of increasing power until reversal of movement
Bielschowsky Head Tilt Test
- EOM movement test
- gaze measurements when head turned rigth & left, tilted right and left
Hirschbert Test
- EOM & light reflex test
- tests for tropias only
- light shone 33 cm away & cornea reflexes observed
- normal reflex seen centrally or slightly nasal
Krimsky Test
- measure of strabismus
- uses light & prisms to move deviated light reflex back to center of pupil
angle kappa
- visual axis an pupillary axis do not coincide
Red (Bruckner) Reflex Test
- should see red reflection of white light from eyes
Single/Double Maddox Rod Testing
- transparent “lens” made of series of parallel red cylinders
- white light viewed through rod should show a red line 90 degrees to the direction of cylinders
SOAP
Subjective
Objective
Assessment
Plan
Slit Lamp Diffuse Illumination
- beam covered by diffusing filter
- for conjunctiva, lids and cornea
Slit Lamp Direct-Narrow Slit Illumination
- for conjunctiva, cornea, lens, vitreous
Slit Lamp Direct-Wide Slit Illumination
- for cornea, iris & lens
Slit Lamp Indirect Illumination
- decentering slit beam
- conjunctiva & iris
Slit Lamp Retro from iris Illumination
- light reflected off iris to illuminate pathology from behind
- cornea
Slit Lamp Retro from fundus Illumination
- light reflected off fundus to illuminate pathology from behind
- lens
phakic eye
- has natural lens
pseudophakic eye
- has intraocular lens implant
aphakie eye
- no lens
potential acuity meter (PAM)
- mini eye chart mounted on slit lamp, patient’s prescription dialled into PAM so no glasses worn
super pinhole
- lightbox to produce ultra high contrast eye chart (white letters on black background)
- use a pinhole
Ways to assess anterior chamber angle
1 - flashlight (shine light on temporal side)
2 - slit lamp
3- goniolens (specialized contact lens to examine chamber angle structures)
accommodative triad
- when looking at near object
1 - eyes converge
2 - pupils constrict
3 - lens accommodates
confrontation fields
- check for gross defects in visual field
- use “counting fingers” in each quadrant of visual field
- static or kinetic
- follow up with automated perimetry