Direct Ophthalmoscopy

Question 1

if you see black dots in fundus reflex against motion, it is:

Answer 1

in front of lens

cells, flare, hyphema

Question 2

if you see black dots in fundus reflex with no motion, it is:

Answer 2

at plane of lens

mittendorf dot, PSC, vacuoles

Question 3

if you see black dots in fundus reflex with motion, it is:

Answer 3

vitreous hemorrhage, asteroid hyalosis

Question 4

color and cause of:

RPE crescent

Answer 4

black, proliferation of RPE

Question 5

color and cause of:

choroidal crescent

Answer 5

dark grey, RPE is not formed flush against ONH during development (allowing underlying choroid to show through)

Question 6

color and cause of:

scleral crescent

Answer 6

variation of white, RPE and choroid fall short in development, revealing white sclera

Question 7

peripapillary atrophy (PPA) is caused from:

Answer 7

degeneration of the posterior short ciliary artery

Question 8

ISNT rule for rim tissue states:

Answer 8

thickest to thinnest part of rim tissue

Inf - Sup - Nas- Temp

Question 9

causes of pale nerve tissue (pallor)

Answer 9

endstage glaucoma, CRAO, CRVO, AION, Optic Neuritis, chronic papilledema, tumor, aneurysm, trauma

Question 10

characteristics of pallor

Answer 10

pale nerve, reduced BCVA, APD (afferent pupillary defect), VF defect, color desaturation, lack of or compromised circulation

Question 11

signs of rim tissue thinning

Answer 11

enlargement of the cup, receding rim tissue

Question 12

cause of rim tissue thinning

Answer 12

progressive endstage glaucoma

Question 13

when does SVP or CRVP occur?

Answer 13

when IOP in normals is higher than the retinal venous pressure

Question 14

what is the normal disc size

Answer 14

1.5mm (medium aperture)

Question 15

what is the normal disc shape

Answer 15

oval vertically (cup elongated more vertically than horizontally)

Question 16

what is tilted disc and how does it occur?

Answer 16

bilteral, congenital anomaly with developmental hypoplasia of the inferior nasal rim tissue

Question 17

appearance and possible sign of tilted disc:

Answer 17

ONH appears like its rotated, pseudo-disc edema appearance and may have VF defect in superior or superior temporal area

Question 18

how does oblique insertion of the disc occur?

Answer 18

unilateral or bilateral malinsertion of ONH through scleral canal that pierces globe at greater than 15 degrees (seen in axial myopes and astigmats)

Question 19

appearance of oblique insertion disc:

Answer 19

raised nasal rim tissue, stretched and flattened temporal rim tissue, kidney beam appearance

Question 20

describe normal cup appearance

Answer 20

C/D ratio from .2-.4, centered and round, round laminar dots, symmetrical to fellow eye

Question 21

what do you look for when examining the retinal nerve fiber layer?

Answer 21

use red free filter to examine along course of retinal vasculature about 0 to 3DD away from the nerve and look for rows of shimmering nerve fiber

Question 22

what do retinal nerve fiber layer (RNFL) defects appear as?

Answer 22

dark, dull, matte-finished appearance, retinal vessels more apparent, associated with rim tissue thinning

Question 23

arteries are ___ than veins by approx. ___

Answer 23

arteries are smaller than veins by 1/3

Question 24

arteries lie ____ (above/below) veins

Answer 24

arteries lie above veins

Question 25

veins are subject to compression by:

Answer 25

overlying hardened arteries

Question 26

how far is the macula from the ONH

Answer 26

2DD temporally

Question 27

proliferation of melanin at the level of the choroid is called:

Answer 27

benign choroidal melanoma (nevus)

Question 28

proliferation of melanin in the RPE cells is called:

Answer 28

RPE Hyperplasia

Question 29

enlargement of the RPE cells in size is called:

Answer 29

congenital hypertrophy of the RPE (CHRPE)