Exam 2: Eyes

Question 1

In elderly, the inward turning of the lid margin

Answer 1

Entropion

Question 2

Drooping of the upper lid. Could be caused from MG, damage to CNIII, dammage to the sympathetis nerve supply (horner syndrome), or cogential.

Answer 2

Ptosis

Question 3

Lid retraction with the visualization of the rim of sclera. Cause from Grave’s Dx

Answer 3

Exopthalmus

Question 4

yellowish triangular nodule in the bulbar conjunctiva. Common in aging

Answer 4

Pinguecula

Question 5

Localized ocular inflammation of the episcleral vessels. Seen in RA, Sjoren, herpes zoster

Answer 5

Episcleritis

Question 6

painful, red, tender outer margin of the eyelid. Caused from staph, also known as stye

Answer 6

hordeolum

Question 7

a subacute nontender, painless nodule caused by a blocked meibomian gland. May become acutely inflammed, but unlike a stye, usually points inside the lid rather than on the lid margin

Answer 7

chalzion

Question 8

slightly raised, yellow, well-circumsized cholesterol-filled plaques along nasal portions of the eyelids. Half of pts with this have hyperlipidemia. Can also be caused from primary biliary cirhhosis

Answer 8

Xanthelasma

Question 9

chronic inflammation of the eyelids at the base of the hair folicile with crusting/scaling of the lashes

Answer 9

blepharitis

Question 10

a thin, grayish-white arc or cirlce at the edge of the cornea: seen with aging, common in AA; usually benign

Answer 10

corneal arcus

Question 11

opacity of the lens, visible through th pupil that sauses the absence of red reflex. Risk factors: older age, smoking, diabetes, corticosteriod use.

Answer 11

cataracts

Question 12

Answer 12

Normal: major vessels, slightly darker fovea

Darker macula

Fovea slightly discernable

No light reflex

Choridal vessels

Darker skinned person vessels may be darker

• color: yellowish orange to creamy pink
• cup is located centrally or somewhat temporally. It may be conspicuous or absent. diameter is usually less than half of the disc

Question 13

Answer 13

Cotton-wool patches: Soft, irregular border exudates-white or grayish (smaller than disc)-HTN, DM, HIV

Question 14

Answer 14

Proliferative retinopathy with neovascularization: new preretinal vessels arising on the disc, extending across the disc margins. Visual aquity is normal, but risk for visual loss is high. Photocoagulation reduces the risk by >50%.

Diabetic retinopathy

Question 15

Answer 15

physiologic cupping: cup is a small white depression in the optic disc, the entry point for the retinal vessels. Although sometimes absent, the cup is usally visible either centrally or towards the temporal sideof the disc. grayish spots are often seen at its base.

Question 16

Answer 16

Rings and cresents: seen around the optic disc. These are developmental variations that appear as either white sclera, black retinal pigment, or both. Not part of the disc itself, but should not be included in the estimate of the disc diameter. Normal finding

Question 17

Answer 17

Medullated (or myelinated) nerve fibers: a much less common, but dramatic finding. Appearing as irregular white patches with feathered margins, they obscure the disc edge and retinal vessels. They have NO PATHOLOGICAL SIGNIFICANCE.

Question 18

Farsightedness: difficulty seeing upclose

Answer 18

Hyperopia

Question 19

Associated with age-related visual changes that cause difficulty with reading. Caused by loss of elasticity of the lens.

Answer 19

Presbyopia

Question 20

Seen with lesions in the brainstem or cerebullum, and/or with weakness or paralysis of oneor more extraocular muscles. Palsy of CN III or VI. Pattern of III, VI, III when extraocular movements.

images appear side by side of object not in focus

Answer 20

Horizontal diplopia

if only in one eye: suggests problem with cornea or lens.

Question 21

Seen with lesions in the brainstem or cerebullum, and/or with weakness or paralysis of oneor more extraocular muscles. Palsy of CN III or IV. Pattern of III, III, IV when assessing extraocular movements.

images appear on top of each other

Answer 21

Vertical diplopia

if only in one eye: suggests problem with cornea or lens.

Question 22

What does the static finger wiggle test evaluate, what should we consider if positive, and how is it performed?

Answer 22

peripheral vision

(visual fields by confrontation)

enlarged blind spot consider: affecting optic nerve (glaucoma), opti neuritis, papilleedema

Method: stand in front/facing of pt, cover matching eyes, instruct to look at nose while present 1-5 fingers to each quadrant of vision

Question 23

What does the kinetic red target test evaluate?

Answer 23

peripheral vision

(visual fields by confrontation)

enlarged blind spot consider: affecting optic nerve (glaucoma), opti neuritis, papilleedema

Question 24

Answer 24

Papilledema: pink, hyperemic optic disk with vessels very numerous, curving over the disc border, with no visibility of the physiologic cup. (swelling of the optic disk and anterior bulding of the cup. caused by increased ICP with intracranial mass, legion, or hemorrhage (SAH), menigitis

Question 25

intermittent convergence: one eye turning in towards nose. what test can be used to diagnose?

Answer 25

esotropia

cover-uncover test

Question 26

If the patient is myoptic, which way do we rotate the lens of the ophthalmascope to assess the optic disc?

Answer 26

counter clockwise to the minus diopter

Question 27

If the pt is hyperoptic, which way do we rotate the lens of the ophthalmascope to assess the optic disc?

Answer 27

clockwise to the positive diopters

Question 28

On ophthalmologic exam, you assess the following. You understand this ti mean…?

Answer 28

Left homonymous hemianopsia (right optic radiation)

• visual loss in both eyes
• involves half of each field

Question 29

What does the cover-uncover test help identify?

Answer 29

Dyconjugate gaze