Exam of eye lecture

Question 1

emmetropia

Answer 1

light rays enter the eye fall directly on the retina. Normal vision

Question 2

Myopia

Answer 2

light rays fall in front of retina-nearsightedness

Question 3

Hyperopia

Answer 3

light rays fall behind the retina-farsightedness

Question 4

astigamtism

Answer 4

irregular shaped cornea-varying refraction

Question 5

What cornerstones of physical exam are used on eye exam?

Answer 5

inspection

VERY GENTLE palpation

Question 6

What is the vital sign of the eye exam?

Answer 6

Visual acuity

Question 7

Where does the Visual acuity belong in the SOAP note?

Answer 7

eye exam section of the O part of the notes

Question 8

What are the mc complaints of the eye pt?

Answer 8

loss of vision
pain in the eye
Visual distortion or aberrations

Question 9

What might be indicated by acute painless visual loss?

Answer 9

Vitreous hemorrhage
Retinal detachment
Retinal artery occlusion
Retinal vein occlusion
exudative macular degeneration
ischemic optic neuropathy
CVA

Question 10

Vitreous hemorrhage: symptoms, assoc dz, PE

Answer 10

spider webs clouding vision
DM, sickle cell
Decreased red reflex, clouding

Question 11

Retinal detachment: symptoms, assoc d/o, PE

Answer 11

flashes of light, curtain covering
severe myopia, post surgery, trauma
difficult to visual with scope, VF or VA loss

Question 12

Retinal artery occlusion: symptoms, cause, PE

Answer 12

Monocular visual loss sudden and nearly complete
Embolic occlusion (TIA)
VA limited to hand motion or light perception only, Cherry red spot

Question 13

Retinal vein occlusion: symptoms, assoc dz, PE

Answer 13

Loss of vision
HTN
retinal hemorrhages, veins tortuous

Question 14

Exudative macular degeneration: r/f, symptoms, PE

Answer 14

age > 60
slow progressive VF loss, metamorphosia
retinal hemorrhage possible

Question 15

Ischemic optic neuropathy: Assoc d/o, R/f, symp, PE

Answer 15

HTN DM >60yo
assoc scalp tenderness, neck pain
Afferent pupillary defect, sudden vision loss, swelling of optic nerve head.

Question 16

What might be indicated by acute PAINLESS visual loss?

Answer 16

Vitreous hemorrhage
Retinal detachment
Retinal artery occlusion
Retinal vein occlusion
exudative macular degeneration
ischemic optic neuropathy
CVA

Question 17

Ischemic optic neuropathy: Assoc d/o, R/f, symp, PE

Answer 17

HTN DM >60yo
assoc scalp tenderness, neck pain
Afferent pupillary defect, sudden vision loss, swelling of optic nerve head.

Question 18

Acute PAINFUL vision loss DDX:

Answer 18

Corneal ulcer
Uveitis
Acute angle closure glaucoma
Endopthalmitis

Question 19

Corneal ulcer: r/f, PE

Answer 19

Hx of trauma, contact lens wearer

Little or no signs on inspection w/ slit lamp might see abrasion

Question 20

Uveitis: signs, r/f, assoc. dz, PE

Answer 20

Inflammation of uveal tract
hx of photophobia
assoc: sarcoidosis, TB, IBD, psoriasis
small pupil, sluggish/non-reactive to light, circular reddening around the cornea, diminished red reflex,

Question 21

Acute angle closure glaucoma: R/f, signs, assoc manifestations, PE:

Answer 21

older individuals, farsighted
hx of blurry vision, halos around lights, pain
Marked increase in IOP-H/A, N/V
Unilateral red eye, mid position pupil non-reactive, vision dec due to corneal edema,

Question 22

Endopthalmitis: m/c cause, PE

Answer 22

post surgical complication

decreased vision, redness, corneal edema, mucopurulent d/c, decreased red reflex

Question 23

Chronic progressive PAINLESS visual loss DDX

Answer 23

Refractive error
cataract
Open angle glaucoma
Atrophic macular degeneration
Brain tumor

Question 24

open angle glaucoma is mc in who?

Answer 24

pt’s with family hx of glaucoma, nearsighted pt’s, african americans

Question 25

Atrophic macular degeneration: r/f, PE

Answer 25

pts >60yo and fam hx.

Drusen in fundus, retinal scar or atrophic area in central macula

Question 26

Causes of Binocular diplopia:

Answer 26

III nerve palsy
IV nerve palsy
VI nerve palsy
uncompensated strabismus
thyroid dz
Myesthenia graves
Blow out fracture.q

Question 27

PE findings of III nerve palsy

Answer 27

gazing lateral and slightly downward. Pt unable to gaze medially or down.

Question 28

What will a pt with IV nerve palsy complain of?

Answer 28

difficulty with reading or going down stairs

Question 29

What will be seen on a pt with VI nerve palsy?

Answer 29

esotropia-eye at rest gazes inward instead of neutral)

Question 30

Addies pupil

Answer 30

Large pupil very sluggish or no reaction to light, accommodation although slowed is present

Question 31

anisocoria related to 3rd nerve paralysis

Answer 31

no reaction to light or accomodation

Question 32

argyll-robertson pupil

Answer 32

small often irregular pupils that do not react to light but do to accomodation

Question 33

Horner’s syndrome

Answer 33

pupil is small but reacts to light and accommodations, ptosis is present on affected side and loss of sweating on the affected side of forehead.

Question 34

Marcus Gunn pupil:

Answer 34

monocular blindness, light directed at affected eye shows no pupillary reaction but swing light to other eye and affected eye constricts
swing light back to affected eye and pupil dilates.

Question 35

EOM: 3rd nerve palsy

Answer 35

Paralysis of medial gaze, upward and downward game on affected side (CN aren’t crossed so deficits are on side of lesion).
Also-dilated pupil that does not react to light or accommodation and ptosis

Question 36

EOM: 6th nerve palsy

Answer 36

paralysis or lateral gaze on affected side

Question 37

EOM: 4th nerve palsy

Answer 37

affected eye cannot look down when turned inward (reading/walking down stairs)