exam2 Flashcards
Mrs. Alden is a 29-year-old pregnant patient in her third trimester. She tells you that her vision has been a little blurred, and she thinks she needs to get new contact lenses. You should
advise her to
a. get new lenses as soon as possible to avoid complications.
b. wait until several weeks after delivery to get new lenses.
c. go to the nearest emergency department for evaluation.
d. change her diet to include more yellow vegetables.
b. wait until several weeks after delivery to get new lenses.
Because of the increased level of lysozyme in the tears during pregnancy, a blurred sensation may occur but will subside several weeks after pregnancy. The blurred vision is a normal occurrence during pregnancy. It is not an emergency, nor is it diet-dependent
A condition that typically develops by the age of 45 years is
a. presbyopia.
b. hyperopia.
c. myopia.
d. astigmatism.
a. presbyopia.
By 45 years of age, a condition known as presbyopia develops; presbyopia involves a weakening of accommodation. Hyperopia occurs in early infancy. Myopia and astigmatism
can occur at any time
Which finding, when seen in the infant, is ominous?
a. Difficulty tracking objects with the eyes
b. Appearing to have better peripheral than central vision
c. Blinking when bright light is directed at the face
d. White pupils on photographs
ANS: D
The absence of a red reflex, determined by physical examination or the appearance of white
pupils on a photograph, is indicative of retinoblastoma, a serious retinal tumor.
d. White pupils on photographs
Mr. C’s visual acuity is 20/50. This means that he
a. can see 50% of what the average person sees at 20 feet.
b. has perfect vision when tested at 50 feet.
c. can see 20% of the letters on the chart’s 20/50 line.
d. can read letters while standing 20 feet from the chart that the average person could read at 50 feet
d. can read letters while standing 20 feet from the chart that the average person could read at 50 feet
The criterion for determining the adequacy of a patient’s visual field is
a. the ability to discriminate primary colors.
b. the ability to discriminate details.
c. correspondence with the visual field of the examiner.
d. distance vision equal to that of an average person.
c. correspondence with the visual field of the examiner.
The examiner compares his or her own peripheral vision to that of the patient while performing the confrontation test, so unless the examiner is aware of a problem with his or her own vision, the examiner could assume that the fields are full if they match.
. Mrs. S. is a 69-year-old woman who presents for a physical examination. On inspection of her eyes, you note that the left upper eyelid droops, covering more of the iris than does the right.
This is recorded as
a. exophthalmos on the right.
b. ptosis on the left.
c. nystagmus on the left.
d. astigmatism on the right.
ANS: B
Ptosis is when one of the upper eyelids covers more of the iris than the other lid, possibly extending over the pupil
A condition in which the eyelids do not completely meet to cover the globe is called
a. glaucoma.
b. lagophthalmos.
c. exophthalmos.
d. hordeolum.
ANS: B
Lagophthalmos is a term used to describe the condition in which eyelids do not completely
meet when closing. Glaucoma involves elevated pressure in the eye. Exophthalmus involves
bulging eyes. A hordeolum is better known as a stye
Mr. Morris is a 38-year-old patient who presents to the clinic with complaints of allergies. An allergy can cause the conjunctiva to have a
a. cobblestone pattern.
b. dry surface.
c. subconjunctival hemorrhage.
d. rust-colored pigment.
ANS: A
A red or cobblestone pattern, especially to the upper conjunctiva, indicates allergic
conjunctivitis. Allergies also cause itchy, watery eyes rather than dry surfaces, hemorrhage, or rust-colored pigment
A pterygium is more common in people heavily exposed to
a. high altitudes.
b. tuberculosis.
c. ultraviolet light.
d. cigarette smoke.
ANS: C
Persons heavily exposed to ultraviolet light are more susceptible to the development of a pterygium.
Mr. Brown was admitted from the emergency department, and you are completing his physical examination. His pupils are 2 mm bilaterally, and you notice that they fail to dilate when the penlight is moved away. This is characteristic in patients who are or have been
a. in a coma.
b. taking sympathomimetic drugs (cocaine).
c. taking opioid drugs (morphine).
d. treated for head trauma.
ANS: C
Pupil constriction to less than 2 mm is called miosis. With miosis, the pupils fail to dilate in the dark, a common result of opioid ingestion or the use of drops for glaucoma. Pupils are usually dilated greater than 6 mm in a patient described in the other choices.
When testing corneal sensitivity controlled by cranial nerve V, you should expect the patient to respond with
a. brisk blinking.
b. copious tearing.
c. pupil dilation.
d. reflex smiling
ANS: A
Brisk blinking is an expected response to corneal sensitivity testing, which involves gently touching the cornea with a piece of cotton
You observe pupillary response as the patient looks at a distant object and then at an object held 10 cm from the bridge of the nose. You are assessing for
a. confrontation reaction.
b. accommodation.
c. pupillary light reflex.
d. nystagmus
ANS: B
Testing for accommodation involves asking the patient to look at an object at a distance (pupils dilate) and then to look at another, much closer object (pupils constrict).
When inspecting the region of the lacrimal gland, palpate
a. the lower orbital rim, near the inner canthus.
b. in the area between the arch of the eyebrow and upper lid.
c. beneath the lower lid, adjacent to the inner canthus.
d. adjacent to the lateral aspect of the eye, just beneath the upper lid.
ANS: A
The lacrimal gland is located at the lower orbital rim near the inner canthus of the eye
Examination to assess for extraocular muscle imbalance is conducted by
a. comparing pupillary responses to different shapes.
b. having the patient follow your finger through planes.
c. inspecting slightly closed lids for fasciculations.
d. transilluminating the cornea with tangential light.
ANS: B
The test for extraocular muscle function is to have the patient follow an object as you move it through planes of vision while observing for nystagmus.
Mr. Older is a 40-year-old patient who presents to the office for a follow-up eye examination after the diagnosis of myopia. To see retinal details in a myopic patient, you will need to
a. adjust your ophthalmoscope into the plus lens.
b. move your ophthalmoscope backward.
c. move your hand farther forward.
d. turn your ophthalmoscope to a minus lens.
ANS: D
The myopic patient (nearsighted) has longer eyeballs, so that light rays focus in front of the retina. To see the retina, use the minus (red) numbers by moving the diopter wheel counterclockwise; to assess a hyperopic patient, use a plus lens.
Ask the patient to look directly at the light of the ophthalmoscope when you are ready to examine the
a. retina.
b. optic disc.
c. retinal vessels.
d. macula.
ANS: D
The macula is the site of central vision and is observed when the patient looks directly at the ophthalmoscope light.
Opacities of the red reflex may indicate the presence of
a. hypertension.
b. hydrocephalus.
c. cataracts.
d. myopia.
ANS: C
Opacities or dark spots of the red reflex may indicate the presence of congenital cataracts in the newborn.
If a patient has early papilledema, using an ophthalmoscope, the examiner will be able to detect
a. dilated retinal veins.
b. retinal vein pulsations.
c. sharply defined optic discs.
d. visual defects.
ANS: A
Papilledema is caused by increased intracranial pressure along the optic nerve, pushing the vessels forward (cup protrudes forward) and dilating the retinal veins. Retinal vein pulsations and visual defects are not visible with an ophthalmoscope. On examination, papilledema is characterized by loss of definition of the optic disc.
Cupping of the optic disc may be a result of
a. migraine headaches.
b. diabetes.
c. glaucoma.
d. dehydration
ANS: C
Cupping is seen with causes of increased intraocular pressure, such as glaucoma. Migraine headaches, diabetes, and dehydration do not cause cupping of the optic disc. Diabetes results in cotton wool patches and hemorrhages.
When drusen bodies are noted to be increasing in number or in intensity of color, the patient should be further evaluated with a(n)
a. Amsler grid.
b. Snellen E chart.
c. litmus test.
d. confrontation test
ANS: A
Drusen bodies, when they increase in number or intensity of color, may indicate a precursor state of macular degeneration. When this happens, the patient’s central vision should be
assessed using the Amsler grid. The Snellen E chart measures visual acuity, the litmus test is used for testing pH, and a confrontation test examines peripheral vision.
Cotton wool spots are most closely associated with
a. glaucoma.
b. normal aging processes.
c. hypertension.
d. eye trauma
ANS: C
Cotton wool spots actually represent infarcts of the retina and are associated with hypertension or diabetes.
Which may be suggestive of Down syndrome?
a. Drusen bodies
b. Papilledema
c. Narrow palpebral fissures
d. Prominent epicanthal folds
ANS: D
Prominent epicanthal folds, or slanting of the eyes, may be normal in Asian infants, but in other ethnic groups it may indicate Down syndrome.
To differentiate between infants who have strabismus and those who have pseudostrabismus, use the
a. confrontation test.
b. corneal light reflex.
c. E chart.
d. Amsler grid
ANS: B
The corneal light reflex is used with infants to differentiate between strabismus and
pseudostrabismus by noting an asymmetric versus symmetric light reflex.
You are attempting to examine the eyes of a newborn. To facilitate eye opening, you would first
a. dim the room lights.
b. elicit pain.
c. place him in the supine position.
d. shine the penlight in his or her eyes.
ANS: A
The best way to assess the eyes of a newborn is to start by dimming the lights because it encourages infants to open their eyes.
Dot hemorrhages, or microaneurysms, in the retina and the presence of hard and soft exudates are most commonly seen in those with
a. Down syndrome.
b. diabetic retinopathy.
c. systemic lupus.
d. glaucoma.
ANS: B
Dot hemorrhages or tiny aneurysms are characteristics of background retinopathy. A trapping of lipids within incompetent capillaries causes the hemorrhages.
Which maneuver can be done to reduce the systemic absorption of cycloplegic and mydriatic agents when examining a pregnant woman if the examination is mandatory?
a. Have the woman keep her eyes closed for several minutes.
b. Instill half the usual dosage.
c. Keep the patient supine, with her head turned and flexed.
d. Use nasolacrimal occlusion after instillation
ANS: D
To reduce absorption systemically, the examiner may use nasolacrimal occlusion after applying, which involves pinching the upper bridge of the nose.
Changes seen in proliferative diabetic retinopathy are the result of
a. anoxic stimulation.
b. macular damage.
c. papilledema.
d. minute hemorrhages.
ANS: A
New vessels are a characteristic seen in proliferative retinopathy resulting from anoxic stimulation. An insufficient blood supply from failing capillaries causes new vessel growth
Which are the signs and symptoms of infant retinoblastoma? (Select all that apply.)
a. White reflex
b. Red reflex
c. Corneal light reflex
d. Absence of a blink reflex
e. Autosomal dominant trait
f. Drainage from the affected eye
g. Visual acuity of 20/500
ANS: A, E
Retinoblastoma in an infant is marked by a characteristic white reflex, also called cat’s eye reflex or leukocoria. Red reflex and corneal light reflex are expected findings. Absence of the blink reflex is not associated with retinoblastoma
Contraction or relaxation of the ciliary body:
a. allows voluntary blinking.
b. changes lens thickness.
c. regulates peripheral vision.
d. sends light impulses to the brain.
e. regulates tear production.
ANS: B
The lens is circularly supported by a framework of fibers from the ciliary body, and contraction or relaxation of this structure results in a change in the thickness of the lens, allowing for accommodation as needed. Voluntary blinking, peripheral vision, tear production, and impulses to the brain are not controlled by the ciliary body.
Term infants have a visual acuity of about:
a. 20/20.
b. 20/100.
c. 20/200.
d. 20/300.
e. 20/400
ANS: E
Term infants are hyperopic, with a visual acuity of less than 20/400.
At what age does an infant usually develop the ability to distinguish color?
a. At birth
b. 2 months
c. 6 months
d. 12 months
e. 16 months
ANS: C
By 6 months of age, vision has developed so that colors can be differentiated.
After focusing on a blood vessel in the retina with your ophthalmoscope, you attempt to locate the optic disc. You should:
a. follow the vessel as it branches out.
b. have the patient move his or her eye laterally.
c. have the patient move his or her eye up.
d. have the patient move his or her eye down.
e. follow the vessel as it converges into larger vessles
ANS: E
When you locate a vessel, follow it in the direction of the optic disc. Vessels nearer the disc are directionally toward the nose, are larger, and have less branching.
An allergy can cause the conjunctiva to have a:
a. cobblestone pattern.
b. dry surface.
c. subconjunctival hemorrhage.
d. rust-colored pigment.
e. pale appearance.
ANS: A
A red or cobblestone pattern, especially to the upper conjunctiva, indicates an allergic conjunctivitis. Allergies also cause itchy, watery eyes rather than dry surfaces, hemorrhage, or rust-colored pigment.
Bone spicule pigmentation is a hallmark of:
a. chorioretinal pigmentosa.
b. cytomegalovirus infection.
c. lipemia retinalis.
d. retinitis pigmentosa.
e. choroidal nevus.
ANS: D
Retinitis pigmentosa is inherited night blindness, characterized by the hallmark pigmentation of the peripheral fields or bone spicules.
Drusen bodies are most commonly a consequence of:
a. glaucoma.
b. aging.
c. presbyopia.
d. papilledema.
e. hypertension.
ANS: B
Drusen bodies, or lesions or spots on the retina, are part of the aging process. Glaucoma, presbyopia, and papilledema do not present with spots on the retina. Retinal hemorrhages and cotton wool spots are associated with hypertensive retinopathy.
Entropion implies that the eyelid is:
a. drooping.
b. everted.
c. edematous.
d. turned inward.
e. inflamed.
ANS: D
Entropion of the lower eyelid does not imply drooping, eversion, inflammation, or edema but is a slight inward turn of the lower eyelid.
Episcleritis may indicate:
a. lipid abnormalities.
b. an autoimmune disorder.
c. an anaphylactoid reaction.
d. severe anemia.
e. thyroid disease.
ANS: B
Episcleritis is an inflammation of the sclera, involves purplish bumps, and is commonly associated with autoimmune disorder. Lipid abnormalities, anaphylactoid reactions, anemia, and thyroid disease are not associated with these symptoms..
Horner syndrome is manifested by:
a. proptosis and contralateral mydriasis.
b. excessive watering of the eyes.
c. blurring of vision when glucose levels fall.
d. ipsilateral miosis and mild ptosis.
e. band keratopathy and miosis.
ANS: D
Horner syndrome is characterized by mild pupil constriction and drooping of the upper eyelid of the same eye. Horner syndrome is a result of a break in the sympathetic nerve supply to that eye. Mydriasis involves enlarged pupils. Watering of the eyes and blurred vision are not affected by a disruption in the sympathetic nervous system. Band keratopathy is a result of chronic corneal disease and is not associated with Horner syndrome.
An increased level of lysozyme in the tears will occur normally during which life stage?
a. Adolescence
b. Childhood
c. Infancy
d. Pregnancy
e. Older adults
ANS: D
Because of rising hormonal levels, lysozyme is present in an increased amount in the tears during pregnancy. Tears are not affected by increased lysozyme at any other stage in life.
Mydriasis accompanies:
a. coma.
b. diabetes.
c. hyperopia.
d. astigmatism.
e. morphine administration.
ANS: A
Coma patients always have mydriasis, which occurs when the pupils are dilated more than 6 mm. Diabetes may cause a coma but not mydriasis. Hyperopia is a condition of infants, describing their visual acuity as at or worse than 20/400. Astigmatism affects the shape of the lens, not the pupils. Opiates cause miosis
Periorbital edema is:
a. an abnormal sign.
b. expected with aging.
c. more common in males.
d. present in children.
e. an abnormality of lipid metabolism.
ANS: A
A clinical finding of periorbital edema should always be regarded as an abnormal finding until ruled otherwise
Peripheral vision can be estimated by means of which test?
a. Confrontation
b. Pupillary reaction
c. Accommodation
d. Snellen E chart
e. Swinging flashligh
ANS: A
The confrontation test measures peripheral vision. The examiner sits or stands across from the patient and asks the patient to close one eye while the examiner closes the opposite eye. The examiner then proceeds to wave the fingers while moving the extended arms from a lateral to a central position along both the temporal and the nasal fields. The pupillary reaction test is done by observing the pupil’s response to light. The accommodation test deals with pupil reaction to light, and the Snellen E chart measures visual acuity. The swinging flashlight test evaluates the health of the optic nerve by looking for an afferent pupillary defect
A pterygium is more common in people heavily exposed to:
a. high altitudes.
b. tuberculosis.
c. ultraviolet light.
d. cigarette smoke.
e. lead.
ANS: C
Persons heavily exposed to ultraviolet light are more susceptible to pterygium developments. High altitudes, tuberculosis, lead, and cigarette smoke do not cause an overgrowth of the conjunctiva.
Ptosis may be secondary to:
a. blepharitis.
b. hyperthyroidism.
c. psoriasis.
d. paresis of a branch of cranial nerve III.
e. entropion.
ANS: D
Ptosis is caused by a congenital defect of the muscle around the eye controlled by cranial nerve III. Hyperthyroidism causes exophthalmos, psoriasis is a skin condition, and blepharitis is a crusting of the eyelashes. Entropion is an inversion of the lower eyelid
Retinal hemorrhages in an infant require investigation for:
a. retinoblastoma.
b. retrolental fibroplasia.
c. pituitary tumor.
d. child abuse.
e. strabismus.
ANS: D
Beyond newborn age, any hemorrhages to the retina indicate infection, allergy, or trauma and should be further investigated. Retinoblastoma, retrolental fibroplasia, pituitary tumors, and strabismus are not associated with retinal hemorrhages.
To see retinal details in a patient with myopia, the examiner will need to:
a. adjust the ophthalmoscope into the plus lenses.
b. move the ophthalmoscope backward.
c. move the hand farther forward.
d. examine the patient in a well-lighted room.
e. turn the ophthalmoscope to a minus lens
ANS: E
A patient with myopia (nearsighted) has longer eyeballs, so light rays focus in front of the retina. To see the retina, the examiner should use the minus (red) numbers by moving the diopter wheel counterclockwise; to assess a patient with hyperopia, a plus lens should be used
The unit of measurement in describing lesion size and location on the fundus is the:
a. disc diameter.
b. macular diameter.
c. pupillary diameter.
d. centimeter.
e. diopter.
ANS: A
When examining the eye and the fundus comes into focus, the branching of blood vessels becomes apparent. These always branch away from the optic disc and can be used as landmarks to locate the optic disc. The disc itself measures about 1.5 mm in diameter and the disc diameter is therefore the unit of measurement used to describe lesion size and location on the fundus.
What is the common cause of a hordeolum?
a. Error in lipid metabolism
b. Increased intraocular pressure
c. Prolonged exposure to ultraviolet light
d. Infection due to Staphylococcus aureus
ANS: D. Infection due to Staphylococcus aureus
When inspecting the region of the lacrimal gland, palpate:
a. the lower orbital rim near the inner canthus.
b. in the area between the arch of the eyebrow and the upper eyelid.
c. beneath the lower eyelid adjacent to the inner canthus.
d. adjacent to the lateral aspect of the eye, just beneath the upper eyelid.
e. medially above the eyebrow.
ANS: A
The lacrimal gland is located in the area between the arch of the eyebrow and the upper lid. The lacrimal sac is located in the corner of the eye closest to the nose near the inner canthus.
Which condition of the eye is associated with impaired vision?
a. Anisocoria
b. Blepharitis
c. Arcus senilis
d. Corneal scar
ANS: D. Corneal scar
Which finding during an ophthalmoscopic examination suggests the patient has hypertension?
a. Narrowed retinal arteries
b. Presence of the red reflex
c. Crossing of arterioles and venules
d. Absence of cones and rods in the optic disc
ANS: A. Narrowed retinal arteries
Which instruction is given to a patient for the Snellen test?
a. Each eye is tested separately and then with both eyes.
b. Testing will be done with and without the corrective lens.
c. The patient advances to the next row if 75% of the letters are correct.
d. Apply slight pressure on the covered eye to assist vision in eye being tested.
ANS: B. Testing will be done with and without the corrective lens.
Which of the following is a genetic eye disorder that should be included in the history and physical examination, under family history, for all members of the affected family?
a. Constrictive iritis
b. Retinoblastoma
c. Oval pupils
d. Retinal hemorrhages
e. Maculates
ANS: B
Retinal cancer, or retinoblastoma, is a tumor originating from the retina and often occurs during the first 24 months of life. It has been found to be caused by an autosomal trait or a mutation of the chromosomes. Constrictive iritis, maculates, oval pupils, and retinal hemorrhages are not autosomal dominant disorders.
Which of the following is a relatively benign condition that may occur during pregnancy or labor?
a. Macular degeneration
b. Papilledema
c. Subconjunctival hemorrhage
d. Cupping of the optic disc
e. Presbyopia
ANS: C
Because of falling intraocular pressure during the late stages of pregnancy, hemorrhages may occur in the conjunctiva and resolve spontaneously. Papilledema is never a benign condition, and presbyopia, macular degeneration, and cupping of the optic disc occur in older adults.
Which patient concern suggests the development of a cataract?
a. Poor night vision
b. Inability to focus close up
c. Having blind spots in vision
d. Gradual loss of peripheral vision
ANS: A. Poor night vision
Which test assesses a patient’s peripheral vision?
a. Cover test
b. Confrontation test
c. Reading from a Jaeger card
d. Reading from a Snellen chart
ANS: B. Confrontation test
White specks scattered in a linear pattern around the entire circumference of the iris are called:
a. drusen bodies.
b. cotton wool spots.
c. rust spots.
d. Brushfield spots.
e. band keratopathy.
ANS: D
Brushfield spots strongly suggest Down syndrome or mental retardation and are characterized by white specks that align perfectly around the circumference of the iris. Drusen bodies, cotton wool spots, band keratopathy, and rust spots are not associated with mental retardation.
Xanthelasma may suggest that the patient has an abnormality of:
a. lipid metabolism.
b. cognitive function.
c. renal metabolism.
d. bone marrow function.
e. thyroid disease.
ANS: A
Small, odd-shaped, yellow-colored plaques around the eyes are actually lipid deposits and are characteristics of a lipid metabolism problem. The other conditions are not associated with eye plaques.
You observe a pupillary response as the patient looks at a distant object and then at an object held 10 cm from the bridge of the nose. You are assessing for:
a. confrontation reaction.
b. accommodation.
c. pupillary light reflex.
d. nystagmus.
e. corneal arcus senilis.
ANS: B
Testing for accommodation involves asking the patient to look at an object at a distance (pupils dilate) and then look at another object much closer (pupils constrict). The other choices do not test for accommodation.
Diplopia is the perception of two images, and may be monocular or binocular. Monocular diplopia is an ______ problem; binocular diplopia is an _______ problem.
Monocular diplopia is an optical problem; binocular diplopia is an alignment problem.
Lesions most likely to produce _____ abnormalities include stroke, retinal detachment, optic neuropathy, pituitary tumor compression at the optic chiasm, and central retinal vascular occlusion.
confrontation
periorbital edema is always abnormal; the significance varies directly with the amount. It may represent the presence of what 4 things
thyroid eye disease
allergies
nephrotic syndrome
congestive heart failure
An acute suppurative inflammation of the follicle of an eyelash can cause an erythematous or yellow lump.
generally caused by a staphylococcal infection
hordeolum, or stye,
Crusting along the eyelashes may represent ______ caused by bacterial infection, seborrhea, psoriasis, a manifestation of rosacea, or an allergic response
blepharitis
An erythematous or cobblestone appearance, especially on the tarsal conjunctiva, may indicate an _____ or ______conjunctivitis
allergic or infectious conjunctivitis
If the closed lids do not completely cover the globe, a condition called ______ the cornea may become dried and be at increased risk of infection.
Thyroid eye disease, seventh nerve palsy (Bell palsy), and overaggressive ptosis or blepharoplasty surgical repair are common causes.
lagophthalmos,
Bright red blood in a sharply defined area surrounded by healthy-appearing conjunctiva indicates __________
subconjunctival hemorrhage
is an abnormal growth of conjunctiva that extends over the cornea from the limbus.
It occurs more commonly on the nasal side but may arise temporally as well. more common in people heavily exposed to ultraviolet light.
pterygium
is often associated with diabetes, herpes simplex and herpes zoster viral infections, or is a sequela of trigeminal neuralgia or ocular surgery.
Decreased corneal sensation
pupillary constriction; usually less than 2 mm in diameter
can be caused by miotic eye drops, opioid abuse
Miosis
(pupillary dilation; usually more than 6 mm in diameter)
caused by
mydriatic or cycloplegic drops, midbrain lesions or hypoxia, oculomotor damage, acute-angle glaucoma, stimulant abuse
Mydriasis
irregularly shaped pupils that fail to constrict with light but retain constriction with convergence; pupils may or may not be equal in size; commonly caused by neurosyphilis or lesions in midbrain where afferent pupillary fibers synapse
Argyll Robertson pupil
(unequal size of pupils)
caused by: Congenital (approximately 20% of healthy people have minor or noticeable differences in pupil size, but reflexes are normal) or caused by local eye medications (constrictors or dilators), or unilateral sympathetic or parasympathetic pupillary pathway destruction (Note: Examiner should test whether pupils react equally to light; if response is unequal, examiner should note whether larger or smaller eye reacts more slowly [or not at all], because either pupil could represent the abnormal size.)
Anisocoria
unilateral; constriction of pupil accompanied by pain and reddened eye, especially adjacent to the iris
Iritis (anterior uveitis) constrictive response
Pupil dilated and fixed; eye deviated laterally and downward; ptosis
Oculomotor nerve (CN III) damage
Affected pupil dilated and reacts slowly or fails to react to light; responds to convergence; caused by impairment of postganglionic parasympathetic innervation to sphincter pupillae muscle or ciliary malfunction; often accompanied by diminished tendon reflexes (as with diabetic neuropathy or alcoholism)
Adie pupil (tonic pupil)
If your patient is myopic, you will need to use a ____ (red) lens; if the patient is hyperopic or lacks a lens (aphakic), you will need a ____ lens
. If your patient is myopic, you will need to use a minus (red) lens; if the patient is hyperopic or lacks a lens (aphakic), you will need a plus lens
Characteristics found on ophthalmologic examination in a patient with ________ include narrowing of vessels, increased vascular tortuosity, copper wiring (diffuse red-brown reflex), arteriovenous nicking, and retinal hemorrhages (
hypertension
A hemorrhage at the disc margin often indicates poorly controlled or undiagnosed
glaucoma
may actually represent microaneurysms, which are common in diabetic retinopathy.
Dot hemorrhages
Loss of definition of optic disc margin initially occurs superiorly and inferiorly, then nasally and temporally central vessels are pushed forward, and veins are markedly dilated.
Venous pulsations are not visible and cannot be induced by pressure applied to the globe.
Venous hemorrhages may occur.
Severe papilledema
White area with soft, ill-defined peripheral margins usually continuous with the optic disc
Myelinated retinal nerve fibers
Physiologic disc margins are raised with a lowered central area.
Blood vessels may disappear over the edge of the physiologic disc and may be seen again deep within the disc.
Result of increased intraocular pressure with loss of nerve fibers and death of ganglion cells.
Glaucomatous optic nerve head cupping
Ill-defined, yellow areas caused by infarction of nerve layer of the retina.
Vascular disease secondary to hypertension or diabetes mellitus is a common cause
Cotton wool spot
Inflammation of the superficial layers of the sclera anterior to the insertion of the rectus muscles
Episcleritis
Uses light for
magnification
of eye
* Thin slit allows
for visualization
of cornea, iris,
and lens.
© Fitzgerald Health Education Associates, Inc. 26
Lens
Iris
Cornea
Using a Slit Lam
Uses light for magnification of eye
- Thin slit allows for visualization of cornea, iris, and lens.
slit lamp
Normal tonometry pressure __–__ mm Hg
Normal pressure 10–20 mm Hg
DO NOT attempt intraocular pressure measurement if _______ is suspected.
globe rupture
Do NOT dilate under what 3 circumstances
–Narrow angle
–Globe rupture
–Head injury (at risk for herniation)
- Detect corneal lacerations
flouriscene eye stain
normal aqueous production but the iris leaflet bows outward blocking the chamber angle and prohibiting flow causing increased intraocular pressure (IOP).
Acute Angle-closure Glaucoma
clinical presentaion
Abrupt onset
● Pain in affected eye
● Visual impairment
● Frontal or supraorbital headache
● Blurred vision
● Nausea and vomiting
Acute Angle-closure Glaucoma
clinical findings
Fixed, midposition pupil
* Hazy, cloudy cornea
* Conjunctival injection
* Rock hard eye
* Elevated IOP with tonometry
– May be as high as 80 mm Hg
Acute Angle-closure Glaucoma
Oil gland blockage causing inflammation of the eyelid
* Acute or chronic
* Painless bump in lid or lid margin
* May be accompanied with localized erythema
Chalazion
Inflammation of eyelash follicles along lash-line of eyelid
- Overgrowth of S. epidermitis releases a toxin causing an inflammatory reaction
- Associated with
– Seborrheic and atopic dermatitis, lice
infestation, or infection (S. aureus
Blepharitis
watery, red, itchy eyes
- Clinical findings
– Swollen erythematous eyelids
– Injected and edematous conjunctiva with papillae on inferior conjunctival fornix
Allergic Conjunctivitis
- Cool compresses QID
- Artificial tears
- Topical antihistamine/decongestant ophthalmic drops
- Topical corticosteroids not recommended
Allergic Conjunctivitis
The most common type of eye disorder is:
A. Refractive errors
B. Macular conditions
C. Neurological conditions
D. Astigmatisms
ANS: A
The most common forms of visual impairment are refractive errors. In fact, over 150 million Americans are reported to use corrective lenses for refractive errors.
Which of the following findings should trigger an urgent referral to a cardiologist or neurologist?
A. History of bright flash of light followed by significantly blurred vision
B. History of transient and painless monocular loss of vision
C. History of monocular severe eye pain, blurred vision, and ciliary flush
D. All of the above
ANS: B
Amaurosis fugax is a monocular, transient loss of vision. It stems from transient ischemia of the retina and presents an important warning sign for impending stroke. Depending on the circumstances reported, the patient should be immediately referred to either a cardiovascular or neurological specialist
The first assessment to complete related to the eyes is:
A. Eye lids
B. Visual acuity
C. Extraocular movements
D. Peripheral vision
ANS: B
The eye examination begins with determination of the patient’s visual acuity. Next, the examiner typically inspects the external and accessory structures before concentrating inward to include the
eye.
It is important to not dilate the eye if is suspected.
A. Cataract
B. Macular degeneration
C. Acute closed-angle glaucoma
D. Chronic open-angle glaucoma
ANS: C
If the patient has experienced sudden onset of eye pain, it is important not to dilate the eyes before determining whether acute closed-angle glaucoma is present because dilating the eye may increase the intraocular pressure.
Which of the following is true concerning adjustment of diopters during funduscopic exam?
A. Moving towards more positive diopters shifts examiner’s focus posteriorly
B. Moving towards more negative diopters shifts examiner’s focus anteriorly
C. Moving towards more positive diopters broadens the examiner’s field of view
D. Moving towards more negative diopters broadens the examiner’s field of view
ANS: B
As the dial on the ophthalmoscope is moved counterclockwise, the diopters shift from positive to negative. Because the more negative diopters direct the focus posteriorly, by moving from the
positive to negative diopters, your focus will shift from the anterior eye to the posterior eye, retina, and optic disk.
A clinician can assess the alignment of the eyes by all except:
A. Checking for a symmetric light reflex
B. Observing eye movements
C. Performing cover/uncover exam
D. Measuring the palpebral gap
ANS: D
Alignment is evaluated by observing eye motion, performing the cover/uncover test, and assessing the light reflex.
Initial symptoms
Itching in ear canal; typically occurs after swimming
Otitis Externa
Inspection
Canal is red, edematous; tympanic membrane obscured
Otitis Externa
Inspection
Tympanic membrane retracted or full, yellowish, mobility impaired; air-fluid level and/or bubbles present
Otitis Media with Effusion
Inspection
Tympanic membrane with distinct erythema, thickened or clouding; bulging; limited or absent movement from positive or negative pressure, air-fluid level and/or bubbles present; vesicles or bullae may be seen
Acute Otitis Media
-bony overgrowth also known as surfer’s ear; may be an incidental finding until it grows large enough to obstruct canal , cause pain or decreased hearing.
Exostosis
vision changes
table 1
table 2
