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OPTHAMOLOGY > Examination > Flashcards

Examination Flashcards

1
Q

Inspection:

Eyelids:

  • What may you notice on the eyelids?
  • What is an entropion?
  • What is an ectropion?
A

Lumps (benign or malignant)
Oedema
Cellulitis

Eyelid turns inwards - eyelashes continuously rub against the cornea causing irritation.

Eyelid turns outward - inner eyelid surface exposed and prone to irritation.

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2
Q

Inspection:

Eyelashes:

  • What is a loss of eyelashes associated with?
  • What is trichiasis?

Diffuse conjunctival (injection) redness - what does this indicate?

Circumcillary injection:

  • What is it?
  • What does it suggest?
  • What are some causes?
A

Malignant lesions

Abnormally positioned eyelashes that grow back toward the eye, touching the cornea or conjunctiva.

Dilated inflamed blood vessels affecting conjunctiva in circular pattern around the cornea

Intraocular inflammation

Acute angle close glaucoma
Uveitis

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3
Q

Inspection:

Discharge:

  • What does watery discharge suggest? - 3
  • What does purulent discharge suggest?

Hyphema:

  • What is it?
  • Where is it found?
  • What usually causes it?

Hypopyon;

  • What is it?
  • Where is it found?
  • What is it associated with?
A

Allergic and viral conjunctivitis

Normal physiological production (e.g. reaction to corneal abrasion/foreign body) 
---
Bacterial C
-----
Inferior settled layer of blood
Anterior chamber 
Trauma

Inferior settled layer of pus
Anterior chamber

Severe corneal ulcers
Endophthalmitis
Anterior uveitis

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4
Q

Inspection:

Periorbital erythema and swelling:

  • What do we call this when it is anterior to the orbital septum?
  • What do we call this when it is posterior to the orbital septum?

What signs indicate there is a foreign body?

A

Preseptal cellulltis

Orbital cellulitis 
----
You may see it embedded in cornea or sclera
Redness 
Pain 
Watering 
'Foreign body sensation'
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5
Q

Inspection:

Corneal abrasion:
- Apart from redness and pain, what is a distinguishing sign?

Corneal ulcer:

  • Apart from redness and pain, what is a distinguishing sign?
  • What may the patient say their vision is like?
A

Photophobia

Photophobia

Hazy - may appear fluffy and irregular

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6
Q

Inspection:

What does a peaked pupil suggest?

Asymmetric pupils:
- If the pupils are more pronounced in bright light, what pupil is abnormal?

  • If the pupils are more pronounced in the dark, what pupil is abnormal?
  • What can cause a large pupil?
  • What can cause a small and reactive pupil?
A

Trauma - suggests injury to the globe - doesn’t affect vision

Larger pupil

Smaller pupil

Oculomotor nerve palsy

Horner’s syndrome

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7
Q

Visual acuity:

What is used first to assess visual acuity?

What should you not forget to ask about?

A

Snellen chart

Ask if they usually wear glasses? - Distance glasses need to be worn - measuring corrected vision

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8
Q

Visual acuity:

Snellen chart:

5 steps:
1. How far away do they stand from the shelled chart?

  1. What should you ask the patient to do? - 2
  2. Record the result!
  3. You can get the patient to look through a pinhole to see if vision improves. If it improves, what does this suggest?
  4. Repeat previous for other eye
A

6 metres

Ask the patient to cover one eye and read the lowest line they are able to.

Reflective component to the patient’s poor vision

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9
Q

Visual acuity:

Recording visual acuity:

Results are written as a fraction e.g. 6/6

> What does the numerator and denominator mean?

> If a patient reads their lowest line but get 2 wrong for example, how would you record that?

> What is a patient gets more than 2 wrong?

> What else do you need to remember when recording the result?

QUESTION:

> What does 6/60 mean?

A

Chart distance (numerator) over the number of the lowest line read (denominator).

6/6 (-2)

Use previous line

6/60 means the subject can only see the top letter when viewed at 6m.

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10
Q

Visual acuity:

Further steps for patients with poor vision:

Step 1:

  • Where should the patient moved to?
  • How would this change the recording of the acuity?

Step 2:

  • Where should the patient moved to?
  • How would this change the recording of the acuity?

Step 3 and 4:

  • Next 2 step if previous 2 fail?
  • How would these be recorded?

Step 5:

  • Last test for any type of vision?
  • How would this be recorded?
A

Move to 3 metres
3/denominator

Move to 1 metre
1/denominator

Assess if they can count the number of fingers you’re holding up (recorded as “Counting Fingers” or “CF”).

Assess if they can see gross hand movements (recorded as “Hand Movements” or “HM”)

Assess if they can detect light from a pen torch shone into each eye (“Perception of Light”/”PL” or “No Perception of Light”/”NPL”).

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11
Q

Visual acuity:

How to test for near vision?

What can cause decreased visual acuity? - READ

A 
Ask the patient to cover one eye and read paragraph of small print in a book or newspaper 
////////////////
- Refractive errors
  • Amblyopia
  • Ocular media opacities such as cataract or corneal scarring
  • Retinal diseases such as age-related macular degeneration
  • Optic nerve (CN II) pathology such as optic neuritis
  • Lesions higher in the visual pathways
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12
Q

Colour vision assessment:

What is used to assess coloured vision?

A

Ishihara plates

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13
Q

Colour vision assessment:

What do you ask the patients to look for?

If the patient is unable to read the first test plate, what should be done?

How many plates are there?

How is the result documented?

A

Look for a number on the plate

Document this

13

13/13 including test plate

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14
Q

Visual fields:

What should you ask the patient to do to begin?

What should you do?

How can you quickly assess central vision?

What object is used as a visual target?

You can test blind spot in the same way as you test visual fields:

  • Where do you move the object used instead?
  • What does an enlarged blind sport suggest?
A

Cover one eye and focus on your nose

Mirror the patient

Ask the patient if any part of your face is missing or distorted

Hatpin (or another visual target)

Laterally instead of diagonally

Swollen optic disc (papilloedema) - raised ICP

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15
Q

Eye movement:

What causes eye movement abnormalities?

How do you test for accommodation?
What should happen to the eyes?

H test:
- What does nystagmus suggest?

What endocrine disorder is lid lag associated with?

A

Nerve palsies

Ask the patient to focus on a distant point, then ask the patient to focus on the object in front of their eyes.
They should converge and constrict.

Vestibular nerve pathology or stroke

Thyroid eye disease

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16
Q

Pupillary reflexes:

What should you do to the room at this point?

How to assess for a direct pupillary reflex?

How to assess for a consensual pupillary reflex?

What does a swinging light test detect?

Explain how this defect presents and why?

A

CUT THE LIGHTS!!

Look for constriction in the same pupil

Relative afferent pupillary defect

  • Normally light shone into either eye should constrict both pupils equally (due to the dual efferent pathways described above).
  • When the afferent limb in one of the optic nerves is damaged, partially or completely, both pupils will constrict less when light is shone into the affected eye compared to the healthy eye.
  • The pupils, therefore, appear to relatively dilate when swinging the torch from the healthy to the affected eye.
17
Q

Pupillary reflexes:

Unilateral efferent defect:

  • What nerve and ganglion is responsible for pupillary reflexes?
  • What may cause this?
  • What does the UED mean?
  • What about the other eye?
A

Oculomotor nerve
Ciliary ganglion

Compression of CN3

The ipsilateral pupil is unresponsive

Other eye should be unaffected as afferent pathway (optic nerve) is unaffected and other eye’s pathways are still intact.

18
Q

Fundoscopy:

Aperture (beam size):

  • When is a micro aperture used?
  • When is a small aperture used?
  • When is a large aperture used?
  • When is a slit aperture used?

Filter:

  • What is a cobalt blue filter?
  • What is the red-free filter?
A

Viewing fundus through VERY small undilated pupils

—- an undilated pupil

—- dilated pupils

Assessing contour abnormalities of the cornea, lens and retina as it makes it elevation easier to see.
//////////
Used to look for corneal abrasions or ulcers with fluorescein

Look at the centre of the macula and other vasculature in more detail.

19
Q

Fundoscopy:

Explaining what you are doing

What should you remember to inform the patient about dilating the pupils?

A

“I will be using a magnifying tool called an ophthalmoscope to look at the front and back of your eyes with the lights off.”“To do this, I’ll need to get quite close to your face. I’ll place a hand on your forehead to prevent us from bumping into each other.”

“I’ll also be using some eye drops to dilate your pupils and to highlight any problems.

The dilating drops will cause your vision to be temporarily blurry and you’ll be more sensitive to light, so you’ll not be able to drive for several hours afterwards.”

20
Q

Fundoscopy:

What is used to dilate the pupils?

Assessing light reflex:

  • What should the diopter dial be set to if you have normal acuity?
  • What should the diopter dial be set to if you have a refractive error in your vision without glasses?
  • How far away do you keep the ophthalmoscope?
  • What do you look for in the eye?
  • What causes an absent reflex in adults? - 3 - think of things that stop the view of the retina
  • The same thing that happens in children happen in adults. What type of cancer can also cause an absent reflex in children?
A

Mydriatic eye drops - tropicamide

0

-2

1 arm’s length, a metre

You see a reddish/orange reflection in each pupil

Cataracts *****
Vitreous haemorrhage
Retinal detachment

Retinoblastoma - looks very white when light shone into it

21
Q

Fundoscopy:

Assessing the anterior segment of the eye:

  • What should the diopter dial be set to?
  • What 2 things are you looking for?
  • What can be applied to the eye to look for the above 2 things?
A

+ 10/15 in the green number

Corneal disease - ulcer/abrasion
Conjunctivital epithelium damage

Fluorescein dye

22
Q

Fundoscopy:

Assessing the fundus:

  • How do you calculate the number to set the diopter dial to?
  • What can be done if things look blurry?
  • How do you begin assessing the fundus?
  • After finding blood vessels, how do you find the optic disc?
A

The net result of yours and the patient’s refractive error:

If you have a refractive error but are planning to wear glasses/contact lenses that correct this, assume you have a refractive error of 0 and add the patient’s refractive error to this (e.g. 0 + -2 = -2).

Approach from a 45-degree angle while maintaining the red reflex.

Follow the branches towards the disc

23
Q

Fundoscopy:

Assessing the optic disc:

What are the 3C’s used to assess it?

A

Contour
Colour
Cup

24
Q

Fundoscopy:

Assessing the optic disc:

Contour:

  • What should the border look like?
  • What would it look like with papilloedema and what does this suggest?

Colour:

  • What is the normal colour?
  • What does a pale optic disc suggest? - 3

Cup:
You estimate the cup-to-disc ratio.
- What is classed as normal?
- What does an increased ratio suggest?

A

Clear and well-defined
Optic disc swelling - raised ICP

Orange-pink doughnut with a pale centre - shows good perfusion

Optic neuritis
Advanced glaucoma
Ischaemic vascular events

Cup-to-disc ratio:

0.3

Reduced volume of healthy neuro-retinal tissue, which can occur in glaucoma.

25
Q

Fundoscopy:

Assessing the retina:

  • What does a copper or silver wire appearance of the arteries suggest?
  • What does bulging veins near the crossing of an artery suggest?
  • What do dot and blot haemorrhages suggest?
  • What do flame haemorrhages suggest? - 3
  • What do cotton wool spots suggest?

DO QUIZ ON DIFFERENT TYPES OF RETINAL HAEMORRAGING

A

Early stages of hypertensive retinopathy

Grade 2 hypertensive retinopathy

Arise from bleeding capillaries in the middle layers of the retina

Diabetic retinopathy

Grade 3 hypertensive retinopathy
Thrombocytopenia
Retinal vein occlusion and trauma

Diabetic retinopathy
Grade 3 hypertensive retinopathy

26
Q

Fundoscopy:

Assessing the retina:

  • What do hard exudates suggest?
  • What does neovascularisation, which is the formation of new blood vessels, suggest?

DO QUIZ ON DIFFERENT TYPES OF RETINAL HAEMORRAGING

A

Diabetic retinopathy
Grade 3 hypertensive retinopathy

End-stage diabetic retinopathy

27
Q

Fundoscopy:

Assessing the macula:

  • What are hard exudates?
  • What does it suggest - 3
  • What is drusen and what does it suggest?
  • What pathology does a cherry spot suggest which could lead to a profound visual loss?
A

Waxy yellow lesions with distinct margins arranged in clumps or rings

Diabetic retinopathy 
Grade 3 hypertensive retinopathy 
Retinal vein occlusions
 ------
Yellow-white flecks scattered around the macular region representing remnants of the dead retinal pigment epithelium.

Central retinal artery occlusion

28
Q

https://geekymedics.com/fundoscopic-appearances-of-retinal-pathologies/

Look through and write out all the pathology of the retina!

A

https://geekymedics.com/fundoscopic-appearances-of-retinal-pathologies/

Look through and write out all the pathology of the retina!

OPTHAMOLOGY (29 decks)

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