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ICM Exam 2 > Eye Exam > Flashcards

Eye Exam Flashcards

1
Q

What is the PE question?

A

Any problems with your vision?

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2
Q

What are you testing for a measurement of central vision?

A

CN 2

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3
Q

What is the chart called that we use to test people’s vision?

A

Snellen Chart

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4
Q

How far do patient’s stand from the Snellen Chart?

A

20 feet (6 meters)

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5
Q

3 requirements for the Snellen Chart Test

A
  1. Make sure the chart is well lit
  2. Test each eye individually
  3. Always test vision without glasses first
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6
Q

What do we determine and record in the Snellen Test?

A

The smallest line in which the patient can identify all of the letters and then record the visual acuity designated by that line

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7
Q

What does the numerator and denominator mean in Visual Acuity?

A
  1. Numerator - distance of pt from chart

2. Denominator - distance at which the average eye can read the line

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8
Q

What does 20/200 vision mean? (visual acuity)

A

Patient can read at 20 feet what the average person can read at 200 feet

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9
Q

What is considered legal blindness?

A

Vision that cannot be correctable from 20/200

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10
Q

How do we reduce memory recall during the Snellen Test?

A

Use one eye to read from right to left, the other eye from left to right

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11
Q

Why do we perform a pinhole test?

A

To check for refractive error; it allows light to enter only the central portion of the lens

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12
Q

Should we test near vision? If so, how?

A

Yes; each eye separate with the Rosenbaum Pocket Vision Screener (handheld card)

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13
Q

How far does the pt hold the Rosenbaum?

A

14 inches from the eyes

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14
Q

How do we test peripheral vision?

A

Confrontation test

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15
Q

Is color vision often tested?

A

No

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16
Q

What is red testing helpful for?

A

Determining subtle optic nerve disease

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17
Q

What often coexists with a red defect?

A

Afferent pupillary defect

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18
Q

Once we assess vision, what do we begin with?

A

Appendages in a systematic manner and move inward (posteriorly)

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19
Q

What do we inspect the eyebrows for?

A

Size, extension, and texture of the hair

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20
Q

How would the eyebrows present in hypothyroidism?

A

Coarse or do not extend beyond the temporal canthus

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21
Q

What do we inspect the orbital and periorbital area for?

A

Edema, puffiness, or redundant tissue below the orbit

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22
Q

What is Xanthelasma?

A

Elevated plaque of cholesterol deposited in macrophages

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23
Q

Where is Xanthelasma most commonly seen?

A

Nasal portion of upper ow lower lid

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24
Q

What do we inspect the eyelids for?

A

Their ability to close completely and open widely

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25
Q

When the eye is open, what should we see?

A

Superior eyelid should cover a portion of the iris but not the pupil itself

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26
Q

What is Ptosis?

A

If one superior eyelid covers more of the iris than the other or extends over the pupil

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27
Q

Ptosis can indicate what?

A
  1. Congenital or acquired weakness of the levator muscle

2. Paresis of a branch of the 3rd CN

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28
Q

What is the average lower lid position?

A

Lower limbus

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29
Q

What do we observe for on the eyelid margin?

A

Flakiness, redness, or swelling

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30
Q

Why do we ask the patients to close their eyes?

A

To note whether or not the eyelids meet completely

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31
Q

What is Lagophthalmos?

A

Closed lids do not completely cover the globe

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32
Q

What could happen due to Lagophthalmos?

A

Cornea may become dried and be at increased risk of infection

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33
Q

What are 4 causes of Lagophthalmos?

A
  1. Thyroid eye disease
  2. 7th CN palsy (Bells Palsy)
  3. Overaggressive ptosis
  4. Blepharoplasty surgical repair
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34
Q

Should we note whether the lids evert or invert?

A

Yes

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35
Q

What is Ectropion? What could result?

A

When the lower lid is turned away; excessive tearing

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36
Q

What is Entropion?

A

Lid turned inward toward globe

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37
Q

What could the lid’s eyelashes cause in Entropion?

A

Corneal and conjunctival irritation

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38
Q

What does the patient often report in Entropion?

A

Foreign body sensation

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39
Q

What could cause a lump on the eyelid?

A

Inflammation of the follicle of an eyelash

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40
Q

What is the eyelid bump called? What is it generally caused by?

A

Hordeolum/stye; staphylococcal infection

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41
Q

What does an Internal Hodeolum involve?

A

Meibomian glands

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42
Q

Conjunctiva are usually what?

A

Translucent and free of erythema

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43
Q

Do we inspect the palpebral conjunctiva? How?

A

Yes; have the pt look upward as we draw the lower lid downward to inspect for translucency and vascular pattern

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44
Q

What do we inspect the upper tarsal conjunctiva?

A

Only when there is a suggestion that a foreign body may be present

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45
Q

What do we observe the conjunctiva for?

A

Erythema or exudate

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46
Q

What can indicate an allergic or infectios conjunctivitis?

A

Erythematous or cobblestone appearance

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47
Q

What indicates a subconjunctival hemorrhage?

A

Bright red blood in a sharply define area

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48
Q

What is a Pterygium?

A

Abnormal growth of conjunctiva that extends over the cornea from the limbus

49
Q

When is a Pterygium more commonly seen?

A

In people heavily expose to ultraviolet light

50
Q

How do we exam “flatness” of the anterior chamber?

A

Shining a light tangentially on it

51
Q

What is Corneal Sensitivity controlled by?

A

CN 5

52
Q

What is a Corneal Arcus?

A

Lipid deposits in the periphery of the cornea

53
Q

What is another name for Corneal Arcus?

A

Arcus Senilis

54
Q

Do we note the subtle clear area between the limbus and arcus?

A

Yes

55
Q

When is Arcus commonly seen?

A

Many individuals older then 60 years

56
Q

What would Arcus Senilis indicate if it was present before age 40?

A

Lipid disorder

57
Q

Why should the sclera be examined?

A

Primarily to ensure that it is white

58
Q

What would be indicated if the sclera was yellow or green?

A

Liver or a hemolytic disease

59
Q

What appears as dark, slate, and gray in the eye?

A

Senile Hyaline Plaque

60
Q

Do we inspect the lacrimal gland and palpate the lower orbital rim near the inner canthus?

A

Yes

61
Q

How should the Puncta be seen as?

A

Slight elevations with a central depression on both the upper and lower lid marginas nasally

62
Q

What do we do if the temporal aspect of the upper lid feels full?

A

Evert the lid and inspect the gland

63
Q

Should the iris pattern be clearly visible?

A

Yes

64
Q

Do we note any irregularities in the shape of the pupil?

A

Yes

65
Q

What should we expect when looking at the pupils?

A

Round, regular, and equal in size

66
Q

We test the pupils for response to light in what 2 ways?

A
  1. Directly

2. Consensually

67
Q

How do we evaluate the health of the optic nerve?

A

Look for afferent pupillary defect by performing the swing flashlight test

68
Q

What is Marcus-Gunn Pupil?

A

Pupil continuing to dilate rather than constrict in the swinging flashlight test

69
Q

Do we test for accommodation as well for pupillary constriction?

A

Yes (bring finger close to nose)

70
Q

Miosis 3 contributing factors

A
  1. Iridocyclitis
  2. Miotic eye drops (pilocarpine)
  3. Drug abuse
71
Q

Mydriasis 3 contributing factos

A
  1. Mydriatic or cycloplegic drops (atropine)
  2. Midbrain (reflex arcs) lesions or hypoxia
  3. Druge abuse
72
Q

Argyll Robertson Pupil

A

Retain constriction with convergence

73
Q

Anisocoria 3 things

A
  1. Congenital (20% of healthy people have minor or noticeable difference in pupil size, but reflexes normal)
  2. Eye medications (constrictors of dilators)
  3. Unilateral sympathetic or parasympathetic pupillary pathway destruction
74
Q

Iritis Constrictive Response

A

Acute uveitis commonly unilateral

75
Q

Oculomotor Nerve Damage 3 things

A
  1. Pupil dilated and fixed
  2. Eye deviated laterally and downward
  3. Ptosis
76
Q

Adie Pupil 3 things

A
  1. Affected pupil dilated and reacts slowly or fails to react to light
  2. Responds to convergence
  3. Diminished tendon reflexes
77
Q

What is Adie Pupil caused by?

A

Impairment of the postganglionic parasympathetic innervation to sphincter

78
Q

How do we help assess the extraocular muscles?

A

Hold the patients chin to prevent movement of the head

79
Q

What is Nystagmus?

A

Involuntary, rhythmic movements of the eyes

80
Q

How do we define Jerking Nystagmus?

A

Rapid movement phase; characterized by fast movements in one direction

81
Q

What is Lid Lag?

A

Exposure of the sclera above the iris when patient is asked to follow your finger

82
Q

What is associated with Lid Lag?

A

Graves Disease - thyroid eye disease

83
Q

How do we test subtle balance of extraocular muscles?

A

Corneal light reflex

84
Q

What is Heterotropia? (ocular malalignements)

A

Manifest of parallelism of the visual axes of the eye

85
Q

What is Heterphoria?

A

Occult of lack of parallelism of the visual axes of the eyes

86
Q

When do we perform a Cover-Uncover Test?

A

When we find an imbalance with the corneal reflex test

87
Q

Do we refer to ophthalmologist for ocular malalignments?

A

Yes

88
Q

When does inspection of the interior eye do?

A

Permits visualization of the optic disc, arteries, veins, and retina

89
Q

How do we achieve adequate pupillary dilation?

A

Dimming the lights

90
Q

Do we sometimes use medications that cause mydriasis?

A

Yes

91
Q

Do we check for adequate anterior chamber depth?

A

Yes

92
Q

Do we examine the patients R eye with our R eye and vice versa for the ophthalmoscope?

A

Yes

93
Q

How do we hold the ophthalmoscope?

A

In the hand that corresponds to the examining eye

94
Q

If the patient is myopic, how do we use the ophthalmoscope?

A

Minus (red) lense

95
Q

If the patient is hyperopic (lacks a lens), we use what with the ophtalmoscope?

A

Plus lens

96
Q

What is a “blind spot”?

A

A part of the retina that cannot respond to light stimulation (optic disk)

97
Q

What is the optic disk?

A

Where retina converges to optic nerve because there are no photoreceptors (rods and cones) in this part of the retina

98
Q

How do the blood vessels on the disc divide in to?

A

Superior and inferior branches

99
Q

What can be seen and noted on the disc?

A

Venous pulsation

100
Q

How should the disc margin be?

A

Sharp and well defined

101
Q

Does the color vary on the disc?

A

Yes; it’s darker in individuals whose skin is dark

102
Q

What is the fundus?

A

The retina

103
Q

What is the Macula also called?

A

Fovea centralis

104
Q

Is the macula the site of central vision? Where is it located?

A

Yes; 2 disc diameters temporal to the optic disc

105
Q

Could it be impossible to examine when the pupil is not dialted?

A

Yes

106
Q

How do we bring the macula into our field of vision?

A

Ask the pt to look directly into the ophthalmoscope

107
Q

Do blood vessels enter the fovea? How does it appear?

A

No; lighter dot surrounded by an avascular area

108
Q

Myelinated Retinal Nerve Fibers

A

Absence of pigment, feathery margins, and full visual fields help distinguish this benign condition from chorioretinitis

109
Q

Papilledema

A

Loss of definition of optic disc

110
Q

General signs of Retinopathy?

A
  1. Reduced visual activity

2. Visual field defect

111
Q

3 things with white spots on Retinal Exam

A
  1. Cotton wool spots (CWS)
  2. Hard exudates (HE)
  3. Drusen
112
Q

3 things with red spots on the Retinal Exam

A
  1. Hemorrhages

2. Microaneurysms

113
Q

Do hemorrhages in the retina vary in color and shape? Why?

A

Yes; depends on cause and location

114
Q

Where does Flame-Shaped Hemorrhages occur? How does blood spread?

A

Nerve fiber layers; spreads parallel to nerve fibers

115
Q

Where do Round Hemorrhages occur? How might they appear?

A

Deeper layers and may appear as a dark color

116
Q

Are Microaneurysms (MA) hemorrhages?

A

No; can be confused with round hemorrhages

117
Q

Do we follow the blood vessels distally as far as we can in each of the 4 quadrants?

A

Yes

118
Q

What do we especially note in the blood vessels? Why?

A

Sites of crossing; characteristics may change when HTN is present

119
Q

What 5 things are expected characteristics found on ophthalmologic exam in a patient with HTN?

A
  1. Narrowing of vessels
  2. Increased vascular tortuosity
  3. Copper wiring (diffuse red-brown reflex)
  4. Arteriovenous nicking
  5. Retinal hemorrhages

ICM Exam 2 (10 decks)

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