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Patient Assessment > Eyes > Flashcards

Eyes Flashcards

1
Q

LR6-SO4-R3

A

Lateral rectus 6
Superior oblique 4
Remainder 3

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2
Q

blurred vision, loss of vision, floaters, flashing lights are

A

important questions to ask for changes in vision

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3
Q

diplopia

A

double vision

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4
Q

what can cause flashing lights?

A

Retinal detachment

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5
Q

How many feet from the snellen chart is the patient

A

6 feet

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6
Q

what are the steps for snellen eye chart?

A
  1. cover one eye
  2. ask the patient to read the smallest line possible
  3. identify the smallest line of print where the pt can read more than half the letters
  4. test the other eye

indicate if the pt is using correctino or not

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7
Q

what does the top number indicate (of visual acuity)

A

how far the pt is from the chart

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8
Q

what chart tests for near vision

A

rosenbaum handheld eye chart

identifies need for bifocals or reading glasses in >45 yo

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9
Q

how far do you hold the rosenbaum chart from the pt

A

14 inches

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10
Q

how to test for visual field?

A

confrontation visual field testing: static finger wiggle test

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11
Q

what tests for color blindness

A

pseudoisochromatic color plates

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12
Q

esotropia

A

one eye inward

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13
Q

what do you exam the eye for?

A

position and alignment

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14
Q

exotropia

A

one eye outward (lateral)

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15
Q

hypertropia

A

one eye goes upward

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16
Q

hypotropia

A

one eye goes downward

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17
Q

what to inspect the eyebrow for

A
  • fullness
  • hair distribution
  • scaliness of underlying
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18
Q

what do you inspect eyelids for

A
  • width of palpebral fissures
  • edema
  • color
  • lesions
  • condition/direction
  • adequacy of eyelid closure
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19
Q

what do you inspect lacrimal appartatus for

A
  • regions of swelling
  • excessive tearing or dryness
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20
Q

what do you inspect the conjunctiva/sclera

A
  • color
  • vascular pattern
  • nodule/swelling chemosis
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21
Q

what do you inspect the cornea/lens for?

A
  • Opacities with oblique lighting
  • opacities in the lens through the pupil
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22
Q

what do you inspect iris for?

A
  • shine a light from the temporal side to look for a cresent shaped shadow on the medial side of the iris (sign of acute narrow angle glaucoma)
  • pupil size
  • diameter
  • light reaction
  • near reaction
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23
Q

small pupil is less than

A

3mm

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24
Q

large pupil is greater than

A

5mm

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25
Q

simple anisocoria is a difference in pupillary diameter of

A

> 0.4mm without a known pathologic cause

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26
Q

when is anisocoria benign

A

equal difference in dim/bright light with a brisk light reaction

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27
Q

pupillary constriction in the same eye

A

direct reaction

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28
Q

pupillary constriction in the opposite eye

A

consenual reaction

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29
Q

what is near reaction testing

A

hold your finger 10cm from the pt’s eye and have them look at a point behind you
watch for pupillary constriction w/ near effort and convergence of eye

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30
Q

how to do light reflection in the corneas

A
  • stand 2 feet directly in front of the pt and shine light into the pts eyes and ask to look at
  • light should be visible/symmetric
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31
Q

a fine rhythmic oscillation of the eye

A

nystagmus

pause during upward and lateral gaze assessment to detect

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32
Q

what system mediates pupillary constriction to light and near reaction

A

parasympathetic pathway

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32
Q

what system regulates pupillary dilation

A

sympathetic pathways

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33
Q

how to test for lid lag

A
  • ask the pt to follow your finger as you move it from up to down midline
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34
Q

what does lid lag indicate

A

hyperthyroidism

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35
Q

how to test for EOM

A
  • ask the pt to follow your finger in an H
  • convergence
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36
Q

what is the first thing you look for in the ophthalmoscope?

A

red reflex (orange glow in the pupil)

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37
Q

what are the 6 steps of examining the optic disc and retina

A
  1. locate the optic disc
  2. bring the optic disc into focus
  3. inspect the optic disc
  4. inspect for papilledema
  5. inspect the retina-arteries, veins, fovea, macula
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38
Q

rotate the focus wheel counterclockwise for

A

nearsighted patient (to the red)

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39
Q

Rotate the focusing wheel clockwise for

A

farsighted (green)

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39
Q

what is a normal color of the disc

A

yellowish orange to creamy pink

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40
Q

what is a normal color of the cup

A

yellowish white

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41
Q

what is a normal diameter of the physiologic cup

A

less than half the diameter of the disc

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42
Q

what is the normal cup:disc ratio

A

1:3

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43
Q

optic nerve head swelling associated with increased intraCRANIAL pressure

A

papilledema

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44
Q

blurring of the disc margin, swelling of the optic disc, physiologic cup bulge or invisible is a sign of

A

papilledema

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45
Q

what does papilledma signal?

A

serious disorder in the brain such as meningitis, subarachnoid hemorrhage, trauma, mass lesion

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46
Q

what characteristics are the arteries on opthalmic exam

A
  • light red
  • smaller
  • bright light reflex
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47
Q

what are characteristics of veins on opthalmascope

A
  • dark red
  • larger
  • absent or dull on light reflex
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48
Q

how many arteries/veins are in visible in the eye

A

5

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49
Q

what is eye protrusion

A

proptosis or exophthalmos

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50
Q

what does bilateral proptosis indicate

A

graves disease (autoimmune hypterthyroidism)

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51
Q

what does unilateral proptosis indicate

A
  • infection
  • trauma
  • bleeding
  • orbital tumor
  • granulomatous disorders: granulosis
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52
Q

what further evaluation should you get done for proptosis

A

CT or MRI if proptosis exceeds normal

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53
Q

what does mucopurulent fluid from the puncta suggest?

A
  • obstructed nasolacrimal duct
  • canaliculitis
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54
Q

how to evaulate for upper eyelid foreign body

A

everting the eyelid

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55
Q

what is anormal response to the swinging flashlight test

A

each illuminated eye constricrts and the opposite eye constricts consensually

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56
Q

what is an abnormal response to swinging flashing test

A

RAPD- relative afferent pupillary defect marcus gunn pupil

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57
Q

left side optic nerve damage, light is shown into the left eye, both pupils partially dialte

A

marcus gunn pupil (RAPD- relative afferent pupillary defect)

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58
Q

what test evaluates for slight or latent muscle imbalance associated with esotropia or exotropia

A

cover-uncover test

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59
Q

nearsightedness, difficulty with distance vision

A

myopia

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60
Q

farsightedness, difficulty with near vision

A

hyperopia

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61
Q

visual changes due to aging causing focusing problems

A

presbyopia

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62
Q

imperfection of the cornea or lens causing distortion while looking at near and far objects

A

astigmatism

63
Q

focal point of the light rays are in front of the retina

A

myopia

64
Q

focal point of the rays are behind the retina

A

hyperopia

65
Q

what is the pattern of redness of conjunctivits

A

redness maximal peripherally

66
Q

what pain is associated with conjunctivitis

A

mild discomfort

67
Q

is vision affected in conjunctivitis

A

not

68
Q

what kind of discharge is see in conjunctivitis

A

watery, mucoid, mucopurulent

69
Q

is the pupil or cornea affected in conjunctivitis

A

pupil is not affected, cornea is clear

70
Q

leakage of blood outside the vessels with a sharply demarcated red area and no pain

A

subconjunctival hemorrhage

71
Q

is vision affected in subconjunctival hemorrhage

A

no

72
Q

is there dischage, damage to the pupil or cornea in subconjunctival hemorrhage

A

no to all 3

73
Q

ciliary injection or diffusely red and moderate-severe pain

A

corneal injury/infection

74
Q

what has decreased vision, watery/purulent discharge and epithelial defect or opacity

A

corneal injury or infection

75
Q

is the pupil affected in corneal injury or infection

A

no

76
Q

ciliary injection or diffusely red with moderate, deep/aching pain, photophobia and decreased vision ?

A

acute iritis

77
Q

is the pupil and cornea affected in acute iritis

A

pupil is small and irregular, cornea is clear or SLIGHTLY clouded

78
Q

what is associated with systemic infections like herpes zoster, tb, autimmune disease

A

acute iritis

79
Q

ciliary injection or diffusley red with severe, aching deep pain; severe photophobia a,d decreased vision

A

acute angle glaucoma

80
Q

is there discharge associated with acute angle closure glaucoma

A

no

81
Q

how is the pupil and cornea affected in acute angle closure glaucoma

A

dilate/fixed puil and steamy or cloudy cornea

82
Q

what is a red eye emergency

A

acute angle closure glaucoma

83
Q

occlusion of a central retinal artery and ischemia of the optic nerve can cause what visual field defect

A

horizontal defect (can only see the top of the affected eye and the whole unaffected eye)

84
Q

lesion of the right eye or right optic nerve can cause what type of visual field defect

A

blind right eye (monocular blindness) (can only see out of the unaffected eye)

85
Q

lesion of the optic chiasm (like a pituitary tumor) can cause what visual field defect

A

bitemporal hemianopsia (can only see medially on both eyes)

86
Q

lesion of the right optic tract and complete lesion of R optic radiation can cause what visual field defect

A

left homonymous hemianopsia (can only see the R temporal and L nasal)

87
Q

partial lesions of the right optic radiation can cause what visual field defect

A

homonymous left superior quadrant defect (upper left quadrant of both eyes blocked)

“pie in the sky”

88
Q

pie in the sky defect

A

homonymous left superior quadrant defect
* partial lesion of R optic radiation

89
Q

drooping of the upper lid

A

ptosis

90
Q
  • myasthenia gravia
  • damage to CN 3
  • aging (senile ptsosis)
  • congenitral
  • horner syndrome
    are causes of what in the eyelid
A

ptosis

91
Q

sympathetic nerve supply injury is aka

A

horner syndrome

92
Q

lower lid margins turn outward exposing palpebral conjunctiva

A

ectropion

93
Q

inward turing of the lid margin and eyelashes irritate the conjuntiva and lower cornea

A

entropion

94
Q

harmless, yellowish triangular nodule in the bulbar conjunctiva on either side of the iris

A

pinguecula

associated with aging

95
Q

localized ocular inflammation of the episcleral vessels

A

episcleritis, usually benign

96
Q
A
97
Q

infection at the margin of the eyelid from obstructed meibomian gland, eyelash follicle, or tear gland that is painful, red and tender

A

stye (hordeolum)

98
Q

common cause of styes (hordeolum)

A

staph. aureus

99
Q

raised, yellow, cholesterol filled plaques along the nasal portion of one or both eyelids

A

xanthelasma

100
Q

what diseases commonly have xanthelasma

A

hyperlipidemia or pbc

101
Q

inflammation of the eylids at the base of the hair follicles

A

blepharitis

102
Q

what organism causes blepharitis

A

s. aureus

103
Q

if scaling is present in blepharitis, what should you consisder

A

seborrhea

104
Q

subacute, nontender nodule cause by a blocked meibomian gland, typically points inside the lid

A

chalazion

105
Q

types of corneal arcus

A
  • acucus senilis
  • arcus juvenilis
106
Q

thin, grayish white arc near the edge of the cornea

A

corneal arcus (opacity of the cornea)

107
Q

benign lipid deposition in both eye related to aging causing corneal arcus

A

arucus senilis

108
Q

corneal arcus due to a lpid metabolism disorder and is strongly associarted with CAD

A

arcus jevenilis

109
Q

what should you check if you suspect arcuss juvenilis

A

serum lipid levels

110
Q

what eye abnormality is associated with wilsons disease

A

kayser-fleischer ring
gold to red brown ring in the periphery of the cornea

111
Q

what is a superficial grayish white opacity in the cornea resulting from an old injury or inflammation

A

corneal scar

112
Q

surfer’s eye is aka ——? what causes it

A

pterygium
long exposure to UV light, eye irritation from weather elements

113
Q

what is a triangular thickening of the bulbar conjunctiva that grows across the cornea

A

pterygium
grows from the nasal side and may interfer with vision

114
Q

opacity of the lens seen through the eye is aka

A

cataracts

115
Q

old age, smoking, DM, corticosteroid use are risk factors of what opacity in the eye

A

cataracts

116
Q

unequal pupils due to a defect in the constriction or dilation of one pupil

A

anisocoria

117
Q

anisocoria greater in bright light causes

A

larger pupil to not constrict properly

118
Q

what are causes of bright light anisocoria

A
  • blunt trauma
  • open angel trauma
  • impaired parasympathetic innervation to the iris (tonic pupil, CN 3 paralysis)
119
Q

anisocoria greater in dim light causes

A

smaller pupil to not dilate properly

120
Q

whats a cause of anisocoria greater in dim light

A

Horner syndrome (imparied PNS innervation to the iris)

121
Q

tonic pupil

A
  • pupil is dilated, regular and unilateral
  • reaction to light is reduced/slowed
  • near reaction is slow
    *
122
Q

oculomotor nerve paralysis

A
  • pupil is dilated and fixed to light and near effort
  • ptosis of the ipsilateral upper eyelid
  • lateral deviation of the eye downward and outward
123
Q

equal pupils and one blind eye

A
  • light directed in seeing eye produced direct reaction in that eye and a consenual reaction in the blind eye
  • light in blind eye causes no respose in either eye
124
Q

pupil is constricted, unilateral, reacts briskly to light and near effort but dilates slowly in dim light

A

horner syndrome

125
Q

what does horner’s syndrome cause in the eyelid

A

ipsilateral ptosis of the eyelid

126
Q

what causes ipsilateral loss of sweating on the forehead in horners syndrome

A
  • ipsilateral brainstem lesion
  • neck or chest tumors affecting the ipsilateral sympathetic ganglia
  • orbital trauma
  • migraines
  • congenital
127
Q

classic triad of the horner syndrome

A
  • miosis
  • ptosis
  • anhydrosis
128
Q

pupils small, irregular, usually bilaterally and has normal near reaction. but does not react to light

A

argyll robertson pupils

129
Q

what can cause argyll robertson pupils

A
  • neurosyphilis
  • diabetes (rare)
130
Q

new onset dysconjugate gaze in adults

A

cranial nerve palsies

131
Q

what causes cranial nerve palsies

A
  • injury
  • lesions
  • abnormalities
  • trauma
  • ms
  • syphilis
132
Q

left cn VI paralysis

A
  • left eye can not look to the left & deviates inward looking straight ahead
  • left eye can look to the right
133
Q

Left CN IV paralysis

A

L eye can not look down when turned inward

134
Q

L CN 3 paralysis

A

eye is pulled outward by action of CN VI
* upward, downward, and inward movements are impaired or lost
* ptosis and pupillary dilation also present

135
Q

small, whitish depresion in the optic disc that is the entry point for retinal vessels

A

physiologic cup
* normal less than half diameter. ofthe disc
*

136
Q

rings & cresents

A

developmental variation
*around the disc, not part of it
*dont include in the estimate of the disc diameter

137
Q

medullated nerve fibers

A
  • white patches with feathers margins
  • no pathologic significance
138
Q

when is papilledema seen?

A

intracranial mass, lesions, hemorrhage, meningitis

139
Q

optic disc abnormalities in papilledema

A
  • pink or hyperemic disc
  • disc vessels increased
  • disc swollen & blurred margins
  • physiologic cup not visible or bulgign
140
Q

glaucomatous cupping

A
  • elevated IOP
  • seen in glaucoma
  • backward depression of the disc and atrophy due to IOP
  • enlarged cup w/ pale base
  • depth of nerve fibers leads to tiny disc vessels
141
Q

arterial wall is usually

A

transparent, only the column of blood is visible with normal light reflex narrow

141
Q

1.

optic atrophy

A
  • enlarged physiologic cup
  • seen in optic neuritis, MS, temporal arteritis
  • disc color is white
  • tiny disc vessels absent
  • cup may extend to the edge of the disc
142
Q

HTN can cause what in regards to arteries

A
  • focal or generalized narrowing of the lumen and light reflex
  • copper wiring
  • silver wiring
  • AV nicking
143
Q

narrowing of the artery wall in HTN is caused by

A

increased pressure that damages the vascular epithelium leading to:
* deposition of plasma macromolecules
* thickening of the arterial wall

144
Q

copper wiring in HTN

A

arteries close to disc become full with increased light reflex and bright coppery luster

145
Q

silver wiring in HTN

A

wall of narrowed artery becomes opague so there is no visible blood

146
Q

AV nicking (concealment)

A

arterial walls lose their transparency, changes appear in the AV crossings.

vein stops abruptly on either side of the artery

147
Q
A
148
Q

Superficial retinal hemorrhages are

A
  • small
  • flame shaped red streaks in the fundi
  • follow the patterns of nerve fibers that radiate from the optic disc
149
Q

what diseases are superficial retinal hemorrhages common in

A
  • severe htn
  • papilledma
  • retinal vein occlusion
150
Q

preretinal hemorrhages are

A
  • anterior to the retina
  • blood escaping into the potential space between the retina and vitreous
  • obscures underlying retinal vessels
  • seen with ssudden increase in intracranial pressure
151
Q

deep retinal hemorrhage are

A
  • small red dots or blots hemorrhages
  • occurs in the deeper layer of the retina
  • commonly seen in diabetes
152
Q

what is a hallmark of diabetic retinopathy

A

tiny, round red spots seen in and around the macular area
* due to minute dilations of small retinal vessels

153
Q

neovascularization

A

formation of new blood vessels
* numerous, narrow
* may grow into the vitreous causing retinal detachment or hemorrhage
* common feature of diabetic retinopathy proliferative stage

154
Q

soft exudates

A
  • white or grayish, ovoid lesions with irregular/soft border
  • moderate in size
  • seen in htn, DM, HIV and other viruses
155
Q

hard exudates

A
  • creamy or yellowish, bright lesions w/ well defined hard borders
  • small and round that occur in clusters/ linear/circular or start like patterns
156
Q

drusen

A
  • yellow spots that vary from tiny to small
  • edges soft or hard
  • concentrated between optic disc and macula
  • seen in aging and macular degeneration

Patient Assessment (20 decks)

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